Racial and ethnic heterogeneity in self-reported diabetes prevalence trends across Hispanic subgroups, National Health Interview Survey, 1997–2012

INTRODUCTION: We examined racial/ethnic heterogeneity in self-reported diabetes prevalence over 15 years. METHODS: We used National Health Interview Survey data for 1997 through 2012 on 452,845 adults aged 18 years or older. Annual self-reported diabetes prevalence was estimated by race/ethnicity and education. We tested for trends over time by education and race/ethnicity. We also analyzed racial/ethnic and education trends in average annual prevalence. RESULTS: During the 15 years studied, diabetes prevalence differed significantly by race/ethnicity (P < .001) and by Hispanic subgroup (P < .001). Among participants with less than a high school education, the 5-year trend in diabetes prevalence was highest among Cubans and Cuban Americans (β(5YR) = 4.8, P = .002), Puerto Ricans (β(5YR) = 2.2, P = .06), non-Hispanic blacks (β(5YR) = 2.2, P < .001), and non-Hispanic whites (β(5YR) = 2.1, P < .001). Among participants with more than a high school education, non-Hispanic blacks had the highest average annual prevalence (5.5%) and Puerto Ricans had the highest 5-year trend in annual diabetes prevalence (β(5YR) = 2.6, P = .001). CONCLUSIONS: In this representative sample of US adults, results show ethnic variations in diabetes prevalence. The prevalence of diabetes is higher among Hispanics than among non-Hispanic whites, unevenly distributed across Hispanic subgroups, and more pronounced over time and by education. Findings support disaggregation of data for racial/ethnic populations in the United States to monitor trends in diabetes disparities and the use of targeted, culturally appropriate interventions to prevent diabetes

A tale of two community networks program centers: Operationalizing and assessing CBPR principles and evaluating partnership outcomes

BACKGROUND: Community Networks Program (CNP) centers are required to use a community-based participatory research (CBPR) approach within their specific priority communities. Not all communities are the same and unique contextual factors and collaborators’ priorities shape each CBPR partnership. There are also established CBPR and community engagement (CE) principles shown to lead to quality CBPR in any community. However, operationalizing and assessing CBPR principles and partnership outcomes to understand the conditions and processes in CBPR that lead to achieving program and project level goals is relatively new in the science of CBPR. OBJECTIVES: We sought to describe the development of surveys on adherence to and implementation of CBPR/CE principles at two CNP centers and examine commonalities and differences in program- versus project-level CBPR evaluation. METHODS: A case study about the development and application of CBPR/CE principles for the Missouri CNP, Program for the Elimination of Cancer Disparities, and Minnesota CNP, Padres Informados/Jovenes Preparados, surveys was conducted to compare project versus program operationalization of principles. Survey participant demographics were provided by CNP. Specific domains found in CBPR/CE principles were identified and organized under an existing framework to establish a common ground. Operational definitions and the number of survey items were provided for each domain by CNP. CONCLUSION: There are distinct differences in operational definitions of CBPR/CE principles at the program and project levels of evaluation. However, commonalities support further research to develop standards for CBPR evaluation across partnerships and at the program and project levels

Glucocorticoid Abnormalities in Female Rats Exposed to a Predator-Based Psychosocial Stress Model of PTSD

People with post-traumatic stress disorder (PTSD) exhibit heightened anxiety and enhanced negative feedback of the hypothalamus-pituitary-adrenal (HPA) axis. We previously reported that male rats exposed to a predator-based psychosocial stress model of PTSD exhibited comparable changes in anxiety-like behavior and HPA axis activity, including lower baseline levels of corticosterone and a greater suppression of corticosterone after dexamethasone administration. Here, we assessed whether we would observe similar effects in female rats exposed to this model. Adult female Sprague-Dawley rats were exposed to a cat on two occasions (separated by 10 days), in combination with chronic social instability. Three weeks after the second cat exposure, we assessed anxiety-like behavior on an elevated plus maze (EPM) and collected blood samples from rats in the absence or presence of dexamethasone to quantify serum corticosterone levels. Although stressed females did not display heightened anxiety on the EPM, they exhibited significantly lower overall corticosterone levels and a greater suppression of corticosterone after dexamethasone administration. The observation of significantly lower overall corticosterone levels in stressed females was replicated in a separate, independent experiment. These findings suggest that the predator-based psychosocial stress model of PTSD may be useful for studying mechanisms that underlie changes in HPA axis function in females exposed to trauma

Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

OBJECTIVES: To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS: Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS: A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION: This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening

Enhanced Negative Feedback of the HPA Axis and Increased Noradrenergic Activity in Females Exposed to a Predator-Based Psychosocial Stress Model of PTSD

People with post-traumatic stress disorder (PTSD) exhibit numerous physiological alterations, including lower baseline cortisol levels, enhanced negative feedback of the hypothalamus-pituitary-adrenal (HPA) axis, increased noradrenergic activity, and reduced serotonergic activity. Male rats exposed to a predator-based psychosocial stress model of PTSD exhibit similar changes in HPA axis function and neurotransmission. Here, we examined whether similar effects would be observed in female rats exposed to this model. Adult female Sprague-Dawley rats were exposed to a cat on two occasions, separated by 10 days, in conjunction with daily social instability. Three weeks following the second cat exposure, we examined rats’ anxiety-like behavior on an elevated plus maze (EPM), collected blood samples at baseline and following dexamethasone administration to quantify corticosterone levels, and extracted brains to quantify markers of noradrenergic and serotonergic activity in the hippocampus and prefrontal cortex (PFC). Stressed females did not exhibit heightened anxiety on the EPM, but, relative to controls, they displayed lower corticosterone levels and a greater suppression of corticosterone following dexamethasone administration. Stressed females also exhibited increased markers of noradrenergic activity in the dorsal hippocampus and PFC. These findings suggest that this model of PTSD may be useful for studying mechanisms underlying trauma-induced changes in female physiology

