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Boxer DJM, Sung YH, Nunez NA, Fitzgerald CE, Renshaw PF, Kondo DG. Exploring the Link between Altitude of Residence and Smoking Patterns in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:226. [PMID: 38397715 PMCID: PMC10887906 DOI: 10.3390/ijerph21020226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Smoking-related diseases affect 16 million Americans, causing approximately 480,000 deaths annually. The prevalence of cigarette smoking varies regionally across the United States, and previous research indicates that regional rates of smoking-related diseases demonstrate a negative association with altitude. The purpose of this study was to determine the relationship between altitude and the prevalence of cigarette smoking by county (N = 3106) in the United States. We hypothesized that smoking prevalence among adults would be negatively associated with mean county altitude. METHODS A multivariate linear regression was performed to examine the relationship between county-level mean altitude and county smoking rate. Covariates were individually correlated with 2020 smoking data, and significant associations were included in the final model. RESULTS The multivariate linear regression indicated that the county-level smoking rates are significantly reduced at high altitudes (p < 0.001). The model accounted for 89.5% of the variance in smoking prevalence, and for each 1000-foot increase in altitude above sea level, smoking rates decreased by 0.143%. Based on multivariate linear regression, the following variables remained independently and significantly associated: race, sex, educational attainment, socioeconomic status, unemployment, physical inactivity, drinking behavior, mental distress, and tobacco taxation. CONCLUSIONS Our results indicate that smoking rates are negatively associated with altitude, which may suggest that altitude affects the pharmacokinetics, pharmacodynamics, and mechanistic pathways involved in cigarette use. Further research is needed to explore the relationship between altitude and smoking and how altitude may serve as a protective factor in the acquisition and maintenance of tobacco use disorders.
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Affiliation(s)
- Danielle Jeanne-Marie Boxer
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; (Y.-H.S.); (N.A.N.); (C.E.F.); (P.F.R.); (D.G.K.)
| | - Young-Hoon Sung
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; (Y.-H.S.); (N.A.N.); (C.E.F.); (P.F.R.); (D.G.K.)
| | - Nicolas A. Nunez
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; (Y.-H.S.); (N.A.N.); (C.E.F.); (P.F.R.); (D.G.K.)
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Colleen Elizabeth Fitzgerald
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; (Y.-H.S.); (N.A.N.); (C.E.F.); (P.F.R.); (D.G.K.)
- Intermountain Health, Oncology Clinical Trials, Intermountain Health, Salt Lake City, UT 84107, USA
| | - Perry Franklin Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; (Y.-H.S.); (N.A.N.); (C.E.F.); (P.F.R.); (D.G.K.)
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), George E. Whalen Department of Veterans Affairs (VA) Medical Center, Salt Lake City, UT 84148, USA
| | - Douglas Gavin Kondo
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84112, USA; (Y.-H.S.); (N.A.N.); (C.E.F.); (P.F.R.); (D.G.K.)
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), George E. Whalen Department of Veterans Affairs (VA) Medical Center, Salt Lake City, UT 84148, USA
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Lafuente JV, Sharma A, Feng L, Muresanu DF, Nozari A, Tian ZR, Buzoianu AD, Sjöquist PO, Wiklund L, Sharma HS. Nanowired Delivery of Mesenchymal Stem Cells with Antioxidant Compound H-290/51 Reduces Exacerbation of Methamphetamine Neurotoxicity in Hot Environment. ADVANCES IN NEUROBIOLOGY 2023; 32:317-352. [PMID: 37480465 DOI: 10.1007/978-3-031-32997-5_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Military personnel are often exposed to hot environments either for combat operations or peacekeeping missions. Hot environment is a severe stressful situation leading to profound hyperthermia, fatigue and neurological impairments. To avoid stressful environment, some people frequently use methamphetamine (METH) or other psychostimulants to feel comfortable under adverse situations. Our studies show that heat stress alone induces breakdown of the blood-brain barrier (BBB) and edema formation associated with reduced cerebral blood flow (CBF). On the other hand, METH alone induces hyperthermia and neurotoxicity. These effects of METH are exacerbated at high ambient temperatures as seen with greater breakdown of the BBB and brain pathology. Thus, a combination of METH use at hot environment may further enhance the brain damage-associated behavioral dysfunctions. METH is well known to induce severe oxidative stress leading to brain pathology. In this investigation, METH intoxication at hot environment was examined on brain pathology and to explore suitable strategies to induce neuroprotection. Accordingly, TiO2-nanowired delivery of H-290/51 (150 mg/kg, i.p.), a potent chain-breaking antioxidant in combination with mesenchymal stem cells (MSCs), is investigated in attenuating METH-induced brain damage at hot environment in model experiments. Our results show that nanodelivery of H-290/51 with MSCs significantly enhanced CBF and reduced BBB breakdown, edema formation and brain pathology following METH exposure at hot environment. These observations are the first to point out that METH exacerbated brain pathology at hot environment probably due to enhanced oxidative stress, and MSCs attenuate these adverse effects, not reported earlier.
