DSpace Repository :: Browsing by Author "Geyer, James D."

Browsing by Author "Geyer, James D."

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Application of the diffusion of innovations theory and the health belief model to describe EMR use among Alabama family medicine physicians: a rural and urban analysis
(University of Alabama Libraries, 2009) Tucker, Melanie Tara; Higginbotham, John C.; University of Alabama Tuscaloosa
The Alabama Black Belt region consists of twelve counties which are characterized by a high percentage of African Americans, acute poverty, rural decline, inadequate education programs, and significantly poor health outcomes. The Alabama Black Belt region suffers significantly with health disparities which, in part, may be attributed to low physician/patient ratio and physician isolation. These physicians tend to practice in private, solo establishments, which often lead to limited communication with other physicians and medical educators. Without continued communication and continuing medical education, rural physicians could lag behind their urban counterparts. In fact it has been shown that some physician practices lag as far as two decades behind their urban counterparts due to such things as limited access to new technologies. With the advent of the electronic medical record (EMR) this lag is likely to decrease exponentially for those in rural areas and could lead to an increase in quality of care for the rural communities. The purpose of this study was to evaluate the adoption and implementation of electronic medical records (EMR) by rural and urban Alabama Family Medicine physicians. The Diffusion of Innovations Theory and Health Belief Model were used to guide the study and develop the survey questions. EMR adoption was assessed in rural areas and compared to their urban counterparts while evaluating the individual characteristic (gender, race, age, and years of practice), organizational characteristics (practice size, patients seen per day, practice location) and individual perceptions regarding adoption (perceived threat, perceived barriers and self-efficacy). Thirty percent (30%) of the 1,205 Alabama Family Medicine physicians responded to the electronic or paper survey. Almost half (49.3%) of the physicians surveyed reported having EMR in their practice; however, 16.3% reported using it to its fullest capacity. Significant differences emerged with respect to EMR use among physicians based on age, years in practice, patients seen per day, practice size and with respect to elements of perceived threat, barriers to adoption and the self-efficacy. Throughout the analysis, differences emerged between Family Medicine physicians from urban Alabama settings and their counterparts from rural and Black Belt region practices.
The association between chronotype and nonrestorative sleep
(University of Alabama Libraries, 2016) Tutek, Joshua; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Nonrestorative sleep (NRS), characterized by a lack of refreshment upon awakening, has received little attention in the sleep literature even though it can occur and cause impairment apart from other sleep difficulties associated with insomnia. The Restorative Sleep Questionnaire (RSQ; Drake et al., 2014) is one of the first validated self-report instruments for investigating NRS severity, presenting new opportunities to explore what factors predict and perhaps contribute to unrefreshing sleep. The present study sought to determine whether inherent circadian preference for morning or evening activity, known as chronotype, predicted restorative sleep in 164 college undergraduates who completed daily RSQs over two weeks. Participants who endorsed greater orientation to evening activity on the morningness-eveningness questionnaire (Terman, Rifkin, Jacobs, & White, 2001) reported significantly less average restorative sleep across their full sampling period, and this association was maintained after accounting for demographic factors, number of sleep-relevant psychiatric and medical diagnoses, sleep diary parameters, self-reported status as an insomniac, and ratings of sleep quality. Furthermore, when analyses were conducted separately for weekday and weekend RSQ scores, eveningness significantly predicted NRS above extraneous variables only during the workweek, not during Saturday and Sunday. These findings have implications for the developing conceptualization of NRS, and continue the work of elucidating the interconnections between common sleep disturbances and the circadian system.
