Six-month Follow-up Period Research Articles

Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries.

Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries.

Depression and alcohol use disorder at antiretroviral therapy initiation led to disengagement from care in South Africa.

We sought to assess mental health at the time of antiretroviral therapy (ART) initiation and subsequent retention in care over a six-month follow-up period. A total of 136 people living with HIV in South Africa were administered surveys measuring demographic information and mental health indicators at the time of ART initiation. Follow-up was completed via chart abstraction to assess for six-month outcomes of retention in care and viral suppression. At enrollment, 45/136 (33%), 67/136 (49%), and 45/136 (33%) participants screened positive for depression, anxiety, and alcohol use disorder, respectively. After six months of follow-up, 96/136 (71%) participants remained in care; 35/87 (40.2%) participants who remained in care had a level <50 copies/mL. Those with depression (49% vs. 77% retained; p < 0.01) and those with alcohol use disorder (52% vs. 76% retained; p < 0.01) were less likely to be retained in care. In multivariable logistic regression, depression OR 3.46 (95% CI: 1.33, 7.97; p < 0.01) and alcohol abuse OR 3.89 (95% CI: 1.70, 8.97; p < 0.01) were independently associated with loss from care. These results emphasize the importance of mental health on early ART outcomes and the HIV care continuum.

The effect analysis of laparoscopic varicocele high ligation and the correlation study of semen quality influence by surgery

Objective To explore the clinical efficacy of laparoscopic varicocele high ligation for male infertile patients and the changes in semen quality after surgery. Methods The records and database of 60 patients with sterility in our hospital between January 2012 and June 2015 who underwent laparoscopic varicocele high ligation were reviewed retrospectively. Among them, 27 cases had scrotum discomfort or bearing-down pain. All of them had been followed regularly in postoperative 1, 3, 6 months as well as semen testing respectively. The clinical symptomatic remissions and postoperative complication in all patients and identify the changes in semen quality after surgery were observed. Results In all 60 cases , scrotum emphysema occurred in 5(8.33% ) patients and only one patient presented scrotum edema (1.67%) and these complications disappeared in the initial visit. Twenty-seven patients who have clinical symptoms, 23(85.19%) patients’ symptoms disappeared, 3 patients’(11.11%) symptoms relieved, only 1 patient(3.70%) didn’t respond in the last visit .There were no recurrence during the six-month follow-up period. Postoperative sperm quality index of sperm density, sperm motility(a), sperm motility(a+ b), total sperms, normal sperm morphology rate were significantly beyond than before surgery and the results were statistically significant(P 0.05) . Semen parameters at postoperative 3 months had been improved obviously compared with at postoperative 1 month except semen volume(P 0.05) . Conclusions Laparoscopic varicocele high ligation can be safe and effective in the treatment of patients with varicocele with infertility and significantly improve postoperative semen parameters. Semen quality is improved to meet a relatively stable level at 3 months after operation. Key words: Varicocele; Laparoscopes; Ligation; Spermatozoa

The effects of mindfulness-based stress reduction on hospital nursing staff

• The MBSR effectively reduces stress among newly graduated nurses. • The effects of MBSR were maintained over a six-month follow-up period. • Providing a support group for nurses can help to reduce their stress, but effects of the support group cannot be maintained during longitudinal follow up.

SAFE (Sarpogrelate Anplone in Femoro-popliteal artery intervention Efficacy) study: study protocol for a randomized controlled trial