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Affiliation(s)
- José Vicente Lafuente
- LaNCE, Department Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Zhongshan, Hebei Province, China
| | - Dafin F Muresanu
- Department Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania
- "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Ala Nozari
- Anesthesiology & Intensive Care, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Z Ryan Tian
- Department Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, USA
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Per-Ove Sjöquist
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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Muacevic A, Adler JR, Penn BA, Mayeux JD, Ma CL, Clapham KR, Abraham AE, Klanderud D, Sadeh B, Beck EM, Hatton ND, Ryan JJ. Characteristics of Patients With Pulmonary Arterial Hypertension in a Pulmonary Hypertension Association-Accredited Comprehensive Care Center: A Contrast in Features When Compared With US National Registry Data. Cureus 2022; 14:e31764. [PMID: 36569732 PMCID: PMC9772347 DOI: 10.7759/cureus.31764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Since the initial description in the 1980s, our understanding of the diversity of pulmonary arterial hypertension (PAH) has continued to evolve. In this study, we report the characteristics of patients seen in an academic medical center for PAH from August 2020 through November 2021 and contrast those with nationally reported data from the United States Pulmonary Hypertension Scientific Registry (USPHSR). Study Design Investigators at the University of Utah Pulmonary Hypertension Program prospectively enrolled adult patients diagnosed with WHO Group 1 PAH, who were evaluated between August 2020 and November 2021 in a program-specific registry. Patient exposure and health histories were collected through structured interviews and questionnaires, along with clinical data and medication use. A total of 242 patients were enrolled in the University of Utah Pulmonary Hypertension Registry (UUPHR). Results Of the 242 enrolled patients, the most common etiology was associated PAH (APAH), accounting for 71.1% of the population. The second largest etiology was idiopathic PAH (IPAH) at 26.4%. The remaining patients were distributed between familial PAH (FPAH), pulmonary veno-occlusive disease (PVOD), and others. Of the total population classified as APAH, 39% of cases were noted as secondary to connective tissue disease (CTD) and 33% as toxin-induced. These represented 28% and 24% of the total population, respectively. Conclusions In this US-based accredited academic medical center, the etiology of PAH in our patient population contrasts with national registry data. In the UUPHR, APAH, specifically CTD-PAH and toxin-associated PAH, accounts for the majority of patients with PAH. This contrasts with IPAH, which nationally is the most reported cause of PAH. Differences in our population may reflect the regional variation of the referral site, but it is noteworthy for its contrast with historically reported phenotypes.
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Nguyen KT, Gates CA, Hassell JE, Foxx CL, Salazar SN, Luthens AK, Arnold AL, Elam BL, Elsayed AI, Leblanc M, Adams SC, Lowry CA, Reuter JD. Evaluation of the effects of altitude on biological signatures of inflammation and anxiety- and depressive-like behavioral responses. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110331. [PMID: 33891978 DOI: 10.1016/j.pnpbp.2021.110331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/11/2022]
Abstract
Over sixteen million people suffer from a depressive episode annually in the United States, with females affected at twice the rate of males. Little is known about the effects of exposure to high altitude on the risk of development of major depressive disorder, despite reports of higher suicide rates at higher altitudes. We hypothesize that exposure to hypobaric hypoxia at high altitude increases endophenotypes of self-directed suicidal violence, including biological signatures of chronic inflammation and vulnerability to anxiety-like and depressive-like behavioral responses in a sex-specific manner. Biological signatures of inflammation, including granulocyte:lymphocyte ratios, monocyte cell counts, and monocyte:lymphocyte ratios were assessed using complete blood count data, anhedonia, and anxiety- and depressive-like behavioral responses were evaluated. We assessed biological signatures of inflammation and behavioral responses in the open-field test, sucrose preference test, and modified Porsolt forced swim test in young adult male and female Long-Evans and Sprague Dawley rats. All tests were conducted near sea level (374 ft [114 m] elevation) and at moderate-high altitude (5430 ft [1655 m] elevation) during acclimation periods of one, two, three, four, and five weeks following shipment from a sea level animal breeding facility (N = 320, n = 8 per group). Exposure to moderate-high altitude induced a biological signature of increased inflammation, as evidenced by main effects of altitude for: 1) increased granulocyte:lymphocyte ratio; 2) increased count and relative abundance of circulating monocytes; and 3) increased monocyte:lymphocyte ratios. Exposure to moderate-high altitude also increased anhedonia as assessed in the sucrose preference test in both male and female rats, when data were collapsed across strain and time. Among male and female Long Evans rats, exposure to moderate-high altitude increased immobility in the forced swim test, without changing anxiety-like behaviors in the open-field test. Finally, granulocyte:lymphocyte ratios were correlated with anhedonia in the sucrose preference test. These data are consistent with the hypothesis that hypobaric hypoxia at moderate-high altitude induces persistent endophenotypes of self-directed suicidal violence including biological signatures of inflammation, anhedonia, and depressive-like behavioral responses.