Effects of Integrated Telehealth-Delivered Cognitive-Behavioral Therapy for Depression and Insomnia in Rural Older Adults
(American Psychological Association, 2018) Scogin, Forrest; Lichstein, Kenneth; DiNapoli, Elizabeth A.; Woosley, Julie; Thomas, S. Justin; LaRocca, Michael A.; Byers, Haley D.; Mieskowski, Lisa; Parker, Christina Pierpaoli; Yang, Xin; Parton, Jason; McFadden, Anna; Geyer, James D.; University of Alabama Tuscaloosa; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Pittsburgh Healthcare System; University of Alabama Birmingham; VA Palo Alto Health Care System; Kaiser Permanente; Permanente Medical Groups
We examined the effects of integrated cognitive-behavioral therapy for depression and insomnia (CBT-D + CBT-I, respectively) delivered via videoconference in rural middle-aged and older adults. Forty patients with depressive and insomnia symptoms were randomized to receive either 10 sessions of CBT-D + CBT-I or usual care (UC). Patients in the integrated CBT condition were engaged in telehealth treatment through Skype at their primary care clinic. Assessments were conducted at baseline, posttreatment, and 3-month follow-up. CBT-D + CBT-I participants had significantly greater improvements in sleep at posttreatment and 3-month follow-up as compared with the UC participants. The Time + Group interaction for depression was not significant; participants in both the CBT-D + CBT-I and UC conditions showed a decrease in depressive symptoms over time. Although integrated CBT benefits both depression and insomnia symptoms, its effects on depression are more equivocal. Further research should consider expanding the depression treatment component of integrated CBT to enhance effectiveness.
Epidemiology of bedtime, arising time, and time in bed: analysis of age, gender, and ethnicity
(University of Alabama Libraries, 2011) Thomas, Stephen Justin; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
This study investigated the epidemiology of subjective behavioral sleep variables (i.e., bedtime, arising time, and time in bed) as a function of age, gender, and ethnicity. Sleep diaries were analyzed for 756 participants. Regression analysis showed a main effect of age on subjective bedtime, arising time, and time in bed, but not for gender or ethnicity. Younger adults had later bedtimes and arising times than other age groups. Older adults had earlier bedtimes and later arising times, which resulted in greater time spent in bed than any age group. These results suggest that there are distinct behavioral sleep patterns based on age but not gender or ethnicity and may have significant clinical implications, particularly for older adults.
The evolution of secondary insomnia in women with breast cancer
(University of Alabama Libraries, 2012) Vander Wal, Gregory Scott; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Secondary insomnia resulting from the onset of a health problem often persists beyond the course of the instigating stressor, suggesting that secondary insomnia evolves into a self-sustaining primary disorder. However, the course of secondary insomnia and how it relates to a primary medical or psychological disorder is poorly understood. Newly diagnosed breast cancer provides an opportunity to study secondary insomnia at the onset of an instigating stressor. The current study explored the feasibility of a methodology to examine the relationship between insomnia and breast cancer over a 2 month period in 29 women newly diagnosed (< 6 weeks) with breast cancer. Primary analyses included exploratory descriptive techniques. A multilevel modeling framework was also applied to the data to examine changes in sleep and cancer symptoms over time. The results show a significant relationship between insomnia severity and breast cancer symptom severity. Evidence is also presented regarding differences in the experience of this relationship for individuals with primary and secondary insomnia. Further evidence is presented supporting a change in the relationship between sleep and stress over time for individuals with secondary insomnia. Implications for timing of intervention and future research are discussed.
