Stephen R Wisniewski

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (425)2271.95 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Functional assessment may represent a valuable addition to postpartum depression screening, providing a more thorough characterization of the mother's health and quality of life. To the authors' knowledge, this analysis represents the first examination of postpartum maternal functioning, as measured by a patient-centered validated tool aimed at ascertainment of functional status explicitly, and its clinical and sociodemographic correlates. Materials and methods: A total of 189 women recruited from a large, urban women's hospital in the northeastern United States who both (1) screened positive for depression between 4 and 6 weeks postpartum and (2) completed a subsequent home (baseline) visit between October 1, 2008, and September 4, 2009, were included in this analysis. Multiple linear regression was conducted to ascertain which clinical and sociodemographic variables were independently associated with maternal functioning. Results: The multivariate analysis revealed independent associations between bipolar status, atypical depression, depression score (17-item Hamilton Rating Scale for Depression), and insurance type with postpartum maternal functioning. The beta coefficient for bipolar status indicates that on average we would expect those with bipolar disorder to have maternal functioning scores that are 5.6 points less than those without bipolar disorder. Conclusions: Healthcare providers treating postpartum women with complicating mental health conditions should be cognizant of the potential ramifications on maternal functioning. Impaired functioning in the maternal role is likely to impact child development, although the precise nature of this relationship is yet to be elucidated.
    Journal of Women's Health 11/2015; DOI:10.1089/jwh.2015.5296 · 2.05 Impact Factor

  • Critical care medicine 11/2015; 43(12 Suppl 1):5. DOI:10.1097/01.ccm.0000473845.82219.9b · 6.31 Impact Factor

  • Critical care medicine 11/2015; 43(12 Suppl 1):3-4. DOI:10.1097/01.ccm.0000473840.00805.63 · 6.31 Impact Factor
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    ABSTRACT: Objective: Although diffuse systemic sclerosis (SSc) is associated with a reduction in life expectancy, there are no validated, prognostic models for 5-year mortality in diffuse SSc. The objective of this study was to derive and validate a 5-year mortality prediction rule for early diffuse SSc patients. Methods: We used an inception cohort of 388 Caucasian US patients with early diffuse SSc (< 2 years from the first symptom). Predefined baseline variables were entered into a stepwise logistic regression model to identify factors independently associated with 5-year all-cause mortality. After rounding the beta-weights to the nearest integer, and summing them, we stratified patients into low (<0 points), moderate (1-2 points) and high-risk (≥ 3 points) groups. We then applied this rule to an external validation cohort of 110 Caucasian early diffuse SSc patients from the Royal Free Hospital cohort and compared stratum-specific 5-year mortality. Results: Six independent predictors (rounded beta-weight) comprised the model: age at first visit (-1, 0, 1), male gender (0,1), tendon friction rubs (0,1), gastrointestinal involvement (0,1), RNA polymerase III antibody (0,1) and anemia (0,1). The 3-level risk stratification model performed well with no significant differences between the US derivation (AUC =0.73 (95% CI 0.69-0.78)) and UK (AUC= 0.69 (95% CI 0.61-0.77)) validation cohorts. Conclusion: We have derived and externally validated in US and UK cohorts an easy-to-use 6-variable prediction rule that assigns low, moderate and high risk categories for 5-year mortality in early diffuse SSc patients. Only history, exam and basic labs are required. This article is protected by copyright. All rights reserved.
