RESUMEN
BACKGROUND: Of 58 medication adherence group-based trajectory modeling (GBTM) published studies, 74% used binary and 26% used continuous GBTM. Few studies provided a rationale for this choice. No medication adherence studies have compared continuous and binary GBTM. OBJECTIVE: The objective of this study was to assess whether continuous versus binary GBTM: (1) impacts adherence trajectory shapes; and (2) results in the differential classification of patients into adherence groups. METHODS: Patients were prevalent statin users with myocardial infarction hospitalization, 66+ years old, and continuously enrolled in fee-for-service Medicare. Statin medication adherence was measured 6 months prehospitalization using administrative claims. Final GBTM specifications beyond default settings were selected using a previously defined standardized procedure and applied separately to continuous and binary (proportion of days covered ≥0.80) medication adherence measures. Assignment to adherence groups was compared between continuous and binary models using percent agreement of patient classification and the κ coefficient. RESULTS: Among 113,296 prevalent statin users, 4 adherence groups were identified in both models. Three groups were consistent: persistently adherent, progressively nonadherent, and persistently nonadherent. The fourth continuous group was moderately adherent (progressively adherent in the binary model). When comparing patient assignment into adherence groups between continuous and binary trajectory models, only 78.4% of patients were categorized into comparable groups (κ=0.641; 95% confidence interval: 0.638-0.645). The agreement was highest in the persistently adherent group (â¼94%). CONCLUSIONS: Continuous and binary trajectory models are conceptually different measures of medication adherence. The choice between these approaches should be guided by study objectives and the role of medication adherence within the study-exposure, outcome, or confounder.
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Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Cumplimiento de la Medicación , Infarto del Miocardio/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Modelos Teóricos , Estudios Retrospectivos , Estados UnidosRESUMEN
PURPOSE: The rationale for choosing a final group-based trajectory modeling (GBTM) specification and evaluations of patient adherence patterns within groups are often omitted in the GBTM medication adherence literature. We aimed to (1) reveal the complexity of GBTM and (2) assess model discrimination of patient medication adherence patterns. METHODS: Medicare administrative claims were used to measure statin medication adherence as a continuous value in the 6 months before an acute myocardial infarction (AMI) hospitalization. Different GBTM specifications beyond default settings were constructed and compared with the Bayesian information criterion. Spaghetti plots were used to compare individual adherence patterns with group averages. RESULTS: Overall, 113,296 prevalent statin users met eligibility criteria. Four adherence groups were identified: persistently adherent, moderately adherent, progressively nonadherent, and persistently nonadherent. Spaghetti plots showed the persistently adherent and persistently nonadherent groups had relatively homogeneous adherence patterns that matched predicted trajectories well. Spaghetti plots also showed that, while adherence patterns in the progressively nonadherent group were not as homogeneous, most patients in this group appeared to be discontinuing statin therapy pre-AMI. CONCLUSIONS: Subjective decisions are necessary to identify a final trajectory model. Greater transparency and disclosure of these decisions in the medication adherence literature are needed. Individual patient adherence patterns from spaghetti plots provided additional diagnostic information about trajectory models beyond standard model-fit assessments to determine if group-average adherence estimates represent homogeneous patterns of medication adherence.
