Joseph J. Gallo

Background Depressive symptoms are common in knee osteoarthritis (OA), exacerbate knee pain severity and may influence outcomes of oral analgesic treatments. The aim was to assess whether oral analgesic effectiveness in knee OA varies by fluctuations in depressive symptoms. Methods The sample included Osteoarthritis Initiative (OAI) participants not treated with oral analgesics at enrolment (n = 1477), with radiographic disease at the first follow-up visit (defined as the index date). Oral analgesic treatment and depressive symptoms, assessed with the Center for Epidemiological Studies Depression [(CES-D) score ≥16] Scale, were measured over three annual visits. Knee pain severity was measured at visits adjacent to treatment and modifier using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (rescaled range = 0–100 …

Objective To assess how changes in depressive symptoms influence physical function over time among those with radiographic knee osteoarthritis (OA). Methods Participants from the Osteoarthritis Initiative with radiographic knee OA (n = 2,212) and complete data were identified at baseline. Depressive symptoms were assessed as a time‐varying score at baseline and the first three annual follow‐up visits using the Center for Epidemiological Studies Depression Scale (CES‐D) Scale. Physical function was measured at the first four follow‐up visits using 20‐meter gait speed meters per second. The following two marginal structural models were fit: one assessing the main effect of depressive symptoms on gait speed and another assessing time‐specific associations. Results Time‐adjusted results indicated that higher CES‐D scores were significantly associated with slower gait speed (−0.0048; 95% confidence …

IntroductionIn the U.S., there are disparities between the well-being of Black and white older adults. Black older adults are more likely to develop chronic illnesses such as hypertension, heart disease, and diabetes, which can diminish their quality of life. The prevalence of chronic illness is compounded by the stressors common in aging, such as decreased income, changes in physical function, and the loss of spouses and friends. Psychological well-being contributes to an individual's overall health, along with their environment and quality of life. Despite Black older adults' burden of stressors and increased vulnerability to stress, only a few qualitative studies focus on the well-being or coping of community-dwelling Black older adults in the U.S. This mixed methods study aims to assess stressors older Black adults experience and how they cope.MethodsWe used data obtained as part of the Peer Enhanced …

ObjectiveTo assess the feasibility of a 24-week, center-based, aerobic exercise program plus duloxetine to treat symptomatic knee osteoarthritis (OA) and major depression.DesignPatients with symptomatic knee OA and major depression were recruited between August 2021 and November 2022 from the University of Maryland and VA Maryland Health Care Systems and Baltimore metropolitan area using medical records and advertisements. The intervention included 1) supervised treadmill walking 3 times weekly and 2) duloxetine starting at 30 ​mg each day and titrating up to the optimal dosage of 60 ​mg daily. Data collection occurred at baseline and 12- and 24-weeks follow-up. Feasibility was evaluated from recruitment rates, reasons for drop out, and treatment adherence. Clinical measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Hamilton Depression Rating Scale (HAM …

BackgroundCaregivers of persons living with heart failure (HF) experience uncertainty related to heart failure trajectory and caregiving demands. Caregiver Support is a nurse-led intervention consisting of a well-being assessment, development of a life purpose statement, and action planning related to self-care and support for caregivers.ObjectivesThe goal of this study was to describe the caregivers’ action plans, action plan achievement and life purpose statements.MethodsWe used inductive content analysis to code life purpose statements and action plans by 2 coders. Descriptive statistics were used to describe the average number of action plans set per caregiver, the average number of themes coded per action plan and life purpose statement, and the status of goal achievement (i.e., by thematic domain, subdomains). Goal achievement was defined categorically: Achieved, not achieved, and not assessed. The …

Background Black‐White disparities in cognitive test scores are well documented. Studies suggest that structural racism‐related factors like quality of education and cumulative stress exposure may contribute to disparities in inflammation and cardiometabolic health that undergird racial disparities in Alzheimer’s disease and cognitive health. Method We used MESA data from (N = 1,839) participants that self‐report being racialized as Black or White. We used path analyses to examine the association between racialized group and age‐ and education‐adjusted cognitive scores from the Cognitive Ability Screening Test (CASI) at Exam 5 (2010‐12) and Exam 6 (2016‐18). We examined the relationship between discrimination using the Everyday Discrimination Scale at Exam 1 (2000‐02) and physiological dysregulation at Exam 5 (using a cardiometabolic index = waist‐to‐hip ratio, triglycerides, low‐density …

This Research Topic aims to move beyond a synthesis of what is already known about mental health in the context of health equity, and instead showcase transformative solutions, recommendations, and research applications that have real-world implications on policy, practice, and future scholarship. Furthermore, the papers included in this Research Topic elevate the importance of transdisciplinary research, draw from various methodologies that highlight lived experiences, and apply a more critical lens at how structures of power and privilege have contributed to present-day inequities, particularly those seen in mental healthcare access, utilization, and outcomes.

