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1.
Addiction ; 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32150316

RESUMO

BACKGROUND AND AIMS: Clinical staff are typically poor at predicting alcohol dependence treatment outcomes. Machine learning (ML) offers the potential to model complex clinical data more effectively. This study tested the predictive accuracy of ML algorithms demonstrated to be effective in predicting alcohol dependence outcomes, compared with clinical judgement and traditional linear regression. DESIGN: Prospective study. ML models were trained on 1016 previously treated patients (training-set) who attended a hospital-based alcohol and drug clinic. ML models (n = 27), clinical psychologists (n = 10) and a 'traditional' logistic regression model (n = 1) predicted treatment outcome during the initial treatment session of an alcohol dependence programme. SETTING: A 12-week cognitive behavioural therapy (CBT)-based abstinence programme for alcohol dependence in a hospital-based alcohol and drug clinic in Australia. PARTICIPANTS: Prospective predictions were made for 220 new patients (test-set; 70.91% male, mean age = 35.78 years, standard deviation = 9.19). Sixty-nine (31.36%) patients successfully completed treatment. MEASUREMENTS: Treatment success was the primary outcome variable. The cross-validated training-set accuracy of ML models was used to determine optimal parameters for selecting models for prospective prediction. Accuracy, sensitivity, specificity, area under the receiver operator curve (AUC), Brier score and calibration curves were calculated and compared across predictions. FINDINGS: The mean aggregate accuracy of the ML models (63.06%) was higher than the mean accuracy of psychologist predictions (56.36%). The most accurate ML model achieved 70% accuracy, as did logistic regression. Both were more accurate than psychologists (P < 0.05) and had superior calibration. The high specificity for the selected ML (79%) and logistic regression (90%) meant they were significantly (P < 0.001) more effective than psychologists (50%) at correctly identifying patients whose treatment was unsuccessful. For ML and logistic regression, high specificity came at the expense of sensitivity (26 and 31%, respectively), resulting in poor prediction of successful patients. CONCLUSIONS: Machine learning models and logistic regression appear to be more accurate than psychologists at predicting treatment outcomes in an abstinence programme for alcohol dependence, but sensitivity is low.

2.
Addict Behav ; 105: 106286, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32007828

RESUMO

Rash impulsiveness, the propensity for approach behaviour despite potential negative consequences, is associated with stronger alcohol craving in patients with Alcohol Use Disorder (AUD). This relationship is poorly understood and implications for treatment response are unexamined. This study explored the relationship between rash impulsiveness, craving, and treatment response among 304 outpatients enrolled in a 12-week abstinence-based Cognitive-Behavioural Therapy (CBT) program for AUD. Assessments were completed pre-and-post treatment, with craving and alcohol consumption monitored at each treatment session. Higher rash impulsiveness predicted more frequent craving over treatment (b = 0.95, 95% CI = 0.40, 1.50). Higher craving was associated with greater lapse-risk (b = 0.04, 95% CI = 0.03, 0.05), with the association between craving and lapse-risk increasing as treatment progressed (b = 0.01, 95% CI = 0.01, 0.02). Craving positively mediated the relationship between rash impulsiveness and lapse-risk (µâ€¯= 0.38, 95% CI = 0.10, 0.70). Contrary to hypotheses, the risk of lapse in response to craving was not moderated by rash-impulsiveness. These results suggest that AUD patients with a predisposition for rash impulsiveness are more vulnerable to alcohol craving, and subsequently, poorer treatment outcomes.

