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1.  Proceedings of the 14th annual conference of INEBRIA 
Holloway, Aisha S. | Ferguson, Jennifer | Landale, Sarah | Cariola, Laura | Newbury-Birch, Dorothy | Flynn, Amy | Knight, John R. | Sherritt, Lon | Harris, Sion K. | O’Donnell, Amy J. | Kaner, Eileen | Hanratty, Barbara | Loree, Amy M. | Yonkers, Kimberly A. | Ondersma, Steven J. | Gilstead-Hayden, Kate | Martino, Steve | Adam, Angeline | Schwartz, Robert P. | Wu, Li-Tzy | Subramaniam, Geetha | Sharma, Gaurav | McNeely, Jennifer | Berman, Anne H. | Kolaas, Karoline | Petersén, Elisabeth | Bendtsen, Preben | Hedman, Erik | Linderoth, Catharina | Müssener, Ulrika | Sinadinovic, Kristina | Spak, Fredrik | Gremyr, Ida | Thurang, Anna | Mitchell, Ann M. | Finnell, Deborah | Savage, Christine L. | Mahmoud, Khadejah F. | Riordan, Benjamin C. | Conner, Tamlin S. | Flett, Jayde A. M. | Scarf, Damian | McRee, Bonnie | Vendetti, Janice | Gallucci, Karen Steinberg | Robaina, Kate | Clark, Brendan J. | Jones, Jacqueline | Reed, Kathryne D. | Hodapp, Rachel M. | Douglas, Ivor | Burnham, Ellen L. | Aagaard, Laura | Cook, Paul F. | Harris, Brett R. | Yu, Jiang | Wolff, Margaret | Rogers, Meighan | Barbosa, Carolina | Wedehase, Brendan J. | Dunlap, Laura J. | Mitchell, Shannon G. | Dusek, Kristi A. | Gryczynski, Jan | Kirk, Arethusa S. | Oros, Marla T. | Hosler, Colleen | O’Grady, Kevin E. | Brown, Barry S. | Angus, Colin | Sherborne, Sidney | Gillespie, Duncan | Meier, Petra | Brennan, Alan | de Vargas, Divane | Soares, Janaina | Castelblanco, Donna | Doran, Kelly M. | Wittman, Ian | Shelley, Donna | Rotrosen, John | Gelberg, Lillian | Edelman, E. Jennifer | Maisto, Stephen A. | Hansen, Nathan B. | Cutter, Christopher J. | Deng, Yanhong | Dziura, James | Fiellin, Lynn E. | O’Connor, Patrick G. | Bedimo, Roger | Gibert, Cynthia | Marconi, Vincent C. | Rimland, David | Rodriguez-Barradas, Maria C. | Simberkoff, Michael S. | Justice, Amy C. | Bryant, Kendall J. | Fiellin, David A. | Giles, Emma L. | Coulton, Simon | Deluca, Paolo | Drummond, Colin | Howel, Denise | McColl, Elaine | McGovern, Ruth | Scott, Stephanie | Stamp, Elaine | Sumnall, Harry | Vale, Luke | Alabani, Viviana | Atkinson, Amanda | Boniface, Sadie | Frankham, Jo | Gilvarry, Eilish | Hendrie, Nadine | Howe, Nicola | McGeechan, Grant J. | Ramsey, Amy | Stanley, Grant | Clephane, Justine | Gardiner, David | Holmes, John | Martin, Neil | Shevills, Colin | Soutar, Melanie | Chi, Felicia W. | Weisner, Constance | Ross, Thekla B. | Mertens, Jennifer | Sterling, Stacy A. | Shorter, Gillian W. | Heather, Nick | Bray, Jeremy | Cohen, Hildie A. | McPherson, Tracy L. | Adam, Cyrille | López-Pelayo, Hugo | Gual, Antoni | Segura-Garcia, Lidia | Colom, Joan | Ornelas, India J. | Doyle, Suzanne | Donovan, Dennis | Duran, Bonnie | Torres, Vanessa | Gaume, Jacques | Grazioli, Véronique | Fortini, Cristiana | Paroz, Sophie | Bertholet, Nicolas | Daeppen, Jean-Bernard | Satterfield, Jason M. | Gregorich, Steven | Alvarado, Nicholas J. | Muñoz, Ricardo | Kulieva, Gozel | Vijayaraghavan, Maya | Adam, Angéline | Cunningham, John A. | Díaz, Estela | Palacio-Vieira, Jorge | Godinho, Alexandra | Kushir, Vladyslav | O’Brien, Kimberly H. M. | Aguinaldo, Laika D. | Sellers, Christina M. | Spirito, Anthony | Chang, Grace | Blake-Lamb, Tiffany | LaFave, Lea R. Ayers | Thies, Kathleen M. | Pepin, Amy L. | Sprangers, Kara E. | Bradley, Martha | Jorgensen, Shasta | Catano, Nico A. | Murray, Adelaide R. | Schachter, Deborah | Andersen, Ronald M. | Rey, Guillermina Natera | Vahidi, Mani | Rico, Melvin W. | Baumeister, Sebastian E. | Johansson, Magnus | Sinadinovic, Christina | Hermansson, Ulric | Andreasson, Sven | O’Grady, Megan A. | Kapoor, Sandeep | Akkari, Cherine | Bernal, Camila | Pappacena, Kristen | Morley, Jeanne | Auerbach, Mark | Neighbors, Charles J. | Kwon, Nancy | Conigliaro, Joseph | Morgenstern, Jon | Magill, Molly | Apodaca, Timothy R. | Borsari, Brian | Hoadley, Ariel | Scott Tonigan, J. | Moyers, Theresa | Fitzgerald, Niamh M. | Schölin, Lisa | Barticevic, Nicolas | Zuzulich, Soledad | Poblete, Fernando | Norambuena, Pablo | Sacco, Paul | Ting, Laura | Beaulieu, Michele | Wallace, Paul George | Andrews, Matthew | Daley, Kate | Shenker, Don | Gallagher, Louise | Watson, Rod | Weaver, Tim | Bruguera, Pol | Oliveras, Clara | Gavotti, Carolina | Barrio, Pablo | Braddick, Fleur | Miquel, Laia | Suárez, Montse | Bruguera, Carla | Brown, Richard L. | Capell, Julie Whelan | Paul Moberg, D. | Maslowsky, Julie | Saunders, Laura A. | McCormack, Ryan P. | Scheidell, Joy | Gonzalez, Mirelis | Bauroth, Sabrina | Liu, Weiwei | Lindsay, Dawn L. | Lincoln, Piper | Hagle, Holly | Wallhed Finn, Sara | Hammarberg, Anders | Andréasson, Sven | King, Sarah E. | Vargo, Rachael | Kameg, Brayden N. | Acquavita, Shauna P. | Van Loon, Ruth Anne | Smith, Rachel | Brehm, Bonnie J. | Diers, Tiffiny | Kim, Karissa | Barker, Andrea | Jones, Ashley L. | Skinner, Asheley C. | Hinman, Agatha | Svikis, Dace S. | Thacker, Casey L. | Resnicow, Ken | Beatty, Jessica R. | Janisse, James | Puder, Karoline | Bakshi, Ann-Sofie | Milward, Joanna M. | Kimergard, Andreas | Garnett, Claire V. | Crane, David | Brown, Jamie | West, Robert | Michie, Susan | Rosendahl, Ingvar | Andersson, Claes | Gajecki, Mikael | Blankers, Matthijs | Donoghue, Kim | Lynch, Ellen | Maconochie, Ian | Phillips, Ceri | Pockett, Rhys | Phillips, Tom | Patton, R. | Russell, Ian | Strang, John | Stewart, Maureen T. | Quinn, Amity E. | Brolin, Mary | Evans, Brooke | Horgan, Constance M. | Liu, Junqing | McCree, Fern | Kanovsky, Doug | Oberlander, Tyler | Zhang, Huan | Hamlin, Ben | Saunders, Robert | Barton, Mary B. | Scholle, Sarah H. | Santora, Patricia | Bhatt, Chirag | Ahmed, Kazi | Hodgkin, Dominic | Gao, Wenwu | Merrick, Elizabeth L. | Drebing, Charles E. | Larson, Mary Jo | Sharma, Monica | Petry, Nancy M. | Saitz, Richard | Weisner, Constance M. | Young-Wolff, Kelly C. | Lu, Wendy Y. | Blosnich, John R. | Lehavot, Keren | Glass, Joseph E. | Williams, Emily C. | Bensley, Kara M. | Chan, Gary | Dombrowski, Julie | Fortney, John | Rubinsky, Anna D. | Lapham, Gwen T. | Forray, Ariadna | Olmstead, Todd A. | Gilstad-Hayden, Kathryn | Kershaw, Trace | Dillon, Pamela | Weaver, Michael F. | Grekin, Emily R. | Ellis, Jennifer D. | McGoron, Lucy | McGoron, Lucy
doi:10.1186/s13722-017-0087-8
PMCID: PMC5606215
2.  Screening Young Adult Cancer Survivors for Distress with the Distress Thermometer (DT): Comparisons with a Structured Clinical Diagnostic Interview 
Cancer  2015;122(2):296-303.
BACKGROUND
The validity of the Distress Thermometer (DT) as a screen for psychological distress in young adult (YA) cancer survivors was assessed by comparing it with results of a psychiatric diagnostic interview, the Structured Clinical Interview for the DSM-IV (SCID), in order to evaluate accuracy of the DT and identify optimal cut-off scores for this population.
METHODS
247 survivors (age 18–40 years) completed the DT and SCID. Based on the SCID, participants were classified as having: 1) One or more SCID diagnoses; 2) Significant symptoms, but no SCID diagnosis; or 3) No significant SCID symptoms. ROC analyses determined sensitivity and specificity of all possible DT cut-off scores for detecting survivors with a SCID diagnosis, and subsequently for survivors with significant SCID symptoms or a SCID diagnosis.
RESULTS
The recommended DT cut-off score of ≥ 5 failed to identify 31.81% of survivors with a SCID diagnosis (sensitivity 68.18%, specificity 78.33%), and 32.81% of survivors with either Significant SCID symptoms or a SCID diagnosis. No alternative DT cut-off score met criteria for acceptable sensitivity (≥.85) and specificity (≥.75).
CONCLUSIONS
The DT does not reliably identify YA cancer survivors with psychiatric problems identified by a “gold standard” structured psychiatric interview; the DT should not be used as a stand-alone psychological screen in this population.
doi:10.1002/cncr.29736
PMCID: PMC4707976  PMID: 26457669
Distress thermometer; cancer survivors; validation; depression; anxiety; SCID
3.  Management of opioid use disorders among veterans in subacute rehab: Use of an interdisciplinary task force to address an emerging concern 
Substance abuse  2015;37(1):4-6.
