Biomedical subjects

Elizabeth O'Connor

Publications and source records attributed to Elizabeth O'Connor.

12 recordsLinked to original sources

PubMed2006

Validation of the asthma impact survey, a brief asthma-specific quality of life tool.

BACKGROUND: The Asthma Impact Survey (AIS-6) is a new six question asthma outcome tool for which information on validity has not been published. OBJECTIVE: To provide validation for the AIS-6 as a brief asthma-specific quality of life tool. METHODS: Surveys were sent to a random sample of members of a large managed care organization who were at least 35 years of age and in the two-year period preceding the survey had either (1) at least one documented asthma-related medical encounter, or (2) at least a 6 months supply of asthma medication dispensed. In addition to the AIS-6, the survey included a validated quality of life tool [the mini-Asthma Quality of Life Questionnaire (AQLQ)]; a validated asthma control questionnaire [the Asthma Therapy Assessment Questionnaire (ATAQ)]; a validated symptom severity scale (AOMS); and information regarding demographics, co-morbidities, asthma severity, and asthma management. The results of the AIS-6 were compared to the results of the other tools by means of correlation and factor analysis. Independent predictors of AIS-6 and AQLQ scores were determined by multiple stepwise linear regression analyses. RESULTS: AIS-6 scores were significantly related to female sex, educational level, income, smoking, body mass index (BMI), COPD, steroid use, and hospitalization history in bivariate analyses. The AIS-6 score significantly correlated (r = - 0.84, p < 0.0001) with the AQLQ total score and loaded on the three factors (activity, symptoms, and concern/bother) reflected by the survey information and on which the AQLQ also loaded. Significant but somewhat smaller correlations were found between the AIS-6 and the ATAQ (r = 0.70, p < 0.0001) and the AOMS (r = 0.55, p < 0.0001). Independent predictors were the same for the AIS-6 and AQLQ and included oral steroid use, COPD history, BMI, female sex, educational level, and hospitalization in the past year. CONCLUSION: These data support the validity of the short six-question AIS-6 as an asthma-specific quality of life tool.

Adult↗

PubMed2006

Gender differences in asthma management and quality of life.

We mailed a survey to a sample of adults with persistent asthma to assess gender differences in asthma management and quality of life. Women were more likely to regularly use a peak flow meter, have a regular clinician for their asthma care, and to have a written asthma management plan. No gender differences in self-reported asthma severity were observed, and men and women ranked their knowledge and confidence in their self-management skills similarly. Women reported significantly worse health status than men, but the differences observed were small and were attenuated after adjusting for socioeconomic status, smoking, body mass index, and comorbid illness.

Adult↗

PubMed2005

Overcoming Depression on the Internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders.

BACKGROUND: Guided self-help programs for depression (with associated therapist contact) have been successfully delivered over the Internet. However, previous trials of pure self-help Internet programs for depression (without therapist contact), including an earlier trial conducted by us, have failed to yield positive results. We hypothesized that methods to increase participant usage of the intervention, such as postcard or telephone reminders, might result in significant effects on depression. OBJECTIVES: This paper presents a second randomized trial of a pure self-help Internet site, ODIN (Overcoming Depression on the InterNet), for adults with self-reported depression. We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN. METHODS: This was a three-arm randomized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls. The setting was a nonprofit health maintenance organization (HMO). We mailed recruitment brochures by US post to two groups: adults (n = 6030) who received depression medication or psychotherapy in the previous 30 days, and an age- and gender-matched group of adults (n = 6021) who did not receive such services. At enrollment and at 5-, 10- and 16-weeks follow-up, participants were reminded by email (and telephone, if nonresponsive) to complete online versions of the Center for Epidemiological Studies Depression Scale (CES-D) and the Short Form 12 (SF-12). We also recorded participant HMO health care services utilization in the 12 months following study enrollment. RESULTS: Out of a recruitment pool of 12051 approached subjects, 255 persons accessed the Internet enrollment site, completed the online consent form, and were randomized to one of the three groups: (1) treatment as usual control group without access to the ODIN website (n = 100), (2) ODIN program group with postcard reminders (n = 75), and (3) ODIN program group with telephone reminders (n = 80). Across all groups, follow-up completion rates were 64% (n = 164) at 5 weeks, 68% (n = 173) at 10 weeks, and 66% (n = 169) at 16 weeks. In an intention-to-treat analysis, intervention participants reported greater reductions in depression compared to the control group (P = .03; effect size = 0.277 standard deviation units). A more pronounced effect was detected among participants who were more severely depressed at baseline (P = .02; effect size = 0.537 standard deviation units). By the end of the study, 20% more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons. We also found no significant intervention effects on the SF-12 or health care services. CONCLUSIONS: In contrast to our earlier trial, in which participants were not reminded to use ODIN, in this trial we found a positive effect of the ODIN intervention compared to the control group. Future studies should address limitations of this trial, including relatively low enrollment and follow-up completion rates, and a restricted number of outcome measures. However, the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large populations with widespread Internet access.

