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1.
Pediatr Transplant ; 27(8): e14577, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37563804

RESUMO

BACKGROUND: A significant number of pediatric heart transplant recipients and their families experience post-traumatic stress symptoms following transplantation, which can impact recipient behavioral and medical health outcomes. Preventive behavioral health interventions may improve outcomes, especially if interventions can be delivered at a distance to decrease barriers to mental health care. This pilot study examined the acceptability and accessibility of an evidence-informed resilience training program delivered using a video telehealth platform. A secondary aim was to assess the preliminary efficacy of the intervention on recipient behavioral health outcomes, perceived barriers to recipient medication adherence, parent behavioral health outcomes, and family functioning. METHODS: Seventeen heart transplant recipients (8-18 years old) and their families were recruited and randomly assigned to a treatment as usual (n = 8) or an intervention group (n = 9). Baseline assessment data collected included demographic information and validated behavioral health measures. Follow-up assessments included the validated measures and acceptability and satisfaction ratings. RESULTS: The study demonstrated that the program has high acceptability by recipients and parents, and a positive impact on recipients and parents, including significant reductions in youth behavioral difficulties as well as parent depression and post-traumatic stress symptoms. CONCLUSIONS: Results of this study are promising and call for further evaluation of hybrid delivery models for behavioral health screening and prevention interventions for pediatric heart transplant recipients and their families.


Assuntos
Transplante de Coração , Telemedicina , Adolescente , Criança , Humanos , Projetos Piloto , Pais/psicologia , Depressão , Transplante de Coração/psicologia
2.
Prev Sci ; 24(7): 1302-1313, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37243867

RESUMO

Evidence-based health interventions are frequently translated into real-world settings where practical needs drive changes to intervention protocols. Due to logistical and resource constraints, these naturally arising adaptations are rarely assessed for comparative effectiveness using a randomized trial. Nevertheless, when observational data are available, it is still possible to identify beneficial adaptations using statistical methods that adjust for differences among intervention groups. As implementation continues and more data are collected and assessed, we also require analysis methods that ensure low statistical error rates as multiple comparisons are made over time. This paper describes how to create a statistical analysis plan for evaluating adaptations to an intervention during ongoing implementation. This can be done by combining methods commonly used in platform clinical trials with methods used for real-world data. We also demonstrate how to use simulations based on previous data to decide the frequency with which to conduct statistical analyses. The illustration uses data from large-scale implementation of a school-based resilience and skill-building preventive intervention to which several adaptations were made. The proposed statistical analysis plan for evaluating the school-based intervention has potential to improve population-level outcomes as implementation scales up further and additional adaptations are anticipated.

3.
Child Psychiatry Hum Dev ; 54(1): 76-83, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34357501

RESUMO

The KidCOPE is a widely used measure designed to examine how children cope in the face of stressful events. The current study aimed to replicate the factor structure of the KidCOPE found in four prior studies. KidCOPE responses from children of military families (2256 children, ages 7-12 years, 47.9% female, Age M = 8.90, SD = 1.62) enrolled in the Families OverComing Under Stress (FOCUS) at baseline were used. No prior factor structure could be replicated. The sample was then split, and exploratory and confirmatory factor analyses were conducted. A 2-factor model including factors for generally positive and negative coping was identified; but not confirmed. Overall, this study supports prior research suggesting limitations of the KidCOPE as a valid measure of coping style.


Assuntos
Família Militar , Militares , Humanos , Feminino , Criança , Masculino , Adaptação Psicológica , Estresse Psicológico , Análise Fatorial
4.
Child Psychiatry Hum Dev ; 53(5): 964-979, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-33963489

RESUMO

Military-connected families face many challenges associated with military life transitions, including deployment separations. We report on a randomized controlled trial to evaluate the efficacy of Families OverComing Under Stress-Early Childhood (FOCUS-EC) delivered through an in-home, virtual telehealth platform. FOCUS-EC is a trauma-informed, family-centered preventive intervention designed to promote family resilience and well-being. Military-connected families with 3- to 6-year-old children (194 mothers; 155 fathers; 199 children) were randomized to FOCUS-EC or an online education condition. Parent psychological health symptoms, child behavior, parenting, and parent-child relationships were examined by parent-report and observed interaction tasks for up to 12 months. Longitudinal regression models indicated that FOCUS-EC families demonstrated significantly greater improvements than online education families in parent-reported and observational measures of child behavior, parenting practices, and parent-child interaction, as well as greater reductions in parent posttraumatic stress symptoms. Findings provide support for the benefit of a virtually-delivered preventive intervention for military-connected families.