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Affiliation(s)
- Kadi T Nguyen
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - Chloé A Gates
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - James E Hassell
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - Christine L Foxx
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - Stephanie N Salazar
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - Amalia K Luthens
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - Andrea L Arnold
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - Brooke L Elam
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - Ahmed I Elsayed
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - Mathias Leblanc
- Animal Resources Department, Gene Expression Laboratory, The Salk Institute for Biological Studies, La Jolla, CA 92037, USA.
| | - Sean C Adams
- Animal Resources Department, Gene Expression Laboratory, The Salk Institute for Biological Studies, La Jolla, CA 92037, USA.
| | - Christopher A Lowry
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA; Center for Microbial Exploration, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Physical Medicine & Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC), Aurora, CO 80045, USA; Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO 80045, USA.
| | - Jon D Reuter
- Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA; Office of Animal Resources, University of Colorado Boulder, Boulder, CO 80309, USA.
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Sharma HS, Lafuente JV, Feng L, Muresanu DF, Menon PK, Castellani RJ, Nozari A, Sahib S, Tian ZR, Buzoianu AD, Sjöquist PO, Patnaik R, Wiklund L, Sharma A. Methamphetamine exacerbates pathophysiology of traumatic brain injury at high altitude. Neuroprotective effects of nanodelivery of a potent antioxidant compound H-290/51. PROGRESS IN BRAIN RESEARCH 2021; 266:123-193. [PMID: 34689858 DOI: 10.1016/bs.pbr.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Military personnel are often exposed to high altitude (HA, ca. 4500-5000m) for combat operations associated with neurological dysfunctions. HA is a severe stressful situation and people frequently use methamphetamine (METH) or other psychostimulants to cope stress. Since military personnel are prone to different kinds of traumatic brain injury (TBI), in this review we discuss possible effects of METH on concussive head injury (CHI) at HA based on our own observations. METH exposure at HA exacerbates pathophysiology of CHI as compared to normobaric laboratory environment comparable to sea level. Increased blood-brain barrier (BBB) breakdown, edema formation and reductions in the cerebral blood flow (CBF) following CHI were exacerbated by METH intoxication at HA. Damage to cerebral microvasculature and expression of beta catenin was also exacerbated following CHI in METH treated group at HA. TiO2-nanowired delivery of H-290/51 (150mg/kg, i.p.), a potent chain-breaking antioxidant significantly enhanced CBF and reduced BBB breakdown, edema formation, beta catenin expression and brain pathology in METH exposed rats after CHI at HA. These observations are the first to point out that METH exposure in CHI exacerbated brain pathology at HA and this appears to be related with greater production of oxidative stress induced brain pathology, not reported earlier.
