Adapting standardized patient training to improve patients' understanding and preparedness for health care encounters.

OBJECTIVE: To examine the impact of standardized patient (SP) training on SPs' real-life healthcare encounters and explore whether SP training elements can be adapted to increase actual patients' understanding, communication and participation in a patient-centered care model. METHODS: Data were collected from surveys and focus groups with standardized patients and a survey of primary care physicians. Findings were used to create an educational video with pre- and post-viewing surveys of patients' understanding of engagement strategies and plans to use them in future encounters. RESULTS: SPs reported medical visits were more productive because of their ability to understand the visit's framework; crediting their SP training. Patients reported the video will help in planning future medical visits by providing information that increases their understanding of their role in the care process. CONCLUSIONS: SPs' understanding of the visit and its impact on knowledge, skills and affective domains can be transferred to patients in the form of specific strategies that enhance communication and patient participation during medical visits. PRACTICE IMPLICATIONS: A brief educational intervention for patients using SPs' understanding of the medical visit may contribute to enhanced patient participation in future health care encounters and could increase patient engagement in patient-centered models of care.

Impact of Resident Involvement on 30-Day Postoperative Outcomes in Orthopedic Shoulder Surgery.

The literature concerning resident involvement in shoulder surgery is limited. The purpose of this study was to examine whether resident involvement across all orthopedic shoulder surgeries is associated with adverse 30-day outcomes. Utilizing the American College of Surgeons National Surgical Quality Improvement Program database, patients who underwent shoulder surgery with or without a resident present were analyzed. Independent t-test and chi-square or Fischer's exact test were used appropriately. A logistic regression model was used to calculate adjusted odds ratios. This study examined 5,648 patients: 3,455 patients in the "Attending alone" group and 2,193 in the "Attending and resident in the operating room" group. Resident presence in the operating room was not associated with increased complications, except for bleeding transfusions (OR 1.71, CI 1.32-2.21, P ≤ 0.001). This study demonstrates that resident involvement in orthopedic shoulder surgery does not present an increased risk for 30-day complications when compared to surgeries performed with the attending surgeon alone.

Who Persists and Who Desists? A Prospective Study of Prescription Stimulant Misuse in College Graduates.

Prescription stimulant misuse (PSM) has been studied extensively in college populations, but few studies have examined how PSM changes after graduation. We used a longitudinal design to follow individuals at risk for PSM two years after college graduation to document PSM prevalence, motives, and predictors of PSM persistence. Participants from two small, private colleges completed online surveys focused on intrapersonal, interpersonal, and sociocultural predictors of PSM. Overall, PSM declined over time. Lack of premeditation, perceived peer norms, positive expectancies, media exposure, and other substance use were associated with continued PSM; however, only lack of premeditation, descriptive norms, and other substance use predicted PSM in a multivariate model. This preliminary study suggests dispositional and behavioral risk factors may help to explain why PSM persists after college. Interventions that enhance decision-making skills, correct misperceptions about peers' PSM, and reduce polysubstance use may be effective in curbing PSM in college graduates.

Daily Stress, Drinking Motives and Alcohol Co-Use with Other Drugs.

Background: Recent evidence indicates that alcohol and other substance co-use, compared to alcohol-only use, might be more closely associated with negative reinforcement processes, and thus more likely during periods of increased stress. The present study examined this possibility by using data from an intensive longitudinal (daily) study of college student drinkers (N = 1461, 54% women). We also examined individual differences in coping and enhancement drinking motives as predictors of alcohol and other substance co-use. Results: We used multilevel multinomial logistic regression to predict, relative to alcohol-only days, the likelihood of alcohol co-use with either cigarettes or marijuana, along with alcohol use with multiple substances and other substance-only use from daily interpersonal and academic stress, day-of-the-week, sex, and individual differences in coping and enhancement drinking motives. We found that, relative to alcohol-only, alcohol and marijuana co-use was more likely, and non-alcohol related substance use was less likely, on weekends. Alcohol and marijuana co-use was less likely, and other substance-only use was more likely, on days characterized by greater academic stress, whereas alcohol and cigarette co-use was more likely on days characterized by greater interpersonal stress. Individuals with higher levels of drinking to cope motivation were more likely to engage in alcohol and cigarette co-use, other substance-only use, and alcohol plus multiple substances, relative to alcohol-only. Individuals with higher levels of enhancement motives were more likely to engage in all types of alcohol and other substance co-use and other substance-only use relative to alcohol-only. Conclusions: Findings are discussed in terms of the complex nature of different patterns of co-use patterns when evaluating indicators of positive- and negative-reinforcement processes.

