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Prevalence and Factors Associated with SSRI Use Among Adults with Depressive and Thyroid Disorders in the United States
No full textBackground:
Patients with hypothyroidism and hyperthyroidism are at high risk for developing anxiety and depression. Sixty percent of adults in the United States with thyroid disorders have depression. Selective serotonin reuptake inhibitors (SSRIs) are used to treat depression. However, SSRIs reduce thyroid function during treatment suggesting SSRIs may not be used in treating depression among adults with thyroid disorders. Few studies have investigated the prevalence and factors associated with SSRI use in adults with diagnosed depression and thyroid disorders.
Objective:
This study estimated the prevalence of SSRI use in adults with diagnosed thyroid and depressive disorders in the United States and examined the factors associated with SSRI use.
Methods:
The study used a cross-sectional design using pooled data from multiple years (2018-2020) of the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the civilian non-institutionalized population in the US, to gain an adequate sample size. The study was restricted to adults with diagnosed thyroid and depressive disorders with health insurance. The final sample was (Unweighted N=729; Weighted N= 3,090,551). SSRI use was identified from prescription drug files using Multum drug classifications. Rao-Scott Chi-square tests were used to examine the unadjusted group differences in SSRI use. Multivariable logistic regression was used to analyze factors associated with SSRI use. The logistic regressions adjusted for age, sex, race and ethnicity, education, income, insurance coverage, prescription drug coverage, polypharmacy (>6 drug classes excluding antidepressants and thyroid hormones), perceived physical and mental health rating, pain, and thyroid hormones.
Results:
A majority (61.6%) of adults diagnosed with thyroid and depression used SSRIs. A lower percentage of African Americans (28.5%vs.61.9%; p<.05) used SSRIs compared to NHWs; Only 47.0% of those reporting poor health used SSRI compared to those reporting excellent physical health (73.8%) (p<0.01). A lower percentage of adults with extreme pain (49.5%vs.65.8%) used SSRIs compared to those with mild or no pain (p<.05). A lower percentage of adults with moderate to vigorous physical activity of 5 days/week used SSRIs compared to adults with no exercise. (54.2%vs.65.3%; p<.05). A lower percentage of adults with polypharmacy (53.0%vs.67.5%; p<0.01) used SSRI compared to those without polypharmacy. In multivariable logistic regression, African Americans had lower odds of SSRI use (AOR=0.28; 95% CI=0.09, 0.88) compared to NHWs. Lower ratings of physical health were associated with SSRI use. Adults with polypharmacy had lower odds of SSRI use (AOR=0.65; 95% CI=0.44, 0.96).
Conclusion:
6 in 10 adults with thyroid and depressive disorders used SSRIs. Racial disparities in SSRI use were observed. We speculate that SSRI use rates may be lower in those with polypharmacy and poor health to reduce the risk of drug-drug interactions and drug-disease interactions.
Strengths and Limitations:
Limitations include cross-sectional study design, self-reported data, no distinction between hyperthyroidism and hypothyroidism, and a small sample size despite pooling multiple years. Nevertheless, the study used nationally representative data adjusted for a comprehensive list of clinical, demographic, and psychosocial factors
The Baby Bites Text Messaging Project with randomized controlled trial: texting to improve infant feeding practices
Get PDFBACKGROUND: Rapid weight gain and overweight in infancy are associated with childhood obesity. Thus, effective, accessible interventions to promote healthy infant feeding practices to prevent early obesity are essential. METHODS: This mixed-methods study involved diverse parents of infants in an urban, low-income pediatric clinic. Qualitative interviews explored parental attitudes towards feeding, early obesity, and communication with the pediatrician. A pilot, randomized controlled trial (RCT) informed by feedback provided by clinic parents compared text messages delivered for 12 months promoting healthy feeding practices to usual care to prevent early pediatric obesity. A computer-generated randomization schedule with balanced distribution for sex was used to place infants into groups. Weight-for-length percentiles and z-scores and feeding practices were measured at 0-2 weeks (baseline), 2-4 months, 6-9 months, and 12 months. Interviews were recorded, transcribed, and coded using thematic analysis. Weight for length percentile, Weight for length z scores, and feeding practices were compared between groups using repeated measures mixed analysis of variance (ANOVA). RESULTS: Participants in the interviews were 15 parents of infants less than 1 month old. RCT participants were 38 parents of newborns (17 control; 21 intervention). Most parents in the qualitative evaluation viewed breastfeeding positively but also discussed barriers. Most also wanted practical information regarding infant feeding. There were no differences in weight-for-length percentile (F=0.52; P=0.60) or z-scores (F=0.7922; P=0.79), breastfeeding persistence chi(2)[1] =1.45, P=0.23, or age of introduction of solids in the intervention (statistical analysis not possible due to low counts) compared to the control group; however, low response to surveys limited the study's power. CONCLUSIONS: Text messaging has potential to extend the healthcare provider's communication beyond clinic. However, texting interventions should be flexible to mitigate barriers such as loss of phone service and challenges customizing messages to parent needs.This work was supported by the Texas Woman's University Research Enhancement Program
