Biomedical subjects

Grace Chang

Publications and source records attributed to Grace Chang.

At least 19 recordsLinked to original sources

PubMed2006

Estimates of prenatal abstinence from alcohol: a matter of perspective.

Abstinence from alcohol has been recommended for both pregnant and pre-conceptional women. The purpose of this study is to compare self and partner reports of abstinence from alcohol in a sample of 253 pregnant women who were T-ACE (Tolerance, Annoy, Cut-down, Eye-opener) alcohol screen positive. Dyads' reports of the women's abstinence from alcohol before, during, and after pregnancy were compared. Based on their own self-report, less than 20% of the pregnant women were abstinent in their first trimester and about half were abstinent for the rest of their pregnancy. Partners significantly over-estimated the women's abstinence from alcohol at all points except in the post-partum period when the dyad had the highest rate of agreement (85.4%). Reasons for the discrepancies in the self and partner reports of prenatal abstinence, and how partners might influence such behavior remain speculative, but identify areas for future research and prevention.

Adult↗

PubMed2006

Stages of change and prenatal alcohol use.

This study evaluated stage of change as a predictor of alcohol use in a sample of 301 pregnant women who were either in the precontemplation (62%) or in the action (38%) stage of change in their first trimester. Stage of change distinguished between different patterns of alcohol consumption before and after pregnancy. Those in the precontemplation stage drank more per episode and more often before pregnancy than those in the action stage. The precontemplation group also had a significantly greater quantity of alcohol after pregnancy. However, stage of change did not directly predict subsequent prenatal alcohol use. Previous alcohol use, age, and education were the most significant predictors of prenatal drinks per drinking day. Temptation to drink alcohol was the best predictor of prenatal drinking frequency after study enrollment. Women in both stages of change reduced the quantity and the frequency of their alcohol consumption while pregnant and achieved comparable rates of abstinence.

Adult↗

PubMed2006

Brief intervention for prenatal alcohol use: the role of drinking goal selection.

The behavioral problems and cognitive deficits resulting from even small amounts of prenatal alcohol exposure can be significant and enduring but completely preventable. The purpose of this study was to examine the impact of a prenatal drinking goal selected during a brief intervention for 115 pregnant women and their partners on subsequent consumption. Higher proportions of women having their first pregnancy chose abstinence as a goal over drinking reduction. Goal selection was highly predictive of subsequent drinking behavior. Interestingly, the participants who were abstinent at enrollment and who chose to remain abstinent had the highest rates of abstinence. In contrast, the women who chose cutting down on drinking were the least likely to drink less subsequently, despite recognizing more situations putting them at risk for drinking and identifying more alternatives to consumption. We conclude that goal choice in behavioral self-management of alcohol use by pregnant women is critical.

Adult↗

PubMed2006

Identifying risk drinking in expectant fathers.

BACKGROUND: Identification of risk drinking in expectant fathers may be helpful as an important part of efforts to minimize maternal alcohol use, and as an opportunity to inform them about a problematic practice during a critical developmental stage for the couple. The purpose of this study was to evaluate the T-ACE screening questionnaire, which asks about tolerance to alcohol, being annoyed by other's comments about drinking, attempts to cut down, and having a drink first thing in the morning ("eye-opener"), in the male partners of pregnant women who themselves were T-ACE positive. METHODS: Two hundred fifty-four male partners were asked to complete the T-ACE embedded in a health survey, the Alcohol Use Disorders Identification Test (AUDIT), and other questions about their alcohol use in the past 30 days when their pregnant partners had a median gestation of 11.5 weeks (T1). After delivery, male partners again completed the T-ACE and quantity-frequency questions (T2). The predictive ability of the T-ACE and AUDIT was compared, using risk drinking (>4 drinks/day or >14 drinks/week) as the criterion standard. RESULTS: A substantial minority of male partners had risk drinking, 31 percent at T1 and 25 percent at T2. Although the AUDIT was better than the T-ACE as an independent predictor of risk drinking, the latter was most accurate when the tolerance threshold exceeded 2 drinks, the same established for pregnant women. The sensitivity (T1= 84.6%, T2= 82.8%) and specificity (T1= 43.8%, T2= 51.1%) of the T-ACE at this threshold compared favorably with those of the AUDIT at the standard cut point of 8. CONCLUSIONS: The T-ACE may be a practical way for clinicians to identify risk drinking in both pregnant women and expectant fathers.

