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Open Access Publications from the University of California

Scholarly Works (17 results)

  • Thesis
  • Peer Reviewed
UC San Diego Electronic Theses and Dissertations (2021)

The effects of prenatal alcohol exposure on sleep quality have been understudied, and the possibility that sleep disturbances contribute to deficits in other domains has not been explored. The current study aimed to characterize sleep quality in children with fetal alcohol spectrum disorders (FASD) and understand relationships with neurobehavioral functioning.Participants aged 6-10 years with (alcohol-exposed [AE] = 27) and without (control [CON] = 27) prenatal alcohol exposure were included in the study. Objective sleep was measured via 24-hour actigraphy for two weeks. Parents completed sleep diaries and sleep questionnaires (Children’s Sleep Habits Questionnaire, Pediatric Sleep Questionnaire). Children completed neuropsychological testing (NIH Toolbox Cognition Battery) and parents completed the Child Behavior Checklist (CBCL) and Behavior Rating Inventory of Executive Functioning – Second Edition (BRIEF-2) as measures of problem behaviors and executive functioning skills. For a subset of participants (n = 31), neuropsychological assessment was modified and conducted remotely due to COVID-19. Multivariate analysis of variance was used to characterize the sleep profile (objective, subjective) and examine group differences. Multiple regression examined the relationships between sleep quality and neurobehavioral performance. There were no group differences on actigraphy metrics averaged across two weeks; however, AE showed significantly greater intraindividual variability on most actigraphy measures, particularly total sleep time. Parents reported significantly more sleep problems in AE than CON, primarily driven by sleep onset delay, night wakings, and daytime sleepiness. AE performed significantly lower than CON on the subset of cognitive measures administered to the full sample. CBCL and BRIEF-2 scores were significantly higher for AE compared to CON, reflecting more behavioral and executive functioning problems. Greater sleep time variability was significantly correlated with poorer memory performance and more behavior problems, but did not moderate effects of group. There were no significant differences between the pre-COVID and COVID samples. Despite similar two-week average sleep outcomes, children with FASD showed greater intraindividual sleep variability and parents reported more sleep problems. Across the sample, greater sleep time variability was associated with poorer episodic memory and more behavior problems. Interventions targeting variability in sleep, particularly sleep duration variability, may improve sleep quality and some aspects of cognition and behavior in children with FASD.

    Cover page: Sleep and Neurobehavioral Outcomes in Children with Fetal Alcohol Spectrum Disorders
    • Article
    International Symposium on Stratified Flows, Volume 8 (2016)
      Cover page: Basin mode internal tides
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2023)
      While older adults account for a disproportionate amount of healthcare spending, they are often underrepresented in clinical research needed to guide clinical care. The purpose of this perspective is to make readers aware of new data on age at enrollment for participants included in National Institutes of Health (NIH)-funded clinical research. We highlight key findings of relevance to general internal medicine and suggest ways readers could support the inclusion of older adults in clinical research. Data from the NIH Research Inclusion Statistics Report show that there were 881,385 participants enrolled in all NIH-funded clinical research in 2021, of whom 170,110 (19%) were 65 years and older. However, on average, studies included a far lower percentage of older adults. Additionally, there were many conditions for which overall enrollment rates for older adults were lower than would be expected. For example, while 10% of participants in studies related to diabetes were ≥ 65 years old, older individuals represent 43% of all prevalent diabetes in the USA. Researchers should work with clinicians to advocate for older adults and ensure their participation in clinical research. Best practices and resources for overcoming common barriers to the inclusion of older adults in research could also be disseminated.
        Cover page: Research Inclusion Across the Lifespan: A Good Start, but There Is More Work to Be Done.
        • Article
        • Peer Reviewed
        UC San Diego Previously Published Works (2021)

        Study objectives

        Depression is prevalent among patients with sleep disorders, and studies show associations between suicidal ideation and insufficient sleep. Using retrospective clinic records, we examined positive depression screening rates among adolescent sleep clinic patients relative to other subspecialty clinic patients. We also examined relationships between sleep diagnoses and positive depression screening rate in adolescent sleep clinic patients.

        Methods

        Data were analyzed from patients ages 12-18 (n = 12,520) who were screened for depression using the Patient Health Questionnaire-2 (PHQ-2). Those who screened positive were administered the PHQ-9. Logistic regression was used to examine effects of age, sex, race, ethnicity, and clinic on likelihood of a positive depression screen. Within sleep clinic patients (n = 308), demographic factors, sleep disorder diagnosis, and body mass index percentile were examined using logistic and linear regression.

