Naming assessment in bilinguals for epilepsy surgery-adaptation and standardization of Boston Naming Test in India.

PURPOSE: Naming difficulty is associated with temporal lobe epilepsy and a decline in naming ability is reported following dominant temporal lobe resections. The Boston Naming Test (BNT) is the most frequently used test for assessing naming ability. Evaluating naming ability in bilingual/multilingual populations is a challenge when participants are restricted to responding in one language. The study aimed to adapt and standardize the BNT as a valid clinical tool for evaluating bilingual/multilingual people undergoing epilepsy surgery in urban India. RESULTS: Culture-appropriate adaptations were done, and participants were allowed to respond in any language. Data from 197 participants showed a strong education effect. The adaptation showed strong internal consistency, reliability, construct validity, and high sensitivity to left temporal lobe epilepsy performance. CONCLUSIONS: The adapted version that allowed for flexible use of more than one language is a useful clinical tool for evaluating bilingual people undergoing epilepsy surgery.

Content level and risk assessment of phthalate esters in surface water of Bosten Lake, China.

Bosten Lake is the main fishing and grazing area in Xinjiang. The pollution of phthalate esters (PAEs) in water has attracted much attention, but limited research has been conducted on PAEs in Bosten Lake. The distribution of PAEs in fifteen sampling sites of surface water in the dry and flood seasons were investigated to explore the content level of PAEs in Bosten Lake, and the risk was evaluated. Seventeen PAEs were detected by GC-MS after liquid-liquid and solid-phase purification. Results showed that the content of ∑PAEs in the water during dry and flood seasons is ND-26.226 µg/L and ND-7.179 µg/L. The content of PAEs in the water of Bosten Lake is at a medium level. DBP and DIBP are the main PAEs. The content of PAEs is related to the physicochemical properties of water, and the physicochemical properties of water in dry season have a more serious impact on PAEs. PAEs in water mainly come from domestic pollution and chemical production. The results of health risk assessment indicate that PAEs in water do not pose a carcinogenic risk or a non carcinogenic risk to human, which can meet the conditions of Bosten Lake as a fishing ground and livestock base, but the pollution of PAEs cannot be ignored.

Household food insecurity is associated with obesogenic health behaviours among a low-income cohort of pregnant women in Boston, MA.

OBJECTIVE: To examine associations of household food insecurity with health and obesogenic behaviours among pregnant women enrolled in an obesity prevention programme in the greater Boston area. DESIGN: Cross-sectional evaluation. Data were collected from structured questionnaires that included a validated two-item screener to assess household food insecurity. We used separate multivariable linear and logistic regression models to quantify the association between household food insecurity and maternal health behaviours (daily consumption of fruits and vegetables, sugar-sweetened beverages and fast food, physical activity, screen time, and sleep), mental health outcomes (depression and stress), hyperglycaemia status and gestational weight gain. SETTING: Three community health centres that primarily serve low-income and racial/ethnic minority patients in Revere, Chelsea and Dorchester, Massachusetts. PARTICIPANTS: Totally, 858 pregnant women participating in the First 1,000 Days program, a quasi-experimental trial. RESULTS: Approximately 21 % of women reported household food insecurity. In adjusted analysis, household food insecurity was associated with low fruit and vegetable intake (ß = -0·31 daily servings; 95 % CI -0·52, -0·10), more screen time (ß = 0·32 daily hours; 95 % CI 0·04, 0·61), less sleep (ß = -0·32 daily hours; 95 % CI -0·63, -0·01), and greater odds of current (adjusted odds ratio (AOR) 4·42; 95 % CI 2·33, 8·35) or past depression (AOR 3·01; 95 % CI 2·08, 4·35), and high stress (AOR 2·91; 95 % CI 1·98, 4·28). CONCLUSIONS: In our sample of mostly low-income, racial/ethnic minority pregnant women, household food insecurity was associated with mental health and behaviours known to increase the likelihood of obesity.

