Susan Rogers

Psychobiological effects of carbohydrate- and protein-rich meals in patients with seasonal affective disorder and normal controls

Patients with seasonal affective disorder (SAD) frequently report carbohydrate craving and note that carbohydrate ingestion energizes them. Bright artificial light has been shown to reverse the symptoms of SAD, including carbohydrate craving. In this study, 16 depressed SAD patients and 16 matched controls were fed two different isocaloric meals, one rich in protein and one rich in carbohydrates, in a crossover design. Although their biochemical response in terms of plasma large neutral amino acid concentrations was identical, SAD patients reported activation following carbohydrate ingestion, whereas normal controls reported sedation. Marked ordering effects on psychological parameters were noted, suggesting that order should be taken into account as a methodological consideration in meal studies.

Sexual behavior in the United States 1930-1990: trends and methodological problems.

Background and Objectives Arguments for population-based research on patterns of sexual behavior are reviewed, and survey data are used to illustrate the insights that can be gained from such research. Study Design Reports of sexual behavior obtained in surveys of large probability samples of the U.S. population are analyzed and compared to make inferences about changes in the age of onset of sexual intercourse and the patterns of heterosexual and same-gender sexual behaviors of American men and women who entered adulthood during the period from 1930 to 1990. Results Strong trends are documented for both a decline in the reported age at first heterosexual intercourse and an increase in the numbers of heterosexual partners reported during adulthood. Similar evidence on patterns of same-gender contact indicate a relatively stable prevalence of reported male-male contact for cohorts of men born from the 1930s through the 1960s. Preliminary analyses suggest, however, that there has been a substantial increase in the proportion of women reporting female-female sexual contact during adulthood. Although the analyses require refinement, it appears that the prevalence of reported female-female contact may have increased by a factor of 3 to 4 for cohorts of women born between the 1930s and the 1960s. Conclusions Although the trends in reported behaviors are robust, inferences about behavior, per se, rest on the assumption that reporting biases were equivalent across cohorts. Methodological challenges in the interpretation of such findings and new technologies for conducting such research are described.

Correlates of sexually transmitted bacterial infections among U.S. women in 1995.

CONTEXT Sexually transmitted diseases (STDs) of bacterial origin such as gonorrhea and chlamydial infection can lead to pelvic inflammatory disease (PID) and infertility. Identifying behaviors and characteristics associated with infection may assist in preventing these often asymptomatic diseases and their sequelae. METHODS Data from 9,882 sexually active women who participated in the 1995 National Survey of Family Growth describe the characteristics of women who report a history of infection with a bacterial STD or of treatment for PID. Multivariate analysis is used to determine which demographic characteristics and sexual and health-related behaviors affect the likelihood of infection or the occurrence of complications. RESULTS Overall, 6% of sexually active women reported a history of a bacterial STD, and 8% reported a history of PID. Women who first had sexual intercourse before age 15 were nearly four times as likely to report a bacterial STD, and more than twice as likely to report PID, as were women who first had sex after age 18. Having more than five lifetime sexual partners also was associated with both having an STD and having PID. PID was more common among women reporting a history of a bacterial STD (23%) than among women who reported no such history (7%). In multivariate analyses, age, race, age at first intercourse and lifetime number of sexual partners had a significant effect on the risk of a bacterial STD. Education, age, a history of IUD use, douching and a history of a bacterial STD had a significant impact on the risk of PID, but early onset of intercourse did not, and lifetime number of partners had only a marginal effect. CONCLUSIONS The pattern of characteristics and behaviors that place women at risk of infection with bacterial STDs is not uniform among groups of women. Further, the level of self-reported PID would suggest higher rates of gonorrhea and chlamydial infection than reported.

