Artificial intelligence with multi-functional machine learning platform development for better healthcare and precision medicine

Zeeshan Ahmed, Khalid Mohamed, Saman Zeeshan, XinQi Dong

Introduction: Over the centuries, quests for answers have led us to take giant leaps. It was only in the last century that the discovery of antibiotics freed us from many of the dreaded diseases of the past …

Human gene and disease associations for clinical‐genomics and precision medicine research

Zeeshan Ahmed, Saman Zeeshan, Dinesh Mendhe, XinQi Dong

Introduction: Since the beginning of scientific discoveries, it has been critically central to understand the cause of disease, pain, and senescence.1 Over the centuries, quests for the answers have led us to take giant leaps. It was only in the last century that the discovery of …

Acculturation stress and allostatic load among Mexican immigrant women

Karen Therese D’Alonzo, Frances Munet-Vilaro, Dennis P. Carmody, Peter Guarnaccia, Anne Marie Linn, Lisa Garsman

Objectives: this case-control study compared levels of stress and allostatic load (AL) among Mexican women in the US (n =19) and Mexico (n = 40).

School Food and Physical Activity Environment: A Longitudinal Analysis of Four School Districts in New Jersey

Francesco Acciai, Michael Yedidia, Robin S. DeWeese, Sarah Martinelli, Punam Ohri-Vachaspati

Purpose: Exposures to favorable environments in childhood, including those in schools, are associated with healthy habits among children. In this study, we developed a series of indices aimed at measuring students’ exposure to different dimensions of the school food and physical activity (PA) environment. We implemented these indices to investigate how different aspects of the school food and PA environment changed over time and examined their correspondence with known changes in relevant policies and programs.

Participation in the Supplemental Nutrition Assistance Program and Dietary Behaviors: Role of Community Food Environment

Cori Lorts, Natasha Tasevska, Marc A. Adams, Michael Yedidia, David Tulloch, Steven P. Hooker, Punam Ohri-Vachaspati

Background: The United States Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) is the country’s largest nutrition assistance program for low-income populations. Although SNAP has been shown to reduce food insecurity, research findings on the diet quality of program participants are inconsistent.

Building a Culture of Health: A Policy Roadmap to Help All New Jerseyans Live Their Healthiest Lives

Margaret Koller, Jolene Chou, Maureen Michael, Amy Dunford, Jennifer Farnham, Giridhar Mallya, Kerry Anne McGeary, Teri Larson

New Jersey has a lot to be proud of when it comes to health, including comparatively low rates of smoking, teen births, infant deaths, and premature deaths, and high rates of preschool enrollment and high school graduation.

Association of Medicaid Enrollee Characteristics and Primary Care Utilization with Cancer Outcomes for the Period Spanning Medicaid Expansion in New Jersey

Jennifer Tsui, Derek DeLia, Antoinette M. Stroup, Jose Nova, Aishwarya Kulkarni, Jeanne M. Ferrante, Joel C. Cantor

Cancer outcomes for Medicaid enrollees may be affected by patients’ primary care (PC) utilization and complex Medicaid enrollment dynamics, which have recently changed for many states under the Affordable Care Act.

The Relationship Between Depressive Symptoms and Health Services Utilization in U.S. Chinese Older Adults

Dexia Kong, Mengting Li, Jinjiao Wang, Joan K. Davitt, Xinqi Dong

BACKGROUND AND OBJECTIVES: Depressive symptomatology is a significant predictor of increased health services utilization and health care cost in the general older adult population. However, there is scant information on the relationship between depressive symptoms and health service utilization among U.S. Chinese older adults. The objective of this study was to examine the relationship between depressive symptoms and physician visits, emergency department (ED) visits, and hospitalization.

Is Social Network a Protective Factor for Cognitive Impairment in US Chinese Older Adults? Findings from the PINE Study

Background: Social network has been identified as a protective factor for cognitive impairment. However, the relationship between social network and global and subdomains of cognitive function remains unclear. Objective: This study aims to provide an analytic framework to examine quantity, composition, and quality of social network and investigate the association between social network, global cognition, and cognitive domains among US Chinese older adults.

Psychological well-being of Chinese Immigrant adult-child caregivers: how do filial expectation, self-rated filial performance, and filial discrepancy matter?

Jinyu Liu, Bei Wu, Xinqi Dong

Background: Given the importance of ethnic culture in family caregiving and recent Chinese immigrant population growth, this study explored effects of multiple filial piety traits—filial expectation, self-rated filial performance, and filial discrepancy—on psychological well-being of Chinese immigrants who care for older parents (adult-child caregivers) in the United States.

Mental Work Demands and Late-Life Cognitive Impairment: Results From the Shanghai Aging Study

Xiaoniu Liang, Zhao Chen, Xinqi Dong, Qianhua Zhao, Qihao Guo, Li Zheng, Wei Deng, Jianfeng Luo, Ding Ding

Objective: The aim of this study is to explore the association between mental work demands (MWDs) and late-life cognition among Chinese older adults. Method: Data were drawn from the baseline of the Shanghai Aging Study.

Is family relations related to health service utilisation among older immigrants: Evidence from Chinese elderly in the United States

Man Guo, Nadia Sabbagh Steinberg, Xinqi Dong, Agnes Tiwari

The family is the key for survival and success of the 4.6 million older immigrants in the United States. It is also an overlooked context to understand older immigrants’ health service utilisation. Most prior studies on this topic either focus on individual or institutional factors that affect how older immigrants use formal health services.

Elder Mistreatment Among Older Chinese Americans: The Role of Family Cohesion

Xiang Gao, Fei Sun, Flavio F. Marsiglia, Xinqi Dong

Cultural values are believed to influence perceptions of and solutions to elder mistreatment (EM) perpetrated by family members. This study aimed to understand the influence of family cohesion on EM reported by community-dwelling older Chinese Americans.

Associations of Child Maltreatment and Intimate Partner Violence with Elder Abuse in a US Chinese Population

Xinqi Dong, Bei Wang

Importance: People who have experienced abuse as a child or violence with an intimate partner might have higher odds of being abused again, but this has been insufficiently investigated regarding elder abuse. More conclusive evidence might be critical to assessment and prevention strategies.

Predictors of timely opioid agonist treatment initiation among veterans with and without HIV

Jessica J. Wyse, Jonathan L. Robbins, Kathleen A. McGinnis, E. Jennifer Edelman, Adam J. Gordon, Ajay Manhapra, David A. Fiellin, Brent A. Moore, P. Todd Korthuis, Julie R. Gaither, Kirsha Gordon, Melissa Skanderson, Declan T. Barry, Stephen Crystal, Amy Justice, Kevin L. Kraemer

Background: Opioid use disorder (OUD) is prevalent among people with HIV (PWH). Opioid agonist therapy (OAT) is the most effective treatment for OUD and is associated with improved health outcomes, but is often not initiated.

Medical intensive care unit admission among patients with and without HIV, hepatitis c virus, and alcohol-related diagnoses in the United States: A national, retrospective cohort study, 1997-2014

Christopher T. Rentsch, Janet P. Tate, Tessa Steel, Adeel A. Butt, Cynthia L. Gibert, Laurence Huang, Margaret Pisani, Guy W. Soo Hoo, Stephen Crystal, Maria C. Rodriguez-Barradas, Sheldon T. Brown, Matthew S. Freiberg, Christopher J. Graber, Joon W. Kim, David Rimland, Amy C. Justice, David A. Fiellin, Kristina A. Crothers, Kathleen M. Akgün

Background: HIV, hepatitis C virus (HCV), and alcohol-related diagnoses (ARD) independently contribute increased risk of all-cause hospitalization. We sought to determine annual medical intensive care unit (MICU) admission rates and relative risk of MICU admission between 1997 and 2014 among people with and without HIV, HCV, and ARD, using data from the largest HIV and HCV care provider in the United States.

Depression and all-cause mortality risk in HIV-infected and HIV-uninfected US veterans: a cohort study

K. So-Armah, S. K. Gupta, S. Kundu, J. C. Stewart, J. L. Goulet, A. A. Butt, J. J. Sico, V. C. Marconi, Stephen Crystal, M. C. Rodriguez-Barradas, M. Budoff, C. L. Gibert, C. C.H. Chang, R. Bedimo, M. S. Freiberg

Objectives: The contribution of depression to mortality in adults with and without HIV infection is unclear. We hypothesized that depression increases mortality risk and that this association is stronger among those with HIV infection. Methods: Veterans Aging Cohort Study (VACS) data were analysed from the first clinic visit on or after 1 April 2003 (baseline) to 30 September 2015.

International priorities for home care education, research, practice, and management: Qualitative content analysis

Olga Jarrin Montaner, Fatemah Ali Pouladi, Elizabeth A. Madigan

Background: Despite growing demand for home care nursing, there is a growing home care workforce shortage, due in part to hospital-centric nursing curricula that lead students to undervalue of home care and community practice setting (Van Iersel et al., 2018a, 2018b).

Comparative Effectiveness of Adjunctive Psychotropic Medications in Patients with Schizophrenia

T. Scott Stroup, Tobias Gerhard, Stephen Crystal, Cecilia Huang, Zhiqiang Tan, Melanie M. Wall, Chacku Mathai, Mark Olfson

Importance: People with schizophrenia are commonly treated with psychotropic medications in addition to antipsychotics, but there is little evidence about the comparative effectiveness of these adjunctive treatment strategies. Objective: To study the comparative real-world effectiveness of adjunctive psychotropic treatments for patients with schizophrenia.

Validation studies of claims data in the Asia-Pacific region: A comprehensive review

Nana Koram, Megan Delgado, James H. Stark, Soko Setoguchi Iwata, Cynthia de Luise

Purpose: To describe published validation studies of administrative health care claims data in the Asia-Pacific region. Methods: A comprehensive literature search was conducted in PubMed for English language articles published through 31-Oct-2017 in humans from 10 Asian-Pacific countries or regions (Japan, Australia, New Zealand, China, Hong Kong, India, Singapore, South Korea, Taiwan, and Thailand) that validated claims-based diagnoses with a gold standard data source. Search terms included the: validation, validity, accuracy, sensitivity, agreement, specificity, positive predictive value, kappa, kappa coefficient, and Cohen’s kappa. Results: Forty-three studies across six countries were identified: Australia (21); Japan (6); South Korea (6); Taiwan (7); Singapore (2); and New Zealand (1).

Patient perspectives on the linkage of health data for research: Insights from an online patient community questionnaire

Emily C. O'Brien, Ana Maria Rodriguez, Hye Chung Kum, Laura E. Schanberg, Marcy Fitz-Randolph, Sean M. O'Brien, Soko Setoguchi Iwata

Objective: To examine the patient perspective on the risks and benefits of linking existing data sources for research. Materials and methods: Between December 2015 and February 2016, we fielded a questionnaire in PatientsLikeMe, an online patient community representing over 2500 health conditions. The questionnaire was developed using subject matter expertise and patient feedback from a concept elicitation phase (N = 57 patients).

Trends in the Supply, Utilization, and Payment for Primary Care Services in New Jersey FamilyCare before and after ACA Medicaid Expansion

Derek DeLia, Jose Nova, David Goldin

Medicaid expansion under the Affordable Care Act (ACA) has raised questions about whether and how the program will be able to meet the rising demand for demand for services from new enrollees. The supply of primary care services is of particular concern. Numerous reports have warned about national shortages in the supply of primary care physicians overall and many practicing physicians do not participate in Medicaid.

Learning from Supportive Housing Programs in New Jersey: Results from Interviews with Program Leaders

Joel C. Cantor, Emmy Tiderington, Oliver Lontok

There is substantial evidence that social factors influence health, health services use, and health care spending. Among these “social determinants of health”, housing is key (Doran, Misa, and Shah 2013).

Prevalence of Rilpivirine and Etravirine Resistance Mutations in HIV-1 Subtype C-Infected Patients Failing Nevirapine or Efavirenz-Based Combination Antiretroviral Therapy in Botswana

Thabo Diphoko, Simani Gaseitsiwe, Ishmael Kasvosve, Sikhulile Moyo, Harriet Okatch, Rosemary Musonda, Mark Wainberg, Joseph Makhema, Richard Marlink, Vladimir Novitsky, Max Essex

Rilpivirine (RPV) and Etravirine (ETR) are approved second-generation non-nucleoside reverse transcriptase inhibitors (NNRTIs) for HIV treatment. There is a cross-resistance HIV mutation profile between first-and second-generation NNRTI drugs. We determined the prevalence of HIV-1 drug resistance mutations (DRMs) to RPV and ETR in Botswana.

Molecular characterization of near full-length genomes of hepatitis B virus isolated from predominantly HIV infected individuals in Botswana

Motswedi Anderson, Wonderful Tatenda Choga, Sikhulile Moyo, Trevor Graham Bell, Tshepiso Mbangiwa, Bonolo Bonita Phinius, Lynnette Bhebhe, Theresa Kibirige Sebunya, Shahin Lockman, Richard Marlink, Anna Kramvis, Max Essex, Rosemary Mubanga Musonda, Jason Tory Blackard, Simani Gaseitsiwe

The World Health Organization plans to eliminate hepatitis B and C Infections by 2030. Therefore, there is a need to study and understand hepatitis B virus (HBV) epidemiology and viral evolution further, including evaluating occult (HBsAg-negative) HBV infection (OBI), given that such infections are frequently undiagnosed and rarely treated.

In silico analysis of hepatitis B virus occult associated mutations in Botswana using a novel algorithm

Motswedi Anderson, Wonderful T. Choga, Sikhulile Moyo, Trevor Graham Bell, Tshepiso Mbangiwa, Bonolo B. Phinius, Lynette Bhebhe, Theresa K. Sebunya, Joseph Makhema, Richard Marlink, Anna Kramvis, Max Essex, Rosemary M. Musonda, Jason T. Blackard, Simani Gaseitsiwe

Occult hepatitis B infections (OBI) represent a reservoir of undiagnosed and untreated hepatitis B virus (HBV), hence the need to identify mutations that lead to this phenotype. Functionally characterizing these mutations by in vitro studies is time-consuming and expensive.

Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana

Lucy Mupfumi, Sikhulile Moyo, Kesaobaka Molebatsi, Prisca K. Thami, Motswedi Anderson, Tuelo Mogashoa, Thato Iketleng, Joseph Makhema, Richard Marlink, Ishmael Kasvosve, Max Essex, Rosemary M. Musonda, Simani Gaseitsiwe

Background There is a high burden of tuberculosis (TB) in HIV antiretroviral programmes in Africa. However, few studies have looked at predictors of incident TB while on Truvada-based combination antiretroviral therapy (cART) regimens. Methods We estimated TB incidence among individuals enrolled into an observational cohort evaluating the efficacy and tolerability of Truvada-based cART in Gaborone, Botswana between 2008 and 2011.

Short-Form Audit Instrument for Assessing Corner Store Healthfulness

Robin S. DeWeese, Michael Todd, Allison Karpyn, Michael Yedidia, Michelle Kennedy, Meg Bruening, Christopher M. Wharton, Punam Ohri-Vachaspati

Purpose: To develop a valid and feasible short-form corner store audit tool (SCAT) that could be used in-store or over the phone to capture the healthfulness of corner stores. Design: Nonexperimental.

Predicted Impact of the Food and Drug Administration’s Menu-Labeling Regulations on Restaurants in 4 New Jersey Cities

Jessie Gruner, Robin S. DeWeese, Cori Lorts, Michael Yedidia, Punam Ohri-Vachaspati

Objectives. To determine the proportion of restaurants that will be required to post calorie information under the Food and Drug Administration’s menu-labeling regulations in 4 New Jersey cities.

Patterns of food and physical activity environments related to children’s food and activity behaviors: A latent class analysis

Robin S. DeWeese, Punam Ohri-Vachaspati, Marc A. Adams, Jonathan Kurka, Seung Yong Han, Michael Todd, Michael Yedidia

Relationships between food and physical activity (PA) environments and children’s related behaviors are complex. Latent class analyses derived patterns from proximity to healthy and unhealthy food outlets, PA facilities and parks, and counts of residential dwellings and intersections.

Impact of the 2010 us Healthy, Hunger-Free Kids Act on School Breakfast and Lunch participation rates between 2008 and 2015

Nicole Vaudrin, Kristen Lloyd, Michael Yedidia, Michael Todd, Punam Ohri-Vachaspati

Objectives; To evaluate National School Lunch Program (NSLP) and School Breakfast Program (SBP) participation over a 7-year period before and after the implementation of the 2010 Healthy, Hunger-Free Kids Act (HHFKA), which required healthier school lunch options beginning in school year (SY) 2012-2013 and healthier school breakfast options beginning in SY2013-2014.

Competencies for engaging high-needs patients in primary care

Michael Yedidia

Background: Patients who heavily utilize hospitals and emergency departments frequently have complex needs requiring services spanning medical, behavioral, and social service sectors. This study identifies essential competencies for caring for high-needs patients and highlights their importance to primary care delivery.

Trends in attention-deficit hyperactivity disorder medication use: a retrospective observational study using population-based databases

Sudha R. Raman, Kenneth K.C. Man, Shahram Bahmanyar, Anick Berard, Scott Bilder, Takoua Boukhris, Greta Bushnell, Stephen Crystal, Kari Furu, Yea Huei KaoYang, Øystein Karlstad, Helle Kieler, Kiyoshi Kubota, Edward Chia Cheng Lai, Jaana E. Martikainen, Géric Maura, Nicholas Moore, Dolores Montero, Hidefumi Nakamura, Anke Neumann & 13 others

Background: The use of medications to treat attention deficit hyperactivity disorder (ADHD) has increased, but the prevalence of ADHD medication use across different world regions is not known. Our objective was to determine regional and national prevalences of ADHD medication use in children and adults, with a specific focus on time trends in ADHD medication prevalence.

Suicide after deliberate self-harm in adolescents and young adults

Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Jeffrey A. Bridge, Shang Min Liu, Carlos Blanco

OBJECTIVES: Among adolescents and young adults with nonfatal self-harm, our objective is to identify risk factors for repeated nonfatal self-harm and suicide death over the following year. METHODS: A national cohort of patients in the Medicaid program, aged 12 to 24 years (n = 32 395), was followed for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index.

Service use preceding opioid-related fatality

Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Carlos Blanco

Objective: This study analyzed health service patterns before opioid-related death among nonelderly individuals in the Medicaid program, focusing on decedents with and without past-year diagnoses of noncancer chronic pain. Methods: The authors identified opioid-related decedents, age #64 years, in the Medicaid program and characterized their clinical diagnoses, filled medication prescriptions, and nonfatal poisoning events during the 30 days and 12 months before death. The study group included 13,089 opioid-related deaths partitioned by presence or absence of chronic noncancer pain diagnoses in the last year of life.

Risks of fatal opioid overdose during the first year following nonfatal overdose

Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Carlos Blanco

Background: Little is known about risk factors for repeated opioid overdose and fatal opioid overdose in the first year following nonfatal opioid overdose. Methods: We identified a national retrospective longitudinal cohort of patients aged 18–64 years in the Medicaid program who received a clinical diagnosis of nonfatal opioid overdose. Repeated overdoses and fatal opioid overdoses were measured with the Medicaid record and the National Death Index. Rates of repeat overdose per 1000 person-years and fatal overdose per 100,000 person-years were determined. Hazard ratios of repeated opioid overdose and fatal opioid overdose were estimated by Cox proportional hazards.

Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees

Hillary Samples, Arthur Robin Williams, Mark Olfson, Stephen Crystal

Introduction: Recent U.S. trends demonstrate sharp rises in adverse opioid-related health outcomes, including opioid use disorder (OUD), overdose, and death. Yet few affected people receive treatment for OUD and a minority of those who receive treatment are effectively retained in care. The purpose of this study was to examine duration of buprenorphine treatment for OUD following treatment initiation to identify risk factors for early discontinuation.

Psychotropic medication use among adults with schizophrenia and schizoaffective disorder in the United States

T. Scott Stroup, Tobias Gerhard, Stephen Crystal, Cecilia Huang, Zhiqiang Tan, Melanie M. Wall, Chacku M. Mathai, Mark Olfson

Objective: The authors examined the use of different classes of psychotropic medication in outpatient treatment of schizophrenia and schizoaffective disorder. Methods: Data from the United States Medicaid program were used to examine psychotropic medication use in a cohort of patients who had a diagnosis of schizophrenia or schizoaffective disorder in the calendar year 2010.

The influence of acculturation level and family relationships on quality of life among U.S. Chinese older adults

Yiwei Chen, Yisheng Peng, Minzhi Ye, Ling Xu, Xinqi Dong

The present study examined the influence of acculturation level and family relationships (i.e., positive family support and negative family strain) on quality of life (QOL), using the data from the Population Study of ChINese Elderly (PINE) in Chicago (N = 3159). Controlling for sociodemographic variables and health status, it was found that individuals’ acculturation level and positive family support were positively related to QOL, whereas negative family strain was negatively associated with QOL. More importantly, higher acculturation levels were associated with increased protective effects of positive family support and reduced risk effects of negative family strain on QOL among U.S. Chinese older adults.

A cross-sectional study of coping resources and mental health of Chinese older adults in the United States

Man Guo, Nadia Sabbagh Steinberg, Xinqi Dong, Agnes Tiwari

Objectives: This study examined the potential influence of coping resources at individual (sense of mastery), family (spousal and family support, children’s filial piety), and community levels (community cohesion) on the mental health (depression, anxiety) of U.S. Chinese older adults.

Neighborhood social cohesion and cognitive function in U.S. Chinese older adults—findings from the PINE study

Wei Zhang, Sizhe Liu, Fei Sun, Xinqi Dong

Objectives: The projected increase in the population of older adults in the United States entails a pressing need to examine risk and protective factors associated with cognitive function. This study aims to examine the association between neighborhood social cohesion and cognitive function among older Chinese adults in the United States.

Health Services Utilization Among Chinese American Older Adults: Moderation of Social Support With Functional Limitation

Jinjiao Wang, Dexia Kong, Benjamin C. Sun, Xinqi Dong

In this study, we aimed to examine the relationship of social support with hospitalizations and emergency department (ED) visits among older Chinese adults in the United States and its possible mechanism.

