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1.
Artigo em Inglês | MEDLINE | ID: mdl-32076886

RESUMO

This study examines racial/ethnic differences in perceived need for mental health treatment, barriers to treatment receipt, and reasons for dropout. Data are from the Collaborative Psychiatric Epidemiology Studies, a pooled dataset from three U.S. nationally-representative adult samples. Among respondents with a 12-month psychiatric disorder who received no treatment (N = 1417), Asians and Latinos reported lower perceived need than Blacks and Whites, and Latinos reported the fewest attitudinal barriers. Among those with a 12-month disorder who dropped out of treatment, Asians and Latinos gave more reasons for dropping out. Significant interactions of race/ethnicity with other characteristics identified subpopulations with high unmet need.

2.
J Psychiatr Res ; 123: 54-61, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32036074

RESUMO

Research consistently documents high rates of mental health problems among college students and strong associations of these problems with academic role impairment. Less is known, though, about prevalence and effects of physical health problems in relation to mental health problems. The current report investigates this by examining associations of summary physical and mental health scores from the widely-used Short-Form 12 (SF-12) Health Survey with self-reported academic role functioning in a self-report survey of 3,855 first-year students from five universities in the northeastern United States (US; mean age 18.5; 53.0% female). The mean SF-12 physical component summary (PCS) score (55.1) was half a standard deviation above the benchmark US adult population mean. The mean SF-12 mental component summary (MCS) score (38.2) was more than a full standard deviation below the US adult population mean. Two-thirds of students (67.1%) reported at least mild and 10.5% severe health-related academic role impairment on a modified version of the Sheehan Disability Scale. Both PCS and MCS scores were significantly and inversely related to these impairment scores, but with nonlinearities and interactions and much stronger associations involving MCS than PCS. Simulation suggests that an intervention that improved the mental health of all students with scores below the MCS median to be at the median would result in a 61.3% reduction in the proportion of students who experienced severe health-related academic role impairment. Although low-cost scalable interventions exist to address student mental health problems, pragmatic trials are needed to evaluate the effectiveness of these interventions in reducing academic role impairment.

3.
JAMA Netw Open ; 3(2): e1921660, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32083693

RESUMO

Importance: Little guidance exists to date on how to select antipsychotic medications for patients with first-episode schizophrenia. Objective: To develop a preliminary individualized treatment rule (ITR) for patients with first-episode schizophrenia. Design, Setting, and Participants: This prognostic study obtained data from Taiwan's National Health Insurance Research Database on patients with prescribed antipsychotic medications, ambulatory claims, or discharge diagnoses of a schizophrenic disorder between January 1, 2005, and December 31, 2011. An ITR was developed by applying a targeted minimum loss-based ensemble machine learning method to predict treatment success from baseline clinical and demographic data in a 70% training sample. The model was validated in the remaining 30% of the sample. The probability of treatment success was estimated for each medication for each patient under the model. The analysis was conducted between July 16, 2018, and July 15, 2019. Exposures: Fifteen different antipsychotic medications. Main Outcomes and Measures: Treatment success was defined as not switching medication and not being hospitalized for 12 months. Results: Among the 32 277 patients in the analysis, the mean (SD) age was 36.7 (14.3) years, and 15 752 (48.8%) were male. In the validation sample, the treatment success rate (SE) was 51.7% (1.0%) under the ITR and was 44.5% (0.5%) in the observed population (Z = 7.1; P < .001). The estimated treatment success if all patients were given a prescription for 1 medication was significantly lower for each of the 13 medications than under the ITR (Z = 4.2-16.8; all P < .001). Aripiprazole (3088 [31.9%]) and amisulpride (2920 [30.2%]) were the medications most often recommended by the ITR. Only 1054 patients (10.9%) received ITR-recommended medications. Observed treatment success, although lower than the success under the ITR, was nonetheless significantly higher than if medications had been randomized (44.5% [SE, 0.55%] vs 41.3% [SE, 0.4%]; Z = 6.9; P < .001), although only marginally higher than if medications had been randomized in their observed population proportions (44.5% [SE, 0.5%] vs 43.5% [SE, 0.4%]; Z = 2.2; P = .03]). Conclusions and Relevance: These results suggest that an ITR may be associatded with an increase in the treatment success rate among patients with first-episode schizophrenia, but experimental evaluation is needed to confirm this possibility. If confirmed, model refinement that investigates biomarkers, clinical observations, and patient reports as additional predictors in iterative pragmatic trials would be needed before clinical implementation.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31814153

