Andrew J. Sarkin

The Relative Roles of Hepatitis B and C Viruses in the Etiology of Hepatocellular Carcinoma in Southern African Blacks

BACKGROUND & AIMS Epidemiological studies have shown the relative roles of hepatitis B and C viruses in hepatocarcinogenesis to vary considerably among populations. The aim of this study was to define the independent and interactive roles of the two viruses in the genesis of hepatocellular carcinoma in southern African blacks. METHODS Blood samples were taken from 231 black patients with hepatocellular carcinoma and matched controls treated at four Johannesburg hospitals. These were tested for hepatitis B surface antigen, antibodies to hepatitis C virus, and hepatitis C virus RNA. RESULTS Relative to individuals without serological evidence of hepatitis B or C infection, those positive for hepatitis B surface antigen alone had a statistically significant 23.3-fold increased risk for hepatocellular carcinoma, whereas those positive for hepatitis C serology alone had a statistically significant risk of 6.6. A synergistic effect on risk was evident when both hepatitis B and C markers were present (relative risk, 82.5). Hepatitis B virus alone is estimated to cause 43% of hepatocellular carcinoma in southern African blacks, hepatitis C alone 5%, and coinfection with the two viruses 20%. CONCLUSIONS Hepatitis B virus plays a predominant role in hepatocellular carcinogenesis in southern African blacks, with hepatitis C virus responsible for a smaller proportion of cases. Coinfection with the two viruses carries a synergistic risk of hepatocellular carcinoma formation.

The effects of a community-based literacy program on young children's language and conceptual development

Effects of a community-based literacy program on 1−, 2−, and 3-year-old childrens language and conceptual development were assessed. University students were trained to teach Head Start parents effective methods for reading to their children. Families were randomly assigned to receive 18, 3, or 0 instructional visits. Results indicated that parents in the 18-instructional-visit program increased their participation in appropriate literacy behaviors such as reading to their children, teaching concepts to their children, and using the library, more than parents in the 0-instructional-visit groups. Children in the 18-instructional-visit program showed greater gains in language and conceptual development than children in the 0-instructional-visit group. Few differences were found between children in the 3-visti and 0-instructional-visit groups. Thus, only a high-intensity community-based intervention designed to train parents was effective in increasing emergent literacy in low-income ethnic children.

Health Care Utilization in Patients with Gout

OBJECTIVE To study health care utilization patterns in patients with gout. METHODS In a gout population from primary care and rheumatology clinics in 3 U.S. metropolitan cities, we collected data on gout-related utilization (primary care, rheumatology, urgent care, emergency room, and other) in the past year. We evaluated the association of comorbidities, age, gender, gout characteristics (time since last gout attack and tophi), and gout severity ratings (mean of serum uric acid, patient-rated, and physician-rated gout severity) and with emergency/urgent care and primary care utilization using regression and correlation analyses. RESULTS Of the 296 patients who reported visiting at least 1 type of health practitioner for gout in the past year, the percentage of patients utilizing the service at least once and annual utilization rates among utilizers were as follows: primary care physician, 60%, 3.0 ± 3.4; nurse practitioner/physician assistant, 26%, 2.7 ± 2.5; rheumatologist, 51%, 3.7 ± 5.7; urgent care, 23%, 2.1 ± 2.2; emergency room, 20%, 2.0 ± 1.7; and hospitalization, 7%, 2.1 ± 1.4. Higher overall gout severity was associated with greater use of each resource type and with overall gout-related utilization. Nonemergency/nonurgent care utilization (primary care physician, nurse practitioner, physicians assistant, and rheumatologist for gout) was the strongest predictor of gout-related emergency/urgent care utilization. Patients with more comorbidities had greater gout-related primary care utilization. CONCLUSIONS Overall gout severity was associated with all types of gout-related utilization. This may help to screen high utilizers for targeted behavioral and therapeutic interventions. Having a higher number of comorbid conditions was a risk factor for higher gout-related primary care utilization.

Sociodemographic differences in quality of life in rheumatoid arthritis.

