Tests Assessed Group Differences Research Articles

A Comparison of Measured Airborne and Self-Reported Secondhand Smoke Exposure in the MADRES Pregnancy Cohort Study.

Secondhand smoke (SHS) exposure during pregnancy is linked to adverse birth outcomes, such as low birth weight and preterm birth. While questionnaires are commonly used to assess SHS exposure, their ability to capture true exposure can vary, making it difficult for researchers to harmonize SHS measures. This study aimed to compare self-reported SHS exposure with measurements of airborne SHS in personal samples of pregnant women. SHS was measured on 48-hour integrated personal PM2.5 Teflon filters collected from 204 pregnant women, and self-reported SHS exposure measures were obtained via questionnaires. Descriptive statistics were calculated for airborne SHS measures, and analysis of variance tests assessed group differences in airborne SHS concentrations by self-reported SHS exposure. Participants were 81% Hispanic, with a mean (standard deviation [SD]) age of 28.2 (6.0) years. Geometric mean (SD) personal airborne SHS concentrations were 0.14 (9.41) µg/m3. Participants reporting lower education have significantly higher airborne SHS exposure (p = .015). Mean airborne SHS concentrations were greater in those reporting longer duration with windows open in the home. There was no association between airborne SHS and self-reported SHS exposure; however, asking about the number of smokers nearby in the 48-hour monitoring period was most correlated with measured airborne SHS (Two + smokers: 0.30 µg/m3 vs. One: 0.12 µg/m3 and Zero: 0.15 µg/m3; p = .230). Self-reported SHS exposure was not associated with measured airborne SHS in personal PM2.5 samples. This suggests exposure misclassification using SHS questionnaires and the need for harmonized and validated questions to characterize this exposure in health studies. This study adds to the growing body of evidence that measurement error is a major concern in pregnancy research, particularly in studies that rely on self-report questionnaires to measure SHS exposure. The study introduces an alternative method of SHS exposure assessment using objective optical measurements, which can help improve the accuracy of exposure assessment. The findings emphasize the importance of using harmonized and validated SHS questionnaires in pregnancy health research to avoid biased effect estimates. This study can inform future research, practice, and policy development to reduce SHS exposure and its adverse health effects.

Paediatric eating disorders: Exploring virtual family therapy during a global pandemic.

Explore treatment response and effectiveness of virtual treatment for a paediatric eating disorder sample. Twenty patients and their families who received either virtual or in-person family therapy were included in the study. Family therapy was informed by family-based treatment (FBT) principles. Patients' weight restoration at 1, 3, and 6months after starting treatment was examined. Independent sample t tests assessed group differences and a Fisher exact test was used to evaluate the association between treatment group and weight restoration. Weight restoration did not significantly differ between treatment groups (virtual vs. in-person) at any time point and there was no association between group and remission weight at 6months. Study results are considered exploratory. Future research addressing study limitations is needed. Results suggest that paediatric eating disorder patients may benefit from family therapy delivered via a virtual platform.

Neurodevelopment of HIV-exposed uninfected children compared with HIV-unexposed uninfected children during early childhood.

HIV-exposed uninfected (HEU) children during the preschool and early school ages may be at-risk for neurodevelopmental challenges due to in utero and perinatal exposure to HIV and/or antiretroviral (ARV) medications. HEU children and HIV-unexposed uninfected (HUU) children from the community were recruited and tested at 3 to 4 and 5 to 6 years of age. Demographic information, HIV/ARV exposure and measures of intelligence, visuomotor skills, and adaptive functioning were obtained. Nonparametric tests assessed group differences and multiple regression analyses adjusted for demographic variables. Additional multiple regression analyses were performed within the HEU group to investigate associations between neurodevelopmental measures and variables of HIV/ARV exposure. At 3 to 4 years, 211 HEU children and 31 HUU children were assessed, and 144 HEU children and 58 HUU children were assessed at 5 to 6 years of age. At 3 to 4 years of age, HEU children scored significantly lower on measures of Full-Scale IQ, Performance IQ, visual motor integration, and adaptive functioning. At 5 to 6 years of age, HEU children scored significantly lower on all neurodevelopmental measures. At both ages, children who were female and those with mothers who were employed achieved higher scores on measures intellectual ability and/or adaptive functioning. Within the HEU group, no consistent associations were found between neurodevelopmental measures and HIV/ARV specific variables. HEU children demonstrated significantly lower scores on neurodevelopmental measures than HUU children during early childhood. Gaps in verbal intellectual abilities were identified with age, highlighting the importance of monitoring neurodevelopment in this population over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Three-Dimensional Biomechanics of the Trunk and Upper Extremity During Overhead Throwing in Wheelchair Lacrosse Athletes With Spinal Cord Injury.

