Search

BACKGROUND Clinical experience and progressive autonomy are essential components of medical education and must be balanced with patient comfort. While previous studies have suggested that most patients accept trainee involvement in their care, few studies have focused specifically on the views of parents of pediatric patients or examined groups who may not report acceptance. OBJECTIVE The purpose of this study is to understand parental profiles of resident and medical student involvement in pediatric care and to use latent class analysis (LCA) methodology to identify classes of responses associated with parent demographic characteristics. METHODS We used data from a national cross-sectional online survey of 3,000 parents. The survey used a 5-point Likert scale to assess 8 measures of parent perceptions of residents and medical students. We included participants who indicated prior experience with residents or medical students. We compared responses about resident involvement in pediatric care with responses about student involvement, used LCA to identify latent classes of parent responses, and compared demographic features between the latent classes. RESULTS Of the 3,000 parents who completed the survey, 1,543 met inclusion criteria for our study. Participants reported higher mean scores for residents than for medical students for perceived quality of care, comfort with autonomously performing an exam, and comfort with autonomously giving medical advice. LCA identified three latent classes of parent responses: Trainee-Hesitant, Trainee-Neutral, and Trainee-Supportive. Compared with the Trainee-Supportive and Trainee-Neutral classes, the Trainee-Hesitant class had significantly more members reporting age < 30, household income < $50,000, no college degree, and lesser desire to receive future care at a teaching hospital. CONCLUSIONS Parents may prefer greater clinical autonomy for residents than medical students. Importantly, Trainee-Hesitant views may be held disproportionately by members of historically and currently socially marginalized demographic groups. Future studies should investigate underlying reasons for trainee hesitancy in these groups, including the possibility of mistrust in medicine.

Objective To develop, implement, and evaluate an acute otitis media (AOM) education website for clinician-educators. Methods We developed an education website following Kern's curriculum model. Results The website contained peer-reviewed content, educational objectives, library search pages to identify evidence-based resources, and a faculty toolbox with instructional and evaluation instruments. Pediatric clinician-educators were purposefully sampled from different clinic sites to evaluate the website. Semistructured interviews explored key website components for content and usability in clinical teaching. In grounded theory tradition, investigators used the constant comparative method with qualitative analysis software to identify themes and representative quotations. Eleven faculty members (9 females and 2 males with teaching experience from 6 to 26 years) participated in the study. Identified themes were: 1) value of visual impact for learning specific topics, 2) promotion of efficiency in teaching clinical topics, 3) varying approaches for using website, and 4) faculty's self-report of knowledge and self-efficacy needs. Conclusions An education website may enhance the teaching of AOM, accommodate different teaching preferences, promote efficiency in teaching, and advance clinician-educator knowledge and skills. Next steps include evaluation of learners’ perspectives, generalizability in varied teaching settings, and assessment of higher learning outcomes including impact on knowledge, skills, and patient outcomes.

Emerging adults often increase problematic drinking during college. Although they generally do not seek help for problematic drinking, college students discuss their drinking on social media. This study followed college students’ Facebook profiles from the inception of their attendance at a university and identified alcohol-related posts. Within 28 days of their first alcohol-related Facebook post, participants were interviewed to assess problematic drinking (binge drinking episodes and number of drinks). Linguistic analysis of alcohol-related Facebook posts found that use of negative emotion language and swear words were related to problematic drinking, in support of proposed hypotheses. Results are situated within alcohol use disorder and health research examining the link between problematic drinking and anxiety, deviant behavior, and negative emotions.

A growing body of research supports that publicly displayed alcohol references on social media are positively associated with alcohol use among college students. However, unaddressed questions remain, particularly what types of alcohol references (i.e., alcohol use vs. intoxication) have such influence, and whether the association between sharing alcohol references on social media and drinking behavior is a within-person effect, or rather reflects group differences. The current study (N = 338) used secondary data analysis of a four-wave longitudinal dataset collected as part of a larger project, which evaluated college students’ Facebook profiles and their alcohol use across their college experience. Using a random intercept cross-lagged panel analysis, we found empirical support for a positive relationship between sharing alcohol references and alcohol use at between-person level rather than the within-person level. Moreover, there was a negative relationship between sharing intoxication alcohol references on Facebook and alcohol use at the within-person level. This means that we find more support for the idea that the association between sharing alcohol references on social media and drinking behavior reflects group differences, rather than true self-effect of social media use.