Objectives Some observers have proposed that physicians may die differently compared with the average patient. Semi-structured interviews with family members of physicians who died offer an opportunity to better understand how patient preferences and wishes are perceived and acted on by family members at the end of life. The decision-making experiences of these family members for a loved one who was a physician may have implications for the lay person at end of life. Methods The Johns Hopkins Precursors Study includes individuals who matriculated into the graduating classes of 1948 to 1964 of the Johns Hopkins University School of Medicine. From this cohort, we interviewed 26 family members of physicians who died. Interviews were coded and analyzed using a comparative, iterative process. Results We found that family members of physicians who died described the uncertainty at end of life …

INTRODUCTION AND OBJECTIVEActive surveillance (AS) is recommended for the management of favorable-risk prostate cancer (PCa) to avoid the harmful effects of overtreatment. Rates of utilization of AS in the US however remain suboptimal due to multi-factorial issues. We sought to engage a diverse group of patients, patient advocates, researchers and clinicians to better understand the current shortcomings in AS implementation, as well as develop a patient-engaged list of research priorities for PCa AS.METHODSWe organized a 2-day conference, Developing Provocative Questions-PCa AS Research Initiative (PCASRI). Through small groups consisting of physicians, patients and families, researchers, and advocates we discussed twelve selected topics in four domains following the PICOTS criteria (Population, Intervention, Outcome, and Setting). Through an iterative process, we generated and then …

Background Disparities in diagnosis persist among persons living with dementia (PLWD); most research on delayed diagnosis relies on medical records or administrative claims. This study aimed to identify factors that delay or facilitate dementia diagnoses in racial or ethnic minoritized PLWD and elicit care partner perspectives on timing and effects of diagnosis. Methods Maryland‐based participants cared for a PLWD age 60 or older, self‐identified as Black/African/African‐American, Asian, or Hispanic/Latino, and spoke English. Nineteen care partner in‐depth, semi‐structured interviews were conducted and analyzed using conventional qualitative content analysis methods. Results Biological, sociocultural, and environmental factors delayed dementia diagnosis. Memory loss was the most common early symptom, but the onset was often subtle or perceived as normal aging. Stigma and secrecy surrounding …

Objectives:The aim of this study is to present an explanatory model of hearing loss in the Bering Strait region of Alaska in order to contextualize the results of a cluster randomized trial and propose implications for regional hearing-related health care.Design:To promote ecological validity, or the generalizability of trial findings to real world experiences, qualitative methods (focus groups and interviews) were used within a mixed methods cluster randomized trial evaluating school hearing screening and follow-up processes in 15 communities in the Bering Strait region of Alaska. Focus groups were held between April and August 2017, and semistructured interviews were conducted between December 2018 and August 2019. Convenience sampling was used for six of the 11 focus groups to capture broad community feedback. Purposive sampling was used for the remaining five focus groups and for all interviews to …

Background and ObjectivesStudies have shown that cultural norms such as filial responsibility and familism operate in the Korean American caregiving context. The purpose of our study is to understand the practice of Korean American caregivers who provide care to a family member living with dementia and their dementia care support needs.Materials and MethodsWe conducted 2 focus groups and individual semi-structured interviews with a total of 20 Korean American caregivers. We used inductive thematic analysis to guide coding and generation of themes.ResultsThree themes were identified; 1) intersectionality in the Korean American caregiver experience, 2) complex family dynamics, and 3) dementia care barriers and caregiver support needs. Within the dyadic relationship and the family, cultural identity, generational, acculturational, and language factors shaped the caregiver experience. The need to …

Background: Hispanic adults with mental health conditions in the United States experience disproportionate access to and utilization of professional mental health treatment. This is believed to be in part due to systemic barriers and challenges, difficulty accessing care, cultural factors, and stigma. Studies to date have failed to examine these specific factors within the unique context of the Paso del Norte US-Mexico border region. Methods: For this study, 25 Hispanic adults identifying primarily of Mexican descent participated in four focus groups exploring these topics. Three groups were facilitated in Spanish and one group in both English and Spanish. Focus groups followed a semi-structured format eliciting perspectives on mental health and mental illness, help-seeking, barriers and facilitators of help-seeking and treatment access, and recommendations for mental health agencies and providers.Results: Qualitative data analysis yielded the following themes: understanding of mental health and help-seeking; barriers to accessing care; mental health treatment facilitators; and recommendations for agencies, providers, and researchers.Conclusion: Findings from this study support the need for innovative mental health engagement strategies to reduce stigma, increase understanding of mental health, foster support systems, reduce individual and systemic barriers to seeking and accessing care, and to continue to engage communities in mental health outreach and research.

