Alcohol consumption level and alcohol use disorder (AUD) diagnosis are moderately heritable traits. We conduct genome-wide association studies of these traits using longitudinal Alcohol Use Disorder ...Identification Test-Consumption (AUDIT-C) scores and AUD diagnoses in a multi-ancestry Million Veteran Program sample (N = 274,424). We identify 18 genome-wide significant loci: 5 associated with both traits, 8 associated with AUDIT-C only, and 5 associated with AUD diagnosis only. Polygenic Risk Scores (PRS) for both traits are associated with alcohol-related disorders in two independent samples. Although a significant genetic correlation reflects the overlap between the traits, genetic correlations for 188 non-alcohol-related traits differ significantly for the two traits, as do the phenotypes associated with the traits' PRS. Cell type group partitioning heritability enrichment analyses also differentiate the two traits. We conclude that, although heavy drinking is a key risk factor for AUD, it is not a sufficient cause of the disorder.
Background and aims
Recent reports have highlighted the emergence of ‘wasp dope’ as an issue of concern, but epidemiological evidence is lacking. Wasp dope is a crystalline substance created by ...electrifying pyrethroid‐containing insecticides (e.g. wasp sprays) that may give users a methamphetamine‐like ‘rush’. This paper describes wasp dope use and correlates of use in a sample of people who use drugs (PWUD) in Appalachian Kentucky, a region that has been an epicenter of opioid use and related harms in the United States.
Methods
Respondent‐driven sampling and targeted street outreach were used to recruit PWUD. Eligibility criteria included being aged at least 18 years, residing in one of five Appalachian Kentucky counties, and having either used opioids or injected any drug to get high in the prior 30 days. Interviewer‐administered surveys queried participants’ (n = 278) recent (past 6 months) wasp dope use, other substance use and demographic characteristics. Prevalence ratios (PR) were estimated using generalized estimating equations assuming a Poisson outcome distribution in a cross‐sectional analysis.
Results
Recent wasp dope use was reported by 16.1% of participants. Men and people who recently experienced homelessness and transportation difficulties were twice or more as likely to have used wasp dope compared with their counterparts PR = 2.08, 95% confidence interval (CI) = 1.11, 3.87, PR = 2.78, 95% CI = 1.64, 4.72 and PR = 2.01, 95% CI = 1.06–3.81, respectively. While wasp dope use was associated with injection drug use and using opioids and other substances to get high in unadjusted analyses, the factor most strongly associated with wasp dope use was methamphetamine use (PR = 17.23, 95% CI = 2.57, 115.61), specifically methamphetamine injection (PR = 4.47, 95% CI = 1.56, 12.78).
Conclusions
Among people who use drugs in rural Kentucky, USA, more than one in six people surveyed reported using wasp dope in the past 6 months, nearing the percentage using cocaine/crack (20%) and fentanyl/carfentanil (25%). Wasp dope use was higher among men and strongly associated with homelessness, transportation access, methamphetamine use and injection drug use.
Background
In the United States, approximately 700 women die annually from pregnancy‐related complications in the first year after birth; a significant number of the deaths occur after hospital ...discharge. Although postpartum monitoring is important, the standard practice is for one healthcare evaluation at 6 weeks post‐birth. Most women are not aware of signs of postpartum complications.
Aim
The aim of the pilot study was to develop a prototype of a mobile app aimed at increasing a new mother's ability to monitor her own health after childbirth.
Design
The design used mixed methods and procedures from human‐centred design in an iterative process.
Methods
Data were collected by the researchers from January ‐ May 2019 in a hospital that serves primarily low income and underserved women in the southern US. Three groups of women provided data related to health education preferences or their reaction to a mock‐up or prototype mobile app. Several women completed the Mobile App Rating Scale (MARS; N = 22).
Results
Themes from interviews indicated that women (N = 5) preferred electronic health education and that they used apps to monitor their pregnancies. Other new mothers (n‐5) described their overall reaction to the proposed features of the app which was incorporated into the design of the app that was tested by the third group of new mothers (N = 22) who were positive about interactions with the app. The MARS scores for the app were positive.
Conclusions
New mothers indicated that they would be willing to use an app to monitor their own postpartum health.
Impact
Data from the pilot study informed the development of a prototype mobile app that can now be used in a clinical trial with new mothers to monitor their own health and report concerns to healthcare providers.