Purpose Increasing numbers of youth are becoming smartphone owners as early adolescents (EAs). Understanding how EAs receive and use their initial smartphones is important towards informing provider counseling and parental guidance. The purpose of this qualitative study was to understand EA perspectives and experiences with smartphone ownership. Methods Focus groups were conducted with EAs ages 10-14years in Washington State. We utilized purposeful sampling to represent different communities and health status. During focus groups, trained facilitators used a semi-structured facilitator guide to prompt discussion about EAs’ smartphone ownership and use. Results A total of 45 EAs with average age 11.2 (SD=0.77), 51.1% female, 64.4% white and 20% rural, participated in 12 focus groups. Of 3 major themes, the first was Maturity, which included EAs’ views that they should achieve milestones rather than an age for smartphone ownership. The second theme was Deference to Parents, which included EAs’ interest in engaging with parents to establish rules for smartphone use. The final theme was Accountability, as EAs described the importance of responsibility and cost-sharing. Two minor themes arose which included the role of EAs asking for phones and the individuality of phone use. Conclusions Early adolescents supported timing of a first smartphone tied to meaningful milestones, and wanted parent engagement in developing rules to support them in initial smartphone ownership. Findings can be used to empower parent involvement in EA smartphone use to promote safe and productive behavior.

BACKGROUND: Alcohol cues on social media may influence young adults’ drinking patterns, these cues may be pro-social or pro-alcohol in nature. The influence of individual Facebook cues on young adults’ drinking intentions and behaviors remains unknown. OBJECTIVES: The purpose of this study was to assess how Facebook cues influence intention to drink, and how intention was associated with Theory of Reasoned Action (TRA) constructs including alcohol-related attitudes and norms, and future behavior. METHODS: Incoming university students completed a pre-college and a 2-year follow-up phone interview. A vignette presented individual Facebook cues representing “pro-social” or “pro-alcohol” sentiments. Participants indicated intention to drink alcohol and their rationale for this intention after each cue. Additional measures included TRA constructs of alcohol-related attitudes and norms, and problem alcohol use. Analyses included a qualitative approach to examine rationales for intention to drink in response to Facebook cues, and linear mixed effects models. RESULTS: Of 338 participants, 56.1% were female, 74.8% were Caucasian. Alcohol-related attitudes and norms were positively associated with intention to drink in response to pro-social and pro-alcohol Facebook cues. Participants’ intention to drink in response to pro-alcohol cues was positively associated with problem alcohol use two years later. CONCLUSIONS/IMPORTANCE: Findings illuminate the influence of social media on alcohol-related behaviors and highlight potential future screening approaches.

Background Mindfulness practices are associated with improved health and well-being for children. Few studies have assessed parents’ acceptance of learning about mindfulness practices. Objective This study aims to assess parents’ beliefs and interest in learning about mindfulness, including from their health care provider, and differences across demographic backgrounds. Methods We conducted a national cross-sectional survey of parents with children aged 0-18 years in October 2018. Measures included beliefs and interest in learning about mindfulness. These measures were compared across demographic backgrounds using chi-square analysis. Multivariate linear and logistic regression analyses were used to perform adjusted comparisons between demographic backgrounds. Results Participants (N=3000) were 87% (n=2621) female and 82.5% (n=2466) Caucasian. Most (n=1913, 64.2%) reported beliefs that mindfulness can be beneficial when parenting, 56.4% (n=1595) showed interest in learning about mindfulness to help their child stay healthy, and 40.8% (n=1214) reported interest in learning about mindfulness from their health care provider. Parents with a college degree 49.6% (n=444) were more likely to report interest in learning about mindfulness from a health care provider compared to those without 37.1% (n=768; P Conclusions This study indicates that many parents believe mindfulness can be beneficial while parenting and are interested in learning how mindfulness could help their child stay healthy. Findings suggest there is an opportunity to educate families about mindfulness practices.

