Precision medicine with multi-omics strategies, deep phenotyping, and predictive analysis

Zeeshan Ahmed

Precision medicine is driven by the paradigm shift of empowering clinicians to predict the most appropriate course of action for patients with complex diseases and to improve routine medical and public health practice. Understanding patients’ multi-omics make-up in conjunction with the clinical data will lead to determining predisposition, diagnostic, prognostic and predictive biomarkers and to optimal paths providing personalized care for diverse and targeted chronic, acute, and infectious diseases…

Multi-omics strategies for personalized and predictive medicine: past, current, and future translational opportunities

Zeeshan Ahmed

Precision medicine is driven by the paradigm shift of empowering clinicians to predict the most appropriate course of action for patients with complex diseases and improve routine medical and public health practice. It promotes integrating collective and individualized clinical data with patient specific multi-omics data to develop therapeutic strategies, and knowledgebase for predictive and personalized medicine in diverse populations…

Investigating underlying human immunity genes, implicated diseases and their relationship to COVID-19

Zeeshan Ahmed, Eduard Gibert Renart & Saman Zeeshan

A human immunogenetics variation study was conducted in samples collected from diverse COVID-19 populations. Materials & methods: Whole-genome and whole-exome sequencing (WGS/WES), data processing, analysis and visualization pipeline were applied to identify variants associated with genes of interest. Results: A total of 2886 mutations were found across the entire set of 13 genomes. Functional annotation of the gene variants revealed mutation type and protein change. Many variants were found to be biologically implicated in COVID-19…

Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use: Evidence from 44 US states

Emilie Bruzelius, Magdalena Cerdá, Corey S. Davis, Victoria Jent, Katherine Wheeler-Martin, Christine M. Mauro, Stephen Crystal, Katherine M. Keyes, Hillary Samples, Deborah S. Hasin, Silvia S. Martins

Naloxone distribution is central to ongoing efforts to address the opioid overdose crisis. Some critics contend that naloxone expansion may inadvertently promote high-risk substance use behaviors among adolescents, but this question has not been directly investigated…

Artificial Intelligence, Healthcare, Clinical Genomics, and Pharmacogenomics Approaches in Precision Medicine

Habiba Abdelhalim, Asude Berber, Mudassir Lodi, Rihi Jain, Achuth Nair, Anirudh Pappu, Kush Patel, Vignesh Venkat, Cynthia Venkatesan, Raghu Wable, Matthew Dinatale, Allyson Fu, Vikram Iyer, Ishan Kalove, Marc Kleyman, Joseph Koutsoutis, David Menna, Mayank Paliwal, Nishi Patel, Thirth Patel, Zara Rafique, Rothela Samadi, Roshan Varadhan, Shreyas Bolla, Sreya Vadapalli and Zeeshan Ahmed

Precision medicine has greatly aided in improving health outcomes using earlier diagnosis and better prognosis for chronic diseases. It makes use of clinical data associated with the patient as well as their multi-omics/genomic data to reach a conclusion regarding how a physician should proceed with a specific treatment. Compared to the symptom-driven approach in medicine, precision medicine considers the critical fact that all patients do not react to the same treatment or medication in the same way. When considering the intersection of traditionally distinct arenas of medicine, that is, artificial intelligence, healthcare, clinical genomics, and pharmacogenomics—what ties them together is their impact on the development of precision medicine as a field and how they each contribute to patient-specific, rather than symptom-specific patient outcomes. This study discusses the impact and integration of these different fields in the scope of precision medicine and how they can be used in preventing and predicting acute or chronic diseases. Additionally, this study also discusses the advantages as well as the current challenges associated with artificial intelligence, healthcare, clinical genomics, and pharmacogenomics…

Racial and Ethnic Disparities in Buprenorphine and Extended-Release Naltrexone Filled Prescriptions During the COVID-19 Pandemic

Thuy Nguyen, Engy Ziedan, Kosali Simon

Abstract: Importance COVID-19 disrupted delivery of buprenorphine and naltrexone treatment for opioid use disorder (OUD), and during the pandemic, members of racial and ethnic minority groups experienced increased COVID-19 and opioid overdose risks compared with White individuals. However, whether filled buprenorphine and naltrexone prescriptions varied across racial and ethnic groups during the COVID-19 pandemic remains unknown…

Opioid overdose survivors: Medications for opioid use disorder and risk of repeat overdose in Medicaid patients

Stephen Crystal, Molly Nowels, Hillary Samples, Mark Olfson, Arthur Robin Williams, Peter Treitler

Background: Patients with medically-treated opioid overdose are at high risk for subsequent adverse outcomes, including repeat overdose. Understanding factors associated with repeat overdose can aid in optimizing post-overdose interventions…

A modified Delphi process to identify experts’ perceptions of the most beneficial and harmful laws to reduce opioid-related harm

Leah K.Hamilton, Katherine Wheeler-Martin, Corey S.Davis, Silvia S.Martins, Hillary Samples, Magdalena Cerdá

Background: States have enacted multiple types of laws, with a variety of constituent provisions, in response to the opioid epidemic, often simultaneously. This temporal proximity and variation in state-to-state operationalization has resulted in significant challenges for empirical research on their effects. Thus, expert consensus can be helpful to classify laws and their provisions by their degree of helpfulness and impact…

One lesson of COVID-19: Conduct more health policy trials

Luchuo Engelbert Bain, Astrid Berner-Rodoreda, Shannon A. McMahon

The Global Health Security Index, published in October 2019 by public health experts (1), rated nations by their readiness to respond to infectious disease outbreaks. The United States ranked first, whereas New Zealand trailed in 35th place. Yet when the coronavirus disease 2019 (COVID-19) pandemic struck months later, these rankings turned out to be unreliable (2): The United States has to date reported the most deaths, whereas New Zealand fares considerably better. These results point to a fundamental challenge more than to the failings of a particular assessment approach. They may demonstrate that, for all our careful testing of pharmaceuticals, researchers lack a solid evidence base regarding the effectiveness of health policies—against pandemics, and more widely…

The ethical case for placebo control in HIV-cure-related studies with ART interruption

Monica Magalhaes, Daniel R. Kuritzkes, Nir Eyal

Abstract: Many studies that seek to cure HIV must ask participants to interrupt their antiretroviral treatment. In such circumstances, is it permissible to include a placebo group in the study? We explain why doing so is a scientific and an ethical necessity, and more benign than imagined…

Coronavirus Disease 2019 (COVID-19) Vaccine Prioritization in Low- and Middle-Income Countries May Justifiably Depart From High-Income Countries’ Age Priorities

Nir Eyal, Anca Gheaus, Axel Gosseries, Monica Magalhaes, Thierry Ngosso, Bastian Steuwer, Viroj Tangcharoensathien, Isa Trifan, Andrew Williams

Abstract: In high-income countries that were first to roll out coronavirus disease 2019 (COVID-19) vaccines, older adults have thus far usually been prioritized for these vaccines over younger adults. Age-based priority primarily resulted from interpreting evidence available at the time, which indicated that vaccinating the elderly first would minimize COVID-19 deaths and hospitalizations…

A new day for human challenge trials?

Abie Rohrig, Nir Eyal

On 31 March 2022, Killingley et al. published the results from the world’s first COVID-19 human challenge trial, in which 36 healthy volunteers between the ages of 18 and 30 years were intranasally exposed to a low dose of wild type severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1.]. Around half (53%) of the volunteers became infected with COVID-19, with researchers finding that the viral load peaked 5 days after inoculation. SARS-CoV-2 was first detectable in the throat, before rising higher in the respiratory tract, where its presence in the nose continued for 10 days. The team found that symptoms develop rapidly, starting on average just 2 days after infection. They also found that lateral flow tests were a reliable indicator of whether or not volunteers were infectious. Six volunteers were given remdesivir after testing positive. No volunteers reported any major negative health outcomes after 180 days, though some reported partial smell disturbance…

Do coronavirus vaccine challenge trials have a distinctive generalisability problem?

Nir Eyal, Tobias Gerhard

Abstract: Notwithstanding the success of conventional field trials for vaccines against COVID-19, human challenge trials (HCTs) that could obtain more information about these and about other vaccines and further strategies against it are about to start in the UK. One critique of COVID-19 HCTs is their distinct paucity of information on crucial population groups. For safety reasons, these HCTs will exclude candidate participants of advanced age or with comorbidities that worsen COVID-19, yet a vaccine should (perhaps especially) protect such populations. We turn this cliché on its head. The truth is that either an HCT or a field trial has intrinsic generalisability limitations, that an HCT can expedite protection of high-risk participants even without challenging them with the virus, and that an important route to obtaining results generalisable to high-risk groups under either strategy is facilitated by HCTs…

Research ethics and public trust in vaccines: the case of COVID-19 challenge trials

Nir Eyal

Abstract: Despite their clearly demonstrated safety and effectiveness, approved vaccines against COVID-19 are commonly mistrusted. Nations should find and implement effective ways to boost vaccine confidence. But the implications for ethical vaccine development are less straightforward than some have assumed. Opponents of COVID-19 vaccine challenge trials, in particular, made speculative or empirically implausible warnings on this matter, some of which, if applied consistently, would have ruled out most COVID-19 vaccine trials and many non-pharmaceutical responses…

Potential sources of moral distress during COVID-19: Perspectives of hospice interdisciplinary teams

Tessa Jones, Shih-Yin Lin, Aditi Durga, Elizabeth A. Luth, Rebecca K.F. Lassell, Abraham A. Brody

Objective: This study aimed to examine the impact of COVID-19 on hospice Interdisciplinary team (IDT) members’ self-reported stress and identify possible sources of moral distress…

Improving the prospective prediction of a near-term suicide attempt in veterans at risk for suicide, using a go/no-go task

Catherine E. Myers Open the ORCID record for Catherine E. Myers[Opens in a new window] , Chintan V. Dave , Michael Callahan , Megan S. Chesin , John G. Keilp , Kevin D. Beck , Lisa A. Brenner , Marianne S. Goodman , Erin A. Hazlett , Alexander B. Niculescu , Lauren St. Hill , Anna Kline , Barbara H. Stanley and Alejandro Interian

Background: Neurocognitive testing may advance the goal of predicting near-term suicide risk. The current study examined whether performance on a Go/No-go (GNG) task, and computational modeling to extract latent cognitive variables, could enhance prediction of suicide attempts within next 90 days, among individuals at high-risk for suicide…

Trends in Prescribing Preferences for Antidiabetic Medications Among Patients With Type 2 Diabetes in the U.K. With and Without Chronic Kidney Disease, 2006–2020

Julia Liaw; Meera Harhay; Soko Setoguchi; Tobias Gerhard; Chintan V. Dave

OBJECTIVE: To evaluate trends in antidiabetic medication initiation patterns among patients with type 2 diabetes mellitus (T2DM) with and without chronic kidney disease (CKD)…

Tobacco Screening and Counseling in the U.S. Smokers With Mental Health and Substance Use Problems

Hillary Samples, Sachini Bandara, Mark Olfson, Brendan Saloner

Introduction: Individuals with mental health and substance use problems have higher rates of smoking and tobacco-related morbidity and mortality than the general population. These increased rates can be explained, in part, by lower cessation rates compared with overall declines in tobacco use in recent years. The purpose of this study was to examine tobacco screening and cessation counseling in healthcare settings to compare rates for adults with mental health and substance use problems with those without such problems…

Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees

Hillary Samples, Arthur Robin Williams, Mark Olfson, Stephen Crystal

Introduction: Recent U.S. trends demonstrate sharp rises in adverse opioid-related health outcomes, including opioid use disorder (OUD), overdose, and death. Yet few affected people receive treatment for OUD and a minority of those who receive treatment are effectively retained in care. The purpose of this study was to examine duration of buprenorphine treatment for OUD following treatment initiation to identify risk factors for early discontinuation…

Mental health spending and intensity of service use among individuals with diagnoses of eating disorders following federal parity

Haiden A. Huskamp, Hillary Samples, Scott E. Hadland, Emma E. McGinty, Teresa B. Gibson, Howard H. Goldman, Susan H. Busch, Elizabeth A. Stuart, Colleen L. Barry

Objective: The Mental Health Parity and Addiction Equity Act (MHPAEA) was intended to eliminate differences in insurance coverage for mental health and substance use disorder services and medical-surgical care. No studies have examined mental health service use after federal parity implementation among individuals with diagnoses of eating disorders, for whom financial access to care has often been limited. This study examined whether MHPAEA implementation was associated with changes in use of mental health services and spending in this population…

Is screening and intervention associated with treatment receipt among individuals with alcohol use disorder? Evidence from a national survey

Sachini N. Bandara, Hillary Samples, Rosa M. Crum, Brendan Saloner

Background: Most individuals with alcohol use disorder do not receive treatment and little national-level United States (U.S.) data exist on the association between screening and intervention with receipt of treatment. Methods: The sample includes adults 18 years and older reporting prior year symptoms of alcohol use disorder from 2013 and 2014 National Survey on Drug Use and Health…

Opioid Use and Misuse and Suicidal Behaviors in a Nationally Representative Sample of US Adults

Hillary Samples, Elizabeth A. Stuart, Mark Olfson

Prior research has shown associations between opioid misuse and suicidal behaviors, but the relationship between medical opioid use and suicidal behaviors is not known. We assessed associations of opioid use and misuse with suicidal ideation, suicide plans, and suicide attempts among adults aged 18-64 years (n = 86,186) using nationally representative cross-sectional data from the 2015 and 2016 administrations of the National Survey on Drug Use and Health…

The Role of Screening in Depression Diagnosis and Treatment in a Representative Sample of US Primary Care Visits

Hillary Samples, Elizabeth A. Stuart, Brendan Saloner, Colleen L. Barry, Ramin Mojtabai

Background: Primary care providers encounter a large proportion of the population with depression. Yet, many primary care patients with depression remain undiagnosed and untreated. Objective: This study aims to examine depression screening patterns and the role of screening in depression diagnosis and treatment in the outpatient primary care setting. Design: This is a cross-sectional analysis of nationally representative survey data of visits to outpatient physician offices from the 2005 to 2015 National Ambulatory Medical Care Surveys…

Impact of long-term buprenorphine treatment on adverse health care outcomes in medicaid

Hillary Samples, Arthur Robin Williams, Stephen Crystal, Mark Olfson

Abstract: The optimal, or even minimum, duration of medication treatment for opioid use disorder (OUD) needed to improve long-term outcomes has not been established empirically. As a result, health plans set potentially restrictive treatment standards to guide benefits and payment. To address this gap, we used a National Quality Forum measure for OUD medication treatment duration (180 days) to examine the impact of longer treatment on health care outcomes within a key population of Medicaid enrollees…

Discussing Drug Use with Health Care Providers Is Associated with Perceived Need and Receipt of Drug Treatment among Adults in the United States: We Need to Talk

Pia M. Mauro, Hillary Samples, Kathryn S. Klein, Silvia S. Martins

Background:Drug treatment utilization is low despite a high public health burden of drug use disorders (DUDs). Engaging people at risk for DUDs across a broader range of health care settings may improve uptake of drug treatment.Objectives:To estimate the prevalence of drug use screening/discussions between health care providers and individuals with past-year drug use, and to assess the associations between drug use screening/discussions and perceived need and use of drug treatment…

Use of Medication for Opioid Use Disorder among US Adolescents and Adults with Need for Opioid Treatment, 2019

Pia M. Mauro, Sarah Gutkind, Erin M. Annunziato, Hillary Samples

Importance: Medication for opioid use disorder (MOUD) is the criterion standard treatment for opioid use disorder (OUD), but nationally representative studies of MOUD use in the US are lacking. Objective: To estimate MOUD use rates and identify associations between MOUD and individual characteristics among people who may have needed treatment for OUD…

Non–prescribed buprenorphine preceding treatment intake and clinical outcomes for opioid use disorder

Arthur Robin Williams, Christine M. Mauro, Tianshu Feng, Amanda Wilson, Angelo Cruz, Mark Olfson, Stephen Crystal, Hillary Samples, Lisa Chiodo

Objective: Successful retention on buprenorphine improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non–prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes. Methods: The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program…

Commentary on Lo-Ciganic et al. The importance of evidence-based clinical and policy approaches to reduce opioid harms

Hillary Samples

The overdose epidemic remains an urgent public health concern, with recent estimates indicating that deaths in the United States have surged to over 100 000 per year, predominantly attributed to opioids. Responses to growth in opioid-involved mortality over time have emphasized opioid prescribing regulations or restrictions, including a proliferation of state laws aimed at reducing harm by limiting exposure to opioids…

Benzodiazepine and Stimulant Prescriptions Before Overdose in Youth

Greta Bushnell, Hillary Samples, Tobias Gerhard, Diane P. Calello, Mark Olfson

In 2019, 4777 youth died of a drug overdose in the United States. Seven-hundred and twenty-seven youth died of overdoses involving benzodiazepines (BZDs) and 902 from overdoses involving psychostimulants. Opioid-related overdose deaths frequently involve other substances, and in youth, stimulants and BZDs are the most commonly involved substances. Overdoses can involve prescription drugs accessed through medical prescriptions or through illicit means. Among persons aged 18 to 25 years, 5.8% report past-year prescription stimulant misuse and 3.8% prescription BZD misuse…

Community rating and sustainable individual health insurance markets in New Jersey

Alan C. Monheit, Joel C. Cantor, Margaret Koller, Kimberley S. Fox

The New Jersey Individual Health Coverage Program (IHCP) was implemented in 1993; key provisions included pure community rating and guaranteed issue/renewal of coverage. Despite positive early evaluations, the IHCP appears to be heading for collapse. Using unique administrative and survey data, we examined trends in IHCP enrollment and premiums. We found the stability of the IHCP to be fragile in light of improving opportunities for job-related health insurance…

Expanding dependent coverage for young adults: Lessons from state initiatives

Joel C. Cantor, Dina Belloff, Alan C. Monheit, Derek DeLia, Margaret Koller

Abstract: The Patient Protection and Affordable Care Act (ACA) requires that adults up to age twenty-six be permitted to enroll as dependents on their parents’ health plans. This article examines the experiences of states that enacted dependent expansion laws. Drawing on public information from thirty-one enacting states and case studies of four diverse reform states, it derives lessons that are pertinent to the implementation of this ACA provision. Dependent coverage laws vary across the states, but most impose residency, marital status, and other restrictions…

Toward a cultural adaptation of pharmacotherapy: LatinO views of depression and antidepressant therapy

Sylvanna M. Vargas, Leopoldo J. Cabassa, Andel Nicasio, Ana Alicia de la Cruz, Elizabeth Jackson, Melissa Rosario, Peter J. Guarnaccia, Roberto Lewis-Fernández

Relative to non-Latino Whites, Latinos in the United States with major depressive disorder (MDD) show low engagement in antidepressant therapy, whether engagement is defined as pharmacotherapy access, medication initiation, pill-taking, or treatment retention. One potential reason for this disparity in depression care is the low cultural congruence of pharmacotherapy for this population…

Idioms of Distress Among Depressed White-Non-Mexican and Mexican-Origin Older Men

Ester Carolina Apesoa-Varano, Judith C. Barker, Jurgen Unutzer, Sergio Aguilar-Gaxiola, Megan Dwight Johnson, Cindy Tran, Peter Guarnaccia, Ladson Hinton

Older men are less likely than older women to receive depression treatment. Latino older men in particular have been found to have significantly lower rates of depression treatment than their white-non-Mexican (WNM) counterparts. Prior research has shown that men are less likely than women to express overt affect and/or report depression symptoms that may prompt primary care physicians’ inquiry about depression. Previous studies have overlooked the idioms of distress common among older men…

The meanings of cultural competence in mental health: an exploratory focus group study with patients, clinicians, and administrators

Neil Krishan Aggarwal, Kryst Cedeño, Peter Guarnaccia, Arthur Kleinman, Roberto Lewis-Fernández

Abstract: Cultural competence training is mandatory in the United States of America to alleviate minority health disparities though few studies have examined perceptions across stakeholders. We conducted separate focus groups with patients, clinicians, and administrators from the psychiatry department at one community hospital and compared responses to hospital policies. Stakeholders defined cultural competence through group-based or person-centered traits despite policies recommended person-centered approaches…

Culture: The missing link in health research

M. Kagawa Singer, W. Dressler, S. George, Claudia R. Baquet, Ronny A. Bell, Linda Burhansstipanov, Nancy J. Burke, Suzanne Dibble, William Elwood, Linda Garro, Clarence C. Gravlee, Peter Guarnaccia, Michael L. Hecht, Jeffrey Henderson, Dan Hruschka, Roberto Lewis-Fernández, Robert Like, Charles Mouton, Hector F. Myers, J. Bryan Page, Rena Pasick, Bernice Pescosolido, Nancy Schoenberg, Bradley Stoner, Gregory Strayhorn, Laura Szalacha, Joseph Trimble, Thomas S. Weisner, David Williams

Abstract: Culture is essential for humans to exist. Yet surprisingly little attention has been paid to identifying how culture works or developing standards to guide the application of this concept in health research. This paper describes a multidisciplinary effort to find consensus on essential elements of a definition of culture to guide researchers in studying how cultural processes influence health and health behaviors…

Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: A systematic review

Neil Krishan Aggarwal, Matthew C. Pieh, Lisa Dixon, Peter Guarnaccia, Margarita Alegría, Roberto Lewis-Fernández

Objective: To describe studies on clinician communication and the engagement of racial/ethnic minority patients in mental health treatment. Methods: Authors conducted electronic searches of published and grey literature databases from inception to November 2014, forward citation analyses, and backward bibliographic sampling of included articles. Included studies reported original data on clinician communication strategies to improve minority treatment engagement, defined as initiating, participating, and continuing services. Results: Twenty-three studies met inclusion criteria…

Developing Research Collaborations in an Academic Clinical Setting: Challenges and Lessons Learned

John A. Sahs, Andel V. Nicasio, Joan E. Storey, Peter J. Guarnaccia, Roberto Lewis-Fernández

Research collaboration in “real world” practice settings may enhance the meaningfulness of the findings and reduce barriers to implementation of novel intervention strategies. This study describes an initiative to integrate research into a hospital-based outpatient psychiatric clinic within an academic medical center, focusing on collaborative processes across three research projects…

Immigration, Diversity and Student Journeys to Higher Education

Peter J. Guarnaccia

Immigration, Diversity and Student Journeys to Higher Education presents an in-depth understanding of how immigrant students at a major public research university balanced keeping their family cultures alive and learning U.S. culture to get to college. A revitalized anthropological understanding of acculturation provides the theoretical framework for the book. The text builds its analysis using extensive quotes from the 160 immigrant students who participated in the 21 focus groups that form the core of this study…

Acculturation stress and allostatic load among Mexican immigrant women

Karen Therese D’Alonzo, Frances Munet-Vilaro, Dennis P. Carmody, Peter J. Guarnaccia, Anne Marie Linn, Lisa Garsman

Objectives: this case-control study compared levels of stress and allostatic load (AL) among Mexican women in the US (n =19) and Mexico (n = 40). Method: measures of stress included the Perceived Stress Scale (PSS) and the Hispanic Women’s Social Stressor Scale (HWSSS). A composite measure of 8 indicators of AL (systolic and diastolic blood pressure, body mass index (BMI), waist-to-hip ratio, total cholesterol, glycated hemoglobin (hemoglobin A1C), triglycerides and C-reactive protein) was calculated…

Medications for Multiple Sclerosis and Risk of Malignancy: What Next?

