Substance use moderates relationships between apolipoprotein E genotype, hepatitis C, cognition, and depression in Miami Adult Studies on HIV (MASH) participants

The impact of APOE on HIV and HCV disease course, cognition, and memory has been understudied in minoritized populations. This study examined whether scores on cognition and depression measures differed by APOE ε4 carrier status while considering HCV and HIV seropositivity and whether these measures were moderated by substance use. A retrospective analysis examined cognitive and psychological data from participants (n = 493) in the Miami Adult Studies on HIV (MASH) cohort. APOE genotyping was performed on banked blood samples. Multiple linear regression was employed to examine differences across participants living with and without HIV and/or HCV and by APOE ε4 genotype. APOE ε4 carriers living with HCV who used cannabis had higher depression scores than non-ε4 carriers, while nonusers had fewer depressive symptoms. APOE ε4 carriers living with HCV had better cognition scores after adjusting for cocaine, opiate, and cannabis use than non-ε4 carriers. Scores on cognitive and depression measures did not differ between APOE ε4 carriers and non-ε4 carriers in participants living with HIV, and substance use did not moderate this relationship. This study was the first of its kind to examine substance use as a moderator for cognition and depression among individuals with HIV and/or HCV stratified by APOE genotype. Findings support further research evaluating the frequency and duration of 1) domains of cognitive functioning impacted by APOE genotype relevant to substance use and 2) the influence of substance use on cognitive and depressive outcomes among adults living with HIV and HCV, HIV, or HCV.

Capturing the Value of Vaccination within Health Technology Assessment and Health Economics-Practical Considerations for Expanding Valuation by Including Key Concepts

Following the development of a value of vaccination (VoV) framework for health technology assessment/cost-effectiveness analysis (HTA/CEA), and identification of three vaccination benefits for near-term inclusion in HTA/CEA, this final paper provides decision makers with methods and examples to consider benefits of health systems strengthening (HSS), equity, and macroeconomic gains. Expert working groups, targeted literature reviews, and case studies were used. Opportunity cost methods were applied for HSS benefits of rotavirus vaccination. Vaccination, with HSS benefits included, reduced the incremental cost-effectiveness ratio (ICER) by 1.4-50.5% (to GBP 11,552-GBP 23,016) depending on alternative conditions considered. Distributional CEA was applied for health equity benefits of meningococcal vaccination. Nearly 80% of prevented cases were among the three most deprived groups. Vaccination, with equity benefits included, reduced the ICER by 22-56% (to GBP 7014-GBP 12,460), depending on equity parameters. Macroeconomic models may inform HTA deliberative processes (e.g., disease impact on the labour force and the wider economy), or macroeconomic outcomes may be assessed for individuals in CEAs (e.g., impact on non-health consumption, leisure time, and income). These case studies show how to assess broader vaccination benefits in current HTA/CEA, providing decision makers with more accurate and complete VoV assessments. More work is needed to refine inputs and methods, especially for macroeconomic gains.

Years of life lost due to unintentional drug overdose relative to the leading underlying causes of death in the United States: a comparative analysis of excess mortality 2017-2019

The present study aims to compare Years of Life Lost for unintentional drug overdose and the leading underlying causes of death in the United States annually from 2017 to 2019. Years of Life Lost provide valuable context to incident deaths when comparing the relative mortality burden of underlying causes of death. Prior research has shown unintentional drug overdose was the third leading cause of Years of Life Lost in the state of Ohio in 2017. However, this finding has yet to be replicated at the national level in the US. Death statistics for 2017-2019 were accessed via CDC WONDER. Years of Life Lost were calculated for unintentional drug overdose and each of the top five causes of incident deaths in the US during the study period. Unintentional drug overdose caused nearly seven million Years of Life Lost in the US during the three-year period of study and was the fourth leading cause of Years of Life Lost after cancer, heart disease and other accidents. Incidence alone provides an incomplete picture of the effect of unintentional drug overdose on overall mortality burden in the US. Years of Life Lost give critical context to the overdose crisis, underscoring unintentional drug overdose as a leading cause of premature mortality.

