Fatigue Indices and Perceived Exertion Highlight Ergometer Specificity for Repeated Sprint Ability Testing.

This study aimed to compare the time course of measures of performance, fatigue, and perceived exertion during repeated-sprint ability (RSA) testing performed on a non-motorized treadmill (NMT) and cycling ergometer (CE). Fourteen physically active participants performed two 10 ×6 s-1 RSA tests with a 1:4 work-to-rest ratio (24 s recovery) on NMT and CE. Measures of performance [peak and mean power output (PPO and MPO), cadence, and the time to reach PPO (TTP)] and of fatigue (fatigue index and decrement score) and ratings of perceived exertion (RPE) were collected during each session. The level of significance was set at p < 0.05. Participants completed the RSA test at a MPO of 1,041 ± 141 W on CE and 431 ± 48 W on NMT, achieving PPO of 2,310 ± 339 W on CE and 1,763 ± 289 W on NMT. Participants' weight was significantly correlated with PPO and MPO on CE (p < 0.001) and with MPO on NMT (p < 0.001). PPO on CE and NMT was significantly correlated only for absolute measures of power (p < 0.01). Cadence was higher and decreased throughout the RSA on NMT compared to CE, where it decreased only at the seventh bout. TTP was significantly shorter and more affected by fatigue on NMT than on CE. Fatigue indices were significantly greater on NMT compared to CE, with significant correlations between the decrement score and absolute and relative PPO on CE and NMT, between the fatigue index and absolute and relative PPO only on NMT, and no significant correlations with MPO. During RSA, RPE increased more on NMT compared to CE from bouts 3 to 7. During recovery, RPE was consistently higher on NMT at 1, 3, and 5 min post exercise compared to CE. These findings indicate that RSA performed on NMT induces greater fatigue and physiological load than CE, which originated in the lower resistive torque typically used on NMT compared to CE, resulting in a front loaded power output profile from the greater acceleration and cadence. From these results, we discuss that despite providing highly correlated measures of power output, NMT and CE should not be used interchangeably to assess RSA as they elicit markedly different responses. We also discuss these results from the fundamental differences in active muscle mass and power application patterns between running and cycling, which could form the basis of future studies.

Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children.

Objective: Few studies have longitudinally followed trends in antidepressant prescribing for Canadian children following the Black Box warning issued in 2004. Using a national data source, we aim to describe trends in antidepressant recommendations for Canadian children ages 1-18 during 2012 to 2016. Methods: A database called the Canadian Disease and Therapeutic Index (CDTI), provided by IQVIA, was used to conduct analyses. The CDTI dataset collects a quarterly sample of pediatric antidepressant recommendations, projected using a weight procedure from a dynamic sample of 652 Canadian office-based physicians. The term "recommendations" is used because nonprescription drugs may be recommended and there is no confirmation in the database that the prescriptions were filled or medications taken. The data were collected from 2012 to 2016 and the sample population was projected by IQVIA to be representative of the entire Canadian pediatric population. Results: The total number of projected antidepressant recommendations for children increased from 2012 to 2016. Selective serotonin reuptake inhibitors were the most recommended class of antidepressants. Analysis indicated that fluoxetine was the most frequently recommended drug. Findings also suggest that recommendations for tricyclic antidepressants (TCAs) are increasing, but predominantly for reasons other than treatment of depression. Conclusions: Overall, antidepressant use in Canadian children increased over the study period. Unsurprisingly, fluoxetine was the most recommended antidepressant for Canadian children. However, the observed increase in TCA use for a pediatric population is unexpected. The data source is descriptive and lacks detailed measures supporting comprehensive explanation of the findings, therefore, further research is required.

The Pharmacoepidemiology of Psychotropic Medication Use in Canadian Children from 2012 to 2016.