UNSTRUCTURED Although the literature on adolescent health includes studies that incorporate youth perspectives via a participatory design, research that is designed, conducted, and presented by youth remains absent. This paper presents the work of 5 youth investigators on the intersecting topics of adolescent health and social media. Each of these youths was equipped with tools, knowledge, and mentorship for scientifically evaluating a research question. The youths developed a research question that aligned with their interests and filled a gap that they identified in the literature. The youths, whose projects are featured in this paper, designed and conducted their own research project, drafted their own manuscript, and revised and resubmitted a draft based on reviewer input. Each youth worked with a research mentor; however, the research questions, study designs, and suggestions for future research were their own.

Background Asthma Action Plans (AAPs) are recommended for pediatric patients to help improve asthma control. Studies have shown variable results for unscheduled doctor and emergency room visits. AAPs may have an impact on parental self-efficacy for asthma management as well as on other daily living factors that are valuable for patients and families, such as the number of missed school days and parental workdays, and on school and caregiver management. Objective The purpose of this study is to understand parent perceptions of AAPs. The goals of this analysis were threefold, including examining (1) the association between pediatric AAPs and parental self-efficacy, (2) parent perceptions of the helpfulness of an AAP for daily living factors, and (3) associations with the type of provider who gave the AAP (a primary care provider or an asthma specialist). Methods A national cross-sectional online survey was completed in October 2018 by parents of children with asthma aged 0-17 years. Survey questions included the presence or absence of a pediatric AAP, the Bursch Parental Self-efficacy for Asthma scale, parental perceptions of the AAP's helpfulness with regard to daily living factors ranked on a 5-point Likert scale, and the provider type who gave the AAP. Survey responses were summarized in terms of percentages or means and standard deviations. A 2-sample t test and analysis of covariance were used to compare self-efficacy for asthma and parental-perception-of-helpfulness scores between subjects with an AAP versus subjects without an AAP. All reported P values were 2-sided. Results A total of 704 parents with a child with asthma completed the survey. The parents had a mean age of 37.5 years (SD 10.9), and 82% (577/704) were women and 18% (127/704) were men. Most (564/704, 80%) parents had an AAP for their child; 65% (367/564) were written, 51% (286/564) were online, and 84% (474/564) were available at school. The Bursch Self-efficacy scale was significantly higher for parents with an AAP (mean 57.7, SD 8.6) versus no AAP (mean 55.1, SD 9.9; P Conclusions Parents who had pediatric AAPs for their children reported increased parental self-efficacy compared to those who did not have AAPs. Parents found AAPs helpful for decreasing missed time from work and school, and for asthma management when at home, school, and with other caregivers. Significant AAP helpfulness was seen regardless of the provider who gave the AAP, the parent's education, and income level. Findings support the usefulness of pediatric AAPs for families and the development of easily sharable electronic AAPs for children.