Quantify differences in overhead throwing kinematics between wheelchair lacrosse athletes with spinal cord injury and able-bodied lacrosse athletes. This is a cross-sectional, prospective study. Motion analysis captured overhead throwing motions of five wheelchair lacrosse athletes with spinal cord injury and six able-bodied lacrosse athletes seated in a wheelchair and standing. Three-dimensional thorax and dominant arm sternoclavicular, acromioclavicular, glenohumeral, elbow, and wrist joint angles, ranges of motion, as well as angular velocities were computed using an inverse kinematics model. Nonparametric tests assessed group differences ( P < 0.05). Participants with spinal cord injury exhibited less peak thorax axial rotation, ranges of motion, and angular velocity, as well as greater wrist flexion than able-bodied participants seated. Participants with spinal cord injury exhibited less peak thorax axial rotation and lateral bending, ranges of motion, and three-dimensional angular velocities; less peak two-dimensional sternoclavicular joint motion, ranges of motion, and peak angular velocities; less peak acromioclavicular joint protraction angular velocity; less glenohumeral joint adduction-abduction and internal-external rotation motion, ranges of motion, and angular velocities; and greater wrist flexion than able-bodied participants standing. Kinematic differences were observed between groups, with athletes with spinal cord injury exhibiting less thorax and upper extremity joint motion and slower joint angular velocities than able-bodied athletes. This knowledge may provide insights for movement patterns and potential injury risk in wheelchair lacrosse.

Innovative approaches in investigating inter-beat intervals: Graph theoretical method suggests altered autonomic functioning in adolescents with ADHD.

Cardiac inter-beat intervals (IBIs) are considered to reflect autonomic functioning and self-regulatory abilities and are often investigated by traditional time- and frequency domain analyses. These analyses investigate IBI fluctuations across relatively long time series. The similarity graph algorithm is a nonlinear method that analyzes segments of IBI time series (i.e., time windows)-possibly being more sensitive to transient and spontaneous IBI fluctuations. We hypothesized that the similarity graph algorithm would detect differences between Attention-Deficit/Hyperactivity Disorder (ADHD) and control groups. Resting electrocardiogram (ECG) recordings were collected in 10-18-year-olds with ADHD (n=37) and controls (n=36). IBIs were converted to graphs that were subsequently investigated for similarity. We varied the criterion for defining IBIs as similar, assessing which setting best distinguished ADHD and control groups. Using this setting, we applied the similarity graph algorithm to time windows of 2-5, 6-13 and 12-25s, respectively. We also performed traditional IBI analyses. Independent samples t tests assessed group differences. Results showed that a 1.5% criterion of similarity and a time window of 2-5s best distinguished adolescents with ADHD and controls. The similarity graph algorithm showed a higher number of edges, maximum edges and cliques, and lower edges10+10/edges2+2 in the ADHD group compared to controls. The results suggested more similar IBIs in the ADHD group compared to the controls, possibly due to altered vagal activity and less effective regulation of heart rate. Traditional analyses did not detect any group differences. Consequently, the similarity graph algorithm might complement traditional IBI analyses as a marker of psychopathology.

Evaluation of a Diabetes Prevention Intervention for Korean American immigrants at Risk for Diabetes.

