Association of anxiety and depressive symptoms with C-reactive protein in diverse Latinos: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

BACKGROUND: High sensitivity C-reactive protein (hsCRP) is a marker of systemic inflammation that has been associated with persistent depressive symptoms. Depression and anxiety are frequently associated with a chronic inflammatory state, yet the nature of this relationship has not been rigorously examined in diverse Hispanic/Latino populations. We aimed to study the association of anxiety and depressive symptoms as well as comorbid presentations, with circulating high sensitivity C-reactive protein (hsCRP) levels in a large Latino cohort of diverse heritages. We hypothesized a significant positive associations of both anxiety and depressive symptoms and hsCRP levels and potential variations among the heritage groups. METHODS: Depressive symptoms and anxiety were measured by the Center for Epidemiological Studies Depression Scale (CES-D) and State-Trait Anxiety Inventory (STAI), respectively. Serum hsCRP (hsCRP) levels of 15,448 participants (age 18 to 75 years; 52.3% women) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were measured and categorized based on the established cardiovascular disease (CVD) risk reference values (< 1mg/L, low; 1-<3 mg/L, intermediate; ≥ 3mg/L, high). RESULTS: Mean CES-D, STAI scores, and hsCRP levels were 7.0 (SD = 5.9), 17.0 (SD = 5.7), and 3.84 (SD = 7.85), respectively. Generalized linear modeling, adjusted for sociodemographic characteristics revealed significant associations between depression (exp(ß) = 1.12; p<0.01) and anxiety symptoms (exp(ß) = 1.10; p<0.05) with continuous hsCRP levels. For categorical values of hsCRP, one SD increase in CES-D and STAI scores was associated with a 10% and 8% increase in the RRRs of high vs. low hsCRP, respectively. However, these relationships between CES-D or STAI and hsCRP were no longer statistically significant after adjustment for CVD risk factors and medications. CONCLUSION: We found modest associations between anxiety and depressive symptoms and systemic inflammation measured by hsCRP among diverse Hispanics/Latinos that did not appreciably differ between heritage groups.

Retrospective analysis of long-term outcome 10 years after liver transplantation for Wilson disease: experience over three decades.

We evaluated long-term outcomes for patients with Wilson disease (WD) after liver transplantation (LT) and searched for risk factors for poor survival. Retrospective analysis of UNOS/OPTN data identified 156 pediatric and 515 adult cases of LT for WD between 1987 and 2016. Comparison cases were 10 442 pediatric and 104 874 adult non-WD transplant recipients. Survival was calculated using Kaplan-Meier analysis. Recipient, donor, and surgical variables were compared by Cox regression. Survival rates 3, 5, and 10 years after LT for adult WD patients (87.5%, 85.4%, and 80.5%, respectively) were significantly higher than those for non-WD patients (P < 0.001); survival rates for pediatric WD patients (90.5%, 89.7%, and 86.5%, respectively) did not differ significantly from non-WD patients. Graft survival in adult and pediatric patients followed similar trends. Regression analysis identified older age, female gender, and use of life support at the time of transplant as risk factors for decreased survival for adults with WD, and younger age, male gender, obesity, and high serum creatinine at the time of transplant as risk factors for poor survival in pediatric recipients with WD. Presentation with fulminant liver failure was not associated with survival in WD patients. No donor characteristic predicted poor survival. Long-term patient and graft survival after LT is excellent for both adult and pediatric WD patients.

Favorable Sustained Virologic Response Rates Using Direct-Acting Antiviral Therapies at a Large Safety-Net Hospital.

BACKGROUND: Direct-acting antivirals (DAA) have revolutionized the treatment of chronic hepatitis C virus (HCV) infection. OBJECTIVE: To evaluate the clinical effectiveness of DAA in a safety-net population. METHODS: Retrospective cohort study including patients who received at least one dose of DAA for chronic HCV infection. Primary outcome was sustained virologic response (SVR) defined as undetectable viral load at least 12 weeks after treatment termination. RESULTS: Notable patient (n=174) characteristics included: 58% racial/ethnic minority group members, 34% Medicaid or uninsured, and 51% cirrhosis. Overall, SVR was 87.4%, including 15 patients who were lost to follow-up and deemed treatment failures. Multivariate analysis significantly associated completion of therapy on time (OR 4.55, p=.009) and the presence of insurance (OR 7.25, p=0.008) with SVR. CONCLUSION: A favorable rate of SVR can be obtained in a safety-net population. The majority of treatment failure was due to patients being lost to follow-up.

