Faculty Bibliography

Background: Partnership, engagement, and collaboration (PEC) are critical factors in dissemination and implementation (D&I) research. Despite a growing recognition that incorporating PEC strategies in D&I research is likely to increase the relevance, feasibility, impacts, and of evidence-based interventions or practices (EBIs, EBPs), conceptual frameworks and methodologies to guide the development and testing of PEC strategies in D&I research are lacking. To address this methodological gap, a review was conducted to summarize what we know, what we think we know, and what we need to know about PEC to inform D&I research. Methods: A cross-field scoping review, drawing upon a broad range of PEC related literature in health, was conducted. Publications reviewed focused on factors influencing PEC, and processes, mechanisms and strategies for promoting effective PEC. The review was conducted separately for three forms of partnerships that are commonly used in D&I research: (1) consumer-provider or patient-implementer partnership; (2) delivery system or implementation team partnership; and (3) sustainment/support or interagency/community partnership. A total of 39 studies, of which 21 were review articles, were selected for an in-depth review. Results: Across three forms of partnerships, four domains (cognitive, interpersonal/affective, behavioral, and contextual domains) were consistently identified as factors and strategies for promoting PEC. Depending on the stage (preparation or execution) and purpose of the partnership (regulating performance or managing maintenance), certain PEC strategies are more or less relevant. Recent developments of PEC frameworks, such as Partnership Stage of Change and multiple dynamic processes, provide more comprehensive conceptual explanations for PEC mechanisms, which can better guide PEC strategies selection and integration in D&I research. Conclusions: This review contributes to D&I knowledge by identifying critical domain factors, processes, or mechanisms, and key strategies for PEC, and offers a multi-level PEC framework for future research to build the evidence base. However, more research is needed to test PEC mechanisms.

Background: Little is known about how well headache smartphone applications (apps) protect patient information and whether they are secure to use. We sought to assess whether there are privacy issues surrounding apps so that physicians and patients could better understand what medical information patients are providing to the app companies, and the potential privacy implications of how the app companies (and other third parties) might use that information. Methods: We conducted a systematic search of the most popular "headache" and "migraine" apps, abstracted from the apps the types of data the apps requested from users, and examined the existence and content of privacy policies. In particular, we analyzed the app function, data storage, and statements in the app';s privacy policy, app store entry, or other documentation to determine whether an app collected various types of personal information from the user such as (a) whether the app requests user input regarding the user';s identity, (b) headache condition (e.g. medications, triggers, dates and times of headaches), or (c) data that might be collected based on a user';s actions rather than their data entries. Results: Twenty-nine apps were examined (14 diary apps, 15 relaxation apps). Of the diary applications, 79% (11/14) had visible privacy policies. Of the diary apps with privacy policies, all (11/11) stated whether or not the app collects and stores information remotely. 55% (6/11) stated that some user data was used to serve targeted advertisements. Sixty four percent (7/11) of the policies (including those for apps without remote headache diary functionality) stated why they shared data with third parties and 18% (2/11) did not clearly explain the purpose of data sharing. 11/15 (73%) of the relaxa-tion apps had privacy policies. Conclusion: Of concern, there were several areas where information may not be transparent to migraine users or to the physicians recommending use of the apps. These include: 1. Whether apps have privacy policies and whether the apps'; policies provide "plain English" explanations about how user';s data is stored and how it is used. 2. Whether any user data (including the very fact that a user downloaded a headache app) could be used for advertising or marketing purposes. In conclusion, headache apps shared information with third parties, posing privacy risks partly because there are few legal protections against the sale or disclosure of data from medical apps to third parties

Background: Level A evidence supports behavioral treatments for migraine. However, such treatments are underutilized due to the lack of 1) time, 2) insurance payment, and 3) patients'; therapeutic education on the behavioral options. Health message framing is a promising way to help guide patients with treatment decisions. Methods: Eight message frames about behavioral treatment for migraine were developed: six specific messages and two nonspecific messages, with half being gain-framed and the other half loss-framed. Message frames were assessed via a survey distributed on Turk Prime to people with migraine. Results: Fifty-six people completed the survey, with seven participants per message frame. Specific gain of frame was the most understood (90% of participants understood) and motivated participants to pursue behavioral therapy (57% willing to try in person behavioral therapy and 76% willing to try smartphone based behavioral treatment options). In this most motivated group, 14% reported that they would pay out of pocket for behavioral treatment. The least understood and least likely to motivate participants were the specific loss of frame messages; 52% were willing to try in person behavioral therapy and 38% were willing to try smartphone behavioral treatment options. 5% would pay out of pocket Conclusion: In this pilot study, the most easily understood and successful message frame was specific gain frame message. Larger studies may help determine best message framing for discussing behavioral treatments for migraine patients

Background: There are limited data on the adherence of migraine patients to recommendations for evidence-based behavioral treatments. Among patients seen by a headache specialist, we sought to determine rates of adherence to recommended behavioral treatments and barriers to adherence. We also sought to determine whether psychosocial factors such as migraine related disability, locus of control and self-efficacy were associated with adherence to migraine behavioral treatment recommendations. Methods: We conducted a prospective study of consecutive patients presenting to four headache specialists who were diagnosed with migraine at our Headache Center from 2016-2017 to examine whether they adhered to the recommendation to receive behavioral treatment. The primary outcome was whether patients had scheduled at least one visit for behavioral treatment. Descriptive statistics were reported. Patients who made an appointment for behavioral treatment were compared to those who did not across multiple categories including demographics, migraine characteristics, and personal beliefs with ANOVA and chi-square tests. Qualitative analyses were also done for open ended survey questions. Results: Of the 234 eligible patients, 69 (29.5%) were referred for behavioral treatment. Fifty-three (76.8%) patients referred for behavioral treatment were successfully reached by phone. Mean duration from time of referral to follow-up was 76 days (median 76, SD5 45). Just over half of patients (56.6%, N530) adhered to the recommendation for behavioral treatment. Patients who had previously seen a psychologist for their migraines were more likely to adhere to the behavioral treatment recommendation than patients who had not. Time constraints were the most common barrier cited for not scheduling a behavioral treatment appointment. Conclusion: Less than one third of eligible patients were referred for behavioral treatment and only about half adhered to the recommendation to schedule an appointment for behavioral treatment. More research should assess factors which might play a role in adherence to migraine behavioral treatment recommendations

