Composite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders.

BACKGROUND: Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem. METHOD: Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives. RESULTS: Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9-38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ2 1 = 0.0-2.9, p = 0.09-0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81-0.86, sensitivity 68.0-80.2%, specificity 90.1-98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR- is 0.1 or less at informative thresholds for all diagnoses. CONCLUSIONS: CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.

Validation of a tool to assess medication treatment satisfaction in patients with Type 2 diabetes: the Diabetes Medication System Rating Questionnaire (DMSRQ).

AIM: To assess the reliability and validity of the Diabetes Medication System Rating Questionnaire among 537 US adults with Type 2 diabetes using five different diabetes medication regimens (oral agents with and without insulin; insulin only by syringe and by pen; glucagon-like peptide 1 agents). METHODS: The Diabetes Medication System Rating Questionnaire assesses the treatment experience of patients using any diabetes medication system that uses nine measures (Convenience, Negative Events, Interference, Self-Monitoring of Blood Glucose Burden, Efficacy, Social Burden, Psychological Well-Being, Treatment Satisfaction, Treatment Preference). It was administered via an initial online survey, along with other validated measures of treatment satisfaction and medication adherence, with a retest administered within 2 weeks. Participants were 52.5% male, 57.4% aged 40-64 years, 83.6% white and 95.2% non-Hispanic. Most (75.6%) had attended college and 58.3% had been diagnosed with diabetes for more than 10 years. RESULTS: Median inter-item agreement was 0.86. Median test-retest reliability was also 0.86. All correlations between Diabetes Medication System Rating Questionnaire measures and criterion measures of treatment satisfaction and adherence were statistically significant (P<0.01) in the expected direction. Correlations between Diabetes Medication System Rating Questionnaire and the corresponding criterion measures of treatment satisfaction ranged from 0.349 to 0.629 (absolute values; interpolated median 0.568); correlations of the same measures with adherence ranged from 0.384 to 0.450 (absolute values; mean 0.411). Diabetes Medication System Rating Questionnaire measures differentiated among groups taking different medications and those using different delivery systems for the same medication. CONCLUSIONS: This study suggests that the Diabetes Medication System Rating Questionnaire has good reliability and validity and provides a more comprehensive set of measures than existing medication satisfaction questionnaires.

An outbreak of Serratia marcescens in 14 adult cardiac surgical patients associated with 12-lead electrocardiogram bulbs.

Two clusters of Serratia marcescens in 14 adult cardiac surgical patients occurred over 10 months in an 876-bed teaching hospital. The 14 infections that were studied were as follows: one sternal and five leg incisions, five pneumonias, one bacteremia, one urinary tract infection, and one infected internal defibrillator site. The first cluster included four pneumonias, one urinary tract infection, and one bacteremia. Corrective actions were taken based on outbreak data through no source was identified. No further infections occurred during the following 2 months. The second cluster included one sternal and five leg incisions, an infected internal defibrillator incision site, and one pneumonia. Serratia marcescens was isolated from six electrocardiogram rubber welsh bulbs with sensitivities identical to patient isolates that indicated a common source outbreak in at least the second cluster of infections. Disposable electrocardiogram leads were introduced and the problem was resolved. We conclude that reusable electrocardiogram welsh bulbs are a vector for postoperative infections.

A comparison of hepatitis C treatment and outcomes at academic, private and Veterans' Affairs treatment centres.

BACKGROUND: Currently, there is a lack of published data examining hepatitis C treatment practices in different care settings. AIM: To provide data describing treatment practices for patients with hepatitis C virus infection in actual clinical practice, and to examine clinical outcomes in patients treated with interferon alpha-2b/ribavirin combination therapy in academically affiliated centres, private treatment centres and Veterans' Affairs treatment centres. METHODS: This multi-centre, retrospective, cohort study of 231 patients examined hepatitis C virus treatment practices in patients receiving interferon alpha-2b from January 1997 to May 2001 and explored outcomes in academically affiliated, private and Veterans' Affairs centres. RESULTS: Differences in treatment practice and use of diagnostic procedures were found. Genotype testing was under-utilized in non-academic sites (academic centres, 79.2%; private centres, 33.7%; Veterans' Affairs centres, 35.9%; P<0.001). Liver biopsies were performed less often in private sites (academic centres, 95.8%; private centres, 80.0%; Veterans' Affairs centres, 92.2%; P<0.01). End-of-treatment viral response (academic centres, 40.0%; private centres, 31.3%; Veterans' Affairs centres, 17.2%; P<0.05) was lower than that found in published trial data. Multivariate analysis revealed genotype 1 as the single significant predictor of treatment failure (P<0.01). CONCLUSIONS: Outside of the academic setting, there is significantly less diagnostic work-up performed prior to the initiation of hepatitis C virus therapy. This suggests a need for a standardization of care across treatment settings.