Differences in BMI between Mexican and Colombian patients receiving antipsychotics: results from the International Study of Latinos on Antipsychotics (ISLA).

Objective: The objective of this study is to examine the association of country of residence with body mass index (BMI) between Mexican and Colombian patients exposed to antipsychotics. We hypothesize that there will be a significant association between country of residence and BMI and that Mexican patients will have higher BMI than their Colombian counterparts.Design: The International Study of Latinos on Antipsychotics (ISLA) is a multisite, international, cross sectional study of adult Latino patients exposed to antipsychotics in two Latin American Countries (i.e. Mexico and Colombia). Data were collected from a total of 205 patients (149 from Mexico and 56 from Colombia). The sites in Mexico included outpatient clinics in Mexicali, Monterrey and Tijuana. In Colombia, data were collected from outpatient clinics in Bogotá. For this study we included patients attending outpatient psychiatric community clinics that received at least one antipsychotic (new and old generation) for the last 3 months. A linear regression model was used to determine the association of country of residence with BMI for participants exposed to an antipsychotic.Results: After controlling for demographics, behaviors, biological and comorbid psychiatric variables, there was a significant difference between Colombia vs. Mexico in the BMI of patients exposed to antipsychotics (ß = 4.9; p < 0.05).Conclusion: Our hypotheses were supported. These results suggest that differences in BMI in patients exposed to antipsychotics in Mexico and Colombia may reflect differences in prevalence of overweight/obesity at the population level in the respective countries, and highlights the involvement of other risk factors, which may include genetics.

Development and testing of a model for risk and protective factors for eating disorders and higher weight among emerging adults: A study protocol.

Research has demonstrated that eating disorders (ED) and higher weight have lifetime co-occurrence suggesting that they may be best considered within a common etiological model. Although we know that body dissatisfaction is likely to be a risk factor for both outcomes, other proposed risk and protective factors for each condition have not been adequately explored. The current paper tests a conceptual model that is based on a review of the existing literature from both areas of scholarship. It considers biological, sociocultural, psychological, and behavioral factors that may contribute to both outcomes. The model will be tested in a longitudinal design with an initial sample of 600 emerging adults (aged 18-30) per country in nine different countries (total sample = 5400 participants). Questionnaires will be completed online on two occasions, 12 months apart. The first full phase of the study commenced in July 2018, the same time Body Image was approached to publish this protocol paper (the final revised paper was submitted in September 2019), and data collection will be finalized in December 2019. Multi-group path analysis will identify the biopsychosocial predictors - both cross-sectionally and longitudinally - of both ED and higher weight, and how these vary across countries and gender.

Psychometric evaluation of the Hospital Anxiety and Depression Scale in Mexican adults with ischemic and hypertensive cardiomyopathy.

Background: Depression and anxiety are frequent comorbid conditions in cardiovascular diseases (CVDs); they are related to poor prognosis and higher mortality risk. Health providers need a clinical tool to identify these psychiatric conditions. The 14-item hospital anxiety and depression scale (HADS) is a screening tool used in patients with different medical conditions. Objective: The aim of this study was to evaluate the psychometric properties of the HADS Mexican Spanish version in a broad sample of Mexican patients with CVDs. Materials and Methods: A total of 953 individuals between 18 and 75 years old with ischemic or hypertensive cardiomyopathy were screened with the HADS Mexican Spanish version. Construct validity, internal consistency, and congruence coefficients of the scale were obtained. Results: The results showed two clear factors which correspond to the original two designated domains of the HADS, anxiety, and depression, with adequate reliability values (alpha > 0.80) and high congruence coefficients (> 0.90) when compared to the sample of other validation studies of the HADS. Conclusions: The present study adds evidence of the validity and reliability of the HADS to assess the presence of both depression and anxiety in Mexican patients with CVD. Its central contribution is that it demonstrates its capacity to differentiate the presence and severity of depression and anxiety in this population.