Effect of Low Medical Literacy on Health Survey Measurements

Paper self-administered questionnaires (SAQs) are a standard interviewing technique for surveys of sensitive topics. Although SAQs afford respondents greater privacy than face-to-face interviews, they have several limitations. First, they require literate respondents. Second, they require forms literacy—the ability to select consistent responses, implement general survey instructions, and correctly follow branching or skip instructions. Survey respondents may have difficulty following skip instructions if they are not forms literate. This brief report examines the relationship between assessed levels of medical literacy, respondent characteristics, and the quality of measurements made in the 1997/98 Baltimore Sexually Transmitted Disease (STD) and Behavior Survey.

Abnormal neuroendocrine responsivity to acute I.V. clomipramine challenge in depressed patients

The neuroendocrine responsivity to an acute serotonergic challenge with low-dose i.v. clomipramine was studied in seven drug-free depressed patients and seven age-matched healthy control subjects. The depressed patients had higher baseline prolactin concentrations than the healthy subjects, and their prolactin response to clomipramine, assessed as either the percent of baseline or the log-transformed concentration, was significantly different (delayed and blunted peak response) compared to healthy controls. The growth hormone response was exaggerated in the depressed patients, and there were also trends toward blunting in their cortisol and adrenocorticotropic hormone responses. These results are consistent with previous findings of altered neuroendocrine responses to a variety of putative serotonin agonists in depressed patients.

The dexamethasone suppression test in seasonal affective disorder

Abstract Twenty patients with seasonal affective disorder (SAD) were given 1 mg of dexamethasone to evaluate the hypothalamic-pituitary-adrenal (HPA) axis. Two patients were found to have 4 PM plasma cortisol levels greater than 5 μgm/dL, the generally used criterion for nonsuppression, after administration of dexamethasone the previous night. Normal suppression of the hypothalamic-pituitary-adrenal axis by dexamethasone appears to be a feature of SAD, unlike many other psychiatric disorders.

T-ACASI reduces bias in STD measurements: The National STD and Behavior Measurement Experiment:

Background: Although telephone surveys provide an economical method for assessing patterns of diagnosed sexually transmitted diseases (STDs) and STD-related behaviors in populations, the requirement that respondents report such information to human telephone interviewers introduces an opportunity for substantial reporting bias. Telephone computer-assisted self-interviewing (T-ACASI) surveys substitute a computer for human interviewers when asking sensitive questions. Methods: A randomized experiment was embedded in a telephone survey that drew probability samples of the populations of the United States (N = 1543) and Baltimore city (N = 744). Respondents were randomly assigned to have sensitive questions asked either by a T-ACASI computer or by a human telephone interviewer. Results: Respondents interviewed by a T-ACASI computer were more likely to report STD symptoms [dysuria, genital sores, genital discharge, and genital warts; adjusted odds ratios (ORs) = 1.5–2.8] and a diagnosis of gonococcal or chlamydial infection during the past year (adjusted ORs = 3.6 and 6.1). T-ACASI respondents with a main sex partner in the past year were more likely to report that their partner has had an STD (adjusted OR = 2.4). For some measurements, the impact of T-ACASI was strongest among younger and less-educated respondents. When sampling weights were applied to project National STD and Behavior Measurement Experiment results to the populations of the United States and Baltimore, we found that reliance on data obtained by human interviewers would underestimate the annual incidence of chlamydial and gonococcal infections in these populations by factors of 2.4 to 9.7. Conclusions: Compared with human telephone interviewers, T-ACASI surveys obtain increased reporting of STD symptoms, infections, and STD-related behaviors.

Evaluation of risk score algorithms for detection of chlamydial and gonococcal infections in an emergency department setting