Correlates of Emergency Department Service Utilization Among U.S. Chinese Older Adults

Dexia Kong, Mengting Li, Yin Ling Irene Wong, Jinjiao Wang, Benjamin C. Sun, Xinqi Dong

Older adults visit emergency departments (EDs) at a disproportionally higher rate than other age groups. Prior studies examining racial disparities in ED utilization focus on African Americans and Hispanics. There is a dearth of information on ED utilization patterns among older Asian Americans despite the evidence that ED expenditures in Asian Americans are comparable to that of Caucasians.

Association of Self-Reported Discrimination and Suicide Ideation in Older Chinese Americans

Lydia W. Li, Gilbert C. Gee, Xinqi Dong

Objective This study examines racial discrimination as a potential novel risk factor for suicide ideation among older Chinese Americans. Design In a cross-sectional analysis, this study drew on data collected in the Population-based Study of Chinese Elderly in Chicago on Chinese older adults age 60 + in the Greater Chicago area (N = 3,157). Thirty-day suicide ideation was a dichotomous variable, derived from items of the Physical Health Questionnaire and the Geriatric Mental State Examination-Version A. Self-reported discrimination was dichotomously coded, based on the Experiences of Discrimination instrument, which asks respondents whether they have ever experienced discrimination in nine situations because of their race/ethnicity/color.

Association Between Neighborhood Cohesion and Cancer Screening Utilization in Chinese American Older Adults

Ailian Hei, Melissa A. Simon, Xinqi Dong

This study aims to examine the association between neighborhood cohesion and cancer screening utilization in a community-dwelling Chinese American older population. Data were drawn from the Population Study of Chinese Elderly including 3159 Chinese American older adults aged 60 and above in the greater Chicago area. Cancer screening utilization was assessed by asking whether participants had undergone colon, breast, cervical, or prostate cancer screening.

Alcohol and Mortality: Combining Self-Reported (AUDIT-C) and Biomarker Detected (PEth) Alcohol Measures Among HIV Infected and Uninfected

VACS Project team

BACKGROUND: Unhealthy alcohol use may be particularly detrimental among individuals living with HIV and/or hepatitis C virus (HCV), and is often under-reported. Direct biomarkers of alcohol exposure may facilitate improved detection of alcohol use

Risk of malignancy associated with paediatric use of tumour necrosis factor inhibitors

Timothy Beukelman, Fenglong Xie, Lang Chen, Daniel Horton, James D. Lewis, Ronac Mamtani, Melissa M. Mannion, Kenneth G. Saag, Jeffrey R. Curtis

Objective to determine whether tumour necrosis factor inhibitor (tnFi) use is associated with an increased rate of incident malignancy compared with no tnFi use in the treatment of juvenile idiopathic arthritis (JIA), paediatric inflammatory bowel disease (pIBd) and paediatric plaque psoriasis (ppso).

Nurses’ and patients’ appraisals show patient safety in hospitals remains a concern

Linda H. Aiken, Douglas M. Sloane, Hilary Barnes, Jeannie P. Cimiotti, Olga Jarrin Montaner, Matthew D. McHugh

The Institute of Medicine concluded in To Err Is Human in 1999 that transformation of nurse work environments was needed to reduce patient harm. We studied 535 hospitals in four large states at two points in time between 2005 and 2016 to determine the extent to which their work environments improved, and whether positive changes were associated with greater progress in patient safety.

Adaptations of the evidence-based Transitional Care Model in the U.S.

Mary D. Naylor, Karen B. Hirschman, Mark P. Toles, Olga Jarrin, Elizabeth Shaid, Mark V. Pauly

Despite a growing body of evidence that adaptations of evidence-based interventions (EBI) are ubiquitous, few studies have examined the nature and rationale for modifications to the components of these interventions.

Risk of sudden sensorineural hearing loss in adults using phosphodiesterase type 5 inhibitors: Population-based cohort study

Wei Liu, Patrick J. Antonelli, Philipp Dahm, Tobias Gerhard, Joseph A.C. Delaney, Richard Segal, Stephen Crystal, Almut G. Winterstein

Purpose: The objective of the study was to determine the risk of sudden sensorineural hearing loss (SNHL) associated with use of phosphodiesterase type 5 (PDE5) inhibitors. Methods: We conducted a retrospective cohort study in the MarketScan Commercial Claims and Encounters Database including adult men who initiated a PDE5 inhibitor (n = 377,722) and 1,957,233 nonusers between 1998 and 2007.

Antipsychotic medication treatment patterns in adult depression

Tobias Gerhard, T. Scott Stroup, Christoph U. Correll, Cecilia Huang, Zhiqiang Tan, Stephen Crystal, Mark Olfson

Objective: To characterize the role of antipsychotic medications in the community treatment of adult depression. Methods: We identified adults (aged 18-64 years) with new episodes of depression treatment (ICD-9-CM 296.2, 296.3, 300.4, or 311) in US national Medicaid data (2001-2010). Patients with alternative ICD-9-CM antipsychotic indications, such as schizophrenia or bipolar disorder, were excluded.

Comparative safety of NSAIDs for gastrointestinal events in Asia-Pacific populations: A multi-database, international cohort study

Edward Chia Cheng Lai, Ju Young Shin, Kiyoshi Kubota, Kenneth K.C. Man, Byung Joo Park, Nicole Pratt, Elizabeth E. Roughead, Ian C.K. Wong, Yea Huei Kao Yang, Soko Setoguchi Iwata

Purpose: The safety of nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used in Asia-Pacific countries has had limited study. We assessed the risk of hospitalization for gastrointestinal events with loxoprofen and mefenamic acid compared with other NSAIDs in Asia-Pacific populations. Methods: We conducted a cohort study using a distributed network with a common data model in Australia, Hong Kong, Japan, Korea, and Taiwan. We included patients who initiated diclofenac, loxoprofen, mefenamic acid, or celecoxib and followed them until their first gastrointestinal hospitalization, switch or discontinuation of medication, disenrollment, or end of database coverage. We used Cox proportional hazards models to assess hospitalization risk.

Applying a common data model to asian databases for multinational pharmacoepidemiologic studies: Opportunities and challenges

Edward Chia Cheng Lai, Patrick Ryan, Yinghong Zhang, Martijn Schuemie, N. Chantelle Hardy, Yukari Kamijima, Shinya Kimura, Kiyoshi Kubota, Kenneth K.C. Man, Soo Yeon Cho, Rae Woong Park, Paul Stang, Chien Chou Su, Ian C.K. Wong, Yea Huei Yang Kao, Soko Setoguchi Iwata

Objective: The goal of the Asian Pharmacoepidemiology Network is to study the effectiveness and safety of medications commonly used in Asia using databases from individual Asian countries. An efficient infrastructure to support multinational pharmacoepidemiologic studies is critical to this effort.

Advanced imaging and hospice use in end-of-life cancer care

Michaela A. Dinan, Lesley H. Curtis, Soko Setoguchi Iwata, Winson Y. Cheung

Introduction: Advanced imaging can inform prognosis and may be a mechanism to de-escalate unnecessary end-of-life care in patients with cancer. Associations between greater use of advanced imaging and less-aggressive end-of-life care in real-world practice has not been examined.

Update on ACO Operations and Care Management Strategies in the New Jersey Medicaid ACO Demonstration Project

Derek DeLia, Michael J. Yedidia, Oliver Lontok

The New Jersey Medicaid Accountable Care Organization (ACO) Demonstration was implemented over a three-year period beginning on July 1, 2015 and recently, a one-year extension of the Demonstration was recently authorized. Previously published reports provided quantitative and qualitative information about activities leading up to and in the first year of the Demonstration. This report provides a detailed assessment of ACO activities in Demonstration year 2.

Spending and Utilization Indicators in the New Jersey Medicaid ACO Demonstration Project.

Derek DeLia, Rizie Kumar, Jose Nova, Kristen Lloyd, David Goldin

This report provides a first assessment of spending and utilization indicators related to the New Jersey Medicaid Accountable Care Organization (ACO) Demonstration Project (NJ P.L. 2011, c.114).

Four Lessons Learned From School Nurses in New Jersey About Building a Culture of Health

Robert Atkins

Building a Culture of Health will give all members of our society the opportunity to lead healthier lives. To achieve this aim, more stakeholders in the community-residents, elected officials, community-based nonprofits, law enforcement, and schools-need to be engaged in addressing the health challenges in our communities. Moreover, all community stakeholders have to think and act “upstream” by addressing the social determinants of health in their communities. Discussed in this article are some of the lessons that are being learned from the “upstream” actions of school nurses in New Jersey about building a Culture of Health.

Education and Family Health Care Spending

Alan C. Monheit and Irina B. Grafova

Michael Grossman’s seminal work on the demand for health extended the concept of a household production function to the commodity “good health.”……

Depression treatment and healthcare expenditures among elderly Medicare beneficiaries with newly diagnosed depression and incident breast, colorectal, or prostate cancer

Monira Alwhaibi, Usha Sambamoorthi, Suresh Madhavan, James Walkup

Objectives: Depression is associated with high healthcare expenditures, and depression treatment may reduce healthcare expenditures. However, to date, there have not been any studies on the effect of depression treatment on healthcare expenditures among cancer survivors. Therefore, this study examined the association between depression treatment and healthcare expenditures among elderly with depression and incident cancer.

The relationship of social engagement and social support with sense of community

Fengyan Tang, Iris Chi, Xinqi Dong

Background: We aimed to investigate the relationship of engagement in social and cognitive activities and social support with the sense of community (SOC) and its components among older Chinese Americans.

The decline of directly observed physical function performance among U.S. Chinese older adults

Xinqi Dong, Stephanie M. Bergren, Melissa A. Simon

Background: Physical function decline is a major public health concern and can predict later mortality. This study aims to examine the sociodemographic factors associated with physical function decline among U.S. Chinese older adults through a longitudinal population-based study.

Urgently Creating the Better in Global Health

Richard Marlink

In this issue of the Hastings Center Report, Govind Persad and Ezekiel Emanuel argue that “[t]he provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.”

Short Communication: Low False Recent Rate of Limiting Antigen-Avidity Assay Combined with HIV-1 RNA Data in Botswana

Sikhulile Moyo, Kenanao P. Kotokwe, Terence Mohammed, Corretah Boleo, Lucy Mupfumi, Samuel Chishala, Lesedi Tsalaile, Hermann Bussmann, Simani Gaseitsiwe, Rosemary Musonda, Joseph Makhema, Marianna Baum, Richard Marlink, Susan Engelbrecht, Max Essex, Vladimir Novitsky

Cross-sectional estimation of HIV incidence could misclassify some established or chronic HIV infections as recent. Usually long-term nonprogressors, elite and viremic controllers, and individuals on ART contribute to misclassification.

Prevalence and distribution of non-AIDS causes of death among HIV-infected individuals receiving antiretroviral therapy: a systematic review and meta-analysis

Mansour Farahani, Holly Mulinder, Alexander Farahani, Richard Marlink

The advent of antiretroviral therapy has significantly improved AIDS-related morbidity and mortality. Yet, among people living with HIV, deaths due to non-AIDS-defining illnesses have been on the rise.

Genome-Wide Analyses Reveal Gene Influence on HIV Disease Progression and HIV-1C Acquisition in Southern Africa

Wen Xie, Denis Agniel, Andrey Shevchenko, Sergey V. Malov, Anton Svitin, Nikolay Cherkasov, Marianna K. Baum, Adriana Campa, Simani Gaseitsiwe, Hermann Bussmann, Joseph Makhema, Richard Marlink, Vladimir Novitsky, Tun Hou Lee, Tianxi Cai, Stephen J. O'Brien, M. Essex

Sub-Saharan Africans infected with HIV-1C make up the largest AIDS patient population in the world and exhibit large heterogeneity in disease progression before initiating antiretroviral therapy.

Developing Research Collaborations in an Academic Clinical Setting: Challenges and Lessons Learned

John A. Sahs, Andel V. Nicasio, Joan E. Storey, Peter Guarnaccia, Roberto Lewis-Fernández

Research collaboration in “real world” practice settings may enhance the meaningfulness of the findings and reduce barriers to implementation of novel intervention strategies.

Determinants of Sugar-Sweetened Beverage Consumption among Low-Income Children: Are There Differences by Race/Ethnicity, Age, and Sex?

Natasha Tasevska, Derek DeLia, Cori Lorts, Michael Yedidia, Punam Ohri-Vachaspati

Background Understanding determinants of high consumption of sugar-sweetened beverages (SSBs), a highly prevalent obesogenic behavior, will help build effective customized public health interventions.

Minority Men Who Have Sex with Men Demonstrate Increased Risk for HIV Transmission

Kirsha S. Gordon, E. Jennifer Edelman, Amy C. Justice, David A. Fiellin, Kathleen Akgün, Stephen Crystal, Mona Duggal, Joseph L. Goulet, David Rimland, Kendall J. Bryant

Black and Hispanic (minority) MSM have a higher incidence of HIV than white MSM. Multiple sexual partners, being under the influence of drugs and/or alcohol during sex, having a detectable HIV-1 RNA, and non-condom use are factors associated with HIV transmission. Using data from the Veterans Aging Cohort Study, we consider minority status and sexual orientation jointly to characterize and compare these factors.

Cumulative Advantage, Cumulative Disadvantage, and Evolving Patterns of Late-Life Inequality

Stephen Crystal, Dennis G. Shea, Adriana M. Reyes

Purpose of the Study Earlier studies have identified a pattern of cumulative advantage leading to increased within-cohort economic inequality over the life course, but there is a need to better understand how levels of inequality by age have changed in the evolving economic environment of recent decades. We utilized Survey of Income and Program Participation (SIPP) data to compare economic inequality across age groups for 2010 versus 1983-1984. Design and Methods We examined changing age profiles of inequality using a summary measure of economic resources taking into account income, annuitized value of wealth, and household size.

Suicide following deliberate self-harm

Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Tobias Gerhard, Carlos Blanco

Objective: The authors sought to identify risk factors for repeat self-harm and completed suicide over the following year among adults with deliberate self-harm. Method: A national cohort of Medicaid-financed adults clinically diagnosed with deliberate self-harm (N=61,297) was followed for up to 1 year. Repeat self-harm per 1,000 personyears and suicide rates per 100,000 person-years (based on cause of death information from the National Death Index) were determined. Hazard ratios of repeat self-harm and suicide were estimated by Cox proportional hazard models.

Impact of the black triangle label on prescribing of new drugs in the United Kingdom: lessons for the United States at a time of deregulation

Daniel Horton, Tobias Gerhard, Amy Davidow, Brian Strom

Purpose: Newly approved novel drugs in Europe receive a black triangle label to promote pharmacovigilance. With growing momentum for earlier drug approvals and reliance on real-world evidence, we studied if the black triangle label promotes more judicious prescribing. Methods: We examined whether general practitioners prescribed escitalopram, tadalafil, and vardenafil with a black triangle more cautiously than the same or similar drugs without a black triangle in The Health Improvement Network (UK). We performed interrupted time-series analyses to estimate changes in new prescription rates and nested case-control studies to compare characteristics of new users before and after removal of a black triangle.

Extent, time course, and moderators of antipsychotic treatment in youth with mood disorders: Results of a meta-analysis and meta-regression analyses

Chiara Cervesi, Su Young Park, Britta Galling, Silvia Molteni, Gabriele Masi, Tobias Gerhard, Mark Olfson, Christoph U. Correll

Objective: To meta-analytically examine the trends and correlates of antipsychotic use in youth with mood disorders. Methods: Systematic literature search without language restriction in PubMed/ MEDLINE/PsycINFO from database inception through March 2015 using the following search terms: (antipsychotic∗OR neuroleptic∗OR “dopamine blocker∗” OR antidopaminergic) AND (child∗OR adolescen∗OR pediatric OR youth) AND (prescription∗OR prescrib∗OR use OR utilization OR database OR pharmacoepidemiolog∗OR frequency OR rate OR rates).

Differential risk of increasing psychotropic polypharmacy use in children diagnosed with ADHD as preschoolers

Almut G. Winterstein, Rene Soria-Saucedo, Tobias Gerhard, Christoph U. Correll, Mark Olfson

Objective: To characterize treatment trajectories in children newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). Methods: We utilized billing records of children aged 3 to 18 years in 28 US states’f Medicaid programs between 1999 and 2006. Children entered the cohort at the first ADHD diagnosis (ICD-9-CM: 314.00) preceded by. 6 months with no psychotropic medication use and no psychiatric diagnoses. We followed children for 5 years to assess use of (1) psychotropic polypharmacy (the use of. 3 psychotropic medication classes), (2) antipsychotics, and (3) anticonvulsants. We used mixedeffects logistic regression to model the probability of each utilization outcome as a function of age at ADHD diagnosis and follow-up year, adjusted for sociodemographic factors.

Comparative adherence to diabetes drugs: An analysis of electronic health records and claims data

James Flory, Tobias Gerhard, Nikita Stempniewicz, Scott Keating, Christopher G. Rowan

Non-adherence to medications is a major challenge in diabetes care. The objective of this brief report is to compare adherence rates for 6 major classes of diabetes medications: metformin, sulfonylurea, thiazolidinedione, basal insulin, DPP-4 inhibitors, and GLP-1 receptor agonists. We used a data source that linked electronic prescriptions with insurance claims to assess whether new electronic prescriptions for diabetes medications were followed by dispensing claims consistent with that prescription.

Cross-sectional and longitudinal association between trust in physician and depressive symptoms among U.S. Community-dwelling Chinese older adults

Xinqi Dong, Stephanie Bergren, Melissa A. Simon

Background: Depression is a major public health concern among older adults and health care professionals play a vital role in screening and treatment. However, this process may be impeded by issues like lack of trust in physician (TIP). This study aims to examine the cross-sectional and longitudinal relationships between TIP and depressive symptoms among Chinese older adults in the Chicago area.

Change of cognitive function in U.S. Chinese older adults: A population-based study

Lydia W. Li, Ding Ding, Bei Wu, Xinqi Dong

Background: This study aims to assess cognitive change in a 2-year period among U.S. Chinese older adults and examine sociodemographic characteristics associated with the change.

Methods: Data were from the Population Study of Chinese Elderly (PINE) in which 2,713 participants (aged 60 and older) received in-home interviews at both the baseline and 2-year follow-up. A battery of cognitive tests that assessed episodic memory, working memory, perceptual speed, and overall cognitive status were administered in both times. A composite global cognition was constructed using all tests. Mixed-effect regression was conducted.

Pathway to better patient care and nurse workforce outcomes in home care

Olga Jarrin, Youjeong Kang, Linda H. Aiken

Background Unlike the Magnet Recognition Program, the newer Pathway to Excellence Program designed to improve work environments in a broader range of organizations has not yet been the focus of substantial research.

Agreement and validity of electronic health record prescribing data relative to pharmacy claims data: A validation study from a US electronic health record database

Christopher G. Rowan, James Flory, Tobias Gerhard, John K. Cuddeback, Nikita Stempniewicz, James D. Lewis, Sean Hennessy

Background: Granular clinical and laboratory data available in electronic health record (EHR) databases provide researchers the opportunity to conduct investigations that would not be possible in insurance claims databases; however, for pharmacoepidemiology studies, accurate classification of medication exposure is critical. Objective: The aim of this study was to evaluate the validity of classifying medication exposure using EHR prescribing (EHR-Rx) data.

Elder self-neglect: Research and practice

Xinqi Dong

Elder self-neglect is a global public health and human rights issue that threatens older people’s health and safety. It commonly refers to refusal or failure to provide oneself with care and protection in areas of food, water, clothing, hygiene, medication, living environments, and safety precautions. While prevalent, the status of self-neglecting individuals remains largely unclear, in particular within community-dwelling populations. By reviewing the epidemiology of elder self-neglect (definition, prevalence, risk factors, and consequences) to date, the present paper identifies key research gaps such as methodological inconsistency in case identification and measurement, and study designs that are inadequate to determine risk factors of self-neglect. More importantly, in light of the rapidly growing older population, relevant stakeholders (researchers, healthcare providers, social service providers, legal professionals, community organizations, and policymakers) must be prepared for an expected increasing number of self-neglect cases and enlarging scope of the problem. Hence, in this article, I present an overview regarding the management issues of elderly self-neglect related to the detection, assessment, reporting and referral, and decision-making capacity. Based on the current literature, the paper is aimed to explore the present knowledge and challenges, and how they can pave the way for solutions to self-neglect research, practice, and policy.

Evidence for updating the core domain set of outcome measures for juvenile idiopathic arthritis: Report from a special interest group at OMERACT 2016

Esi M. Morgan, Meredith P. Riebschleger, Jennifer Horonjeff, Alessandro Consolaro, Jane E. Munro, Susan Thornhill, Timothy Beukelman, Hermine I. Brunner, Emily L. Creek, Julia G. Harris, Daniel Horton, Daniel J. Lovell, Melissa L. Mannion, Judyann C. Olson, Homaira Rahimi, Maria Chiara Gallo, Serena Calandra, Angelo Ravelli, Sarah Ringold, Susan Shenoi & 4 others

Objective. The current Juvenile Idiopathic Arthritis (JIA) Core Set was developed in 1997 to identify the outcome measures to be used in JIA clinical trials using statistical and consensus-based techniques, but without patient involvement.

Attitudes and approaches for withdrawing drugs for children with clinically inactive nonsystemic JIA: A survey of the childhood arthritis and rheumatology research alliance

Daniel Horton, Karen B. Onel, Timothy Beukelman, Sarah Ringold

Objective. To assess the attitudes and strategies of pediatric rheumatology clinicians toward withdrawing medications for children with clinically inactive juvenile idiopathic arthritis (JIA). Methods.

Predictors of unplanned hospitalizations in patients with nonmetastatic lung cancer during chemotherapy

Kristen L. Fessele, Matthew J. Hayat, Robert Atkins

Purpose/Objectives: To determine predictors of unplanned hospitalizations in patients with lung cancer to receive chemotherapy in the outpatient setting and examine the potential financial burden of these events.

