Commitment and capacity for providing evidence-based tobacco treatment in US drug treatment facilities.

BACKGROUND: Although people with mental illness, including substance use disorders, consume 44% of cigarettes in the United States, few facilities provide tobacco treatment. This study assesses staff- and facility-level drivers of tobacco treatment in substance use treatment. METHODS: Surveys were administered to 405 clinic directors selected from a comprehensive inventory of 3800 US outpatient facilities. The main outcome was the validated 7-item Index of Tobacco Treatment Quality. Other measures included the validated Tobacco Treatment Commitment Scale and indicators of facility resources for providing tobacco treatment. RESULTS: Stepwise model selection was used to determine the relationship between capacity/resources and treatment quality. The final model retained 7 items and had good fit (adjusted R2 = 0.43). Four capacities significantly predicted treatment quality. Structural equation modeling (SEM) was used to test the impact of staff commitment on treatment quality; the model had good fit and the relationship was significant (comparative fit index [CFI] = 0.951, root mean square error of approximation [RMSEA] = 0.054). Adding the 7 capacity/resources maintained similar model fit (CFI = 0.922, RMSEA = 0.053). Staff commitment was slightly strengthened in this model, with a rise in parameter estimate from 0.449 to 0.560. All resource/capacity items were also significant predictors of treatment quality; the strongest was receiving training in how to provide tobacco treatment (0.360), followed by dedicated staff time (0.279) and having a policy that requires staff to offer treatment (0.272). CONCLUSIONS: Staff commitment to providing tobacco treatment was the strongest predictor of tobacco treatment quality, followed by resources for providing treatment. Interventions to change staff attitudes and improve resources for tobacco treatment have the strongest potential for improving quality of care.

Effects of Morphine on Behavioral Task Performance in SIV-Infected Rhesus Macaques.

The abuse of opiates such as morphine in synergy with HIV infection not only exacerbates neuropathogenesis but significantly impacts behavioral attributes in HIV infected subjects. Thus, the goal of the current study was to characterize behavioral perturbations in rhesus macaques subjected to chronic morphine and SIV infection. Specifically, we assessed three behavioral tasks: motor skill (MS), forelimb force (FFT) and progressive ratio (PR) tasks. After collecting baseline control data (44 weeks) and data during the morphine-only dependency period (26 weeks), a subset of animals were productively infected with neurovirulent strains of SIVmac (R71/E17) for an additional 33 weeks. A general pattern in the results is that behavioral decline occurred with high CSF viral loads but not necessarily with high plasma viral loads. Compared to saline controls, all treated animals showed significant decreases in performance on all three behavioral tasks during the morphine-only dependency period. During the post infection period, only the morphine plus SIV group showed a significant further decline and this only occurred for the MS task. Taken together, these data demonstrate a clear effect of morphine to produce behavioral deficits and also suggest that morphine can act synergistically with SIV/HIV to exacerbate behavioral deficits.

Risk factors for self-injury, aggression, and stereotyped behavior among young children at risk for intellectual and developmental disabilities.

Before the 1990s, research on the early identification and prevention of severe behavior disorders (SBDs), such as aggression, self-injury, and stereotyped behavior, among young children with intellectual and developmental disabilities (IDD), was mostly done with children 3 years or older. More recent work suggests that signs of SBDs may occur as early as 6 months in some infants. The present study combined a cross-sectional and longitudinal approach to examine SBDs in 180 young children aged 4-48 months recruited through mass screening, then receiving an interdisciplinary evaluation and six-month follow-ups for one year. Twelve potential risk factors related to SBDs were examined. Eight of these risk factors, including age, gender, diagnosis, intellectual and communication levels, visual impairment, parent education, family income, were differentially related to scores for Aggression, SIB, and Stereotyped Behavior subscales on the Behavior Problems Inventory (BPI-01) at initial interdisciplinary evaluation. BPI-01 scores decreased over the year for 57% of the children and increased for 43%. The amount of decrease on each BPI-01 subscale varied with age, gender, and diagnosis.

The index of tobacco treatment quality: development of a tool to assess evidence-based treatment in a national sample of drug treatment facilities.