Cost Effectiveness and Budget Impact of the Boston University Approach to Psychiatric Rehabilitation for Increasing the Social Participation of Individuals With Severe Mental Illnesses.

Background: The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation. Method: In a randomized clinical trial with 188 individuals with SMIs, BPR (n = 98) was compared to ACC (n = 90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants. Results: Total costs per participant at 12-month follow-up were € 12,886 in BPR and € 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to €190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions. Conclusions: This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.

The Boston Process Approach and Digital Neuropsychological Assessment: Past Research and Future Directions.

Neuropsychological assessment using the Boston Process Approach (BPA) suggests that an analysis of the strategy or the process by which tasks and neuropsychological tests are completed, and the errors made during test completion convey much information regarding underlying brain and cognition and are as important as overall summary scores. Research over the last several decades employing an analysis of process and errors has been able to dissociate between dementia patients diagnosed with Alzheimer's disease, vascular dementia associated with MRI-determined white matter alterations, and Parkinson's disease; and between mild cognitive impairment subtypes. Nonetheless, BPA methods can be labor intensive to deploy. However, the recent availability of digital platforms for neuropsychological test administration and scoring now enables reliable, rapid, and objective data collection. Further, digital technology can quantify highly nuanced data previously unobtainable to define neurocognitive constructs with high accuracy. In this paper, a brief review of the BPA is provided. Studies that demonstrate how digital technology translates BPA into specific neurocognitive constructs using the Clock Drawing Test, Backward Digit Span Test, and a Digital Pointing Span Test are described. Implications for using data driven artificial intelligence-supported analytic approaches enabling the creation of more sensitive and specific detection/diagnostic algorithms for putative neurodegenerative illness are also discussed.

The BNT-15 provides an accurate measure of English proficiency in cognitively intact bilinguals - a study in cross-cultural assessment.

This study was designed to replicate earlier reports of the utility of the Boston Naming Test - Short Form (BNT-15) as an index of limited English proficiency (LEP). Twenty-eight English-Arabic bilingual student volunteers were administered the BNT-15 as part of a brief battery of cognitive tests. The majority (23) were women, and half had LEP. Mean age was 21.1 years. The BNT-15 was an excellent psychometric marker of LEP status (area under the curve: .990-.995). Participants with LEP underperformed on several cognitive measures (verbal comprehension, visuomotor processing speed, single word reading, and performance validity tests). Although no participant with LEP failed the accuracy cutoff on the Word Choice Test, 35.7% of them failed the time cutoff. Overall, LEP was associated with an increased risk of failing performance validity tests. Previously published BNT-15 validity cutoffs had unacceptably low specificity (.33-.52) among participants with LEP. The BNT-15 has the potential to serve as a quick and effective objective measure of LEP. Students with LEP may need academic accommodations to compensate for slower test completion time. Likewise, LEP status should be considered for exemption from failing performance validity tests to protect against false positive errors.

Assessment of the Role and Timing of Glaucoma Surgery in Boston Keratoprosthesis Type 1 Patients.