BackgroundSarpogrelate is expected to reduce restenosis by protecting blood vessels from oxidative stress and vascular endothelial dysfunction as well as by acting as an antiplatelet agent after endovascular treatment (EVT). This trial was designed to compare aspirin plus sustained-release (SR) sarpogrelate with aspirin plus clopidogrel for the prevention of restenosis in patients with femoro-popliteal (FP) peripheral artery disease (PAD) who underwent EVT.Methods/DesignThis is an open label, multicenter, prospective randomized controlled clinical trial. Patients will be eligible for inclusion in this study if they require EVT for stenosis or occlusion of a de novo FP lesion. Patients in each group will receive aspirin 100 mg with clopidogrel 75 mg or aspirin 100 mg with SR sarpogrelate 300 mg (Anplone®) orally once a day for six months. The primary outcome of the study is the restenosis rate, defined as > 50% luminal reduction by computed tomography angiography or catheter angiography in the six-month follow-up period. Secondary outcomes include target lesion revascularization, major bleeding, ipsilateral major amputation, all-cause mortality, and all adverse events that take place in those six months.DiscussionThis study is a multicenter randomized controlled trial designed to show non-inferiority in terms of the re-stenosis rate of SR sarpogrelate compared to clopidogrel for EVT for PAD in FP lesion patients.Trial registrationClinicalTrials.gov, NCT02959606. Registered on 9 November 2016.

Intravitreal bevacizumab as rescue therapy following treatment failure with laser photocoagulation in retinopathy of prematurity

PurposeTo evaluate the efficacy of intravitreal bevacizumab (IVB) in case of treatment failure with laser photocoagulation in retinopathy of prematurity (ROP). MethodsA retrospective review of infants treated with IVB injection due to treatment failure with laser photocoagulation was performed. The anatomical results and complications were evaluated after treatment. Results9 eyes of 6 premature infants with a mean gestational age of 26.8 ± 3.0 weeks (range, 23–32 w) and mean birth weight of 958 ± 319 g (range, 600–1400 g) were identified. Six of the eyes had zone 1 disease, and all of these eyes were classified as aggressive posterior ROP (APROP). Three of the eyes had zone 2 disease, and one of these eyes was classified as APROP, and the other two eyes were classified as high-risk pre-threshold disease. All of the eyes showed regression of the disease except one patient, both eyes of whom progressed to stage 4A. None of the patients developed ocular and systemic complications at the end of the six-month follow-up period. ConclusionIVB could be an option in patients with ROP in whom laser photocoagulation failed.

Electrical impedance tomography in children with community acquired pneumonia: preliminary data

BackgroundElectrical impedance tomography (EIT) is a noninvasive pulmonary function test that provides spatial and temporal information of changes in regional lung ventilation. We aimed to assess the feasibility of EIT as a supplementary tool in the evaluation of community acquired pneumonia in children. Furthermore, we performed a prospective evaluation of regional lung ventilation changes during a six-month follow-up period. MethodsWe enrolled otherwise healthy children aged 2–15 years with radiological diagnosis of community acquired pneumonia on admission at pediatric emergency department. Chest EIT was performed at enrollment, at three and six-months from baseline. ResultsNineteen children were enrolled. A significant agreement between EIT and chest radiography in identifying the affected lung (left or right) was observed (Cohen K statistic = 0.73, 95% CI 0.5–0.98). Ventilation improvement was documented at three-month follow-up, but a full recovery only at six months. ConclusionEIT reliably provides additional information on lung ventilation disorders due to CAP in children. It further allows bedside, real time and radiation free monitoring of lung functional recovery. Future studies are needed to expand the generalizability of this method and evaluate effectiveness on clinical practice.

Prolonged Perioperative Low-Dose Ketamine Does Not Improve Short and Long-term Outcomes After Pediatric Idiopathic Scoliosis Surgery.

