The significant impact of education, poverty, and race on Internet-based research participant engagement

PURPOSE: Internet-based technologies are increasingly being used for research studies. However, it is not known whether Internet-based approaches will effectively engage participants from diverse racial and socioeconomic backgrounds. METHODS: A total of 967 participants were recruited and offered genetic ancestry results. We evaluated viewing Internet-based genetic ancestry results among participants who expressed high interest in obtaining the results. RESULTS: Of the participants, 64% stated that they were very or extremely interested in their genetic ancestry results. Among interested participants, individuals with a high school diploma (n = 473) viewed their results 19% of the time relative to 4% of the 145 participants without a diploma (P < 0.0001). Similarly, 22% of participants with household income above the federal poverty level (n = 286) viewed their results relative to 10% of the 314 participants living below the federal poverty level (P < 0.0001). Among interested participants both with a high school degree and living above the poverty level, self-identified Caucasians were more likely to view results than self-identified African Americans (P < 0.0001), and females were more likely to view results than males (P = 0.0007). CONCLUSION: In an underserved population, engagement in Internet-based research was low despite high reported interest. This suggests that explicit strategies should be developed to increase diversity in Internet-based research. Genet Med 19 2, 240–243

Effect of Age on the Profile of Psychotropic Users: Results from the 2010 National Ambulatory Medical Care Survey

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106103/1/jgs12640.pd

Temporal Patterns of Medications Dispensed to Children and Adolescents in a National Insured Population

This study aimed to comprehensively describe prevalence and temporal dispensing patterns for medications prescribed to children and adolescents in the United States. Participants were 1.6 million children (49% female) under 18 years old enrolled in a nation-wide, employer-provided insurance plan. All medication claims from 1999–2006 were reviewed retrospectively. Drugs were assigned to 16 broad therapeutic categories. Effects of trend over time, seasonality, age and gender on overall and within category prevalence were examined. Results: Mean monthly prevalence for dispensed medications was 23.5% (range 19.4–27.5), with highest rates in winter and lowest in July. The age group with the highest prevalence was one-year-old children. On average each month, 17.1% of all children were dispensed a single drug and 6.4% were dispensed two or more. Over time, prevalence for two or more drugs did not change, but the proportion of children dispensed a single drug decreased (slope -.02%, p = .001). Overall, boys had higher monthly rates than girls (average difference 0.9%, p = .002). However, differences by gender were greatest during middle childhood, especially for respiratory and central nervous system agents. Contraceptives accounted for a large proportion of dispensed medication to older teenage girls. Rates for the drugs with the highest prevalence in this study were moderately correlated (average Pearson r.66) with those from a previously published national survey. Conclusion: On average, nearly one quarter of a population of insured children in the United States was dispensed medication each month. This rate decreased somewhat over time, primarily because proportionally fewer children were dispensed a single medication. The rate for two or more drugs dispensed simultaneously remained steady

Variation in referral and access to new psychological therapy services by age: an empirical quantitative study.

Background: Older people with common mental health problems (CMHPs) are known to have reduced rates of referral to psychological therapy. Aim: We aimed to assess referral rates to the Improving Access to Psychological Therapies (IAPT) service, contact with a therapist and clinical outcome by age. Design and Setting: Empirical research using patient episodes of care from South West IAPT. Method: By analysing 82,513 episodes of care (2010-2011), referral rates and clinical improvement were compared to both total population and estimated prevalence in each age group using IAPT data. Probable recovery of those completing treatment were calculated for each group. Results: Estimated prevalence of CMHPs peaks in 45–49 year olds (20.59% of population). The proportions of patients identified with CMHPs being referred peaks at 20-24 years (22.95%) and reduces with increase in age thereafter to 6.00% for 70-74 year olds. Once referred, the proportion of those attending first treatment increases with age between 18 years (57.64%) and 64 years (76.97%). In addition, the percentage of those having a clinical improvement gradually increases from the age 20 years (12.94%) to 69 years (20.74%). Conclusion: Younger adults are more readily referred to IAPT services. However, as a proportion of those referred, probabilities of attending once, attending more than once, and clinical improvement, increase with age. It is uncertain whether optimum levels of referral have been reached for young adults. It is important to establish whether changes to service configuration, treatment options, and GP behaviour can increase referrals for middle-aged and older adults

