Clinical Research and National Children's Study Copyright (c) 2013 University of Massachusetts Medical School All rights reserved. http://escholarship.umassmed.edu/peds_research Recent documents in Clinical Research and National Children's Study en-us Wed, 08 May 2013 12:30:35 PDT 3600 A therapeutic dose of ketoprofen causes acute gastrointestinal bleeding, erosions, and ulcers in rats http://escholarship.umassmed.edu/peds_research/10 http://escholarship.umassmed.edu/peds_research/10 Mon, 22 Apr 2013 11:21:10 PDT Perioperative treatment of several rats in our facility with ketoprofen (5 mg/kg SC) resulted in blood loss, peritonitis, and death within a day to a little more than a week after surgery that was not related to the gastrointestinal tract. Published reports have established the 5-mg/kg dose as safe and effective for rats. Because ketoprofen is a nonselective nonsteroidal antiinflammatory drug that can damage the gastrointestinal tract, the putative diagnosis for these morbidities and mortalities was gastrointestinal toxicity caused by ketoprofen (5 mg/kg). We conducted a prospective study evaluating the effect of this therapeutic dose of ketoprofen on the rat gastrointestinal tract within 24 h. Ketoprofen (5 mg/kg SC) was administered to one group of rats that then received gas anesthesia for 30 min and to another group without subsequent anesthesia. A third group was injected with saline followed by 30 min of gas anesthesia. Our primary hypothesis was that noteworthy gastrointestinal bleeding and lesions would occur in both groups treated with ketoprofen but not in rats that received saline and anesthesia. Our results showed marked gastrointestinal bleeding, erosions, and small intestinal ulcers in the ketoprofen-treated rats and minimal damages in the saline-treated group. The combination of ketoprofen and anesthesia resulted in worse clinical signs than did ketoprofen alone. We conclude that a single 5-mg/kg dose of ketoprofen causes acute mucosal damage to the rat small intestine.

]]> Lisa J. Shientag et al. Ketoprofen Rats Intestine, Small Intestinal Mucosa Gastrointestinal Diseases Identifying symptom profiles of depression and anxiety in patients with an acute coronary syndrome using latent class and latent transition analysis http://escholarship.umassmed.edu/peds_research/9 http://escholarship.umassmed.edu/peds_research/9 Tue, 19 Jun 2012 19:12:23 PDT OBJECTIVE: To identify symptom profiles of depression and anxiety in patients with an acute coronary syndrome (ACS), to examine changes in symptom profiles over time, and finally, to examine the effects of age and sex on patients' symptom profiles.

METHODS: One hundred ACS patients with mild to severe symptoms of depression and/or anxiety at 1 month post-hospital discharge were enrolled in a randomized trial of cognitive behavioral therapy. Latent class and latent transition analyses were used to identify symptom profiles and describe change over the time in profile membership.

RESULTS: A two-class solution was selected to describe depression and anxiety symptom profiles. Class I (76% of patients at baseline) was labeled "depression and some anxiety symptoms." Class II (24% of patients at baseline) was labeled "anxiety and some depression symptoms." Approximately 25% of patients in the treatment condition transitioned from the depression and some anxiety symptoms class to the anxiety and some depression symptoms class at follow-up compared to 10% of patients in the control condition at follow-up; nearly 50% of patients in the control condition showed worsening of symptoms as compared to 28% in the treatment condition. Results suggested age differences in the probabilities of transitioning between the classes; older patients were more likely to continue having depression and some anxiety symptoms at the time of follow-up.

CONCLUSIONS: Identifying symptom profiles of depression and anxiety in patients with an ACS may improve diagnostic practices and help to design tailored interventions.

]]> Mayra Tisminetzky et al. Acute Coronary Syndrome Adaptation, Psychological Aged Angina, Unstable Anxiety Disorders Cognitive Therapy Comorbidity Cross-Sectional Studies Depressive Disorder, Major Fear Female Humans Male Middle Aged Myocardial Infarction Personality Inventory Classes of depression, anxiety, and functioning in acute coronary syndrome patients http://escholarship.umassmed.edu/peds_research/8 http://escholarship.umassmed.edu/peds_research/8 Tue, 19 Jun 2012 19:12:21 PDT OBJECTIVES: To describe change in subgroups characterized by patterns of depression, anxiety, and functional impairment; examine treatment effects on subgroup membership; examine effects of sex and age on subgroup membership.

METHODS: Latent class models were used to meet the first 2 objectives using 79 patients with depression/anxiety. Generalized estimating equations were used to meet the third objective.

RESULTS: Three subgroups characterized by different combinations of psychiatric disorders and functioning were identified. Patients who received treatment were more likely to transition to a less impaired subgroup.

CONCLUSIONS: Unique information about holistic treatment effects can be gained when multiple outcomes are considered simultaneously.

