Christian Nimsch

OBJECTIVE:
To characterize the spectrum of clinical outcomes achieved with depression treatment and the associated impact on quality of life (QOL), functional status, overall well-being, health-care costs, and productivity.
SOURCES:
Electronic databases including Medline were searched for English language sources between 1995 and 2007 using key words of depression, nonresponse, partial response, and remission and QOL, functional status, utility, cost, and productivity.
STUDY… Show more

OBJECTIVE:
To characterize the spectrum of clinical outcomes achieved with depression treatment and the associated impact on quality of life (QOL), functional status, overall well-being, health-care costs, and productivity.
SOURCES:
Electronic databases including Medline were searched for English language sources between 1995 and 2007 using key words of depression, nonresponse, partial response, and remission and QOL, functional status, utility, cost, and productivity.
STUDY SELECTION:
Relevant abstracts were obtained for 488 references and full-text articles were reviewed that included primary data and compared outcomes by treatment response. Data were abstracted from 26 full-text articles.
DATA ABSTRACTION:
Detailed evidence tables were prepared with the relevant data as well as information on the study design. All data abstracted were checked for accuracy. synthesis: Treatment remitters and partial responders reported clinically and statistically significant improvements in QOL, functional status, and overall well-being compared to nonresponders. Annual health-care costs and productivity losses were significantly lower for remitters and partial responders compared to nonresponders.
CONCLUSIONS:
The reduced disease burden for remitters and partial responders compared to nonresponders indicates that new treatment strategies that improve the rates of response/remission with initial treatment might have value to patients and to society. Show less

OBJECTIVE:
Existing estimates of human immunodeficiency virus (HIV)-related health state utilities are inadequate for comparing alternative treatments on the basis of regimen-specific attributes such as dosing requirements or tolerability. The objective of this study was to examine the marginal impact of dosing, adverse events (AEs), and other factors on patients' health state utilities.
METHODS:
Treatment naive and experienced HIV patients participating in five open-label trials of… Show more

OBJECTIVE:
Existing estimates of human immunodeficiency virus (HIV)-related health state utilities are inadequate for comparing alternative treatments on the basis of regimen-specific attributes such as dosing requirements or tolerability. The objective of this study was to examine the marginal impact of dosing, adverse events (AEs), and other factors on patients' health state utilities.
METHODS:
Treatment naive and experienced HIV patients participating in five open-label trials of highly active antiretroviral therapy (HAART) completed the 36-Item Short Form Health Survey (SF-36) instrument at various time points. SF-36 responses were converted to utilities using a previously reported algorithm. Expected utilities were estimated as a function of patient demographics, regimen attributes, disease status, and AEs using a mixed-effects maximum likelihood model. Mean utilities for five HIV health states were derived from predicted patient utilities.
RESULTS:
Negative predictors of utility included greater age (-0.001), prior acquired immune deficiency syndrome-defining events (-0.036), female gender (-0.038), and injection drug use (-0.056; P < 0.01 for all). Utility also depended on CD4+ cell count (P < 0.01), but not the presence of undetectable viral load. Regimen attributes were marginally associated with changes in utility. Depression was associated with the largest decrease in utility (-0.054, P < 0.001) among the AEs examined. Using the model to generate predicted utilities from the sample provided mean estimates ranging from 0.742 (SD 0.058) to 0.798 (0.052) for CD4+ counts between 0 and 99 and > or =500 cells/mm(3), respectively.
CONCLUSIONS:
HIV patients' health-related quality of life may be substantially affected by clinically relevant patient-, disease-, and treatment-related factors, such as injection drug use, disease status, food/drink restrictions, and AEs. Show less

OBJECTIVES:
To investigate whether associations between anti-secondhand smoke (SHS) media, social cognitions about SHS, and home restrictions on smoking follow patterns observed in smoking behavior.
METHODS:
Based on a nationally representative sample of 2348 US adults drawn from the American Legacy Foundation's American Smoking and Health Survey, we tested relationships among scales of anti-SHS media, social cognitions, and home restrictions.
RESULTS:
We found anti-SHS media and… Show more

OBJECTIVES:
To investigate whether associations between anti-secondhand smoke (SHS) media, social cognitions about SHS, and home restrictions on smoking follow patterns observed in smoking behavior.
METHODS:
Based on a nationally representative sample of 2348 US adults drawn from the American Legacy Foundation's American Smoking and Health Survey, we tested relationships among scales of anti-SHS media, social cognitions, and home restrictions.
RESULTS:
We found anti-SHS media and SHS cognitions, as well as social cognitions and home restrictions, to be significantly associated. Social cognitions mediated the relationship between anti-SHS media and home restrictions.
CONCLUSIONS:
Previously observed relationships between media, social cognitions, and smoking also exist for SHS. Anti-SHS media campaigns to increase home restrictions may help to reduce SHS exposure. Show less

Through the American Legacy Foundation's Statewide Youth Movement Against Tobacco Use (SYMATU), programs aimed at empowering youths to take action against tobacco use were funded. It is believed that the activities these groups undertake result in changes at the community level. This article examines the relationships between community support of tobacco control and the number and types of tobacco control-related activities these local youth groups conduct. Regression analyses examine the… Show more