PURPOSE: To determine the role and optimal timing of glaucoma surgery in relation to Boston keratoprosthesis type 1 (KPro) implantation. DESIGN: Retrospective, comparative, nonrandomized clinical study. METHODS: Single-center study of a total of 100 eyes (100 patients) implanted with a KPro between 2008 and 2017, and diagnosed with glaucoma before or after KPro. Patients were separated into 2 groups: those with preexisting glaucoma and those who developed de novo glaucoma after KPro. Groups were then divided based on whether patients were medically or surgically managed. Glaucoma surgery included glaucoma drainage device (GDD) implantation, trabeculectomy, and cyclophotocoagulation (CPC). Primary outcomes included best-corrected visual acuity (BCVA), glaucoma progression, and complications. Differences in outcomes were compared using parametric and nonparametric tests, as well as log-rank test to compare time-to-outcome events. RESULTS: Among 72 eyes with preexisting glaucoma, 27 (38%) had glaucoma surgery before KPro (18 GDD), whereas 45 (62%) were medically managed only. Among the latter, 19 (42%) needed glaucoma surgery post-KPro (16 GDD). Among 28 eyes with de novo glaucoma, 12 (43%) had glaucoma surgery post-KPro (9 GDD). For eyes with preexisting glaucoma, glaucoma progression was greater with glaucoma surgery performed post-KPro (100%) compared with pre-KPro (74%, P = .016) and to medical management (54%, P = .002). No increase in complications were observed with glaucoma surgery compared to medications only (P > .05), whereas fewer eyes maintained a BCVA of 20/200 or better over time with medical management (P = .013). Eyes with de novo glaucoma had similar progression, BCVA, and complications between medical and surgical care (P > .05). CONCLUSIONS: Glaucoma surgery should be performed before or at the same time as KPro implantation in eyes with preexisting glaucoma. Complication rates are not increased when glaucoma surgery is performed in KPro eyes with either preexisting or de novo glaucoma. To ensure optimal glaucoma control, glaucoma surgery should be performed as early as possible in KPro eyes with good visual potential.

Removing the noose item from the Boston naming test: A step toward antiracist neuropsychological assessment.

Objective: The Boston Naming Test-Second Edition (BNT-2), the "gold-standard" assessment of confrontation naming used to diagnosis disorders such as dementia, includes aculturally insensitive item, the noose. Given calls to stop structural racism in psychology, this study examined changes in scores and performance classification if the noose item were omitted from the BNT-2. Methods: Participants were 291 Black, White, and Latinx adults who were administered the BNT-2 within a comprehensive neuropsychological evaluation. Ethnoracial differences in BNT-2 scores with and without the noose item and percentages of participants answering the noose item incorrectly were investigated. Results: Significant differences were found between ethnoracial groups in BNT-2 raw scores, T-scores, and percentage of participants incorrectly answering the noose item. Follow-up analyses revealed White participants obtained significantly higher raw scores and had significantly fewer participants answer the noose item incorrectly than Black and Latinx groups, who did not differ significantly. For T-scores, Black participants obtained significantly higher scores than White participants who obtained significantly higher scores than Latinx participants. Despite these differences, giving credit for the omitted noose item changed performance classification for only 10 participants (3.4%). Conclusions: Performance classification did not change significantly for the vast majority of a large ethnoculturally diverse sample when giving credit for the noose item as if it were not administered. Therefore, the non-noose BNT-2remains accurate while reducing cultural insensitivity towards Black populations, emphasizing a step in working towards anti-racism and fostering culturally-competent services within psychology.

Split Versus Non-Split Morning Dosing Regimen for Assessment of Quality of Bowel Preparation for Colonoscopy.

BACKGROUND: Different bowel preparation regimens are available. Currently we are giving the entire preparation on the day of colonoscopy. Multiple studies have shown splitting the regimen might improve the quality of bowel preparation with lesser side effects and better compliance. The study was done to compare the efficacy and tolerability of split bowel preparation regimen with non-split dosing regimen. METHODS: Single centered observational comparative study was done in a tertiary care hospital. One hundred ninety eight patients requiring elective colonoscopy were assigned to receive one of the two preparations (split versus morning) prior to colonoscopy. Main outcomes were bowel preparation quality and patient compliance and tolerability. RESULTS: There was no significant difference between the two regimen for the mean total Boston Bowel Preparation Scale (6.79VS 6.74,P value -0.777).Patient compliance was better for split dosing compared to single dosing (99 vs 5 p value-<0.001).There were more side effects in the single dosage compared to split dosing except for sleep disturbance which was more in split dosing. CONCLUSIONS: The study found that split-dose and single dose polyethylene glycol solution for bowel preparation before colonoscopy had similar efficacy in the quality of bowel preparation. Split-dose polyethylene glycol appears to be superior to single-dose PEG for patient compliance and side effects.