Years of Life Lost to Firearm Suicide Among Young People in the US

This cross-sectional study examines years of life lost among the top 3 causes of death and compares firearm suicide with other methods of suicide among individuals aged 10 to 24 years in the US.

B - 38 Cognitive and Motor Functioning of Black and Asian Stroke Patients Admitted to Inpatient Rehabilitation Facilities across the United States

OBJECTIVE

To examine racial and ethnic differences in cognition and motor skills post-stroke in Asian and Black patients at admission and discharge.

METHOD

Participants were Asian (N = 5659), Black (N = 51,909), and non-Asian/non-Black stroke patients (N = 174,679) admitted to inpatient rehabilitation facilities across the United States. Patient functionality was assessed via the Functional Independence Measure (FIM). Age at admission, admission year, sex, marital status, insurance type, and length of stay were included as covariates.

RESULTS

Hierarchical linear regression analyses showed that at admission, Asian and African American stroke patients were associated with reduced cognitive and motor functioning compared to non-Asian/non-Black stroke patients (β's ranged from = -0.020 to -0.032 for both groups; all p's < 0.001). Upon discharge, Asian and Black stroke patients were associated with lower cognitive and motor functioning compared to non-Asian/non-Black stroke patients (β's ranged from = -0.012 to -0.052) for both groups; all p's < 0.001).

CONCLUSION

In an inpatient sample of stroke patients, findings showed race/ethnicity was associated with lower cognitive and motor functioning across at admission and discharge. These data may provide evidence on the role of social determinants of stroke health (Skolarus, 2020) for Asian and Black patients in the inpatient rehabilitation context. Implications for the assessment and practice of Clinical Neuropsychologists working in these settings with Asian and Black stroke patients are discussed.

Years of life lost due to deaths of despair and COVID-19 in the United States in 2020: patterns of excess mortality by gender, race and ethnicity

BACKGROUND

In 2020 COVID-19 was the third leading cause of death in the United States. Increases in suicides, overdoses, and alcohol related deaths were seen-which make up deaths of despair. How deaths of despair compare to COVID-19 across racial, ethnic, and gender subpopulations is relatively unknown. Preliminary studies showed inequalities in COVID-19 mortality for Black and Hispanic Americans in the pandemic's onset. This study analyzes the racial, ethnic and gender disparities in years of life lost due to COVID-19 and deaths of despair (suicide, overdose, and alcohol deaths) in 2020.

METHODS

This cross-sectional study calculated and compared years of life lost (YLL) due to Deaths of Despair and COVID-19 by gender, race, and ethnicity. YLL was calculated using the CDC WONDER database to pull death records based on ICD-10 codes and the Social Security Administration Period Life Table was used to get estimated life expectancy for each subpopulation.

RESULTS

In 2020, COVID-19 caused 350,831 deaths and 4,405,699 YLL. By contrast, deaths of despair contributed to 178,598 deaths and 6,045,819 YLL. Men had more deaths and YLL than women due to COVID-19 and deaths of despair. Among White Americans and more than one race identification both had greater burden of deaths of despair YLL than COVID-19 YLL. However, for all other racial categories (Native American/Alaskan Native, Asian, Black/African American, Native Hawaiian/Pacific Islander) COVID-19 caused more YLL than deaths of despair. Also, Hispanic or Latino persons had disproportionately higher mortality across all causes: COVID-19 and all deaths of despair causes.

CONCLUSIONS

This study found greater deaths of despair mortality burden and differences in burden across gender, race, and ethnicity in 2020. The results indicate the need to bolster behavioral health research, support mental health workforce development and education, increase access to evidence-based substance use treatment, and address systemic inequities and social determinants of deaths of despair and COVID-19.

Years of Life Lost due to Unintentional Drug Overdose among Perinatal Individuals in the United States

BACKGROUND

The United States has one of the highest maternal mortality rates of developing countries, but the contribution of perinatal drug overdose is not known. Communities of color also have higher rates of maternal morbidity and mortality when compared to White communities, however the contribution due to overdose has not yet been examined in this population.