PurposeDespite the small but growing number of studies documenting the increasing prevalence of diabetes among Korean Americans, no culturally adapted interventions have been developed for Korean Americans at risk for diabetes. We evaluate the efficacy of a culturally tailored lifestyle intervention among Korean American immigrants at risk for diabetes in New York City (NYC).MethodsKorean Americans at risk for diabetes were recruited into a culturally adapted, community health worker (CHW) intervention in NYC. Treatment group participants received 6 group sessions and 10 follow-up phone calls from CHWs over the 6-month period. Control participants received only the first session. Study outcomes included changes in weight, body mass index (BMI), blood pressure, physical activity (PA) and PA behaviors, nutrition behaviors, and diabetes knowledge. Paired t-tests and chi-square tests assessed group differences for each group for each outcome measure.ResultsThe treatment group reported significant positive changes in recommended weekly PA, PA self-efficacy, PA barriers, nutrition self-efficacy, diabetes knowledge, weight, BMI, and systolic blood pressure compared with control participants. Generalized estimated equations models for repeated measures assessed change across time while adjusting for study arm, time point, and the interaction between study arm and time point. The intervention effect was significant for weekly moderate and vigorous PA, recommended weekly PA, PA self-efficacy, and diabetes knowledge.ConclusionsResults suggest that a culturally adapted lifestyle intervention for Korean American immigrants at risk for diabetes have the potential to improve behaviors associated with cardiovascular disease outcomes and diabetes prevention. Further research among Korean Americans is warranted.

The Adaptive GameSquad Xbox-Based Physical Activity and Health Coaching Intervention for Youth With Neurodevelopmental and Psychiatric Diagnoses: Pilot Feasibility Study.

BackgroundThe prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences.ObjectiveThis pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs.MethodsParticipants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA.ResultsOf the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67%) reported intention to continue, and 8 (89%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (−58.8 min; P=.04) but not for the intervention group (−5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames.ConclusionsAGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing.Trial RegistrationClinicalTrials.gov NCT03665415; https://clinicaltrials.gov/ct2/show/NCT03665415.

A Mixed Methods Study on Engagement and Satisfaction with a Digitally-Enhanced Pilot Intervention Among African American and Hispanic Women.

African American and Hispanic women report less physical activity (PA) than non-Hispanic White women. As such, a digitally-enhanced 16-week social support pilot intervention was conducted to promote PA among African American and Hispanic women dyads. This study quantitatively and qualitatively examined the engagement and satisfaction of participants (N = 30; 15 dyads) assigned to the intervention. Intervention participants received telephone counseling calls based on motivational interviewing and a Jawbone UP activity monitor. Intervention engagement and satisfaction data were collected from the Jawbone UP, call logs, self-report questionnaires conducted at the 16-week follow-up, and two post-intervention focus groups. Nonparametric tests assessed group differences across engagement and satisfaction measures, and a manually-driven coding scheme was used to evaluate emerging themes from qualitative text. Participants demonstrated high engagement in the telephone counseling sessions and moderate engagement with the Jawbone UP. Friend/co-worker dyads and participants who were 45years and older were more likely to use the device. Qualitative results emphasized participants' appreciation for the counseling calls, the Jawbone UP, and the overall dyadic framework of the study to collectively nurture social support and accountability for PA. Overall, the intervention group reacted positively to study components. Additional research is needed to understand the role of technology in facilitating long-lasting PA change via social support in minority populations.

What Is the Cost of a "Cast Holiday" in Treating Children With Early Onset Scoliosis (EOS) With Elongation Derotation Flexion (EDF, "Mehta") Casting?

Serial casting of children with early onset scoliosis (EOS) is an established treatment option. A break from cast treatment often called a "cast holiday," (CH) is often allowed by some centers, particularly over the summer months. The impact of CHs on treatment duration or outcome has not been examined. Institution review board approved retrospective review of children treated for EOS with elongation derotation flexion ("Mehta") casting at a children's hospital between 2001 and 2016 with a minimum of 2 years' follow-up. A CH was defined as a minimum of 4 weeks out of the cast, braced, or unbraced.The analysis was performed to determine the impact of a CH within the first 18 months of treatment. Separate analyses were performed for the entire cohort of children castedduring the study period, and then separately looking at idiopathic EOS in isolation. The impact of a CH was assessed in terms of the likelihood of achieving scoliosis <15 degrees at the final follow-up ("success"). Odds ratios were used to assess group differences between "success" ratios, and Student t tests assessed group differences for parametric data. Ninety children met inclusion and exclusion criteria, 31 of whom took a CH during the first 18 months of treatment (34%). This included 59 patients with idiopathic EOS (66%), 18 with syndromic EOS, 5 congenital, and 1 neuromuscular. There were no statistically significant differences between CH and no CH groups.Forty-four percent of the no CH group achieved scoliosis <15 degrees at final follow-up, as opposed to 13% of the CH group, an odds ratio of 5.3 for success without a CH. When limited to children with idiopathic EOS, 56% achieved success in the no CH, versus only 22% in the group that took a CH, an odds ratio of 4.4 for success with no CH. This study demonstrates that children treated for EOS with serial casting who take a CH within the first 18 months of treatment are less likely to achieve scoliosis <15 degrees than those who persist with treatment. Level III.

