Science Says

Background: In order to improve interventions for problem gambling, there is a need for studies that can highlight psychological factors that support the desire to reduce gambling.

Objective: To explore online problem gamblers' motivation for change by studying participants' reactions to an online treatment referral website designed to motivate at-risk gamblers to seek help.

Design: A qualitative evaluation study, combining focus groups and in-depth interviews. Data were analyzed using the general inductive approach.

Informants: The informants included 19 male, treatment- and non-treatment seeking, online gamblers who played a variety of games, including poker, sports betting and online casino.

Results: Motivation to change emerged as two processes including (a) empathy with others, which included projection of their thoughts and feelings onto others, and (b) dissonance between gambling behavior and ideal self-image. Dissonance included two subthemes: (i) dissonance due to positive feelings towards sports and athletics, and (ii) dissonance due to gambling among family.

Conclusions: The findings have implications for interventions designed to evoke motivation early in treatment of online problem gambling. Inducing problem gamblers to reflect on the thoughts and feelings of concerned significant others, real or fictional, could be a viable strategy to motivate online problem gamblers to consider change.

Johansen AB, Helland PF, Wennesland DK, Henden E, Brendryen H. Exploring online problem gamblers' motivation to change. Addict Behav Rep. 2019;10:100187. Published 2019 Jun 17. doi:10.1016/j.abrep.2019.100187

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Sections of the Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597935/

Climate change impacts on health—including increased exposures to heat, poor air quality, extreme weather events, altered vector-borne disease transmission, reduced water quality, and decreased food security—affect men and women differently, depending on local geographic and socioeconomic factors.

Climate change threatens to widen existing gender-based health disparities, especially in low- and middle-income countries.

Health impacts, and gender differences in those impacts, are mediated through socioeconomic, cultural, and physiologic factors. Policy action targeted towards these factors, which are often modifiable, can decrease negative health outcomes.

Integration of a gendered perspective into existing climate, development, and disaster-risk reduction policy frameworks requires improvement in data acquisition, monitoring of gender-specific targets, coordination between sectors, and equitable stakeholder engagement.

Empowering women as educators, caregivers, holders of knowledge, and agents of social change can improve mitigation and adaptation policy interventions.

Sorensen C, Murray V, Lemery J, Balbus J. Climate change and women's health: Impacts and policy directions. PLoS Med. 2018;15(7):e1002603. Published 2018 Jul 10. doi:10.1371/journal.pmed.1002603.

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Sections of the Summary, Introduction, Health Imacts, and Conclusion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038986/

Purpose: Cardiologists are known to consider patients' race when treating heart failure, but their views on the benefits and harms of this practice are largely undocumented. We set out to explore cardiologists' perspectives on the benefits and harms of race-based drug labels and guidelines. Specifically, we focused on isosorbide dinitrate and hydralazine hydrochloride (sold in a patented form as BiDil), a combination of drugs recommended for the treatment of black patients receiving optimal medical therapy for symptomatic heart failure and reduced ejection fraction.

Methods: We conducted 81 semistructured interviews at an American College of Cardiology Annual meeting to assess cardiologists' and cardiology fellows' attitudes toward the use of race in drug prescribing. Investigators reviewed and coded the interviews using inductive qualitative analysis techniques.

Results: Many participants believed that race-based drug labels might help doctors prescribe effective medications to patients sooner. More than half of the participants expressed concerns, however, that considering race within the context of treating heart failure could potentially harm patients as well. Harms identified included the likelihood that patients who could benefit from a drug may not receive it because of their race; insufficient understanding about gene–drug–environment interactions; and simplistic applications of race in the clinic.

Conclusions: Few participants expressed approval of using race in drug prescribing without recognizing the potential harms, yet most participants stated that they continue to consider race when prescribing isosorbide dinitrate and hydralazine hydrochloride. Within the context of treating heart failure, more open discussions about the benefits and harms of race-based drug labels and prescribing are needed to address cardiologists' concerns.