OBJECTIVES

To quantify the years of life lost due to unintentional overdose in perinatal individuals from 2010 to 2019 and assess for disparity by race.

STUDY DESIGN

This was a cross-sectional retrospective study with summary-level mortality statistics for the years 2010-2019 obtained from the Centers for Disease Control (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) mortality file. A total of 1,586 individuals of childbearing age (15-44 years) who died during pregnancy or six weeks postpartum (perinatal) from unintentional overdose in the United States from January 1, 2010 to December 31, 2019 were included. Total years of life lost (YLL) was calculated and summated for White, Black, Hispanic, Asian/Pacific Islander, and American Indian/Native Alaska women. Additionally, the top three overall causes of death were also identified for women in this age group for comparison.

RESULTS

Unintentional drug overdose accounted for 1,586 deaths and 83,969.78 YLL in perinatal individuals from 2010 to 2019 in the United States. Perinatal American Indian/Native American individuals had a disproportionate amount of YLL when compared to other ethnic groups, with 2.39% of YLL due to overdose, while only making up 0.80% of the population. During the last two years of the study, only American Indian/Native American and Black individuals had increased rates of mortality when compared to other races. During the ten-year study period, when including the top three causes of mortality, unintentional drug overdoses made up 11.98% of the YLL overall and 46.39% of accidents. For the years 2016-2019, YLL due to unintentional overdose was the third leading cause of YLL overall for this population.

CONCLUSIONS

Unintentional drug overdose is a leading cause of death for perinatal individuals in the United States, claiming nearly 84,000 years of life over a ten-year period. When examining by race, American Indian/Native American women are most disproportionately affected.

Building Blocks for the Long-acting and Permanent Contraceptives Coordinated Registry Network

Objectives

A multistakeholder expert group under the Women's Health Technology Coordinated Registry Network (WHT-CRN) was organized to develop the foundation for national infrastructure capturing the performance of long-acting and permanent contraceptives. The group, consisting of representatives from professional societies, the US Food and Drug Administration, academia, industry and the patient community, was assembled to discuss the role and feasibility of the CRN and to identify the core data elements needed to assess contraceptive medical product technologies.

Design

We applied a Delphi survey method approach to achieve consensus on a core minimum data set for the future CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated and analyzed by a study design team from Weill Cornell Medicine. After the first survey, questions for subsequent surveys were based on the analysis process and conference call discussions with group members. This process was repeated two times over a 6-month time period until consensus was achieved.

Results

Twenty-three experts participated in the Delphi process. Participation rates in the first and second round of the Delphi survey were 83% and 100%, respectively. The working group reached final consensus on 121 core data elements capturing reproductive/gynecological history, surgical history, general medical history, encounter information, long-acting/permanent contraceptive index procedures and follow-up, procedures performed in conjunction with the index procedure, product removal, medications, complications related to the long-acting and/or permanent contraceptive procedure, pregnancy and evaluation of safety and effectiveness outcomes.

Conclusions

The WHT-CRN expert group produced a consensus-based core set of data elements that allow the study of current and future contraceptives. These data elements influence patient and provider decisions about treatments and include important outcomes related to safety and effectiveness of these medical devices, which may benefit other women's health stakeholders.

Trends and outcomes of veno-arterial extracorporeal membrane oxygenation for acute myocardial infarction-cardiogenic shock

Background

Mortality for acute myocardial infarction-cardiogenic shock (AMI-CS) remains high. Trends of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use and outcomes as a function of ECMO requirement are not well described.

Purpose

To identify the trends and outcomes of VA-ECMO use for AMI-CS in the United States.

Methods

We used the Nationwide Readmissions Database (NRD) and the Healthcare Cost and Utilization Project (HCUP) to obtain our cohort. We identified patients with AMI-CS requiring VA-ECMO using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD 10 CM) and procedure (ICD 10-PCS) codes. We excluded patients with missing data on in-hospital mortality.