Household food insecurity is associated with greater autonomic dysfunction testing score in Latinos with type 2 diabetes.

AIM: We examined household food insecurity (HFI) and autonomic nervous system (ANS) function in a subset of low-income Latinos with type 2 diabetes with data from a stress management trial. METHODS: InclusionLatino or Hispanic, Spanish speaking, age less than 18 years, ambulatory status, type 2 diabetes more than 6 months, A1c less than 7.0%. ExclusionPain or dysfunction in hands (e.g., arthritis) precluding handgrip testing; medical or psychiatric instability. HFI was assessed with the 6-item U.S. household food security survey module; with responses to > = 1 question considered HFI. An ANS dysfunction index was calculated from xix autonomic function tests which were scored 0 = normal or 1 = abnormal based on normative cutoffs and then summed. Autonomic function tests were: 1) 24-hour heart rate variability as reflected in standard deviation of the normal-to-normal (SDNN) heart rate acquired with 3-channel, 7-lead ambulatory electrocardiogram (Holter) monitors; 2) difference between the highest diastolic blood pressure (DBP) during sustained handgrip and the average DBP at rest; 3) difference between baseline supine and the minimal BP after standing up; and, from 24-hour urine specimens 4) cortisol, 5) normetanephrine, and, 6) metanephrine. RESULTS: Thirty-five individuals participated, 23 (65.7%) of them were women, age mean = 61.6 (standard deviation = 11.2) years, HbA1c mean = 8.5% (standard deviation = 1.6) and 20 participants (57.1%) used insulin. Twenty-two participants (62.9%) reported HFI and 25 (71.4%) had one or more abnormal ANS measure. Independent t-tests showed that participants with HFI had a higher ANS dysfunction index (mean = 1.5, standard deviation = 0.9) than patients who were food secure (mean = 0.7, standard deviation = 0.8), p = 0.02. Controlling for financial strain did not change significance. Total ANS index was not related to glycemia, insulin use or other socioeconomic indicators. In this sample, HFI was associated with ANS dysfunction. Policies to improve food access and affordability may benefit health outcomes for Latinos with diabetes.

Relationship Between Rhabdomyolysis and SARS-CoV-2 Disease Severity.

Background Rhabdomyolysis has historically been associated with viral infections, of which influenza A is the most common. A literature review suggests that up to 1/3 of patients hospitalized with COVID-19 develop acute kidney injury (AKI), and of those, nearly half are admitted to the ICU. AKI complicating COVID-19 infection is attributed to several pathogeneses, including sepsis, direct cytopathic effects on the kidneys, and rhabdomyolysis. Objective We aimed to link COVID-19 infection to the development of rhabdomyolysis via creatine kinase (CK) measurement to assess whether this association increases ICU admission, length of stay (LOS), and mortality. Design and setting In this single-center, retrospective cohort study, we enrolled 984 adult patients with confirmed COVID-19 infection requiring admission to a community hospital between March 2020 and May 2021. Measurements Demographic data, laboratory values, and clinical outcomes were collected. The primary outcome measured was the development of rhabdomyolysis and/or AKI. Secondary outcomes included associations of rhabdomyolysis with ICU admission, length of hospital stay, and mortality, utilizing multivariable logistic regression methods. Results Out of the 984 patients included, 39 met the clinical criteria for rhabdomyolysis (4%). The incidence of rhabdomyolysis was higher in patients with AKI (38.3%) and in those who required ICU admission (53.8%) (p<0.001). There was an insignificant difference in death in this cohort (11 patients, 52.4%, p=0.996). However, the mean LOS in patients who had rhabdomyolysis was 18.2 days versus 9.8 days in patients who did not develop rhabdomyolysis (p<0.001). Conclusion Objectively tracking CK levels in COVID-19-infected patients can assist in diagnosing rhabdomyolysis, identifying AKI etiology, and accordingly making a preliminary prognosis for COVID-19 infection, which could direct physicians to initiate more intensive treatment earlier.