    Arthritis and Rheumatology 11/2015; DOI:10.1002/art.39490

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    ABSTRACT: Objective: The aims of this study were to assess the agreement of physicians and nurses performing tender and swollen joint counts (TJCs/SJCs) in rheumatoid arthritis (RA) and identify factors that might influence their examinations including patient age, sex, race, RA disease duration, body mass index, RA disease activity level, comorbid fibromyalgia, comorbid osteoarthritis, and levels of acute-phase reactants. Methods: Seventy-two RA participants underwent TJCs/SJCs of 28 joints using a standardized protocol by 2 nurses and 2 rheumatologists. Demographic, laboratory, radiographic, and clinical data were obtained to assess the influence of these factors on TJCs/SJCs. Intraclass correlations (ICCs) among examiners were determined for TJCs/SJCs. Nurse-physician differences and agreement of individual joints were evaluated using Cohen κ. Analysis of variance was performed to detect differences in means between examiners for TJCs/SJCs. Intraclass correlation and Fisher Z tests were used to identify factors influencing TJCs/SJCs. Results: Agreement was strong among these nurses and physicians for total TJCs/SJCs (ICC = 0.84/ICC = 0.79, respectively). κ was best for hand joint tenderness and poorest for shoulder swelling. Some significant differences in mean TJCs/SJCs were found between examiners. Fibromyalgia significantly reduced agreement of both TJCs and SJCs. Agreement of TJC was significantly reduced when patients had lower disease activity, greater work impairment, lower mental health quality of life, and elevated erythrocyte sedimentation rate, whereas female sex, assessor's perception of but not radiographic hand osteoarthritis, and elevated C-reactive protein significantly reduced agreement for SJC. Conclusions: Strong agreement was found among nurses and physicians for total 28-joint counts, with agreement at individual joints being stronger for tenderness than swelling. Fibromyalgia significantly reduced ICCs of TJCs/SJCs.
    Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 10/2015; DOI:10.1097/RHU.0000000000000324 · 1.08 Impact Factor

  • 37th Annual Meeting of the Society for Medical Decision Making, St. Louis, MO; 10/2015
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    ABSTRACT: Sarcoidosis is a systemic disease characterized by noncaseating granulomatous inflammation with tremendous clinical heterogeneity and uncertain pathobiology and lacking in clinically useful biomarkers. The Genomic Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis (GRADS) study is an observational cohort study designed to explore the role of the lung microbiome and genome in these two diseases. This article describes the design and rationale for the GRADS study sarcoidosis protocol. The study addresses the hypothesis that distinct patterns in the lung microbiome are characteristic of sarcoidosis phenotypes and are reflected in changes in systemic inflammatory responses as measured by peripheral blood changes in gene transcription. The goal is to enroll 400 participants, with a minimum of 35 in each of 9 clinical phenotype subgroups prioritized by their clinical relevance to understanding of the pathobiology and clinical heterogeneity of sarcoidosis. Participants with a confirmed diagnosis of sarcoidosis undergo a baseline visit with self-administered questionnaires, chest computed tomography, pulmonary function tests, and blood and urine testing. A research or clinical bronchoscopy with a research bronchoalveolar lavage will be performed to obtain samples for genomic and microbiome analyses. Comparisons will be made by blood genomic analysis and with clinical phenotypic variables. A 6-month follow-up visit is planned to assess each participant's clinical course. By the use of an integrative approach to the analysis of the microbiome and genome in selected clinical phenotypes, the GRADS study is powerfully positioned to inform and direct studies on the pathobiology of sarcoidosis, identify diagnostic or prognostic biomarkers, and provide novel molecular phenotypes that could lead to improved personalized approaches to therapy for sarcoidosis.