Assuntos
Família Militar , Resiliência Psicológica , Criança , Pré-Escolar , Saúde da Família , Feminino , Humanos , Família Militar/psicologia , Poder Familiar/psicologia , Pais/psicologia
5.
Am J Epidemiol ; 190(5): 728-737, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-32830844

RESUMO

We examined associations between maternal smoking and autism spectrum disorder (ASD) in children in a statewide population-based cohort and sibling-comparison design using California birth records (n = 2,015,104) with information on maternal smoking, demographic factors, and pregnancy (2007-2010). ASD cases (n = 11,722) were identified through California Department of Developmental Services records with diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders-IV-TR. We estimated odds ratios for ASD with and without intellectual disability in the full cohort using logistic regression and in a sibling comparison using conditional logistic regression. In the full cohort, the adjusted odds ratio for ASD and maternal smoking 3 months before/during pregnancy compared with nonsmoking was 1.15 (95% confidence interval (CI): 1.04, 1.26), and it was similar in cases with (odds ratio = 1.12, 95% CI: 0.84, 1.49) and without intellectual disability (odds ratio = 1.15, 95% CI: 1.04, 1.27). Heavy prenatal smoking (≥20 cigarettes/day in any trimester) was related to an odds ratio of 1.55 (95% CI: 1.21, 1.98). In the sibling comparison, the odds ratio for heavy smoking was similarly elevated but the confidence interval was wide. Our findings are consistent with an increased risk for ASD in offspring of mothers who smoked ≥20 cigarettes/day during pregnancy; associations with lighter smoking were weaker.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal , Irmãos , Fumar/epidemiologia , California/epidemiologia , Criança , Feminino , Humanos , Masculino , Gravidez , Sistema de Registros
6.
BMC Health Serv Res ; 21(1): 703, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271912

RESUMO

BACKGROUND: Depression causes significant morbidity, which impacts mental health, overall general health outcomes, everyday functioning and quality of life. This study aims to contribute to knowledge in the field through enhanced understanding of factors that influence depression response and remission, with consideration for design of treatment services to optimize depression outcomes within integrated care programs. METHODS: Using routine behavioral health screening and electronic health record data, we identified a retrospective cohort consisting of 615 adult patients receiving depression treatment within an integrated care program. Cohort member Patient Health Questionnaire (PHQ-9) data was analyzed for the 6 months following initiation of treatment. Multinomial regression models were estimated to identify factors associated with depression treatment response (PHQ-9 < 10) and remission (PHQ-9 < 5). RESULTS: At 6 months, 47% of patients demonstrated treatment response and 16% demonstrated remission. Baseline trauma symptoms and suicidal ideation were significantly associated with decreased odds of achieving remission (Odds Ratio (95% CI) [OR] = 0.45 (0.23, 0.88) and OR = 0.49 (0.29, 0.82), respectively). In fully adjusted models, baseline suicidal ideation remained significant (OR = 0.53 (0.31, 0.89)) and some evidence of an association persisted for baseline trauma symptoms (OR = 0.51 (0.25, 1.01)). CONCLUSIONS: After controlling for baseline depression symptoms, the presence of suicidal ideation is associated with reduced likelihood of remission. Increased understanding of factors associated with depression treatment outcomes may be employed to help guide the delivery and design of clinical services. Alongside routine screening for co-morbid anxiety, suicidal ideation and traumatic stress should be assessed and considered when designing depression treatment services.


