Karabi Sinha

The effect of therapeutic touch on behavioral symptoms and cortisol in persons with dementia.

Background: Between 75–90% of nursing home (NH) residents with dementia develop behavioral symptoms (BSD) which may be associated with a stress response. Therapeutic touch has been shown to decrease restlessness in NH residents, however the mechanism is unknown. The purpose of this randomized controlled trial (RCT) was to examine the effect of therapeutic touch on BSD and basal cortisol levels among NH residents with dementia. Participants and Methods: Using a double blind experimental interrupted time series ABAB design, 65 participants were assigned to one of three groups. The experimental group received therapeutic touch with contact on the neck and shoulders delivered twice daily for 3 days (administered over 2 separate treatment periods); the placebo group received a mimic treatment identical in appearance, and the control group received routine care. Study outcomes were BSD, measured by the modified Agitated Behavior Rating Scale (mABRS), and salivary cortisol levels, measured by enzyme-linked immunosorbent assay (ELISA). Results: 64 residents, aged 67–93 years (M = 85.5, SD = 5.50), completed the study. Restlessness was significantly reduced in the experimental group compared to the control group (p = 0.03). There was a significant difference in morning cortisol variability among groups across time periods (<0.0001). Findings suggest that therapeutic touch may be effective for management of symptoms like restlessness coupled with stress reduction. At a time when cost containment is a consideration in health care, therapeutic touch is an intervention that is non-invasive, readily learned, and can provide a non-pharmacologic alternative for selected persons with BSD.

Gabapentin improves Cold-pressor Pain Responses in Methadone-maintained Patients

Individuals on methadone maintenance for the treatment of addiction (MM) are demonstrated to be hyperalgesic to cold-pressor pain in comparison to matched controls and ex-opioid addicts, a finding described as clinical evidence of opioid-induced hyperalgesia (OIH). Interestingly, opioids induce hyperalgesia via many of the same neuro-inflammatory and central sensitization processes that occur with the development of neuropathic pain. Evaluated in this study was the efficacy of a key pharmacotherapy for neuropathic pain, gabapentin (GPN), to reverse OIH in MM patients. Utilizing a clinical trial design and double blind conditions, changes in cold-pressor pain threshold and tolerance following a 5-week trial of GPN (titrated to 2400mg/day) were evaluated at peak and trough methadone plasma levels in a well-characterized MM sample. Drug abstinence was encouraged via an escalating payment schedule, and compliance monitored via pill counts and GPN plasma levels; entered into the analyses were only those subjects compliant and abstinent throughout the study (approximately 45%). Utilizing change scores from baseline, significant improvements in cold-pressor pain threshold and pain tolerance were observed at both peak and trough methadone levels (p<0.05). Notably, drop-out rates due to medication side effects were low (2%) and the medication was well-tolerated. These results support that GPN, as prescribed for the treatment of neuropathic pain, is effective in decreasing OIH in patients who are abstinent and stable in methadone treatment.

Correlates of Adult Assault among Homeless Women

The purpose of this study was to assess predictors of sexual and physical assault among homeless women. A multivariate, correlation design was utilized to identify independent correlates of adult physical and sexual assault. The sample consisted of 202 homeless women residing in shelters or living on the street in the Skid Row area of Los Angeles. Respondents reporting a history of child sexual abuse were almost four times more likely to report being sexually assaulted as adults and were almost two and one third times more likely to report being physically assaulted as adults. A range of factors increase homeless womens risk of adult physical and sexual victimization, including child sexual abuse, substance use, lifetime sex trade activity, and previous incarceration. It is important for homeless service providers to develop an individual risk profile for homeless women and to intervene in order to decrease their risk of re-victimization.