    Annals of the American Thoracic Society 10/2015; 12(10):1561-1571. DOI:10.1513/AnnalsATS.201503-172OT
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    ABSTRACT: Severe deficiency of alpha-1 antitrypsin has a highly variable clinical presentation. The GRADS Alpha-1 Study is a prospective, multicenter, cross-sectional, study of adults > age 35 with PiZZ or PiMZ alpha-1 antitrypsin genotypes designed to better understand if microbial factors influence this heterogeneity. Clinical symptoms, pulmonary function testing, computed chest tomography, exercise capacity, and bronchoalveolar lavage (BAL) will be used to define COPD phenotypes that can be studied with an integrated systems biology approach that includes plasma proteomics; mouth, BAL, and stool microbiome and virome analysis; blood miRNA, and blood mononuclear cell RNA and DNA profiling, and relies on global genome, transcriptome, proteome, and metabolome datasets. Matched cohorts of PiZZ participants on or off augmentation therapy, PiMZ participants not on augmentation therapy, and control participants from SPIROMICS who match on FEV1 and age will be compared. The primary analysis will determine if the PiZZ individuals on augmentation therapy have a difference in lower respiratory tract microbes identified compared to matched PiZZ individuals who are not on augmentation therapy. By characterizing the microbiome in alpha-1 antitrypsin deficiency (AATD), we hope to define new phenotypes of COPD that explain some of the diversity of clinical presentations. As a unique genetic cause of COPD, AATD may inform usual COPD pathogenesis and help understand the complex interplay between the environment and genetics. Although the biologic approaches are hypothesis-generating, the results may lead to development of novel biomarkers, better understanding of COPD phenotypes, and development of novel diagnostic and therapeutic trials in AATD and COPD. Clinical Trial registered with (NCT01832220).
    Annals of the American Thoracic Society 07/2015; 12(10). DOI:10.1513/AnnalsATS.201503-143OC
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    ABSTRACT: To determine the effects of symptoms and presence of confirmed influenza on intention to receive an influenza vaccine, specifically in patients recovering from a medically-attended acute (≤ 7 days' duration) respiratory illness (ARI). During the 2013-14 influenza season individuals seeking outpatient care for an ARI that included cough were tested for influenza using reverse transcription polymerase chain reaction assays (PCR) and completed surveys. Children (6 months-18 years) and adults (≥ 18 years) were grouped by their combined current season's influenza vaccination status (vaccinated/not vaccinated) and their vaccination intentions for next season (intend/do not intend). Overall, 41% (323/786) were unvaccinated at enrollment; of those, nearly half (151/323) intended to be vaccinated next season. When adjusting for demographic, health, and other factors, unvaccinated individuals who intended to be vaccinated next season were approximately 1.5 times more likely to have PCR-confirmed influenza compared with vaccinated individuals who intended to be vaccinated next season. The combined experience of not being vaccinated against influenza and seeking medical attention for an ARI seemed to influence approximately one-half of unvaccinated participants to consider influenza vaccination for next season.
    American journal of health behavior 07/2015; 39(4). DOI:10.5993/AJHB.39.4.14 · 1.31 Impact Factor
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    ABSTRACT: Postpartum depression occurs in 14.5% of women in the first 3 months after birth. This study was an 8-week acute phase randomized trial with 3 cells [transdermal estradiol (E2), sertraline (SERT), and placebo (PL)] for the treatment of postpartum major depressive disorder. However, the study was stopped after batch analysis revealed that the E2 serum concentrations were lower than prestudy projections. This paper explores our experiences that will inform future investigations of therapeutic E2 use. Explanations for the low E2 concentrations were as follows: (1) study patch nonadhesion, which did not explain the low concentrations across the entire sample. (2) Ineffective transdermal patch preparations, although 2 different patch preparations were used and no significant main effect of patch type on E2 concentrations was found. (3) Obesity, at study entry, E2-treated women had body mass index of 32.9 (7.4) [mean (SD)]. No pharmacokinetic data comparing E2 concentrations from transdermal patches in obese women versus normal weight controls are available. (4) Induction of cytochrome P450 (CYP450) 3A4 and other E2 elimination pathways in pregnancy. CYP4503A4 is induced in pregnancy and is a pathway for the metabolism of E2. Conversion to estrone and phase II metabolism via glucuronidation and sulfation, which also increase in pregnancy, are routes of E2 elimination. The time required for these pathways to normalize after delivery has not been elucidated. The observation that transdermal E2 doses greater than 100 μg/d did not increase serum concentrations was unexpected. Another hypothesis consistent with this observation is suppression of endogenous E2 secretion with increasing exogenous E2 dosing.