There is both rapidly growing need, and limited evidence-based guidelines, for the management of opioid use disorders in subacute rehab and other nonaddiction medical settings. Following 2 unintentional opioid overdoses within the Community Living Center (CLC), a VA (Veterans Administration) subacute rehab setting, an interdisciplinary CLC Addictions Task Force was created to address a critical issue: how to best meet the combined neuropsychiatric and medical needs of the opiate use disorder patient through a multifaceted treatment approach. The goals of the task force were to develop and institute educational initiatives for providers; create patient care guidelines; increase safety on the unit; improve provider confidence when caring for this high-risk population; and mitigate the risk of unintentional overdose. The task force divided into 4 working groups to meet these aims. Process and outcomes are discussed. We found that in-services by addiction specialists improved clinician comfort in caring for this high-risk patient group. Specific areas that yielded the greatest clinician satisfaction ratings included didactics on how to identify at-risk patients and techniques on how to manage the patient in a general rehab setting. Utilizing an interdisciplinary approach, and an iterative process, at all stages was critical to the success of the CLC Addictions Task Force, as it improved buy-in and motivation from all disciplines. Improvements have been made to enhance patient safety, improve communication amongst providers, and provide a foundation to improve patient outcomes. Our preliminary work to enhance the identification and management of opioid use disorders at our CLC is an important first step towards a standardized curriculum that could be applied to other VA and non-VA subacute rehab settings.
doi:10.1080/08897077.2015.1127871
PMCID: PMC5069695  PMID: 26672391
Interdisciplinary; intervention; opioid, rehabilitation
4.  Computer-Delivered Screening and Brief Intervention for Alcohol Use in Pregnancy: A Pilot Randomized Trial 
Background
Although screening and brief intervention (SBI) for unhealthy alcohol use has demonstrated efficacy in some trials, its implementation has been limited. Technology-delivered approaches are a promising alternative, particularly during pregnancy when the importance of alcohol use is amplified. The present trial evaluated the feasibility and acceptability of an interactive, empathic, video-enhanced, and computer-delivered SBI (e-SBI) plus three separate tailored mailings, and estimated intervention effects.
Methods
We recruited 48 pregnant women who screened positive for alcohol risk at an urban prenatal care clinic. Participants were randomly assigned to the e-SBI plus mailings or to a control session on infant nutrition, and were reevaluated during their postpartum hospitalization. The primary outcome was 90-day period-prevalence abstinence as measured by timeline follow-back interview.
Results
Participants rated the intervention as easy to use and helpful (4.7-5.0 on a 5-point scale). Blinded follow-up evaluation at childbirth revealed medium-size intervention effects on 90-day period prevalence abstinence (OR = 3.4); similarly, intervention effects on a combined healthy pregnancy outcome variable (live birth, normal birthweight, and no NICU stay) were also of moderate magnitude in favor of e-SBI participants (OR=3.3). As expected in this intentionally under-powered pilot trial, these effects were non-significant (p = .19 and .09, respectively).
Conclusions
This pilot trial demonstrated the acceptability and preliminary efficacy of a computer-delivered screening and brief intervention (e-SBI) plus tailored mailings for alcohol use in pregnancy. These findings mirror the promising results of other trials using a similar approach, and should be confirmed in a fully-powered trial.
doi:10.1111/acer.12747
PMCID: PMC4490994  PMID: 26010235
5.  Acceptability of a Computerized Brief Intervention for Alcohol among Abstinent but at-Risk Pregnant Women 
Background
Limitations in time and training have hindered widespread implementation of alcohol-based interventions in prenatal clinics. Also, despite the possibility of under-reporting or relapse, many at risk women report that they quit drinking after pregnancy confirmation so that interventions focusing on current drinking may seem unnecessary. The Computerized Brief Intervention for Alcohol Use in Pregnancy (C-BIAP) was designed to (a) be implemented via a handheld device in prenatal clinics, and (b) use a modified brief intervention strategy with women who screen at-risk but report no current drinking.
Methods
We administered the C-BIAP to 18 T-ACE (Tolerance, Annoyance, Cut Down, and Eye Opener) positive, pregnant African-American women who provided quantitative and qualitative feedback.
Results
The C-BIAP received high ratings of acceptability; qualitative feedback was also positive overall and suggested good acceptance of abstinence themes.
Conclusions
Technology may be a feasible and acceptable method for brief intervention delivery with pregnant women who do not report current drinking.
doi:10.1080/08897077.2013.857631
PMCID: PMC4031312  PMID: 24266770
alcohol/alcoholism; intervention programs; pregnancy; research; mixed methods; technology
6.  Parent Outlook: How Parents View the Road Ahead as They Embark on Hematopoietic Stem Cell Transplantation for Their Child 
Pediatric hematopoietic stem cell transplantation (HSCT) offers cure for high-risk malignancies and other conditions, but carries a risk of complications. Parental outlook regarding their child’s transplantation course and future health has been largely unexplored. This report presents the Parent Outlook Scale, describes its properties, and examines the outlook of parents embarking on their child’s transplantation course and the associated variables. Parents of children scheduled to undergo HSCT (n = 363) at 8 US transplantation centers completed the Parent Outlook Scale, comprising 4 items assessing frequency of the parent’s thoughts about the potential difficulty of the child’s transplantation (Transplant Diffficult subscale) and worsened health (Health Worse subscale). Item responses were rated on a 5-point Likert scale (ranging from “none” to “all of the time”) and, along with scale/subscale scores, transformed to 100-point scales, with higher scores connoting greater thought frequency. Psychometrics were explored. Multivariable models identified personal and clinical characteristics associated with scale and subscale scores. The Parent Outlook Scale (α = 0.75) and subscales were found to have sound psychometric properties. Factor loading supported the single scale with 2 subscales representing distinct aspects of overall outlook. Mean scores (Parent Outlook, 52.5 ± 21.7; Transplant Difficult, 64.4 ± 25.6; Health Worse, 40.7 ± 25.7) revealed variability within and across scale/subscales. Significantly different mean subscale scores (P < .001) indicated more frequent Transplant Difficult thoughts than Health Worse thoughts. Clinical factors (solid tumor diagnosis and unrelated donor transplant) and a parent factor (worse emotional functioning) were associated with higher scale and subscale scores. Our findings show that the outlook of parents embarking on their child’s HSCT course is varied and not solely a product of clinical factors readily apparent to clinicians. Referring and transplantation clinicians should create opportunities to explore with parents their perspectives and concerns before and during the course of HSCT.