Antecedentes: La depresión y la ansiedad son afecciones comórbidas frecuentes en las enfermedades cardiovasculares; se relacionan con mal pronóstico y mayor riesgo de mortalidad. Los proveedores de salud requieren de una herramienta clínica para identificar estas condiciones psiquiátricas. La Escala de Ansiedad y Depresión Hospitalaria de 14 ítems (HADS) es una herramienta de detección utilizada en pacientes con diferentes afecciones médicas. Objetivo: Evaluar las propiedades psicométricas de la versión mexicana-española de la HADS en una amplia muestra de pacientes mexicanos con enfermedades cardiovasculares (ECV). Método: Un total de 953 individuos entre 18 y 75 años de edad con cardiomiopatía isquémica o hipertensiva se examinaron con la versión Mexicana en español de la HADS. Se obtuvieron la validez de constructo, la consistencia interna y los coeficientes de congruencia de la escala. Resultados: Los resultados mostraron dos factores que corresponden a los dos dominios designados originales de la HADS, ansiedad y depresión, con valores de confiabilidad adecuados (alfa > 0.80) y altos coeficientes de congruencia (> 0.90) en comparación con la muestra de otros estudios de validación de la HADS. Conclusiones: El presente estudio sustenta la validez y confiabilidad de la HADS para evaluar la presencia de depresión y ansiedad en pacientes Mexicanos con ECV. Su contribución central es su capacidad para diferenciar la presencia y la gravedad de la depresión y la ansiedad en esta población.

Psychometric evaluation of the Hospital Anxiety and Depression Scale in Mexican adults with ischemic and hypertensive cardiomyopathy / Evaluación psicométrica de la Escala de Ansiedad y Depresión Hospitalaria en adultos Mexicanos con cardiopatía isquémica e hipertensiva

Abstract Background: Depression and anxiety are frequent comorbid conditions in cardiovascular diseases (CVDs); they are related to poor prognosis and higher mortality risk. Health providers need a clinical tool to identify these psychiatric conditions. The 14-item hospital anxiety and depression scale (HADS) is a screening tool used in patients with different medical conditions. Objective: The aim of this study was to evaluate the psychometric properties of the HADS Mexican Spanish version in a broad sample of Mexican patients with CVDs. Materials and Methods: A total of 953 individuals between 18 and 75 years old with ischemic or hypertensive cardiomyopathy were screened with the HADS Mexican Spanish version. Construct validity, internal consistency, and congruence coefficients of the scale were obtained. Results: The results showed two clear factors which correspond to the original two designated domains of the HADS, anxiety, and depression, with adequate reliability values (alpha > 0.80) and high congruence coefficients (> 0.90) when compared to the sample of other validation studies of the HADS. Conclusions: The present study adds evidence of the validity and reliability of the HADS to assess the presence of both depression and anxiety in Mexican patients with CVD. Its central contribution is that it demonstrates its capacity to differentiate the presence and severity of depression and anxiety in this population.

Resumen Antecedentes: La depresión y la ansiedad son afecciones comórbidas frecuentes en las enfermedades cardiovasculares; se relacionan con mal pronóstico y mayor riesgo de mortalidad. Los proveedores de salud requieren de una herramienta clínica para identificar estas condiciones psiquiátricas. La Escala de Ansiedad y Depresión Hospitalaria de 14 ítems (HADS) es una herramienta de detección utilizada en pacientes con diferentes afecciones médicas. Objetivo: Evaluar las propiedades psicométricas de la versión mexicana-española de la HADS en una amplia muestra de pacientes mexicanos con enfermedades cardiovasculares (ECV). Método: Un total de 953 individuos entre 18 y 75 años de edad con cardiomiopatía isquémica o hipertensiva se examinaron con la versión Mexicana en español de la HADS. Se obtuvieron la validez de constructo, la consistencia interna y los coeficientes de congruencia de la escala. Resultados: Los resultados mostraron dos factores que corresponden a los dos dominios designados originales de la HADS, ansiedad y depresión, con valores de confiabilidad adecuados (alfa > 0.80) y altos coeficientes de congruencia (> 0.90) en comparación con la muestra de otros estudios de validación de la HADS. Conclusiones: El presente estudio sustenta la validez y confiabilidad de la HADS para evaluar la presencia de depresión y ansiedad en pacientes Mexicanos con ECV. Su contribución central es su capacidad para diferenciar la presencia y la gravedad de la depresión y la ansiedad en esta población.

Psychometric evaluation of the Hospital Anxiety and Depression Scale in Mexican adults with ischemic and hypertensive cardiomyopathy.