Self-report stability of adolescent substance use: are there differences for gender, ethnicity and age?

This study used the National Longitudinal Survey of Youth and is the first to examine a 2-year report stability of substance use among adolescents while stratifying for gender, ethnicity, and age. This study examined lifetime use and age at onset report stability, and the internal consistency of reports while excluding nonusers and incident cases (respondents who may have initiated substance use between the two reporting periods) from the analyses. Report agreement of lifetime use for each substance was over 80% and was highest among alcohol users and lowest for cigarette and marijuana users. Report agreement was higher for female compared to male cigarette users. External consistency of lifetime use of cigarettes and marijuana was higher for whites compared to Hispanic or African American adolescents. Internal consistency was high but lifetime use reports were more stable than age at onset reports.

Subjective reports of withdrawal among cocaine users: recommendations for DSM-IV.

The proposed DSM-IV criteria for substance use disorders have included, as an option, a subtyping for physiologic dependence, characterized by either tolerance or withdrawal. Even if this option is not chosen at this stage of system revision, this weighting scheme justifies wider surveillance of these symptoms, especially for the more newly described cocaine dependence disorder. Wider surveillance of withdrawal is possible with the CIDI Substance Abuse Module (SAM), a WHO/ADAMHA diagnostic interview which covers criteria of substance use disorders according to the DSM-III, III-R, ICD-10 and proposed DSM-IV systems. To aid in this effort, we used the SAM, which includes a master list of all symptoms (n = 16) in the DSM manuals related to withdrawal from any substance to assess withdrawal symptoms from all substances. In this study, we hypothesized that the persons who used opiates with cocaine might misattribute their symptoms to cocaine; thus, we compared the responses of persons who used cocaine and opiates (opiate users) with the responses of persons who used cocaine without opiates (non-opiate users). Data from two St. Louis studies were combined for these analyses, users not in treatment or newly enrolled to drug-free or methadone treatment from a NIDA demonstration project and users selected for the St. Louis DSM-IV Field Trial. Of the 196 persons included from the field trial, 80% reported lifetime cocaine use compared with 91% of the 412 persons from the demonstration project. The symptoms mentioned in the diagnostic manuals were among the most frequently endorsed by both cocaine use groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Is antisocial personality disorder associated with increased HIV risk behaviors in cocaine users?

Previous reports have shown antisocial personality disorder (ASPD) to be strongly associated with injection equipment sharing and increased rates of human immunodeficiency virus (HIV) infection in a sample of heroin injectors. Another report has shown ASPD to be associated with injection drug use, needle sharing, sexual promiscuity, and prostitution in a sample of methadone maintenance clients. The current study extends this work by examining the relationship of ASPD and human immunodeficiency virus (HIV) risk behaviors in a sample of cocaine users (48% out of treatment and 52% just entering treatment). Associations were tested for sexually risky behaviors in addition to injection behaviors. The principle finding of this study is that ASPD was shown to be associated with increased rates of injection drug use and sharing syringes, with earlier age of onset of injection drug use, with certain venereal diseases, and with a variety of HIV risk sexual behaviors. When men and women were tested separately, the pattern of association of risky behaviors with ASPD varied considerably. Overall, this work confirms that psychiatric status, especially the presence of ASPD, may have to be considered in evaluating the results of HIV risk-reduction interventions.

Self-report stability for substance use over 10 years: data from the St. Louis Epidemiologic Catchment Study.