Comparing Web-Based and Classroom-Based Memory Training for Older Adults: The ACTIVE Memory Works™ Study.

To compare the efficacy of a web-based versus a classroom-based memory training program in enhancing cognition and everyday functioning in older adults, and program satisfaction and acceptability. Participants (N = 208; mean age = 71.1) were randomly assigned to a web-based or classroom-based training, or to a wait-list control condition. Cognitive and everyday functioning measures were administered at baseline, immediate, and 6 months post-training; both training groups evaluated program satisfaction and acceptability at immediate post-training. Repeated-measures analyses of variance assessed training effects on cognitive and functioning outcomes; independent-samples t tests assessed group differences in program satisfaction and acceptability. Compared to controls, neither training group showed a significant improvement on measures of memory or everyday functioning as assessed by dependence or difficulty on instrumental activities of daily living over time. Training effects did not transfer to non-trained cognitive abilities. The web-based group was as satisfied with the training as the classroom-based group (p > .05). Although no significant training effects were found, we demonstrated that a web-based platform is an acceptable and feasible mode to provide memory training to healthy older adults. Further studies are needed to investigate the potential of web-based memory training programs for improving cognition and function in cognitively healthy older adults.

C-02 An Unbiased Biomarker Approach to Neuropsychological, Behavioral, and Psychiatric Symptoms in a Mixed Clinical Sample

Abstract Objective Suspected Non-Alzheimer’s Pathology (SNAPs) are individuals who present with a cognitive syndrome meeting clinical criteria for Alzheimer’s disease (AD) but are found to lack underlying AD pathology. Current clinical criteria for AD lack specificity in predicting underlying neurodegenerative pathology. With the advent of amyloid positron emission tomography (PET) the presence of amyloid pathology can now be identified in vivo. Using a biomarker-based approach, we aimed to characterize the neuropsychological, behavioral, and psychiatric profile of SNAPs in contrast to those with AD pathology (APs). Method 76 individuals (26 amyloid-negative [SNAPs], 50 amyloid- positive [APs]) completed neuropsychological testing and a PET amyloid scan as a part of a longitudinal observational study at the Cleveland Clinic LRCBH. Individuals meeting NIA-A criteria for MCI or mild AD with a Clinical Dementia Rating score of .05 -1 were included. Amyloid status was determined via clinical read of two clinicians trained in reading amyloid scans (neuroradiologist and neuropsychiatrist). Independent samples t tests assessed group differences between SNAPs and APs across cognitive, behavioral, and psychiatric measures. Results Mini-Mental State Examination scores were equivalent between SNAPs and APs. SNAPs performed significantly better on measures of verbal and nonverbal memory, set-shifting, and semantic fluency, as well as aspects of processing speed and working memory (all p’s &lt; .05). Additionally, SNAPs endorsed more RBD symptoms (p &lt; .05). No significant group differences were observed across neuropsychiatric or functional measures. Conclusion(s) Differences in an individual’s neuropsychological, behavioral, and psychiatric profile in consideration with a biomarker approach may provide key insights and afford greater diagnostic clarity.

From Wary Wearers to d-Embracers: Personas of Readiness to Use Diabetes Devices.