Grandparent caregiving and psychological well-being among Chinese American older adults—the roles of caregiving burden and pressure

Background: Though ample research on grandparent caregiving and psychological well-being outcomes exist in Western literature, little attention has been focused on Chinese American grandparents. Based on role enhancement and role strain theories, this study examined grandparent caregiving and psychological well-being among Chinese American older adults and tested whether caregiving burden or pressure from adult children moderated such association.

Family relationships and depressive symptoms among Chinese older immigrants in the United States

Jinyu Liu, Xinqi Dong, Duy Nguyen, Daniel W.L. Lai

Background: Given the growth in the number of older Chinese immigrants in the United States and the importance of family support in Chinese culture, this study examines how supportive and negative relationships with family members (children and spouse) influence depressive symptom severity among this population.

Family and marital conflict among Chinese older adults in the United States: The influence of personal coping resources

Man Guo, Xinqi Dong, Agnes Tiwari

Background: Conflict in the family is a major risk factor for the well-being of older immigrants, whose lives are centered around their families. This study examined the potential linkage between personal coping resources and family and marital conflict among U.S. Chinese older adults.

Variations between sources of social support and cancer screen behaviors in U.S. Chinese older adults

Xinqi Dong, Andi Liu

Background: Social support is a key indicator of utilization of preventive health care among older adults, but we have limited knowledge on these associations in U.S. Chinese older adults. This study aims to examine the association between sources of social support and cancer screening behaviors among Chinese older adults in the greater Chicago area.

Breast cancer screening beliefs among older Chinese women in Chicago’s Chinatown

Melissa A. Simon, Laura S. Tom, Xinqi Dong

Background: Chicago’s Chinatown is home to a sizeable community of first-generation Chinese American immigrants. This qualitative study seeks to describe the attitudes toward, and barriers and facilitators of, breast cancer screening among Chinese women in Chicago’s Chinatown to inform strategies for future interventions.

Oral glucocorticoid use and osteonecrosis in children and adults with chronic inflammatory diseases: A population-based cohort study

Daniel Horton, Kevin Haynes, Michelle R. Denburg, Mihir M. Thacker, Carlos D. Rose, Mary E. Putt, Mary B. Leonard, Brian Strom

Objectives We studied oral glucocorticoids and osteonecrosis, a rare but serious bone disease, in individuals with various chronic inflammatory diseases. We hypothesised that we would find stronger associations in adults versus children and in people with autoimmune diseases.

How Does Actual Unemployment and the Perceived Risk of Joblessness Affect Smoking Behavior? Gender and Intra-family Effects

Irina B. Grafova and Alan C. Monheit

Using the 1999–2011 waves of the Panel Study of Income Dynamics, we examine how actual unemployment …

Treating the Child or Syndrome: Does Context Matter for Treatment Decisions for Antisocially Behaving Youth?

Kathleen J. Pottick, Xin Tian, Stuart A. Kirk, and Derek K. Hsieh

Using a between-subject 3 × 3 design of an experimentally manipulated realistic case vignette of Black…….

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

Miwa Yasui, Kathleen J. Pottick, and Yun Chen

Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families…….

National Rates and Patterns of Depression Screening in Primary Care: Results From 2012 and 2013

Ayse Akincigil and Elizabeth B. Matthews

Objectives: Despite high prevalence rates of depression in primary care ,depressive symptoms are often undetected by physicians……..

Depression treatment among elderly medicare beneficiaries with incident cases of cancer and newly diagnosed depression

Monira Alwhaibi, Suresh Madhavan, Thomas Bias, Kimberly Kelly, James Walkup, Usha Sambamoorthi

Objective: Depression treatment can improve the health outcomes of elderly cancer survivors. There is a paucity of studies on the extent to which depression is treated among elderly cancer survivors. Therefore, this study estimated the rates of depression treatment among elderly cancer survivors and identified the factors affecting depression treatment.

Musculoskeletal MRI findings of juvenile localized scleroderma

Eric P. Eutsler, Daniel Horton, Monica Epelman, Terri Finkel, Lauren W. Averill

Background: Juvenile localized scleroderma comprises a group of autoimmune conditions often characterized clinically by an area of skin hardening. In addition to superficial changes in the skin and subcutaneous tissues, juvenile localized scleroderma may involve the deep soft tissues, bones and joints, possibly resulting in functional impairment and pain in addition to cosmetic changes.

Cancer type and risk of newly diagnosed depression among elderly medicare beneficiaries with incident breast, colorectal, and prostate cancers

Monira Alwhaibi, Usha Sambamoorthi, Suresh Madhavan, Thomas Bias, Kimberly Kelly, James Walkup

Background: Elderly individuals (age >65 years) with cancer are at high risk for newly diagnosed depression after a cancer diagnosis. It is not known whether the risk of newly diagnosed depression varies by cancer type.

Examination of chronic smoking behavior and eligibility for low-dose computed tomography for lung cancer screening among older Chinese Male smokers

Chien Ching Li, Alicia K. Matthews, Xinqi Dong

Background: Low-dose computed tomography lung cancer (LDCT) screening is an effective way to decrease lung cancer mortality. Both Medicare and private insurers offer coverage of LDCT screening to beneficiaries who are at high risk of developing lung cancer. In this study, we examined rates and predictors of chronic smoking behavior and eligibility for coverage of LDCT screening among older Chinese men living in the greater Chicago area

Elder Abuse: Research, Practice and Policy

Xinqi Dong

This book provides a global comprehensive and systematic state-of-the review of this field that fills the gaps between research, practice, and policy. The book addresses the epidemiology of the issue and the global prevalence of elder abuse in both developed and developing countries, which synthesizes the most up-to-date data about risk factors and protective factors associated with elder abuse and consequences of elder abuse; clinical assessment and management of elder abuse, including screening, detection, management of elder abuse, and the role of decision making capacity and forensic approaches;

Voices of Informal Caregivers and Community Stakeholders: Whether and How to Develop an Informal Caregiver Training Program

Sara S. Phillips, Daiva M. Ragas, Laura S. Tom, Nadia Hajjar, Xinqi Dong, Melissa A. Simon

Our primary objective was to gather pilot data from caregivers and stakeholders to guide the development of a training program to assist informal caregivers in re-entering the job market. The goal of the program would be to help caregivers rebound from their incurred economic burden by transitioning into a paid caregiving or other health-service role.

Using community-based participatory research to address Chinese older women’s health needs: Toward sustainability

E. Shien Chang, Melissa A. Simon, Xinqi Dong

ABSTRACT: Although community-based participatory research (CBPR) has been recognized as a useful approach for eliminating health disparities, less attention is given to how CBPR projects may address gender inequalities in health for immigrant older women. The goal of this article is to share culturally sensitive strategies and lessons learned from the PINE study—a population-based study of U.S. Chinese older adults that was strictly guided by the CBPR approach.

Sociodemographic and socioeconomic characteristics of elder self-neglect in an US Chinese aging population

Xinqi Dong

This study aimed to examine the socio-demographic and socioeconomic characteristics associated with prevalence and severity of elder self-neglect in an U.S. Chinese older population. The PINE study is a population-based epidemiological study in the greater Chicago area.

Psychological Well-Being of Older Chinese-American Grandparents Caring for Grandchildren

Fengyan Tang, Ling Xu, Iris Chi, Xinqi Dong

The rapid increase in grandparents caring for grandchildren has received growing attention, but little research has focused on Chinese-American grandparents and their caregiving experiences.

Prevalence of elder self-neglect in a Chicago Chinese population: The role of cognitive physical and mental health

Xinqi Dong, Melissa Simon

Aim: The present study examined the cognitive, physical and psychological characteristics associated with elder self-neglect in a USA Chinese older population.

Leveraging the Experiences of Informal Caregivers to Create Future Healthcare Workforce Options

Sara S. Phillips, Daiva M. Ragas, Nadia Hajjar, Laura S. Tom, Xinqi Dong, Melissa A. Simon

The objective of this study was gather pilot data from informal caregivers regarding the potential for a training program to assist current or past caregivers in reentering the job market, and thus offering a pathway to economic resilience.

Elder Mistreatment in U.S. Community-Dwelling Chinese Older Women

Xinqi Dong, Ruijia Chen, Melissa A. Simon

This study explored the prevalence and correlates of elder mistreatment among community-dwelling Chinese women in the U.S. Data were from the Population Study of Chinese Elderly in Chicago (PINE), a population-based study of U.S. Chinese older adults aged 60 years and above.

2015 Rosalie Wolf Memorial Award Lecture: Past, present, and future of elder abuse

Xinqi Dong, Bei Wang

This article aims to advance the global issue of elder abuse through exploring how the current body of elder abuse literature can collectively pave the way for present and future directions for research, practice, and policy.

Wide variations in compliance with tuberculosis screening guidelines and tuberculosis incidence between antiretroviral therapy facilities – Côte d’Ivoire

Andrew F. Auld, Michela Blain, Kunomboa Alexandre Ekra, Joseph Sylvain Kouakou, Virginie Ettiègne-Traoré, Moise Zanga Tuho, Fayama Mohamed, Ray W. Shiraishi, Jennifer Sabatier, Joseph Essombo, Georgette Adjorlolo-Johnson, Richard Marlink, Tedd V. Ellerbrock

Background: In Côte d’Ivoire, tuberculosis (TB) is a common cause of death among HIV-infected antiretroviral therapy (ART) enrollees. Ivorian guidelines recommend screening for TB and initiation of TB treatment before ART initiation. Compliance with these guidelines can help reduce TB-related mortality during ART and possibly nosocomial TB transmission.

Variation in attrition at subnational level: Review of the Botswana National HIV/AIDS Treatment (Masa) programme data (2002-2013)

Mansour Farahani, Natalie Price, Shenaaz El-Halabi, Naledi Mlaudzi, Koona Keapoletswe, Refeletswe Lebelonyane, Ernest Benny Fetogang, Tony Chebani, Poloko Kebaabetswe, Tiny Masupe, Keba Gabaake, Andrew Auld, Oathokwa Nkomazana, Richard Marlink

Objective: To evaluate the variation in all-cause attrition [mortality and loss to follow-up (LTFU)] among HIV-infected individuals in Botswana by health district during the rapid and massive scale-up of the National Treatment Program.

Trends and determinants of survival for over 200 000 patients on antiretroviral treatment in the Botswana National Program: 2002-2013

Mansour Farahani, Natalie Price, Shenaaz El-Halabi, Naledi Mlaudzi, Koona Keapoletswe, Refeletswe Lebelonyane, Ernest Benny Fetogang, Tony Chebani, Poloko Kebaabetswe, Tiny Masupe, Keba Gabaake, Andrew Auld, Oathokwa Nkomazana, Richard Marlink

Objectives: To determine the incidence and risk factors of mortality for all HIV-infected patients receiving antiretroviral treatment at public and private healthcare facilities in the Botswana National HIV/AIDS Treatment Programme. Design: We studied routinely collected data from 226 030 patients enrolled in the Botswana National HIV/AIDS Treatment Programme from 2002 to 2013.

Slow CD4+ T-Cell recovery in human immunodeficiency virus/hepatitis B virus-coinfected patients initiating truvada-based combination antiretroviral therapy in Botswana

Motswedi Anderson, Simani Gaseitsiwe, Sikhulile Moyo, Kerapetse P. Thami, Terence Mohammed, Ditiro Setlhare, Theresa K. Sebunya, Eleanor A. Powell, Joseph Makhema, Jason T. Blackard, Richard Marlink, Max Essex, Rosemary M. Musonda

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection has emerged as an important cause of morbidity and mortality. We determined the response to Truvada-based first-line combination antiretroviral therapy (cART) in HIV/HBV-coinfected verus HIV-monoinfected patients in Botswana.

Plasma cytokine levels in chronic asymptomatic HIV-1 Subtype C infection as an indicator of disease progression in Botswana: A retrospective case control study

Thato Iketleng, Sikhulile Moyo, Simani Gaseitsiwe, Balthazar Nyombi, Rebecca M. Mitchell, Joseph Makhema, Marianna K. Baum, Richard Marlink, Max Essex, Rosemary Musonda

HIV infects cells of the immune system causing immune activation and proliferation of immune cells, leading to alteration of production and activity of a number of cytokines. These changes in cytokine levels can affect the immune function, and have the potential to directly impact the course of HIV disease.

Personal views about womanhood amongst women living with HIV in Botswana

Michelle Marian Schaan, Myra Taylor, Nontombi Gungqisa, Richard Marlink

The social construction of womanhood in Africa can be said to have two central defining elements: being a wife and being a mother. The interplay between HIV and these elements is not well understood outside of prevention efforts.

Impact of health system inputs on health outcome: A multilevel longitudinal analysis of Botswana national antiretroviral program (2002-2013)

Mansoor Farahani, Natalie Price, Shenaaz El-Halabi, Naledi Mlaudzi, Koona Keapoletswe, Refeletswe Lebelonyane, Ernest Benny FetogangR, Tony Chebani, Poloko Kebaabetswe, Tiny Masupe, Keba Gabaake, Andrew F. Auld, Oathokwa Nkomazana, Richard Marlink

Objective To measure the association between the number of doctors, nurses and hospital beds per 10,000 people and individual HIV-infected patient outcomes in Botswana.

How providers influence the implementation of provider-initiated HIV testing and counseling in Botswana: A qualitative study

Shahira Ahmed, Till Bärnighausen, Norman Daniels, Richard Marlink, Marc J. Roberts

Background: Understanding the motivations and perspectives of providers in following guidance and evidence-based policies can contribute to the evidence on how to better implement and deliver care, particularly in resource-constrained settings. This study explored how providers’ attitudes and behaviors influenced the implementation of an intervention, provider-initiated HIV testing and counseling, in primary health care settings in Botswana.

Effect of BMI and fat mass on HIV disease progression in HIV-infected, antiretroviral treatment-naïve adults in Botswana

S. S. Martinez, A. Campa, H. Bussmann, S. Moyo, J. Makhema, F. G. Huffman, O. D. Williams, M. Essex, Richard Marlink, M. K. Baum

An obesity paradox has been proposed in many conditions including HIV. Studies conducted to investigate obesity and its effect on HIV disease progression have been inconclusive and are lacking for African settings.

The meanings of cultural competence in mental health: an exploratory focus group study with patients, clinicians, and administrators

Neil Krishan Aggarwal, Kryst Cedeño, Peter Guarnaccia, Arthur Kleinman, Roberto Lewis-Fernández

Cultural competence training is mandatory in the United States of America to alleviate minority health disparities though few studies have examined perceptions across stakeholders.

Culture: The missing link in health research

M. Kagawa Singer, W. Dressler, S. George, Claudia R. Baquet, Ronny A. Bell, Linda Burhansstipanov, Nancy J. Burke, Suzanne Dibble, William Elwood, Linda Garro, Clarence C. Gravlee, Peter Guarnaccia, Michael L. Hecht, Jeffrey Henderson, Dan Hruschka, Roberto Lewis-Fernández, Robert Like, Charles Mouton, Hector F. Myers, J. Bryan Page & 9 others

Culture is essential for humans to exist. Yet surprisingly little attention has been paid to identifying how culture works or developing standards to guide the application of this concept in health research.

Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: A systematic review

Neil Krishan Aggarwal, Matthew C. Pieh, Lisa Dixon, Peter Guarnaccia, Margarita Alegría, Roberto Lewis-Fernández

Objective: To describe studies on clinician communication and the engagement of racial/ethnic minority patients in mental health treatment.

Healthy store programs and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but not the Supplemental Nutrition Assistance Program (SNAP), are associated with corner store healthfulness

Robin S. DeWeese, Michael Todd, Allison Karpyn, Michael Yedidia, Michelle Kennedy, Meg Bruening, Christopher M. Wharton, Punam Ohri-Vachaspati

In response to lack of access to healthy foods, many low-income communities are instituting local healthy corner store programs. Some stores also participate in the United States Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP).

Use of the landmark method to address immortal person-time bias in comparative effectiveness research: a simulation study

Xiaojuan Mi, Bradley G. Hammill, Lesley H. Curtis, Edward Chia Cheng Lai, Soko Setoguchi Iwata

Observational comparative effectiveness and safety studies are often subject to immortal person-time, a period of follow-up during which outcomes cannot occur because of the treatment definition. Common approaches, like excluding immortal time from the analysis or naïvely including immortal time in the analysis, are known to result in biased estimates of treatment effect.

Dimension reduction and shrinkage methods for high dimensional disease risk scores in historical data

Hiraku Kumamaru, Sebastian Schneeweiss, Robert J. Glynn, Soko Setoguchi Iwata, Joshua J. Gagne

Background: Multivariable confounder adjustment in comparative studies of newly marketed drugs can be limited by small numbers of exposed patients and even fewer outcomes. Disease risk scores (DRSs) developed in historical comparator drug users before the new drug entered the market may improve adjustment. However, in a high dimensional data setting, empirical selection of hundreds of potential confounders and modeling of DRS even in the historical cohort can lead to over-fitting and reduced predictive performance in the study cohort.

Comparison of high-dimensional confounder summary scores in comparative studies of newly marketed medications

Hiraku Kumamaru, Joshua J. Gagne, Robert J. Glynn, Soko Setoguchi Iwata, Sebastian Schneeweiss

Objective To compare confounding adjustment by high-dimensional propensity scores (hdPSs) and historically developed high-dimensional disease risk scores (hdDRSs) in three comparative study examples of newly marketed medications: (1) dabigatran vs. warfarin on major hemorrhage; (2) on death; and (3) cyclooxygenase-2 inhibitors vs. nonselective nonsteroidal anti-inflammatory drugs on gastrointestinal bleeds. Study Design and Setting In each example, we constructed a concurrent cohort of new and old drug initiators using US claims databases.

Comparative validity of methods to select appropriate cutoff weight for probabilistic linkage without unique personal identifiers

Ying Zhu, Chih Ying Chen, Yutaka Matsuyama, Yasuo Ohashi, Jessica M. Franklin, Soko Setoguchi Iwata

Purpose: Record linkage can enhance data quality of observational database studies. Probabilistic linkage, a method that allows partial match of linkage variables, overcomes disagreements arising from errors and omissions in data entry but also results in false-positive links. The study aimed to assess the validity of probabilistic linkage in the absence of unique personal identifiers (UPI) and the methods of cutoff weight selection.

Comparative risk of oral ulcerations among antipsychotics users – population-based retrospective cohort study

Edward Chia Cheng Lai, Cheng Yang Hsieh, Monera B. Wong, Swu Jane Lin, Yang Kuang Yang, Yea Huei Kao Yang, Soko Setoguchi Iwata

Purpose: The study aimed to evaluate the comparative risk of oral ulcerations among antipsychotic medications. Methods: We analyzed the National Health Insurance Research Database of Taiwan and included patients newly initiated with a single antipsychotic agent including haloperidol, sulpiride, olanzapine, quetiapine, risperidone, or amisulpride during 2002 to 2010. The outcome of interest was oral ulceration, defined by the presence diagnoses of stomatitis and mucositis, aphthous-like ulceration and oral burns, or dispensing of stomatological corticosteroids included triamcinolone, dexamethasone, hydrocortisone, and prednisolone.

Comparative persistence of antiepileptic drugs in patients with epilepsy: A STROBE-compliant retrospective cohort study

Edward Chia Cheng Lai, Cheng Yang Hsieh, Chien Chou Su, Yea Huei Kao Yang, Chin Wei Huang, Swu Jane Lin, Soko Setoguchi Iwata

We compared persistence of antiepileptic drugs (AEDs) including carbamazepine, oxcarbazepine, gabapentin, lamotrigine, topiramate, valproic acid, and phenytoin in an Asian population with epilepsy. A retrospective cohort study was conducted by analyzing Taiwan’s National Health Insurance Research Database (NHIRD). Adult epilepsy patients newly prescribed with AEDs between 2005 and 2009 were included.

Trends in Any and High-Dose Opioid Analgesic Receipt Among Aging Patients With and Without HIV

William C. Becker, Kirsha Gordon, E. Jennifer Edelman, Robert D. Kerns, Stephen Crystal, James D. Dziura, Lynn E. Fiellin, Adam J. Gordon, Joseph L. Goulet, Amy C. Justice, David A. Fiellin

Harms of opioid analgesics, especially high-dose therapy among individuals with comorbidities and older age, are increasingly recognized. However, trends in opioid receipt among HIV-infected patients are not well characterized. We examined trends, from 1999 to 2010, in any and high-dose (≥120 mg/day) opioid receipt among patients with and without HIV, by age strata, controlling for demographic and clinical correlates. Of 127,216 patients, 64 % received at least one opioid prescription.

The quality of medication treatment for mental disorders in the department of veterans affairs and in private-sector plans

Katherine E. Watkins, Brad Smith, Ayse Akincigil, Melony E. Sorbero, Susan Paddock, Abigail Woodroffe, Cecilia Huang, Stephen Crystal, Harold Alan Pincus

Objective: The quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) was compared with care provided to a comparable population treated in the private sector. Methods: Two cohorts of individuals with mental disorders (schizophrenia, bipolar disorder, posttraumatic stress disorder, major depression, and substance use disorders) were created with VA administrative data (N=836,519) and MarketScan data (N=545,484).

The effect of substance use disorders on the association between guideline-concordant long-term opioid therapy and all-cause mortality

Julie R. Gaither, Joseph L. Goulet, William C. Becker, Stephen Crystal, E. Jennifer Edelman, Kirsha Gordon, Robert D. Kerns, David Rimland, Melissa Skanderson, Amy C. Justice, David A. Fiellin

Objective: Patients with substance use disorders (SUDs) prescribed long-term opioid therapy (LtOT) are at risk for overdose and mortality. Prior research has shown that receipt of LtOT in accordance with clinical practice guidelines has the potential to mitigate these outcomes. Our objective was to determine whether the presence of a SUD modifies the association between guideline-concordant care and 1-year all-cause mortality among patients receiving LtOT for pain.

The Association Between Receipt of Guideline-Concordant Long-Term Opioid Therapy and All-Cause Mortality

Julie R. Gaither, Joseph L. Goulet, William C. Becker, Stephen Crystal, E. Jennifer Edelman, Kirsha Gordon, Robert D. Kerns, David Rimland, Melissa Skanderson, Amy C. Justice, David A. Fiellin

Purpose: For patients receiving long-term opioid therapy (LtOT), the impact of guideline-concordant care on important clinical outcomes—notably mortality—is largely unknown, even among patients with a high comorbidity and mortality burden (e.g., HIV-infected patients). Our objective was to determine the association between receipt of guideline-concordant LtOT and 1-year all-cause mortality.