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Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Adulto , Anciano , Teorema de Bayes , Femenino , Hospitalización , Humanos , Masculino , Medicare , Persona de Mediana Edad , Infarto del Miocardio , Estados UnidosAsunto(s)
Desarrollo del Adolescente/fisiología , Salud del Adolescente/estadística & datos numéricos , Estado de Salud , Salud Mental , Adolescente , Conducta del Adolescente/fisiología , Conducta del Adolescente/psicología , Niño , Estudios de Cohortes , Ambiente , Femenino , Conductas Relacionadas con la Salud , Humanos , Relaciones Interpersonales , Estudios Longitudinales , Masculino , Pruebas Neuropsicológicas , Personalidad , Proyectos de Investigación , Conducta Sexual , Medio Social , Factores Socioeconómicos , Estados Unidos/epidemiologíaRESUMEN
Background Many older patients have a change in statin adherence-either an increase or a decrease-from before to after an acute myocardial infarction ( AMI ), but its association with mortality is unknown. Methods and Results Using Medicare administrative claims, a cohort of patients ≥66 years old with an AMI hospitalization from 2008 to 2010 was assembled. Statin adherence was measured for 180 days pre- AMI and 180 days post- AMI and categorized as severely nonadherent, moderately nonadherent, or adherent. Categorical change in statin adherence from pre- to post- AMI was assessed. Patients were then followed for up to 18 months for all-cause mortality. A Cox proportional hazards model was applied to estimate the effects of statin adherence change on all-cause mortality, adjusted for patient baseline characteristics. Of 101 011 eligible patients, 20% had a categorical increase in adherence, 16% decreased, and 14% remained nonadherent both pre- and post- AMI . Compared with patients who were always severely nonadherent (both pre- and post- AMI ), patients whose adherence increased from severely nonadherent to adherent (hazard ratio=0.83; 95% CI : 0.75-0.92) and patients who were always adherent (hazard ratio=0.88; 95% CI : 0.82-0.94) were less likely to die; patients whose adherence decreased from moderately nonadherent to severely nonadherent were more likely to die (hazard ratio=1.11; 95% CI : 1.01-1.22). Conclusions After an AMI , patients with decreased statin adherence had the worst mortality outcomes. However, patients with increased statin adherence had a similar risk of mortality compared with continuously adherent patients, suggesting that, even after an AMI , it is not too late to improve statin adherence.
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Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Causas de Muerte , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/mortalidad , Análisis de Supervivencia , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Hospitalizations for acute myocardial infarctions (AMIs) are associated with changes in statin adherence. It is unclear to what extent adherence changes, which patients are likely to change, and how post-discharge follow-up is associated with statin adherence change. METHODS AND RESULTS: This retrospective study used Medicare data for all fee-for-service beneficiaries 66 years and older with an AMI hospitalization in 2008-2010 and statin use before their index AMI. Multivariable multinomial logistic regression models (odds ratio [OR] and 99% confidence interval [CI]) were applied to assess associations between both patient characteristics and follow-up with a primary care provider and/or cardiologist with the outcome of statin adherence change (increase or decrease) from the 6-month pre- to 6-month post-AMI periods. Of 113 296 patients, 64.0% had no change in adherence, while 19.7% had increased and 16.3% had decreased adherence after AMI hospitalization. Black and Hispanic patients were more likely to have either increased or decreased adherence than white patients. Patients who required coronary artery bypass graft surgery (OR, 1.34; 99% CI, 1.21-1.49) or percutaneous transluminal coronary angioplasty/stent procedure (OR, 1.25; 99% CI, 1.17-1.32) during their index hospitalization were more likely to have increased adherence. Follow-up with a primary care provider was only mildly associated with increased adherence (OR, 1.08; 99% CI, 1.00-1.16), while follow-up with a cardiologist (OR, 1.15; 99% CI, 1.05-1.25) or both provider types (OR, 1.21; 99% CI, 1.12-1.30) had stronger associations with increased adherence. CONCLUSIONS: Post-AMI changes in statin adherence varied by patient characteristics, and improved adherence was associated with post-discharge follow-up care, particularly with a cardiologist or both a primary care provider and a cardiologist.