Joint bleeds in mild hemophilia: Prevalence and clinical characteristics.

INTRODUCTION: Joint bleeds are a common and frequent complication associated with hemophilia, increasing the risk of hemophilic arthropathy. It is important to define and characterize the presence of joint complications in mild hemophilia to develop strategies to mitigate disease burden. AIMS: To characterize the prevalence, clinical characteristics of joint bleeds, and risk factors that may lead to hemarthrosis in people with mild hemophilia. METHODS: Following Institutional Review Board approval, a retrospective chart review was conducted for patients with mild hemophilia seen at the Yale Hemophilia Treatment Center or Classical Hematology Program. RESULTS: The medical records of 70 patients were reviewed. Eighty one percent were male and 19 percent were female. Twenty individuals with mild hemophilia had a history of joint bleeding, 13 were traumatic bleeds, 7 were spontaneous. The age of first joint bleed ranged from 4 to 58 years old, with an average age of 20.8-years old. Ten patients developed joint bleeds between the ages of 10 and 20 years old. The most common locations of joint bleeding were the knee (n = 11) and ankle (n = 7). Eight of 70 patients had hepatitis C (HCV), 6 experienced joint bleeding. CONCLUSIONS: In this study, almost one third of patients with mild hemophilia experienced joint bleeding, often without history of trauma. Joint range of motion was abnormal in more than a third of the patients with mild hemophilia regardless. These data highlight the need for ongoing evaluation and characterization of joint health in individuals with mild hemophilia. HIGHLIGHTS: Twenty-nine percent of individuals with mild hemophilia had history of joint bleed. PwH and mild diseases with previous or current hepatitis C had higher likelihood of joint bleeding. Approximately 15% of PwH and mild diseases had abnormal joint examinations without a confirmed history of joint bleeding.

Evaluation of 18 CT signs in diagnosing cecal volvulus: a multi-reader retrospective study.

PURPOSE: To assess the diagnostic performance and reliability of 18 CT signs to diagnose cecal volvulus, a surgical emergency, versus a group of non-volvulus mimickers. MATERIALS AND METHODS: Four radiologists retrospectively and independently assessed 18 CT signs in 191 patients with cecal volvulus (n = 63) or a non-volvulus control group ((n = 128), including cecal bascule (n = 19), mobile cecum (n = 95), and colonic pseudo-obstruction (n = 14)) at a single institution from 2013 to 2021. Fleiss' kappa coefficient was used to assess inter-reader agreement. For diagnostic performance metrics, we assessed sensitivity, specificity, and positive and negative predictive values. For predictive performance, all 18 signs were included in bivariate and stepwise lasso multivariate logistic regression models to diagnose cecal volvulus. Performance was assessed by ROC curves. RESULTS: 191 patients (mean age: 63 years +/- 15.5 [SD]; 135 women) were included in the study. Nine of the 18 CT signs of cecal volvulus demonstrated good or better (> 0.6) inter-reader agreement. Individual CT signs with sensitivity, specificity, positive and negative predictive values all above 70% for diagnosing cecal volvulus were transition point, bird beak, and X-marks-the-spot. A lasso regression model determined four CT features: transition point, bird beak, coffee bean, and whirl had excellent prediction (AUC = .979) for cecal volvulus if all present. CONCLUSION: CT signs for cecal volvulus that have high sensitivity and specificity include: transition point, bird beak, and X-marks-the-spot and were reliable in distinguishing non-volvulus mimickers. If the following four features were present: transition point, bird beak, coffee bean, and whirl, there was excellent prediction (AUC = .979) for cecal volvulus.

Adverse Childhood Events, Mood and Anxiety Disorders, and Substance Dependence: Gene X Environment Effects and Moderated Mediation.