Callier SL, Cunningham BA, Powell J, McDonald MA, Royal CDM. Cardiologists' Perspectives on Race-Based Drug Labels and Prescribing Within the Context of Treating Heart Failure. Health Equity. 2019;3(1):246–253. Published 2019 May 22. doi:10.1089/heq.2018.0074.

This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sections of the Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6608680/

As the sport of outdoor rock climbing rapidly grows, there is increasing pressure to understand how it can affect communities of organisms in cliff habitats. To that end, we surveyed 32 cliff sites in Boulder, Colorado, USA, and assessed the relative roles of human recreation and natural habitat features as drivers of bird diversity and activity. We detected only native avian species during our observations. Whereas avian abundance was not affected by climbing, avian species diversity and community conservation value were higher at low-use climbing formations. Models indicated that climber presence and cliff aspect were important predictors of both avian diversity and avian cliff use within our study area, while long-term climbing use frequency has a smaller, but still negative association with conservation value and cliff use by birds in the area. In contrast, the diversity of species on the cliff itself was not affected by any of our measured factors. To assess additional community dynamics, we surveyed vegetation and arthropods at ten site pairs. Climbing negatively affected lichen communities, but did not significantly affect other vegetation metrics or arthropods. We found no correlations between avian diversity and diversity of either vegetation or arthropods. Avian cliff use rate was positively correlated with arthropod biomass. We conclude that while rock climbing is associated with lower community diversity at cliffs, some common cliff-dwelling birds, arthropods and plants appear to be tolerant of climbing activity. An abiotic factor, cliff aspect strongly affected patterns of both avian diversity and cliff use, suggesting that the negative effects of rock climbing may be mitigated by informed management of cliff habitat that considers multiple site features.

Covy N, Benedict L, Keeley WH. Rock climbing activity and physical habitat attributes impact avian community diversity in cliff environments. PLoS One. 2019;14(1):e0209557. Published 2019 Jan 16. doi:10.1371/journal.pone.0209557.

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Sections of the Abstract, Introduction, and Conclusion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334907/

Rationale & objective: As the prevalence of obesity continues to rise in the United States, it is important to understand its impact on the lifetime risk of chronic kidney disease (CKD).

Study design: The CKD Health Policy Model was used to simulate the lifetime risk of CKD for those with and without obesity at baseline. Model structure was updated for glomerular filtration rate (GFR) decline to incorporate new longitudinal data from the Chronic Renal Insufficiency Cohort (CRIC) study.

Setting and population: The updated model was populated with a nationally representative cohort from National Health and Nutrition Examination Survey (NHANES).

Outcomes: Lifetime risk of CKD, highest stage and any stage.

Model, perspective, & timeframe: Simulation model following up individuals from current age through death or age 90 years.

Results: Lifetime risk of any CKD stage was 32.5% (95% CI 28.6%–36.3%) for persons with normal weight, 37.6% (95% CI 33.5%–41.7%) for persons who were overweight, and 41.0% (95% CI 36.7%–45.3%) for persons with obesity at baseline. The difference between persons with normal weight and persons with obesity at baseline was statistically significant (p<0.01). Lifetime risk of CKD stages 4 and 5 was higher for persons with obesity at baseline (Stage 4: 2.1%, 95% CI 0.9%–3.3%; stage 5: 0.6%, 95% CI 0.0%–1.1%), but the differences were not statistically significant (stage 4: p = 0.08; stage 5: p = 0.23).

Limitations: Due to limited data, our simulation model estimates are based on assumptions about the causal pathways from obesity to CKD, diabetes, and hypertension.

Conclusions: The results of this study indicate that obesity may have a large impact on the lifetime risk of CKD. This is important information for policymakers seeking to set priorities and targets for CKD prevention and treatment.

Yarnoff BO, Hoerger TJ, Shrestha SS, et al. Modeling the impact of obesity on the lifetime risk of chronic kidney disease in the United States using updated estimates of GFR progression from the CRIC study. PLoS One. 2018;13(10):e0205530. Published 2018 Oct 19. doi:10.1371/journal.pone.0205530

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Sections of the Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6195263/

Continuity is a critical but often neglected function of high-quality primary care and has three core domains: relational, informational and managerial continuity.