Daniel B. Horton, Anthony T. Reder

Many autoimmune diseases confer a higher risk of cancer on patients compared to the general population. A controversial factor tying autoimmune diseases to malignancy is harm from immunosuppressive treatment. Nonetheless, multiple sclerosis is different from other autoimmune diseases, and findings from other disease populations may not apply…

Making Decisions About Stopping Medicines for Well-Controlled Juvenile Idiopathic Arthritis: A Mixed-Methods Study of Patients and Caregivers

Daniel B. Horton, Jomaira Salas, Aleksandra Wec, Melanie Kohlheim, Pooja Kapadia, Timothy Beukelman, Alexis Boneparth, Ky Haverkamp, Melissa L. Mannion, L. Nandini Moorthy, Sarah Ringold, Marsha Rosenthal

Objective: Improved treatments for juvenile idiopathic arthritis (JIA) have increased remission rates. We conducted this study to investigate how patients and caregivers make decisions about stopping medications when JIA is inactive. Methods: We performed a mixed-methods study of caregivers and patients affected by JIA, recruited through social media and flyers, and selected by purposive sampling. Participants discussed their experiences with JIA, medications, and decision-making through recorded telephone interviews…

Highly versatile antibody binding assay for the detection of SARS-CoV-2 infection and vaccination

Pratik Datta, Rahul Ukey, Natalie Bruiners, William Honnen, Mary O. Carayannopoulos, Charles Reichman, Alok Choudhary, Alberta Onyuka, Deborah Handler, Valentina Guerrini, Pankaj K. Mishra, Hannah K. Dewald, Alfred Lardizabal, Leeba Lederer, Aliza L. Leiser, Sabiha Hussain, Sugeet K. Jagpal, Jared Radbel, Tanaya Bhowmick, Daniel B. Horton, Emily S. Barrett, Yingda L. Xie, Patricia Fitzgerald-Bocarsly, Stanley H. Weiss, Melissa Woortman, Heta Parmar, Jason Roy, Maria Gloria Dominguez-Bello, Martin J. Blaser, Jeffrey Carson, Reynold A. Panettieri, Steven Libutti, Henry F. Raymond, Abraham Pinter, Maria Laura Gennaro

Monitoring the burden and spread of infection with the new coronavirus SARS-CoV-2, whether within small communities or in large geographical settings, is of paramount importance for public health purposes. Serology, which detects the host antibody response to the infection, is the most appropriate tool for this task, since virus-derived markers are most reliably detected during the acute phase of infection…

Determinants and Dynamics of SARS-CoV-2 Infection in a Diverse Population: 6-Month Evaluation of a Prospective Cohort Study

Daniel B. Horton, Emily S. Barrett, Jason Roy, Maria Laura Gennaro, Tracy Andrews, Patricia Greenberg, Natalie Bruiners, Pratik Datta, Rahul Ukey, Senthil K. Velusamy, Daniel Fine, William J. Honnen, Yue Sandra Yin, Abraham Pinter, Andrew Brooks, Jay Tischfield, Sabiha Hussain, Sugeet Jagpal, Shobha Swaminathan, Veenat Parmar, Nancy Reilly, Sunanda Gaur, Reynold A. Panettieri, Jeffrey Carson, Martin J. Blaser

Background: We studied risk factors, antibodies, and symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a diverse, ambulatory population. Methods: A prospective cohort (n = 831) previously undiagnosed with SARS-CoV-2 infection underwent serial testing (SARS-CoV-2 polymerase chain reaction, immunoglobulin G [IgG]) for 6 months…

Biologic switching among nonsystemic juvenile idiopathic arthritis patients: A cohort study in the childhood arthritis and rheumatology research alliance registry

Melissa L. Mannion, Fenglong Xie, Daniel B. Horton, Sarah Ringold, Colleen K. Correll, Anne Dennos and Timothy Beukelman for the CARRA Registry Investigators

Objective: Biologic medications have significantly improved disease control and outcomes of patients with juvenile idiopathic arthritis (JIA). Current treatment recommendations suggest escalating therapy, including changing biologics if needed, when inactive or low disease activity is not attained. The patterns and reasons for switching biologics in clinical practice in North America are not well described…

Acute respiratory distress syndrome and COVID-19 in a child with systemic lupus erythematosus

Simone Sukhdeo, Emily Negroponte, Hariprem Rajasekhar, Sunanda Gaur, Daniel B. Horton, Amisha Malhotra, L. Nandini Moorthy

We report a case of COVID-19 in a pediatric patient with systemic lupus erythematosus (SLE), who presented with respiratory distress marked by increased work of breathing and low oxygen saturation. Lab tests confirmed COVID-19, and showed lymphocytopenia and elevated markers of inflammation and coagulopathy. Chest X-ray showed bilateral mid-lung opacities, and the patient required intubation early in his disease course…

Comparative Risk of Alzheimer Disease and Related Dementia among Medicare Beneficiaries with Rheumatoid Arthritis Treated with Targeted Disease-Modifying Antirheumatic Agents

Rishi J. Desai, Vijay R. Varma, Tobias Gerhard, Jodi Segal, Mufaddal Mahesri, Kristyn Chin, Daniel B. Horton, Seoyoung C. Kim, Sebastian Schneeweiss, Madhav Thambisetty

Importance: Cytokine signaling, including tumor necrosis factor (TNF) and interleukin (IL)-6, through the Janus-kinase (JAK)-signal transducer and activator of transcription pathway, was hypothesized to attenuate the risk of Alzheimer disease and related dementia (ADRD) in the Drug Repurposing for Effective Alzheimer Medicines (DREAM) initiative based on multiomics phenotyping. Objective: To evaluate the association between treatment with tofacitinib, tocilizumab, or TNF inhibitors compared with abatacept and risk of incident ADRD…

Feeling anxious yet? Interpreting findings on drug safety from large healthcare databases

Greta A. Bushnell, Daniel Horton, Tobias Gerhard

In this issue of Clinical and Translational Science, Yun-Han Wang and colleagues report on a potential link between treatment with proton pump inhibitors (PPIs) and incident depression and anxiety disorders in children. The proposed mechanism between PPI use and anxiety and depression is related to the “microbiota-gut-brain axis.”…

2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging

Karen B. Onel, Daniel B. Horton, Daniel J. Lovell, Susan Shenoi, Carlos A. Cuello, Sheila T. Angeles-Han, Mara L. Becker, Randy Q. Cron, Brian M. Feldman, Polly J. Ferguson, Harry Gewanter, Jaime Guzman, Yukiko Kimura, Tzielan Lee, Katherine Murphy, Peter A. Nigrovic, Michael J. Ombrello, C. Egla Rabinovich, Melissa Tesher, Marinka Twilt

Objective: To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype…

2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis

Karen B. Onel, Daniel B. Horton, Daniel J. Lovell, Susan Shenoi, Carlos A. Cuello, Sheila T. Angeles-Han, Mara L. Becker, Randy Q. Cron, Brian M. Feldman, Polly J. Ferguson, Harry Gewanter, Jaime Guzman, Yukiko Kimura, Tzielan Lee, Katherine Murphy, Peter A. Nigrovic, Michael J. Ombrello, C. Egla Rabinovich, Melissa Tesher, Marinka Twilt, Marisa Klein-Gitelman, Fatima Barbar-Smiley, Ashley M. Cooper, Barbara Edelheit, Miriah Gillispie-Taylor, Kimberly Hays, Melissa L. Mannion, Rosemary Peterson, Elaine Flanagan, Nadine Saad, Nancy Sullivan, Ann Marie Szymanski, Rebecca Trachtman, Marat Turgunbaev, Keila Veiga, Amy S. Turner, James T. Reston

Objective: To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided…

Baseline Results: The Association between Cardiovascular Risk and Preclinical Alzheimer’s Disease Pathology (ASCEND) Study

Veena V. Kumar, Hanfeng Huang, Liping Zhao, Danielle D. Verble, Alexandra Nutaitis, Sonum D. Tharwani, Alexandra L. Brown, Henrik Zetterberg, William Hu, Ryan Shin, Patrick G. Kehoe, Arshed Quyyumi, Joe Nocera, Andrea Kippels, Whitney Wharton

Background: The rate of AD for African Americans (AAs) is 64% higher than for non-Hispanic White Americans (Whites). It is hypothesized that poor peripheral vascular function, in combination with genetics, stress, and inflammation may directly contribute to the accumulation of AD pathologic biomarkers. These risk factors may disproportionately affect AAs.

Antibody profiles according to mild or severe SARS-CoV-2 infection, Atlanta, Georgia, USA, 2020

William T. Hu, J. Christina Howell, Tugba Ozturk, Karima Benameur, Leda C. Bassit, Richard Ramonell, Kevin S. Cashman, Shama Pirmohammed, John D. Roback, Vincent C. Marconi, Irene Yang, Valerie V. Mac, Daniel Smith, Ignacio Sanz, Whitney Wharton, F. Eun-Hyung Lee, Raymond F. Schinazi

Abstract : Among patients with coronavirus disease (COVID-19), IgM levels increased early after symptom onset for those with mild and severe disease, but IgG levels increased early only in those with severe disease. A similar pattern was observed in a separate serosurveillance cohort. Mild COVID-19 should be investigated separately from severe COVID-19…

A Community-Based Study Identifying Metabolic Biomarkers of Mild Cognitive Impairment and Alzheimer’s Disease Using Artificial Intelligence and Machine Learning

Ali Yilmaz, Ilyas Ustun, Zafer Ugur, Sumeyya Akyol, William T. Hu, Massimo S. Fiandaca, Mark Mapstone, Howard Federoff, Michael Maddens, Stewart F. Graham

ackground: Currently, there is no objective, clinically available tool for the accurate diagnosis of Alzheimer’s disease (AD). There is a pressing need for a novel, minimally invasive, cost friendly, and easily accessible tool to diagnose AD, assess disease severity, and prognosticate course. Metabolomics is a promising tool for discovery of new, biologically, and clinically relevant biomarkers for AD detection and classification…

Sex hormone-binding globulin (Shbg) in cerebrospinal fluid does not discriminate between the main ftld pathological subtypes but correlates with cognitive decline in ftld tauopathies

Marta Del Campo, Yolande A.L. Pijnenburg, Alice Chen-Plotkin, David J. Irwin, Murray Grossman, Harry A.M. Twaalfhoven, William T. Hu, Lieke H. Meeter, John van Swieten, Lisa Vermunt, Frans Martens, Annemieke C. Heijboer, Charlotte E. Teunissen

Abstract: Biomarkers to discriminate the main pathologies underlying frontotemporal lobar degeneration (FTLD-Tau, FTLD-TDP) are lacking. Our previous FTLD cerebrospinal fluid (CSF) proteome study revealed that sex hormone-binding globulin (SHBG) was specifically increased in FTLD-Tau patients. Here we investigated the potential of CSF SHBG as a novel biomarker discriminating the main FTLD pathological subtypes…

Natural History of “Pure” Primary Lateral Sclerosis

Anhar Hassan, Shivam Om Mittal, William T. Hu, Keith A. Josephs, Eric J. Sorenson, J. Eric Ahlskog

OBJECTIVE: To assess whether primary lateral sclerosis (PLS), classified as pure when the EMG is normal, converts to amyotrophic lateral sclerosis (ALS) after longitudinal follow-up. METHODS: Retrospective chart review was performed of patients with pure PLS at Mayo Clinic in Rochester, MN (1990-2016). Inclusion criteria required a normal EMG during the first 4 years of symptoms…

Higher CSF sTNFR1-related proteins associate with better prognosis in very early Alzheimer’s disease

William T. Hu, Tugba Ozturk, Alexander Kollhoff, Whitney Wharton, J. Christina Howell

Abstract: Neuroinflammation is associated with Alzheimer’s disease, but the application of cerebrospinal fluid measures of inflammatory proteins may be limited by overlapping pathways and relationships between them. In this work, we measure 15 cerebrospinal proteins related to microglial and T-cell functions, and show them to reproducibly form functionally-related groups within and across diagnostic categories in 382 participants from the Alzheimer’s Disease Neuro-imaging Initiative as well participants from two independent cohorts…

Cerebrospinal fluid biomarkers in Parkinson’s disease with freezing of gait: an exploratory analysis

J. M. Hatcher-Martin, J. L. McKay, A. F. Pybus, B. Sommerfeld, J. C. Howell, F. C. Goldstein, L. Wood, W. T. Hu, S. A. Factor

Abstract: We explore the association between three Alzheimer’s disease-related and ten inflammation-related CSF markers and freezing of gait (FOG) in patients with Parkinson’s disease (PD). The study population includes PD patients with FOG (PD-FOG, N = 12), without FOG (PD-NoFOG, N = 19), and healthy controls (HC, N = 12). Age and PD duration are not significantly different between groups…

A Pilot randomized clinical trial of adapted tango to improve cognition and psychosocial function in African American women with family history of Alzheimer’s disease (ACT trial)

Whitney Wharton, Leanne Jeong, Liang Ni, Allison A. Bay, Ryan J. Shin, Lauren E. McCullough, Hayley Silverstein, Ariel R. Hart, Dominika Swieboda, William Hu, Madeleine E. Hackney

Alzheimer’s disease (AD) is a devastating, progressive neurodegenerative disease resulting in memory loss and a severe reduction in the ability to perform activities of daily living. Ethnicity-related genetic factors promoting the development of dementias among African Americans (AA) and increased risk among women for developing AD indicates that AA women with a parental history of AD are at great risk for developing AD…

Reporting and social construction of race in Alzheimer’s disease clinical trials

William T. Hu

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Does limited EMG denervation in early primary lateral sclerosis predict amyotrophic lateral sclerosis?

Anhar Hassan, Shivam O. Mittal, William T. Hu, Keith A. Josephs, Eric J. Sorenson, J. Eric Ahlskog

Objective: We assessed whether a cohort of patients with primary lateral sclerosis (PLS) and limited electromyography (EMG) motor unit denervation changes evolve into amyotrophic lateral sclerosis (ALS) with prolonged follow-up. Methods: We initially ascertained all PLS patients diagnosed at Mayo Clinic-Rochester (1990–2016). Of 64 total cases, 43 had normal EMGs (“pure” PLS) during the first 4 years after symptom onset and were the focus of a prior publication, documenting absence of evolution to ALS…

A Methodology for Studying Organizational Performance: A Multistate Survey of Front-line Providers

Karen B. Lasater, Olga F. Jarrín, Linda H. Aiken, Matthew D. McHugh, Douglas M. Sloane, Herbert L. Smith

Background:Rigorous measurement of organizational performance requires large, unbiased samples to allow inferences to the population. Studies of organizations, including hospitals, often rely on voluntary surveys subject to nonresponse bias. For example, hospital administrators with concerns about performance are more likely to opt-out of surveys about organizational quality and safety, which is problematic for generating inferences.Objective:The objective of this study was to describe a novel approach to obtaining a representative sample of organizations using individuals nested within organizations, and demonstrate how resurveying nonrespondents can allay concerns about bias from low response rates at the individual-level…

Validity of Race and Ethnicity Codes in Medicare Administrative Data Compared with Gold-standard Self-reported Race Collected during Routine Home Health Care Visits

Olga F. Jarrín, Abner N. Nyandege, Irina B. Grafova, Xinqi Dong, Haiqun Lin

Background:Misclassification of Medicare beneficiaries’ race/ethnicity in administrative data sources is frequently overlooked and a limitation in health disparities research.Objective:To compare the validity of 2 race/ethnicity variables found in Medicare administrative data [enrollment database (EDB) and Research Triangle Institute (RTI) race] against a gold-standard source also available in the Medicare data warehouse: the self-reported race/ethnicity variable on the home health Outcome and Assessment Information Set (OASIS)…

The Perfect Storm: Stakeholder Perspectives on Factors Contributing to Hospital Admissions for Patients Undergoing Maintenance Hemodialysis

Maya N. Clark-Cutaia, Olga F. Jarrín, Charlotte Thomas-Hawkins, Karen B. Hirschman

Abstract: Patients living with end stage renal disease (ESRD) who are undergoing hemodialysis experience frequent hospitalizations associated with complications of care and exacerbations of illness. Efforts to reduce hospitalizations have had limited success. The purpose of this study was to explore why hospitalizations occur from the perspectives of patients undergoing hemodialysis treatment, their caregivers, and health care providers. Semi-structured interviews and focus groups were conducted with 21 patients living with ESRD, 10 caregivers, and three focus groups with health care professionals…

National partnership to improve dementia care in nursing homes campaign: State and facility strategies, impact, and antipsychotic reduction outcomes

Stephen Crystal, Olga F. Jarrín, Marsha Rosenthal, Richard Hermida, Beth Angell

Abstract: Background and Objectives: Antipsychotic medications have been widely used in nursing homes to manage behavioral and psychological symptoms of dementia, despite significantly increased mortality risk. Use grew rapidly during the 2000s, reaching 23.9% of residents by 2011. A national campaign for safer dementia care in U.S. nursing homes was launched in 2012, with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. By the second quarter of 2019, use had declined by 40.1% to 14.3%. We assessed the impact of state and facility initiatives during the Campaign aimed at encouraging more-judicious prescribing of antipsychotic medications…

Timing of home health care initiation and 30-day rehospitalizations among medicare beneficiaries with diabetes by race and ethnicity

Jamie M. Smith, Haiqun Lin, Charlotte Thomas-Hawkins, Jennifer Tsui, Olga F. Jarrín

Abstract: Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015…

Racial disparities in post-acute home health care referral and utilization among older adults with diabetes

Jamie M. Smith, Olga F. Jarrín, Haiqun Lin, Jennifer Tsui, Tina Dharamdasani, Charlotte Thomas-Hawkins

Abstract: Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients and their caregivers…

Beyond Black and White: Mapping Misclassification of Medicare Beneficiaries Race and Ethnicity

Irina B. Grafova, Olga F. Jarrín

Abstract: The Centers for Medicare and Medicaid Services administrative data contains two variables that are used for research and evaluation of health disparities: the enrollment database (EDB) beneficiary race code and the Research Triangle Institute (RTI) race code. The objective of this article is to examine state-level variation in racial/ethnic misclassification of EDB and RTI race codes compared with self-reported data collected during home health care…

COVID-19 controlled human infection studies: Worries about local community impact and demands for local engagement

Kyungdo Lee, Nir Eyal

Abstract: In spring, summer and autumn 2020, one abiding argument against controlled human infection (CHI) studies of SARS-CoV-2 vaccines has been their impact on local communities. Leading scientists and bioethicists expressed concern about undue usage of local residents’ direly needed scarce resources at a time of great need and even about their unintended infection. They recommended either avoiding CHI trials or engaging local communities before conducting any CHIs…

Broad cross-national public support for accelerated COVID-19 vaccine trial designs

David Broockman, Joshua Kalla, Alexander Guerrero, Mark Budolfson, Nir Eyal, Nicholas P. Jewell, Monica Magalhaes, Jasjeet S. Sekhon

Abstract: A vaccine for COVID-19 is urgently needed. Several vaccine trial designs may significantly accelerate vaccine testing and approval, but also increase risks to human subjects. Concerns about whether the public would see such designs as ethical represent an important roadblock to their implementation; accordingly, both the World Health Organization and numerous scholars have called for consulting the public regarding them…

“The research assistants kept coming to follow me up; I counted myself as a lucky person”: Social support arising from a longitudinal HIV cohort study in Uganda

Jeffrey I. Campbell, Angella Musiimenta, Sylvia Natukunda, Nir Eyal, Jessica E. Haberer

Abstract: Background Participation in longitudinal research studies in resource-limited settings often involves frequent interactions with study staff and other participants, as well as receipt of incentives and transportation reimbursements. Social support—receipt of material and emotional resources from one’s social network—has been linked to antiretroviral adherence in sub-Saharan Africa. The extent to which social support arises from study participation, its range and depth, and its implications for observational study conduct, have not been extensively described. Methods We conducted individual open-ended and semi-structured interviews with participants in a longitudinal, observational antiretroviral therapy adherence monitoring study in Mbarara, Uganda.

The Ethics of Human Challenge Trials Using Emerging Severe Acute Respiratory Syndrome 2 Variants

Abie Rohrig, Nir Eyal

Abstract: The world’s first coronavirus disease 2019 human challenge trial using the D614G strain of severe acute respiratory syndrome 2 (SARS-CoV-2) is underway in the United Kingdom. The Wellcome Trust is funding challenge stock preparation of the Beta and Delta variant for a follow-up human challenge trial, and researchers at hVIVO are considering conducting these trials. However, little has been written thus far about the ethical justifiability of human challenge trials with SARS-CoV-2 variants of concern. We explore 2 specific characteristics of some variants that may initially be thought to make such trials unethical and conclude that SARS-CoV-2 variant challenge trials can remain ethical…

COVID vaccine efficacy against the B.1.351 (“South African”) variant—The urgent need to lay the groundwork for possible future challenge studies

Nir Eyal, Arthur Caplan, Stanley Plotkin

SARS-CoV-2’s B.1.351 (“South African”) variant “is markedly more resistant to neutralization by convalescent plasma (9.4 fold) and vaccinee sera (10.3–12.4 fold),”1,2 raising the specter that that variant could resist the leading authorized spike-based vaccines.2 Indeed, in earlier lab exams, Moderna’s vaccine showed “A six-fold reduction in neutralizing titers … with the B.1.351 variant relative to prior variants.”3 Pfizer-BioNTech’s “neutralization of the B.1.351-spike virus was weaker by approximately two thirds.”4 When tested in human volunteers, AstraZeneca’s vaccine provided only 10% protection from mild to moderate disease caused by that variant, and its distribution in South Africa was suspended.5 Janssen’s vaccine also did less well in South Africa than elsewhere, presumably due to lower neutralization of infecting viruses…

Consent Requirements for Testing Health Policies: An Intercontinental Comparison of Expert Opinions

Astrid Berner-Rodoreda, Shannon McMahon, Nir Eyal, Puspita Hossain, Atonu Rabbani, Mrittika Barua, Malabika Sarker, Emmy Metta, Elia Mmbaga, Melkizedeck Leshabari, Daniel Wikler, Till Bärnighausen

Abstract: Individual informed consent is a central requirement for clinical research on human subjects, yet whether and how consent requirements should apply to health policy experiments (HPEs) remains unclear. HPEs test and evaluate public health policies prior to implementation. We interviewed 58 health experts in Tanzania, Bangladesh and Germany on informed consent requirements for HPEs…

Risk of clinically relevant hyperglycemia with metoprolol compared to carvedilol in older adults with heart failure and diabetes

Chintan V. Dave, Brian L. Strom, Fred A. Kobylarz, Daniel B. Horton, Tobias Gerhard, Chin Lin Tseng, Ilja Dejanovic, Abner Nyandege, Soko Setoguchi

Background: Although prior literature suggests that metoprolol may worsen glucose control compared to carvedilol, whether this has clinical relevance among older adults with diabetes and heart failure (HF) remains an open question…

Considerations when assessing the effect of nightshifts on hypertension prevalence

Maxwell Everett, Soko Setoguchi, Aayush Visaria

Considerations when assessing the effect of nightshifts on hypertension prevalence …

Validation of a claims-based algorithm to identify cases of ulcerative colitis in Japan

Haruei Ogino, Hiromu Morikubo, Keita Fukaura, Tasuku Okui, Sean Gardiner, Naonobu Sugiyama, Noritoshi Yoshii, Tsutomu Kawaguchi, Haoqian Chen, Edward Nonnenmacher, Soko Setoguchi, Naoki Nakashima, Taku Kobayashi

Background and Aim: The prevalence of ulcerative colitis (UC) is increasing in Japan. Validated claims-based definitions are required to investigate the epidemiology of UC and its treatment and disease course in clinical practice. This study aimed to develop a claims-based algorithm for UC in Japan…

Thirty-Year Trends in Graft Survival After Heart Transplant: Modeled Analyses of a Transplant Registry

Marlena E. Sabatino, Matthew L. Williams, Ike S. Okwuosa, Ehimare Akhabue, Jung Hyun Kim, Mark J. Russo, Soko Setoguchi

Background: Heart failure is an epidemic in the United States, and transplantation remains the most definitive therapy. We describe multidecade trends in posttransplant graft survival, adjusted for concurrent changes in the population, over the 30 years antecedent to the most recent heart allocation policy change…

Risks for Anaphylaxis With Intravenous Iron Formulations: A Retrospective Cohort Study

Chintan V. Dave, Gary M. Brittenham, Jeffrey Carson, Soko Setoguchi

BACKGROUND: The risks for anaphylaxis among intravenous (IV) iron products currently in use have not been assessed. OBJECTIVE: To compare risks for anaphylaxis among 5 IV iron products that are used frequently. DESIGN: Retrospective cohort study using a target trial emulation framework. SETTING: Medicare fee-for-service data with Part D coverage between July 2013 and December 2018…

Regulator-Requested Non-Interventional Postauthorization Safety and Effectiveness Studies for Oncology Drugs: A Systematic Review

Xiao Zhang, Lei Chen, Oswaldo L. Bracco, Soko Setoguchi, Wei Zhou, Mehmet Burcu

Abstract: There has been a growing number of oncology drug approvals. Non-interventional postauthorization safety/effectives studies (PASSs/PAESs) aim to provide real-world evidence on the safety/effectiveness of oncology drugs postapproval. To understand the current landscape, a comprehensive search as of March 1, 2021, was conducted in major register/databases…

Climate Change, Health, and Health Care Systems: A Global Perspective

Soko Setoguchi, Desmond Leddin, Geoffrey Metz, M. Bishr Omary

Many of us who have served in health care long enough witnessed a transition from cloth gowns, sheets, and reusable surgical trays to disposal plastic replacements decades ago. However, we have rarely connected a pair of gloves and equipment that were discarded after each use to melting ice caps and dying polar bears…

Frailty Risks of Prescription Analgesics and Sedatives across Frailty Models: the Health and Retirement Study

Andrew W. Bergen, Gulcan Cil, Lana J. Sargent & Chintan V. Dave

Introduction: Limited evidence for incident frailty risks associated with prescription analgesics and sedatives in older (≥ 65 years) community-living adults prompted a more comprehensive investigation…

Cross-substance patterns of alcohol, cigarette, and cannabis use initiation in Black and White adolescent girls

Carolyn E. Sartor, Feifei Ye, Patricia Simon, Zu Wei Zhai, Alison E. Hipwell, Tammy Chung

Characterizing variations in the timing of alcohol, cigarette, and cannabis use onset both among and between Black and White youth can inform targeted prevention. The current study aimed to capture cross-substance initiation patterns in Black and White girls and characterize these patterns with respect to substance use related socioeconomic, neighborhood, family, community, and individual level factors. Data were drawn from interviews conducted at ages 8 through 17 in an urban sample of girls (n = 2172; 56.86% Black, 43.14% White). Discrete-time multiple event process survival mixture modeling was used to identify patterns (i.e., classes) representing timing of alcohol, cigarette, and cannabis use initiation, separately by race. Class characteristics were compared using multinomial logistic regression. Among both Black and White girls, four classes, including abstainer and cross-substance early onset classes, emerged. Two classes characterized by mid-adolescence onset (Black girls) and variation in onset by substance (White girls) were also observed. Class differences centered around cannabis for Black girls (e.g., preceding or following cigarette use) and alcohol for White girls (e.g., (in)consistency over time in greater likelihood of initiation relative to cigarette and cannabis use). Several factors distinguishing the classes were common across race (e.g., externalizing behaviors, friends’ cannabis use); some were specific to Black girls (e.g., intentions to smoke cigarettes) or White girls (e.g., primary caregiver problem drinking). Findings underscore the need to recognize a more complex picture than a high-risk/low-risk dichotomy for substance use initiation and to attend to nuanced differences in markers of risky onset pathways between Black and White girls…

Increased risk for binge drinking among college students with disability who report sexual violence

Carla D. Chugani, Kelley A. Jones, Robert W.S. Coulter, Jocelyn C. Anderson, Janine Talis, Tina R. Goldstein, Tammy Chung, Elizabeth Miller

Objective This study investigated binge drinking in college students with and without disabilities and sexual violence (SV). Participants: This analysis includes 2,113 college students recruited from campus health or counseling centers between 2015 and 2017, aged 18-24. Method: Multinomial logistic regression procedures were used to estimate adjusted odds ratios (AOR) for past month binge drinking days (BDD). Results: Among students with disabilities, 68% endorsed SV, compared with 53% of those without disability. Disability was not significantly associated with BDD; SV was significantly associated with BDD (p <.0001). Students with SV, regardless of disability status, had 1.7- to 2.1-fold greater odds of having 4+ past month BDD. Conclusions: While disability alone is not a risk factor for binge drinking, novel findings include that students with disabilities binge drink at similarly high rates to their nondisabled peers, and are at elevated risk for SV, which is closely associated with binge drinking...