Background Problematic internet use (PIU) is associated with mental health concerns such as depression and affects more than 12% of young adults. Few studies have explored potential influences of parent–college student digital communication on college students’ risk of PIU. Objective This study sought to understand the relationship between parent–college student digital communication frequency via phone calls, text messages, and Facebook contacts and PIU among college students. Methods Incoming first-year students were randomly selected from registrar lists of a midwestern and northwestern university for a 5-year longitudinal study. Data from interviews conducted in summer 2014 were used. Measures included participants’ daily Facebook visits, communication frequency with parents via phone call and text message, and 3 variables related to Facebook connection status and communication: (1) parent–college student Facebook friendship status, (2) college student blocking personal Facebook content from parent, and (3) Facebook communication frequency. PIU risk was assessed using the Problematic and Risky Internet Use Screening Scale. Analysis included participants who reported visiting Facebook at least once per day. Multiple linear regression was used, followed by a post hoc mediation with Hayes process macro to further investigate predictive relationships among significant variables. Results A total of 151 participants reported daily Facebook use and were included in analyses. Among these participants, 59.6% (90/151) were female, 62.3% (94/151) were from the midwestern university, and 78.8% (119/151) were white. Mean Facebook visits per day was 4.3 (SD 3.34). There was a collective significant effect between participant daily Facebook visits, college student–parent phone calls, texts, and all 3 Facebook connection variables (F6,144=2.60, P=.02, R2=.10). Phone calls, text messages, and Facebook contacts were not associated with PIU risk. However, two individual items were significant predictors for PIU: participant daily Facebook visits were positively associated with increased PIU risk (b=0.04, P=.006) and being friends with a parent on Facebook was negatively associated with PIU risk (b=–0.66, P=.008). Participant daily Facebook visits were not a significant mediator of the relationship between college student–parent Facebook friendship and PIU risk (b=–0.04; 95% CI –0.11 to 0.04). Conclusions This study did not find support for a relationship between parent–college student digital communication frequency and PIU among college students. Instead, results suggested Facebook friendship may be a protective factor. Future studies should examine how a parent-child Facebook friendship might protect against PIU among children at varying developmental stages.

Background Suicide prevention remains challenging among youth, as many do not disclose suicidal ideation. Nearly one-third of American Indian and Alaska Native (AI and AN, tribal, or native) youth see concerning messages on social media at least weekly. Objective To prepare adults to support AI and AN youth who post or view concerning messages, our team designed an hour-long training: Responding to Concerning Posts on Social Media. This study tested the usability, appeal, and impact of the training. Methods A purposive sample of 70 adults was recruited to participate in the pilot, which included 2 study arms. Arm 1 participants completed a 30-min training video and reviewed accompanying handouts, including the Viewer Care Plan (VCP). The VCP provided a 3-step planning and response tool: (1) Start the Conversation, (2) Listen, Gather Information, and Assess Viewer Experience, and (3) Plan and Act. The intent of the VCP was to support and connect AI and AN youth who either view or post concerning messages on social media to life-saving resources. Those enrolled in arm 2 participated in an additional interactive role-play scenario with a coach that took place after the training, via text message. Participants provided qualitative and quantitative feedback on the training’s relevance, appeal, and utility. Paired t tests were used to assess confidence in addressing concerning posts between pre- and postsurveys. Content analysis of the role-play transcripts was used to assess the quality and completion of the coached role-plays, in relation to the recommended VCP. Results Altogether, 35 participants finished the training and completed pre- and postsurveys; 22 participants completed the 6-month follow-up survey. Pre-post analyses of differences in means found significant improvement across several efficacy measures, including confidence starting a conversation about social media (P=.003), confidence contacting the person who posted something concerning (P Conclusions Findings indicate that the Responding to Concerning Posts on Social Media training is a promising tool to prepare adults to intervene and complete the VCP. Additional evaluation with a larger cohort of participants is needed to determine the unique impact of the role-play scenario and changes in mental health referral rates, behaviors, and skills.