We aimed to identify caregiver characteristics associated with the trajectory of quality of life (QoL) in Parkinson's disease (PD). We fit a growth mixture model to longitudinal data from the Parkinson Foundation Parkinson's Outcomes Project (POP) to identify the heterogeneity of QOL trajectories in PD. We then used multinomial logistic regression to model baseline factors that predicted class membership. Baseline growth models were fit to QOL scores measured over 4 disease duration time points. A random intercept and slope model was determined to best fit the data. Next, growth mixture models (1, 2, 3, 4, and 5-class) were fit with covariates (Hoehn & Yahr, sex, and depression) and a three-class model was found to provide the best fit. Class 1 (problematic class (10.0%)) represented individuals with poor QOL at baseline and minor improvement over time. Class 2 (moderate class (32.6%)) represented individuals …

INTRODUCTION AND OBJECTIVE While financial toxicity such as out-of-pocket cost and indirect cost facing men with prostate cancer is acknowledged, it remains understudied. We assessed the out-of-pocket burden by treatment type across low, intermediate and high risk prostate cancer groups. METHODS We used data from a multi-centered randomized controlled study among localized prostate cancer patients. Patient reported Out-of-pocket, and generic and prostate-cancer specific HRQoL outcomes were assessed at baseline, and at 3, 6, 12 and 24-month follow-up. Treatments were robotic-assisted laparoscopic radical prostatectomy (RALP), radiation therapy (RT) and active surveillance (AS). Participants were categorized into risk groups as: low risk (PSA< 10 ng/ml, Gleason≤ 6, clinical stage T1-2a), intermediate risk (PSA 10-20 ng/ml, Gleason 7, clinical stage T2b), and high risk (PSA> 20, Gleason≥ 8 …

ObjectiveLow-income White and older adults of color face barriers to depression care. Our purpose is to describe the methods and challenges encountered during the implementation of a randomized controlled trial to test the effectiveness of a peer support depression care intervention for low-income White and older adults of color during the COVID-19 pandemic.MethodsPeer Enhanced Depression Care (Peers) is an 8-week community-based intervention that uses peer mentors who are trained and supervised to provide social support and self-care skills to depressed older adults. The effectiveness of the intervention in reducing depression will be evaluated by following a sample of older adults recruited in the community over a 12-month period. Target enrollment is 160 older adults. We hypothesize that participants randomized to the Peer Enhanced Depression Care intervention will experience greater decrease …

Objectives To explore the experiences of older Peruvian adults living in urban areas of Lima under lockdown due to the National COVID-19 Emergency, this study analyzes how older adults (aged 60 and older) exercise agency while also living with the negative impacts of coronavirus disease 2019 (COVID-19) and related control measures. Methods Between August and December 2020, our research team conducted a telephone-based, qualitative study, in which we undertook semistructured interviews with a purposive sample of low-income older adults living with chronic multimorbidities and limited resources. Forty older adults, 24 women and 16 men, with a mean age of 72 years, participated in the study. For data analysis, we employed thematic analysis with a predominantly inductive approach. Results Older adults demonstrated several forms of …

BackgroundSchool-based programmes, including hearing screening, provide essential preventive services for rural children. However, minimal evidence on screening methodologies, loss to follow-up, and scarcity of specialists for subsequent care compound rural health disparities. We hypothesised telemedicine specialty referral would improve time to follow-up for school hearing screening compared with standard primary care referral.MethodsIn this cluster-randomised controlled trial conducted in 15 rural Alaskan communities, USA, we randomised communities to telemedicine specialty referral (intervention) or standard primary care referral (control) for school hearing screening. All children (K–12; aged 4–21 years) enrolled in Bering Straight School District were eligible. Community randomisation occurred within four strata using location and school size. Participants were masked to group allocation until …

ObjectiveTo explore barriers towards mental health services for older adults with symptoms of depression and/or anxiety in a low-resource community in Lima, Peru. We explored these barriers from the perspective of older adults and health providers.MethodsWe conducted an interview-based qualitative study. The first set of interviews was carried out between October 2018 and February 2019, and the second, between January 2022 and September 2022. In the first sample, we interviewed 38 older adults ≥60 years with symptoms of depression (Patient Health Questionnaire-9 ≥ 10), anxiety (Beck Anxiety Inventory ≥ 16), or those who had previous experience using formal mental health care irrespective of current symptoms. In the second sample, we included 20 health providers (8 psychologists, 2 general practitioners, 2 nurses, 4 psychiatrists, 4 social workers). We used an inductive thematic data analysis …

AimWe examined information sharing between direct care workers, family caregivers, and clinicians involved in the care of older adults with disabilities.MethodsSemi-structured interviews with N = 11 representatives of home care agencies (“residential service agencies” in Maryland).ResultsWork system and process characteristics relevant to information sharing included: (1) using electronic management systems and patient portals to communicate within agencies and with clinicians, (2) implementing tools to gather information about client goals, preferences, and routines, and (3) relying on family members for information about clients’ needs. Participants did not report differences in dementia-related care coordination; however, dementia-related adaptations involved additional considerations for navigating relationships with family and standardizing processes to communicate with clinicians.ConclusionFindings …