Lily Trofimovich

National Center for Telehealth and Technology, Spanaway, Washington, United States

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Publications (8)11.85 Total impact

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    ABSTRACT: Monitoring of treatment coverage following mass drug administration is essential to ensure program success. Coverage results reported by drug administrators are often validated by using population surveys. This study evaluates the design of a multistage cluster sample survey conducted in 2007-2008 and implemented at the district level to assess drug coverage in the 4 African countries of Burkina Faso, Ghana, Niger, and Uganda. Estimates of precision of coverage were calculated, and factors contributing to the observed variance were analyzed. Precision of ±5 percentage points was obtained in 39% (n = 12) of cases, and precision of ±10 percentage points was obtained in 77% (n = 24) of cases. The factor having the largest impact on the actual precision obtained in these surveys was the high level of clustering, the impact of which is incorporated in the design effect. Key recommendations are made for the design and analysis of future surveys; guidelines are presented for thinking through the number of clusters that should be selected and how a cluster should be designed.
    American journal of epidemiology 07/2013; 178(2):268-75. · 5.59 Impact Factor
  • David D Luxton, Lily Trofimovich, Leslie L Clark
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    ABSTRACT: OBJECTIVE The rising rate of suicide and the increase in psychiatric hospitalizations in the U.S. military underscore the need to determine risk among service members in psychiatric care so that targeted interventions and prevention programs are implemented. The purpose of this study was to determine the suicide rates of active-duty U.S. service members after discharge from a psychiatric hospitalization. METHODS Data from 68,947 patients who had psychiatric hospitalizations at military treatment facilities between 2001 and 2011 were obtained from the Defense Medical Surveillance System. Rates of suicide were compared between the cohort group and the general active-duty U.S. military population. Survival analysis was used to determine time-dependent patterns of suicide after hospital discharge. RESULTS A total of 153 suicides occurred among the 68,947 service members. The overall suicide rate in the cohort was 71.6 per 100,000 person-years, compared with the rate of 14.2 per 100,000 person-years in the general active-duty U.S. military population. Personnel released from a psychiatric hospitalization were therefore five times more likely to die from suicide. The risk of dying from suicide within the first 30 days after a psychiatric hospitalization was 8.2 times higher than the risk at more than one year after hospitalization. CONCLUSIONS Active-duty U.S. service members who are released from a psychiatric hospitalization are a group at high risk of suicide. Aggressive safety planning and targeted interventions during and after hospitalization are recommended.
    Psychiatric services (Washington, D.C.) 05/2013; · 2.81 Impact Factor
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    ABSTRACT: Suicide risk based on occupational cohorts within the U.S. military was investigated. Rates of suicide based on military occupational categories were computed for the Department of Defense (DoD) active component population between 2001 and 2010. The combined infantry, gun crews, and seamanship specialist group was at increased risk of suicide compared to the overall military population even when adjusted for gender, age, and deployment history. The results provide useful information that can help inform the DoD's suicide prevention mission. Data limitations and recommended areas for future research are discussed.
    Suicide and Life-Threatening Behavior 01/2013; · 1.33 Impact Factor
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    ABSTRACT: OBJECTIVE: To conduct a blinded study to examine the diagnostic efficiency of the Department of Defense (DoD) Post-Deployment Health Reassessment (PDHRA) screens for major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and alcohol abuse. METHOD: Participants were 148 post-deployed soldiers who were completing the PDHRA protocol. Soldiers' mean age was 27.7 (standard deviation = 6.6) years, and 89.0% were male. Mental health professionals blinded to the PDHRA screening results administered the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition directly after the PDHRA assessment protocol. RESULTS: All screens exhibited excellent negative predictive power. Sensitivity metrics were lower, consistent with the relatively low base rates observed for MDD (10.1%), PTSD (8.8%), and alcohol abuse (5.4%). Metrics obtained for the PTSD screen were consistent with previous research with a similar base rate. A two-item screen containing PTSD reexperiencing and hyperarousal symptom items revealed excellent psychometric properties (sensitivity = .92; specificity = .79). The alcohol abuse screen yielded high sensitivity (.86), but very poor precision; these metrics were somewhat improved when the screen was reduced to a single item. CONCLUSIONS: The PDHRA MDD, PTSD, and alcohol abuse screens appear to be functioning well in accurately ruling out these diagnoses, consistent with a population-level screening program. Cross validation of the current results is indicated. Additional refinement may yield more sensitive screening measures within constraints imposed by the low base rates in a typically healthy population.
    Journal of Clinical Psychology 07/2012; · 2.12 Impact Factor
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    ABSTRACT: Suicide is a leading cause of deaths of U.S. service members. Medical care providers may play a role in suicide prevention. We summarized the outpatient experiences of service members prior to suicide or self-inflicted injury and compared them with service members without suicidal behavior. During 2001-2010, 45 percent of individuals who completed suicide and 75 percent of those who injured themselves had outpatient encounters within 30 days prior to suicide/self-harm. Primary care was the most frequently visited clinical service prior to suicide/self-harm. As compared to their counterparts, service members with suicidal behavior had especially excessive outpatient visit rates within, but not prior to, 60 days of their deaths/injuries. The finding suggests that there may be one or more "triggering" events that lead to care-seeking. These results may help identify individuals that should be screened for suicide risk.
    MSMR. 02/2012; 19(2):2-6.
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    ABSTRACT: This retrospective case-control study of members of the active component of the U.S. Armed Forces compared those who died from suicide to controls matched by service, gender, race, age, date of entry into the active component, and years of service. Th e surveillance period was 2001 to 2009. The groups were compared with respect to numbers of deployments and documented diagnoses of traumatic brain injury (TBI), mood disorders, alcohol dependence, post-traumatic stress disorder (PTSD), partner relationship problems, and family circumstance problems. Cases and controls were similar regarding frequencies and types of TBIs and numbers of deployments. In multivariate analyses, increased odds of suicide were associated with mood disorders, partner relationship problems, and family circumstance problems, but not with mild TBI, alcohol dependence, or PTSD. A separate analysis revealed that psychiatric comorbidities increased odds of suicide. Limitations are discussed, including the possibility that some controls with mild TBIs may have died from suicide after their military service.
    MSMR. 02/2012; 19(2):7-11.
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    01/2006;
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    ABSTRACT: The Accession Medical Standards and Research Activity (AMSARA) has completed its fourth year of providing the DoD with evidence-based evaluations of accession standards. Included in this report are studies on asthma, mental health conditions, early hospitalization and rehabilitation of injured recruits. The first study demonstrates that recruits waived for a history of asthma were more likely to remain on active duty than those who did not need a wavier to enter active duty. Those waived for a history of attention deficit disorder remain on active duty as long as matched controls. However those waived for other mental health disorders are at increased risk for both psychiatric hospitalization and attrition. However, stricter standards might screen out many recruits who would do well on active duty in order to prevent an excess loss of approximately 9 recruits per year. Mental health conditions are major reason for early hospitalization and early loss. 25.5% of all individuals hospitalized within the first 6 months have a mental health diagnosis. 70% to 96% of those hospitalized with a mental health condition leave the service within the next 6 months. This report also includes an analysis of the Physical Training Rehabilitation Program at Fort Jackson. Descriptive data on all applicants to the US military, the recruits entering active duty service, EPTS discharges, early hospitalizations and disability discharges are also included. Collaborative efforts with the Centers for Disease Control and Prevention, the National Institute of Mental Health and the University of Michigan are described.