Assuntos
Prestação Integrada de Cuidados de Saúde , Depressão , Adulto , Depressão/epidemiologia , Depressão/terapia , Humanos , Qualidade de Vida , Estudos Retrospectivos , Ideação Suicida
7.
J Trauma Stress ; 33(3): 307-317, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32233043

RESUMO

Infants, toddlers, and preschool-aged children have unique developmental needs that render them vulnerable to challenges associated with parental military service. We used a sample of military-connected families with 3-6-year-old children (N = 104) to examine associations among children's socioemotional development and fathers' trauma-related deployment experiences, including perceived threat during deployment and exposure to combat and the aftermath of battle. Of these potential stressors, only paternal perceived threat during deployment was significantly associated with measures of mother-reported child adjustment. Fathers' perceived threat during deployment was associated with child behavior problems even after accounting for demographic variables and current paternal symptoms of posttraumatic stress, depression, and anxiety, ß = .36, p = .007. The association between fathers' perceived threat during deployment and child behavior problems was mediated by several family processes related to emotion socialization, including father-reported sensitive parenting, indirect effect (IE) B = 0.106, 95% CI [0.009, 0.236]; parent-child dysfunctional interaction, IE B = 0.119, 95% CI [0.014, 0.252]; and mother-reported family emotional responsiveness, IE B = 0.119, 95% CI [0.011, 0.258]. Implications for future research on the intergenerational transmission of traumatic stress as well as prevention and intervention efforts for military-connected families with young children are discussed.


Assuntos
Comportamento Infantil/psicologia , Pai/psicologia , Destacamento Militar/psicologia , Família Militar/psicologia , Militares/psicologia , Adulto , Ansiedade/diagnóstico , Ansiedade/psicologia , Criança , Pré-Escolar , Relações Pai-Filho , Feminino , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Guerra/psicologia
8.
AIDS Behav ; 22(10): 3117-3129, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29478146

RESUMO

For individuals living with human immunodeficiency virus (HIV), viral suppression positively affects quality and length of life and reduces risks for HIV transmission. Men of color who have sex with men (MoCSM) who have been diagnosed with HIV have disproportionately low rates of viral suppression, with concomitant increases in incidence. We identified specific social, structural, and psychiatric factors associated with viral suppression among a sample of 155 HIV-positive MoCSM. Cigarette smoking and biological markers of recent drug use were significantly associated with detectable viral load. In contrast, individuals reporting a history of psychiatric illness during medical examination were more likely to be virally suppressed. Further analyses demonstrated that psychiatric illness may affect virologic outcomes through increased probability of being prescribed HIV medications. Alternatively, cigarette smoking and drug use appear to negatively affect subsequent HIV Care Continuum milestones such as medication adherence. Findings provide support for comprehensive intervention programs that emphasize prevention and treatment of cigarette, methamphetamine, and other drug use, and promote improved connection to psychiatric care. Continual achievement of this goal may be a crucial step to increase rates of viral suppression and slow HIV incidence in communities of MoCSM in Los Angeles and other urban areas.


Assuntos
Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Homossexualidade Masculina/estatística & dados numéricos , Adesão à Medicação/psicologia , Transtornos Mentais/epidemiologia , Grupos Minoritários/psicologia , Carga Viral/efeitos dos fármacos , Adolescente , Adulto , Continuidade da Assistência ao Paciente , Infecções por HIV/psicologia , Humanos , Los Angeles/epidemiologia , Masculino , Adesão à Medicação/estatística & dados numéricos , Transtornos Mentais/psicologia , Prevalência , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/psicologia , População Urbana , Adulto Jovem
9.
J Pediatr Nurs ; 43: 62-68, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30473158