Mobile phone sensor-based detection of subjective cannabis intoxication in young adults: A feasibility study in real-world settings

Sang Won Bae, Tammy Chung, Rahul Islam, Brian Suffoletto, Jiameng Du, Serim Jang, Yuuki Nishiyama, Raghu Mulukutla, Anind Dey

Background: Given possible impairment in psychomotor functioning related to acute cannabis intoxication, we explored whether smartphone-based sensors (e.g., accelerometer) can detect self-reported episodes of acute cannabis intoxication (subjective “high” state) in the natural environment. Methods: Young adults (ages 18–25) in Pittsburgh, PA, who reported cannabis use at least twice per week, completed up to 30 days of daily data collection: phone surveys (3 times/day), self-initiated reports of cannabis use (start/stop time, subjective cannabis intoxication rating: 0–10, 10 = very high), and continuous phone sensor data. We tested multiple models with Light Gradient Boosting Machine (LGBM) in distinguishing “not intoxicated” (rating = 0) vs subjective cannabis “low-intoxication” (rating = 1–3) vs “moderate-intensive intoxication” (rating = 4–10). We tested the importance of time features (i.e., day of the week, time of day) relative to smartphone sensor data only on model performance, since time features alone might predict “routines” in cannabis intoxication…

Moderators of Substance Use Disorder Treatment for Adolescents

Rachel L. Bachrach, Tammy Chung

Objective: This brief review covers the current state of the literature on moderators of adolescent substance use disorder (SUD) treatment. These moderators provide information on “for whom” a specific treatment may work best. Method: We used Google Scholar, PubMed, PsycInfo, and manual search of relevant reference lists to identify eligible peer-reviewed publications from January 2005 to December 2019. Results: We summarize 21 published studies (including meta-analyses, randomized clinical trials, and correlational work) testing moderators and/or predictors of adolescent SUD treatment outcomes…

Adolescent childbirth, miscarriage, and abortion: associations with changes in alcohol, marijuana, and cigarette use

Irene Tung, Jordan Beardslee, Dustin Pardini, Tammy Chung, Kate Keenan, Alison E. Hipwell

Background: Adolescent girls who become pregnant demonstrate greater risk for substance use than same-aged peers. However, it remains unclear how risk relates to normative changes in adolescence. Few studies have examined adolescent substance use changes before, during, and after pregnancy and considered how pregnancy outcomes (childbirth, miscarriage, abortion) differentially influence substance use changes. The present study examined associations between different adolescent pregnancy outcomes and within-person changes in substance use from prepregnancy to postpregnancy. Methods: Participants included 2,450 girls (52% Black) oversampled from low-income urban neighborhoods in Pittsburgh, PA. Participants self-reported pregnancy outcomes and substance use frequency (alcohol, cigarette, marijuana) annually from ages 11–20. Fixed effects regressions focused on first births, first miscarriages, and first abortions occurring from ages 12–19 to test the associations between pregnancy outcomes and within-individual changes in substance use from prepregnancy to postpregnancy…

Adolescent development of inhibitory control and substance use vulnerability: A longitudinal neuroimaging study

Alina Quach, Brenden Tervo-Clemmens, William Foran, Finnegan J. Calabro, Tammy Chung, Duncan B. Clark, Beatriz Luna

Abstract: Previous research indicates that risk for substance use is associated with poor inhibitory control. However, it remains unclear whether at-risk youth follow divergent patterns of inhibitory control development. As part of the longitudinal National Consortium on Adolescent Neurodevelopment and Alcohol study, participants (N = 113, baseline age: 12–21) completed a rewarded antisaccade task during fMRI, with up to three time points…

Affective and sensation-seeking pathways linking borderline personality disorder symptoms and alcohol-related problems in young women

Carla D. Chugani, Amy L. Byrd, Sarah L. Pedersen, Tammy Chung, Alison E. Hipwell, Stephanie D. Stepp

Borderline personality disorder (BPD) and alcohol use disorder often cooccur, yet we know little about risk processes underlying this association. We tested two mechanistic pathways linking BPD symptoms and alcoholrelated problems. In the “affective pathway,” we hypothesized that BPD symptoms would be associated with alcohol-related problems through affective instability and drinking to cope. In the “sensation-seeking pathway,” we proposed that BPD symptoms would be related to alcoholrelated problems through sensation seeking and drinking to enhance positive experiences…

Alcohol Use Trajectories Before and After Pregnancy Among Adolescent and Young Adult Mothers

Irene Tung, Tammy Chung, Robert T. Krafty, Kate Keenan, Alison E. Hipwell

Background: Moderate to heavy alcohol use during pregnancy (≥3 drinks/occasion) is linked to a range of adverse offspring outcomes. Prior studies suggest that adolescent and young adult mothers may be particularly vulnerable to these risky drinking behaviors during and after pregnancy. This study used latent class growth analysis (LCGA) to examine changes in risky drinking from prepregnancy to postpregnancy and identified prepregnancy predictors representing cognitive and social factors to inform prevention. Methods: Participants included 432 adolescent and young adult mothers (aged 13 to 24; 78% Black) assessed annually since childhood in the Pittsburgh Girls Study. Participants prospectively reported frequency of risky drinking (≥3 drinks/occasion) in the year of pregnancy and 2 years before and after pregnancy, as well as social–cognitive risk factors for drinking (alcohol expectancies, drinking motives, caregiver, and peer alcohol use)…

Attentional and approach biases to alcohol cues among young adult drinkers: An ecological momentary assessment study.

Brian Suffoletto, Matt Field, Tammy Chung

Alcohol-specific attentional biases (AttB) and approach biases (AppB) are postulated to play a role in alcohol use disorders but their association with drinking in young adults remains unknown. A subsample of young adults with risky alcohol use (N = 296) enrolled in a randomized trial, testing different text message interventions completed weekly tasks via a mobile app for up to 14 weeks: Alcohol Stroop was used to measure AttB and Approach-Avoidance Task was used to measure AppB…

Change in Marijuana Use and Related Problems among Adolescents in Substance Use Disorder Treatment: The Mediating Effects of Alcohol Consumption

Suzanne Spinola, Dezarie Moskal, Stephen A. Maisto, Aesoon Park, Allison K. Labbe, Tammy A. Chung

As the number of adolescents seeking treatment for marijuana use increases, it is important to identify factors that mediate marijuana treatment outcomes. Alcohol consumption is highly prevalent in clinical samples of adolescents but has been neglected as a potential mediator of marijuana use treatment outcomes. In this study, we sought to examine alcohol consumption as a mediator of both marijuana use frequency (number of use days) and negative consequences related to marijuana use in a longitudinal study of 159 adolescents (Mage = 16.69 years; 35% female; 87% White; 70% marijuana as a preferred drug) enrolled in intensive outpatient substance use disorder (SUD) treatment…

Characteristics of precollege sexual violence victimization and associations with sexual violence revictimization during college

Jocelyn C. Anderson, Carla D. Chugani, Kelley A. Jones, Robert W.S. Coulter, Tammy Chung, Elizabeth Miller

Objective: To examine the prevalence and characteristics of precollege sexual victimization (SV) experiences and associations with revictimization and recent substance use behaviors among a sample of college students who reported precollege SV. Participants: A sub-sample of 931 college students who reported precollege SV at baseline data collection for an ongoing multi-site clinical trial. Methods: Data were collected via electronic surveys between September 2015 and March 2017. Measures included precollege and during college SV, recent substance use, and alcohol-related harm reduction behaviors…

Drinking beyond the binge threshold in a clinical sample of adolescents

Kasey G. Creswell, Tammy Chung, Carillon J. Skrzynski, Rachel L. Bachrach, Kristina M. Jackson, Duncan B. Clark, Christopher S. Martin

Background and aims: Nearly all the research conducted on high-intensity drinking has focused on college and school-based samples, with recent calls for research to understand this risky drinking pattern in non-school-based samples and across time. This study aimed to characterize predictors and consequences of non-binge drinking, age- and gender-adjusted binge drinking (level I) and drinking at levels representing two or more times (level II) and three or more times the level I binge threshold (level III) in a clinical sample of adolescents followed into young adulthood…

In-Person Contacts and Their Relationship With Alcohol Consumption Among Young Adults With Hazardous Drinking During a Pandemic

Brian Suffoletto, Nilam Ram, Tammy Chung

Purpose: Social distancing strategies such as “stay-at-home” (SAH) orders can slow the transmission of contagious viruses like the SARS-CoV-2 virus, but require population adherence to be effective. This study explored adherence to SAH orders by young adults with hazardous drinking, and the role of alcohol consumption with in-person contacts on adherence…

Mobile assessment of acute effects of marijuana on cognitive functioning in young adults: Observational study

Tammy Chung, Sang Won Bae, Eun Young Mun, Brian Suffoletto, Yuuki Nishiyama, Serim Jang, Anind K. Dey

Background: Mobile assessment of the effects of acute marijuana on cognitive functioning in the natural environment would provide an ecologically valid measure of the impacts of marijuana use on daily functioning. Objective: This study aimed to examine the association of reported acute subjective marijuana high (rated 0-10) with performance on 3 mobile cognitive tasks measuring visuospatial working memory (Flowers task), attentional bias to marijuana-related cues (marijuana Stroop), and information processing and psychomotor speed (digit symbol substitution task [DSST])…

Public and private religious involvement and initiation of alcohol, cigarette, and marijuana use in Black and White adolescent girls

Carolyn E. Sartor, Alison E. Hipwell, Tammy Chung

Purpose: This longitudinal study aimed to identify variation by race in the associations between religious involvement and initiation of alcohol, cigarette, and marijuana use, including distinctions by substance or type of religious involvement, in Black and White adolescent girls. Methods: Data were drawn from interviews conducted at ages 11 through 17 with 2172 Pittsburgh Girls Study participants (56.8% Black; 43.2% White)…

Relational Peer Victimization Interacts With Depression Severity to Predict the Timing of Alcohol Use Initiation in Adolescent Girls

Jacqueline Woerner, Feifei Ye, Alison E. Hipwell, Tammy Chung, Carolyn E. Sartor

Background: Peer victimization is consistently linked to adolescents’ alcohol use. However, the relative influence of relational and physical peer victimization on alcohol use, and timing of drinking initiation, is not well understood. In this study, we evaluate the impact of both relational and physical peer victimization on adolescent girls’ alcohol use initiation, and the extent to which depression severity moderates these associations…

The effect of SMS behavior change techniques on event-level desire to get drunk in young adults

Brian Suffoletto, James Huber, Levent Kirisci, Duncan Clark, Tammy Chung

Abstract: Text messaging (SMS) interventions incorporating a combination of behavior change techniques can assist reductions in alcohol consumption among young adult hazardous drinkers, but mechanisms of action remain unknown. In this secondary analysis, we test the hypothesis that desire to get drunk (DD) recorded prior to drinking episodes would mediate SMS intervention effects on the likelihood of event-level heavy drinking (4+/5+ drinks for women/men)…

Youth perceptions of parental involvement and monitoring, discrepancies with parental perceptions, and their associations with first cigarette use in black and white girls

Carolyn E. Sartor, Feifei Ye, Patricia Simon, Zu Wei Zhai, Alison E. Hipwell, Tammy Chung

Objective: Low parental involvement and monitoring are risk factors for adolescent cigarette use. Assessments of parental involvement and monitoring by youth and parents may capture an additional source of risk: Differences in perceptions of these parenting behaviors. This study tested for unique contributions of youth-reported parental involvement and monitoring and youth–parent discrepancies in reporting to first cigarette use in girls. Method: Data were drawn from interviews at ages 8–17 with 1,869 girls (57.3% Black, 42.7% White) and their primary caregivers (94% mothers) in the Pittsburgh Girls Study…

Are Hispanic, Black, and Asian Physicians Truly Less Burned out Than White Physicians? Individual and Institutional Considerations

Joel C. Cantor, Dawne M. Mouzon

Garcia and colleagues1 delve into an understudied but vitally important physician workforce concern: professional burnout. Their work draws on a national survey of physicians with a sample large enough to examine differences in important metrics by race/ethnicity. Given the long-standing struggle to improve the diversity of the medical profession, examining the extent of burnout among physicians of minority racial/ethnic groups is imperative…

Control Versus Administrative Discretion in Negotiating Voluntary P4P Networks: The Case of Medicaid Accountable Care Organizations

Frank J. Thompson, Joel C. Cantor, Rob Houston

Abstract: Government sponsored pay-for-performance systems (P4P) have emerged in many contexts, including those featuring third-party federalism such as Medicaid. In this vein, voluntary networks called Medicaid accountable care organizations (ACOs) seek to achieve health care savings while boosting the quality of care. Drawing on evidence from four states, this study probes how collaborative governance strategies that downplay formal democratic controls and enhance administrative flexibility shaped the response to two implementation problems. We find that administrative flexibility, combined with signals of support from political principals, helped galvanize ACO formation but undermined efforts to tailor performance metrics to the needs of Medicaid enrollees…

Medicaid Utilization and Spending among Homeless Adults in New Jersey: Implications for Medicaid-Funded Tenancy Support Services

Joel C. Cantor, Sujoy Chakravarty, Jose Nova, Taiisa Kelly, Derek Delia, Emmy Tiderington, Richard W. Brown

Abstract: Policy Points Large numbers of homeless adults gained Medicaid coverage under the Affordable Care Act, increasing policymaker interest in strategies to improve care and reduce avoidable hospital costs for homeless populations. Compared with nonhomeless adult Medicaid beneficiaries, homeless adult beneficiaries have higher levels of health care needs, due in part to mental health issues and substance use disorders. Homeless adults are also more likely to visit the emergency department or require inpatient admissions…

Racial Disparities in Health Care Utilization at the End of Life among New Jersey Medicaid Beneficiaries with Advanced Cancer

Annie Yang, David Goldin, Jose Nova, Jyoti Malhotra, Joel C. Cantor, Jennifer Tsui

PURPOSE Racial and ethnic disparities in cancer care near the end of life (EOL) have been recognized, but EOL care experienced by Medicaid beneficiaries is not well understood. We assessed the prevalence of aggressive EOL care and hospice enrollment for Medicaid beneficiaries and determined whether racial and ethnic disparities exist. PATIENTS AND METHODS We identified Medicaid beneficiaries (age 21-64 years) who were diagnosed from 2011 to 2015 with stage IV breast and colorectal cancer and who died by January 2016 through a New Jersey State Cancer Registry–Medicaid claims linked data set…

Understanding the impact of insurance coverage across the cancer care continuum: Moving beyond fragmented systems and cross-sectional data to inform policy

Jennifer Tsui, Lindsay M. Sabik, Joel C. Cantor

Understanding the impact of health insurance coverage on access to and quality of cancer care, as well as the implications for cancer outcomes, is critically important for informing practice and policy within the complex and changing health-care context. In this issue of the Journal, Yabroff et al. (1) conducted a systematic review of 29 studies, published between 1980 and 2019, evaluating health insurance coverage disruptions and cancer care and outcomes in the United States…

Using ICD-10 codes to identify elective epilepsy monitoring unit admissions from administrative billing data: A validation study

Brad K. Kamitaki, Shelly Rishty, Ram Mani, Stephen Wong, Lisa M. Bateman, Charlotte Thomas-Hawkins, Joel C. Cantor, Lawrence C. Kleinman

Abstract: Video-electroencephalogram (EEG) monitoring in the epilepsy monitoring unit (EMU) is essential for managing epilepsy and seizure mimics. Evaluation of care in the EMU would benefit from a validated code set capable of identifying EMU admissions from administrative databases comprised of large, diverse cohorts. We assessed the ability of code-based queries to parse EMU admissions from administrative billing records in a large academic medical center over a four-year period, 2016–2019. We applied prespecified queries for admissions coded as follows: 1) elective, 2) receiving video-EEG monitoring, and 3) including diagnoses typically required by major US healthcare payers for EMU admission…

Change in Alcohol Use Based on Self-Report and a Quantitative Biomarker, Phosphatidylethanol, in People With HIV

Kathleen A. McGinnis, Janet P. Tate, Kendall J. Bryant, Amy C. Justice, Patrick G. O’Connor, Maria C. Rodriguez-Barradas, Stephen Crystal, Christopher J. Cutter, Nathan B. Hansen, Stephen A. Maisto, Vincent C. Marconi, Emily C. Williams, Robert L. Cook, Adam J. Gordon, Kirsha S. Gordon, Oghenowede Eyawo, E. Jennifer Edelman, David A. Fiellin

Abstract: The timeline followback (TLFB) takes more resources to collect than the Alcohol Use Disorder Identification Test (AUDIT-C). We assessed agreement of TLFB and AUDIT-C with the biomarker phosphatidylethanol (PEth) and compared changes in TLFB and PEth among persons with HIV (PWH) using secondary data from randomized trials. We calculated operating characteristics and agreement between TLFB (> 1 and > 2 average drinks/day), AUDIT-C ≥ 4 and PEth ≥ 20 among 275 men with HIV…

Longitudinal analysis of the prevalence and correlates of heavy episodic drinking and self-reported opioid use among a national cohort of patients with HIV

Benjamin J. Oldfield, Yu Li, Rachel Vickers-Smith, Declan T. Barry, Stephen Crystal, Kirsha S. Gordon, Robert D. Kerns, Emily C. Williams, Brandon D.L. Marshall, E. Jennifer Edelman

Background: Heavy episodic drinking (HED) is a risk factor for opioid-related overdose and negatively impacts HIV disease progression. Among a national cohort of patients with HIV (PWH), we examined sociodemographic and clinical correlates of concomitant HED and self-reported opioid use. Methods: We used data collected from 2002 through 2018 from the Veterans Aging Cohort Study, a prospective cohort including PWH in care at eight US Veterans Health Administration sites. HED was defined as consuming six or more drinks at least once in the year prior to survey collection. We examined the relationship between HED and self-reported opioid use and created a 4-level composite variable of HED and opioid use…

Non–prescribed buprenorphine preceding treatment intake and clinical outcomes for opioid use disorder

Arthur Robin Williams, Christine M. Mauro, Tianshu Feng, Amanda Wilson, Angelo Cruz, Mark Olfson, Stephen Crystal, Hillary Samples, Lisa Chiodo

Objective: Successful retention on buprenorphine improves outcomes for opioid use disorder (OUD); however, we know little about associations between use of non–prescribed buprenorphine (NPB) preceding treatment intake and clinical outcomes. Methods: The study conducted observational retrospective analysis of abstracted electronic health record (EHR) data from a multi-state nationwide office-based opioid treatment program. The study observed a random sample of 1000 newly admitted patients with OUD for buprenorphine maintenance (2015–2018) for up to 12 months following intake. We measured use of NPB by mandatory intake drug testing and manual EHR coding…

Opioid overdose survivors: Medications for opioid use disorder and risk of repeat overdose in Medicaid patients

Stephen Crystal, Molly Nowels, Hillary Samples, Mark Olfson, Arthur Robin Williams, Peter Treitler

Background: Patients with medically-treated opioid overdose are at high risk for subsequent adverse outcomes, including repeat overdose. Understanding factors associated with repeat overdose can aid in optimizing post-overdose interventions. Methods: We conducted a longitudinal, retrospective cohort study using NJ Medicaid data from 2014 to 2019. Medicaid beneficiaries aged 12–64 with an index opioid overdose from 2015 to 2018 were followed for one year for subsequent overdose. Exposures included patient demographics; co-occurring medical, mental health, and substance use disorders; service and medication use in the 180 days preceding the index overdose; and MOUD following index overdose. Results: Of 4898 individuals meeting inclusion criteria, 19.6% had repeat opioid overdoses within one year…

Perspectives of opioid use disorder treatment providers during COVID-19: Adapting to flexibilities and sustaining reforms

Peter C. Treitler, Cadence F. Bowden, James Lloyd, Michael Enich, Amesika N. Nyaku, Stephen Crystal

Objective: The COVID-19 pandemic led to unprecedented temporary federal and state regulatory flexibilities that rapidly transformed medication for opioid use disorder (MOUD) treatment delivery. This study aimed to understand changes in treatment providers’ care during COVID-19, provider experiences with the adaptations, and perceptions of which changes should be sustained long-term. Methods: We conducted in-depth, semi-structured interviews with 20 New Jersey MOUD providers, purposively sampled to reflect diversity in provider setting, specialty, and other characteristics. Using a rapid analysis approach, we summarized content within interview domains and analyzed domains across participants for recurring concepts and themes…

Psychosocial and behavioral therapy in conjunction with medication for opioid use disorder: Patterns, predictors, and association with buprenorphine treatment outcomes

Hillary Samples, Arthur Robin Williams, Stephen Crystal, Mark Olfson

Introduction: Current evidence indicates that buprenorphine is a highly effective treatment for opioid use disorder (OUD), though premature medication discontinuation is common. Research on concurrent psychosocial and behavioral therapy services and related outcomes is limited. The goal of this study was to define patterns of OUD-related psychosocial and behavioral therapy services received in the first 6 months after buprenorphine initiation, identify patients’ characteristics associated with service patterns, and examine the course of buprenorphine treatment, including the association of therapy with medication treatment duration…

Twelve-Month Retention in Opioid Agonist Treatment for Opioid Use Disorder Among Patients With and Without HIV

Jessica J. Wyse, Kathleen A. McGinnis, E. Jennifer Edelman, Adam J. Gordon, Ajay Manhapra, David A. Fiellin, Brent A. Moore, P. Todd Korthuis, Amy J. Kennedy, Benjamin J. Oldfield, Julie R. Gaither, Kirsha S. Gordon, Melissa Skanderson, Declan T. Barry, Kendall Bryant, Stephen Crystal, Amy C. Justice, Kevin L. Kraemer

Abstract: Although opioid agonist therapy (OAT) is associated with positive health outcomes, including improved HIV management, long-term retention in OAT remains low among patients with opioid use disorder (OUD). Using data from the Veterans Aging Cohort Study (VACS), we identify variables independently associated with OAT retention overall and by HIV status…

“Medication Is Just One Piece of the Whole Puzzle”: How Nursing Homes Change Their Use of Antipsychotic Medications

Marsha Rosenthal, Jessica Poling, Aleksandra Wec, Elizabeth Connolly, Beth Angell, Stephen Crystal

Abstract: Antipsychotic medication use for nursing home residents with dementia poses major patient safety challenges. This article investigates health professionals’ experiences with decision-making during changes under the National Partnership to Improve Dementia Care in Nursing Homes (National Partnership) and its companion state coalitions. These programs were introduced in 2012 to encourage reductions in antipsychotic use and increased use of nonpharmacological treatments for dementia…

Brief original report: Does smoking status provide information relevant to screening for other substance use among US adults?