Results

During the study period (2016–2019), 2,005,607 records with myocardial infarction (ST-elevation myocardial infarction [STEMI] and non-ST-elevation myocardial infarction [NSTEMI]) were identified (national estimate of 3,674,083 records), 127,939 records (6.4%) had concomitant CS (national estimate of 234,630 patients), and 3,469 records (national estimate of 6,365 records) (2.7%) received VA-ECMO for CS support. Impella and Intra-aortic balloon pump were used within the same admission in 34.5% and 38.1% of VA-ECMO cases, respectively. VA-ECMO use for AMI-CS significantly increased over the study period (from 2.3% in the first quarter of 2016 to 3.3% in the last quarter of 2019, p=0.001) (Figure 1).

In unadjusted analysis, patients undergoing VA-ECMO for AMI-CS were more likely to be male, have hypertension, congestive heart failure, and coagulopathy, present with STEMI, and receive multivessel PCI. Other comorbid conditions including diabetes, atrial fibrillation, end-stage renal disease, and prior MI, CABG, and stroke were less common in the VA-ECMO cohort. Medicare patients were less likely to receive VA-ECMO (39.4% vs. 63.8%, p&lt;0.001), whereas patients at large or teaching hospitals were more likely. Patients requiring VA-ECMO had higher in-hospital mortality, length of stay, and rates of complications (Table 1).

Conclusion

Utilization of VA-ECMO for AMI-CS is increasing, and in one out three patients, VA-ECMO is used in combination with other MCS devices. Patients with underlying medical comorbidities and Medicare are less likely to receive VA-ECMO. Critically ill patients requiring VA-ECMO for AMI-CS are more likely to present with STEMI and have high morbidity and mortality.

Funding Acknowledgement

Type of funding sources: None.

The effect of polymorphisms in FSHR gene on late follicular phase progesterone and estradiol serum levels in predicted normoresponders

STUDY QUESTION

Does the presence of FSHR single-nucleotide polymorphisms (SNPs) affect late follicular phase progesterone and estradiol serum levels in predicted normoresponders treated with rFSH?

SUMMARY ANSWER

The presence of FSHR SNPs (rs6165, rs6166, rs1394205) had no clinically significant impact on late follicular phase serum progesterone and estradiol levels in predicted normoresponders undergoing a GnRH antagonist protocol with a fixed daily dose of 150 IU rFSH.

WHAT IS KNOWN ALREADY

Previous studies have shown that late follicular phase serum progesterone and estradiol levels are significantly correlated with the magnitude of ovarian response. Several authors have proposed that individual variability in the response to ovarian stimulation (OS) could be explained by variants in FSHR. However, so far, the literature is scarce on the influence of this genetic variability on late follicular phase steroidogenic response. Our aim is to determine whether genetic variants in the FSHR gene could modulate late follicular phase serum progesterone and estradiol levels.

STUDY DESIGN, SIZE, DURATION

In this multicenter multinational prospective study conducted from November 2016 to June 2019, 366 patients from Vietnam, Belgium and Spain (166 from Europe and 200 from Asia) underwent OS followed by oocyte retrieval in a GnRH antagonist protocol with a fixed daily dose of 150 IU rFSH. All patients were genotyped for 3 FSHR SNPs (rs6165, rs6166, rs1394205) and had a serum progesterone and estradiol measurement on the day of trigger.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Included patients were predicted normal responder women <38 years old undergoing their first or second OS cycle. The prevalence of late follicular phase progesterone elevation (PE), as well as mean serum progesterone and estradiol levels on the day of trigger were compared between the different FSHR SNPs genotypes. PE was defined as >1.50 ng/ml.

