Joel B. Greenhouse

A symptom rating scale for delirium

The authors present a 10-item clinician-rated symptom rating scale for delirium. Compared to demented, schizophrenic, and normal control groups, 20 delirious subjects scored significantly higher on the scale, which quantitates multiple parameters affected by delirium. The scale can be used alone or in conjunction with an electroencephalogram and bedside cognitive tests to assess the delirious subject.

Optimism and physical health: a meta-analytic review.

BackgroundPrior research links optimism to physical health, but the strength of the association has not been systematically evaluated.PurposeThe purpose of this study is to conduct a meta-analytic review to determine the strength of the association between optimism and physical health.MethodsThe findings from 83 studies, with 108 effect sizes (ESs), were included in the analyses, using random-effects models.ResultsOverall, the mean ES characterizing the relationship between optimism and physical health outcomes was 0.17, p < .001. ESs were larger for studies using subjective (versus objective) measures of physical health. Subsidiary analyses were also conducted grouping studies into those that focused solely on mortality, survival, cardiovascular outcomes, physiological markers (including immune function), immune function only, cancer outcomes, outcomes related to pregnancy, physical symptoms, or pain. In each case, optimism was a significant predictor of health outcomes or markers, all p < .001.ConclusionsOptimism is a significant predictor of positive physical health outcomes.

Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation.

Background. Despite the impact of medical regimen nonadherence on health outcomes after organ transplantation, there is mixed and conflicting evidence regarding the prevalence and predictors of posttransplant nonadherence. Clinicians require precise information on nonadherence rates in order to evaluate patients’ risks for this problem. Methods. A total of 147 studies of kidney, heart, liver, pancreas/kidney-pancreas, or lung/heart-lung recipients published between 1981 and 2005 were included in a meta-analysis. Average nonadherence rates were calculated for 10 areas of the medical regimen. Correlations between nonadherence and patient psychosocial risk factors were examined. Results. Across all types of transplantation, average nonadherence rates ranged from 1 to 4 cases per 100 patients per year (PPY) for substance use (tobacco, alcohol, illicit drugs), to 19 to 25 cases per 100 PPY for nonadherence to immunosuppressants, diet, exercise, and other healthcare requirements. Rates varied significantly by transplant type in two areas: immunosuppressant nonadherence was highest in kidney recipients (36 cases per 100 PPY vs. 7 to 15 cases in other recipients). Failure to exercise was highest in heart recipients (34 cases per 100 PPY vs. 9 to 22 cases in other recipients). Demographics, social support, and perceived health showed little correlation with nonadherence. Pretransplant substance use predicted posttransplant use. Conclusions. The estimated nonadherence rates, overall and by transplant type, allow clinicians to gauge patient risk and target resources accordingly. Nonadherence rates in some areas—including immunosuppressant use—appear unacceptably high. Weak correlations of most patient psychosocial factors with nonadherence suggest that attention should focus on other classes of variables (e.g., provider-related and systems-level factors), which may be more influential.

Meta-Analysis of Risk for Relapse to Substance Use After Transplantation of the Liver or Other Solid Organs

For patients receiving liver or other organ transplants for diseases associated with substance use, risk for relapse posttransplantation is a prominent clinical concern. However, there is little consensus regarding either the prevalence or risk factors for relapse to alcohol or illicit drug use in these patients. Moreover, the evidence is inconsistent as to whether patients with pretransplantation substance use histories show poorer posttransplantation medical adherence. We conducted a meta‐analysis of studies published between 1983 and 2005 to estimate relapse rates, rates of nonadherence to the medical regimen, and the association of potential risk factors with these rates. The analysis included 54 studies (50 liver, 3 kidney, and 1 heart). Average alcohol relapse rates (examined only in liver studies) were 5.6 cases per 100 patients per year (PPY) for relapse to any alcohol use and 2.5 cases per 100 PPY for relapse with heavy alcohol use. Illicit drug relapse averaged 3.7 cases per 100 PPY, with a significantly lower rate in liver vs. other recipients (1.9 vs. 6.1 cases). Average rates in other areas (tobacco use, immunosuppressant and clinic appointment nonadherence) were 2 to 10 cases per 100 PPY. Risk factors could be examined only for relapse to any alcohol use. Demographics and most pretransplantation characteristics showed little correlation with relapse. Poorer social support, family alcohol history, and pretransplantation abstinence of ≤6 months showed small but significant associations with relapse (r = 0.17‐0.21). Future research should focus on improving the prediction of risk for substance use relapse, and on testing interventions to promote continued abstinence posttransplantation. Liver Transpl 14:159–172. 2008.

