The Effectiveness of Cognitive Behavioral Therapy and Emotional Freedom Techniques in Reducing Depression and Anxiety Among Adults: A Pilot Study.
Integr Med (Encinitas). 2016 Apr ;15(2):27-34. PMID: 27330487
Hannah Chatwin, Peta Stapleton, Brett Porter, Sharon Devine, Terri Sheldon
CONTEXT: The World Health Organization (WHO) places major depressive disorder (MDD), or depression, as the fourth leading cause of disability worldwide. Some studies have found that cognitive behavioral therapy (CBT) represents the most superior approach in treating mild to severe symptoms. Recent literature has indicated a number of limitations to this therapeutic approach. An approach that has received increasing attention within the literature is the emotional freedom technique (EFT).
OBJECTIVE: The current pilot study aimed to evaluate the effectiveness of CBT and EFT in the treatment of depression and comorbid anxiety.
DESIGN: The research team designed a pilot study structured as a randomized, controlled trial with 2 intervention arms.
SETTING: The study took place at Bond University in Gold Coast, Queensland, Australia.
PARTICIPANTS: Participants (n = 10) were local community members who had screened positive for a primary diagnosis of MDD.
INTERVENTION: Participants were randomly assigned to an 8-wk CBT or EFT treatment program, the intervention groups. A sample of individuals from the community was assessed for comparative purposes (control group) (n = 57).
OUTCOME MEASURES: Pre- and postintervention, all participants were interviewed using the Mini-International Neuropsychiatric Interview (MINI) 6.0, and they completed the following validated questionnaires: (1) the Beck Depression Inventory, second edition (BDI-2) and (2) the Depression, Anxiety, and Stress Scales (DASS-21).
RESULTS: Findings revealed that both treatment approaches produced significant reductions in depressive symptoms, with the CBT group reporting a significant reduction postintervention, which was not maintained with time. The EFT group reported a delayed effect involving a significant reduction in symptoms at the 3- and 6-mo follow-ups only. Examination of the individual cases revealed clinically significant improvements in anxiety across both interventions.
CONCLUSIONS: Overall, the findings provide evidence to suggest that EFT might be an effective treatment strategy worthy of further investigation.
Article Published Date : Mar 31, 2016
Reduction in behavior problems with omega-3 supplementation in children aged 8-16 years: a randomized, double-blind, placebo-controlled, stratified, parallel-group trial.
J Child Psychol Psychiatry. 2015 May ;56(5):509-20. Epub 2014 Aug 22. PMID: 25146492
Adrian Raine, Jill Portnoy, Jianghong Liu, Tashneem Mahoomed, Joseph R Hibbeln
BACKGROUND: While limited evidence suggests that omega-3 supplementation may reduce antisocial behavior in children, studies have not reported on posttreatment follow-up and most treatment periods have been of short duration. This study tests the hypothesis that omega-3 supplementation over 6 months will reduce behavior problems in children both at the end of treatment and at 6 months post treatment.
METHODS: In this randomized, double-blind, placebo-controlled, stratified, parallel-group trial, a community sample of 8-16 year old children were randomized into a treatment group (N = 100) and a placebo-control group (N = 100). The supplementation consisted of a fruit drink containing 1 g/day of omega-3 or a placebo consisting of the same fruit drink without omega-3. Participants, caregivers, and research assistants were blinded to group assignment. The primary outcome measures of externalizing and internalizing behavior problems were reported by both caregivers and their children in a laboratory setting at 0 months (baseline), 6 months (end of treatment) and 12 months (6 months post treatment), together with the secondary outcome measures of parental antisocial behavior. Data were analyzed on an intention-to-treat basis including all participants.
TRIAL REGISTRATION: ClinicalTrials.gov: http://clinicaltrials.gov/ct2/show/NCT02016079?term=mauritius&rank=2 RESULTS: Significant group × time interactions were observed with the treatment group showing long-term improvements in child behavior problems. The average posttreatment effect size was d = -.59. Effects were documented for parent reports, but with the exception of proactive and reactive aggression, child-report data were nonsignificant. Parents whose children took omega-3 showed significant posttreatment reductions in their own antisocial and aggressive behavior. This improvement in caregiver behavior partly mediated the improvements observed in child behavior.
CONCLUSIONS: Findings provide initial evidence that omega-3 supplementation can produce sustained reductions in externalizing and internalizing behavior problems. Results are the first to report improvements in caregiver behavior, and to establish this improvement as a part-mechanism for the efficacy of omega-3.
Article Published Date : Apr 30, 2015
Dysfunctional personality disorder beliefs and lifetime suicide attempts among psychiatrically hospitalized military personnel.
Compr Psychiatry. 2018 Jan 31;82:108-114
Authors: Ghahramanlou-Holloway M, Lee-Tauler SY, LaCroix JM, Kauten R, Perera K, Chen R, Weaver J, Soumoff A
BACKGROUND: Personality disorders (PDs) are associated with an increased risk for suicide. However, the association between PDs and suicide risk has not been examined among military personnel. This study evaluated whether endorsement of different PD dysfunctional beliefs was associated with lifetime suicide attempt status.
METHODS AND MATERIALS: Cross-sectional data were collected during the baseline phase of a randomized controlled trial, evaluating the efficacy of an inpatient cognitive behavior therapy protocol for the prevention of suicide. Participants (N = 185) were military service members admitted for inpatient psychiatric care following a suicide-related event. MANOVA and Poisson regression evaluated the association between each type of PD dysfunctional belief and the number of suicide attempts.
RESULTS: Service members' PBQ subscale scores for borderline (p = 0.049) and histrionic PD dysfunctional beliefs (p = 0.034) significantly differed across those with suicide ideation only, single attempt, and multiple attempts. Upon further analysis, histrionic PD dysfunctional beliefs scores were significantly higher among those with multiple suicide attempts than those with single attempts. One point increase of dependent (Incidence Risk Ratio = 1.04, p = 0.009), narcissistic (IRR = 1.07, p < 0.001), and paranoid PD dysfunctional beliefs (IRR = 1.04, p = 0.002) was associated with a greater number of lifetime suicide attempts.
CONCLUSIONS: Assessment and targeting dependent, narcissistic, paranoid, borderline, and histrionic beliefs as part of a psychosocial intervention will be useful.
PMID: 29475056 [PubMed - as supplied by publisher]
Society of Behavioral Medicine (SBM) position statement: restore CDC funding for firearms and gun violence prevention research.
Transl Behav Med. 2018 Feb 21;:
Authors: Behrman P, Redding CA, Raja S, Newton T, Beharie N, Printz D
The Society for Behavioral Medicine (SBM) urges restoration of Centers for Disease Control and Prevention (CDC) funding for firearms and gun violence prevention research. Gun violence in the United States is an important and costly public health issue in need of research attention. Unfortunately, there have been no concerted CDC-funded research efforts in this area since 1996, due to the passage of the Dickey Amendment. To remedy the information-gathering restrictions caused by the Dickey Amendment bans, it is recommended that Congress remove 'policy riders' on federal appropriations bills that limit firearms research at the CDC; expand NVDRS firearms-related data collection efforts to include all fifty states; fund CDC research on the risk and protective factors of gun use and gun violence prevention; fund research on evidence-based primary, secondary, and tertiary prevention and treatment initiatives for communities that are seriously impacted by the effects of gun violence; and support the development of evidence-based policy and prevention recommendations for gun use and ownership.
PMID: 29474678 [PubMed - as supplied by publisher]
CDKL5 PROTEIN SUBSTITUTION THERAPY RESCUES NEUROLOGICAL PHENOTYPES OF A MOUSE MODEL OF CDKL5 DISORDER.
Hum Mol Genet. 2018 Feb 20;:
Authors: Trazzi S, De Franceschi M, Fuchs C, Bastianini S, Viggiano R, Lupori L, Mazziotti R, Medici G, Lo Martire V, Ren E, Rimondini R, Zoccoli G, Bartesaghi R, Pizzorusso T, Ciani E
Cyclin-dependent kinase like-5 (CDKL5) disorder is a rare neurodevelopmental disease caused by mutations in the CDKL5 gene. The consequent misexpression of the CDKL5 protein in the nervous system leads to a severe phenotype characterized by intellectual disability, motor impairment, visual deficits, and early-onset epilepsy. No therapy is available for CDKL5 disorder. It has been reported that a protein transduction domain (TAT) is able to deliver macromolecules into cells and even into the brain when fused to a given protein. We demonstrate that TAT-CDKL5 fusion protein is efficiently internalized by target cells and retains CDKL5 activity. Intracerebroventricular infusion of TAT-CDKL5 restored hippocampal development, hippocampus-dependent memory and breathing pattern in Cdkl5-null mice. Notably, systemically-administered TAT-CDKL5 protein passed the blood-brain-barrier, reached the CNS, and rescued various neuroanatomical and behavioral defects, including breathing pattern and visual responses. Our results suggest that CDKL5 protein therapy may be an effective clinical tool for the treatment of CDKL5 disorder.
PMID: 29474534 [PubMed - as supplied by publisher]
Expressive writing intervention and self-reported physical health out-comes - Results from a nationwide randomized controlled trial with breast cancer patients.
PLoS One. 2018;13(2):e0192729
Authors: Jensen-Johansen MB, O'Toole MS, Christensen S, Valdimarsdottir H, Zakowski S, Bovbjerg DH, Jensen AB, Zachariae R
The objective was to examine the effect of Expressive Writing Intervention (EWI) on self-reported physical symptoms and healthcare utilization in a nationwide randomized controlled trial with Danish women treated for primary breast cancer, and to explore participant characteristics related to emotion regulation as possible moderators of the effect. Women who had recently completed treatment for primary breast cancer (n = 507) were randomly assigned to three 20 min. home-based writing exercises, one week apart, focusing on emotional disclosure (EWI) of a distressing experience (their cancer or a non-cancer topic) or a non-disclosing topic (control). Outcomes were self-reported physical symptoms and healthcare utilization (visits and telephone contacts with GP) 3 and 9 months post-intervention. Potential moderators were repressive coping, alexithymia, rumination, social constraints, and writing topic. Results revealed no group by time interaction effects for any outcomes. Moderation analyses showed that 1) low alexithymic women in the EWI group showed larger decreases in GP telephone calls over time than both high alexithymic women and controls and 2) women in the EWI group writing about their own cancer, but not women writing about other topics, showed a larger decrease than controls. The results from this large randomized trial are concordant with previous findings showing that EWI is unlikely to be a generally applicable intervention to improve health-related outcomes in cancer patients and cancer survivors. However, written disclosure might have a beneficial impact for individuals who write about their own cancer, as well as for those low in alexithymia.
PMID: 29474441 [PubMed - in process]
Efficacy of proprioceptive neuromuscular facilitation compared to other stretching modalities in range of motion gain in young healthy adults: A systematic review.
Physiother Theory Pract. 2018 Feb 23;:1-21
Authors: Wanderley D, Lemos A, Moretti E, Barros MMMB, Valença MM, de Oliveira DA
The objective of this study was to evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) on range of motion (ROM) gain in young healthy adults. We performed a systematic review of randomized controlled trials and quasi-randomized trials, including young healthy adults. The interventions were: PNF compared with different PNF techniques, control, other muscle stretching exercises and musculoskeletal manipulations. The outcome measures were: articular ROM and adverse effects. The final number of included studies was 46, involving 1,864 adults. There was difference on ROM comparing assisted hold-relax (HR) on diagonal plane to control, based on very low-quality evidence. There was also difference on ROM comparing assisted HR to self-HR; self-contract-relax (CR) to control; assisted CR contract to control; and assisted HR contract to control, based on low-quality evidence. Moderate-quality evidence shows that results differ between self HR and control (SMD: 0.95; 95%CI 0.03, 1.86; I249%; P = 0.16) in terms of ROM gain. When performing the other comparisons, the results were based on low or very low-quality evidence and do not allow to state if PNF is more or less effective than other stretches for improving ROM in healthy young adults. No adverse effects were mentioned.
PMID: 29474101 [PubMed - as supplied by publisher]
Assessment and Treatment of Pediatric Sleep Problems: Knowledge, Skills, Attitudes and Practices in a Group of Community Child Psychiatrists.
Med Sci (Basel). 2018 Feb 23;6(1):
Authors: Anwar A, Yingling MD, Zhang A, Ramtekkar U, Nicol GE
As part of a university-based quality improvement project, we aimed to evaluate child psychiatrists' knowledge, skills, attitudes, and practices regarding assessment and treatment of pediatric sleep problems. We developed a nine-question survey of knowledge, skills, attitudes, and practices regarding assessing for and treating sleep complaints in pediatric patients, and administered this survey to child psychiatrists in training and in practice in the state of Missouri. Respondents reported sleep hygiene as the first-line treatment strategy, followed by the use of supplements or over-the-counter remedies. The most common barriers to evidence-based assessment and treatment of sleep problems were the lack of ability to obtain reliable history, and parental preference for medications over behavioral approaches for sleep concerns. These results suggest potential opportunities for enhancing knowledge regarding validated assessment tools and non-pharmacological treatment options for sleep problems. Additional research is needed to further assess the quality and type of sleep education provided in child psychiatry training programs.
PMID: 29473880 [PubMed]
The Atrial Fibrillation Health Literacy Information Technology System: Pilot Assessment.
JMIR Cardio. 2017 Jul-Dec;1(2):e7
Authors: Magnani JW, Schlusser CL, Kimani E, Rollman BL, Paasche-Orlow MK, Bickmore TW
Background: Atrial fibrillation (AF) is a highly prevalent heart rhythm condition that has significant associated morbidity and requires chronic treatment. Mobile health (mHealth) technologies have the potential to enhance multiple aspects of AF care, including education, monitoring of symptoms, and encouraging and tracking medication adherence. We have previously implemented and tested relational agents to improve outcomes in chronic disease and sought to develop a smartphone-based relational agent for improving patient-centered outcomes in AF.
Objective: The objective of this study was to pilot a smartphone-based relational agent as preparation for a randomized clinical trial, the Atrial Fibrillation Health Literacy Information Technology Trial (AF-LITT).
Methods: We developed the relational agent for use by a smartphone consistent with our prior approaches. We programmed the relational agent as a computer-animated agent to simulate a face-to-face conversation and to serve as a health counselor or coach specific to AF. Relational agent's dialogue content, informed by a review of literature, focused on patient-centered domains and qualitative interviews with patients with AF, encompassed AF education, common symptoms, adherence challenges, and patient activation. We established that the content was accessible to individuals with limited health or computer literacy. Relational agent content coordinated with use of the smartphone AliveCor Kardia heart rate and rhythm monitor. Participants (N=31) were recruited as a convenience cohort from ambulatory clinical sites and instructed to use the relational agent and Kardia for 30 days. We collected demographic, social, and clinical characteristics and conducted baseline and 30-day assessments of health-related quality of life (HRQoL) with the Atrial Fibrillation Effect on Quality of life (AFEQT) measure; self-reported medication adherence with the Morisky 8-item Medication Adherence Scale (MMAS-8); and patient activation with the Patient Activation Measure (PAM).