In substance abuse research many study protocols require the recall and report of behavior from the distant past that may affect reliability. This study addresses the stability of substance use reports over a 10-year follow-up period. We reinterviewed 223 ECA subjects who reported baseline drug use. Reports from baseline to follow-up were categorized as either incident cases, agreements, or discrepancies. Different patterns were found for each substance group. The authors found that cannabis, cocaine, sedatives, and opiates had high agreement rates ranging from 82-86% and amphetamines had the lowest (73%). Implications for future drug research are discussed.

Patients' self-reported functional status after granisetron or ondansetron therapy to prevent chemotherapy-induced nausea and vomiting at six cancer centers.

Patient functional status after administration of either granisetron or ondansetron to prevent acute chemotherapy-induced nausea and vomiting (CINV) was studied. Pharmacists and nurses from six cancer centers distributed Functional Living Index-Emesis (FLIE) questionnaires to 115 outpatients receiving either granisetron or ondansetron for prevention of CINV. The emetogenic potential of each patient's chemotherapy regimen was high, moderately high, or moderate. Immediately before and 72 hours after chemotherapy, each patient rated his or her reaction to each of 18 items on the questionnaire on a 7-point scale. Possible scores ranged from 18 to 126, with higher scores indicating higher levels of functioning. The occurrence of nausea in the granisetron group was 40.0% compared with 43.2% in the ondansetron group; the occurrence of vomiting was 18.8% in the granisetron group and 11.1% in the ondansetron group. Patients who received highly emetogenic chemotherapy had significantly lower scores on the FLIE after chemotherapy than before. Patients with both nausea and vomiting reported a much higher negative impact on functional status after chemotherapy than those with nausea only. The mean prechemotherapy and postchemotherapy FLIE scores were 124.2 and 110.4 for granisetron and 124.9 and 111.9 for ondansetron. Granisetron and ondansetron did not differ significantly in their effect on functional status reported by patients before and 72 hours after receiving cancer chemotherapy.

Caregiver AOD use, case substantiation, and AOD treatment: studies based on two southwestern counties.

This article includes two separate studies: the first explores the impact of caregiver AOD use on CPS case substantiation; the second compares CPS-involved and CPS-noninvolved females in AOD treatment systems. Results suggest that cases with indications of AOD use are more likely to be substantiated than cases without; and increasing numbers of children and younger maternal ages are risk factors for CPS involvement among AOD-using women. Related findings are also presented, followed by implications for practice and research.

Ongoing issues in pneumonia care: when to admit, how to treat and the role of oral therapy.

In recent decades the understanding of the diagnosis and treatment of community acquired pneumonia (CAP) has increased within the medical scientific community. The challenge remains how best to disseminate new information to the practicing clinician to facilitate improved outcomes and cost-effective care. To accomplish this end, professional organizations such as the Infectious Disease Society of America (IDSA) and the American Thoracic Society (ATS) have developed and published consensus guidelines reflecting the proposed standard of medical care. Three ongoing areas of ambiguity and divergence between published guidelines and clinical practice include treatment selection, the admission decision, and the utility and role of oral therapy.

Environmental predictors of heavy episodic drinking.

This study examined the relationship between environmental characteristics and heavy episodic drinking by examining college students' last drinking events. For this study, 409 undergraduate students attending a large public university were randomly selected. Students were asked to report on their last drinking event within the 30-day period prior to being surveyed. There were 274 drinking events analyzed. Bivariate analyses and multiple logistic regression analysis were used to identify contextual factors predictive of heavy episodic drinking in specific drinking events. Drinking with friends, drinking beer and hard liquor, and having many people intoxicated at an event were predictive of heavy episodic drinking events. Dating events were protective of heavy episodic drinking. Implications for future research and prevention are discussed.

Substance use problems reported by college students: combined marijuana and alcohol use versus alcohol-only use.

This study examines the relationships among selected demographic characteristics, alcohol use only, alcohol plus marijuana use and substance-use related problems. Data are from 409 randomly selected undergraduate college students attending a large urban university. Poly-substance users were more likely than alcohol only users to be younger and experience all substance-use related problems studied. The relationship between poly-substance use and increased substance use-associated problems was also identified when controlling for other common predictors of substance use problems.

Beer and bongs: differential problems experienced by older adolescents using alcohol only compared to combined alcohol and marijuana use.