doi:10.1016/j.bbmt.2015.08.040
PMCID: PMC4706486  PMID: 26348891
Health-related quality of life; Hematopoietic stem cell transplantation; Pediatrics; Supportive care
7.  The impact of pediatric blood and marrow transplant on parents: introduction of the parent impact scale 
Background
Parents often experience stress-related complications when their child requires blood and marrow transplant (BMT). Previous studies have described the emotional toll BMT places on parents during the acute phase of care and within the context of clinical complications. In this paper we introduce the Parent Impact Scale (PARimpact), designed to capture physical and emotional challenges of the child’s health on the parent. The primary aim of this paper is to examine psychometric properties of PARimpact, and the secondary aim is to explore factors associated with PARimpact scores for further hypothesis generation.
Methods
This analysis used a merged dataset of two longitudinal studies. Accompanying parents (n = 363) of children undergoing BMT were surveyed up to six times from pre-BMT baseline to one year after their child’s BMT. For this analysis, pre-BMT baseline responses to PARimpact were used to examine the factor structure with Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA). Construct validity was assessed, and multivariable regression was used to examine relationships between PARimpact and BMT clinical variables.
Results
PCA and EFA revealed a one-factor solution with acceptable item loading; Cronbach’s α was 0.83 at baseline. Hypothesized differences in known groups were detected for BMT complications with significantly higher PARimpact scores for those with vs. without each complication. In the adjusted multivariable regression models, acute graft versus host disease (b = 5.3; p = 0.03), end organ toxicity (b = 5.9; p < 0.01), and systemic infection (b = 9.1; p < 0.01) were associated with significantly higher mean PARimpact scores in the first 3 months following transplant. After the first 3 months to 1 year post BMT, systemic infection was associated with increased mean PARimpact scores (b = 19.2; p < 0.01).
Conclusions
Initial results suggest that the PARimpact is valid and reliable. Our finding that clinical complications increase the impact of BMT on the caretaking parent indicates the need for BMT healthcare professionals to identify these events and help parents navigate the BMT course. Clinical application of the PARimpact scale should be considered to identify high-risk families and provide targeted interventions to augment care.
doi:10.1186/s12955-015-0240-6
PMCID: PMC4408604  PMID: 25890070
Blood and marrow transplantation; Caregiving; Stress; Parent impact
8.  In Vitro Fertilization Outcomes and Alcohol Consumption in At-Risk Drinkers: The Effects of a Randomized Intervention 
Background and Objectives
Women’s use of alcohol in pregnancy is associated with an increase risk of fetal loss and birth defects. Also, alcohol use in women decreases the success of infertility treatment, such as in vitro fertilization (IVF). Our goal was to determine if there were differences in IVF outcomes and alcohol use parameters among at-risk drinkers randomized to a brief intervention (BI) vs. assessment only (AO).
Methods
We conducted a randomized controlled trial to determine the effect of brief intervention (BI) or assessment only (AO) among at-risk drinkers on in vitro fertilization (IVF). We studied 37 women (AO= 21; BI= 16).
Results
While the BI group had a significantly greater decrease in the number of drinks/drinking day compared to the AO group (P=0.04), there were no differences in the likelihood of implantation failure, chemical pregnancy, spontaneous abortion, preterm birth, or live birth.
Conclusions
BI and AO contributed to a decrease in alcohol use and did not demonstrate differences in IVF outcomes. A larger study may confirm these preliminary findings.
Scientific Significance
Our results will assist care providers in treating alcohol use in pregnancy in an effective way, such that IVF cycles and the chance of pregnancy are optimized.
doi:10.1111/j.1521-0391.2013.12019.x
PMCID: PMC3748391  PMID: 23952894
9.  Alcohol Use and Religiousness/Spirituality Among Adolescents 
Southern medical journal  2007;100(4):349-355.
Background
Previous studies indicate that religiousness is associated with lower levels of substance use among adolescents, but less is known about the relationship between spirituality and substance use. The objective of this study was to determine the association between adolescents’ use of alcohol and specific aspects of religiousness and spirituality.
Methods
Twelve- to 18-year-old patients coming for routine medical care at three primary care sites completed a modified Brief Multidimensional Measure of Religiousness/Spirituality; the Spiritual Connectedness Scale; and a past-90-days alcohol use Timeline Followback calendar. We used multiple logistic regression analysis to assess the association between each religiousness/spirituality measure and odds of any past-90-days alcohol use, controlling for age, gender, race/ethnicity, and clinic site. Timeline Followback data were dichotomized to indicate any past-90-days alcohol use and religiousness/spirituality scale scores were z-transformed for analysis.