Background: Depression and anxiety are frequent comorbid conditions in cardiovascular diseases (CVDs); they are related to poor prognosis and higher mortality risk. Health providers need a clinical tool to identify these psychiatric conditions. The 14-item hospital anxiety and depression scale (HADS) is a screening tool used in patients with different medical conditions. Objective: The aim of this study was to evaluate the psychometric properties of the HADS Mexican Spanish version in a broad sample of Mexican patients with CVDs. Materials and Methods: A total of 953 individuals between 18 and 75 years old with ischemic or hypertensive cardiomyopathy were screened with the HADS Mexican Spanish version. Construct validity, internal consistency, and congruence coefficients of the scale were obtained. Results: The results showed two clear factors which correspond to the original two designated domains of the HADS, anxiety, and depression, with adequate reliability values (alpha > 0.80) and high congruence coefficients (> 0.90) when compared to the sample of other validation studies of the HADS. Conclusions: The present study adds evidence of the validity and reliability of the HADS to assess the presence of both depression and anxiety in Mexican patients with CVD. Its central contribution is that it demonstrates its capacity to differentiate the presence and severity of depression and anxiety in this population.

Antecedentes: La depresión y la ansiedad son afecciones comórbidas frecuentes en las enfermedades cardiovasculares; se relacionan con mal pronóstico y mayor riesgo de mortalidad. Los proveedores de salud requieren de una herramienta clínica para identificar estas condiciones psiquiátricas. La Escala de Ansiedad y Depresión Hospitalaria de 14 ítems (HADS) es una herramienta de detección utilizada en pacientes con diferentes afecciones médicas. Objetivo: Evaluar las ­propiedades psicométricas de la versión mexicana-española de la HADS en una amplia muestra de pacientes mexicanos con enfermedades cardiovasculares (ECV). Método: Un total de 953 individuos entre 18 y 75 años de edad con cardiomiopatía isquémica o hipertensiva se examinaron con la versión Mexicana en español de la HADS. Se obtuvieron la validez de constructo, la consistencia interna y los coeficientes de congruencia de la escala. Resultados: Los resultados mostraron dos factores que corresponden a los dos dominios designados originales de la HADS, ansiedad y depresión, con valores de confiabilidad adecuados (alfa > 0.80) y altos coeficientes de congruencia (> 0.90) en comparación con la muestra de otros estudios de validación de la HADS. Conclusiones: El presente estudio sustenta la validez y confiabilidad de la HADS para evaluar la presencia de depresión y ansiedad en pacientes Mexicanos con ECV. Su contribución central es su capacidad para diferenciar la presencia y la gravedad de la depresión y la ansiedad en esta población.

Family factors mediate discrimination related stress and externalizing symptoms in rural Latino adolescents.

INTRODUCTION: Externalizing disorders are more prevalent in rural than urban settings and account for disproportionately high mental health service costs for rural adolescents. Although cultural stressors such as discrimination have been associated with externalizing problems in ethnic minority youth broadly, this relationship is understudied in Latinos, particularly those in rural settings. Further, though the associations of family processes such as familism and family conflict have been studied in relation to youth externalizing symptoms, whether these processes change in the face of adolescent discrimination stress remains unknown. METHODS: A moderated multiple mediation model was used to examine the association between perceived discrimination, externalizing symptoms, and the indirect effect of family factors (familism, and family conflict) in a large sample (n = 455) of rural Latino youth. We also evaluated whether indirect and direct effects of discrimination on externalizing symptoms differed in boys versus girls. RESULTS: Familism and family conflict each independently mediated the relationship between discrimination related stress and externalizing symptoms. However, discrimination had a direct effect on externalizing symptoms for boys only. In girls, this association held only when family factors were accounted for. Post-hoc analyses reveal that the moderating effect of sex on discrimination is driven by differences in rule-breaking behavior, as opposed to aggressive behavior. CONCLUSION: Findings suggest that discrimination is associated with changes in the family environment which in turn invoke elevated risk for externalizing problems. Further, family-focused interventions that address externalizing problems may be especially effective for adolescent girls.

Telephone-assisted, parent-mediated CBT for rural Latino youth with anxiety: A feasibility trial.

