Risk Factors of Dermatophytosis in Young Adults: A Nationwide Population-Based Study

Dermatophytosis includes all fungal infections caused by dermatophytes in humans. Some risk factors for the development of subtypes of dermatophytosis have been studied; however, large-scale epidemiologic studies on risk factors for total dermatophytosis are scarce. We investigated the risk factors of dermatophytosis using a nationwide study. Total 4,532,655 subjects with dermatophytosis aged between 20 to 40 years were examined using data from the Korean National Health Insurance Service from 2009 to 2018. Women showed a lower risk of development of dermatophytosis compared to men (hazard ratio [HR], 0.848; 95% confidence interval [CI], 0.843–0.853). Subjects with elevated waist circumference (HR, 1.057; 95% CI, 1.048–1.065), heavy drinking (HR, 1.053; 95% CI, 1044–1.061), engaging in mild-to-heavy exercise (HR, 1.071; 95% CI, 1.064–1.077) had a higher risk of dermatophytosis. In addition, subjects with body mass index (BMI) of more than 30 kg/m2 exhibited a higher risk of dermatophytosis (HR, 1.36; 95% CI, 1.342–1.378) compared to those with BMIs in the range of 18.5 to 23 kg/m2. In this study, the risk of developing dermatophytosis significantly increased in individuals with elevated waist circumference or high BMI. Lifestyle modifications, including weight management, are suggested to be important in preventing dermatophytosis.

#BingeDrinking: Using Social Media to Understand College Binge Drinking (Preprint)

BACKGROUND Hazardous drinking among college students persists, despite ongoing university alcohol education and harmful drinking intervention programs. College students often post comments or pictures about drinking episodes on social media platforms. OBJECTIVE We sought to understand the real-time contexts of student drinking that are shown on social media platforms, and to identify opportunities to reduce alcohol-related harms and inform novel alcohol interventions. METHODS We analyzed social media posts from 7 social media platforms using qualitative inductive coding based on grounded theory to identify the contexts of student drinking, and the attitudes and behaviors of students and peers during drinking episodes. We reviewed publicly available social media posts that included references to alcohol, collaborating with undergraduate students at one university to select their most-used platforms and develop locally-relevant search terms. We coded text and visual posts for explicit and implicit alcohol use, classified them as positive, neutral, or negative, and analyzed the frequency of each code. From codes, we derived themes about the student culture around alcohol use. RESULTS A total of 1,151 social media posts was the sample for this study. These included 809 Twitter tweets, 113 Instagram posts, 23 Facebook posts, 8 YouTube posts, 64 Reddit posts, 34 College Confidential posts, and 100 Greek Rank posts. Posts included implicit and explicit portrayal of alcohol use. Across all types of posts reviewed, we found that positive drinking attitudes were most common, followed by negative and then neutral, but valence varied by platform. Posts that portrayed drinking positively received positive peer feedback, and support the idea that drinking is an essential and positive part of student culture. CONCLUSIONS Social media provides a real-time picture of students’ behavior during their own and others’ heavy drinking. Posts portray heavy drinking as a normal part of student culture, reinforced by peers’ positive feedback on posts. Interventions for college drinking should help students manage alcohol intake in real-time, provide safety information during alcohol use, and raise awareness of online privacy concerns and reputation management. Additional interventions for students, alumni, and parents are needed to address the impact of positive attitudes about and traditions of drinking.