Targeted sequencing identifies genetic polymorphisms of flavin-containing monooxygenase genes contributing to susceptibility of nicotine dependence in European American and African American

BACKGROUND: Smoking is a leading cause of preventable death. Early studies based on samples of twins have linked the lifetime smoking practices to genetic predisposition. The flavin‐containing monooxygenase (FMO) protein family consists of a group of enzymes that metabolize drugs and xenobiotics. Both FMO1 and FMO3 were potentially susceptible genes for nicotine metabolism process. METHODS: In this study, we investigated the potential of FMO genes to confer risk of nicotine dependence via deep targeted sequencing in 2,820 study subjects comprising 1,583 nicotine dependents and 1,237 controls from European American and African American. Specifically, we focused on the two genomic segments including FMO1,FMO3, and pseudo gene FMO6P, and aimed to investigate the potential association between FMO genes and nicotine dependence. Both common and low‐frequency/rare variants were analyzed using different algorithms. The potential functional significance of SNPs with association signal was investigated with relevant bioinformatics tools. RESULTS: We identified different clusters of significant common variants in European (with most significant SNP rs6674596, p = .0004, OR = 0.67, MAF_EA = 0.14, FMO1) and African Americans (with the most significant SNP rs6608453, p = .001, OR = 0.64, MAF_AA = 0.1, FMO6P). No significant signals were identified through haplotype‐based analyses. Gene network investigation indicated that both FMO1 and FMO3 have a strong relation with a variety of genes belonging to CYP gene families (with combined score greater than 0.9). Most of the significant variants identified were SNPs located within intron regions or with unknown functional significance, indicating a need for future work to understand the underlying functional significance of these signals. CONCLUSIONS: Our findings indicated significant association between FMO genes and nicotine dependence. Replications of our findings in other ethnic groups were needed in the future. Most of the significant variants identified were SNPs located within intronic regions or with unknown functional significance, indicating a need for future work to understand the underlying functional significance of these signals

Mixed Anxiety Depression Should Not Be Included in DSM-5

Contains fulltext : 102705.pdf (publisher's version ) (Closed access)Subthreshold anxiety and subthreshold depressive symptoms often co-occur in the general population and in primary care. Based on their associated significant distress and impairment, a psychiatric classification seems justified. To enable classification, mixed anxiety depression (MAD) has been proposed as a new diagnostic category in DSM-5. In this report, we discuss arguments against the classification of MAD. More research is needed before reifying a new category we know so little about. Moreover, we argue that in patients with MAD symptoms and a history of an anxiety or depressive disorder, symptoms should be labeled as part of the course trajectories of these disorders, rather than calling it a different diagnostic entity. In patients with incident co-occurring subthreshold anxiety and subthreshold depression, subthreshold categories of both anxiety and depression could be classified to maintain a consistent classification system at both threshold and subthreshold levels.5 p

EEG study of perceptual bias in facial expressions, mood, and the mirror-neuron system

Research suggests that interpretation of facial emotion expressions, such as happy or sad, is influenced by current mood. In particular, those in an “elevated” mood see faces as happier, while those in “lower” moods see these same faces as being sadder. This phenomenon may be due to the idea of empathy, or one’s ability to feel what another person is feeling. Thus, those in a “bad mood” will empathize more with faces that they deem to be sad because it is what they can currently easily experience themselves. Empathy has also been linked to the human mirror neuron system (MNS), specialized areas of the brain which allow a person to “mirror” in their mind the actions of another and therefore infer the intention of the action. This study examined at the link between MNS activity, everyday mood fluctuations, and empathy. Current mood was assessed with established and validated measures. Participants were asked to view and rate face as “happy” or “sad” while MNS activity was measured via electroencephalography (EEG). The results found that those in a more elevated mood found more neutral faces to be happy than those in a lower mood. Similarly, the elevated individuals had more of a MNS response to those faces they found happy and those in a lower mood had more of a MNS response to the faces they found to be sad. This suggests that the human MNS is involved in mood-congruency perceptual effects