RESUMO

PURPOSE: The primary goal of this study was to test the feasibility of an educational online self-assessment of burnout, resilience, trauma, depression, anxiety, and common workplace stressors among nurses working in a pediatric intensive care unit or neonatal intensive care unit setting. The secondary, exploratory objectives were to estimate the prevalence of psychiatric symptoms in this sample and to identify those variables that most strongly predict burnout. DESIGN AND METHODS: Data from optional and anonymous online measures were analyzed for 115 nurses (67.9% aged 25-44; 61.7% Caucasian) working in an urban children's hospital pediatric or neonatal ICU. Multiple linear regressions identified demographic variables and workplace stressors that significantly predicted each of three components of burnout. RESULTS: Most respondents found the educational assessment and feedback to be helpful. Choosing nursing as a second career was associated with better resilience. Having worked in ICU settings longer and being older were both linked to lower levels of anxiety. Predictors of burnout varied across the three burnout subscales. CONCLUSIONS: Implementation of an online self-assessment with immediate educational feedback is feasible in critical care settings. The variability of predictors across the three burnout subscales indicates the need for tailored interventions for those at risk. Future research may include follow-up of nurses to examine changes in scores over time and expansion of the tool for other medical personnel. PRACTICE IMPLICATIONS: An educational online self-assessment can be a helpful tool for pediatric critical care nurses experiencing varying degrees of burnout and distress.


Assuntos
Esgotamento Profissional/psicologia , Cuidados Críticos/métodos , Saúde Mental , Comportamento de Redução do Risco , Autoavaliação (Psicologia) , Adulto , Pré-Escolar , Educação a Distância , Estudos de Viabilidade , Retroalimentação , Feminino , Hospitais Pediátricos , Humanos , Lactente , Unidades de Terapia Intensiva Neonatal , Unidades de Terapia Intensiva Pediátrica , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Enfermagem Neonatal/métodos , Enfermagem Pediátrica/métodos , Projetos Piloto , Qualidade de Vida , Estados Unidos , Adulto Jovem
11.
Stat Med ; 35(24): 4459-4473, 2016 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-27324278

RESUMO

Understanding the impact of concurrency, defined as overlapping sexual partnerships, on the spread of HIV within various communities has been complicated by difficulties in measuring concurrency. Retrospective sexual history data consisting of first and last dates of sexual intercourse for each previous and ongoing partnership is often obtained through use of cross-sectional surveys. Previous attempts to empirically estimate the magnitude and extent of concurrency among these surveyed populations have inadequately accounted for the dependence between partnerships and used only a snapshot of the available data. We introduce a joint multistate and point process model in which states are defined as the number of ongoing partnerships an individual is engaged in at a given time. Sexual partnerships starting and ending on the same date are referred to as one-offs and modeled as discrete events. The proposed method treats each individual's continuation in and transition through various numbers of ongoing partnerships as a separate stochastic process and allows the occurrence of one-offs to impact subsequent rates of partnership formation and dissolution. Estimators for the concurrent partnership distribution and mean sojourn times during which a person has k ongoing partnerships are presented. We demonstrate this modeling approach using epidemiological data collected from a sample of men having sex with men and seeking HIV testing at a Los Angeles clinic. Among this sample, the estimated point prevalence of concurrency was higher among men later diagnosed HIV positive. One-offs were associated with increased rates of subsequent partnership dissolution. Copyright © 2016 John Wiley & Sons, Ltd.


Assuntos
Infecções por HIV , Anamnese , Parceiros Sexuais , Estudos Transversais , Interpretação Estatística de Dados , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Comportamento Sexual
13.
Child Psychiatry Hum Dev ; 47(6): 938-949, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-26797704

RESUMO

Since 9/11, military service in the United States has been characterized by wartime deployments and reintegration challenges that contribute to a context of stress for military families. Research indicates the negative impact of wartime deployment on the well being of service members, military spouses, and children. Yet, few studies have considered how parental deployments may affect adjustment in young children and their families. Using deployment records and parent-reported measures from primary caregiving (N = 680) and military (n = 310) parents, we examined the influence of deployment on adjustment in military families with children ages 0-10 years. Greater deployment exposure was related to impaired family functioning and marital instability. Parental depressive and posttraumatic stress symptoms were associated with impairments in social emotional adjustment in young children, increased anxiety in early childhood, and adjustment problems in school-age children. Conversely, parental sensitivity was associated with improved social and emotional outcomes across childhood. These findings provide guidance to developing preventive approaches for military families with young children.