Results: Participants (mean age 68 [SD 11]; 39% [12/31] women) used the relational agent for an average 17.8 (SD 10.0) days. The mean number of independent log-ins was 19.6 (SD 10.7), with a median of 20 times over 30 days. The mean number of Kardia uses was 26.5 (SD 5.9), and participants using Kardia were in AF for 14.3 (SD 11.0) days. AFEQT scores improved significantly from 64.5 (SD 22.9) at baseline to 76.3 (SD 19.4) units at 30 days (P<.01). We observed marginal but statistically significant improvement in self-reported medication adherence (baseline: 7.3 [SD 0.9], 30 days: 7.7 [SD 0.5]; P=.01). Assessments of acceptability identified that most of the participants found the relational agent useful, informative, and trustworthy.
Conclusions: We piloted a 30-day smartphone-based intervention that combined a relational agent with dedicated content for AF alongside Kardia heart rate and rhythm monitoring. Pilot participants had favorable improvements in HRQoL and self-reported medication adherence, as well as positive responses to the intervention. These data will guide a larger, enhanced randomized trial implementing the smartphone relational agent and the Kardia monitor system.
PMID: 29473644 [PubMed]
Goal setting in paediatric rehabilitation for children with motor disabilities: a scoping review.
Clin Rehabil. 2018 Feb 01;:269215518758484
Authors: Pritchard-Wiart L, Phelan SK
OBJECTIVES: The three objectives of this scoping review were to (1) identify key conceptual/theoretical frameworks and the extent to which they are used to inform goal setting related to rehabilitation goal setting with children with motor disabilities, (2) describe research that has evaluated goal setting processes and outcomes, and (3) summarize the purposes of goal setting described in paediatric rehabilitation literature.
METHODS: The scoping review process described by Arksey and O'Malley was used to guide article selection and data extraction.
RESULTS: A total of 62 articles were included in the final review. While the concept of family-centered care was well represented, theoretical frameworks specific to goal setting (i.e. goal setting theory described by Locke and Latham, mastery motivation, social cognitive, personal construct, and self-determination theories) were rarely addressed. No articles reviewed addressed prominent behavior change theory. With the exception of the description of tools specifically designed for use with children, the role of the child in the goal setting process was generally absent or not well described. Few studies ( n = 6) discussed the linkage between goals and intervention strategies explicitly. Only two studies in the review evaluated outcomes associated with goal setting. The primary purpose for goal setting identified in the literature was to develop goals that are meaningful to families ( n = 49).
CONCLUSION: The results highlight significant gaps in the literature explicating a sound theoretical basis for goal setting in paediatric rehabilitation and research evaluating the effects of goal qualities and goal setting processes on the achievement of meaningful outcomes.
PMID: 29473440 [PubMed - as supplied by publisher]
Polyphenolic Compounds Alter Stress-Induced Patterns of Global DNA Methylation in Brain and Blood.
Mol Nutr Food Res. 2018 Feb 22;:
Authors: Blaze J, Wang J, Ho L, Mendelev N, Haghighi F, Pasinetti GM
SCOPE: Stress is a known contributor to various forms of disease in humans and animals, although mechanisms are still unknown. In animals, psychosocial stress-induced depression/anxiety phenotypes are coincidental with increased inflammation in both brain and blood. We recently showed that a novel treatment with a select bioactive polyphenol preparation promotes resilience to stress-mediated depression/anxiety phenotypes mice. Moreover, we identified selective bioactive phenolic compounds within the polyphenol preparation that were effective in mitigating the behavioral effects of bone marrow transplantation from stressed mice.
METHODS AND RESULTS: Here we used an animal model of adult stress and bone marrow transplantation to identify an epigenetic signature of repeated social defeat stress (RSDS) that was passed through bone marrow hematopoietic progenitor cells to naïve mice, revealing the maintenance of epigenetic memory following stress both centrally and peripherally. Further, we administered polyphenols to naïve and stress-susceptible mice, demonstrating that polyphenol treatment in mice from both susceptible and naïve donors alters global DNA methylation in the central nervous system and periphery and likewise has an effect on human blood cells after immune challenge.
CONCLUSIONS: Findings highlight the enduring molecular memory of stress and the possible mechanism by which select bioactive polyphenols may promote resiliency to stress. Polyphenols may be an efficacious alternative to traditional pharmacological treatments in psychiatry. This article is protected by copyright. All rights reserved.
PMID: 29473292 [PubMed - as supplied by publisher]
Treating women with opioid use disorder during pregnancy in Appalachia: Initial neonatal outcomes following buprenorphine + naloxone exposure.
Am J Addict. 2018 Feb 23;:
Authors: Nguyen L, Lander LR, O'Grady KE, Marshalek PJ, Schmidt A, Kelly AK, Jones HE
BACKGROUND AND OBJECTIVES: Rising concerns regarding diversion and misuse of mono-buprenorphine for treatment of pregnant women with opioid use disorders have sparked interest in the use of buprenorphine + naloxone to reduce misuse and diversion rates. Examined the relationship of prenatal buprenorphine + naloxone exposure to neonatal outcomes.
METHODS: This is a retrospective chart review of 26 mother infant dyads in comprehensive medication-assisted treatment with buprenorphine + naloxone during pregnancy.
RESULTS: All neonatal birth outcome parameters were within normal ranges, albeit on the lower side of normal for gestational age and birth weight. Only 19% of neonates required morphine pharmacology for NAS.
CONCLUSIONS: Use of buprenorphine + naloxone shows relative safety in pregnancy.
SCIENTIFIC SIGNIFICANCE: These findings can help better guide prescribing practices for pregnant patients at risk for misuse or diversion of buprenorphine. (Am J Addict 2018;XX:1-5).
PMID: 29473258 [PubMed - as supplied by publisher]
Variance of the global signal as a pretreatment predictor of antidepressant treatment response in drug-naïve major depressive disorder.
Brain Imaging Behav. 2018 Feb 23;:
Authors: Zhu J, Cai H, Yuan Y, Yue Y, Jiang D, Chen C, Zhang W, Zhuo C, Yu Y
Several behavioral and neuroimaging markers could be used to predict eventual antidepressant medication (ADM) outcomes in patients with major depressive disorder (MDD). However, these predictors are either subjective or complex, which has limited their clinical use. Thus, we aimed to identify an objective and easy-to-get marker to predict early therapeutic efficacy. Forty-seven drug-naïve patients with MDD and 47 age-, gender- and education-matched healthy controls underwent resting-state functional magnetic resonance imaging (fMRI) scans. We calculated the variable coefficient (VC) of the global signal for each subject. Baseline Hamilton Rating Scale for Depression (HRSD) score and that after 2 weeks of ADM were assessed for patients. Although there was no difference in VC between patients with MDD and healthy controls, we found a significant positive correlation between the VC and the decline rate of HRSD scores in the patients. Compared with the non-responding depression (NRD) group, the treatment-responsive depression (TRD) group had a higher VC. Receiver operator characteristic curve analysis revealed that the VC exhibited a good ability to differentiate TRD from NRD. In addition, the linear and logistic regression analyses showed that the VC was a significant predictor of the decline rate of HRSD scores and the antidepressant treatment response. These findings suggest that variance of the global signal may serve as a useful marker to help clinicians find an appropriate drug for individuals with MDD at the earliest opportunity and then further to facilitate personalized therapy.
PMID: 29473140 [PubMed - as supplied by publisher]
The Effects of Cariprazine and Aripiprazole on PCP-Induced Deficits on Attention Assessed in the 5-Choice Serial Reaction Time Task.
Psychopharmacology (Berl). 2018 Feb 22;:
Authors: Barnes SA, Young JW, Markou A, Adham N, Gyertyán I, Kiss B
RATIONALE: Attentional processing deficits are a core feature of schizophrenia, likely contributing to the persistent functional and occupational disability observed in patients with schizophrenia. The pathophysiology of schizophrenia is hypothesized to involve dysregulation of NMDA receptor-mediated glutamate transmission, contributing to disruptions in normal dopamine transmission. Preclinical investigations often use NMDA receptor antagonists, such as phencyclidine (PCP), to induce cognitive disruptions relevant to schizophrenia. We sought to test the ability of partial dopamine D2/D3 agonists, cariprazine and aripiprazole, to attenuate PCP-induced deficits in attentional performance.
OBJECTIVES: The objective of this study is to determine whether systemic administration of cariprazine or aripiprazole attenuated 5-choice serial reaction time task (5-CSRTT) deficits induced by repeated exposure to PCP.
METHODS: We utilized a repeated PCP-treatment regimen (2 mg/kg, subcutaneous [s.c.], once daily for 5 days) in rats to induce deficits in the 5-CSRTT. Rats were pre-treated with cariprazine (0.03, 0.1, or 0.3 mg/kg, oral [p.o.]) or aripiprazole (1, 3, or 10 mg/kg, p.o.) to determine whether they prevented PCP-induced deficits in the 5-CSRTT performance.
RESULTS: PCP treatment increased inappropriate responding in the 5-CSRTT, elevating incorrect, premature, and timeout responses. Cariprazine treatment reduced PCP-induced increases in inappropriate responding. However, at higher doses, cariprazine produced non-specific response suppression, confounding interpretation of the attenuated PCP-induced deficits. Aripiprazole treatment also attenuated PCP-induced deficits; however, unlike cariprazine treatment, aripiprazole reduced correct responding and increased omissions.
CONCLUSIONS: Cariprazine and aripiprazole both demonstrated potential in attenuating PCP-induced deficits in the 5-CSRTT performance. While both compounds produced non-specific response suppression, these effects were absent when 0.03 mg/kg cariprazine was administered.
PMID: 29473089 [PubMed - as supplied by publisher]
Fluoxetine Administration in Juvenile Monkeys: Implications for Pharmacotherapy in Children.
Front Pediatr. 2018;6:21
Authors: Golub MS, Hogrefe CE, Sherwood RJ, Turck CW
Fluoxetine therapy has been approved for children with major depressive disorder and obsessive compulsive disorder for over 14 years and has expanded to other childhood behavior disorders. As use increases, more detail on fluoxetine effects during juvenile brain development can help maintain safe and effective use of this therapy. Here, a narrative review is provided of previously published findings from a large nonhuman primate project. Fluoxetine was administered to juvenile male rhesus monkeys for an extended period (2 years) prior to puberty. Compared to controls, treated monkeys showed sleep disruption, facilitated social interaction, greater impulsivity, and impaired sustained attention during treatment. No effects on growth were seen. Metabolomics assays characterized a distinctive response to fluoxetine and demonstrated individual differences that were related to the impulsivity measure. Fluoxetine interactions with monoamine oxidase A polymorphisms that influenced behavior and metabolomics markers were an important, previously unrecognized finding of our studies. After treatment was discontinued, some behavioral effects persisted, but short-term memory and cognitive flexibility testing did not show drug effects. This detailed experimental work can contribute to clinical research and continued safe and effective fluoxetine pharmacotherapy in children.
PMID: 29473029 [PubMed]
Improving Depression, and Quality of Life in Patients with Type 2 Diabetes: Using Group Cognitive Behavior Therapy.
Iran J Psychiatry. 2017 Oct;12(4):281-286
Authors: Noroozi Z, Hamidian S, Khajeddin N, Mehrabi Zadeh Honarmand M, Zargar Y, Rashidi H, Dolatshahi B
Objective: Depression is a chronic condition comorbid with diabetes type 2 that often remains untreated. Dealing with diabetes is a challenging task for patients and can lead to depression in long term. These two conditions have a negative influence on each other and on the individual's quality of life. The purpose of this study was to investigate the effect of group cognitive behavior therapy on depression, quality of life in women with diabetes type 2. Method: We conducted a clinical trial among 30 women with diabetes type 2 comorbid with depression. The women were divided randomly into the two groups of intervention and control. Each group consisted of 15 individuals. The intervention group received 10 sessions of group cognitive behavior therapy while the control group didn't. Results: The results suggested that group cognitive-behavior therapy decreased depression symptoms (F=72.17, p<0.001), and improved quality of life of the patients (F=8.82, p<0.05) of the intervention group compared to the control group. Conclusion: The results shows that group cognitive behavior therapy can affect depression symptoms, and consequently patients' quality of life with diabetes type 2.
PMID: 29472955 [PubMed]
Evaluation of the Effectiveness of the Friends for Life Program on Children's Anxiety and Depression.
Iran J Psychiatry. 2017 Oct;12(4):272-280
Authors: Moharreri F, Heydari Yazdi AS
Objective: Anxiety disorders and depression during childhood and adolescence are among highly prevalent serious mental health problems, which lead to reduced performance in children and can also negatively affect children's emotional and social long-term development. This study, which was conducted in Mashhad in 2015, aimed at evaluating the effectiveness of the Friends for Life cognitive-behavioral program in reducing the symptoms of anxiety and depression in children. Method: In this controlled clinical trial, 248 male students aged 10 were screened for mild to moderate symptoms of anxiety and depression using the Revised Children's Manifest Anxiety (RCMA) and the Children's Depression Inventory (CDI). Of the participants, 40 students met the inclusion criteria. The demographic questionnaire, the Strengths and Difficulties Questionnaire (SDQ), and the Depression-Anxiety-Stress Scale (DASS) were filled out by parents. The children in the experimental group received the Friends for Life cognitive-behavioral training program for eight 1-hour weekly sessions. RCMA, CDI, SDQ, and DASS were filled out again by both groups at the end of the sessions and 3 months later. To evaluate comparability between the 2 groups, Mann-Whitney test was used for qualitative variables and paired t test and repeated measure for quantitative variables with normal distribution. Statistical analysis was performed using SPSS-16. All statistical references were made at □=0.05. Results: Children's depression and manifest anxiety scores were not significantly different in the 2 groups before the intervention; however, their changes immediately after intervention and at the 3- month follow-up were significant (p<0.001). Moreover, hyperactivity (p = 0.039), peer problems (p = 0.011), and parental depression (p = 0.015) scores significantly changed in both groups over time. Conclusion: Implementation of Friends for Life program is effective in prevention and treatment of the symptoms of anxiety and depression in children.
PMID: 29472954 [PubMed]
Bacterial Therapy of Cancer: Promises, Limitations, and Insights for Future Directions.
Front Microbiol. 2018;9:16
Authors: Kramer MG, Masner M, Ferreira FA, Hoffman RM
Spontaneous tumors regression has been associated with microbial infection for 100s of years and inspired the use of bacteria for anticancer therapy. Dr. William B. Coley (1862-1936), a bone- sarcoma surgeon, was a pioneer in treating his patients with both live bacterial-based and mixture of heat-killed bacteria known as "Coley's toxins." Unfortunately, Coley was forced to stop his work which interrupted this field for about half a century. Currently, several species of bacteria are being developed against cancer. The bacterial species, their genetic background and their infectious behavior within the tumor microenvironment are thought to be relevant factors in determining their anti-tumor effectiveness in vivo. In this perspective article we will update the most promising results achieved using bacterial therapy (alone or combined with other strategies) in clinically-relevant animal models of cancer and critically discuss the impact of the bacterial variants, route of administration and mechanisms of bacteria-cancer-cell interaction. We will also discuss strategies to apply this information using modern mouse models, molecular biology, genetics and imaging for future bacterial therapy of cancer patients.
PMID: 29472896 [PubMed]
Pharmacoresistant Severe Mental Health Disorders in Children and Adolescents: Functional Abnormalities of Cytochrome P450 2D6.
