Melinda F. Davis

Omega-3 fatty acids and supportive psychotherapy for perinatal depression: A randomized placebo-controlled study

BACKGROUND Perinatal major depressive disorder (MDD), including antenatal and postpartum depression, is common and has serious consequences. This study was designed to investigate the feasibility, safety, and efficacy of omega-3 fatty acids for perinatal depression in addition to supportive psychotherapy. METHODS Perinatal women with MDD were randomized to eicosapentaenoic (EPA) and docosahexaenoic acids (DHA), 1.9g/day, or placebo for 8weeks. A manualized supportive psychotherapy was provided to all subjects. Symptoms were assessed with the Hamilton Rating Scale for Depression (HAM-D) and Edinburgh Postnatal Depression Scale (EPDS) biweekly. RESULTS Fifty-nine women enrolled; N = 51 had two data collection points that allowed for evaluation of efficacy. Omega-3 fatty acids were well tolerated. Participants in both groups experienced significant decreases in EPDS and HAM-D scores (p<.0001) from baseline. We did not find a benefit of omega-3 fatty acids over placebo. Dietary omega-3 fatty acid intake was low among participants. LIMITATIONS The ability to detect an effect of omega-3 fatty acids may have been limited by sample size, study length, or dose. The benefits of supportive psychotherapy may have limited the ability to detect an effect of omega-3 fatty acids. CONCLUSIONS There was no significant difference between omega-3 fatty acids and placebo in this study in which all participants received supportive psychotherapy. The manualized supportive psychotherapy warrants further study. The low intake of dietary omega-3 fatty acids among participants is of concern, in consideration of the widely established health advantages in utero and in infants.

Pharmacokinetics of Sertraline Across Pregnancy and Postpartum

Abstract Insufficient data inform dosing of antidepressants and clinical monitoring for Major Depressive Disorder (MDD) during the perinatal period. The objectives were to assess the pharmacokinetics of sertraline (SER) across pregnancy and postpartum. Participants treated with SER for MDD underwent serial sampling to measure steady-state concentrations of SER and norsertraline during the second and third trimesters and postpartum (total of 3 assessments). Blood was drawn before observed SER administration and 0.5, 1, 2, 4, 6, 8, 10, 12, and 24 hours after administration. A sensitive high-performance liquid chromatography/mass spectrometric method for simultaneous determination of serum concentrations of SER and norsertraline was developed and validated. For each sampling period for SER, area under the serum concentration versus time curve, maximal serum concentration (Cmax), and the time at which Cmax occurred (Tmax) were determined. Of 11 women initially enrolled, 6 completed second- and third-trimester assessments, and 3 completed all 3 assessments (including the postpartum assessment). Mean changes on all pharmacokinetic parameters were nonsignificant between assessments, although there was a marked heterogeneity among individuals. Results were not significantly altered by incorporation of body weights into the analyses. The range of pharmacokinetic changes between individuals was broad, indicating heterogeneity regarding the impact of pregnancy on SER metabolism. Overall, lowest observed SER area under the curve and Cmax occurred in the third trimester (observed in 5 of 6 participants). Despite nonsignificant mean pharmacokinetic changes, the range of pharmacokinetic changes across pregnancy warrants careful monitoring of depressive symptoms in women with MDD in late pregnancy and further study.

PALLIATIVE CARE SERVICES IN FAMILIES OF MALES WITH DUCHENNE MUSCULAR DYSTROPHY

Introduction: Palliative care services that address physical pain and emotional, psychosocial, and spiritual needs may benefit individuals with Duchenne muscular dystrophy (DMD). Methods: The objective of this study was to describe the palliative care services that families of males with DMD report they receive. A questionnaire was administered to families of males with DMD born prior to January 1, 1982. Thirty‐four families responded. Results: Most families (85%) had never heard the term palliative care. Only attendant care and skilled nursing services showed much usage, with 44% and 50% indicating receipt of these services, respectively. Receipt of other services was reported less frequently: pastoral care (27%); respite care (18%); pain management (12%); and hospice care (6%). Only 8 respondents (25%) reported having any type of directive document in place. Conclusion: The data suggest a need for improved awareness of palliative care and related services among families of young men with DMD. Muscle Nerve 44: 93–101, 2011

Motivational interviewing versus prescriptive advice for smokers who are not ready to quit

OBJECTIVE Smokers who are not ready to quit are a very difficult group to treat. Physicians, nurses, and nurse practitioners are in a unique position to encourage patients to quit smoking. However, the best approach to do so is not clear. METHODS A two-group randomized controlled trial with 218 pack-a-day precontemplative and contemplative smokers recruited from the community. The laboratory-based study was designed to simulate outpatient visits to general practitioners. Participants were randomized to a 15-min intervention to compare the effectiveness of brief motivational or prescriptive counseling by a health professional. Thirteen outcome variables included intentions to quit and verbal reports at 1 and 6 months with biological verification. A composite outcome measure was constructed to provide greater power to detect study differences. RESULTS Approximately 33% of the sample reported at least one 24-h quit period during the 6 months they were followed after the trial. Results suggest that while neither treatment was superior, there were subgroup differences. Participants in the motivational condition were also more likely to respond to follow-up calls. CONCLUSIONS AND PRACTICE IMPLICATIONS Motivational interviewing and prescriptive advice were equally effective for precontemplative and contemplative smokers. Practitioners should use the method that appeals to them.