BACKGROUND Problematic internet use (PIU) is associated with mental health concerns such as depression and affects more than 12% of young adults. Few studies have explored potential influences of parent–college student digital communication on college students’ risk of PIU. OBJECTIVE This study sought to understand the relationship between parent–college student digital communication frequency via phone calls, text messages, and Facebook contacts and PIU among college students. METHODS Incoming first-year students were randomly selected from registrar lists of a midwestern and northwestern university for a 5-year longitudinal study. Data from interviews conducted in summer 2014 were used. Measures included participants’ daily Facebook visits, communication frequency with parents via phone call and text message, and 3 variables related to Facebook connection status and communication: (1) parent–college student Facebook friendship status, (2) college student blocking personal Facebook content from parent, and (3) Facebook communication frequency. PIU risk was assessed using the Problematic and Risky Internet Use Screening Scale. Analysis included participants who reported visiting Facebook at least once per day. Multiple linear regression was used, followed by a post hoc mediation with Hayes process macro to further investigate predictive relationships among significant variables. RESULTS A total of 151 participants reported daily Facebook use and were included in analyses. Among these participants, 59.6% (90/151) were female, 62.3% (94/151) were from the midwestern university, and 78.8% (119/151) were white. Mean Facebook visits per day was 4.3 (SD 3.34). There was a collective significant effect between participant daily Facebook visits, college student–parent phone calls, texts, and all 3 Facebook connection variables (F6,144=2.60, P=.02, R2=.10). Phone calls, text messages, and Facebook contacts were not associated with PIU risk. However, two individual items were significant predictors for PIU: participant daily Facebook visits were positively associated with increased PIU risk (b=0.04, P=.006) and being friends with a parent on Facebook was negatively associated with PIU risk (b=–0.66, P=.008). Participant daily Facebook visits were not a significant mediator of the relationship between college student–parent Facebook friendship and PIU risk (b=–0.04; 95% CI –0.11 to 0.04). CONCLUSIONS This study did not find support for a relationship between parent–college student digital communication frequency and PIU among college students. Instead, results suggested Facebook friendship may be a protective factor. Future studies should examine how a parent-child Facebook friendship might protect against PIU among children at varying developmental stages.

The objective of the study was to evaluate the effect of lesinurad, a selective uric acid uptake inhibitor, alone and in combination with the xanthine oxidase inhibitor allopurinol, on serum uric acid and urinary urate excretion in patients with gout and hyperuricemia. A phase 1b, multicenter, open‐label, multiple‐dose study was carried out in patients with gout with serum uric acid ≥8 mg/dL following washout of urate‐lowering therapy. Patients were treated with allopurinol 300 mg/day alone in week 1; lesinurad 400 or 600 mg/day was added in week 2, followed by lesinurad 400 or 600 mg/day alone in week 3. Serum uric acid and urine uric acid were evaluated each week. Safety was assessed throughout the study. Lesinurad 400 or 600 mg/day added to allopurinol 300 mg/day reduced serum uric acid by 60% and 72%, respectively, versus allopurinol alone (37%) or lesinurad 400 mg/day (44%) or 600 mg/day (47%) alone. A 100% response rate of serum uric acid

Background Transgender, nonbinary, and gender-diverse (TNG) youth encounter barriers to psychosocial wellness and also describe exploring identities and communities on the web. Studies of cisgender youth connect increased digital technology use with lower well-being, parent relationships, and body image scores as well as increased loneliness and fear of missing out (FOMO). However, little is known about the psychosocial factors associated with digital technology use among TNG compared with cisgender youth. Objective This study aims to examine the associations between psychosocial measures and digital technology use and its importance for cisgender and TNG youth. Methods We surveyed a nationally representative sample of adolescents (aged 13-18 years) about psychosocial wellness and digital technology use. Psychosocial measures included assessment of well-being, parental relationships, body image, loneliness, and FOMO. Digital media use assessments included the short Problematic and Risky Internet Use Screening Scale-3 and the Adolescent Digital Technology Interactions and Importance (ADTI) scale and subscales. We compared psychosocial measures between gender identity groups. We also compared stratified correlations for psychosocial measures (well-being, parent relationships, body image, loneliness, and FOMO) with ADTI and Problematic and Risky Internet Use Screening Scale-3 scores between gender identity groups. All comparisons were adjusted for age, race, and ethnicity. Results Among 4575 adolescents, 53 (1.16%) self-identified as TNG youth. TNG youth had lower scores for well-being (23.76 vs 26.47; P Conclusions Overall, this study supports previously demonstrated disparities in the psychosocial wellness of TNG youth and adds that these disparities include loneliness and FOMO. This study shows prediction of PIU by both higher well-being and better body image, indicating that PIU may not be unilaterally driven by problematic factors among TNG youth. We suggest that this may be because of the specific digital media functions that TNG youth engage with as a disenfranchised population.