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Dislipidemias/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Cumplimiento de la Medicación , Infarto del Miocardio/terapia , Prevención Secundaria/métodos , Reclamos Administrativos en el Cuidado de la Salud , Cuidados Posteriores/métodos , Anciano , Anciano de 80 o más Años , Cardiología , Comorbilidad , Bases de Datos Factuales , Dislipidemias/diagnóstico , Dislipidemias/etnología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Modelos Logísticos , Masculino , Medicare , Análisis Multivariante , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/etnología , Oportunidad Relativa , Alta del Paciente , Atención Primaria de Salud , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
SETTING: Mexico City, Mexico. OBJECTIVE: To identify proteins synthetised by Mycobacterium tuberculosis in hypoxic culture, which resemble more closely a granuloma environment than aerobic culture, and to determine if they are recognised by antibodies from patients with active pulmonary tuberculosis (PTB). DESIGN: Soluble extracts from M. tuberculosis H37Rv cultured under aerobic or hypoxic conditions were analysed using two-dimensional polyacrylamide gel electrophoresis, and proteins over-expressed under hypoxia were identified by mass spectrometry. The presence of immunoglobulin (Ig) G, IgA and IgM antibodies against these proteins was determined in the serum of 42 patients with active PTB and 42 healthy controls. RESULTS: We selected three M. tuberculosis H37Rv proteins (alpha-crystallin protein [Acr, Rv2031c], universal stress protein Rv2623 and isocitrate lyase [ICL, RV0467]) that were over-expressed under hypoxia. Titres of anti-Acr and anti-ICL IgA antibodies were higher in patients than in healthy controls, with an area under the receiver operating characteristic curve of 0.71 for anti-ICL IgA antibodies. CONCLUSION: ICL could be used in combination with other M. tuberculosis antigens to improve the sensitivity and specificity of current serological TB diagnostic methods.
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Anticuerpos Antibacterianos/sangre , Inmunoglobulina A/sangre , Isocitratoliasa/inmunología , Tuberculosis Pulmonar/diagnóstico , alfa-Cristalinas/inmunología , Adulto , Anciano , Antígenos Bacterianos/sangre , Estudios de Casos y Controles , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , México , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Sensibilidad y Especificidad , Tuberculosis Pulmonar/sangre , Adulto JovenRESUMEN
BACKGROUND: The low transcriptionally efficient short-allele of the 5HTTLPR serotonin transporter polymorphism has been implicated to moderate the relationship between the experience of stressful life events (SLEs) and depression. Despite numerous attempts at replicating this observation, results remain inconclusive. METHODS: We examined this relationship in young-adult Non-Hispanic white males and females between the ages of 22 and 26 (n = 4724) participating in the National Longitudinal Study of Adolescent to Adult Health (Add Health) with follow-up information every six years since 1995. RESULTS: Linear and logistic regression models, corrected for multiple testing, indicated that carriers of one or more of the S-alleles were more sensitive to stress than those with two L-alleles and at a higher risk for depression. This relationship behaved in a dose-response manner such that the risk for depression was greatest among those who reported experiencing higher numbers of SLEs. In post-hoc analyses we were not able to replicate an interaction effect for suicide ideation but did find suggestive evidence that the effects of SLEs and 5HTTLPR on suicide ideation differed for males and females. There were no effects of childhood maltreatment. DISCUSSION: Our results provide partial support for the original hypothesis that 5-HTTLPR genotype interacts with the experience of stressful life events in the etiology of depression during young adulthood. However, even with this large sample, and a carefully constructed a priori analysis plan, the results were still not definitive. For the purposes of replication, characterizing the 5HTTLPR in other large data sets with extensive environmental and depression measures is needed.