Feasibility of Polyclonal Avian Immunoglobulins (IgY) as Prophylaxis against Human Norovirus Infection
(MDPI, 2022) Artman, Chad; Idegwu, Nnebuefe; Brumfield, Kyle D.; Lai, Ken; Hauta, Shirley; Falzarano, Darryl; Parreno, Viviana; Yuan, Lijuan; Geyer, James D.; Goepp, Julius G.; University of Maryland College Park; University of Saskatchewan; Virginia Polytechnic Institute & State University; Instituto Nacional de Tecnologia Agropecuaria (INTA); University of Alabama Tuscaloosa
Background: Human norovirus (HuNoV) is the leading viral cause of diarrhea, with GII.4 as the predominant genotype of HuNoV outbreaks globally. However, new genogroup variants emerge periodically, complicating the development of anti-HuNoV vaccines; other prophylactic or therapeutic medications specifically for HuNoV disease are lacking. Passive immunization using oral anti-HuNoV antibodies may be a rational alternative. Here, we explore the feasibility of using avian immunoglobulins (IgY) for preventing HuNoV infection in vitro in a human intestinal enteroid (HIE) model. Methods: Hens were immunized with virus-like particles (VLP) of a GII.4 HuNoV strain (GII.4/CHDC2094/1974/US) by intramuscular injection. The resulting IgY was evaluated for inhibition of binding to histo-blood group antigens (HBGA) and viral neutralization against representative GII.4 and GII.6 clinical isolates, using an HIE model. Results: IgY titers were detected by three weeks following initial immunization, persisting at levels of 1:2(21) (1:2,097,152) from 9 weeks to 23 weeks. Anti-HuNoV IgY significantly (p < 0.05) blocked VLP adhesion to HBGA up to 1:12,048 dilution (0.005 mg/mL), and significantly (p < 0.05) inhibited replication of HuNoV GII.4[P16] Sydney 2012 in HIEs up to 1:128 dilution (0.08 mg/mL). Neutralization was not detected against genotype GII.6. Conclusions: We demonstrate the feasibility of IgY for preventing infection of HIE by HuNoV GII.4. Clinical preparations should cover multiple circulating HuNoV genotypes for comprehensive effects. Plans for animal studies are underway.
Insomnia and suicide risk
(University of Alabama Libraries, 2015) Woosley, Julie; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
A growing body of literature supports the notion that sleep disturbances, including insomnia, are related to suicidality. However, the mechanism through which insomnia correlates with suicide risk is unclear. The primary goal of the present research was to determine whether hopelessness, a robust predictor of suicidality, mediates the relation between insomnia and suicidal ideation (SI). Additionally, analyses were conducted to determine which demographic, health, sleep, and daytime functioning variables best predict hopelessness. Finally, this research will address gaps in the literature by determining which types of insomnia best predict suicide risk (i.e., hopelessness and SI), and whether a complaint of insomnia, poor sleep (as defined by quantitative criteria), or the combination of these factors best predicts suicide risk. The present study used an existing data set consisting of self-report data from a community-dwelling epidemiological sample. Participants (n = 766) completed a Health Survey, two weeks of daily sleep diaries, and five measures of daytime functioning, including the Beck Depression Inventory (BDI). BDI item 2 was used to assess hopelessness, and BDI item 9 was used to assess SI. Criteria from the Diagnostic and statistical manual of mental disorders (4th ed., text rev.) as well as quantitative criteria were used to identify participants with insomnia (n = 135). The analyses revealed that hopelessness is a significant mediator of the relation between insomnia and SI (Percentile 95% CI [0.24, 0.71]). Additionally, stepwise logistic regression revealed that, of a large pool of candidate variables, depression, anxiety, mean sleep efficiency, and intra-individual variability in sleep quality ratings are the best predictors of hopelessness. Finally, stepwise logistic regression revealed that a complaint of insomnia is a better predictor of suicide risk than quantitatively-defined poor sleep or the combination of these factors. Recommendations for future research include determining whether cognitive behavioral therapy for insomnia decreases hopelessness, which could ultimately decrease suicide risk. Additionally, the present research suggests the need for clinicians to routinely screen clients who report insomnia for hopelessness and SI.
Personality disorder features and insomnia status amongst hypnotic-dependent adults
(Elsevier, 2012) Ruiter, Megan E.; Lichstein, Kenneth L.; Nau, Sidney D.; Geyer, James D.; University of Alabama Birmingham; University of Alabama Tuscaloosa; University of Memphis
Objective: To determine the prevalence of personality disorders and their relation to insomnia parameters among persons with chronic insomnia with hypnotic dependence. Methods: Eighty-four adults with chronic insomnia with hypnotic dependence completed the SCID-II personality questionnaire, two-weeks of sleep diaries, polysomnography, and measures of insomnia severity, impact, fatigue severity, depression, anxiety, and quality of life. Frequencies, between-subjects t-tests and hierarchical regression models were conducted. Results: Cluster C personality disorders were most prevalent (50%). Obsessive-Compulsive personality disorder (OCPD) was most common (n = 39). These individuals compared to participants with no personality disorders did not differ in objective and subjective sleep parameters. Yet, they had poorer insomnia-related daytime functioning. OCPD and Avoidant personality disorders features were associated with poorer daytime functioning. OCPD features were related to greater fatigue severity, and overestimation of time awake was trending. Schizotypal and Schizoid features were positively associated with insomnia severity. Dependent personality disorder features were related to underestimating time awake. Conclusions: Cluster C personality disorders were highly prevalent in patients with chronic insomnia with hypnotic dependence. Features of Cluster C and A personality disorders were variously associated with poorer insomnia-related daytime functioning, fatigue, and estimation of nightly wake-time. Future interventions may need to address these personality features. (C) 2012 Elsevier B.V. All rights reserved.