背景
在美国,每年约有700名女性在产后第一年死于妊娠相关并发症;大量死亡事件发生在她们出院后。产后监测虽然很重要,标准做法却是在产后6周进行一次医疗评估。大部分女性没有察觉产后并发症的迹象。
目的
试点研究的目的是开发一款旨在提高新手妈妈们产后监控自身健康的能力的手机应用程序的雏形。
设计
该设计在迭代过程中使用了以人为中心的混合方法及种种程序。
方法
研究人员搜集了美国南部一家主要服务于低收入及受到低质量服务的女性的医院2019年1月至5月期间的数据。
三组女性提供了与健康教育偏好或她们对模型或手机应用程序雏形的反应相关的数据。几名女性完成了手机应用程序评分量表(MARS; N = 22)。
结果
访谈主题表明,女性( N = 5 )更偏向电子健康教育并使用手机应用程序来监控怀孕情况。其他的新手妈妈( n ‐ 5 )描述了她们对该手机应用程序已有功能的整体使用感受,这些感受也被写入该手机应用程序的设计中并由第三组女性进行了测试(N = 22),这些女性对该手机应用程序的使用持肯定态度。这款手机应用程序在评分量表中的得分也很高。
结论
新手妈妈们表示她们很乐意用手机应用程序来检测自己的孕期健康。
影响
试点研究的数据为手机应用程序雏形的开发提供了信息,该应用程序现在可以用于新手妈妈的临床试验,以监测她们自己的健康状况,并向医务人员报告问题。
In the absence of official clinical trial information, data from social networks can be used by public health and medical researchers to assess public claims about loosely regulated substances such ...as cannabidiol (CBD). For example, this can be achieved by comparing the medical conditions targeted by those selling CBD against the medical conditions patients commonly treat with CBD.
The objective of this study was to provide a framework for public health and medical researchers to use for identifying and analyzing the consumption and marketing of unregulated substances. Specifically, we examined CBD, which is a substance that is often presented to the public as medication despite complete evidence of efficacy and safety.
We collected 567,850 tweets by searching Twitter with the Tweepy Python package using the terms "CBD" and "cannabidiol." We trained two binary text classifiers to create two corpora of 167,755 personal use and 143,322 commercial/sales tweets. Using medical, standard, and slang dictionaries, we identified and compared the most frequently occurring medical conditions, symptoms, side effects, body parts, and other substances referenced in both corpora. In addition, to assess popular claims about the efficacy of CBD as a medical treatment circulating on Twitter, we performed sentiment analysis via the VADER (Valence Aware Dictionary for Sentiment Reasoning) model on the personal CBD tweets.
We found references to medically relevant terms that were unique to either personal or commercial CBD tweet classes, as well as medically relevant terms that were common to both classes. When we calculated the average sentiment scores for both personal and commercial CBD tweets referencing at least one of 17 medical conditions/symptoms terms, an overall positive sentiment was observed in both personal and commercial CBD tweets. We observed instances of negative sentiment conveyed in personal CBD tweets referencing autism, whereas CBD was also marketed multiple times as a treatment for autism within commercial tweets.
Our proposed framework provides a tool for public health and medical researchers to analyze the consumption and marketing of unregulated substances on social networks. Our analysis showed that most users of CBD are satisfied with it in regard to the condition that it is being advertised for, with the exception of autism.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background
A variety of measures have been developed to screen for hazardous or harmful drinking. The Alcohol Use Disorders Identification Test—Consumption (AUDIT‐C) is one of the screening measures ...recommended by the U.S. Preventive Services Task Force. Annual administration of the AUDIT‐C to all primary care patients is required by the U.S. Veterans Affairs Health System. The availability of data from the repeated administration of this instrument over time in a large patient population provides an opportunity to evaluate the utility of the AUDIT‐C for identifying distinct drinking groups.
Methods
Using data from the Million Veteran Program cohort, we modeled group‐based drinking trajectories using 2,833,189 AUDIT‐C scores from 495,178 Veterans across an average 6‐year time period. We also calculated patients’ age‐adjusted mean AUDIT‐C scores to compare to the drinking trajectories. Finally, we extracted data on selected clinical diagnoses from the electronic health record and assessed their associations with the drinking trajectories.