    Journal of clinical psychopharmacology 06/2015; 35(4). DOI:10.1097/JCP.0000000000000351 · 3.24 Impact Factor
  • Y.G. Hwang · G. Wu · J. Feng · J. Lyons · H.F. Eng · S.R. Wisniewski · C.C. Hwang · E.H. Sasso · O.G. Segurado · L.W. Moreland ·
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    ABSTRACT: Background Accurate measurement of disease activity is important for optimal management of patients with rheumatoid arthritis (RA). Better understanding of similarities and differences among the available clinical and biomarker-based disease activity measures may improve their use for therapeutic decision-making. Objectives Evaluate the relationship between available disease activity indices and their association with other clinical variables. Methods A cross-sectional analysis was performed for 734 RA patients enrolled in the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Registry (RACER), using all first visits and excluding patients (N=6) who were receiving tocilizumab. Spearman's rank correlation and percentage agreement among 4 disease activity categories (remission, low, moderate, high) were calculated for Disease Activity Score 28 with C-reactive protein (DAS28-CRP), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), Routine Assessment of Patient Index 3 (RAPID3) and the Multi-biomarker Disease Activity (MBDA) score. Univariate regression analyses were performed to assess association between each disease activity score and American College of Rheumatology (ACR) Core Data Set measures, demographics, and co-morbidities. P-values were adjusted for multiple comparisons using the Benjamini-Hochberg procedure. Results For 734 patients, mean age and disease duration were 60 and 15 years, respectively. Mean RAPID3, DAS28-CRP, SDAI, CDAI, and MBDA scores were 3.6, 3.3, 15.1, 14.1, and 41.3, respectively. Each disease activity measure was significantly correlated with the others. DAS28-CRP, CDAI, and SDAI correlated strongly with each other (r=0.92–0.99) and to a lesser degree with RAPID3 (r=0.65–0.66) and MBDA score (r=0.35–0.51). Correlation between MBDA score and RAPID3 was lowest (r=0.27). Agreement among categories between DAS28-CRP and CDAI or SDAI was 45% and 56%, respectively, and between CDAI and SDAI was 88%. Agreement between DAS28-CRP and RAPID3 or MBDA score was 47% and 44%, respectively. Agreement between RAPID3 and MBDA score was 38%. All 7 ACR Core measures were significantly associated with disease activity for each index (Figure). RAPID3 was significantly associated with all measured comorbidities and opiate use; DAS28-CRP, SDAI, and CDAI with fibromyalgia and opiate use; and MBDA score with the Deyo-Charlson comorbidity index. DAS28-CRP, SDAI, and CDAI were not significantly associated with the demographic variables. RAPID3 was significantly associated with race and BMI, and MBDA score with age and BMI. Only MBDA score was significantly associated with seropositivity and not with the Short Form Health Survey (SF12) mental composite score Conclusions Disease activity indices were significantly correlated with each other and associated with ACR core measures. However, they differed in their relationships with co-morbidities or demographics. These results suggest that disease activity may not be comprehensively assessed by any single composite measure. Disclosure of Interest Y. G. Hwang: None declared, G. Wu Shareholder of: Myriad Genetics, Inc, Employee of: Crescendo Bioscience, J. Feng: None declared, J. Lyons: None declared, H. Eng: None declared, S. Wisniewski: None declared, C. Hwang Shareholder of: Myriad Genetics, Inc, Employee of: Crescendo Bioscience, E. Sasso Shareholder of: Myriad Genetics, Inc, Employee of: Crescendo Bioscience, O. Segurado Shareholder of: Myriad Genetics, Inc, Employee of: Crescendo Bioscience, L. Moreland: None declared
    Annals of the Rheumatic Diseases; 06/2015
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    ABSTRACT: Background Women with bipolar disorder (BD) are at high risk for postpartum affective episodes and psychosis. Although validated screening tools are available for postpartum unipolar depression, few screening tools for hypomania/mania exist. Screening tools for BD in the postpartum period are essential for improving detection and planning appropriate treatment. We evaluated whether adding the Mood Disorders Questionnaire (MDQ) to the Edinburgh Postnatal Depression Scale (EPDS) increased the identification of BD in the early postpartum period.Methods Women (N = 1,279) who delivered a live infant and screened positive on the EPDS and/or MDQ at 4–6 weeks postbirth were invited to undergo an in-home Structured Clinical Interview for DSM-IV (SCID).ResultsPositive EPDS and/or MDQ screens occurred in 12% of the sample (n = 155). In home SCID diagnostic interviews were completed in 93 (60%) of the mothers with positive screens. BD was the primary diagnosis in 37% (n = 34). Women with BD screened positive on the EPDS and/or MDQ as follows: EPDS+/MDQ+ (n = 14), EPDS+/MDQ- (n = 17), and EPDS-/MDQ+ (n = 3). The MDQ identified 50% (17/34) of the women with BD and 6 additional cases of BD when the MDQ question regarding how impaired the mother perceived herself was excluded from the screen criterion.Conclusion Addition of the MDQ to the EPDS improved the distinction of unipolar depression from bipolar depression at the level of screening in 50% of women with traditional MDQ scoring and by nearly 70% when the MDQ was scored without the impairment criterion.