        Results

        Among all patients screened, older age and female sex predicted positive depression screens. Sleep clinic patients were more likely to screen positive than patients in 9 other clinics [odds ratios 2.03-6.83]. Results were similar even when the PHQ-9 sleep item was excluded [odds ratios 2.18-6.41]. Within sleep clinic patients, sleep disorder diagnosis (eg, insomnia, obstructive sleep apnea) was predictive of a positive depression screen (χ²(1) = 10.88, P = .004): insomnia patients were most likely to be experiencing depression.

        Conclusions

        Adolescent sleep clinic patients are at increased risk for depressive symptoms. Among insomnia patients, risk was independent of age, sex, and obesity, suggesting a unique relationship between insomnia and affective distress, as has been found in adults. Assessing adolescents for sleep disorders should be prioritized, given the strong association with depression.
          Cover page: Elevated risk of depression among adolescents presenting with sleep disorders.
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2016)

          Background

          Nutrition is an important factor that affects brain development. Nutritional deficiencies can exacerbate alcohol's damaging effects. Conversely, nutritional supplementation can serve a protective role against alcohol damage and may prove to be a worthwhile intervention strategy. This study investigated dietary intake in school-aged children with heavy prenatal alcohol exposure to understand their nutritional status, compared to a national sample of typically developing children and Dietary Reference Intakes.

          Methods

          Dietary intake data were collected from children with confirmed histories of heavy prenatal alcohol exposure (5 to 10 years, n = 55) using the Automated Self-Administered 24-Hour Dietary Recall (ASA24). Observed nutrient levels were compared to the Dietary Reference Intakes to evaluate adequacy of nutrient intake as well as to national averages for same-aged children (What We Eat in America, NHANES 2007-2008).

          Results

          Alcohol-exposed children exhibited poorer nutritional status compared to the typically developing NHANES sample, consuming lower levels of protein, omega-3 fatty acids, magnesium, potassium, zinc, vitamins C and K, niacin, and choline. Moreover, their diets did not meet Recommended Dietary Allowance or Adequate Intake for dietary fiber, potassium, vitamins E and K, omega-3 fatty acids, and choline.

          Conclusions

          The present findings are consistent with prior studies investigating nutritional intake in preschoolers with FASD, indicating that these children are vulnerable to nutritional inadequacies. Moreover, data suggest a specific profile of dietary intake in this population. As several nutrients are important for cognitive development, targeted interventions in clinical populations might be effective in boosting outcomes. Thus, further clinical investigation into the role of nutrition in improving cognitive outcomes is warranted.
            Cover page: Dietary Nutrient Intake in School‐Aged Children With Heavy Prenatal Alcohol Exposure
            • Article
            • Peer Reviewed
            UC San Diego Previously Published Works (2020)
            This editorial reports on an anonymous survey question posed to eating disorders researchers about changes the International Journal of Eating Disorders (IJED) should implement to support the eating disorders research community affected by COVID-19. The editorial accompanies an IJED article that details responses to the larger survey focusing more broadly on COVID-19-related research disruptions. Survey invitations were sent to editorial board members of eating disorders journals, members of eating disorder scientific organizations (e.g., Eating Disorders Research Society), and individuals who provided at least three IJED reviews in the prior 12 months. We reviewed the responses of 187 participants and identified three categories of changes that: (a) had already been implemented by the journal, (b) cannot be implemented because they fall outside the scope of IJED, or (c) will be implemented in coming weeks or months. The latter category includes publishing topical COVID-19 papers, making some COVID-19-related content available open access, revising statistical guidelines, and issuing author guidance on reporting protocol changes caused by COVID-19-related disruptions. IJED recognizes the disruptive impacts that COVID-19 has on all activities in our field, including clinical work, teaching, and advocacy, and is committed to supporting authors during this difficult time while striving to publish high-quality research.
              Cover page: IJED support for eating disorders research in the time of COVID‐19
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2016)

              Background

              Prenatal alcohol exposure results in a broad range of cognitive and behavioral impairments. Because of the long-lasting problems that are associated with fetal alcohol spectrum disorders (FASDs), the development of effective treatment programs is critical. Preclinical animal studies have shown that choline, which is an essential nutrient, can attenuate the severity of alcohol-related cognitive impairments.

              Objective

              We aimed to translate preclinical findings to a clinical population to investigate whether choline supplementation can ameliorate the severity of memory, executive function, and attention deficits in children with FASDs.

              Design

              In the current study, which was a randomized, double-blind, placebo-controlled clinical trial, we explored the effectiveness of a choline intervention for children with FASDs who were aged 5-10 y. Fifty-five children with confirmed histories of heavy prenatal alcohol exposure were randomly assigned to either the choline (n = 29) or placebo (n = 26) treatment arms. Participants in the choline group received 625 mg choline/d for 6 wk, whereas subjects in the placebo group received an equivalent dose of an inactive placebo treatment. Primary outcomes, including the performance on neuropsychological measures of memory, executive function, and attention and hyperactivity, were assessed at baseline and postintervention.