Background: Adverse childhood events (ACEs) contribute to the development of mood and anxiety disorders and substance dependence. However, the extent to which these effects are direct or indirect and whether genetic risk moderates them is unclear. Methods: We examined associations among ACEs, mood/anxiety disorders, and substance dependence in 12,668 individuals (44.9% female, 42.5% African American/Black, 42.1% European American/White). We generated latent variables for each phenotype and modeled direct and indirect effects of ACEs on substance dependence, mediated by mood/anxiety disorders (forward or "self-medication" model) and of ACEs on mood/anxiety disorders, mediated by substance dependence (reverse or "substance-induced" model). In a sub-sample, we also generated polygenic scores for substance dependence and mood/anxiety disorder factors, which we tested as moderators in the mediation models. Results: Although there were significant indirect effects in both directions, mediation by mood/anxiety disorders (forward model) was greater than by substance dependence (reverse model). Greater genetic risk for substance dependence was associated with a weaker direct effect of ACEs on substance dependence in both the African- and European-ancestry groups (i.e., gene-environment interaction) and a weaker indirect effect in European-ancestry individuals (i.e., moderated mediation). Conclusion: We found greater evidence that substance dependence results from self-medication of mood/anxiety disorders than that mood/anxiety disorders are substance induced. Among individuals at higher genetic risk for substance dependence who are more likely to develop a dependence diagnosis, ACEs exert less of an effect in promoting that outcome. Following exposure to ACEs, multiple pathways lead to mood/anxiety disorders and substance dependence. Specification of these pathways could inform individually targeted prevention and treatment approaches.

Adverse Childhood Events, Mood and Anxiety Disorders, and Substance Dependence: Gene x Environment Effects and Moderated Mediation.

Background: Adverse childhood events (ACEs) contribute to the development of mood and anxiety disorders and substance dependence. However, the extent to which these effects are direct or indirect and whether genetic risk moderates them is unclear. Methods: We examined associations among ACEs, mood/anxiety disorders, and substance dependence in 12,668 individuals (44.9% female, 42.5% African American/Black, 42.1% European American/White). We generated latent variables for each phenotype and modeled direct and indirect effects of ACEs on substance dependence, mediated by mood/anxiety disorders (forward or "self-medication" model) and of ACEs on mood/anxiety disorders, mediated by substance dependence (reverse or "substance-induced" model). In a sub-sample, we also generated polygenic scores for substance dependence and mood/anxiety disorder factors, which we tested as moderators in the mediation models. Results: Although there were significant indirect effects in both directions, mediation by mood/anxiety disorders (forward model) was greater than by substance dependence (reverse model). Greater genetic risk for substance dependence was associated with a weaker direct effect of ACEs on substance dependence in both the African- and European-ancestry groups (i.e., gene-environment interaction) and a weaker indirect effect in European-ancestry individuals (i.e., moderated mediation). Conclusion: We found greater evidence that substance dependence results from self-medication of mood/anxiety disorders than that mood/anxiety disorders are substance induced. Among individuals at higher genetic risk for substance dependence who are more likely to develop a dependence diagnosis, ACEs exert less of an effect in promoting that outcome. Following exposure to ACEs, multiple pathways lead to mood/anxiety disorders and substance dependence. Specification of these pathways could inform individually targeted prevention and treatment approaches.

Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep.

BACKGROUND: Refugees have high levels of psychological distress that hamper lifestyle change efforts. We previously reported that community health educator (CHE) diabetes prevention interventions decreased HbA1c and depressive symptoms among Cambodian-American refugees with depression; this paper reports health behavior outcomes of those interventions. METHODS: Participants were aged 35-75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either a) antidepressant medication and/or b) prolonged elevated depressive symptoms. Participants were randomized to one of three CHE interventions: 1) lifestyle intervention called Eat, Walk, Sleep (EWS), 2) EWS plus medication therapy management with a pharmacist/CHE team (EWS + MTM), or, 3) social services (SS; control). Physical activity and sleep were measured with 7 days of actigraphy. Nutrition was measured as carbohydrates as reported in a culturally tailored food frequency questionnaire. Assessments were at baseline, end point (12 months), and follow-up (15 months). RESULTS: The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal education was 7.0 years. Individuals in the two treatment groups that received the EWS intervention significantly increased their brown rice consumption (p < .001, Cohen's d = 0.76) and their moderate-to-vigorous activity (p = .039, d = 0.32). No intervention changed sleep duration, timing, efficiency or wake after sleep onset. Across groups, individuals who increased brown rice consumption, increased vigorous activity and decreased total sleep time variability showed decreased HbA1c, with small effect sizes. CONCLUSIONS: CHEs may improve nutrition and physical activity in refugees with depression but more intensive interventions may be required to impact sleep. Improvements in all three behaviors appear to be associated with HbA1c lowering TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02502929.

