Effects of Mindfulness-based Stress Reduction on Anxiety & Depression in Primary Care Patients

The objective of this study was to examine effects of mindfulness-based stress reduction (MBSR) on the ability to decrease anxiety and depression and increase mindfulness compared to cognitive-behavioral stress management (CBSM). Thirty-five subjects were recruited from a community healthcare center and took part in MBSR (n = 21) and CBSM (n =14) groups. There were no initial differences between MBSR and CBSM subjects on demographics including age, gender, education, and income. MBSR was an 8-week course using meditation, gentle yoga, and body scanning exercises to increase mindfulness. CBSM was an 8-week course using cognitive and behavioral techniques to change thinking and reduce distress. Anxiety, depression, and mindfulness were assessed before and after each group. An analysis of covariance (ANCOVA) was used to examine initial group differences between MBSR and CBSM and between Latinos and Non-Latino Whites (NLWs). Effect sizes and paired t-tests were used to examine changes in pre to post measures within groups and ethnicities. Correlational analyses were used to examine changes in anxiety, depression, and mindfulness, as well as changes in mindfulness subscales. Chi-square analyses examined dropout rates between Latino and NLW subjects. Results showed no significant differences in depression and anxiety when comparing MBSR and CBSM groups, but effect sizes showed significant reductions in anxiety and depression and increases in mindfulness. MBSR also showed significant reductions in all three variables, while CBSM showed reductions in anxiety depression, but no changes in mindfulness. NLWs showed reductions in both anxiety and depression, while Latinos decreased only in depression. NLWs showed large effects on all variables, while Latinos showed small increases in mindfulness, medium reductions in anxiety, and large reductions in depression. There were significant correlations between reductions in anxiety and increases in mindfulness and between reductions in depression and increases in mindfulness. There were no significant differences in attrition between groups or ethnicities. Future research should compare cognitive-behavioral and mindfulness-based interventions in a large sample. Research may also benefit from studying the mechanisms involved in mindfulness instead of focusing on group differences

Planning for the Strategic Redevelopment of Downtown Detroit

Executive Summary Since its founding in 1701, Downtown Detroit has evolved from a major shipping port and industrial mega-power, to a place of racial unrest and economic troubles, to its present incarnation as a gritty city looking for a comeback. At this point, the main question for the downtown area concerns how to revitalize this once glorious city into a major hub of entertainment, retail, office and residential for residents and visitors alike. Our goal for the city was to create an oasis of walkable urbanity that would be a destination place for visitors and a safe, clean and attractive city for residents. This study begins with a summary of Detroit’s history. In our historical review, we concentrated on information that pertained to the downtown’s layout and character and could help inform future redevelopment. Additionally, an inventory of the historic buildings, public spaces, and known sites of environmental concern was conducted to get an accurate snapshot of some of the key features of the study area. Working closely with the Brookings Institution Metropolitan Policy Program Urban Markets Initiative and the Social Compact, we conducted an in-depth market analysis. The market analysis included a review and revision of the widely available demographic information. Using alternative data sources to the census, we found that the current downtown population is higher than previously thought and the earning potential, aggregate income, and disposable income are all higher than previously anticipated.Master of ScienceSchool of Natural Resources & EnvironmentA. Alfred Taubman College of Architecture and Urban PlanningStephen M. Ross School of BusinessUniversity of Michiganhttps://deepblue.lib.umich.edu/bitstream/2027.42/48791/4/Strategic Redevelopment of Dtwn Detroit Jan 07.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/48791/6/downtown_detroit.mp4Description of Strategic Redevelopment of Dtwn Detroit Jan 07.pdf : OpusDescription of downtown_detroit.mp4 : Video: Downtown Detroit, Oct. 24, 200

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect

OBJECTIVE: Physical pain and negative affect have been described as risk factors for alcohol use following alcohol treatment. The current study was a secondary analysis of two clinical trials for alcohol use disorder (AUD) to examine the associations between pain, negative affect and AUD treatment outcomes. METHOD: Participants included 1383 individuals from the COMBINE Study (COMBINE Study Group, 2003; 31% female, 23% ethnic minorities, average age=44.4 (SD=10.2)), a multisite combination pharmacotherapy and behavioral intervention study for AUD in the United States, and 742 individuals from the United Kingdom Alcohol Treatment Trial (UKATT Research Team, 2001; 25.9% female, 4.4% ethnic minorities, average age=41.6 (SD=10.1)) a multisite behavioral intervention study for AUD in the United Kingdom. The Form-90 was used to collect alcohol use data, the Short Form Health Survey and Quality of Life measures were used to assess pain, and negative affect was assessed using the Brief Symptom Inventory (COMBINE) and the General Health Questionnaire (UKATT). RESULTS: Pain scores were significantly associated with drinking outcomes in both datasets. Greater pain scores were associated with greater negative affect and increases in pain were associated with increases in negative affect. Negative affect significantly mediated the association between pain and drinking outcomes and this effect was moderated by social behavior network therapy (SBNT) in the UKATT study, with SBNT attenuating the association between pain and drinking. CONCLUSION: Findings suggest pain and negative affect are associated among individuals in AUD treatment and that negative affect mediated pain may be a risk factor for alcohol relapse

Citation

Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect. Journal of Consulting and Clinical Psychology, 83 (6)

Pain as a predictor of heavy drinking and any drinking lapses in the COMBINE study and the UK Alcohol Treatment Trial

Aims: To test the association between pain and heavy drinking lapses during and following treatment for alcohol use disorders (AUD). Design: Secondary data analysis of data from two clinical trials for AUD. Setting and participants: Participants included 1383 individuals from the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study in the United States [69.0% male, 76.8% non-Hispanic White average age=44.4, standard deviation (SD)=10.2] and 742 individuals from the UK Alcohol Treatment Trial (UKATT) in the United Kingdom [74.1% male, 95.6% White, average age=41.6 (SD=10.1)]. Measurements: Form-90 (a structured assessment interview) was used to assess the primary outcome: time to first heavy drinking day. The Short Form Health Survey and Quality of Life measures were used to assess pain interference and pain intensity. Findings: Pain was a significant predictor of heavy drinking lapses during treatment in UKATT [odds ratio (OR)=1.19, 95% confidence interval (CI)=1.08, 1.32, P=0.0003] and COMBINE (OR=1.12, 95% CI=1.03, 1.21, P=0.009), and was a significant predictor of heavy drinking lapses following treatment in COMBINE (OR=1.163, 95% CI=1.15, 1.17, P&lt;0.00001). After controlling for other relapse risk factors (e.g. dependence severity, self-efficacy, temptation, psychiatric distress), pain remained a significant predictor of heavy drinking lapses during treatment in UKATT (OR=1.19, 95% CI=1.06, 1.34, P=0.004) and following treatment in COMBINE (OR=1.44, 95% CI=1.07, 1.92, P=0.01). Conclusions: Among people treated for alcohol use disorder, being in physical pain appears to predict heavy drinking lapses during or after treatment.</p