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Affiliation(s)
- Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Lianyuan Feng
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province, China
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Preeti K Menon
- Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Ala Nozari
- Anesthesiology & Intensive Care, Massachusetts General Hospital, Boston, MA, United States
| | - Seaab Sahib
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Per-Ove Sjöquist
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ranjana Patnaik
- Department of Biomaterials, School of Biomedical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, India
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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Kanekar S, Ettaro R, Hoffman MD, Ombach HJ, Brown J, Lynch C, Sheth CS, Renshaw PF. Sex-Based Impact of Creatine Supplementation on Depressive Symptoms, Brain Serotonin and SSRI Efficacy in an Animal Model of Treatment-Resistant Depression. Int J Mol Sci 2021; 22:ijms22158195. [PMID: 34360959 PMCID: PMC8348220 DOI: 10.3390/ijms22158195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Rates of major depressive disorder (MDD) increase with living at altitude. In our model, rats housed at moderate altitude (in hypobaric hypoxia) exhibit increased depression-like behavior, altered brain serotonin and a lack of antidepressant response to most selective serotonin reuptake inhibitors (SSRIs). A forebrain deficit in the bioenergetic marker creatine is noted in people living at altitude or with MDD. Methods: Rats housed at 4500 ft were given dietary creatine monohydrate (CRMH, 4% w/w, 5 weeks) vs. un-supplemented diet, and impact on depression-like behavior, brain bioenergetics, serotonin and SSRI efficacy assessed. Results: CRMH significantly improved brain creatine in a sex-based manner. At altitude, CRMH increased serotonin levels in the female prefrontal cortex and striatum but reduced male striatal and hippocampal serotonin. Dietary CRMH was antidepressant in the forced swim test and anti-anhedonic in the sucrose preference test in only females at altitude, with motor behavior unchanged. CRMH improved fluoxetine efficacy (20 mg/kg) in only males at altitude: CRMH + SSRI significantly improved male striatal creatine and serotonin vs. CRMH alone. Conclusions: Dietary CRMH exhibits sex-based efficacy in resolving altitude-related deficits in brain biomarkers, depression-like behavior and SSRI efficacy, and may be effective clinically for SSRI-resistant depression at altitude. This is the first study to link CRMH treatment to improving brain serotonin.
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Affiliation(s)
- Shami Kanekar
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA; (R.E.); (M.D.H.); (H.J.O.); (J.B.); (C.L.); (C.S.S.); (P.F.R.)
- VISN19 MIRECC, 500 Foothill Drive, Salt Lake City, UT 84148, USA
- Veterans Affairs Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
- Correspondence: ; Tel.: +1-801-587-1477 or +1-801-585-5375
| | - Robert Ettaro
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA; (R.E.); (M.D.H.); (H.J.O.); (J.B.); (C.L.); (C.S.S.); (P.F.R.)
| | - Michael D. Hoffman
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA; (R.E.); (M.D.H.); (H.J.O.); (J.B.); (C.L.); (C.S.S.); (P.F.R.)
| | - Hendrik J. Ombach
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA; (R.E.); (M.D.H.); (H.J.O.); (J.B.); (C.L.); (C.S.S.); (P.F.R.)
| | - Jadeda Brown
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA; (R.E.); (M.D.H.); (H.J.O.); (J.B.); (C.L.); (C.S.S.); (P.F.R.)
| | - Cayla Lynch
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA; (R.E.); (M.D.H.); (H.J.O.); (J.B.); (C.L.); (C.S.S.); (P.F.R.)
| | - Chandni S. Sheth
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA; (R.E.); (M.D.H.); (H.J.O.); (J.B.); (C.L.); (C.S.S.); (P.F.R.)
| | - Perry F. Renshaw
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA; (R.E.); (M.D.H.); (H.J.O.); (J.B.); (C.L.); (C.S.S.); (P.F.R.)
- VISN19 MIRECC, 500 Foothill Drive, Salt Lake City, UT 84148, USA
- Veterans Affairs Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, USA
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Regional Variation in Methamphetamine-associated Pulmonary Arterial Hypertension: Who'd Better Call Saul? Ann Am Thorac Soc 2021; 18:584-585. [PMID: 33792520 PMCID: PMC8009004 DOI: 10.1513/annalsats.202011-1415ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kerry R, Yoo E, Ingram B. Spatial analysis of drug poisoning deaths in the American west: A comparison study using profile regression to adjust for collinearity and spatial correlation. Drug Alcohol Depend 2019; 204:107598. [PMID: 31606724 DOI: 10.1016/j.drugalcdep.2019.107598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The USA has seen dramatic increases in drug poisoning deaths (DPD) recently. State-level rates have responded to federal and state initiatives, yet the counties with the highest rates are stable. Spatial analysis enables investigators to identify the highest risk counties and most important risk factors, although results are often confounded by spatial autocorrelation and multicollinearity. METHODS Profile regression (PR) is an integrated method for cluster and regression analysis, which adjusts for spatial-autocorrelation and multi-collinearity. RESULTS With PR, three clusters were identified in the Western USA with most of NM, NV and UT and several counties in AZ, CO, ID and WY being high-risk. Cluster analysis in a previous study only identified high-risk counties in northern CA, NM and NV. Elevation, suicide and LDS population were positively, and population density was negatively linked with DPD for PR and standard regression (SR) showing differences between the mountain west and coastal areas. Complex relationships between DPD and several variables were identified by PR which was not possible with SR. CONCLUSIONS Statistically principled methods like PR are needed for appropriate identification of the highest risk counties and important risk factors given the complex relationships with DPD. Funding for prevention, education and medical services should be targeted at rural, mountain communities in the west which have high %LDS and suicide rates. Counties with high %poverty and %Hispanic were also at high-risk. Individual-level studies are needed to confirm important risk factors in high-risk counties.