Legislature Impacting Transgender Health: A Literature Review Exploring the Possible Implications on Medical Providers
Get PDFThe 2023 midterm cycle saw an increase in bills restricting gender-affirming medical care for transgender Americans. These bills go against the standards of care for the treatment of gender dysmorphia. In this review, the laws from Texas, Oklahoma, and Florida were analyzed along with transgender healthcare literature to postulate the consequences for medical providers if these bills were passed. Additionally, literature describing similar experiences in restrictive healthcare law for undocumented people in the Latinx community were considered. This review showed that the bills from the 2023 midterm cycle poses financial, moral, and professional hardships on providers. To counteract these laws, it is necessary for providers to mobilize and voice their concerns as an advocate for their patients
Correlative Findings of Maternal and Placental Health with Congenital Heart Disease and Post-Operative Acute Kidney Injury
No full textPurpose: Acute kidney injury (AKI) is a common complication in pediatric patients with congenital heart disease (CHD) who undergo cardiopulmonary bypass (CPB). Besides established risk factors such as time on CPB, factors affecting fetal development may contribute to the prevalence of AKI within this population. Adverse intrauterine microenvironments associated with certain maternal conditions have been shown to impact nephrogenesis. These factors also increase the risk of preterm delivery, shortening the timeframe for nephrogenesis. Thus, infants that develop in these microenvironments may be predisposed to develop AKI when subjected to secondary insults such as CPB. This study aims to examine the incidence of AKI in this patient population and determine whether maternal or fetal variables predict the development of AKI. Methods: Retrospective review of electronic medical records of pediatric patients at Cook Children’s Medical Center (CCMC) between 3/1/2022 and 4/14/2022. Inclusion criteria were as follows: patients aged 0-12 months who underwent surgical repair or palliation of CHD with care in the cardiac intensive care unit (CICU). Data collected included maternal variables such as pre-eclampsia, gestational diabetes, obesity, and smoking status; individual variables such as gestational age and other congenital factors; and surgical variables such as CPB time and average PAO2 during CPB. AKI was determined using creatinine levels from established Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results: Twenty patients met inclusion criteria. No statistical significance was noted between maternal and surgical variables. Twenty percent of patients developed at least Stage 1 AKI. Conclusions: Identification of maternal risk factors for AKI in the pediatric population may allow further insight into the mechanisms of the development of AKI. Our results were impacted by the low power of our study. Inclusion of more patients into our study will positively impact our power
LABEL-FREE QUANTITATIVE PROTEOMICS REVEAL PROTEIN NETWORKS AND ASSOCIATED BIOLOGICAL PROCESSES IN ANDROGEN DEPRIVED MOUSE SEMINAL VESICLES IN RESPONSE TO 17-β-ESTRADIOL (E2) TREATMENT
No full textResearch Appreciation Day Award Winner - School of Biomedical Sciences, 2023 Department of Pharmacology & Neuroscience Award - 2nd PlacePurpose: Androgen deprivation therapy (ADT) remains the primary treatment strategy for inhibiting prostate cancer progression. However, systemic ablation of androgen-mediated signaling induces various metabolic disorders, cognitive decline, and osteoporosis. Therefore, like in menopausal women, 17-β-estradiol (E2) supplementation has been suggested as a treatment to reduce side effects associated with ADT. A recent clinical trial utilizing transdermal estrogen patches reported reduced osteoporosis markers and hot flashes. Estrogen receptors ER) are expressed in the male reproductive system and play a role alongside androgens in maintaining function and growth. Under normal physiological conditions, increased E2 concentrations induce an inhibitory effect on the size of the male reproductive organs, including the seminal vesicles (SV); however, under androgen depletion, E2 supplementation has been reported to reduce the atrophy of the SV in mice. In this