Maria R. Khan, Kaoon Ban, Ellen C. Caniglia, Jennifer E. Edelman, Julie Gaither, Stephen Crystal, Natalie E. Chichetto, Kailyn E. Young, Janet Tate, Amy C. Justice, R. Scott Braithwaite

Abstract: We assessed whether tobacco screening provides clinically meaningful information about other substance use, including alcohol and other drug use, potentially facilitating targeting of screening for substance use. Using data from the Veterans Aging Cohort Study survey sample (VACS; N = 7510), we calculated test performance characteristics of tobacco use screening results for identification of other substance use including sensitivity, specificity, positive-likelihood-ratio (+LR = [sensitivity/(1-specificity)]: increase in odds of substance use informed by a positive tobacco screen), and negative-likelihood-ratio (-LR: [(1-sensitivity)/specificity]: reduction in odds of substance use informed by a negative tobacco screen). The sample was 95% male, 75% minority, and 43% were current and 33% were former smokers. Never smoking, versus any history, indicated an approximate four-fold decrease in the odds of injection drug use (-LR = 0.26), an approximate 2.5-fold decrease in crack/cocaine (-LR = 0.35) and unhealthy alcohol use (-LR = 0.40), an approximate two-fold decrease in marijuana (-LR = 0.51) and illicit opioid use (-LR = 0.48), and an approximate 30% decrease in non-crack/cocaine stimulant use (-LR = 0.75)…

Depression as a risk factor for incident ischemic stroke among hiv-positive veterans in the veterans aging cohort study

Jason J. Sico, Suman Kundu, Kaku So-Armah, Samir K. Gupta, Chung Chou H. Chang, Adeel A. Butt, Cynthia L. Gibert, Vincent C. Marconi, Stephen Crystal, Hilary A. Tindle, Matthew S. Freiberg, Jesse C. Stewart

BACKGROUND: HIV infection and depression are each associated with increased ischemic stroke risk. Whether depression is a risk factor for stroke within the HIV population is unknown. METHODS AND RESULTS: We analyzed data on 106 333 (33 528 HIV-positive; 72 805 HIV-negative) people who were free of baseline cardiovascular disease from an observational cohort of HIV-positive people and matched uninfected veterans in care from April 1, 2003 through December 31, 2014. International Classification of Diseases, Ninth Revision (ICD-9) codes from medical records were used to determine baseline depression and incident stroke…

HIV Testing and Counseling at U.S. Substance Use Treatment Facilities: A Missed Opportunity for Early Identification

Nicholas S. Riano, Hannah M. Borowsky, Emily A. Arnold, Mark Olfson, James T. Walkup, Eric Vittinghoff, Francine Cournos, Lindsey Dawson, Alexander R. Bazazi, Stephen Crystal, Christina Mangurian

OBJECTIVE: The objective of this study was to determine the availability and national distribution of HIV testing and counseling at substance use treatment facilities in the United States. METHODS: Analyses of data from the 2018 National Survey of Substance Abuse Treatment Services assessed HIV testing and counseling availability in U.S. substance use treatment facilities (excluding those in U.S. territories). Facilities were subcategorized by availability of mental health services and medication for opioid use disorders and compared by using logistic models. Descriptive statistics were calculated to characterize the availability of HIV testing and counseling by state, state HIV incidence, and facility characteristics…

Medically treated opioid overdoses among New Jersey Medicaid beneficiaries: Rapid growth and complex comorbidity amid growing fentanyl penetration

Stephen Crystal, Molly Nowels, Mark Olfson, Hillary Samples, Arthur Robinson Williams, Peter Treitler

Objective: Medically treated opioid overdoses identify a population at high risk of subsequent mortality and need for treatment. This study reports on medically treated opioid overdose trends in a state with rapid fentanyl spread. Methods: We conducted stratified trend analysis of medically treated overdose due to heroin, synthetic opioids, methadone, or other natural opioids among New Jersey Medicaid beneficiaries aged 12–64 years (2014–2019); evaluated associations with demographics and co-occurring conditions; and examined trends in fentanyl penetration in suspected heroin seizures from New Jersey State Police data. Results: Overdose risk more than tripled from 2014 to 2019, from 120.5 to 426.8 per 100,000 person-years, respectively…

Prescription Opioid Laws and Opioid Dispensing in US Counties: Identifying Salient Law Provisions with Machine Learning

Silvia S. Martins, Emilie Bruzelius, Jeanette A. Stingone, Katherine Wheeler-Martin, Hanane Akbarnejad, Christine M. Mauro, Megan E. Marziali, Hillary Samples, Stephen Crystal, Corey S. Davis, Kara E. Rudolph, Katherine M. Keyes, Deborah S. Hasin, Magdalena Cerdá

Background: Hundreds of laws aimed at reducing inappropriate prescription opioid dispensing have been implemented in the United States, yet heterogeneity in provisions and their simultaneous implementation have complicated evaluation of impacts. We apply a hypothesis-generating, multistage, machine-learning approach to identify salient law provisions and combinations associated with dispensing rates to test in future research…

Spatiotemporal Analysis of the Association Between Pain Management Clinic Laws and Opioid Prescribing and Overdose Deaths

Magdalena Cerdá, Katherine Wheeler-Martin, Emilie Bruzelius, William Ponicki, Paul Gruenewald, Christine Mauro, Stephen Crystal, Corey S. Davis, Katherine Keyes, Deborah Hasin, Kara E. Rudolph, Silvia S. Martins

Abstract: Pain management clinic (PMC) laws were enacted by 12 states to promote appropriate opioid prescribing, but their impact is inadequately understood. We analyzed county-level opioid overdose deaths (National Vital Statistics System) and patients filling long-duration (≥30 day) or high-dose (≥90 morphine milligram equivalents per day) opioid prescriptions (IQVIA, Inc.) in the United States in 2010-2018…

Pandemic vaccine testing: Combining conventional and challenge studies

Tobias Gerhard, Brian L. Strom, Nir Eyal

Abstract: Early into COVID, human challenge trials were considered, but usually as alternatives to conventional randomized controlled trials. Instead, assessment of authorized COVID vaccines, of further COVID vaccines, and of vaccines …

Benzodiazepine and Stimulant Prescriptions Before Overdose in Youth

Greta Bushnell, Hillary Samples, Tobias Gerhard, Diane P. Calello, Mark Olfson

In 2019, 4777 youth died of a drug overdose in the United States.1 Seven-hundred and twenty-seven youth died of overdoses involving benzodiazepines (BZDs) and 902 from overdoses involving psychostimulants.2 Opioid-related overdose deaths frequently involve other substances, and in youth, stimulants and BZDs are the most commonly involved substances.3 Overdoses can involve prescription drugs accessed through […]

Using Mindfulness-Based Cognitive Therapy to Prevent Suicide Among High Suicide–Risk Patients Who Also Misuse Opioids: a Preliminary Probe of Feasibility and Effectiveness

Megan S. Chesin, Chintan V. Dave, Catherine Myers, Barbara Stanley, Anna Kline, Maureen Monahan, Miriam Latorre, Lauren M.St Hill, Rachael B. Miller, Arlene R. King, Dianna R. Boschulte, Megan Sedita, Alejandro Interian

Abstract: Knowledge of how to effectively prevent suicide attempt (SA) in high suicide–risk patients who also misuse opioids is limited. In a subset of data from 36 participants with baseline opioid misuse in a randomized clinical trial testing adjunctive mindfulness-based cognitive therapy to prevent suicide among high suicide–risk veterans (n = 18 per treatment condition), MBCT-S reduced the likelihood of SA and acute psychiatric hospitalization over 12-month follow-up…

Where to begin? Thirty must-read papers for newcomers to pharmacoepidemiology

Anton Pottegård, Lucas Morin, Jesper Hallas, Tobias Gerhard, Almut G. Winterstein, Susanna Perez-Gutthann, Mina Tadrous

Pharmacoepidemiology, the study of use and effects of medications, devices, diagnostics, and other medical interventions in large populations, is a science under constant development. New study designs are added to the armamentarium, new data sources are being leveraged, and new approaches are developed. All are changing the conduct of pharmacoepidemiological studies…

Acceptability, validity, and engagement with a mobile app for frequent, continuous multiyear assessment of youth health behaviors (mNCANDA): Mixed methods study

Kevin M. Cummins, Ty Brumback, Tammy Chung, Raeanne C. Moore, Trevor Henthorn, Sonja Eberson, Alyssa Lopez, Tatev Sarkissyan, Kate B. Nooner, Sandra A. Brown, Susan F. Tapert

Background: Longitudinal studies of many health behaviors often rely on infrequent self-report assessments.

Brain anatomical covariation patterns linked to binge drinking and age at first full drink

Yihong Zhao, R. Todd Constable, Denise Hien, Tammy Chung, Marc N. Potenza

Binge drinking and age at first full drink (AFD) of alcohol prior to 21 years (AFD < 21) have been linked to neuroanatomical differences in cortical and subcortical grey matter (GM) volume, cortical thickness, and surface area.

Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action.

June Gruber, Mitchell J. Prinstein, Lee Anna Clark, Jonathan Rottenberg, Jonathan S. Abramowitz, Anne Marie Albano, Amelia Aldao, Jessica L. Borelli, Tammy Chung, Joanne Davila, Erika E. Forbes, Dylan G. Gee, Gordon C.Nagayama Hall, Lauren S. Hallion, Stephen P. Hinshaw, Stefan G. Hofmann, Steven D. Hollon, Jutta Joormann, Alan E. Kazdin, Daniel N. Klein, Annette M. La Greca, Robert W. Levenson, Angus W. MacDonald, Dean McKay, Katie A. McLaughlin, Jane Mendle, Adam Bryant Miller, Enrique W. Neblett, Matthew Nock, Bunmi O. Olatunji, Jacqueline B. Persons, David C. Rozek, Jessica L. Schleider, George M. Slavich, Bethany A. Teachman, Vera Vine, Lauren M. Weinstock

COVID-19 presents significant social, economic, and medical challenges.

Patterns of bi-directional relations across alcohol use, religiosity, and self-control in adolescent girls

Meredith H. Palm, Shawn J. Latendresse, Tammy Chung, Alison E. Hipwell, Carolyn E. Sartor

Examining predictors of alcohol use among adolescent girls is increasingly important to enhance prevention efforts, given that the gender gap in alcohol use is steadily closing.

Profiles of young women’s alcohol and cannabis use linked to risk for sexually transmitted infection highlight the importance of multi-level targeted interventions: Findings from the Pittsburgh girls study

Tammy Chung, Alison E. Hipwell, Stephanie D. Stepp, Elizabeth Miller, Carolyn E. Sartor

Background: Social ecological models designed to understand disparities in sexually transmitted infection (STI) prevalence highlight understudied structural and community risk factors.

Retaining Adolescent and Young Adult Participants in Research During a Pandemic: Best Practices From Two Large-Scale Developmental Neuroimaging Studies (NCANDA and ABCD)

Kate B. Nooner, Tammy Chung, Sarah W. Feldstein Ewing, Ty Brumback, Zjanya Arwood, Susan F. Tapert, Sandra A. Brown, Linda Cottler

The novel coronavirus pandemic that emerged in late 2019 (COVID-19) has created challenges not previously experienced in human research.

Substance Use and Sexual-Minority Status: Examining the Mediating Roles of Stress and Emotion Dysregulation in Young Adult Women

Connor J. McCabe, Alison E. Hipwell, Kate Keenan, Stephanie D. Stepp, Tammy Chung, Kevin M. King

Sexual-minority women (SMW) report higher rates of substance use and disorder across the life span and greater levels of minority stress in adolescence and young adulthood.

The influence of negative mood on solitary drinking preference: An experiment with young adult solitary drinkers

Carillon J. Skrzynski, Kasey G. Creswell, Timothy Verstynen, Rachel L. Bachrach, Tammy Chung

Solitary drinking is a risk marker for alcohol use disorder; thus, it is important to identify why individuals drink alone and for whom this association is particularly relevant.

Time-varying associations of alcohol and cannabis use with intimate partner violence for black and white young women

Tammy Chung, Carolyn Sartor, Imade Ihianle

Background: Substance use is linked to increases in young women’s risk for intimate partner violence (IPV).

Age-Specific Prevalence and Incidence of Dementia Diagnoses among Older US Adults with Schizophrenia

T. Scott Stroup, Mark Olfson, Cecilia Huang, Melanie M. Wall, Terry Goldberg, Davangere P. Devanand, Tobias Gerhard

Importance: People with schizophrenia are at high risk of receiving a diagnosis of dementia.

Medication Use for ADHD and the Risk of Driving Citations and Crashes Among Teenage Drivers: A Population-Based Cohort Study

Almut G. Winterstein, Yan Li, Tobias Gerhard, Stephan Linden, Jonathan J. Shuster

Objectives: To evaluate the real-world effectiveness of ADHD medications on adverse driving outcomes in teenage drivers with ADHD.

Outpatient prescribing of opioids to adults diagnosed with mental disorders in the United States

Matthew T. Taylor, Daniel B. Horton, Theresa Juliano, Mark Olfson, Tobias Gerhard

Background: Adults with mood and anxiety disorders have an increased likelihood of being prescribed opioids.

Pharmacoepidemiology: A time for a new multidisciplinary approach to precision medicine

Amalia M. Issa, Bruce Carleton, Tobias Gerhard, Kelly K. Filipski, Andrew N. Freedman, Stephen Kimmel, Geoffrey Liu, Cristina Longo, Anke H. Maitland-van der Zee, Leah Sansbury, Wei Zhou, Gillian Bartlett

The advent of the genomic age has created a rapid increase in complexity for the development and selection of drug treatments.

Comorbidity Management in Black Women Diagnosed with Breast Cancer: the Role of Primary Care in Shared Care

Michelle Doose, Michael B. Steinberg, Cathleen Y. Xing, Yong Lin, Joel C. Cantor, Chi Chen Hong, Kitaw Demissie, Elisa V. Bandera, Jennifer Tsui

Background: Black women are more likely to have comorbidity at breast cancer diagnosis compared with White women, which may account for half of the Black-White survivor disparity.

Effects of Permanent Supportive Housing on Health Care Utilization and Spending Among New Jersey Medicaid Enrollees Experiencing Homelessness

Derek DeLia, Jose Nova, Sujoy Chakravarty, Emmy Tiderington, Taiisa Kelly, Joel C. Cantor

BACKGROUND: Permanent supportive housing (PSH) programs have the potential to improve health and reduce Medicaid expenditures for beneficiaries experiencing homelessness.

Fragmentation of Care Among Black Women With Breast Cancer and Comorbidities: The Role of Health Systems

Michelle Doose, Janeth I. Sanchez, Joel C. Cantor, Jesse J. Plascak, Michael B. Steinberg, Chi Chen Hong, Kitaw Demissie, Elisa V. Bandera, Jennifer Tsui

PURPOSE: Black women are disproportionately burdened by comorbidities and breast cancer.

Health Related Social Needs Among Chinese American Primary Care Patients During the COVID-19 Pandemic: Implications for Cancer Screening and Primary Care

Jennifer Tsui, Annie Yang, Bianca Anuforo, Jolene Chou, Ruth Brogden, Binghong Xu, Joel C. Cantor, Su Wang

Research Objective: Initiatives to address social determinants of health (SDOH) and measure health-related social needs (HRSN) within clinic settings are increasing.

Medicaid Waivers and Tenancy Supports for Individuals Experiencing Homelessness: Implementation Challenges in Four States

Frank J. Thompson, Jennifer Farnham, Emmy Tiderington, Michael K. Gusmano, Joel C. Cantor

Policy Points Medicaid policymakers have a growing interest in addressing homelessness as a social determinant of health and driver of the potentially avoidable use of expensive medical services.

Patterns of chronic disease management and health outcomes in a population-based cohort of Black women with breast cancer

Michelle Doose, Jennifer Tsui, Michael B. Steinberg, Cathleen Y. Xing, Yong Lin, Joel C. Cantor, Chi Chen Hong, Kitaw Demissie, Elisa V. Bandera

Purpose: Diabetes and hypertension are two common comorbidities that affect breast cancer patients, particularly Black women.

Trends in Antipsychotic Medication Use in Young Privately Insured Children

Greta A. Bushnell, Stephen Crystal, Mark Olfson

Objective: To estimate trends of annual antipsychotic medication use by privately insured young children (aged 2–7 years) in the United States, and to describe the clinical and treatment characteristics of these children.

A best-worst scaling experiment to identify patient-centered claims-based outcomes for evaluation of pediatric antipsychotic monitoring programs

Thomas I. Mackie, Katherine M. Kovacs, Cassandra Simmel, Stephen Crystal, Sheree Neese-Todd, Ayse Akincigil

Objective: This article employs a best-worst scaling (BWS) experiment to identify the claims-based outcomes that matter most to patients and other relevant parties when evaluating pediatric antipsychotic monitoring programs in the United States.

Alcohol Use and Antiretroviral Adherence Among Patients Living with HIV: Is Change in Alcohol Use Associated with Change in Adherence?

Emily C. Williams, Kathleen A. McGinnis, Anna D. Rubinsky, Theresa E. Matson, Jennifer F. Bobb, Gwen T. Lapham, E. Jennifer Edelman, Derek D. Satre, Sheryl L. Catz, Julie E. Richards, Kendall J. Bryant, Brandon D.L. Marshall, Kevin L. Kraemer, Stephen Crystal, Adam J. Gordon, Melissa Skanderson, David A. Fiellin, Amy C. Justice, Katharine A. Bradley

Alcohol use increases non-adherence to antiretroviral therapy (ART) among persons living with HIV (PLWH).

Antipsychotic treatment for youth in foster care: Perspectives on improving youths’ experiences in providing informed consent.

Cassandra Simmel, Cadence F. Bowden, Sheree Neese-Todd, Justeen Hyde, Stephen Crystal

The disproportionate prescribing of high-risk antipsychotic medication for youth in foster care is a significant social problem across the U.S.

Sociodemographic and clinical correlates of gabapentin receipt with and without opioids among a national cohort of patients with HIV

Benjamin J. Oldfield, Yu Li, Rachel Vickers-Smith, William C. Becker, Declan T. Barry, Stephen Crystal, Kirsha S. Gordon, Robert D. Kerns, Christopher T. Rentsch, Brandon D.L. Marshall, E. Jennifer Edelman

Gabapentin is commonly prescribed for chronic pain, including to patients with HIV (PWH). There is growing concern regarding gabapentin’s potential for harm, particularly in combination with opioids.

Suicide Risk in Medicare Patients with Schizophrenia across the Life Span

Mark Olfson, T. Scott Stroup, Cecilia Huang, Melanie M. Wall, Stephen Crystal, Tobias Gerhard

Importance: Although adults with schizophrenia have an increased risk of suicide, sample size limitations of previous research have hindered characterizations of suicide risk across the life span.

Association Between Different Forms of Elder Mistreatment and Cognitive Change

Mengting Li, Xin Qi Dong

Objectives: Elder mistreatment (EM) is associated with worse physical health and psychological well-being, but little is known regarding its cognitive consequences.

Development and validation of a predictive index of elder self-neglect risk among a Chinese population

Bei Wang, Ying Xiao Hua, Xin Qi Dong

Objective: To develop a predictive index that estimates the individual risk of incident self-neglect onset among the US Chinese older adults.

Art Attendance and Change in Cognitive Function Among U.S. Community-Dwelling Chinese Older Adults

Darina V. Petrovsky, Bei Wu, Nancy A. Hodgson, Xin Qi Dong

Engaging in leisure activities that are cognitively simulating and enjoyable may be protective against cognitive decline in older adults; yet, few studies have examined this topic.

Associations between unmet palliative care needs and cognitive impairment in a sample of diverse, community-based older adults

Elissa Kozlov, Matthew J. Wynn, M. Carrington Reid, Charles R. Henderson, Xinqi Dong, Jo Anne Sirey

Objective Given a large number of community-based older adults with mild cognitive impairment, it is essential to better understand the relationship between unmet palliative care (PC) needs and mild cognitive impairment in community-based samples.

Age at Migration and Cognitive Health Among Chinese Older Immigrants in the United States

Man Guo, Mengting Li, Hanzhang Xu, Meredith Stensland, Bei Wu, Xin Qi Dong

Objectives: This study addressed two questions: (1) Is age at migration associated with cognitive function among Chinese older immigrants? and (2) what personal and environmental factors confound the above relationship?

Cognitive deficit, physical frailty, hospitalization and emergency department visits in later life

Jinjiao Wang, Dexia Kong, Fang Yu, Yeates Conwell, Xinqi Dong

Objectives: To examine the added effect of having both cognitive deficit and physical frailty, compared to having either one only, on hospitalization and emergency department (ED) visits.

Family Relationships and Cognitive Function Among Community-Dwelling U.S. Chinese Older Adults

Mengting Li, Man Guo, Meredith Stensland, Xin Qi Dong

A broad literature has explored racial disparities in cognitive aging. Research incorporating sociocultural factors would provide a more comprehensive understanding of minority aging.

Integrative clinical, genomics and metabolomics data analysis for mainstream precision medicine to investigate COVID-19

Zeeshan Ahmed, Saman Zeeshan, David J. Foran, Lawrence C. Kleinman, Fredric E. Wondisford, Xin Qi Dong

Despite significant scientific and medical discoveries, the genetics of novel infectious diseases like COVID-19 remains far from understanding.

Intergenerational Solidarity and Being Primary Caregiver for Older Parents in Chinese American Families: Findings From PIETY Study

Ling Xu, Jinyu Liu, Weiyu Mao, Man Guo, Iris Chi, Xinqi Dong

Introduction: Guided by the intergenerational solidarity theory, this study examined how different dimension of intergenerational solidarity of adult children associated with their choice of being a primary caregiver for aging parents in the Chinese American families.

Family type and cognitive function in older Chinese Americans: acculturation as a moderator

Mengting Li, Shou En Lu, Donald R. Hoover, Linda Flynn, Merril Silverstein, Bei Wu, Xin Qi Dong

Objectives: Acculturation to the mainstream culture and the settlement contexts could shape cognitive function of older immigrants.

Longitudinal Association Between Hearing Loss, Vision Loss, Dual Sensory Loss, and Cognitive Decline

Shaoqing Ge, Eleanor S. McConnell, Bei Wu, Wei Pan, Xin Qi Dong, Brenda L. Plassman

BACKGROUND/OBJECTIVES: To better understand the role of sensory loss as a potentially modifiable risk factor for cognitive decline, this study examined cognitive decline in relation to single modality hearing or vision loss and dual sensory loss.

Loss of friends and psychological well-being of older Chinese immigrants

Jinyu Liu, Weiyu Mao, Man Guo, Ling Xu, Iris Chi, Xinqi Dong

Background and objectives: Focusing on a less studied aspect of friendship and an overlooked type of loss, this study examined associations between loss of friends and psychological well-being among older Chinese immigrants and whether such associations are moderated by age, gender, marital status, and social connection.

Lower urinary tract symptoms in older Chinese American women: prevalence and risk factors

Tsung Mou, Oluwateniola Brown, Melissa Simon, Xin Qi Dong, Kimberly Kenton, C. Emi Bretschneider

Introduction and hypothesis: The aim was to examine the prevalence of and risk factors for lower urinary tract symptoms (LUTS) in a community-dwelling cohort of older Chinese American women.