Ten-Year Trends In Treatment Services For Children With Attention Deficit Hyperactivity Disorder Enrolled In Medicaid

Kimberly E. Hoagwood, Kelly Kelleher, Bonnie T. Zima, James M. Perrin, Scott Bilder, Stephen Crystal

Closing the gap between evidence-based clinical practice standards and their inclusion in routine practice continues to be a major goal of health policy reforms. This gap is especially large for the care of children with psychiatric disorders-especially those from low-income families, many of whom are insured through Medicaid.

Risk factors associated with acute exacerbation of chronic obstructive pulmonary disease in HIV-infected and uninfected patients

Timothy B. Depp, Kathleen A. McGinnis, Kevin Kraemer, Kathleen M. Akgun, E. Jennifer Edelman, David A. Fiellin, Adeel A. Butt, Stephen Crystal, Adam J. Gordon, Matthew Freiberg, Cynthia L. Gibert, David Rimland, Kendall J. Bryant, Kristina Crothers

Objective: To determine the association between HIV infection and other risk factors for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Design: Longitudinal, national Veterans Aging Cohort Study including 43 618 HIV-infected and 86 492 uninfected veterans. Methods: AECOPD was defined as an inpatient or outpatient COPD ICD-9 diagnosis accompanied by steroid and/or antibiotic prescription within 5 days.

Rapid growth of antipsychotic prescriptions for children who are publicly insured has ceased, but concerns remain

Stephen Crystal, Thomas Mackie, Miriam C. Fenton, Shahla Amin, Sheree Neese-Todd, Mark Olfson, Scott Bilder

The rapid growth of antipsychotic medication use among publicly insured children in the early and mid-2000s spurred new state efforts to monitor and improve prescription behavior. A starting point for many oversight initiatives was the foster care system, where most of the children are insured publicly through Medicaid.

Quality of HIV Care and Mortality Rates in HIV-Infected Patients

Philip Todd Korthuis, Kathleen A. McGinnis, Kevin L. Kraemer, Adam J. Gordon, Melissa Skanderson, Amy C. Justice, Stephen Crystal, Matthew Bidwell Goetz, Cynthia L. Gibert, David Rimland, Lynn E. Fiellin, Julie R. Gaither, Karen Wang, Steven M. Asch, Donald Keith McInnes, Michael E. Ohl, Kendall Bryant, Janet P. Tate, Mona Duggal, David A. Fiellin

Background. The Patient Protection and Affordable Care Act encourages healthcare systems to track quality-of-care measures; little is known about their impact on mortality rates. The objective of this study was to assess associations between HIV quality of care and mortality rates.

Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study

Geetanjoli Banerjee, E. Jennifer Edelman, Declan T. Barry, William C. Becker, Magdalena Cerdá, Stephen Crystal, Julie R. Gaither, Adam J. Gordon, Kirsha S. Gordon, Robert D. Kerns, Silvia S. Martins, David A. Fiellin, Brandon D.L. Marshall

AIMS: To estimate the influence of non-medical use of prescription opioids (NMUPO) on heroin initiation among US veterans receiving medical care.

DESIGN: Using a multivariable Cox regression model, we analyzed data from a prospective, multi-site, observational study of HIV-infected and an age/race/site-matched control group of HIV-uninfected veterans in care in the United States. Approximately annual behavioral assessments were conducted and contained self-reported measures of NMUPO and heroin use.

Hepatic Safety of Buprenorphine in HIV-Infected and Uninfected Patients With Opioid Use Disorder: The Role of HCV-Infection

Jeanette M. Tetrault, Janet P. Tate, E. Jennifer Edelman, Adam J. Gordon, Vincent Lo Re, Joseph K. Lim, David Rimland, Joseph Goulet, Stephen Crystal, Julie R. Gaither, Cynthia L. Gibert, Maria C. Rodriguez-Barradas, Lynn E. Fiellin, Kendall Bryant, Amy C. Justice, David A. Fiellin

Introduction Individuals with HIV and hepatitis C (HCV) infection, alcohol use disorder, or who are prescribed potentially hepatotoxic medications may be at increased risk for buprenorphine (BUP) associated hepatotoxicity. Materials and methods We examined a cohort of HIV-infected and uninfected patients receiving an initial BUP prescription between 2003 and 2012. We compared changes in alanine and aspartate aminotransferases (ALT and AST) and total bilirubin (TB) stratified by HIV status.

Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients

Kathleen A. McGinnis, Janet P. Tate, Emily C. Williams, Melissa Skanderson, Kendall J. Bryant, Adam J. Gordon, Kevin L. Kraemer, Stephen A. Maisto, Stephen Crystal, David A. Fiellin, Amy C. Justice

Background Using electronic medical record (EMR) data for clinical decisions, quality improvement, and research is common. While unhealthy alcohol use is particularly risky among HIV infected individuals (HIV+), the validity of EMR data for identifying unhealthy alcohol use among HIV+ is unclear. Among HIV+ and uninfected, we: (1) assess agreement of EMR and research AUDIT-C at validated cutoffs for unhealthy alcohol use; (2) explore EMR cutoffs that maximize agreement; and (3) assess subpopulation variation in agreement.

Association of chronic obstructive pulmonary disease with frailty measurements in HIV-infected and uninfected Veterans

Kathleen M. Akgun, Janet P. Tate, Krisann K. Oursler, Stephen Crystal, David A. Leaf, Julie A. Womack, Todd T. Brown, Amy C. Justice, Kristina Crothers

Objective: Chronic obstructive pulmonary disease (COPD) prevalence is increasing among aging HIV-infected individuals. We determined the association between COPD and self-reported measures of frailty [adapted frailty-related phenotype (aFRP)] and physical limitation, and a clinical biomarker of physiologic frailty [Veterans Aging Cohort Study (VACS) Index] in HIV-infected compared with uninfected individuals. Design: Cross-sectional study of VACS participants between 2002 and 2012.

Alcohol-Related Diagnoses and All-Cause Hospitalization Among HIV-Infected and Uninfected Patients: A Longitudinal Analysis of United States Veterans from 1997 to 2011

Christopher Rentsch, Janet P. Tate, Kathleen M. Akgün, Stephen Crystal, Karen H. Wang, S. Ryan Greysen, Emily A. Wang, Kendall J. Bryant, David A. Fiellin, Amy C. Justice, David Rimland

Individuals with HIV infection are living substantially longer on antiretroviral therapy, but hospitalization rates continue to be relatively high. We do not know how overall or diagnosis-specific hospitalization rates compare between HIV-infected and uninfected individuals or what conditions may drive hospitalization trends. Hospitalization rates among United States Veterans were calculated and stratified by HIV serostatus and principal diagnosis disease category.

Access to psychosocial services prior to starting antipsychotic treatment among medicaid-insured youth

Molly Finnerty, Sheree Neese-Todd, Riti Pritam, Emily Leckman-Westin, Scott Bilder, Sepheen C. Byron, Sarah Hudson Scholle, Stephen Crystal, Mark Olfson

Objective To examine rates and predictors of receiving a psychosocial service before initiating antipsychotic treatment among young people in the Medicaid program. Method A retrospective new-user cohort study of 8 state Medicaid programs focused on children and adolescents 0 to 20 years, initiating antipsychotic treatment (N = 24,372).

Type 2 diabetes mellitus in youth exposed to antipsychotics: A systematic review and meta-analysis

Britta Galling, Alexandra Roldán, René E. Nielsen, Jimmi Nielsen, Tobias Gerhard, Maren Carbon, Brendon Stubbs, Davy Vancampfort, Marc De Hert, Mark Olfson, Kai G. Kahl, Andres Martin, Jeff J. Guo, Hsien Yuan Lane, Fung Chang Sung, Chun Hui Liao, Celso Arango, Christoph U. Correll

IMPORTANCE Antipsychotics are used increasingly in youth for nonpsychotic and off-label indications, but cardiometabolic adverse effects and (especially) type 2 diabetes mellitus (T2DM) risk have raised additional concern. OBJECTIVE To assess T2DM risk associated with antipsychotic treatment in youth. DATA SOURCES Systematic literature search of PubMed and PsycINFO without language restrictions from database inception until May 4, 2015. Data analyses were performed in July 2015, and additional analyses were added in November 2015.

Short-Term suicide risk after psychiatric hospital discharge

Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Shang Min Liu, Tobias Gerhard, Carlos Blanco

IMPORTANCE Although psychiatric inpatients are recognized to be at increased risk for suicide immediately after hospital discharge, little is known about the extent to which their short-Term suicide risk varies across groups with major psychiatric disorders. OBJECTIVE To describe the risk for suicide during the 90 days after hospital discharge for adults with first-listed diagnoses of depressive disorder, bipolar disorder, schizophrenia, substance use disorder, and other mental disorders in relation to inpatients with diagnoses of nonmental disorders and the general population.

Risk of suicidal events with atomoxetine compared to stimulant treatment: A cohort study

Stephan Linden, Regina Bussing, Paul Kubilis, Tobias Gerhard, Richard Segal, Jonathan J. Shuster, Almut G. Winterstein

BACKGROUND: Antidepressant effects on increased suicidality in children have raised public concern in recent years. Approved in 2002 for attention-deficit/hyperactivity disorder treatment, the selective noradrenalin-reuptake-inhibitor atomoxetine was initially investigated for the treatment of depression. In post-hoc analyses of clinical trial data, atomoxetine has been associated with an increased risk of suicidal ideation in children and adolescents. We analyzed whether the observed increased risk of suicidal ideation in clinical trials translates into an increased risk of suicidal events in pediatric patients treated with atomoxetine compared with stimulants in 26 Medicaid programs.

Comparative effectiveness of clozapine and standard antipsychotic treatment in adults with schizophrenia

T. Scott Stroup, Tobias Gerhard, Stephen Crystal, Cecilia Huang, Mark Olfson

Objective: The authors compared the effectiveness of initiating treatment with either clozapine or a standard antipsychotic among adults with evidence of treatment-resistant schizophrenia in routine clinical practice. Method: U.S. national Medicaid data from 2001 to 2009 were used to examine treatment out comes in a cohort of patients with schizophrenia and evidence of treatment resistance that initiated clozapine (N=3,123) and in a propensity score-matched cohort that initiated a standard antipsychotic (N=3,123).

Antipsychotic Use Trends in Youth With Autism Spectrum Disorder and/or Intellectual Disability: A Meta-Analysis

Su Young Park, Chiara Cervesi, Britta Galling, Silvia Molteni, Frozan Walyzada, Stephanie H. Ameis, Tobias Gerhard, Mark Olfson, Christoph U. Correll

Objective Although irritability and aggression are relevant treatment targets in autism spectrum disorders (ASDs) and intellectual disability (ID) that may prompt antipsychotic use, antipsychotic prescribing patterns in such youth have not been systematically reviewed. Method We systematically searched PubMed/MEDLINE/PsycInfo until March 2015 for studies reporting data on the frequency of youth diagnosed with ASDs and/or ID among antipsychotic-treated youth, as well as antipsychotic use in youth with ASD/ID, conducting a meta-analysis and meta-regression analysis of potential moderators, including publication year, study time point, country, setting, sample size, age, sex, and race/ethnicity.

Nav1.7-A1632G mutation from a family with inherited erythromelalgia: Enhanced firing of dorsal root ganglia neurons evoked by thermal stimuli

Yang Yang, Jianying Huang, Malgorzata A. Mis, Mark Estacion, Lawrence Macala, Palak Shah, Betsy R. Schulman, Daniel Horton, Sulayman D. Dib-Hajj, Stephen G. Waxman

Voltage-gated sodium channel Nav1.7 is a central player in human pain. Mutations in Nav1.7 produce several pain syndromes, including inherited erythromelalgia (IEM), a disorder in which gain-of-function mutations render dorsal root ganglia (DRG) neurons hyperexcitable. Although patients with IEM suffer from episodes of intense burning pain triggered by warmth, the effects of increased temperature on DRG neurons expressing mutant Nav1.7 channels have not been well documented.

State Medicaid Expansion and Changes in Hospital Volume According to Payer

Katherine Hempstead, Joel C. Cantor

The Affordable Care Act (ACA) has many potential implications for the hospital industry. One of the most closely followed issues is the expansion of Medicaid, which became a state option as a result of the Supreme Court decision of 2012.1 As of this writing, 31 states and Washington, D.C., have elected to expand Medicaid, and […]

How Much Time Do Families Spend on the Health Care of Children with Diabetes?

Jane Miller, Colleen N. Nugent, Louise B. Russell

Introduction: Family time caring for children with diabetes is an overlooked component of the overall burden of the condition. We document and analyze risk factors for time family members spend providing health care at home and arranging/coordinating health care for children with diabetes. Methods: Data for 755 diabetic children and 16,161 non-diabetic children whose chronic conditions required only prescription (Rx) medication were from the 2009–2010 United States National Survey of Children with Special Health Care Needs (NS-CSHCN). We used generalized ordered logistic regressions to estimate adjusted odds ratios (AORs) of time burden by diabetes, insulin use, and stability of the child’s health care needs, controlling for health and socioeconomic status.

Factors associated with unplanned hospitalizations among patients with nonmetastatic colorectal cancers intended for treatment in the ambulatory setting

Kristen L. Fessele, Matthew J. Hayat, Deborah K. Mayer, Robert Atkins

Background: Chemotherapy administration and supportive management for solid tumors is intended to take place in the ambulatory setting, but little is known about why some patients experience treatment-related adverse events so severe as to require acute inpatient care.

Epidemiology of clostridium difficile infection-associated reactive arthritis in children: An underdiagnosed, potentially morbid condition

Daniel Horton, Brian Strom, Mary E. Putt, Carlos D. Rose, David D. Sherry, Julia S. Sammons

Importance: The incidence of Clostridium difficile infection has increased among children. The epidemiology of pediatric C difficile infection-associated reactive arthritis is poorly understood.

Administration of Antibiotics to Children Before Age 2 Years Increases Risk for Childhood Obesity

Frank I. Scott, Daniel Horton, Ronac Mamtani, Kevin Haynes, David S. Goldberg, Dale Y. Lee, James D. Lewis

Background & Aims Childhood obesity is increasing and is associated with adult obesity. Antibiotics have been used to promote weight gain in livestock for several decades. Antibiotics are commonly prescribed for children, but it is not clear how exposure to antibiotics early in life affects risk for obesity. We performed a population-based cohort study to assess the association between antibiotic exposure before age 2 years and obesity at age 4 years.

Prognostic value of HIV-1 RNA on CD4 trajectories and disease progression among antiretroviral-naive HIV-infected adults in Botswana: A joint modeling analysis

Mansour Farahani, Vladimir Novitsky, Rui Wang, Hermann Bussmann, Sikhulile Moyo, Rosemary M. Musonda, Themba Moeti, Joseph M. Makhema, Max Essex, Richard Marlink

Although HIV-1 RNA levels are measured at the time of initial diagnosis, the results are not used for the clinical follow-up of the patients. This study evaluates the prognostic value of the baseline HIV-1 RNA levels (above or below 10,000 copies/ml) on rate of disease progression, among antiretroviral therapy (ART)-naive patients in Botswana.

Antibiotic exposure, infection, and the development of pediatric psoriasis a nested case-control study

Daniel Horton, Frank I. Scott, Kevin Haynes, Mary E. Putt, Carlos D. Rose, James D. Lewis, Brian Strom

IMPORTANCE Antibiotics disrupt human microbiota and have been associated with several pediatric autoimmune diseases. Psoriasis activity has been linked to group A streptococcal and viral infections.

Antibiotic exposure and juvenile idiopathic arthritis: A case-control study

Daniel Horton, Frank I. Scott, Kevin Haynes, Mary E. Putt, Carlos D. Rose, James D. Lewis, Brian Strom

BACKGROUND AND OBJECTIVE: Recent evidence has linked childhood antibiotic use and microbiome abstract disturbance to autoimmune conditions. This study tested the hypothesis that antibiotic exposure was associated with newly diagnosed juvenile idiopathic arthritis (JIA).

Traditional Chinese Medicine Use and Health in Community-Dwelling Chinese-American Older Adults in Chicago

Xinqi Dong, Stephanie M. Bergren, E. Shien Chang

Chinese people have practiced traditional Chinese medicine (TCM) for thousands of years, but there is a paucity of research regarding TCM use in Chinese older adult immigrants in the United States. This study aims to provide an overall estimate of TCM use for Chinese older adults in the United States and to examine associations between sociodemographic characteristics, health measures, and TCM use.

The Development of a Communication Tool to Facilitate the Cancer Trial Recruitment Process and Increase Research Literacy among Underrepresented Populations

Samantha Torres, Erika E. de la Riva, Laura S. Tom, Marla L. Clayman, Chirisse Taylor, Xinqi Dong, Melissa A. Simon

Despite increasing need to boost the recruitment of underrepresented populations into cancer trials and biobanking research, few tools exist for facilitating dialogue between researchers and potential research participants during the recruitment process.

Suicide in the global Chinese aging population: A review of risk and protective factors, consequences, and interventions

Xinqi Dong, E. Shien Chang, Ping Zeng, Melissa A. Simon

As one of the leading causes of death around the world, suicide is a global public health threat. In the Chinese population, suicides constitute one-fifth of all recorded suicides in the world.

Religiosity Among U.S. Chinese Older Adults in the Greater Chicago Area—Findings From the PINE Study

Xinqi Dong, Manrui Zhang

Background: Religiosity influences health and well-being. We assessed religiosity among U.S. Chinese older adults. Methods: Data were drawn from the PINE study based on 3,159 community-dwelling U.S. Chinese older adults aged 60+ in the greater Chicago area. Two items retrieved from Duke University Religion Index (DUREL) were used to assess the frequency of participating in religious activities, and a separate item was used to assess the importance of religion.

Providers’ Views on a Community-Wide Patient Navigation Program: Implications for Dissemination and Future Implementation

Erika E. de la Riva, Nadia Hajjar, Laura S. Tom, Sara Phillips, Xinqi Dong, Melissa A. Simon

The DuPage Patient Navigation Collaborative (DPNC) adapted and scaled the Patient Navigation Research Program’s intervention model to navigate uninsured suburban DuPage County women with an abnormal breast or cervical cancer screening result.

Perceived stress and elder abuse: A population-based study of adult protective services cases in Chicago

Susan K. Roepke-Buehler, Xinqi Dong

Objectives To characterize the relationship between perceived stress and Adult Protective Services (APS) elder abuse cases in a population-based sample.

Levels of acculturation of Chinese older adults in the greater Chicago area – The population study of Chinese Elderly in Chicago

Xinqi Dong, Stephanie M. Bergren, E. Shien Chang

Acculturation is a difficult process for minority older adults for a variety of reasons, including access and exposure to mainstream culture, competing ethnic identities, and linguistic ability and preference. There is a paucity of research regarding overall level of acculturation for Chinese older adults in the United States.

Evaluating a bilingual patient navigation program for uninsured women with abnormal screening tests for breast and cervical cancer: Implications for future navigator research

Melissa A. Simon, Laura S. Tom, Narissa J. Nonzee, Kara R. Murphy, Richard Endress, Xinqi Dong, Joe Feinglass

Objectives: The DuPage Patient Navigation Collaborative evaluated the Patient Navigation Research Program (PNRP) model for uninsured women receiving free breast or cervical cancer screening through the Illinois Breast and Cervical Cancer Program in DuPage County, Illinois.

Elder Abuse in Chinese Populations: A Global Review

Xinqi Dong

This review focuses on the epidemiology of elder abuse in the global Chinese population with respect to its prevalence, risk factors, and consequences, as well as the perceptions of elder abuse.

Elder abuse: Systematic review and implications for practice

Xinqi Dong

This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem. Evidence suggests that elder abuse is prevalent, predictable, costly, and sometimes fatal. This review will highlight the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences in community populations.

Delays in cancer care among low-income minorities despite access

Narissa J. Nonzee, Daiva M. Ragas, Thanh Ha Luu, Ava M. Phisuthikul, Laura Tom, Xinqi Dong, Melissa A. Simon

Introduction: Narrowing the racial/ethnic and socioeconomic disparities in breast and cervical cancer requires an in-depth understanding of motivation for adherence to cancer screening and follow-up care. To inform patient-centered interventions, this study aimed to identify reasons why low-income women adhered to or delayed breast or cervical cancer screening, follow-up and treatment despite access to cancer care-related services.

Association between Elder Mistreatment and Suicidal Ideation among Community-Dwelling Chinese Older Adults in the USA

Xinqi Dong, Ruijia Chen, Bei Wu, Ning Jackie Zhang, Ada Chan Yuk Sim Mui, Iris Chi

Elder mistreatment and suicidal ideation are important public health concerns among aging populations. However, very few studies have been conducted to explore the association between elder mistreatment and suicidal ideation.

Association between elder abuse and metabolic syndromes: Findings from the chicago health and aging project

Xinqi Dong, Melissa Simon

Background: Elder abuse and metabolic syndromes are both important public health issues and are associated with increased morbidity and mortality. This study aimed to examine the associations between elder abuse and risk for metabolic syndromes.

Association between Depressive Symptoms, Multiple Dimensions of Depression, and Elder Abuse

Susan K. Roepke-Buehler, Melissa Simon, Xinqi Dong

Objective: Depression is conceptualized as both a risk factor for and a consequence of elder abuse; however, current research is equivocal. This study examined associations between elder abuse and dimensions of depressive symptoms in older adults.

Molecular characterisation of hepatitis B virus in HIV-1 subtype C infected patients in Botswana

Motswedi Anderson, Simani Gaseitsiwe, Sikhulile Moyo, Matthijs J.C. Wessels, Terence Mohammed, Theresa K. Sebunya, Eleanor A. Powell, Joseph Makhema, Jason T. Blackard, Richard Marlink, Max Essex, Rosemary M. Musonda

Background: Hepatitis B virus (HBV) is a major global health problem especially in sub-Saharan Africa and in East Asia. Ten hepatitis B virus genotypes have been described that differ by geographic distribution, disease progression, and response to treatment.