Results
Participants (n = 305) were 67% female, 74% Hispanic or black, and 45% from two-parent families. Mean ± SD age was 16.0 ± 1.8 years. Approximately 1/3 (34%) reported past-90-day alcohol use. After controlling for demographics and clinic site, Religiousness/Spirituality scales that were not significantly associated with alcohol use included: Commitment (OR = 0.81, 95% CI 0.36, 1.79), Organizational Religiousness (OR = 0.83, 95% CI 0.64, 1.07), Private Religious Practices (OR = 0.94, 95% CI 0.80, 1.10), and Religious and Spiritual Coping – Negative (OR = 1.07, 95% CI 0.91, 1.23). All of these are measures of religiousness, except for Religious and Spiritual Coping – Negative. Scales that were significantly and negatively associated with alcohol use included: Forgiveness (OR = 0.55, 95% CI 0.42–0.73), Religious and Spiritual Coping –Positive (OR = 0.67, 95% CI 0.51–0.84), Daily Spiritual Experiences (OR = 0.67, 95% CI 0.54–0.84), and Belief (OR = 0.76, 95% CI 0.68–0.83), which are all measures of spirituality. In a multivariable model that included all significant measures, however, only Forgiveness remained as a significant negative correlate of alcohol use (OR = 0.56, 95% CI 0.41, 0.74).
Conclusions
Forgiveness is associated with a lowered risk of drinking during adolescence.
doi:10.1097/SMJ.0b013e3180316a32
PMCID: PMC4143181  PMID: 17458392
spirituality; religion; substance-related disorders; alcoholism; adolescence
10.  Performance of the parent emotional functioning (PREMO) screener in parents of children undergoing hematopoietic stem cell transplantation 
PURPOSE
Parents of children undergoing hematopoietic stem cell transplantation (HSCT) may face emotional distress while managing intense treatments with uncertain outcomes. We evaluated a brief parental emotional functioning (PREMO) screener from a health-related quality of life instrument to identify parental emotional distress, as measured by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID).
METHODS
As part of a longitudinal pediatric HSCT study, parents (N=165) completed the Child Health Ratings Inventories, which contain the 7-item PREMO screener. Some parents (n=117) also completed SCID modules for anxiety, mood, and adjustment disorders at baseline and/or 12 months. A composite outcome was created for threshold or subthreshold levels of any of these disorders. Receiver operating characteristic (ROC) analysis assessed how the PREMO screener predicted emotional distress as measured by the SCID. A prediction model was then built.
RESULTS
52% of parents completing the SCID had an Axis I disorder at baseline, while 41% had an Axis I disorder at 12 months. The area under the ROC curve was 0.75 for the PREMO screener and 0.81 for the prediction model.
CONCLUSIONS
The PREMO screener may identify parents with, or at risk for, emotional distress and facilitate further evaluation and intervention.
doi:10.1007/s11136-012-0240-5
PMCID: PMC3753102  PMID: 22836377
quality of life; hematopoietic stem cell transplantation; ROC analysis; pediatric
11.  Psychosocial Changes Six Months after Face Transplantation 
Psychosomatics  2012;54(4):367-371.
The goal of facial transplantation is to transform severely deformed features in a single, complex operation. Although nearly 20 have been completed since 2005, there is limited information about the subsequent psychosocial status of recipients. The purpose of this study is to describe such changes as captured on a variety of psychosocial measures three and six months after full facial transplantation among three adults who all completed a comprehensive psychiatric assessment before the procedure. We hypothesized and found that participants experienced significant improvement on quality of life measures of physical and mental health based on the MOS-SF-12. While the recipients experienced a decline in their physical quality of life in the three months immediately after surgery, they had improvement by six months (p=.02). Overall mental health showed steady improvement from the time before surgery to six months later (p=.04). These changes, however, were not reflected in another popular measure of quality of life, the EQ-5D. There were no changes in participants’ self-esteem or dyadic function over the same period of time. As facial transplantation evolves from being a novel surgical procedure to an increasingly common clinical practice, future efforts to delineate the psychosocial changes experienced by recipients might include mixed methods analyses, with both qualitative and quantitative data, as well as collaborative assessment protocols shared among facial transplantation programs.
doi:10.1016/j.psym.2012.07.012
PMCID: PMC3593952  PMID: 23194929
12.  Predictors of Neuropsychological Change in Patients with Chronic Myelogenous Leukemia and Myelodysplastic Syndrome 
This study examined the course of neuropsychological functioning in patients with chronic myelogeous leukemia (n = 91) or myelodysplastic syndrome (n = 15) who underwent standard treatment for their disease or allogeneic hematopoietic stem cell transplantation (HSCT) at baseline, 12 months, and 18 months post-treatment. At baseline, 23% of the participants (n = 75) in the longitudinal sample had Z-scores on at least one of the neuropsychological tests that were <1.4. Participants in the study showed improvement over baseline at the 12 and 18 months assessments. The average Z-scores for the six cognitive domains in the longitudinal data set over the course of the study ranged from −0.89 to 0.59. Significant predictors of change in neuropsychological test scores included age, with older participants showing less improvement over time. Other predictors included baseline cognitive domains (language, memory, and attention), previous cocaine use, disease status, intelligence quotient, and quality of life measures. Findings support previous studies in patients with hematological malignancies who showed cognitive impairments at baseline prior to HSCT. However, there was little evidence for further cognitive decline over the course of 18 months.
doi:10.1093/arclin/acs141
PMCID: PMC3656510  PMID: 23391504
Cancer; Neuropsychology; Hematological malignancy; Cognition; Cancer treatment; Hematopoietic stem cell transplantation
13.  Parental Emotional Functioning Declines with Occurrence of Clinical Complications in Pediatric Hematopoietic Stem Cell Transplant 
Purpose
Parents’ stress levels are high prior to their child's hematopoietic stem cell transplant (HSCT) and during transplant hospitalization, usually abating after discharge. Nevertheless, a subgroup of parents continues to experience frequent anxiety and mood disruption, the causes of which are not well understood. The purpose of this study was to assess whether clinical complications of HSCT could explain variation in parents’ recovery of emotional functioning.