Meta-Analysis of Medical Regimen Adherence Outcomes in Pediatric Solid Organ Transplantation*

Background. Adherence to the medical regimen after pediatric organ transplantation is important for maximizing good clinical outcomes. However, the literature provides inconsistent evidence regarding prevalence and risk factors for nonadherence posttransplant. Methods. A total of 61 studies (30 kidney, 18 liver, 8 heart, 2 lung/heart-lung, and 3 with mixed recipient samples) were included in a meta-analysis. Average rates of nonadherence to six areas of the regimen, and correlations of potential risk factors with nonadherence, were calculated. Results. Across all types of transplantation, nonadherence to clinic appointments and tests was most prevalent, at 12.9 cases per 100 patients per year (PPY). The immunosuppression nonadherence rate was six cases per 100 PPY. Nonadherence to substance use restrictions, diet, exercise, and other healthcare requirements ranged from 0.6 to 8 cases per 100 PPY. Only the rate of nonadherence to clinic appointments and tests varied by transplant type: heart recipients had the lowest rate (4.6 cases per 100 PPY vs. 12.7–18.8 cases per 100 PPY in other recipients). Older age of the child, family functioning (greater parental distress and lower family cohesion), and the child’s psychological status (poorer behavioral functioning and greater distress) were among the psychosocial characteristics significantly correlated with poorer adherence. These correlations were small to modest in size (r=0.12–0.18). Conclusions. These nonadherence rates provide benchmarks for clinicians to use to estimate patient risk. The identified psychosocial correlates of nonadherence are potential targets for intervention. Future studies should focus on improving the prediction of nonadherence risk and on testing interventions to reduce risk.

Applying Cognitive Theory to Statistics Instruction

Abstract This article presents five principles of learning, derived from cognitive theory and supported by empirical results in cognitive psychology. To bridge the gap between theory and practice, each of these principles is transformed into a practical guideline and exemplified in a real teaching context. It is argued that this approach of putting cognitive theory into practice can offer several benefits to statistics education: A means for explaining and understanding why reform efforts work; a set of guidelines that can help instructors make well-informed design decisions when implementing these reforms; and a framework for generating new and effective instructional innovations.

Rate and Predictors of Divorce among Parents of Youths with ADHD.

Numerous studies have asserted the prevalence of marital conflict among families of children with attention-deficit/hyperactivity disorder (ADHD), but evidence is surprisingly less convincing regarding whether parents of youths with ADHD are more at risk for divorce than are parents of children without ADHD. Using survival analyses, the authors compared the rate of marital dissolution between parents of adolescents and young adults with and without ADHD. Results indicated that parents of youths diagnosed with ADHD in childhood (n = 282) were more likely to divorce and had a shorter latency to divorce compared with parents of children without ADHD (n = 206). Among a subset of those families of youths with ADHD, prospective analyses indicated that maternal and paternal education level; paternal antisocial behavior; and child age, race/ethnicity, and oppositional-defiant/conduct problems each uniquely predicted the timing of divorce between parents of youths with ADHD. These data underscore how parent and child variables likely interact to exacerbate marital discord and, ultimately, dissolution among families of children diagnosed with ADHD.

Comparing the effects of antidepressants: Consensus guidelines for evaluating quantitative reviews of antidepressant efficacy

With increasing numbers of treatment options available for patients with major depression over the last decade and the growing body of evidence describing their efficacy and safety, clinicians often find it difficult to determine the best and most appropriate evidence-based treatment for each patient. Systematic reviews utilizing statistical methods that synthesize and evaluate data from a number of studies have become increasingly more available over the past decade. We review major findings and lessons learned from salient examples of quantitative analyses of antidepressant research and provide recommendations for meta-analysts, journal and grant reviewers, and research ‘consumers’ (ie, clinicians) for conducting, reporting, and evaluating such analyses.

