Publications by authors named "Kassandra Martinez"

6 Publications

  • Page 1 of 1

Longitudinal Profiling of the Macaque Vaginal Microbiome Reveals Similarities to Diverse Human Vaginal Communities.

mSystems 2021 Apr 27;6(2). Epub 2021 Apr 27.

Department of Molecular Biology and Biochemistry, University of California, Irvine, Irvine, California, USA

The vaginal microbiota plays an important role in women's reproductive and urogenital health. It is now well accepted that a "healthy" vaginal microbiome is dominated by species. Disturbances in this microbial community can lead to several adverse outcomes, including pelvic inflammatory disease and bacterial vaginosis (BV), as well as increased susceptibility to sexually transmitted infections, miscarriage, and preterm births. However, vaginal communities, especially those of women in the developing world, can be comprised of a diverse set of microorganisms in the absence of overt clinical symptoms. The implications of these diverse vaginal microbiomes for women's health remain poorly understood. Rhesus macaques are an excellent translational animal model to address these questions due to significant physiological and genetic homology with humans. In this study, we performed a longitudinal analysis of clinical and microbiome data from 16 reproductive-age female rhesus macaques. At both the taxonomic and functional levels, the rhesus macaque vaginal microbiome was most similar to that of women who harbor a diverse vaginal community associated with asymptomatic/symptomatic bacterial vaginosis. Specifically, rhesus macaque vaginal microbiomes harbored a diverse set of anaerobic Gram-negative bacteria, including , , , and Interestingly, some animals were transiently colonized by and some with Our in-depth and comprehensive analysis highlights the importance of the model to understand the health implications of a diverse vaginal microbiome and test interventions for manipulating this community. It is widely accepted that the "healthy" vaginal microbiome of women in the developed world is dominated by species. However, in the developing world, many asymptomatic women harbor diverse vaginal microbial communities that are typically associated with bacterial vaginosis. Many questions remain about the drivers and health implications of a diverse vaginal microbial community. Rhesus macaques provide an excellent translational model to address these questions due to significant physiological and genetic homology with humans. In this study, we performed a longitudinal analysis of clinical and microbiome data from a large cohort of reproductive-age rhesus macaques. At the taxonomic, genomic, and functional levels, the rhesus macaque vaginal microbiome was most similar to that of humans, who harbor a diverse vaginal community associated with asymptomatic/symptomatic bacterial vaginosis. Our in-depth and comprehensive analysis highlights the utility of macaques as a model to study diverse vaginal community state types and test interventions for manipulating the vaginal microbiome.
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http://dx.doi.org/10.1128/mSystems.01322-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092128PMC
April 2021

Characterizing therapist delivery of evidence-based intervention strategies in publicly funded mental health services for children with autism spectrum disorder: Differentiating practice patterns in usual care and AIM HI delivery.

Autism 2021 Aug 28;25(6):1709-1720. Epub 2021 Mar 28.

Child and Adolescent Services Research Center, University of California, San Diego, USA.

Lay Abstract: This study was conducted to identify patterns of therapist delivery of evidence-based intervention strategies with children with autism spectrum disorder receiving publicly funded mental health services and compare strategy use for therapists delivering usual care to those trained to deliver AIM HI ("An Individualized Mental Health Intervention for ASD"), an intervention designed to reduce challenging behaviors in children with autism spectrum disorder. For therapists trained in AIM HI, intervention strategies grouped onto two factors, and , while strategies used by usual care therapists grouped onto a broader single factor, . Among usual care therapists, were related to an increase in child behavior problems, whereas for AIM HI therapists, were related with reductions in child behavior problems over 18 months. Findings support the use of active teaching strategies in reducing challenging behaviors in children with autism spectrum disorder and provide support for the effectiveness of training therapists in evidence-based interventions to promote the delivery of targeted, specific intervention strategies to children with autism spectrum disorder in mental health services.
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http://dx.doi.org/10.1177/13623613211001614DOI Listing
August 2021

Training Community Therapists to Deliver an Individualized Mental Health Intervention for Autism Spectrum Disorder: Changes in Caregiver Outcomes and Mediating Role on Child Outcomes.

J Am Acad Child Adolesc Psychiatry 2021 03 2;60(3):355-366. Epub 2020 Aug 2.

Child and Adolescent Services Research Center, San Diego, California; University of California, San Diego; San Diego State University, California.

Objective: This study examines the impact of training therapists to deliver "An Individualized Mental Health Intervention for Autism Spectrum Disorder (ASD)" (AIM HI) for children with autism spectrum disorder on caregiver outcomes and the mediating role of changes in caregiver outcomes on child outcomes.

Method: Data were drawn from a cluster randomized trial conducted in 29 publicly funded mental health programs randomized to receive AIM HI training or usual care. Therapists were recruited from enrolled programs and child/caregiver participants enrolled from therapists' caseloads. Participants included 202 caregivers of children 5 to 13 years of age with autism spectrum disorder. Caregiver strain and sense of competence were assessed at baseline and 6 month postbaseline. Child behaviors were assessed at baseline and 6, 12, and 18 months postbaseline. Therapist delivery of evidence-based intervention strategies were assessed between baseline and 6 months.