Hypothalamic—Pituitary— Adrenal Axis Dysregulation in Women With Irritable Bowel Syndrome in Response to Acute Physical Stress

Irritable bowel syndrome (IBS) supports the concept of a dysregulated hypothalamic—pituitary—adrenal (HPA) axis. This study investigates the neuroendocrine and psychological responses to the acute physical stress of a lumbar puncture (LP) in women with diarrhea-predominant IBS by assessing central and peripheral HPA activity and affective measures. Blood samples have been collected at baseline and immediately post- and 1 hr following LP from 13 women with IBS and 13 controls. Plasma adrenocorticotropic hormone (ACTH), cortisol, epinephrine, and norepinephrine levels are analyzed. A single measure of cerebrospinal fluid (CSF) concentrations of corticotropin-releasing factor (CRFCSF) and norepinephrine CSF is noted. Affective assessments are used to rate anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) and acute mood state is rated using the Stress Symptom Rating questionnaire (stress, anxiety, anger, arousal). The women with IBS display blunted ACTH and cortisol responses to the LP along with a profile of affective responsiveness suggestive of chronic psychosocial stress, although no CRF CSF differences between groups are observed.

Predictors of HAV/HBV Vaccination Completion among Methadone Maintenance Clients

This randomized, controlled study (N = 256) was conducted to compare three interventions designed to promote hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination completion among clients undergoing methadone maintenance (MM) treatment. Participants were recruited from five MM treatment sites in Southern California and randomized into three groups: Motivational Interviewing-Single (MI-Single), Motivational Interviewing-Group (MI-Group); and Nurse-Led Hepatitis Health Promotion (HHP). All were offered the three-series HAV/HBV vaccine. A total of 148 participants completed the vaccine. Groups did not differ in rate of vaccination completion (73.6%, HHP group, vs. 65% and 69% for the MI-Single and MI-Group, respectively). The equivalence of findings across groups suggests the value of including nurses with a comprehensive health focus in promoting vaccination completion.

Feasibility of completing an accelerated vaccine series for homeless adults.

Summary.  Homeless adults are at high risk for hepatitis B virus (HBV) infection. In addition to culturally sensitive programmes designed to enhance vaccination compliance, accelerated HBV vaccination (three doses over 21 days) have also been suggested to improve compliance among high‐risk groups. In this paper, we examined predictors of completers of two of three doses of a HAV/HBV vaccine series, normally delivered over a 6‐month period, to simulate compliance with an accelerated series, dosed over 4 weeks. A convenience sample of 865 homeless adults was randomized into a nurse case‐managed approach (NCMIT) vs standard programmes with (SIT) and without tracking (SI). Each group was assessed for completion of two of the three dose HAV/HBV vaccine series as well as the full three dose vaccine series. Sixty‐eight percent of the NCMIT participants completed the three dose vaccination series at 6 months compared to 61% of SIT participants and 54% of SI participants. Eighty‐one percent of the NCMIT participants completed two of the vaccinations compared to 78% of SIT participants and 73% of SI participants. The NCMIT approach resulted in greater numbers of completers of two of three doses and of the full three dose vaccine series. Predictors of completers of two doses and the full three dose vaccine series are provided. A greater number of homeless persons completed two doses across the three groups compared to the three dose vaccine series. The use of nurse case‐management and tracking, coupled with an accelerated HAV/HBV vaccination schedule, may optimize vaccination compliance in homeless adults.

Correlates of Heavy Smoking Among Alcohol-Using Methadone Maintenance Clients

This cross-sectional study examines predictors of heavy smoking among 256 male and female methadone maintenance therapy (MMT) clients from five MMT clinics in the Los Angeles area. The authors find that women report lower rates of heavy smoking than men (47% vs. 54%, respectively), in concordance with current literature pointing to gender differences in smoking behaviors. In particular, men who report heavy drinking, fair or poor health, and recent heroin use are more likely to report heavy smoking compared with men not reporting these factors. Women who report recent heroin use, a lifetime history of sex trade, and who have been ill enough to require a blood transfusion also have greater odds of reporting heavy cigarette smoking. Findings from this study may aid not only in designing gender-based smoking cessation programs for MMT clients but also in addressing the gender-based issues related to smoking in such a population.