3.
Br J Psychiatry ; : 1-7, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31950892

RESUMO

BACKGROUND: Methamphetamine has been consistently associated with positive psychotic symptoms, but little is known about whether the reverse also occurs. AIMS: This study determined whether the relationship between methamphetamine use and positive psychotic symptoms is bidirectional over 12 months. The impact of lifetime psychotic disorders and methamphetamine dependence on these relationships was also examined. METHOD: A total of 201 regular (at least monthly) primary methamphetamine users were recruited from free needle and syringe programmes in three Australian cities. Data on the frequency of methamphetamine and other drug use (from Timeline Followback inteviews) and the severity of positive psychotic symptoms (using the Brief Psychiatric Rating Scale) in the past 2 weeks were collected in 12 contiguous monthly face-to-face interviews (mean of 9.14/11 (s.d. = 3.16) follow-ups completed). Diagnoses were derived using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders. RESULTS: The mean age of participants was 31.71 years (s.d. = 8.19) and 39% (n = 77) were women. At baseline 55% (n = 110) were dependent on methamphetamine and 51% (n = 102) had a lifetime psychotic disorder. Cross-lagged dynamic panel models found a significant bidirectional relationship between psychotic symptoms and methamphetamine use (Comparative Fit Index (CFI) = 0.94, standardised root mean square residual (SRMR) = 0.05, root mean square error of approximation (RMSEA) = 0.05, 95% CI 0.04-0.06). The magnitude of the relationship in each direction was similar, and the presence of methamphetamine dependence or a lifetime psychotic disorder did not have an impact on results. CONCLUSIONS: A dynamic, bidirectional relationship between methamphetamine and psychotic symptoms of similar magnitude in each direction was found over 1 year. This suggests integrated treatments that target methamphetamine, psychotic symptoms and their interrelationship may be of most benefit.

4.
Gene ; 725: 144163, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-31639433

RESUMO

BACKGROUND: Previous studies have established that coronary artery disease is associated with excess inflammation. These studies have shown an elevation of both pro and anti-inflammatory cytokines in sufferers of coronary artery disease. There is increasing interest in the role played by the inflammasome Nod Like Receptor family pyrin domain containing 3 (NLRP3) in the aetiology of coronary artery disease. Increased severity of coronary artery disease correlates with higher levels of expression of NLRP3. Does NLRP3 polymorphisms play a role in the aetiology of coronary artery disease? METHOD: In a cohort of Vietnam War (n-299) veterans who have been previously exposed to trauma, NLRP3 polymorphisms were analysed for association with coronary calcium scores using analyses of variance. Independent t-test was used to analyse genotypes. In samples with a small representation of minor homozygotes, genotypes were combined and analysed using independent t-test. If any of the genotype analysis suggested the potential for a dominant or a recessive model the model was further explored. Hardy-Weinberg Equilibrium was calculated using Hardy-Weinberg equilibrium calculator including analysis for ascertainment bias. RESULTS: The NLRP3 polymorphism, rs10159239 was significantly associated (p = 0.001) with a higher raised coronary calcium score. The Single Nucleotide Polymorphism rs10159239 was examined by logistic regression with known risk factors for Coronary artery disease and remained significant (0.035). This is the first time rs10159239 A-allele has been associated with raised coronary calcium score. CONCLUSIONS: This is the first time rs10159239 A-allele has been associated with raised coronary calcium score. Further research is needed to replicate our results in larger well-characterised cohorts.


Assuntos
Doença da Artéria Coronariana/genética , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Idoso , Idoso de 80 Anos ou mais , Alelos , Proteínas de Transporte/genética , Estudos de Coortes , Doença da Artéria Coronariana/metabolismo , Citocinas/genética , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Frequência do Gene/genética , Predisposição Genética para Doença/genética , Genótipo , Humanos , Inflamação/genética , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco , Veteranos , Guerra do Vietnã
5.
J Ethn Subst Abuse ; : 1-16, 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31596186

RESUMO

Alcohol is a commonly used substance among Vietnamese medical students, especially males. Vietnamese male medical students drink more alcohol, report more intentions to binge drink, and experience more alcohol-related problems than females. As medical students' alcohol consumption may influence their attitudes and medical practice relating to alcohol counseling and prevention, research about the cultural and drinking norms underlying the drinking behavior of Vietnamese male medical students is warranted. This study aims to explore the norms underlying drinking behavior of Vietnamese male medical students. A qualitative study including 32 in-depth interviews with Vietnamese male medical students at a medical university. Thematic analysis was used to analyze the data. This study found Vietnamese male medical students considered alcohol consumption as a way to show their masculinity and become accepted by groups. Given these beliefs and adherence to norms, they followed rules to force others to consume more alcohol or be intoxicated in drinking occasions among medical students. This study showed the importance of gender and group norms in influencing Vietnamese male medical students' alcohol consumption. These norms should be considered in future research and interventions addressing alcohol use among this target population.