Adolescent↗

PubMed2006

Alcohol use by pregnant women: partners, knowledge, and other predictors.

OBJECTIVE: The impact of a couple's knowledge about healthy pregnancy habits involving alcohol and substance use was assessed in the context of other factors previously identified to predict prenatal alcohol consumption in a sample of 254 pregnant women and their male partners. METHOD: Couples were asked to assess independently a series of statements (true or false) describing the consequences of prenatal substance exposure, while also providing information about their own drinking. RESULTS: Although the couples demonstrated good knowledge of healthy habits during pregnancy, they did not agree when the element of chance was considered. Median household income was more highly predictive of a pregnant woman's knowledge score than her partner's score. In turn, the subject's knowledge of healthy pregnancy habits as manifested in the assessment score had only a weak relationship with prenatal alcohol consumption. Previous alcohol use by the pregnant woman was the strongest predictor of prenatal alcohol use. CONCLUSIONS: Because previous alcohol consumption use by the pregnant woman was the strongest predictor of prenatal alcohol use, the importance of its accurate identification is emphasized. Although pending further investigation, knowledge about healthy pregnancy behaviors may exert greater impact if it is shared by a pregnant woman and her partner.

Adult↗

PubMed2005

Risk during pregnancy--self-report versus medical record.

OBJECTIVE: This study was undertaken to compare the frequencies with which physicians and patients report medical and behavioral risk factors during pregnancy, with particular attention to identification of women at risk for prenatal alcohol use. STUDY DESIGN: The sample included 278 women, drawn from a randomized trial of T-ACE (alcohol screening questionnaire) positive pregnant women receiving obstetric care. Medical records and participants' self-reports were available for comparison. RESULTS: Physicians identified only 10.8% of women recognized as at risk for alcohol consumption by the T-ACE screening measure. In contrast, the physicians' records were more inclusive for medical risk factors than the participant's self-reports. Physicians were significantly more likely to correctly identify nonwhite participants as being at risk for prenatal alcohol use (odds ratio = 3.59, P = .026), compared with their white counterparts. CONCLUSION: Self-report on the T-ACE questionnaire is more effective than medical records in identifying women at risk for prenatal alcohol use.

Adult↗

PubMed2005

Adolescent cigarette smoking and mental health symptoms.

PURPOSE: Adolescent cigarette smoking has been reported to be associated with substance use and depression. Less is known about the association between smoking and other mental health symptoms, or the impact of mental health treatment on cigarette smoking and psychiatric morbidity including the substance use disorders. The purpose of this study is to examine the association among adolescent cigarette smoking, mental health symptoms including substance use disorders, and mental health treatment among adolescents treated at a large, hospital-based young adult clinic. METHODS: Observational study of 486 adolescent patients presenting for routine medical care. RESULTS: Participants were two-thirds female with an average age of 16.6 years and of diverse ethnic background; 129 (28.6%) reported ever-using tobacco products, and 68 (14%) were current smokers who had an average of 2 cigarettes per day. Current smoking was associated with significantly increased odds of having mental health symptoms and substance use disorders, even after controlling for age and previous mental health treatment, and in both boys and girls. CONCLUSIONS: This study supports the increasing appreciation that adolescent tobacco use is clinically important, even at apparently low levels. Adolescent cigarette smoking is generally more common than alcohol and illicit drug use, and these results highlight its multifarious linkages with use of other substances and mental health symptoms. Thus, early identification and intervention of adolescent cigarette smoking may help not only to avert later daily smoking, but also may assist in identifying patients at increased risk for substance use and psychiatric problems.

Adolescent↗

PubMed2005

Motivational interviewing for adolescent substance use: a pilot study.

We developed and pilot tested a 2-session motivational interviewing intervention for substance use among 14- to 18-year-old medical patients. Recruitment and retention were more challenging than anticipated. A substantial number of completers reduced their use of substances and risk of driving after drinking during the 3-month follow-up period.