Longitudinal relations of sleep quality with depressive symptoms, diabetes distress and self-efficacy in young people with type 1 diabetes.

PURPOSE: To examine the longitudinal, bidirectional associations of sleep quality with depressive symptoms, diabetes-specific distress and diabetes management self-efficacy among adolescents and young adults with type 1 diabetes. METHODS: Cross-lagged analyses used baseline, three-, six- and nine-month data from a randomized trial among 60 young people. Self-report measures included the Pittsburgh Sleep Quality Index, Center for Epidemiological Studies - Depressed Mood scale, Problem Areas in Diabetes Teen version, and Diabetes Management Self-efficacy Scale. RESULTS: Lower sleep quality at baseline was associated with higher three-month depressive symptoms (b = 0.21, p = 0.005) and lower diabetes self-efficacy (b = -0.18, p = 0.014), but not diabetes distress (b = 0.06, p = 0.403). Similar patterns were found at six and nine months. Three-month psychological functioning was not associated with six-month sleep quality. CONCLUSIONS: Among adolescents and young adults with type 1 diabetes, lower sleep quality predicted subsequent depressive symptoms and lower diabetes self-efficacy rather than vice versa. Sleep deserves a central place in diabetes care.

Resident Involvement in Shoulder-Stabilization Procedures Is Not Associated With an Increased Risk of 30-Day Postoperative Complications.

Purpose: To examine the 30-day postoperative outcomes of resident involvement in shoulder-stabilization surgical procedures using the American College of Surgeons National Surgical Quality Improvement database. Methods: We conducted a retrospective review of the National Surgical Quality Improvement database for all shoulder-stabilization procedures from 2010 to 2018. Procedures included arthroscopic Bankart, arthroscopic Bankart with SLAP repair, arthroscopic Bankart with Remplissage, open Bankart, anterior bone block, posterior bone block, Latarjet coracoid process transfer, and capsular shift/capsulorrhaphy for multidirectional instability. Data included preoperative demographics, comorbidities, and 30-day postoperative outcomes. Cases were categorized into 2 groups: "attending alone" and "attending and resident." Statistical analysis comparing groups on demographics and comorbidities included independent t-test for continuous variables and Pearson χ2 or Fischer exact for categorical variables. A logistic regression model including propensity score was used to calculate adjusted odds ratio for outcomes. Results: A total of 3,954 patients undergoing shoulder-stabilization procedures were included in the study and 28.8% of patients had a resident involved in their procedure. Residents were more likely to be involved in procedure for patients who were of minority ethnicity (P < .001), a lower body mass index (P < .001) and less likely to have a history of chronic obstructive pulmonary disease (P = .029). Resident involvement resulted in statistically significant longer total operation time (91 vs 85 minutes, P < .001). In terms of postsurgical outcomes, complication rates were low for both groups (∼0.8%). Resident involvement was not associated with any significant increase in 30-day postsurgical complications. Conclusions: Our results show that resident involvement in shoulder-stabilization surgery is associated with a significant increase in operative time without any significant increase in 30-day postsurgical complications. Level of Evidence: Level III, retrospective comparative study.

Interprofessional Approach to Educate Health Care Students About Intellectual and Developmental Disabilities: Adaptive Communication and Physical Activity Planning.

Introduction: People with intellectual and/or developmental disabilities (IDD) are a historically marginalized population and often require complex team-based health care services. Health care students receive little, if any, training about caring for this population. Improving training at the student level can improve health care quality for this population. Methods: We developed a two-part interprofessional seminar series to increase students' knowledge, attitudes, and skills regarding caring for patients with IDD. The seminars were taught over Zoom and utilized presentation slides, prerecorded mock video interviews, and breakout room discussions focused on adaptive communication and developing adaptive physical activity plans for people with IDD. Participants comprised undergraduate and graduate students from various health care professional programs, including occupational therapy, medicine, and nursing. Results: Part 1 had 208 participants, and part 2 had 107 participants. Both seminars were assessed using pre- and postsurveys that demonstrated increased participant comfort and confidence with the respective subjects. Competence of learned skills was not assessed. Participants in both seminars felt they would benefit from more direct interaction with people with IDD to practice learned skills. Discussion: The results are encouraging for continued implementation at Quinnipiac University, with potential for use in other programs. Further iterations may include people with IDD serving as seminar cofacilitators, opportunities for students to directly interact with people with IDD, and use of an assessment approach evaluating learned skills competence. Curriculum expansion should cover the unique health care inequities faced by people with IDD who also belong to other marginalized groups.