Self-rated health as a mediator between physical health conditions and depressive symptoms in older Chinese and Korean Americans

Yuri Jang, Hyunwoo Yoon, Mengting Li, Nan Sook Park, David A. Chiriboga, Bei Wu, Xin Qi Dong, Miyong T. Kim

In the present study, we examined self-rated health as a mediator between physical health conditions (chronic diseases and functional disability) and depressive symptoms in older Chinese and Korean Americans.

Sources of Intergenerational Conflict in Chinese Immigrant Families in the United States

Man Guo, Amy Lemke, Xinqi Dong

Studies of family relations have not kept pace with the acceleration of international migration.

Social Networks and Depressive Symptoms among Chinese Older Immigrants: Does Quantity, Quality, and Composition of Social Networks Matter?

Mengting Li, Xin Qi Dong, Dexia Kong

This study aims to investigate the relationship between quantity, quality, and composition of social networks and depressive symptoms among U.S. Chinese older adults.

The Associations Between Sociodemographic Characteristics and Trust in Physician With Immunization Service Use in U.S. Chinese Older Adults

Mengxiao Wang, Mengting Li, Xin Qi Dong

This study investigated sociodemographic factors for immunization care use and the relationship between trust in physician (TIP) and immunization service use in older Chinese Americans.

Large-Scale New Jersey Prison Releases During COVID-19: Experiences of Released Prisoners with Substance Use Disorders

Peter Treitler, MSW, Madeline H. Bono, PsyM, Brendan Saloner, PhD, Stephen Crystal, PhD

Large-Scale New Jersey Prison Releases During COVID-19: Experiences of Released Prisoners with Substance Use Disorders

Use of hydroxychloroquine, remdesivir, and dexamethasone among adults hospitalized with covid-19 in the united states: A retrospective cohort study

Hemalkumar B. Mehta, Huijun An, Kathleen M. Andersen, Omar Mansour, Vithal Madhira, Emaan S. Rashidi, Benjamin Bates, Soko Setoguchi, Corey Joseph, Paul T. Kocis, Richard Moffitt, Tellen D. Bennett, Christopher G. Chute, Brian T. Garibaldi, G. Caleb Alexander

Background: Relatively little is known about the use patterns of potential pharmacologic treatments of COVID-19 in the United States. Objective: To use the National COVID Cohort Collaborative (N3C), a large, multicenter, longitudinal cohort, to characterize the use of hydroxychloroquine, remdesivir, and dexamethasone, overall as well as across individuals, health systems, and time…

Profiles of young women’s alcohol and cannabis use linked to risk for sexually transmitted infection highlight the importance of multi-level targeted interventions: Findings from the Pittsburgh girls study

Tammy Chung, Alison E. Hipwell, Stephanie D. Stepp, Elizabeth Miller, Carolyn E. Sartor

Background: Social ecological models designed to understand disparities in sexually transmitted infection (STI) prevalence highlight understudied structural and community risk factors. Guided by a social ecological model, this study identified profiles based on substance use-related STI risk, and examined associations of the profiles with selected indicators of structural-, community-, and individual-level STI risk factors. Methods: Repeated measures latent class analysis was applied to Pittsburgh Girls Study data (n = 2,138; 58% Black, 42% White) at ages 18–20. Profile indicators included: women’s and partner’s alcohol and cannabis use, women’s sexual risk behavior, and self-reported STI. Profile predictors included racial background, structural-, community-, and individual-level risk factors…

Validity of claims-based algorithms for selected cancers in Japan: Results from the VALIDATE-J study

Cynthia de Luise, Naonobu Sugiyama, Toshitaka Morishima, Takakazu Higuchi, Kayoko Katayama, Sho Nakamura, Haoqian Chen, Edward Nonnenmacher, Ryota Hase, Sadao Jinno, Mitsuyo Kinjo, Daisuke Suzuki, Yoshiya Tanaka, Soko Setoguchi

Purpose: Real-world data from large administrative claims databases in Japan have recently become available, but limited evidence exists to support their validity. VALIDATE-J validated claims-based algorithms for selected cancers in Japan. Methods: VALIDATE-J was a multicenter, cross-sectional, retrospective study. Disease-identifying algorithms were used to identify cancers diagnosed between January or March 2012 and December 2016 using claims data from two hospitals in Japan…

What is the research question?

Elizabeth A. Suarez, Soko Setoguchi

Abstract: A well-articulated research question will clearly define the hypothesis, the research rationale, and core elements of the study: the population, the intervention, the comparator, the outcome, the timing or duration of study, the setting, and the effect to be estimated. Clear definition of these elements will facilitate a research design that answers the intended clinical question…

Corrigendum to “Using ICD-10 codes to identify elective epilepsy monitoring unit admissions from administrative billing data: A validation study” [Epilepsy Behav 111 (2020) 107194] (Epilepsy & Behavior (2020) 111, (S1525505020303735), (10.1016/j.yebeh.2020.107194))

Brad K. Kamitaki, Shelly Rishty, Ram Mani, Stephen Wong, Lisa M. Bateman, Charlotte Thomas-Hawkins, Joel C. Cantor, Lawrence C. Kleinman

Abstract: The authors regret that they did not acknowledge Dr. Kleinman’s funding source. Dr. Kleinman was supported by grant U3DMC32755-02 from the Health Resources & Services Administration. The authors would like to apologize for any inconvenience caused…

Age and Incidence of Dementia Diagnosis

Mark Olfson, Thomas Scott Stroup, Cecilia Huang, Melanie M. Wall, Tobias Gerhard

Growth in the US population of older adults places an increasing number of people at risk of developing dementia. Most, but not all, studies report an increase in dementia incidence with each successive age group. Results have also been inconsistent regarding whether incidence of dementia varies between men and women of the same age. Although the incidence of dementia is higher for similarly aged black than white adults, whether age-adjusted incidence differs between other racial/ethnic groups remains unclear …

Analyzing functional status and its correlates in Chinese centenarians: A cross-sectional study

Zhaoyong Huang, Yuzhu Chen, Weiwen Zhou, Xiaopeng Li, Qiulan Qin, Yunqing Fei, Xinqi Dong, Fang Yu

Factors affecting independence in basic and instrumental activities of daily living have been established in older adults, but not centenarians. The purpose of this study …

Anxiety Symptoms, Depressive Symptoms, and Traditional Chinese Medicine Use in U.S. Chinese Older Adults

Ying Yu Chao, Eunhea You, Yu Ping Chang, Xin Qi Dong

This study examined the association between anxiety symptoms, depressive symptoms, and Traditional Chinese Medicine (TCM) use among U.S. Chinese older adults …

Artificial intelligence with multi-functional machine learning platform development for better healthcare and precision medicine

Zeeshan Ahmed, Khalid Mohamed, Saman Zeeshan, Xin Qi Dong

Precision medicine is one of the recent and powerful developments in medical care, which has the potential to improve the traditional symptom-driven practice of medicine …

Association between personality traits and elder abuse in a community-dwelling Chinese population: findings from the PINE study

Mengting Li, Dexia Kong, Ying Yu Chao, Xin Qi Dong

Elder abuse is a pervasive public health issue. The relationship between personality traits and elder abuse remains unclear. This study aims to examine the associations between neuroticism …

Associations between unmet palliative care needs and cognitive impairment in a sample of diverse, community-based older adults

Elissa Kozlov, Matthew J. Wynn, M. Carrington Reid, Charles R. Henderson, Xin Qi Dong, Jo Anne Sirey

Objective: Given a large number of community-based older adults with mild cognitive impairment, it is essential to better understand the relationship between unmet palliative …

A Vulnerability Risk Index of Self-Neglect in a Community-Dwelling Older Population

Bei Wang, Donald R. Hoover, Todd Beck, Xin Qi Dong

BACKGROUND: The only way to systematically screen for self-neglect among older adults is through in-home observations, which are often difficult and unfeasible …

Development and validation of a predictive index of elder self-neglect risk among a Chinese population

Bei Wang, Ying Xiao Hua, Xin Qi Dong

Objective: To develop a predictive index that estimates the individual risk of incident self-neglect onset among the US Chinese older adults …

Elder mistreatment across diverse cultures

Mengting Li, Ruijia Chen, Xin Qi Dong

Elder mistreatment, a pervasive public health issue, is of growing concern. Interpersonal relationships are culturally constructed, and attempts to understand elder mistreatment …

Elder mistreatment and psychological distress among U.S. Chinese older adults

Ying Yu Chao, Mengting Li, Shou En Lu, Xin Qi Dong

Objective: This study aimed to examine the associations between different types of elder mistreatment, anxiety symptoms, and depressive symptoms among U.S. Chinese older adults …

Face-Saving and Depressive Symptoms Among U.S. Chinese Older Adults

Dexia Kong, Yin Ling Irene Wong, Xinqi Dong

Face-saving represents a unique culturally salient construct among Chinese. However, our understanding regarding its relationship with psychological distress …

Family Relationships and Cognitive Function Among Community-Dwelling U.S. Chinese Older Adults

Mengting Li, Man Guo, Meredith Stensland, Xin Qi Dong

A broad literature has explored racial disparities in cognitive aging. Research incorporating sociocultural factors would provide a more comprehensive understanding …

Filial discrepancy and mortality among community-dwelling older adults: a prospective cohort study

Mengting Li, Xin Qi Dong

Objectives: Adult children play a significant role in ageing parents’ health and well-being. However, the evidence is mixed regarding whether the parent-child relations will affect older adults’ …

Filial expectation among Chinese immigrants in the United States of America: A cohort comparison

Man Guo, Elizabeth Byram, Xinqi Dong

Relying on two unique data-sets on Chinese older immigrants (N = 3,157) and younger immigrants with ageing parents (N = 469) in Chicago, this study compared the level of filial expectation …

Health Services Utilization Among Chinese American Older Adults: Moderation of Social Support With Functional Limitation

Jinjiao Wang, Dexia Kong, Benjamin C. Sun, Xin Qi Dong

In this study, we aimed to examine the relationship of social support with hospitalizations and emergency department (ED) visits among older Chinese adults in the United States …

Importance of Activity Engagement and Neighborhood to Cognitive Function Among Older Chinese Americans

Fengyan Tang, Wei Zhang, Iris Chi, Mengting Li, Xin Qi Dong

This study investigates the differential associations of activity engagement and perceived neighborhood characteristics (i.e., cohesion, disorder, sense of community) with cognitive measures …

Kinship bereavement and psychological well-being of U.S. Chinese older women and men

Peiyi Lu, Mack Shelley, Yiwei Chen, Xinqi Dong

This study examined the relationship of kinship bereavement with the psychological well-being of Chinese American older women and men. Data from the Population Study of ChInese …

Neighborhood Cohesion and Oral Health Problems among Older Chinese American Immigrants: Does Acculturation Make a Difference?

Weiyu Mao, Bei Wu, Iris Chi, Wei Yang, Xinqi Dong, Suzanne Meeks

Background and Objectives: Despite an increasing, yet still limited amount of research on social determinants of oral health, the influences of neighborhood characteristics…

Parent-adult child relations of chinese older immigrants in the United States: Is there an optimal type?

Man Guo, Meredith Stensland, Mengting Li, Xinqi Dong

Objectives: This study aims to identify (a) different types of parent-child relations among Chinese older immigrants, (b) predictors of each relation type, and (c) the most “optimal” …

Psychological well-being of Chinese Immigrant adult-child caregivers: how do filial expectation, self-rated filial performance, and filial discrepancy matter?

Jinyu Liu, Bei Wu, Xinqi Dong

Background: Given the importance of ethnic culture in family caregiving and recent Chinese immigrant population growth, this study explored effects of multiple filial …

Reply to: Comment on: Transforming Asian Health Equity—PINE/PIETY Study Special Issue

Mengting Li, XinQi Dong

In reply to Dr. Yoshikawa’s comments, we acknowledge that the PINE/PIETY studies have limited generalizability that may not apply to other ethnic …

Transition in Older Parent-Adult Child Relations in U.S. Chinese Immigrant Families

Man Guo, Meredith Stensland, Mengting Li, Todd Beck, Xinqi Dong, Suzanne Meeks

Background and Objectives: The family fundamentally underpins the immigration and acculturation processes. But most existing research on acculturation …

Advancing Asian Health Equity: Multimodal Approach to Translate Research into Practice and Policy

XinQi Dong

Minority populations are increasing rapidly in the United States, with the Asians the fastest growing population. Preliminary research showed marked disparities in relationship …

Association Between Neighborhood Cohesion and Cancer Screening Utilization in Chinese American Older Adults

Ailian Hei, Melissa A. Simon, Xinqi Dong

This study aims to examine the association between neighborhood cohesion and cancer screening utilization in a community-dwelling Chinese American older population …

Associations of Child Maltreatment and Intimate Partner Violence with Elder Abuse in a US Chinese Population

Xin Qi Dong, Bei Wang

Importance: People who have experienced abuse as a child or violence with an intimate partner might have higher odds of being abused again, but this has been insufficiently investigated …

Cognitive deficit, physical frailty, hospitalization and emergency department visits in later life

Jinjiao Wang, Dexia Kong, Fang Yu, Yeates Conwell, Xinqi Dong

Objectives: To examine the added effect of having both cognitive deficit and physical frailty, compared to having either one only, on hospitalization and emergency department (ED) visits …

Comorbid Depressive Symptoms and Chronic Medical Conditions Among US Chinese Older Adult

Dexia Kong, Phyllis Solomon, Xin Qi Dong

OBJECTIVES: The prevalence and health consequences of comorbid depressive symptoms (DSs) and chronic medical conditions (CMCs) among older ethnic minority populations ..

Correlates of Emergency Department Service Utilization Among U.S. Chinese Older Adults

Dexia Kong, Mengting Li, Yin Ling Irene Wong, Jinjiao Wang, Benjamin C. Sun, Xinqi Dong

Older adults visit emergency departments (EDs) at a disproportionally higher rate than other age groups. Prior studies examining racial disparities in ED utilization focus on African Americans and Hispanics …

Depressive Symptoms and Onset of Functional Disability Over 2 Years: A Prospective Cohort Study

Dexia Kong, Phyllis Solomon, Xin Qi Dong

OBJECTIVES: This prospective cohort study examined the relationship between depressive symptoms and onset of functional disability over 2 years among US Chinese older adults …

Different Definitions of Elder Mistreatment and Mortality: A Prospective Cohort Study From 2011 to 2017

Mengting Li, Ying Liang, Xin Qi Dong

OBJECTIVES: To investigate the relationship between different definitions and subtypes of elder mistreatment (EM) and yearly mortality …

Education, Activity Engagement, and Cognitive Function in US Chinese Older Adults

Wei Zhang, Fengyan Tang, Yiwei Chen, Merril Silverstein, Sizhe Liu, Xin Qi Dong

OBJECTIVES: To examine whether and how early-life experiences such as years of schooling affect late-life cognitive function through a pathway of activity engagement …

Elder Mistreatment Among Older Chinese Americans: The Role of Family Cohesion

Xiang Gao, Fei Sun, Flavio F. Marsiglia, Xinqi Dong

Cultural values are believed to influence perceptions of and solutions to elder mistreatment (EM) perpetrated by family members. This study aimed to understand the influence of family …

Environmental Factors Associated with Chinese Older Immigrants’ Social Engagement

Daniel W.L. Lai, Jia Li, Vincent W.P. Lee, Xin Qi Dong

BACKGROUND/ OBJECTIVES: Prior research has shown that social engagement is beneficial to older adults’ health and well-being. This study examined the association between environmental …

Health Service Use Among Chinese American Older Adults: Is There a Somatization Effect?

Lin Jiang, Fei Sun, Wei Zhang, Bei Wu, Xin Qi Dong

BACKGROUND/OBJECTIVES: Somatization of depressive symptoms among Chinese American older adults remains understudied. This study aimed to identify whether the relationship between …

Is family relations related to health service utilisation among older immigrants: Evidence from Chinese elderly in the United States

Man Guo, Nadia Sabbagh Steinberg, Xinqi Dong, Agnes Tiwari

The family is the key for survival and success of the 4.6 million older immigrants in the United States. It is also an overlooked context to understand older immigrants …

Is Migration at Older Age Associated with Poorer Psychological Well-Being? Evidence from Chinese Older Immigrants in the United States

Man Guo, Meredith Stensland, Mengting Li, Xinqi Dong, Agnes Tiwari

Background and Objectives The migrating age of an individual has far-reaching implications for their acculturation experience, social integration, and well-being …

Leveraging Technology to Improve Health Disparity Research: Trilingual Data Collection Using Tablets

Xin Qi Dong, Dexia Kong, Dinesh Mendhe, Stephanie M. Bergren

Survey research is an essential component of epidemiological research to understand the health of older adults. However, there are several limitations to conventional data …

Life Course Violence: Child Maltreatment, IPV, and Elder Abuse Phenotypes in a US Chinese Population

Bei Wang, Xin Qi Dong

OBJECTIVES: To examine the associations between violence experiences including phenotypes (psychological, physical/sexual abuse, financial exploitation, caregiver neglect) …

Loss of friends and psychological well-being of older Chinese immigrants

Jinyu Liu, Weiyu Mao, Man Guo, Ling Xu, Iris Chi, Xinqi Dong

Background and objectives: Focusing on a less studied aspect of friendship and an overlooked type of loss, this study examined associations between loss of friends and psychological …

Mental Work Demands and Late-Life Cognitive Impairment: Results From the Shanghai Aging Study

Xiaoniu Liang, Zhao Chen, Xinqi Dong, Qianhua Zhao, Qihao Guo, Li Zheng, Wei Deng, Jianfeng Luo, Ding Ding

Objective: The aim of this study is to explore the association between mental work demands (MWDs) and late-life cognition among Chinese older adults …

Neighborhood social cohesion and cognitive function in U.S. Chinese older adults—findings from the PINE study

Wei Zhang, Sizhe Liu, Fei Sun, Xin Qi Dong

Objectives: The projected increase in the population of older adults in the United States entails a pressing need to examine risk and protective factors associated with cognitive function …

Oral Health Symptoms and Cognitive Function Among US Community-Dwelling Chinese Older Adults

Darina V. Petrovsky, Bei Wu, Weiyu Mao, Xin Qi Dong

BACKGROUND/OBJECTIVES: Limited research is available on the relationship between oral health symptoms and cognitive function among community-dwelling US Chinese older adults …

Perceived Stress and Cognitive Decline in Chinese-American Older Adults

Yiwei Chen, Ying Liang, Wei Zhang, Jennifer C. Crawford, Katie L. Sakel, Xin Qi Dong

OBJECTIVES: To examine whether higher levels of perceived stress are associated with lower levels of cognitive function and faster cognitive decline in older Chinese-American adults …

Sense of Filial Obligation and Caregiving Burdens Among Chinese Immigrants in the United States

Man Guo, Sohyun Kim, Xin Qi Dong

BACKGROUND/OBJECTIVES: Focusing on Chinese immigrants, this study examined (1) whether filial obligation, the core social norm in the Chinese culture, is related to caregiving burdens …

Sex Differences in the Prevalence and Incidence of Cognitive Impairment: Does Immigration Matter?

Fengyan Tang, Iris Chi, Xin Qi Dong

OBJECTIVES: We aimed to examine the associations between immigration-related factors and prevalent and incident cognitive impairment (CI) and whether the associations varied by sex among …

Sources and Variations in Social Support and Risk for Elder Mistreatment in a US Chinese Population

Shenglin Zheng, Mengting Li, Dexia Kong, Xin Qi Dong

OBJECTIVES: Research has examined the relationships between positive social support (PSS) and elder mistreatment (EM) but less is known regarding the negative aspect of social …

The associations between social support and negative social interaction with suicidal ideation in US Chinese older adults

Xinqi Dong, Stephanie Bergren, Bei Wang, Elissa Kozlov

To examine associations between social support and negative social interaction with past suicidal ideation (SI) at multiple time intervals …

The Chinatown Patient Navigation Program: Adaptation and Implementation of Breast and Cervical Cancer Patient Navigation in Chicago’s Chinatown

Melissa A. Simon, Laura S. Tom, Ivy Leung, Esther Wong, Eileen E. Knightly, Daniel P. Vicencio, Ann Yau, Karen Ortigara, Xin Qi Dong

Background: As health care reform continues within the United States, navigators may play increasingly diverse and vital roles across the health care continuum …

The Epidemiology of Depressive Symptoms in the Last Year of Life

Elissa Kozlov, Xin Qi Dong, Amy S. Kelley, Claire K. Ankuda

BACKGROUND/OBJECTIVE: Depression impacts quality of life at all life stages, but the epidemiology of depression in the last year of life is unknown. This study’s objectives were to document …

The Impact of Intergenerational Relationship on Health and Well-Being of Older Chinese Americans

Daniel W.L. Lai, Vincent W.P. Lee, Jia Li, Xin Qi Dong

BACKGROUND/OBJECTIVES: Among older adults, intergenerational support can help to improve well-being. This study examines the correlation between intergenerational relationships and the subjective …

The Influence of Smoking Status on the Health Profiles of Older Chinese American Men

Chien Ching Li, Alicia K. Matthews, Xin Qi Dong, Melissa Simon

OBJECTIVE: To examine the influence of smoking status on the health profiles of community-dwelling older Chinese American men in the greater Chicago, IL, area.
DESIGN: This study utilized a cross-sectional study design to analyze data obtained from the larger Population Study of Chinese Elderly in Chicago (PINE).

Integrative clinical, genomics and metabolomics data analysis for mainstream precision medicine to investigate COVID-19

Zeeshan Ahmed, Saman Zeeshan, David J Foran, Lawrence C Kleinman, Fredric E Wondisford, XinQi Dong

The time has never been more critical for drug discovery data and innovative solutions development based on artificial intelligence …

Application of Healthcare ‘Big Data’ in CNS Drug Research: The Example of the Neurological and mental health Global Epidemiology Network (NeuroGEN)

Jenni Ilomäki, J. Simon Bell, Adrienne Y.L. Chan, Anna Maija Tolppanen, Hao Luo, Li Wei, Edward Chia Cheng Lai, Ju Young Shin, Giorgia De Paoli, Romin Pajouheshnia, Frederick K. Ho, Lorenna Reynolds, Kui Kai Lau, Stephen Crystal, Wallis C.Y. Lau, Kenneth K.C. Man, Ruth Brauer, Esther W. Chan, Chin Yao Shen, Ju Hwan Kim, Terry Y.S. Lum, Sirpa Hartikainen, Marjaana Koponen, Evelien Rooke, Marloes Bazelier, Olaf Klungel, Soko Setoguchi, Jill P. Pell, Sharon Cook, Ian C.K. Wong

Abstract: Neurological and psychiatric (mental health) disorders have a large impact on health burden globally. Cognitive disorders (including dementia) and stroke are leading causes of disability. Mental health disorders, including depression, contribute up to one-third of total years lived with disability. The Neurological and mental health Global Epidemiology Network (NeuroGEN) is an international multi-database network that harnesses administrative and electronic medical records from Australia, Asia, Europe and North America.

Artificial intelligence with multi-functional machine learning platform development for better healthcare and precision medicine

Zeeshan Ahmed, Khalid Mohamed, Saman Zeeshan, XinQi Dong

Introduction: Over the centuries, quests for answers have led us to take giant leaps. It was only in the last century that the discovery of antibiotics freed us from many of the dreaded diseases of the past …

Human gene and disease associations for clinical‐genomics and precision medicine research

Zeeshan Ahmed, Saman Zeeshan, Dinesh Mendhe, XinQi Dong

Introduction: Since the beginning of scientific discoveries, it has been critically central to understand the cause of disease, pain, and senescence.1 Over the centuries, quests for the answers have led us to take giant leaps. It was only in the last century that the discovery of …

Acculturation stress and allostatic load among Mexican immigrant women

Karen Therese D’Alonzo, Frances Munet-Vilaro, Dennis P. Carmody, Peter Guarnaccia, Anne Marie Linn, Lisa Garsman

Objectives: this case-control study compared levels of stress and allostatic load (AL) among Mexican women in the US (n =19) and Mexico (n = 40).

School Food and Physical Activity Environment: A Longitudinal Analysis of Four School Districts in New Jersey

Francesco Acciai, Michael Yedidia, Robin S. DeWeese, Sarah Martinelli, Punam Ohri-Vachaspati

Purpose: Exposures to favorable environments in childhood, including those in schools, are associated with healthy habits among children. In this study, we developed a series of indices aimed at measuring students’ exposure to different dimensions of the school food and physical activity (PA) environment. We implemented these indices to investigate how different aspects of the school food and PA environment changed over time and examined their correspondence with known changes in relevant policies and programs.

