Ron A. Cisler

Immediate Neurocognitive Effects of Concussion

OBJECTIVE To prospectively measure the immediate neurocognitive effects and early course of recovery from concussion and to examine the effects of loss of consciousness (LOC) and posttraumatic amnesia (PTA) on the severity of neurocognitive impairment immediately after concussion. METHODS A sports-related concussion research model was used to allow prospective immediate evaluation of concussion. A total of 2385 high school and college football players were studied. Ninety-one players (3.8%) sustained concussions during the study. A brief neurocognitive and neurological screening measure, the Standardized Assessment of Concussion, was used to assess cognitive functioning before the football season, immediately after injury, and 15 minutes, 48 hours, and 90 days after injury. RESULTS Standardized Assessment of Concussion scores immediately after concussion were significantly lower than the preseason baseline score and the noninjured population baseline mean, even for injured subjects without LOC or PTA. Subjects with LOC were most severely impaired immediately after injury, whereas those without LOC or PTA were least impaired. Significant impairment was also detected 15 minutes after injury, but all three groups returned to baseline levels of cognitive functioning within 48 hours. CONCLUSION These findings are the first to demonstrate not only that a gradient of increasing concussion severity is represented by PTA and LOC but also that measurable neurocognitive abnormalities are evident immediately after injury without PTA or LOC.

Sociodemographic correlates of energy drink consumption with and without alcohol: results of a community survey.

OBJECTIVE We examined the sociodemographic correlates of energy drink use and the differences between those who use them with and without alcohol in a representative community sample. METHODS A random-digit-dial landline telephone survey of adults in the Milwaukee, Wisconsin area responded to questions about energy drink and alcohol plus energy drink use. RESULTS Almost one-third of respondents consumed at least one energy drink in their lifetime, while slightly over 25% used energy drinks in the past year and 6% were past-year alcohol plus energy drink users. There were important racial/ethnic differences in consumption patterns. Compared to non-users, past-year energy drink users were more likely to be non-Black minorities; and past-year alcohol plus energy drink users when compared to energy drink users only were more likely to be White and younger. Alcohol plus energy drink users also were more likely to be hazardous drinkers. CONCLUSIONS Our results which are among the first from a community sample suggest a bifurcated pattern of energy drink use highlighting important population consumption differences between users of energy drinks only and those who use alcohol and energy drinks together.

Cost and Cost-effectiveness of the COMBINE Study in Alcohol-Dependent Patients

CONTEXT The COMBINE (Combined Pharmacotherapies and Behavioral Intervention) clinical trial recently evaluated the efficacy of medications, behavioral therapies, and their combinations for the outpatient treatment of alcohol dependence. The costs and cost-effectiveness of these combinations are unknown and of interest to clinicians and policy makers. OBJECTIVE To evaluate the costs and cost-effectiveness of the COMBINE Study interventions after 16 weeks of treatment. DESIGN A prospective cost and cost-effectiveness study of a randomized controlled clinical trial. SETTING Eleven US clinical sites. PARTICIPANTS One thousand three hundred eighty-three patients having a diagnosis of primary alcohol dependence. INTERVENTIONS The study included 9 treatment groups; 4 groups received medical management for 16 weeks with naltrexone, 100 mg/d, acamprosate, 3 g/d, or both, and/or placebo; 4 groups received the same therapy as mentioned earlier with combined behavioral intervention; and 1 group received combined behavioral intervention only. MAIN OUTCOMES MEASURES Incremental cost per percentage point increase in percentage of days abstinent, incremental cost per patient of avoiding heavy drinking, and incremental cost per patient of achieving a good clinical outcome. RESULTS On the basis of the mean values of cost and effectiveness, 3 interventions are cost-effective options relative to the other interventions for all 3 outcomes: medical management (MM) with placebo (

Neuropsychological Functioning of Homeless Men

409 per patient), MM plus naltrexone therapy (

Second births to teenage mothers: risk factors for low birth weight and preterm birth.

671 per patient), and MM plus combined naltrexone and acamprosate therapy (

Clinical and Methodological Utility of a Composite Outcome Measure for Alcohol Treatment Research

1003 per patient). CONCLUSIONS To our knowledge, this is only the second prospective cost-effectiveness study with a randomized controlled clinical trial design that has been performed for the treatment of alcohol dependence. Focusing only on effectiveness, MM-naltrexone-acamprosate therapy is not significantly better than MM-naltrexone therapy. However, considering cost and cost-effectiveness, MM-naltrexone-acamprosate therapy may be a better choice, depending on whether the cost of the incremental increase in effectiveness is justified by the decision maker.