Assessment of health-related quality of life (HR-QOL) in people with rheumatoid arthritis (RA) has become important in health research and can inform clinical care. Many studies have found sociodemographic differences in the HR-QOL of people with RA, and interpreting these differences can be challenging. Biological, health disparity, reporting and assessment instrument differences are a few of the possible explanations that should be considered when interpreting results. Our review of the evidence of sociodemographic differences in HR-QOL in people with RA produced 34 articles describing 49 studies.Typically, patients with RA who were older, female, less educated, non-employed and/or less affluent tended to have significantly lower HR-QOL than other groups. Some evidence also indicated that people with RA who are non-White or who live in rural settings may also tend to have lower HR-QOL scores, but the number of studies supporting these findings was sparse.Researchers and clinicians can optimise their assessment of HR-QOL by finding well validated instruments for the context they are working in. Additional research is needed to identify the exact causes of HR-QOL differences so that quality treatment can be provided to those in need.

Gout disease-specific quality of life and the association with gout characteristics.

Purpose: Assess the association of gout characteristics with health-related quality of life (HRQoL) using a new gout-specific HRQoL instrument, the Gout Impact Scale (GIS). Patients and methods: Gout patients completed the GIS (five scales [0–100 score each] representing impact of gout overall [three scales] and during an attack [two scales]) and other questions describing recent gout attacks, treatment, gout history, comorbidities, and demographics. Physicians confirmed gout diagnosis, presence of tophi, and most recent serum uric acid (sUA) level. Relationships between gout characteristics and GIS scores were examined using analysis of variance and correlation analyses. Results: The majority of patients were male (90.2%) with a mean age of 62.2 (±11.8) years. Approximately one-half (49.7%) reported ≥3 gout attacks in the past year and the majority (57.9%) reported experiencing gout-related pain between attacks. Patients had appreciable concern about their gout (“gout concern overall” scale, 63.1 ± 28.0) but believed their treatment was adequate (“unmet gout treatment need” scale (38.2 ± 21.4) below scale mid-point). Significantly worse GIS scores were associated with increasing attack frequency and greater amount of time with pain between attacks (most scales, P < 0.001). Common objective measures such as sUA level, presence of tophi and the number of joints involved in a typical attack did not appear to be good indicators of the impact of gout on the patients’ HRQoL. Conclusion: Attack frequency and gout pain between attacks were important correlates of patients’ ratings of gout impact on their HRQoL. Further studies are needed to determine the minimal important difference for each GIS scale and interpret our results relative to other patient populations with gout.

Minimally important differences of the gout impact scale in a randomized controlled trial

OBJECTIVE The Gout Impact Scale (GIS) is a gout-specific quality of life instrument that assesses impact of gout during an attack and impact of overall gout. The GIS has five scales and each is scored from 0 to 100 (worse health). Our objective was to assess minimally important differences (MIDs) for the GIS administered in a randomized controlled trial (RCT) assessing rilonacept vs placebo for prevention of gout flares during initiation of allopurinol therapy. METHODS Trial subjects (n = 83) included those with two or more gout flares (self-reported) in the past year. Of these, 73 had data for Weeks 8 vs 4 and formed the MID analysis group and were analysed irrespective of the treatment assignment. Subjects completed the GIS and seven patient-reported anchors. Subjects with a one-step change (e.g. from very poor to poor) were considered as the MID group for each anchor. The mean change in GIS scores and effect size (ES) was calculated for each anchors MID group. The average of these created the overall summary MID statistics for each GIS. An ES of 0.2-0.5 was considered to represent MID estimates. Results. Trial subjects (n = 73) were males (96.0%), White (90.4%), with mean age of 50.5 years and serum uric acid of 9.0 mg/dl. The mean change score for the MID improvement group for scales ranged from -5.24 to -7.61 (0-100 scale). The ES for the MID improvement group for the four scales ranged from 0.22 to 0.38. CONCLUSION The MID estimates for GIS scales are between 5 and 8 points (0-100 scale). This information can aid in interpreting the GIS results in future gout RCTs. Trial Registration. Clinicaltrials.gov, www.clinicaltrials.gov, NCT00610363.