Front Psychiatry. 2018;9:2
Authors: Thümmler S, Dor E, David R, Leali G, Battista M, David A, Askenazy F, Verstuyft C
Background: Severe mental health disorders in children and adolescents represent a major public health problem. Despite adequate drug treatment, some patients develop pharmacoresistant disease. As a consequence, physicians are confronted with prescribing challenges, prolonged hospitalization and increased risk of adverse events, thus aggravating short-, medium-, and long-term prognosis. The majority of psychotropic treatments, particularly antipsychotics and antidepressants, are metabolized at hepatic level by cytochrome P450 (CYP), particularly by CYP3A4 and CYP2D6. Several CYP2D6 genetic polymorphisms are described to be associated with ultrarapid (UM) or poor drug metabolism (PM), inducing clinical resistance and/or adverse events, and might therefore be related to pharmacoresistant severe mental health disease.
Case presentation: A total of nine pharmacoresistant patients (four females, five males) aged 11-16 (mean 14.1) years have been genotyped for CYP2D6 between January, 2015 and April, 2016. Patients were diagnosed with schizophrenia (n = 5), autism spectrum disorders (n = 2), intellectual disability with challenging behavior (n = 2), oppositional defiant disorder (n = 1), and post-traumatic stress and borderline personality disorders (n = 1). They had a treatment history with on average 6.1 (3-9) psychotropic, 5 (3-7) antipsychotic, and 3.4 (2-5) CYP2D6-metabolized antipsychotic and antidepressant molecules. Five patients (56%) presented functional anomalies of the CYP2D6 gene: three patients were UM metabolizers with gene duplication and two patients were PM with *4/*41 and *3/*4 polymorphisms.
Conclusion: Functional anomalies of CYP2D6 concerned more than half of our pediatric inpatient sample with pharmacoresistant disease. However, our case reports are limited by the low sample size. Nevertheless, knowledge of individual metabolism and in particular CYP2D6 genotyping should be considered for clinical workup and therapy adjustment in resistant patients in child and adolescent psychiatry and might permit better treatment outcome, increased treatment adherence and diminished adverse events.
PMID: 29472872 [PubMed]
Decreased Hippocampal Neuroplasticity and Behavioral Impairment in an Animal Model of Inhalant Abuse.
Front Neurosci. 2018;12:35
Authors: Malloul H, Bennis M, Bonzano S, Gambarotta G, Perroteau I, De Marchis S, Ba-M'hamed S
Thinners are highly toxic chemicals widely employed as organic solvents in industrial and domestic use. They have psychoactive properties when inhaled, and their chronic abuse as inhalants is associated with severe long-term health effects, including brain damage and cognitive-behavioral alterations. Yet, the sites and mechanisms of action of these compounds on the brain are far from being fully understood. Here, we investigated the consequences of paint thinner inhalation in adult male mice. Depression-like behaviors and an anxiolytic effect were found following repeated exposure in chronic treatments lasting 12 weeks. Both subchronic (6 weeks) and chronic treatments impaired learning and memory functions, while no changes were observed after acute treatment. To investigate possible molecular/structural alterations underlying such behavioral changes, we focused on the hippocampus. Notably, prolonged, but not acute thinner inhalation strongly affected adult neurogenesis in the dentate gyrus (DG), reducing progenitor cell proliferation after chronic treatments and impairing the survival of newborn neurons following both chronic and subchronic treatments. Furthermore, a down-regulation in the expression of BDNF and NMDA receptor subunits as well as a reduction in CREB expression/phosphorylation were found in the hippocampi of chronically treated mice. Our findings demonstrate for the first time significant structural and molecular changes in the adult hippocampus after prolonged paint thinner inhalation, indicating reduced hippocampal neuroplasticity and strongly supporting its implication in the behavioral dysfunctions associated to inhalant abuse.
PMID: 29472835 [PubMed]
Role of trace amine-associated receptor 1 in nicotine's behavioral and neurochemical effects.
Neuropsychopharmacology. 2018 Feb 05;:
Authors: Liu JF, Seaman R, Siemian JN, Bhimani R, Johnson B, Zhang Y, Zhu Q, Hoener MC, Park J, Dietz DM, Li JX
Nicotine addiction and abuse remains a global health issue. To date, the fundamental neurobiological mechanism of nicotine addiction remains incompletely understood. Trace amine-associated receptor 1 (TAAR1) is thought to directly modulate dopaminergic system and are thought to be a neural substrate underlying addictive-like behaviors. We aimed to investigate the role of TAAR1 in nicotine addictive-like behaviors. TAAR1 expression after nicotine treatment was evaluated by western blotting. c-Fos immunofluorescence and in vivo fast-scan cyclic voltammetry were used to examine the activation of brain regions and dopamine release, respectively. We then thoroughly and systematically examined the role of TAAR1 in mediating nicotine-induced sensitization, nicotine discrimination, nicotine self-administration, nicotine demand curve, and the reinstatement of nicotine-seeking. Local pharmacological manipulation was conducted to determine the role of TAAR1 in the nucleus accumbens (NAcs) in the reinstatement of nicotine-seeking. We found that the expression of TAAR1 protein was selectively downregulated in the NAc, with no change in either dorsal striatum or prefrontal cortex. TAAR1 activation was sufficient to block nicotine-induced c-Fos expression in the NAc, while also reducing nicotine-induced dopamine release in the NAc. Systemic administration of TAAR1 agonists attenuated the expression and development of nicotine-induced sensitization, nicotine self-administration, the reinstatement of nicotine-seeking, and increased the elasticity of nicotine demand curve, while intra-NAc infusions of a TAAR1 agonist was sufficient to attenuate nicotine reinstatement. Moreover, TAAR1-knockout rats showed augmented cue-induced and drug-induced reinstatement of nicotine-seeking. These results indicated that modulation of TAAR1 activity regulates nicotine addictive-like behaviors and TAAR1 represents a novel target towards the treatment of nicotine addiction.
PMID: 29472642 [PubMed - as supplied by publisher]
Luminal A Breast Cancer and Molecular Assays: A Review.
Oncologist. 2018 Feb 22;:
Authors: Gao JJ, Swain SM
PURPOSE: Chemotherapy has been the historical mainstay of treatment for patients with breast cancer, with immunohistochemical markers and tumor characteristics driving treatment decisions. The discovery of different intrinsic subtypes of breast cancer has advanced the understanding of breast cancer, with gene-based assays shedding further light on tumor behavior and response to treatment.
DESIGN: This review focuses on the landscape of the luminal A subtype, its definition based on immunohistochemistry (IHC) and gene assays, the prognostic and predictive value of these assays, guideline recommendations, and treatment implications.
RESULTS: Clinical studies of the prognostic value of gene-based and IHC-based assays in patients with luminal A-subtype breast cancers suggest a better prognosis for these patients compared with those with breast cancers of other subtypes.
CONCLUSION: In today's era of precision medicine, the best treatment regimen for patients with luminal A-subtype tumors is still undetermined, but available data raise the question whether chemotherapy can be omitted and endocrine therapy alone is sufficient for this patient population.
IMPLICATIONS FOR PRACTICE: Immunohistochemical markers have traditionally guided treatment decisions in breast cancer. However, advances in gene-expression profiling and availability of gene-based assays have launched these newer tests into everyday clinical practice. Luminal A-subtype tumors are a unique subset that may have favorable tumor biology. Properly defining this tumor subtype is important and may identify a subset of patients for whom endocrine therapy alone is sufficient.
PMID: 29472313 [PubMed - as supplied by publisher]
Inducing Behavioral Change in Seekers of Pro-Anorexia Content Using Internet Advertisements: Randomized Controlled Trial.
JMIR Ment Health. 2018 Feb 22;5(1):e6
Authors: Yom-Tov E, Brunstein-Klomek A, Mandel O, Hadas A, Fennig S
BACKGROUND: The influence of pro-anorexia (pro-ana) websites is debated, with studies indicating both negative and positive effects, as well as significant variation in the effects of different websites for those suffering from eating disorders (EDs) and the general population. Online advertising, known to induce behavioral change both online and in the physical world, has not been used so far to modify the search behavior of people seeking pro-ana content.
OBJECTIVE: The objective of this randomized controlled trial (RCT) was to examine if online advertisements (ads) can change online search behaviors of users who are looking for online pro-ana content.
METHODS: Using the Bing Ads system, we conducted an RCT to randomly expose the searchers for pro-ana content to 10 different ads referring people to one of the three websites: the National Eating Disorders Association, the National Institutes of Mental Health, and MyProAna. MyProAna is a pro-ana website that was found in a previous study to be associated with less pathological online behaviors than other pro-ana websites. We followed participants exposed and unexposed to the ads to explore their past and future online searches. The ads were shown 25,554 times and clicked on 217 times.
RESULTS: Exposure to the ads was associated with a decrease in searches for pro-ana and self-harm content. Reductions were greatest among those referred to MyProAna (reduction of 34.0% [73/215] and 37.2% [80/215] for pro-ana and self-harm, respectively) compared with users who were referred elsewhere (reduction of 15.47% [410/2650] and 3.21% [85/2650], respectively), and with users who were not shown the ads, who increased their behaviors (increase of 57.12% [6462/11,314] and 4.07% [461/11,314], respectively). In addition, those referred to MyProAna increased their search for treatment, as did control users, who did so to a lesser extent. However, users referred elsewhere decreased their searches for this content.
CONCLUSIONS: We found that referring users interested in ED-related content to specific pro-ana communities might lessen their maladaptive online search behavior. This suggests that those who are preoccupied with EDs can be redirected to less pathological online searches through appropriate pathways.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03439553; https://clinicaltrials.gov/show/NCT03439553 (Archived by WebCite at http://www.webcitation.org/6xNYnxYlw).
PMID: 29472176 [PubMed]
Effects of motivational interviewing fidelity on substance use treatment engagement in primary care.
J Subst Abuse Treat. 2018 Apr;87:64-69
Authors: Osilla KC, Watkins KE, D'Amico EJ, McCullough CM, Ober AJ
OBJECTIVE: Primary care (PC) may be an opportune setting to engage patients with opioid and alcohol use disorders (OAUDs) in treatment. We examined whether motivational interviewing (MI) fidelity was associated with engagement in primary care-based OAUD treatment in an integrated behavioral health setting.
METHODS: We coded 42 first session therapy recordings and examined whether therapist MI global ratings and behavior counts were associated with patient engagement, defined as the patient receiving one shot of extended-release injectable naltrexone or any combination of at least two additional behavioral therapy, sublingual buprenorphine/naloxone prescriptions, or OAUD-related medical visits within 30days of their initial behavioral therapy visit.
RESULTS: Autonomy/support global ratings were higher in the non-engaged group (OR=0.28, 95%CI: 0.09-0.93; p=0.037). No other MI fidelity ratings were significantly associated with engagement.
CONCLUSION: We did not find positive associations between MI fidelity and engagement in primary care-based OAUD treatment. More research with larger samples is needed to examine how providing autonomy/support to patients who are not ready to change may affect engagement.
PRACTICE IMPLICATIONS: Training providers to strategically use MI to reinforce change as opposed to the status quo is needed. This may be especially important in primary care where patients may not be specifically seeking help for their OAUDs.
PMID: 29471928 [PubMed - in process]
Employment after beginning treatment for substance use disorders: The impact of race/ethnicity and client community of residence.
J Subst Abuse Treat. 2018 Apr;87:31-41
Authors: Acevedo A, Miles J, Garnick DW, Panas L, Ritter G, Campbell K, Acevedo-Garcia D
Employment is an important substance use treatment outcome, frequently used to assess individual progress during and after treatment. This study examined whether racial/ethnic disparities exist in employment after beginning treatment. It also examined the extent to which characteristics of clients' communities account for such disparities. Analyses are based on data that linked individual treatment information from Washington State's Behavioral Health Administration with employment data from the state's Employment Security Department. Analyses subsequently incorporated community-level data from the U.S. Census Bureau. The sample includes 10,636 adult clients (Whites, 68%; American Indians, 13%, Latinos, 10%; and Blacks, 8%) who had a new outpatient treatment admission to state-funded specialty treatment. Heckman models were used to test whether racial/ethnic disparities existed in the likelihood of post-admission employment, as well as employment duration and wages earned. Results indicated that there were no racial/ethnic disparities in the likelihood of employment in the year following treatment admission. However, compared to White clients, American Indian and Black clients had significantly shorter lengths of employment and Black clients had significantly lower wages. With few exceptions, residential community characteristics were associated with being employed after initiating treatment, but not with maintaining employment or with wages. After accounting for community-level variables, disparities in length of employment and earned wages persisted. These findings highlight the importance of considering the race/ethnicity of a client when examining post-treatment employment alongside community characteristics, and suggest that the effect of race/ethnicity and community characteristics on post-treatment employment may differ based on the stage of the employment process.
PMID: 29471924 [PubMed - in process]
Approach bias modification for cannabis use disorder: A proof-of-principle study.
J Subst Abuse Treat. 2018 Apr;87:16-22
Authors: Sherman BJ, Baker NL, Squeglia LM, McRae-Clark AL
BACKGROUND: More effective treatments for cannabis use disorder (CUD) are needed. Evidence suggests that biases in cognitive processing of drug-related stimuli are central to the development and maintenance of addiction. The current study examined the feasibility and effect of a novel intervention - approach bias modification (ApBM) - on cannabis approach bias and cue-reactivity.
METHODS: A randomized, double-blind, sham-controlled proof-of-principle laboratory experiment investigated the effect of a four-session computerized ApBM training protocol on cannabis approach bias and cue-reactivity in non-treatment seeking adults age 18-65 with CUD (N = 33). ApBM procedures involved responding to cannabis or neutral stimuli using a computer joystick to model approach or avoidance behavior. Reactivity to tactile, olfactory, and auditory cue sets was assessed with physiological (blood pressure and heart rate) and subjective (cannabis craving) measures. Cannabis use was assessed via self-report.
RESULTS: Participants receiving ApBM showed blunted cannabis cue-induced craving at the end of training compared to those in the sham-ApBM condition (p = .05). A preliminary gender effect on cannabis use was also found; men receiving ApBM reported fewer cannabis use sessions per day at the end of training compared to women (p = .02), while there were no differences between men and women in the sham condition. ApBM did not attenuate cannabis approach bias following training.
CONCLUSION: Preliminary results indicate that ApBM may be efficacious in reducing cannabis cue-reactivity and improving cannabis use outcomes. While encouraging, the results should be interpreted with caution. Investigation of ApBM as an adjunct to psychosocial treatments for treatment-seeking adults with CUD is warranted.
PMID: 29471922 [PubMed - in process]
Concurrent drug injection during opioid agonist treatment among people who inject drugs in Ukraine.