Case studies in biometry

Partial table of contents: ENVIRONMENTAL HAZARDS Spatial Pattern Analyses to Detect Rare Disease Clusters (L. Waller, et al.) Prediction Models for Personal Ozone Exposure Assessment (D. Wypij & L.-J Liu) FORESTRY, FISHERIES, GENETICS Estimating Pine Seedling Response to Ozone and Acidic Rain (J. Rawlings & S. Spruill) Survival Analysis for Size Regulation of Atlantic Halibut (S. Smith, et al.) HABITAT AND ANIMAL STUDIES Spatial Association Learning in Hummingbirds (J. Graham & A. Petkau) Time-Series Analyses of Beaver Body Temperatures (P. Reynolds) HEALTH CARE AND PUBLIC HEALTH POLICY Analysis of Attitudes Towards Workplace Smoking Restrictions (S. Bull) CLINICAL TRIALS Early Lung Cancer Detection Studies (B. Flehinger & M. Kimmel) Quality Control for Bone Mineral Density Scans (S. Wong & N. Lane) EPIDEMIOLOGY, TOXICOLOGY Patterns of Lung Cancer Risk in Ex-Smokers (B. Gillespie, et al.) Drug Interactions Between Morphine and Marijuana (C. Gennings, et al.) Appendix References Indexes.

Suicide Trends Among Youths Aged 10 to 19 Years in the United States, 1996-2005

To the Editor: Following a decade of steady decline, the suicide rate among US youth younger than 20 years increased by 18% from 2003 to 2004, the largest singleyear change in the pediatric suicide rate over the past 15 years. Federal health officials have urged caution in interpreting this 1-year apparent spike in youth suicide until data from additional years are available for comparison. We examined available national fatal injury data to assess whether the increase in suicide rates among US youth persisted from 2004 to 2005, the latest year for which data are available. Methods. Data on deaths for which suicide (coded E950-E959 for International Classification of Diseases, Ninth Revision [ICD-9] [1996-1998] and X60-X84, Y87.0, and U03 for ICD-10 [1999-2005]) was listed as the underlying cause of death among 10to-19-year-olds were obtained from the National Vital Statistics Systems using WISQARS (Web-based Injury Statistics Query and Reporting System; National Center for Injury Prevention and Control, Atlanta, Georgia). There is excellent agreement between classification of suicide deaths in ICD-9 and ICD-10 (comparability ratio = 1.002). The 10to 19-year age group was selected to facilitate comparison with previous research; the 1996-2005 time period was selected to provide a relatively recent context for evaluating single-year changes in suicide rates in 2004 and 2005. Information was extracted regarding number of suicide deaths per year, age, and sex. Rates of suicide per 100 000 persons were calculated with the use of population estimates obtained from WISQARS. The trend in suicide rates from 1996-2003 was estimated using log-linear regression. There was no evidence of serial correlation, overdispersion, or nonconstant variance in the fitted model. Using the 1996-2003 trend line, we estimated the expected suicide rates in 2004 and 2005 and calculated 95% prediction intervals (PIs) for each year. We then calculated total excess suicide deaths in 2004 and 2005 by taking the difference between the observed number of deaths and the expected number of deaths estimated from the 1996-2003 trend. Analyses were performed using R statistical software version 2.6.0 (R Foundation for Statistical Computing, Vienna, Austria). Results. Although the overall observed rate of suicide among youth aged 10 to 19 years decreased by 5.3% between 2004 and 2005 (4.74 to 4.49 per 100 000), both the 2004 and 2005 rates were still significantly greater than the expected rates based on the 1996-2003 trend (2004 95% PI, 3.64-4.30; 2005 95% PI, 3.47-4.15). This same pattern of significance was also found for males and females separately (FIGURE 1) and in the 10to 17-year and 18to 19-year age groups (FIGURE 2). In absolute numbers, in 2004 there were an estimated 326 excess suicide deaths among youth aged 10 to 19 years (167 females, 159 males) compared with the number of deaths predicted by the regression model. In 2005, the overall number of excess suicide deaths was 292 (105 females, 187 males). Comment. The significant excess mortality due to youth suicide in 2004 and 2005 suggests that the marked increase in suicide rates from 2003 to 2004 was not a single-