Assuntos
Ansiedade , Comportamento Infantil/fisiologia , Ajustamento Emocional , Emprego/psicologia , Família Militar/psicologia , Relações Pais-Filho , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/prevenção & controle , Ansiedade/psicologia , Criança , Comportamento Infantil/psicologia , Pré-Escolar , Inteligência Emocional , Feminino , Humanos , Masculino , Pais/psicologia , Psicologia Militar/métodos , Ajustamento Social , Estresse Psicológico , Estados Unidos
14.
Epidemiology ; 25(6): 851-8, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25051312

RESUMO

BACKGROUND: Genetic and environmental factors are believed to contribute to the development of autism, but relatively few studies have considered potential environmental risks. Here, we examine risks for autism in children related to in utero exposure to monitored ambient air toxics from urban emissions. METHODS: Among the cohort of children born in Los Angeles County, California, 1995-2006, those whose mothers resided during pregnancy in a 5-km buffer around air toxics monitoring stations were included (n = 148,722). To identify autism cases in this cohort, birth records were linked to records of children diagnosed with primary autistic disorder at the California Department of Developmental Services between 1998 and 2009 (n = 768). We calculated monthly average exposures during pregnancy for 24 air toxics selected based on suspected or known neurotoxicity or neurodevelopmental toxicity. Factor analysis helped us identify the correlational structure among air toxics, and we estimated odds ratios (ORs) for autism from logistic regression analyses. RESULTS: Autism risks were increased per interquartile range increase in average concentrations during pregnancy of several correlated toxics mostly loading on 1 factor, including 1,3-butadiene (OR = 1.59 [95% confidence interval = 1.18-2.15]), meta/para-xylene (1.51 [1.26-1.82]), other aromatic solvents, lead (1.49 [1.23-1.81]), perchloroethylene (1.40 [1.09-1.80]), and formaldehyde (1.34 [1.17-1.52]), adjusting for maternal age, race/ethnicity, nativity, education, insurance type, parity, child sex, and birth year. CONCLUSIONS: Risks for autism in children may increase following in utero exposure to ambient air toxics from urban traffic and industry emissions, as measured by community-based air-monitoring stations.


Assuntos
Poluentes Atmosféricos/toxicidade , Transtorno Autístico/induzido quimicamente , Transtorno Autístico/epidemiologia , Exposição Ambiental/efeitos adversos , Adolescente , Adulto , Declaração de Nascimento , Criança , Monitoramento Ambiental , Feminino , Humanos , Los Angeles/epidemiologia , Masculino , Idade Materna , Gravidez , Risco , Emissões de Veículos/toxicidade
15.
Jt Comm J Qual Patient Saf ; 50(6): 442-448, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38556442

RESUMO

BACKGROUND: Most anesthesia providers experience an adverse event during their training or career. Limited evidence suggests skilled peer support programs (SPSPs) reduce initial distress and support adaptive functioning and coping. This study evaluated second victim perceptions of a voluntary SPSP. METHODS: An SPSP was developed and implemented for all clinical and administrative personnel in the Department of Anesthesiology and Perioperative Medicine in three hospitals and six outpatient surgery centers in December 2017. The program incorporated the Scott Three-Tiered Interventional Model of Second Victim Support. Surveys were offered to clinicians in the department prior to implementation of the SPSP and again 18 months after implementation. Among the subset of respondents who experienced a serious adverse patient event, the authors used multiple logistic regression models that adjusted for role and number of night shifts per month to examine differences in perceived resource availability and post-event support received following implementation of the program. RESULTS: There were 94 surveys (83 complete; 11 partially complete) collected prior to implementation and 84 surveys (67 complete; 17 partially complete) collected after implementation. A total of 25 individuals took the survey at both pre and post (19 complete). After implementation, 62.5% of respondents indicated that institutional support had improved since the occurrence of their serious adverse patient event. Statistical models identified a significant improvement in the probability that a clinician agreed with the statement "I think that the organization learned from the event and took appropriate steps to reduce the chance of it happening again" at post vs. pre (adjusted odds ratio [aOR] 3.9, 95% confidence interval [CI] 1.01-15.1. A statistically significant increase from pre to post in the perceived availability of formal emotional support was identified (aOR 5.2, 95% CI 1.9-22.5). CONCLUSION: Implementation of a skilled peer support program within a large department of anesthesiology can improve institutional-based emotional support.