Digital Neuropsychological Assessment: New Technology for Measuring Subtle Neuropsychological Behavior.

Technology has transformed the science and practice of medicine. In this special mini-forum, data using digital neuropsychological technology are reported. All of these papers demonstrate how coupling digital technology with standard paper and pencil neuropsychological tests are able to extract behavior not otherwise obtainable. As digital assessment methods mature, early identification of persons with emergent neurodegenerative and other neurological illness may be possible.

Features and psychometric properties of the Montreal Cognitive Assessment: Review and proposal of a process-based approach version (MoCA-PA).

The current study presents a rapid review of the psychometric features of the standard Montreal Cognitive Assessment (MoCA), and the proposal for a modified version of the test, informed by the methodology of the Boston Process Approach to neuropsychological assessment. In order to aid the process of identification of the primary underlying neurocognitive mechanism responsible for defective test performance, the MoCA-Process-Based Approach (MoCA-PA) adds complementary or satellite test conditions in some of its subtests, includes "new" qualitative indices to capture the cognitive processes involved in each cognitive task, and incorporates new qualitative classifications of error subtypes. It provides concurrent assessment of multiple cognitive processes within each task, without significantly increasing administration time or placing significant additional burden upon the respondent. We present preliminary results obtained from an initial sample of 45 community-dwelling older adults attending a University program for seniors. Results suggest the usefulness of additional indices in providing additional information on cognitive deterioration that may be overlooked with the only consideration of quantitative scores. Future research will aim to collect normative data for different clinical populations using the newly developed indices in order to determine the validity and clinical utility of the relatively novel qualitative process-based methods used in the MoCA-PA.

[Cerebral amyloid angiopathy revealed or hypertension-related cerebral small vessel diseases: A clinical challenge]. / Angiopathie amyloïde cérébrale ou atteinte des microvaisseaux cérébraux en rapport avec l'HTA : un challenge clinique.

Cerebral amyloid angiopathy (CAA) is a entity characterized by degenerative Amyloïd deposits in the walls of the meningeal and cortical vessels. It is considered as the second cause of primitives cerebral hemorrhage in elderly. The differential diagnosis between AAC and hypertension-related cerebral small vessel diseases is difficult and represent a true challenge for the clinician. We report two cases of cerebral small vessel diseases revealed by malignant hypertension.

Provider and Staff Feedback on Screening for Social and Behavioral Determinants of Health for Pediatric Patients.

INTRODUCTION: Screening and referral for Social and Behavioral Determinants of Health (SDOH) are increasingly recommended in clinical guidelines and consensus statements. It is important to understand barriers and facilitators to implementation of standardized SDOH screening and referral practices, as well as the scope of current existing SDOH screening. METHODS: We conducted a mixed-methods study to understand the current state of SDOH screening and to assess the barriers and facilitators to implementing a standardized SDOH screening and referral practice in Boston community health centers (CHCs) for pediatric patients. We requested all SDOH screening documents from 15 Boston CHCs and conducted provider and staff focus groups at intervention sites of an SDOH implementation pilot in Boston. RESULTS: All CHCs screened in some form for SDOH, but there was no agreement on which domains to screen. Participating CHCs screened for a mean of 8 SDOH domains (range, 5 to 16). Overall, 16 SDOH domains emerged. From the focus groups, 5 themes emerged: 1) provider perspectives, 2) work flow, 3) prior experience, 4) site resources and staffing, and 5) sustainability. There was little agreement among participants within each theme, as all were seen as barriers and facilitators depending on the respondent. DISCUSSION: This study highlights the various SDOH screening methods currently used in Boston CHCs, and the need for workflow and process individualization of SDOH screening and referral. Providers and clinical staff should be part of the discussion when implementing SDOH screening and referral procedures to ensure appropriate work flow, staff buy-in, and to maximize resources available.