]]> Mayra Tisminetzky et al. Acute Coronary Syndrome Adaptation, Psychological Age Factors Anxiety Cognitive Therapy Depression Female Humans Male Middle Aged Models, Psychological Psychiatric Status Rating Scales Sex Factors A Collaborative Care Model to Improve Access to Pediatric Mental Health Services http://escholarship.umassmed.edu/peds_research/7 http://escholarship.umassmed.edu/peds_research/7 Tue, 19 Jun 2012 19:12:20 PDT To examine if an innovative collaborative care model known as Targeted Child Psychiatric Services designed for primary care pediatricians (PCPs) and child psychiatrists (1) was associated with improved access to child psychiatry services, (2) had the potential to identify optimal care settings for pediatric mental health care and (3) examined if pediatricians appeared as likely to accept children back into their practices at discharge from TCPS depending upon diagnostic category, controlling for severity of illness and function. The diagnostic classes examined were ADHD (39%), depression (31%) and anxiety (13%). This prospective cohort design study collected medical records of 329 children referred to TCPS by 139 PCPs. To detect the likelihood of return to referring pediatricians for follow-up care at discharge from TCPS, we employed logistic regression models. Mean age was 12.3 (SD = 4.0); 43% were female. Ninety-three percent of parents complied with pediatricians' recommendations to have their child assessed by a child psychiatrist. A total of 28.0% of referrals returned to PCPs for follow-up care; the remainder were followed in mental health. Regression findings indicated that children with major depression (OR = 7.5) or anxiety disorders (OR = 5.1) were less likely to return to PCPs compared to ADHD even though severity of psychiatric illness and functional levels did not differ across diagnostic groups. Families widely accepted pediatricians' recommendations for referral to child psychiatrists. Depression and anxiety were strong correlates of retention in mental health settings at discharge from TCPS though children with these disorders appeared to be no more severely ill or functionally limited than peers with ADHD. These children possibly could be managed in a less intensive and expensive primary care treatment setting that could access mental health specialty services as needed in a collaborative model of care. TCPS is contrasted with the well-known collaborative model for adult depression in primary care. TCPS could serve as a feasible model of care that addresses the daunting barriers in accessing pediatric mental health services.

]]> Onesky Aupont et al. Mental Health Services Child Existing capacity to manage pharmaceuticals and related commodities in East Africa: an assessment with specific reference to antiretroviral therapy http://escholarship.umassmed.edu/peds_research/6 http://escholarship.umassmed.edu/peds_research/6 Wed, 13 Jun 2012 05:52:51 PDT BACKGROUND: East African countries have in the recent past experienced a tremendous increase in the volume of antiretroviral drugs. Capacity to manage these medicines in the region remains limited. Makerere University, with technical assistance from the USAID supported Rational Pharmaceutical Management Plus (RPM Plus) Program of Management Sciences for Health (MSH) established a network of academic institutions to build capacity for pharmaceutical management in the East African region. The initiative includes institutions from Uganda, Tanzania, Kenya and Rwanda and aims to improve access to safe, effective and quality-assured medicines for the treatment of HIV/AIDS, TB and Malaria through spearheading in-country capacity. The initiative conducted a regional assessment to determine the existing capacity for the management of antiretroviral drugs and related commodities.

METHODS: Heads and implementing workers of fifty HIV/AIDS programs and institutions accredited to offer antiretroviral services in Uganda, Kenya, Tanzania and Rwanda were key informants in face-to-face interviews guided by structured questionnaires. The assessment explored categories of health workers involved in the management of ARVs, their knowledge and practices in selection, quantification, distribution and use of ARVs, nature of existing training programs, training preferences and resources for capacity building.

RESULTS: Inadequate human resource capacity including, inability to select, quantify and distribute ARVs and related commodities, and irrational prescribing and dispensing were some of the problems identified. A competence gap existed in all the four countries with a variety of healthcare professionals involved in the supply and distribution of ARVs. Training opportunities and resources for capacity development were limited particularly for workers in remote facilities. On-the-job training and short courses were the preferred modes of training.

CONCLUSION: There is inadequate capacity for managing medicines and related commodities in East Africa. There is an urgent need for training in aspects of pharmaceutical management to different categories of health workers. Skills building activities that do not take healthcare workers from their places of work are preferred.

]]> Paul J. Waako et al. Pharmacy Administration Drug and Narcotic Control Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice http://escholarship.umassmed.edu/peds_research/5 http://escholarship.umassmed.edu/peds_research/5 Wed, 13 Jun 2012 05:52:50 PDT OBJECTIVE: Data are scarce regarding the sociodemographic predictors of antenatal and postpartum depression. This study investigated whether race/ethnicity, age, finances, and partnership status were associated with antenatal and postpartum depressive symptoms.

SETTING: 1662 participants in Project Viva, a US cohort study.

DESIGN: Mothers indicated mid-pregnancy and six month postpartum depressive symptoms on the Edinburgh postpartum depression scale (EPDS). Associations of sociodemographic factors with odds of scoring >12 on the EPDS were estimated.