6.
Subst Use Misuse ; 54(14): 2380-2386, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31429362

RESUMO

Background: Alexithymia is a personality trait associated with emotion regulation difficulties. Up to 67% of alcohol-dependent patients in treatment have alexithymia. Objectives: The objective of this study was to investigate the direct and indirect effects of alexithymia, negative mood (stress, anxiety, and depression) and alcohol craving on alcohol dependence severity. Methods: Three hundred and fifty-five outpatients (mean age = 38.70, SD = 11.00, 244 males, range 18-71 years) undergoing Cognitive-Behavioral Therapy for alcohol dependence completed the Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scales (DASS-21), Obsessive Compulsive Drinking Scale (OCDS), and Alcohol Use Disorders Identification Test (AUDIT) prior to the first treatment session. Results: Alexithymia had an indirect effect on alcohol dependence severity, via both negative mood and alcohol craving (b = 0.03, seb = 0.008, 95% CI: 0.02-0.05). An indirect effect of negative mood on alcohol dependence via alcohol craving was also observed (b = 0.12, seb = 0.03, 95% CI: 0.07-0.16). Conclusions/importance: Alexithymia worked through negative mood and alcohol craving leading to increased alcohol dependence severity, indicating that craving had an indirect effect on the relationship between alexithymia and alcohol dependence severity. Targeting alcohol craving and negative mood for alcohol-dependent patients with alexithymia seems warranted.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31225931

RESUMO

ISSUE ADDRESSED: Stimulant use has been identified as a key risk factor for sexual behaviours leading to HIV transmission. Substance-related expectancies are associated with substance use and postsubstance use thoughts, feelings and behaviours. Expectancies held by specific cultural subgroups have rarely been investigated, particularly regarding a range of commonly used stimulants. METHOD: The Stimulant Expectancy Questionnaire for Men who have Sex with Men (SEQ-MSM) was initially generated through consumer panel and interviews regarding the most commonly used stimulants among MSM in Australia (methamphetamine, amphetamines and ecstasy), with initial administration among 98 MSM to facilitate item reduction. A community sample of 427 MSM was used to validate the SEQ-MSM, with exploratory factor analysis (EFA; n = 202) and confirmatory factor analysis (CFA; n = 225). RESULTS: EFA revealed three distinct substance reinforcement domains ('Enhanced sexual experience', 'Sexual communication and negotiation' and 'Cognitive impairment'). The scale was associated with stimulant consumption patterns (including greater expectancies regarding sexual enhancement among methamphetamine users), and the factor structure, comprising a final form of the MSM-SEQ, was confirmed through CFA. CONCLUSIONS: The SEQ-MSM represents a reliable measure of outcome expectancies related to the range of commonly used stimulants among Australian MSM. Development of applied validation studies with the SEQ-MSM is a key next step in advancing health promotion, clinical interventions and research efforts to reduce harm (eg, HIV transmission) associated with stimulant use (particularly methamphetamine) among MSM. SO WHAT?: Objectives: This research maps expectancies specific among gay and men who have sex with men (MSM), and relationships between expectancies and stimulant use patterns and behaviours postuse - including sexual activity (eg, condomless anal sex).