Diabetes devices such as insulin pumps and continuous glucose monitoring (CGM) are associated with improved health and quality of life in adults with type 1 diabetes (T1D). However, uptake remains low. The aim of this study was to develop different "personas" of adults with T1D in relation to readiness to adopt new diabetes technology. Participants were 1498 T1D Exchange participants who completed surveys on barriers to uptake, technology attitudes, and other psychosocial variables. HbA1c data was available from the T1D Exchange for 30% of the sample. K-means cluster analyses grouped the sample by device barriers and attitudes. The authors assigned descriptive labels based on cluster characteristics. ANOVAs and chi-square tests assessed group differences by demographic and psychosocial variables (eg, diabetes duration, diabetes distress). Analyses yielded five distinct personas. The d-Embracers (54% of participants) endorsed few barriers to device use and had the highest rates of device use, lowest HbA1c, and were the least distressed. The Free Rangers (23%) had the most negative technology attitudes. The Data Minimalists (10%) used pumps but had lower CGM use and did not want more diabetes information. The Wary Wearers (11%) had lower overall device use, were younger, more distressed, endorsed many barriers, and had higher HbA1c. The High Distress (3%) group members were the youngest, had the shortest diabetes duration, reported the most barriers, and were the most distressed. These clinically meaningful personas of device readiness can inform tailored interventions targeting barriers and psychosocial needs to increase device uptake.

Using Cluster Analysis to Understand Clinician Readiness to Promote Continuous Glucose Monitoring Adoption.

Many people with type 1 diabetes (T1D) report barriers to using continuous glucose monitoring (CGM). Diabetes care providers may have their own barriers to promoting CGM uptake. The goal of this study was to develop clinician "personas" with regard to readiness to promote CGM uptake. Diabetes care providers who treat people with T1D (N = 209) completed a survey on perceived patient barriers to device uptake, technology attitudes, and characteristics and barriers specific to their clinical practice. K-means cluster analyses grouped the sample by CGM barriers and attitudes. ANOVAs and chi-square tests assessed group differences on provider and patient characteristics. The authors assigned descriptive names for each persona. Analyses yielded three clinician personas regarding readiness to promote CGM uptake. Ready clinicians (20% of sample; 24% physicians, 38% certified diabetes educators/CDEs) had positive technology attitudes, had clinic time to work with patients using CGM, and found it easy to keep up with technology advances. In comparison, Cautious clinicians (41% of sample; 17% physicians, 53% CDEs) perceived that their patients had many barriers to adopting CGM and had less time than the Ready group to work with patients using CGM data. Not Yet Ready clinicians (40% of sample; 9% physicians; 79% CDEs) had negative technology attitudes and the least clinic time to work with CGM data. They found it difficult to keep up with technology advances. Some diabetes clinicians may benefit from tailored interventions and additional time and resources to empower them to help facilitate increased uptake of CGM technology.

Disease burden and pain in obese cancer patients with chemotherapy-induced peripheral neuropathy.

Chemotherapy-induced peripheral neuropathy (CIPN) and obesity are prevalent in cancer survivors and decrease quality of life; however, the impact of the co-occurrence of these conditions has garnered little attention. This study investigated differences between obese and non-obese cancer survivors with CIPN and predictors of symptom burden and pain. Patients with CIPN were administered the MD Anderson Symptom Inventory and a modified version of pain descriptors from the McGill Pain Inventory. Independent t tests assessed group differences between obese and non-obese survivors, and linear regression analyses explored predictors of patient outcomes. Results indicated a significant difference in symptom severity scores for obese (M=32.89, SD=25.53) versus non-obese (M=19.35, SD=16.08) patients (t(37.86)=-2.49, p=.02). Significant differences were also found for a total number of pain descriptors endorsed by obese (M=4.21, SD=3.45) versus non-obese (M=2.42, SD=2.69) participants (t(74)=-2.53, p=.01). Obesity was a significant predictor of symptom severity and total pain descriptors endorsed. Other significant predictors included age and months since treatment. Cancer survivors with CIPN and co-occurring obesity may be more at risk for decreased quality of life through increased symptom severity and pain compared to non-obese survivors. This paper identified risk factors, including obesity, age, and months since treatment, that can be clinically identified for monitoring distress in CIPN patients. Future research should focus on the longitudinal relationship between obesity and CIPN, and robust interventions to address the multifaceted issues faced by cancer survivors.