Community organizations and mental health after the 2013 Boston Marathon bombings.

OBJECTIVE: Disasters are place-based traumatic events, yet contemporary understandings of disaster recovery often do not consider the role of community organizations. We examine organization type and proximity as they relate to post-disaster mental health in a longitudinal study following the 2013 Boston Marathon bombings. METHOD: Residents of metropolitan Boston (N = 846) were recruited via a probability-based sampling strategy within weeks of the bombings and were surveyed several times over a two-year period. Residents of metropolitan New York (N = 941) were recruited and surveyed at the same time and used for comparison due to similarities in community demographics, geography, and disaster histories. We identified six different organization types nearby resident: safety-based organizations, religious organizations, educational organizations, child- and family-promoting organizations, health-based organizations, and voluntary community organizations. With possible environmental detriments (crowds and noise) or benefits of organizations amplified in areas closest to the resident, the concentration of these local organization types was examined at different distance-based boundaries. Contextual data for both communities came from the U.S. Census, Google Places API, and Guidestar. RESULTS: For Boston metropolitan area residents, having more safety-based organizations within a half-mile to one-mile area in the aftermath of the bombings was associated with poorer functioning six to seven months later and greater psychological distress two years later. However, the presence of more safety-based organizations in the one to three mile area was associated with decreased psychological distress two years later. More health-based and voluntary community organizations in the half-mile to one-mile area were also associated with fewer fears and worries about future adversity two years post-bombing. Exposure to the bombings and other community traumas moderated this relationship among Boston area participants. CONCLUSION: Results suggest that local community organizations are not merely buildings or structures but ecological sources of support to those in need after a disaster.

Inhaler use and education characteristics among English and non-English speaking patients: A pilot needs assessment survey.

OBJECTIVE: Identify inhaler use characteristics among English (ESP) and non-English speaking patients (NSP) to develop quality improvement efforts. METHODS: Outpatients were surveyed for technique confidence, education, preferences and disease control. We compared characteristics between ESP and NSP. RESULTS: Of 197 respondents, 75% were ESP, 25% were NSP. Compared to NSP, ESP responders were more likely female (57% vs 31%, p = 0.001), used inhalers for a longer time (10 vs 6 years, p = 0.008) and had higher rates of metered dose inhaler use (85% vs. 60%, p < 0.001). Both language groups had similar confidence in inhaler use, after adjustment for age, gender and duration of use. Similar rates of inhaler technique education were reported by ESP and NSP at the initial visit. More NSP reported receiving education at subsequent visits (54% vs. 72%, p = 0.03). Education for both groups was mostly performed by a clinician. Both language groups reported low internet use for learning proper technique, low interest in a separate education session, preferred an active learning method. CONCLUSIONS: These findings will be used to further develop quality inhaler education efforts at our institution. PRACTICAL IMPLICATIONS: Local patient preferences should be considered when designing inhaler education programs.

Cardiovascular magnetic resonance assessment of 1st generation CoreValve and 2nd generation Lotus valves.

OBJECTIVES: We sought to compare using serial CMR, the quantity of AR and associated valve hemodynamics, following the first-generation CoreValve (Medtronic, Minneapolis, MN) and the second-generation Lotus valve (Boston Scientific, Natick, MA). BACKGROUND: Aortic regurgitation (AR) following Transcatheter Aortic Valve Replacement (TAVR) confers a worse prognosis and can be accurately quantified using cardiovascular magnetic resonance (CMR). Second generation valves have been specifically designed to reduce paravalvular AR and improve clinical outcomes. METHODS: Fifty-one patients (79.0 ± 7.7 years, 57% male) were recruited and imaged at three time points: immediately pre- and post-TAVR, and at 6 months. RESULTS: CMR-derived AR fraction immediately post-TAVR was greater in the CoreValve compared to Lotus group (11.7 ± 8.4 vs. 4.3 ± 3.4%, P = 0.001), as was the frequency of ≥moderate AR (9/24 (37.5%) versus 0/27, P < 0.001). However, at 6 months AR fraction had improved significantly in the CoreValve group such that the two valve designs were comparable (6.4 ± 5.0 vs 5.6 ± 5.3%, P = 0.623), with no patient in either group having ≥moderate AR. The residual peak pressure gradient immediately following TAVR was significantly lower with CoreValve compared to Lotus (14.1 ± 5.6 vs 25.4 ± 11.6 mmHg, P = 0.001), but again by 6 months the two valve designs were comparable (16.5 ± 9.4 vs 19.7 ± 10.5 mmHg, P = 0.332). There was no difference in the degree of LV reverse remodeling between the two valves at 6 months. CONCLUSION: Immediately post-TAVR, there was significantly less AR but a higher residual peak pressure gradient with the Lotus valve compared to CoreValve. However, at 6 months both devices had comparable valve hemodynamics and LV reverse remodeling.