Methods
Pediatric HSCT recipients (n=165) aged 5 to 18 and their parents were followed over the first year post-transplant. Health-related quality of life (HRQL) assessments and medical chart reviews were performed at each time period (baseline, 45 days, 3, 6, and 12 months). We tested the association between clinical complications (acute and chronic graft versus host disease - aGVHD and cGVHD, organ toxicity, and infection) and longitudinally measured parental emotional functioning, as assessed by the Child Health-Ratings Inventories (CHRIs). The models used maximum likelihood estimation with repeated measures.
Results
In adjusted analyses covering the early time period (45 days and 3 months), aGVHD grade ≥ 2, intermediate or poor organ toxicity, and systemic infection were associated with decreases in mean parental emotional functioning of 5.2 (p=0.086), 5.8 (p=0.052), and 5.1 (p=0.023) points, respectively. In the later time period (6 and 12 months) systemic infection was associated with a decrease of 20 points (p<0.0001). cGVHD was not significantly associated.
Conclusions
When children experience clinical complications after HSCT, parental emotional functioning can be impacted. Intervening at critical junctures could mitigate potential negative consequences for parents and their children.
doi:10.1007/s00520-012-1566-9
PMCID: PMC3540150  PMID: 22936494
Pediatric hematopoietic stem cell transplant; Parental emotional functioning; Parental distress; Transplant-related toxicity
14.  Drug Screens for Psychiatric Patients in the Emergency Department: Evaluation and Recommendations 
Psychosomatics  2012;54(1):60-66.
Objective
To better understand how toxicology screening for psychiatric patients in the emergency department (ED) setting affects diagnostic decisions.
Methods
Retrospective chart review of 439 ED visits of adult patients receiving psychiatry consultations at two hospitals, one an academic medical center (n = 224) and the other a community hospital (n = 220), between July 2008 and February 2009. Clinical, demographic, and ED length of stay (LOS) information was abstracted from the psychiatry consultation notes and the medical records.
Results
Positive urine toxicology results, when combined with a basic substance abuse history, were not associated independently with a patient’s receiving a substance-related diagnosis as part of the psychiatric assessment. By contrast, a positive blood alcohol level was associated independently with a patient’s receiving one of these diagnoses while a positive alcohol use history was not.
Conclusions
Urine toxicology screens do not add significant diagnostic value to all ED psychiatric evaluations when combined with standard substance use histories.
doi:10.1016/j.psym.2012.08.007
PMCID: PMC3743233  PMID: 23194932
15.  Growth Inhibition of Pathogenic Bacteria by Sulfonylurea Herbicides 
Emerging resistance to current antibiotics raises the need for new microbial drug targets. We show that targeting branched-chain amino acid (BCAA) biosynthesis using sulfonylurea herbicides, which inhibit the BCAA biosynthetic enzyme acetohydroxyacid synthase (AHAS), can exert bacteriostatic effects on several pathogenic bacteria, including Burkholderia pseudomallei, Pseudomonas aeruginosa, and Acinetobacter baumannii. Our results suggest that targeting biosynthetic enzymes like AHAS, which are lacking in humans, could represent a promising antimicrobial drug strategy.
doi:10.1128/AAC.02327-12
PMCID: PMC3591922  PMID: 23263008
16.  Bottlenecks in the Emergency Department: the psychiatric clinicians’ perspective☆ 
General hospital psychiatry  2012;34(4):403-409.
Objective
To ask psychiatric clinicians for their perspectives on the rate-limiting steps (RLS) in patient care in the Emergency Department (ED) and to compare them to the patient’s actual length of stay.
Method
Prospective cohort study of clinicians’ perspectives on the RLS among 1092 adult ED patients. Medical records were abstracted for ED time and other data.
Results
Clinicians identified five RLS: limited availability of staff, limited availability of beds after discharge, need for clinical stability, need for additional history and patient’s financial issues. The last RLS was the only one not associated with increased wait times in the ED. There were significant differences in the patterns of RLS by trainee status and hospital. For example, significantly higher proportions of trainees reported that RLS in patient care were due to the need for clinical stability and additional history and lack of bed availability. In contrast, non-trainee clinicians were more likely to cite problems with the availability of ED staff as an RLS.
Conclusions
Most of the RLS in patient care identified by clinicians were associated with actual increases in ED wait time for their patients. Next steps include asking clinicians for possible solutions to the delays their patients experience.
doi:10.1016/j.genhosppsych.2012.03.005
PMCID: PMC3729212  PMID: 22516215
Emergency department; Mental health; Psychiatric patients
17.  Improving Treatment Outcome in Pregnant Opiate-Dependent Women 
Outcomes for 6 pregnant methadone-maintained opiate-dependent subjects in enhanced treatment were compared to those of 6 women receiving conventional methadone maintenance. Enhanced treatment consisted of weekly prenatal care, relapse prevention groups, thrice weekly urine toxicology screening with positive contingency awards for abstinence, and therapeutic child care during treatment visits in addition to treatment as usual. Treatment as usual included daily methadone, group counseling, and random urine toxicology screening. Study patients differed from the comparison group in three important ways, having fewer urine toxicology screens positive for illicit substances (59% vs. 76%), three times as many prenatal visits (8.8 vs. 2.7), and heavier infants (median birth weight, 2959 vs. 2344 grams). These results suggest that enhanced drug treatment can improve pregnancy outcome and, in particular, reduce low birth weight for this high-risk population.
