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Scholarly Works (4 results)

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Thesis
Peer Reviewed

Research on the Effect of Paraoxonase Single Nucleotide Polymorphisms on the Association of Race with Cardiovascular Disease

UC San Diego Electronic Theses and Dissertations (2019)

Background: Cardiovascular disease (CVD) is the leading cause of death in the US accounting for the highest death rates found in Blacks and Whites. Human paraoxonase (PON1, PON2, PON3) enzymes have antioxidant properties inhibiting the formation and accumulation of cholesterol. Major adverse cardiac events (MACE) is a composite cardiovascular outcome comprised of first occurrence of pre-specified cardiac events. Ankle-brachial index (ABI) is the ratio of systolic blood pressures of the lower extremity divided by the upper extremity. Peripheral arterial disease (PAD) is diagnosed as ABI <0.9. Objectives were to evaluate the association of race with 1) MACE 2) PAD and 3) change in ABI over time and effect modification of PON SNPs on these associations.

Methods: Data analyzed came from the Atherosclerosis Risk in Communities (ARIC) Study, a large population-based prospective cohort conducted at 4 field-centers across the US. Participants 45-64 years, Black or White race, enrolled in 1987 with four follow-up visits. Analysis was limited to 12,711 participants with genotype data.

Results: After adjusting for age, gender, BMI, cigarette and alcohol use, educational and marital status and reported aspirin use, Blacks had 1.24 times greater hazard of MACE compared to Whites, which became non-significant after adjusting for comorbidities. After adjusting for age, BMI, and gender, Blacks had 1.27 higher odds of PAD than Whites, but differences became non-significant after adjustment for smoking, education and comorbidities. After adjusting for confounders, Whites had significantly higher (better) ABI values than Blacks at both follow-up visits. When stratified by education, ABI over time was better in both Blacks and Whites who completed high school than those with less education. Due to the lack of main effect of PON SNPs, there was no effect modification found on these associations.

Conclusions: Modifiable health and behavioral risk factors and comorbidities may be major determinants of MACE and PAD. ABI differences by race were statistically significant but small and may not be clinically significant. Higher education may influence health management contributing to better ABI in Blacks and Whites. No effect modification was found on these associations due to the lack of main effect of the PON SNPs.

Cover page: Research on the Effect of Paraoxonase Single Nucleotide Polymorphisms on the Association of Race with Cardiovascular Disease

Article
Peer Reviewed

Caregiver-Reported Burden in RE-KINECT: Data From a Prospective Real-World Tardive Dyskinesia Screening Study.

UC San Francisco Previously Published Works (2023)

BACKGROUND: RE-KINECT (NCT03062033), a real-world study of possible tardive dyskinesia (TD) in antipsychotic-treated patients, included a questionnaire to assess the effects of patients abnormal involuntary movements on caregivers. AIMS: To capture the experiences of caregivers who assisted individuals with abnormal involuntary movements that were confirmed by clinicians as being consistent with TD. METHODS: Qualified (nonpaid) caregivers were invited to complete a questionnaire that included the following: caregivers sociodemographic characteristics, their perceptions about the impact of abnormal involuntary movements on patients, and the impact of these movements on themselves (caregivers). RESULTS: Of the 41 participating caregivers, 25 (61.0%) were women, 20 (48.8%) were employed full time or part time, and 35 (85.4%) were family members or friends. Based on responses from caregivers who noticed patients abnormal involuntary movements and were caring for individuals who also noticed those movements, 48.0% of patients had a lot of severity in ≥1 body region and 76.0% had abnormal involuntary movements in ≥2 regions. Caregiver ratings were significantly correlated with patient ratings (but not with clinician ratings) for maximum severity of abnormal involuntary movements and the number of affected regions (both p <.05). Based on their own judgments and perceptions, caregivers reported that the patients movements had some or a lot of impact on their (caregivers) ability to continue usual activities (50.0%), be productive (58.3%), socialize (55.6%), or take care of self (50.0%). CONCLUSIONS: Caregivers as well as patients are negatively affected by TD, and the impact of TD on caregivers lives should be considered when determining treatment options.