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Affiliation(s)
- Ruth Kerry
- Department of Geography, Brigham Young University, UT, USA.
| | - Eunhye Yoo
- Department of Geography, University at Buffalo, SUNY, USA
| | - Ben Ingram
- Facultad de Ingeniería, Universidad de Talca, Chile
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Ombach HJ, Scholl LS, Bakian AV, Renshaw KT, Sung YH, Renshaw PF, Kanekar S. Association between altitude, prescription opioid misuse, and fatal overdoses. Addict Behav Rep 2019; 9:100167. [PMID: 31193784 PMCID: PMC6542744 DOI: 10.1016/j.abrep.2019.100167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/10/2019] [Accepted: 02/01/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Prescription opioid misuse and fatal overdoses have increased significantly over the last two decades. Living at altitude has been linked to greater reward benefits of other drugs of abuse, and living at altitude may also exacerbate the respiratory depression linked to opioid use. Therefore, we examined the relationships between living at altitude, and prescription opioid misuse and fatal overdoses. METHOD State-level past year rates of prescription opioid misuse were retrieved from the Substance Abuse and Mental Health Services Administration. County-level overdose data were extracted from the Centers for Disease Control and Prevention. Multiple linear regression models were fit to determine the relationship between average state elevation and state rates of opioid misuse. Logistic regression models were fit to determine the relationship between county elevation and county-level fatal opioid overdose prevalence. RESULTS After controlling for state opioid prescribing rates and other confounders, we identified a significant positive association between mean state altitude and state-level opioid misuse rates for women, but not men. We also found a significant positive association between county-level altitude and prevalence of fatal opioid overdose. CONCLUSIONS Living at altitude is thus demographically associated with increasing rates of misuse of prescription opioids, as well as of cocaine and methamphetamine. Animal studies suggest that the hypobaric hypoxia exposure involved with living at altitude may disrupt brain neurochemistry, to increase reward benefits of drugs of abuse. This increased misuse of both stimulants and opioids may increase likelihood of overdose at altitude, with overdoses by opioid use also potentially facilitated by altitude-related hypoxia.
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Affiliation(s)
- Hendrik J. Ombach
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
| | - Lindsay S. Scholl
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
| | - Amanda V. Bakian
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
| | - Kai T. Renshaw
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
| | - Young-Hoon Sung
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
| | - Perry F. Renshaw
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
- Utah Science Technology and Research (USTAR) Initiative, Salt Lake City, UT, 84108, United States
- Rocky Mountain VISN19 Mental Illness Research, Education, and Clinical Centers (MIRECC), 500 Foothill Drive, Salt Lake City, UT, 84148, United States
- Salt Lake City Veterans Affairs Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, United States
| | - Shami Kanekar
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Drive, Salt Lake City, UT, 84108, United States
- Rocky Mountain VISN19 Mental Illness Research, Education, and Clinical Centers (MIRECC), 500 Foothill Drive, Salt Lake City, UT, 84148, United States
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10
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Sabic H, Kious B, Boxer D, Fitzgerald C, Riley C, Scholl L, McGlade E, Yurgelun-Todd D, Renshaw PF, Kondo DG. Effect of Altitude on Veteran Suicide Rates. High Alt Med Biol 2019; 20:171-177. [PMID: 31045435 PMCID: PMC6602111 DOI: 10.1089/ham.2018.0130] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/15/2019] [Indexed: 11/12/2022] Open
Abstract
Aims: Suicide rates in the general population in the United States are correlated with altitude. To explore factors contributing to suicide among military veterans, we examined the relationship between veteran state-level suicide rates and altitude for 2014, including firearm-related and nonfirearm-related rates. Methods: Pearson's coefficients were calculated for altitude and each outcome. Mixed linear models were used to determine the association between suicide and altitude while adjusting for demographic confounds. Results: State mean altitude was significantly correlated with total veteran suicide rate (r = 0.678, p < 0.0001), veteran firearm-related suicide rate (r = 0.578, p < 0.0001), and veteran nonfirearm suicide rate (r = 0.609, p < 0.0001). In mixed models, altitude was significantly correlated with total veteran suicide rate (β = 0.331, p < 0.05), veteran firearm suicides (β = 0.282, p < 0.05), and veteran nonfirearm suicides (β = 0.393, p < 0.05). Conclusion: This study adds to evidence linking altitude and suicide rates, arguing for additional research into the relationship between altitude and suicide among veterans.