Depression and/or PTSD Comorbidity Affects Response to Antidepressants in Those With Alcohol Use Disorder

Objective: Depression and post-traumatic stress disorder (PTSD) highly co-occur with alcohol use disorder (AUD). The comparative effects of noradrenergic vs. serotonergic antidepressants on drinking and depressive outcomes for those with AUD and co-occurring depression and/or PTSD are not well known.Methods: This study was an analysis of a randomized control trial of 128 patients with AUD who had co-occurring depression and/or PTSD. They were randomized to treatment with paroxetine vs. desipramine and naltrexone vs. placebo leading to four groups: paroxetine plus naltrexone, paroxetine plus placebo, desipramine plus naltrexone, and desipramine plus placebo. Outcomes were percent of drinking days, percent heavy drinking days, drinks per drinking day (Time Line Follow-back Method), and depressive symptoms (Hamilton Depression Scale). Groups compared were (1) depression without PTSD (depression group; n = 35), (2) PTSD without depression (PTSD group; n = 33), and (3) both depression and PTSD (comorbid group; n = 60).Results: There were no overall significant differences in drinking outcomes by medication in the entire sample, and no significant interaction when diagnostic groups were not considered. However, when diagnostic groups were included in the model, the interactions between time, diagnostic group, and medication (desipramine vs. paroxetine) were significant for percent drinking days (p = 0.042), and percent heavy drinking days (p = 0.036); paroxetine showed better drinking outcomes within the depression group, whereas desipramine showed better drinking outcomes in the PTSD and comorbid groups. Regarding depressive symptoms, paroxetine was statistically superior to desipramine in the total sample (p = 0.007), but there was no significant interaction of diagnostic group and medication. Naltrexone led to a decrease in craving but no change in drinking outcomes.Conclusions: The results of this study suggest that drinking outcomes may respond differently to desipramine and paroxetine depending on comorbid MDD and/or PTSD.

Parents’ Participation in School Health Examinations for Their Adolescent Children in Finland

Engaging parents in school health examinations can promote adolescents’ well-being. We examined parents’ participation in universal school health examinations in Finland reported by adolescents in school surveys (14 to 16-year-olds, N = 58,232). Further we studied variation between service providers and schools, and student and school-level factors in participation. National data were analyzed using multilevel logistic regression models. Less than half of the adolescents reported parents’ participation. The variation between service providers and schools was large. Non-participation was associated with mother's low education, students’ immigrant background, daily health complaints, heavy drinking, and discussion difficulties with parents. Boys and those who did not live with both mother and father had a higher risk for parents’ non-participation. Adolescents with a long-term illness or being bullied reported participation more often. Inviting parents and the school health nurse resource were not associated with participation. Our results raise the question of barriers to participation in health examinations.

Epigenome-wide association study of alcohol consumption in N = 8161 individuals and relevance to alcohol use disorder pathophysiology: identification of the cystine/glutamate transporter SLC7A11 as a top target

Alcohol misuse is common in many societies worldwide and is associated with extensive morbidity and mortality, often leading to alcohol use disorders (AUD) and alcohol-related end-organ damage. The underlying mechanisms contributing to the development of AUD are largely unknown; however, growing evidence suggests that alcohol consumption is strongly associated with alterations in DNA methylation. Identification of alcohol-associated methylomic variation might provide novel insights into pathophysiology and novel treatment targets for AUD. Here we performed the largest single-cohort epigenome-wide association study (EWAS) of alcohol consumption to date (N = 8161) and cross-validated findings in AUD populations with relevant endophenotypes, as well as alcohol-related animal models. Results showed 2504 CpGs significantly associated with alcohol consumption (Bonferroni p value < 6.8 × 10−8) with the five leading probes located in SLC7A11 (p = 7.75 × 10−108), JDP2 (p = 1.44 × 10−56), GAS5 (p = 2.71 × 10−47), TRA2B (p = 3.54 × 10−42), and SLC43A1 (p = 1.18 × 10−40). Genes annotated to associated CpG sites are implicated in liver and brain function, the cellular response to alcohol and alcohol-associated diseases, including hypertension and Alzheimer’s disease. Two-sample Mendelian randomization confirmed the causal relationship of consumption on AUD risk (inverse variance weighted (IVW) p = 5.37 × 10−09). A methylation-based predictor of alcohol consumption was able to discriminate AUD cases in two independent cohorts (p = 6.32 × 10−38 and p = 5.41 × 10−14). The top EWAS probe cg06690548, located in the cystine/glutamate transporter SLC7A11, was replicated in an independent cohort of AUD and control participants (N = 615) and showed strong hypomethylation in AUD (p < 10−17). Decreased CpG methylation at this probe was consistently associated with clinical measures including increased heavy drinking days (p < 10−4), increased liver function enzymes (GGT (p = 1.03 × 10−21), ALT (p = 1.29 × 10−6), and AST (p = 1.97 × 10−8)) in individuals with AUD. Postmortem brain analyses documented increased SLC7A11 expression in the frontal cortex of individuals with AUD and animal models showed marked increased expression in liver, suggesting a mechanism by which alcohol leads to hypomethylation-induced overexpression of SLC7A11. Taken together, our EWAS discovery sample and subsequent validation of the top probe in AUD suggest a strong role of abnormal glutamate signaling mediated by methylomic variation in SLC7A11. Our data are intriguing given the prominent role of glutamate signaling in brain and liver and might provide an important target for therapeutic intervention.