Applying person-centered research ethics in the design of dementia-specific measures.

There is an emerging call for new strengths-based measures to guide research, care, and support for persons living with Alzheimer's disease and related dementias. Person-centered interventions have demonstrated a positive impact in global quality of life, but many promising approaches lack strengths-based measures with sufficient sensitivity to document relevant outcomes. Human centered design is an innovative method for person-centered instrument development. This paper describes a research process using Human Centered Design and highlights ethical principles considered during the translation of the design process to experiential world of Alzheimer's disease and related dementia. Including persons living with dementia and care partners as members of the design team offers new insights, while requiring focused attention on inclusivity, transparency, and person-centered ethics.

Contribution of Working Memory and Inferencing to Narrative Discourse Comprehension and Production in Traumatic Brain Injury.

PURPOSE: The goal of this study was to identify some potential key cognitive and communicative processes underlying narrative discourse ability following traumatic brain injury (TBI). Specifically, this study (a) investigated the contribution of working memory (WM) and inferencing to narrative discourse comprehension and production; (b) tested key assumptions posited by the Structure Building Framework (SBF), a discourse model; and (c) evaluated the potential for inferencing to contribute to discourse ability beyond a shared variance with WM. METHOD: Twenty-one individuals with TBI completed six tasks yielding seven measures: verbal and nonverbal WM updating (WMU-V and WMU-NV, respectively), predictive inferencing, the Discourse Comprehension Test (DCT), a picture story comprehension (PSC) task, and story retelling (story grammar and story completeness). Regression analyses were performed using WM and inferencing as predictors for narrative performance. RESULTS: WM measures were significant predictors of DCT performance and approached significance as predictors of PSC. Inferencing approached significance as a unique predictor for the DCT and story completeness. WMU-V and WMU-NV were highly collinear, and neither WM measure predicted discourse outcomes over and above the other's contribution. CONCLUSIONS: WM was more strongly associated with comprehension processes, whereas inferencing may be associated with both comprehension and production outcomes. Findings were interpreted as supporting SBF assumptions of domain generality of cognitive processes and mechanisms involved in discourse while also challenging assumptions that the same cognitive substrates are marshaled for comprehension and production processes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23148647.

Monitoring and responding to emerging infectious diseases in a university setting: A case study using COVID-19.

Emerging infection diseases (EIDs) are an increasing threat to global public health, especially when the disease is newly emerging. Institutions of higher education (IHEs) are particularly vulnerable to EIDs because student populations frequently share high-density residences and strongly mix with local and distant populations. In fall 2020, IHEs responded to a novel EID, COVID-19. Here, we describe Quinnipiac University's response to SARS-CoV-2 and evaluate its effectiveness through empirical data and model results. Using an agent-based model to approximate disease dynamics in the student body, the University established a policy of dedensification, universal masking, surveillance testing via a targeted sampling design, and app-based symptom monitoring. After an extended period of low incidence, the infection rate grew through October, likely due to growing incidence rates in the surrounding community. A super-spreader event at the end of October caused a spike in cases in November. Student violations of the University's policies contributed to this event, but lax adherence to state health laws in the community may have also contributed. The model results further suggest that the infection rate was sensitive to the rate of imported infections and was disproportionately impacted by non-residential students, a result supported by the observed data. Collectively, this suggests that campus-community interactions play a major role in campus disease dynamics. Further model results suggest that app-based symptom monitoring may have been an important regulator of the University's incidence, likely because it quarantined infectious students without necessitating test results. Targeted sampling had no substantial advantages over simple random sampling when the model incorporated contact tracing and app-based symptom monitoring but reduced the upper boundary on 90% prediction intervals for cumulative infections when either was removed. Thus, targeted sampling designs for surveillance testing may mitigate worst-case outcomes when other interventions are less effective. The results' implications for future EIDs are discussed.

Community-based diabetes prevention randomized controlled trial in refugees with depression: effects on metabolic outcomes and depression.