MAIN RESULTS AND THE ROLE OF CHANCE

The overall prevalence of PE was 15.8% (n = 58). No significant difference was found in the prevalence of PE in Caucasian and Asian patients (17.5% versus 14.5%). Estradiol levels on the day of trigger and the number of retrieved oocytes were significantly higher in patients with PE (4779 ± 6236.2 versus 3261 ± 3974.5 pg/ml, P = 0.003, and 16.1 ± 8.02 versus 13.5 ± 6.66, P = 0.011, respectively). Genetic model analysis, adjusted for patient age, body mass index, number of retrieved oocytes and continent (Asia versus Europe), revealed a similar prevalence of PE in co-dominant, dominant and recessive models for variants FSHR rs6166, rs6165 and rs1394205. No statistically significant difference was observed in the mean late follicular phase progesterone serum levels according to the genotypes of FSHR rs6166 (P = 0.941), rs6165 (P = 0.637) and rs1394205 (P = 0.114) in the bivariate analysis. Also, no difference was found in the genetic model analysis regarding mean late follicular phase progesterone levels across the different genotypes. Genetic model analysis has also revealed no statistically significant difference regarding mean estradiol levels on the day of trigger in co-dominant, dominant and recessive models for variants FSHR rs6166, rs6165 and rs1394205. Haplotype analysis revealed a statistically significant lower estradiol level on the day of trigger for rs6166/rs6165 haplotypes GA, AA and GG when compared to AG (respectively, estimated mean difference (EMD) -441.46 pg/ml (95% CI -442.47; -440.45), EMD -673.46 pg/ml (95% CI -674.26; -672.67) and EMD -582.10 pg/ml (95% CI -584.92; -579.28)). No statistically significant differences were found regarding the prevalence of PE nor late follicular phase progesterone levels according to rs6166/rs6165 haplotypes.

LIMITATIONS, REASONS FOR CAUTION

Results refer to a population of predicted normal responders treated with a normal/low fixed dose of 150 IU rFSH throughout the whole OS. Consequently, caution is needed before generalizing our results to all patient categories.

WIDER IMPLICATIONS OF THE FINDINGS

Based on our results, FSHR SNPs rs6165, rs6166 and rs1394205 do not have any clinically significant impact neither on late follicular phase serum progesterone nor on estradiol levels in predicted normal responders. These findings add to the controversy in the literature regarding the impact of individual genetic susceptibility in response to OS in this population.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by an unrestricted grant by Merck Sharp & Dohme (MSD, IISP56222). N.P.P. reports grants and/or personal fees from MSD, Merck Serono, Roche Diagnostics, Ferring International, Besins Healthcare, Gedeon Richter, Organon, Theramex and Institut Biochimique SA (IBSA). C.A. reports conference fees from Merck Serono, Medea and Event Planet. A.R.N., C.B., C.S., P.Q.M.M., H.T., C.B., N.L.V., M.T.H. and S.G. report no conflict of interests related to the content of this article.

TRIAL REGISTRATION NUMBER

NCT03007043.

The effect of changing the military's sexual assault laws on law enforcement investigative findings in the U.S. Army

OBJECTIVE

In 2007, Congress changed the military's sexual assault laws as part of an effort to improve sexual assault case processing. This study looked at the U.S. Army law enforcement investigative finding for every sexual assault reported to the Army from 2004 through June 2012, along with every nonsexual assault. Our objective was to measure whether the legal intervention affected the investigative findings made by Army law enforcement officers in sexual assault cases (penetrative, nonpenetrative, and combined) as compared to assault cases (aggravated, simple, and combined).

HYPOTHESES

We hypothesized that we would not find evidence that the legal intervention affected the rate of sexual assault cases labeled as "founded" by Army law enforcement, such that for the best-fitting time-series models, any difference in the residuals of the means before and after the intervention would not be statistically significant.

METHOD

We received data from the U.S. Army on all sexual assaults and nonsexual assaults from 2004 through June 2012. The data comprised 47,058 observations. We used time-series analysis with autoregressive integrated moving average modeling. The variable tracked over time was the ratio of the proportion of founded sexual assault cases to the proportion of founded nonsexual assault cases. We then conducted t tests of the means of the residuals before and after the legal intervention.

RESULTS

The difference in the means of the residuals before and after the intervention was not statistically significant for combined sexual assaults versus combined assaults, penetrative sexual assaults versus aggravated assaults, or nonpenetrative sexual assaults versus simple assaults.