OBJECTIVE: In this study, we tailor a child anxiety cognitive-behavior therapy (CBT) program to fit the needs of rural Latino/a Spanish-speaking families and examine the feasibility, acceptability, tolerability, and safety of this intervention using 2 modes of service delivery. METHOD: Children (n = 31; age 8-13) with anxiety disorders were recruited from primary care settings and randomized to 1 of 2 modes of parent-mediated CBT bibliotherapy: (1) telephone-delivered, therapist-assisted bibliotherapy (TTB; n = 15), and (2) a more minimal contact, self-directed, bibliotherapy condition (SB; n = 16). Independent evaluators administered a diagnostic interview at baseline and posttreatment; demographic and engagement-related questionnaires were also administered. RESULTS: In the TTB group, 10 of 15 parents (66.7%) completed the requisite number of therapist-assisted bibliotherapy sessions, and in the SB group, 4 of 16 parents (25%) completed the requisite number of self-directed bibliotherapy modules; this comparison was significant, χ2(1) = 5.43, p = .02. In the TTB condition, treatment length and session duration were longer than reported in previous studies. Barriers that were most strongly endorsed were stressors and obstacles competing with treatment, as well as treatment demandingness. Findings revealed good satisfaction across the conditions, although ratings were significantly higher in the TTB group, F = 5.67, p = .028. Remission rates (i.e., no anxiety disorder) for those that provided posttreatment data (N = 25) were 50% and 36% for the TTB and SB groups, respectively, χ2(1) = .465, p = .50. CONCLUSIONS: Implications of these feasibility findings and suggestions for future research are discussed. (clinicaltrials.gov unique identifier: NCT01491880). (PsycINFO Database Record

Anxious Depression and Neurocognition among Middle-Aged and Older Hispanic/Latino Adults: Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Results.

OBJECTIVE: The purpose of this study is to examine the association between verbal learning, fluency, and processing speed with anxious depression symptomatology (ADS) among diverse Hispanics. We hypothesized an inverse association of anxious depression with neurocognition among Hispanics of different heritage. DESIGN: Data are from the Hispanic Community Health Study/Study of Latinos. The sample included 9,311participants aged 45-74 years (mean: 56.5 years). A latent class analysis of items from the Center for Epidemiological Studies for Depression scale and the Spielberger Trait Anxiety Inventory was used to derive an anxious depression construct. Neurocognitive measures included scores on the Brief Spanish English Verbal Learning Test (B-SEVLT, learning and recall trials), Word Fluency (WF), Digit Symbol Substitution (DSS) test, and a Global Cognitive Score (GCS). We fit survey linear regression models to test the associations between anxious depression symptomatology and cognitive function. We tested for effect modification by sex, Hispanic heritage, and age groups. RESULTS: Among men, 71.6% reported low, 23.3% moderate, and 5.1% high ADS. Among women, 55.1% reported low, 33.2% moderate, and 11.8% high ADS. After controlling for age, sex, sociodemographic characteristics, cardiovascular risk factors and disease, and antidepressant use, we found significant inverse associations between moderate and high anxious depression (ref:low) with B-SEVLT learning and recall, DSS and GCS. Moderate, but not high, anxious depression was inversely associated with WF. Associations were not modified by sex, Hispanic heritage, or age. CONCLUSIONS: Increased anxious depression symptomatology is associated with decreased neurocognitive function among Hispanics. Longitudinal studies are needed to establish temporality and infer if negative emotional symptoms precede cognitive deficits.

Psychosocial Factors in the Relationship between Socioeconomic Status and Cardiometabolic Risk: the HCHS/SOL Sociocultural Ancillary Study.

BACKGROUND: U.S. Hispanics/Latinos display a high prevalence of metabolic syndrome (MetSyn), a group of co-occurring cardiometabolic risk factors (abdominal obesity, impaired fasting glucose, dyslipidemia, elevated blood pressure) associated with higher cardiovascular disease and mortality risk. Low socioeconomic status (SES) is associated with higher risk for MetSyn in Hispanics/Latinos, and psychosocial factors may play a role in this relationship. PURPOSE: This cross-sectional study examined psychosocial factors in the association of SES and MetSyn components in 4,996 Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. METHODS: MetSyn components were measured at the baseline examination. Participants completed interviews to determine psychosocial risks (e.g., depression) and resources (e.g., social support) within 9 months of baseline (< 4 months in 72.6% of participants). Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to identify latent constructs and examine associations. RESULTS: Participant mean age was 41.7 years (SE = 0.4) and 62.7% were female. CFA identified single latent factors for SES and psychosocial indicators, and three factors for MetSyn [blood pressure, lipids, metabolic factors]. SEMs showed that lower SES was related to MetSyn factors indirectly through higher psychosocial risk/lower resources (Y-Bχ2 (df = 420) = 4412.90, p < .05, RMSEA = .042, SRMR = .051). A statistically significant effect consistent with mediation was found from lower SES to higher metabolic risk (glucose/waist circumference) via psychosocial risk/resource variables (Mackinnon's 95% asymmetric CI = -0.13 to -0.02). CONCLUSIONS: SES is related to metabolic variables indirectly through psychosocial factors in U.S. Hispanics/Latinos of diverse ancestries.

