The Value of Serum NR2 Antibody in Prediction of Post-Cardiopulmonary Resuscitation Survival

Introduction: N-methyl-D-aspartate receptor subunits antibody (NR2-ab) is a sensitive marker of ischemic brain damage in clinical circumstances, such as cerebrovascular accidents. We aimed to assess the value of serum NR2-ab in predicting the post-cardiopulmonary resuscitation (CPR) survival. Methods: In this cohort study, we examined serum NR2-ab levels 1 hour after the return of spontaneous circulation (ROSC) in 49 successfully resuscitated patients. Patients with traumatic or asphyxic arrests, prior neurological insults, or major medical illnesses were excluded. Participants were followed until death or hospital discharge. Demographic data, coronary artery disease risk factors, time before initiation of CPR, and CPR duration were documented.  In addition, Glasgow coma scale (GCS), blood pressure, and survival status of patients were recorded at 1, 6, 24, and 72 hour(s) after ROSC. Descriptive analyses were performed, and the Cox proportional hazard model was applied to assess if NR2-ab level is an independent predictive factor of survival. Results: 49 successfully resuscitated patients were evaluated; 27 (55%) survived to hospital discharge, 4 (8.1%) were in vegetative state, 10 (20.4%) were physically disabled, and 13 (26.5%) were physically functional. Within 72 hours of ROSC all of the 12 NR2-ab positive patients died. In contrast, 31 (84%) of the NR2-ab negative patients survived. Sensitivity, specificity, positive and negative likelihood ratios of NR2-ab in prediction of survival were 54.5% (95%CI=32.7%-74.9%), 100% (95%CI=84.5%-100%), infinite, and 45.5% (95%CI=28.8%-71.8%), respectively. Subsequent analysis showed that both NR2-ab status and GCS were independent risk factors of death. Conclusions: A positive NR2-ab serum test 1 hour after ROSC correlated with lower 72-hour survival. Further studies are required to validate this finding and demonstrate the value of a quantitative NR2-ab assay and its optimal time of measurement

Confirmatory Factor Analysis of the 12- Item Center for Epidemiologic Studies Depression Scale (CES-D) among Blacks and Whites

Background: The Center for Epidemiologic Studies Depression (CES-D) scale is one of the most widely used tools to measure depressive symptoms in epidemiological studies. Given the importance of cross-racial measurement equivalence of CES-D scale for research, we performed confirmatory factor analysis of 12 - item CES-D in a nationally representative sample of Black and White adults in the United States.Methods: We used data from the National Survey of American Life (NSAL), 2001-2003. A total number of 3,570 Blacks (African Americans) and 891 non-Hispanic Whites were included in the present study. Confirmatory factor analysis was carried out on the 12-item CES-D scale using multi-group structural equation modeling (SEM).Results: For both Blacks and Whites, best fitting model was found to be the 3-factor model, indicating invariance of factor structure between Blacks and Whites. Statistically different fit of the models with and without constraints indicated lack of invariance of factor loadings between Blacks and Whites. Some of the positive (i.e. as good, and hopeful) and interpersonal (i.e. people were unfriendly) items showed poor loadings, even in the 3- factor solution that allowed separate domains for positive affect, negative affect, and interpersonal problems. Despite the good fit of our final model, more items (i.e. as good, hopeful, keeping mind, and everything effort) had poor loadings in Blacks than Whites (i.e. as good).Conclusion: There is invariance in factor structure but lack of invariance in factor/item loadings among Blacks and Whites. These findings have implications for cross-racial studies of depressive symptoms using CES-D among Blacks and Whites. Further research is warranted to scrutinize the role of socio-economics and culture in explaining lack of invariance of CES-D scale between Blacks and Whites

Impact of opioid agonists on mental health in substitution treatment for opioid use disorder : a systematic review and Bayesian network meta-analysis of randomized clinical trials