Maternal child feeding practices and eating behaviors of women with extreme obesity and those who have undergone bariatric surgery

BackgroundBariatric surgery is the most effective treatment of extreme obesity. Few studies, however, have explored some of the lifestyle behaviors (i.e., grocery shopping and cooking methods) thought to contribute to postoperative weight maintenance. To date, the child feeding practices of women who have undergone bariatric surgery have not been explored. The study setting was a university in the United States. MethodsA total of 41 women awaiting bariatric surgery were assessed preoperatively; an additional 23 women who had undergone bariatric surgery (6–24 mo previously) were also assessed. The participants had to be responsible for feeding a child (age range 2–16 yr) in their home. Self-report measures assessed demographics, maternal child feeding practices, eating behaviors, and available household foods. Bivariate correlations were used to investigate the relationships among the measures. Independent sample t tests assessed group differences, and 1-way analysis of variance and concepts of linear progression and regression were used to determine whether the findings remained statistically significant after controlling for demographic variables. ResultsWomen who had undergone surgery, compared with those awaiting surgery, reported more frequent modeling of healthy eating for their child (P = .009), significantly greater levels of cognitive restraint (P = .001), and lower levels of disinhibition (P = .019). Some between-group differences were found in grocery shopping frequency (P = .093) and in select foods available in the home (P = .101 to P = .151), which approached statistical significance. ConclusionMothers who had undergone bariatric surgery demonstrated healthy eating for their child and were engaged in healthier eating behaviors themselves compared with women awaiting surgery. Intervening with mothers who are undergoing bariatric surgery could present a unique opportunity for modifying the home food environment and promoting healthy eating among other family members, especially those children at risk of extreme obesity.

Treatment-completion rates with olanzapine long-acting injection versus risperidone long-acting injection in a 12-month, open-label treatment of schizophrenia: indirect, exploratory comparisons.

BackgroundLittle is known about the comparative effectiveness of atypical antipsychotics in long-acting injection formulation. Due to the absence of head-to-head studies comparing olanzapine long-acting injection and risperidone long-acting injection, this study was intended to make exploratory, indirect, cross-study comparisons between the long-acting formulations of these two atypical antipsychotics in their effectiveness in treating patients with schizophrenia.MethodsIndirect, cross-study comparisons between olanzapine long-acting injection and risperidone long-acting injection used 12-month treatment-completion rates, because discontinuation of an antipsychotic for any cause is a recognized proxy measure of the medication’s effectiveness in treating schizophrenia. Following a systematic review of the literature, two indirect comparisons were conducted using open-label, single-cohort studies in which subjects were stabilized on an antipsychotic medication before depot initiation. The first analysis compared olanzapine long-acting injection (one study) with pooled data from nine identified risperidone long-acting injection studies. The second analysis was a “sensitivity analysis,” using only the most similar studies, one for olanzapine long-acting injection and one for risperidone long-acting injection, which shared near-identical study designs and involved study cohorts with near-identical patient characteristics. Pearson Chi-square tests assessed group differences on treatment-completion rates.ResultsComparison of olanzapine long-acting injection data (931 patients) with the pooled data from the nine risperidone long-acting injection studies (3950 patients) provided almost identical 12-month treatment-completion rates (72.7% versus 72.4%; P = 0.87). When the two most similar studies were compared, the 12-month completion rate for olanzapine long-acting injection was significantly higher than for risperidone long-acting injection (81.3% versus 47.0%; P < 0.001). However, any conclusions drawn from this comparison may be limited by differences in the studies’ geographic catchment areas.ConclusionUsing treatment-completion rates as a proxy measure of medication effectiveness, olanzapine long-acting injection did not differ significantly from risperidone long-acting injection when including all eligible studies. However, the findings of this exploratory analysis should be interpreted with caution, considering the methodological limitations of these indirect, cross-study comparisons.