Delivering CBT to Rural Latino Children with Anxiety Disorders: A Qualitative Study.

Qualitative methods were used to understand community perspectives about ways to deliver cognitive behavior therapy (CBT) to rural Latino youth with anxiety. First, four focus groups were conducted with 28 bilingual Latino mental health providers to examine perceptions of CBT using telephone based, therapist supported bibliotherapy, and bibliotherapy without therapist support. Second, qualitative interviews were conducted with 15 Latino parents from a rural community to better understand attitudes toward CBT, and modes of service delivery. Qualitative findings revealed that parents were mostly positive about psychotherapy, and the core elements of CBT for anxiety. However, both parents and providers emphasized the need for adaptations to address practical and perceived barriers to treatment, such as time, convenience, homework, and literacy. Many parents spoke favorably of a telephone-based approach that could address many of their perceived barriers, while providers were expressed more negative views. Such findings are important for data-driven treatment development efforts.

Measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D 10): Findings from HCHS/SOL.

The Center for Epidemiologic Studies Depression Scale (CES-D) is a widely used self-report measure of depression symptomatology. This study evaluated the reliability, validity, and measurement invariance of the CES-D 10 in a diverse cohort of Hispanics/Latinos from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The sample consisted of 16,415 Hispanic/Latino adults recruited from 4 field centers (Miami, FL; San Diego, CA; Bronx, NY; Chicago, IL). Participants completed interview administered measures in English or Spanish. The CES-D 10 was examined for internal consistency, test-retest reliability, convergent validity, and measurement invariance. The total score for the CES-D 10 displayed acceptable internal consistencies (Cronbach's alpha's = .80-.86) and test-retest reliability (r values = .41-.70) across the total sample, language group and ethnic background group. The total CES-D 10 scores correlated in a theoretically consistent manner with the Spielberger State-Trait Anxiety Inventory, r = .72, p < .001, the Patient Health Questionnaire-9 depression measure, r = .80, p < .001, the Short Form-12's Mental Component Summary, r = -.65, p < .001, and Physical Component Summary score, r = -.25, p < .001. A confirmatory factor analysis showed that a 1-factor model fit the CES-D 10 data well (CFI = .986, RMSEA = .047) after correlating 1 pair of item residual variances. Multiple group analyses showed the 1-factor structure to be invariant across English and Spanish speaking responders and partially invariant across Hispanic/Latino background groups. The total score of the CES-D 10 can be recommended for use with Hispanics/Latinos in English and Spanish. (PsycINFO Database Record

Interferon-based hepatitis C therapy in a safety net hospital: access, efficacy, and safety.

AIMS: This study assesses the efficacy, accessibility, and safety of hepatitis C virus (HCV) treatment in a safety net hospital population. METHODS: Patients at Denver Health receiving pegylated interferon for HCV infection between 2008 and 2012 were included in this retrospective study. Sociodemographic, biochemical, and virologic data were collected on each patient. The primary outcomes were the rate of sustained virologic response and early treatment discontinuation, with reason for discontinuation documented. Multivariable analyses were performed to identify factors associated with the primary outcomes. RESULTS: Detectable HCV antibodies were found in 2912 patients, and 1630 had a detectable viral load. Eighty percent of these patients were uninsured/underinsured. Only 46% were seen in the hepatology clinic, and 8% received interferon-based HCV treatment. Of the 125 patients treated with interferon-containing regimens, 54% had genotype 1 infection. The overall rate of sustained virologic response (SVR) was 47%. Rapid virologic response, low FIB-4 score combined with age, and increasing number of days on therapy were associated with SVR in multivariable analysis. Therapy was prematurely discontinued in 43% of patients related to being lost to follow-up (30%), null response (24%), and intolerance to pegylated interferon/ribavirin (24%). Genotype 1 infection and unfavorable viral kinetics were associated with premature treatment discontinuation in multivariable analysis. There were no statistically significant associations between age, sex, ethnicity, race, diabetes, BMI, psychiatric comorbidities, income, employment status, homelessness, or insurance status and the primary outcomes. CONCLUSION: An acceptable SVR rate is achievable in a safety net patient population. Addressing the barriers to care will be paramount when using direct-acting antivirals.

