Do Behavioral Risk Factors for Prediabetes and Insulin Resistance Differ across the Socioeconomic Gradient? Results from a Community-Based Epidemiologic Survey.

To examine whether behavioral risk factors associated with diabetes (diet, BMI, waist circumference, physical activity, and sleep duration) are also related to both prediabetes and insulin resistance (IR), we used data from Boston Area Community Health (BACH) Survey (2010-2012, n = 3155). Logistic and linear regression models were used to test the association of lifestyle factors with prediabetes status, insulin resistance, and prediabetes or insulin resistance. All regression models were stratified by education and income levels (to examine whether risk factors had differential effects across socioeconomic factors) and adjusted for age, gender, race/ethnicity, family history of diabetes, and smoking status. We found that large waist circumference was consistently associated with higher levels of insulin resistance (IR) and increased odds of prediabetes. While the association between large waist circumference and IR was consistent across all levels of SES (P < 0.001), the association between large waist circumference and prediabetes was only statistically significant in the highest socioeconomic strata with odds ratios of 1.68 (95% CI 1.07-2.62) and 1.88 (95% CI 1.22-2.92) for postgraduate degree and income strata, respectively. There was no association between diet, physical activity, sleep duration, and the presence of multiple risk factors and prediabetes or IR within SES strata.

Racial ethnic differences in type 2 diabetes treatment patterns and glycaemic control in the Boston Area Community Health Survey.

OBJECTIVES: Numerous studies continue to report poorer glycaemic control, and a higher incidence of diabetes-related complications among African-Americans and Hispanic-Americans as compared with non-Hispanic Caucasians with type 2 diabetes. We examined racial/ethnic differences in receipt of hypoglycaemic medications and glycaemic control in a highly insured Massachusetts community sample of individuals with type 2 diabetes. SETTING: Community-based sample from Boston, Massachusetts, USA. PARTICIPANTS: 682 patients with physician-diagnosed diabetes from the third wave of the Boston Area Community Health Survey (2010-2012). The study included approximately equal proportions of African-Americans, Hispanics and Caucasians. METHODS: We examined racial/ethnic disparities in diabetes treatment by comparing proportions of individuals on mutually exclusive diabetes treatment regimens across racial/ethnic subgroups. Using multivariable linear and logistic regression, we also examined associations between race/ethnicity and glycaemic control in the overall population, and within treatment regimens, adjusting for age, gender, income, education, health insurance, health literacy, disease duration, diet and physical activity. RESULTS: Among those treated (82%), the most commonly prescribed antidiabetic regimens were biguanides only (31%), insulin only (23%), and biguanides and insulin (16%). No overall racial/ethnic differences in treatment or glycaemic control (per cent difference for African-Americans: 6.18, 95% CI -1.00 to 13.88; for Hispanic-Americans: 1.01, 95% CI -10.42 to 12.75) were observed. Within regimens, we did not observe poorer glycaemic control for African-Americans prescribed biguanides only, insulin only or biguanides combined with insulin/sulfonylureas. However, African-Americans prescribed miscellaneous regimens had higher risk of poorer glycaemic control (per cent difference=23.37, 95% CI 7.25 to 43.33). There were no associations between glycaemic levels and Hispanic ethnicity overall, or within treatment regimens. CONCLUSIONS: Findings suggest a lack of racial/ethnic disparities in diabetes treatment patterns and glycaemic control in this highly insured Massachusetts study population. Future studies are needed to understand impacts of increasing insurance coverage on racial/ethnic disparities in treatment patterns and related outcomes.

Association of sleep adequacy with more healthful food choices and positive workplace experiences among motor freight workers.

OBJECTIVES: We assessed whether adequate sleep is linked to more healthful eating behaviors among motor freight workers and whether it mediates the effects of workplace experiences. METHODS: Data were derived from a baseline survey and assessment of permanent employees at 8 trucking terminals. Bivariate and multivariate regression models were used to examine relationships between work environment, sleep adequacy, and dietary choices. RESULTS: The sample (n = 542) was 83% White, with a mean age of 49 years and a mean body mass index of 30 kg/m(2). Most of the participants were satisfied with their job (87.5%) and reported adequate sleep (51%); 30% reported job strain. In our first model, lack of job strain and greater supervisor support were significantly associated with adequate sleep. In our second model, educational level, age, and adequate sleep were significantly associated with at least 2 of the 3 healthful eating choices assessed (P < .05). However, work experiences were not significant predictors of healthful food choices when adequate sleep was included. CONCLUSIONS: Adequate sleep is associated with more healthful food choices and may mediate the effects of workplace experiences. Thus, workplace health programs should be responsive to workers' sleep patterns.

Association of the cannabinoid receptor gene (CNR1) with ADHD and post-traumatic stress disorder.