RESUMO

OBJECTIVE: There is growing interest in the development of composite precision treatment rules (PTRs) to guide the selection of the treatments most likely to be helpful for individual patients. We present here the results of an effort to develop a preliminary PTR for Collaborative Assessment and Management of Suicidality (CAMS) relative to enhanced-care as usual based on secondary analysis of the Operation Worth Living (OWL) randomized controlled trial. The outcome of interest is eliminating suicide ideation (SI) within 3 months of initiating treatment. METHOD: A state-of-the-art ensemble machine learning method was used to develop the PTR among the n = 148 U.S. Soldiers (predominately male and White, age range 18-48) OWL patients. RESULTS: We estimated that CAMS was the better treatment for 77.8% of patients and that treatment assignment according to the PTR would result in a 13.6% (95% CI: 0.9%-26.3%) increase in 3-month SI remission compared to random treatment assignment. CONCLUSIONS: Although promising, results are limited by the small sample size, restrictive baseline assessment, and inability to evaluate effects on suicidal behaviors or disaggregate based on history of suicidal behaviors. Replication is needed in larger samples with comprehensive baseline assessments, longer-term follow-ups, and more extensive outcomes.

5.
Liver Int ; 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31755208

RESUMO

AIMS: As previous reports show an association of chronic hepatitis C (HCV) with hepatocellular carcinoma (HCC) and non-liver cancers, we examine the association of HCV with liver cancer and non-liver cancers. METHODS: Retrospective cross-sectional study at Kaiser Permanente Southern California (KPSC) evaluating HCV and non-HCV patients from 1 January 2008 to 12 December 2012. Cancer diagnoses were obtained from the KPSC-SEER-affiliated registry. Logistic regression analyses were used for rate ratios and time-to-event analyses were performed using Cox proportional hazards models, adjusted for age, gender, race, smoking and cirrhosis. Cancer rate ratios were stratified by tobacco, alcohol abuse, diabetes and body mass index (BMI). RESULTS: The initial population and final population of multivariable analysis were N = 5 332 903 and N = 2 080 335 respectively. Cancer burden (all sites) was significantly higher in HCV than in non-HCV patients and HCV patients had a high rate of liver cancer. When liver cancer was excluded, cancer rates remained significantly increased in HCV. Unadjusted cancer rates were significantly higher in HCV compared to non-HCV for oesophageal, stomach, colorectal, pancreas, myeloma, non-Hodgkin's lymphoma, head/neck, lung, renal and prostate cancer. After stratification for alcohol abuse, tobacco, diabetes and BMI, increased cancer rates remained significant for all cancer sites, liver cancer and non-Hodgkin's lymphoma. Multivariable analyses demonstrated a strong correlation between cirrhosis and cancer. Tobacco use and diabetes were also associated with cancer. In the absence of cirrhosis, HCV, tobacco use and diabetes significantly increased the cancer risk. Mediation analyses showed that cirrhosis was responsible for a large proportion on the effect of HCV on cancer risk. CONCLUSION: This study supports the concept of HCV as a systemic illness and treating HCV regardless of disease severity and prior to progression to cirrhosis.