BACKGROUND: Quitting smoking improves health and drug use outcomes among people in treatment for substance abuse. The twofold purpose of this study is to describe tobacco treatment provision across a representative sample of U.S. facilities and to use these data to develop the brief Index of Tobacco Treatment Quality (ITTQ). METHODS: We constructed survey items based on current tobacco treatment guidelines, existing surveys, expert input, and qualitative research. We administered the survey to a stratified sample of 405 facility administrators selected from all 3,800 U.S. adult outpatient facilities listed in the SAMHSA Inventory of Substance Abuse Treatment Services. We constructed the ITTQ with a subset of 7 items that have the strongest clinical evidence for smoking cessation. RESULTS: Most facilities (87.7%) reported that a majority of their clients were asked if they smoke cigarettes. Nearly half of facilities (48.6%) reported that a majority of their smoking clients were advised to quit. Fewer (23.3%) reported that a majority of their smoking clients received tobacco treatment counseling and even fewer facilities (18.3%) reported a majority of their smoking clients were advised to use quit smoking medications. The median facility ITTQ score was 2.57 (on a scale of 1-5) and the ITTQ displayed good internal consistency (Cronbach's alpha = .844). Moreover, the ITTQ had substantial test-retest reliability (.856), and ordinal confirmatory factor analysis found that our one-factor model for ITTQ fit the data very well with a CFI of 0.997 and an RMSEA of 0.042. CONCLUSIONS: The ITTQ is a brief and reliable tool for measuring tobacco treatment quality in substance abuse treatment facilities. Given the clear-cut room for improvement in tobacco treatment, the ITTQ could be an important tool for quality improvement by identifying service levels, facilitating goal setting, and measuring change.

Validity and reliability of the Behavior Problems Inventory, the Aberrant Behavior Checklist, and the Repetitive Behavior Scale-Revised among infants and toddlers at risk for intellectual or developmental disabilities: a multi-method assessment approach.

Reliable and valid assessment of aberrant behaviors is essential in empirically verifying prevention and intervention for individuals with intellectual or developmental disabilities (IDD). Few instruments exist which assess behavior problems in infants. The current longitudinal study examined the performance of three behavior-rating scales for individuals with IDD that have been proven psychometrically sound in older populations: the Aberrant Behavior Checklist (ABC), the Behavior Problems Inventory (BPI-01), and the Repetitive Behavior Scale - Revised (RBS-R). Data were analyzed for 180 between six and 36 months old children at risk for IDD. Internal consistency (Cronbach's α) across the subscales of the three instruments was variable. Test-retest reliability of the three BPI-01 subscales ranged from .68 to .77 for frequency ratings and from .65 to .80 for severity ratings (intraclass correlation coefficients). Using a multitrait-multimethod matrix approach high levels of convergent and discriminant validity across the three instruments was found. As anticipated, there was considerable overlap in the information produced by the three instruments; however, each behavior-rating instrument also contributed unique information. Our findings support using all three scales in conjunction if possible.

Mass Screening for Severe Problem Behavior among Infants and Toddlers In Peru.

INTRODUCTION: Severe behavior problems among people with intellectual and developmental disabilities (IDD) are a major barrier to integration in the community. Recent research suggests that these behaviors often begin very early in life and might be prevented by early identification and intervention (Rojahn, Schroeder, & Hoch, 2008). The current paper presents a method of mass screening for early signs of severe behavior problems among infants and toddlers in Peru. METHODS: A Parental Concerns Questionnaire (PCQ) which asks 15 questions, each related to a risk factor for severe behavior problems, based on past research on IDD, was used by veteran parents to interview 341 new parents who had been solicited by TV, radio, and public service announcements across the country. Of these, 262 were recruited and enrolled in a longitudinal study in which they will be followed for 12 months, to see if at-risk children actually will develop severe behavior problems. An extensive initial interdisciplinary evaluation was given to each child. Consumer satisfaction questionnaires were given to the parents as to their attitude toward the screening method. RESULTS: Data from the Interdisciplinary Evaluations of the sample suggest a very high hit rate (96%) by the screening instrument (PCQ). Consumer satisfaction was 98%, suggesting that the method was tolerated well by parents. DISCUSSION: The PCQ is a brief and efficient method to screen infants and toddlers at risk for severe behavior problems. The data also suggest that parents suspect these problems at a very early age. Early intervention thus seems a feasible strategy to intervene before these problems become deeply ingrained as children develop.

Resistance training volume, energy balance and weight management: rationale and design of a 9 month trial.