PMCID: PMC3677856  PMID: 1479630
opiate dependence; pregnancy; low birthweight
18.  Children's Psychological Distress during Pediatric HSCT: Parent and Child Perspectives 
Pediatric blood & cancer  2011;58(2):289-296.
Background
Hematopoietic stem cell transplantation (HSCT) can be challenging to pediatric recipients and their families. Little is known about the recipients' psychological status as they initiate treatment and in the year afterwards. The purpose of this study is to describe the psychological status of 107 pediatric HSCT recipients from their parents' perspective, and to compare reports from parents and children in a subset of 55 children. We hypothesized that there would be discrepancies between parent and child report of child distress.
Procedure
Multi-site, prospective study of eligible child participants and their parents who completed selected modules from the Structured Clinical Interview for DSM-IV-TR, Childhood Version (KID-SCID) the month before and one year after HSCT. Diagnoses were threshold or subthreshold.
Results
According to parents, nearly 30% of children had anxiety disorder_both before and after HSCT; approximately half of these met threshold criteria. Agreement between parents and children for anxiety disorders was poor at baseline (κ= −0.18, 95th % CI= −0.33, −0.02) and fair at 12 months (κ= 0.31, 95th % CI= −0.04, 0.66). Agreement about mood disorders was fair at baseline (10% prevalence, κ=0.39, 95th % CI=−0.02, 0.79) and moderate at 12 months (14% prevalence, κ=0.41, 95th % CI= 0.02, 0.80).
Conclusions
Anxiety (30%) and mood (10 to 14%) symptoms are common in children both before and after HSCT; parent and child reports of these symptoms do not agree. Input from parents and children is recommended to identify more accurately children who may need additional intervention during and following HSCT.
doi:10.1002/pbc.23185
PMCID: PMC3257159  PMID: 21618413
parent; child; psychological distress
19.  Brief Intervention for Women with Risky Drinking and Medical Diagnoses: A Randomized Controlled Trial 
Randomized controlled trial of 511 eligible women treated for diabetes, hypertension, infertility, or osteoporosis on an out-patient basis to test the hypothesis that those randomized to a brief intervention (BI) will drink less than those in the control condition 12 months later. A secondary goal was to identify the characteristics associated with changes in drinking outcome. All 511 completed the initial Alcohol Assessment and 96% completed the 12-month follow up interview. Those receiving the BI also had 3 and 6 month interviews. Four outcomes were assessed: 1) mean drinks per drinking day, 2) percent drinking days, 3) binge episodes defined as 4 or more drinks per occasion, and 4) weeks of drinking exceeding NIAAA sensible drinking limits. Overall, there were no differences in drinking outcome by treatment group. Characteristics associated with changes in drinking, however, were identified to provide possible direction for future investigation.
doi:10.1016/j.jsat.2011.02.011
PMCID: PMC3139715  PMID: 21489738
Women; Alcohol; Brief Intervention; Health problems
21.  Self-Reported alcohol and Drug Use in Pregnant Young Women: A Pilot Study of Prevalence and Associated Factors 
Journal of addiction medicine  2011;5(3):221-226.
Objectives
This study describes the prevalence and factors associated with self-reported substance use in young women receiving prenatal care at a hospital clinic.
Methods
Cross-sectional, study of 30 pregnant young adults who responded to a mail survey containing the CRAFFT screening tool. All completed a diagnostic interview that included self-report information on their use of alcohol and drugs before and during pregnancy, including the contexts in which they would be likely to use.
Results
One third of participants consumed alcohol, marijuana, or both while pregnant. Many had lifetime diagnoses of alcohol (23%) or cannabis (30%) use disorders, but only one met criteria for current diagnosis. The CRAFFT was best in identifying prenatal substance use (c-statistic=0.9). Age, race, education, and children, were not associated with either prenatal alcohol or cannabis use. Before pregnancy alcohol drinking was associated with prenatal alcohol use (p=.02) and prenatal cannabis use (p=.06). Another trend of before pregnancy cannabis use being associated with prenatal cannabis use (p=.08) was observed. Most participants indicated little likelihood of substance use in convivial, intimate, or negative coping contexts while pregnant. However, participants with prenatal substance use had significantly higher convivial (p=.02) and intimate (p=.01) subscale scores of the Drinking Context Scale before pregnancy.
Conclusions
Asking directly about the circumstances of prenatal alcohol and drug is not likely to be helpful. Two promising approaches in the identification of prenatal substance use were identified: the CRAFFT screening instrument and asking about the contexts during which alcohol might have been consumed before pregnancy.
doi:10.1097/ADM.0b013e318214360b
PMCID: PMC3157047  PMID: 21844837
prenatal substance use young women CRAFFT
22.  Predictors of Drinking During Pregnancy: A Systematic Review 
Journal of Women's Health  2011;20(6):901-913.
Abstract
Background
Many pregnant women continue to drink alcohol despite clinical recommendations and public health campaigns about the risks associated with alcohol use during pregnancy. This review examines the predictors of prenatal alcohol use, with the long-term goal of developing more effective preventive efforts.