6.
J Psychiatr Res ; 119: 48-59, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31563857

RESUMO

The purpose of this study was to: (1) examine the associations of individual-level objective socioeconomic status (OSS), subjective socioeconomic status (SSS), and area-based indicators of socioeconomic status, with 12-month DSM-IV mood, anxiety, alcohol use, and drug use disorders; and, (2) determine the extent of racial/ethnic differences in these associations across non-Latino White, non-Latino Black, Latino, and Asian participants. Data are from the Collaborative Psychiatric Epidemiology Studies dataset, a collection of three population-based surveys of mental disorders among U.S. residents aged 18 and older (n = 13,775). Among all indicators of socioeconomic status, SSS was most consistently associated with 12-month mental disorders. Income was negatively associated with mood and anxiety disorders; education was negatively associated with alcohol use and drug use disorders. Significant interactions with race/ethnicity were found for the associations of socioeconomic indicators with anxiety, alcohol use, and drug use disorders but not with mood disorders. SSS was not associated with any of the 12-month mental disorders among Blacks. Education had stronger associations with 12-month anxiety and alcohol use disorders among Whites than among other racial/ethnic groups. Among Asians, low income compared to high income was associated with a lower risk of anxiety disorders and less than high school completion compared to college or more was associated with a lower risk of alcohol use disorders. Finally, tract-level income inequality was associated with a greater risk of drug use disorders only among Blacks. The patterns and magnitudes of the associations of individual-level and area-based socioeconomic indicators differed by type of disorder and race/ethnicity.

7.
Asian Pac J Allergy Immunol ; 37(2): 73-86, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29888928

RESUMO

BACKGROUND: Little is known concerning the relative effectiveness of LTRAs compared to ICSs as monotherapy or LABA as add-on therapy in the Asian population. OBJECTIVES: In this retrospective cohort study, we examined the comparative effectiveness of montelukast to ICS as a first-line monotherapy and as an add-on in comparison with LABA on asthma exacerbations among Asian and non -Hispanic white persistent asthma patients in a large managed care organization. METHODS: The three add-on comparisons were montelukast plus low-dose ICS versus LABA plus low-dose ICS, montelukast plus low-dose ICS versus medium-dose ICS, and montelukast plus medium-dose ICS versus LABA plus medium-dose ICS. Patients were identified based on ICD-9 diagnosis codes and administrative pharmacy dispensing. Exacerbations were defined as asthma emergency department visit or hospitalization, or asthma outpatient visits requiring systemic corticosteroid dispensing. Patient demographic and clinical characteristics were balanced by using inverse probability treatment weighting. Multivariable robust Poisson and Cox-proportional hazards regression models were applied to estimate rate ratios and hazard ratios. RESULTS: Compared with low-dose ICS monotherapy, montelukast monotherapy evidenced a lower incidence rate (RR 0.89, CI 0.79-0.99, p = 0.03) but similar hazard rate (HR 0.96, CI 0.86-1.06, p = 0.43) of asthma exacerbation in white patients 12 years of age or older. No difference was observed in Asian patients or in white children 4-11 years of age. All other comparisons did not reveal a statistically significant difference in incidence or hazard rate. CONCLUSION: In a real-world comparative effectiveness study, asthma exacerbation rates were similar among guideline alternative controller regimens in Asians and whites.


Assuntos
Grupo com Ancestrais do Continente Asiático , Asma/terapia , Grupo com Ancestrais do Continente Europeu , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Antiasmáticos/administração & dosagem , Antiasmáticos/efeitos adversos , Antiasmáticos/uso terapêutico , Asma/diagnóstico , Criança , Pré-Escolar , Gerenciamento Clínico , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Projetos de Pesquisa , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
Psychol Med ; 49(13): 2215-2226, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30378513