    Depression and Anxiety 06/2015; 32(7). DOI:10.1002/da.22373 · 4.41 Impact Factor
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    ABSTRACT: Conclusive evidence is lacking regarding the benefits and risks of performing off-pump versus on-pump coronary artery bypass graft (CABG) for patients with diabetes. This study aims to compare clinical outcomes after off-pump and on-pump procedures for patients with diabetes. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease, 615 of whom underwent CABG during the trial. The procedural complications, 30-day outcomes, long-term clinical and functional outcomes were compared between the off-pump and on-pump groups overall and within a subset of patients matched on propensity score. On-pump CABG was performed in 444 (72%) patients, and off-pump CABG in 171 (28%). The unadjusted 30-day rate of death/myocardial infarction (MI)/stroke was significantly higher after off-pump CABG (7.0 vs 2.9%, P = 0.02) despite fewer complications (10.3 vs 20.7%, P = 0.003). The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P = 0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47, P = 0.1061) did not differ statistically between the off-pump and on-pump patients. Within the propensity-matched sample (153 pairs), patients who underwent off-pump CABG had a higher risk of the composite outcome of death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural complications and death did not differ significantly, and there were no significant differences in the functional outcomes. Patients with diabetes had greater risk of major cardiovascular events long-term after off-pump CABG than after on-pump CABG. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2015; DOI:10.1093/ejcts/ezv170 · 3.30 Impact Factor
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    ABSTRACT: Suicide is one of the leading causes of death in postpartum women. Identifying modifiable factors related to suicide risk in mothers after delivery is a public health priority. Our study aim was to examine associations between suicidal ideation (SI) and plausible risk factors (experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms) in depressed postpartum women. This secondary analysis included 628 depressed mothers at 4-6 weeks postpartum. Diagnosis was confirmed with the Structured Clinical Interview for DSM-IV. We examined SI from responses to the Edinburgh Postnatal Depression Scale-EPDS item 10; depression levels on the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms (SIGH-ADS); plus sleep disturbance and anxiety levels with subscales from the EPDS and SIGH-ADS items on sleep and anxiety symptoms. Of the depressed mothers, 496 (79%) 'never' had thoughts of self-harm; 98 (15.6%) 'hardly ever'; and 34 (5.4%) 'sometimes' or 'quite often'. Logistic regression models indicated that having frequent thoughts of self-harm was related to childhood physical abuse (odds ratio-OR = 1.68, 95% CI = 1.00, 2.81); in mothers without childhood physical abuse, having frequent self-harm thoughts was related to sleep disturbance (OR = 1.15, 95% CI = 1.02, 1.29) and anxiety symptoms (OR = 1.11, 95% CI = 1.01, 1.23). Because women with postpartum depression can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment, that includes evaluation of childhood abuse history and current symptoms of sleep disturbance and anxiety, is a key component in the management of depressed mothers. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Psychiatric Research 05/2015; 66-67. DOI:10.1016/j.jpsychires.2015.04.021 · 3.96 Impact Factor