Depression and antidepressant medications increase risk for type 2 diabetes. Cambodian-Americans have exceedingly high rates of both depression and diabetes. This paper reports outcomes of a diabetes prevention trial for Cambodian-Americans with depression. Primary outcomes were HbA1c, insulin resistance and depressive symptoms. Participants were aged 35-75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either (a) antidepressant medication and/or (b) prolonged elevated depressive symptoms. Participants were randomized to one of three community health worker (CHW) interventions: (1) lifestyle intervention called Eat, Walk, Sleep (EWS), (2) EWS plus medication therapy management sessions with a pharmacist/CHW team to resolve drug therapy problems (EWS + MTM), or, (3) social services (SS; control). Assessments were at baseline, post-treatment (12 months), and follow-up (15 months). The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal educational attainment was 7.0 years. Compared to the other arms, EWS + MTM showed a significant decrease in HbA1c and a trend for reduced inflammation and stress hormones. Depressive symptoms improved for EWS and EWS + MTM relative to SS. There was no change in insulin resistance. Cardiometabolic and mental health can be improved in tandem among immigrant and refugee groups.

Does polygenic risk for substance-related traits predict ages of onset and progression of symptoms?

BACKGROUND AND AIMS: Genetic risk can influence disease progression. We measured the impact of genetic risk for substance use disorders (SUDs) on substance use onset and progression of symptoms. DESIGN, SETTING, PARTICIPANTS: Using findings from genome-wide association studies (GWASs) of alcohol use disorder (AUD), opioid use disorder (OUD) and smoking trajectory (SMK) as discovery samples, we calculated polygenic risk scores (PRSs) in a deeply phenotyped independent target sample. Participants in the target sample were recruited from 2000 to 2020 from US inpatient or outpatient settings or through advertisements and comprised 5692 European-ancestry individuals (EUR) (56.2% male) and 4918 African-ancestry individuals (AFR) (54.9% male). MEASUREMENTS: This study measured age of first substance use, regular use, reported problems and dependence diagnosis and progression from regular use to onset of problems and dependence for alcohol, opioids and smoking. We examined the contribution of PRS to each milestone and progression measure. FINDINGS: EUR and males reported an earlier onset and shorter progression times than AFR and females, respectively. Among EUR, higher AUD PRS predicted earlier onset and more rapid progression to alcohol-related milestones (P < 0.001). Although the AUD PRS was a stronger moderator of problem onset among females (P = 0.017), it was more predictive of the progression to problems among males (P = 0.005). OUD and SMK PRS in EUR also predicted earlier onset of the respective milestones (P < 0.001). Among AFR, where power is lower due to the smaller discovery sample, AUD PRS predicted age of regular alcohol use (P = 0.039) and dependence (P = 0.001) and progression from regular use to diagnosis (P = 0.045), while SMK PRS predicted earlier age of initiation (P = 0.036). CONCLUSIONS: Genetic risk for SUDs appears to predict substance use milestones and symptom progression among European-ancestry individuals and, to a lesser extent, African-ancestry individuals.

Individual Differences in Affect Dynamics and Alcohol-Related Outcomes.

Background: To examine whether individual differences in intensive longitudinal data-derived affective dynamics (i.e. positive and negative affect variability and inertia and positive affect-negative affect bipolarity) - posited to be indicative of emotion dysregulation - are uniquely related to drinking level and affect-regulation drinking motives after controlling for mean levels of affective states. Method: We used a large sample of college student drinkers (N = 1640, 54% women) who reported on their affective states, drinking levels and drinking motives daily for 30 days using a web-based daily diary. We then calculated from the daily data positive and negative affect variability, inertia, affect bipolarity and mean levels of affect and used these as predictors of average drinking level and affect-regulation drinking motives (assessed using both retrospective and daily reporting methods). Results: Findings from dynamic structural equation models indicated that mean levels of affect were uniquely related to drinking motives, but not drinking level. Few dynamic affect predictors were uniquely related to outcomes in the predicted direction after controlling for mean affect levels. Conclusion: Our results add to the inconsistent literature regarding the associations between affective dynamics and alcohol-related outcomes, suggesting that any effects of these indicators, after controlling for mean affect levels, might be more complex than can be detected with simple linear models.