RESUMO

BACKGROUND: The prevalence of mental disorders among Black, Latino, and Asian adults is lower than among Whites. Factors that explain these differences are largely unknown. We examined whether racial/ethnic differences in exposure to traumatic events (TEs) or vulnerability to trauma-related psychopathology explained the lower rates of psychopathology among racial/ethnic minorities. METHODS: We estimated the prevalence of TE exposure and associations with onset of DSM-IV depression, anxiety and substance disorders and with lifetime post-traumatic stress disorder (PTSD) in the Collaborative Psychiatric Epidemiology Surveys, a national sample (N = 13 775) with substantial proportions of Black (35.9%), Latino (18.9%), and Asian Americans (14.9%). RESULTS: TE exposure varied across racial/ethnic groups. Asians were most likely to experience organized violence - particularly being a refugee - but had the lowest exposure to all other TEs. Blacks had the greatest exposure to participation in organized violence, sexual violence, and other TEs, Latinos had the highest exposure to physical violence, and Whites were most likely to experience accidents/injuries. Racial/ethnic minorities had lower odds ratios of depression, anxiety, and substance disorder onset relative to Whites. Neither variation in TE exposure nor vulnerability to psychopathology following TEs across racial/ethnic groups explained these differences. Vulnerability to PTSD did vary across groups, however, such that Asians were less likely and Blacks more likely to develop PTSD following TEs than Whites. CONCLUSIONS: Lower prevalence of mental disorders among racial/ethnic minorities does not appear to reflect reduced vulnerability to TEs, with the exception of PTSD among Asians. This highlights the importance of investigating other potential mechanisms underlying racial/ethnic differences in psychopathology.

9.
Soc Psychiatry Psychiatr Epidemiol ; 54(5): 553-565, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30547212

RESUMO

PURPOSE: There has been no comprehensive examination of how race/ethnicity and nativity intersect in explaining differences in lifetime prevalence of mental disorders among Asian, Black, Latino, and White adults. This study aims to estimate racial/ethnic differences in lifetime risk of mental disorders and examine how group differences vary by nativity. METHODS: Survival models were used to estimate racial/ethnic and nativity differences in lifetime risk of DSM-IV anxiety, mood, and substance use disorders in a nationally representative sample of over 20,000 respondents to four US surveys. RESULTS: Asians had the lowest lifetime prevalence of mental disorders (23.5%), followed by Blacks (37.0%), Latinos (38.8%), and Whites (45.6%). Asians and Blacks had lower lifetime risk than Whites for all disorders even after adjusting for nativity; Latinos and Whites had similar risk after adjusting for nativity. Risk of disorder onset was lowest for foreign-born respondents in years before migration. There were significant race/ethnicity and nativity interactions for mood and substance use disorders. Odds of mood disorder onset were higher for Whites with at least one US-born parent. Odds of substance use disorder onset among Asians were higher for US-born respondents; for Latinos, they were higher for those with at least one US-born parent. CONCLUSIONS: Parental foreign-born nativity is associated with a low risk of mental disorders, but not uniformly across racial/ethnic groups or disorders. Exposure to the US context may be associated with greater mental disorder risk for Latinos and Whites particularly. Investigations of cultural processes, including among Whites, are needed to understand group differences.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Transtornos Mentais/etnologia , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Grupos de Populações Continentais/psicologia , Grupos Étnicos/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pais/psicologia , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
10.
Compr Psychiatry ; 89: 52-60, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30594752

RESUMO

BACKGROUND: Despite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders. METHOD: Data were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence. RESULTS: Non-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels. CONCLUSION: Nativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites.


Assuntos
Transtornos de Ansiedade/epidemiologia , Grupos de Populações Continentais/psicologia , Grupos Étnicos/psicologia , Transtornos do Humor/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Transtornos de Ansiedade/etnologia , Grupos de Populações Continentais/etnologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/etnologia , Prevalência , Classe Social , Transtornos Relacionados ao Uso de Substâncias/etnologia , Estados Unidos/epidemiologia
11.
Depress Anxiety ; 35(3): 195-208, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29356216

RESUMO

BACKGROUND: Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. METHODS: Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for "problems with emotions, nerves, mental health, or use of alcohol or drugs." Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). RESULTS: Of 51,547 respondents (response = 71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. CONCLUSIONS: Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.