Improving continuity is feasible in low-income and middle-income country health systems by using comprehensive empanelment systems or community-based follow-up programmes to improve retention in care.

Continuity must receive more attention, measurement and improvement efforts, in order to achieve equitable, high-quality health for all.

Schwarz D, Hirschhorn LR, Kim JH, Ratcliffe HL, Bitton A. Continuity in primary care: a critical but neglected component for achieving high-quality universal health coverage. BMJ Glob Health. 2019;4(3):e001435. Published 2019 May 23. doi:10.1136/bmjgh-2019-001435.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: http://creativecommons.org/licenses/by/4.0/.

Sections of the Summary, Introduction, You cannot improve what you do not see, and Conclusion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6570977/

We studied whether medical conditions across 21 broad categories were predictable from social media content across approximately 20 million words written by 999 consenting patients. Facebook language significantly improved upon the prediction accuracy of demographic variables for 18 of the 21 disease categories; it was particularly effective at predicting diabetes and mental health conditions including anxiety, depression and psychoses. Social media data are a quantifiable link into the otherwise elusive daily lives of patients, providing an avenue for study and assessment of behavioral and environmental disease risk factors. Analogous to the genome, social media data linked to medical diagnoses can be banked with patients’ consent, and an encoding of social media language can be used as markers of disease risk, serve as a screening tool, and elucidate disease epidemiology. In what we believe to be the first report linking electronic medical record data with social media data from consenting patients, we identified that patients’ Facebook status updates can predict many health conditions, suggesting opportunities to use social media data to determine disease onset or exacerbation and to conduct social media-based health interventions.

Sections of the Abstract, Introduction, and Results and discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6576767/

Dietary intake of adult vegetarians from large prospective studies has been well-characterized but is rarely reported in vegetarian adolescents. Our objective was to describe and compare the dietary intake of vegetarian adolescents with their non-vegetarian counterparts in a population known to espouse healthy living. Adolescents (n = 534) aged 12–18 years old from middle and high schools near major Adventist universities in Michigan and Southern California provided dietary, demographic, and anthropometric data. Dietary intake was measured with a validated 151-item self-administered web-based food frequency questionnaire; weight and height were measured during school visits. Vegetarian was defined as the combined intake of meat, meat derivatives, poultry, and fish of <1 serving per week. Descriptive statistics and ANCOVA were used to compare the intake of vegetarians and non-vegetarians. Vegetarians significantly ate more fruits, vegetables, and other plant-based foods, but significantly less foods of animal origin, sugar-sweetened beverages, and coffee/tea compared to non-vegetarians. Vegetarians had significantly higher intakes of carbohydrates and total protein but lower intakes of fats, animal protein, and zinc compared to their counterparts. A majority (75% or more) of both groups met the 2015 Dietary Guidelines' age-and-gender-specific recommendations for most nutrients but only 16–18% of vegetarians/non-vegetarians did not exceed the upper limit for sodium. More vegetarians (49%) than non-vegetarians (25%) had <10% of their caloric intake from SFA. More than 90% of both groups met dairy recommendations, but greater proportions of vegetarians met recommendations for vegetables, fruits, nuts/soy products, and legumes than non-vegetarians. Of the non-vegetarians, only 7% and 44% met the fish and meats/poultry/eggs recommendation, respectively, which none of the vegetarians met. Compared to the general US adolescent population, both diet groups ate more fruits, vegetables, dairy and protein foods, and also consumed more micronutrients but less macronutrients. Overall, vegetarian adolescents have a more favorable dietary intake profile than non-vegetarians, but both vegetarians and non-vegetarians in this study population have a more adequate diet than the general US adolescent population. The influence of the Adventist plant-based diet culture that is translated both at home and at school is evident in our findings.