study, we report for the first time a discovery-driven proteomic analysis of E2’s effects on the SV in mice under the conditions of surgical castration to model patients undergoing ADT. Methods: Surgically castrated mice (n=4) were subcutaneously injected with E2 (treated group) or vehicle (control) daily for five days and sacrificed to obtain SV. Proteins were extracted, reduced, alkylated, and digested with trypsin for analyses using data-dependent microflow liquid chromatography–electrospray ionization tandem mass spectrometry (LC–ESI-MS/MS) on LTQ Orbitrap Velos ProTM (Thermo Fisher Scientific). MS/MS data was searched against the UniProt Mouse protein database using Sequest in Proteome Discoverer (Thermo Fisher Scientific) and MaxQuant (Max Planck Institute). Validation of protein and label-free quantification (LFQ), combining spectral counting and total TIC, were performed using Scaffold (Proteome Software) to identify significantly affected proteins. Post-hoc t-test was performed to identify differences in protein abundances between groups. Regulated proteins we mapped to protein interaction networks and biological functions employing Ingenuity Pathway Analysis® (IPA®, Qiagen). Targeted proteomics- sed validation of significant candidate proteins is ongoing, and data will be analyzed using Skyline TM (MacCoss Lab, University of Washington). Results: Our discovery-driven LC–ESI-MS/MS analyses identified 7000 proteins with high confidence from the SV of E2-treated and control mice. IPA®-based bioinformatics of the E2-regulated proteins showed molecular and cellular functions-associated enrichment of carbohydrate metabolism, DNA replication, recombination, and repair, as well as free radical scavenging. The topmost regulated protein interaction network represented cell cycle, cell signaling, and small molecule biochemistry. Enhanced activation of the estrogen receptor β (ESR2) was implicated by the molecule activity predictor (MAP) tool of IPA®. Additionally, MAP predicted that the protein interaction represented within this network might impact disease and physiological processes associated with the proliferation of prostate cancer and regulation of gonadal cells. Furthermore, we were able to screen several preclinical biomarkers that participate in androgen receptor activity, modulating ER-mediated transcription and reproductive system development and function. Targeted proteomics-based validation of these biomarkers is ongoing. Conclusion: Our study aims to provide an in-depth account of the alterations occurring at the protein level in the SVs in response to E2 supplementation during ADT and to select and validate preclinical biomarkers for prognostic and therapeutic applications.This study was supported by a grant (CA215550) from the National Institutes of Health and by the Robert A. Welch Foundation (endowment BK-0031) to Dr. Laszlo Prokai
HPV and Other Vaccination Rates in Texas: Association with Racial and Ethnic Distribution
No full textAbstract
Presenter: Maya DePlaza
Authors: Maya DePlaza, Amil Dudhia, Sam Ferguson; Riyaz Basha,
Title: HPV and Other Vaccination Rates in Texas: Association with Racial and Ethnic Distribution
Background: Human Papilloma Virus (HPV) is a sexually transmitted disease responsible for ~70% of cervical cancer worldwide and can result in genital warts, anal, penile, and oropharyngeal cancers. Since the adoption of HPV vaccines, high-risk HPV incidences have decreased by 50%1. Vaccination is recommended from ages 11-26 and requires 3 doses to be up to date. While vaccination rates have increased, racial and ethnic minorities are less likely to complete the series, with rates of initiation and completion particularly low amongst African American adolescents2.
Objective: This project examined the association between rates of HPV and other regularly recommended vaccines at the national, state-wide, and county level with consideration given to racial and ethnic distribution.
Methods: Data was collected from the Centers of Disease Control and Prevention (CDC) and the National Immunization survey. Vaccination rates were compared between HPV, Tdap, and MenACWY vaccines at the national, state-wide, and county level3. Racial and ethnic makeup was also compared in these regions4.
Results: When compared to the Tdap and MenACWY vaccines, vaccination rates for HPV (UTD and ≥1 dose) were significantly lower across national, state-wide, and county levels. The national vaccination rate for HPV UTD and ≥1 dose were 48.6% and 65.5% while the rates for Tdap and MenACWY vaccinations were 88.7% and 85.1%. Additionally, Texas had an overall lower vaccination rate of 39.7%, 57.8% and 83.2% for HPV UTD, HPV ≥1 dose, and Tdap, respectively. Texas county vaccination rates were lowest in Dallas County with HPV UTD at 35.7%, HPV ≥1 dose at 54.5%, and Tdap at 77%. Dallas county has the highest percentage of African American and Hispanic residents when compared to other major Texas counties, Texas, and national average. The non-white population in Dallas county makes up 48.5% while it is 32.3% and 28.2% at the state and nation level.