Through the American Legacy Foundation's Statewide Youth Movement Against Tobacco Use (SYMATU), programs aimed at empowering youths to take action against tobacco use were funded. It is believed that the activities these groups undertake result in changes at the community level. This article examines the relationships between community support of tobacco control and the number and types of tobacco control-related activities these local youth groups conduct. Regression analyses examine the influence that different levels and sources of community support have on the quantity and focus of a group's activities. The influences of community support are briefly explored to understand if certain group characteristics have an impact on the quantity or sources of support for tobacco control. A deeper understanding of the importance and impact of community support will help groups understand the need for building community support networks and how these networks can assist them with implementation of program activities Show less

This paper reports on the measurement properties of a scale intended to measure nicotine dependence in adolescents using data from the American Legacy Longitudinal Tobacco Use Reduction Study. The Nicotine Dependence Scale for Adolescents (NDSA) is a simple linear sum of items associated with behaviors to avoid withdrawal and items associated with experiences of craving. An exploratory factor analysis indicated that the items formed a single scale. The reliability of the scale was assessed by… Show more

This paper reports on the measurement properties of a scale intended to measure nicotine dependence in adolescents using data from the American Legacy Longitudinal Tobacco Use Reduction Study. The Nicotine Dependence Scale for Adolescents (NDSA) is a simple linear sum of items associated with behaviors to avoid withdrawal and items associated with experiences of craving. An exploratory factor analysis indicated that the items formed a single scale. The reliability of the scale was assessed by estimating Cronbach's alpha for the scale items. The estimated alpha reliability was.81. The scale's validity was assessed by estimating the correlation between the scale and measures of smoking and quitting behaviors. As hypothesized, the scale was positively correlated with lifetime number of cigarettes smoked (r=.44, p<.001), days smoked in the past 30 days (r=.66, p<.001), cigarettes smoked per day on days smoked (r=.61, p<.001), and number of quit attempts (r=.10, p<.001) and negatively correlated with the length of the quit attempt (r=-.22, p<.001). We also examined the measurement properties of the NDSA separately for middle and high school students and by gender and race or ethnicity. We found no meaningful differences in the measurement properties of the NDSA across these groups. The six-item self-report NDSA had good measurement properties in our sample. Show less

Objective: This study examines total pharmacy cost and usage patterns of schizophrenic patients in acute mental health inpatient settings for three atypical antipsychotics risperidone, olanzapine, and quetiapine. Despite the readily available unit cost information for drugs, actual pharmacy costs may deviate significantly from 'labeled costs'. Recent research findings indicate the need for more robust evaluation of such pharmacy costs. Research design and methods: This study used data from… Show more

Objective: This study examines total pharmacy cost and usage patterns of schizophrenic patients in acute mental health inpatient settings for three atypical antipsychotics risperidone, olanzapine, and quetiapine. Despite the readily available unit cost information for drugs, actual pharmacy costs may deviate significantly from 'labeled costs'. Recent research findings indicate the need for more robust evaluation of such pharmacy costs. Research design and methods: This study used data from non-randomized inpatient retrospective charts from three acute care inpatient mental health facilities. Show less

A core component of Legacy’s Statewide Youth Movement Against Tobacco Use is the ability of state and local initiatives to empower youth to effect change in their communities. The authors’ conceptual framework proposes that youth empowerment is an outcome of the process by which youths become active participants in local efforts. Youths are proposed to attain specific skills (e.g., assertiveness, advocacy), attitudes (e.g., domain-specific self-efficacy, perceived sociopolitical control… Show more

A core component of Legacy’s Statewide Youth Movement Against Tobacco Use is the ability of state and local initiatives to empower youth to effect change in their communities. The authors’ conceptual framework proposes that youth empowerment is an outcome of the process by which youths become active participants in local efforts. Youths are proposed to attain specific skills (e.g., assertiveness, advocacy), attitudes (e.g., domain-specific self-efficacy, perceived sociopolitical control, participatory competence), and knowledge of relevant resources. All are proposed outcomes of their individual participation in these local efforts. Data collected in fall 2002 through a tested survey instrument designed to obtain data on key components of empowerment are presented. Regression modeling was used to examine the extent to which characteristics of empowerment are an outcome of individual participation in these groups. A summary of lessons learned pertaining to effectively measuring empowerment and enhancing the empowerment process through local initiatives is provided. Show less

The objective of this paper is to estimate the demand for tar and nicotine in cigarettes as a function of cigarette prices in a cohort of cigarette 11,966 smokers followed for 5 years. Data for the analysis come from a longitudinal telephone survey of 11,966 smokers who were interviewed in 1988 and 1993 as part of the Community Intervention Trial for Smoking Cessation (COMMIT). Separate models are estimated for three age groups to account for differences in levels of addiction and brand loyalty… Show more

The objective of this paper is to estimate the demand for tar and nicotine in cigarettes as a function of cigarette prices in a cohort of cigarette 11,966 smokers followed for 5 years. Data for the analysis come from a longitudinal telephone survey of 11,966 smokers who were interviewed in 1988 and 1993 as part of the Community Intervention Trial for Smoking Cessation (COMMIT). Separate models are estimated for three age groups to account for differences in levels of addiction and brand loyalty across age. We found that smokers respond to higher cigarette prices by reducing the number of cigarettes smoked per day but also by switching to cigarettes that are higher in tar and nicotine per cigarette. Show less

Report generated for the Canadian health authority.