OBJECTIVES: This pilot study examined the feasibility, preliminary efficacy, and determined the effect sizes of external qigong therapy (EQT) in reducing cue-elicited cocaine craving and associated symptoms among recently abstinent cocaine-dependent (CD) individuals.
METHODS: This study randomized 101 CD subjects to either a real EQT (n=51) or sham EQT control (n=50) group. Subjects underwent a baseline assessment and a weekly cue-exposure session for 2 weeks. Total EQT or sham treatments ranged from 4 to 6 sessions in 2 weeks.
RESULTS: EQT-treated subjects displayed a greater reduction in cue-elicited craving (p=0.06) and symptoms of depression (p<0.05) with medium effect sizes.
CONCLUSIONS: This study demonstrated the feasibility of delivering EQT among CD individuals early in residential treatment. Future research should include a larger sample and examine the mechanisms and potential longitudinal benefits of EQT.
Incremental efficacy of adding bupropion to the nicotine patch for smoking cessation in smokers with a recent history of alcohol dependence: results from a randomized, double-blind, placebo-controlled study
AIMS: The primary aim of this study was to compare the efficacy of smoking cessation treatment using a combination of nicotine patch and bupropion vs. nicotine patch and placebo bupropion. A secondary aim was to investigate whether the efficacy of bupropion is moderated by belief about whether one is receiving active or placebo medication.
METHODS: Participants were recruited from a residential substance abuse treatment program and the community. We randomly assigned 148 smokers with between 2 and 12 months of alcohol abstinence to nicotine patch plus bupropion or nicotine patch plus placebo. All participants also received seven counseling sessions.
RESULTS: At follow up, differences between medication conditions were not significant. Seven-day point prevalence quit rates in the patch plus bupropion vs. patch plus placebo conditions at week 24 were 6% and 11%, respectively. Differences between groups on prolonged abstinence and time to first smoking lapse were also not significant. However, among participants who received bupropion, those who accurately "guessed" that they were receiving bupropion were more likely to remain abstinent than those who incorrectly believed they were receiving placebo.
CONCLUSIONS: Findings do not support combining nicotine patch and bupropion for smoking cessation in this population. However, findings support previous studies suggesting the importance of assessing the blind in smoking cessation studies and its possible moderating effect on medication efficacy. Future directions for enhancing smoking cessation outcome in these smokers include investigations of intensive behavioral and pharmacological interventions, including studies of potential interactions between individual genetic differences and medication efficacy.
Impact of traumatic and violent victimization experiences in individuals with schizophrenia and schizoaffective disorder
Individuals with schizophrenia or schizoaffective disorder (SZ) experience more violent victimization and noninterpersonal traumatic experiences than the general population. Earlier studies, however, have generally excluded one or grouped together victimization and trauma experiences into single outcome variables, which may obscure their contributory role to SZ symptoms. This issue is important because there is some evidence that intentionally induced violence produces higher rates of psychopathology than nonintentional traumatic experiences. We examined the independent contribution of both types of victimization experiences on SZ patients' symptomatology. We were also interested in determining whether SZ patients' pattern of acute symptom presentation could discriminate between SZ patients with and without posttraumatic stress disorder (PTSD) comorbidity. SZ inpatients (n = 70) were assessed for the presence of comorbid PTSD diagnosis, violent victimization, and noninterpersonal traumatic experiences. Patients were also rated on SZ symptom severity and general psychopathology measures. Past violent victimization experiences predicted severity of dysphoria and anxiety in SZ. Past traumatic experiences, however, predicted severity of psychosis. Victimization predicted severity of patients' autistic/cognitive symptoms. SZ patients with comorbid PTSD presented with significantly more anxiety and dysphoria symptoms and SZ illness chronicity than their non-PTSD counterparts. Discriminant function analysis revealed that the severity of positive, dysphoric, autistic/cognitive, and anxiety symptoms differentiated comorbid PTSD patients from their non-PTSD counterparts, with an overall 72.9% classification rate. Past traumatic and victimization experiences are significantly associated with SZ patients' symptom severity and illness course in partially overlapping domains. Use of common assessment strategies may be employed to increase detection of PTSD in SZ patients presenting for acute treatment.
Physical activity and screen time in metabolically healthy obese phenotypes in adolescents and adults
Introduction. The purpose of this study was to examine levels of physical activity (PA) and screen time (ST) in metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO) adolescents and adults.