Impact of Alcohol on the Development of PTSD-Like Sequelae following Intense Stress

Traumatic events are frequently accompanied by alcohol use, and although some research has shown that alcohol increases intrusive memory formation in healthy subjects, limited work has examined the impact of alcohol on the development of post-traumatic stress disorder (PTSD). Moreover, there has been no work experimentally testing the influence of alcohol on PTSD-like symptoms in animal models. Thus, we examined the effects of alcohol on the development of PTSD-like symptoms in rats exposed to a predator-based model of traumatic stress. Male and female Sprague-Dawley rats were given intraperitoneal injections of alcohol (1.5 g/kg) or vehicle (water) 30 minutes before being exposed to an adult, female cat for 1 hr. One week later, the rats were tested for symptoms of anxiety-like behavior on an elevated plus maze and in an open field. We also assessed rats’ hyperarousal by examining their baseline startle responses. According to the results, males, but not females, that were treated with alcohol prior to stress displayed significantly greater anxiety and larger startle responses than rats treated with vehicle before stress. These findings suggest that peri-traumatic alcohol ingestion could increase the risk of developing PTSD, at least in males

Ketamine Sex- and Dose-Dependently Mitigates Behavioral Sequelae Induced by a Predator-Based Psychosocial Stress Model of PTSD

Few pharmacological agents effectively treat the array of symptoms involved in post-traumatic stress disorder (PTSD). SSRIs are the only FDA-approved medications for PTSD, but they lead to remission rates of barely 50% and take weeks to months before producing symptom relief. Therefore, we examined the impact of ketamine, an NMDA receptor antagonist that has rapid antidepressant effects, on PTSD-like symptom development in rats. Male and female rats were exposed to psychosocial stress for 31 days. The stress procedure involved two separate cat exposures and daily social instability. Immediately after the first cat exposure, rats in the stress groups were injected with ketamine (10 mg/kg or 15 mg/kg) or vehicle (0.9% saline). Three weeks following the second cat exposure, the rats were tested for symptoms of anxiety and hyperarousal. Stressed males treated with vehicle exhibited heightened anxiety on an elevated plus maze and less activity in an open field. Stressed females treated with vehicle displayed exaggerated startle responses, as well as heightened anxiety and less activity in an open field. These effects were prevented by ketamine treatment, particularly the 10 mg/kg dose. Such findings indicate that peri-traumatic administration of a sub-anesthetic dose of ketamine can prevent the onset of PTSD-like symptoms

Impact of Ketamine on Physiological and Behavioral Sequelae Induced by a Predator-Based Psychosocial Stress Model of PTSD

Few pharmacological agents effectively treat the array of symptoms involved in post-traumatic stress disorder (PTSD). SSRIs are the most commonly prescribed medication for PTSD, but they lead to remission rates of barely 50% and take weeks to months before producing symptom relief. Therefore, we examined the impact of ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist that has rapid antidepressant effects, on PTSD-like symptom development in rats exposed to a predator-based psychosocial stress model of PTSD. Male and female Sprague-Dawley rats were exposed to psychosocial stress for 31 days. The psychosocial stress procedure involved two separate cat exposures and daily social instability. Immediately after the first cat exposure, rats were given intraperitoneal injections of ketamine (15 mg/kg) or vehicle. Three weeks following the second cat exposure, the rats were tested for symptoms of anxiety-like behavior on an elevated plus maze and in an open field; we also assessed rats’ hyperarousal by examining their baseline startle responses. Data collection is still in progress, but preliminary results suggest that ketamine reduced anxiety on the EPM and in the open field in psychosocially stressed males. These and the ensuing results in females will be discussed

Acute and Chronic Ethanol Administration Exacerbate the Long-Term Behavioral Effects of Predator Stress

Trauma is frequently associated with alcohol use, yet limited work has examined the impact of alcohol ingestion on the development of post-traumatic stress disorder (PTSD) symptoms. In two separate experiments, we examined the effects of acute and chronic alcohol administration on the development of PTSD-like symptoms in rats exposed to predator stress. In Experiment 1, rats were injected with alcohol or water 30 minutes before being exposed to an adult, female cat for 1 hour. One week later, the rats were tested for anxiety-like behavior and hyperarousal. Stressed males, but not stressed females, treated with alcohol prior to stress displayed heightened anxiety and a trend toward larger startle responses, relative to stressed rats treated with vehicle. In Experiment 2, rats were injected with alcohol or water on Mondays, Wednesdays, and Fridays for 7 weeks. On the Monday of the 7th week, the rats were injected 30 minutes prior to cat exposure. During the 8th week, the rats were tested for anxiety-like behavior and hyperarousal. Stressed males and females given alcohol exhibited greater anxiety, and stressed females given alcohol displayed exaggerated startle responses. These findings suggest that acute and chronic peri-traumatic alcohol ingestion sex-dependently increases the risk of developing PTSD-like symptoms