CONCLUSIONS

This reform to sexual assault laws does not appear to have affected sexual assault case processing by U.S. Army law enforcement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Case report: evaluation of an open-source synthetic data platform for simulation studies

Simulation is a mainstay of comparative- and cost-effectiveness research when empirical data are not available. The Synthea platform, originally designed for generating realistically coded longitudinal health records for software testing, implements data generation models specified in publicly contributed modules representing patients’ life cycle and disease and treatment progression. We test the hypothesis that Synthea can be used for simulation studies that draw parameters from observational studies and randomized trials. We benchmarked the results and assessed the effort required to create a Synthea module that replicates a recently published cost-effectiveness simulation comparing levofloxacin prophylaxis to usual care for leukemia. A module was iteratively developed using published parameters from the original study; we replicated the initial conditions and simulation endpoints of demographics, health events, costs, and mortality. We compare Synthea’s Generic Module Framework to platforms designed for simulation and show that Synthea can be used, with modifications, for some types of simulation studies.

Nitrous Oxide in Treatment Resistant Major Depression: Should We Laugh About It?

Introduction

Nitrous oxide (NO), also known as “laughing gas” is a colorless gas used as an anesthetic, a propellant in some foods, an engine performance enhancer and a recreational drug. When inhaled, it is known to provoke a rapid feeling of euphoria or excitement for a short period of time, dissociative phenomena and sometimes laughter. As its fellow anesthetic agent and NMDA-receptor antagonist, ketamine, NO is being studied for its possible therapeutic profile in treatment resistant major depression (TRMD).

Objectives

TRMD is a serious illness, that urges for effective alternative treatments. In that regard, we explored the recent studies conducted in these patients, using NO in different dosages when compared to placebo.

Methods

The authors revised the published literature about this topic, selecting relevant articles with the topic words: “Depression”, “Treatment Resistant Major Depression” and “Nitrous Oxide” in scientific data base.

Results

Since 2018, at least two randomized clinical trials have demonstrated that NO has considerable antidepressant effects in TRMD, when compared to placebo. Investigators noted that these positive effects where maintained at least for two weeks after a single 1-hour inhalation. In a more recent study, scientists compared different NO concentrations (25% vs. 50%) concluding that the 25% concentration had similar efficacy with a lower risk of adverse effects.

Conclusions

There appears to be encouraging results when treating patients with TRMD with NO in a 25% concentration. Nonetheless, there is need for further investigation, namely through studies that compare NO with other valid TRMD treatments and not only versus placebo.

Disclosure

No significant relationships.

Treating Patients with Aripiprazol: A Safe Gamble?

Introduction

Aripiprazole (ARI) is an atypical antipsychotic drug with D2 partial agonist properties, usually prescribed to treat mood disorders (major depression or bipolar disorder) and schizophrenic disorder (schizophrenia or schizoaffective disorder). Dopamine receptor agonists, as is ARI, have been implicated in some cases of impulse-control problems, such as gambling disorder (GD), increased spending, hypersexuality and compulsive eating.

Objectives

Currently, it is hypothesized that aripiprazole may cause impulse-control problems because it can produce a hyperdopaminergic state in the mesolimbic pathway (reward system) through its predominant action on dopamine D3 receptors. We intend to do a non-systematic review of the scientific information regarding this subject.

Methods

The authors revised the published literature about this topic, selecting relevant articles, systematic reviews and case reports, with the topic words: “aripiprazol”, “gambling disorder” and “dopamine receptor” in scientific data base.

Results

Overall, a few cases of ARI-induced pathological gambling as well as ARI-induced hypersexuality have been reported. In one study it was verified that comorbid psychiatric and substance use disorders were common among those who have experienced GD or worsened GD after beginning ARI treatment. In another study, it was verified that the group of patients who reported this alleged side-effect were mostly young (mean age, 33.6 years), mostly men (88.2%) and most lived alone.

Conclusions

Attributing to dopamine agonists the only factor that can explain the onset of GD is simplistic and dangerous. Many other potential risk factors, including individual vulnerability factors (temperament, genetics) as well as environmental factors, must be considered.

Disclosure

No significant relationships.

Unintentional Drug Overdose Mortality in Years of Life Lost Among Adolescents and Young People in the US From 2015 to 2019

This cross-sectional study assesses the mortality among adolescents and young people in the US from 2015 to 2019 in years of life lost from unintentional drug overdose.