Objective: The goal of this study was to characterize the frequency and trends of psychotropic drug prescribing in Canadian children from 2010 to 2016 and to compare these results with a previous study conducted between 2005 and 2009. Methods: Using a national physician panel survey database from IQVIA Canada, aggregated frequencies of written prescriptions and therapeutic indications for antipsychotics, attention-deficit/hyperactivity disorder (ADHD) medications (psychostimulants and nonstimulants), and antidepressants were analyzed in children. Changes in frequency of written prescriptions and therapeutic indications are presented using descriptive statistics. Results: Written prescriptions for antipsychotics decreased by 10% from 2010 to 2016, in contrast to a 114% increase in written prescriptions for antipsychotics observed between 2005 and 2009. Written prescriptions for psychostimulants and antidepressants rose by 35% and 27%, respectively, between 2012 and 2016, comparable with previous results. The most common reasons for recommending an antipsychotic were ADHD and conduct disorder, although there appears to be a downward trend for ADHD compared with other conditions. In contrast, the share of written prescriptions for antipsychotics for autism increased 34% over the study period. Within the second-generation antipsychotics, written prescriptions for aripiprazole increased. An increase in the use of guanfacine extended release for ADHD was also observed. Conclusion: Several factors may be involved in stabilization and small decrease in antipsychotic use in recent years, including physician and patient awareness of adverse effects related to antipsychotic use, knowledge implementation strategies advocating short-term and judicious use of antipsychotics in children, and the approval of guanfacine extended release for use in Canada for ADHD in 2013.

Neutralization technique use predicts delinquency and substance use outcomes.

This study was part of a larger research intervention that uses motivational interviewing (MI) as part of an in-school substance use intervention in local high schools in the greater Seattle area. Our aim was to test hypothesized relationships between marijuana use, other delinquent behavior, and neutralization techniques used by participants and determine their impact on the effectiveness of an MI-based substance use intervention. Of the 84 participants that completed Intake assessments, 60% were male and identified as an ethnic minority sample: Caucasian/White = 34%; African American/Black = 16%; Hispanic/Latin@ = 16%; Asian American/Asian = 8%; multiethnic = 8%. Forty-eight students completed Week 8 Follow Up assessments. Substance abuse was measured using the Customary Drinking and Drug Use Record (CDDR; Brown et al., 1998). Delinquency was measured using a revised version of the Late Adolescent Delinquency Scale (LADS; McCartan, 2007). Neutralization technique use was measured using a revised version of the Inventory of Neutralization Techniques (Ball, 1966; Ball, 1973; Mitchell & Dodder, 1983; Shields & Whitehall, 1994). Hierarchical linear regression analyses revealed that alcohol use at intake significantly predicted alcohol use at Week 8 Follow Up, F(1,47) = 8.503, p = .005 and accounted for approximately 16% of the model variance. Adding total neutralization to the model also yielded significant outcomes and accounted for 24% of the total variance, FΔ(2,46) = 4.835, p = .033. Data showed similar findings for marijuana, with Intake marijuana use predicting use at Week 8 Follow Up, F(1,47) = 9.542, p = .003, and accounting for approximately 18% of the model variance. Including total neutralization to this model also provided significant outcomes and accounted for 26% of the variance, FΔ(2,46) = 4.611, p = .037. Including delinquency did not significantly contribute to either regression model. Understanding these participants' cognitive strategies will be valuable in determining the most effective type of substance use treatment for each student.

The Effectiveness of a School-Based Intervention for Adolescents in Reducing Disparities in the Negative Consequences of Substance Use Among Ethnic Groups.

Ethnic minority youth are disproportionately affected by substance use-related consequences, which may be best understood through a social ecological lens. Differences in psychosocial consequences between ethnic majority and minority groups are likely due to underlying social and environmental factors. The current longitudinal study examined the outcomes of a school-based motivational enhancement treatment intervention in reducing disparities in substance use consequences experienced by some ethnic minority groups with both between and within-subjects differences. Students were referred to the intervention through school personnel and participated in a four-session intervention targeting alcohol and drug use. Participants included 122 youth aged 13-19 years. Participants were grouped by ethnicity and likelihood of disparate negative consequences of substance use. African American/Hispanic/Multiethnic youth formed one group, and youth identifying as White or Asian formed a second group. We hypothesized that (1) there would be significant disparities in psychosocial, serious problem behavior, and school-based consequences of substance use between White/Asian students compared to African American/Hispanic/Multiethnic students at baseline; (2) physical dependence consequences would not be disparate at baseline; and (3) overall disparities would be reduced at post-treatment follow-up. Results indicated that African American/Hispanic/Multiethnic adolescents demonstrated statistically significant disparate consequences at baseline, except for physical dependency consequences. Lastly, significant reductions in disparities were evidenced between groups over time. Our findings highlight the efficacy of utilizing school-based substance use interventions in decreasing ethnic health disparities in substance use consequences.

