Alopecia areata (AA) affects men at similar rates to women, yet comparatively little is known about men’s experience of the condition. We interviewed a demographically diverse group of 18 men with AA ...to explore this gap. From qualitative thematic analysis, participants’ accounts described a profound yet often-minimised impact of AA on their lives, in the context of poor public awareness and misguided assumptions about AA in men. Conversely, this adversity appeared to facilitate personal growth for many. These findings can help health professionals better understand men’s gendered experience of AA, which we discuss through the lens of masculinities theory.
Background
Alopecia describes a group of dermatological conditions characterised by hair loss, which are either non‐scarring or scarring in nature, and range from bald patches to complete body hair ...loss, to general thinning. In the UK, the General Practitioner (GP) is typically the first point of contact, and some patients are referred for specialist dermatology consultation. However, little is known about how individuals with alopecia in the UK experience the care provided by the National Health Service.
Objectives
We aimed to understand patients' perceptions of primary healthcare and dermatology provision. Further, we aimed to investigate how care provision and patients' overall patient journey might be improved in the UK, and how these lessons may apply internationally.
Methods
An online mixed methods survey was distributed by Alopecia UK to UK‐based individuals with alopecia. Open‐ended text responses were analysed using qualitative content analysis. Quantitative data were analysed using descriptive analyses and dependent measures t‐tests.
Results
A total of 291 participants completed the survey. They reported neutral‐to‐partial dissatisfaction with their GP appointments, with greater satisfaction in their most recent compared to their first appointment. Participants highlighted positive experiences with GPs and dermatologists as well as areas for improvement. Participants also expressed a desire for a greater degree of support and understanding about the psychological impact of alopecia.
Conclusions
Results highlight the importance of being empathic and caring healthcare professionals for patients with alopecia, the need for training for GPs on alopecia, as well as a simplified and joined up pathway between primary and secondary healthcare.
This study sought the subjective experiences of patients with alopecia in their healthcare consultations. Findings suggest health professionals' empathy for the psychosocial impact of alopecia is a crucial element in patients' experience.
Abstract Background The most common forms of hair loss in men, alopecia areata (AA) (an autoimmune condition) and androgenetic alopecia (AGA) (pattern baldness), alter individuals' appearance in ways ...that may impact psychological and social wellbeing. We currently have a limited understanding about this impact of alopecia in men, their support needs, and preferences. Objectives We sought to investigate and explore the psychosocial impact of alopecia on men, alongside their experiences of treatment and support. Methods The study used a mixed methods cross‐sectional online survey with 177 men aged 17–79: 83 with AGA and 94 with AA. Quantitative questions included purpose‐made rating scales of men's support experiences, and standardised measures of wellbeing and appearance‐focused anxiety. Qualitative data comprised participants' answers to an open‐ended question asking about their subjectively salient experiences related to their alopecia. Results The combined findings indicate that while participants in both subsamples had sought minimal support for psychosocial concerns, such concerns were in fact commonplace. Over half of participants (56%–57%) shared qualitative accounts of depleted confidence, while wellbeing scores were on average lower than matched norms. Participants identifying as sexual minority also reported greater appearance‐focused anxiety compared to those identifying as straight. Conclusions The apparent contrast between participants' minimal help‐seeking and accounts of affected wellbeing suggests an unmet support need for men with alopecia. Masculine norms may impede men from accessing psychosocial support, both by discouraging help‐seeking behaviours and by encouraging minimisation of appearance concerns. The findings also suggest sexual minority status may pose a greater risk of distress in affected men.
Meta-analyses of genome-wide association studies (GWAS) have identified more than 240 loci that are associated with type 2 diabetes (T2D)
; however, most of these loci have been identified in ...analyses of individuals with European ancestry. Here, to examine T2D risk in East Asian individuals, we carried out a meta-analysis of GWAS data from 77,418 individuals with T2D and 356,122 healthy control individuals. In the main analysis, we identified 301 distinct association signals at 183 loci, and across T2D association models with and without consideration of body mass index and sex, we identified 61 loci that are newly implicated in predisposition to T2D. Common variants associated with T2D in both East Asian and European populations exhibited strongly correlated effect sizes. Previously undescribed associations include signals in or near GDAP1, PTF1A, SIX3, ALDH2, a microRNA cluster, and genes that affect the differentiation of muscle and adipose cells
. At another locus, expression quantitative trait loci at two overlapping T2D signals affect two genes-NKX6-3 and ANK1-in different tissues
. Association studies in diverse populations identify additional loci and elucidate disease-associated genes, biology, and pathways.
Existing knowledge of genetic variants affecting risk of coronary artery disease (CAD) is largely based on genome-wide association study (GWAS) analysis of common SNPs. Leveraging phased haplotypes ...from the 1000 Genomes Project, we report a GWAS meta-analysis of ~185,000 CAD cases and controls, interrogating 6.7 million common (minor allele frequency (MAF) > 0.05) and 2.7 million low-frequency (0.005 < MAF < 0.05) variants. In addition to confirming most known CAD-associated loci, we identified ten new loci (eight additive and two recessive) that contain candidate causal genes newly implicating biological processes in vessel walls. We observed intralocus allelic heterogeneity but little evidence of low-frequency variants with larger effects and no evidence of synthetic association. Our analysis provides a comprehensive survey of the fine genetic architecture of CAD, showing that genetic susceptibility to this common disease is largely determined by common SNPs of small effect size.
Background
Physical activity can improve function and decrease healthcare spending among overweight and obese older adults. Although unstructured physical activity has been related to cardiometabolic ...improvements, the relationship between unstructured activity and movement quality is unclear.