Toward a cultural adaptation of pharmacotherapy: LatinO views of depression and antidepressant therapy

Sylvanna M. Vargas, Leopoldo J. Cabassa, Andel Nicasio, Ana Alicia de la Cruz, Elizabeth Jackson, Melissa Rosario, Peter Guarnaccia, Roberto Lewis-Fernández

Relative to non-Latino Whites, Latinos in the United States with major depressive disorder (MDD) show low engagement in antidepressant therapy, whether engagement is defined as pharmacotherapy access, medication initiation, pill-taking, or treatment retention.

Idioms of Distress Among Depressed White-Non-Mexican and Mexican-Origin Older Men

Ester Carolina Apesoa-Varano, Judith C. Barker, Jurgen Unutzer, Sergio Aguilar-Gaxiola, Megan Dwight Johnson, Cindy Tran, Peter Guarnaccia, Ladson Hinton

Older men are less likely than older women to receive depression treatment. Latino older men in particular have been found to have significantly lower rates of depression treatment than their white-non-Mexican (WNM) counterparts.

The relative contribution of layers of the Social Ecological Model to childhood obesity

Punam Ohri-Vachaspati, Derek DeLia, Robin S. DeWeese, Noe C. Crespo, Michael Todd, Michael Yedidia

Objective: The Social Ecological Model (SEM) has been used to describe the aetiology of childhood obesity and to develop a framework for prevention. The current paper applies the SEM to data collected at multiple levels, representing different layers of the SEM, and examines the unique and relative contribution of each layer to children’s weight status.

The Influence of Parental Nativity, Neighborhood Disadvantage and the Built Environment on Physical Activity Behaviors in Latino Youth

Sandra E. Echeverría, Punam Ohri-Vachaspati, Michael Yedidia

Little evidence exists examining if parental nativity, neighborhood disadvantage and built environment features are associated with physical activity behaviors in Latino youth.

Association of faculty perceptions of work–life with emotional exhaustion and intent to leave academic nursing: Report on a national survey of nurse faculty

Michael Yedidia, Jolene Chou, Susan Brownlee, Linda Flynn, Christine A. Tanner

The current and projected nurse faculty shortage threatens the capacity to educate sufficient numbers of nurses for meeting demand. As part of an initiative to foster strategies for expanding educational capacity, a survey of a nationally representative sample of 3,120 full-time nurse faculty members in 269 schools and programs that offered at least one prelicensure degree program was conducted.

When to conduct probabilistic linkage vs. deterministic linkage? A simulation study

Ying Zhu, Yutaka Matsuyama, Yasuo Ohashi, Soko Setoguchi Iwata

Introduction: When unique identifiers are unavailable, successful record linkage depends greatly on data quality and types of variables available. While probabilistic linkage theoretically captures more true matches than deterministic linkage by allowing imperfection in identifiers, studies have shown inconclusive results likely due to variations in data quality, implementation of linkage methodology and validation method. The simulation study aimed to understand data characteristics that affect the performance of probabilistic vs. deterministic linkage.

Surgeon Case Volume and 30-Day Mortality after Carotid Endarterectomy among Contemporary Medicare Beneficiaries

Hiraku Kumamaru, Jessica J. Jalbert, Louis L. Nguyen, Marie D. Gerhard-Herman, Lauren A. Williams, Chih Ying Chen, John D. Seeger, Jun Liu, Jessica M. Franklin, Soko Setoguchi Iwata

Background and Purpose – After the 2005 National Coverage Determination to reimburse carotid artery stenting (CAS) for Medicare beneficiaries, the number of CAS procedures increased and carotid endarterectomy (CEA) decreased. We evaluated trends in surgeons’ past-year CEA case-volume and 30-day mortality after CEA, and their association before and after the National Coverage Determination.

Risk of pneumonia in new users of cholinesterase inhibitors for dementia

Edward Chia Cheng Lai, Monera B. Wong, Isao Iwata, Yinghong Zhang, Cheng Yang Hsieh, Yea Huei Kao Yang, Soko Setoguchi Iwata

Objectives To compare the risk of pneumonia in older adults receiving donepezil, galantamine, or rivastigmine for dementia. Design Retrospective cohort study. Setting Nationally representative 5% sample of Medicare databases. Participants Medicare beneficiaries aged 65 and older who newly initiated cholinesterase inhibitor therapy between 2006 and 2009.

Relationship between physician and hospital procedure volume and mortality after carotid artery stenting among medicare beneficiaries

Jessica J. Jalbert, Marie D. Gerhard-Herman, Louis L. Nguyen, Michael R. Jaff, Hiraku Kumamaru, Lauren A. Williams, Chih Ying Chen, Jun Liu, John D. Seeger, Andrew T. Rothman, Peter Schneider, Thomas G. Brott, Thomas T. Tsai, Herbert D. Aronow, Joseph A. Johnston, Soko Setoguchi Iwata

Background – Clinical trials demonstrated the efficacy of carotid artery stenting (CAS) relative to carotid endarterectomy when performed by physicians with demonstrated proficiency. It is unclear how CAS performance may be influenced by the diversity in CAS and non-CAS provider volumes in routine clinical practice.

Real world effectiveness of primary implantable cardioverter defibrillators implanted during hospital admissions for exacerbation of heart failure or other acute co-morbidities: Cohort study of older patients with heart failure

Chih Ying Chen, Lynne Warner Stevenson, Garrick C. Stewart, Deepak L. Bhatt, Manisha Desai, John D. Seeger, Lauren Williams, Jessica J. Jalbert, Soko Setoguchi Iwata

OBJECTIVE: To examine the effectiveness of primary implantable cardioverter defibrillators (ICDs) in elderly patients receiving the device during a hospital admission for exacerbation of heart failure or other acute co-morbidities, with an emphasis on adjustment for early mortality and other factors reflecting healthy candidate bias rather than the effect of the ICD.

Outcomes after carotid artery stenting in Medicare beneficiaries, 2005 to 2009

Jessica J. Jalbert, Louis L. Nguyen, Marie D. Gerhard-Herman, Michael R. Jaff, Christopher J. White, Andrew T. Rothman, John D. Seeger, Hiraku Kumamaru, Lauren A. Williams, Chih Ying Chen, Jun Liu, Thomas T. Tsai, Herbert D. Aronow, Joseph A. Johnston, Thomas G. Brott, Soko Setoguchi Iwata

IMPORTANCE: Despite increased carotid artery stenting (CAS) dissemination following the 2005 National Coverage Determination, to our knowledge, periprocedural and long-term outcomes have not been described among Medicare beneficiaries. OBJECTIVE: To describe the incidence of outcomes during and after the periprocedural period among Medicare beneficiaries undergoing CAS.

Databases in the Asia-pacific region: The potential for a distributed network approach

Edward Chia Cheng Lai, Kenneth K.C. Man, Nathorn Chaiyakunapruk, Ching Lan Cheng, Hsu Chih Chien, Celine S.L. Chui, Piyameth Dilokthornsakul, N. Chantelle Hardy, Cheng Yang Hsieh, Chung Y. Hsu, Kiyoshi Kubota, Tzu Chieh Lin, Yanfang Liu, Byung Joo Park, Nicole Pratt, Elizabeth E. Roughead, Ju Young Shin, Sawaeng Watcharathanakij, Jin Wen, Ian C.K. Wong & 3 others

Background: This study describes the availability and characteristics of databases in Asian-Pacific countries and assesses the feasibility of a distributed network approach in the region. Methods: A web-based survey was conducted among investigators using healthcare databases in the Asia-Pacific countries. Potential survey participants were identified through the Asian Pharmacoepidemiology Network.

Comparative adherence to oral hormonal agents in older women with breast cancer

Winson Y. Cheung, Edward Chia Cheng Lai, Jenny Y. Ruan, Jennifer T. Chang, Soko Setoguchi Iwata

We aim to (1) compare compliance of anastrozole, letrozole, exemestane, and tamoxifen in women and (2) identify clinical factors associated with medication non-adherence and non-persistence. Female Medicare beneficiaries who were new users of anastrozole, letrozole, exemestane, or tamoxifen between 2007 and 2010 were analyzed.

Thirty-day postoperative mortality among individuals with HIV infection receiving antiretroviral therapy and procedure-matched, uninfected comparators

Joseph T. King, Melissa F. Perkal, Ronnie A. Rosenthal, Adam J. Gordon, Stephen Crystal, Maria C. Rodriguez-Barradas, Adeel A. Butt, Cynthia L. Gibert, David Rimland, Michael S. Simberkoff, Amy C. Justice

IMPORTANCE: Antiretroviral therapy (ART) has converted human immunodeficiency virus (HIV) infection into a chronic condition, and patients now undergo a variety of surgical procedures, but current surgical outcomes are inadequately characterized. OBJECTIVE: To compare 30-day postoperative mortality in patients with HIV infection receiving ART with the rates in uninfected individuals. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of nationwide electronic medical record data from the US Veterans Health Administration Healthcare System, October 1, 1996, to September 30, 2010.

Long-term prescription of opioids and/or benzodiazepines and mortality among HIV-infected and uninfected patients

Daniel F. Weisberg, Kirsha S. Gordon, Declan T. Barry, William C. Becker, Stephen Crystal, Eva J. Edelman, Julie Gaither, Adam J. Gordon, Joseph Goulet, Robert D. Kerns, Brent A. Moore, Janet Tate, Amy C. Justice, David A. Fiellin

Background: Increased long-term prescription of opioids and/or benzodiazepines necessitates evaluating risks associated with their receipt. We sought to evaluate the association between long-term opioids and/or benzodiazepines and mortality in HIV-infected patients receiving antiretroviral therapy and uninfected patients.

Premature mortality among adults with schizophrenia in the United States

Mark Olfson, Tobias Gerhard, Cecilia Huang, Stephen Crystal, T. Scott Stroup

IMPORTANCE Although adults with schizophrenia have a significantly increased risk of premature mortality, sample size limitations of previous research have hindered the identification of the underlying causes. OBJECTIVE To describe overall and cause-specific mortality rates and standardized mortality ratios (SMRs) for adults with schizophrenia compared with the US general population.

Lithium treatment and risk for dementia in adults with bipolar disorder: Population-based cohort study

Tobias Gerhard, D. P. Devanand, Cecilia Huang, Stephen Crystal, Mark Olfson

Background: Lithium inhibits glycogen synthase kinase-3, an enzyme implicated in the pathogenesis of dementia. Aims: To examine the association of lithium and dementia risk in a large claims-based US cohort of publicly insured older adults with bipolar disorder. Method: The cohort included individuals ≥50 years diagnosed with bipolar disorder who did not receive dementia-related services during the prior year. Each follow-up day was classified by past-year cumulative duration of lithium use (0, 1-60, 61-300 and 301-365 days).

Antipsychotics and mortality: Adjusting for mortality risk scores to address confounding by terminal Illness

Yoonyoung Park, Jessica M. Franklin, Sebastian Schneeweiss, Raisa Levin, Stephen Crystal, Tobias Gerhard, Krista F. Huybrechts

Objectives To determine whether adjustment for prognostic indices specifically developed for nursing home (NH) populations affect the magnitude of previously observed associations between mortality and conventional and atypical antipsychotics. Design Cohort study. Setting A merged data set of Medicaid, Medicare, Minimum Data Set (MDS), Online Survey Certification and Reporting system, and National Death Index for 2001 to 2005. Participants Dual-eligible individuals aged 65 and older who initiated antipsychotic treatment in a NH (N = 75,445).

Prehospital Transportation to Therapeutic Hypothermia Centers and Survival from Out-of-Hospital Cardiac Arrest

Derek DeLia, Henry E. Wang, Jared Kutzin, Mark Merlin, Jose Nova, Kristen Lloyd, Joel C. Cantor

Clinical trials supporting the use of therapeutic hypothermia (TH) in the treatment of out-of-hospital cardiac arrest (OHCA) are based on small patient samples and do not reflect the wide variation in patient selection, cooling methods, and other elements of post-arrest care that are used in everyday practice. This study provides a real world evaluation of the effectiveness of post-arrest care in TH centers during a time of growing TH dissemination in the state of New Jersey (NJ).

Risk factors for family time burdens providing and arranging health care for children with special health care needs: Lessons from nonproportional odds models

Jane Miller, Colleen N. Nugent, Louise B. Russell

We identify need, enabling, and predisposing factors for high family time burdens associated with the health care of chronically-ill children, using data from the U.S. 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), a population-based survey of 40,242 children with special health care needs (CSHCN).

Innovation in creating a strategic plan for research within an academic community

Kaitlin M. Best, Olga Jarrín, Alison M. Buttenheim, Kathryn H. Bowles, Martha A.Q. Curley

Strategic planning for research priorities in schools of nursing requires consensus building and engagement of key stakeholders. However, traditional approaches to strategic planning using work groups and committees sometimes result in low rates of faculty participation and fail to engage other important stakeholders.

Which components of medical homes reduce the time burden on families of children with special health care needs?

Jane Miller, Colleen N. Nugent, Louise B. Russell

Objectives To examine which components of medical homes affect time families spend arranging/coordinating health care for their children with special health care needs (CSHCNs) and providing health care at home.

Prevalence and correlates of elder mistreatment in a community-dwelling population of U.S. Chinese older adults

Xinqi Dong, Ruijia Chen, Terry Fulmer, Melissa A. Simon

Objective: This study aimed to examine the prevalence and correlates of elder mistreatment among U.S. Chinese older adults. Method: Data were drawn from the Population-Based Study of ChINese Elderly (PINE) study, a population-based epidemiological survey of 3,159 U.S. Chinese older adults in the Greater Chicago area.

Physical function assessment in a community-dwelling population of U.S. Chinese older adults

Xinqi Dong, E. Shien Chang, Melissa A. Simon

Background. This report describes the levels of physical function in U.S. Chinese older adults utilizing self-reported and performance-based measures, and examines the association between sociodemographic characteristics and physical function.

Perceived barriers and facilitators to implement elder abuse intervention for victims and perpetrators: Views from US Chinese older adults

Xinqi Dong, E. Shien Chang, Esther Wong, Melissa A. Simon

Purpose – The purpose of this paper is to explore US Chinese older adults’ views regarding elder abuse interventions in order to understand barriers and facilitators of help-seeking behaviors.

Patient navigators’ reflections on the navigator-patient relationship

Sara Phillips, Narissa Nonzee, Laura Tom, Kara Murphy, Nadia Hajjar, Charito Bularzik, Xinqi Dong, Melissa A. Simon

Patient navigation emerged as a strategy to reduce cancer disparities among low-income and minority patients and has demonstrated efficacy in improving clinical outcomes.

Levels of health literacy in a community-dwelling population of Chinese older adults

Melissa A. Simon, Yu Li, Xinqi Dong

Background. Lower levels of health literacy have been associated with adverse health outcomes, especially for older adults. However, limited research has been conducted to understand health literacy levels among Chinese American older adults.

Improving diversity in cancer research trials: The story of the cancer disparities research network

Melissa A. Simon, Erika E. De La Riva, Raymond Bergan, Carrie Norbeck, June M. McKoy, Piotr Kulesza, Xinqi Dong, Julian Schink, Linda Fleisher

The participation of racial and ethnicminorities and underserved populations in clinical trials is a critical link between scientific innovation and improvements in health care delivery and health outcomes.

Experience of discrimination among U.S. Chinese older adults

Xinqi Dong, Ruijia Chen, Melissa A. Simon

Background. Experiences of discrimination are detrimental to health and well-being. This study aimed to examine experiences of discrimination and responses to unfair treatment among community-dwelling U.S. Chinese older adults.

Elder self-neglect is associated with an increased rate of 30-day hospital readmission: Findings from the chicago health and aging project

Xinqi Dong, Melissa A. Simon

Background/Aim: Elder self-neglect is associated with increased morbidity and mortality. The objective of this study is to examine the prospective relationship between reported elder self-neglect and the rate of 30-day hospital readmission in a community population.

Elder abuse and dementia: A review of the research and health policy

Xinqi Dong, Ruijia Chen, Melissa A. Simon

Older adults with dementia may be at high risk for abuse, but the topic has not been well studied. We conducted a literature review to examine the relationships between elder abuse and dementia.

Elder abuse: Research, practice, and health policy. the 2012 GSA Maxwell pollack award lecture

Xinqi Dong

Elder abuse, also called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse, neglect (caregiver neglect and self-neglect), and financial exploitation.

Do the definitions of elder mistreatment subtypes matter? Findings from the PINE study

Xinqi Dong

Background: Elder mistreatment (EM) is a pervasive public health issue and is associated with morbidity and premature mortality. This study aimed to examine how the prevalence of EM and its subtypes vary using different definitions among U.S. Chinese older adults.

Demographic characteristics of U.S. Chinese older adults in the Greater Chicago area: Assessing the representativeness of the PINE study

Melissa A. Simon, E. Shien Chang, Kumar Bharat Rajan, Mary Jane Welch, Xinqi Dong

Objective: We aimed to assess the representativeness of the demographic characteristics of the PINE study to the Chinese aging population in the Greater Chicago area.

Decline in cognitive function and elder mistreatment: Findings from the Chicago Health and Aging Project

Xinqi Dong, Melissa Simon, Todd Beck, Denis Evans

Objective: This study aimed to examine the longitudinal association between decline in cognitive function and elder mistreatment (EM). Methods: Chicago Health and Aging Project (CHAP) is an epidemiologic study conducted in a geographically defined community (N = 6,159).

Community-campus partnership in action: Lessons learned from the dupage county patient navigation collaborative

Athena T. Samaras, Kara Murphy, Narissa J. Nonzee, Richard Endress, Shaneah Taylor, Nadia Hajjar, Rosario Bularzik, Carmi Frankovich, Xinqi Dong, Melissa A. Simon

Background: Using community-based participatory research (CBPR), the DuPage County Patient Navigation Collaborative (DPNC) developed an academic campus-community research partnership aimed at increasing access to care for underserved breast and cervical cancer patients within DuPage County, a collar county of Chicago. Given rapidly shifting demographics, targeting CBPR initiatives among underserved suburban communities is essential.

Association of depressive symptomatology and elder mistreatment in a U.S. Chinese population: Findings from a community-based participatory research study

Xinqi Dong, E. Shien Chang, Esther Wong, Bernarda Wong, Melissa A. Simon

Elder mistreatment (EM) is associated with increased morbidity and mortality. The objective of this study is to examine the association between depressive symptoms and EM in a U.S. Chinese population.

A psychometric assessment of the psychological and social well-being indicators in the PINE study

E. Shien Chang, Todd Beck, Melissa A. Simon, Xinqi Dong

Objective: This report aims to establish the reliability and validity of five psychological and social well-being indictors in their applications to a U.S. Chinese aging population.

A population-based study of physical function and risk for elder abuse reported to social service agency: Findings from the Chicago health and aging project

Xinqi Dong, Melissa Simon, Denis Evans

We examined the association between physical function and the risk for reported elder abuse. In the Chicago Health and Aging Project (N = 8,932), 238 participants had reported elder abuse.

Anxiety among community-dwelling U.S. Chinese older adults

Xinqi Dong, Ruijia Chen, Melissa A. Simon

Background. This study aimed to explore the prevalence and correlates of anxiety disorders and any anxiety symptoms among community-dwelling U.S. Chinese older adults.

Addressing health and well-being of U.S. Chinese older adults through community-based participatory research: Introduction to the pine study

Xinqi Dong

The PINE Study-the Population Study of Chinese Elderly in Chicago, sōng nián yán jiū) is a population-based epidemiological study of U.S. Chinese older adults in the greater Chicago area with primary aims to examine their health status and well-being.

A battery of tests for assessing cognitive function in U.S. Chinese older adults-findings from the PINE study

E. Shien Chang, Xinqi Dong

Background. Existing methodological challenges in aging research has dampened our assessment of cognitive function among minority older adults. We aim to report the composite scores of five cognitive function tests among U.S. Chinese older adults, and examine the association between cognitive function and key sociodemographic characteristics.

Tuberculosis in human immunodeficiency virus-infected children starting antiretroviral therapy in Côte d’Ivoire

Andrew F. Auld, M. Z. Tuho, K. A. Ekra, J. Kouakou, R. W. Shiraishi, G. Adjorlolo-Johnson, Richard Marlink, T. V. Ellerbrock

SETTING: In Côte d’Ivoire, more than 2000 human immunodeficiency virus (HIV) infected children aged <15 years were started on antiretroviral therapy (ART) during 2004-2008.

Temporal trends in treatment outcomes for HIV-1 and HIV-2-infected adults enrolled in Côte d’Ivoire’s national antiretroviral therapy program

Andrew F. Auld, Kunomboa A. Ekra, Ray W. Shiraishi, Moise Z. Tuho, Joseph S. Kouakou, Fayama Mohamed, Virginie Ettieg̀ne-Traoré, Jennifer Sabatier, Joseph Essombo, Georgette Adjorlolo-Johnson, Richard Marlink, Tedd V. Ellerbrock

Background: In Côte d’Ivoire during 2004-2007, numbers of ART enrollees increased from <5,000 to 36,943. Trends in nationally representative ART program outcomes have not yet been reported.

Temporal trends in mortality and loss to follow-up among children enrolled in côte d’ivoire’s national antiretroviral therapy program

Andrew F. Auld, Moise Z. Tuho, Kunomboa A. Ekra, Ray W. Shiraishi, Fayama Mohamed, Joseph S. Kouakou, Virginie Ettiègne-Traoré, Jennifer Sabatier, Joseph Essombo, Emilia D. Rivadeneira, Georgette Adjorlolo-Johnson, Richard Marlink, Tedd V. Ellerbrock

Background: During 2004-2008, >2000 children (<15 years old) initiated antiretroviral therapy (ART) in Côte d'Ivoire. Nationally representative outcomes, temporal trends in outcomes during 2004-2008 and site-level outcome determinants have not been investigated.

Reproductive behaviour among women on antiretroviral therapy in Botswana: Mismatched pregnancy plans and contraceptive use

Michelle M. Schaan, Myra Taylor, Richard Marlink

Understanding pregnancy planning and contraceptive use is important in preventing unplanned/unwanted pregnancies among women on antiretroviral therapy (ART).

