Childhood Mistreatment, PTSD, and Substance Use in Latinx: The Role of Discrimination in an Omitted-Variable Bias.

BACKGROUND: Childhood mistreatment (CM) has been associated with adult posttraumatic disorder (PTSD) and substance use disorders (SUDs) in the general population. Few studies have examined the role of PTSD in the CM-SUD association among Latinx. This cross-sectional study evaluated a theory-driven conceptual model with a specific focus on the impact of perceived discrimination, which may interfere with these associations. METHOD: Using a nationally representative sample and structural equation modeling (SEM), the study evaluated the mediation of PTSD in the CM-SUD link, adjusting for or omitting discrimination and other sociodemographic variables that are known predictors of Latinx behavioral health. Multi-subsample analyses were then conducted to review nativity differences (US-born = 924.43% and immigrant = 1630.57%). RESULTS: The fully specified final model (model 1, covariates adjusted) failed to show a significant mediation of PTSD in the tested link, but a direct detrimental effect group of discrimination, for all Latinx. The mediation was only supported, when treating discrimination and other covariates as omitted variables (model 5), which also showed additional direct and indirect effect of CM on SUD. In subsample analyses, models of US-born and immigrant-Latinx subpopulations were identical but showed nativity differences when omitting covariates. CONCLUSION: When discrimination and other covariates were fully adjusted, Latinx exposed to trauma were more likely to develop SUD in adulthood, regardless of when traumatic exposure occurred. This unexpected finding challenges theories explaining the CM-SUD connection, suggesting possible model misspecifications of parametric SES; namely, omitting the unique impact of perceived discrimination in Latinx can lead to biased results. From a clinical standpoint, both trauma and discrimination must be addressed when assessing Latinx behavioral health.

Does glucose influence multidien cycles of interictal and/or ictal activities?

PURPOSE: There are multidien patterns of seizure occurrence. Predicting seizure risk may be easier with biomarker correlates to multidien patterns. We hypothesize multiday hyper or hypoglycemia contributes to seizure risk. METHODS: In a type I diabetic (T1D) with focal onset epilepsy with continuous glucose monitoring (CGM) and responsive neurostimulation (RNS) devices, we studied multiday interictal activities (IEA), seizures, and glucose. Hourly CGM data was matched to hourly RNS captures of interictal and ictal activities over 33 months. RNS detection settings were unchanged. Multidien cycles were analyzed, active blocks of IEA and ictal episodes defined, and tissue glucose averages studied. RESULTS: Average glucose was 161 mg/dl. A 40-day cycle of interictal and ictal activities occurred, though no similar glucose cycle was evident. Glucose elevations relative to patient average were associated with increases in IEA but not seizure. Frequent seizures were not associated with obvious elevations or decreases of glucose from baseline, most seizures occurred at +/- 10 mg/dl of average daily glucose (i.e. 150-170 mg/dl). CONCLUSION: Tissue glucose may influence IEA but may not influence multiday seizure activity or very frequent seizures. In an ambulatory T1D patient multiday hypo or hyperglycemic extremes do not appear to provoke seizure activities.