Participation in the Supplemental Nutrition Assistance Program and Dietary Behaviors: Role of Community Food Environment

Cori Lorts, Natasha Tasevska, Marc A. Adams, Michael Yedidia, David Tulloch, Steven P. Hooker, Punam Ohri-Vachaspati

Background: The United States Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) is the country’s largest nutrition assistance program for low-income populations. Although SNAP has been shown to reduce food insecurity, research findings on the diet quality of program participants are inconsistent.

Building a Culture of Health: A Policy Roadmap to Help All New Jerseyans Live Their Healthiest Lives

Margaret Koller, Jolene Chou, Maureen Michael, Amy Dunford, Jennifer Farnham, Giridhar Mallya, Kerry Anne McGeary, Teri Larson

New Jersey has a lot to be proud of when it comes to health, including comparatively low rates of smoking, teen births, infant deaths, and premature deaths, and high rates of preschool enrollment and high school graduation.

Association of Medicaid Enrollee Characteristics and Primary Care Utilization with Cancer Outcomes for the Period Spanning Medicaid Expansion in New Jersey

Jennifer Tsui, Derek DeLia, Antoinette M. Stroup, Jose Nova, Aishwarya Kulkarni, Jeanne M. Ferrante, Joel C. Cantor

Cancer outcomes for Medicaid enrollees may be affected by patients’ primary care (PC) utilization and complex Medicaid enrollment dynamics, which have recently changed for many states under the Affordable Care Act.

The Relationship Between Depressive Symptoms and Health Services Utilization in U.S. Chinese Older Adults

Dexia Kong, Mengting Li, Jinjiao Wang, Joan K. Davitt, Xinqi Dong

BACKGROUND AND OBJECTIVES: Depressive symptomatology is a significant predictor of increased health services utilization and health care cost in the general older adult population. However, there is scant information on the relationship between depressive symptoms and health service utilization among U.S. Chinese older adults. The objective of this study was to examine the relationship between depressive symptoms and physician visits, emergency department (ED) visits, and hospitalization.

Is Social Network a Protective Factor for Cognitive Impairment in US Chinese Older Adults? Findings from the PINE Study

Background: Social network has been identified as a protective factor for cognitive impairment. However, the relationship between social network and global and subdomains of cognitive function remains unclear. Objective: This study aims to provide an analytic framework to examine quantity, composition, and quality of social network and investigate the association between social network, global cognition, and cognitive domains among US Chinese older adults.

Psychological well-being of Chinese Immigrant adult-child caregivers: how do filial expectation, self-rated filial performance, and filial discrepancy matter?

Jinyu Liu, Bei Wu, Xinqi Dong

Background: Given the importance of ethnic culture in family caregiving and recent Chinese immigrant population growth, this study explored effects of multiple filial piety traits—filial expectation, self-rated filial performance, and filial discrepancy—on psychological well-being of Chinese immigrants who care for older parents (adult-child caregivers) in the United States.

Mental Work Demands and Late-Life Cognitive Impairment: Results From the Shanghai Aging Study

Xiaoniu Liang, Zhao Chen, Xinqi Dong, Qianhua Zhao, Qihao Guo, Li Zheng, Wei Deng, Jianfeng Luo, Ding Ding

Objective: The aim of this study is to explore the association between mental work demands (MWDs) and late-life cognition among Chinese older adults. Method: Data were drawn from the baseline of the Shanghai Aging Study.

Is family relations related to health service utilisation among older immigrants: Evidence from Chinese elderly in the United States

Man Guo, Nadia Sabbagh Steinberg, Xinqi Dong, Agnes Tiwari

The family is the key for survival and success of the 4.6 million older immigrants in the United States. It is also an overlooked context to understand older immigrants’ health service utilisation. Most prior studies on this topic either focus on individual or institutional factors that affect how older immigrants use formal health services.

Elder Mistreatment Among Older Chinese Americans: The Role of Family Cohesion

Xiang Gao, Fei Sun, Flavio F. Marsiglia, Xinqi Dong

Cultural values are believed to influence perceptions of and solutions to elder mistreatment (EM) perpetrated by family members. This study aimed to understand the influence of family cohesion on EM reported by community-dwelling older Chinese Americans.

Associations of Child Maltreatment and Intimate Partner Violence with Elder Abuse in a US Chinese Population

Xinqi Dong, Bei Wang

Importance: People who have experienced abuse as a child or violence with an intimate partner might have higher odds of being abused again, but this has been insufficiently investigated regarding elder abuse. More conclusive evidence might be critical to assessment and prevention strategies.

Predictors of timely opioid agonist treatment initiation among veterans with and without HIV

Jessica J. Wyse, Jonathan L. Robbins, Kathleen A. McGinnis, E. Jennifer Edelman, Adam J. Gordon, Ajay Manhapra, David A. Fiellin, Brent A. Moore, P. Todd Korthuis, Julie R. Gaither, Kirsha Gordon, Melissa Skanderson, Declan T. Barry, Stephen Crystal, Amy Justice, Kevin L. Kraemer

Background: Opioid use disorder (OUD) is prevalent among people with HIV (PWH). Opioid agonist therapy (OAT) is the most effective treatment for OUD and is associated with improved health outcomes, but is often not initiated.

Medical intensive care unit admission among patients with and without HIV, hepatitis c virus, and alcohol-related diagnoses in the United States: A national, retrospective cohort study, 1997-2014

Christopher T. Rentsch, Janet P. Tate, Tessa Steel, Adeel A. Butt, Cynthia L. Gibert, Laurence Huang, Margaret Pisani, Guy W. Soo Hoo, Stephen Crystal, Maria C. Rodriguez-Barradas, Sheldon T. Brown, Matthew S. Freiberg, Christopher J. Graber, Joon W. Kim, David Rimland, Amy C. Justice, David A. Fiellin, Kristina A. Crothers, Kathleen M. Akgün

Background: HIV, hepatitis C virus (HCV), and alcohol-related diagnoses (ARD) independently contribute increased risk of all-cause hospitalization. We sought to determine annual medical intensive care unit (MICU) admission rates and relative risk of MICU admission between 1997 and 2014 among people with and without HIV, HCV, and ARD, using data from the largest HIV and HCV care provider in the United States.

Depression and all-cause mortality risk in HIV-infected and HIV-uninfected US veterans: a cohort study

K. So-Armah, S. K. Gupta, S. Kundu, J. C. Stewart, J. L. Goulet, A. A. Butt, J. J. Sico, V. C. Marconi, Stephen Crystal, M. C. Rodriguez-Barradas, M. Budoff, C. L. Gibert, C. C.H. Chang, R. Bedimo, M. S. Freiberg

Objectives: The contribution of depression to mortality in adults with and without HIV infection is unclear. We hypothesized that depression increases mortality risk and that this association is stronger among those with HIV infection. Methods: Veterans Aging Cohort Study (VACS) data were analysed from the first clinic visit on or after 1 April 2003 (baseline) to 30 September 2015.

International priorities for home care education, research, practice, and management: Qualitative content analysis

Olga Jarrin Montaner, Fatemah Ali Pouladi, Elizabeth A. Madigan

Background: Despite growing demand for home care nursing, there is a growing home care workforce shortage, due in part to hospital-centric nursing curricula that lead students to undervalue of home care and community practice setting (Van Iersel et al., 2018a, 2018b).

Comparative Effectiveness of Adjunctive Psychotropic Medications in Patients with Schizophrenia

T. Scott Stroup, Tobias Gerhard, Stephen Crystal, Cecilia Huang, Zhiqiang Tan, Melanie M. Wall, Chacku Mathai, Mark Olfson

Importance: People with schizophrenia are commonly treated with psychotropic medications in addition to antipsychotics, but there is little evidence about the comparative effectiveness of these adjunctive treatment strategies. Objective: To study the comparative real-world effectiveness of adjunctive psychotropic treatments for patients with schizophrenia.

Validation studies of claims data in the Asia-Pacific region: A comprehensive review

Nana Koram, Megan Delgado, James H. Stark, Soko Setoguchi Iwata, Cynthia de Luise

Purpose: To describe published validation studies of administrative health care claims data in the Asia-Pacific region. Methods: A comprehensive literature search was conducted in PubMed for English language articles published through 31-Oct-2017 in humans from 10 Asian-Pacific countries or regions (Japan, Australia, New Zealand, China, Hong Kong, India, Singapore, South Korea, Taiwan, and Thailand) that validated claims-based diagnoses with a gold standard data source. Search terms included the: validation, validity, accuracy, sensitivity, agreement, specificity, positive predictive value, kappa, kappa coefficient, and Cohen’s kappa. Results: Forty-three studies across six countries were identified: Australia (21); Japan (6); South Korea (6); Taiwan (7); Singapore (2); and New Zealand (1).

Patient perspectives on the linkage of health data for research: Insights from an online patient community questionnaire

Emily C. O'Brien, Ana Maria Rodriguez, Hye Chung Kum, Laura E. Schanberg, Marcy Fitz-Randolph, Sean M. O'Brien, Soko Setoguchi Iwata

Objective: To examine the patient perspective on the risks and benefits of linking existing data sources for research. Materials and methods: Between December 2015 and February 2016, we fielded a questionnaire in PatientsLikeMe, an online patient community representing over 2500 health conditions. The questionnaire was developed using subject matter expertise and patient feedback from a concept elicitation phase (N = 57 patients).

Trends in the Supply, Utilization, and Payment for Primary Care Services in New Jersey FamilyCare before and after ACA Medicaid Expansion

Derek DeLia, Jose Nova, David Goldin

Medicaid expansion under the Affordable Care Act (ACA) has raised questions about whether and how the program will be able to meet the rising demand for demand for services from new enrollees. The supply of primary care services is of particular concern. Numerous reports have warned about national shortages in the supply of primary care physicians overall and many practicing physicians do not participate in Medicaid.

Learning from Supportive Housing Programs in New Jersey: Results from Interviews with Program Leaders

Joel C. Cantor, Emmy Tiderington, Oliver Lontok

There is substantial evidence that social factors influence health, health services use, and health care spending. Among these “social determinants of health”, housing is key (Doran, Misa, and Shah 2013).

Prevalence of Rilpivirine and Etravirine Resistance Mutations in HIV-1 Subtype C-Infected Patients Failing Nevirapine or Efavirenz-Based Combination Antiretroviral Therapy in Botswana

Thabo Diphoko, Simani Gaseitsiwe, Ishmael Kasvosve, Sikhulile Moyo, Harriet Okatch, Rosemary Musonda, Mark Wainberg, Joseph Makhema, Richard Marlink, Vladimir Novitsky, Max Essex

Rilpivirine (RPV) and Etravirine (ETR) are approved second-generation non-nucleoside reverse transcriptase inhibitors (NNRTIs) for HIV treatment. There is a cross-resistance HIV mutation profile between first-and second-generation NNRTI drugs. We determined the prevalence of HIV-1 drug resistance mutations (DRMs) to RPV and ETR in Botswana.

Molecular characterization of near full-length genomes of hepatitis B virus isolated from predominantly HIV infected individuals in Botswana

Motswedi Anderson, Wonderful Tatenda Choga, Sikhulile Moyo, Trevor Graham Bell, Tshepiso Mbangiwa, Bonolo Bonita Phinius, Lynnette Bhebhe, Theresa Kibirige Sebunya, Shahin Lockman, Richard Marlink, Anna Kramvis, Max Essex, Rosemary Mubanga Musonda, Jason Tory Blackard, Simani Gaseitsiwe

The World Health Organization plans to eliminate hepatitis B and C Infections by 2030. Therefore, there is a need to study and understand hepatitis B virus (HBV) epidemiology and viral evolution further, including evaluating occult (HBsAg-negative) HBV infection (OBI), given that such infections are frequently undiagnosed and rarely treated.

In silico analysis of hepatitis B virus occult associated mutations in Botswana using a novel algorithm

Motswedi Anderson, Wonderful T. Choga, Sikhulile Moyo, Trevor Graham Bell, Tshepiso Mbangiwa, Bonolo B. Phinius, Lynette Bhebhe, Theresa K. Sebunya, Joseph Makhema, Richard Marlink, Anna Kramvis, Max Essex, Rosemary M. Musonda, Jason T. Blackard, Simani Gaseitsiwe

Occult hepatitis B infections (OBI) represent a reservoir of undiagnosed and untreated hepatitis B virus (HBV), hence the need to identify mutations that lead to this phenotype. Functionally characterizing these mutations by in vitro studies is time-consuming and expensive.

Immunological non-response and low hemoglobin levels are predictors of incident tuberculosis among HIV-infected individuals on Truvada-based therapy in Botswana

Lucy Mupfumi, Sikhulile Moyo, Kesaobaka Molebatsi, Prisca K. Thami, Motswedi Anderson, Tuelo Mogashoa, Thato Iketleng, Joseph Makhema, Richard Marlink, Ishmael Kasvosve, Max Essex, Rosemary M. Musonda, Simani Gaseitsiwe

Background There is a high burden of tuberculosis (TB) in HIV antiretroviral programmes in Africa. However, few studies have looked at predictors of incident TB while on Truvada-based combination antiretroviral therapy (cART) regimens. Methods We estimated TB incidence among individuals enrolled into an observational cohort evaluating the efficacy and tolerability of Truvada-based cART in Gaborone, Botswana between 2008 and 2011.

Short-Form Audit Instrument for Assessing Corner Store Healthfulness

Robin S. DeWeese, Michael Todd, Allison Karpyn, Michael Yedidia, Michelle Kennedy, Meg Bruening, Christopher M. Wharton, Punam Ohri-Vachaspati

Purpose: To develop a valid and feasible short-form corner store audit tool (SCAT) that could be used in-store or over the phone to capture the healthfulness of corner stores. Design: Nonexperimental.

Predicted Impact of the Food and Drug Administration’s Menu-Labeling Regulations on Restaurants in 4 New Jersey Cities

Jessie Gruner, Robin S. DeWeese, Cori Lorts, Michael Yedidia, Punam Ohri-Vachaspati

Objectives. To determine the proportion of restaurants that will be required to post calorie information under the Food and Drug Administration’s menu-labeling regulations in 4 New Jersey cities.

Patterns of food and physical activity environments related to children’s food and activity behaviors: A latent class analysis

Robin S. DeWeese, Punam Ohri-Vachaspati, Marc A. Adams, Jonathan Kurka, Seung Yong Han, Michael Todd, Michael Yedidia

Relationships between food and physical activity (PA) environments and children’s related behaviors are complex. Latent class analyses derived patterns from proximity to healthy and unhealthy food outlets, PA facilities and parks, and counts of residential dwellings and intersections.

Impact of the 2010 us Healthy, Hunger-Free Kids Act on School Breakfast and Lunch participation rates between 2008 and 2015

Nicole Vaudrin, Kristen Lloyd, Michael Yedidia, Michael Todd, Punam Ohri-Vachaspati

Objectives; To evaluate National School Lunch Program (NSLP) and School Breakfast Program (SBP) participation over a 7-year period before and after the implementation of the 2010 Healthy, Hunger-Free Kids Act (HHFKA), which required healthier school lunch options beginning in school year (SY) 2012-2013 and healthier school breakfast options beginning in SY2013-2014.

Competencies for engaging high-needs patients in primary care

Michael Yedidia

Background: Patients who heavily utilize hospitals and emergency departments frequently have complex needs requiring services spanning medical, behavioral, and social service sectors. This study identifies essential competencies for caring for high-needs patients and highlights their importance to primary care delivery.

Trends in attention-deficit hyperactivity disorder medication use: a retrospective observational study using population-based databases

Sudha R. Raman, Kenneth K.C. Man, Shahram Bahmanyar, Anick Berard, Scott Bilder, Takoua Boukhris, Greta Bushnell, Stephen Crystal, Kari Furu, Yea Huei KaoYang, Øystein Karlstad, Helle Kieler, Kiyoshi Kubota, Edward Chia Cheng Lai, Jaana E. Martikainen, Géric Maura, Nicholas Moore, Dolores Montero, Hidefumi Nakamura, Anke Neumann & 13 others

Background: The use of medications to treat attention deficit hyperactivity disorder (ADHD) has increased, but the prevalence of ADHD medication use across different world regions is not known. Our objective was to determine regional and national prevalences of ADHD medication use in children and adults, with a specific focus on time trends in ADHD medication prevalence.

Suicide after deliberate self-harm in adolescents and young adults

Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Jeffrey A. Bridge, Shang Min Liu, Carlos Blanco

OBJECTIVES: Among adolescents and young adults with nonfatal self-harm, our objective is to identify risk factors for repeated nonfatal self-harm and suicide death over the following year. METHODS: A national cohort of patients in the Medicaid program, aged 12 to 24 years (n = 32 395), was followed for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index.

Service use preceding opioid-related fatality

Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Carlos Blanco

Objective: This study analyzed health service patterns before opioid-related death among nonelderly individuals in the Medicaid program, focusing on decedents with and without past-year diagnoses of noncancer chronic pain. Methods: The authors identified opioid-related decedents, age #64 years, in the Medicaid program and characterized their clinical diagnoses, filled medication prescriptions, and nonfatal poisoning events during the 30 days and 12 months before death. The study group included 13,089 opioid-related deaths partitioned by presence or absence of chronic noncancer pain diagnoses in the last year of life.

Risks of fatal opioid overdose during the first year following nonfatal overdose

Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Carlos Blanco

Background: Little is known about risk factors for repeated opioid overdose and fatal opioid overdose in the first year following nonfatal opioid overdose. Methods: We identified a national retrospective longitudinal cohort of patients aged 18–64 years in the Medicaid program who received a clinical diagnosis of nonfatal opioid overdose. Repeated overdoses and fatal opioid overdoses were measured with the Medicaid record and the National Death Index. Rates of repeat overdose per 1000 person-years and fatal overdose per 100,000 person-years were determined. Hazard ratios of repeated opioid overdose and fatal opioid overdose were estimated by Cox proportional hazards.

Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees

Hillary Samples, Arthur Robin Williams, Mark Olfson, Stephen Crystal

Introduction: Recent U.S. trends demonstrate sharp rises in adverse opioid-related health outcomes, including opioid use disorder (OUD), overdose, and death. Yet few affected people receive treatment for OUD and a minority of those who receive treatment are effectively retained in care. The purpose of this study was to examine duration of buprenorphine treatment for OUD following treatment initiation to identify risk factors for early discontinuation.

Psychotropic medication use among adults with schizophrenia and schizoaffective disorder in the United States

T. Scott Stroup, Tobias Gerhard, Stephen Crystal, Cecilia Huang, Zhiqiang Tan, Melanie M. Wall, Chacku M. Mathai, Mark Olfson

Objective: The authors examined the use of different classes of psychotropic medication in outpatient treatment of schizophrenia and schizoaffective disorder. Methods: Data from the United States Medicaid program were used to examine psychotropic medication use in a cohort of patients who had a diagnosis of schizophrenia or schizoaffective disorder in the calendar year 2010.

The influence of acculturation level and family relationships on quality of life among U.S. Chinese older adults

Yiwei Chen, Yisheng Peng, Minzhi Ye, Ling Xu, Xinqi Dong

The present study examined the influence of acculturation level and family relationships (i.e., positive family support and negative family strain) on quality of life (QOL), using the data from the Population Study of ChINese Elderly (PINE) in Chicago (N = 3159). Controlling for sociodemographic variables and health status, it was found that individuals’ acculturation level and positive family support were positively related to QOL, whereas negative family strain was negatively associated with QOL. More importantly, higher acculturation levels were associated with increased protective effects of positive family support and reduced risk effects of negative family strain on QOL among U.S. Chinese older adults.

A cross-sectional study of coping resources and mental health of Chinese older adults in the United States

Man Guo, Nadia Sabbagh Steinberg, Xinqi Dong, Agnes Tiwari

Objectives: This study examined the potential influence of coping resources at individual (sense of mastery), family (spousal and family support, children’s filial piety), and community levels (community cohesion) on the mental health (depression, anxiety) of U.S. Chinese older adults.

Neighborhood social cohesion and cognitive function in U.S. Chinese older adults—findings from the PINE study

Wei Zhang, Sizhe Liu, Fei Sun, Xinqi Dong

Objectives: The projected increase in the population of older adults in the United States entails a pressing need to examine risk and protective factors associated with cognitive function. This study aims to examine the association between neighborhood social cohesion and cognitive function among older Chinese adults in the United States.

Health Services Utilization Among Chinese American Older Adults: Moderation of Social Support With Functional Limitation

Jinjiao Wang, Dexia Kong, Benjamin C. Sun, Xinqi Dong

In this study, we aimed to examine the relationship of social support with hospitalizations and emergency department (ED) visits among older Chinese adults in the United States and its possible mechanism.

Correlates of Emergency Department Service Utilization Among U.S. Chinese Older Adults

Dexia Kong, Mengting Li, Yin Ling Irene Wong, Jinjiao Wang, Benjamin C. Sun, Xinqi Dong

Older adults visit emergency departments (EDs) at a disproportionally higher rate than other age groups. Prior studies examining racial disparities in ED utilization focus on African Americans and Hispanics. There is a dearth of information on ED utilization patterns among older Asian Americans despite the evidence that ED expenditures in Asian Americans are comparable to that of Caucasians.

Association of Self-Reported Discrimination and Suicide Ideation in Older Chinese Americans

Lydia W. Li, Gilbert C. Gee, Xinqi Dong

Objective This study examines racial discrimination as a potential novel risk factor for suicide ideation among older Chinese Americans. Design In a cross-sectional analysis, this study drew on data collected in the Population-based Study of Chinese Elderly in Chicago on Chinese older adults age 60 + in the Greater Chicago area (N = 3,157). Thirty-day suicide ideation was a dichotomous variable, derived from items of the Physical Health Questionnaire and the Geriatric Mental State Examination-Version A. Self-reported discrimination was dichotomously coded, based on the Experiences of Discrimination instrument, which asks respondents whether they have ever experienced discrimination in nine situations because of their race/ethnicity/color.

Association Between Neighborhood Cohesion and Cancer Screening Utilization in Chinese American Older Adults

Ailian Hei, Melissa A. Simon, Xinqi Dong

This study aims to examine the association between neighborhood cohesion and cancer screening utilization in a community-dwelling Chinese American older population. Data were drawn from the Population Study of Chinese Elderly including 3159 Chinese American older adults aged 60 and above in the greater Chicago area. Cancer screening utilization was assessed by asking whether participants had undergone colon, breast, cervical, or prostate cancer screening.

Alcohol and Mortality: Combining Self-Reported (AUDIT-C) and Biomarker Detected (PEth) Alcohol Measures Among HIV Infected and Uninfected

VACS Project team

BACKGROUND: Unhealthy alcohol use may be particularly detrimental among individuals living with HIV and/or hepatitis C virus (HCV), and is often under-reported. Direct biomarkers of alcohol exposure may facilitate improved detection of alcohol use

Risk of malignancy associated with paediatric use of tumour necrosis factor inhibitors

Timothy Beukelman, Fenglong Xie, Lang Chen, Daniel Horton, James D. Lewis, Ronac Mamtani, Melissa M. Mannion, Kenneth G. Saag, Jeffrey R. Curtis

Objective to determine whether tumour necrosis factor inhibitor (tnFi) use is associated with an increased rate of incident malignancy compared with no tnFi use in the treatment of juvenile idiopathic arthritis (JIA), paediatric inflammatory bowel disease (pIBd) and paediatric plaque psoriasis (ppso).

Nurses’ and patients’ appraisals show patient safety in hospitals remains a concern

Linda H. Aiken, Douglas M. Sloane, Hilary Barnes, Jeannie P. Cimiotti, Olga Jarrin Montaner, Matthew D. McHugh

The Institute of Medicine concluded in To Err Is Human in 1999 that transformation of nurse work environments was needed to reduce patient harm. We studied 535 hospitals in four large states at two points in time between 2005 and 2016 to determine the extent to which their work environments improved, and whether positive changes were associated with greater progress in patient safety.

Adaptations of the evidence-based Transitional Care Model in the U.S.

Mary D. Naylor, Karen B. Hirschman, Mark P. Toles, Olga Jarrin, Elizabeth Shaid, Mark V. Pauly

Despite a growing body of evidence that adaptations of evidence-based interventions (EBI) are ubiquitous, few studies have examined the nature and rationale for modifications to the components of these interventions.