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Depresión/genética , Predisposición Genética a la Enfermedad , Acontecimientos que Cambian la Vida , Polimorfismo Genético , Proteínas de Transporte de Serotonina en la Membrana Plasmática/genética , Estrés Psicológico/genética , Adolescente , Adulto , Alelos , Maltrato a los Niños/rehabilitación , Depresión/etiología , Depresión/fisiopatología , Femenino , Expresión Génica , Genotipo , Heterocigoto , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Factores de Riesgo , Factores Sexuales , Estrés Psicológico/complicaciones , Estrés Psicológico/fisiopatología , Ideación Suicida , Estados UnidosRESUMEN
OBJECTIVES: To evaluate pneumococcal immunization in older adults living in retirement communities and to measure nasopharyngeal carriage of Streptococcus pneumoniae to better assess the potential for herd protection from the 13-valent pneumococcal conjugate vaccine (PCV-13) in these settings. DESIGN: Cross-sectional observational study of adults aged 65 and older living in retirement communities to determine coverage with 23-valent pneumococcal vaccine (PPSV-23), coverage with PCV-13 in immuncompromised individuals according to 2012 Advisory Committee on Immunization Practices (ACIP) guidelines, and nasopharyngeal carriage of S. pneumoniae. SETTING: Two retirement communities in North Carolina. PARTICIPANTS: Older adults recruited between December 2013 and April 2014 (N = 21, 64.8% female, mean age 81.4). MEASUREMENTS: A survey was used to assess chronic illnesses, immunization history, and potential risk factors for pneumococcal carriage; a chart review was used to confirm immunization history and abstract chronic conditions; and a nasopharyngeal swab was collected and cultured for S. pneumoniae. RESULTS: Eighty-seven percent of participants reported receiving PPSV-23 since age 65. Of the 16.2% of participants with an immunocompromising condition, only one had received PCV-13. Nasopharyngeal carriage with S. pneumoniae was detected in 1.9% (95% confidence interval = 0.0-3.8%) of participants. CONCLUSION: In this select sample, PPSV-23 coverage was high, but adherence to the ACIP recommendation for PCV-13 in immunocompromised groups was low. Nasopharyngeal carriage of S. pneumoniae was present, although infrequent, suggesting that immunization with PCV-13 could provide an individual benefit and a small degree of herd protection.
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Portador Sano , Viviendas para Ancianos , Nasofaringe/microbiología , Vacunas Neumococicas , Streptococcus pneumoniae/aislamiento & purificación , Vacunación/estadística & datos numéricos , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Huésped Inmunocomprometido , Masculino , North Carolina/epidemiología , Neumonía Neumocócica/prevención & control , Vacunas ConjugadasRESUMEN
PURPOSE: We investigated understudied biomarker-based diabetes among young US adults, traditionally characterized by low cardiovascular disease risk. METHODS: We examined 15,701 participants aged 24 to 32 years at Wave IV of the National Longitudinal Study of Adolescent Health (Add Health, 2008). The study used innovative and relatively noninvasive methods to collect capillary whole blood via finger prick at in-home examinations in all 50 states. RESULTS: Assays of dried blood spots produced reliable and accurate values of HbA1c. Reliability was lower for fasting glucose and lowest for random glucose. Mean (SD) HbA1c was 5.6% (0.8%). More than a quarter (27.4%) had HbA1c-defined prediabetes. HbA1c was highest in the black, non-Hispanic race/ethnic group, inversely associated with education, and more common among the overweight/obese and physically inactive. The prevalence of diabetes defined by previous diagnosis or use of antidiabetic medication was 2.9%. Further incorporating HbA1c and glucose values, the prevalence increased to 6.8%, and among these participants, 38.9% had a previous diagnosis of diabetes (i.e., aware). Among those aware, 37.6% were treated and 64.0% were controlled (i.e., HbA1c < 7%). CONCLUSIONS: A contemporary cohort of young adults faces a historically high risk of diabetes but there is ample opportunity for early detection and intervention.