8.
J Psychiatr Res ; 116: 42-50, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31195163

RESUMO

In this study we investigated genome-wide sperm DNA methylation patterns in trauma-exposed Vietnam veterans. At the genome-wide level, we identified 3 CpG sites associated with PTSD in sperm including two intergenic and one CpG within the CCDC88C gene. Of those associated with PTSD in sperm at a nominal level, 1868 CpGs were also associated with PTSD in peripheral blood (5.6% overlap) including the RORA, CRHR1 and DOCK2 genes that have been previously implicated in PTSD. A total of 10 CpG sites were significantly associated with a reported history of a diagnosed mental health condition in children and reached genome-wide significance. CpGs associated with a history of a reported mental health condition in children were also enriched (90% of tested genes) for genes previously reported to be resistant to demethylation, making them strong candidates for transgenerational inheritance. In conclusion, our findings identify a unique sperm-specific DNA methylation pattern that is associated with PTSD.

9.
Health Educ Res ; 34(4): 447-459, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31168575

RESUMO

Alcohol use is common among Vietnamese students. Previous qualitative findings showed Vietnamese medical students believed they were not binge drinkers while reporting many binge drinking occasions they participated in or witnessed. This dichotomy warrants examination. This study aims to establish drinking patterns and examine the factors underlying Vietnamese medical students' binge drinking intention and behaviour. This study used a prospective-correlational design, with two waves of data collection, drawing from established health behaviour models. At Time 1, 206 students completed the Alcohol Use Disorder Identification Test, the standard Theory of Planned Behaviour measures (attitude, subjective norm and perceived behavioural control) and their underlying beliefs, as well as group norm, role identity, drinking culture and past binge drinking behaviour. At Time 2, 156 medical students reported their binge drinking behaviour 2 weeks later. Only 6.8% of participants were classified as problematic drinkers and few participants reported binge drinking occasions at the 2-week follow-up. Perceived behavioural control, friends' group norms, role identity as future doctors, and past behaviour significantly predicted binge drinking intentions and key beliefs were identified. This study indicated Vietnamese medical students' limited engagement with binge drinking and identified key factors to address for those with risky drinking behaviour intentions.

10.
Gene ; 698: 107-112, 2019 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-30831210

RESUMO

Brain-derived neurotrophic factor (BDNF) gene is associated with increased risk of posttraumatic stress disorder (PTSD) and plays a role in neuroplasticity, cognition and memory. BDNF has strong potential as a therapeutic target as studies have shown that antidepressants, electroconvulsive treatment and exercise modulate BDNF expression and methylation. In this study we examined the role of BDNF methylation and expression in PTSD and the implications of exercise in mediating these effects. BDNF DNA methylation and gene expression analysis was performed in a sample of 96 male Vietnam veterans. Cases were combat-exposed veterans with current PTSD (n = 48) and controls were combat exposed veterans with no past or current PTSD diagnosis (n = 48). No association between BDNF mRNA and PTSD was identified. PTSD was associated with decreased methylation at three BDNF CpG sites (cg01546433 P = 0.004835; cg24650785 P = 0.000259 and cg002298481 P = 0.000672). Differential BDNF methylation was associated with exercise, with active exercise associated with lower methylation levels at three CpG sites (cg04481212 P = 0.005; cg01546433 P = 0.025 and cg00298481 P = 0.035). Given that exercise mediates BDNF action on cognitive plasticity, exercise may be a non-invasive, drug free option in the treatment of PTSD.


Assuntos
Fator Neurotrófico Derivado do Encéfalo/genética , Transtornos de Estresse Pós-Traumáticos/genética , Idoso , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Ilhas de CpG/genética , Metilação de DNA/genética , Epigênese Genética/genética , Exercício/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Veteranos/psicologia , Guerra do Vietnã
11.
J Subst Abuse Treat ; 99: 156-162, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30797388