La epidemia de la obesidad en España: la retórica de su discurso y riesgos potenciales / A epidemia de obesidade na Espanha: a retórica do seu discurso e riscos potenciais / The obesity epidemic in spain: the rhetoric of its discourse and potential risks

Resumen: La obesidad se ha convertido en una prioridad para las políticas de salud pública en España. Basándose en el aumento de su prevalencia ha sido catalogada como una epidemia. A pesar de estas afirmaciones, las investigaciones no parecen siempre tan concluyentes. El objetivo de este artículo es revisar algunas de las 'verdades' en torno a la obesidad: a) que la obesidad va en aumento y es una epidemia en España; b) que existe una relación directa entre peso y salud; y c) que la obesidad tenga su consecuencia única en el desequilibrio entre gasto y consumo energético. Además, dado que las ideas vertidas en torno a la epidemia de la obesidad, y el modo exagerado y alarmista en que se produce, pueden tener consecuencias dañinas e impredecibles sobre la salud de las personas, un segundo objetivo es delinear algunos de los posibles riesgos de estas prácticas de comunicación. (AU)

Resumo: A obesidade tornou-se uma prioridade para as políticas de saúde pública na Espanha. Com base no aumento da prevalência foi classificada como uma epidemia. Apesar dessas afirmações, as investigações nem sempre parecem tão conclusivas. O objetivo deste artigo é analisar algumas das 'verdades' sobre a obesidade: a) que a obesidade está aumentando e é uma epidemia em Espanha; b) existe uma relação direta entre peso e saúde; e c) que a obesidade tenha uma consequência única em um desequilíbrio entre gasto e consumo de energia. Além disso, uma vez expressas as ideias sobre a epidemia da obesidade, a maneira exagerada e alarmista que ocorre pode ter consequências imprevisíveis sobre a saúde das pessoas; um segundo objetivo é delinear alguns dos possíveis riscos dessas práticas de comunicação. (AU)

Abstract: Obesity has become a top priority for public health policies in Spain. Based on increasing prevalence, it has been classified as an epidemic. Despite these claims, research does not always seem so conclusive. The purpose of this article is to review some of the 'truths' about obesity: a) that it is on the rise and is an epidemic in Spain; b) that there is a direct relationship between weight and health; c) that its sole effect is the imbalance between energy expenditure and intake. In addition, since the ideas expressed about the obesity epidemic and the exaggerated and alarmist way they are produced might have harmful and unpredictable consequences on people's health, a second aim is to point out some of the possible risks inherent in those communication practices. (AU)

Antidepressant Use and Subclinical Measures of Atherosclerosis: The Multi-Ethnic Study of Atherosclerosis.

BACKGROUND: Antidepressants are commonly prescribed medications used in primary care. The cardiovascular safety profile of antidepressant medications, in terms of subclinical atherosclerosis, is underexamined. METHODS: A total of 6814 participants in the Multi-Ethnic Study of Atherosclerosis were examined. At baseline, the mean age was 62 years with 4 race/ethnic groups represented: European Americans (38%), Hispanic Americans (23%), African Americans (28%), and Chinese Americans (11%). Antidepressants were subgrouped as serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and "other" (bupropion, nefazodone, trazodone, mirtazapine). After adjusting for potential confounders, we estimated the association between antidepressant use and the following measures of subclinical atherosclerosis: coronary artery calcium (CAC), the ankle-brachial index, and carotid intima-media thickness, both cross-sectionally and prospectively. RESULTS: A total of 324 participants were exposed to SSRIs, 88 to TCAs, 41 to SNRIs, and 123 to other antidepressants. For CAC incidence, the fully adjusted longitudinal analyses revealed no consistent associations with SSRIs (relative risk [RR], 0.99; 95% confidence interval [CI], 0.71-1.37), SNRIs (RR, 0.49; 95% CI, 0.13-1.86), TCAs (RR, 0.94; 95% CI, 0.50-1.77), other antidepressant (RR, 0.87; 95% CI, 0.73-1.03) exposure, and subclinical disease. Similar null results were obtained in the cross-sectional and longitudinal exposure to antidepressants with changes in baseline CAC greater than 0, ankle-brachial index, and carotid intima-media thickness. CONCLUSIONS: The results of the current study do not support an association between antidepressants and subclinical atherosclerosis.

Life's Simple 7's Cardiovascular Health Metrics are Associated with Hispanic/Latino Neurocognitive Function: HCHS/SOL Results.