Results
Of the trajectory models, the 4‐group model demonstrated the best fit to the data. AUDIT‐C trajectories were highly correlated with the age‐adjusted mean AUDIT‐C scores (rs = 0.94). Those with an alcohol use disorder diagnosis had 10 times the odds of being in the highest trajectory group (consistently hazardous/harmful) compared to the lowest drinking trajectory group (infrequent). Those with hepatitis C, posttraumatic stress disorder, liver cirrhosis, and delirium had 10, 7, 21, and 34%, respectively, higher odds of being classified in the highest drinking trajectory group versus the lowest drinking trajectory group.
Conclusions
Trajectories and age‐adjusted mean scores are potentially useful approaches to optimize the information provided by the AUDIT‐C. In contrast to trajectories, age‐adjusted mean AUDIT‐C scores also have clinical relevance for real‐time identification of individuals for whom an intervention may be warranted.
We identified lifetime drinking patterns among 495,178 participants in the multi‐generational Million Veteran Program. Using an average of seven annual scores from the Alcohol Use Disorders Identification Test–Consumption (AUDIT‐C) and group‐based trajectory modeling, we identified four distinct patterns of alcohol use–infrequent, lower risk, potentially hazardous/harmful, and consistently hazardous/harmful. These patterns were associated with hepatitis C, post‐traumatic stress disorder, liver cirrhosis, and delirium, making them potentially useful in evaluating harmful drinking in research and clinical settings.
Purpose
With surging opioid‐involved overdoses, maintaining access to opioid use disorder (OUD) treatment is critical during the COVID‐19 pandemic. We examined changes in transmucosal buprenorphine ...prescribing for OUD treatment in Kentucky after the national COVID‐19 emergency declaration, with a focus on rural‐urban differences.
Methods
Using 2019‐2020 prescription monitoring data, we performed segmented regression analysis for an interrupted time series design to evaluate changes in weekly rates (per 100,000 residents) of dispensed prescriptions, unique individuals with dispensed prescriptions, and average days’ supply for dispensed prescriptions of transmucosal buprenorphine.
Findings
The weekly rates of dispensed prescriptions and unique individuals with dispensed prescriptions were higher for rural residents than urban residents. After the national COVID‐19 emergency declaration, rural and urban residents experienced similar immediate drops in the rate of dispensed prescriptions (rural –33.4; urban –24.3) and unique patients with dispensed prescriptions (rural –25.0; urban –17.1), followed by similar sustained increases. Both measures surpassed the prepandemic levels in mid‐June 2020. Patients residing in urban areas received averagely longer prescriptions at baseline (urban: 11.0 days; rural: 10.5 days). The average weekly days’ supply increased in the week after the national emergency declaration, but the estimated increase was higher (P = .004) for urban (0.8 days) versus rural (0.5 days) residents.
Conclusions
Transmucosal buprenorphine utilization increased during the COVID‐19 pandemic after experiencing interruption during the initial weeks of the pandemic. Future studies should evaluate the contribution of the relaxed telemedicine buprenorphine prescribing regulations during the COVID‐19 national emergency on initiation and maintenance of buprenorphine treatment.
Background
Heavy episodic drinking (HED) is a risk factor for opioid‐related overdose and negatively impacts HIV disease progression. Among a national cohort of patients with HIV (PWH), we examined ...sociodemographic and clinical correlates of concomitant HED and self‐reported opioid use.
Methods
We used data collected from 2002 through 2018 from the Veterans Aging Cohort Study, a prospective cohort including PWH in care at eight US Veterans Health Administration sites. HED was defined as consuming six or more drinks at least once in the year prior to survey collection. We examined the relationship between HED and self‐reported opioid use and created a 4‐level composite variable of HED and opioid use. We used multinomial logistic regression to estimate odds of reporting concomitant HED and self‐reported opioid use.
Results
Among 3702 PWH, 1458 (39.4%) reported HED during the study period and 350 (9.5%) reported opioid use. In the multinomial model, compared to reporting neither HED nor opioid use, lifetime housing instability (adjusted odds ratio aOR 1.54, 95% confidence interval CI 1.01 to 2.35), Veterans Aging Cohort Study Index 2.0 (a measure of disease severity; aOR 1.14, 95% CI 1.02 to 1.28), depressive symptoms (aOR 2.27, 95% CI 1.42 to 3.62), past‐year cigarette smoking (aOR 3.06, 95% CI 1.53 to 6.14), cannabis use (aOR 1.69, 95% CI 1.09 to 2.62), and cocaine/stimulant use (aOR 11.54, 95% CI 7.40 to 17.99) were independently associated with greater odds of concomitant HED and self‐reported opioid use. Compared to having attended no college, having some college or more (aOR 0.39, 95% CI 0.26 to 0.59) was associated with lower odds of concomitant HED and self‐reported opioid use.