OBJECTIVES To develop and evaluate screening algorithms to predict current chlamydial and gonococcal infections in emergency department (ED) settings and assess their performance. METHODS Between 2002 and 2005, adult patients aged 18 to 35 years attending an urban ED were screened for Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (GC) and completed a brief demographic and behavioral questionnaire. Using multiple unconditional logistic regressions, the authors developed four separate predictive models and applicable clinical risk scores to screen for infection. They developed models for females and males separately, for Ct and GC infections combined, and for Ct infection alone. The sensitivities and specificities of the clinical risk scores at different cutoffs were used to examine performance of the algorithms. RESULTS Among 5,537 patients successfully screened for Ct and GC, the overall prevalence of infection was 9.6%. Age was the strongest predictor of infection. Adjusting for other predictors, the prevalence odds ratio (POR) was 2.2 (95% confidence interval [CI] = 1.7 to 2.8) for Ct and GC combined and 2.9 (95% CI = 2.1 to 4.1) for Ct alone comparing females 25 years and younger to females older than 25 years. Among males, the association was stronger with an adjusted POR of 3.3 (95% CI = 2.3 to 4.7) for Ct and GC combined and 3.2 (95% CI = 2.1 to 4.7) for Ct infection alone. CONCLUSIONS If the decision to incorporate Ct and GC screening into routine ED care is made, age alone appears to be a sufficient screening criterion.

Health Care Access and Follow-Up of Chlamydial and Gonococcal Infections Identified in an Emergency Department

Background: We examined 2 potentially important factors influencing successful treatment of Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (GC) infections identified in an emergency department (ED), health care coverage and reporting the ED as a primary source for health care. Methods: Adult patients aged 18 to 35 years attending an urban ED were screened for Ct and GC. Patients testing positive were contacted by Disease Intervention Specialists and notified of their infection status. Analyses focus on infected patients for whom we have treatment and follow-up information. We used generalized linear models with log link and binomial error distribution to estimate risk ratios (RRs) and 95% confidence intervals (CI). Results: Of 5537 patients screened in the ED, 348 (6.3%) tested positive for Ct, 143 (2.6%) tested positive for GC, and 43 (0.8%) tested positive for both. Overall, 20% of infected patients did not receive treatment. Among infected patients with no health care coverage 25% (n = 56) were untreated compared with 15% (n = 47) of patients reporting health care coverage (RR: 1.7, 95% CI: 1.2–2.3). Among patients reporting the ED as a primary source for health care 26% (n = 27) were untreated compared with the 18% (n = 77) reporting receiving health care from non-ED sources (RR: 1.4, 95% CI: 1.0–2.1). Conclusions: EDs often serve as primary care sites for difficult-to-reach populations. We were able to successfully locate and treat the greater part of ED-identified infections. However, one-fifth of infected patients did not receive treatment. ED-based screening programs can benefit from integration with local public health infrastructure to improve notification and treatment services.

Entretiens autoadministrés sur ordinateur et mesure des comportements sensibles

Rogers Susan M., Gribble James N., Turner Charles F., Miller Heather G.- Encuestas auto-administradas a traves de ordenador y medicion de cuestiones delicadas Las encuestas que confian en las respuestas de los individuos sobre comportamientos controvertidos, estigmatizados о ilegales pueden contener sesgos. Investigadores del Research Triangle Institute, de Estados Unidos, han desarrollado una tecnica audio de auto- encuesta asistida por ordenador (audio-CASI) para superar las limitaciones de los cuestionarios auto-administrados de forma tradicional, «con lapiz y papel » (SAQs) o reali- zados por un entrevistador (IAQs). El desarrollo de la tecnica audio-CASI ha alterado de forma significativa el contexto de las entrevistas para medir comportamientos sexuales y otras cuestiones delicadas, ya que respeta la privacidad pero no requiere que el individuo sepa leer y escribir. Este articulo analiza el desarrollo cientifico de audio-CASI y describe los resultados de experimentos metodologicos que se han realizado con el objetivo de comparar este meto- do a otras formas de entrevista. En 1995 se probo audio-CASI en dos encuestas norteameri- canas de gran envergadura: la Encuesta Nacional de Hombres Adolescentes (NSAM) y la Encuesta Nacional de Crecimiento de la Familia (NSFG). Las encuestas hallaron niveles si- gnificativamente mas elevados en la declaracion del uso de drogas, contactos sexuales con individuos del mismo sexo y recurso al aborto provocado cuando se utilizo audio-CASI que a traves de IAQs y SAQs.