Lesinurad is a selective uric acid reabsorption inhibitor approved for the treatment of hyperuricemia associated with gout in combination with xanthine oxidase inhibitors. In vitro assays indicate that lesinurad is an inducer of CYPs in the order CYP3A > CYP2C8 > CYP2C9 > CYP2C19 > CYP2B6 and an inhibitor of CYP2C8 and CYP2C9. To investigate the drug interaction potential of lesinurad, clinical drug interaction studies were conducted. Open-label studies in volunteers investigated the effects of single-/multiple-dose lesinurad on the pharmacokinetics of sildenafil and amlodipine (CYP3A4 induction), tolbutamide (CYP2C9 inhibition/induction), and repaglinide (CYP2C8 inhibition/induction). There was no apparent induction of CYP2C8 and CYP2C9 following repeated lesinurad administration, although no inhibition of CYP2C9 and modest inhibition of CYP2C8 were observed following single-dose lesinurad. Consistent with in vitro observations, lesinurad (200 mg once daily) was an inducer of CYP3A based on the effects on sildenafil exposure. Sildenafil exposure decreased by approximately 34% for Cmax and AUC when administered with multiple-dose lesinurad 200 mg and allopurinol 300 mg, relative to sildenafil alone. During lesinurad therapy, the possibility of reduced efficacy of concomitant drugs that are CYP3A substrates should be considered and their efficacy monitored because of induction of CYP3A by lesinurad.

Purpose This study aimed to understand American Indian and Alaska Native (AI/AN) adolescents' perspectives on concerning social media posts, including those expressing suicidal intent. Methods A purposive sample of AI/AN youth were recruited; trained facilitators conducted focus groups. Participants discussed experiences viewing concerning posts on social media. Qualitative analysis used the constant comparative method. Results A total of 32 AI/AN youth ages 14-22 participated. Three salient themes emerged: 1) youth typically respond alone; 2) barriers to action; 3) recommended training and support - trusted adults, anonymity, and privacy. Conclusion Study findings will guide the development of resources trusted by AI/AN youth.

Zancong Shen,1 Michael Gillen,2 Kathy Tieu,1 Mai Nguyen,1 Erin Harmon,1 David M Wilson,1 Bradley Kerr,1 Caroline A Lee1 1Ardea Biosciences, Inc., San Diego, CA, 2AstraZeneca LP, Gaithersburg, MD, USA Introduction: Lesinurad is a selective uric acid reabsorption inhibitor approved in the United States and Europe for treatment of gout in combination with a xanthine oxidase inhibitor. Amaximum tolerated dose study was conducted to determine the lesinurad supratherapeutic dose, followed by a thorough QTc study to characterize the effect of lesinurad on cardiac repolarization.Methods: The maximum tolerated dose study was a randomized, double-blind, placebo-controlled, single-ascending dose study that enrolled 35 healthy men and women. Lesinurad plasma exposure (maximum observed plasma concentration and area under the plasma concentration versus time curve) was determined at doses of 800mg, 1,200mg, and 1,600mg. The thorough QTc study was a double-blind, four-period, placebo-controlled crossover study with 54 healthy men and women who received single doses of lesinurad 1,600mg (supratherapeutic dose), lesinurad 400mg, moxifloxacin 400mg, and placebo in randomized sequence. Digital 12-lead electrocardiograms were recorded at eleven time points over 24hours in each treatment period. QT intervals were corrected for heart rate using an individual-specific correction factor (QTcI).Results: The upper bound of the one-sided 95% confidence interval for time-matched, placebo-subtracted, baseline-adjusted QTcI intervals (ΔΔQTcI) was 480ms or QTcI increases >30ms were observed. Moxifloxacin mean QTcI intervals were >5ms, and the lower bounds of the 90% confidence interval were >5ms at 2hours, 3hours, and 4hours, confirming assay sensitivity.Conclusion: Lesinurad, at supratherapeutic doses, does not have a significant effect on the QT interval in healthy male or female subjects. Keywords: pharmacokinetics, maximum tolerated dose study, QT interval, selective uric acid reabsorption inhibitor