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Affiliation(s)
- Hana Sabic
- Brain Institute, University of Utah, Salt Lake City, Utah
| | - Brent Kious
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
| | - Danielle Boxer
- Brain Institute, University of Utah, Salt Lake City, Utah
| | | | - Colin Riley
- Brain Institute, University of Utah, Salt Lake City, Utah
| | - Lindsay Scholl
- Brain Institute, University of Utah, Salt Lake City, Utah
| | - Erin McGlade
- Brain Institute, University of Utah, Salt Lake City, Utah
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
- Veterans Integrated Service Network 19 Mental Illness Research Education Clinical, Centers of Excellence, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Deborah Yurgelun-Todd
- Brain Institute, University of Utah, Salt Lake City, Utah
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
- Veterans Integrated Service Network 19 Mental Illness Research Education Clinical, Centers of Excellence, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Perry F. Renshaw
- Brain Institute, University of Utah, Salt Lake City, Utah
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
- Veterans Integrated Service Network 19 Mental Illness Research Education Clinical, Centers of Excellence, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Douglas G. Kondo
- Brain Institute, University of Utah, Salt Lake City, Utah
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
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11
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Abstract
After participating in this activity, learners should be better able to:• Assess epidemiologic evidence that increased altitude of residence is linked to increased risk of depression and suicide• Evaluate strategies to address hypoxia-related depression and suicidal ideation ABSTRACT: Suicide and major depressive disorder (MDD) are complex conditions that almost certainly arise from the influences of many interrelated factors. There are significant regional variations in the rates of MDD and suicide in the United States, suggesting that sociodemographic and environmental conditions contribute. Here, we review epidemiological evidence that increases in the altitude of residence are linked to the increased risk of depression and suicide. We consider the possibility that chronic hypobaric hypoxia (low blood oxygen related to low atmospheric pressure) contributes to suicide and depression, which is suggested by animal models, short-term studies in humans, and the effects of hypoxic medical conditions on suicide and depression. We argue that hypobaric hypoxia could promote suicide and depression by altering serotonin metabolism and brain bioenergetics; both of these pathways are implicated in depression, and both are affected by hypoxia. Finally, we briefly examine treatment strategies to address hypoxia-related depression and suicidal ideation that are suggested by these findings, including creatine monohydrate and the serotonin precursors tryptophan and 5-hydroxytryptophan.
