Antidepressant therapy in primary care: Does patient preference affect response?

Context Current research and practice guidelines support the use of both psychotherapy and pharmacotherapy for the treatment of depression in primary care. Identifying predictors of response to therapy can assist patients and providers in choosing the most effective treatment for individual patients. Objective To assess the effect of patient treatment preference on therapeutic outcome in a trial of antidepressant therapy for patients with depressive symptoms. Design Secondary analysis of a randomized, controlled trial of 3 selective serotonin reuptake inhibitors (SSRis) in primary care. Setting Participants A total of 573 patients with symptoms warranting antidepressant therapy in 37 primary care practices organized in 2 U.S. primary care research networks. Intervention Participants were queried at baseline about the acceptability of antidepressants, counseling, and waiting as treatments for depression before being randomized to one of three SSRis. Outcome Measures The two primary outcomes were 1) depressive symptoms, measured by the Symptoms Checklist (SCL-20), and 2) functional status, measured by the Medical Outcomes Study 12-ltem Short Form Health Survey Mental Component Summary Score (MCS-12). Outcomes were assessed by telephone interview at 1, 3, 6, and 9 months after initiation of antidepressant therapy. Results Patients were categorized as having a strong antidepressant preference (23%), mild antidepressant preference (48%), counseling preference (12%), or a preference for waiting (17%). Logistic regression revealed that white race, longer chronicity of symptoms, and a past history of depression treatment were significantly associated with a strong antidepressant preference versus other groups. Longitudinal models demonstrated significant time by preference group interactions for both SCL-20 (p < 0.001) and MCS-12 (p < 0.001) scores, adjusting for baseline covariates of age, gender, race/ethnicity, anxiety, chronicity of symptoms, past history of depression treatment, and medical comorbidity. Conclusions Patients who believe antidepressants are a definitely acceptable treatment for depression respond more rapidly to SSRI therapy than other patients. Patient treatment preference is a significant predictor of the rate of response to pharmacotherapy for depression.Master of Public Healt

MS-1 magA: Revisiting Its Efficacy as a Reporter Gene for MRI

Bacterial genes involved in the biomineralization of magnetic nanoparticles in magnetotactic bacteria have recently been proposed as reporters for magnetic resonance imaging (MRI). In such systems, the expression of the bacterial genes in mammalian cells purportedly leads to greater concentrations of intracellular iron or the biomineralization of iron oxides, thus leading to an enhancement in relaxation rate that is detectable via MRI. Here, we show that the constitutive expression of the magA gene from Magnetospirillum magnetotacticum is tolerated by human embryonic kidney (HEK) cells but induces a strong toxic effect in murine mesenchymal/stromal cells and kidney-derived stem cells, severely restricting its effective use as a reporter gene for stem cells. Although it has been suggested that magA is involved in iron transport, when expressed in HEK cells, it does not affect the transcription of endogenous genes related to iron homeostasis. Furthermore, the magA -induced enhancement in iron uptake in HEK cells is insignificant, suggesting this gene is a poor reporter even for cell types that can tolerate its expression. We suggest that the use of magA for stem cells should be approached with caution, and its efficacy as a reporter gene requires a careful assessment on a cell-by-cell basis

The Key Events Dose-Response Framework: A Foundation for Examining Variability in Elicitation Thresholds for Food Allergens

Food allergies are caused by immunological reactions in individuals sensitized to normal protein components of foods. For any given sensitized individual, the severity of a reaction is generally assumed to be proportional to the dose of allergenic protein. There is substantial clinical evidence that “threshold” doses exist for the elicitation of an allergic reaction; however, the threshold (i.e., lowest dose that elicits a reaction) varies substantially across the sensitized population. Current approaches to protecting sensitized individuals from exposure to food allergens are highly qualitative (i.e., they rely on food avoidance). The Key Events Dose-Response Framework is an analytical approach for refining understanding of the biological basis of the dose-response. Application of this approach to food allergy provides a foundation for a more rigorous quantitative understanding of variability in allergic response. This study reviews the allergic disease process and the current approaches to identifying thresholds for food allergens. The pathway of key biological events occurring between food intake and allergic response is considered, along with factors that may determine the nature and severity of response to food allergens. Data needs, as well as implications for identifying thresholds, and for characterizing variability in thresholds, are also discussed

Malaria parasites and red cell variants: when a house is not a home

Multiple red cell variants are known to confer protection from malaria. Here we review advances in identifying new variants that modulate malaria risk and in defining molecular mechanisms that mediate malaria protection

Book Review: \u3ci\u3eWhy Are All the Black Kids Sitting Together in the Cafeteria? and Other Conversations About Race\u3c/i\u3e

Why Are All the Black Kids Sitting Together in the Cafeteria? and Other Conversations About Race is a 2017 revised and updated edition to Dr. Beverly Daniel Tatum’s original book written in 1997. The book explores decades of research on the psychology of racism, with an emphasis on the psychology of racial identity in Black, White, and other ethnic and cultural identities. The author helps readers gain a better understanding of historic and modern racism and the implications it has on individuals today. The book also contains important messages for people who work with diverse groups of adults and particularly of youth

Data relating to early child development in the Avon Longitudinal Study of Parents and Children (ALSPAC), their relationship with prenatal blood mercury and stratification by fish consumption.

As part of the Avon Longitudinal Study of Parents and Children (ALSPAC), measures of early child development were collected using both hands-on expert assessment (on a random 10% sub-sample) by trained psychologists at 18 months using the Griffiths Mental Development Scales (Extended 0–8 years) and from detailed questionnaires completed by the study mothers on the whole cohort using assessments based on the Denver Developmental Screening Test. The development determined by the psychologists on the 10% subsample showed a correlation of 0.49 (R. Wilson, 2003) [9] with the developmental level estimated from the maternal report. Maternal reports were used to determine the associations between prenatal blood mercury levels and scores of social achievement, fine motor skills, gross motor skills and communication at various preschool ages. (For results, please see doi:10.1016/j.neuro.2016.02.006 [1].