Pregnancy outcomes and birth defects from an antiretroviral drug safety study of women in South Africa and Zambia

K. Cherry Liu, Mansour Farahani, Tshililo Mashamba, Muthuhadini Mawela, Jessica Joseph, Nienke Van Schaik, Engela Honey, Michelle Gill, Waasila Jassat, Elizabeth M. Stringer, Namiwnga Chintu, Richard Marlink

Objective: To evaluate the safety of combination antiretroviral therapy (ART) in conception and pregnancy in different health systems. Design: A pilot ART registry to measure the prevalence of birth defects and adverse pregnancy outcomes in South Africa and Zambia.

Outcomes of the Botswana national HIV/AIDS treatment programme from 2002 to 2010: A longitudinal analysis

Mansour Farahani, Anusha Vable, Refeletswe Lebelonyane, Khumo Seipone, Marina Anderson, Ava Avalos, Tim Chadborn, Hailu Tilahun, Danae Roumis, Themba Moeti, Godfrey Musuka, Lesego Busang, Tendani Gaolathe, Kolaatamo C.S. Malefho, Richard Marlink

Background: Short-term mortality rates among patients with HIV receiving antiretroviral therapy (ART) in sub-Saharan Africa are higher than those recorded in high-income countries, but systematic long-term comparisons have not been made because of the scarcity of available data. We analysed the effect of the implementation of Botswana’s national ART programme, known as Masa, from 2002 to 2010.

Evaluation of the false recent classification rates of multiassay algorithms in estimating HIV type 1 subtype C incidence

Sikhulile Moyo, Tessa LeCuyer, Rui Wang, Simani Gaseitsiwe, Jia Weng, Rosemary Musonda, Hermann Bussmann, Madisa Mine, Susan Engelbrecht, Joseph Makhema, Richard Marlink, Marianna K. Baum, Vladimir Novitsky, M. Essex

Laboratory cross-sectional assays are useful for the estimation of HIV incidence, but are known to misclassify individuals with long-standing infection as recently infected.

Contextual factors in the health of people with serious mental illness

Leopoldo J. Cabassa, Elizabeth Siantz, Andel Nicasio, Peter Guarnaccia, Roberto Lewis-Fernández

People living with serious mental illness (SMI) have shorter life expectancies than the general population. We examined how contextual factors influence the physical health of this population. We conducted interviews, focus groups, and participant observations with stakeholders from six behavioral health organizations.

The New Jersey medicaid ACO demonstration project: Seeking opportunities for better care and lower costs among complex low-income patients

Joel Cantor, Sujoy Chakravarty, Jian Tong, Michael Yedidia, Oliver Lontok, Derek DeLia

A small but growing number of states are turning to accountable care concepts to improve their Medicaid programs. In 2011 New Jersey enacted the Medicaid Accountable Care Organization (ACO) Demonstration Project to offer local provider coalitions the opportunity to share any savings they generate.

Associations between food environment around schools and professionally measured weight status for middle and high school students

Xuyang Tang, Punam Ohri-Vachaspati, Joshua K. Abbott, Rimjhim Aggarwal, David Tulloch, Kristen Lloyd, Michael Yedidia

Background: Obesity rates among school-age children remain high. Access to energy-dense foods at home, in schools, in stores, and restaurants around homes and schools is of concern. Research on the relationship between food environment around schools and students’ weight status is inconclusive. This study examines the association between weight status of middle and high school students and proximity to a comprehensive set of food outlets around schools.

Validity of deterministic record linkage using multiple indirect personal identifiers linking a large registry to claims data

Soko Setoguchi Iwata, Ying Zhu, Jessica J. Jalbert, Lauren A. Williams, Chih Ying Chen

Background-Linking patient registries with administrative databases can enhance the utility of the databases for epidemiological and comparative effectiveness research. However, registries often lack direct personal identifiers, and the validity of record linkage using multiple indirect personal identifiers is not well understood.

Validity of claims-based stroke algorithms in contemporary medicare data: Reasons for geographic and racial differences in stroke (REGARDS) study linked with medicare claims

Hiraku Kumamaru, Suzanne E. Judd, Jeffrey R. Curtis, Rekha Ramachandran, N. Chantelle Hardy, J. David Rhodes, Monika M. Safford, Brett M. Kissela, George Howard, Jessica J. Jalbert, Thomas G. Brott, Soko Setoguchi Iwata

Background-The accuracy of stroke diagnosis in administrative claims for a contemporary population of Medicare enrollees has not been studied. We assessed the validity of diagnostic coding algorithms for identifying stroke in the Medicare population by linking data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study to Medicare claims.

Use of combination antihypertensive therapy initiation in older americans without prevalent cardiovascular disease

Xiaojuan Li, Wendy Camelo Castillo, Til Stürmer, Virginia Pate, Christine L. Gray, Ross J. Simpson, Soko Setoguchi Iwata, Laura C. Hanson, Michele Jonsson Funk

Objectives To describe new users of antihypertensive medications and identify predictors of combination therapy initiation in older Americans. Design Retrospective observational cohort study. Setting Population-based study using U.S. Medicare fee-for-service healthcare claims (2007-2010). Participants Medicare beneficiaries aged 65 and older with no recent diagnoses, procedures, or medications for cardiovascular disease who newly initiated an antihypertensive therapy (n = 275,493; 210,605 initiated monotherapy, 64,888 initiated combination therapy).

Methodological considerations in observational comparative effectiveness research for implantable medical devices: An epidemiologic perspective

Jessica J. Jalbert, Mary Elizabeth Ritchey, Xiaojuan Mi, Chih Ying Chen, Bradley G. Hammill, Lesley H. Curtis, Soko Setoguchi Iwata

Medical devices play a vital role in diagnosing, treating, and preventing diseases and are an integral part of the health-care system. Many devices, including implantable medical devices, enter the market through a regulatory pathway that was not designed to assure safety and effectiveness. Several recent studies and high-profile device recalls have demonstrated the need for well-designed, valid postmarketing studies of medical devices.

Linkage of a de-identified united states rheumatoid arthritis registry with administrative data to facilitate comparative effectiveness research

Jeffrey R. Curtis, Lang Chen, Aseem Bharat, Elizabeth Delzell, Jeffrey D. Greenberg, Leslie Harrold, Joel Kremer, Soko Setoguchi Iwata, Daniel H. Solomon, Fenglong Xie, Huifeng Yun

Objective. Linkages between registries and administrative data may provide a valuable resource for comparative effectiveness research. However, personal identifiers that uniquely identify individuals are not always available. Here we describe methods to link a de-identified arthritis registry and US Medicare data. The linked data set was also used to evaluate the generalizability of the registry to the US Medicare population.

Lifestyle factors as predictors of nonadherence to statin therapy among patients with and without cardiovascular comorbidities

Heli Halava, Maarit Jaana Korhonen, Risto Huupponen, Soko Setoguchi Iwata, Jaana Pentti, Mika Kivimäki, Jussi Vahtera

Methods: We included 9285 participants from the Finnish Public Sector Study who began statin therapy after completing the survey. We linked their survey data with data in national health registers. We used prescription dispensing data to determine participants’ nonadherence to statin therapy during the first year of treatment (defined as < 80% of days covered by filled prescriptions). We used logistic regression to estimate the association of several lifestyle factors with nonadherence, after adjusting for sex, age and year of statin initiation.

Influence of healthy candidate bias in assessing clinical effectiveness for implantable cardioverter-defibrillators: Cohort study of older patients with heart failure open access

Soko Setoguchi Iwata, Lynne Warner Stevenson, Garrick C. Stewart, Deepak L. Bhatt, Andrew E. Epstein, Manisha Desai, Lauren A. Williams, Chih Ying Chen

Objective: To assess the potential contribution of unmeasured general health status to patient selection in assessments of the clinical effectiveness of implantable cardioverter-defibrillator (ICD) therapy. Design: Retrospective cohort study. Setting: Linked data from an ICD registry, heart failure registry, and Medicare claims data for ICDs implanted in 2005 through 2009.

Association between the choice of IV crystalloid and in-hospital mortality among critically Ill adults with sepsis

Karthik Raghunathan, Andrew Shaw, Brian Nathanson, Til Stürmer, Alan Brookhart, Mihaela S. Stefan, Soko Setoguchi Iwata, Chris Beadles, Peter K. Lindenauer

OBJECTIVE:: Isotonic saline is the most commonly used crystalloid in the ICU, but recent evidence suggests that balanced fluids like Lactated Ringer’s solution may be preferable. We examined the association between choice of crystalloids and in-hospital mortality during the resuscitation of critically ill adults with sepsis.

Antidepressant use in pregnancy and the risk of cardiac defects

Krista F. Huybrechts, Kristin Palmsten, Jerry Avorn, Lee S. Cohen, Lewis B. Holmes, Jessica M. Franklin, Helen Mogun, Raisa Levin, Mary Kowal, Soko Setoguchi Iwata, Sonia Hernández-Díaz

BACKGROUND: Whether the use of selective serotonin-reuptake inhibitors (SSRIs) and other antidepressants during pregnancy is associated with an increased risk of congenital cardiac defects is uncertain. In particular, there are concerns about a possible association between paroxetine use and right ventricular outflow tract obstruction and between sertraline use and ventricular septal defects.

Comparative mortality risks of antipsychotic medications in community-dwelling older adults

Tobias Gerhard, K. Huybrechts, M. Olfson, S. Schneeweiss, W. V. Bobo, P. M. Doraiswamy, D. P. Devanand, J. A. Lucas, C. Huang, E. S. Malka, R. Levin, Stephen Crystal

Background All antipsychotic medications carry warnings of increased mortality for older adults, but little is known about comparative mortality risks between individual agents. Aims To estimate the comparative mortality risks of commonly prescribed antipsychotic agents in older people living in the community.

An adapted frailty-related phenotype and the VACS index as predictors of hospitalization and mortality in HIV-infected and uninfected individuals

Kathleen M. Akgün, Janet P. Tate, Kristina Crothers, Stephen Crystal, David A. Leaf, Julie Womack, Todd T. Brown, Amy C. Justice, Krisann K. Oursler

Background: Frailty is a geriatric syndrome of decreased physiologic reserve and a risk factor for hospitalization and mortality. We hypothesized that an adapted survey-based frailtyrelated phenotype (aFRP) predicts hospitalization and mortality among HIV-infected and uninfected individuals in adjusted models but is uncommon among those achieving undetectable HIV-1 RNA.

Antipsychotic medication use in nursing homes: A proposed measure of quality

Judith A. Lucas, Sujoy Chakravarty, John R. Bowblis, Tobias Gerhard, Ece Kalay, Eun Kwang Paek, Stephen Crystal

Objective: The potential misuse of antipsychotic medications (APMs) is an ongoing quality concern in nursing homes (NHs), especially given recent black box warnings and other evidence regarding the risk of APMs when used in NH populations. One mechanism regulators could use is public reporting of APM use by NHs; however, there is currently no agreed-upon measure of guideline-inconsistent APM use. In this paper, we describe a proposed measure of quality of APM use that is based on Centers for Medicare and Medicaid Services (CMS) Interpretive Guidelines, Food and Drug Administration (FDA) indications for APMs, and severity of behavioral symptoms.

Adherence to guidelines for glucose assessment in starting second-generation antipsychotics

Marsha A. Raebel, Robert Penfold, Ann W. McMahon, Marsha Reichman, Susan Shetterly, Glenn Goodrich, Susan Andrade, Christoph U. Correll, Tobias Gerhard

OBJECTIVES: In 2003, the US Food and Drug Administration issued warnings about hyperglycemia and diabetes with second-generation antipsychotics (SGAs); guidelines have recommended metabolic screening since 2004. However, little is known of contemporary practices of glucose screening among youth initiating SGAs. Our objective was to evaluate baseline glucose assessment among youth in the Mini-Sentinel Distributed Database starting an SGA. METHODS: The cohort included youth ages 2 through 18 newly initiating SGAs January 1, 2006, through December 31, 2011, across 10 sites. Baseline glucose was defined as fasting/random glucose or hemoglobin A1c (GLU) measurement occurring relative to first SGA dispensing. Differences in GLU assessment were evaluated with χ2 tests and logistic regression.

Home health agency work environments and hospitalizations

Olga Jarrin Montaner, Linda Flynn, Eileen T. Lake, Linda H. Aiken

Background: An important goal of home health care is to assist patients to remain in community living arrangements. Yet home care often fails to prevent hospitalizations and to facilitate discharges to community living, thus putting patients at risk of additional health challenges and increasing care costs.

Frontloading and Intensity of Skilled Home Health Visits: A State of the Science

Melissa O'Connor, Kathryn H. Bowles, Penny H. Feldman, Mary St. Pierre, Olga Jarrin, Shivani Shah, Christopher M. Murtaugh

Frontloading of skilled nursing visits is one way home health providers have attempted to reduce hospital readmissions among skilled home health patients. Upon review of the frontloading evidence, visit intensity emerged as being closely related. This state of the science presents a critique and synthesis of the published empirical evidence related to frontloading and visit intensity. OVID/Medline, PubMed, and Scopus were searched. Seven studies were eligible for inclusion. Further research is required to define frontloading and visit intensity, identify patients most likely to benefit, and to provide a better understanding of how home health agencies can best implement these strategies.

The moral and civic effects of learning to serve

Daniel Hart, M. Kyle Matsuba, Robert Atkins

By 1999, 64% of all public schools had students participating in service activities, and then between 1984 and 1999 the number of high schools offering community service opportunities rose from 27% to over 80% (National Center for Education Statistics, n.d.). More recently, in a 2007-2008 survey of 1,190 colleges, it was found that nearly one-third of students participated in service (Campus Compact, 2009).

Civic engagement and child and adolescent well-being

Daniel Hart, Kyle Matsuba, Robert Atkins

The implications of civic engagement for child and adolescent well-being are explored conceptually and empirically. To establish a foundation for this chapter, the meaning of well-being for individuals and societies is first considered. Flourishingis distinguished from pleasure and conventional success, and we argue that flourishing is (1) the essence of well-being, and (2) requires civic participation for its attainment. The evidence for dynamic relations among civic engagement in childhood and adolescence and individual and societal flourishing is reviewed and evaluated. We conclude that research to date supports the conclusion that fostering civic engagement among children and adolescents can promote well-being.

Strategies for postmarketing surveillance of drugs and devices in patients with ESRD undergoing dialysis

Moshe Vardi, Robert W. Yeh, Charles A. Herzog, Wolfgang C. Winkelmayer, Soko Setoguchi Iwata, David M. Charytan

The lack of evidence on the effectiveness and safety of interventions in chronic dialysis patients has been a subject of continuing criticism. Newtechnologies are often introduced into themarketwithout having specifically studied or even included patients with advanced kidney disease.

Treatment considerations for HIV-infected individuals with severe mental illness

Michael B. Blank, Seth Himelhoch, James Walkup, Marlene M. Eisenberg

There has been a general recognition of a syndemic that includes HIV/AIDS and serve mental illnesses including schizophrenia, major depression, bipolar disorder, post-traumatic stress disorder, and others.

Unicompartmental knee arthroplasty and total knee arthroplasty among medicare beneficiaries, 2000 to 2009

Michael P. Bolognesi, Melissa A. Greiner, David E. Attarian, Tyler Steven Watters, Samuel S. Wellman, Lesley H. Curtis, Keith R. Berend, Soko Setoguchi Iwata

Background: Unicompartmental knee arthroplasty is a less-invasive alternative to total knee arthroplasty for patients with arthritis affecting only the medial or lateral compartment. However, little is known about recent trends in the use of these procedures and the associated outcomes among older patients.

Using registries to identify adverse events in rheumatic diseases

Geraldina Lionetti, Yukiko Kimura, Laura E. Schanberg, Timothy Beukelman, Carol A. Wallace, Norman T. Ilowite, Jane Winsor, Kathleen Fox, Marc Natter, John S. Sundy, Eric Brodsky, Jeffrey R. Curtis, Vincent Del Gaizo, Solomon Iyasu, Angelika Jahreis, Ann Meeker-O'connell, Barbara B. Mittleman, Bernard M. Murphy, Eric D. Peterson, Sandra C. Raymond & 9 others

The proven effectiveness of biologics and other immunomodulatory products in inflammatory rheumatic diseases has resulted in their widespread use as well as reports of potential short- And longterm complications such as infection and malignancy.

Use of antidepressants near delivery and risk of postpartum hemorrhage: Cohort study of low income women in the United States

Kristin Palmsten, Sonia Hernández-Díaz, Krista F. Huybrechts, Paige L. Williams, Karin B. Michels, Eric D. Achtyes, Helen Mogun, Soko Setoguchi Iwata

Objective: To determine whether use of serotonin or non-serotonin reuptake inhibitors near to delivery is associated with postpartum hemorrhage. Design: Cohort study. Setting: 2000-07 nationwide Medicaid data (Medicaid Analytic eXtract). Population 106 000 pregnant women aged 12-55 with a diagnosis of mood or anxiety disorder.

Opioid use for noncancer pain and risk of fracture in adults: A nested case-control study using the general practice research database

Lin Li, Soko Setoguchi Iwata, Howard Cabral, Susan Jick

Opioid use has been reported to be associated with increased fracture risks. In a nested case-control study using the United Kingdom-based General Practice Research Database, we tested the hypotheses that fracture risk was associated with 1) an elevated risk of falls caused by the acute central nervous system effects of opioids including sedation and dizziness, and 2) osteoporosis caused by chronic opioid-induced hypogonadism.

Impact of immortal person-time and time scale in comparative effectiveness research for medical devices: A case for implantable cardioverter-defibrillators

Xiaojuan Mi, Bradley G. Hammill, Lesley H. Curtis, Melissa A. Greiner, Soko Setoguchi Iwata

Objectives: To assess the extent of immortal time bias in estimating the clinical effectiveness of implantable cardioverter-defibrillators (ICDs) and the impact of methods of handling immortal time bias.

Antidepressant Adherence among Latinos: The Role of the Family

Igda Martinez, Alejandro Interian, Peter Guarnaccia

Familismo (familism) has been introduced in various ways in Latino mental health. For people with mental illnesses such as depression, familism can create pressures that are treatment discouraging.

Neighborhood perceptions and active school commuting in low-income cities

Robin S. DeWeese, Michael Yedidia, David Tulloch, Punam Ohri-Vachaspati

Background: Few children accumulate the recommended ≥60 minutes of physical activity each day. Active travel to and from school (ATS) is a potential source of increased activity for children, accounting for 22% of total trips and time spent traveling by school-aged children.

A closer examination of the relationship between children’s weight status and the food and physical activity environment

Punam Ohri-Vachaspati, Kristen Lloyd, Derek DeLia, David Tulloch, Michael Yedidia

Objectives: Conflicting findings on associations between food and physical activity (PA) environments and children’s weight status demand attention in order to inform effective interventions. We assess relationships between the food and PA environments in inner-city neighborhoods and children’s weight status and address sources of conflicting results of prior research.

Antidepressant use and risk for preeclampsia

Kristin Palmsten, Krista F. Huybrechts, Karin B. Michels, Paige L. Williams, Helen Mogun, Soko Setoguchi Iwata, Sonia Hernández-Díaz

BACKGROUND: Prior studies suggest that women who use antidepressants during pregnancy have an increased risk for preeclampsia, yet the comparative safety of specific antidepressants remains unclear. US nationwide Medicaid Analytic eXtract (MAX) data have not been used to study medication safety during pregnancy.

Algorithms to estimate the beginning of pregnancy in administrative databases

Andrea V. Margulis, Soko Setoguchi Iwata, Murray A. Mittleman, Robert J. Glynn, Colin R. Dormuth, Sonia Hernández-Díaz

Purpose: The role of administrative databases for research on drug safety during pregnancy can be limited by their inaccurate assessment of the timing of exposure, as the gestational age at birth is typically unavailable. Therefore, we sought to develop and validate algorithms to estimate the gestational age at birth using information available in these databases.

Variations in postoperative complications according to race, ethnicity, and sex in older adults

J. Margo Brooks Carthon, Olga Jarrin, Douglas Sloane, Ann Kutney-Lee

Objectives To explore differences in the incidence of postoperative complications between three racial and ethnic groups (white, black, Hispanic) before and after taking into account potentially confounding patient and hospital characteristics.

Persistently elevated serum interleukin-6 predicts mortality among adults receiving combination antiretroviral therapy in Botswana: Results from a clinical trial

Bethan McDonald, Sikhulile Moyo, Lesego Gabaitiri, Simani Gaseitsiwe, Hermann Bussmann, John R. Koethe, Rosemary Musonda, Joseph Makhema, Vladimir Novitsky, Richard Marlink, C. William Wester, Max Essex

Elevated serum levels of inflammatory biomarkers have been associated with increased mortality and morbidity among HIV-infected individuals receiving combination antiretroviral therapy (cART) in European and U.S. cohorts. Few similar data are available from sub-Saharan Africa, where most cART-treated adults reside and the prevalence of advanced immunosuppression and opportunistic infections (OIs) at cART initiation is higher.

Harnessing the Medicaid Analytic eXtract (MAX) to Evaluate Medications in Pregnancy: Design Considerations

Kristin Palmsten, Krista F. Huybrechts, Helen Mogun, Mary K. Kowal, Paige L. Williams, Karin B. Michels, Soko Setoguchi Iwata, Sonia Hernández-Díaz

Background:In the absence of clinical trial data, large post-marketing observational studies are essential to evaluate the safety and effectiveness of medications during pregnancy. We identified a cohort of pregnancies ending in live birth within the 2000-2007 Medicaid Analytic eXtract (MAX). Herein, we provide a blueprint to guide investigators who wish to create similar cohorts from healthcare utilization data and we describe the limitations in detail.

Reasons for unmet need for child and family health services among children with special health care needs with and without medical homes

Jane Miller, Colleen N. Nugent, Dorothy Gaboda, Louise B. Russell

Objectives: Medical homes, an important component of U.S. health reform, were first developed to help families of children with special health care needs (CSHCN) find and coordinate services, and reduce their children’s unmet need for health services.