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12
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Kanekar S, Sheth CS, Ombach HJ, Olson PR, Bogdanova OV, Petersen M, Renshaw CE, Sung YH, D'Anci KE, Renshaw PF. Hypobaric hypoxia exposure in rats differentially alters antidepressant efficacy of the selective serotonin reuptake inhibitors fluoxetine, paroxetine, escitalopram and sertraline. Pharmacol Biochem Behav 2018; 170:25-35. [PMID: 29738811 DOI: 10.1016/j.pbb.2018.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 01/19/2023]
Abstract
Treatment-resistant depression, a chronic condition that affects 30% of depressed patients on antidepressants, is highly linked to suicidal behavior. Chronic hypoxia exposure via living at altitude (hypobaric hypoxia) or with chronic hypoxic diseases is demographically linked to increased risk for depression and suicide. We previously demonstrated that housing rats at altitude for a week incrementally increases depression-like behavior in the forced swim test (FST) in females, but not males. In animal models, high altitude exposure reduces brain serotonin, and selective serotonin reuptake inhibitors (SSRIs) can lose efficacy when brain serotonin levels are low. To address whether residence at moderate altitude is detrimental to SSRI function, we examined SSRI efficacy in the FST after a week of housing rats at altitudes of 4500 ft. or 10,000 ft. as compared to at sea level. In females, the tricyclic antidepressant desipramine (positive control) functioned well in all groups, increasing latency to immobility and decreasing immobility, by increasing climbing. However, the SSRIs fluoxetine, paroxetine and escitalopram were ineffective in females in all groups: only paroxetine improved swimming in the FST as expected of a SSRI, while all three unexpectedly reduced climbing. Fluoxetine was also ineffective in male rats. Sertraline was the only SSRI with antidepressant efficacy at altitude in both females and males, increasing swimming, climbing and latency to immobility, and reducing immobility. Hypobaric hypoxia thus appears to be detrimental to efficacy of the SSRIs fluoxetine, paroxetine and escitalopram, but not of sertraline. Unlike the other SSRIs, sertraline can improve both serotonergic and dopaminergic transmission, and may be less impacted by a hypoxia-induced serotonin deficit. A targeted approach may thus be necessary for successful antidepressant treatment in patients with depression who live at altitude or with chronic hypoxic diseases, and that sertraline may be the SSRI of choice for prescription for this population.
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Affiliation(s)
- Shami Kanekar
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT, United States; VISN19 MIRECC, 500 Foothill Drive, Salt Lake City, UT 84148, United States; The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States.
| | - Chandni S Sheth
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | - Hendrik J Ombach
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | - Paul R Olson
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States
| | - Olena V Bogdanova
- The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States
| | - Matthew Petersen
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | - Chloe E Renshaw
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | - Young-Hoon Sung
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | | | - Perry F Renshaw
- Diagnostic Neuroimaging, Department of Psychiatry, University of Utah, Salt Lake City, UT, United States; VISN19 MIRECC, 500 Foothill Drive, Salt Lake City, UT 84148, United States; The Brain Institute, University of Utah, 383 Colorow Drive, Salt Lake City, UT 84108, United States; Veterans Affairs Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, United States
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Kerry R, Goovaerts P, Vowles M, Ingram B. Spatial analysis of drug poisoning deaths in the American West, particularly Utah. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 33:44-55. [PMID: 27286759 PMCID: PMC4947563 DOI: 10.1016/j.drugpo.2016.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 02/10/2016] [Accepted: 05/09/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Most states in the Western US have high rates of drug poisoning death (DPD), especially New Mexico, Nevada, Arizona and Utah (UT). This seems paradoxical in UT where illicit drug use, smoking and drinking rates are low. To investigate this, spatial analysis of county level DPD data and other relevant factors in the Western US and UT was undertaken. METHODS Poisson kriging was used to smooth the DPD data, populate data gaps and improve the reliability of rates recorded in sparsely populated counties. Links between DPD and economic, environmental, health, lifestyle, and demographic factors were investigated at four scales using multiple linear regression. LDS church membership and altitude, factors not previously considered, were included. Spatial change in the strength and sign of relationships was investigated using geographically weighted regression and significant DPD clusters were identified using the Local Moran's I. RESULTS Economic factors, like the sharp social gradient between rural and urban areas were important to DPD throughout the west. Higher DPD rates were also found in areas of higher elevation and the desert rural areas in the south. The unique characteristics of DPD in UT in terms of health and lifestyle factors, as well as the demographic structure of DPD in the most LDS populous states (UT, Idaho, Wyoming), suggest that high DPD in heavily LDS areas are predominantly prescription opioid related whereas in other Western states a larger proportion of DPD might come from illicit drugs. CONCLUSION Drug policies need to be adapted to the geographical differences in the dominant type of drug causing death. Educational materials need to be marketed to the demographic groups at greatest risk and take into account differences in population characteristics between and within States. Some suggestions about how such adaptations can be made are given and future research needs outlined.
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Affiliation(s)
- Ruth Kerry
- Department of Geography, Brigham Young University, UT, USA.
| | | | - Maureen Vowles
- Department of Public Health & Policy, University of Liverpool, UK
| | - Ben Ingram
- Facultad de Ingeniería, Universidad de Talca, Chile
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14
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Sightings edited by Erik Swenson and Peter Bärtsch. High Alt Med Biol 2015. [DOI: 10.1089/ham.2015.29000.stg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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