Segovia-Siapco G, Burkholder-Cooley N, Haddad Tabrizi S, Sabaté J. Beyond Meat: A Comparison of the Dietary Intakes of Vegetarian and Non-vegetarian Adolescents. Front Nutr. 2019;6:86. Published 2019 Jun 13. doi:10.3389/fnut.2019.00086.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Sections of the Abstract, Introduction, and Conclusions are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584749/

Purpose of Review: Effective responses to the US opioid overdose epidemic rely on accurate and timely drug overdose mortality data, which are generated from medicolegal death investigations (MDI) and certifications of overdose deaths. We identify nuances of MDI and certification of overdose deaths that can influence drug overdose mortality surveillance, as well as recent research, recommendations, and epidemiological tools for improved identification and quantification of specific drug involvement in overdose mortality.

Recent Findings: Death certificates are the foundation of drug overdose mortality surveillance. Accordingly, counts and rates of specific drug involvement in overdose deaths are only as accurate as the drug listed on death certificates. Variation in systematic approaches or jurisdictional office policy in drug overdose death certification can lead to bias in mortality rate calculations. Recent research has examined statistical adjustments to improve underreported opioid involvement in overdose deaths. New cause-of-death natural language text analysis tools improve quantification of specific opioid overdose mortality rates. Enhanced opioid overdose surveillance, which combines death certificate data with other MDI-generated data, has the potential to improve understanding of factors and circumstances of opioid overdose mortality.

Summary: The opioid overdose crisis has brought into focus some of the limitations of US MDI systems for drug overdose surveillance and has given rise to a sense of urgency regarding the pressing need for improvements in our MDI data for public health action and research. Epidemiologists can stimulate positive changes in MDI data quality by demonstrating the critical role of data in guiding public health and safety decisions and addressing the challenges of accurate and timely overdose mortality measures with stakeholders. Education, training, and resources specific to drug overdose surveillance and analysis will be essential as the nation’s overdose crisis continues to evolve.

Slavova S, Delcher C, Buchanich JM, Bunn TL, Goldberger BA, Costich JF. Methodological Complexities in Quantifying Rates of Fatal Opioid-Related Overdose. Curr Epidemiol Rep. 2019;6(2):263–274. doi:10.1007/s40471-019-00201-9.

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Sections of the Abstract, Introduction, Epidemiologic Analysis of Drug Overdose Death Data,Death Certificates Remain the Core of Population-Based Drug Overdose Mortality Surveillance, and Conclusions are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559129/

Early life adversity (ELA) contributes to behavioral impulsivity along with risk for substance use disorders, both accompanied by blunted stress-axis reactivity. However, the biological contributors to blunted stress reactivity are not known. We took advantage of the fact that women have significant opioid inhibition of cortisol output by using the opioid antagonist, naltrexone, to unmask opioid interactions due to ELA. We administered 50 mg of naltrexone or placebo to 72 healthy women (23 years of age) in a double-blind crossover study and observed deviations in cortisol secretion from placebo over the next 180 minutes. ELA was assessed by reported exposure to physical and sexual abuse or neglect and low socioeconomic status and scored as Low, Medium, or High (0, 1–2, and 3+). The ELA groups all had identical placebo-day cortisol secretion, indicating normal basal regulation of the hypothalamic-pituitary-adrenocortical axis. Cortisol rises to naltrexone were largest in the Low-ELA group and strongly blunted in the High-ELA group (F = 3.51, p = 0.035), indicating a lack of opioid function in women with high degrees of ELA. The Low-ELA women reported dysphoric responses to naltrexone (F = 4.05, p = .022) indicating a mild opioid withdrawal, an effect that was absent in the High-ELA group. Women exposed to ELA have blunted cortisol responses to naltrexone, indicating reduced opioid regulation of the stress axis. Central opioid changes may be one pathway linking ELA to blunted stress reactivity in adulthood.

Lovallo WR, Acheson A, Vincent AS, Sorocco KH, Cohoon AJ. Early life adversity diminishes the cortisol response to opioid blockade in women: Studies from the Family Health Patterns project. PLoS One. 2018;13(10):e0205723. Published 2018 Oct 12. doi:10.1371/journal.pone.0205723.

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Sections of the Abstract, Introduction, and Conclusion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6185842/