READY or Not: Findings From a School-Based MI Intervention for Adolescent Substance Use.

We aimed to examine the impact of a school-based Motivational Interviewing (MI) intervention, Project READY, on reducing adolescent substance use. We randomly assigned students (N = 244) to receive the intervention immediately (READY First) or to be in a waitlist control group (WLC). Those in WLC received the intervention once those in READY First had completed the intervention. Our hypotheses were: (1) adolescents in READY First would make greater initial reductions in their alcohol and marijuana use compared to adolescents assigned to WLC, (2) adolescents in READY First would make greater initial reductions in their alcohol and marijuana-related consequences compared to adolescents assigned to WLC, and (3) upon completing treatment, adolescents assigned to WLC would yield substance-related outcomes comparable to their peers in the READY First group. We found that those in READY First made greater initial decreases in their marijuana use and substance-related consequences upon completing treatment than participants in WLC, during the first phase of the study. Once both groups had completed the active intervention, those in the WLC had comparable marijuana use to those in READY First. At enrollment, daily marijuana users were equally represented in both groups. Post-treatment, significantly fewer participants reported daily marijuana use in the READY First group, prior to treatment initiation for WLC. Comparable reductions were observed once WLC began treatment. Those in WLC were observed to make reductions in their alcohol use at the same rate as those in READY First, prior to treatment initiation. Participants were not observed to make differential reductions in alcohol use based on group assignment. The findings from this study support the effectiveness of school-based MI interventions for adolescent marijuana use and provide evidence that MI is a critical and effective component within such interventions.

The Impact of Marijuana Legalization on Adolescent Use, Consequences, and Perceived Risk.

BACKGROUND: Currently, only four states have legalized recreational marijuana use for adults over 21 years of age. Therefore, little is known about the influence that legalization will have on adolescent marijuana use. OBJECTIVES: This study examines how marijuana legalization has impacted the frequency and consequences of adolescent use in a sample of participants in a school-based, substance use intervention. We hypothesized that adolescents enrolled in the intervention in years after marijuana legalization would present with more problematic use compared to those enrolled prior, and that changes in the perceived risk of marijuana would be a mechanism of problematic use. METHODS: Participants were 262 students enrolled in a school-based substance use intervention in 2010 to 2015. The Customary Drinking and Drug Use Record, Alcohol and Drug Use Consequences Questionnaire, and a decisional balance matrix were used to assess marijuana frequency, negative consequences, and perceived risk of use. A mediation model was used to test the degree to which marijuana legalization may lead to increased frequency and consequences of use through perceived risk. RESULTS: Findings indicated a significantly positive correlation between marijuana-related consequences and perceived risk post legalization. Despite relatively equal use between both groups, adolescents in the legalization group experienced higher levels of perceived risk and increased negative consequences. CONCLUSIONS/IMPORTANCE: Due to the rising legalization status of marijuana in the United States, it is imperative that psychoeducation is provided to adults and adolescents about the consequences of underage marijuana use.

Motivation and substance use outcomes among adolescents in a school-based intervention.

