Navigating health sources on the Internet: A mixed-methods examination of online consumer reviews and expert text on psychotropic drugs

Purpose. The Internet has provided an unprecedented opportunity for psychotropic medication consumers, a traditionally silenced group in clinical trial research, to have voice by contributing to the construction of drug knowledge in an immediate, direct manner. Currently, there are no systematic appraisals of the potential of online consumer drug reviews to contribute to drug knowledge. The purpose of this research was to explore the content of drug information on various websites representing themselves as consumer- and expert-constructed, and as a practical consideration, to examine how each source may help and hinder treatment decision-making.^ Methodology. A mixed-methods research strategy utilizing a grounded theory approach was used to analyze drug information on 5 exemplar websites (3 consumer- and 2 expertconstructed) for 2 popularly prescribed psychotropic drugs (escitalopram and quetiapine). A stratified simple random sample was used to select 1,080 consumer reviews from the websites (N=7,114) through February 2009. Text was coded using QDA Miner 3.2 software by Provalis Research. A combination of frequency tables, descriptive excerpts from text, and chi-square tests for association were used throughout analyses.^ Findings. The most frequently mentioned effects by consumers taking either drug were related to psychological/behavioral symptoms and sleep. Consumers reported many of the same effects as found on expert health sites, but provided more descriptive language and situational examples. Expert labels of less serious on certain effects were not congruent with the sometimes tremendous burden described by consumers. Consumers mentioned more than double the themes mentioned in expert text, and demonstrated a diversity and range of discourses around those themes.^ Conclusions. Drug effects from each source were complete relative to the information provided in the other, but each also offered distinct advantages. Expert health sites provided concise summaries of medications’ effects, while consumer reviews had the added advantage of concrete descriptions and greater context. In short, consumer reviews better prepared potential consumers for what it’s like to take psychotropic drugs. Both sources of information benefit clinicians and consumers in making informed treatment-related decisions. Social work practitioners are encouraged to thoughtfully utilize online consumer drug reviews as a legitimate additional source for assisting clients in learning about treatment options.^

Medical Advice and Diabetes Self-Management Reported by Mexican-American, Black- and White-Non-Hispanic Adults Across the United States

Background: Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods: We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 MexicanAmericans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with ‘undiagnosed diabetes’ [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants’ diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results: Although medical advice to the patient is considered a standard of care for diabetes, approximately onethird of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats. Conclusions: Providing standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.

Do Dietary Factors Contribute to Medical Cost for Cuban Americans with and without Type 2 Diabetes?

BACKGROUND: Cuban Americans have a high prevalence of type 2 diabetes, placing them at risk for cardiovascular disease (CVD) and increased medical costs. Little is known regarding the lifestyle risk factors of CVD among Cuban Americans. This study investigated modifiable CVD risk factors of Cuban Americans with and without type 2 diabetes. METHODS: Sociodemographics, anthropometrics, blood pressure, physical activity, dietary intake, and biochemical parameters were collected and assessed for n=79 and n=80 Cuban Americans with and without type 2 diabetes. RESULTS: Fourteen percent with diabetes and 24 percent without diabetes engaged in the recommended level of physical activity. Over 90 percent had over the recommended intake of saturated fats. Thirty-five percent were former or current smokers. DISCUSSION: Cuban Americans had several lifestyle factors that are likely to increase the risk of CVD. Their dietary factors were associated with blood cholesterol and body weight, which has been shown to impact on medical expenses. These findings may be used for designing programs for the prevention of CVD as well as type 2 diabetes for Cuban Americans.