Risk of sudden sensorineural hearing loss in adults using phosphodiesterase type 5 inhibitors: Population-based cohort study

Wei Liu, Patrick J. Antonelli, Philipp Dahm, Tobias Gerhard, Joseph A.C. Delaney, Richard Segal, Stephen Crystal, Almut G. Winterstein

Purpose: The objective of the study was to determine the risk of sudden sensorineural hearing loss (SNHL) associated with use of phosphodiesterase type 5 (PDE5) inhibitors. Methods: We conducted a retrospective cohort study in the MarketScan Commercial Claims and Encounters Database including adult men who initiated a PDE5 inhibitor (n = 377,722) and 1,957,233 nonusers between 1998 and 2007.

Antipsychotic medication treatment patterns in adult depression

Tobias Gerhard, T. Scott Stroup, Christoph U. Correll, Cecilia Huang, Zhiqiang Tan, Stephen Crystal, Mark Olfson

Objective: To characterize the role of antipsychotic medications in the community treatment of adult depression. Methods: We identified adults (aged 18-64 years) with new episodes of depression treatment (ICD-9-CM 296.2, 296.3, 300.4, or 311) in US national Medicaid data (2001-2010). Patients with alternative ICD-9-CM antipsychotic indications, such as schizophrenia or bipolar disorder, were excluded.

Comparative safety of NSAIDs for gastrointestinal events in Asia-Pacific populations: A multi-database, international cohort study

Edward Chia Cheng Lai, Ju Young Shin, Kiyoshi Kubota, Kenneth K.C. Man, Byung Joo Park, Nicole Pratt, Elizabeth E. Roughead, Ian C.K. Wong, Yea Huei Kao Yang, Soko Setoguchi Iwata

Purpose: The safety of nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used in Asia-Pacific countries has had limited study. We assessed the risk of hospitalization for gastrointestinal events with loxoprofen and mefenamic acid compared with other NSAIDs in Asia-Pacific populations. Methods: We conducted a cohort study using a distributed network with a common data model in Australia, Hong Kong, Japan, Korea, and Taiwan. We included patients who initiated diclofenac, loxoprofen, mefenamic acid, or celecoxib and followed them until their first gastrointestinal hospitalization, switch or discontinuation of medication, disenrollment, or end of database coverage. We used Cox proportional hazards models to assess hospitalization risk.

Applying a common data model to asian databases for multinational pharmacoepidemiologic studies: Opportunities and challenges

Edward Chia Cheng Lai, Patrick Ryan, Yinghong Zhang, Martijn Schuemie, N. Chantelle Hardy, Yukari Kamijima, Shinya Kimura, Kiyoshi Kubota, Kenneth K.C. Man, Soo Yeon Cho, Rae Woong Park, Paul Stang, Chien Chou Su, Ian C.K. Wong, Yea Huei Yang Kao, Soko Setoguchi Iwata

Objective: The goal of the Asian Pharmacoepidemiology Network is to study the effectiveness and safety of medications commonly used in Asia using databases from individual Asian countries. An efficient infrastructure to support multinational pharmacoepidemiologic studies is critical to this effort.

Advanced imaging and hospice use in end-of-life cancer care

Michaela A. Dinan, Lesley H. Curtis, Soko Setoguchi Iwata, Winson Y. Cheung

Introduction: Advanced imaging can inform prognosis and may be a mechanism to de-escalate unnecessary end-of-life care in patients with cancer. Associations between greater use of advanced imaging and less-aggressive end-of-life care in real-world practice has not been examined.

Update on ACO Operations and Care Management Strategies in the New Jersey Medicaid ACO Demonstration Project

Derek DeLia, Michael J. Yedidia, Oliver Lontok

The New Jersey Medicaid Accountable Care Organization (ACO) Demonstration was implemented over a three-year period beginning on July 1, 2015 and recently, a one-year extension of the Demonstration was recently authorized. Previously published reports provided quantitative and qualitative information about activities leading up to and in the first year of the Demonstration. This report provides a detailed assessment of ACO activities in Demonstration year 2.

Spending and Utilization Indicators in the New Jersey Medicaid ACO Demonstration Project.

Derek DeLia, Rizie Kumar, Jose Nova, Kristen Lloyd, David Goldin

This report provides a first assessment of spending and utilization indicators related to the New Jersey Medicaid Accountable Care Organization (ACO) Demonstration Project (NJ P.L. 2011, c.114).

Four Lessons Learned From School Nurses in New Jersey About Building a Culture of Health

Robert Atkins

Building a Culture of Health will give all members of our society the opportunity to lead healthier lives. To achieve this aim, more stakeholders in the community-residents, elected officials, community-based nonprofits, law enforcement, and schools-need to be engaged in addressing the health challenges in our communities. Moreover, all community stakeholders have to think and act “upstream” by addressing the social determinants of health in their communities. Discussed in this article are some of the lessons that are being learned from the “upstream” actions of school nurses in New Jersey about building a Culture of Health.

Education and Family Health Care Spending

Alan C. Monheit and Irina B. Grafova

Michael Grossman’s seminal work on the demand for health extended the concept of a household production function to the commodity “good health.”……

Depression treatment and healthcare expenditures among elderly Medicare beneficiaries with newly diagnosed depression and incident breast, colorectal, or prostate cancer

Monira Alwhaibi, Usha Sambamoorthi, Suresh Madhavan, James Walkup

Objectives: Depression is associated with high healthcare expenditures, and depression treatment may reduce healthcare expenditures. However, to date, there have not been any studies on the effect of depression treatment on healthcare expenditures among cancer survivors. Therefore, this study examined the association between depression treatment and healthcare expenditures among elderly with depression and incident cancer.

The relationship of social engagement and social support with sense of community

Fengyan Tang, Iris Chi, Xinqi Dong

Background: We aimed to investigate the relationship of engagement in social and cognitive activities and social support with the sense of community (SOC) and its components among older Chinese Americans.

The decline of directly observed physical function performance among U.S. Chinese older adults

Xinqi Dong, Stephanie M. Bergren, Melissa A. Simon

Background: Physical function decline is a major public health concern and can predict later mortality. This study aims to examine the sociodemographic factors associated with physical function decline among U.S. Chinese older adults through a longitudinal population-based study.

Urgently Creating the Better in Global Health

Richard Marlink

In this issue of the Hastings Center Report, Govind Persad and Ezekiel Emanuel argue that “[t]he provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.”

Short Communication: Low False Recent Rate of Limiting Antigen-Avidity Assay Combined with HIV-1 RNA Data in Botswana

Sikhulile Moyo, Kenanao P. Kotokwe, Terence Mohammed, Corretah Boleo, Lucy Mupfumi, Samuel Chishala, Lesedi Tsalaile, Hermann Bussmann, Simani Gaseitsiwe, Rosemary Musonda, Joseph Makhema, Marianna Baum, Richard Marlink, Susan Engelbrecht, Max Essex, Vladimir Novitsky

Cross-sectional estimation of HIV incidence could misclassify some established or chronic HIV infections as recent. Usually long-term nonprogressors, elite and viremic controllers, and individuals on ART contribute to misclassification.

Prevalence and distribution of non-AIDS causes of death among HIV-infected individuals receiving antiretroviral therapy: a systematic review and meta-analysis

Mansour Farahani, Holly Mulinder, Alexander Farahani, Richard Marlink

The advent of antiretroviral therapy has significantly improved AIDS-related morbidity and mortality. Yet, among people living with HIV, deaths due to non-AIDS-defining illnesses have been on the rise.

Genome-Wide Analyses Reveal Gene Influence on HIV Disease Progression and HIV-1C Acquisition in Southern Africa

Wen Xie, Denis Agniel, Andrey Shevchenko, Sergey V. Malov, Anton Svitin, Nikolay Cherkasov, Marianna K. Baum, Adriana Campa, Simani Gaseitsiwe, Hermann Bussmann, Joseph Makhema, Richard Marlink, Vladimir Novitsky, Tun Hou Lee, Tianxi Cai, Stephen J. O'Brien, M. Essex

Sub-Saharan Africans infected with HIV-1C make up the largest AIDS patient population in the world and exhibit large heterogeneity in disease progression before initiating antiretroviral therapy.

Developing Research Collaborations in an Academic Clinical Setting: Challenges and Lessons Learned

John A. Sahs, Andel V. Nicasio, Joan E. Storey, Peter Guarnaccia, Roberto Lewis-Fernández

Research collaboration in “real world” practice settings may enhance the meaningfulness of the findings and reduce barriers to implementation of novel intervention strategies.

Determinants of Sugar-Sweetened Beverage Consumption among Low-Income Children: Are There Differences by Race/Ethnicity, Age, and Sex?

Natasha Tasevska, Derek DeLia, Cori Lorts, Michael Yedidia, Punam Ohri-Vachaspati

Background Understanding determinants of high consumption of sugar-sweetened beverages (SSBs), a highly prevalent obesogenic behavior, will help build effective customized public health interventions.

Minority Men Who Have Sex with Men Demonstrate Increased Risk for HIV Transmission

Kirsha S. Gordon, E. Jennifer Edelman, Amy C. Justice, David A. Fiellin, Kathleen Akgün, Stephen Crystal, Mona Duggal, Joseph L. Goulet, David Rimland, Kendall J. Bryant

Black and Hispanic (minority) MSM have a higher incidence of HIV than white MSM. Multiple sexual partners, being under the influence of drugs and/or alcohol during sex, having a detectable HIV-1 RNA, and non-condom use are factors associated with HIV transmission. Using data from the Veterans Aging Cohort Study, we consider minority status and sexual orientation jointly to characterize and compare these factors.

Cumulative Advantage, Cumulative Disadvantage, and Evolving Patterns of Late-Life Inequality

Stephen Crystal, Dennis G. Shea, Adriana M. Reyes

Purpose of the Study Earlier studies have identified a pattern of cumulative advantage leading to increased within-cohort economic inequality over the life course, but there is a need to better understand how levels of inequality by age have changed in the evolving economic environment of recent decades. We utilized Survey of Income and Program Participation (SIPP) data to compare economic inequality across age groups for 2010 versus 1983-1984. Design and Methods We examined changing age profiles of inequality using a summary measure of economic resources taking into account income, annuitized value of wealth, and household size.

Suicide following deliberate self-harm

Mark Olfson, Melanie Wall, Shuai Wang, Stephen Crystal, Tobias Gerhard, Carlos Blanco

Objective: The authors sought to identify risk factors for repeat self-harm and completed suicide over the following year among adults with deliberate self-harm. Method: A national cohort of Medicaid-financed adults clinically diagnosed with deliberate self-harm (N=61,297) was followed for up to 1 year. Repeat self-harm per 1,000 personyears and suicide rates per 100,000 person-years (based on cause of death information from the National Death Index) were determined. Hazard ratios of repeat self-harm and suicide were estimated by Cox proportional hazard models.

Impact of the black triangle label on prescribing of new drugs in the United Kingdom: lessons for the United States at a time of deregulation

Daniel Horton, Tobias Gerhard, Amy Davidow, Brian Strom

Purpose: Newly approved novel drugs in Europe receive a black triangle label to promote pharmacovigilance. With growing momentum for earlier drug approvals and reliance on real-world evidence, we studied if the black triangle label promotes more judicious prescribing. Methods: We examined whether general practitioners prescribed escitalopram, tadalafil, and vardenafil with a black triangle more cautiously than the same or similar drugs without a black triangle in The Health Improvement Network (UK). We performed interrupted time-series analyses to estimate changes in new prescription rates and nested case-control studies to compare characteristics of new users before and after removal of a black triangle.

Extent, time course, and moderators of antipsychotic treatment in youth with mood disorders: Results of a meta-analysis and meta-regression analyses

Chiara Cervesi, Su Young Park, Britta Galling, Silvia Molteni, Gabriele Masi, Tobias Gerhard, Mark Olfson, Christoph U. Correll

Objective: To meta-analytically examine the trends and correlates of antipsychotic use in youth with mood disorders. Methods: Systematic literature search without language restriction in PubMed/ MEDLINE/PsycINFO from database inception through March 2015 using the following search terms: (antipsychotic∗OR neuroleptic∗OR “dopamine blocker∗” OR antidopaminergic) AND (child∗OR adolescen∗OR pediatric OR youth) AND (prescription∗OR prescrib∗OR use OR utilization OR database OR pharmacoepidemiolog∗OR frequency OR rate OR rates).

Differential risk of increasing psychotropic polypharmacy use in children diagnosed with ADHD as preschoolers

Almut G. Winterstein, Rene Soria-Saucedo, Tobias Gerhard, Christoph U. Correll, Mark Olfson

Objective: To characterize treatment trajectories in children newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). Methods: We utilized billing records of children aged 3 to 18 years in 28 US states’f Medicaid programs between 1999 and 2006. Children entered the cohort at the first ADHD diagnosis (ICD-9-CM: 314.00) preceded by. 6 months with no psychotropic medication use and no psychiatric diagnoses. We followed children for 5 years to assess use of (1) psychotropic polypharmacy (the use of. 3 psychotropic medication classes), (2) antipsychotics, and (3) anticonvulsants. We used mixedeffects logistic regression to model the probability of each utilization outcome as a function of age at ADHD diagnosis and follow-up year, adjusted for sociodemographic factors.

Comparative adherence to diabetes drugs: An analysis of electronic health records and claims data

James Flory, Tobias Gerhard, Nikita Stempniewicz, Scott Keating, Christopher G. Rowan

Non-adherence to medications is a major challenge in diabetes care. The objective of this brief report is to compare adherence rates for 6 major classes of diabetes medications: metformin, sulfonylurea, thiazolidinedione, basal insulin, DPP-4 inhibitors, and GLP-1 receptor agonists. We used a data source that linked electronic prescriptions with insurance claims to assess whether new electronic prescriptions for diabetes medications were followed by dispensing claims consistent with that prescription.

Cross-sectional and longitudinal association between trust in physician and depressive symptoms among U.S. Community-dwelling Chinese older adults

Xinqi Dong, Stephanie Bergren, Melissa A. Simon

Background: Depression is a major public health concern among older adults and health care professionals play a vital role in screening and treatment. However, this process may be impeded by issues like lack of trust in physician (TIP). This study aims to examine the cross-sectional and longitudinal relationships between TIP and depressive symptoms among Chinese older adults in the Chicago area.

Change of cognitive function in U.S. Chinese older adults: A population-based study

Lydia W. Li, Ding Ding, Bei Wu, Xinqi Dong

Background: This study aims to assess cognitive change in a 2-year period among U.S. Chinese older adults and examine sociodemographic characteristics associated with the change.

Methods: Data were from the Population Study of Chinese Elderly (PINE) in which 2,713 participants (aged 60 and older) received in-home interviews at both the baseline and 2-year follow-up. A battery of cognitive tests that assessed episodic memory, working memory, perceptual speed, and overall cognitive status were administered in both times. A composite global cognition was constructed using all tests. Mixed-effect regression was conducted.

Pathway to better patient care and nurse workforce outcomes in home care

Olga Jarrin, Youjeong Kang, Linda H. Aiken

Background Unlike the Magnet Recognition Program, the newer Pathway to Excellence Program designed to improve work environments in a broader range of organizations has not yet been the focus of substantial research.

Agreement and validity of electronic health record prescribing data relative to pharmacy claims data: A validation study from a US electronic health record database

Christopher G. Rowan, James Flory, Tobias Gerhard, John K. Cuddeback, Nikita Stempniewicz, James D. Lewis, Sean Hennessy

Background: Granular clinical and laboratory data available in electronic health record (EHR) databases provide researchers the opportunity to conduct investigations that would not be possible in insurance claims databases; however, for pharmacoepidemiology studies, accurate classification of medication exposure is critical. Objective: The aim of this study was to evaluate the validity of classifying medication exposure using EHR prescribing (EHR-Rx) data.

Elder self-neglect: Research and practice

Xinqi Dong

Elder self-neglect is a global public health and human rights issue that threatens older people’s health and safety. It commonly refers to refusal or failure to provide oneself with care and protection in areas of food, water, clothing, hygiene, medication, living environments, and safety precautions. While prevalent, the status of self-neglecting individuals remains largely unclear, in particular within community-dwelling populations. By reviewing the epidemiology of elder self-neglect (definition, prevalence, risk factors, and consequences) to date, the present paper identifies key research gaps such as methodological inconsistency in case identification and measurement, and study designs that are inadequate to determine risk factors of self-neglect. More importantly, in light of the rapidly growing older population, relevant stakeholders (researchers, healthcare providers, social service providers, legal professionals, community organizations, and policymakers) must be prepared for an expected increasing number of self-neglect cases and enlarging scope of the problem. Hence, in this article, I present an overview regarding the management issues of elderly self-neglect related to the detection, assessment, reporting and referral, and decision-making capacity. Based on the current literature, the paper is aimed to explore the present knowledge and challenges, and how they can pave the way for solutions to self-neglect research, practice, and policy.

Evidence for updating the core domain set of outcome measures for juvenile idiopathic arthritis: Report from a special interest group at OMERACT 2016

Esi M. Morgan, Meredith P. Riebschleger, Jennifer Horonjeff, Alessandro Consolaro, Jane E. Munro, Susan Thornhill, Timothy Beukelman, Hermine I. Brunner, Emily L. Creek, Julia G. Harris, Daniel Horton, Daniel J. Lovell, Melissa L. Mannion, Judyann C. Olson, Homaira Rahimi, Maria Chiara Gallo, Serena Calandra, Angelo Ravelli, Sarah Ringold, Susan Shenoi & 4 others

Objective. The current Juvenile Idiopathic Arthritis (JIA) Core Set was developed in 1997 to identify the outcome measures to be used in JIA clinical trials using statistical and consensus-based techniques, but without patient involvement.

Attitudes and approaches for withdrawing drugs for children with clinically inactive nonsystemic JIA: A survey of the childhood arthritis and rheumatology research alliance

Daniel Horton, Karen B. Onel, Timothy Beukelman, Sarah Ringold

Objective. To assess the attitudes and strategies of pediatric rheumatology clinicians toward withdrawing medications for children with clinically inactive juvenile idiopathic arthritis (JIA). Methods.

Predictors of unplanned hospitalizations in patients with nonmetastatic lung cancer during chemotherapy

Kristen L. Fessele, Matthew J. Hayat, Robert Atkins

Purpose/Objectives: To determine predictors of unplanned hospitalizations in patients with lung cancer to receive chemotherapy in the outpatient setting and examine the potential financial burden of these events.

Grandparent caregiving and psychological well-being among Chinese American older adults—the roles of caregiving burden and pressure

Background: Though ample research on grandparent caregiving and psychological well-being outcomes exist in Western literature, little attention has been focused on Chinese American grandparents. Based on role enhancement and role strain theories, this study examined grandparent caregiving and psychological well-being among Chinese American older adults and tested whether caregiving burden or pressure from adult children moderated such association.

Family relationships and depressive symptoms among Chinese older immigrants in the United States

Jinyu Liu, Xinqi Dong, Duy Nguyen, Daniel W.L. Lai

Background: Given the growth in the number of older Chinese immigrants in the United States and the importance of family support in Chinese culture, this study examines how supportive and negative relationships with family members (children and spouse) influence depressive symptom severity among this population.

Family and marital conflict among Chinese older adults in the United States: The influence of personal coping resources

Man Guo, Xinqi Dong, Agnes Tiwari

Background: Conflict in the family is a major risk factor for the well-being of older immigrants, whose lives are centered around their families. This study examined the potential linkage between personal coping resources and family and marital conflict among U.S. Chinese older adults.

Variations between sources of social support and cancer screen behaviors in U.S. Chinese older adults

Xinqi Dong, Andi Liu

Background: Social support is a key indicator of utilization of preventive health care among older adults, but we have limited knowledge on these associations in U.S. Chinese older adults. This study aims to examine the association between sources of social support and cancer screening behaviors among Chinese older adults in the greater Chicago area.

Breast cancer screening beliefs among older Chinese women in Chicago’s Chinatown

Melissa A. Simon, Laura S. Tom, Xinqi Dong

Background: Chicago’s Chinatown is home to a sizeable community of first-generation Chinese American immigrants. This qualitative study seeks to describe the attitudes toward, and barriers and facilitators of, breast cancer screening among Chinese women in Chicago’s Chinatown to inform strategies for future interventions.

Oral glucocorticoid use and osteonecrosis in children and adults with chronic inflammatory diseases: A population-based cohort study

Daniel Horton, Kevin Haynes, Michelle R. Denburg, Mihir M. Thacker, Carlos D. Rose, Mary E. Putt, Mary B. Leonard, Brian Strom

Objectives We studied oral glucocorticoids and osteonecrosis, a rare but serious bone disease, in individuals with various chronic inflammatory diseases. We hypothesised that we would find stronger associations in adults versus children and in people with autoimmune diseases.

How Does Actual Unemployment and the Perceived Risk of Joblessness Affect Smoking Behavior? Gender and Intra-family Effects

Irina B. Grafova and Alan C. Monheit

Using the 1999–2011 waves of the Panel Study of Income Dynamics, we examine how actual unemployment …

Treating the Child or Syndrome: Does Context Matter for Treatment Decisions for Antisocially Behaving Youth?

Kathleen J. Pottick, Xin Tian, Stuart A. Kirk, and Derek K. Hsieh

Using a between-subject 3 × 3 design of an experimentally manipulated realistic case vignette of Black…….

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

Miwa Yasui, Kathleen J. Pottick, and Yun Chen

Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families…….

National Rates and Patterns of Depression Screening in Primary Care: Results From 2012 and 2013

Ayse Akincigil and Elizabeth B. Matthews

Objectives: Despite high prevalence rates of depression in primary care ,depressive symptoms are often undetected by physicians……..

Depression treatment among elderly medicare beneficiaries with incident cases of cancer and newly diagnosed depression

Monira Alwhaibi, Suresh Madhavan, Thomas Bias, Kimberly Kelly, James Walkup, Usha Sambamoorthi

Objective: Depression treatment can improve the health outcomes of elderly cancer survivors. There is a paucity of studies on the extent to which depression is treated among elderly cancer survivors. Therefore, this study estimated the rates of depression treatment among elderly cancer survivors and identified the factors affecting depression treatment.

Musculoskeletal MRI findings of juvenile localized scleroderma

Eric P. Eutsler, Daniel Horton, Monica Epelman, Terri Finkel, Lauren W. Averill

Background: Juvenile localized scleroderma comprises a group of autoimmune conditions often characterized clinically by an area of skin hardening. In addition to superficial changes in the skin and subcutaneous tissues, juvenile localized scleroderma may involve the deep soft tissues, bones and joints, possibly resulting in functional impairment and pain in addition to cosmetic changes.

Cancer type and risk of newly diagnosed depression among elderly medicare beneficiaries with incident breast, colorectal, and prostate cancers

Monira Alwhaibi, Usha Sambamoorthi, Suresh Madhavan, Thomas Bias, Kimberly Kelly, James Walkup

Background: Elderly individuals (age >65 years) with cancer are at high risk for newly diagnosed depression after a cancer diagnosis. It is not known whether the risk of newly diagnosed depression varies by cancer type.

Examination of chronic smoking behavior and eligibility for low-dose computed tomography for lung cancer screening among older Chinese Male smokers

Chien Ching Li, Alicia K. Matthews, Xinqi Dong

Background: Low-dose computed tomography lung cancer (LDCT) screening is an effective way to decrease lung cancer mortality. Both Medicare and private insurers offer coverage of LDCT screening to beneficiaries who are at high risk of developing lung cancer. In this study, we examined rates and predictors of chronic smoking behavior and eligibility for coverage of LDCT screening among older Chinese men living in the greater Chicago area

Elder Abuse: Research, Practice and Policy

Xinqi Dong

This book provides a global comprehensive and systematic state-of-the review of this field that fills the gaps between research, practice, and policy. The book addresses the epidemiology of the issue and the global prevalence of elder abuse in both developed and developing countries, which synthesizes the most up-to-date data about risk factors and protective factors associated with elder abuse and consequences of elder abuse; clinical assessment and management of elder abuse, including screening, detection, management of elder abuse, and the role of decision making capacity and forensic approaches;

Voices of Informal Caregivers and Community Stakeholders: Whether and How to Develop an Informal Caregiver Training Program

Sara S. Phillips, Daiva M. Ragas, Laura S. Tom, Nadia Hajjar, Xinqi Dong, Melissa A. Simon

Our primary objective was to gather pilot data from caregivers and stakeholders to guide the development of a training program to assist informal caregivers in re-entering the job market. The goal of the program would be to help caregivers rebound from their incurred economic burden by transitioning into a paid caregiving or other health-service role.