A randomized, double-blind, placebo-controlled study, with a six-month follow-up period. The aim of this study was to test the hypothesis that a 72-hour dose of subanesthetic ketamine in this surgical procedure reduces postoperative morphine use and to assess whether there are fewer adverse effects, if postoperative recovery is faster, if there is less peri-incisional hyperalgesia, or if there is lower incidence of persistent postsurgical pain. Tissue injury and high opioid requirements following posterior spinal fusion surgery produce central sensitization, which can in turn be associated with hyperalgesia and chronic pain. Clinical trials involving this type of procedure using subanesthetic ketamine doses have assessed pain and morphine requirements with contradictory results. The effects of prolonged subanesthetic ketamine doses on postoperative recovery, mechanical hyperalgesia, and the incidence of chronic pain are unknown. A total of 48 pediatric patients between 10 and 18 years diagnosed with idiopathic scoliosis were randomized to receive perioperative low-dose ketamine or placebo for 72 hours. They received general anesthesia, intraoperative remifentanil, and morphine postoperatively (patient-controlled analgesia). We measured morphine consumption, pain at rest and during movement (coughing), undesirable effects, and sedation during morphine treatment. The onset of oral intake, ambulation, and hospital stay were recorded. The extent of the peri-incisional hyperalgesia was measured at 72 hours and pain controls were conducted postsurgery. Primary endpoint results (total cumulative morphine consumption while admitted) were obtained in 44 patients. Results were 2.72 (SD 1.13) in the placebo group and 3.13 (SD 1.13) in the study group (P = 0.2903), with no significant differences. Moreover, differences were not found between the experimental group and the placebo group in the secondary endpoints analyzed. Our findings do not support the routine combining of prolonged subanesthetic ketamine doses with opioids in posterior fusion surgery in children with idiopathic scoliosis. 2.

Improvement in orthopedic outcome score and reduction in IL-1β, CXCL13, and TNF-α in synovial fluid of osteoarthritis patients following arthroscopic knee surgery.

Knee osteoarthritis (KOA) is a common degenerative joint disease and immune system dysregulation has been implicated in its pathogenesis. The effect of arthroscopic knee surgery, an important method for KOA diagnosis and treatment, on the expression of immune regulators remains poorly understood. We aimed to investigate the clinical efficacy of such surgery and its impact on IL-1β, CXCL13, and TNF-α expression in the knee joint synovial fluid of osteoarthritis patients. Fifty-seven patients having undergone arthroscopic knee surgery in our hospital were included. Visual analog scale (VAS) and Lysholm scores were recorded before surgery, and knee joint synovial fluid was collected during the procedure. According to Outerbridge cartilage damage score (grade 0, 1, 2, 3, or 4), patients were divided into five groups. In addition, VAS and Lysholm scores were recorded and knee joint synovial fluid was collected after a six-month follow-up period. Expression of IL-1β, CXCL13, and TNF-α in synovial fluid samples was then measured. In each group, levels of these molecules and VAS and Lysholm scores were significantly lower after surgery (P < 0.05). IL-1β, CXCL13, and TNF-α levels were significantly elevated in patients with higher cartilage damage scores compared to those with lower scores. Arthroscopic knee surgery can reduce IL-1β, CXCL13, and TNF-α levels in the knee joint synovial fluid of osteoarthritis patients. Moreover, reduced presence of these molecules correlates with clinical improvement of this condition. Therefore, reduction in IL-1β, CXCL13, and TNF-α expression might be used as a factor for long-term osteoarthritis prognosis.

Minithoracotomy as the primary alternative for left ventricular lead implantation during cardiac resynchronization therapy: Can the cardiac surgeon reduce the number of nonresponders

Introduction/Objective. Numerous anomalies of the cardiac venous system prevent the optimal endovascular implantation of the left ventricular (LV) lead in more than 15% of patients with indication for cardiac resynchronization therapy (CRT). The endovenous approach in these patients can be one of the potential reasons for the large number of nonresponders reported in the literature. The purpose of this study was to analyze the results of an alternative myoepicardial approach to the stimulation of the left ventricle in CRT. Methods. From June 2014 to December 2015 at the Department of Cardiac Surgery of the Clinical Centre of Serbia, 15 myoepicardial LV leads for CRT were implanted. Coronary sinus venography revealed thrombosis of the coronary sinus in nine patients, and unfavorable anatomy of the coronary venous system in six patients. In all patients, limited left thoracotomy was used as an approach to the lateral wall of the heart. Results. There were no major surgical complications and no lethal hospital outcomes. In a six-month follow-up period we registered a significant increase in the length of the six-minute walk test (for an average of 57.9 m), reduction of the QRS complex width (to 26.25 ms), increase in left ventricular ejection fraction (12.2%), and reduction of mitral regurgitation for 1+. Based on all the parameters, it was concluded that all patients responded favorably to the applied CRT. Conclusion. Closer cooperation between cardiologists and cardiac surgeons in identifying patients who would benefit the most from a myoepicardial approach for LV stimulation is necessary in order to attempt to reduce the nonresponder rate.