Assuntos
Transtornos de Ansiedade/terapia , Saúde Global/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
World Psychiatry ; 16(3): 299-307, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28941090

RESUMO

Substance use is a major cause of disability globally. This has been recognized in the recent United Nations Sustainable Development Goals (SDGs), in which treatment coverage for substance use disorders is identified as one of the indicators. There have been no estimates of this treatment coverage cross-nationally, making it difficult to know what is the baseline for that SDG target. Here we report data from the World Health Organization (WHO)'s World Mental Health Surveys (WMHS), based on representative community household surveys in 26 countries. We assessed the 12-month prevalence of substance use disorders (alcohol or drug abuse/dependence); the proportion of people with these disorders who were aware that they needed treatment and who wished to receive care; the proportion of those seeking care who received it; and the proportion of such treatment that met minimal standards for treatment quality ("minimally adequate treatment"). Among the 70,880 participants, 2.6% met 12-month criteria for substance use disorders; the prevalence was higher in upper-middle income (3.3%) than in high-income (2.6%) and low/lower-middle income (2.0%) countries. Overall, 39.1% of those with 12-month substance use disorders recognized a treatment need; this recognition was more common in high-income (43.1%) than in upper-middle (35.6%) and low/lower-middle income (31.5%) countries. Among those who recognized treatment need, 61.3% made at least one visit to a service provider, and 29.5% of the latter received minimally adequate treatment exposure (35.3% in high, 20.3% in upper-middle, and 8.6% in low/lower-middle income countries). Overall, only 7.1% of those with past-year substance use disorders received minimally adequate treatment: 10.3% in high income, 4.3% in upper-middle income and 1.0% in low/lower-middle income countries. These data suggest that only a small minority of people with substance use disorders receive even minimally adequate treatment. At least three barriers are involved: awareness/perceived treatment need, accessing treatment once a need is recognized, and compliance (on the part of both provider and client) to obtain adequate treatment. Various factors are likely to be involved in each of these three barriers, all of which need to be addressed to improve treatment coverage of substance use disorders. These data provide a baseline for the global monitoring of progress of treatment coverage for these disorders as an indicator within the SDGs.

13.
Ann Intern Med ; 167(2): 85-94, 2017 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-28631003

RESUMO

Background: Yoga is effective for mild to moderate chronic low back pain (cLBP), but its comparative effectiveness with physical therapy (PT) is unknown. Moreover, little is known about yoga's effectiveness in underserved patients with more severe functional disability and pain. Objective: To determine whether yoga is noninferior to PT for cLBP. Design: 12-week, single-blind, 3-group randomized noninferiority trial and subsequent 40-week maintenance phase. (ClinicalTrials.gov: NCT01343927). Setting: Academic safety-net hospital and 7 affiliated community health centers. Participants: 320 predominantly low-income, racially diverse adults with nonspecific cLBP. Intervention: Participants received 12 weekly yoga classes, 15 PT visits, or an educational book and newsletters. The maintenance phase compared yoga drop-in classes versus home practice and PT booster sessions versus home practice. Measurements: Primary outcomes were back-related function, measured by the Roland Morris Disability Questionnaire (RMDQ), and pain, measured by an 11-point scale, at 12 weeks. Prespecified noninferiority margins were 1.5 (RMDQ) and 1.0 (pain). Secondary outcomes included pain medication use, global improvement, satisfaction with intervention, and health-related quality of life. Results: One-sided 95% lower confidence limits were 0.83 (RMDQ) and 0.97 (pain), demonstrating noninferiority of yoga to PT. However, yoga was not superior to education for either outcome. Yoga and PT were similar for most secondary outcomes. Yoga and PT participants were 21 and 22 percentage points less likely, respectively, than education participants to use pain medication at 12 weeks. Improvements in yoga and PT groups were maintained at 1 year with no differences between maintenance strategies. Frequency of adverse events, mostly mild self-limited joint and back pain, did not differ between the yoga and PT groups. Limitations: Participants were not blinded to treatment assignment. The PT group had disproportionate loss to follow-up. Conclusion: A manualized yoga program for nonspecific cLBP was noninferior to PT for function and pain. Primary Funding Source: National Center for Complementary and Integrative Health of the National Institutes of Health.