Appropriateness of cardiovascular care in elderly adult cancer survivors

Winson Y. Cheung, Raisa Levin, Soko Setoguchi Iwata

Research suggests that the quality of non-cancer-related care among cancer survivors (CS) is suboptimal. Secondary disease prevention is an important component of survivorship care that has not been previously evaluated. Our aims were (1) to assess the utilization of and adherence to medications and treatments for the secondary prevention of myocardial infarction (MI) in CS versus non-cancer patients (NCP) and (2) to compare temporal trends in cardiovascular care between these two patient cohorts.

Claims-Based Definition of Death in Japanese Claims Database: Validity and Implications

Nobuhiro Ooba, Soko Setoguchi Iwata, Takashi Ando, Tsugumichi Sato, Takuhiro Yamaguchi, Mayumi Mochizuki, Kiyoshi Kubota

Background: For the pending National Claims Database in Japan, researchers will not have access to death information in the enrollment files. We developed and evaluated a claims-based definition of death.

Impact of baseline heart failure burden on post-implantable cardioverter-defibrillator mortality among medicare beneficiaries

Chih Ying Chen, Lynne Warner Stevenson, Garrick C. Stewart, John D. Seeger, Lauren Williams, Jessica J. Jalbert, Soko Setoguchi Iwata

Objectives: This study sought to assess the impact of baseline heart failure (HF) burden on survival with primary implantable cardioverter- defibrillator (ICD) among Medicare recipients. Background: Survival after primary ICD implantation may differ between trial and Medicare populations.

Opioid use for noncancer pain and risk of myocardial infarction amongst adults

L. Li, Soko Setoguchi Iwata, H. Cabral, S. Jick

Backgrounds: With increasing use of opioids for chronic noncancer pain comes concern about safety of this class of drugs. Opioid-induced hypogonadism, which could increase the risk for myocardial infarction (MI), has recently come to the attention of clinicians.

National trends in antidepressant medication treatment among publicly insured pregnant women

Krista F. Huybrechts, Kristin Palmsten, Helen Mogun, Mary Kowal, Jerry Avorn, Soko Setoguchi Iwata, Sonia Hernández-Díaz

Objective: The risk of depression in women is greatest at childbearing age. We sought to examine and explain national trends in antidepressant use in pregnant women.

Enrollment and events of hospice patients with heart failure vs. cancer

Winson Y. Cheung, Kristen Schaefer, Christopher W. May, Robert J. Glynn, Lesley H. Curtis, Lynne W. Stevenson, Soko Setoguchi Iwata

Context: Hospice care is traditionally used for patients with advanced cancer, but it is increasingly considered for patients with end-stage heart failure. Objectives: We compared enrollment patterns and clinical events of hospice patients with end-stage heart failure with those of patients with advanced cancer.

Follow-up of patients with new cardiovascular implantable electronic devices: Are experts’ recommendations implemented in routine clinical practice?

Sana M. Al-Khatib, Xiaojuan Mi, Bruce L. Wilkoff, Laura G. Qualls, Camille Frazier-Mills, Soko Setoguchi Iwata, Paul L. Hess, Lesley H. Curtis

Background – A 2008 expert consensus statement outlined the minimum frequency of follow-up of patients with cardiovascular implantable electronic devices (CIEDs). Methods and Results – We studied 38 055 Medicare beneficiaries who received a new CIED between January 1, 2005, and June 30, 2009. The main outcome measure was variation of follow-up by patient factors and year of device implantation.

Who enrolls in the medicare part D prescription drug benefit program? Medication use among patients with heart failure

Zubin J. Eapen, Bradley G. Hammill, Soko Setoguchi Iwata, Kevin A. Schulman, Eric D. Peterson, Adrian F. Hernandez, Lesley H. Curtis

Background–Dispensing data from Medicare Part D standalone prescription drug plans are now available, but characteristics of enrollees with heart failure have not been well described.

Simultaneous vs Staged bilateral total knee arthroplasty among medicare beneficiaries, 2000-2009

Michael P. Bolognesi, Tyler Steven Watters, David E. Attarian, Samuel S. Wellman, Soko Setoguchi Iwata

Simultaneous bilateral total knee arthroplasty (TKA) reportedly has higher postoperative complication rates than staged procedures, but little is known about recent trends and outcomes among Medicare patients.

Heart failure: Transitional adherence and persistence in the use of aldosterone antagonist therapy in patients with heart failure

Lesley H. Curtis, Xiaojuan Mi, Laura G. Qualls, Devon K. Check, Bradley G. Hammill, Stephen C. Hammill, Paul A. Heidenreich, Frederick A. Masoudi, Soko Setoguchi Iwata, Adrian F. Hernandez, Gregg C. Fonarow

Background Aldosterone antagonist therapy is recommended for selected patients with heart failure and reduced ejection fraction. Adherence to therapy in the transition from hospital to home is not well understood.

Epidemiologic and Statistical Methods for Comparative Effectiveness Research

Mark A. Hlatky, Wolfgang C. Winkelmayer, Soko Setoguchi Iwata

Observational methods are evolving in response to the widespread availability of data from clinical registries, electronic health records, and administrative databases. These approaches will never eliminate the need for randomized trials, but clearly have a role in evaluating the effect of therapies in unselected populations treated in routine practice. This article reviews several approaches to the analysis of observational data that are in common use, or that may have promise even though they are not yet often applied.

Scaling up pediatric HIV care and treatment in Africa: Clinical site characteristics associated with favorable service utilization

Georgette Adjorlolo-Johnson, Andrea Wahl Uheling, Shobana Ramachandran, Susan Strasser, Joseph Kouakou, Denis Tindyebwa, Cathrien Alons, Tshiwela Neluheni, Stephen Lee, Richard Marlink

Background: To improve pediatric enrollment and retention in HIV treatment programs in Africa, we examined factors associated with service utilization within the Elizabeth Glaser Pediatric AIDS Foundation program in Côte d’Ivoire, Mozambique, South Africa, Tanzania and Zambia.

Comparative cardiovascular safety of dementia medications: A cross-national study

Emil L. Fosbøl, Eric D. Peterson, Ellen Holm, Gunnar H. Gislason, Yinghong Zhang, Lesley H. Curtis, Lars Kober, Isao Iwata, Christian Torp-Pedersen, Soko Setoguchi Iwata

Objectives To compare the cardiovascular safety of currently marketed dementia medications in new users in the United States and Denmark. Design Retrospective cohort study. Setting Nationally representative sample of Medicare beneficiaries from 2006 through 2009 and nationwide Danish administrative registries from 1997 through 2007.

How the global call for elimination of pediatric HIV can support HIV-positive women to achieve their pregnancy intentions

Corinne I. Mazzeo, Elizabeth H. Flanagan, Emily A. Bobrow, Christian S. Pitter, Richard Marlink

The global call to eliminate new pediatric HIV infections requires a comprehensive approach, including consideration of the pregnancy intentions of HIV-positive women.

Outcomes associated with warfarin use in older patients with heart failure and atrial fibrillation and a cardiovascular implantable electronic device: Findings from the ADHERE registry linked to medicare claims

Paul L. Hess, Melissa A. Greiner, Gregg C. Fonarow, Winslow Klaskala, Roger M. Mills, Soko Setoguchi Iwata, Sana M. Al-Khatib, Adrian F. Hernandez, Lesley H. Curtis

Background: Warfarin use and associated outcomes in patients with heart failure and atrial fibrillation and a cardiovascular implantable electronic device have not been described previously.

Implications of m bias in epidemiologic studies: A simulation study

Liu Wei, M. Alan Brookhart, Sebastian Schneeweiss, Xiaojuan Mi, Soko Setoguchi Iwata

Collider-stratification bias arises from conditioning on a variable (collider) which opens a path from exposure to outcome. M bias occurs when the collider-stratification bias is transmitted through ancestors of exposure and outcome.

Serious mental illness and risk of new HIV/AIDS diagnoses: An analysis of medicaid beneficiaries in eight states

Jonathan D. Prince, James Walkup, Ayse Akincigil, Shahla Amin, Stephen Crystal

Objective: A longitudinal analysis was used to explore the relationship between diagnosis of serious mental illness and subsequent new diagnoses of HIV. Methods: Logistic regression was used to predict HIV/AIDS diagnoses in 2002-2004 among Medicaid beneficiaries in eight states (N=6,417,676) who were without HIV in 2001.

Completion of guideline-recommended initial evaluation of atrial fibrillation

Moritz F. Sinner, Melissa A. Greiner, Xiaojuan Mi, Adrian F. Hernandez, Paul N. Jensen, Jonathan P. Piccini, Soko Setoguchi Iwata, Allan J. Walkey, Susan R. Heckbert, Emelia J. Benjamin, Lesley H. Curtis

Background: Guidelines recommend evaluation of cardiac function, valvular and ischemic heart disease, and thyroid, kidney, and liver function on initial diagnosis of atrial fibrillation (AF).

Sexual and reproductive health needs of HIV-positive women in Botswana – A study of health care worker’s views

Michelle M. Schaan, Myra Taylor, John Puvimanasinghe, Lesego Busang, Koona Keapoletswe, Richard Marlink

Botswana’s HIV prevalence is one of the highest in the world at 31.8% in the 15-49 years antenatal population. Being HIV-positive for a woman presents unique challenges with regard to sexuality, child bearing, and partner relations.

Effect modification by sex and baseline CD4+ cell count among adults receiving combination antiretroviral therapy in botswana: Results from a clinical trial

C. William Wester, Ori M. Stitelman, Victor Degruttola, Hermann Bussmann, Richard Marlink, Mark J. Van Der Laan

The Tshepo study was the first clinical trial to evaluate outcomes of adults receiving nevirapine (NVP)-based versus efavirenz (EFV)-based combination antiretroviral therapy (cART) in Botswana. This was a 3 year study (n=650) comparing the efficacy and tolerability of various first-line cART regimens, stratified by baseline CD4+: <200 (low) vs. 201-350 (high).

Risk factors for symptomatic hyperlactatemia and lactic acidosis among combination antiretroviral therapy-treated adults in Botswana: Results from a clinical trial

C. William Wester, Svetlana K. Eden, Bryan E. Shepherd, Hermann Bussmann, Vladimir Novitsky, David C. Samuels, Sher L. Hendrickson, Cheryl A. Winkler, Stephen J. O'Brien, Max Essex, Richard T. D'Aquila, Victor Degruttola, Richard Marlink

Nucleoside analogue reverse transcriptase inhibitors are an integral component of combination antiretroviral treatment regimens. However, their ability to inhibit polymerase-γ has been associated with several mitochondrial toxicities, including potentially life-threatening lactic acidosis.

‘We eat meat every day’: Ecology and economy of dietary change among Oaxacan migrants from Mexico to New Jersey

Peter Guarnaccia, Teresa Vivar, Anne C. Bellows, Gabriela V. Alcaraz

In the late twentieth and early twenty-first centuries, the USA has experienced large-scale and continuing immigration from around the world, especially Latin America and, within Latin America, from Mexico.

The integrality of situated caring in nursing and the environment

Olga Jarrin

Much emphasis has been placed on the importance of the environment as a determinant of health; however, little theoretical work in nursing has specifically articulated the importance of the nursing practice environment as a factor in patient outcomes. This work advances the unitary-transformative- caring paradigm by focusing on the concept of integrality and exploring the nursing meta-paradigm concepts (nursing, environment, human being, and health) through integral philosophical inquiry.

Applying propensity scores estimated in a full cohort to adjust for confounding in subgroup analyses

Jeremy A. Rassen, Robert J. Glynn, Kenneth J. Rothman, Soko Setoguchi Iwata, Sebastian Schneeweiss

Background: A correctly specified propensity score (PS) estimated in a cohort (“cohort PS”) should, in expectation, remain valid in a subgroup population. Objective: We sought to determine whether using a cohort PS can be validly applied to subgroup analyses and, thus, add efficiency to studies with many subgroups or restricted data.

Nurse staffing and postsurgical outcomes in black adults

J. Margo Brooks Carthon, Ann Kutney-Lee, Olga Jarrin, Douglas Sloane, Linda H. Aiken

OBJECTIVES: To determine the association between nurse staffing and postsurgical outcomes for older black adults, including 30-day mortality and failure to rescue. DESIGN: A cross-sectional study of University of Pennsylvania Multi-State Nursing Care and Patient Safety Survey data, linked to 2006-2007 administrative patient discharge data from four states (CA, PA, NJ, FL), American Hospital Association Annual Survey data, and a U.S. Census-derived measure of socioeconomic status (SES).

Elevated risk of preeclampsia in pregnant women with depression: Depression or antidepressants?

Kristin Palmsten, Soko Setoguchi Iwata, Andrea V. Margulis, Amanda R. Patrick, Sonia Hernández-Díaz

A previous study suggested an increased risk of preeclampsia among women treated with selective serotonin reuptake inhibitors (SSRIs). Using population-based health-care utilization databases from British Columbia (1997-2006), the authors conducted a study of 69,448 pregnancies in women with depression.

Gender-sensitive reporting in medical research

Shirin Heidari, Quarraisha Abdool Karim, Judith D. Auerbach, Simone E. Buitendijk, Pedro Cahn, Mirjam J. Curno, Catherine Hankins, Elly Katabira, Susan Kippax, Richard Marlink, Joan Marsh, Ana Marusic, Heidi M. Nass, Julio Montaner, Elizabeth Pollitzer, Maria Teresa Ruiz-Cantero, Lorraine Sherr, Papa Salif Sow, Kathleen Squires, Mark A. Wainberg

Sex and gender differences influence the health and wellbeing of men and women. Although studies have drawn attention to observed differences between women and men across diseases, remarkably little research has been pursued to systematically investigate these underlying sex differences.

Racial and ethnic disparities in depression care in community-dwelling elderly in the United States

Ayse Akincigil, Mark Olfson, Michele Siegel, Karen A. Zurlo, James Walkup, Stephen Crystal

Objectives. We investigated racial/ethnic disparities in the diagnosis and treatment of depression among community-dwelling elderly. Methods. We performed a secondary analysis of Medicare Current Beneficiary Survey data (n=33708) for 2001 through 2005.

Unresolved antiretroviral treatment management issues in HIV-infected children

Shirin Heidari, Lynne M. Mofenson, Charlotte V. Hobbs, Mark F. Cotton, Richard Marlink, Elly Katabira

Antiretroviral therapy in children has expanded dramatically in low-income and middle-income countries. The World Health Organization revised its pediatric HIV guidelines to recommend initiation of antiretroviral therapy in all HIV-infected children younger than 2 years, regardless of CD4 count or clinical stage.

Factors Influencing School Psychologists’ “Willingness to Implement” Evidence-Based Interventions

Susan Forman, Nancy Fagley, Brian Chu, James Walkup

Cognitive-behavioral interventions are effective in preventing and treating various child and adolescent mental health problems and are useful components in treating pediatric medical disorders.

A systematic review of validated methods for identifying suicide or suicidal ideation using administrative or claims data

James Walkup, Lisa Townsend, Stephen Crystal, Mark Olfson

Purpose: As part of the Mini-Sentinel pilot program, under contract with the Food and Drug Administration, an effort has been made to evaluate the validity of algorithms useful for identifying health outcomes of interest, including suicide and suicide attempt.

Design and rationale of a retrospective clinical effectiveness study of aldosterone antagonist therapy in patients with heart failure

Lesley H. Curtis, Xiaojuan Mi, Laura G. Qualls, Bradley G. Hammill, Stephen C. Hammill, Paul A. Heidenreich, Frederick A. Masoudi, Soko Setoguchi Iwata, Adrian F. Hernandez, Gregg C. Fonarow

Background: Despite demonstrated efficacy in randomized trials, aldosterone antagonist therapy is not used in many eligible patients with heart failure. Questions remain about its clinical effectiveness and safety for patients who are underrepresented in randomized trials and those at risk for hyperkalemia.

Validation of a point-of-care lactate device for screening at-risk adults receiving combination antiretroviral therapy in Botswana

Sikhulile Moyo, Hermann Bussmann, Phibeon Mangwendeza, Priti Dusara, Tendani Gaolathe, Madisa Mine, Rosemary Musonda, Erik van Widenfelt, Vladimir Novitsky, Joseph Makhema, Richard Marlink, Max Essex, C. William Wester

Background: Nucleoside reverse-transcriptase inhibitors (NRTIs) are a major component of combination antiretroviral therapy (cART) worldwide but they have been associated with mitochondrial toxicities, with one of the most significant being lactic acidosis.

Antidepressant treatment and adherence to antiretroviral medications among privately insured persons with HIV/AIDS

Ayse Akincigil, Ira B. Wilson, James Walkup, Michele J. Siegel, Cecilia Huang, Stephen Crystal

In order to examine relationships between depression treatments (antidepressant and/or psychotherapy utilization) and adherence to antiretroviral therapy (ART), we conducted a retrospective analysis of medical and pharmacy insurance claims for privately insured persons living with HIV/AIDS (PLWHA) diagnosed with depression (n = 1,150). Participants were enrolled in 80 insurance plans from all 50 states. Adherence was suboptimal. Depression treatment initiators were significantly more likely to be adherent to ART than the untreated. We did not observe an association between psychotherapy utilization and ART adherence, yet given the limitations of the data (e.g., there is no information on types of psychological treatment and its targets), the lack of association should not be interpreted as lack of efficacy.

Antiretroviral drugs for preventing mother-to-child transmission of HIV: A review of potential effects on HIV-exposed but uninfected children

Shirin Heidari, Lynne Mofenson, Mark F. Cotton, Richard Marlink, Pedro Cahn, Elly Katabira

The provision of antiretroviral drugs for the prevention of mother-to-child HIV transmission has been rising sharply in low- and middle-income countries. Changes to the World Health Organization guidelines support further extension of these programs.

Non-AIDS-defining events among HIV-1-infected adults receiving combination antiretroviral therapy in resource-replete versus resource-limited urban setting

C. William Wester, John R. Koethe, Bryan E. Shepherd, Samuel E. Stinnette, Peter F. Rebeiro, Aaron M. Kipp, Hwanhee Hong, Hermann Bussmann, Tendani Gaolathe, Catherine C. McGowan, Timothy R. Sterling, Richard Marlink

Objective: To compare incidence and distribution of non-AIDS-defining events (NADEs) among HIV-1-infected adults receiving combination antiretroviral therapy (cART) in urban sub-Saharan African versus United States settings.

Perceived discrimination and antisocial behaviors in Puerto Rican Children

Fernando Rivera, Irene López, Peter Guarnaccia, Rafael Ramirez, Glorisa Canino, Hector Bird

This study examined whether perceived discrimination was related to antisocial behaviors (ASB) in a probability sample of Puerto Rican children living in the South Bronx, New York and the San Juan Metropolitan area of Puerto Rico (N = 1,271).

Contextualizing the trauma experience of women immigrants from Central America, South America, and Mexico

Stacey Kaltman, Alejandra Hurtado de Mendoza, Felisa A. Gonzales, Adriana Serrano, Peter Guarnaccia

Trauma has been understudied among Latina immigrants from Central and South America. This study examined the types and context of trauma exposure experienced by immigrant women from Central America, South America, and Mexico living in the United States.

Ataques de Nervios and Somatic Complaints Among Island and Mainland Puerto Rican Children

Irene Lopez, Rafael Ramirez, Peter Guarnaccia, Glorisa Canino, Hector Bird

Previous research has documented the association between the Latino cultural idiom of distress, ataques de nervios (i.e., “attacks of nerves”), and unexplained neurological symptoms among adults. However, the associations between ataques and somatic complaints in children have not been sufficiently explored.

Association of frontal and posterior cortical gray matter volume with time to alcohol relapse: A prospective study

enneth Rando, Kwang Ik Hong, Zubin Bhagwagar, Chiang Shan Ray Li, Bergquist Keri, Peter Guarnaccia, Rajita Sinha

Objective: Alcoholism is associated with gray matter volume deficits in frontal and other brain regions. Whether persistent brain volume deficits in abstinence are predictive of subsequent time to alcohol relapse has not been established. The authors measured gray matter volumes in healthy volunteers and in a sample of treatment-engaged, alcohol-dependent patients after 1 month of abstinence and assessed whether smaller frontal gray matter volume was predictive of subsequent alcohol relapse outcomes.

Improving data accuracy of commercial food outlet databases

Punam Ohri-Vachaspati, Diane Martinez, Michael Yedidia, Nirvana Petlick

Purpose. Assessing food environments often requires using commercially available data. Disparate methods used for classifying food outlets in these databases call for creating a classification approach using common definitions. A systematic strategy for reclassifying food stores and restaurants, as they appear in commercial databases, into categories that differentiate the availability of healthy options is described here.

Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005

Ayse Akincigil, Mark Olfson, James Walkup, Michele J. Siegel, Ece Kalay, Shahla Amin, Karen A. Zurlo, Stephen Crystal

OBJECTIVE: To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer-generation antidepressants. DESIGN: Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005.

Prevalence of transmitted HIV drug resistance in Botswana: Lessons learned from the HIVDR-threshold survey conducted among women presenting for routine antenatal care as part of the 2007 national sentinel survey

Hermann Bussmann, Florindo De La Hoz Gomez, Thierry H. Roels, C. William Wester, Stephane M. Bodika, Sikhulile Moyo, Negussie Taffa, Marina G. Anderson, Madisa Mine, Ebi Celestin Bile, Chunfu Yang, Kereng Mphoyakgosi, Erica Ann Lehotzky, Busisiwe Mlotshwa, Mpho Mmelesi, Khumo Seipone, Moeketsi J. Makhema, Richard Marlink, Vladimir Novitsky, M. Essex

The emergence and spread of transmitted drug resistance (TDR) poses a major threat to the success of the rapidly expanding antiretroviral treatment (ART) programs in resource-limited countries.