Methods. NHANES data from obese adolescents (12-18 years, BMI z-score >/= 95th percentile) and adults (19-85 years, BMI >/= 30 kg/m(2)) were pooled from 2003-2005 cycles. Metabolic phenotypes were categorized as MHO (0 or 1 cardiometabolic risk factor; triglycerides, HDL-C, blood pressure, or glucose) or MUO (>/=2 cardiometabolic risk factors). Logistic regression models estimated associations between phenotype and PA/ST adjusted for age, gender, BMI, race/ethnicity, menopausal status, and NHANES cycle.
Results. Among adolescents, PA was not associated with MHO. In contrast, MHO adults 19-44 years were 85% more likely to engage in active transportation and 2.7 times more likely to be involved in light intensity usual daily activity versus sitting. For each minute per day, adults 45-85 years were 36% more likely to have the MHO phenotype with higher levels of moderate PA. ST was not associated with metabolic phenotypes in adolescents or adults.
Conclusion. The current study provides evidence that PA, but not ST, differs between MHO and MUO in adults, but not in adolescents. Future studies are needed to confirm results.
Reliable change in depression during behavioral weight loss treatment among women with major depression
OBJECTIVE: Although behavioral weight loss interventions generally have been shown to improve depressive symptoms, little is known as to whether some people with major depressive disorder experience worsening of depression during a weight loss intervention.
DESIGN AND METHODS: Rates and predictors of change in depression symptoms among 148 obese women with major depressive disorder who participated in a trial comparing depression treatment plus behavioral weight loss treatment (Behavioral Activation; BA) to behavioral weight loss treatment alone (Lifestyle Intervention; LI) were examined. a statistically reliable change in depression was calculated as >/=9 points on the beck depression inventory in this sample.
RESULTS: At 6 months, 73% of participants in BA and 54% of participants in LI showed reliable improvement in depression symptoms and 1.5% of participants in BA and 1.3% of participants in LI showed reliable worsening in depression symptoms. Rates of reliable change were similar at 12 months. Participants who experienced reliable improvement in depression lost significantly more weight than those who did not in both conditions. In the LI condition, baseline psychiatric variables and change in physical activity during treatment were also related to reliable improvement in depression.
CONCLUSION: No evidence for an iatrogenic effect of behavioral weight loss treatment on depressive symptoms among obese women with major depressive disorder was detected; rather, behavioral weight loss treatment appears to be associated with significant concurrent improvement in depression. Even greater rates of reliable improvement were observed when depression treatment was added to weight loss treatment.
Caloric beverages may promote obesity by yielding energy without producing satiety, but prior laboratory and intervention studies are inconclusive. This study examined whether the diets of free-living overweight and obese women show evidence that calories from beverages are offset by reductions in solid food within individual eating occasions and across entire days. Eighty-two women weighed and recorded all consumed foods and beverages for seven days. Beverages were coded as high-calorie (>/=0.165kcal/g) or low-calorie (<0.165kcal/g), and total energy intake and energy intake from solid food were calculated for each eating occasion and day. In covariate-adjusted models, energy intake from solid food did not differ between eating occasions that included high-calorie or low-calorie beverages and those with no reported beverage. Energy intake from solid food was also unrelated to the number of high-calorie or low-calorie beverages consumed per day. On average, eating occasions that included a high-calorie beverage were 169kcal higher in total energy than those with no reported beverage, and 195kcal higher in total energy than those that included a low-calorie beverage. Each high-calorie beverage consumed per day contributed an additional 147kcal to women's daily energy intake, whereas low-calorie beverage intake was unrelated to daily energy intake. Beverages contributed to total energy intake in a near-additive fashion among free-living overweight and obese women, suggesting a need to develop more effective interventions to reduce caloric beverage intake in the context of weight management, and to potentially reexamine dietary guidelines.
OBJECTIVE: Obesity and depression are associated with somatic complaints that may complicate the measurement of depression in obese individuals. The Beck Depression Inventory-II (BDI-II) and the Hamilton Rating Scale for Depression (HRSD) are frequently used to measure depression severity. The BDI-II and HRSD's ability to measure depression severity may be compromised in those with obesity, to the extent that scores on their somatic items stem more from obesity than from depression. This study examined the: 1) internal consistency of the BDI-II and HRSD among obese women who varied in depressive symptomatology and 2) total and item-level change in the measures among participants who met the criteria for depression remission at 6-months.
METHODS: Data were from a randomized controlled trial of obese women with depression who received either behavioral activation for depression followed by a lifestyle intervention or a lifestyle intervention with attention control.