Screening for obstructive sleep apnea: a validation study
(University of Alabama Libraries, 2018) Moran, Caitlin; Hamilton, James C.; University of Alabama Tuscaloosa
Obstructive sleep apnea (OSA) is a debilitating sleep disorder that, when left untreated, causes a myriad of health, safety, and financial problems. Effective treatments for this disorder exist; the largest barrier to treatment is currently diagnosis. The DSM-5 requires polysomnography, an expensive and time-consuming measure, for diagnosis. Research indicates that up to 93% of women and 82% of men with moderate to severe sleep apnea remain undiagnosed (Young, Evans, Finn, & Palta, 1997). Questionnaires are frequently used as screening tools to identify individuals at risk for OSA, but few have both high sensitivity and specificity. Spoormaker and colleagues (2005) developed the SLEEP-50 questionnaire to assess symptoms of various sleep disorders; they found the sleep apnea subscale to have both high specificity (.88) and sensitivity (.85). The current research tested the psychometric properties of the SLEEP-50 sleep apnea subscale in a sample of 300 sleep center patients and found lower specificity (.64) and sensitivity (.56) than Spoormaker (2005).
Seizure prediction: Methods
(Elsevier, 2011) Carney, Paul R.; Myers, Stephen; Geyer, James D.; University of Florida; University of Alabama Tuscaloosa
Epilepsy, one of the most common neurological diseases, affects over 50 million people worldwide. Epilepsy can have a broad spectrum of debilitating medical and social consequences. Although antiepileptic drugs have helped treat millions of patients, roughly a third of all patients have seizures that are refractory to pharmacological intervention. The evolution of our understanding of this dynamic disease leads to new treatment possibilities. There is great interest in the development of devices that incorporate algorithms capable of detecting early onset of seizures or even predicting them hours before they occur. The lead time provided by these new technologies will allow for new types of interventional treatment. In the near future, seizures may be detected and aborted before physical manifestations begin. In this chapter we discuss the algorithms that make these devices possible and how they have been implemented to date. We also compare and contrast these measures, and review their individual strengths and weaknesses. Finally, we illustrate how these techniques can be combined in a closed-loop seizure prevention system. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction. (C) 2011 Elsevier Inc. All rights reserved.
Self-affirmation and working memory capacity's influence on adherence to brief behavioral insomnia treatment
(University of Alabama Libraries, 2011) Ruiter, Megan; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Sleep disorders are among medical conditions with the lowest treatment adherence rates (DiMatteo, 2004). Chronic insomnia has known, effective behavioral interventions, but these also suffer from poor treatment adherence (Perlis et al., 2004). This study evaluated the efficacy of a self-affirmation task on adherence to behavioral treatments for insomnia including sleep restriction therapy, stimulus control, and sleep hygiene. Self-affirmation, administered through a value-essay manipulation, is known to decrease defensiveness to a persuasive health message, and is predicted to enhance adherence rates to insomnia treatment. Working memory capacity, determined through an operation span task, was also hypothesized to promote adherence. A self-affirmation (presence vs. absence) by working memory capacity (continuous) hierarchical regression analysis controlling for participants' baseline insomnia severity, and need for cognition determined self-reported adherence rates two weeks after one-session of insomnia treatment. In a sample of 54 undergraduate college students with chronic insomnia, the results indicated that self-affirmed participants were not more likely to adhere to effective, behavioral treatments for insomnia than participants who were not self-affirmed. Similarly, the working memory capacities of these participants had no predictive influence on adherence. Both groups were moderately to highly adherent to treatment which resulted in a significant reduction in insomnia severity. The only effect of the self-affirmation intervention was its ability to increase cognitive intentions to adhere compared to the control condition. A major limitation of the study was its low sample size. These findings join a literature of mixed results on the effect of self-affirmation on health behavior change. The literature and the current study suggest the positive effect of self-affirmation may be highly dependent on its delivery and the qualities of the subsequent health message. Future research ought to examine the long-term outcomes of variations of self-affirmation manipulations on multiple health behaviors in large samples. The relation between self-affirmation and other predictors of cognitive intentions to adhere and actual adherence also should be investigated to ascertain mediation chains to health behavior change.