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Glucemia/metabolismo , Diabetes Mellitus Tipo 2/epidemiología , Pruebas con Sangre Seca/métodos , Hemoglobina Glucada/metabolismo , Homeostasis , Adulto , Negro o Afroamericano/estadística & datos numéricos , Población Negra/estadística & datos numéricos , Glucemia/análisis , Índice de Masa Corporal , Diabetes Mellitus Tipo 2/sangre , Femenino , Hemoglobina Glucada/análisis , Humanos , Estudios Longitudinales , Masculino , Encuestas Nutricionales , Prevalencia , Reproducibilidad de los Resultados , Población Blanca/estadística & datos numéricos , Adulto JovenRESUMEN
Simple sequence repeats (SSRs) are one of the earliest available forms of genetic variation available for analysis and have been utilized in studies of neurological, behavioral, and health phenotypes. Although findings from these studies have been suggestive, their interpretation has been complicated by a variety of factors including, among others, limited power due to small sample sizes. The current report details the availability, diversity, and allele and genotype frequencies of six commonly examined SSRs in the ethnically diverse, population-based National Longitudinal Study of Adolescent Health. A total of 106,743 genotypes were generated across 15,140 participants that included four microsatellites and two di-nucleotide repeats in three dopamine genes (DAT1, DRD4, DRD5), the serotonin transporter, and monoamine oxidase A. Allele and genotype frequencies showed a complex pattern and differed significantly between populations. For both di-nucleotide repeats we observed a greater allelic diversity than previously reported. The availability of these six SSRs in a large, ethnically diverse sample with extensive environmental measures assessed longitudinally offers a unique resource for researchers interested in health and behavior.
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Predisposición Genética a la Enfermedad/genética , Variación Genética/genética , Genotipo , Adolescente , Etnicidad/genética , Femenino , Humanos , Estudios Longitudinales , Masculino , Repeticiones de Minisatélite/genéticaRESUMEN
Gene flow within and between species is a fundamental process shaping the evolutionary history of taxa. However, the extent of hybridization and reinforcement is little documented in the tropics. Here we explore the pattern of gene flow between three sister species from the herbaceous genus Marantochloa (Marantaceae), sympatrically distributed in the understorey of the African rainforest, using data from the chloroplast and nuclear genomes (DNA sequences and AFLP). We found highly contrasting patterns: while there was no evidence of gene flow between M. congensis and M. monophylla, species identity between M. monophylla and M. incertifolia was maintained despite considerable gene flow. We hypothesize that M. incertifolia originated from an ancient hybridization event between M. congensis and M. monophylla, considering the current absence of hybridization between the two assumed parent species, the rare presence of shared haplotypes between all three species and the high percentage of haplotypes shared by M. incertifolia with each of the two parent species. This example is contrasted with two parapatrically distributed species from the same family in the genus Haumania forming a hybrid zone restricted to the area of overlap. This work illustrates the diversity of speciation/introgression patterns that can potentially occur in the flora of tropical Africa.
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Flujo Génico , Marantaceae/genética , Filogenia , África , ADN de Plantas/genética , Bosques , Haplotipos , Hibridación Genética , Filogeografía , Análisis de Secuencia de ADNRESUMEN
BACKGROUND: Maltreatment by an adult or caregiver during childhood is a prevalent and important predictor of antisocial behaviors in adulthood. A functional promoter polymorphism in the monoamine oxidase A (MAOA) gene has been implicated as a moderating factor in the relationship between childhood maltreatment and antisocial behaviors. Although there have been numerous attempts at replicating this observation, results remain inconclusive. METHODS: We examined this gene-environment interaction hypothesis in a sample of 3356 white and 960 black men (aged 24-34) participating in the National Longitudinal Study of Adolescent Health. RESULTS: Primary analysis indicated that childhood maltreatment was a significant risk factor for later behaviors that violate rules and the rights of others (p < .05), there were no main effects of MAOA genotype, and MAOA genotype was not a significant moderator of the relationship between maltreatment and antisocial behaviors in our white sample. Post hoc analyses identified a similar pattern of results among our black sample in which maltreatment was not a significant predictor of antisocial behavior. Post hoc analyses also revealed a main effect of MAOA genotype on having a disposition toward violence in both samples and for violent convictions among our black sample. None of these post hoc findings, however, survived correction for multiple testing (p > .05). Power analyses indicated that these results were not due to insufficient statistical power. CONCLUSIONS: We could not confirm the hypothesis that MAOA genotype moderates the relationship between childhood maltreatment and adult antisocial behaviors.