How concerned significant others experience Community Reinforcement and Family Training (CRAFT) – a qualitative study

Introduction Heavy drinking causes serious harm, not only to the drinker but also to relationships and concerned significant others (CSOs). Community Reinforcement and Family Training (CRAFT) is an intervention developed to help the CSOs of substance users. The aim of this study was to investigate the drivers and aims underlying CSO participation in CRAFT, as well as their experience of the intervention itself and their module preferences. Method This is a qualitative study based on data from semi-structured interviews with 11 female help-seeking CSOs of individuals with alcohol problems. The participants were recruited from an RCT study of a variety of CRAFT delivery formats (group sessions + written material, individual sessions + written material or self-delivered CRAFT with written material only). The interviews were audio-recorded, transcribed, and analyzed by Interpretative Phenomenological Analysis. Results CSOs reported CRAFT helpful when both delivered by means of individual sessions or group sessions. The “Communication Element” in CRAFT, the module focusing on positive reinforcement and acquiring a clearer understanding of AUD, appeared to be particularly helpful elements of CRAFT. Furthermore, being met with acceptance and non-judgmental attitudes seemed to count highly for the CSOs. The written material a helpful supplement to the face-to-face interventions. The written material a helpful supplement to the face-to-face interventions. Conclusion CSOs who participated in the CRAFT intervention felt helped by its components, irrespective of delivery format.

Marital Quality and Heavy Alcohol Use Among Older Couples

Supportive marital relationships may reduce partners’ problematic health behaviors, whereas unhappy relationships may lack efficacious spousal monitoring of health and increase the likelihood of using maladaptive coping strategies, such as heavy alcohol use, to deal with relationship problems. We used pooled data from the 2014 and 2016 waves of the Health and Retirement Study to examine how both partners’ perceptions of marital quality were associated with heavy drinking. Our analytic sample included married couples in which both spouses were over age 50, completed the leave-behind psychosocial questionnaire, and provided non-missing data on marital quality and alcohol use (n=2,095 couples). Measures included both positive and negative dimensions of marital quality and controls for sociodemographic, economic, health, household and marital characteristics. Using Proc Glimmix, we estimated a dual-intercept Actor-Partner Interdependence Model (APIM), in which separate equations were computed simultaneously for husbands and wives. For husbands, higher negative marital quality was associated with an increase in the odds of their own heavy drinking (OR=1.27), but there was no significant association between wives’ marital quality and husbands’ heavy drinking behavior. For wives, marital quality was not significantly associated with their own heavy drinking, but husbands’ higher ratings of both negative and positive marital quality increased the risk of wives’ heavy drinking (OR=1.60 and OR=1.75, respectively). Results suggest that marital quality is associated with heavy drinking in later life: self-ratings of marital quality matter for men, whereas spousal perceptions of marital quality are more important for women.