Co-designing the next generation of home energy management systems with lead-users

Home energy management systems are widely promoted as essential components of future low carbon economies. It is argued in this paper that assumptions surrounding their deployment, and the methods used to design them, emerge from discredited models of people and energy. This offers an explanation for why their field trial performance is so inconsistent. A first of a kind field trial is reported. Three eco communities took part in a comprehensive participatory design exercise as lead users. The challenge was to help users synchronise their energy use behaviours with the availability of locally generated renewable energy sources. To meet this aim, a set of highly novel Home Energy Management interfaces were co-designed and tested. Not only were the designs radically different to the norm, but they also yielded sustained user engagement over a six-month follow-up period. It is argued that user-centred design holds the key to unlocking the energy saving potential of new domestic technologies, and this study represents a bold step in that direction.

Predictors of Venous Thmromboembolism in Colorectal Cancer: Results from a Global Prospective Study

BACKGROUNDVenous thromboembolism (VTE) is an important complication among patients with colorectal cancer but its prevalence and predictors are incompletely understood. The Khorana Score (KS), comprising primary site, baseline hemoglobin, leukocyte and platelet counts, and body mass index [Khorana et al, Blood, 2008], has been demonstrated to predict VTE in various cancer settings. We evaluated the value of this Score and other key prognostic variables in a global prospective cohort study to define the incidence, predictors and consequences of VTE in patients undergoing adjuvant or palliative chemotherapy for colorectal cancer.METHODSCANTARISK was a prospective, non-interventional, international cohort study in patients with lung and colorectal cancer on chemotherapy; data for the colorectal cohort are presented here. Clinical data were collected at baseline, and at 2, 4 and 6 months. All data were compiled centrally and analyzed after the study had closed. KS categories were as defined previously [Blood, 2008]. Statistically significant univariable associations and a priori variables were tested in multivariable models; adjusted odds ratios (OR) with confidence intervals (CIs) are presented.RESULTSA total of 1,789 patients with colorectal cancer were enrolled from 2011 to 2012. Median age was 62 years; 61% were male; 71% were Caucasian; 18% were Asian; 37% were from Europe, 28% from North America, 23% from Asia, and 12% from South America. During the six-month follow-up period, 92 (5.1%) patients experienced VTE events; 18 patients experienced 2 events each, and 2 patients experienced 3 events each, for a total of 112 VTE events. Of these 112 events, 69 (61.6%) were deep venous thromboses (DVT), 22 (19.6%) were pulmonary emboli (PE), 14 (12.5%) were catheter-associated thrombi, and 7 (6.3%) were visceral thrombi. The majority (n=94, 83.9%) were symptomatic. For low, intermediate, and high KS, there were 4.3% (n=42), 6.8% (n=39), and 12.5% (n=5) VTE events, respectively (N=1596 due to some missing values for KS components). In adjusted multivariable analyses, KS (OR for high/intermediate vs. low = 1.82, 95% CI = 1.15-2.87), ECOG performance score (OR for 2/3/4 vs. 0/1 = 2.17, 95% CI=1.07-4.43), and central venous catheter (OR for yes vs. no = 4.01, 95% CI=2.32-6.94) were independent predictors of VTE. Notably, age, metastatic (vs. non-metastatic) disease, surgery or immobilization within the prior 6 months, current smoking, and history of VTE were not associated with new VTE events.CONCLUSIONSThis global prospective study demonstrates that VTE events are prevalent among patients with colorectal cancer receiving systemic chemotherapy. Khorana Score category is a strong predictor of risk. Ongoing clinical trials are focusing on the benefit of prophylactic anticoagulation in high-risk patients in these settings. DisclosuresKuderer:Janssen Scientific Affairs, LLC: Consultancy, Honoraria. Lyman:Amgen: Research Funding. Khorana:Amgen: Consultancy, Honoraria, Research Funding; Bayer: Consultancy, Honoraria; Halozyme: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Leo: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria; Roche: Consultancy, Honoraria; Janssen Scientific Affairs, LLC: Consultancy, Honoraria, Research Funding.