Pain Management at End of Life When There is a Co-Occurrence of Substance Use Disorder: A Qualitative Metasynthesis

Pain management, end of life (EOL) care, and substance use disorder (SUD) are individually identified as National healthcare challenges and priorities. Despite 50 years of advances in the understanding of pain management, pain is still inconsistently assessed and undertreated in all populations, including those with life limiting illness. When a patient with a life limiting illness and history of SUD is encountered, pain management becomes further complicated. Effective pain management for all patients, regardless of coexisting complications, is an ethical obligation of health care providers. Given the lack of research into EOL pain management of patients with SUD, it is not surprising that such individuals have been identified as a vulnerable population at high risk for undertreatment of pain. Additionally, the physical, psychosocial/spiritual care of this population can be challenging and frustrating, and there are few studies to guide health professionals in any of these areas. In this qualitative metasynthesis, the findings were derived from collecting, analyzing, interpreting and synthesizing the qualitative literature from 2010 – 2015 on the phenomena. The findings of this project reaffirm that pain can only be a subjective experience, and there is no more reliable gauge of pain than the individual’s subjective report. The findings demonstrate also that clinicians continue to struggle with this subjectivity. The overarching finding of this project is that the concept of “knowing the patient” becomes even more significant as the foundation of effective care in the EOL/ SUD patient population. The combination of the key findings of this project, recommendations concerning pain management in EOL SUD patients, along with expert clinical knowledge and experience of end of life interdisciplinary team members, can provide a roadmap for the care of this challenging patient population

Male Verses Female Brains

Researching what makes brains unique has been studied for generations; the unique differences between the brains of males and females and what causes them has recently begun to surface as a topic to study. This paper addresses the way that the different brain sexes have been handled over the course of history, from religion to the latest findings

Refining Associations between Targeted Genes and the Development of Substance Use Disorders

Recent genome-wide association studies (GWAS) provide strong evidence for the contribution of a few specific genes to alcohol and nicotine dependence. Chapter 2 explores numerous previously identified candidate genes for alcohol dependence using a publicly available GWAS. I found that many candidate loci do not replicate, highlighting the utility of GWAS for focusing on disease associated genes. Chapters 3-5 dissect associations between three genome-wide significant genes and substance use disorders. Chapter 3 focuses on a functional variant in alcohol dehydrogenase (ADH) 1B. Through examining 1,550 adolescent drinkers in the Collaborative Study on the Genetics of Alcoholism (COGA), I extended adult findings by showing that this ADH1B variant protected against early drinking milestones. Furthermore, I provided evidence for a gene-by-environment interaction where best friends drinking eliminated this genetic protective effect, illustrating the important interplay between genetic and environmental factors in the development of drinking behaviors. Chapter 4 examines variation in the nicotine metabolizing cytochrome P450 gene CYP2A6. Previous studies show slow metabolizers smoke fewer cigarettes, but provide conflicting results on the role of CYP2A6 in nicotine dependence. Using a COGA young adult sample, I found that CYP2A6 metabolism was not associated with smoking initiation or daily smoking, but among daily smokers, slow metabolism was associated with increased risk of dependence. This association was replicated in an independent sample from the Collaborative Study of Nicotine Dependence, adding insight into the complex role of CYP2A6 across stages of smoking behaviors. Chapter 5 focuses on coding variation in the 5 nicotinic receptor subunit gene (CHRNA5), which harbors a nonsynonymous common variant robustly associated with nicotine dependence. I examined targeted sequence data of CHRNA5 from approximately 3,000 nicotine dependent cases and controls, with independent replication of common and low frequency variants in 12 studies. I found that common, low frequency, and rare CHRNA5 coding variants were independently associated with increased nicotine dependence risk. Incorporating coding variants beyond the well-studied common variant increased the variance in nicotine dependence explained by CHRNA5. Overall, this dissertation advances our understanding of targeted genes for substance use disorders by incorporating important environments, critical developmental periods, and rare variants