Assuntos
Dor Crônica/terapia , Dor Lombar/terapia , Educação de Pacientes como Assunto , Modalidades de Fisioterapia , Ioga , Adulto , Dor Crônica/etnologia , Pesquisa Comparativa da Efetividade , Feminino , Seguimentos , Humanos , Dor Lombar/etnologia , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Modalidades de Fisioterapia/efeitos adversos , Pobreza , Método Simples-Cego , Resultado do Tratamento
14.
J Allergy Clin Immunol Pract ; 5(1): 144-153.e8, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27665383

RESUMO

BACKGROUND: Severe uncontrolled asthma (SUA) is associated with increased asthma exacerbations. Whether high blood eosinophil counts are related to this burden is uncertain. OBJECTIVES: To determine the relationship of blood eosinophil counts to asthma exacerbations, utilization, and cost in patients with SUA. METHODS: Patients with persistent asthma (age ≥ 12 years) were identified administratively with SUA in phase I by evidencing (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting ß2-agonist; and (3) 3 or more dispensed non-ICS controllers. Of the 541 patients with SUA invited to participate in the prospective phase II follow-up study, 261 (48.2%) had blood tests (index date) to determine eosinophil count and other atopic biomarkers. The relationship of blood eosinophil cutoff points to asthma exacerbations and direct costs 1 year after the index date were determined by multivariable regression. RESULTS: A blood eosinophil cutoff point of greater than or equal to 400 cells/mm3 compared with less than 400 cells/mm3, but not 150 cells/mm3 or 300 cells/mm3, was a risk factor in the outcome year in adjusted analyses for 2 or more asthma exacerbations (risk ratio, 1.55; 95% CI, 1.02-2.35; P =.04) and any asthma emergency department visit or hospitalization (risk ratio, 2.29; 95% CI, 1.16-4.55; P =.02), but not for rate of asthma exacerbations or incremental total direct asthma costs per patient ($202; 95% CI, -286 to 691). CONCLUSIONS: A high blood eosinophil count was an independent risk factor for 2 or more asthma exacerbations or any asthma emergency department visit or hospitalization, but not direct costs in patients with SUA, possibly constrained by limited power.


Assuntos
Asma/diagnóstico , Células Sanguíneas/patologia , Eosinófilos/patologia , Adulto , Idoso , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Biomarcadores , Contagem de Células , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Resultado do Tratamento
15.
J Midwifery Womens Health ; 61(4): 419-26, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27336953

RESUMO

INTRODUCTION: Little is known about the changes in prevalence of dietary supplement use in pregnancy, postpartum, and in a comparison group of nonpregnant women. METHODS: We conducted a secondary analysis of the Infant Feeding Practices II study. The purpose of this study is to report the prevalence of herbal or botanical and nonvitamin, nonmineral dietary supplement use by US women with respect to demographic, behavioral, and health factors. We compared pregnant and postpartum women to a comparison group of nonpregnant women who had not given birth in the past 12 months. Our main outcome was the prevalence of dietary supplements. Multiple logistic regression models were used to examine factors associated with herbal or botanical and nonvitamin, nonmineral dietary supplement use during reproductive age, pregnancy, and postpartum. RESULTS: The total sample included 1444 women assessed during the prenatal period, 1422 from the postpartum period, and 1517 women in a comparison group. In terms of herb or botanical use, 15% of the prenatal group, 16% of the postpartum group, and 22% of the comparison group reported using herbs or botanicals. The most frequently used nonvitamin, nonmineral supplement was omega-3 fatty acid. Among the total prenatal group and comparison group, women eating 5 or more servings of fruits or vegetables were less likely to report using herbs or botanicals. Women in the comparison group self-identifying as black were 4 times as likely to report using herbs or botanicals compared to participants self-identifying as white. In addition, women identifying as a race other than white were almost twice as likely to report herb or botanical use across all study groups. DISCUSSION: This is one of the rare studies that shows the changing prevalence of herbs or botanicals and nonvitamin, nonmineral dietary supplement use in women in the reproductive stage of their lives.