Parental eligibility and enrollment in state children’s health insurance program: The roles of parental health, employment, and family structure

Jane Miller, Dorothy Gaboda, Colleen N. Nugent, Theresa M. Simpson, Joel Cantor

We examined eligibility and enrollment among parents of children in New Jersey’s State Children’s Health Insurance Program following expansion of parental eligibility for NJ FamilyCare coverage. Data were from the 2003 NJ FamilyCare Family Health Survey (n=416 families). Parental eligibility was higher in households without a full-time employedparent(oddsratio [OR]=5.50; 95% confidence interval [CI]=2.72, 11.14) and lower among single parents (OR=0.38; 95% CI=0.23, 0.61). Enrollment was higher among single parents (OR=2.24; 95% CI=1.17, 4.31). Roughly one third of eligible parents did not enroll, suggesting the need to increase awareness of parental eligibility and reduce barriers to enrollment.

Patterns and correlates of tic disorder diagnoses in privately and publicly insured youth

Mark Olfson, Stephen Crystal, Tobias Gerhard, Cecilia Huang, James Walkup, Lawrence Scahill, John T. Walkup

Objective This study examined the prevalence and demographic and clinical correlates of children diagnosed with Tourette disorder, chronic motor or vocal tic disorder, and other tic disorders in public and private insurance plans over the course of a 1-year period.

Bipolar medication use and adherence to antiretroviral therapy among patients with HIV-AIDS and bipolar disorder

James Walkup, Ayse Akincigil, Sujoy Chakravarty, Mark Olfson, Scott Bilder, Shahla Amin, Michele J. Siegel, Stephen Crystal

Objective: The study examined relationships between adherence to bipolar medication and to antiretroviral therapy, measured by medication fills, among patients with diagnoses of bipolar disorder and HIV infection. Methods: A retrospective study was conducted of Medicaid claims data (2001-2004) from eight states, focusing on antiretroviral adherence. The unit of analysis was person-month (N=53,971). The average observation period for the 1,687 patients was 32 months.

Prevalence of diagnosed HIV disease among medicaid beneficiaries with schizophrenia in U.S. metropolitan areas

James Walkup, Ayse Akincigil, Shahla Amin, Donald Hoover, Michele Siegel, Stephen Crystal

Numerous reports suggest HIV may be elevated among those with severe mental illnesses such as schizophrenia or bipolar illness, but this has been studied in only a limited number of sites. Medicaid claim’s files from 2002 to 2003 were examined for metropolitan statistical areas (MSAs) in 8 states, focusing on schizophrenia. Across 102 MSAs, 1.81% of beneficiaries with schizophrenia had received diagnoses of HIV/AIDS. MSA rates ranged widely, from 5.2% in Newark, NJ, to no cases in 16 of the MSAs.

Development of a Measure of “Acculturation” for Ethnic Fijians: MethodologiC and Conceptual Considerations for Application to Eating Disorders Research

Anne E. Becker, Kristen Fay, Jessica Agnew-Blais, Peter Guarnaccia, Ruth H. Striegel-Moore, Stephen E. Gilman

Acculturation has been examined as a risk factor for eating disorders, but interpretation of findings has been limited by inconsistent operationalization of this construct across studies.

Ataque de nervios as a marker of social and psychiatric vulnerability: Results from the NLAAS

Peter Guarnaccia, Roberto Lewis-Fernandez, Igda Martinez Pincay, Patrick Shrout, Jing Guo, Maria Torres, Glorisa Canino, Margarita Alegria

Background: This article presents the fi rst epidemiological portrait of ataques de nervios among Latinos in the mainland United States. Much of the previous literature has focused on Puerto Ricans in Puerto Rico and New York City.

Association of trauma-related disorders and dissociation with four idioms of distress among Latino psychiatric outpatients

Roberto Lewis-Fernández, Magdaliz Gorritz, Greer A. Raggio, Clara Peláez, Henian Chen, Peter Guarnaccia

Past research on idioms of distress among U. S. Latinos has revealed that ataque de nervios and altered perceptions, such as hearing and seeing things when alone, are independent markers of higher morbidity and mental health utilization despite having no one-to-one relationships with any single psychiatric diagnosis.

Adaptation of a Motivational Interviewing Intervention to Improve Antidepressant Adherence Among Latinos

Alejandro Interian, Igda Martinez, Lisbeth Iglesias Rios, Jonathan Krejci, Peter Guarnaccia

Poor antidepressant adherence is a significant issue in depression treatment that adversely affects treatment outcomes. Although being a common problem, it tends to be more common among Latinos.

Core Elements of U.S. Nurse Practice Acts and Incorporation of Nursing Diagnosis Language

Olga Jarrin Montaner

Purpose: This paper describes the core elements of U.S. nurse practice acts and provides an update of Lavin, Meyer, and Carlson (1999) Review of the Use of Nursing Diagnosis in U.S. Nurse Practice Acts. Methods: Nurse practice acts from all states and the District of Columbia were collected and analyzed using qualitative content analysis with the software NVivo8. Findings: Major themes identified were nursing “care,” nursing process, supervision/delegation, executing the medical regimen, health maintenance/prevention, and teaching nursing.

Quantitative literacy across the curriculum: Integrating skills from english composition, mathematics, and the substantive disciplines

Jane Miller

Quantitative literacy is an important profi ciency that pertains to “word problems” from science, history, and other fi elds. Unfortunately, teaching how to solve such problems often is relegated to math courses alone. This article examines how quantitative literacy also involves concepts and skills from English composition and the substantive disciplines. The author outlines a systematic approach to writing the answers to word problems-a fundamental skill that applies to ongoing education, everyday life, and the workplace.

HIV patients with psychiatric disorders are less likely to discontinue HAART

Seth Himelhoch, Clayton H. Brown, James Walkup, Geetanjali Chander, P. Todd Korthius, Joseph Afful, Kelly A. Gebo

OBJECTIVE: We examined whether having a psychiatric disorder among HIV-infected individuals is associated with differential rates of discontinuation of HAART and whether the number of mental health visits impact these rates.

Significance of endorsement of psychotic symptoms by US latinos

Roberto Lewis-Fernández, Marcela Horvitz-Lennon, Carlos Blanco, Peter Guarnaccia, Zhun Cao, Margarita Alegría

In US regional studies, Latinos frequently endorse psychotic symptoms associated with impairment and mental health service use, yet do not meet criteria for psychotic disorder. Using a nationally representative Latino sample (N = 2554), we examined the prevalence of psychotic symptoms, their relationship to psychotic disorder, their correlates, and their relationship to mental health outcomes.

Religiosity and spiritual engagement in two American Indian populations

Eva M. Garroutte, Janette Beals, Ellen M. Keane, Carol Kaufman, Paul Spicer, Jeff Henderson, Patricia N. Henderson, Christina M. Mitchell, Spero M. Manson, Cecelia K. Big Crow, Dedra Buchwald, Buck Chambers, Michelle L. Christensen, Denise A. Dillard, Karen DuBray, Paula A. Espinoza, Candace M. Fleming, Ann Wilson Frederick, Joseph Gone, Diana Gurley & 66 others

Social scientific investigation into the religiospiritual characteristics of American Indians rarely includes analysis of quantitative data. After reviewing information from ethnographic and autobiographical sources, we present analyses of data from a large, population-based sample of two tribes (n = 3,084).

Ataques de nervios and their psychiatric correlates in puerto rican children from two different contexts

Irene López, Fernando Rivera, Rafael Ramirez, Peter Guarnaccia, Glorisa Canino, Héctor R. Bird

Among Latino adults and children, ataques de nervios has been associated with an array of psychiatric disorders. Using data from a probability sample of Puerto Rican children, aged 5 to 13 years (N = 2491), we assessed the lifetime prevalence and psychiatric correlates of ataques in youth residing in the South Bronx, New York and San Juan, Puerto Rico.

What do prospective research participants want to know? What do they assume they know already?

James Walkup, Elinor Bock

Using a framework based on conversational pragmatics, data were collected on spontaneous information requests by people who were invited to participate in a simple research study.

Psychiatric diagnosis and antiretroviral adherence among adolescent medicaid beneficiaries diagnosed with human immunodeficiency virus/acquired immunodeficiency syndrome

James Walkup, Ayse Akincigil, Scott Bilder, Nancy Scotto Rosato, Stephen Crystal

Research on adults with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has suggested that psychiatric and substance abuse comorbidities are prevalent in this population, and that these may sometimes be associated with use of antiretroviral therapy (ART) and adherence.

Substance Abuse and Hospitalization for Mood Disorder among Medicaid Beneficiaries

Jonathan D. Prince, Ayse Akincigil, Donald Hoover, James Walkup, Scott Bilder, Stephen Crystal

Objectives. We compared the influence of substance abuse with that of other comorbidities (e.g., anxiety, HIV) among people with mood disorder (N=129524) to explore risk factors for psychiatric hospitalization and early readmission within 3 months of discharge.

Testing language effects in psychiatric epidemiology surveys with randomized experiments: Results from the national Latino and Asian American study

Patrick E. Shrout, Margarita Alegría, Glorisa Canino, Peter Guarnaccia, William A. Vega, Naihua Duan, Zhun Cao

To evaluate the prevalence of mental disorders for persons of non-English-language origin, it is essential to use translated diagnostic interviews. The equivalence of translated surveys is rarely tested formally.

Lay and expert interpretations of cancer cluster evidence

Andrea Gurmankin Levy, Neil Weinstein, Erin Kidney, Suzanne Scheld, Peter Guarnaccia

Conflict frequently occurs between community members and environmental/public health officials when an unusual number of cancer cases is reported.

Holes in the safety net: A case study of access to prescription drugs and specialty care

Ava Stanley, Joel Cantor, Peter Guarnaccia

The health care safety net in the United States is intended to fill gaps in health care services for uninsured and other vulnerable populations. This paper presents a case study of New Brunswick, NJ, a small city rich in safety net resources, to examine the adequacy of the American model of safety net care.

Family cohesion and its relationship to psychological distress among Latino groups

Fernando I. Rivera, Peter Guarnaccia, Norah Mulvaney-Day, Julia Y. Lin, Maria Torres, Margarita Alegra

This article presents analyses of a representative sample of U.S. Latinos (N = 2,540) to investigate whether family cohesion moderates the effects of cultural conflict on psychological distress.

Medicare inpatient treatment for elderly non-dementia psychiatric illnesses 1992-2002; length of stay and expenditures by facility type

Donald Hoover, Ayse Akincigil, Jonathan D. Prince, Ece Kalay, Judith A. Lucas, James Walkup, Stephen Crystal

We summarize Medicare utilization and payment for inpatient treatment of non-dementia psychiatric illnesses (NDPI) among the elderly during 1992 and 2002. From 1992 to 2002, overall mean Medicare expenditures per elderly NDPI inpatient stay declined by $2,254 (in 2002 dollars) and covered days by 2.8.

Antidepressant treatment and adherence to combination antiretroviral therapy among patients with AIDS and diagnosed depression

James Walkup, Wenhui Wei, Usha Sambamoorthi, Stephen Crystal

Background: The prevalence of depression is elevated among HIV-infected individuals and there is evidence that depression exerts a negative impact on HIV medication adherence.

Hospitalization for psychiatric illness among community-dwelling elderly persons in 1992 and 2002

Ayse Akincigil, Donald Hoover, James Walkup, Jonathan D. Prince, Ece Kalay, Stephen Crystal

Objective: The authors evaluated the evolution of inpatient care for psychiatric illness in 1992 and 2002 for senior community-dwelling Medicare beneficiaries. Methods: National Medicare Provider Analysis and Review files for 1992 and 2002 were analyzed.

Transforming Doctor-Patient Relationships to Promote Patient-Centered Care: Lessons from Palliative Care

Michael Yedidia

Palliative care was studied for its potential to yield lessons for transforming doctor-patient relationships to promote patient-centered care. Examination of patient and provider experiences of the transition from curative to palliative care promises valuable insights about establishing and maintaining trust as the goals of care shift and about addressing a broad spectrum of patient needs.

The impact of implementing a chronic care residency training initiative on asthma outcomes

Jessica Greene, Victoria W. Rogers, Michael Yedidia

PURPOSE: To examine the impact of a chronic care residency training intervention on continuity clinic patients’ asthma-related emergency department use and primary care residents’ application of key elements of the Chronic Care Model (CCM).

Self-medication practices of Spanish-speaking older adults in Hartford, Connecticut

Patricia J. Neafsey, Olga Jarrin Montaner, Surheil Luciano, Maren J. Coffman

The self-medication practices of Spanish-speaking older adults in Hartford, Connecticut, are documented. A previously validated English self-medication practices survey was systematically translated into Spanish, pilot tested, and verbally administered via face-to-face interviews to 100 Spanish-speaking participants. Participants were recruited from five senior congregate housing sites. Eligibility criteria were age 60 and over, diagnosis of hypertension and/or diabetes, and independent physical and cognitive functioning.

A survey of psychiatric residency directors on current priorities and preparation for public-sector care

Michael Yedidia, Colleen C. Gillespie, Carol A. Bernstein

Objective: This study assessed how resident psychiatrists are being prepared to deliver effective public-sector care. Methods: Ten leaders in psychiatric education and practice were interviewed about which tasks they consider to be essential for effective public-sector care. The leaders identified 16 tasks. Directors of all general psychiatry residency programs in the United States were then surveyed to determine how they rate the importance of these tasks for delivery of care and how their training program prepares residents to perform each task.

Results from the Nurse Manifest 2003 Study: Nurses’ perspectives on nursing

Olga Jarrin Montaner

The purpose of this article is to raise awareness, inspire action, and open dialogue about professional values and workplace conditions. Results of the Nurse Manifest 2003 Study are presented through meta-synthesis of group summaries answering the questions: What is it like to practice nursing? and, What changes do nurses desire to support practice? The results illuminate the underlying framework of professional values that splits our profession, nursing units, and educational institutions. An analysis of the similarities and differences within and between groups reflect values which are rooted in the history of our profession and affected by present working conditions.

Provider behaviors contributing to patient self-management of chronic illness among underserved populations

Jessica Greene, Michael Yedidia

Effective treatment of chronic illness requires active engagement of patients in managing their own conditions. This research explores the influence of provider support for self-management on patients’ performance of self-care activities, a widely presumed but under-studied relationship, particularly among underserved populations.

Assessing Residents’ Competency in Care Management: Report of a Consensus Conference

John G. Frohna, Adina Kalet, Elizabeth Kachur, Sondra Zabar, Malcolm Cox, Ralph Halpern, Mariana G. Hewson, Michael Yedidia, Brent C. Williams

Background: Residency programs must prepare physicians to practice in the current health care environment. This mandate is reflected in 3 of the 6 competency domains now required by the Accreditation Council for Graduate Medical Education: systems-based practice, interpersonal skills and communication, and practice-based learning and improvement.

Realizing the promise of breast cancer screening: Clinical follow-up after abnormal screening among Black women

Jon F. Kerner, Michael Yedidia, Deborah Padgett, Barbara Muth, Kathleen Shakira Washington, Mariella Tefft, K. Robin Yabroff, Erini Makariou, Harold Freeman, Jeanne S. Mandelblatt

Background. Delayed or incomplete follow-up after abnormal screening results may compromise the effectiveness of breast cancer screening programs, particularly in medically underserved and minority populations. This study examined the role of socioeconomic status, breast cancer risk factors, health care system barriers, and patient cognitive-attitudinal factors in the timing of diagnostic resolution after abnormal breast cancer screening exams among Black women receiving breast cancer screening at three New York city clinics.

Effect of Communications Training on Medical Student Performance

Michael Yedidia, Colleen C. Gillespie, Elizabeth Kachur, Mark D. Schwartz, Judith Ockene, Amy E. Chepaitis, Clint W. Snyder, Aaron Lazare, Mack Lipkin

Context: Although physicians’ communication skills have been found to be related to clinical outcomes and patient satisfaction, teaching of communication skills has not been fully integrated into many medical school curricula or adequately evaluated with large-scale controlled trials.

Oxidized low-density lipoprotein augments and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors limit CD40 and CD40L expression in human vascular cells

Uwe Schönbeck, Norbert Gerdes, Nerea Varo, Rebecca S. Reynolds, Daniel Horton, Udo Bavendiek, Linda Robbie, Peter Ganz, Scott Kinlay, Peter Libby

Background – Although CD40 signaling participates in atherosclerosis, links between lipid risk factors and this inflammatory pathway remain obscure. Cardiovascular risk reduction by 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) may involve actions beyond lipid lowering, including reduced inflammation. Therefore, this study analyzed whether oxidized low-density lipoprotein (oxLDL) induces CD40/CD40L expression on cells implicated in atherogenesis and whether statins affect their expression in vitro as well as the expression of soluble CD40L (sCD40L) in vivo.

Expression of neutrophil collagenase (matrix metalloproteinase-8) in human atheroma: A novel collagenolytic pathway suggested by transcriptional profiling

Michael P. Herman, Galina K. Sukhova, Peter Libby, Norbert Gerdes, Nga Tang, Daniel Horton, Meagan Kilbride, Roger E. Breitbart, Miyoung Chun, Uwe Schönbeck

Background – Loss of interstitial collagen, particularly type I collagen, the major load-bearing molecule of atherosclerotic plaques, renders atheroma prone to rupture. Initiation of collagen breakdown requires interstitial collagenases, a matrix metalloproteinase (MMP) subfamily consisting of MMP-1, MMP-8, and MMP-13. Previous work demonstrated the overexpression of MMP-1 and MMP-13 in human atheroma. However, no study has yet evaluated the expression of MMP-8, known as “neutrophil collagenase,” the enzyme that preferentially degrades type I collagen, because granulocytes do not localize in plaques.

Confronting the prospect of dying: Reports of terminally ill patients

Michael Yedidia, Betsy MacGregor

To identify dominant themes characterizing patients’ perspectives on death during their last months of life, an ethnographic technique of interviewing and an inductive qualitative approach to analysis were employed.

Changing patterns of inpatient care for children and adolescents at the Menninger Clinic, 1988-1994

Kathleen J. Pottick, Carol Cornsweet Barber, Stephen Hansell, Lolafaye Coyne

The authors describe trends in inpatient psychiatric length of stay (LOS) and admissions for the population of children and adolescents (N = 784) at the Menninger Clinic from 1988 to 1994. During this period, median LOS declined dramatically from 7 months to 3 weeks, whereas admissions increased 4-fold. The diagnostic case mix changed substantially, with a crossover in modal principal diagnosis from personality disorder to affective disorder. Use of medications became almost universal. Diagnosis and medication use became less important determinants of LOS over time. The practical implications of these patterns include higher patient turnover, fewer inpatient clinical contact hours, and heightened importance of continuity with outpatient care. Research should center on the impact of declining LOS on clinical and functional outcomes for children and adolescents.

A very large protein with diverse functional motifs is deficient in rjs (runty, jerky, sterile) mice

Anne L. Lehman, Yoshimichi Nakatsu, Ada Ching, Roderick T. Bronson, Rebecca J. Oakey, Natalie Keiper-Hrynko, Joshua N. Finger, Donna Durham-Pierre, Daniel Horton, J. M. Newton, Mary F. Lyon, Murray H. Brilliant

Three radiation-induced alleles of the mouse p locus, p(6H), p(25H), and p(bs), cause defects in growth, coordination, fertility, and maternal behavior in addition to p gene-related hypopigmentation.

An inpatient measure of adolescent and child psychosocial services and treatment

Kathleen J. Pottick, Stephen Hansell, Carol Cornsweet Barber

Now more than ever there exists an urgent need to develop and test conceptually grounded, theoretically differentiated measures of mental health services because of the rapid adoption of managed mental health care throughout the United States. This article presents the results of testing a new research instrument, the Inpatient Measure of Adolescent and Child Services and Treatment (I-MACST). The instrument assesses eight psychosocial mental health service strategies for psychiatrically hospitalized children and adolescents and provides an understanding of the therapeutic and case management service orientations of inpatient facilities. Data collected from three hospitals, one of them at two time points, demonstrate reliability for the eight scales. In addition, results show that the I-MACST differentiates between services in child and adolescent inpatient units and that it detects differences in services that reflect changes in the organization of one hospital. The I-MACST characterizes the treatment practices of on entire facility with little demand on staff time.

Factors Associated with Inpatient and Outpatient Treatment for Children and Adolescents with Serious Mental Illness

KATHLEEN POTTICK, Stephen Hansell, ELANE GUTTERMAN, Helene White

This study describes the distribution of children and adolescents in psychiatric inpatient and outpatient facilities and identifies factors associated with the selection of individuals into inpatient versus outpatient care. Sample Data: The data are from a 1986 nationally representative sample surveyed by the National Institute of Mental Health. Results indicate that the vast majority of children and adolescents with psychiatric problems receive outpatient treatment rather than inpatient care. Factors that predict psychiatric hospitalization rather than outpatient care are (1) public or private insurance coverage versus no insurance; (2) previous hospitalization; (3) psychiatric diagnosis of affective or psychotic disorders versus conduct disorders, adjustment disorders, drug and alcohol abuse, and other disorders; and (4) age, with adolescents more likely to be hospitalized than children. Further research is needed to explore the role of insurance in mental health sorting processes. Moreover, systematic, controlled research is needed to determine how different financing strategies affect mental health outcomes for children and adolescents.

Child and adolescent outcomes of inpatient psychiatric services: A research agenda

Kathleen Pottick, Stephen Hansell, Dorothy Gaboda, Elane Gutterman

Psychiatric inpatient hospitalization is viewed generally as an expensive, most-restrictive treatment setting which should be replaced by communitybased alternatives for children and adolescents. But little is known about the outcomes of psychiatric hospitalization, and evidence that the alternatives are more effective is inconclusive. We describe the distribution of services provided to children and adolescents in psychiatric inpatient, outpatient and partial care facilities from 1986 national estimates. We find that over the course of a year, 682,756 children and adolescents receive treatment in inpatient (16.4%), outpatient (80.8%), or partial care (2.6%) facilities in a year. We then review the research literature and find that the existing research on outcomes of hospitalization is methodologically inadequate, severely limiting the causal inferences that can be made. However, trends in the evidence suggest that treatment and aftercare are important predictors of better psychiatric outcomes, controlling for organicity, symptoms, and diagnosis. Finally, we recommend testing treatment and aftercare services explicitly; using systematic, controlled research designs with comparison groups; and developing more refined descriptions of services in order to replicate effective interventions, and to generate and test theory about causes and effects of services and outcomes.