Susan P. Williams

Cytomegalovirus urinary excretion and long term outcome in children with congenital cytomegalovirus infection.

Background. Cytomegalovirus (CMV) is the most frequent cause of congenital infection, and both symptomatic and asymptomatic infants may have long term sequelae. Children with congenital CMV infection are chronically infected and excrete CMV in the urine for prolonged periods. However, the effect of prolonged viral replication on the long term outcome of these children is unknown. Objective. To determine whether duration of CMV excretion is associated with outcome at 6 years of life in symptomatic and asymptomatic congenitally infected children. Methods. Longitudinal cohort study. Children congenitally infected with CMV were identified at birth and followed prospectively in a study of long term effects of congenital CMV infection. The relationship between duration of CMV urinary excretion and growth, neurodevelopment and presence and progression of sensorineural hearing loss (SNHL) at 6 years of age was determined. Results. There was no significant difference in the duration of viral urinary excretion between children born with asymptomatic (median, 4.55 years) and symptomatic (median, 2.97 years) congenital CMV infection (P = 0.11). Furthermore there was no association between long term growth or cognitive outcome and duration of viral excretion. However, a significantly greater proportion of children who excreted CMV for <4 years had SNHL and progressive SNHL compared with children with CMV excretion >4 years (P = 0.019, P = 0.009, respectively). Conclusions. Children congenitally infected with CMV are chronically infected for years, but the duration of CMV urinary excretion is not associated with abnormalities of growth, or neurodevelopmental deficits. However, SNHL and progressive SNHL were associated with a shorter duration of CMV excretion.

LAY PROVIDERS CAN DELIVER EFFECTIVE COGNITIVE BEHAVIOR THERAPY FOR OLDER ADULTS WITH GENERALIZED ANXIETY DISORDER: A RANDOMIZED TRIAL

The Institute of Medicine recommends developing a broader workforce of mental health providers, including nontraditional providers, to expand services for older adults. Cognitive behavior therapy (CBT) is effective for late‐life generalized anxiety disorder (GAD), but no study has examined outcomes with delivery by lay providers working under the supervision of licensed providers. The current study examined the effects of CBT delivered by lay, bachelor‐level providers (BLP) relative to Ph.D.‐level expert providers (PLP), and usual care (UC) in older adults with GAD.

Postradiation Squamous Cell Cancer of the Breast

Abstract Primary squamous cell carcinoma of the breast is a rare clinical entity. We diagnosed a patient who presented with a pure squamous cell cancer of the breast 12 years after local radiation for a primary adenocarcinoma of breast. Previously reported cancers related to radiation of the breast have been squamous cell of skin and esophagus and sarcomas, especially angiosarcomas, and on literature review this is the first reported case of primary squamous carcinoma of the breast related to previous radiation. Although our observation suggests a possible link, no established cause and effect relationship is known at this point.

Treating late-life generalized anxiety disorder in primary care: An effectiveness pilot study

Abstract To increase the sustainability of cognitive behavior therapy (CBT) in primary care for late-life anxiety, we incorporated nonexpert counselors, options for telephone meetings, and integration with primary care clinicians. This open trial examines the feasibility, satisfaction, and clinical outcomes of CBT delivered by experienced and nonexperienced counselors for older adults with generalized anxiety disorder (GAD). Clinical outcomes assessed worry (Penn State Worry Questionnaire), GAD (Generalized Anxiety Disorder Severity Scale), and anxiety (Beck Anxiety Inventory and Structured Interview Guide for Hamilton Anxiety Scale). After 3 months of treatment, Cohen’s d effect sizes for worry and anxiety ranged from 0.48 to 0.78. Patients treated by experienced and nonexperienced counselors had similar reductions in worry and anxiety, although treatment outcomes were more improved on the Beck Anxiety Inventory for experienced therapists. Preliminary results suggest that adapted CBT can effectively reduce worry. The piloted modifications can provide acceptable and feasible evidence-based care.

Cognitive behavior therapy for late‐life generalized anxiety disorder delivered by lay and expert providers has lasting benefits

Peaceful Living, a cognitive‐behavioral treatment (CBT) for late‐life generalized anxiety disorder (GAD), produced positive outcomes in GAD severity, anxiety, depression, insomnia, and mental health quality of life relative to usual care with treatment delivered by either bachelor‐level lay providers (BLPs) or PhD‐level expert providers (PLPs). We examined long‐term maintenance of gains during 12 months following CBT for patients in this trial who received the intervention delivered by BLPs and PLPs and completed post‐treatment assessments.

Tandem walking as a quick screening test for vestibular disorders: Tandem Walking for Vestibular Screening

Although many screening tests of balance are available, few of them have been well validated for clinical or research uses. The goal of this study was to test an updated version of an old test, Tandem Walking, to determine how useful it is for screening patients with vestibular disorders.

Utility of quick oculomotor tests for screening the vestibular system in the subacute and chronic populations

Abstract Objective: The goal of this study was to determine the sensitivity and specificity of some widely used, easily administered clinical tests. Background: Simple tests of oculomotor function have become widely used for clinical screening of patients suspected of having vestibular disorders despite a paucity of evidence showing good statistical support for their use in this highly variable population. Methods: Healthy controls with no history of otologic or neurologic disorders (n = 291) were compared to patients with known vestibular disorders (n = 62). All subjects performed passive and active head shaking, un-instrumented head impulse tests (HT), and video head impulse tests (vHIT) recorded with infrared video-oculography. Results: For both passive and active head shaking, using presence/absence of vertigo and of nystagmus, sensitivity was low (<0.40). Sensitivity of presence/absence of saccades on HT was even lower (<0.15). On vHIT, gains were all approximately = 1.0, so sensitivity was very low (approximately 0.15–0.35). Sensitivity and specificity for presence/absence of saccades were moderately poor (less than 0.70). Conclusion: None of these tests are adequate for screening patients in the out-patient clinic for vestibular disorders or for screening people in epidemiologic studies to determine the prevalence of vestibular disorders.