RESUMO

BACKGROUND AND OBJECTIVES: Clinical staff providing addiction treatment predict patient outcome poorly. Prognoses based on linear statistics are rarely replicated. Addiction is a complex non-linear behavior. Incorporating non-linear models, Machine Learning (ML) has successfully predicted treatment outcome when applied in other areas of medicine. Using identical assessment data across the two groups, this study compares the accuracy of ML models versus clinical staff to predict alcohol dependence treatment outcome in behavior therapy using patient data only. METHODS: Machine learning models (n = 28) were constructed ('trained') using demographic and psychometric assessment data from 780 previously treated patients who had undertaken a 12 week, abstinence-based Cognitive Behavioral Therapy program for alcohol dependence. Independent predictions applying assessment data for an additional 50 consecutive patients were obtained from 10 experienced addiction therapists and the 28 trained ML models. The predictive accuracy of the ML models and the addiction therapists was then compared with further investigation of the 10 best models selected by cross-validated accuracy on the training-set. Variables selected as important for prediction by staff and the most accurate ML model were examined. RESULTS: The most accurate ML model (Fuzzy Unordered Rule Induction Algorithm, 74%) was significantly more accurate than the four least accurate clinical staff (51%-40%). However, the robustness of this finding may be limited by the moderate area under the receiver operator curve (AUC = 0.49). There was no significant difference in mean aggregate predictive accuracy between 10 clinical staff (56.1%) and the 28 best models (58.57%). Addiction therapists favoured demographic and consumption variables compared with the ML model using more questionnaire subscales. CONCLUSIONS: The majority of staff and ML models were not more accurate than suggested by chance. However, the best performing prediction models may provide useful adjunctive information to standard clinically available prognostic data to more effectively target treatment approaches in clinical settings.

12.
Subst Use Misuse ; 54(3): 459-472, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30595056

RESUMO

OBJECTIVES: China is the world's largest tobacco consumer and its adolescent smoking rate is increasing. Smoking interventions among high school students are limited. The aim of this study was to deliver and evaluate a brief theory-based smoking intervention in China, with a focus on anti-smoking cognitions. METHODS: The intervention was based on the constructs of an extended theory of planned behavior and life skills training. Using class-level randomization sampling, 106 tenth graders from two high schools in Kunming, China received a four-session intervention; 101 students were assigned as control group members. Surveys were conducted at three time-points (1 week before the intervention, 1 week post-intervention, and 6 months post-intervention). MANOVA and latent class analysis were used to test the intervention's effectiveness and personal change trajectories over time. RESULTS: The intervention failed to change smoking behavior, intention or willingness, but improved anti-smoking attitudes and perceived control over smoking. Skills showed a general enhancement, consistent with participants' qualitative feedback. Trajectories of smoking behavior, intention, and willingness all assumed two distinct but constant latent classes independent of the intervention. CONCLUSIONS: This study suggests that addressing attitudinal and control beliefs among adolescents and building on assertiveness via additional strategies in life skills such as appropriate refusal skills may be beneficial. The absence of a successful change in subjective norm should be a focus for future anti-smoking programs in China.


Assuntos
Atitude , Cognição , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/métodos , Fumar/psicologia , Adolescente , China , Feminino , Humanos , Intenção , Masculino , Instituições Acadêmicas , Abandono do Hábito de Fumar/psicologia , Estudantes/psicologia , Inquéritos e Questionários
13.
Int J Behav Med ; 26(1): 91-97, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30607537

RESUMO

BACKGROUND: China is the world's largest tobacco consumer. Smoking initiation dramatically increases from teenage to adulthood. In this study, we investigated adolescents' future smoking intention at critical ages and its associated predictors. METHODS: Using a longitudinal design (3 waves) across 6 months in 2016, data from 156 10th graders in two high schools in China were examined. We used latent class growth modelling to explore the heterogeneous trajectories of smoking intentions for two future age groups. Logistic regression was then used to estimate the predictors of trajectories. RESULTS: Two trajectories and three trajectories were identified for future smoking intention in their twenties and forties, respectively. Gender, current smoking status, and mothers' and friends' smoking status all played distinct roles in future smoking intentions. CONCLUSIONS: Chinese adolescents' future intentions at critical ages are of concern. Future tobacco control should target the critical ages as well as incorporate social and cultural meanings of smoking in China. As important factors related to future smoking trajectories, gender and mothers' smoking status should also be considered in anti-smoking prevention efforts. Meanings associated with smoking status in the future should also be explored especially for female adolescents.