Asunto(s)
Trastorno de Personalidad Antisocial , Maltrato a los Niños/psicología , Interacción Gen-Ambiente , Predisposición Genética a la Enfermedad/genética , Monoaminooxidasa/genética , Adulto , Negro o Afroamericano , Trastorno de Personalidad Antisocial/etnología , Trastorno de Personalidad Antisocial/etiología , Trastorno de Personalidad Antisocial/genética , Niño , Genotipo , Humanos , Masculino , Población BlancaRESUMEN
AFLP markers are often used to study patterns of population genetic variation and gene flow because they offer a good coverage of the nuclear genome, but the reliability of AFLP scoring is critical. To assess interspecific gene flow in two African rainforest liana species (Haumania danckelmaniana, H. liebrechtsiana) where previous evidence of chloroplast captures questioned the importance of hybridization and species boundaries, we developed new AFLP markers and a novel approach to select reliable bands from their degree of reproducibility. The latter is based on the estimation of the broad-sense heritability of AFLP phenotypes, an improvement over classical scoring error rates, which showed that the polymorphism of most AFLP bands was affected by a substantial nongenetic component. Therefore, using a quantitative genetics framework, we also modified an existing estimator of pairwise kinship coefficient between individuals correcting for the limited heritability of markers. Bayesian clustering confirms the recognition of the two Haumania species. Nevertheless, the decay of the relatedness between individuals of distinct species with geographic distance demonstrates that hybridization affects the nuclear genome. In conclusion, although we showed that AFLP markers might be substantially affected by nongenetic factors, their analysis using the new methods developed considerably advanced our understanding of the pattern of gene flow in our model species.
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Análisis del Polimorfismo de Longitud de Fragmentos Amplificados/métodos , Flujo Génico , Variación Genética , Marantaceae/genética , África Central , Teorema de Bayes , ADN de Plantas/genética , Marcadores Genéticos , Haplotipos , Hibridación Genética , Marantaceae/clasificación , Filogenia , Filogeografía , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Type 2 diabetes is a prevalent chronic condition globally that results in extensive morbidity, decreased quality of life, and increased health services utilization. Lifestyle changes can prevent the development of diabetes, but require patient engagement. Genetic risk testing might represent a new tool to increase patients' motivation for lifestyle changes. Here we describe the rationale, development, and design of a randomized controlled trial (RCT) assessing the clinical and personal utility of incorporating type 2 diabetes genetic risk testing into comprehensive diabetes risk assessments performed in a primary care setting. METHODS/DESIGN: Patients are recruited in the laboratory waiting areas of two primary care clinics and enrolled into one of three study arms. Those interested in genetic risk testing are randomized to receive either a standard risk assessment (SRA) for type 2 diabetes incorporating conventional risk factors plus upfront disclosure of the results of genetic risk testing ("SRA+G" arm), or the SRA alone ("SRA" arm). Participants not interested in genetic risk testing will not receive the test, but will receive SRA (forming a third, "no-test" arm). Risk counseling is provided by clinic staff (not study staff external to the clinic). Fasting plasma glucose, insulin levels, body mass index (BMI), and waist circumference are measured at baseline and 12 months, as are patients' self-reported behavioral and emotional responses to diabetes risk information. Primary outcomes are changes in insulin resistance and BMI after 12 months; secondary outcomes include changes in diet patterns, physical activity, waist circumference, and perceived risk of developing diabetes. DISCUSSION: The utility, feasibility, and efficacy of providing patients with genetic risk information for common chronic diseases in primary care remain unknown. The study described here will help to establish whether providing type 2 diabetes genetic risk information in a primary care setting can help improve patients' clinical outcomes, risk perceptions, and/or their engagement in healthy behavior change. In addition, study design features such as the use of existing clinic personnel for risk counseling could inform the future development and implementation of care models for the use of individual genetic risk information in primary care. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00849563.