An Admission-to-Discharge BNP Increase Is a Predictor of Six-Month All-Cause Death in ADHF Patients: Inferences from Multivariate Analysis Including Admission BNP and Various Clinical Measures of Congestion.

Background: According to some authors, a single isolated measurement of serum B-type natriuretic peptide (BNP) executed on hospital admission would not be a sufficiently accurate method to predict the outcome of patients with acute decompensated heart failure (ADHF). Aims: To verify this assumption, a retrospective study was conducted on patients hospitalized for ADHF. Our main objective was to ascertain whether there was any difference in midterm mortality among patients with increasing BNP at discharge as compared with those with decreasing BNP at discharge. Methods: Medical records were examined so as to make a partition of the ADHF patient population into two groups, the former characterized by a rise in BNP during hospitalization, and the latter exhibiting a decrease in BNP in the measurement taken at hospital discharge. Results: 177 patients were enrolled in a retrospective study. Among them, 53 patients (30%) had increased BNP at the time of discharge, whereas 124 (70%) showed decreases in serum BNP during their hospital stay. The group with patients who exhibited BNP increases at the time of discharge had a higher degree of congestion evident in the higher frequency of persistent jugular venous distention and persistent orthopnea at discharge. Moreover, patients with increased BNP at the time of discharge had a lower reduction in inferior vena cava maximum diameter (1.58 ± 2.2 mm vs. 6.32 ± 1.82 mm; p (one-way ANOVA) = 0.001). In contrast, there was no significant difference in weight loss when patients with increased BNP at discharge were compared with those with no such increase. A total of 14 patients (7.9%) died during the six-month follow-up period. Multivariable Cox proportional-hazards regression analysis revealed that a BNP increase at the time of discharge was an independent predictor of six-month all-cause mortality after adjustment for persistent jugular venous distention, persistent orthopnea, reduction in inferior vena cava maximum diameter at discharge, weight loss, serum urea, systolic blood pressure at admission, and BNP at admission (hazard ratio = 30.5424; 95% CI: 1.7409–535.8294, p = 0.0199). Conclusions: Among patients with a history of ADHF, more elevated BNP levels at the time of discharge from the hospital compared with those detected at admission identify a patient subset with a higher grade of congestion and higher six-month mortality.

Free Vascularized Fibular Graft Transfer in the Reconstruction of Defects for Premalignant and Malignant Musculoskeletal Conditions of the Femur in a Tertiary Care Setting in Pakistan: A Series of Six Cases.

ObjectiveTo determine the application, success and complications of the utilization of free vascularized fibular grafts (FVFG) in the reconstruction of lower limb defects after resection of primary lower limb musculoskeletal tumors.MethodologyThis descriptive retrospective case series analysis was conducted at Shifa International Hospital from January 2011 to January 2016. It included patients who had premalignant and malignant conditions of the lower limb and subsequently had the lesion resected followed by FVFG surgery. The data collected was to outline the demographic profile, clinical features, and post-procedure outcomes and complications.ResultsThere was a total of six patients. The mean age of the patients was 25.8 ± 11.8 years (range: 15-40 years). The patients presented with pain, swelling, inability to bear weight and/or restriction of movement at the joint. Postoperatively, one patient had proximal wound necrosis and one patient had a thrombus in the anastomosed vessels, both of which were managed successfully.ConclusionWith a success rate of 100% at the end of the six-month follow-up period, FVFG surgery is a reliable procedure that may be successfully carried out for musculoskeletal tumors of the lower limb with minimal complications.