The stages of change (Precontemplation, Contemplation, Preparation, Action, and Maintenance) have been well studied in adult populations. However, fewer studies have examined how the stages of change are related to adolescent substance use. Furthermore, there have been no studies that have examined how the stages of change relate to outcomes in a school-based intervention. To better capture adolescent motivation, we added an additional group to the Transtheoretical Model of Change, which we titled Coerced Action, to represent adolescents that made changes to their substance use despite low problem recognition (representing the internal motivation of Precontemplation and the change behaviors of the Action group). We then examined how the stages of change were related to a thorough assessment of substance use at baseline and corresponding treatment outcomes. Our sample consisted of 264 adolescents (mean age: 16.1, 44.5% Caucasian, 37.5% female) who participated in an 8-week, school-based Motivational Enhancement intervention. Results indicated significant group differences across the stages of change in substance use patterns (alcohol use, negative consequences, affective dysregulation), as well as treatment outcomes (alcohol use and negative consequences). For instance, adolescents in the Action group demonstrated more negative consequences at 16weeks follow-up than those in Precontemplation and Coerced Action, F(1, 3)=8.23, p<.001. The Coerced Action group reported the most alcohol use at 16weeks follow-up, although the finding was not significant when post-hoc tests were conducted. This study provides meaningful support for the assessment of motivation among adolescent substance users within school-based settings.

Perceptions of Family Alcohol Use in a Young Adult Sample.

Perceptions of family alcohol use have been linked to adolescent alcohol use behaviors, yet there have been no studies that have assessed this relationship in young adults. This study examined perceptions of family alcohol use and their association with participants' self-reported alcohol use. Participants included 171 undergraduate students (mean age = 21.67, 71.9 percent female, 75.4 percent Caucasian). Participants completed measures assessing quantity and frequency of alcohol use, negative consequences of use, and sibling relationship quality. They also reported their perceptions of alcohol use for siblings and parents during a typical week. Perceptions of siblings' quantity of weekly alcohol use were significantly associated with participants' quantity of alcohol use (r = .21, p = .006) and frequency of alcohol use (r = .23, p = .002). Perceptions of parental alcohol use were not related to the participants' alcohol use patterns.

Effectiveness of Motivational Incentives for Adolescent Marijuana Users in a School-Based Intervention.

PURPOSE: This study examined whether adolescents receiving Motivational Interviewing (MI) intervention have different outcomes compared to those receiving Motivational Incentives (Motivational Interviewing combined with Contingency Management; MI+CM). METHOD: A total of 136 adolescents (from a parent study of 220 adolescents) with problematic substance use were recruited from 8 high schools in Washington State, where they completed either 8-weeks of MI or MI+CM. Frequency of marijuana use was assessed at baseline, at the end-of-treatment, and at 16-week follow-up. RESULTS: A balanced and matched sample was created using propensity scores, then analyzed using Hierarchical Linear Modeling (HLM). Multilevel regression analyses revealed that adolescents who received MI+CM exhibited a greater reduction in use across time (p<.05). Reductions at the end-of-treatment were greater for the MI+CM condition (Cohen's d=-.82) compared to MI alone (Cohen's d=-.33), but did not differ at 16-week follow-up. Adolescents receiving MI+CM showed significantly fewer negative consequences of marijuana use at the end-of-treatment (t1, 124=2.26, p<.05), higher use of coping strategies (t1, 124=3.01, p<.01), and increased likelihood to attend additional treatment for substance use (χ2 1, 124=4.12 p<.05), though hypothesized improvements in motivation and school attendance were not found. Use of coping strategies at the end-of-treatment had a significant indirect effect on the relationship between the intervention condition and marijuana use at the end-of-treatment (F3, 121=10.20, R2=.20, p<.01). CONCLUSION: These results suggest that the inclusion of contingencies into adolescent marijuana treatment decreases the end-of-treatment frequency of marijuana use and related consequences while increasing the use of coping strategies and the pursuit of additional treatment.

Modeling motivation three ways: effects of MI metrics on treatment outcomes among adolescents.