Methods
A literature search of several databases for relevant articles was undertaken. Studies were included if they occurred in the context of antenatal care, collected data during the woman's pregnancy (between 1999 and 2009), investigated predictors of any drinking, had a population-based orientation (e.g., did not focus only on high-risk drinkers), and were published in English in a scientific peer-reviewed journal between 1999 and 2009.
Results
Fourteen studies published between 2002 and 2009 fulfilled the inclusion criteria (United States, 4; Europe, 4; Australia and New Zealand, 3; Japan, 2; and Uganda, 1). The predictors of prenatal alcohol use most consistently identified were prepregnancy alcohol consumption and having been abused or exposed to violence. Less consistent predictors of drinking during pregnancy were high income/social class and positive dependence screen. Unemployment, marital status, and education level were examined in many studies but found to be predictive only infrequently.
Conclusions
Women's prepregnancy alcohol consumption (i.e., quantity and frequency of typical drinking) and exposure to abuse or violence were consistently associated with drinking during pregnancy. Antenatal care providers should assess these factors for improved detection of women at risk for alcohol-exposed pregnancies.
doi:10.1089/jwh.2010.2216
PMCID: PMC3159119  PMID: 21671775
23.  Readiness to Change and Risk-Drinking Women 
The predictive value of the Readiness to Change Questionnaire (RTCQ) for subsequent drinking was evaluated in 499 women. These women had medical problems potentially exacerbated by alcohol use and were enrolled in an intervention study. Correlates and predictors of stage-of-change were analyzed. Results indicated that the categorical application of the RTCQ did not predict drinking in the 6–12 months after enrollment. Preliminary findings support rescoring the RTCQ into a continuous measure. Following this conversion, situational risks factors for drinking were examined as potential mediators of RTC. Heightened risk for alcohol consumption during an argument or boredom was found to attenuate the association between one’s RTC and later drinking. Finally, medical condition moderated the association of RTC on later drinking; women with diabetes, infertility or osteoporosis drank the most in the contemplation stage. In contrast, hypertensive women drank most when action-oriented to change. The implications for intervening with risk-drinking women are discussed.
doi:10.1016/j.jsat.2010.11.004
PMCID: PMC3072060  PMID: 21193283
24.  Identification of Risk Drinking Women: T-ACE Screening Tool or the Medical Record 
Journal of Women's Health  2010;19(10):1933-1939.
Abstract
Background
Risk drinking for women is defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as >7 drinks per week or >3 drinks per occasion. This study compares the T-ACE screening tool and the medical record for identification of risk drinking by 611 women receiving outpatient treatment for diabetes, hypertension, infertility, or osteoporosis in Boston, Massachusetts, between February 2005 and May 2009.
Methods
All subjects completed a diagnostic interview about their health habits, and medical records were abstracted. Calculations were weighted to reflect the oversampling of risk drinking women.
Results
T-ACE-positive women (n = 419) had significantly more drinks per drinking day (2.1 vs. 1.6, p < 0.0001) and a trend toward more binges (6.3 vs. 3.8, p = 0.07) but similar percent drinking days and risk drinking weeks compared with those with negative screens (n = 192). Among the 521 (85%) medical records available, 46% acknowledged alcohol use, 25% denied use, and 29% were silent. The rates of abstinence among women were 2%, 17%, and 4%, respectively. Significantly more women were risk drinkers (63%) and had current alcohol use disorders (12%) when their medical records acknowledged alcohol use.
Conclusions
The main findings of this study are that neither the T-ACE nor the medical record was especially effective in identifying risk drinking by the women enrolled in the study. The identification of risky or heavy alcohol use in women, particularly if they have health problems exacerbated by alcohol, is desirable and represents an area of improvement for patients and providers alike.
doi:10.1089/jwh.2009.1911
PMCID: PMC2965701  PMID: 20839966
25.  Mental Status Changes after Hematopoietic Stem Cell Transplantation 
Cancer  2009;115(19):4625-4635.
Background
The growing numbers of survivors of innovative cancer treatments such as hematopoietic stem cell transplantation (HSCT) often report subsequent cognitive difficulties. The purpose of this study is to evaluate and compare neurocognitive changes in patients with chronic myelogenous leukemia (CML) or primary myelodysplastic syndrome (MDS) after allogeneic HSCT or other therapies.
Methods
Prospective cohort study employing serial evaluations of attention, concentration, memory, mood and quality of life in a consecutive sample of 106 eligible patients with CML (n=91) or MDS (n=15) at enrollment, and then 12 and 18 months after HSCT or other therapy.
Results
The three evaluations were completed by 98%, 95%, and 89% of surviving participants, respectively. Among all patients, there was significant improvement in memory over 18 months. For example, the 45 people receiving HSCT (42 with CML, 3 with MDS) compared favorably to those who had other treatment on most measures of neuropsychological function, except they had improved mental health (p=.034), worse physical function (p=.049), and more difficulty with coordination and fine motor speed bilaterally (dominant, p=.005, and non-dominant hands, p=.0019). CML patients overall had improved phonemic fluency (p=.014).
Conclusions
Time and diagnosis may be important factors when assessing neurocognitive and other changes. Complaints about “chemobrain” following HSCT merit further study, as deficits may actually pre-date initiation of treatment and then subsequently improve. Study results could reassure prospective HSCT recipients since it compares favorably to other treatments when mental status side effects are considered.
doi:10.1002/cncr.24496
PMCID: PMC2749960  PMID: 19551887
Chemobrain; HSCT; Chronic Myelogenous Leukemia; Quality of life; Memory; Myelodysplastic Syndrome

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