Background: Concurrent mental health problems is a major issue in opioid use disorder. As the first step in developing effective interventions, a clear understanding of factors that potentially contribute to the improvement of mental health in this population, most prominently the role of opioid medications, is required. Previous reviews did not isolate the impact of opioid agonists on mental health from those of psychosocial interventions in substitution treatment of opioid use disorder. We compared mental health outcomes between opioid medications and control conditions, i.e. placebo or waitlist, to isolate these effects. Methods: Embase, MEDLINE, PsychInfo, CINAHL Complete, Web of Science Core Collection and RCT registries were among the systematically searched databases. RCTs were included if they com- pared any opioids with each other or with a placebo/waitlist in substitution treatment of patients with opioid use disorder and reported mental health outcomes using a validated measure. Individual study-level data were extracted from all available sources. Primary outcomes included difference in standardized mean score changes (SMD) for depressive symptoms and overall mental health symptomatol- ogy between opioid agonists and placebo/waitlist. Random effects model was used for both the direct pairwise meta-analysis and network meta-analysis. (Registered at https://www.crd.york.ac.uk/pros- pero/, CRD42018109375) Results: Out of 6034 citations, 19 studies were included in the qualitative synthesis and 16 in the quantitative synthesis. Out of 19 studies, 18 had high overall risk of bias. Direct pairwise meta-analysis indicated that diacetylmorphine (DAM) outperformed methadone on overall mental health (SMD (CI95%)= -0.23 (-0.34, -0.13)). Buprenorphine outperformed waitlist or placebo on improvement of depressive symptoms (SMD (CI95%)= -0.95 (-1.53, -0.36)) and overall mental health (SMD (CI95%)= -0.68 (-1.33, -0.03)). Based on network meta-analysis for primary outcomes, buprenorphine (SMD (CI95%)= -0.61 (-1.20, -0.11)), DAM (SMD (CI95%)= -1.40 (-2.70, -0.23)), and methadone (SMD (CI95%)= -1.20 (-2.30, -0.11)) were superior to waitlist/placebo on overall mental health symp- tomatology, but none of the medications were superior to waitlist in improving depressive symptoms. Conclusions: Opioid agonists used in substitution treatment improve overall mental health, and DAM outperforms methadone in this regard which has implications for treatment guidelines. Future trials will benefit from stricter control for sources of bias.Medicine, Faculty ofExperimental Medicine, Division ofMedicine, Department ofGraduat

Racial Discrimination during Adolescence Predicts Mental Health Deterioration in Adulthood: Gender Differences among Blacks

BackgroundDespite the existing knowledge regarding the negative mental health consequences of perceived racial discrimination, very few researchers have used a longitudinal design with long-term follow-up periods to explore gender differences in this association over time.ObjectiveThe current longitudinal study aimed to investigate gender differences in predictive role of an increase in perceived racial discrimination during adolescence for mental health deterioration a decade later when they are transitioning to young adulthood.MethodsCurrent study followed 681 Black youths for 18 years from 1994 (mean age 15) to 2012 (mean age 32). All participants spent their adolescence and transition to young adulthood in an economically disadvantaged urban area in the Midwest of the United States. Independent variable was perceived racial discrimination measured in 1999 and 2002. Outcomes were psychological symptoms (anxiety and depression) measured in 1999 and at end of follow-up (2012). Covariates included sociodemographics (age, family structure, and parental employment) measured in 1994. Gender was used to define groups in a multigroup structural equation model to test moderating effects.ResultsMultigroup structural equation modeling showed that among male Black youth, an increase in perceived racial discrimination from age 20 to 23 was predictive for an increase in symptoms of anxiety and depression from age 20 to 32. Among female Black youth, change in perceived racial discrimination did not predict future change in depressive or anxiety symptoms.ConclusionWhile racial discrimination is associated with negative mental health consequences for both genders, male and female Black youth differ in regard to long-term effects of an increase in perceived discrimination on deterioration of psychological symptoms. Black males seem to be more susceptible than Black females to the psychological effects of an increase in racial discrimination over time