Adolescent↗

PubMed2005

Brief intervention for prenatal alcohol use: a randomized trial.

OBJECTIVE: To test the effectiveness of a brief intervention in the reduction of prenatal alcohol consumption by women when a partner is included. METHODS: Randomized trial of a single session brief intervention given by the study nurse or principal investigator for 304 pregnant women and their partners. The women had positive T-ACE (Tolerance, Annoyed, Cut down, Eye-opener, an alcohol screening test) results and were at risk for alcohol consumption while pregnant. All completed initial diagnostic and postpartum interviews. RESULTS: Fewer than 20% of participants (median 11.5 weeks of gestation) were abstinent at study enrollment, averaging more than 1.5 drinks per episode. Nearly 30% had 2 or more drinks at a time while pregnant. Prenatal alcohol use declined in both the treatment and control groups after study enrollment, based on a 95% follow-up rate. Factors associated with increased prenatal alcohol use after randomization included more years of education, extent of previous alcohol consumption, and temptation to drink in social situations. Brief interventions for prenatal alcohol reduced subsequent consumption most significantly for the women with the highest consumption initially (regression coefficient, b = -0.163, standard error (b) = 0.063, P < .01). Moreover, the effects of the brief intervention were significantly enhanced when a partner participated (b = -0.932, standard error (b) = 0.468), P < .05). CONCLUSION: Pregnant women with the highest levels of alcohol use reduced their drinking most after a brief intervention that included their partners. Recommendations include consistent screening for prenatal alcohol use followed by diagnostic assessment when indicated, and if confirmed by other studies, a patient-partner brief intervention for the heaviest drinkers.

Adult↗

PubMed2004

Depression, cigarette smoking, and hematopoietic stem cell transplantation outcome.

BACKGROUND: The relationships between psychological and behavioral variables and patient outcomes after hematopoietic stem cell transplantation (HSCT) are not known definitively but have great potential importance, since this lifesaving procedure is used increasingly to treat a variety of malignancies. The objective of this study was to evaluate psychosocial predictors of long-term survival and disease recurrence after patients underwent allogeneic HSCT for chronic myelogenous leukemia (CML). METHODS: In this prospective cohort study, 114 adults were admitted for allogeneic HSCT to the Brigham and Women's Hospital between July, 1997 and January, 2002. The median follow-up was 882 days, and serial measures were taken for mood and substance use 6 months and 12 months posttransplantation. RESULTS: With a 93% participation rate by all potentially eligible patients and with < 3% of patients loss to follow-up, univariate predictors of long-term survival and recurrence were identified. Cox proportional hazards regression models for survival and recurrence were developed. Depressive symptoms, as measured by the most recent Beck Depression Inventory (BDI), increased the risk of death by 7% for each point increase in the BDI score (P = 0.006). Fourteen of 17 patients who developed recurrent disease were cigarette smokers with an average of 22.3 pack-years. For each pack-year of cigarette smoking, the risk of recurrence increased by 1.7% (P = 0.01). CONCLUSIONS: This study assessed the role of psychosocial variables prospectively among a clinically homogeneous but representative cohort of patients who underwent allogeneic HSCT. Although additional confirmatory studies are pending, it appears that depressive symptoms posttransplantation and cigarette smoking prior to transplantation affect outcomes adversely and may represent opportunities to improve the morbidity and mortality associated with HSCT for patients with CML.

Adult↗

PubMed2004

Middle-aged and older Latino American women in the patient-doctor interaction.

Latino women's views of and actual experiences in the patient-doctor interaction have been little explored. In focus groups with middle-aged and older Latino women, topics including assertiveness in the medical encounter, experiences in actual medical encounters, and characteristics of the "ideal" doctor were explored. Contrary to conceptualizations in the literature, assertiveness was viewed as a reciprocal process between patient and doctor, rather than the behavior of the patient alone. Assertiveness centered on obtaining answers to patient health questions. Strategies for self-advocacy were indirect, primarily changing doctors when dissatisfied; while strategies for advocating for family members were direct, primarily expressing dissatisfaction directly to medical staff. Undocumented immigrant status was described as limiting self-assertion and medical care access. Age was linked to doctor gender preferences. Middle-aged women preferred female doctors, while older women preferred male doctors. Across groups, women expressed preference for Spanish-speaking doctors, but not for doctors of the same ethnicity. Trustworthiness was identified by participants as the most important doctor characteristic, and learnable behaviors as exemplifying trustworthiness.