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    ABSTRACT: Primary care management decisions for patients with symptomatic lumbar spinal stenosis (LSS) are challenging, and nonsurgical guidance is limited by lack of evidence. To compare surgical decompression with physical therapy (PT) for LSS and evaluate sex differences. Multisite randomized, controlled trial. ( NCT00022776). Neurologic and orthopedic surgery departments and PT clinics. Surgical candidates with LSS aged 50 years or older who consented to surgery. Surgical decompression or PT. Primary outcome was physical function score on the Short Form-36 Health Survey at 2 years assessed by masked testers. The study took place from November 2000 to September 2007. A total of 169 participants were randomly assigned and stratified by surgeon and sex (87 to surgery and 82 to PT), with 24-month follow-up completed by 74 and 73 participants in the surgery and PT groups, respectively. Mean improvement in physical function for the surgery and PT groups was 22.4 (95% CI, 16.9 to 27.9) and 19.2 (CI, 13.6 to 24.8), respectively. Intention-to-treat analyses revealed no difference between groups (24-month difference, 0.9 [CI, -7.9 to 9.6]). Sensitivity analyses using causal-effects methods to account for the high proportion of crossovers from PT to surgery (57%) showed no significant differences in physical function between groups. Without a control group, it is not possible to judge success attributable to either intervention. Surgical decompression yielded similar effects to a PT regimen among patients with LSS who were surgical candidates. Patients and health care providers should engage in shared decision-making conversations that include full disclosure of evidence involving surgical and nonsurgical treatments for LSS. National Institutes of Health and National Institute of Arthritis and Musculoskeletal and Skin Diseases.
    Annals of internal medicine 04/2015; 162(7):465-473. DOI:10.7326/M14-1420 · 17.81 Impact Factor

  • Journal of Allergy and Clinical Immunology 03/2015; 133(2). DOI:10.1016/j.jaip.2015.01.021 · 11.48 Impact Factor
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    ABSTRACT: One percent of women experience bipolar disorder and are likely to suffer from mood disorders during the postpartum period, potentially impacting interaction with their infants.
    Applied Nursing Research 02/2015; DOI:10.1016/j.apnr.2015.01.012 · 0.73 Impact Factor
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    ABSTRACT: Background: Women report many nonvasomotor symptoms across the menopausal transition, including sleep disturbances, depressed mood, and sexual problems. The co-occurrence of these three symptoms may represent a specific menopausal symptom triad. We sought to evaluate the interrelatedness of disturbed sleep, depressed mood, and sexual problems in the Study of Women's Health Across the Nation (SWAN) and determine the characteristics of women exhibiting this symptom triad. Methods: SWAN is a multisite, multiethnic observational cohort study of the menopausal transition in the United States. Sleep disturbance, sexual problems, and depressed mood were determined based on self-report. Women who reported all three symptoms simultaneously were compared to those who did not. Logistic regression models estimated the association of demographic, psychosocial, and clinical characteristics with the symptom triad. Results: Study participants (n=1716) were 49.8 years old on average and primarily in very good or excellent health. Sixteen and a half percent had depressed mood, 36.6% had a sleep problem, and 42.2% had any sexual problem. Five percent of women (n=90) experienced all three symptoms. Women with the symptom triad compared with those without had lower household incomes, less education, were surgically postmenopausal or late perimenopausal, rated their general health as fair or poor, and had more stressful life events and lower social support. Conclusions: The symptom triad of sleep disturbance, depressed mood, and sexual problems occurred in only 5% of women, and occurred most often among women with lower socioeconomic status, greater psychosocial distress, and who were surgically menopausal or in the late perimenopause.