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Diabetes Mellitus Tipo 2/genética , Predisposición Genética a la Enfermedad/psicología , Pruebas Genéticas , Conductas Relacionadas con la Salud , Evaluación de Resultado en la Atención de Salud , Atención Primaria de Salud/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Actitud Frente a la Salud , Diabetes Mellitus Tipo 2/prevención & control , Humanos , Persona de Mediana Edad , Educación del Paciente como Asunto , Estudios Prospectivos , Proyectos de Investigación , Medición de Riesgo , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Genomic risk profiling involves the analysis of genetic variations linked through statistical associations to a range of disease states. There is considerable controversy as to how, and even whether, to incorporate these tests into routine medical care. OBJECTIVE: To assess physician attitudes and uptake of genomic risk profiling among an 'early adopter' practice group. DESIGN: We surveyed members of MDVIP, a national group of primary care physicians (PCPs), currently offering genomic risk profiling as part of their practice. POPULATION: All physicians in the MDVIP network (N = 356) RESULTS: We obtained a 44% response rate. One third of respondents had ordered a test for themselves and 42% for a patient. The odds of having ordered personal testing were 10.51-fold higher for those who felt well-informed about genomic risk testing (p < 0.0001). Of those who had not ordered a test for themselves, 60% expressed concerns for patients regarding discrimination by life and long-term/disability insurers, 61% about test cost, and 62% about clinical utility. The odds of ordering testing for their patients was 8.29-fold higher among respondents who had ordered testing for themselves (p < 0.0001). Of those who had ordered testing for patients, concerns about insurance coverage (p = 0.014) and uncertain clinical utility (p = 0.034) were associated with a lower relative frequency of intention to order testing again in the future. CONCLUSIONS: Our findings demonstrate that respondent familiarity was a key predictor of physician ordering behavior and clinical utility was a primary concern for genomic risk profiling. Educational and interpretive support may enhance uptake of genomic risk profiling.
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Actitud del Personal de Salud , Perfilación de la Expresión Génica/estadística & datos numéricos , Pruebas Genéticas/estadística & datos numéricos , Genómica , Médicos de Atención Primaria , Atención Primaria de Salud/métodos , Femenino , Variación Genética/genética , Encuestas Epidemiológicas/métodos , Humanos , MasculinoRESUMEN
Species delimitation is a fundamental biological concept which is frequently discussed and altered to integrate new insights. These revealed that speciation is not a one step phenomenon but an ongoing process and morphological characters alone are not sufficient anymore to properly describe the results of this process. Here we want to assess the degree of speciation in two closely related lianescent taxa from the tropical African genus Haumania which display distinct vegetative traits despite a high similarity in reproductive traits and a partial overlap in distribution area which might facilitate gene flow. To this end, we combined phylogenetic and phylogeographic analyses using nuclear (nr) and chloroplast (cp) DNA sequences in comparison to morphological species descriptions. The nuclear dataset unambiguously supports the morphological species concept in Haumania. However, the main chloroplastic haplotypes are shared between species and, although a geographic analysis of cpDNA diversity confirms that individuals from the same taxon are more related than individuals from distinct taxa, cp-haplotypes display correlated geographic distributions between species. Hybridization is the most plausible reason for this pattern. A scenario involving speciation in geographic isolation followed by range expansion is outlined. The study highlights the gain of information on the speciation process in Haumania by adding georeferenced molecular data to the morphological characteristics. It also shows that nr and cp sequence data might provide different but complementary information, questioning the reliability of the unique use of chloroplast data for species recognition by DNA barcoding.