Assuntos
Suplementos Nutricionais/estatística & dados numéricos , Ácidos Graxos Ômega-3 , Comportamento Materno , Preparações de Plantas , Plantas Medicinais , Período Pós-Parto , Gravidez , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Modelos Logísticos , Estados Unidos
16.
Contemp Clin Trials ; 45(Pt B): 151-156, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26343332

RESUMO

BACKGROUND: The Re-Engineered Discharge (Project RED) reduces 30-day readmission rates by 30%. However, our data indicates that for patients displaying depressive symptoms during hospitalization, Project RED is less effective in preventing unplanned readmission. We aim to examine the effectiveness of RED-D, a modified brief Cognitive behavioral therapy (CBT) protocol delivered as a post-discharge extension of the Re-Engineered Discharge, in reducing 30-day readmissions rates and emergency department (ED) use as well as depressive symptoms for medical patients with comorbid depressive symptoms. METHODS: This paper details the study design and implementation of an ongoing, federally funded randomized controlled trial of our post-discharge mental health intervention, RED-D, compared to the RED plus usual care. This research has two primary objectives: (1) to determine whether RED-D delivered telephonically by a mental health professional immediately following discharge is effective in reducing hospital readmission and emergency department use for patients displaying depressive symptoms during their inpatient stay, and (2) to examine whether this approach yields a clinically significant reduction in depressive symptoms. We intend to recruit 1200 participants randomized to our intervention, RED-D (n=600), and to RED plus usual care (n=600). CONCLUSIONS: Hospitalized patients with depressive symptoms are at increased risk for 30-day readmission. We aim to conduct a randomized clinical trial to evaluate the comparative effectiveness of RED-D, our post-discharge modified brief CBT intervention compared to RED alone in reducing readmissions and depressive symptoms for this at-risk population.


Assuntos
Terapia Cognitivo-Comportamental/organização & administração , Depressão/epidemiologia , Depressão/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Comportamento Cooperativo , Depressão/diagnóstico , Humanos , Serviços de Saúde Mental/organização & administração , Equipe de Assistência ao Paciente , Projetos de Pesquisa
17.
J Altern Complement Med ; 21(10): 638-44, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26270001

RESUMO

BACKGROUND: Little is known about the feasibility of online education in improving communication and documentation of dietary supplements (DS) among clinicians. METHODS: This prospective educational study included clinicians at an urban teaching hospital. The curriculum included video streams, didactics, and interactive case presentations to discuss (1) DS safety and effectiveness, (2) cultural competency, (3) managing DS in a hospital setting, and (4) DS adverse events. Participants were surveyed, at baseline and after training, about DS knowledge, confidence, communication, and documentation practices. RESULTS: Thirty-nine of 61 (64%) recruited clinicians completed all four patient cases and post-tests. Most (82%) were women and 59% were physicians. The mean DS knowledge test score increased after the curriculum (p < 0.0001), and the clinician confidence score also increased (p < 0.0001). Most (82%) participants reported that curriculum changed their use of evidence-based resources (p = 0.01). There was a change in the indications for symptom management (p = 0.05) and gastrointestinal/digestive health issues (p = 0.03). There were statistically significant increases in the frequency of asking patients about DS use during discharge (p = 0.01), and 82% responded that the curriculum changed their DS documentation. CONCLUSION: An online curriculum is an effective tool for presenting DS education to clinicians with the goal of improving clinicians' knowledge, confidence, and documentation practices about DS.


Assuntos
Competência Clínica , Comunicação , Currículo , Suplementos Nutricionais , Documentação , Pessoal de Saúde/educação , Internet , Adulto , Competência Cultural , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Médicos , Padrões de Prática Médica , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
18.
J Am Board Fam Med ; 28(4): 441-51, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26152434