    Journal of Women's Health 01/2015; 24(2). DOI:10.1089/jwh.2014.4798 · 2.05 Impact Factor
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    ABSTRACT: To evaluate the association between neuromuscular blocking agents and outcome, intracranial pressure, and medical complications in children with severe traumatic brain injury. A secondary analysis of a randomized, controlled trial of therapeutic hypothermia. Seventeen hospitals in the United States, Australia, and New Zealand. Children (< 18 yr) with severe traumatic brain injury. None for this secondary analysis. Children received neuromuscular blocking agent on the majority of days of the study (69.6%), and the modified Pediatric Intensity Level of Therapy scores (modified by removing neuromuscular blocking agent administration from the score) were increased on days when neuromuscular blocking agents were used (9.67 ± 0.21 vs 5.48 ± 0.26; p < 0.001). Children were stratified into groups based on exposure to neuromuscular blocking agents (group 1 received neuromuscular blocking agents each study day; group 2 did not). Group 1 had increased number of daily intracranial pressure readings more than 20 mm Hg (4.4 ± 1.1 vs 2.4 ± 0.5;p = 0.015) and longer ICU and hospital length of stay (p = 0.003 and 0.07, respectively, Kaplan-Meier). The Glasgow Outcome Score-Extended for Pediatrics at hospital discharge and 3, 6, and 12 months after traumatic brain injury and medical complications observed during the acute hospitalization were similar between groups. Administration of neuromuscular blocking agents was ubiquitous and daily administration of neuromuscular blocking agents was associated with intracranial hypertension but not outcomes-likely indicating that increased injury severity prompted their use. Despite this, neuromuscular blocking agent use was not associated with complications. A different study design-perhaps using randomization or methodologies-of a larger cohort will be required to determine if neuromuscular blocking agent use is helpful after severe traumatic brain injury in children.
    Pediatric Critical Care Medicine 01/2015; 16(4). DOI:10.1097/PCC.0000000000000344 · 2.34 Impact Factor

Publication Stats

22k Citations
2,271.95 Total Impact Points


  • 1996-2015
    • University of Pittsburgh
      • • Graduate School of Public Health
      • • Department of Epidemiology
      • • Department of Psychiatry
      • • Safar Center for Resuscitation Research
      • • Department of Pediatric Neurosurgery
      Pittsburgh, Pennsylvania, United States
  • 2013
    • Childrens Hospital of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 1998-2012
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 2011
    • University of California, San Diego
      • Department of Psychiatry
      San Diego, California, United States
  • 2006-2011
    • Columbia University
      • Department of Psychiatry
      New York, New York, United States
    • Via Christi Health
      Wichita, Kansas, United States
    • Brown University
      • Department of Psychiatry and Human Behavior
      Providence, Rhode Island, United States
    • New York State Psychiatric Institute
      • Anxiety Disorders Clinic
      New York, New York, United States
  • 2010
    • Virginia Commonwealth University
      • Institute for Women's Health
      Richmond, VA, United States
  • 2008-2010
    • University of Texas Southwestern Medical Center
      • Department of Psychiatry
      Dallas, TX, United States
    • University of Pennsylvania
      • Department of Psychiatry
      Philadelphia, PA, United States
    • Eli Lilly
      Indianapolis, Indiana, United States
    • University of Texas at Dallas
      Richardson, Texas, United States
    • Northwestern University
      • Asher Center – Study & Treatment of Mood Disorders
      Evanston, Illinois, United States
    • Karolinska Institutet
      • Department of Neuroscience
      Solna, Stockholm, Sweden
  • 2008-2009
    • University of North Carolina at Chapel Hill
      • Department of Psychiatry
      Chapel Hill, NC, United States
  • 2007
    • Psychotherapy Associates
      Nebraska City, Nebraska, United States
    • University of Colorado at Boulder
      Boulder, Colorado, United States
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2006-2007
    • Boston University
      • Department of Psychology
      Boston, Massachusetts, United States
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2005
    • Massachusetts General Hospital
      • Department of Psychiatry
      Boston, MA, United States
    • Harvard Medical School
      • Department of Psychiatry
      Boston, MA, United States
  • 2004
    • University of Colorado
      • Department of Psychiatry
      Denver, Colorado, United States