A survey of sleep disorders in college students: a study of prevalence and outcomes
(University of Alabama Libraries, 2014) Thomas, Stephen Justin; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Sleep complaints are prevalent among college students and are associated with a number of negative outcomes. It is known that college students frequently report difficulties falling asleep, daytime hypersomnolence, and fatigue. However, specific data regarding the presentation of sleep disordered symptoms and exact diagnostic prevalence are lacking. College students (n = 143) were recruited to complete sleep questionnaires and, if indicated, a brief clinical interview to determine the prevalence of sleep symptoms and resulting diagnoses. Additionally, these students also completed questionnaires assessing mental and physical health to determine any negative outcomes that may be associated with sleep complaints. Lastly, academic performance was assessed in all students with greater than 24 credit hours to determine the relation between sleep presentation and academic performance. It was found that sleep complaints were reported by 88% of students, based on a self-report questionnaire, but only 34% of students, based on clinical interview. Furthermore, a diagnosable sleep disorder was found in 24% of students. Insufficient Sleep Syndrome and Delayed Sleep Phase Disorder were the two most prevalent sleep disorders, both occurring in 8% of the sample. Insomnia was the next most prevalent sleep disorder, occurring in 6% of the sample. Students with a sleep disorder reported more physical and mental health complaints but not worse academic performance than students without a sleep disorder. These results suggest that sleep complaints and disorders are prevalent among college students. Furthermore, sleep problems are associated with increased mental and physical health complaints. However, it does not appear that sleep problems affect academic performance. These results suggest that sleep complaints are not only prevalent among college students but are associated with negative mental/physical health outcomes. Therefore, sleep symptoms should be considered in the management of students' health. Additionally, sleep education and, when necessary, sleep disorder treatment may improve college students' overall quality of life.
Variability in self-reported normal sleep across adulthood
(University of Alabama Libraries, 2013) Dillon, Haley Rebecca; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
This study used archival data to examine variability in sleep diary measures across a two-week period. Data were analyzed for 592 normal sleepers (defined as absence of sleep disorder) ranging in age from 20 to 96 years. Variability was examined in four sleep diary parameters: total sleep time (TST), number of nighttime awakenings (NWAK), sleep-onset latency (SOL), and wake time after sleep onset (WASO) for the overall sample and by age, sex (male, n = 294, female, n = 298) and race (White, n = 415; Black, n = 177). Intraclass correlation coefficients were calculated from multilevel models to describe the extent to which self-reported sleep varied within- and between-individuals across the two-week period. Night-to-night differences in sleep within the same individual generally exceeded sleep differences between individuals for TST, SOL, and WASO. Multiple regression analyses were conducted to test for age, sex, and race differences in night-to-night, intra-individual variability (measured by the intra-individual standard deviation across nightly values for each individual). Results showed that the amount of intra-individual variability in TST and NWAK decreased with older age. Further, the degree of reduction in variability in TST associated with age was dependent on sex and race. Although effect sizes were small, females tended to have more intra-individual variability in SOL and NWAK than males. Results of this study provide empirical support for considerable night-to-night variability in subjective sleep in the general population and should be taken into account in future research linking sleep with various psychological and physical health outcomes. Methodological implications regarding measurement/research design are also discussed.

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Browsing by Author "Geyer, James D."

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