Adult↗

PubMed2003

Ontogenetic transition in fetal wound transforming growth factor-beta regulation correlates with collagen organization.

Fetal rat skin transitions from scarless fetal-type repair to adult-type repair with scar between day 16 (E16) and day 18 (E18) of gestation (term = 21.5 days). Deficient transforming growth factor (TGF)-beta 1 and -beta 2 injury response has been proposed as a mechanism for scarless fetal-type repair. However, previous fetal studies have inconsistently reported the degree of TGF-beta induction after injury. To minimize developmental variables in fetal versus adult TGF-beta regulation, we narrowed our study to wounded fetal animals. We hypothesize that TGF-beta ligand and receptor expression will be differentially regulated during the transition from early gestation (E16) wounds manifesting scarless fetal-type repair to late gestation (E19) wounds manifesting adult-type repair with scar. In this study, decreased and rapidly cleared TGF-beta 1 and -beta 2 expression accompanied by increased and prolonged TGF-beta 3 levels in wounded E16 animals correlated with organized collagen deposition. In contrast, increased and prolonged TGF-beta 1 and -beta 2 expression accompanied by decreased and delayed TGF-beta 3 expression in wounded E19 animals correlated with disorganized collagen architecture. Similarly, expression of TGF-beta receptors type I and II were also increased or prolonged in E19 animals. Our results implicate increased TGF-beta 1, -beta 2, and decreased TGF-beta 3 expression, as well as increased type I and II receptor expression in late gestation fetal scar formation.

Animals↗

PubMed2003

Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT.

BACKGROUND: Adolescents should be screened for alcohol misuse as part of routine care. The objective of this study was to compare the criterion validity of the Alcohol Use Disorders Identification Test (AUDIT), the Problem Oriented Screening Instrument for Teenagers substance use/abuse scale (POSIT), and the CAGE and CRAFFT questions among adolescents. METHODS: Fourteen- to 18-year-old patients arriving for routine healthcare at a large, hospital-based adolescent clinic completed the four screens and the criterion standard Adolescent Diagnostic Interview, which yields DSM-IV diagnoses of alcohol abuse and dependence. Receiver operating characteristic (ROC) curves were plotted to determine optimal cut-points. Areas under the ROC curves of the four screens were compared, and sensitivities and specificities were calculated. RESULTS: Participants' past 12-month alcohol diagnostic classifications were as follows: no use (58.6%), nonproblem use (13.0%), problem use (20.8%), abuse (5.4%), and dependence (2.2%). Optimal cut-points associated with problem use or higher were 2 for AUDIT, 1 for POSIT, 1 for CAGE, and 1 for CRAFFT. ROC curve area of the CAGE was significantly lower compared with areas of all other screens. Sensitivities (95% confidence intervals) were AUDIT 0.88 (0.83-0.93), POSIT 0.84 (0.79-0.90), CAGE 0.37 (0.29-0.44), and CRAFFT 0.92 (0.88-0.96); specificities were AUDIT 0.81 (0.77-0.85), POSIT 0.89 (0.86-0.92), CAGE 0.96 (0.94-0.98), and CRAFFT 0.64 (0.59-0.69). CONCLUSIONS: The AUDIT, POSIT, and CRAFFT have acceptable sensitivity for identifying alcohol problems or disorders in this age group. The CAGE is not recommended for use among adolescents.

Adolescent↗

PubMed2002

Variability of the downwelling diffuse attenuation coefficient with consideration of inelastic scattering.

In situ time-series measurements of spectral diffuse downwelling irradiance from the Bermuda Testbed Mooring are presented. Averaged diffuse attenuation coefficients of downwelling irradiance, Kd,and their elastic and inelastic components are investigated at seven wavelengths. At shorter wavelengths (<510 nm), Kd is weakly dependent on the solar zenith angle owing to the prevailing scattering effect and therefore can be considered a quasi-inherent optical property. At longer wavelengths (>510 nm), Kd shows a strong dependence on the solar zenith angle. As depth increases, inelastic scattering plays a greater role for the underwater light field at red wavelengths.