Low early morning plasma cortisol in posttraumatic stress disorder is associated with co-morbid depression but not with enhanced glucocorticoid feedback inhibition

Co-morbid major depressive disorder (MDD) in individuals with posttraumatic stress disorder (PTSD) confers a more severe clinical course and is associated with distinct biologic abnormalities. Although dysregulation in the hypothalamic pituitary adrenal (HPA) axis has been well established in PTSD, the impact of commonly co-occuring MDD has received scant attention. Overnight (7p.m. to 7a.m.) plasma cortisol, adrenocorticotropic hormone (ACTH), dehydroepiandrosterone sulphate (DHEA-S) were measured at 30 min intervals in 9 participants with PTSD with MDD (PTSD+MDD), 9 with PTSD without MDD (PTSD-MDD) and 16 non-traumatized healthy controls. A low-dose dexamethasone suppression test was administered to evaluate feedback sensitivity to glucocorticoids. Linear mixed models with body mass index (BMI) and age as covariates and Bonferroni corrected post hoc tests assessed group differences. Compared to healthy controls, subjects with PTSD+MDD, but not those subjects with PTSD-MDD, exhibited lower basal plasma cortisol levels between 1:30 a.m. and 3:30 a.m. and at 4:30 a.m. and 6:30 a.m. (effect size d=0.75). Despite similar plasma ACTH levels between the three groups, the ACTH/cortisol ratio was higher in PTSD+MDD patients compared to controls. We obtained similar results when the patient and control groups were re-studied 1 week later, and when men and current smokers were excluded. Basal plasma DHEA-S levels, and cortisol and ACTH response to a low-dose dexamethasone suppression test were similar in all three groups. Lower early morning plasma cortisol levels and a high ACTH/cortisol ratio in subjects with PTSD and co-morbid MDD may not be due to enhanced peripheral sensitivity to glucocorticoids. A central abnormality in glucocorticoid regulation could explain HPA axis dysfunction in this subgroup.

Laterality of cortical response to ethanol is moderated by TaqIA A1 allele

Acute ethanol releases dopamine, implicated in drug-related reinforcement, and suppresses glucose metabolism, particularly within the right cerebral hemisphere (Volkow et al., 2008; Volkow et al., 2006). This is consistent with a predominance of left hemisphere activity being associating with positive affect or approach, and right hemisphere predominance with negative affect/avoidance (Davidson, 2002; Tomer et al., 2008). Despite substantial evidence linking the Taq1 DRD2 A1 allele with lower dopaminergic tone and greater vulnerability to alcoholism (Noble, 2000), its role in modulating acute effects of alcohol is unknown. We hypothesized that in individuals with the A1 allele, acute ethanol would improve mood and alter relative hemispheric activity. Twelve healthy right-handed white men (mean age [sd]= 29.0 [5.0]) with no history of psychiatric diagnosis or dependence on alcohol had TaqI A DRD2 alleles assessed from blood. Six had the A1A2 genotype (A1+) and six the A2A2 genotype (A1-). In two order-counterbalanced [F-18]fluorodeoxyglucose (FDG) positron emission tomography (PET- Siemens ECAT EXACT HR+ tomography; CTI, Knoxville, TN) sessions 10 ± 8 days apart, globally-scaled counts served as a surrogate marker of relative glucose metabolism while participants performed a 35-min auditory vigilance task. Five min before testing, participants drank 250-ml of diet soda containing either 0.75 g/kg body weight or a trivial dose of ethanol, and self-rated their anxiety and fatigue (McNair et al., 1971). Five min after task initiation, FDG (≤5 mCi, ≤185 MBq) was injected intravenously. PET images were acquired for 30 min, and analyzed via statistical parametric mapping software (SPM5; http://www.fil.ion.ucl.ac.uk/spm/software/spm5/), as previously detailed (London et al., 2004). Individual hemispheric comparisons of relative activity within lateral cortex also analyzed 56 anatomical regions-of-interest (ROIs) from a parcellation of MNI-space (Tzourio-Mazoyer et al., 2002). We hypothesized that presence of the A1 allele would influence effects of ethanol on laterality ([Right/(Left+Right)]×100ethanol - [Right/(Left+Right)]×100placebo). Within-subject hemispheric differences were assessed with t-tests. Wilcoxon Signed-Rank tests assessed group differences. Correlation analysis quantified the relationship between ethanol-related change in mood and laterality.