RESULTS: At screening (n=355), internal consistency was strong for the BDI-II (alpha=0.89), but moderate for the HRSD (alpha=0.67). Among the participants who met the criteria for depression remission following treatment (n=115), every BDI-II item showed significant change at 6-months. In contrast, three HRSD items did not significantly change: the anxiety-somatic (p=0.063), somatic symptoms-gastrointestinal (p=1.000) and loss of weight (p=0.319) items.
CONCLUSION: The BDI-II may be more reliable and sensitive to change than the HRSD in obese women with comorbid depression. Intervention studies involving obese, depressed women should consider these findings in selecting depression outcome measures.
IMPORTANCE The effect of obesity on late-age survival in women without disease or disability is unknown.
OBJECTIVE To investigate whether higher baseline body mass index and waist circumference affect women's survival to 85 years of age without major chronic disease (coronary disease, stroke, cancer, diabetes mellitus, or hip fracture) and mobility disability.
DESIGN, SETTING, AND PARTICIPANTS Examination of 36 611 women from the Women's Health Initiative observational study and clinical trial programs who could have reached 85 years or older if they survived to the last outcomes evaluation on September 17, 2012. Recruitment was from 40 US clinical centers from October 1993 through December 1998. Multinomial logistic regression models were used to estimate odds ratios and 95% CIs for the association of baseline body mass index and waist circumference with the outcomes, adjusting for demographic, behavioral, and health characteristics.
MAIN OUTCOMES AND MEASURES Mutually exclusive classifications: (1) survived without major chronic disease and without mobility disability (healthy); (2) survived with 1 or more major chronic disease at baseline but without new disease or disability (prevalent diseased); (3) survived and developed 1 or more major chronic disease but not disability during study follow-up (incident diseased); (4) survived and developed mobility disability with or without disease (disabled); and (5) did not survive (died).
RESULTS Mean (SD) baseline age was 72.4 (3.0) years (range, 66-81 years). The distribution of women classified as healthy, prevalent diseased, incident diseased, disabled, and died was 19.0%, 14.7%, 23.2%, 18.3%, and 24.8%, respectively. Compared with healthy-weight women, underweight and obese women were more likely to die before 85 years of age. Overweight and obese women had higher risks of incident disease and mobility disability. Disability risks were striking. Relative to healthy-weight women, adjusted odds ratios (95% CIs) of mobility disability were 1.6 (1.5-1.8) for overweight women and 3.2 (2.9-3.6), 6.6 (5.4-8.1), and 6.7 (4.8-9.2) for class I, II, and III obesity, respectively. Waist circumference greater than 88 cm was also associated with higher risk of earlier death, incident disease, and mobility disability.
CONCLUSIONS AND RELEVANCE Overall and abdominal obesity were important and potentially modifiable factors associated with dying or developing mobility disability and major chronic disease before 85 years of age in older women.
An outline of altmetrics activities by librarians at UMass Medical School's Lamar Soutter Library, which include: utilizing altmetrics in the the medical school's institutional repository, eScholarship@UMMS, for a journal published by the library; and, education and outreach efforts.
Has it ever felt like your money, or the lack of it, is telling you what you can or can not do? If you take control of your money and spending, you can find ways to do more with what you have. This sheet provides tips on how this can be done.
Predictors of financial self-sufficiency among Social Security beneficiaries with psychiatric disabilities
This study explored the predictors of financial self-sufficiency among Social Security beneficiaries with psychiatric disabilities. The study was conducted with individuals who were either past or current disability beneficiaries and who had sustained competitive employment as evidenced by their involvement in a longitudinal investigation on sustained employment among persons with serious mental illnesses. We conducted an exploratory cross-sectional study employing a survey methodology to determine what factors were associated with participants' capacity to leave the Social Security disability rolls due to gainful employment. We used a stepwise approach to data analysis to explore the association of demographic, clinical, vocational and motivational factors with financial self-sufficiency. Results suggested that individuals with higher occupational status, higher levels of proactive coping and without medical comorbidities were more likely to terminate Social Security disability benefits and achieve financial self-sufficiency due to gainful employment. Study findings can inform the development of innovative interventions targeting these malleable predictors associated with financial self-sufficiency among persons with psychiatric disabilities.
Sudden cardiac arrest (SCA) in the young is the leading cause of death in the U.S. afflicting over 300,000 individuals each year. SCA is also the leading cause of death in young athletes during sports participation, and typically the result of undiagnosed structural or electrical cardiovascular disease. Sport's physical exams that include cardiac screenings (EKG, cardiac ultrasound if warranted, and review of family heart history) will assist in identifying those young athletes most at risk for a sudden cardiac arrest.