Attention deficit hyperactivity disorder (ADHD) is a highly heritable disorder affecting some 5-10% of children and 4-5% of adults. The cannabinoid receptor gene (CNR1) is a positional candidate gene due to its location near an identified ADHD linkage peak on chromosome 6, its role in stress and dopamine regulation, its association with other psychiatric disorders that co-occur with ADHD, and its function in learning and memory. We tested SNP variants at the CNR1 gene in two independent samples-an unselected adolescent sample from Northern Finland, and a family-based sample of trios (an ADHD child and their parents). In addition to using the trios for association study, the parents (with and without ADHD) were used as an additional case/control sample of adults for association tests. ADHD and its co-morbid psychiatric disorders were examined. A significant association was detected for a SNP haplotype (C-G) with ADHD (P = 0.008). A sex by genotype interaction was observed as well with this haplotype posing a greater risk in males than females. An association of an alternative SNP haplotype in this gene was found for post-traumatic stress disorder (PTSD) (P = 0.04 for C-A, and P = 0.01 for C-G). These observations require replication, however, they suggest that the CNR1 gene may be a risk factor for ADHD and possibly PTSD, and that this gene warrants further investigation for a role in neuropsychiatric disorders.

Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study.

OBJECTIVE: ADHD is a childhood-onset psychiatric condition that often continues into adulthood. Stimulant medications are the mainstay of treatment; however, additional approaches are frequently desired. In recent years, mindfulness meditation has been proposed to improve attention, reduce stress, and improve mood. This study tests the feasibility of an 8-week mindfulness training program for adults and adolescents with ADHD. METHOD: Twenty-four adults and eight adolescents with ADHD enrolled in a feasibility study of an 8-week mindfulness training program. RESULTS: The majority of participants completed the training and reported high satisfaction with the training. Pre-post improvements in self-reported ADHD symptoms and test performance on tasks measuring attention and cognitive inhibition were noted. Improvements in anxiety and depressive symptoms were also observed. CONCLUSION: Mindfulness training is a feasible intervention in a subset of ADHD adults and adolescents and may improve behavioral and neurocognitive impairments. A controlled clinical study is warranted.

Prevalence and psychiatric comorbidity of attention-deficit/hyperactivity disorder in an adolescent Finnish population.

OBJECTIVE: The purpose of the study was to estimate the prevalence of attention-deficit/hyperactivity disorder (ADHD) and its clinical characteristics in the Northern Finland Birth Cohort 1986. METHOD: A general population Northern Finland Birth Cohort 1986 of 9,432 children followed prospectively from the early fetal period was surveyed at adolescence (ages 16-18) for ADHD behaviors. Among 6,622 respondents to the survey, a subset of 457 likely cases and controls were evaluated for ADHD and other psychiatric disorders. Chi-square and descriptive statistics were used to examine clinical characteristics of ADHD in the subset, and logistic regression was used to estimate prevalence by weighted extrapolation in the larger cohort. RESULTS: The estimated prevalence of ADHD among adolescents in the Northern Finland Birth Cohort 1986 is 8.5% with a male/female ratio of 5.7:1. The distribution of ADHD subtypes among the ADHD adolescents is 28% Combined, 64% Inattentive, and 8% Hyperactive-Impulsive. A lifetime diagnosis of a broadly defined ADHD (probable or definite) had a prevalence of 18.2% with a male/female odds ratio (OR) of 3.2. This lifetime diagnosis of ADHD is significantly associated with anxiety (OR 2.4), mood (OR 2.9), and disruptive behavioral disorders (OR 17.3) in the cohort. CONCLUSIONS: ADHD is a common neurobehavioral disorder among Northern Finnish adolescents and significantly associated with psychiatric comorbidity in adolescence.

Subtypes versus severity differences in attention-deficit/hyperactivity disorder in the Northern Finnish Birth Cohort.

OBJECTIVE: To investigate whether behaviors of inattention, hyperactivity, and impulsivity among adolescents in Northern Finland reflect qualitatively distinct subtypes of ADHD, variants along a single continuum of severity, or of severity differences within subtypes. METHOD: Latent class models, exploratory factor models, and factor mixture models were applied to questionnaire data of ADHD behaviors obtained from the Northern Finland Birth Cohort (NFBC). Latent class models correspond to qualitatively distinct subtypes, factor analysis corresponds to severity differences, and factor mixture analysis allows for both subtypes and severity differences within subtypes. RESULTS: A comparison of the different models shows that models that distinguish between a low scoring majority class (unaffecteds) and a high scoring minority class (affecteds), and allow for two factors (inattentive, hyperactive-impulsive) with severity differences provide the best fit. CONCLUSIONS: The analysis provides support that a high-scoring minority group (8.8% of males and 6.8% of females) likely reflects an ADHD group in the Northern Finland Birth Cohort, whereas the majority of the population falls into a low-scoring group of unaffecteds. Distinct factors composed of items of inattention and hyperactivity-impulsivity are evident for both sexes with considerable variability in severity within each class.