Article
Peer Reviewed

RE-KINECT

UC San Francisco Previously Published Works (2020)

Purpose/background

RE-KINECT (NCT03062033) was designed to assess the presence and impact of possible tardive dyskinesia (TD) in antipsychotic-treated outpatients.

Methods/procedures

The study included adults with 3 or more months of lifetime antipsychotic exposure and 1 or more psychiatric disorder. Based on clinician observation and assessment, patients were assigned to cohort 1 (without involuntary movements or with non-TD involuntary movements) or cohort 2 (with involuntary movements confirmed by clinician as possible TD). Baseline assessments included the following: patient characteristics; location/severity of involuntary movements; and impact of possible TD on health-related quality of life, including the EuroQoL 5-Dimensions 5-Level questionnaire.

Findings/results

Of 739 eligible patients, 204 (27.6%) had clinician-confirmed possible TD (cohort 2). Compared with cohort 1, patients in cohort 2 were significantly older (P < 0.0001), more likely to have schizophrenia or schizoaffective disorder (P < 0.0001) and longer lifetime exposure to antipsychotics (P < 0.0001), and less likely to be working or studying, based on clinician perception (P = 0.0010). Clinician- and patient-rated severity of possible TD movements was significantly correlated in each of 4 body regions (head/face, neck/trunk, upper extremities, lower extremities), for maximum severity in any region, and for total number of affected regions (P < 0.001 for all correlations). For the patient-rated EuroQoL 5-Dimensions 5-Level, the health state visual analog scale score was significantly lower (worse) in cohort 2 versus cohort 1 (66.8 vs 69.7; P = 0.0002), as was the utility index score (0.71 vs 0.76; P < 0.0175).

Implications/conclusions

Results from this real-world population indicate that TD occurs frequently and can significantly reduce quality of life in patients with a psychiatric disorder.

Article
Peer Reviewed

Impact of possible tardive dyskinesia on physical wellness and social functioning: results from the real-world RE-KINECT study

UC San Francisco Previously Published Works (2023)

Background

Tardive dyskinesia (TD) is a persistent and potentially disabling movement disorder associated with antipsychotic use. Data from RE-KINECT, a real-world study of antipsychotic-treated outpatients, were analyzed to assess the effects of possible TD on patient health and social functioning.

Methods

Analyses were conducted in Cohort 1 (patients with no abnormal involuntary movements) and Cohort 2 (patients with possible TD per clinician judgment). Assessments included: EuroQoL's EQ-5D-5L utility (health); Sheehan Disability Scale (SDS) total score (social functioning); patient- and clinician-rated severity of possible TD ("none", "some", "a lot"); and patient-rated impact of possible TD ("none", "some", "a lot"). Regression models were used to analyze the following: associations between higher (worse) severity/impact scores and lower (worse) EQ-5D-5L utility (indicated by negative regression coefficients); and associations between higher (worse) severity/impact scores and higher (worse) SDS total score (indicated by positive regression coefficients).

Results

In Cohort 2 patients who were aware of their abnormal movements, patient-rated TD impact was highly and significantly associated with EQ-5D-5L utility (regression coefficient: - 0.023, P < 0.001) and SDS total score (1.027, P < 0.001). Patient-rated severity was also significantly associated with EQ-5D-5L utility (- 0.028, P < 0.05). Clinician-rated severity was moderately associated with both EQ-5D-5L and SDS, but these associations were not statistically significant.

Conclusions

Patients were consistent in evaluating the impacts of possible TD on their lives, whether based on subjective ratings ("none", "some", "a lot") or standardized instruments (EQ-5D-5L, SDS). Clinician-rated severity of TD may not always correlate with patient perceptions of the significance of TD.