Bob Wong

Obesity in early adulthood as a risk factor for psoriatic arthritis.

OBJECTIVE To study whether obesity increases the risk of psoriatic arthritis (PsA), given that obesity is a risk factor for psoriasis and is associated with more severe disease. DESIGN Case series. We used Cox regression analysis to study the relationship between obesity and PsA while controlling for age at psoriasis onset, current body mass index (BMI), sex, family history of psoriasis, worst-ever body surface area (BSA) involvement, Koebner phenomenon, and nail involvement. SETTING Dermatology clinics at the University of Utah School of Medicine. Patients Volunteer sample of patients with dermatologist-diagnosed psoriasis enrolled in the Utah Psoriasis Initiative from November 2002 to October 2008 (943 subjects; 50.2% women, 49.8% men). MAIN OUTCOME MEASURES Physician diagnosis of PsA from self-report questionnaire. RESULTS In our subjects, we found that BMI at age 18 years was predictive of PsA (odds ratio [OR], 1.06) (P < .01) over and above control variables. Other variables that were predictors of PsA included younger age at psoriasis onset (odds ratio [OR], 0.98) (P < .01), female sex (OR, 1.45) (P = .01), higher worst-ever BSA involvement with psoriasis (OR, 1.01) (P = .04), Koebner phenomenon (OR, 1.59) (P < .01), and nail involvement (OR, 1.76) (P < .01). Current BMI and family history of psoriasis were not significant predictors of PsA. CONCLUSIONS This study suggests that obesity at age 18 years increases the risk of developing PsA. Adiposity is associated with higher levels of inflammatory cytokines known to be associated with psoriasis. This inflammatory milieu could increase the risk of PsA in predisposed subjects. Prevention and early treatment of obesity may decrease the risk of PsA.

Time to Prison Return for Offenders With Serious Mental Illness Released From Prison A Survival Analysis

Serious mental illness (SMI) represents a major risk for repeated incarceration, yet recidivism studies often do not specifically focus on persons with SMI as compared to non-SMI offenders. The study reported here systematically identified Utah State prisoners released from 1998 to 2002 (N = 9,245) who meet criteria for SMI and compared SMI and non-SMI offenders on length of time to prison return. Findings indicate that 23% of the sample met criteria for SMI (n = 2,112). Moreover, survival analyses demonstrated a significant difference in return rates and community tenure for offenders with SMI compared to non-SMI offenders when controlling for demographics, condition of release, offense type, and condition of return (parole violation vs. new commitment). The median time for all SMI offenders to return to prison was 385 days versus 743 days for all non-SMI offenders, 358 days sooner (p < .001). Implications of these findings are discussed.

Association between IL13 Polymorphisms and Psoriatic Arthritis Is Modified by Smoking

Genetic and environmental factors influence the development of psoriasis (Ps) and psoriatic arthritis (PsA). Recently, we reported that three IL13 polymorphisms, rs1800925, rs20541, and rs848, on chromosome 5q31 conferred the risk for Ps. IL13 encodes IL-13, a Th2 cytokine, and rs1800925 and rs20541 confer risk of asthma. Further, smoking may increase the risk of developing Ps. We examined the association between IL13 polymorphisms, smoking, and PsA in two Ps sample sets genotyped for rs1800925, rs20541, and rs848. We found that the minor alleles (rs1800925*T, rs20541*A, and rs848*A) were significantly associated with protection from PsA versus controls, and that no association with Ps is seen when the PsA cases are excluded. This effect was strongest with rs1800925*T (odds ratio (OR) 0.40, P(allelic) 0.000067). The prevalence of PsA in cases with the rs1800925*CT or TT genotype is about half that of those with the CC genotype (15.5 vs 32.1%, P=0.0002). However, smoking appears to abrogate this effect (CT/TT/non-smoker, prevalence of PsA 13%, OR 0.20, P=0.0001; CT/TT/smoker, prevalence 38%, OR 0.88, P=0.74, CC/non-smoker, prevalence 42% (reference), CC/smoker prevalence 47%, OR 1.21, P=0.47). This study suggests that IL13 polymorphisms associate most strongly with PsA and that smoking may modulate this effect.

Public Attitudes Regarding the Use of Residual Newborn Screening Specimens for Research

BACKGROUND AND OBJECTIVES: Many state newborn screening (NBS) programs retain residual NBS bloodspots after the completion of screening. Potential uses for residual specimens include laboratory quality assurance, biomedical research, and, rarely, forensic applications. Our objective was to evaluate public opinion about the policies and practices relevant to the retention and use of residual bloodspots for biomedical research. METHODS: A total of 3855 respondents were recruited using 3 methods: focus groups (n = 157), paper or telephone surveys (n = 1418), and a Knowledge Networks panel (n = 2280). Some participants (n = 1769) viewed a 22-minute movie about the retention and use of residual specimens while other participants were provided only written information about this practice. All participants were surveyed using a 38-item questionnaire. RESULTS: A diverse set of participants was recruited. Respondents were very supportive of NBS in general and accepting of the use of residual bloodspots for important research activities. Respondents were evenly divided on the acceptability of NBS without parental permission, but the majority of respondents supported the use of an “opt-in” process for parental permission for residual bloodspot retention and use. Viewing the educational movie was associated with greater support for bloodspot retention and use. CONCLUSIONS: Our results show that the general public surveyed here was supportive of NBS and residual sample retention and research use. However, there was a clear preference for an informed permission process for parents regarding these activities. Education about NBS was associated with a higher level of support and may be important to maintain public trust in these important programs.