J Subst Abuse Treat. 2018 Apr;87:1-8
Authors: Makarenko I, Mazhnaya A, Marcus R, Pykalo I, Madden L, Filippovich S, Dvoriak S, Altice FL
Ongoing drug use during opioid agonist treatment (OAT) negatively affects treatment and health outcomes, and increases treatment dropout. This study aimed to examine correlates of concurrent illicit drug use among OAT patients in Ukraine. A random sample of 434 patients currently on OAT receiving buprenorphine (BMT) or methadone maintenance treatment (MMT) from five cities in Ukraine were assessed for factors associated with self-reported concurrent illicit drug use during OAT using a multivariable logistic regression. Among 434 OAT patients, 100 (23%) reported concurrent drug injecting in the previous 30 days; 28% of these were injecting ≥20 days. While 100 (100%) of these injected opioids, 24 (24%) injected stimulants; 40 (40%) met criteria for polysubstance use disorder that included opioids, stimulants and alcohol. Independent correlates of concurrent drug injection included: being on MMT vs. BMT (aOR = 2.8, 95%CI = 1.4-5.8), lower OAT dosage (aOR = 1.7, 95%CI = 1.1-2.7), more severe addiction severity (aOR = 2.3, 95%CI = 1.4-3.8), younger age of injection initiation (aOR = 2.3, 95%CI = 1.3-3.9), and presence of alcohol use disorder (aOR = 2.1, 95%CI = 1.3-3.5); participants living with parents were negatively associated with concurrent drug injection. Concurrent drug use was prevalent among OAT patients in Ukraine indicating the urgent needs for tailored interventions and changes in OAT program design and implementation. Results highlight the importance of prescribing an adequate OAT dosage, and discrepancies between MMT and BMT programs in Ukraine addressing needs of OAT patients with specific characteristics such as severe opioid and alcohol dependence.
PMID: 29471921 [PubMed - in process]
Phase-based treatment versus immediate trauma-focused treatment in patients with childhood trauma-related posttraumatic stress disorder: study protocol for a randomized controlled trial.
Trials. 2018 Feb 22;19(1):138
Authors: van Vliet NI, Huntjens RJC, van Dijk MK, de Jongh A
BACKGROUND: The treatment of posttraumatic stress disorder (PTSD) related to a history of sexual and/or physical abuse in childhood is the subject of international debate, with some favouring a phase-based approach as their preferred treatment, while others argue for immediate trauma-focused treatment. A history of (chronic) traumatisation during childhood has been linked to the development of distinct symptoms that are often labelled as symptoms of complex PTSD. Many therapists associate the presence of symptoms of complex PTSD with a less favourable treatment prognosis. The purpose of this study is to determine whether a phase-based approach is more effective than stand-alone trauma-focused therapy in individuals with PTSD and possible symptoms of complex PTSD resulting from a history of repeated sexual and/or physical abuse in childhood. An additional aim is to investigate moderators, predictors of treatment (non) response and drop-out.
METHOD: The sample consists of patients between 18 and 65 years old with a diagnosis of PTSD who report a history of repeated sexual and/or physical abuse in childhood (N = 122). Patients will be blindly allocated to either 16 sessions of eye movement desensitization and reprocessing (EMDR) therapy preceded by a stabilization phase (eight sessions of Skills Training in Affect and Interpersonal Regulation (STAIR)) or only 16 sessions of EMDR therapy. Assessments are carried out pre-treatment, after every eighth session, post-treatment, and at 3 and 6 months follow up. The main parameter will be the severity of PTSD symptoms (PTSD Symptoms Scale-Self Report). Secondary outcome variables are the presence of a PTSD diagnosis (Clinician-Administered PTSD Scale for DSM-5), severity of complex PTSD symptoms (Structured Interview for Disorders of Extreme Stress-Revised and symptoms-specific questionnaires), changes in symptoms of general psychopathology (Brief Symptom Inventory), and quality of life (Euroqol-5D). Health care consumption and productivity loss in patients will also be indexed.
DISCUSSION: The study results may help to inform the ongoing debate about whether a phase-based approach has added value over immediate trauma-focused therapy in patients suffering from PTSD due to childhood abuse. Furthermore, the results will contribute to knowledge about the safety, efficacy, and cost-effectiveness of treatments in this target group.
TRIAL REGISTRATION: Nederlands Trialregister, NTR5991 . Registered on 23 august 2016. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5991.
PMID: 29471855 [PubMed - in process]
Risk factors associated with sexually transmitted infections among women under community supervision in New York City.
Int J STD AIDS. 2018 Jan 01;:956462418755223
Authors: Davis A, Goddard-Eckrich D, Dasgupta A, El-Bassel N
The number of women under community supervision in the United States has increased, and this population has a high risk for sexually transmitted infections (STIs). We examined STI prevalence and multiple risk factors among drug-involved women under community supervision in New York City. Data were from a randomized controlled trial testing the efficacy of a behavioral HIV/STI intervention (Women on the Road to Health [WORTH]) among drug-involved women in the community corrections system in New York City from 2009 to 2012. To be eligible for inclusion, women had to be under community supervision within the past 90 days, have used illicit drugs at least once in the past six months, and have unprotected sex at least once in the past 90 days. Participants completed a survey containing items on STI risk factors and were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Multivariable regression was used to examine associations between risk factors and STI diagnosis. Of 333 women tested, 89 (26.7%) tested positive for an STI. Ten (3.0%) were positive for C. trachomatis, 4 (1.2%) for N. gonorrhoeae, and 77 (23.1%) for T. vaginalis. Women with any STI were more likely to be black (AOR: 2.02; 95% CI: 1.08-3.77), homeless in the past 90 days (AOR: 2.07; 95% CI: 1.01-4.26), arrested in the past 90 days (AOR: 1.97; 95% CI: 1.14-3.39), and have a greater number of sexual partners in the past 90 days (AOR: 1.24; 95% CI: 1.08-1.42). Drug-using women under community supervision have a high burden of STIs driven by multiple risk factors. Implementing STI screening, prevention, and treatment programs in community supervision settings could facilitate a reduction in STIs among this population.
PMID: 29471763 [PubMed - as supplied by publisher]
Spearmint Extract Improves Working Memory in Men and Women with Age-Associated Memory Impairment.
J Altern Complement Med. 2018 Jan;24(1):37-47
Authors: Herrlinger KA, Nieman KM, Sanoshy KD, Fonseca BA, Lasrado JA, Schild AL, Maki KC, Wesnes KA, Ceddia MA
OBJECTIVE: The purpose of this study was to investigate the effects of supplementation with a spearmint (Mentha spicata L.) extract, high in polyphenols including rosmarinic acid, on cognitive performance, sleep, and mood in individuals with age-associated memory impairment (AAMI).
DESIGN: Subjects with AAMI (N = 90; 67% female; age = 59.4 ± 0.6 years) were randomly assigned (n = 30/group) to consume 900, 600, or 0 mg/day (two capsules, once daily) spearmint extract for 90 days, in this double-blind, placebo-controlled trial. Assessments were completed for cognition (days 0, 45, and 90), sleep (days 0 and 90), and mood (days 0 and 90) by using the Cognitive Drug Research (CDR) System™, Leeds Sleep Evaluation Questionnaire (LSEQ), and Profile of Mood States (POMS™), respectively.
RESULTS: Quality of working memory and spatial working memory accuracy improved after supplementation with 900 mg/day spearmint extract by 15% (p = 0.0469) and 9% (p = 0.0456), respectively, versus placebo. Subjects consuming 900 mg/day spearmint extract reported improvement in their ability to fall asleep, relative to subjects consuming placebo (p = 0.0046). Overall treatment effects were evident for vigor-activity (p = 0.0399), total mood disturbance (p = 0.0374), and alertness and behavior following wakefulness (p = 0.0415), with trends observed for improvements after spearmint supplementation relative to placebo.
CONCLUSIONS: These results suggest that the distinct spearmint extract may be a beneficial nutritional intervention for cognitive health in older subjects with AAMI.
PMID: 29314866 [PubMed - indexed for MEDLINE]
A Dermatologist's Ammunition in the War Against Smoking: A Photoaging App.
J Med Internet Res. 2017 Sep 21;19(9):e326
Authors: Brinker TJ, Enk A, Gatzka M, Nakamura Y, Sondermann W, Omlor AJ, Petri MP, Karoglan A, Seeger W, Klode J, von Kalle C, Schadendorf D
This viewpoint reviews the perspectives for dermatology as a specialty to go beyond the substantial impact of smoking on skin disease and leverage the impact of skin changes on a person's self-concept and behavior in the design of effective interventions for smoking prevention and cessation.
PMID: 28935619 [PubMed - indexed for MEDLINE]
Associations between eating disorder related symptoms and participants' utilization of an individualized Internet-based prevention and early intervention program.
Int J Eat Disord. 2017 Oct;50(10):1215-1221
Authors: Kindermann S, Moessner M, Ozer F, Bauer S
OBJECTIVE: Flexible, individualized interventions allow participants to adjust the intensity of support to their current needs. Between-persons, participants with greater needs can receive more intense support, within-persons, participants can adjust utilization to their current level of symptoms. The purpose of the present study was to analyze associations between ED-related symptoms and utilization of the individualized program ProYouth both between- and within-persons, aiming to investigate whether participants adapt utilization intensity to their current needs.
METHOD: Generalized estimated equations (GEEs) were used to analyze log data on program utilization (monthly page visits, monthly use of chats and forum) assessed via server logs and self-reported data on ED-related symptoms from N = 394 ProYouth participants who provided longitudinal data for at least two months.
RESULTS: Between-persons, page visits per month were significantly associated with compensatory behavior, body dissatisfaction, and binge eating. Monthly use of the more intense modules with personal support chat and forum was associated with the frequency of compensatory behavior. Within-persons, unbalanced nutrition and dieting showed the strongest associations with monthly page visits. Monthly use of chats and forum was significantly associated with compensatory behavior and unbalanced nutrition and dieting.
DISCUSSION: Results indicate that program utilization is associated with ED-related symptoms between- as well as within-persons. The individualized, flexible approach of ProYouth thus seems to be a promising way for Internet-based provision of combined prevention and early intervention programs addressing ED.
PMID: 28921689 [PubMed - indexed for MEDLINE]
Australian adolescents' beliefs and help-seeking intentions towards peers experiencing symptoms of depression and alcohol misuse.
BMC Public Health. 2017 Aug 16;17(1):658
Authors: Lubman DI, Cheetham A, Jorm AF, Berridge BJ, Wilson C, Blee F, Mckay-Brown L, Allen N, Proimos J
BACKGROUND: Many young people are reluctant to seek professional help for mental health problems, preferring to rely on their friends for support. It is therefore important to ensure that adolescents can identify signs of psychological distress in their peers, talk to them about these, and help them access appropriate services when necessary. The current study examined adolescents' ability to recognise symptoms of depression and alcohol misuse, perceived barriers to help-seeking, and their intentions to encourage a peer to seek help from a range of informal and formal help sources.
METHOD: The current study used baseline data from a randomised controlled trial of a school-based intervention that teaches adolescents how to overcome barriers to accessing professional help for mental health and substance use problems (MAKINGtheLINK). Participants (n = 2456) were presented with two vignettes portraying depression and alcohol misuse, respectively, and were asked to identify the problems described. Participants provided data on their past help-seeking behaviour, confidence to help a peer, perceived barriers to help-seeking, and intentions to encourage a peer to seek help.
RESULTS: Health professionals were the main source of help that participants had relied on for depressive symptoms, followed by friends and parents. In contrast, friends were the main source of help that participants had relied on for alcohol and other drug problems, followed by health professionals and parents. Just over half of the sample correctly identified the problems described in the two vignettes, although the majority of participants were confident that they could talk to a peer and help them seek professional help if needed. Most agreed that the vignettes described problems that warranted professional help, however approximately half the sample was unsure or considered it unlikely that they would seek help if they experienced similar problems. For both disorders, participants were most likely to encourage a peer to seek help from their family, followed by formal help sources and friends.
CONCLUSIONS: While the results point towards a greater willingness to approach formal help sources, particularly for depression, peers remain an important source of support for young people experiencing mental health and substance use problems.
PMID: 28814325 [PubMed - indexed for MEDLINE]
Internet-delivered eating disorder prevention: A randomized controlled trial of dissonance-based and cognitive-behavioral interventions.
Int J Eat Disord. 2017 Oct;50(10):1142-1151
Authors: Chithambo TP, Huey SJ
OBJECTIVE: The current study evaluated two web-based programs for eating disorder prevention in high-risk, predominantly ethnic minority women.
METHOD: Two hundred and seventy-one women with elevated weight concerns were randomized to Internet dissonance-based intervention (DBI-I), Internet cognitive-behavioral intervention (CBI-I), or no intervention (NI). Both interventions consisted of four weekly online sessions. Participants were assessed at pre- and post intervention. Outcome measures included eating pathology, body dissatisfaction, dieting, thin-ideal internalization, and depression.
RESULTS: At postintervention, DBI-I and CBI-I led to greater reductions in body dissatisfaction, thin-ideal internalization, and depression than NI. In addition, CBI-I was effective at reducing dieting and composite eating pathology relative to NI. No outcome differences were found between the active conditions. Moderation analyses suggested that both active conditions were more effective for ethnic minorities than Whites relative to NI.
DISCUSSION: Results suggest that both DBI-I and CBI-I are effective at reducing eating disorder risk factors in a high-risk, predominantly minority population relative to no intervention.
PMID: 28801926 [PubMed - indexed for MEDLINE]
Reduced Willingness to Expend Effort for Reward in Obesity: Link to Adherence to a 3-Month Weight Loss Intervention.
Obesity (Silver Spring). 2017 Oct;25(10):1676-1681
Authors: Mata F, Treadway M, Kwok A, Truby H, Yücel M, Stout JC, Verdejo-Garcia A
OBJECTIVE: This study aimed to (1) compare the willingness to expend effort for rewards between young adults with healthy weight, overweight, and obesity; and (2) to examine how individual differences in the willingness to expend effort for rewards predict adherence to weight loss treatment.
METHODS: Seventy-three participants completed the Effort Expenditure for Rewards Task (EEfRT). Of those 73 participants, 42 young adults with excess weight took part in a 3-month weight loss treatment after completing the EEfRT. Generalized estimating equation models were used to compare the groups with healthy weight, overweight, and obesity in the EEfRT. Logistic regression models, including the proportion of hard-task choices for each reward probability condition as predictors (12%, 50%, and 88%), were conducted to longitudinally predict adherence in the treatment.
RESULTS: Young adults with obesity were significantly less willing to expend effort for high-magnitude rewards compared with participants with overweight (P = 0.05). The willingness to expend effort for uncertain rewards (50% probability) was distinguished between completers and dropouts in the weight loss treatment (χ2 = 5.04, P < 0.02).
CONCLUSIONS: Young adults with obesity, compared with their counterparts with overweight, have diminished motivation to expend effort for obtaining high-magnitude rewards. Less willingness to expend effort for the most uncertain rewards predicts poor adherence to weight loss treatment.
PMID: 28782916 [PubMed - indexed for MEDLINE]
Development and initial evaluation of a mobile application to help with mindfulness training and practice.
Int J Med Inform. 2017 Sep;105:59-67
Authors: Plaza García I, Sánchez CM, Espílez ÁS, García-Magariño I, Guillén GA, García-Campayo J
BACKGROUND AND OBJECTIVE: Different review articles support the usefulness and effectiveness of mindfulness techniques in health and wellbeing. In this paper we present a first prototype of a mobile application to help with the training and practice of mindfulness, taking into account the lacks detected in a previous literature review. Our aim was to measure acceptance and perceived quality, as well as gather data about app usage. Their dependence on demographic variables and the change in mindful level was also measured.
MATERIALS AND METHODS: Two versions of a new application were developed, "Mindfulness" and "Mindfulness Sci". The application has been tested in two pilot studies: in traditional face-to-face mindfulness groups and in individual and independent use.