Conclusion: While HPV vaccine rates have increased since its induction in 2006, it is still among the lowest vaccines received across all populations. This study suggests that there is a correlation between vaccination rates and racial/ethnic distributions. African Americans and Hispanics at the national and county level were shown to have the lowest vaccine rates, especially African American girls. Further analysis is required to determine the source of such health disparities and further links to socioeconomic factors.
References:
Jeudin P, et al. Race, ethnicity, and income factors impacting human papillomavirus vaccination rates. Clin Ther. 2014 Jan 1;36(1):24-37. doi: 10.1016/j.clinthera.2013.11.001. PMID: 24417783.
Hirth J. Disparities in HPV vaccination rates and HPV prevalence in the United States: a review of the literature. Hum Vaccin Immunother. 2019;15(1):146-155. doi: 10.1080/21645515.2018.1512453. Epub 2018 Sep 6. PMID: 30148974; PMCID: PMC6363146.
Boersma, Peter; Black, Lindsey. "Human Papillomavirus Vaccination Among Adults Aged 18−26.” DHHS Publication.
Center for Disease Control and Prevention. "Human Papillomavirus (HPV) Vaccination & Cancer Prevention.” CDC, July 2022, https://www.cdc.gov/vaccines/vpd/hpv/index.htm
Hypermethylation at CREBBP Is Associated with Cognitive Impairment in a Mexican American Cohort
No full textBACKGROUND: The aging Mexican American (MA) population is the fastest growing ethnic minority group in the US. MAs have a unique metabolic-related risk for Alzheimer's disease (AD) and mild cognitive impairment (MCI), compared to non-Hispanic whites (NHW). This risk for cognitive impairment (CI) is multifactorial involving genetics, environmental, and lifestyle factors. Changes in environment and lifestyle can alter patterns and even possibly reverse derangement of DNA methylation (a form of epigenetic regulation). OBJECTIVE: We sought to identify ethnicity-specific DNA methylation profiles that may be associated with CI in MAs and NHWs. METHODS: DNA obtained from peripheral blood of 551 participants from the Texas Alzheimer's Research and Care Consortium was typed on the Illumina Infinium® MethylationEPIC chip array, which assesses over 850K CpG genomic sites. Within each ethnic group (N = 299 MAs, N = 252 NHWs), participants were stratified by cognitive status (control versus CI). Beta values, representing relative degree of methylation, were normalized using the Beta MIxture Quantile dilation method and assessed for differential methylation using the Chip Analysis Methylation Pipeline (ChAMP), limma and cate packages in R. RESULTS: Two differentially methylated sites were significant: cg13135255 (MAs) and cg27002303 (NHWs) based on an FDR p < 0.05. Three suggestive sites obtained were cg01887506 (MAs) and cg10607142 and cg13529380 (NHWs). Most methylation sites were hypermethylated in CI compared to controls, except cg13529380 which was hypomethylated. CONCLUSION: The strongest association with CI was at cg13135255 (FDR-adjusted p = 0.029 in MAs), within the CREBBP gene. Moving forward, identifying additional ethnicity-specific methylation sites may be useful to discern CI risk in MAs.This research project was supported (in part) by funding provided to the Texas Alzheimer's Research and Care Consortium by the Darrell K Royal Texas Alzheimer's Initiative, directed by the Texas Council on Alzheimer's Disease and Related Disorders. This work was also supported by the Office of Vice President for Research and Innovation, the Institute for Healthy Aging, and National Institutes of Health/National Institute on Aging (T32 AG020494) (2018 and 2020) including half predoctoral international fellowship through the Neurobiology of Aging and Alzheimer's Disease (NBAAD) Training Program 2021-2022 and R01AG070862 to RCB
Leading Predictors of COVID-19-Related Poor Mental Health in Adult Asian Indians: An Application of Extreme Gradient Boosting and Shapley Additive Explanations
No full textDuring the COVID-19 pandemic, an increase in poor mental health among Asian Indians was observed in the United States. However, the leading predictors of poor mental health during the COVID-19 pandemic in Asian Indians remained unknown. A cross-sectional online survey was administered to self-identified Asian Indians aged 18 and older (N = 289). Survey collected information on demographic and socio-economic characteristics and the COVID-19 burden. Two novel machine learning techniques-eXtreme Gradient Boosting and Shapley Additive exPlanations (SHAP) were used to identify the leading predictors and explain their associations with poor mental health. A majority of the study participants were female (65.1%), below 50 years of age (73.3%), and had income >/= $75,000 (81.0%). The six leading predictors of poor mental health among Asian