Assuntos
Comportamento do Adolescente/psicologia , Fumar/psicologia , Estudantes/psicologia , Adolescente , China , Feminino , Amigos , Humanos , Intenção , Modelos Logísticos , Estudos Longitudinais , Masculino , Mães , Instituições Acadêmicas , Prevenção do Hábito de Fumar/métodos
15.
Drug Alcohol Depend ; 194: 216-224, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30453107

RESUMO

BACKGROUND: The bioSocial Cognitive Theory (bSCT) hypothesizes two pathways linking dimensions of impulsivity to substance use. The first predicts that the association between reward sensitivity and substance use is mediated by positive outcome expectancies. The second predicts that the relationship between rash impulsiveness and substance use is mediated by refusal self-efficacy. This model has received empirical support in studies of alcohol use. The present research provides the first application of bSCT to a cannabis treatment population and aims to extend its utility to understanding cannabis use and severity of dependence. DESIGN: 273 patients referred for cannabis treatment completed a clinical assessment that contained measures of interest. SETTING: A public hospital alcohol and drug clinic. MEASUREMENTS: The Sensitivity to Reward Scale, Dysfunctional Impulsivity Scale, Cannabis Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire and Severity of Dependence Scale-Cannabis were completed, along with measures of cannabis consumption. FINDINGS: The bSCT model provided a good fit to the data for cannabis use and severity of dependence outcomes. The association between reward sensitivity and each cannabis outcome was fully mediated by positive cannabis expectancies and cannabis refusal self-efficacy. The relationship between rash impulsiveness and each cannabis outcome was fully mediated by cannabis refusal self-efficacy. CONCLUSIONS: Findings support the application of the bSCT model to cannabis use and dependence severity and highlight the important role of social cognitive mechanisms in understanding the association between impulsivity traits and these outcomes. The differential association of impulsivity traits to social cognition may assist targeted treatment efforts.


Assuntos
Cognição , Abuso de Maconha/psicologia , Abuso de Maconha/terapia , Modelos Psicológicos , Encaminhamento e Consulta , Comportamento Social , Adulto , Cognição/fisiologia , Estudos Transversais , Feminino , Humanos , Comportamento Impulsivo/fisiologia , Masculino , Encaminhamento e Consulta/tendências , Recompensa , Autoeficácia , Inquéritos e Questionários , Resultado do Tratamento
16.
Psychooncology ; 28(3): 505-510, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30552786

RESUMO

OBJECTIVE: Sun safety is crucial for preventing skin cancer. This study evaluated a school-based intervention based on the theory of planned behaviour (TPB), which aimed to encourage sun-protective behaviour among adolescents. METHODS: Secondary school students (N = 382; 61.1% female; Mage  = 13.73 y) in Queensland, Australia, participated in the study. Schools were randomly allocated to an intervention or control group. The intervention focussed on fostering positive attitudes, increasing perceptions of normative support, and strengthening control perceptions. Participants completed questionnaires assessing the TPB variables and sun-protective behaviour (weekday and weekend) 1 week before intervention (time 1), 1 week after intervention (time 2), and 4 weeks after intervention (time 3). RESULTS: With baseline between-group differences in TPB variables matched, repeated-measures multivariate analysis of variance was used to evaluate the Time × Condition effects across time. Multigroup comparisons using path models traced the intervariable changes. From times 1 to 3, a significant improvement in weekend sun-protective behaviour was identified in the intervention group (but not the control group), whereas cognitions showed no significant changes across time for either conditions. Multigroup comparisons on path coefficients between the intervention and control group participants indicated that the intervention group members formed stronger positive associations between perceived behavioural control and intention at time 2 and between perceived control and behaviour at time 3. CONCLUSION: The significant behavioural change on weekends highlights the value of targeting control perceptions, which may encourage adolescents' sun-protective behaviour. Further studies are needed to understand the absence of significant changes in weekday sun-safe behaviour among this at-risk cohort.