Adult↗

PubMed2005

Species specific membrane anchoring of nyctalopin, a small leucine-rich repeat protein.

Mutations in the gene NYX, which encodes nyctalopin, lead to the retinal disorder congenital stationary night blindness which is characterized by defective night vision (nyctalopia) from birth. Nyctalopin is of unknown function but is predicted to be a secreted glycoprotein of the extracellular small leucine-rich repeat (SLRP) proteoglycan and protein family attached to the cell membrane in humans via a glycosylphosphatidylinositol (GPI) anchor but in mouse via a transmembrane domain. We investigated membrane association and attachment for human and mouse nyctalopin and show, conclusively, that human nyctalopin is a GPI anchored protein. In addition, the orthologous mouse protein, although it localizes to the cell surface, is not GPI anchored. We also confirm both mouse and human nyctalopins are glycosylated. Further sequence analysis suggests that chimp, dog and frog nyctalopins are likely to be GPI anchored but that rat nyctalopin is not. This is the first reported example of orthologous proteins which have different mechanisms of cell membrane attachment. Notably, the disease-causing mutations that have been identified to date in the human NYX gene are all distributed throughout the core LRR region and not in the C-terminal GPI anchor signal sequence. We propose that the presence of nyctalopin on the surface of the cell rather than the mechanism of anchoring is crucial to its function.

Animals↗

PubMed2005

Cost-effectiveness of an intervention to prevent depression in at-risk teens.

CONTACT: Depression is common in adolescent offspring of depressed parents and can be prevented, but adoption of prevention programs is dependent on the balance of their incremental costs and benefits. OBJECTIVE: To examine the incremental cost-effectiveness of a group cognitive behavioral intervention to prevent depression in adolescent offspring of depressed parents. DESIGN: Cost-effectiveness analysis of a recent randomized controlled trial. SETTING: Kaiser Permanente Northwest, a large health maintenance organization. PARTICIPANTS: Teens 13 to 18 years old at risk for depression. INTERVENTIONS: Usual care (n = 49) or usual care plus a 15-session group cognitive therapy prevention program (n = 45). MAIN OUTCOME MEASURES: Clinical outcomes were converted to depression-free days and quality-adjusted life-years. Total health maintenance organization costs, costs of services received in other sectors, and family costs were combined with clinical outcomes in a cost-effectiveness analysis comparing the intervention with usual care for 1 year after the intervention. RESULTS: Average cost of the intervention was $1632, and total direct and indirect costs increased by $610 in the intervention group. However, the result was not statistically significant, suggesting a possible cost offset. Estimated incremental cost per depression-free day in the base-case analysis was $10 (95% confidence interval, -$13 to $52) or $9275 per quality-adjusted life-year (95% confidence interval, -$12 148 to $45 641). CONCLUSIONS: Societal cost-effectiveness of a brief prevention program to reduce the risk of depression in offspring of depressed parents is comparable to that of accepted depression treatments, and the program is cost-effective compared with other health interventions commonly covered in insurance contracts.

Adolescent↗

PubMed2005

Metabolic and perceptual responses during Spinning cycle exercise.