Effect of Body Mass Index on Mortality and Morbidity in Patients Undergoing Coronary Artery Bypass Grafting Surgery.

This study aims to investigate the effect of body mass index (BMI) on mortality and morbidity in patients undergoing coronary artery bypass grafting (CABG) surgery. We retrospectively evaluated the medical records of 403 patients undergoing coronary artery bypass surgery in our center. The patients were divided into 5 groups according to their BMI values. Preoperative demographic characteristics, operative data, and postoperative complications during the six-month follow-up period were compared between the groups. There were no statistically significant differences between the groups except the coexistence of peripheral artery disease (P = .009), ejection fraction (P = .021) and chronic obstructive pulmonary disease (P = .044). There were no statistically significant differences between the groups in terms of postoperative complications. No relationship was found between postoperative complications and the implemented surgical procedures. An overall 30-day mortality rate of 1.48% was observed, and the six-month mortality rate was 1.7%. According to this study, obesity does not lead to an increased risk of mortality and other adverse outcomes after CABG surgery. However, obesity may prolong hospital stay and increase the cost of CABG operation.

The Influence of Type of Anesthesia, Perioperative Pain, and Preoperative Health Status on Chronic Pain Six Months After Thoracotomy—A Prospective Cohort Study

Chronic post-thoracotomy pain (CPP) has a high incidence. However, less is known about risk factors and the influence of different analgesia therapies. In this prospective cohort study, patients either received standardized epidural analgesia or began an oral analgesic protocol with controlled-release oxycodone immediately postoperatively. Patients answered a baseline questionnaire on the day before surgery and a follow-up questionnaire six months postoperatively. The questionnaire included Short-Form 12, the Neuropathic Pain Scale, and descriptive questions for CPP. Pain protocols of all patients were examined. Logistic regression was used to analyze the risk factors related to CPP. One hundred seventy-four patients were enrolled; data of 131 patients were available after the six-month follow-up period. Fifty-one patients (39%) had CPP six months postoperatively. Of these, more than 80% had impaired daily activity or ability to work, or reported sleeping disturbance due to CPP. The strongest predictive factors for the development of CPP were: thoracic pain for three months preoperatively (odds ratio [OR] = 3.54, 95% confidence interval [CI] = 1.69-7.40, P = 0.001), thoracic pain for 12 months preoperatively (OR = 2.73, 95% CI = 1.28-5.83, P = 0.009), and higher pain scores at rest in the first five postoperative days compared with patients without CPP (OR = 1.79, 95% CI = 1.24-2.57, P = 0.002). Neuropathic pain was present in 4.8% of patients. Patients with CPP had a reduced physical (P = 0.005) and mental health status (P = 0.03) six months after surgery compared with patients without CPP. Preoperative thoracic pain and higher pain scores in the first five postoperative days seem to be the strongest risk factors for the development of CPP. CPP patients reported poorer mental and physical health before and six months after surgery.

Testing a Brief Substance Misuse Preventive Intervention for Parents of Pre-Adolescents: Feasibility, Acceptability, Preliminary Efficacy.

Evidence-based interventions to reduce substance misuse among adolescents are resource and time intensive. We conducted a pilot RCT to evaluate a novel, adaptable, and resource-efficient substance misuse preventive intervention for parents/guardians, focusing on talking with children about substance use and on eating family meals. We randomized 70 parents of children in third-through-sixth grades within a large, urban public school system in New England to the intervention or control condition. Over a six-month follow-up period, we assessed feasibility and acceptability of the intervention and examined frequency of parent-child conversations about alcohol, marijuana, and other drugs, and frequency and duration of family meals. A total of 29 parents were assigned to the intervention and 35 to the control condition. The intervention was found to be feasible and acceptable to participants as evidenced by high recruitment and retention rates and positive feedback from qualitative exit interviews. At three- and six-month follow up, 64.3% and 44.5% of parents in the intervention condition were talking "a lot" to their children about alcohol, compared to 8.7% and 8.7% of the parents in the control condition, respectively (p<0.01 and p=0.03). Patterns in frequency and duration of family meals between the two conditions were not significantly different over time. In conclusion, a higher percentage of parents randomized to the intervention condition spoke with their children about alcohol, marijuana, and other drugs, but the frequency and duration of meals was not impacted. Further testing of the brief intervention with a larger sample to assess efficacy is warranted.