Results: A significant training effect was observed for caregiver sense of competence, with AIM HI caregivers reporting significantly greater improvement relative to usual care. There was no significant training effect for caregiver strain. Observer-rated therapist delivery of evidence-based interventions strategies over 6 months mediated training effects for sense of competence at 6 months. Changes in sense of competence from baseline to 6 months was associated with reduced child challenging behaviors at 6 months and mediated child outcomes at 12 and 18 months.

Conclusion: Combined with research demonstrating effectiveness of therapist AIM HI training on child outcomes, this study provides further evidence of the positive impact of training community therapists in the AIM HI intervention.

Clinical Trial Registration Information: Effectiveness and Implementation of a Mental Health Intervention for ASD (AIM HI); https://clinicaltrials.gov/; NCT02416323.
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http://dx.doi.org/10.1016/j.jaac.2020.07.896DOI Listing
March 2021

Pediatric Primary Care Perspectives on Integrated Mental Health Care for Autism.

Acad Pediatr 2020 Nov - Dec;20(8):1140-1147. Epub 2020 Mar 20.

Department of Psychiatry, University of California (NA Stadnick, GA Aarons, DA Lee, and L Brookman-Frazee), San Diego, La Jolla, Calif; University of California San Diego Dissemination and Implementation Science Center (NA Stadnick, GA Aarons, and L Brookman-Frazee), La Jolla, Calif; Child and Adolescent Services Research Center (NA Stadnick, K Martinez, GA Aarons, DA Lee, and L Brookman-Frazee), San Diego, Calif; Rady Children's Hospital-San Diego, Autism Discovery Institute (L Brookman-Frazee), San Diego, Calif.

Objective: Timely identification of mental health needs and linkage to services is critical to provide comprehensive care for children with autism spectrum disorder (ASD). Pediatric primary care is well-positioned to facilitate this process through integrated care approaches. As a first step toward mental health integration, this study applied the Exploration, Preparation, Implementation, and Sustainment framework to characterize determinants of implementing integrated care practices for ASD.

Methods: Sixty pediatric primary care providers and leaders from 3 organizations completed focus groups and surveys about identification of mental health needs in children with ASD and access to mental health services. Findings were integrated to examine convergence (ie, do the 2 methods confirm or find similar results) and expansion (ie, do the 2 methods provide insights beyond either method alone).

Results: Results converged regarding 3 primary influences to integrated care practices for ASD: 1) limited specialized mental health referral options for ASD, 2) unique structural characteristics of the mental health system act as barriers to accessing care, and 3) caregivers differ in the degree to which they understand co-occurring mental health conditions and pursue recommended services. Qualitative results provided expansion by highlighting unique implementation considerations (eg, alignment with health care delivery priorities and values) based on primary care characteristics.

Conclusions: Findings confirm need for a tailored approach for linking children with ASD to appropriate mental health treatment. Results yield insight into the needs for organizational capacity to support integrated care and provide direction toward adapting an integrated mental health care model for children with ASD.
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http://dx.doi.org/10.1016/j.acap.2020.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502427PMC
July 2021

Measuring treatment response in children with autism spectrum disorder: Applications of the Brief Observation of Social Communication Change to the Autism Diagnostic Observation Schedule.

Autism 2019 07 10;23(5):1176-1185. Epub 2018 Oct 10.

1 Weill Cornell Medicine, White Plains, NY, USA.

This study aims to determine the validity and reliability of applying the coding strategy from the Brief Observation of Social Communication Change, a newly validated treatment outcome measure, to videotaped segments of the Autism Diagnostic Observation Schedule. Results indicate strong reliability and validity of the Brief Observation of Social Communication Change ratings using the Autism Diagnostic Observation Schedule segments in detecting changes in social communication over the course of treatment in young, minimally verbal children with autism spectrum disorder. Results also suggest that the Brief Observation of Social Communication Change, when applied to Autism Diagnostic Observation Schedule segments, may be more sensitive in detecting subtle changes in social communication compared to the Autism Diagnostic Observation Schedule Calibrated Severity Scores. These results may support the application of the Brief Observation of Social Communication Change to pre-existing datasets of Autism Diagnostic Observation Schedule videos to examine treatment responses.
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http://dx.doi.org/10.1177/1362361318793253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522321PMC
July 2019

Response to Distress Varies by Social Impairment and Familiarity in Infants at Risk for Autism.

J Autism Dev Disord 2018 Nov;48(11):3885-3898

Department of Psychology, The University of Texas at Austin, 305 E. 23rd St., Stop E9000, Austin, TX, 78712, USA.

Early impaired response to social partners' distress may negatively impact subsequent social development. Identifying factors contributing to successful responding may inform assessment and intervention. This study explores how: (1) social impairment, and (2) partner familiarity relate to response to partners' distress. Infants with and without older siblings with ASD were assessed at 12 (n = 29) and 15 (n = 35) months for social impairment markers, and responses to mother and experimenter each feigning distress. Infants with more social impairment showed less attention and affect at 15, but not 12 months. Infants attended more to the unfamiliar person, but exhibited greater affect toward the familiar person at 12 months. Results revealed social impairment and familiarity were separately related to infant response to partners' distress.
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http://dx.doi.org/10.1007/s10803-018-3653-3DOI Listing
November 2018
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