Using community-based participatory research to address Chinese older women’s health needs: Toward sustainability

E. Shien Chang, Melissa A. Simon, Xinqi Dong

ABSTRACT: Although community-based participatory research (CBPR) has been recognized as a useful approach for eliminating health disparities, less attention is given to how CBPR projects may address gender inequalities in health for immigrant older women. The goal of this article is to share culturally sensitive strategies and lessons learned from the PINE study—a population-based study of U.S. Chinese older adults that was strictly guided by the CBPR approach.

Sociodemographic and socioeconomic characteristics of elder self-neglect in an US Chinese aging population

Xinqi Dong

This study aimed to examine the socio-demographic and socioeconomic characteristics associated with prevalence and severity of elder self-neglect in an U.S. Chinese older population. The PINE study is a population-based epidemiological study in the greater Chicago area.

Psychological Well-Being of Older Chinese-American Grandparents Caring for Grandchildren

Fengyan Tang, Ling Xu, Iris Chi, Xinqi Dong

The rapid increase in grandparents caring for grandchildren has received growing attention, but little research has focused on Chinese-American grandparents and their caregiving experiences.

Prevalence of elder self-neglect in a Chicago Chinese population: The role of cognitive physical and mental health

Xinqi Dong, Melissa Simon

Aim: The present study examined the cognitive, physical and psychological characteristics associated with elder self-neglect in a USA Chinese older population.

Leveraging the Experiences of Informal Caregivers to Create Future Healthcare Workforce Options

Sara S. Phillips, Daiva M. Ragas, Nadia Hajjar, Laura S. Tom, Xinqi Dong, Melissa A. Simon

The objective of this study was gather pilot data from informal caregivers regarding the potential for a training program to assist current or past caregivers in reentering the job market, and thus offering a pathway to economic resilience.

Elder Mistreatment in U.S. Community-Dwelling Chinese Older Women

Xinqi Dong, Ruijia Chen, Melissa A. Simon

This study explored the prevalence and correlates of elder mistreatment among community-dwelling Chinese women in the U.S. Data were from the Population Study of Chinese Elderly in Chicago (PINE), a population-based study of U.S. Chinese older adults aged 60 years and above.

2015 Rosalie Wolf Memorial Award Lecture: Past, present, and future of elder abuse

Xinqi Dong, Bei Wang

This article aims to advance the global issue of elder abuse through exploring how the current body of elder abuse literature can collectively pave the way for present and future directions for research, practice, and policy.

Wide variations in compliance with tuberculosis screening guidelines and tuberculosis incidence between antiretroviral therapy facilities – Côte d’Ivoire

Andrew F. Auld, Michela Blain, Kunomboa Alexandre Ekra, Joseph Sylvain Kouakou, Virginie Ettiègne-Traoré, Moise Zanga Tuho, Fayama Mohamed, Ray W. Shiraishi, Jennifer Sabatier, Joseph Essombo, Georgette Adjorlolo-Johnson, Richard Marlink, Tedd V. Ellerbrock

Background: In Côte d’Ivoire, tuberculosis (TB) is a common cause of death among HIV-infected antiretroviral therapy (ART) enrollees. Ivorian guidelines recommend screening for TB and initiation of TB treatment before ART initiation. Compliance with these guidelines can help reduce TB-related mortality during ART and possibly nosocomial TB transmission.

Variation in attrition at subnational level: Review of the Botswana National HIV/AIDS Treatment (Masa) programme data (2002-2013)

Mansour Farahani, Natalie Price, Shenaaz El-Halabi, Naledi Mlaudzi, Koona Keapoletswe, Refeletswe Lebelonyane, Ernest Benny Fetogang, Tony Chebani, Poloko Kebaabetswe, Tiny Masupe, Keba Gabaake, Andrew Auld, Oathokwa Nkomazana, Richard Marlink

Objective: To evaluate the variation in all-cause attrition [mortality and loss to follow-up (LTFU)] among HIV-infected individuals in Botswana by health district during the rapid and massive scale-up of the National Treatment Program.

Trends and determinants of survival for over 200 000 patients on antiretroviral treatment in the Botswana National Program: 2002-2013

Mansour Farahani, Natalie Price, Shenaaz El-Halabi, Naledi Mlaudzi, Koona Keapoletswe, Refeletswe Lebelonyane, Ernest Benny Fetogang, Tony Chebani, Poloko Kebaabetswe, Tiny Masupe, Keba Gabaake, Andrew Auld, Oathokwa Nkomazana, Richard Marlink

Objectives: To determine the incidence and risk factors of mortality for all HIV-infected patients receiving antiretroviral treatment at public and private healthcare facilities in the Botswana National HIV/AIDS Treatment Programme. Design: We studied routinely collected data from 226 030 patients enrolled in the Botswana National HIV/AIDS Treatment Programme from 2002 to 2013.

Slow CD4+ T-Cell recovery in human immunodeficiency virus/hepatitis B virus-coinfected patients initiating truvada-based combination antiretroviral therapy in Botswana

Motswedi Anderson, Simani Gaseitsiwe, Sikhulile Moyo, Kerapetse P. Thami, Terence Mohammed, Ditiro Setlhare, Theresa K. Sebunya, Eleanor A. Powell, Joseph Makhema, Jason T. Blackard, Richard Marlink, Max Essex, Rosemary M. Musonda

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection has emerged as an important cause of morbidity and mortality. We determined the response to Truvada-based first-line combination antiretroviral therapy (cART) in HIV/HBV-coinfected verus HIV-monoinfected patients in Botswana.

Plasma cytokine levels in chronic asymptomatic HIV-1 Subtype C infection as an indicator of disease progression in Botswana: A retrospective case control study

Thato Iketleng, Sikhulile Moyo, Simani Gaseitsiwe, Balthazar Nyombi, Rebecca M. Mitchell, Joseph Makhema, Marianna K. Baum, Richard Marlink, Max Essex, Rosemary Musonda

HIV infects cells of the immune system causing immune activation and proliferation of immune cells, leading to alteration of production and activity of a number of cytokines. These changes in cytokine levels can affect the immune function, and have the potential to directly impact the course of HIV disease.

Personal views about womanhood amongst women living with HIV in Botswana

Michelle Marian Schaan, Myra Taylor, Nontombi Gungqisa, Richard Marlink

The social construction of womanhood in Africa can be said to have two central defining elements: being a wife and being a mother. The interplay between HIV and these elements is not well understood outside of prevention efforts.

Impact of health system inputs on health outcome: A multilevel longitudinal analysis of Botswana national antiretroviral program (2002-2013)

Mansoor Farahani, Natalie Price, Shenaaz El-Halabi, Naledi Mlaudzi, Koona Keapoletswe, Refeletswe Lebelonyane, Ernest Benny FetogangR, Tony Chebani, Poloko Kebaabetswe, Tiny Masupe, Keba Gabaake, Andrew F. Auld, Oathokwa Nkomazana, Richard Marlink

Objective To measure the association between the number of doctors, nurses and hospital beds per 10,000 people and individual HIV-infected patient outcomes in Botswana.

How providers influence the implementation of provider-initiated HIV testing and counseling in Botswana: A qualitative study

Shahira Ahmed, Till Bärnighausen, Norman Daniels, Richard Marlink, Marc J. Roberts

Background: Understanding the motivations and perspectives of providers in following guidance and evidence-based policies can contribute to the evidence on how to better implement and deliver care, particularly in resource-constrained settings. This study explored how providers’ attitudes and behaviors influenced the implementation of an intervention, provider-initiated HIV testing and counseling, in primary health care settings in Botswana.

Effect of BMI and fat mass on HIV disease progression in HIV-infected, antiretroviral treatment-naïve adults in Botswana

S. S. Martinez, A. Campa, H. Bussmann, S. Moyo, J. Makhema, F. G. Huffman, O. D. Williams, M. Essex, Richard Marlink, M. K. Baum

An obesity paradox has been proposed in many conditions including HIV. Studies conducted to investigate obesity and its effect on HIV disease progression have been inconclusive and are lacking for African settings.

The meanings of cultural competence in mental health: an exploratory focus group study with patients, clinicians, and administrators

Neil Krishan Aggarwal, Kryst Cedeño, Peter Guarnaccia, Arthur Kleinman, Roberto Lewis-Fernández

Cultural competence training is mandatory in the United States of America to alleviate minority health disparities though few studies have examined perceptions across stakeholders.

Culture: The missing link in health research

M. Kagawa Singer, W. Dressler, S. George, Claudia R. Baquet, Ronny A. Bell, Linda Burhansstipanov, Nancy J. Burke, Suzanne Dibble, William Elwood, Linda Garro, Clarence C. Gravlee, Peter Guarnaccia, Michael L. Hecht, Jeffrey Henderson, Dan Hruschka, Roberto Lewis-Fernández, Robert Like, Charles Mouton, Hector F. Myers, J. Bryan Page & 9 others

Culture is essential for humans to exist. Yet surprisingly little attention has been paid to identifying how culture works or developing standards to guide the application of this concept in health research.

Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: A systematic review

Neil Krishan Aggarwal, Matthew C. Pieh, Lisa Dixon, Peter Guarnaccia, Margarita Alegría, Roberto Lewis-Fernández

Objective: To describe studies on clinician communication and the engagement of racial/ethnic minority patients in mental health treatment.

Healthy store programs and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but not the Supplemental Nutrition Assistance Program (SNAP), are associated with corner store healthfulness

Robin S. DeWeese, Michael Todd, Allison Karpyn, Michael Yedidia, Michelle Kennedy, Meg Bruening, Christopher M. Wharton, Punam Ohri-Vachaspati

In response to lack of access to healthy foods, many low-income communities are instituting local healthy corner store programs. Some stores also participate in the United States Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP).

Use of the landmark method to address immortal person-time bias in comparative effectiveness research: a simulation study

Xiaojuan Mi, Bradley G. Hammill, Lesley H. Curtis, Edward Chia Cheng Lai, Soko Setoguchi Iwata

Observational comparative effectiveness and safety studies are often subject to immortal person-time, a period of follow-up during which outcomes cannot occur because of the treatment definition. Common approaches, like excluding immortal time from the analysis or naïvely including immortal time in the analysis, are known to result in biased estimates of treatment effect.

Dimension reduction and shrinkage methods for high dimensional disease risk scores in historical data

Hiraku Kumamaru, Sebastian Schneeweiss, Robert J. Glynn, Soko Setoguchi Iwata, Joshua J. Gagne

Background: Multivariable confounder adjustment in comparative studies of newly marketed drugs can be limited by small numbers of exposed patients and even fewer outcomes. Disease risk scores (DRSs) developed in historical comparator drug users before the new drug entered the market may improve adjustment. However, in a high dimensional data setting, empirical selection of hundreds of potential confounders and modeling of DRS even in the historical cohort can lead to over-fitting and reduced predictive performance in the study cohort.

Comparison of high-dimensional confounder summary scores in comparative studies of newly marketed medications

Hiraku Kumamaru, Joshua J. Gagne, Robert J. Glynn, Soko Setoguchi Iwata, Sebastian Schneeweiss

Objective To compare confounding adjustment by high-dimensional propensity scores (hdPSs) and historically developed high-dimensional disease risk scores (hdDRSs) in three comparative study examples of newly marketed medications: (1) dabigatran vs. warfarin on major hemorrhage; (2) on death; and (3) cyclooxygenase-2 inhibitors vs. nonselective nonsteroidal anti-inflammatory drugs on gastrointestinal bleeds. Study Design and Setting In each example, we constructed a concurrent cohort of new and old drug initiators using US claims databases.

Comparative validity of methods to select appropriate cutoff weight for probabilistic linkage without unique personal identifiers

Ying Zhu, Chih Ying Chen, Yutaka Matsuyama, Yasuo Ohashi, Jessica M. Franklin, Soko Setoguchi Iwata

Purpose: Record linkage can enhance data quality of observational database studies. Probabilistic linkage, a method that allows partial match of linkage variables, overcomes disagreements arising from errors and omissions in data entry but also results in false-positive links. The study aimed to assess the validity of probabilistic linkage in the absence of unique personal identifiers (UPI) and the methods of cutoff weight selection.

Comparative risk of oral ulcerations among antipsychotics users – population-based retrospective cohort study

Edward Chia Cheng Lai, Cheng Yang Hsieh, Monera B. Wong, Swu Jane Lin, Yang Kuang Yang, Yea Huei Kao Yang, Soko Setoguchi Iwata

Purpose: The study aimed to evaluate the comparative risk of oral ulcerations among antipsychotic medications. Methods: We analyzed the National Health Insurance Research Database of Taiwan and included patients newly initiated with a single antipsychotic agent including haloperidol, sulpiride, olanzapine, quetiapine, risperidone, or amisulpride during 2002 to 2010. The outcome of interest was oral ulceration, defined by the presence diagnoses of stomatitis and mucositis, aphthous-like ulceration and oral burns, or dispensing of stomatological corticosteroids included triamcinolone, dexamethasone, hydrocortisone, and prednisolone.

Comparative persistence of antiepileptic drugs in patients with epilepsy: A STROBE-compliant retrospective cohort study

Edward Chia Cheng Lai, Cheng Yang Hsieh, Chien Chou Su, Yea Huei Kao Yang, Chin Wei Huang, Swu Jane Lin, Soko Setoguchi Iwata

We compared persistence of antiepileptic drugs (AEDs) including carbamazepine, oxcarbazepine, gabapentin, lamotrigine, topiramate, valproic acid, and phenytoin in an Asian population with epilepsy. A retrospective cohort study was conducted by analyzing Taiwan’s National Health Insurance Research Database (NHIRD). Adult epilepsy patients newly prescribed with AEDs between 2005 and 2009 were included.

Trends in Any and High-Dose Opioid Analgesic Receipt Among Aging Patients With and Without HIV

William C. Becker, Kirsha Gordon, E. Jennifer Edelman, Robert D. Kerns, Stephen Crystal, James D. Dziura, Lynn E. Fiellin, Adam J. Gordon, Joseph L. Goulet, Amy C. Justice, David A. Fiellin

Harms of opioid analgesics, especially high-dose therapy among individuals with comorbidities and older age, are increasingly recognized. However, trends in opioid receipt among HIV-infected patients are not well characterized. We examined trends, from 1999 to 2010, in any and high-dose (≥120 mg/day) opioid receipt among patients with and without HIV, by age strata, controlling for demographic and clinical correlates. Of 127,216 patients, 64 % received at least one opioid prescription.

The quality of medication treatment for mental disorders in the department of veterans affairs and in private-sector plans

Katherine E. Watkins, Brad Smith, Ayse Akincigil, Melony E. Sorbero, Susan Paddock, Abigail Woodroffe, Cecilia Huang, Stephen Crystal, Harold Alan Pincus

Objective: The quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) was compared with care provided to a comparable population treated in the private sector. Methods: Two cohorts of individuals with mental disorders (schizophrenia, bipolar disorder, posttraumatic stress disorder, major depression, and substance use disorders) were created with VA administrative data (N=836,519) and MarketScan data (N=545,484).

The effect of substance use disorders on the association between guideline-concordant long-term opioid therapy and all-cause mortality

Julie R. Gaither, Joseph L. Goulet, William C. Becker, Stephen Crystal, E. Jennifer Edelman, Kirsha Gordon, Robert D. Kerns, David Rimland, Melissa Skanderson, Amy C. Justice, David A. Fiellin

Objective: Patients with substance use disorders (SUDs) prescribed long-term opioid therapy (LtOT) are at risk for overdose and mortality. Prior research has shown that receipt of LtOT in accordance with clinical practice guidelines has the potential to mitigate these outcomes. Our objective was to determine whether the presence of a SUD modifies the association between guideline-concordant care and 1-year all-cause mortality among patients receiving LtOT for pain.

The Association Between Receipt of Guideline-Concordant Long-Term Opioid Therapy and All-Cause Mortality

Julie R. Gaither, Joseph L. Goulet, William C. Becker, Stephen Crystal, E. Jennifer Edelman, Kirsha Gordon, Robert D. Kerns, David Rimland, Melissa Skanderson, Amy C. Justice, David A. Fiellin

Purpose: For patients receiving long-term opioid therapy (LtOT), the impact of guideline-concordant care on important clinical outcomes—notably mortality—is largely unknown, even among patients with a high comorbidity and mortality burden (e.g., HIV-infected patients). Our objective was to determine the association between receipt of guideline-concordant LtOT and 1-year all-cause mortality.

Ten-Year Trends In Treatment Services For Children With Attention Deficit Hyperactivity Disorder Enrolled In Medicaid

Kimberly E. Hoagwood, Kelly Kelleher, Bonnie T. Zima, James M. Perrin, Scott Bilder, Stephen Crystal

Closing the gap between evidence-based clinical practice standards and their inclusion in routine practice continues to be a major goal of health policy reforms. This gap is especially large for the care of children with psychiatric disorders-especially those from low-income families, many of whom are insured through Medicaid.

Risk factors associated with acute exacerbation of chronic obstructive pulmonary disease in HIV-infected and uninfected patients

Timothy B. Depp, Kathleen A. McGinnis, Kevin Kraemer, Kathleen M. Akgun, E. Jennifer Edelman, David A. Fiellin, Adeel A. Butt, Stephen Crystal, Adam J. Gordon, Matthew Freiberg, Cynthia L. Gibert, David Rimland, Kendall J. Bryant, Kristina Crothers

Objective: To determine the association between HIV infection and other risk factors for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Design: Longitudinal, national Veterans Aging Cohort Study including 43 618 HIV-infected and 86 492 uninfected veterans. Methods: AECOPD was defined as an inpatient or outpatient COPD ICD-9 diagnosis accompanied by steroid and/or antibiotic prescription within 5 days.

Rapid growth of antipsychotic prescriptions for children who are publicly insured has ceased, but concerns remain

Stephen Crystal, Thomas Mackie, Miriam C. Fenton, Shahla Amin, Sheree Neese-Todd, Mark Olfson, Scott Bilder

The rapid growth of antipsychotic medication use among publicly insured children in the early and mid-2000s spurred new state efforts to monitor and improve prescription behavior. A starting point for many oversight initiatives was the foster care system, where most of the children are insured publicly through Medicaid.

Quality of HIV Care and Mortality Rates in HIV-Infected Patients

Philip Todd Korthuis, Kathleen A. McGinnis, Kevin L. Kraemer, Adam J. Gordon, Melissa Skanderson, Amy C. Justice, Stephen Crystal, Matthew Bidwell Goetz, Cynthia L. Gibert, David Rimland, Lynn E. Fiellin, Julie R. Gaither, Karen Wang, Steven M. Asch, Donald Keith McInnes, Michael E. Ohl, Kendall Bryant, Janet P. Tate, Mona Duggal, David A. Fiellin

Background. The Patient Protection and Affordable Care Act encourages healthcare systems to track quality-of-care measures; little is known about their impact on mortality rates. The objective of this study was to assess associations between HIV quality of care and mortality rates.

Non-medical use of prescription opioids is associated with heroin initiation among US veterans: a prospective cohort study

Geetanjoli Banerjee, E. Jennifer Edelman, Declan T. Barry, William C. Becker, Magdalena Cerdá, Stephen Crystal, Julie R. Gaither, Adam J. Gordon, Kirsha S. Gordon, Robert D. Kerns, Silvia S. Martins, David A. Fiellin, Brandon D.L. Marshall

AIMS: To estimate the influence of non-medical use of prescription opioids (NMUPO) on heroin initiation among US veterans receiving medical care.

DESIGN: Using a multivariable Cox regression model, we analyzed data from a prospective, multi-site, observational study of HIV-infected and an age/race/site-matched control group of HIV-uninfected veterans in care in the United States. Approximately annual behavioral assessments were conducted and contained self-reported measures of NMUPO and heroin use.

Hepatic Safety of Buprenorphine in HIV-Infected and Uninfected Patients With Opioid Use Disorder: The Role of HCV-Infection

Jeanette M. Tetrault, Janet P. Tate, E. Jennifer Edelman, Adam J. Gordon, Vincent Lo Re, Joseph K. Lim, David Rimland, Joseph Goulet, Stephen Crystal, Julie R. Gaither, Cynthia L. Gibert, Maria C. Rodriguez-Barradas, Lynn E. Fiellin, Kendall Bryant, Amy C. Justice, David A. Fiellin

Introduction Individuals with HIV and hepatitis C (HCV) infection, alcohol use disorder, or who are prescribed potentially hepatotoxic medications may be at increased risk for buprenorphine (BUP) associated hepatotoxicity. Materials and methods We examined a cohort of HIV-infected and uninfected patients receiving an initial BUP prescription between 2003 and 2012. We compared changes in alanine and aspartate aminotransferases (ALT and AST) and total bilirubin (TB) stratified by HIV status.

Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients

Kathleen A. McGinnis, Janet P. Tate, Emily C. Williams, Melissa Skanderson, Kendall J. Bryant, Adam J. Gordon, Kevin L. Kraemer, Stephen A. Maisto, Stephen Crystal, David A. Fiellin, Amy C. Justice

Background Using electronic medical record (EMR) data for clinical decisions, quality improvement, and research is common. While unhealthy alcohol use is particularly risky among HIV infected individuals (HIV+), the validity of EMR data for identifying unhealthy alcohol use among HIV+ is unclear. Among HIV+ and uninfected, we: (1) assess agreement of EMR and research AUDIT-C at validated cutoffs for unhealthy alcohol use; (2) explore EMR cutoffs that maximize agreement; and (3) assess subpopulation variation in agreement.

Association of chronic obstructive pulmonary disease with frailty measurements in HIV-infected and uninfected Veterans

Kathleen M. Akgun, Janet P. Tate, Krisann K. Oursler, Stephen Crystal, David A. Leaf, Julie A. Womack, Todd T. Brown, Amy C. Justice, Kristina Crothers

Objective: Chronic obstructive pulmonary disease (COPD) prevalence is increasing among aging HIV-infected individuals. We determined the association between COPD and self-reported measures of frailty [adapted frailty-related phenotype (aFRP)] and physical limitation, and a clinical biomarker of physiologic frailty [Veterans Aging Cohort Study (VACS) Index] in HIV-infected compared with uninfected individuals. Design: Cross-sectional study of VACS participants between 2002 and 2012.

Alcohol-Related Diagnoses and All-Cause Hospitalization Among HIV-Infected and Uninfected Patients: A Longitudinal Analysis of United States Veterans from 1997 to 2011

Christopher Rentsch, Janet P. Tate, Kathleen M. Akgün, Stephen Crystal, Karen H. Wang, S. Ryan Greysen, Emily A. Wang, Kendall J. Bryant, David A. Fiellin, Amy C. Justice, David Rimland

Individuals with HIV infection are living substantially longer on antiretroviral therapy, but hospitalization rates continue to be relatively high. We do not know how overall or diagnosis-specific hospitalization rates compare between HIV-infected and uninfected individuals or what conditions may drive hospitalization trends. Hospitalization rates among United States Veterans were calculated and stratified by HIV serostatus and principal diagnosis disease category.

Access to psychosocial services prior to starting antipsychotic treatment among medicaid-insured youth

Molly Finnerty, Sheree Neese-Todd, Riti Pritam, Emily Leckman-Westin, Scott Bilder, Sepheen C. Byron, Sarah Hudson Scholle, Stephen Crystal, Mark Olfson

Objective To examine rates and predictors of receiving a psychosocial service before initiating antipsychotic treatment among young people in the Medicaid program. Method A retrospective new-user cohort study of 8 state Medicaid programs focused on children and adolescents 0 to 20 years, initiating antipsychotic treatment (N = 24,372).

Type 2 diabetes mellitus in youth exposed to antipsychotics: A systematic review and meta-analysis

Britta Galling, Alexandra Roldán, René E. Nielsen, Jimmi Nielsen, Tobias Gerhard, Maren Carbon, Brendon Stubbs, Davy Vancampfort, Marc De Hert, Mark Olfson, Kai G. Kahl, Andres Martin, Jeff J. Guo, Hsien Yuan Lane, Fung Chang Sung, Chun Hui Liao, Celso Arango, Christoph U. Correll

IMPORTANCE Antipsychotics are used increasingly in youth for nonpsychotic and off-label indications, but cardiometabolic adverse effects and (especially) type 2 diabetes mellitus (T2DM) risk have raised additional concern. OBJECTIVE To assess T2DM risk associated with antipsychotic treatment in youth. DATA SOURCES Systematic literature search of PubMed and PsycINFO without language restrictions from database inception until May 4, 2015. Data analyses were performed in July 2015, and additional analyses were added in November 2015.