Recent advances in mobile computing and body sensing technologies have enabled new ways to practice medicine and promote public health using mobile devices such as smart phones and tablets. These applications include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information, real-time monitoring of patient vital signs, and direct provision of care (via mobile telemedicine). In this poster we will describe a recent experience in partnering for community engaged research in Peru. The partnership seeks to promote maternal and child health via mobile health applications in two study sites. The first site is located in Carabayllo, a town located in the outskirts of the metropolitan area of Lima, the capital of Peru. The second site includes two rural communities in Huancavelica, a region located in the Central Andean region. On both sites, researchers at UMASS Lowell have established partnerships with local researchers and practitioners and are using Community-Based Participatory Research (CBPR) principles in the processes of establishing the partnership and defining the project goals, methodologies and implementation activities.
The poster places emphasis on the technological and human systems interactions that should be considered when developing mobile applications to address health disparities in general, and maternal and child health in particular. The challenge of this community-based effort lies in the integration of mobile technology into the current socio-technical system in both study sites. Our interdisciplinary research team includes faculty and students from Computer Science, Engineering, Medicine, Public Health, and Obstetrics (OB-GYN). The team is aware that in order to ensure populations can and will use our new technologies, we need to first understand the social and cultural barriers to technology adoption broadly, and to the health devices and applications specifically. Throughout the phases of the project we plan to incorporate a human factors engineering approach –focusing on the individual capabilities and limitations (e.g. health professional and patient)–together with a culturally relevant approach to technology design. The need to become knowledgeable and respectful of the communities’ cultural attributes, beliefs and practices is also discussed.
Evaluation of a Patient Communication Program and Patient Appointment Reminder Calls in a Community Health Center Setting
Community health centers across the country struggle with patients who frequently miss appointments. Missed and unused appointment slots represent lost revenue for health centers and disruption in care continuity. The medical home model recognizes these challenges and establishes patient access as a core element, key components of which include more efficient scheduling functions and capacity for same-day appointments. Identifying effective and feasible strategies to reduce the no-show rate is a critical component of these efforts.
The Massachusetts League of Community Health Centers, the University of Massachusetts Medical School, and the Edward M. Kennedy Community Health Center came together to launch a patient communications pilot program that involved outsourcing and centralizing patient communication functions. With grant funding, the collaborators were able to evaluate the effectiveness of the pilot program and the performance of the appointment reminder system. Secondary data sources - call reminder disposition data merged with data on patients and other characteristics - were analyzed to assess the performance of the call reminder system and the factors associated with a patient showing up for an appointment. The collaborators will present their innovative partnership approach and findings on patient demographics and other factors that can result in missed appointments.
UMass Worcester Prevention Research Center: Partnering to Achieve Optimal Health among Worcester Residents
The UMass Worcester Prevention Research Center’s vision is to achieve optimal health among residents in Worcester. Based in the Division of Preventive and Behavioral Medicine of UMass Medical School, it uses a team approach to partner with community organizations to improve health. The Mission of the UMass Prevention Research Center is to establish community, public health, health care and academic capacity to engage in equitable research partnerships for conducting applied public health research targeting physical activity, healthy eating, obesity and associated chronic conditions among Worcester area residents.
Get the Word Out: Utilizing Traditional and Emerging Tools to Disseminate and Measure the Impact of Your Research
Publishing articles and presenting at conferences are tried and true ways for promoting your research within academic and professional circles, but with changes to scholarly communications and the emergence of many new forms that allow individuals to disseminate information more freely, openly, and quickly, researchers have a host of opportunities to both promote their work to a larger audience and track the impact of their research in a more accurate manner. From article-level metrics (altmetrics) to open access publications to the use of social media, this poster gives an introduction to some of the vehicles available today, how to use them effectively, and where to find support (your librarians can help!) to make your scholarly footprint larger.
BACKGROUND: Tailored, web-assisted interventions can reach many smokers. Content from other smokers (peers) through crowdsourcing could enhance relevance.
PURPOSE: To evaluate whether peers can generate tailored messages encouraging other smokers to use a web-assisted tobacco intervention (Decide2Quit.org).
METHODS: Phase 1: In 2009, smokers wrote messages in response to scenarios for peer advice. These smoker-to-smoker (S2S) messages were coded to identify themes. Phase 2: resulting S2S messages, and comparison expert messages, were then e-mailed to newly registered smokers. In 2012, subsequent Decide2Quit.org visits following S2S or expert-written e-mails were compared.