Executive functioning among Finnish adolescents with attention-deficit/hyperactivity disorder.

OBJECTIVE: The present study examined cognitive functioning in a population sample of adolescents with and without attention-deficit/hyperactivity disorder (ADHD) from the Northern Finland Birth Cohort 1986. METHOD: The sample consisted of 457 adolescents ages 16 to 18 who were assessed using a battery of cognitive tasks. Performance according to diagnostic group (control, behavior disorder, and ADHD) and sex was compared. Then, the effect of executive function deficit (EFD) was assessed by diagnostic group status on behavioral and cognitive measures. RESULTS: When compared to non-ADHD groups, adolescents with ADHD exhibited deficits on almost all of the cognitive measures. The behavior disorder group obtained scores that were generally intermediate between the ADHD and control groups, but exhibited deficits in intelligence and executive function similar to the ADHD group. Approximately half the ADHD sample had EFD; however, the type and presence of EFDs were not differentially related to cognitive performance as a function of diagnosis. CONCLUSIONS: These findings indicate that EFDs are more frequent in ADHD than control or behavior disorder groups. EFDs are a general risk factor for poor cognitive functioning across multiple domains, irrespective of diagnostic status.

Familial association and frequency of learning disabilities in ADHD sibling pair families.

In a sample of 235 families with at least two children with Attention-Deficit/ Hyperactivity Disorder (ADHD), the frequency and familial association of learning disabilities (LD) were assessed. Familiality was examined both between sibling pairs and between parents and their children. Two methods for defining LD, a discrepancy-based and a low-achievement model, were employed to examine the occurrence of LD in this sample. The specific types of LD examined included Reading Disability (RD), Math Disability (MD), and Writing Disability (WD). The prevalence rates were highest for RD, followed by WD then MD. The two definitions of LD yielded similar prevalence rates but identified different groups of children with vastly different IQ scores. Strong familial association was demonstrated for RD both between sibling pairs and between parents and children, with weaker association for WD. There was evidence of nonrandom mating for LD among parents, but not for ADHD or for ADHD + LD. Despite the high comorbidity of ADHD and LD among parents, the presence of ADHD in the parents did not predict child LD supporting independent familial factors underlying ADHD and LD.

Relationship of family environment and parental psychiatric diagnosis to impairment in ADHD.

OBJECTIVE: Family environmental factors as well as parental attention-deficit/hyperactivity disorder (ADHD) status have shown associations with variability in ADHD. The purpose of the present study was to examine the links among family environment, parental psychiatric diagnosis, and child impairment within a sample of ADHD-affected sibling pairs (ASPs) ages 5 to 18 years. METHOD: Parents in 220 ASP families completed a measure of family functioning, the Family Environment Scale. Children's impairment was measured by clinical ratings of global functioning and by maternal ratings of behavior. RESULTS: Parents of children with ADHD rate their families as higher in conflict and lower in achievement and organization than normative samples. High family conflict is significantly associated with impairment in ADHD ASPs accounting for approximately 40% of the sibling similarity in impairment. Parental psychiatric diagnosis revealed no significant direct link to sibling impairment, but rather a significant indirect link to impairment mediated by family conflict. Direct associations with parental diagnosis depend on birth order of the ASP members despite the comparable mean impairment scores for older and younger ADHD siblings. CONCLUSIONS: There are strong links between impairment in children with ADHD and family environment. Different processes and mechanisms may contribute to impairment in different children in the same family.

Toward localizing genes underlying cerebral asymmetry and mental health.

Genome investigations of autism, attention deficit hyperactivity disorder (ADHD), and dyslexia suggest possible genetic overlap. Atypical cerebral asymmetry (ACA), the absence of the left hemisphere dominance for language, may be a shared phenotype due to genes located in regions of overlap. A binomal test is used to evaluate whether linked regions overlap more than expected by chance for 15 genome-wide scans in autism, ADHD, and dyslexia. Significant evidence of linkage overlap (P = 10(-7)) is seen for autism, ADHD, and dyslexia for seven chromosomal regions (2p11-12, 5p13, 7q22-33, 9q33-34, 13q22, 16p13, and 17p11-q11). Linkage analysis of ACA and molecular markers for 270 sibling pairs with ADHD is conducted using the Haseman-Elston statistic. Linkage analysis supports ACA as a shared phenotype with risk genes located on 9q33-34 or 16p13 (P < 0.004). Further support stems from the overlap of these regions in schizophrenia, bipolar illness, specific language impairment (SLI), and handedness, all traits associated with ACA. Autism, ADHD, and dyslexia share regions of linkage overlap and ACA may be a shared phenotype for such genes similar to HLA in autoimmune disease. Because ACA is associated with certain aspects of creativity, such risk genes may also be enhancer genes for creativity.