RESULTS: 3977 users were involved in this study: 26 in the first trial during an 8-week usage period and 3951 in the second trial during 17 months. In the first study, participants assessed the app with high scores. They considered it as a helping tool for mindfulness practice, user-friendly and with high quality of use. The positive perception was maintained after 8-weeks meditation workshops, and participants considered that its use could contribute to obtain benefits for mental and physical health. In the second study, we found rather weak associations between usage time and age, nationality and educational level. The mindful level showed a weak positive correlation with the session accomplished but slightly above the boundary of statistical significance (p-value=0.051). Videos and information stood out as the most accessed resources.
CONCLUSIONS: Up to our knowledge, this is the first app developed with the help of health professionals in Spanish that could be used with a general aim, in health and wellbeing. The results are promising with a positive evaluation in face-to-face and independent use situations. Therefore, the number of potential users is enormous in a global worldwide context.
PMID: 28750912 [PubMed - indexed for MEDLINE]
Intensive cognitive therapy for post-traumatic stress disorder in routine clinical practice: A matched comparison audit.
Br J Clin Psychol. 2017 Nov;56(4):474-478
Authors: Murray H, El-Leithy S, Billings J
OBJECTIVES: Intensive cognitive therapy for post-traumatic stress disorder (PTSD) has been shown to be as effective as weekly treatment in controlled trials. In this study, outcome data comparing standard and intensive treatments delivered in routine clinical practice were analysed.
METHODS: A consecutive case series of intensive treatment cases were compared to matched control cases who had completed weekly treatment.
RESULTS: Both groups showed significant improvements on PTSD and depression measures. The intensive group showed larger PTSD symptomatic improvement. There were differences between the groups in age and time since trauma, suggesting selection biases in who is offered, and/or who chooses intensive treatment.
CONCLUSIONS: For some individuals, an intensive format may be more effective than weekly treatment.
PMID: 28741670 [PubMed - indexed for MEDLINE]
Therapy With a Consensually Nonmonogamous Couple.
J Clin Psychol. 2017 Aug;73(8):954-964
Authors: Kolmes K, Witherspoon RG
While a significant minority of people practice some form of consensual nonmonogamy (CNM) in their relationships, there is very little published research on how to work competently and effectively with those who identify as polyamorous or who have open relationships. It is easy to let one's cultural assumptions override one's work in practice. However, cultural competence is an ethical cornerstone of psychotherapeutic work, as is using evidence-based treatment in the services we provide to our clients. This case presents the work of a clinician using both evidence-based practice and practice-based evidence in helping a nonmonogamous couple repair a breach in their relationship. We present a composite case representing a common presenting issue in the first author's psychotherapy practice, which is oriented toward those engaging in or identifying with alternative sexual practices. Resources for learning more about working with poly, open, and other consensually nonmonogamous relationship partners are provided.
PMID: 28672051 [PubMed - indexed for MEDLINE]
Sex-Positive Assessment and Treatment Among Female Trauma Survivors.
J Clin Psychol. 2017 Aug;73(8):965-974
Authors: Baggett LR, Eisen E, Gonzalez-Rivas S, Olson LA, Cameron RP, Mona LR
Sexuality and intimacy difficulties are often a part of the aftermath of sexual trauma. We argue that combining techniques from evidence-based, trauma-focused treatment with sex-positive techniques used in sex therapy can best help survivors reduce trauma-related symptoms and develop or regain comfort with their sexuality. In this article, we illustrate this approach by describing the case of a survivor of sexual assault, who completed 20 sessions of treatment that combined modules of trauma-focused therapies, Cognitive Processing Therapy (CPT), and Prolonged Exposure (PE) with sensate focus therapy, a technique often used in sex therapy. The outcome of this case suggests that clinicians who work with sexual trauma survivors may want to consider a sex-positive approach to conceptualizing and planning the course of treatment, to achieve optimal results.
PMID: 28662273 [PubMed - indexed for MEDLINE]
The impact of human adipose tissue-derived stem cells on breast cancer cells: implications for cell-assisted lipotransfers in breast reconstruction.
Stem Cell Res Ther. 2017 May 25;8(1):121
Authors: Koellensperger E, Bonnert LC, Zoernig I, Marmé F, Sandmann S, Germann G, Gramley F, Leimer U
BACKGROUND: In this study we evaluated the interactions of human adipose tissue-derived stem cells (ADSCs) and different human breast cancer cell lines (BRCAs) with regard to the safety of cell-assisted lipotransfers for breast reconstruction and a thereby unintended co-localization of ADSCs and BRCAs.
METHODS: ADSCs were co-cultured with five different human BRCAs (MCF-7, MDA-MB-231, SK-BR-3, ZR-75-30, and EVSA-T) and primary BRCAs from one patient in a transwell system, and cell-cell-interactions were analyzed by assessing doubling time, migration and invasion, angiogenesis, quantitative real-time polymerase chain reaction (PCR) of more than 300 tumor-associated genes, and multiplex protein assays of 20 chemokines and growth factors and eight matrix metalloproteinases (MMPs). Results of co-culture were compared to those of the respective monoculture.
RESULTS: Quantitative real-time PCR revealed remarkable changes in the expression of multiple tumor-associated genes in co-culture compared to monocultures of both ADSCs and BRCAs. Concomitantly, the concentration of several tumor-associated proteins, such as cytokines and MMPs, were strongly increased in co-culture. Furthermore, exclusively in co-culture with ADSCs, the different BRCAs were exposed to several important tumor-modulating proteins, such as CCL2, HGF, or interleukins. Co-culture did not significantly affect cellular proliferation of either ADSCs or BRCAs (p > 0.05). The migration of MCF-7 and MDA-MB-231 BRCAs was significantly increased in co-culture with ADSCs by a mean of 11% and 23%, respectively (p = 0.04 and 0.012), as well as that of ADSCs in co-culture with MDA-MB-231, ZR-75-30, and EVSA-T (+11-15%, p = 0.035-0.045). Co-culture with MDA-MB-231, SK-BR-3, and EVSA-T BRCAs significantly increased the invasive behavior of ADSCs by a mean of 24-41% (p = 0.014-0.039). There were no significant differences in the in vitro invasive properties of BRCAs in co-culture compared to monoculture. An in vitro angiogenesis assay revealed an increased tube formation of conditioned media from co-cultured BRCAs and ADSCs compared to the respective monocultures.
CONCLUSION: This study further elucidates the possible interactions of primary human ADSCs with human BRCAs, pointing towards a potential increased oncological risk which should not be neglected when considering a clinical use of cell-assisted lipoaspirates in breast reconstruction.
PMID: 28545495 [PubMed - indexed for MEDLINE]
Photothermal and photodynamic activity of polymeric nanoparticles based on α-tocopheryl succinate-RAFT block copolymers conjugated to IR-780.
Acta Biomater. 2017 Jul 15;57:70-84
Authors: Palao-Suay R, Martín-Saavedra FM, Rosa Aguilar M, Escudero-Duch C, Martín-Saldaña S, Parra-Ruiz FJ, Rohner NA, Thomas SN, Vilaboa N, San Román J
The aim of this work was the generation of a multifunctional nanopolymeric system that incorporates IR-780 dye, a near-infrared (NIR) imaging probe that exhibits photothermal and photodynamic properties; and a derivate of α-tocopheryl succinate (α-TOS), a mitochondria-targeted anticancer compound. IR-780 was conjugated to the hydrophilic segment of copolymer PEG-b-polyMTOS, based on poly(ethylene glycol) (PEG) and a methacrylic derivative of α-tocopheryl succinate (MTOS), to generate IR-NP, self-assembled nanoparticles (NPs) in aqueous media which exhibit a hydrophilic shell and a hydrophobic core. During assembly, the hydrophobic core of IR-NP could encapsulate additional IR-780 to generate derived subspecies carrying different amount of probe (IR-NP-eIR). Evaluation of photo-inducible properties of IR-NP and IR-NP-eIR were thoroughly assessed in vitro. Developed nanotheranostic particles showed distinct fluorescence and photothermal behavior after excitation by a laser light emitting at 808nm. Treatment of MDA-MB-453 cells with IR-NP or IR-NP-eIR resulted in an efficient internalization of the IR-780 dye, while subsequent NIR-laser irradiation led to a severe decrease in cell viability. Photocytoxicity conducted by IR-NP, which could not be attributed to the generation of lethal hyperthermia, responded to an increase in the levels of intracellular reactive oxygen species (ROS). Therefore, the fluorescence imaging and inducible phototoxicity capabilities of NPs derived from IR-780-PEG-b-polyMTOS copolymer confer high value to these nanotheranostics tools in clinical cancer research.
STATEMENT OF SIGNIFICANCE: Multifunctional polymeric nanoparticles (NPs) that combine imaging and therapeutic properties are highly valuable in cancer treatment. In this paper we describe the development of NPs that are fluorescent in the near-infrared (NIR). This is important for their visualization in living tissues that present low absorption and low autofluorescence in this wavelength region (between 700 and 1000nm). Moreover, NPs present photothermal and photodynamic properties when NIR irradiated: the NPs produce an efficient increment of temperature and increase the intracellular reactive oxygen species (ROS) when laser irradiated at 808nm. These tuneable photoinduced properties make the NPs highly cytotoxic after NIR irradiation and provide a new tool for highly precise cancer treatment.
PMID: 28511874 [PubMed - indexed for MEDLINE]
Variations of isovaline structure related to activity in the formalin foot assay in mice.
Amino Acids. 2017 Jul;49(7):1203-1213
Authors: Fung T, Asiri YI, Wall R, Schwarz SKW, Puil E, MacLeod BA
Current centrally acting analgesics such as opioids are associated with adverse effects that limit their use and threaten patient safety. Isovaline is a novel prototype analgesic that produces peripheral antinociception in several pain models with little or no effect on the central nervous system. The aim of this study was to establish a preliminary structure-activity relationship for isovaline derivatives by assaying efficacy in the formalin foot assay and central adverse effect profile in mice. Selected compounds were tested using the formalin foot assay to determine efficacy in reducing formalin-induced behaviors. Of the compounds tested, R-isovaline, S-isovaline, and 1-amino-1-cyclobutanecarboxylic acid reduced nocifensive behavior in phase II of the assay. These effects occurred without affecting performance on the rotarod, indicating that the reduction in nocifensive behaviors was not due to sedation or motor incoordination. Modifications to isovaline that increased its steric size without a cyclobutane ring formation produced compounds with no activity in the formalin foot assay. These findings indicate that the conformational stability of isovaline or the ability to form a cyclobutane ring is necessary for activity in the formalin foot assay.
PMID: 28432424 [PubMed - indexed for MEDLINE]
Suvorexant in Elderly Patients with Insomnia: Pooled Analyses of Data from Phase III Randomized Controlled Clinical Trials.
Am J Geriatr Psychiatry. 2017 Jul;25(7):791-802
Authors: Herring WJ, Connor KM, Snyder E, Snavely DB, Zhang Y, Hutzelmann J, Matzura-Wolfe D, Benca RM, Krystal AD, Walsh JK, Lines C, Roth T, Michelson D
OBJECTIVE: Suvorexant is an orexin receptor antagonist approved for treating insomnia at doses of 10-20 mg. Previously reported phase III results showed that suvorexant was effective and well-tolerated in a combined-age population (elderly and nonelderly adults). The present analysis evaluated the clinical profile of suvorexant specifically in the elderly.
METHODS: Prespecified subgroup analyses of pooled 3-month data from two (efficacy) and three (safety) randomized, double-blind, placebo-controlled, parallel-group trials. In each trial, elderly (≥65 years) patients with insomnia were randomized to suvorexant 30 mg, suvorexant 15 mg, and placebo. By design, fewer patients were randomized to 15 mg. Patient-reported and polysomnographic (subset of patients) sleep maintenance and onset endpoints were measured.
RESULTS: Suvorexant 30 mg (N = 319) was effective compared with placebo (N = 318) on patient-reported and polysomnographic sleep maintenance, and onset endpoints at Night 1 (polysomnographic endpoints)/Week 1 (patient-reported endpoints), Month 1, and Month 3. Suvorexant 15 mg (N = 202 treated) was also effective across these measures, although the onset effect was less evident at later time points. The percentages of patients discontinuing because of adverse events over 3 months were 6.4% for 30 mg (N = 627 treated), 3.5% for 15 mg (N = 202 treated), and 5.5% for placebo (N = 469 treated). Somnolence was the most common adverse event (8.8% for 30 mg, 5.4% for 15 mg, 3.2% for placebo).
CONCLUSION: Suvorexant generally improved sleep maintenance and onset over 3 months of nightly treatment and was well-tolerated in elderly patients with insomnia (clinicaltrials.gov; NCT01097616, NCT01097629, NCT01021813).
PMID: 28427826 [PubMed - indexed for MEDLINE]
CD1: A Singed Cat of the Three Antigen Presentation Systems.
Arch Immunol Ther Exp (Warsz). 2017 Jun;65(3):201-214
Authors: Kaczmarek R, Pasciak M, Szymczak-Kulus K, Czerwinski M
Contrary to general view that the MHC Class I and II are the kapellmeisters of recognition and response to antigens, there is another big player in that part of immunity, represented by CD1 glycoproteins. In contrast to MHC Class I or II, which present peptides, CD1 molecules present lipids. Humans express five CD1 proteins (CD1a-e), four of which (CD1a-d) are trafficked to the cell surface, where they may display lipid antigens to T-cell receptors. This interaction may lead to both non-cognate and cognate T cell help to B cells, the latter eliciting anti-lipid antibody response. All CD1 proteins can bind a broad range of structurally different exogenous and endogenous lipids, but each shows a preference to one or more lipid classes. This unorthodox binding behavior is the result of elaborate architectures of CD1 binding clefts and distinct intracellular trafficking routes. Together, these features make CD1 system a versatile player in immune response, sitting at the crossroads of innate and adaptive immunity. While CD1 system may be involved in numerous infectious, inflammatory, and autoimmune diseases, its involvement may lead to opposite outcomes depending on different pathologies. Despite these ambiguities and complexity, CD1 system draws growing attention and continues to show glimmers of therapeutic potential. In this review, we summarize the current knowledge about CD1 proteins, their structures, lipid-binding profiles, and roles in immunity, and evaluate the role of CD1 proteins in eliciting humoral immune response.
PMID: 28386696 [PubMed - indexed for MEDLINE]
Effects of Regular and Long-Acting Insulin on Cognition and Alzheimer's Disease Biomarkers: A Pilot Clinical Trial.
J Alzheimers Dis. 2017;57(4):1325-1334
Authors: Craft S, Claxton A, Baker LD, Hanson AJ, Cholerton B, Trittschuh EH, Dahl D, Caulder E, Neth B, Montine TJ, Jung Y, Maldjian J, Whitlow C, Friedman S
BACKGROUND: Long acting insulin detemir administered intranasally for three weeks enhanced memory for adults with Alzheimer's disease dementia (AD) or amnestic mild cognitive impairment (MCI). The investigation of longer-term administration is necessary to determine whether benefits persist, whether they are similar to benefits provided by regular insulin, and whether either form of insulin therapy affects AD biomarkers.
OBJECTIVE: The present study aimed to determine whether four months of treatment with intranasal insulin detemir or regular insulin improves cognition, daily functioning, and AD biomarkers for adults with MCI or AD.