Conclusions
Among PWH, concomitant HED and self‐reported opioid use are more common among individuals with depressive symptoms and substance use, structural vulnerabilities, and greater illness severity. Efforts to minimize opioid‐related risk should address high‐risk drinking as a modifiable risk factor for harm among these groups.
Concomitant heavy episodic drinking (HED) and opioid use increases overdose risk and negatively impacts HIV disease progression. Among a national cohort of patients with HIV, concomitant HED and self‐reported opioid use are more common among individuals with depressive symptoms and substance use, structural vulnerabilities, and greater severity of illness. Efforts to minimize risks related to opioid use should address high‐risk alcohol use as an attendant condition among these groups.
Here we report a large genome-wide association study (GWAS) for longitudinal smoking phenotypes in 286,118 individuals from the Million Veteran Program (MVP) where we identified 18 loci for smoking ...trajectory of current versus never in European Americans, one locus in African Americans, and one in Hispanic Americans. Functional annotations prioritized several dozen genes where significant loci co-localized with either expression quantitative trait loci or chromatin interactions. The smoking trajectories were genetically correlated with 209 complex traits, for 33 of which smoking was either a causal or a consequential factor. We also performed European-ancestry meta-analyses for smoking status in the MVP and GWAS & Sequencing Consortium of Alcohol and Nicotine use (GSCAN) (N
= 842,717) and identified 99 loci for smoking initiation and 13 loci for smoking cessation. Overall, this large GWAS of longitudinal smoking phenotype in multiple populations, combined with a meta-GWAS for smoking status, adds new insights into the genetic vulnerability for smoking behavior.
Objective
This study examines the effectiveness of an anger management program among veterans with posttraumatic stress disorder (PTSD) and other mental health issues.
Method
Veterans with (n = 76) ...and without (n = 58) PTSD completed anger management groups at the Crescenz Veterans Affairs Medical Center. Self‐rated checklists of anger and PTSD symptoms (for those with PTSD) were completed before and after the group.
Results
Significant improvement in anger was observed in the overall sample (p < .001) but did not differ based on PTSD diagnosis. No significant PTSD symptom changes were observed.
Conclusions
Veterans with broad mental health concerns benefited significantly from this anger management program, consistent with prior research. Implications for program improvement and future research are discussed.
Asthma is common in older adults and is confirmed by demonstration of variable expiratory air-flow limitations, typically evaluated by spirometric assessment of bronchodilator responsiveness. ...However, many patients with clinically suspected asthma and documented air-flow obstruction do not exhibit a post-bronchodilator response that meets or exceeds current established guidelines. We investigated if extending the time from bronchodilator administration to assessment of bronchodilator response increases the yield of spirometry for the diagnosis of asthma in older adults.
This was a cross-sectional study. The subjects were non-smokers, ≥ 60 y old, and with suspected asthma. Subjects were characterized as (1) those with a positive bronchodilator response on the 30-min post-bronchodilator spirometry, (2) those with a positive bronchodilator response on the 60-min post-bronchodilator spirometry, and (3) those without a positive bronchodilator response but with a positive methacholine challenge test. Factors associated with a late response to bronchodilator were evaluated by using bivariate analysis and by multivariate analysis by using a logistic regression model.
This study enrolled 165 subjects. Of these, 81 (49.1%) had a positive bronchodilator response on 30-min post-bronchodilator spirometry; 25 (15.2%) had a positive bronchodilator response on the 1-h post-bronchodilator spirometry; and 59 (35.8%) had no positive bronchodilator response but had a positive methacholine challenge test. On multivariable regression analysis, those with a higher baseline percentage of predicted FEV
, higher scores on a standard asthma control test, and wheezing and/or cough after exercise were more likely to either have a late bronchodilator response or no bronchodilator response.
Our study showed that a late positive response to bronchodilator use was more common than previously presumed in older subjects with suspected asthma. Pulmonary function testing laboratories should consider routinely reassessing spirometry at 1 h after bronchodilator use if the earlier assessment did not reveal a significant response.
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