Indians were sleep disturbance, age, general health, income, wearing a mask, and self-reported discrimination. SHAP plots indicated that higher age, wearing a mask, and maintaining social distancing all the time were negatively associated with poor mental health while having sleep disturbance and imputed income levels were positively associated with poor mental health. The model performance metrics indicated high accuracy (0.77), precision (0.78), F1 score (0.77), recall (0.77), and AUROC (0.87). Nearly one in two adults reported poor mental health, and one in five reported sleep disturbance. Findings from our study suggest a paradoxical relationship between income and poor mental health; further studies are needed to confirm our study findings. Sleep disturbance and perceived discrimination can be targeted through tailored intervention to reduce the risk of poor mental health in Asian Indians.This research was, in part, funded by the National Institutes of Health Agreement No. 1OT2OD032581 AIM-AHEAD (Usha Sambamoorthi, Jamboor K Vishwanatha), National Institutes of Health- NIH/1OT2HL158258 Texas CEAL Alliance (Usha Sambamoorthi, Jamboor K Vishwanatha), and the National Institute on Minority Health and Health Disparities through the Texas Center for Health Disparities (NIMHD), 5U54MD006882 (Usha Sambamoorthi, Jamboor K Vishwanatha). The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies, either expressed or implied, of the NIH
Assessing Postural Sway Among Older Adult Females with Hypertension
No full textPurpose: Hypertension and use of antihypertensive medications have been generally suggested as risk factors for falls; however, supporting evidence remains unclear on the link between hypertension and balance. With minimal research assessing postural control using a force plate among older adults with hypertension, the purpose of this study is to evaluate the relationship between postural sway and blood pressure status and identify variables that contribute to falls.
Methods: This study is a retrospective, matched case-control analysis incorporating Quiet Stance Test data from the UNTHSC Human Movement Performance Lab for a case group of older adult females aged 55 to 94 with hypertension (n=100) and an age-matched and gender-matched normotensive control group (n=44) generated from previous studies conducted through the UNTHSC HMP Lab. The Quiet Stance Test involved participants standing barefoot with disposable foot covers, on pre-marked footprints on a force plate (Bertec, Columbus, OH and BioSway, Shirley, NY), both arms relaxed on the sides while looking at an eye-level target for three 10-second trials each in eyes open (EO) and eyes closed (EC) conditions. Twenty sway variables were analyzed using Paired Samples t-Test. Data were also stratified for age and height for One-Way ANOVA and Pearson Correlation tests. Tables were generated to compare mean differences between case and control groups in the EO and EC conditions. (UNTHSC IRB# 2013-102)
Results: Participants’ ages ranged from 55 to 90 (M=70.7, SD=9.3) and height from 1.45m to 1.78m (M=1.62, SD=0.07) in the case group. In the control group, participants’ ages ranged from 57 to 89 (M=68.8, SD=6.0) and height from 1.47m to 1.73m (M=1.62, SD=0.06). Roughly 80% of all participants identified as White. The Paired Samples t-Test comparing EC and EO conditions revealed significant mean differences (p<.001) for thirteen of twenty sway variables in the case group. Meanwhile, the control group showed no significant mean differences in any variable. The mean differences for four of twenty sway variables were significant (p<.001) for at least one of the height subgroups in the case group (EC condition), while the control group had no significant mean differences. The only variable that was found to have significant (p<.001) mean differences for at least one of the age subgroups is rotational frequency for the case group (EC condition). For the same group and condition, a significant positive correlation was found between rotational frequency and age (r=0.404, p<.001). The center of pressure’s (COP) position is dynamic. Rotational frequency is a measure of COP instability and is the mean velocity of the COP traveling over a circular path defined by the mean displacement from the center position of the COP stabilogram.
Conclusion: These findings suggest there may be differences in balance between normotensive and hypertensive older adult females related to age and height. A limitation of this study is that the sampling of convenience included hypertensive subjects that also have back pain concerns. Further studies should include male participants, create more racially diverse research cohorts, and consider comorbidities as variables that may provide insight into other influences on sway