Psoriatic arthritis is a strong predictor of sleep interference in patients with psoriasis

OBJECTIVE We sought to determine what clinical features of psoriasis predict sleep interference. METHODS Data were obtained from 420 respondents to the 2005 National Psoriasis Foundation telephone and e-mail surveys. Logistic regression was used to determine whether disease severity, body mass index, age of onset, psoriatic arthritis, income, ethnicity, sex, current therapy, and quality-of-life measures predicted reported sleep interference within the last month. RESULTS Psoriatic arthritis was the most significant predictor of sleep disturbance (odds ratio = 3.26). Itch, pain of lesions, and impact on emotional well-being were also significant predictors (odds ratio 1.26, 1.22, and 1.18, respectively). Body surface area covered with psoriasis, body mass index, and therapy were not significant predictors of sleep interference. LIMITATIONS All data were self-reported and not physician-assessed. CONCLUSIONS History of psoriatic arthritis, presence of itch and pain of psoriatic lesions, and impact of psoriasis on overall emotional well-being predict sleep interference.

Assessing public attitudes on the retention and use of residual newborn screening blood samples: a focus group study.

This paper discusses attitudes and opinions of a diverse group of participants toward the retention and use of residual newborn blood samples for research. Data were drawn from focus groups based in six states in the USA, and results provide support for the retention and use of residual newborn blood samples for research when parental permission is asked beforehand. However, there were a number of concerns that also warrant attention for the development of policy and maintaining trust with the public, such as timing of permission, use of samples already stored, level of personal control of sample use and education. The results demonstrate the complexity of the topic and the ethical ambiguities associated with the retention and use of residual newborn blood samples.

Concerns of Newborn Blood Screening Advisory Committee Members Regarding Storage and Use of Residual Newborn Screening Blood Spots

OBJECTIVES We assessed attitudes and opinions of members of newborn blood screening (NBS) advisory committees regarding the storage and secondary research use of residual specimens from NBS. METHODS We conducted focus groups in 2008 and 2009 with NBS advisory committees (4 focus groups; n = 39 participants) in the Mountain States region (i.e., AZ, CO, MT, NM, NV, TX, UT, and WY). RESULTS Participants identified several challenges to implementing policies for storage of and research on residual newborn blood specimens. Themes that emerged from the data were public health relevancy; improvement of parental knowledge; impact of enhanced parental involvement; concerns over ownership, privacy, and confidentiality; identification of secondary research uses; and role of advisory committees. CONCLUSIONS Participants indicated that secondary uses of residual specimens entailed opportunities for improvements in NBS programs but also carried significant risks for their programs. Addressing concerns from stakeholders will be necessary for state-level adoption of national recommendations.

Women, serious mental illness and recidivism: A gender-based analysis of recidivism risk for women with SMI released from prison

&NA; Two groups now constitute the fastest growing segment of the U.S. prison population: women and persons with mental illness. Few large‐scale studies have explored associations among serious mental illness (SMI), gender, and recidivism, or compared factors such as illness severity and clinical history as these construct notably different situations for incarcerated women and men. We report on our recent study comparing prison recidivism rates, severity of mental illness, and clinical history for women and men released from Utah State Prison 1998–2002. Implications: While women generally have better recidivism outcomes than men, we find that SMI related factors have a greater negative effect on the trajectories of women in this sample as compared with the men. This suggests that programs and policies focused on the SMI‐specific risks and needs of women could significantly reduce prison recidivism and increase community tenure for this group, with far‐reaching effects for families and communities.

A randomized controlled trial of an electronic informed consent process.

A pilot study assessed an electronic informed consent model within a randomized controlled trial (RCT). Participants who were recruited for the parent RCT project were randomly selected and randomized to either an electronic consent group (n = 32) or a simplified paper-based consent group (n = 30). Results from the electronic consent group reported significantly higher understanding of the purpose of the study, alternatives to participation, and who to contact if they had questions or concerns about the study. However, participants in the paper-based control group reported higher mean scores on some survey items. This research suggests that an electronic informed consent presentation may improve participant understanding for some aspects of a research study.

Duration of Maternal Stress and Depression: Predictors of Newborn Admission to Neonatal Intensive Care Unit and Postpartum Depression.

BackgroundMaternal psychosocial factors contribute to adverse pregnancy outcome, but very few studies have assessed associations of duration and experiences of stress, depression, and intimate partner violence (IPV) with maternal and newborn outcomes. ObjectivesIt was hypothesized that duration and level of maternal stress, depression, and IPV would predict increased risk of adverse maternal/newborn outcomes. MethodsA secondary data analysis of a population-based data set collected by the Utah Department of Health Pregnancy Risk Assessment and Monitoring System and birth certificates for 4682 live births was conducted, reflecting a total population size of 143,373 live births in 2009–2011. Exposures of interest were experiences and duration of maternal stress, depression, and IPV before and during pregnancy. Outcomes were gestational age, birth weight, newborn admission to the neonatal intensive care unit (NICU), and postpartum depression (PPD) symptoms and diagnosis. ResultsAfter controlling for maternal demographics, body mass index, and smoking, women with greater duration of depression before and during pregnancy showed an increase in admission of their newborn to NICU (adjusted odds ratios [aORs] = 1.66–2.48, p < .001), PPD symptoms (aORs = 3.94–9.13, p < .001), and diagnosis of PPD (aORs = 7.72–59.60, p < .001). More kinds of experiences of maternal stress were associated with higher odds of PPD symptoms (aORs = 1.34–5.51, p < .001), but not PPD diagnosis or NICU admissions. DiscussionLonger lasting maternal depression and stress are associated with poorer outcomes for mothers and newborns. Future prospective studies should evaluate the usefulness of preconception and continuous prenatal risk identification of maternal depression and stress. This would facilitate timely psychosocial interventions as an approach to improving maternal/newborn outcomes for these higher risk women.