Sons or Daughters: a Cross-Cultural Study of Sex Ratio Biasing and Differential Parental Investment

ABSTRACT Survivorship of children is dependent upon numerous variables, including the role that preferential treatment may play in biasing the birth and survival of sons and daughters across cultures. This study draws upon an evolutionary approach by examining a theory referred to as the “Trivers-Willard hypothesis” concerning condition-dependent sex allocation and differential parental investment. Previous research on humans concerning this hypothesis tends to be restricted to one cultural group and thereby limited in sample size. For this study, nationally representative household survey data collected by the Demographic and Health Surveys (DHS+) program across 35 countries was used to test biological, resource-oriented, and behavioral aspects affecting maternal condition, sex allocation, and parental investment in humans. The units of analysis for this study were the mothers and their lastborn child (N = 128,039 woman-child pairs). A series of hierarchical regressions were executed to empirically investigate the TW hypothesis in humans. Scales were developed for maternal socioeconomic resources (MSR), maternal biological condition (MBC), prenatal care for the lastborn child (PCL), and health-seeking for the lastborn child (HSL). MSR was measured by relative household economic status, womans and partners education, and residence in an urban/rural setting. MBC was defined by body mass index, pregnancy status and duration, and breast-feeding status. PCL was an index for type of prenatal care received, number of prenatal visits, and assistance during delivery of the lastborn child. Lastly, HSL measured indicators of treatment for diarrhea and immunizations received by the lastborn child. Across the 35 countries, the analyses did not support the Trivers-Willard hypothesis. However, there is evidence of regional and country level differences.

Randomized trial of Healthy Families Arizona: quantitative and qualitative outcomes

Home visitation has the potential to improve parent, child, and maternal outcomes and has become a widely implemented prevention program across the United States. The purpose of this research was to use a randomized controlled trial to assess the short-term effectiveness of the Arizona Healthy Families program across a range of outcomes. Two hundred and forty-five families were randomly assigned to the experimental group (Healthy Families) or control group (Child Development assessment only). Results revealed significant findings across four domains including safety and resources, parenting attitudes and behaviors, health and maternal outcomes, and mental health and coping. These results were further corroborated with an analysis of qualitative findings that analyzed linguistic differences between how the treatment and control group described their parenting. These results add to the existing literature on the effectiveness of the Healthy Families model of home visitation.

Correlates of care for young men with Duchenne and Becker muscular dystrophy.

Introduction: In progressive conditions, such as Duchenne and Becker muscular dystrophy (DBMD), the need for care may outpace care use. We examined correlates that contribute to utilization of needed care. Methods: Structured interviews were conducted on use of care among 34 young men with DBMD who were born before 1982. Results: Disease severity, per capita income, and presence of other relatives with DBMD predicted greater use of services. Race/ethnicity, acculturation, and level of caregiver education did not significantly predict service utilization. Conclusions: We identified disparities in receipt of healthcare and related services in adult men with DBMD that can affect quality of life. Despite the high disease severity identified in this population, these men utilized only half of the services available to individuals with significant progressive conditions. Providers should be aware of low service utilization and focus on awareness and assistance to ensure access to available care. Muscle Nerve 49: 21–25, 2014

Measuring impairment and functional limitations in children with cerebral palsy

Objective. The disablement model provides a theoretical framework for the assessments of individuals with cerebral palsy (CP). The purpose of this study was to evaluate the relative validity of multiple measures for impairment and functional limitations and to estimate the relationship between the two global factors using confirmatory factor analysis. Methods. Over 50 measures of impairment and functional limitations were collected for 57 children with spastic CP. There were 12, 10, 5, 7 and 23 children who were classified in Gross Motor Function Classification System (GMFCS) Levels I to V, respectively. Results. The measures of impairment with the highest factor loadings were several single-item ratings of spasticity; the Modified Ashworth hamstring and biceps ratings, and goniometric measures. All of the functional limitation measures had high factor loadings, including the gross motor function measure, GMFCS, the Paediatric Evaluation of Disability Inventory and WeeFIM self care and mobility scales. The correlation between the global factors of impairment and functional limitations was 0.96, indicating that the two factors are highly correlated in spastic CP. Conclusion. The disablement model is a valuable theoretical tool that can be used to organise assessments in CP and to explain how they are related.

Differential Parental Investment in the Southwestern United States

ABSTRACT The Trivers-Willard model (1973) predicts differential parental investment in children by sex and income; wealthier families will invest more in boys, while poorer families will invest more in girls. We investigated the TW Hypothesis in a sample of 103 six month old Tucson babies and their mothers. Hierarchical multiple regression equations were used entering babys age, babys sex, mothers age, male paternal commitment, a dichotomous poverty measure, per capita income, and four interaction terms, babys sex by 1 ) mothers age 2) mothers education, 3) male paternal commitment, 4) poverty, and 5) per capita income. We included three dependent variables in successive regression equations; mothers attitudes towards ideal baby size for boy versus girl babies, weeks breast fed and the babys weight at six months. These variables measure attitude, behavior, and physical outcomes. Poverty was a significant predictor of differential preference in ideal body size for boys versus girls; poor mothers preferred bigger baby girls. There was no evidence of differential preference in breast feeding. Education was also a significant predictor; but in the opposite direction than predicted by the TWH. Mothers with higher levels of education had heavier baby girls. Within Hispanics only, poverty was a significant predictor of sex-biased weight; poor mothers had heavier baby girls. This effect was not seen in Caucasians. These results provide mixed evidence for the Trivers-Willard model in a resource rich environment for humans.

The Smoking Hazards Scale

Abstract The Smoking Hazards Scale (SHS) is a 12-item questionnaire with four scales designed to assess respondent perceptions of obvious health risks due to smoking, subtle health risks due to smoking, health risks not associated with smoking, and risks for stressful life events. The SHS focuses on risk perceptions for objective consequences and can be used to test causal pathways in behavioral treatment programs for smoking cessation. Reliability and validity information are presented from a sample of 215 smokers in the precontemplative and contemplative stages of change. While these smokers see themselves at an increased risk for the obvious health risks due to smoking, they are unaware of the subtle risks of smoking.