The purpose of this study was to determine how three different measures of motivation (cognitive motivation, taking steps, and self-efficacy for change and maintenance) predict substance use outcomes after engaging in a Motivational Interviewing intervention. Participants were 225 high school students enrolled in Project Reducing the Effects of Alcohol and Drugs on Youth (Project READY), a NIDA-funded intervention initially developed with Motivational Interviewing (MI) principles for adolescents identified by schools as having problems with alcohol or other drug use. We measured motivation at multiple time points during the intervention in multiple methods. Cognitive motivation was assessed using a Decisional Balance matrix at Session 3 of treatment. We measured self-efficacy with the Situational Confidence Questionnaire, administered at 4-, 8-, 12-, and 16-week follow-ups. A measure of taking steps (SOCRATES, v. 8) was administered at intake and Session 8. We hypothesized that motivation would follow the Transtheoretical Model (TTM) pathway, and we proposed a model where cognitive motivation would predict self-confidence for change and taking steps toward change, and self-confidence and taking steps would predict substance use outcomes. We tested our model using path analysis in AMOS and found support for a motivational continuum predicting percent days abstinent at 16-week follow-up [χ(2) = 2.75, df = 7, p = .90, CFI = 1, RMSEA (90% confidence interval) = .00 - .03]. This model demonstrates that motivational metrics predict unique outcomes at different time points and serve as important components of intervention.

Behavioral health services influence medical treatment utilization among primary care patients with comorbid substance use and depression.

Although research has shown benefits of integrating psychological care in primary care settings, it is unclear how this form of treatment impacts individuals with comorbid substance use and depression. The findings are also mixed concerning how frequently this comorbid population seeks primary care services. This study examined the associations between substance use, depression, and medical treatment utilization among 224 primary care patients. The aim of the investigation was twofold. First, to determine if depression increases medical treatment utilization among patients with substance use disorders; second, to evaluate if behavioral health treatment reduces medical service utilization. A moderated mediation model with bootstrapping analyses revealed that depression strengthened the relationship between substance use and primary care treatment utilization (both medical and behavioral health). The model also indicated that behavioral health services were associated with fewer primary care visits for individuals with comorbid substance use and depression. Clinical and social implications are discussed.

Classification of co-occurring depression and substance abuse symptoms predicts suicide attempts in adolescents.

Although both depression and substance use have been found to contribute to suicide attempts, the synergistic impact of these disorders has not been fully explored. Additionally, the impact of subthreshold presentations of these disorders has not been researched. We utilized the Quadrant Model of Classification (a matrix of severity of two disorders) to assess for suicide attempt risk among adolescents. Logistic regression was used to examine the impact of co-occurring disorder classification on suicide risk attempts. Results indicate that quadrant classification had a dramatic impact on suicide attempt risk, with individuals with high severity co-occurring disorders at greatest risk.

The indirect effect of somatic complaints on report of posttraumatic psychological symptomatology among Somali refugees.

Somali refugees are a growing population of displaced persons at risk for considerable traumatic exposure and its subsequent psychological symptomatology. Two hypotheses were proposed to evaluate the relationships between somatic complaints and posttraumatic psychological symptoms in a community-based sample of 74 adult Somali participants. As hypothesized, traumatic exposure predicted increased symptoms of posttraumatic stress disorder (PTSD; r = .64, p < .01), depression (r = .31, p < .01), and anxiety (r = .38, p < .01) in the basal model. In evaluation of the second hypothesis, somatic complaints were found to have a statistically significant indirect effect on the predictive relationship between traumatic life events and mood disturbance, accounting for 9% of the variance in depression and 14% of the variance in anxiety. However, somatic complaints failed to have an indirect effect on the relationship between traumatic exposure and symptoms of PTSD. Post hoc analyses revealed that, consistent with research conducted with nonrefugee populations, PTSD had a statistically significant indirect effect that accounted for 13% of the variance in the relationship between trauma and somatic complaints. These findings provide preliminary data regarding the influence of somatic complaints on the self-reported psychological symptoms of internationally displaced Somali refugees.

Subscapularis repair after shoulder arthroplasty: biomechanical and clinical validation of a novel technique.