Psychiatric symptoms and mental health court engagement

ABSTRACTPeople with mental illnesses are overrepresented in the criminal justice system. Many interventions have been implemented to treat the underlying causes of criminal justice involvement and prevent people with mental illnesses from recidivating. Mental health courts (MHC) are one of these programs. This analysis examines the relationship between psychiatric symptoms and MHC engagement. Eighty MHC participants from two Midwestern MHCs were interviewed. Symptom severity was assessed at baseline using the Brief Psychiatric Rating Scale. MHC engagement was estimated by treatment adherence, substance use, days spent in jail, probation violations, and MHC retention during a six-month follow-up period. Using nonparametric statistical tests and logistic regression, results indicate symptoms of depression, anxiety, and guilt are more severe at baseline for those people who are incarcerated during the follow-up period. Symptoms of anxiety are more severe for people who are terminated or went missing during the follow-up period. Further research is needed to determine the directionality and causality of these relationships. MHCs professionals should be aware of the relationship between symptom severity and MHC engagement and attempt to connect participants with treatment and services as early as possible and individualize treatment plans based on current symptoms and need.

Incorporating Individualized Placement and Support Principles Into Vocational Rehabilitation for Formerly Incarcerated Veterans.

This study evaluated the six-month outcomes of incorporating the principles of supported employment, specifically Individual Placement and Support (IPS), into the About Face program, an existing standardized group-based vocational program for previously incarcerated veterans. Participants (N=84) with a history of at least one felony conviction and a substance use disorder (88%) or mental illness or combination (59%) were recruited from a large urban veterans hospital. Veterans were randomly assigned to either the About Face program (AF) or to that program plus a modification of IPS (AF+IPS). Veterans were followed for six months. Employment outcomes, including time to employment, hours worked, and income earned, were evaluated with survival analyses and nonparametric tests. Rates of employment over the follow-up period were significantly higher for those receiving AF+IPS, with 21 of 46 (46%) finding employment, compared with only eight of 38 (21%) who received AF alone. As a group, those receiving AF+IPS worked more hours and earned more wages than those receiving AF alone. Incorporating many of the principles and techniques of IPS into an existing vocational program was associated with improved employment outcomes over the six-month follow-up period and should be considered a viable rehabilitation option when working with this vulnerable population.

Trajectories of depressive symptoms in community-dwelling older adults: A six-month longitudinal study with monthly assessment

BackgroundThis study aimed to examine six-month trajectories of depressive symptoms and their predictors for community-dwelling older adults. Innovations included monthly assessments, examination of non-linear trajectories, and inclusion of coping styles as predictors. MethodData were derived from a six-month longitudinal study of 144 community-dwelling older adults with depressive symptoms (Short-Geriatric Depression Scale [S-GDS]≥5) with seven waves of data. Descriptive analyses and individual growth curve modeling were conducted. ResultsThe majority of participants changed symptom levels over time; most participants with severe symptoms at baseline remained at least mildly depressed at six months. Younger participants were more depressed at baseline and improved slightly more than older participants. Those who used more active and emotional support coping had faster improvement and maintained gains, whereas those who used less of these coping styles demonstrated worse symptoms over the six-month follow-up period. LimitationsThe most significant limitations are the convenience sampling methods and relatively small sample size, although the large number of assessments (7 waves) increases precision of the statistical methods used. ConclusionsFindings suggest that it may be beneficial to target interventions to older adults with more severe depressive symptoms and who display low levels of active and emotional support coping. Behavioral interventions that improve these coping styles may help depressed older adults recover and maintain treatment gains over time.