Alcohol and other drug problems experienced by adolescents who use only alcohol compared to those who use both alcohol and marijuana (A + M) is studied. Using the national longitudinal survey of youth 1994 data, forward multiple regression analyses revealed that impulsivity, A + M use (compared to alcohol-only use), age, sex, religiosity, frequency of substance use were associated with a higher number of behavioral problems. Youth with more alcohol problems were found to be binge drinkers, impulsive, more frequent alcohol users, and nonHispanic. Implications and future research needs are discussed.

Deconstructing contexts of binge drinking among college students.

This paper examines the contextual characteristics common to binge drinking occasions reported by college students. In addition, the study examines the influence of such contextual characteristics on alcohol-related problems experienced by students. Using random sampling and telephone interview methodology, 401 college students attending a large southern California university were surveyed by trained research staff. The interview protocol was based on the Core Survey and included context of use questions from the College Risk Assessment Guide. Results of stepwise multiple logistic regressions indicate that drinking with friends and events with food available protect against alcohol problems, while drinking events in which illicit drugs are available present higher risk for problems. Implications for future research and prevention are discussed.

Is there a relationship between "heavy drinking" and HIV high risk sexual behaviors among general population subjects?

The authors investigated the association between "heavy drinking" and sexual behaviors among 2,581 general population subjects from the St. Louis Epidemiologic Catchment Area survey conducted from 1981 to 1983. Lifetime sexual behaviors included promiscuity, infidelity, receiving money for sex, and same gender sex. It was found that sexual behaviors were associated with lifetime heavy drinking. Regardless of gender, race, or age, "heavy drinkers" were significantly more likely to report each of the high risk sexual behaviors, except same gender sex, compared to "nonheavy drinkers." With the multiple logistic regression analyses it was found that "heavy drinking" non-Black females, Black males regardless of drinking history, "heavy drinking" males, and younger subjects regardless of drinking history were at higher risk to report the high risk sexual behaviors. This study confirms that there is a strong association between "heavy drinking" and high risk sexual behaviors in a midwestern population. This is the first study to find an association between alcohol drinking patterns and high risk sexual behaviors in the general population. Implications of these findings for public health education efforts are discussed.

A pilot study of nevirapine, indinavir, and lamivudine among patients with advanced human immunodeficiency virus disease who have had failure of combination nucleoside therapy.

The effects of nevirapine, indinavir, and lamivudine in combination were studied among 22 human immunodeficiency virus (HIV)-infected patients with CD4 cell counts < or =50/mm3, whose options for antiretroviral therapy were limited by clinical or laboratory failure or toxicity with previous regimens. Median plasma HIV RNA was 5.16 log10 copies/mL at baseline, decreasing by a median of 3.12 log10 copies/mL at 24 weeks. Median baseline CD4 cell count was 30/mm3, increasing by a median of 95/mm3 at week 24. Adverse reactions led to drug discontinuation in 4 cases. Steady-state pharmacokinetic analysis in 17 patients was consistent with an interaction between nevirapine and indinavir. Nevirapine plasma levels were within the expected range, while indinavir levels were lower than expected. Despite this interaction, the combination of nevirapine, indinavir, and lamivudine was safe and well-tolerated and had substantial antiviral and immunologic effects lasting for the 24-week study.

Stavudine plus lamivudine in advanced human immunodeficiency virus disease: a short-term pilot study.

The short-term effects of stavudine (d4T) plus lamivudine (3TC) were evaluated among 48 human immunodeficiency virus-infected patients for whom zidovudine therapy had failed or who could not tolerate zidovudine. Patients were followed for 8 weeks after initiation of open-label d4T plus 3TC. Four patients discontinued therapy, because of neutropenia (1), hepatitis (1), or neuropathy (2). Reduction in virus load was -0.86 (+0.3 to -3.4) log10 copies/mL and CD4 cell increase was 30 (-100 to +290) cells/mm3. Virologic response was associated with a higher CD4 cell count, no prior exposure to d4T and 3TC, and no previous AIDS-defining illness. Virus load reduction for patients naive to 3TC and d4T was -1.47 (-0.14 to -3.37) log10 copies/mL. Short-term use of d4T plus 3TC is safe, well-tolerated, and associated with virologic and substantial immunologic benefits. Further evaluation of d4T and 3TC in combination is warranted.