RESULTS: Phase 1: a total of 39 smokers produced 2886 messages (message themes: attitudes and expectations, improvements in quality of life, seeking help, and behavioral strategies). For not-ready-to-quit scenarios, S2S messages focused more on expectations around a quit attempt and how quitting would change an individual's quality of life. In contrast, for ready-to-quit scenarios, S2S messages focused on behavioral strategies for quitting. Phase 2: In multivariable analysis, S2S messages were more likely to generate a return visit (OR=2.03, 95% CI=1.74, 2.35), compared to expert messages. A significant effect modification of this association was found, by time-from-registration and message codes (both interaction terms p
CONCLUSIONS: S2S peer messages that increased longitudinal engagement in a web-assisted tobacco intervention were successfully collected and delivered. S2S messages expanded beyond the biomedical model to enhance relevance of messages.
TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT00797628 (web-delivered provider intervention for tobacco control [QUIT-PRIMO]) and NCT01108432 (DPBRN Hygienists Internet Quality Improvement in Tobacco Cessation [HiQuit]).
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease resulting in severe muscle weakness and eventual death by respiratory failure. Although little is known about its pathogenesis, mutations in fused in sarcoma/translated in liposarcoma (FUS) are causative for familial ALS. FUS is a multifunctional protein that is involved in many aspects of RNA processing. To elucidate the role of FUS in ALS, we overexpressed wild-type and two mutant forms of FUS in HEK-293T cells, as well as knocked-down FUS expression. This was followed by RNA-Seq to identify genes which displayed differential expression or altered splicing patterns. Pathway analysis revealed that overexpression of wild-type FUS regulates ribosomal genes, whereas knock-down of FUS additionally affects expression of spliceosome related genes. Furthermore, cells expressing mutant FUS displayed global transcription patterns more similar to cells overexpressing wild-type FUS than to the knock-down condition. This observation suggests that FUS mutants do not contribute to the pathogenesis of ALS through a loss-of-function. Finally, our results demonstrate that the R521G and R522G mutations display differences in their influence on transcription and splicing. Taken together, these results provide additional insights into the function of FUS and how mutations contribute to the development of ALS.
Lactose Intolerance: Lack of Evidence for Short Stature or Vitamin D Deficiency in Prepubertal Children
Background: The health consequences of lactose intolerance (LI) are unclear.
Aims: To investigate the effects of LI on stature and vitamin D status.
Hypotheses: LI subjects will have similar heights and vitamin D status as controls.
Subjects and Methods: Prepubertal children of ages 3-12 years with LI (n=38, age 8.61 ± 3.08y, male/female 19/19) were compared to healthy, age- and gender-matched controls (n=49, age 7.95±2.64, male/female 28/21). Inclusion criteria: prepubertal status (boys: testicular volume
Results: There was no significant difference in 25(OH)D between the LI and non-LI subjects (60.1±21.1, vs. 65.4 ± 26.1 nmol/L, p = 0.29). Upon stratification into normal weight (BMI percentile) vs. overweight/obese (BMI ≥85th percentile), the normal weight controls had significantly higher 25(OH)D level than both the normal weight LI children (78.3 ± 32.6 vs. 62.9 ± 23.2, p = 0.025), and the overweight/obese LI children (78.3±32.6 vs. 55.3±16.5, p = 0.004). Secondly, there was no overall difference in height z-score between the LI children and controls. The normal weight LI patients had similar height as normal controls (-0.46 ± 0.89 vs. -0.71 ± 1.67, p = 0.53), while the overweight/obese LI group was taller than the normal weight controls (0.36 ± 1.41 vs. -0.71 ± 1.67, p = 0.049), and of similar height as the overweight/obese controls (0.36 ± 1.41 vs. 0.87 ± 1.45, p = 0.28). MPTH z-score was similar between the groups.
Conclusion: Short stature and vitamin D deficiency are not features of LI in prepubertal children.
Reviewing the literature on police-induced confessions, we identified suspect characteristics and interrogation tactics that influence confessions and their effects on juries. We concluded with a call for the mandatory electronic recording of interrogations and a consideration of other possible reforms. The preceding commentaries make important substantive points that can lead us forward-on the effects of videotaping of interrogations on case dispositions; on the study of non-custodial methods, such as the controversial Mr. Big technique; and on an analysis of why confessions, once withdrawn, elicit such intractable responses compared to statements given by child and adult victims. Toward these ends, we hope that this issue provides a platform for future research aimed at improving the diagnostic value of confession evidence.