Christopher R. D'Adamo

Benzodiazepine Use and Misuse Among Patients in a Methadone Program

BackgroundBenzodiazepines (BZD) misuse is a serious public health problem, especially among opiate-dependent patients with anxiety enrolled in methadone program because it puts patients at higher risk of life-threatening multiple drug overdoses. Both elevated anxiety and BZD misuse increase the risk for ex-addicts to relapse. However, there is no recent study to assess how serious the problem is and what factors are associated with BZD misuse. This study estimates the prevalence of BZD misuse in a methadone program, and provides information on the characteristics of BZD users compared to non-users.MethodsAn anonymous survey was carried out at a methadone program in Baltimore, MD, and all patients were invited to participate through group meetings and fliers around the clinic on a voluntary basis. Of the 205 returned questionnaires, 194 were complete and entered into final data analysis. Those who completed the questionnaire were offered a

Serum 25-hydroxyvitamin D, transitions between frailty states, and mortality in older adults: the Invecchiare in Chianti Study

5 gift card as an appreciation.Results47% of the respondents had a history of BZD use, and 39.8% used BZD without a prescription. Half of the BZD users (54%) started using BZD after entering the methadone program, and 61% of previous BZD users reported increased or resumed use after entering methadone program. Compared to the non-users, BZD users were more likely to be White, have prescribed medication for mental problems, have preexistent anxiety problems before opiate use, and had anxiety problems before entering methadone program. They reported more mental health problems in the past month, and had higher scores in anxiety state, depression and perceived stress (p < .05).ConclusionsImportant information on epidemiology of BZD misuse among methadone-maintenance patients suggests that most methadone programs do not address co-occurring anxiety problems, and methadone treatment may trigger onset or worsening of BZD misuse. Further study is needed to explore how to curb misuse and abuse of BZD in the addiction population, and provide effective treatments targeting simultaneously addiction symptoms, anxiety disorders and BZD misuse.

Factors Associated with Exercise Among Older Adults in a Continuing Care Retirement Community

To assess whether serum 25‐hydroxyvitamin D (25(OH)D) concentrations relate to transitions between the states of robustness, prefrailty, and frailty and to mortality in older adults.

Qualitative and Quantitative Evaluation of a Pilot Integrative Coping and Resiliency Program for Healthcare Professionals

&NA; The objectives of this study were to test a model of the factors that influence exercise activities among a group of older adults living in a continuing care retirement community with a wellness center that features a pool, exercise room, and exercise classes. This was a correlational study using a one‐time survey. A total of 163 residents with an average age of 86.6 years (SD = 6.1) participated in the study. Ninety (55%) of the participants exercised regularly (30 minutes daily), 88% of whom used the wellness center. Of all participating residents, 49% reported using the wellness center. Self‐efficacy and negative outcome expectations directly related to exercise behavior Marital status, resilience, health status, pain, and fear of falling were indirectly related to exercise. All of these factors explained 15% of the variance in exercise behavior. These findings support previous work and provide future direction for research regarding interventions to increase exercise among older adults. Further, access to a wellness center providing exercise opportunities may increase adherence to a regular exercise regimen among older adults.

Short-term changes in body composition after surgical repair of hip fracture

Stress, fatigue, and burnout are common maladies among healthcare employees. To address this problem, a holistic integrative self-care program for healthcare practitioners was designed, implemented, and evaluated. A total of 84 participants, recruited via presentations, flyers, and word of mouth, completed the 8-week program. The experiential course, entitled Healing Pathways, combined training in Reiki, guided imagery, yoga, toning, meditation, intuitive scanning, creative expression, and mentorship to foster more empowered and resilient individuals. We measured the effectiveness of the program via mixed methods consisting of qualitative interviews providing in-depth feedback and quantitative analysis demonstrating statistically significant benefit. Participants reported significantly lower levels of stress and significantly increased confidence in their ability to cope at treatment conclusion (8 weeks) and long-term follow-up (12 months). These findings suggest that an integrative wellness and resiliency program, coupled with individual mentorship, may improve coping, decrease stress, and improve functioning and well-being for nurses and other health care providers.

Probiotics and gastrointestinal conditions: An overview of evidence from the Cochrane Collaboration

BACKGROUND the deleterious changes in body composition that occur during the year after hip fracture are associated with increased disability, recurrent fracture, and mortality. While the majority of these unfavourable changes have been shown to occur during the first 2 months after fracture, potential changes in body composition occurring earlier than 2 months post-fracture have not been studied. Accordingly, the aim of this study was to rigorously assess short-term changes in body composition after hip fracture. METHODS total body mass, lean mass, fat mass and total hip and femoral neck bone mineral density (BMD) were assessed via dual energy X-ray absorptiometry at 3 days, 10 days and 2 months post-fracture among 155 hip fracture patients from the Baltimore Hip Studies. Longitudinal regression analysis using mixed models was conducted to model short-term changes in body composition. RESULTS no significant changes in body composition were revealed from 3- to 10 days post-fracture. However, significant decreases from 10 days to 2 months post-fracture were noted in the total body mass (-1.95 kg, P < 0.001), lean mass (-1.73 kg, P < 0.001), total hip BMD (-0.00812 g/cm(2), P = 0.04) and femoral neck BMD (-0.015 g/cm(2), P = 0.03). No meaningful changes in fat mass were uncovered. CONCLUSIONS the adverse changes in body composition during the first 2 months after hip fracture appear to have occurred primarily between 10 days and 2 months post-fracture. More research is needed to determine how these findings might help inform the optimal timing of interventions aimed at improving body composition and related outcomes after hip fracture.