Framing infectious diseases and U.S. public opinion

The United States has been increasingly concerned with the transnational threat posed by infectious diseases. Effective policy implementation to contain the spread of these diseases requires active engagement and support of the American public. To influence American public opinion and enlist support for related domestic and foreign policies, both domestic agencies and international organizations have framed infectious diseases as security threats, human rights disasters, economic risks, and as medical dangers. This study investigates whether American attitudes and opinions about infectious diseases are influenced by how the issue is framed. It also asks which issue frame has been most influential in shaping public opinion about global infectious diseases when people are exposed to multiple frames. The impact of media frames on public perception of infectious diseases is examined through content analysis of newspaper reports. Stories on SARS, avian flu, and HIV/AIDS were sampled from coverage in The New York Times and The Washington Post between 1999 and 2007. Surveys of public opinion on infectious diseases in the same time period were also drawn from databases like Health Poll Search and iPoll. Statistical analysis tests the relationship between media framing of diseases and changes in public opinion. Results indicate that no one frame was persuasive across all diseases. The economic frame had a significant effect on public opinion about SARS, as did the biomedical frame in the case of avian flu. Both the security and human rights frames affected opinion and increased public support for policies intended to prevent or treat HIV/AIDS. The findings also address the debate on the role and importance of domestic public opinion as a factor in domestic and foreign policy decisions of governments in an increasingly interconnected world. The public is able to make reasonable evaluations of the frames and the domestic and foreign policy issues emphasized in the frames.

Synthesis and Biological Evaluation of Novel Folic Acid Receptor-Targeted, β-Cyclodextrin-Based Drug Complexes for Cancer Treatment

Drug targeting is an active area of research and nano-scaled drug delivery systems hold tremendous potential for the treatment of neoplasms. In this study, a novel cyclodextrin (CD)-based nanoparticle drug delivery system has been assembled and characterized for the therapy of folate receptor-positive [FR(+)] cancer. Water-soluble folic acid (FA)-conjugated CD carriers (FACDs) were successfully synthesized and their structures were confirmed by 1D/2D nuclear magnetic resonance (NMR), matrix-assisted laser desorption ionization time-of-flight mass spectrometer (MALDI-TOF-MS), high performance liquid chromatography (HPLC), Fourier transform infrared spectroscopy (FTIR), and circular dichroism. Drug complexes of adamatane (Ada) and cytotoxic doxorubicin (Dox) with FACD were readily obtained by mixed solvent precipitation. The average size of FACD-Ada-Dox was 1.5–2.5 nm. The host-guest association constant Ka was 1,639 M−1 as determined by induced circular dichroism and the hydrophilicity of the FACDs was greatly enhanced compared to unmodified CD. Cellular uptake and FR binding competitive experiments demonstrated an efficient and preferentially targeted delivery of Dox into FR-positive tumor cells and a sustained drug release profile was seen in vitro. The delivery of Dox into FR(+) cancer cells via endocytosis was observed by confocal microscopy and drug uptake of the targeted nanoparticles was 8-fold greater than that of non-targeted drug complexes. Our docking results suggest that FA, FACD and FACD-Ada-Dox could bind human hedgehog interacting protein that contains a FR domain. Mouse cardiomyocytes as well as fibroblast treated with FACD-Ada-Dox had significantly lower levels of reactive oxygen species, with increased content of glutathione and glutathione peroxidase activity, indicating a reduced potential for Dox-induced cardiotoxicity. These results indicate that the targeted drug complex possesses high drug association and sustained drug release properties with good biocompatibility and physiological stability. The novel FA-conjugated β-CD based drug complex might be promising as an anti-tumor treatment for FR(+) cancer.

Hypertension, poor glycemic control, and microalbuminuria in Cuban Americans with type 2 diabetes

Purpose: To investigate to what degree the presence of hypertension (HTN) and poor glycemic control (GC) influences the likelihood of having microalbuminuria (MAU) among Cuban Americans with type 2 diabetes (T2D).Methods: A cross-sectional study conducted in Cuban Americans (n = 179) with T2D. Participants were recruited from a randomly generated mailing list purchased from KnowledgeBase Marketing, Inc. Blood pressure (BP) was measured twice and averaged using an adult size cuff. Glycosylated hemoglobin (A1c) levels were measured from whole blood samples with the Roche Tina-quant method. First morning urine samples were collected from each participant to determine MAU by a semiquantitative assay (ImmunoDip).Results: MAU was present in 26% of Cuban Americans with T2D. A significantly higher percentage of subjects with MA had HTN (P = 0.038) and elevated A1C (P = 0.002) than those with normoalbuminuria. Logistic regression analysis showed that after controlling for covariates, subjects with poor GC were 6.76 times more likely to have MAU if they had hypertension compared with those without hypertension (P = 0.004; 95% confidence interval [CI]: 1.83, 23.05). Conclusion: The clinical significance of these findings emphasizes the early detection of MAU in this Hispanic subgroup combined with BP and good GC, which are fundamentals in preventing and treating diabetes complications and improving individuals’ renal and cardiovascular outcomes.