Assuntos
Grupo Associado , Humanos , Feminino , Masculino , Anestesiologia , Apoio Social , Adulto , Inquéritos e Questionários , Serviço Hospitalar de Anestesia/organização & administração
16.
Soc Work Public Health ; 39(5): 405-421, 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38722275

RESUMO

This school program evaluation aims to highlight the mental health needs of students in special education with behavioral and emotional challenges and describe the implementation of a resilience curriculum with this population. We evaluated district mental health data from a convenience sample of 814 students in grades 5-12 special education to identify risk for mental health symptoms, violence exposure, and substance use. School social workers provided feedback on the implementation of the resilience curriculum to inform program evaluation. Students reported significant risk for traumatic stress, anxiety, and depressive symptoms, and high rates of violence exposure and substance use. School social workers described adaptations to the resilience curriculum and gave recommendations for future implementation. Students receiving special education services for behavioral and emotional challenges had high mental health need, including high rates of violence exposure, and may benefit from a trauma-informed school-based resilience curriculum adapted for their needs.


Assuntos
Currículo , Educação Inclusiva , Resiliência Psicológica , Humanos , Masculino , Feminino , Adolescente , Criança , Estudantes/psicologia , Avaliação de Programas e Projetos de Saúde
17.
Res Sq ; 2024 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-38464044

RESUMO

Informed by models of resilience in military families, we explored factors theorized to be associated with social-emotional resilience and risk among young military-connected children. Our secondary analysis of cross-sectional data from 199 military-connected families (n = 346 parents) with at least one preschool-age child in the home (n = 199) led to the empirical identification of two distinct clusters: families with children demonstrating healthy social-emotional functioning and those showing indicators of poor social-emotional functioning. We then identified factors associated with membership in each cluster to determine which deployment and parental wellbeing variables were salient for young child adjustment. Parent psychological health symptoms, parenting, child behavior, and parent-child relationships were measured by parent report and observed interaction. Children with healthier social-emotional functioning were found to be residing with families experiencing less stress and distress. The importance of maternal trauma history is highlighted in our study, as elevated maternal symptoms across all three posttraumatic stress disorder symptom domains were associated with child social-emotional risk. Basic family demographic characteristics did not contribute significantly to the cluster distinctions, nor did military service factors such as active duty, reserve or veteran status, military rank or parent deployment history. These findings are important as the results deemphasize the importance of military service characteristics and highlight the importance of parent wellbeing when considering social-emotional risk and resilience of young children within military families.

18.
Stat Methods Med Res ; 32(8): 1511-1526, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37448319

RESUMO

Multistate models are useful for studying exposures that affect transitions among a set of health states. However, they can be challenging to apply when exposures are time-varying. We develop a multistate model and a method of likelihood construction that allows application of the model to data in which interventions or other exposures can be time-varying and an individual may to be exposed to multiple intervention conditions while progressing through states. The model includes cure proportions, reflecting the possibility that some individuals will never leave certain states. We apply the approach to analyze patient vaccination data from a stepped wedge design trial evaluating two interventions to increase uptake of human papillomavirus vaccination. The states are defined as the number of vaccine doses the patient has received. We model state transitions as a semi-Markov process and include cure proportions to account for individuals who will never leave a given state (e.g. never receive their next dose). Multistate models typically quantify intervention effects as hazard ratios contrasting the intensities of transitions between states in intervention versus control conditions. For multistate processes, another clinically meaningful outcome is the change in the percentage of the study population that has achieved a specific state (e.g. completion of all required doses) by a specific point in time due to an intervention. We present a method for quantifying intervention effects in this manner. We apply the model to both simulated and real-world data and also explore some conditions under which such models may give biased results.