Journal Article↗

PubMed2002

Validity of the CRAFFT substance abuse screening test among adolescent clinic patients.

OBJECTIVE: To determine the accuracy of the CRAFFT substance abuse screening test. DESIGN: Criterion standard validation study comparing the score on the 6-item CRAFFT test with screening categories determined by a concurrently administered substance-use problem scale and a structured psychiatric diagnostic interview. Screening categories were "any problem" (ie, problem use, abuse, or dependence), "any disorder" (ie, abuse or dependence), and "dependence." SETTING: A large, hospital-based adolescent clinic. PARTICIPANTS: Patients aged 14 to 18 years arriving for routine health care. MAIN OUTCOME MEASURES: The CRAFFT receiver operating characteristic curve, sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: Of the 538 participants, 68.4% were female, and 75.8% were from racial and ethnic minority groups. Diagnostic classifications for substance use during the past 12 months were no use (49.6%), occasional use (23.6%), problem use (10.6%), abuse (9.5%), and dependence (6.7%). Classifications were strongly correlated with the CRAFFT score (Spearman rho, 0.72; P<.001). A CRAFFT score of 2 or higher was optimal for identifying any problem (sensitivity, 0.76; specificity, 0.94; positive predictive value, 0.83; and negative predictive value, 0.91), any disorder (sensitivity, 0.80; specificity, 0.86; positive predictive value, 0.53; and negative predictive value, 0.96) and dependence (sensitivity, 0.92; specificity, 0.80; positive predictive value, 0.25; and negative predictive value 0.99). Approximately one fourth of participants had a CRAFFT score of 2 or higher. Validity was not significantly affected by age, sex, or race. CONCLUSION: The CRAFFT test is a valid means of screening adolescents for substance-related problems and disorders, which may be common in some general clinic populations.

Adolescent↗

PubMed2002

Brief interventions for problem drinking and women.

Early identification and intervention among problem drinking women may avert the more severe, adverse consequences of alcohol abuse and dependence. Screening and brief interventions, while generally effective, have not been adequately examined among subgroups, such as women. The purpose of this review article is to examine the efficacy of brief interventions for the population of women in need of some alcohol treatment. Representative studies with random assignment to treatment conditions and either substantial numbers of women, or a special focus on women, were included. Findings suggest brief interventions are not consistently helpful to women drinkers.

Alcoholism↗

PubMedDate not supplied

Hallucinations in Latino psychiatric outpatients: a preliminary investigation.

Accuracy of diagnosis and efficacy of treatment depend on recognition of cultural variation in symptomatology of mental illness. Caribbean Latinos have been observed to present in outpatient settings with a higher than expected prevalence of hallucinations; however little is known about this phenomenon and whether it reflects psychotic illness. This study is a retrospective record review of 54 Spanish-speaking psychiatric outpatients who were evaluated in their own language. Demographic and clinical data were extracted from the records and relationships to hallucinations were examined. Of the total sample, 46% reported hallucinations, and 84% of these were simple (e.g., hearing one's name called). Thought disorder was diagnosed in only 9% of the sample. Caribbean Latinos presented to this outpatient mental health setting with a high rate of perceptual symptoms in the absence of other signs of psychosis. Since hallucinations are known to be nonspecific, the symptoms reported in this patient sample are best understood as nonpsychotic hallucinations. Further research is necessary to clarify the epidemiological and cultural aspects of this phenomenon, and to guide treatment.

Adult↗

PubMedDate not supplied

Problem drinking in women evaluated for infertility.

Clinicians may wish to use the T-ACE, a screening instrument for prenatal risk drinking, for their infertile patients. Twenty-eight T-ACE negative and 23 T-ACE positive women presenting to an academic infertility clinic completed two interviews about their drinking. The 23 T-ACE positive participants were also randomized to receive a brief intervention. The T-ACE distinguished between heavier and lighter patterns of alcohol use in this sample. Moreover, it appeared that although the average quantity of alcohol consumed per drinking day was unchanged, the overall mean percentage of days drinking declined significantly from the time of enrollment to follow-up in all groups.

Adult↗