The increased prevalence of obesity and the lack of treatment success both argue for the design and evaluation of strategies to prevent the development of overweight and obesity. To date, the role of resistance training (RT) in this regard is largely unexplored. RT may be effective for weight management as a result of increased fat-free mass (FFM), which may result in increased resting metabolic rate and increased physical activity energy expenditure. However, the literature relative to the efficacy of RT protocols recommended for healthy adults to alter the aforementioned parameters is inconsistent or inadequately evaluated. We will conduct a 9 month randomized controlled efficacy trial to compare changes in body composition (fat mass, FFM, % body fat) and energy balance in response to 2 volumes of RT (1 vs. 3 sets vs. non-exercise control) both at the completion of training (9 months) and 1 year later (body composition). This investigation will be conducted in a sample of healthy, normal and overweight, sedentary, young adult men and women; a group at high risk for development of overweight and obesity. Our results will provide information relative to the minimum volume of RT that may be associated with body weight/fat gain which may inform the development of guidelines for RT to prevent weight gain or to alter body composition.

Development of the communication complexity scale.

PURPOSE: Accurate description of an individual's communication status is critical in both research and practice. Describing the communication status of individuals with severe intellectual and developmental disabilities is difficult because these individuals often communicate with presymbolic means that may not be readily recognized. Our goal was to design a communication scale and summary score for interpretation that could be applied across populations of children and adults with limited (often presymbolic) communication forms. METHOD: The Communication Complexity Scale (CCS) was developed by a team of researchers and tested with 178 participants with varying levels of presymbolic and early symbolic communication skills. Correlations between standardized and informant measures were completed, and expert opinions were obtained regarding the CCS. RESULTS: CCS scores were within expected ranges for the populations studied, and interrater reliability was high. Comparison across other measures indicated significant correlations with standardized tests of language. Scores on informant report measures tended to place children at higher levels of communication. Expert opinions generally favored the development of the CCS. CONCLUSIONS: The scale appears to be useful for describing a given individual's level of presymbolic or early symbolic communication. Further research is needed to determine whether it is sensitive to developmental growth in communication.

Maternal responsivity predicts language development in young children with fragile X syndrome.

The relationship between early maternal responsivity and later child communication outcomes in young children with fragile X syndrome was investigated. Data were obtained from 55 mother-child dyads over a 36-month period. Performance data were obtained at each measurement point from video observations of four different contexts. These were coded for (a) child communication behaviors, (b) parent responsivity, and (c) behavior management behaviors. Results indicate that early maternal responsivity predicts the level of four important child language outcomes at 36 months of age after controlling for child developmental level and autism symptomology.

The effects of Fast ForWord Language on the phonemic awareness and reading skills of school-age children with language impairments and poor reading skills.

PURPOSE: To examine the efficacy of Fast ForWord Language (FFW-L) and 2 other interventions for improving the phonemic awareness and reading skills of children with specific language impairment with concurrent poor reading skills. METHOD: A total of 103 children (age 6;0 to 8;11 [years;months]) with language impairment and poor reading skills participated. The children received either FFW-L computerized intervention, a computer-assisted language intervention (CALI), an individualized language intervention (ILI), or an attention control (AC) computer program. RESULTS: The children in the FFW-L, CALI, and ILI conditions made significantly greater gains in blending sounds in words compared with the AC group at immediate posttest. Long-term gains 6 months after treatment were not significant but yielded a medium effect size for blending sounds in words. None of the interventions led to significant changes in reading skills. CONCLUSION: The improvement in phonemic awareness, but not reading, in the FFW-L, CALI, and ILI interventions limits their use with children who have language impairment and poor reading skills. Similar results across treatment conditions suggest that acoustically modified speech was not a necessary component for improving phonemic awareness.

Enhancing the ability of experimental autoimmune encephalomyelitis to serve as a more rigorous model of multiple sclerosis through refinement of the experimental design.

Advancing the understanding of the mechanisms involved in the pathogenesis of multiple sclerosis (MS) likely will lead to new and better therapeutics. Although important information about the disease process has been obtained from research on pathologic specimens, peripheral blood lymphocytes and MRI studies, the elucidation of detailed mechanisms has progressed largely through investigations using animal models of MS. In addition, animal models serve as an important tool for the testing of putative interventions. The most commonly studied model of MS is experimental autoimmune encephalomyelitis (EAE). This model can be induced in a variety of species and by various means, but there has been concern that the model may not accurately reflect the disease process, and more importantly, it may give rise to erroneous findings when it is used to test possible therapeutics. Several reasons have been given to explain the shortcomings of this model as a useful testing platform, but one idea provides a framework for improving the value of this model, and thus, it deserves careful consideration. In particular, the idea asserts that EAE studies are inadequately designed to enable appropriate evaluation of putative therapeutics. Here we discuss problem areas within EAE study designs and provide suggestions for their improvement. This paper is principally directed at investigators new to the field of EAE, although experienced investigators may find useful suggestions herein.