Assuntos
Comportamentos Relacionados com a Saúde , Educação em Saúde/métodos , Serviços de Saúde Escolar/organização & administração , Neoplasias Cutâneas/prevenção & controle , Queimadura Solar/prevenção & controle , Adolescente , Análise de Variância , Austrália , Feminino , Humanos , Masculino , Teoria Psicológica , Queensland , Neoplasias Cutâneas/psicologia , Luz Solar/efeitos adversos , Inquéritos e Questionários
17.
Psychiatry Res ; 270: 775-779, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30551324

RESUMO

Several studies have established that Major depressive disorder is associated with excess inflammation with an elevation of both pro and anti-inflammatory cytokines in major depressive disorder. In addition, individuals with major depressive disorder are at higher risk of developing coronary artery disease. The role of innate immunity and NFκB-mediated inflammation in depression and its increased association with coronary artery disease is yet to be fully elucidated. Polymorphisms in the Nucleotide-Binding Oligomerization Domain, Leucine Rich Repeat and Pyrin Domain Containing 12 (NLRP12), are associated with depression and coronary artery disease in trauma exposed individuals. In a cohort of Vietnam War veterans (n = 299) NLRP12 polymorphisms were analysed for association with depression and coronary calcium scores. The NLRP12 polymorphism, rs34436714 was associated with a higher DASS21 Score for depression (p = 0.037). NLRP12 polymorphisms rs34971363 and rs6509825 (p = 0.022 and p = 0.020) were associated with raised coronary calcium score. To our knowledge, this is the first time rs34436714 has been investigated in Vietnam veterans identifying AC as a risk genotype for depression in Caucasian cohorts. It is also the first time the rs34971363 (CG) and rs6509825 (CT) genotype have been associated with raised coronary calcium score.


Assuntos
Distúrbios de Guerra/genética , Doença da Artéria Coronariana/genética , Transtorno Depressivo Maior/genética , Genótipo , Inflamassomos/genética , Peptídeos e Proteínas de Sinalização Intracelular/genética , Veteranos , Estudos de Coortes , Distúrbios de Guerra/imunologia , Doença da Artéria Coronariana/imunologia , Transtorno Depressivo Maior/imunologia , Humanos , Imunidade Inata/genética , Imunidade Inata/imunologia , Inflamassomos/imunologia , Masculino , NF-kappa B/genética , Polimorfismo Genético , Fatores de Risco
18.
Brain Behav Immun ; 74: 133-142, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30189241

RESUMO

BACKGROUND: Posttraumatic stress disorder (PTSD) is a serious condition that emerges following trauma exposure and involves long-lasting psychological suffering and health-issues. Uncovering critical genes and molecular networks is essential to understanding the biology of the disorder. We performed a genome-wide scan to identify transcriptome signatures of PTSD. METHODS: Genome-wide peripheral blood transcriptomic data from 380 service personnel were investigated. This included a discovery sample of 96 Australian Vietnam War veterans and two independent pre and post-deployment replication samples of U.S. Marines (N = 188 and N = 96). RESULTS: A total of 60 transcripts were differentially expressed between veterans with and without PTSD, surviving Bonferroni multiple testing correction. Genes within the cytokine-cytokine receptor interaction, Jak-STAT signaling and Toll-like receptor signaling pathways were enriched. For 49% of the genes, gene expression changes were also accompanied by DNA methylation changes. Using replication data from two U.S. Marine cohorts, we observed that of the differentially expressed genes, 71% genes also showed significant gene expression changes between pre and post-deployment. Weighted gene co-expression networks revealed two modules of genes associated with PTSD. The first module (67 genes, p-value = 6e-4) was enriched for genes within the 11p13 locus including BDNF. The second module (266 genes, p-value = 0.01) was enriched for genes in 17q11 including SLC6A4, STAT5A and STAT5B. CONCLUSIONS: We identified novel transcriptomic loci and biological pathways for PTSD in service personnel. Network analysis revealed enrichment of loci harboring key candidate genes in PTSD. These findings highlight the role of transcriptional biomarkers in the molecular etiology of PTSD.