RESUMO

BACKGROUND: Systems and tools are needed to identify and mitigate preconception health (PCH) risks, particularly for African American (AA) women, given persistent health disparities. We developed and tested "Gabby," an online preconception conversational agent system. METHODS: One hundred nongravid AA women 18-34 years of age were screened for over 100 PCH risks and randomized to the Gabby or control group. The Gabby group interacted with the system for up to six months; the control group received a letter indicating their health risks with a recommendation to talk with their clinician. The numbers, proportions, and types of risks were compared between groups. RESULTS: There were 23.7 (SD 5.9) risks identified per participant. Eighty-five percent (77 of 91) provided 6 month follow up data. The Gabby group had greater reductions in the number (8.3 vs. 5.5 risks, P < .05) and the proportion (27.8% vs 20.5%, P < 0.01) of risks compared to controls. The Gabby group averaged 63.7 minutes of interaction time. Seventy-eight percent reported that it "was easy to talk to Gabby" and 64% used information from Gabby to improve their health. CONCLUSION: Gabby was significantly associated with preconception risk reduction. More research is needed to determine if Gabby can benefit higher risk populations and if risk reduction is clinically significant.


Assuntos
Afro-Americanos , Promoção da Saúde/métodos , Disparidades nos Níveis de Saúde , Aplicações da Informática Médica , Cuidado Pré-Concepcional/métodos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Internet , Entrevista Motivacional , Participação do Paciente , Relações Profissional-Paciente , Medição de Risco/métodos , Comportamento de Redução do Risco , Estados Unidos , Adulto Jovem
19.
Complement Ther Med ; 23(3): 405-12, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26051576

RESUMO

OBJECTIVE: Little is known about the use of Stress Management and Relaxation Techniques (SMART) in racially diverse inpatients. We hope to identify socioeconomic status (SES) factors, health behavior factors, and clinical factors associated with the use of SMART. DESIGN AND MAIN OUTCOME MEASURES: We conducted a secondary analysis of baseline data from 623 hospitalized patients enrolled in the Re-Engineered Discharge (RED) clinical trial. We assessed socio-demographic characteristics and use of SMART. We used bivariate and multivariate logistic regression to test the association of SMART with socio-demographic characteristics, health behaviors, and clinical factors. RESULTS: A total of 26.6% of participants reported using SMART and 23.6% used mind body techniques. Thirty six percent of work disabled patients, 39% of illicit drug users, and 38% of participants with depressive symptoms used SMART. Patients who both reported illicit drug use and screened positive for depression had significantly increased odds of using SMART [OR=4.94, 95% CI (1.59, 15.13)]. Compared to non-Hispanic whites, non-Hispanic blacks [0.55 (0.34-0.87)] and Hispanic/other race individuals [0.40 (0.20-0.76)] were less likely to use SMART. CONCLUSIONS: We found greater utilization of SMART among all racial groups compared to previous national studies. In the inner city inpatient setting, patients with depression, illicit drug use, and work disability reported higher rates of using SMART.


Assuntos
Hospitais Urbanos/estatística & dados numéricos , Terapia de Relaxamento/estatística & dados numéricos , Estresse Psicológico/terapia , Populações Vulneráveis/estatística & dados numéricos , Adulto , Feminino , Alfabetização em Saúde , Humanos , Masculino , Pessoa de Meia-Idade
20.
Artigo em Inglês | MEDLINE | ID: mdl-25949262

RESUMO

Purpose. To identify characteristics associated with the use of potentially harmful combinations of dietary supplements (DS) and cardiac prescription medications in an urban, underserved, inpatient population. Methods. Cardiac prescription medication users were identified to assess the prevalence and risk factors of potentially harmful dietary supplement-prescription medication interactions (PHDS-PMI). We examined sociodemographic and clinical characteristics for crude (χ (2) or t-tests) and adjusted multivariable logistic regression associations with the outcome. Results. Among 558 patients, there were 121 who also used a DS. Of the 110 participants having a PHDS-PMI, 25% were asked about their DS use at admission, 75% had documentation of DS in their chart, and 21% reported the intention to continue DS use after discharge. A multivariable logistic regression model noted that for every additional medication or DS taken the odds of having a PHDS-PMI increase and that those with a high school education are significantly less likely to have a PHDS-PMI than those with a college education. Conclusion. Inpatients at an urban safety net hospital taking a combination of cardiac prescription medications and DS are at a high risk of harmful supplement-drug interactions. Providers must ask about DS use and should consider the potential for interactions when having patient discussions about cardiac medications and DS.

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