METHODS: This randomized, double-blind, placebo-controlled trial included an intent-to-treat sample consisting of 36 adults diagnosed with MCI or mild to moderate AD. Participants received placebo (n = 12), 40 IU of insulin detemir (n = 12), or 40 IU of regular insulin (n = 12) daily for four months, administered with a nasal delivery device. A cognitive battery was administered at baseline and after two and four months of treatment. MRI was administered for all participants and lumbar puncture for a subset (n = 20) at baseline and four months. The primary outcome was change from baseline to four months on a memory composite (sum of Z scores for delayed list and story recall). Secondary outcomes included: global cognition (Alzheimer's Disease Assessment Scale-Cognition), daily functioning (Dementia Severity Rating Scale), MRI volume changes in AD-related regions of interest, and cerebrospinal fluid AD markers.
RESULTS: The regular insulin treated group had better memory after two and four months compared with placebo (p < 0.03). No significant effects were observed for the detemir-assigned group compared with the placebo group, or for daily functioning for either group. Regular insulin treatment was associated with preserved volume on MRI. Regular insulin treatment was also associated with reduction in the tau-P181/Aβ42 ratio.
CONCLUSION: Future research is warranted to examine the mechanistic basis of treatment differences, and to further assess the efficacy and safety of intranasal insulin.
PMID: 28372335 [PubMed - indexed for MEDLINE]
Assessment of vestibulo-ocular function without measuring eye movements.
J Neurosci Methods. 2017 May 01;283:1-6
Authors: Beaton KH, Schubert M, Shelhamer M
BACKGROUND: The vestibulo-ocular reflex (VOR) maintains stable gaze during head motion. Deficiencies lead to apparent world motion due to incomplete stabilization of eyes in space. VOR measurement requires specialized apparatus, trained operators, and significant setup time.
NEW METHOD: We present a system (VON: vestibulo-ocular nulling) for rapid vestibulo-ocular assessment without measuring eye movements per se. VON uses a head-mounted motion sensor, laptop computer with user input control, and laser target whose position is controlled by the computer. As the head moves, the target is made to move in the same manner with a gain set by the subject. When the subject sets the gain so the target appears stationary in space, it is stationary on the retinas. One can determine from this gain the extent to which the eyes move in space when the head moves, which is the amount by which the VOR is deficient. From this the gain of the compensatory eye movements is derived.
RESULTS: VON was compared with conventional video-based VOR measures. Both methods track expected changes in gain over 20min of adaptation to minifying spectacles. VON measures are more consistent across subjects, and pre-adaptation values are closer to compensatory.
COMPARISON WITH EXISTING METHOD: VON is a rapid means to assess vestibulo-ocular performance. As a functional perceptual measure, it accounts for gaze-stabilizing contributions that are not apparent in the standard VOR, such as pursuit and perceptual tolerance.
CONCLUSIONS: VON assesses functional VOR performance. Future implementations will make VOR assessment widely available to investigators and clinicians.
PMID: 28336357 [PubMed - indexed for MEDLINE]
Violation of Laws in Frontotemporal Dementia: A Multicenter Study in Japan.
J Alzheimers Dis. 2017;57(4):1221-1227
Authors: Shinagawa S, Shigenobu K, Tagai K, Fukuhara R, Kamimura N, Mori T, Yoshiyama K, Kazui H, Nakayama K, Ikeda M
Although violations of laws, such as shoplifting, are considered to be common in frontotemporal dementia (FTD) patients, there have been few studies on this subject and the frequencies and types of such violations have not been clarified. The objective of this study was to conduct a retrospective investigation of FTD patients in the psychiatry departments of multiple institutions to determine the types and frequencies of any law violations and compare them with those of AD patients. All patients were examined between January 2011 and December 2015 at the specialized dementia outpatient clinics of 10 facilities (5 psychiatry departments of university hospitals, 5 psychiatric hospitals). According to diagnostic criteria, 73 behavior variant FTD (bvFTD) patients, 84 semantic variant of primary progressive aphasia (svPPA) patients, and 255 age- and sex-matched AD subjects as the control group were selected. The findings revealed a higher rate of law violations in the bvFTD and svPPA patients before the initial consultation as compared to the AD group (bvFTD: 33%, svPPA: 21%, AD: 6%) and that many patients had been referred due to such violations. Laws had been broken 4 times or 5 or more times in several cases in the FTD group before the initial consultation. Regarding rates for different types of violation, in bvFTD subjects, the highest rate was for theft, followed by nuisance acts and hit and run. In svPPA, theft had the highest rate, followed by ignoring road signs. There was no gender difference in law violations but they were more frequent when the disease was severe at the initial consultation in the FTD group. As the rates of law violations after the initial consultation were lower than before it, interventions were considered to have been effective. These findings may be useful for future prevention as well as to the legal system.
PMID: 28304308 [PubMed - indexed for MEDLINE]
Communication Between Physicians and Patients with Ulcerative Colitis: Reflections and Insights from a Qualitative Study of In-Office Patient-Physician Visits.
Inflamm Bowel Dis. 2017 Apr;23(4):494-501
Authors: Rubin DT, Dubinsky MC, Martino S, Hewett KA, Panés J
BACKGROUND: We analyzed in-office communication between patients with ulcerative colitis (UC) and their gastroenterologists.
METHODS: Participating gastroenterologists (United States N = 15; Europe N = 8) identified eligible patients with scheduled clinic visits. Patients (United States N = 40; Europe N = 28; ≥18 yr old; physician-defined moderately-to-severely active ulcerative colitis for approximately ≥1 yr; ≥1 flare in preceding year; prior or current therapy with 5-aminosalicylates and/or corticosteroids) consented to have their visit recorded. Follow-up interviews were conducted separately with gastroenterologists and patients. Transcripts were analyzed using sociolinguistic methods to explore quality of life (QoL) impacts, treatment goals, and attitudes to therapies.
RESULTS: In the European and U.S. research, the trend was for patients not to discuss ulcerative colitis QoL impacts during their visits. In the U.S. research, complete patient-physician alignment on QoL impacts (patient and physician stating the same impacts) was seen in 40% of cases. Variation in treatment goals was seen between gastroenterologists and patients: 3% of U.S. patients described absence of inflammation as a treatment goal versus 25% of gastroenterologists. This goal was not always conveyed to the patient during visits. Consistent with guidelines, physicians generally framed biologic therapy as suitable for patients refractory to conventional therapies. However, although putative efficacy offered by biologic therapy is generally aligned with patients' stated treatment goals, many considered biologic therapy as more appropriate for more severe disease than theirs.
CONCLUSIONS: Alignment between patients and physicians on ulcerative colitis QoL impact, treatment goals, and requirement of advanced therapies is poor. New tools are needed to cover this gap.
PMID: 28296817 [PubMed - indexed for MEDLINE]
Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System.
Pain Res Manag. 2017;2017:7941238
Authors: Garret-Bernardin A, Cantile T, D'Antò V, Galanakis A, Fauxpoint G, Ferrazzano GF, De Rosa S, Vallogini G, Romeo U, Galeotti A
Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal-Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.
PMID: 28293129 [PubMed - indexed for MEDLINE]
Cardiopulmonary Resuscitation Training in Schools Following 8 Years of Mandating Legislation in Denmark: A Nationwide Survey.
J Am Heart Assoc. 2017 Mar 14;6(3):
Authors: Malta Hansen C, Zinckernagel L, Ersbøll AK, Tjørnhøj-Thomsen T, Wissenberg M, Lippert FK, Weeke P, Gislason GH, Køber L, Torp-Pedersen C, Folke F
BACKGROUND: School cardiopulmonary resuscitation (CPR) training has become mandatory in many countries, but whether legislation has translated into implementation of CPR training is largely unknown. We assessed CPR training of students following 8 years of legislative mandates in Denmark.
METHODS AND RESULTS: A nationwide cross-sectional survey of Danish school leadership (n=1240) and ninth-grade homeroom teachers (n=1381) was carried out for school year 2013-2014. Qualitative interviews and the Theory of Planned Behavior were used to construct the survey. Logistic regression models were employed to identify factors associated with completed CPR training. Information from 63.1% of eligible schools was collected: 49.3% (n=611) of leadership and 48.2% (n=665) of teachers responded. According to teachers, 28.4% (95% CI 25.0% to 32.0%) and 10.3% (95% CI 8.1% to 12.8%) of eligible classes had completed CPR and automated external defibrillator training, respectively. Among leadership, 60.2% (95% CI 56.2% to 64.1%) reported CPR training had occurred during the 3 years prior to the survey. Factors associated with completed CPR training included believing other schools were conducting training (odds ratio [OR] 9.68 [95% CI 4.65-20.1]), awareness of mandating legislation (OR 4.19 [95% CI 2.65-6.62]), presence of a school CPR training coordinator (OR 3.01 [95% CI 1.84-4.92]), teacher feeling competent to conduct training (OR 2.78 [95% CI 1.74-4.45]), and having easy access to training material (OR 2.08 [95% CI 1.57-2.76]).
CONCLUSIONS: Despite mandating legislation, school CPR training has not been successfully implemented. Completed CPR training was associated with believing other schools were conducting training, awareness of mandating legislation, presence of a school CPR training coordinator, teachers teacher feeling competent to conduct training, and having easy access to training material. Facilitating these factors may increase rates of school CPR training.
PMID: 28292745 [PubMed - indexed for MEDLINE]
Chronic Lithium Treatment in a Rat Model of Basal Forebrain Cholinergic Depletion: Effects on Memory Impairment and Neurodegeneration.
J Alzheimers Dis. 2017;56(4):1505-1518
Authors: Gelfo F, Cutuli D, Nobili A, De Bartolo P, D'Amelio M, Petrosini L, Caltagirone C
Alzheimer's disease (AD) is an age-related neurodegenerative disorder with multifactorial etiopathogenesis, characterized by progressive loss of memory and other cognitive functions. A fundamental neuropathological feature of AD is the early and severe brain cholinergic neurodegeneration. Lithium is a monovalent cation classically utilized in the treatment of mood disorders, but recent evidence also advances a beneficial potentiality of this compound in neurodegeneration. Interestingly, lithium acts on several processes whose alterations characterize the brain cholinergic impairment at short and long term. On this basis, the aim of the present research was to evaluate the potential beneficial effects of a chronic lithium treatment in preventing the damage that a basal forebrain cholinergic neurodegeneration provokes, by investigating memory functions and neurodegeneration correlates. Adult male rats were lesioned by bilateral injections of the immunotoxin 192 IgG-Saporin into the basal forebrain. Starting 7 days before the surgery, the animals were exposed to a 30-day lithium treatment, consisting of a 0.24% Li2CO3 diet. Memory functions were investigated by the open field test with objects, the sociability and preference for social novelty test, and the Morris water maze. Hippocampal and neocortical choline acetyltransferase (ChAT) levels and caspase-3 activity were determined. Cholinergic depletion significantly impaired spatial and social recognition memory, decreased hippocampal and neocortical ChAT levels and increased caspase-3 activity. The chronic lithium treatment significantly rescued memory performances but did not modulate ChAT availability and caspase-3 activity. The present findings support the lithium protective effects against the cognitive impairment that characterizes the brain cholinergic depletion.
PMID: 28222508 [PubMed - indexed for MEDLINE]
Therapeutics of Neurotransmitters in Alzheimer's Disease.
J Alzheimers Dis. 2017;57(4):1049-1069
Authors: Kandimalla R, Reddy PH
Alzheimer's disease (AD) is a progressive neurodegenerative disease, characterized by the loss of memory, multiple cognitive impairments and changes in the personality and behavior. Several decades of intense research have revealed that multiple cellular changes are involved in disease process, including synaptic damage, mitochondrial abnormalities and inflammatory responses, in addition to formation and accumulation of amyloid-β (Aβ) and phosphorylated tau. Although tremendous progress has been made in understanding the impact of neurotransmitters in the progression and pathogenesis of AD, we still do not have a drug molecule associated with neurotransmitter(s) that can delay disease process in elderly individuals and/or restore cognitive functions in AD patients. The purpose of our article is to assess the latest developments in neurotransmitters research using cell and mouse models of AD. We also updated the current status of clinical trials using neurotransmitters' agonists/antagonists in AD.
PMID: 28211810 [PubMed - indexed for MEDLINE]
Efficacy of early treatment in patients with cobalamin C disease identified by newborn screening: a 16-year experience.
Genet Med. 2017 Aug;19(8):926-935
Authors: Ahrens-Nicklas RC, Whitaker AM, Kaplan P, Cuddapah S, Burfield J, Blair J, Brochi L, Yudkoff M, Ficicioglu C
PURPOSE: Despite implementation of newborn screening (NBS), outcomes in cobalamin C disease (cblC) remain poor. Therapy with hydroxycobalamin and betaine is widely used, but dietary recommendations vary among metabolic centers. We present a longitudinal analysis of the relationship between metabolic control, diet, and outcomes in a cohort of cblC patients.
METHODS: We completed a retrospective analysis of 12 patients with cblC referred for abnormal NBS results and followed in our center between 1999 and 2015.
RESULTS: Of the patients, 87.5% had intellectual disability and 75% had retinopathy; 16.7% had one episode of mild acidosis. However, no patients manifested major metabolic decompensation. Developmental outcomes correlated more closely with initial metabolic abnormalities than with long-term metabolic control. Increased intake of medical foods resulted in better control but also perturbations in the ratios of essential amino acids and lower z-scores for head circumference. We found no relationship between diet and cognitive outcomes.
CONCLUSIONS: Although dietary therapy for cblC patients improves metabolic control, few patients experience metabolic decompensation regardless of diet. Increased incomplete protein intake is not correlated with improvements in outcomes. Overall, outcomes are poor despite early initiation of therapy and regardless of the dietary strategy used.Genet Med advance online publication 02 February 2017.
PMID: 28151490 [PubMed - indexed for MEDLINE]
Effectiveness of Aquatic Therapy vs Land-based Therapy for Balance and Pain in Women with Fibromyalgia: a study protocol for a randomised controlled trial.
BMC Musculoskelet Disord. 2017 Jan 19;18(1):22
Authors: Rivas Neira S, Pasqual Marques A, Pegito Pérez I, Fernández Cervantes R, Vivas Costa J
BACKGROUND: Fibromyalgia is a disease with an increasing incidence. It impairs the quality of life of patients and decreases their functional capacity. Aquatic therapy has already been used for managing the symptoms of this syndrome. However, aquatic therapy has only recently been introduced as a treatment modality for improving proprioception in fibromyalgia. The main objective of this study is to determine the effectiveness of two physiotherapy protocols, one in and one out of water, for improving balance and decreasing pain in women with fibromyalgia.
METHODS/DESIGN: The study protocol will be a single-blind randomised controlled trial. Forty women diagnosed with fibromyalgia will be randomly assigned into 2 groups: Aquatic Therapy (n = 20) or Land-based Therapy (n = 20). Both interventions include 60-min therapy sessions, structured into 4 sections: Warm-up, Proprioceptive Exercises, Stretching and Relaxation. These sessions will be carried out 3 times a week for 3 months. Primary outcomes are balance (static and dynamic) and pain (intensity and threshold). Secondary outcomes include functional balance, quality of life, quality of sleep, fatigue, self-confidence in balance and physical ability. Outcome measures will be evaluated at baseline, at the end of the 3-month intervention period, and 6-weeks post-treatment. Statistical analysis will be carried out using the SPSS 21.0 program for Windows and a significance level of p ≤ 0.05 will be used for all tests.