Positive and negative schizotypal symptoms relate to different aspects of crossover reaction time task performance

Although the expressions of both positive and negative symptoms in schizophrenia spectrum illnesses can each occur with varying degrees of severity, researchers have often dichotomized patients as generally positive or negative subtypes. Studies of schizophrenia and schizotypal personality disorder (SPD) have not typically controlled for the severity of the other symptom types when examining the relationship between positive and negative symptom subtypes and cognitive impairment. The present study investigated the relationship between the severity of both symptom types and reaction time crossover task performance in SPD in groups made equivalent on the severity of the other type of symptom. Fifty-eight out of 458 undergraduates were screened into one of four groups (high negative-high positive, low negative-low positive, high negative-low positive or low negative-high positive) by the Schizotypal Personality Questionnaire and assessed with the reaction time crossover task. The results indicated that negative schizotypal symptoms were associated with the early crossover pattern, while positive schizotypal symptoms related to longer overall reaction time. Therefore, different cognitive mechanisms involved in crossover task performance appeared to be associated with different symptom subtypes.

The psychometric properties of the Illness Management and Recovery scale in a large American public mental health system.

The Illness Management and Recovery (IMR) scale was created to measure recovery outcomes produced by the IMR program. However, many other mental health care programs are now designed to impact recovery-oriented outcomes, and the IMR has been identified as a potentially valuable measure of recovery-oriented mental health outcomes. The purpose of this study was to examine the psychometric properties and structural validity of the IMR clinician scale within a variety of therapeutic modalities other than IMR in a large multiethnic sample (N=10,659) of clients with mental illness from a large U.S. county mental health system. Clients completed the IMR on a single occasion. Our estimates of internal consistency were stronger than those found in previous studies (α=0.82). The scale also related to other measures of theoretically similar constructs, supporting construct and criterion validity claims. Additionally, confirmatory factor analyses supported the multidimensional representation of the IMR clinician scale. The three-factor model of illness self-management and recovery was represented by dimensions of recovery, management, and substance use. These reliable psychometric properties support the use of both the original one-factor and revised three-factor models to assess illness self-management and recovery among a broad spectrum of clients with mental illness.

A Systematic Scoping Review of Yoga Intervention Components and Study Quality

CONTEXT The scientific study of yoga requires rigorous methodology. This review aimed to systematically assess all studies of yoga interventions to (1) determine yoga intervention characteristics; (2) examine methodologic quality of the subset of RCTs; and (3) explore how well these interventions are reported. EVIDENCE ACQUISITION Searches were conducted through April 2012 in PubMed, PsycINFO, Ageline, and Ovids Alternative and Complementary Medicine database using the text term yoga, and through handsearching five journals. Original studies were included if the intervention (1) consisted of at least one yoga session with some type of health assessment; (2) targeted adults aged ≥18 years; (3) was published in an English-language peer-reviewed journal; and (4) was available for review. EVIDENCE SYNTHESIS Of 3,062 studies identified, 465 studies in 30 countries were included. Analyses were conducted through 2013. Most interventions took place in India (n=228) or the U.S. (n=124), with intensity ranging from a single yoga session up to two sessions per day. Intervention lengths ranged from one session to 2 years. Asanas (poses) were mentioned as yoga components in 369 (79%) interventions, but were either minimally or not at all described in 200 (54%) of these. Most interventions (74%, n=336) did not include home practice. Of the included studies, 151 were RCTs. RCT quality was rated as poor. CONCLUSIONS This review highlights the inadequate reporting and methodologic limitations of current yoga intervention research, which limits study interpretation and comparability. Recommendations for future methodology and reporting are discussed.

Effects of schizophrenia and aging on pupillographic measures of working memory

The amount of cognitive resources used to perform a task can be indexed as changes in pupil size. In a previous study, we examined pupillary response measures of slave store and central executive cognitive resources during a working memory task and found abnormally reduced utilization of these resources in schizophrenia. In the present study, multiple regression analyses were performed to examine the independent and combined effects of aging and schizophrenia on pupillary response and recall measures in a larger sample of community-dwelling schizophrenia patients. Schizophrenia was associated with a significant decline in working memory capacity, and an additional moderate decline was associated with aging, but these two factors did not interact. Baseline pupil size was significantly correlated with symptom severity, independent of medication. However, pupillary responses evoked by the working memory task and recall scores were not related to symptom severity. Results were consistent with an additive, rather than a synergistic, relationship between aging and schizophrenia, and suggested that working memory impairment in noninstitutionalized outpatients with schizophrenia may remain stable across symptom status and across the life span.