Rhesus macaque model of chronic opiate dependence and neuro-AIDS: longitudinal assessment of auditory brainstem responses and visual evoked potentials.

Our work characterizes the effects of opiate (morphine) dependence on auditory brainstem and visual evoked responses in a rhesus macaque model of neuro-AIDS utilizing a chronic continuous drug delivery paradigm. The goal of this study was to clarify whether morphine is protective, or if it exacerbates simian immunodeficiency virus (SIV)-related systemic and neurological disease. Our model employs a macrophage tropic CD4/CCR5 coreceptor virus, SIV(mac)239 (R71/E17), which crosses the blood-brain barrier shortly after inoculation and closely mimics the natural disease course of human immunodeficiency virus infection. The cohort was divided into three groups: morphine only, SIV only, and SIV + morphine. Evoked potential (EP) abnormalities in subclinically infected macaques were evident as early as 8 weeks postinoculation. Prolongations in EP latencies were observed in SIV-infected macaques across all modalities. Animals with the highest cerebrospinal fluid viral loads and clinical disease showed more abnormalities than those with subclinical disease, confirming our previous work (Raymond et al., J Neurovirol 4:512-520, 1998; J Neurovirol 5:217-231, 1999; AIDS Res Hum Retroviruses 16:1163-1173, 2000). Although some differences were observed in auditory and visual evoked potentials in morphine-treated compared to morphine-untreated SIV-infected animals, the effects were relatively small and not consistent across evoked potential type. However, morphine-treated animals with subclinical disease had a clear tendency toward higher virus loads in peripheral and central nervous system tissues (Marcario et al., J Neuroimmune Pharmacol 3:12-25, 2008) suggesting that if had been possible to follow all animals to end-stage disease, a clearer pattern of evoked potential abnormality might have emerged.

The Acquisition of Tense in English: Distinguishing child second language from first language and specific language impairment.

This study reports on a comparison of the use and knowledge of tense-marking morphemes in English by first language (L1), second language (L2) and specifically language-impaired (SLI) children. The objective of our research was to ascertain whether the L2 children's tense acquisition patterns were similar or dissimilar to those of the L1 and SLI groups, and whether they would fit an (Extended) Optional Infinitive profile, or an L2-based profile, e.g., the Missing Surface Inflection Hypothesis. Results showed that the L2 children had a unique profile compared with their monolingual peers, which was better characterized by the Missing Surface Inflection Hypothesis. At the same time, results reinforce the assumption underlying the (Extended) Optional Infinitive profile that internal constraints on the acquisition of tense could be a component of L1 development, with and without SLI.

Effect of morphine on the neuropathogenesis of SIVmac infection in Indian Rhesus Macaques.

Morphine is known to prevent the development of cell-mediated immune (CMI) responses and enhance expression of the CCR5 receptor in monocyte macrophages. We undertook a study to determine the effect of morphine on the neuropathogenesis and immunopathogenesis of simian immunodeficiency virus (SIV) infection in Indian Rhesus Macaques. Hypothetically, the effect of morphine would be to prevent the development of CMI responses to SIV and to enhance the infection in macrophages. Sixteen Rhesus Macaques were divided into three experimental groups: M (morphine only, n = 5), VM (morphine + SIV, n = 6), and V (SIV only, n = 5). Animals in groups M and VM were given 2.5 mg/kg of morphine sulfate, four times daily, for up to 59 weeks. Groups VM and V were inoculated with SIVmacR71/17E 26 weeks after the beginning of morphine administration. Morphine prevented the development of enzyme-linked immunosorbent spot-forming cell CMI responses in contrast to virus control animals, all of which developed CMI. Whereas morphine treatment had no effect on viremia, cerebrospinal fluid viral titers or survival over the time course of the study, the drug was associated with a tendency for greater build-up of virus in the brains of infected animals. Histopathological changes in the brains of animals that developed disease were of a demyelinating type in the VM animals compared to an encephalitic type in the V animals. This difference may have been associated with the immunosuppressive effect of the drug in inhibiting CMI responses.

A crossover study of risperidone in children, adolescents and adults with mental retardation.

Risperidone has shown safety and efficacy for aggressive and destructive behaviors in short-term studies. This longer-duration study includes a broad sample. Forty subjects, aged 8-56 years (mean=22), all with mental retardation and 36 with autism spectrum disorders participated in this 22-week crossover study, with 24 weeks of open maintenance thereafter. Of 40 subjects, 23 (57.5%) responded fully (50% decrease in Aberrant Behavior Checklist-Community Irritability subscale score), while 35 subjects (87.5%) showed a 25% decrease. Gender, mood disorder, and antiseizure medications did not alter response. Increased appetite and weight gain were common. Low dose risperidone was effective for aggressive behavior in persons with MR. More long-term studies are needed, incorporating weight control interventions.