Monounsaturated fatty acid, carbohydrate intake, and diabetes status are associated with arterial pulse pressure

Background Diabetes is a global epidemic. Cardiovascular disease (CVD) is one of the most prevalent consequences of diabetes. Nutrition is considered a modifiable risk factor for CVD, particularly for individuals with diabetes; albeit, there is little consensus on the role of carbohydrates, proteins and fats for arterial health for persons with or without diabetes. In this study, we examined the association of macronutrients with arterial pulse pressure (APP), a surrogate measure of arterial health by diabetes status and race. Methods Participants were 892 Mexican Americans (MA), 1059 Black, non-Hispanics (BNH) and 2473 White, non-Hispanics (WNH) with and without diabetes of a weighted sample from the National Nutrition and Health Examination Survey (NHANES) 2007-2008. The cross-sectional analysis was performed with IBM-SPSS version 18 with the complex sample analysis module. The two-year sample weight for the sub-sample with laboratory values was applied to reduce bias and approximate a nationally, representative sample. Arterial stiffness was assessed by arterial pulse pressure (APP). Results APP was higher for MA [B = 0.063 (95% CI 0.015 to 0.111), p = 0.013] and BNH [B = 0.044 (95% CI 0.006 to 0.082), p = 0.018] than WNH, controlling for diabetes, age, gender, body mass index (BMI), fiber intake, energy intake (Kcal) and smoking. A two-way interaction of diabetes by carbohydrate intake (grams) was inversely associated with APP [B = -1.18 (95% CI -0.178 to -0.058), p = 0.001], controlling for race, age, gender, BMI, Kcal and smoking. BNH with diabetes who consumed more mono-unsaturated fatty acids (MUFA) than WNH with diabetes had lower APP [B = -0.112 (95%CI-0.179 to -0.045), p = 0.003] adjusting for saturated fatty acids, Kcal, age, gender, BMI and smoking. Conclusion Higher MUFA and carbohydrate intake for persons with diabetes reflecting lower APP may be due to replacement of saturated fats with CHO and MUFA. The associations of APP with diabetes, race and dietary intake need to be confirmed with intervention and prospective studies. Confirmation of these results would suggest that dietary interventions for minorities with diabetes may improve arterial health.

Television Watching, Diet Quality, and Physical Activity and Diabetes among Three Ethnicities in the United States

Diabetes is a world-wide epidemic associated with multiple environmental factors. Prolonged television viewing (TV) time has been related to increased risk of obesity and type 2 diabetes in several studies. TV viewing has been positively associated with cardiovascular disease risk factors, lower energy expenditure, over-eating high-calorie and high-fat foods. The objective of this study was to assess the associations of hours of TV viewing with dietary quality, obesity and physical activity for three ethnic minorities with and without type 2 diabetes. Diet quality and physical activity were inversely related to prolonged TV viewing. African Americans and participants with type 2 diabetes were more likely to watch more than 4 hours of TV per day as compared to their counterparts. Diet quality was inversely associated with physical activity level. Future studies are needed to establish the risk factors of prolonged TV watching in adult populations for the development of diabetes or diabetes-related complications. Although strategies to reduce TV watching have been proven effective among children, few trials have been conducted in adults. Intervention trials aimed at reducing TV viewing targeting people with type 2 diabetes may be beneficial to improve dietary quality and physical activity, which may reduce diabetes complications.

Potential for Cell-Transplant Therapy with Human Neuronal Precursors to Treat Neuropathic Pain in Models of PNS and CNS Injury: Comparison of hNT2.17 and hNT2.19 Cell Lines

Effective treatment of sensory neuropathies in peripheral neuropathies and spinal cord injury (SCI) is one of the most difficult problems in modern clinical practice. Cell therapy to release antinociceptive agents near the injured spinal cord is a logical next step in the development of treatment modalities. But few clinical trials, especially for chronic pain, have tested the potential of transplant of cells to treat chronic pain. Cell lines derived from the human neuronal NT2 cell line parentage, the hNT2.17 and hNT2.19 lines, which synthesize and release the neurotransmitters gamma-aminobutyric acid (GABA) and serotonin (5HT), respectively, have been used to evaluate the potential of cell-based release of antinociceptive agents near the lumbar dorsal (horn) spinal sensory cell centers to relieve neuropathic pain after PNS (partial nerve and diabetes-related injury) and CNS (spinal cord injury) damage in rat models. Both cell lines transplants potently and permanently reverse behavioral hypersensitivity without inducing tumors or other complications after grafting. Functioning as cellular minipumps for antinociception, human neuronal precursors, like these NT2-derived cell lines, would likely provide a useful adjuvant or replacement for current pharmacological treatments for neuropathic pain.