Composite Outcome Measures in Alcoholism Treatment Research: Problems and Potentialities

Numerous biological and psychological factors associated with impaired neurological functioning have been identified as common among the homeless, but there has been relatively little systematic examination of the cognitive functioning of homeless people. This study explored the neuropsychological functioning of 90 homeless men. There was great variability in their test scores, but the presence of possible cognitive impairment was detected in 80% of the sample. Average general intellectual functioning and reading abilities were found to be relatively low, and the incidence of impairments in reading, new verbal learning, memory, and attention and concentration was high. These findings suggest that the homeless men in this study had considerable assessment and treatment needs that were not being met by most of the health and social services offered to them.

Aberrant fetal growth and early, late, and postneonatal mortality: an analysis of Milwaukee births, 1996–2007

CONTEXT Teenagers are more likely than older women to have a low-birth-weight infant or a preterm birth, and the risks may be particularly high when they have a second birth. Identifying predictors of these outcomes in second teenage births is essential for developing preventive strategies. METHODS Birth certificate data for 1993-2002 were linked to identify second births to Milwaukee teenagers. Predictors of having a low-birth-weight second infant or a preterm second birth were identified using logistic regression. RESULTS The same proportion of first and second infants were low-birth-weight (12%), but second births were more likely than first births to be preterm (15% vs. 12%). In analyses that adjusted for demographic, pregnancy and behavioral characteristics, the odds that a second infant was low-birth-weight or preterm were elevated if the mother smoked during pregnancy (odds ratios, 2.2 and 1.9, respectively), had inadequate prenatal weight gain (1.8 and 1.4), had an interpregnancy interval of less than 18 months (1.6-2.9 and 1.4-2.3) or was black (2.7 and 1.7). Women who had received an adequate level of prenatal care had reduced odds of both outcomes (0.6 and 0.4). Women younger than 16 also had increased odds of having a low-birth-weight second infant. Further adjustment for socioeconomic characteristics yielded largely the same results. In addition, women who were unmarried or did not identify a father were at increased risk of both outcomes (1.5 for each), and poor women were at risk of having a low-birth-weight infant (1.3). CONCLUSIONS Predictors of poor birth outcomes include modifiable behaviors. Prenatal interventions addressing these behaviors could help improve outcomes.

The effect of alcohol treatment on social costs of alcohol dependence: results from the COMBINE study

BACKGROUND How to capture different response patterns resulting from alcohol treatment has been a troublesome issue for alcohol researchers. A composite measure is one approach to capturing multiple treatment outcomes among diverse client populations. This article provides the rationale, development, and work conducted thus far on the composite outcome index and discusses the clinical utility of the measure. METHODS With the use of Project MATCH data, the composite outcome measure was examined in relation to self-reported alcohol consumption and alcohol problems and biological markers as well as in relation to other areas of functioning, such as psychiatric dysfunction and quality of life. Also, for assessing the stability of the measure, different composite outcomes statuses were assessed over time. RESULTS Individuals with better scores on composite outcome index had fewer percent days abstinent, consumed more alcohol when they drank, had a greater number of alcohol problems, and evidenced higher blood levels as measured by gamma-glutamyltranspeptidase and carbohydrate-deficient transferrin. Individuals with poorer composite outcome statuses had poorer social and behavioral role functioning and mental and physical health-related quality of life. Findings on short- and long-term composite outcome statuses revealed that only a minority of clients (30%) sustained a remitted status (i.e., abstinent or moderate drinking without problems) over the 1-year follow-up, and fully 70% of the clients had reached a nonremitted status (i.e., heavy drinking and/or problems) on the composite measure at one or more time points during the 12-month follow-up. CONCLUSIONS The composite outcome index could be used usefully along with singular measures of consumption to obtain a more complete picture of what has occurred among clients posttreatment. Future work will involve the testing of the composite outcome index with other client populations and/or different treatments to further our understanding of the varying response patterns found among alcohol-dependent clients.

Social Media, Big Data, and Public Health Informatics: Ruminating Behavior of Depression Revealed through Twitter

Alcoholism treatment researchers have increasingly incorporated multiple measures representing multiple dimensions in assessing treatment outcomes. However, no satisfactory model exists for examining the dynamic interrelationships of multiple measures in determining clinically meaningful and interpretable outcomes. One approach to analyzing multiple outcomes is to combine them into a composite measure. In their most elementary form, composite measures combine alcohol consumption and consumption-related problems dimensions into treatment outcome classifications. This paper discusses conceptual and methodological issues in studies reporting composite outcomes and provides a model and recommendations for using composite measures in alcohol treatment research.