              Results

              Compared with the placebo group, participants in the choline group did not differentially improve in cognitive performance in any domain. Treatment compliance and mean dietary choline intake were not predictive of treatment outcomes.

              Conclusions

              Findings of the current study do not support that choline, administered at a dose of 625 mg/d for 6 wk, is an effective intervention for school-aged (5-10 y old) children with FASDs. This research provides important information about choline's therapeutic window. Combined with other studies of choline and nutritional interventions in this population, this study emphasizes a further need for the continued study of the role of nutritional status and supplementation in children with FASDs and the contributions of nutrition to neurocognition. This trial was registered at clinicaltrials.gov as NCT01911299.
                • Article
                • Peer Reviewed
                UCLA Previously Published Works (2016)
                OBJECTIVES: We have shown that, in a randomized trial comparing adherence to different colorectal cancer (CRC) screening strategies, participants assigned to either fecal occult blood testing (FOBT) or given a choice between FOBT and colonoscopy had significantly higher adherence than those assigned to colonoscopy during the first year. However, how adherence to screening changes over time is unknown. METHODS: In this trial, 997 participants were cluster randomized to one of the three screening strategies: (i) FOBT, (ii) colonoscopy, or (iii) a choice between FOBT and colonoscopy. Research assistants helped participants to complete testing only in the first year. Adherence to screening was defined as completion of three FOBT cards in each of 3 years after enrollment or completion of colonoscopy within the first year of enrollment. The primary outcome was adherence to assigned strategy over 3 years. Additional outcomes included identification of sociodemographic factors associated with adherence. RESULTS: Participants assigned to annual FOBT completed screening at a significantly lower rate over 3 years (14%) than those assigned to colonoscopy (38%, P<0.001) or choice (42%, P<0.001); however, completion of any screening test fell precipitously, indicating the strong effect of patient navigation. In multivariable logistic regression analysis, being randomized to the choice or colonoscopy group, Chinese language, homosexuality, being married/partnered, and having a non-nurse practitioner primary care provider were independently associated with greater adherence to screening (P<0.01). CONCLUSIONS: In a 3-year follow-up of a randomized trial comparing competing CRC screening strategies, participants offered a choice between FOBT and colonoscopy continued to have relatively high adherence, whereas adherence in the FOBT group fell significantly below that of the choice and colonoscopy groups. Patient navigation is crucial to achieving adherence to CRC screening, and FOBT is especially vulnerable because of the need for annual testing.
                  Cover page: Adherence to Competing Strategies for Colorectal Cancer Screening Over 3 Years.
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2023)
                  Aim: The cost-effectiveness of treatment options (anticholinergics, β3-adrenoceptor agonists, onabotulinumtoxinA, sacral nerve stimulation and percutaneous tibial stimulation [the latter two including new rechargeable neurostimulators]) for the management of overactive bladder (OAB) were compared with best supportive care (BSC) using a previously published Markov model. Materials & methods: Cost-effectiveness was evaluated over a 15-year time horizon, and sensitivity analyses were performed using 2- and 5-year horizons. Discontinuation rates, resource utilization, and costs were derived from published sources. Results: Using Medicare and commercial costs over a 15-year time period, onabotulinumtoxinA 100U had incremental cost-effectiveness ratios (ICERs) gained of $39,591/quality-adjusted life-year (QALY) and $42,255/QALY, respectively, versus BSC, which were the lowest ICERs of all assessed treatments. The sensitivity analyses at 2- and 5-year horizons also showed onabotulinumtoxinA to be the most cost-effective of all assessed treatments versus BSC. Conclusion: OnabotulinumtoxinA 100U is currently the most cost-effective treatment for OAB.
                    Cover page: Cost-effectiveness of overactive bladder treatments from a US commercial and&nbsp;payer perspective.
                    • Article
                    • Peer Reviewed
                    UC San Diego Previously Published Works (2021)
                    This editorial seeks to encourage the increased application of three open science practices in eating disorders research: Preregistration, Registered Reports, and the sharing of materials, data, and code. For each of these practices, we introduce updated International Journal of Eating Disorders author and reviewer guidance. Updates include the introduction of open science badges; specific instructions about how to improve transparency; and the introduction of Registered Reports of systematic or meta-analytical reviews. The editorial also seeks to encourage the study of open science practices. Open science practices pose considerable time and other resource burdens. Therefore, research is needed to help determine the value of these added burdens and to identify efficient strategies for implementing open science practices.
                      Cover page: Open science practices for eating disorders research
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