Healthy Eating Index and Alternate Healthy Eating Index among Haitian Americans and African Americans with and without Type 2 Diabetes

Ethnicities within Black populations have not been distinguished in most nutrition studies. We sought to examine dietary differences between African Americans (AA) and Haitian Americans (HA) with and without type 2 diabetes using the Healthy Eating Index, 2005 (HEI-05), and the Alternate Healthy Eating Index (AHEI). The design was cross-sectional (225 AA, 246 HA) and recruitment was by community outreach. The eating indices were calculated from data collected with the Harvard food-frequency questionnaire. African Americans had lower HEI-05 scores (−8.67, 13.1); , than HA. Haitian American females and AA males had higher AHEI than AA females and HA males, respectively, () adjusting for age and education. Participants with diabetes had higher adherence to the HEI-05 (1.78, 6.01), , and lower adherence to the AHEI (16.3, −3.19), , , than participants without diabetes. The findings underscore the importance of disaggregating ethnicities and disease state when assessing diet.

The relationship of aptitude, course grades, and program length, to performance on a standards based test (NCLEX -RN)

The purpose of this study was threefold: first, to investigate variables associated with learning, and performance as measured by the National Council Licensure Examination for Registered Nurses (NCLEX-RN). The second purpose was to validate the predictive value of the Assessment Technologies Institute (ATI) achievement exit exam, and lastly, to provide a model that could be used to predict performance on the NCLEX-RN, with implications for admission and curriculum development. The study was based on school learning theory, which implies that acquisition in school learning is a function of aptitude (pre-admission measures), opportunity to learn, and quality of instruction (program measures). Data utilized were from 298 graduates of an associate degree nursing program in the Southeastern United States. Of the 298 graduates, 142 were Hispanic, 87 were Black, non-Hispanic, 54 White, non-Hispanic, and 15 reported as Others. The graduates took the NCLEX-RN for the first time during the years 2003–2005. This study was a predictive, correlational design that relied upon retrospective data. Point biserial correlations, and chi-square analyses were used to investigate relationships between 19 selected predictor variables and the dichotomous criterion variable, NCLEX-RN. The correlation and chi square findings indicated that men did better on the NCLEX-RN than women; Blacks had the highest failure rates, followed by Hispanics; older students were more likely to pass the exam than younger students; and students who passed the exam started and completed the nursing program with a higher grade point average, than those who failed the exam. Using logistic regression, five statistical models that used variables associated with learning and student performance on the NCLEX-RN were tested with a model adapted from Bloom's (1976) and Carroll's (1963) school learning theories. The derived model included: NCLEX-RNsuccess = f (Nurse Entrance Test and advanced medical-surgical nursing course grade achieved). The model demonstrates that student performance on the NCLEX-RN can be predicted by one pre-admission measure, and a program measure. The Assessment Technologies Institute achievement exit exam (an outcome measure) had no predictive value for student performance on the NCLEX-RN. The model developed accurately predicted 94% of the student's successful performance on the NCLEX-RN.