MAIN RESULTS: The prevalence of depressive symptoms was 9% at mid-pregnancy and 8% postpartum. Black and Hispanic mothers had a higher prevalence of depressive symptoms compared with non-Hispanic white mothers. These associations were explained by lower income, financial hardship, and higher incidence of poor pregnancy outcome among minority women. Young maternal age was associated with greater risk of antenatal and postpartum depressive symptoms, largely attributable to the prevalence of financial hardship, unwanted pregnancy, and lack of a partner. The strongest risk factor for antenatal depressive symptoms was a history of depression (OR = 4.07; 95% CI 3.76, 4.40), and the strongest risk for postpartum depressive symptoms was depressive symptoms during pregnancy (6.78; 4.07, 11.31) or a history of depression before pregnancy (3.82; 2.31, 6.31).

CONCLUSIONS: Financial hardship and unwanted pregnancy are associated with antenatal and postpartum depressive symptoms. Women with a history of depression and those with poor pregnancy outcomes are especially vulnerable to depressive symptoms during the childbearing year. Once these factors are taken in account, minority mothers have the same risk of antenatal and postpartum depressive symptoms as white mothers.

]]> Janet W. Rich-Edwards et al. Adult Age Factors Depression, Postpartum Epidemiologic Methods Ethnic Groups Female Humans Marital Status Mothers Pregnancy Psychiatric Status Rating Scales Questionnaires Socioeconomic Factors United States A naturalistic study of medication reduction in a residential treatment setting http://escholarship.umassmed.edu/peds_research/2 http://escholarship.umassmed.edu/peds_research/2 Wed, 13 Jun 2012 05:52:48 PDT The primary aim of this pilot study was to ascertain if psychiatric medications could be reduced in a convenience sample of seriously emotionally disturbed children and adolescents over the course of residential treatment. We also sought to understand factors correlated with reduction in the number of medications during treatment. A review of the treatment of 141 patients (n = 112 admitted on medication and n = 29 admitted on no medication) admitted to, and discharged from, a residential treatment setting between 1992 and 2001 was undertaken. Significantly more children were discharged from treatment on no medications than were admitted to residential treatment on no medications. In children receiving more than 1 medication at admission, the number of combined medications was significantly reduced over the course of residential treatment. However, the majority of children admitted on medications continued on some psychiatric medications, indicating that psychopharmacology continued to play an important role in their treatment. In 112 patients admitted on psychoactive medications, our pilot data suggests that improvement in externalizing, internalizing, psychotic, and autistic psychopathology while in residential treatment, the presence of an intact family (adoptive or biological), the absence of a history of either sexual or physical abuse, and the type of medication used appear to be factors that correlate with a reduced use of medications in this population.

]]> Daniel F. Connor et al. Adolescent Adult Child Female Humans Male Mental Disorders Pilot Projects Psychotropic Drugs Residential Treatment Retrospective Studies The effect of a telephone counseling intervention on self-rated health of cardiac patients http://escholarship.umassmed.edu/peds_research/1 http://escholarship.umassmed.edu/peds_research/1 Wed, 13 Jun 2012 05:52:47 PDT OBJECTIVE: The objective of this study was to evaluate the effectiveness of a telephone-based intervention on psychological distress among patients with cardiac illness.

METHODS: We recruited hospitalized patients surviving an acute coronary syndrome with scores on the Hospital and Anxiety Depression Scale (HADS) indicating mild to severe depression and/or anxiety at 1 month postdischarge. Recruited patients were randomized into either an intervention or control group. Intervention patients received up to six 30-minute telephone-counseling sessions focused on identifying cardiac-related fears. Control patients received usual care. For both groups, we collected patients' responses to the HADS and to the Global Improvement (CGI-I) subscale of the Clinical Global Impressions (CGI) Scale at baseline and at 2, 3, and 6 months postbaseline using Interactive Voice Recognition (IVR) technologies. We used mixed-effects analysis to estimate patients' changes in CGI-I measures over the three time points of data collection postbaseline.

RESULTS: We enrolled 100 patients, and complete CGI-I measures were collected for 79 study patients. The mean age was 60 years (standard deviation = 10), and 67% of the patients were male. A mixed-effects analysis confirmed that patients in the intervention group had significantly greater improvements in self-rated health (SRH) between baseline and month 3 than the control group (p = .01). Between month 3 and month 6, no significant differences in SRH improvements were observed between the control and intervention groups.

CONCLUSIONS: Study patients reported greater SRH improvement resulting from the telephone-based intervention compared with control subjects. Future research should include additional outcome measures to determine the effect of changes in SRH on patients with comorbid physical and emotional disorders.

]]> Kara Zivin Bambauer et al. Aged Angina Pectoris Anxiety Counseling Depression Female Humans Interviews as Topic Male Middle Aged Myocardial Infarction Prospective Studies Psychological Tests Self-Assessment Stress, Psychological Treatment Outcome