Background: There are no clear guidelines on how to treat post-traumatic headache (PTH) or post-concussive symptoms (PCS). However, behavioral interventions such as cognitive behavioral therapy, biofeedback and relaxation are Level-A evidence-based treatments for headache prevention. To understand how to develop and study further mind body interventions (MBIs) and behavioral therapies for PTH and PCS, we developed the following question using the PICO framework: Are behavioral therapies and MBIs effective for treating PTH and PCS? Methods: We conducted a systematic search of three databases (Medline, PsycINFO and EMBASE) for behavioral interventions and MBIs with the subject headings and keywords for PTH, concussion, and traumatic brain injury (TBI). Inclusion criteria were (1) ran-domized controlled trial (RCT) (2) the majority of the intervention had to be behavioral or mind-body therapy focused (3) the majority of the participants (>50%) had to have had a mild TBI (not a moderate or severe TBI) (4) published in a peer reviewed publication. The search identified 917 individual studies. Two independent reviewers screened citations and full text articles independently. Nineteen articles were pulled for full article review. Seven articles met the final inclusion criteria. The systematic review was registered in Prospero (CRD42017070072). Results: In total from all studies, there were 1,120 adult participants ranging from 18-80. Sixty-nine percent were male. Of the 7 studies, 3/7 were focused on military staff (retired and active). Time post injury for inclusion into the studies varied from 48 hours post-injury to more than two years post injury. Two studies recruited from patients who had visited their emergency depart-ments. There was vast heterogeneity across studies making it difficult to fully assess efficacy. The heterogeneity ranged from differences in patient populations, the timing of when the interventions were initiated (2 weeks-2 years post injury), the types of intervention e.g. in-person CBT, group CBT, telephone counseling, the amount of contact with study staff, and the methods for assessing outcomes e.g. Rivermead and Post Concussive Score. Conclusion: Many of the interventions offered vastly different methods of delivery of intervention and doses of intervention. Many of the negative studies were done after an extended duration post injury (>one-year post TBI). In addition, participants were lumped together regardless of their pre-concussion comorbidities, their mechanism of injury, their symptoms, and the duration from injury to the start of the intervention. Thus, there are various considerations for the design of the intervention for future behavioral/MBI studies for PTH and concussion

Cigarette smoking alters the oral microbiome; however, the effect of alternative tobacco products remains unclear. Middle Eastern tobacco products like dokha and shisha, are becoming globally widespread. We tested for the first time in a Middle Eastern population the hypothesis that different tobacco products impact the oral microbiome. The oral microbiome of 330 subjects from the United Arab Emirates Healthy Future Study was assessed by amplifying the bacterial 16S rRNA gene from mouthwash samples. Tobacco consumption was assessed using a structured questionnaire and further validated by urine cotinine levels. Oral microbiome overall structure and specific taxon abundances were compared, using PERMANOVA and DESeq analyses respectively. Our results show that overall microbial composition differs between smokers and nonsmokers (p = 0.0001). Use of cigarettes (p = 0.001) and dokha (p = 0.042) were associated with overall microbiome structure, while shisha use was not (p = 0.62). The abundance of multiple genera were significantly altered (enriched/depleted) in cigarette smokers; however, only Actinobacillus, Porphyromonas, Lautropia and Bifidobacterium abundances were significantly changed in dokha users whereas no genera were significantly altered in shisha smokers. For the first time, we show that smoking dokha is associated to oral microbiome dysbiosis, suggesting that it could have similar effects as smoking cigarettes on oral health.

Background: Methamphetamine (MA) use remains a major public health concern around the world. Recent findings suggest that buprenorphine may be helpful for cocaine use reduction. Moreover, animal studies described reduced dopamine peak effect following MA use, due to the administration of low dose buprenorphine. Objectives: This study examined the effectiveness of buprenorphine with brief cognitive behavioral therapy on MA use disorder. Methods: The study was conducted in an outpatient substance abuse treatment center in Qazvin, Iran. Nineteen MA users received buprenorphine for 24 weeks combined with brief cognitive behavioral therapy in an outpatient substance abuse treatment program, three times per week, as a before and after non - randomization study. Clinical outcomes included treatment retention, MA use, degree of MA dependency and craving, quality of life, cognitive abilities questionnaire, addiction severity and also adverse events. Data was analyzed by performing repeated measures analysis and the Friedman test for nonparametric variables. Results: Fifteen participants completed the study during six months and frequency of MA use was significantly decreased at 24 weeks (P < 0.001). There were also significant reductions in craving (P < 0.001), degree of MA dependence (P < 0.001), and improvements in quality of life, cognitive ability, and some subscales of addiction severity. Conclusions: The results of this preliminary clinical study demonstrated that buprenorphine could potentially attenuateMAcraving and alternate rewarding effects of MAand had promising effects on cognitive impairment. Furthermore, buprenorphine can be considered as a harm reduction intervention in some communities, in which the people, as a result of cultural beliefs, do not accept a therapy, which only consists of counseling and no medications.