Specific Increase in MDR1 Mediated Drug-Efflux in Human Brain Endothelial Cells following Co-Exposure to HIV-1 and Saquinavir

Persistence of HIV-1 reservoirs within the Central Nervous System (CNS) remains a significant challenge to the efficacy of potent anti-HIV-1 drugs. The primary human Brain Microvascular Endothelial Cells (HBMVEC) constitutes the Blood Brain Barrier (BBB) which interferes with anti-HIV drug delivery into the CNS. The ATP binding cassette (ABC) transporters expressed on HBMVEC can efflux HIV-1 protease inhibitors (HPI), enabling the persistence of HIV-1 in CNS. Constitutive low level expression of several ABC-transporters, such as MDR1 (a.k.a. P-gp) and MRPs are documented in HBMVEC. Although it is recognized that inflammatory cytokines and exposure to xenobiotic drug substrates (e.g HPI) can augment the expression of these transporters, it is not known whether concomitant exposure to virus and anti-retroviral drugs can increase drug-efflux functions in HBMVEC. Our in vitro studies showed that exposure of HBMVEC to HIV-1 significantly up-regulates both MDR1 gene expression and protein levels; however, no significant increases in either MRP-1 or MRP-2 were observed. Furthermore, calcein-AM dye-efflux assays using HBMVEC showed that, compared to virus exposure alone, the MDR1 mediated drug-efflux function was significantly induced following concomitant exposure to both HIV-1 and saquinavir (SQV). This increase in MDR1 mediated drug-efflux was further substantiated via increased intracellular retention of radiolabeled [3H-] SQV. The crucial role of MDR1 in 3H-SQV efflux from HBMVEC was further confirmed by using both a MDR1 specific blocker (PSC-833) and MDR1 specific siRNAs. Therefore, MDR1 specific drug-efflux function increases in HBMVEC following co-exposure to HIV-1 and SQV which can reduce the penetration of HPIs into the infected brain reservoirs of HIV-1. A targeted suppression of MDR1 in the BBB may thus provide a novel strategy to suppress residual viral replication in the CNS, by augmenting the therapeutic efficacy of HAART drugs.

Forgotten Women: Incarceration and Health Concerns of Minority Women

Paper Presentation

Construction and screening of A cDNA library for the C3 gene(s) of the Nurse Shark (Ginglymostoma Cirratum)

Mammalian C3 is a complement protein which consists of an α chain (125kDa) and β chain (75kDa) held together by a disulfide bond. The a chain contains a conserved thiolester site which provides the molecule with opsonic properties. The protein is synthesized as a single pro-C3 molecule which is post-translationally modified. C3 genes have been identified in organisms from different phyla, however, the shark C3 gene remains to be cloned. Sequence data from the shark will contribute to understanding further the evolution of this key protein. To obtain additional sequence data for shark C3 genes a cDNA library was constructed and screened with a DIG-labeled C3 probe. Fifty clones were isolated and sequenced. Analysis identified four sequences that yielded positive alignments with C3 of a variety of organisms including human C3. Deduced amino acid sequence analysis confirmed a β/α cut site (RRRR), the CR3 and properdin binding sites, the catalytic histidine, and the reactive thiolester sequence. In the shark there are at least two C3-like genes as the gene sequence obtained is distinct from that previously described.

MobiMed: Framework for Rapid Application Development of Medical Mobile Apps

In the medical field images obtained from high definition cameras and other medical imaging systems are an integral part of medical diagnosis. The analysis of these images are usually performed by the physicians who sometimes need to spend long hours reviewing the images before they are able to come up with a diagnosis and then decide on the course of action. In this dissertation we present a framework for a computer-aided analysis of medical imagery via the use of an expert system. While this problem has been discussed before, we will consider a system based on mobile devices. Since the release of the iPhone on April 2003, the popularity of mobile devices has increased rapidly and our lives have become more reliant on them. This popularity and the ease of development of mobile applications has now made it possible to perform on these devices many of the image analyses that previously required a personal computer. All of this has opened the door to a whole new set of possibilities and freed the physicians from their reliance on their desktop machines. The approach proposed in this dissertation aims to capitalize on these new found opportunities by providing a framework for analysis of medical images that physicians can utilize from their mobile devices thus remove their reliance on desktop computers. We also provide an expert system to aid in the analysis and advice on the selection of medical procedure. Finally, we also allow for other mobile applications to be developed by providing a generic mobile application development framework that allows for access of other applications into the mobile domain. In this dissertation we outline our work leading towards development of the proposed methodology and the remaining work needed to find a solution to the problem. In order to make this difficult problem tractable, we divide the problem into three parts: the development user interface modeling language and tooling, the creation of a game development modeling language and tooling, and the development of a generic mobile application framework. In order to make this problem more manageable, we will narrow down the initial scope to the hair transplant, and glaucoma domains.