HYPOTHESIS: We hypothesized that releasing the subscapularis with lesser tuberosity bone may improve strength of fixation of the subscapularis during total shoulder atthroplasty (TSA). MATERIALS AND METHODS: In 15 cadaveric humeri, all musculature was removed except the subscapularis. A standard humeral head osteotomy was performed for TSA. The subscapularis was released with a fleck of lesser tuberosity bone in 10 specimens from five matched pairs, and a tenotomy was performed in five. Five osteotomies were repaired with single-row heavy non-absorbable sutures and five with an additional double-row. Repairs were subjected to cyclical loading at 180 newtons for 400 cycles, increasing by 180 newtons to failure. A retrospective review of 100 consecutive patients who underwent dual-row repair of the subscapularis fleck osteotomy following TSA was also performed with minimal follow-up of 24 months (24-48). RESULTS: Both single (430 N) and double-row (466 N) fixation of the fleck osteotomy were significantly stronger than tenotomy suture repair (252 N) (p < .04). There was no significant difference between single and double-row ultimate strengths. Qualitatively, double-row fixation fixed the fleck osteotomy more securely to the donor site with respect to gross rotational motion. At final clinical review, the lift-off test was rated as normal in 79%. The belly press was rated as normal in 86%. Eighty-two percent were able to tuck in their shirts. CONCLUSION: Subscapularis release with fleck osteotomy provides superior biomechanical ultimate strength compared to standard tenotomy. There was no visible motion during biomechanical testing with dual-row osteotomy fixation compared to single-row fixation. Clinical results of this dual-row technique document showed good restoration of subscapularis integrity for activities of daily living. LEVEL OF EVIDENCE: Basic science study and level 4; retrospective review, case series, no control group.

Use of a noninvasive halo in children.

STUDY DESIGN: Retrospective review of clinical experience in children using a new noninvasive halo. OBJECTIVE: To report on the efficacy, complications and indications for use of a noninvasive halo in the pediatric population. SUMMARY OF BACKGROUND DATA: A halo vest with pins in the skull is the gold standard for providing maximum immobilization and control of the cervical spine. Inherent complications include scarring, infection, cerebral spinal fluid leakage, loosening of pins, and penetration of the cranial vault. Less invasive orthoses historically provide significantly less immobilization and control of the cervical spine. A Minerva cast has problems with patient tolerance and skin care. METHODS: The noninvasive halo was used on 30 children (ages 6 months to 16 years) for the following indications: muscular torticollis release, 18 children; cervical fusion immobilization 7 children; closed reduction of C1-C2 rotatory subluxation, 5 children. RESULTS: The noninvasive halo was successful with no complications in 29 of 30 patients. One complication consisted of dislodgment of a C2-C4 anterior strut graft, though fusion ensued without further surgery and the clinical result was successful. Longstanding C1-C2 rotatory subluxations were safely reduced in 5 children with the noninvasive halo. In 18 children following sternocleidomastoid release, the cervical spine was successfully immobilized in an overcorrected position after surgery. CONCLUSION: A noninvasive halo was used successfully for postoperative immobilization of children with stable cervical spines. This device was particularly useful for the gentle and safe reduction of C1-C2 subluxations, and for postoperative immobilization in an overcorrected position following stenocleidomastoid release for congenital muscular torticollis.

Using the short mood and feelings questionnaire to detect depression in detained adolescents.

The Mood and Feelings Questionnaire (MFQ) is examined for its utility in screening youth in juvenile justice settings for depression. In a cross-sectional study conducted at King County Juvenile Detention Center, a representative sample of 228 detained adolescents complete structured assessments, including the MFQ and the Massachusetts Youth Screening Instrument. Fifty youth also complete the Voice-Diagnostic Interview Schedule for Children. Internal reliability coefficient for the MFQ short form (SMFQ) is = .87. Factor analysis produces a unifactorial scale with item loadings of .43 to .78. At SMFQ cutoff > or = 10, sensitivity and specificity are optimized at 1.00/0.79. Prevalence of major depressive disorder is estimated at 32.1% (95% Confidence Interval = 25.3% to 39.2%). The SMFQ shows potential for depression screening of detained adolescents.