Assuntos
Infecções por Papillomavirus , Vacinas contra Papillomavirus , Humanos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Projetos de Pesquisa , Vacinação , Probabilidade
19.
Front Psychol ; 14: 1233901, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37790229

RESUMO

Introduction: Youth in under-resourced communities are more likely to have greater social risk factors for mental health needs yet have less access to needed care. School-based mental health services are effective in treating common disorders such as adolescent depression; however, few have a family-centered approach, which may especially benefit specific populations. Methods: Utilizing a community-partnered approach, we adapted an established, trauma-informed, resilience skill-building family intervention for adolescents with depression. We conducted a small randomized controlled feasibility pilot of an adapted intervention in a large school district that serves predominately low-income, Latinx students in the Southwest United States between 2014-2017. Youth between the ages of 12-18 years old with a Patient Health Questionnaire (PHQ-8) score of 10 or higher, who spoke English or Spanish, were recruited from 12 school mental health clinics. Twenty-five eligible adolescents with depression and their participating caregivers were enrolled and randomly assigned to receive either the adapted intervention, Families OverComing Under Stress for Families with Adolescent Depression (FOCUS-AD), or usual care, Cognitive Behavioral Therapy (CBT) only. Most of the sample was Latinx and female. We evaluated feasibility, acceptability, and preliminary effectiveness. Results: Among participants who completed standardized assessments administered at baseline and approximately five months post-randomization (n = 10 FOCUS-AD, n = 11 CBT only), effectiveness was explored by identifying significant changes over time in adolescent mental health within the FOCUS-AD and CBT only groups and comparing the magnitude of these changes between groups. Nonparametric statistical tests were used. We found the FOCUS-AD intervention to be feasible and acceptable; participant retention was high. Adolescent symptoms of depression (measured by the PHQ-8) improved significantly from baseline to follow-up for youth in both FOCUS-AD (median decrease [MD] = 10, p = 0.02) and control (MD = 6, p = 0.01) groups, with no significant difference across the two groups. Results were similar for symptoms of PTSD (measured by the Child PTSD Symptom Scale; FOCUS-AD MD = 12.5, p = 0.01; CBT only MD = 7, p = 0.04; no significant difference between groups). Conclusion: Family-centered approaches to depression treatment among adolescents living in under-resourced communities may lead to improved mental health, although further research is warranted.

20.
Mil Med ; 177(8): 917-23, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22934370

RESUMO

Few studies have evaluated high altitude headache (HAH) and acute mountain sickness (AMS) in military populations training at moderate (1,500-2,500 m) to high altitudes (>2,500 m). In the current study, researchers interviewed active duty personnel training at Marine Corps Mountain Warfare Training Center. Participants were asked about HAH and AMS symptoms, potential risk factors, and medications used. In a sample of 192 U.S. Navy and Marine Corps personnel, 14.6% reported AMS (Lake Louise Criteria > or = 3) and 28.6% reported HAH. Dehydration and recent arrival at altitude (defined as data collected on days 2-3) were significantly associated with AMS; decreased sleep allowance was significantly associated with HAH. Although ibuprofen/Motrin users were more likely to screen positive for AMS, among AMS-positive participants, ibuprofen/Motrin users had decreased likelihood of reporting robust AMS relative to non-ibuprofen/Motrin users (p < 0.01). These results suggest that maintenance of hydration and adequate sleep allowance may be critical performance requirements at altitude. Further, ibuprofen/Motrin may be a reasonable treatment for the symptoms of AMS and HAH, although further study is warranted.


Assuntos
Doença da Altitude/etiologia , Altitude , Exercício Físico , Cefaleia/etiologia , Militares , Adolescente , Adulto , Desidratação/complicações , Humanos , Masculino , Privação do Sono/complicações , Estados Unidos , Adulto Jovem
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