The 15-item version of the Boston Naming Test as an index of English proficiency.

OBJECTIVE: The present study was designed to examine the potential of the Boston Naming Test - Short Form (BNT-15) to provide an objective estimate of English proficiency. A secondary goal was to examine the effect of limited English proficiency (LEP) on neuropsychological test performance. METHOD: A brief battery of neuropsychological tests was administered to 79 bilingual participants (40.5% male, MAge = 26.9, MEducation = 14.2). The majority (n = 56) were English dominant (EN), and the rest were Arabic dominant (AR). The BNT-15 was further reduced to 10 items that best discriminated between EN and AR (BNT-10). Participants were divided into low, intermediate, and high English proficiency subsamples based on BNT-10 scores (≤6, 7-8, and ≥9). Performance across groups was compared on neuropsychological tests with high and low verbal mediation. RESULTS: The BNT-15 and BNT-10 respectively correctly identified 89 and 90% of EN and AR participants. Level of English proficiency had a large effect (partial η2 = .12-.34; Cohen's d = .67-1.59) on tests with high verbal mediation (animal fluency, sentence comprehension, word reading), but no effect on tests with low verbal mediation (auditory consonant trigrams, clock drawing, digit-symbol substitution). CONCLUSIONS: The BNT-15 and BNT-10 can function as indices of English proficiency and predict the deleterious effect of LEP on neuropsychological tests with high verbal mediation. Interpreting low scores on such measures as evidence of impairment in examinees with LEP would likely overestimate deficits.

The clinical and cost effectiveness of steroid injection compared with night splints for carpal tunnel syndrome: the INSTINCTS randomised clinical trial study protocol.

BACKGROUND: Patients diagnosed with idiopathic mild to moderate carpal tunnel syndrome (CTS) are usually managed in primary care and commonly treated with night splints and/or corticosteroid injection. The comparative effectiveness of these interventions has not been reliably established nor investigated in the medium and long term. The primary objective of this trial is to investigate whether corticosteroid injection is effective in reducing symptoms and improving hand function in mild to moderate CTS over 6 weeks when compared with night splints. Secondary objectives are to determine specified comparative clinical outcomes and cost effectiveness of corticosteroid injection over 6 and 24 months. METHOD/DESIGN: A multicentre, randomised, parallel group, clinical pragmatic trial will recruit 240 adults aged ≥18 years with mild to moderate CTS from GP Practices and Primary-Secondary Care Musculoskeletal Interface Clinics. Diagnosis will be by standardised clinical assessment. Participants will be randomised on an equal basis to receive either one injection of 20 mg Depo-Medrone or a night splint to be worn for 6 weeks. The primary outcome is the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks. Secondary outcomes are the BCTQ symptom severity and function status subscales, symptom intensity, interrupted sleep, adherence to splinting, perceived benefit and satisfaction with treatment, work absence and reduction in work performance, EQ-5D-5L, referral to surgery and health utilisation costs. Participants will be assessed at baseline and followed up at 6 weeks, 6, 12 and 24 months. The primary analysis will use an intention to treat (ITT) approach and multiple imputation for missing data. The sample size was calculated to detect a 15 % greater improvement in the BTCQ overall score in the injection group compared to night-splinting at approximately 90 % power, 5 % two-tailed significance and allows for 15 % loss to follow-up. DISCUSSION: The trial makes an important contribution to the evidence base available to support effective conservative management of CTS in primary care. No previous trials have directly compared these treatments for CTS in primary care populations, reported on clinical effectiveness at more than 6 months nor compared cost effectiveness of the interventions. TRIAL REGISTRATION: Trial registration: EudraCT 2013-001435-48 (registered 05/06/2013), ClinicalTrials.gov NCT02038452 (registered 16/1/2014), and Current Controlled Trials ISRCTN09392969 (retrospectively registered 01/05/2014).

