Adam Awerbuch’s research while affiliated with University of Miami and other places

Background: Impairments in social functioning are central to Schizophrenia (SCZ). Patients with SCZ have challenges in the ability to evaluate their functioning. A correlate of self-assessments in SCZ is depression, wherein negligible depression predicts overestimation. Healthy individuals misestimate their functioning, but mild dysthymia predicts accuracy. We examined depression, gender, and schizophrenia as predictors of self-reported everyday functioning. Methods: 218 people with SCZ and 154 healthy controls self-reported their social functioning. They self-reported their depression with the Beck Depression Inventory (BDI) and their social cognitive ability on the Observable Social Cognition Rating Scale (OSCARS). Results: 64% of subjects were male. Schizophrenia patients reported more depression, poorer social functioning, and worse social cognition. Linear regression analyses revealed significant correlations between self-reported social functioning and BDI scores, which also predicted self-reported social cognition. There was no significant effect of sex on self-reports of social functioning or social cognition. Finally, when BDI and OSCARS were directly compared to diagnosis and sex for prediction of self-reported social functioning, there was no impact of diagnosis or sex. Implications: Self-reported interpersonal functioning is determined by current depression. Both healthy people and people with schizophrenia index their social functioning and their social cognitive by their level of depression.

Background: This is the first meta-analysis to study optimal radiation dose in the setting of concurrent neoadjuvant chemoradiotherapy (cnCRT) for esophageal cancer (EC). We sought to compare outcomes between high dose radiotherapy (HDRT) [>48.85 Gy biologically effective dose (BED)] group and low dose radiotherapy (LDRT) (≤48.85 Gy BED) for patients with EC receiving cnCRT. Methods: Medline, Embase, and Cochrane databases were searched independently by two members of our team on August 07, 2017. Articles were screened using Covidence. Study quality was assessed via CONSORT. Eligible studies had to be randomized controlled trials (RCT) comparing cnCRT vs. surgery alone in full-text English. Those with induction or sequential chemoradiotherapy were excluded. We captured data points including radiation dose, hazard ratios (HRs) for overall survival (OS), and treatment-related mortality (TRM). We analyzed HRs for OS and risk ratio (RR) for TRM and corresponding 95% confidence interval (CI) as the summary statistic. We used both fixed- and random-effects models in the presence of heterogeneity. The primary outcome was OS; secondary endpoint was treatment related mortality (TRM). We compared outcomes by HDRT vs. LDRT. To minimize chemotherapy heterogeneity, we performed a pre-planned analysis excluding the CROSS trial. Results: The eleven included studies contained a total of 1,697 patients. Eight hundred forty-eight were randomized into the cnCRT. Of these 848 patients, 287 received HDRT and 561 received LDRT. HR for OS was not statistically different between LDRT (HR 0.67; 95% CI, 0.55-0.8) and HDRT (HR 0.68; 95% CI, 0.45-0.91). Excluding the CROSS trial, there was still no difference in outcomes between LDRT and HDRT. TRM was similar between LDRT and HDRT. Conclusions: With no difference in OS or TRM between LDRT and HDRT, 48.85 Gy BED cnCRT may be a sufficient radiation dose for cnCRT for patients with EC fit for surgery.

Background Impairments in social functioning are central features of Schizophrenia (SCZ). Patients with SCZ also have challenges in self-assessment and the ability to evaluate their own level of functioning across cognitive, social cognitive, and functional domains. One of the major correlates of self-assessments in schizophrenia is depression, wherein patients who have very low levels of self-reported depression over-estimate their functioning when compared to objective milestone data and reports of knowledgeable informants. Interestingly, healthy individuals also generated reports of functioning that are related to mood states, wherein mild levels of dysthymia are associated with reduced over-estimation of functioning; this finding appears to be stronger in females than in males. In this study, we examine depression, gender, and psychiatric diagnoses as predictors of self-reported everyday functioning. Methods 372 subjects were enrolled in this study, including 218 with SCZ and 154 healthy controls. Participants self-reported their everyday social functioning using the 31-item Specific Level of Functioning (SLOF) scale. All participants self-reported their depression with the BDI and their impressions of their social cognitive ability on the Observable Social Cognition Rating Scale (OSCAR). The resulting data was analyzed using linear regression models, predicting self-reported social functioning and social cognition with sex, diagnosis, and self-reported depression. Results 64% of subjects were male and 36% were female. Schizophrenia patients reported more depression, poorer social functioning, and worse social cognition. Linear regression analyses revealed a significant correlation between self-reported social functioning and scores on the BDI: R2=.23. BDI scores also predicted self-reported social cognition on the OSCARS: R2=.30. There was no significant effect of sex on either self-reported social functioning or social cognition. Diagnosis accounted for 6% of the variance in OSCARS scores, but none for self-reported social functioning when depression was accounted for. Finally, when both the BDI and OSCARS were added to diagnosis and sex to predict self-reported social functioning, both depression, R2=.23, and OSCARS scores, R2=.06 predicted self-reported social functioning, with no impact of diagnosis or sex. Discussion Self-reported interpersonal functioning is largely determined by levels of depression, with these influences being more important than sex or diagnosis of schizophrenia. Both healthy people and people with schizophrenia judge their social functioning by their level of depression, with the impact of sex not being statistically significant.

Background:: There is a lack of evidence on the clinical management of patients who have suffered human trafficking. Synthesizing the evidence from similar patient populations may provide valuable insight. This review summarizes findings on therapeutic interventions for survivors of sexual assault and intimate partner violence (IPV). Method:: We conducted two systematic reviews using the MEDLINE database. We included only randomized controlled trials of therapies with primary outcomes related to health for survivors of sexual assault and IPV. For the sexual assault review, there were 78 abstracts identified, 16 full-text articles reviewed, and 10 studies included. For the IPV review, there were 261 abstracts identified, 24 full-text articles reviewed, and 17 studies included. Analysis compared study size, intervention type, patient population, primary health outcomes, and treatment effect. Results:: Although our search included physical and mental health outcomes, almost all the studies meeting inclusion and exclusion criteria focused on mental health. The interventions for sexual assault included spiritually focused group therapy, interference control training, image rehearsal therapy, sexual revictimization prevention, educational videos, cognitive behavioral therapy, and exposure therapy. The interventions in the IPV review included group social support therapy, exposure therapy, empowerment sessions, physician counseling, stress management programs, forgiveness therapy, motivational interviewing, and interpersonal psychotherapy. Conclusions:: Insights from these reviews included the importance of culturally specific group therapy, the central role of survivor empowerment, and the overwhelming focus on mental health. These key features provide guidance for the development of interventions to improve the health of human trafficking survivors.