PURPOSE: The present investigation was undertaken to compare metabolic and perceptual responses between exercise performed at constant intensity (CON) and with a Spinning protocol of variable intensity (VAR). METHOD: Fifteen subjects, including seven males and eight females (23 +/- 5 yr, 72 +/- 17 kg, and 171 +/- 10 cm), underwent two experimental trials. During each trial, subjects performed a 30-min cycle exercise protocol that was followed by a 30-min recovery period. Exercise was performed at 67 +/- 3% (means +/- SD) of HR(max) in CON. In VAR, the similar intensity (68 +/- 4% HR(max)) was also achieved, although the protocol entailed alternating phases of both higher and lower intensity arranged similarly to what is designed for a typical Spinning workout. Oxygen uptake (VO2) and HR were measured at rest and throughout both exercise and recovery, whereas RPE were recorded during exercise only. Plasma lactate concentrations [La] were determined at rest, the end of exercise, and the end of recovery. RESULTS: No differences in average VO2, HR, and RPE were found during exercise between CON and VAR. However, average VO2 and HR were higher (P < 0.05) in VAR than CON (0.33 +/- 0.03 vs 0.26 +/- 0.02 L x min(-1) and 91 +/- 3 vs 80 +/- 2 beats x min(-1), respectively). [La] was higher (P < 0.05) at the end of exercise in VAR than CON (7.2 +/- 0.8 vs 2.7 +/- 0.3 mmol x L(-1)), but became similar at the end of recovery. CONCLUSION: An exercise regimen in which intensity varies exerts no added effect on metabolic and perceptual responses during exercise as long as the average intensity is kept the same. However, VAR resulted in a greater [latin capital V with dot above]O2 after exercise, and this augmented postexercise oxygen consumption may be mediated in part by elevated plasma [La].

Adult↗

PubMed2005

A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication.

OBJECTIVE: To test a collaborative-care, cognitive-behavioral therapy (CBT) program adjunctive to selective serotonin reuptake inhibitor (SSRI) treatment in HMO pediatric primary care. METHOD: A randomized effectiveness trial comparing a treatment-as-usual (TAU) control condition consisting primarily of SSRI medication delivered outside the experimental protocol (n = 75) versus TAU SSRI plus brief CBT (n = 77). Participants were identified by a recent dispense of SSRI medication followed by telephone screening. Adolescents with a diagnosis of major depressive disorder (n = 152) were enrolled. The CBT program employed cognitive restructuring and/or behavioral activation training. Therapists consulted with prescribing pediatricians to improve medication adherence. RESULTS: Through 1-year follow-up, the authors found CBT advantages on the Short Form-12 Mental Component Scale (p = .04), reductions in TAU outpatient visits (p = .02), and days' supply of all medications (p = .01). No effects were detected for major depressive disorder episodes; a nonsignificant trend favoring CBT was detected on the Center for Epidemiology Depression Scale (p = .07). CONCLUSIONS: The authors detected a weak CBT effect, possibly rendered less significant by the small sample and likely attenuated by the unexpected reduction in SSRI pharmacotherapy in the CBT condition. Small, incremental improvements over monotherapy, such as observed in this study, most likely represent the new norm in adolescent depression treatment research.

Adolescent↗

PubMed2004

Combinatorial genetic technology for the development of new anti-infectives.

CONTEXT: We previously developed a novel technology known as instant evolution for high-throughput analysis of mutations in Escherichia coli ribosomal RNA. OBJECTIVE: To develop a genetic platform for the isolation of new classes of anti-infectives that are not susceptible to drug resistance based on the instant evolution system. DESIGN: Mutation libraries were constructed in the 16S rRNA gene of E coli and analyzed. In addition, the rRNA genes from a number of pathogenic bacteria were cloned and expressed in E coli. The 16S rRNA genes were incorporated into the instant-evolution system in E coli. SETTING: The Department of Biological Sciences, Wayne State University, Detroit, Mich. MAIN OUTCOME MEASURES: Ribosome function was assayed by measuring the amount of green fluorescent protein produced by ribosomes containing mutant or foreign RNA in vivo. RESULTS: We have developed a new combinatorial genetic technology (CGT) platform that allows high-throughput in vivo isolation and analysis of rRNA mutations that might lead to drug resistance. This information is being used to develop anti-infectives that recognize the wild type and all viable mutants of the drug target. CGT also provides a novel mechanism for identifying new drug targets. CONCLUSIONS: Antimicrobials produced using CGT will provide new therapies for the treatment of infections caused by human pathogens that are resistant to current antibiotics. The new therapeutics will be less susceptible to de novo resistance because CGT identifies all mutations of the target that might lead to resistance during the earliest stages of the drug discovery process.