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ADN de Cloroplastos/genética , ADN de Plantas/genética , Marantaceae/clasificación , Marantaceae/genética , Filogenia , África Central , Código de Barras del ADN Taxonómico , Flujo Génico/genética , Filogeografía , Especificidad de la EspecieRESUMEN
Sociometric nominations, social cognitive maps, and self-report questionnaires were completed in consecutive years by 327 students (56% girls) followed longitudinally from grade 7 to grade 8 to examine the stability of social standing in peer groups and correlates of changes in social standing. Social preference, perceived popularity, network centrality, and leadership were moderately stable from grade 7 to grade 8. Alcohol use and relational aggression in grade 7 predicted changes in social preference and centrality, respectively, between grade 7 and grade 8, but these effects were moderated by gender and ethnicity. Changes in social standing from grade 7 to grade 8 were unrelated to grade 8 physical aggression, relational aggression, and alcohol use after controlling for the grade 7 corollaries of these behaviors. Results are discussed in terms of their implications for understanding links between social standing and problem behaviors during adolescence.
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Conducta del Adolescente/psicología , Relaciones Interpersonales , Grupo Paritario , Autoimagen , Percepción Social , Adolescente , Factores de Edad , Agresión , Consumo de Bebidas Alcohólicas , Niño , Femenino , Humanos , Liderazgo , Estudios Longitudinales , Masculino , Factores Sexuales , Técnicas Sociométricas , Encuestas y CuestionariosRESUMEN
This study examined associations among early adolescent romantic relationships, peer standing, problem behaviors, and gender as a moderator of these associations, in a sample of 320 seventh-grade students. Popular and controversial status youth were more likely to have a romantic partner, whereas neglected status youth were less likely to have a romantic partner. Similarly, youth perceived as conventional and unconventional leaders were also more likely to have a romantic partner than were non-leaders. Youth who had a romantic partner drank more alcohol and were more aggressive than were youth who did not have a romantic partner. Among those youth who had romantic partners, those who reported having more deviance-prone partners were themselves more likely to use alcohol and to be more aggressive, and those who engaged in deviant behavior with their partners used more alcohol. However, these associations varied somewhat by gender. These findings underscore the salience of early romantic partner relationships in the adjustment of early adolescents.
RESUMEN
We examined the relations between group context and self- and other-perceptions of aggressive behavior in an ethnically-diverse sample of 168 male and female grade 7 adolescents. We used self- and peer-reports of aggression in high- and average-aggressive mixed-sex and same-sex cliques to examine whether group members would assimilate their self-report of aggression to the aggression report of their peers by way of perceived homophily or, conversely, engage in contrast and see their level of aggression as comparatively low in the face of high-aggression peers. Among boys in mixed-sex groups, comparison with highly-aggressive others resulted in a self-perception of lower levels of aggression than those perceived by their peers. Conversely, girls in mixed-sex groups reported their own levels of aggression to be higher than those perceived by their peers. We interpret these findings in terms of the notion of "norm narrowing": rather than being set by the larger social environment, such as the school, norms are more narrowly determined within one's immediate peer group.
RESUMEN
Two competing hypotheses were tested concerning the associations between current alcohol and cigarette use and measures of individual, group and network peer standing in an ethnically-diverse sample of 156 male and female adolescents sampled at two time points in the seventh grade. Findings lent greater support to the person hypothesis, with early regular substance users enjoying elevated standing amongst their peers and maintaining this standing regardless of their maintenance of or desistance from current use later in the school year. In the fall semester, users (n=20, 13%) had greater social impact, were described by their peers as more popular, and were more central to the peer network than abstainers (i.e., those who did not report current use).Conversely, in the spring semester, there were no differences between users (n=22, 13%) and abstainers in peer ratings of popularity or social impact. Notably, the spring semester users group retained fewer than half of the users from the fall semester. Further, students who had reported current use in the fall, as a group, retained their positions of elevated peer standing in the spring, compared to all other students, and continued to be rated by their peers as more popular and as having greater social impact. We discuss the findings in terms of the benefit of employing simultaneous systemic and individual measures of peer standing or group prominence, which in the case of peer-based prevention programs, can help clarify the truly influential from the "pretenders" in the case of diffusion of risk-related behaviors.