BACKGROUND: Hispanics/Latinos are purportedly at increased risk for neurocognitive decline and dementias. Without dementia cures, low-cost, well-tolerated public health means for mitigating neurocognitive decline are needed. OBJECTIVE: We examined associations between neurocognition and cardiovascular health (CVH) metrics (Life's Simple 7; LS7) among diverse Hispanics/Latinos. We hypothesized that higher LS7 would be associated with healthier brain function (neurocognitive performance). METHODS: We used baseline (2008-2011) Hispanic Community Health Study/Study of Latinos (HCHS/SOL; N = 9,623; ages 45-74 years) to examine neurocognition in relation to CVH LS7 scores. RESULTS: In age and sex adjusted models, a one unit LS7 score increase (range = 0-14) was associated with higher neurocognitive function on the B-SEVLT sum (0.23 [p < 0.01]; range = 3-42), B-SEVLT recall (0.12 [p < 0.01]; range = 0-15), Word Fluency (phonemic; 0.46 (p < 0.01); range = 0-49), and Digit Symbol Substitution (0.49 (p < 0.01); range = 0-83) tests, respectively. Stated differently, a change from the minimum LS7 (0) to maximum LS7 (14) score corresponded to higher scores on verbal learning (4.62) and memory (2.24), verbal fluency (7.0), and psychomotor processing speed (12). In fully adjusted models the associations were attenuated, but remained statistically significant. Incremental adjustments indicated that Latino background and, to a lesser extent, education were primary contributors to the evinced attenuations. CONCLUSIONS: We found that higher neurocognitive function was associated with better LS7 CVH metrics among middle-aged and older Hispanics/Latinos. Associations between neurocognitive function and LS7 were strongest among two at-risk groups for neurocognitive decline and dementia, women and Hispanics/Latinos with lower education. Public health efforts to reduce cardiovascular disease morbidity and mortality may have additional neurocognitive benefits among at-risk Hispanics/Latinos.

Psychometric Properties of the DASS-21 Among Latina/o College Students by the US-Mexico Border.

Anxious-depression symptomatology is frequently encountered among Latina/o individuals. There is a dearth of studies that examine this mixed class of anxiety and depression symptomatology, especially among Latina/o college students by the US-Mexico border. A total of 505 participants from rural institutions of higher education completed the DASS21. Psychometric properties were measured by means of confirmatory and exploratory factor analysis (EFA). A multivariate analysis of variance (MANOVA) was conducted to determine gender differences in depression, anxiety and stress. Among women, 18 % reported at least moderate levels of depressive symptoms, 33.1 % reported at least moderate levels of anxiety symptoms, and 16.4 % reported at least moderate levels of stress. In men, 15.9 % reported at least moderate levels of depressive symptoms, 34.1 % reported at least moderate levels of anxiety symptoms, and 12.9 % reported at least moderate levels of stress. The EFA supported a one dimension factor (anxious/stress-depression) among this sample of Latina/o college students (Bartlett's test = 4960.9; df = 210; p ≤ 0.01; Kaiser-Meyer-Olkin = 0.95). The MANOVA found no significant gender differences in depression, anxiety symptomatology and stress [Wilks'Λ = 0.99; F = (3, 500) = 2.41; p = 0.07]. The DASS-21 showed a one dimensional construct of anxious/stress-depression symptomatology in a Latina/o rural undergraduate sample, raising awareness to the need to screen and monitor this constellation of symptoms.

Attitudes Towards Gambling, Gambling Problems, and Treatment Among Hispanics in Imperial County, CA.

Gambling problems are associated with a wide range of serious negative personal, social, health, and mental health consequences and are an important public health concern. Some data suggest that gambling problems may be more prevalent among Hispanics, but few studies have been conducted in this community. The aim of the current study was to gather community-based, gambling-related data in order to increase understanding of gambling problems and their treatment in the Hispanic community. We conducted a mixed-methods study of gambling behavior and attitudes towards gambling, those with gambling problems, and professional treatment for gambling problems in a publicly funded health center serving a primarily Hispanic clientele. Study participants included clinic staff and clinic patients. All participants completed a brief, self-report survey; however, staff participated in a focus group on gambling issues and patients were interviewed individually about gambling issues. Nearly 80 % of patients had gambled in the past month, as compared to about 36 % of clinic staff. Survey data showed that patients had many risk factors for gambling problems. Focus group and interview information indicated that most viewed gambling problems as a form of addiction, the elderly were seen as being at increased risk for gambling problems, and gambling outings represented one of the few recreational opportunities in the region. The majority of both staff and patients believed that there was a need for gambling-related treatment services in the county; however, a notable minority of patients said that they would first seek help from a trusted relative or family member. Possible avenues to increase awareness of, screening for, and treatment for gambling problems may include collaborations with publicly funded health care centers and the training of promotoras to serve as an interface between health services and the community.