The Omega-3 Index Is Inversely Associated with Depressive Symptoms among Individuals with Elevated Oxidative Stress Biomarkers.

BACKGROUND: Omega-3 (n-3) fatty acid (FA) consumption is thought to improve depressive symptoms. However, current evidence is limited, and whether this association exists among Puerto Ricans, a population burdened by depression, remains uncertain. OBJECTIVES: We examined the association between ω-3 FA biomarkers and depressive symptoms as well as the potential influence of oxidative stress. METHODS: Baseline and longitudinal analyses were conducted in the Boston Puerto Rican Health Study (n= 787; participants aged 57 ± 0.52 y, 73% women). Urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) concentration, a measure of oxidative stress, and erythrocyte FA composition were collected at baseline. We calculated the omega-3 index as the sum of eicosapentaenoic and docosahexaenoic acids, expressed as a percentage of total FAs. Baseline and 2-y depressive symptoms were characterized by using the Center for Epidemiological Studies-Depression Scale (CES-D). Statistical analyses included linear and logistic regression. RESULTS: Urinary 8-OHdG concentration tended to modify the relation between the erythrocyte omega-3 index and baseline CES-D score (P-interaction = 0.10). In stratified analyses, the omega-3 index was inversely associated with CES-D score (ß = -1.74, SE = 0.88;P= 0.02) among those in the top quartile of 8-OHdG concentration but not among those in the lower quartiles. The relation between the omega-3 index and CES-D at 2 y was more clearly modified by 8-OHdG concentration (P-interaction = 0.04), where the omega-3 index was inversely associated with CES-D at 2 y, adjusted for baseline (ß = -1.66, SE = 0.66;P= 0.02), only among those with elevated 8-OHdG concentrations. Among individuals not taking antidepressant medications and in the top tertile of urinary 8-OHdG concentration, the omega-3 index was associated with significantly lower odds of a CES-D score ≥16 at baseline (OR: 0.72; 95% CI: 0.53, 0.96) but not at 2 y (OR: 0.83; 95% CI: 0.60, 1.15). CONCLUSIONS: An inverse association between the omega-3 index and depressive symptoms was observed among participants with elevated oxidative stress biomarkers. These data suggest that oxidative stress status may identify those who might benefit from ω-3 FA consumption to improve depressive symptoms.

Standard form of the Boston Naming Test: Normative data for the Latin American Spanish speaking adult population.

OBJECTIVE: To generate normative data on the Boston Naming Test (BNT) across 10 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate. METHOD: The sample consisted of 3,779 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the BNT as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms. RESULTS: The final multiple linear regression models explained between 3-32% of the variance in BNT scores. Although t-tests showed significant differences between men and women for Mexico, Argentina, Chile, Cuba, Guatemala, and Bolivia on the BNT, none of the six countries had an effect size larger than 0.3. As a result, gender-adjusted norms were not generated. CONCLUSIONS: This is the first normative multicenter study conducted in Latin America to generate norms for the BNT; this study will have substantial repercussions for the practice of neuropsychology throughout the global region.