DISCUSSION: This study protocol details two physiotherapy interventions in women with fibromyalgia to improve balance and decrease pain: aquatic therapy and land-based therapy. In current literature there is a lack of methodological rigour and a limited number of studies that describe physiotherapy protocols to manage fibromyalgia symptoms. High-quality scientific works are required to highlight physiotherapy as one of the most recommended treatment options for this syndrome.
TRIAL REGISTRATION: Date of publication in ClinicalTrials.gov: 18/02/2016. ClinicalTrials.gov Identifier: NCT02695875 .
PMID: 28103853 [PubMed - indexed for MEDLINE]
Military-Civilian Collaborations for mTBI Rehabilitation Research in an Active Duty Population: Lessons Learned From the Assessment of Military Multitasking Performance Project.
J Head Trauma Rehabil. 2017 Jan/Feb;32(1):70-78
Authors: McCulloch KL, Cecchini AS, Radomski MV, Scherer MR, Smith L, Cleveland C, McMillan HP, Davidson LF, Weightman MM
This article describes lessons learned in the planning, development, and administration of a collaborative military-civilian research project, the Assessment of Military Multitasking Performance, which was designed to address a gap in clinical assessment for active duty service members with mild traumatic brain injury who wish to return to active duty. Our team worked over the course of multiple years to develop an assessment for military therapists to address this need. Insights gained through trial and error are shared to provide guidance for civilian researchers who may wish to collaborate with active duty researchers.
PMID: 28060056 [PubMed - indexed for MEDLINE]
The Effect of the Association between Donepezil and Choline Alphoscerate on Behavioral Disturbances in Alzheimer's Disease: Interim Results of the ASCOMALVA Trial.
J Alzheimers Dis. 2017;56(2):805-815
Authors: Carotenuto A, Rea R, Traini E, Fasanaro AM, Ricci G, Manzo V, Amenta F
BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are a group of psychological reactions, psychiatric symptoms, and behaviors commonly found in Alzheimer's disease (AD). Four clusters of BPSD have been described: mood disorders (depression, anxiety, and apathy), psychotic symptoms (delusions and hallucinations), aberrant motor behaviors (pacing, wandering, and other purposeless behaviors), and inappropriate behaviors (agitation, disinhibition, and euphoria). Most of them are attributed to acetylcholine deficiency.
OBJECTIVE: To evaluate if a higher amount of acetylcholine obtained by associating donepezil and choline alphoscerate might have a favorable effect on BPSD.
METHODS: BPSD were measured at baseline and after 24 months in 113 mild/moderate AD patients, included in the double-blind randomized trial ASCOMALVA, by the Neuropsychiatric Inventory (NPI). Two matched groups were compared: group A treated with donepezil (10 mg/day) plus choline alphoscerate (1200 mg/day), and group B treated with donepezil (10 mg/day) plus placebo.
RESULTS: Data of NPI revealed a significant decrease of BPSD severity and distress of the caregiver in patients of group A compared with group B. Mood disorders (depression, anxiety and apathy) were significantly decreased in subjects treated with donepezil and choline alphoscerate, while their severity and frequency was increased in the other group.
CONCLUSIONS: Patients treated with donepezil plus choline alphoscerate showed a lower level of behavioral disturbances than subjects treated with donepezil only, suggesting that the association can have beneficial effects.
PMID: 28035924 [PubMed - indexed for MEDLINE]
A Preliminary Study on the Feasibility of Using a Virtual Reality Cognitive Training Application for Remote Detection of Mild Cognitive Impairment.
J Alzheimers Dis. 2017;56(2):619-627
Authors: Zygouris S, Ntovas K, Giakoumis D, Votis K, Doumpoulakis S, Segkouli S, Karagiannidis C, Tzovaras D, Tsolaki M
BACKGROUND: It has been demonstrated that virtual reality (VR) applications can be used for the detection of mild cognitive impairment (MCI).
OBJECTIVE: The aim of this study is to provide a preliminary investigation on whether a VR cognitive training application can be used to detect MCI in persons using the application at home without the help of an examiner.
METHODS: Two groups, one of healthy older adults (n = 6) and one of MCI patients (n = 6) were recruited from Thessaloniki day centers for cognitive disorders and provided with a tablet PC with custom software enabling the self-administration of the Virtual Super Market (VSM) cognitive training exercise. The average performance (from 20 administrations of the exercise) of the two groups was compared and was also correlated with performance in established neuropsychological tests.
RESULTS: Average performance in terms of duration to complete the given exercise differed significantly between healthy(μ = 247.41 s/ sd = 89.006) and MCI (μ= 454.52 s/ sd = 177.604) groups, yielding a correct classification rate of 91.8% with a sensitivity and specificity of 94% and 89% respectively for MCI detection. Average performance also correlated significantly with performance in Functional Cognitive Assessment Scale (FUCAS), Test of Everyday Attention (TEA), and Rey Osterrieth Complex Figure test (ROCFT).
DISCUSSION: The VR application exhibited very high accuracy in detecting MCI while all participants were able to operate the tablet and application on their own. Diagnostic accuracy was improved compared to a previous study using data from only one administration of the exercise. The results of the present study suggest that remote MCI detection through VR applications can be feasible.
PMID: 28035922 [PubMed - indexed for MEDLINE]
Illustrating and Analyzing the Processes of Interprofessional Collaboration: A Lesson Learned from Palliative Care in Deconstructing the Concept.
J Palliat Med. 2017 Mar;20(3):227-234
Authors: Witt Sherman D, Maitra K, Gordon Y, Simon S, Olenick M, Barbara S, Doherty-Restrepo J, Hough M, Randolph M, Singh A
BACKGROUND: A basic tenet of palliative care is interprofessional collaboration. Palliative care educators and practitioners lead the way in responding to the Institute of Medicine's (2003) challenge to transform educational and health care systems through interprofessional collaboration. Through exemplary commitment to interprofessional collaboration, a college's academic and palliative care leader, in collaboration with Department Chairs and Directors of nursing and allied health professions, can illustrate and analyze the processes of interprofessional collaboration through the development of a simulated case study of a combat veteran with traumatic brain injury.
METHODS: Methodologic components: (1) interprofessional development of a palliative care case study and (2) debriefing interviews regarding the experience of collaboration of interprofessional team members.
RESULTS: The results provide the identification of steps of the interprofessional process and the shared and unique disciplinary competencies in determining a comprehensive health history, physical examination, identifying and prioritizing diagnoses, and determining collaborative discipline-specific interventions. Content analysis of debriefing team interviews provides a description of group composition, structure, process, development, and performance, as well as team member's perceptions of what fosters and challenges collaboration, benefits, and drawbacks, and what could have been done differently in developing an interprofessional initiative.
DISCUSSION: Transformative change in healthcare education and clinical practice involves interprofessional collaboration of colleagues within, across, and beyond universities/colleges and healthcare systems and agencies. Advocating for teamwork has to go beyond talking about being a team player or not to having the language and behaviors we need to observe and measure. This article not only provides key processes in interprofessional collaboration but also identifies key attitudes and behaviors critical to teamwork. It provides a starting point to determine observable and measurable outcomes for interprofessional education, practice, and research. This article highlights expert behavior to move professionals from being novices in interprofessional collaboration to mastering the skills.
PMID: 28001457 [PubMed - indexed for MEDLINE]
Benefits of Occupational Therapy in Dementia Patients: Findings from a Real-World Observational Study.
J Alzheimers Dis. 2017;56(2):509-517
Authors: Pimouguet C, Le Goff M, Wittwer J, Dartigues JF, Helmer C
BACKGROUND: There is a growing interest in developing non-pharmacological approaches in dementia. Clinical efficacy of occupational therapy (OT) under routine care conditions has not been investigated yet.
OBJECTIVE: To analyze the short-term effects of OT in patients with dementia; and to identify factors related to greater benefit.
METHODS: Patients referred to OT were evaluated before starting a 3-month intervention and at 3 and 6 months later. Measures included: Mini-Mental State Examination (MMSE), Disability Assessment in Dementia (DAD), Neuropsychiatric Inventory (NPI) Questionnaire, patients' quality of life (EQ 5D-VAS), caregivers' burden (Zarit scale), and amount of informal care. Linear mixed models were used to analyze trajectories of outcomes. Logistic regressions with stepwise descending selection were used to study factors associated with benefits.
RESULTS: 421 dementia patients benefited from OT (mean MMSE = 17.3). Patients remained cognitively stable over time. Functional performances also remained stable at 3 months and significantly decreased at 6 months (crude reduction of 2.8 points, p < 0.01). Behavioral troubles were significantly reduced over the intervention period and remained stable after (p < 0.01). Patients' quality of life increased over the 3-month intervention (p = 0.16) and significantly decreased thereafter. Caregivers' burden and informal care significantly decreased over the 3-month intervention and remained stable thereafter. Patients who benefited from OT with regard to function were less educated and had higher cognitive level.
CONCLUSION: OT may be an effective intervention to maintain cognition and functionality and to reduce psychiatric symptoms in dementia patients. Mild stages of dementia could gain more benefits from OT with regard to functional decline.
PMID: 27983551 [PubMed - indexed for MEDLINE]
Nerve growth factor modulates the tumor cells migration in ovarian cancer through the WNT/β-catenin pathway.
Oncotarget. 2016 Dec 06;7(49):81026-81048
Authors: Li B, Cai S, Zhao Y, He Q, Yu X, Cheng L, Zhang Y, Hu X, Ke M, Chen S, Zou M
Nerve growth factor (NGF)/nerve growth factor receptors (NGFRs) axis and canonical WNT/β-catenin pathway have shown to play crucial roles in tumor initiation, progression and prognosis. But little did we know the relationship between them in modulation of tumor progress. In this report, we found that NGF/NGFRs and β-catenin were coexpression in ovarian cancer cell lines, and NGF can decrease the expression level of β-catenin and affect its activities, which may be related to the NGF-induced down-regulation of B-cell CLL/lymphoma 9-like (BCL9L, BCL9-2). Furthermore, NGF can also increase or decrease the downstream target gene expression levels of WNT/β-catenin depending on the cell types. Especially, we created a novel in vitro cell growth model based on a microfluidic device to intuitively observe the effects of NGF/NGFRs on the motility behaviors of ovarian cancer cells. The results showed that the migration area and maximum distance into three dimensional (3D) matrigel were decreased in CAOV3 and OVCAR3 cells, but increased in SKOV3 cells following the stimulation with NGF. In addition, we found that the cell colony area was down-regulated in CAOV3 cells, however, it was augmented in OVCAR3 cells after treatment with NGF. The inhibitors of NGF/NGFRs, such as Ro 08-2750, K252a and LM11A-31,can all block NGF-stimulated changes of gene expression or migratory behavior on ovarian cancer cells. The different results among ovarian cancer cells illustrated the heterogeneity and complexity of ovarian cancer. Collectively, our results suggested for the first time that NGF is functionally linked to β-catenin in the migration of human ovarian cancer cells, which may be a novel therapeutic perspective to prevent the spread of ovarian carcinomas by studying the interaction between NGF/NGFRs and canonical WNT/β-catenin signaling.
PMID: 27835587 [PubMed - indexed for MEDLINE]
Preventing Suture Extrusion and Recurrence in Mustarde and Furnas Otoplasties by Using Laterally Based Postauricular Dermal Flap, Long-Term Results.
J Craniofac Surg. 2016 Sep;27(6):1476-80
Authors: Basat SO, Ceran F, Askeroglu U, Aksan T, Orman C, Yazar M, Uscetin I, Akan M, Bozkurt M
BACKGROUND: Prominent ear deformity (PD) is an unacceptable condition of pinna that affects 5% of the population and is associated with emotional stress, behavioral disturbances, and social restrictions in relationships. Conchal hypertrphy, inadequate formation of antihelical fold, earlobe placement ahead than it should be, or various combinations of these changes are main characteristics of PD. Many surgical techniques have been described for the PD.The authors' aim was to present laterally based postauricular dermal flap combination with cartilage-sparing methods and effectiveness of this technique in suture extrusion prevention and reducing the rate of recurrence with long-term results.
METHODS: Forty-one patients had bilateral and 6 patients had unilateral PD, a total of 47 patients with a mean age of 14.48 were operated by using this combined procedure. A laterally based supraperichondrial dermal flap was prepared from a deepithelized elliptical postauricular incision. Mustarde and Furnas suture techniques were used solely for PD correction. The dissected laterally based dermal flap was fixed to the mastoid bone with sutures in stretched position after reshaping the auricular cartilage with sutures.
RESULTS: The average helix-mastoid distance was (mm) 16.28 ± 2.36, concha-mastoid angle was 25.71 ± 0.96° on 12-month measurements. The helix-mastoid distance showed an increase of 1 to 3 mm, in the concha-mastoid angle measurements of 1° to 2°. Statistically significant changes were observed between the average preoperative, postoperative 1. month, postoperative 12. month helix-mastoid distances (mm), and month concha-mastoid angle (°) measurements (P = 0.0001).
CONCLUSIONS: The laterally based postauricular dermal flap technique is an effective method to prevent suture extrusion and recurrence which are the most important complications of otoplasty procedure and easy to apply.
PMID: 27607117 [PubMed - indexed for MEDLINE]
Culinary Grief Therapy: Cooking for One Series.
J Palliat Med. 2017 Feb;20(2):181-183
Authors: Nickrand HL, Brock CM
BACKGROUND: Although loss of loved ones is a universal experience, individuals who experience this loss grieve in different ways. Complicated grief involves the development of trauma symptoms, such as flashbacks, anxiety, and fear associated with daily activities after a death that disrupts the healthy grieving process. Daily activities such as eating, meal planning, grocery shopping, managing finances, and household maintenance can become painful and isolating for those experiencing complicated grief. Cognitive behavioral therapy is used to address irrational beliefs, feelings of depression or anger, and avoidance or numbing behaviors with a goal of leading the individual to adapting to a life, which no longer includes the lost loved one.
OBJECTIVE: As part of the bereavement counseling program in a hospice, a need was identified in individuals who had lost loved ones and were having difficulty with adjusting to meal planning, grocery shopping, and cooking for one. To address this need for grief counseling centered on meal planning, grocery shopping, meal preparations, and eating meals alone, "Culinary Grief Therapy: Cooking for One Series" was developed with a local Culinary Arts Program.
DESIGN: Partnering with a local community college culinary arts program, the Cooking for One Series provides an interactive venue for cognitive behavioral therapy centered on meal planning and meal times. Along with demonstrations and hands-on experiences, participants are engaged in bereavement counseling with hospice staff.
RESULTS: Initial reactions to Culinary Grief Therapy have been positive. Many attendees have participated in multiple workshops, and the number of participants grows for each offering.
CONCLUSIONS: Culinary Grief Therapy is a novel approach to the needs of those experiencing the loss of a loved one and may reduce or prevent complicated grief associated with meal planning, grocery shopping, and cooking for one.
PMID: 27602803 [PubMed - indexed for MEDLINE]
Piracetam Facilitates the Anti-Amnesic but not Anti-Diabetic Activity of Metformin in Experimentally Induced Type-2 Diabetic Encephalopathic Rats.