Statistical analysis of data from studies on experimental autoimmune encephalomyelitis.

Research in multiple sclerosis often employs animal models of the disease, especially experimental autoimmune encephalomyelitis (EAE) in rodents. The statistical analysis procedures chosen for these studies are often suboptimal, either because of violations of the assumptions of the procedure or because the analysis selected is inappropriate for the research question. In this paper, we discuss the types of research questions frequently asked in EAE studies and suggest appropriate and useful research designs and statistical methods that will optimize the information contained within the data. We also discuss other troublesome issues such as missing data, atypical disease profiles, and power analysis.

Quantifying immunohistochemical staining of phospho-eIF2alpha, heme oxygenase-2 and NADPH cytochrome P450 reductase in oligodendrocytes during experimental autoimmune encephalomyelitis.

As a consequence of inflammation associated with multiple sclerosis and its animal model, experimental autoimmune encephalomyelitis (EAE), stress responses are induced in many cells within the CNS, however, those that occur within the primary pathological target, the oligodendrocyte, are not fully established. Recently, we found that phosphorylated eukaryotic initiation factor-2alpha (eIF2alpha), an inhibitor of protein translation associated with the stress response, is expressed in a greater number of oligodendrocytes in EAE animals compared to controls. However, since numerous oligodendrocytes in control animals also expressed phospho-eIF2alpha, a method was developed to detect expression levels within oligodendrocytes that did not rely on the number of oligodendrocytes that were stained. This method utilized a high dilution of the primary antibody so that the staining density was kept below a maximum plateau which could eliminate expression differences. Furthermore, the staining density within oligodendrocytes, as determined by image analysis, was corrected by the background density or that within neurons. In either case, the density of staining was greater in oligodendrocytes from EAE animals versus controls. The expression of heme oxygenase-2 and NADPH cytochrome P450 reductase also were examined, but unlike phospho-eIF2alpha, neither was increased in oligodendrocytes from EAE animals compared to controls. In summary, a protocol involving a high dilution of primary antibody and image analysis revealed that the expression of phospho-eIF2alpha within oligodendrocytes was increased in EAE animals compared to control animals.

Grammatical tense deficits in children with SLI and nonspecific language impairment: relationships with nonverbal IQ over time.

The relationship between children's language acquisition and their nonverbal intelligence has a long tradition of scientific inquiry. Current attention focuses on the use of nonverbal IQ level as an exclusionary criterion in the definition of specific language impairment (SLI). Grammatical tense deficits are known as a clinical marker of SLI, but the relationship with nonverbal intelligence below the normal range has not previously been systematically studied. This study documents the levels of grammatical tense acquisition (for third-person singular -s, regular and irregular past tense morphology) in a large, epidemiologically ascertained sample of kindergarten children that comprises 4 groups: 130 children with SLI, 100 children with nonspecific language impairments (NLI), 73 children with low cognitive levels but language within normal limits (LC), and 117 unaffected control children. The study also documents the longitudinal course of acquisition for the SLI and NLI children between the ages of 6 and 10 years. The LC group did not differ from the unaffected controls at kindergarten, showing a dissociation of nonverbal intelligence and grammatical tense marking, so that low levels of nonverbal intelligence did not necessarily yield low levels of grammatical tense. The NLI group's level of performance was lower than that of the SLI group and showed a greater delay in resolution of the overgeneralization phase of irregular past tense mastery, indicating qualitative differences in growth. Implications for clinical groupings for research and clinical purposes are discussed.

Prelinguistic predictors of language growth in children with developmental disabilities.

This study followed 18 children with developmental disabilities, whose chronological ages were between 3 years and 6 years at the start of the study, over a 2-year period. At initial observation, children communicated primarily through prelinguistic gestures, vocalizations, and single-word utterances. Children's language skills were measured every 6 months with the Sequenced Inventory of Communication Development-Revised (D. E. Hedrick, E. M. Prather, and A. R. Tobin, 1984). Prelinguistic communication rate and parental responsiveness were also measured at each observation. Development of language over time differed between participants in accordance with their entry-level communication. Hierarchical linear modeling indicated that children's level of gestural attainment, rate of communication, and parent response contingency were significant predictors of language outcome.