Animals↗

PubMed2004

Latex allergy.

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Gloves, Surgical↗

PubMed2002

Association of asthma control with health care utilization: a prospective evaluation.

Population-based disease management should be enhanced by good risk assessment models and instruments. We prospectively evaluated the ability of a simple measure of short-term asthma control (scored 0 to 4) to predict asthma 12-mo health care utilization (HCU). A total of 5,172 adult asthma patients completed a brief questionnaire in fall 1997 to assess current level of asthma control. We then evaluated HCU for calendar year 1998. Ninety-three percent had health plan eligibility in 1998 and were included in this analysis. Both acute and routine asthma utilization increased with increasing numbers of asthma control problems. Rates of acute care episodes were 3.5 (95% confidence interval [CI] = 2.9, 4.3) times more likely for those with 3 to 4 control problems versus those with no control problems. Lesser, but statistically significant, increases were seen for those with two (relative risk [RR] = 1.7, 95% CI = 1.4, 2.2) or one (RR = 1.4, 95% CI = 1.1, 1.8) control problems. These patterns were similar for men and women, and diminished with increasing age. The asthma control index contributed significantly to prospective prediction models even after adjusting for administrative data such as medication use and prior HCU. These data reinforce the usefulness of measures of short-term asthma control both for the individual clinician and for those interested in population-based asthma management.

Adolescent↗

PubMed2002

Group cognitive-behavioral treatment for depressed adolescent offspring of depressed parents in a health maintenance organization.

OBJECTIVE: A randomized, controlled effectiveness trial of group cognitive-behavioral therapy (CBT) for depressed adolescent offspring of depressed parents in a health maintenance organization (HMO) was conducted. METHOD: Potential adult cases were found by reviewing antidepressant medication prescriptions, mental health appointments, and medical charts. Introductory study letters signed by each parent's treating physician were mailed to the appropriate adults. Eligible offspring aged 13 to 18 who met current DSM-III-R criteria for major depression and/or dysthymia were randomly assigned to either usual HMO care (n = 47) or usual care plus a 16-session group CBT program (n = 41). Assessments were conducted at baseline, after treatment, and at 12- and 24-month follow-up. RESULTS: Using intent-to-treat analyses, the authors were unable to detect any significant advantage of the CBT program over usual care, either for depression diagnoses, continuous depression measures, nonaffective measures, or functioning outcomes. CONCLUSIONS: Group CBT does not appear to be incrementally beneficial for depressed offspring of depressed parents who are receiving other mental health care. However, given that many other studies have found positive effects of CBT for youth depression, this single study should not be viewed as evidence that CBT is ineffective overall.

Adolescent↗

PubMed2002

Overcoming depression on the Internet (ODIN): a randomized controlled trial of an Internet depression skills intervention program.

BACKGROUND: Psychoeducational programs are increasingly being delivered over the Internet. We created an Internet-based, cognitive therapy, self-help program to be used as a stand-alone intervention for mild-to-moderate depression, or as an adjunct to traditional services for more severe depression. OBJECTIVE: To evaluate the effectiveness of a web-based intervention program to reduce depression in a randomized, controlled trial. METHODS: In a private, nonprofit health maintenance organization, we mailed recruitment brochures to two populations: depressed adults (n = 6994) who received traditional medical services for depression, and an age/gender matched sample of nondepressed adults (n = 6996). Participants consenting to the study were randomized to either the experimental Web site (n = 144), or a no-access control group (n = 155). Participants in both groups were free to obtain nonexperimental, usual care services for their depression. All participants completed an on-line version of the Center for Epidemiological Studies Depression Scale (CES-D) at enrollment and at 4-, 8-, 16- and 32-weeks after enrollment. Mean intake scores were in the severely depressed range. 74% of participants completed at least one follow-up assessment. Unfortunately, most intervention participants accessed the Internet site infrequently. RESULTS: We failed to find an effect for the Internet program across the entire sample. However, post-hoc, exploratory analyses revealed a modest effect among persons reporting low levels of depression at intake. CONCLUSIONS: The negative results might have resulted from infrequent patient use of the Internet site, or a more seriously depressed sample than the intervention was intended to help. Future studies should focus on recruiting persons with mild to moderate levels of depression, and on increasing participant use of the Internet site.

Adult↗