Aims
This study aimed to evaluate the association of amount of unstructured free-living moderate-vigorous physical activity (MVPA) with measures of movement quality in overweight and obese older adults.
Methods
The association of MVPA with movement quality was assessed in 165 overweight and obese older adults (Age: 77.0(8.0) years; Body mass index (BMI): 29.2(5.3) kg/m
2
). Participants performed overground walking, the Figure of 8 Walk test, and the Five-Times Sit to Stand. Weekly physical activity was measured using a waist-worn Actigraph activity monitor.
Results
Movement quality during straight path gait speed (ρ = 0.30,
p
< 0.01), stride length (ρ = 0.33,
p
< 0.01), double-limb support time (ρ = −0.26,
p
< 0.01), and gait symmetry (ρ = 0.17,
p
= 0.02) and curved path F8W time (ρ = −0.22,
p
< 0.01) and steps (ρ = −0.22,
p
< 0.01) walking were associated with weekly minutes of MVPA after controlling for age. Five-Times Sit to Stand performance was not significantly associated with weekly minutes of MVPA (ρ = −0.10,
p
= 0.13).
Conclusions
Older adults with high BMIs who are less active also demonstrate poorer movement quality, independent of age. Physical activity engagement and task-specific training should be targeted in interventions to promote healthy aging, decrease falls, and delay disability development. Future work should consider the interconnected nature of movement quality with physical activity engagement and investigate if targeting one influences the other.
Health plans guide enrollees' access to specialty drugs through coverage policies. Practice guidelines recommend that the evidence supporting drug coverage policies should be comprehensive and ...routinely updated to reflect evidence-based medicine.
To examine the frequency with which health plans update their coverage criteria and supporting evidence and to determine the pattern with which plans cited relevant literature in their coverage policies.
Coverage policies from 17 large US commercial health plans were retrieved from the Tufts Medical Center Specialty Drug Evidence and Coverage database for August 2017 and August 2019. We identified drug-indication pairs (eg, infliximab for rheumatoid arthritis) for which plans had issued coverage policies in August 2017 and August 2019. We examined the frequency with which plans reissued these policies (ie, issued a new coverage document) between these 2 time points and the frequency with which plans altered coverage criteria or updated the cited evidence. A random sample of 20 drug-indication pairs was chosen to determine the comprehensiveness of cited evidence from the Specialty Drug Evidence and Coverage database. For each pair, a systematic literature search was conducted to identify relevant clinical and economic studies. A comparison of the systematic literature search with the evidence cited in each drug-indication pair's coverage policy was conducted to determine the comprehensive nature of each coverage policy's evidence.
We identified 4,597 instances of plans issuing a coverage policy for the same drug-indication pair in both August 2017 and August 2019. Of those 4,597 instances, plans reissued an updated coverage document in 4,468 (97%). Fifteen percent of reissued policies revised both their coverage criteria and the evidence cited, 2% only their coverage criteria, 69% only the cited evidence, and 14% made no change. A total of 2,760 literature documents were identified relevant to at least one of the 20 drug-indication pairs, of which at least one plan cited 146 of these documents at least once (5.3%). Plans cited health technology assessments, randomized controlled trials (RCTs), systematic reviews/meta-analyses, and clinical guidelines most comprehensively.
Health plans reissued most of their specialty drug coverage policies over a 2-year period. When plans revised their drug coverage criteria, they also tended to revise the evidence cited in their coverage polices. Of all the evidence found in our systematic review, plans more comprehensively cite health technology assessments, RCTs, and systematic reviews/meta-analyses.
This study was funded by the National Pharmaceutical Council.
Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes (ACS) afflicting predominantly younger to middle-aged women. Observational studies have ...reported a high prevalence of extracoronary vascular anomalies, especially fibromuscular dysplasia (FMD) and a low prevalence of coincidental cases of atherosclerosis. PHACTR1/EDN1 is a genetic risk locus for several vascular diseases, including FMD and coronary artery disease, with the putative causal noncoding variant at the rs9349379 locus acting as a potential enhancer for the endothelin-1 (EDN1) gene.
This study sought to test the association between the rs9349379 genotype and SCAD.
Results from case control studies from France, United Kingdom, United States, and Australia were analyzed to test the association with SCAD risk, including age at first event, pregnancy-associated SCAD (P-SCAD), and recurrent SCAD.
The previously reported risk allele for FMD (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 (95% confidence interval CI: 1.50 to 1.86) per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was found to be higher for the association with SCAD in patients without FMD (OR: 1.89; 95% CI: 1.53 to 2.33) than in SCAD cases with FMD (OR: 1.60; 95% CI: 1.28 to 1.99). There was no effect of genotype on age at first event, P-SCAD, or recurrence.
The first genetic risk factor for SCAD was identified in the largest study conducted to date for this condition. This genetic link may contribute to the clinical overlap between SCAD and FMD.
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To evaluate the shared genetic etiology of type 2 diabetes (T2D) and coronary heart disease (CHD), we conducted a genome-wide, multi-ancestry study of genetic variation for both diseases in up to ...265,678 subjects for T2D and 260,365 subjects for CHD. We identify 16 previously unreported loci for T2D and 1 locus for CHD, including a new T2D association at a missense variant in HLA-DRB5 (odds ratio (OR) = 1.29). We show that genetically mediated increase in T2D risk also confers higher CHD risk. Joint T2D-CHD analysis identified eight variants-two of which are coding-where T2D and CHD associations appear to colocalize, including a new joint T2D-CHD association at the CCDC92 locus that also replicated for T2D. The variants associated with both outcomes implicate new pathways as well as targets of existing drugs, including icosapent ethyl and adipocyte fatty-acid-binding protein.
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