Assuntos
Transtornos de Estresse Pós-Traumáticos/genética , Transtornos de Estresse Pós-Traumáticos/imunologia , Idoso , Austrália , Metilação de DNA/genética , Perfilação da Expressão Gênica/métodos , Redes Reguladoras de Genes/genética , Estudo de Associação Genômica Ampla/métodos , Humanos , Sistema Imunitário/fisiopatologia , Masculino , Militares , Transtornos de Estresse Pós-Traumáticos/sangue , Transcriptoma/genética , Estados Unidos , Veteranos/psicologia
19.
J Clin Sleep Med ; 14(9): 1577-1586, 2018 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-30176975

RESUMO

STUDY OBJECTIVES: Recent results from the PTSD Initiative, a cross-sectional cohort study in Australian Vietnam veterans (VV) with and without posttraumatic stress disorder (PTSD), demonstrated an increased prevalence of self-reported sleep disturbances in those with PTSD. This study aimed to objectively assess the prevalence of sleep disorders in the same cohort using detailed polysomnography (PSG). METHODS: Participants from the PTSD Initiative were recruited to undergo PSG. PTSD status was determined with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). Subjective sleep information was attained via structured questionnaires. Data from single night PSG were compared between trauma-exposed VV with and without PTSD. RESULTS: A total of 74 trauma-exposed male VV (40 with PTSD) underwent PSG (prospective n = 59, retrospective n = 15). All PSG parameters were similar between groups. No difference was seen in PSG-diagnosed obstructive sleep apnea (OSA) or periodic limb movements of sleep (PLMS). VV with PTSD showed a trend toward increased duration of sleep with oxygen saturations < 90% (10% versus 1.8%; P = .07). VV with PTSD reported increased sleep onset latency (42.4 versus 13.3 minutes; P < .01); were less likely to report sleeping well (32.5% versus 67.5%; P < .01); had higher OSA risk using Berlin Questionnaire (BQ) (70% versus 38.2%; P < .01); and had higher rates of partner-reported limb movements (56.4% versus 17.6%; P < .01). No association between PSG-diagnosed OSA and PTSD severity was evident. CONCLUSIONS: In Australian VV with and without PTSD, no difference was seen across all PSG parameters including the diagnosis and severity of OSA and PLMS. However, VV with PTSD demonstrated an increased perception of sleep disturbances.


Assuntos
Polissonografia/métodos , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/estatística & dados numéricos , Idoso , Austrália/epidemiologia , Estudos de Coortes , Comorbidade , Estudos Transversais , Humanos , Masculino , Prevalência , Índice de Gravidade de Doença , Guerra do Vietnã
20.
Australas Psychiatry ; 26(5): 524-530, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30113869

RESUMO

OBJECTIVES: There are some psychosocial factors that have similar importance to biological factors in the genesis of coronary diseases. However, reasons for high rates of coronary heart disease in individuals with post-traumatic stress disorder (PTSD) are yet to be fully elucidated. Using a meta-analysis, we investigated the longitudinal relationship between PTSD and coronary heart disease (CHD) as an independent factor in the aetiology of CHD. METHODS: The databases of Medline, EBSCOhost and Psychoinfo were electronically searched for relevant articles. RESULTS: The pooled hazard ratio (HR) for the magnitude of the relationship between PTSD and CHD was an HR of 1.61, and p-value of p < 0.0005, 95% confidence interval (CI) [1.46-1.77] before adjustment for depression in nine studies ( N = 151,144) that met inclusion criteria. The HR estimates for the seven depression-adjusted estimates was 1.46, and a p-value of p < 0.0005, 95% CI[0.26-1.69]. CONCLUSIONS: This study demonstrates an association between CHD and PTSD.


Assuntos
Comorbidade , Doença da Artéria Coronariana , Transtorno Depressivo , Transtornos de Estresse Pós-Traumáticos , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etiologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia
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