Serum Vitamin E Concentrations and Recovery of Physical Function During the Year After Hip Fracture

Alterations in the composition of the gut microbiota are associated with a number of gastrointestinal (GI) conditions, including diarrhea, inflammatory bowel diseases (IBD), and liver diseases. Probiotics, live microorganisms that may confer a health benefit to the host when consumed, are commonly used as a therapy for treating these GI conditions by means of modifying the composition or activity of the microbiota. The purpose of this review was to summarize the evidence on probiotics and GI conditions available from Cochrane, a nonprofit organization that produces rigorous and high-quality systematic reviews of health interventions. Findings from this review will help provide more precise guidance for clinical use of probiotics and to identify gaps in probiotic research related to GI conditions.

Spice MyPlate: Nutrition Education Focusing Upon Spices and Herbs Improved Diet Quality and Attitudes Among Urban High School Students

BACKGROUND Poor nutritional status after hip fracture is common and may contribute to physical function decline. Low serum concentrations of vitamin E have been associated with decline in physical function among older adults, but the role of vitamin E in physical recovery from hip fracture has never been explored. METHODS Serum concentrations of α- and γ-tocopherol, the two major forms of vitamin E, were measured in female hip fracture patients from the Baltimore Hip Studies cohort 4 at baseline and at 2-, 6-, and 12-month postfracture follow-up visits. Four physical function measures-Six-Minute Walk Distance, Lower Extremity Gain Scale, Short Form-36 Physical Functioning Domain, and Yale Physical Activity Survey-were assessed at 2, 6, and 12 months postfracture. Generalized estimating equations modeled the relationship between baseline and time-varying serum tocopherol concentrations and physical function after hip fracture. RESULTS A total of 148 women aged 65 years and older were studied. After adjusting for covariates, baseline vitamin E concentrations were positively associated with Six-Minute Walk Distance, Lower Extremity Gain Scale, and Yale Physical Activity Survey scores (p < .1) and faster improvement in Lower Extremity Gain Scale and Yale Physical Activity Survey scores (p < .008). Time-varying vitamin E was also positively associated with Six-Minute Walk Distance, Lower Extremity Gain Scale, Yale Physical Activity Survey, and Short Form-36 Physical Functioning Domain (p < .03) and faster improvement in Six-Minute Walk Distance and Short Form-36 Physical Functioning Domain (p < .07). CONCLUSIONS Serum concentrations of both α- and γ-tocopherol were associated with better physical function after hip fracture. Vitamin E may represent a potentially modifiable factor related to recovery of postfracture physical function.

Rating of Included Trials on the Efficacy–Effectiveness Spectrum: development of a new tool for systematic reviews

Purpose: To determine whether an experiential nutrition education intervention focusing on spices and herbs (“Spice MyPlate”) is feasible and improves diet quality and healthy eating attitudes among an urban and predominantly African-American sample of adolescents more than standard nutrition education alone. Design: A nonrandomized controlled trial compared standard nutrition education in U.S. Department of Agriculture MyPlate guidelines (control group) with standard nutrition education plus adjuvant Spice MyPlate curriculum (intervention group). Data were collected at baseline and after 3, 6, and 10 weeks. Setting: Study setting was two public high schools in Baltimore, Maryland. Subjects: A total of 110 students in grades 9 to 12 participated. Intervention: The 6-week school-based intervention conducted during health class focused on cooking using spices and herbs to eat healthier diets according to MyPlate. Measures: Dietary intake reported on 3-day food records and healthy eating attitudes questionnaires was analyzed. Analysis: Differences in diet quality and healthy eating attitudes between study groups were estimated by t-tests, Wilcoxon-Mann-Whitney tests, and covariate-adjusted regression models. Results: Spice MyPlate was feasible and there were modest but significant improvements (p ≤ .05) in the Spice MyPlate group compared with control in whole grains (31.2 g/wk) and protein foods (13.2 ounces per week) intake, and attitudes toward eating vegetables, whole grains, lean protein, and low-fat dairy. Conclusions: Although randomized trials are needed, experiential nutrition education focusing on spices and herbs may help urban and predominantly African-American adolescent populations eat healthier diets.

Serum vitamin E concentrations among highly functioning hip fracture patients are higher than in nonfracture controls

BACKGROUND AND OBJECTIVE Randomized trials may be designed to provide evidence more strongly related to efficacy or effectiveness of an intervention. When systematic reviews are used to inform clinical or policy decisions, it is important to know the efficacy-effectiveness nature of the included trials. The objective of this study was to develop a tool to characterize randomized trials included in a systematic review on an efficacy-effectiveness continuum. METHODS We extracted rating domains and descriptors from existing tools and used a modified Delphi procedure to condense the domains and develop a new tool. The feasibility and interrater reliability of the tool was tested on trials from four systematic reviews. RESULTS The Rating of Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool rates clinical trials on a five-point Likert scale in four domains: (1) participant characteristics, (2) trial setting, (3) flexibility of interventions, and (4) clinical relevance of interventions. When RITES was piloted on trials from three reviews by unaffiliated raters, ratings were variable (intraclass correlation coefficient [ICC] 0.25-0.66 for the four domains); but, when RITES was used on one review by the review authors with expertise on the topic, the ratings were consistent (ICCs > 0.80. CONCLUSION RITES may help to characterize the efficacy-effectiveness nature of trials included in systematic reviews.