Cell Mol Neurobiol. 2017 Jul;37(5):791-802
Authors: Pandey S, Garabadu D
Piracetam exhibits anti-amnesic activity in several animal models of dementia. However, its anti-amnesic potential has yet to be evaluated in type-2 diabetes mellitus (T2DM)-induced encephalopathy. Therefore, in the present study, piracetam (25, 50 and 100 mg/kg) was screened for anti-amnesic and anti-diabetic activity in T2DM-induced encephalopathic male rats. Subsequently, anti-amnesic and anti-diabetic activities were evaluated for piracetam, metformin and their combination in T2DM-induced encephalopathic animals. Rats received streptozotocin (45 mg/kg) and nicotinamide (110 mg/kg) injections on day-1 (D-1) of the experimental schedule and were kept undisturbed for 35 days to exhibit T2DM-induced encephalopathy. All drug treatments were continued from D-7 to D-35 in both experiments. Piracetam (100 mg/kg) attenuated loss in learning and memory in terms of increase in escape latency on D-4 (D-34) and decrease in time spent in the target quadrant on D-5 (D-35) of Morris water maze test protocol, and spatial memory in terms of reduced spontaneous alternation behavior in Y-maze test of encephalopathic rats. Additionally, piracetam attenuated altered levels of fasting plasma glucose and insulin, HOMA-IR and HOMA-B in encephalopathic animals, comparatively lesser than metformin. In the next experiment, combination of piracetam and metformin exhibited better anti-amnesic but not anti-diabetic activity than respective monotherapies in encephalopathic rats. Further, the combination attenuated reduced acetylcholine level and increased acetylcholinesterase activity, increased glycogen synthase kinase-3β level and decreased brain-derived neurotropic factor level in hippocampus and pre-frontal cortex of encephalopathic animals. Thus, piracetam could be used as an adjuvant to metformin in the management of dementia in T2DM-induced encephalopathy.
PMID: 27585927 [PubMed - indexed for MEDLINE]
Risk Categorization Predicts Disability in Pain-associated Functional Gastrointestinal Disorders After 6 Months.
J Pediatr Gastroenterol Nutr. 2017 May;64(5):685-690
Authors: Cunningham NR, Jagpal A, Peugh J, Farrell MK, Cohen MB, Mezoff AG, Lynch-Jordan A, Kashikar-Zuck S
INTRODUCTION: For a large portion of youth, pain-associated functional gastrointestinal disorders (FGIDs) are associated with significant impairment over time. Clinically feasible methods to categorize youth with FGIDs at greatest risk for persistent pain-related impairment have not yet been identified.
METHODS: Measures of functional disability, pain intensity, and anxiety were collected on 99 patients with FGIDs (ages 8-18) during a visit to a pediatric gastroenterology office to assess for the presence of risk. Follow-up data were obtained on a subset of this sample (n = 64) after 6 months, either in person or via mail. The present study examined whether a greater number of risk factors at baseline predicted greater pain-related disability at follow-up.
RESULTS: Patients were divided into 4 groups based on number of risk factors present at the initial assessment: 0 (18.2%), 1 (24.2%), 2 (26.3%), and 3 (31.3%). The presence of 2 or 3 risk factors significantly predicted greater disability at follow-up compared to those with 0 risk factors (R = 0.311) and those with just 1 risk factor (Cohen's d values of -1.07 and -1.44, respectively).
DISCUSSION: A simple approach to risk categorization can identify youth with FGIDs who are most likely to report increased levels of pain-related impairment over time. These findings have important clinical implications that support the utility of a brief screening process during medical care to inform referral for targeted treatment approaches to FGIDs.
PMID: 27437930 [PubMed - indexed for MEDLINE]
The effects of an early motor skill intervention on motor skills, levels of physical activity, and socialization in young children with autism spectrum disorder: A pilot study.
Autism. 2017 May;21(4):481-492
Authors: Ketcheson L, Hauck J, Ulrich D
Despite evidence suggesting one of the earliest indicators of an eventual autism spectrum disorder diagnoses is an early motor delay, there remain very few interventions targeting motor behavior as the primary outcome for young children with autism spectrum disorder. The aim of this pilot study was to measure the efficacy of an intensive motor skill intervention on motor skills (Test of Gross Motor Development-2), physical activity (accelerometers), and socialization (Playground Observation of Peer Engagement) in young children with autism spectrum disorder. A total of 20 children with autism spectrum disorder aged 4-6 years participated. The experimental group ( n = 11) participated in an 8-week intervention consisting of motor skill instruction for 4 h/day, 5 days/week. The control group ( n = 9) did not receive the intervention. A repeated-measures analysis of covariance revealed statistically significant differences between groups in all three motor outcomes, locomotor ( F(1, 14) = 10.07, p < 0.001, partial η2 = 0.42), object control ( F(1, 14) = 12.90, p < 0.001, partial η2 = 0.48), and gross quotient ( F(1, 14) = 15.61, p < 0.01, partial η2 = 0.53). Findings shed light on the importance of including motor programming as part of the early intervention services delivered to young children with autism spectrum disorder.
PMID: 27354429 [PubMed - indexed for MEDLINE]
Effectiveness of school-based mental health playgroups for diagnosable and at-risk preschool children.
Am J Orthopsychiatry. 2017;87(3):304-316
Authors: Bekar Ö, Shahmoon-Shanok R, Steele M, Levy J, deFressine L, Giuseppone K, Steele H
Risk factors during preschool years, such as poverty and unattended social/emotional problems, are known to have a strong negative influence on children's later functioning. This study aimed to investigate the effectiveness of an on-site integrated school-based mental health services and consultation program for preschool children and their families. The sample consisted of 47 children and parents in 3 childcare centers who came from low-socioeconomic, urban backgrounds. Parents provided questionnaire data on children's social-emotional functioning at 2 assessment times. Children's ages ranged between 2 and 4 years at Time 1. Approximately half of the sample consisted of children who were selected for and received twice-weekly peer play psychotherapy (PPP) and, at-times, other mental health services from clinicians (playgroup [PG] children). The other half of the sample consisted of better functioning non-playgroup (NPG) children from the same centers. When PG and NPG were compared at Time1, the PG children were significantly behind the NPG children justifying their assignment to PG. However, at Time 2, the difference between PG and NPG was no longer significant on vital measures of adaptation, revealing the ways in which Relationships for Growth & Learning (RfGL) Program arguably led to 'catch up'. PG children's behavioral problems and total symptomatology decreased significantly from Time 1 to Time 2. Higher dosage of PPP was linked with higher social competence and decreased behavioral problems. Areas of gain differed between internalizing and externalizing children, indicating that intervention was helpful to different types of children. Clinical and research implications were discussed. (PsycINFO Database Record
PMID: 27322159 [PubMed - indexed for MEDLINE]
Mental health treatment seeking patterns and preferences of Appalachian women with depression.
Am J Orthopsychiatry. 2017;87(3):233-241
Authors: Snell-Rood C, Hauenstein E, Leukefeld C, Feltner F, Marcum A, Schoenberg N
This qualitative study explored social-cultural factors that shape treatment seeking behaviors among depressed rural, low-income women in Appalachia-a region with high rates of depression and a shortage of mental health services. Recent research shows that increasingly rural women are receiving some form of treatment and identifying their symptoms as depression. Using purposive sampling, investigators recruited 28 depressed low-income women living in Appalachian Kentucky and conducted semistructured interviews on participants' perceptions of depression and treatment seeking. Even in this sample of women with diverse treatment behaviors (half reported current treatment), participants expressed ambivalence about treatment and its potential to promote recovery. Participants stressed that poor treatment quality-not merely access-limited their engagement in treatment and at times reinforced their depression. While women acknowledged the stigma of depression, they indicated that their resistance to seek help for their depression was influenced by the expectation of women's self-reliance in the rural setting and the gendered taboo against negative thinking. Ambivalence and stigma led women to try to cope independently, resulting in further isolation. This study's findings reiterate the need for improved quality and increased availability of depression treatment in rural areas. In addition, culturally appropriate depression interventions must acknowledge rural cultural values of self-reliance and barriers to obtaining social support that lead many women to endure depression in isolation. (PsycINFO Database Record
PMID: 27322157 [PubMed - indexed for MEDLINE]
Effects of an employer-based intervention on employment outcomes for youth with significant support needs due to autism.
Autism. 2017 Apr;21(3):276-290
Authors: Wehman P, Schall CM, McDonough J, Graham C, Brooke V, Riehle JE, Brooke A, Ham W, Lau S, Allen J, Avellone L
The purpose of this study was to develop and investigate an employer-based 9-month intervention for high school youth with autism spectrum disorder to learn job skills and acquire employment. The intervention modified a program titled Project SEARCH and incorporated the use of applied behavior analysis to develop Project SEARCH plus Autism Spectrum Disorder Supports. A randomized clinical trial compared the implementation of Project SEARCH plus Autism Spectrum Disorder Supports with high school special education services as usual. Participants were 49 high-school-aged individuals between the ages of 18 and 21 years diagnosed with an autism spectrum disorder and eligible for supported employment. Students also had to demonstrate independent self-care. At 3 months post-graduation, 90% of the treatment group acquired competitive, part-time employment earning US$9.53-US$10.66 per hour. Furthermore, 87% of those individuals maintained employment at 12 months post-graduation. The control group's employment outcomes were 6% acquiring employment by 3 months post-graduation and 12% acquiring employment by 12 months post-graduation. The positive employment outcomes generated by the treatment group provide evidence that youth with autism spectrum disorder can gain and maintain competitive employment. Additionally, there is evidence that they are able to advance within that time toward more weekly hours worked, while they also displayed increasing independence in the work setting.
PMID: 27154907 [PubMed - indexed for MEDLINE]
Parent perceptions of an adapted evidence-based practice for toddlers with autism in a community setting.
Autism. 2017 Feb;21(2):217-230
Authors: Stahmer AC, Brookman-Frazee L, Rieth SR, Stoner JT, Feder JD, Searcy K, Wang T
Although data from parent-implemented Naturalistic Developmental Behavioral Interventions have shown positive effects on decreasing core symptoms of autism, there has been limited examination of the effectiveness of Naturalistic Developmental Behavioral Interventions in community settings. In addition, parent perspectives of their involvement in parent-implemented early intervention programs have not been well studied. Using both qualitative and quantitative data to examine parent perspectives and the perceived feasibility of parent training by community providers, 13 families were followed as they received training in the Naturalistic Developmental Behavioral Intervention, Project ImPACT. Data indicate that parent training by community providers is feasible and well received, and parents find value in participating in intervention and perceive benefit for their children. Recommendations for adaptation of program elements and future research are discussed.
PMID: 27121242 [PubMed - indexed for MEDLINE]
Compensatory Cognitive Training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans With Mild Traumatic Brain Injury.
J Head Trauma Rehabil. 2017 Jan/Feb;32(1):16-24
Authors: Storzbach D, Twamley EW, Roost MS, Golshan S, Williams RM, OʼNeil M, Jak AJ, Turner AP, Kowalski HM, Pagulayan KF, Huckans M
OBJECTIVE: The purpose of the study was to evaluate the efficacy of group-based compensatory cognitive training (CCT) for Operation Enduring Freedom (OEF)/Operation Iraqi Freedom(OIF)/Operation New Dawn (OND) Veterans with a history of mild traumatic brain injury.
METHOD: One hundred nineteen OEF/OIF/OND Veterans with history of mild traumatic brain injury participated at 3 sites, and 50 of the Veterans were randomized to CCT group, while 69 Veterans were randomized to the usual care control group. The CCT group participated in 10 weeks of CCT. Both CCT and usual care groups were assessed at baseline, 5 weeks (midway through CCT), 10 weeks (immediately following CCT), and 15 weeks (5-week follow-up) on measures of subjective cognitive complaints, use of cognitive strategies, psychological functioning, and objective cognitive performance.
RESULTS: Veterans who participated in CCT reported significantly fewer cognitive and memory difficulties and greater use of cognitive strategies. They also demonstrated significant improvements on neurocognitive tests of attention, learning, and executive functioning, which were 3 of the cognitive domains targeted in CCT.
CONCLUSIONS: Findings indicate that training in compensatory cognitive strategies facilitates behavioral change (ie, use of cognitive strategies) as well as both subjective and objective improvements in targeted cognitive domains.
PMID: 27022961 [PubMed - indexed for MEDLINE]
Long-Term School Outcomes of Children and Adolescents With Traumatic Brain Injury.
J Head Trauma Rehabil. 2017 Jan/Feb;32(1):E24-E32
Authors: Prasad MR, Swank PR, Ewing-Cobbs L
OBJECTIVE: To better understand the impact of age at injury, severity of injury, and time since injury on long-term school outcomes of children with traumatic brain injury (TBI).
PARTICIPANTS: Four groups of children: complicated mild/moderate TBI (n = 23), severe TBI (n = 56), orthopedic injury (n = 35), and healthy controls (n = 42). Children with TBI were either 2 years postinjury or 6 years postinjury.
DESIGN: Cross-sectional design.
MEASURES: School records as well as parental ratings of functional academic skills and school competency.
RESULTS: Children with severe TBI had consistently high usage of school services and low school competency ratings than children with orthopedic injuries and healthy controls. In contrast, children with complicated-mild/moderate TBI were significantly more likely to receive school support services and have lower competence ratings at 6 years than at 2 years postinjury. Students injured at younger ages had lower functional academic skill ratings than those injured at older ages.
CONCLUSIONS: These findings highlight the increasing academic challenges faced over time by students with complicated-mild/moderate TBI and the vulnerability of younger children to poorer development of functional academic skills.
PMID: 26828713 [PubMed - indexed for MEDLINE]
Utility of the Neurobehavioral Symptom Inventory As an Outcome Measure: A VA TBI Model Systems Study.
J Head Trauma Rehabil. 2017 Jan/Feb;32(1):46-54
Authors: Belanger HG, Silva MA, Donnell AJ, McKenzie-Hartman T, Lamberty GJ, Vanderploeg RD
OBJECTIVE: To examine the utility of the Neurobehavioral Symptom Inventory (NSI)-a measure of postconcussion symptoms used within the Veterans Health Administration-as an index of rehabilitation outcome.
SETTING: Veterans Administration Polytrauma Rehabilitation Centers Traumatic Brain Injury (TBI) Model Systems program.
PARTICIPANTS: A total of 159 Veterans (14% with mild TBI; 86% with moderate-severe TBI).
MAIN MEASURES: Disability Rating Scale; Functional Independence Measure; Glasgow Outcome Scale-Extended; NSI; Participation Assessment with Recombined Tools-Objective; Posttraumatic Stress Disorder Checklist-Civilian Version; Satisfaction With Life Scale; Supervision Rating Scale.
ANALYSES: Correlations and exploratory factor analyses examined the interrelations among outcome measures. Hierarchical regression analyses were utilized to determine if the NSI predicted rehabilitation outcome measures after controlling for demographic variables, TBI severity, and time since injury. NSI reliable changes from pretreatment to 1-year follow-up were examined. Receiver operating characteristics curve analyses were conducted to evaluate the ability of changes in the NSI to predict meaningful change in functioning and employment status.
RESULTS: The NSI correlated with psychological distress measures. The NSI administered prior to brain injury rehabilitation had limited predictive utility beyond satisfaction with life. A minority of patients (32%) demonstrated reliable changes on the NSI from baseline to 1-year follow-up. Changes on the NSI were not predictive of meaningful change in employment or functioning.
CONCLUSION: The NSI was not useful for assessing meaningful change in a sample of mixed severity TBI patients.
PMID: 26709585 [PubMed - indexed for MEDLINE]