Background Literature has consistently shown a positive relationship between young adults’ social media alcohol-related posts and drinking outcomes; however, the reasons for this association and the psychosocial influences behind students’ posting of alcohol-related content are still unclear. Peer influences have been robustly shown to predict students’ drinking such that students’ perceptions of their friends’ drinking is positively associated with their own drinking. Objective Although research has demonstrated that online and offline peer influences are robust predictors of drinking among college students, perceptions of friends’ approval and students’ drinking in relation to alcohol-related posting have yet to be explored longitudinally. Methods The current multi-site, multi-method study examined students ( N=316; 58.7% female) from a Midwest (58.8%) and Northwest university over a 4-year period. All Facebook alcohol-related posts were coded each academic calendar year and perceived friends’ approval of drinking and students’ alcohol use were assessed annually. A lagged, random coefficients negative binomial model was specified to examine between- and within-person effects. Results After controlling for perceptions of friends’ alcohol-related posts, results revealed that time, drinking more, and perceiving friends as more approving of drinking were significantly and positively associated with posting alcohol-related content at the between-person level. Moreover, a significant interaction of Time X Drinking, with drinking at the between-person level, emerged such that heavier drinkers tended to post less often over time. Conclusions Increases in alcohol-related content posts are likely to over-inflate students’ drinking norms and their drinking. Thus, it is plausible that social media networks containing more alcohol-related content may contribute to cyclical increases in drinking for individuals within that network.

Background Youth exposure to positive marijuana messages increases their risk of marijuana use. Since Washington State legalized recreational marijuana in 2012, marijuana businesses have used social media business pages to promote their products. Regulations to prevent youth access and targeting by marijuana businesses on social media in Washington State are absent. The purpose of this study was to engage youth in conceptualizing prevention approaches to limit youth exposure to marijuana business promotions on social media. Methods Towards our goal of generating novel prevention approaches and promoting youth interaction to build ideas, we used focus groups. Adolescents ages 15-20 years in Washington State were recruited through purposeful sampling to achieve a diverse sample from six schools across two counties. During focus groups, trained facilitators used a semi-structured guide to prompt discussion about marijuana business presence on social media. In the latter half of focus groups, facilitators showed example social media posts from marijuana businesses. All focus groups were audio recorded and manually transcribed. Qualitative analysis was conducted using the constant comparative method. Results A total of 32 adolescents with average age 17 years (SD = 0.6), 71% female, 43.8% Asian and 21.9% mixed race, participated in 5 focus groups. Recommendations for prevention focused in two main thematic areas. First, participants supported policies to restrict underage access to marijuana social media pages, an example quote was: “you have access to [the social media page] without being 21 and I think that’s a problem.” Second, participants proposed regulation of content that marijuana companies can post on social media, an example quote was: “I’m thinking they shouldn’t be allowed to use children or anything associated with children and the memes that they post.” Conclusions Our findings indicate two strategies to limit youth exposure to marijuana content on social media. These specific strategies represent potential avenues to revise state policies and test the effectiveness of these approaches for states that permit recreational marijuana.

Lesinurad is a selective uric acid reabsorption inhibitor approved for use in combination with xanthine oxidase inhibitors for the treatment of hyperuricemia associated with gout. In vitro, lesinurad was shown to be a weak inhibitor of cytochrome P450 (CYP)2C9 and a weak inducer of CYP3A4. Warfarin is a widely prescribed oral coumarin-based anticoagulant commonly prescribed in gout patients. In an open-label clinical study in healthy adult male subjects, the effects of multiple daily doses of 400 mg lesinurad on the pharmacokinetics and pharmacodynamics of a single dose of 25 mg warfarin (racemic mixture of R- and S- enantiomers) were evaluated. Lesinurad had no effect on the absorption or the exposure (area under the concentration-time curve [AUC] and peak concentration) of the more active S-warfarin enantiomer. A slight reduction (19%) in overall plasma exposure (AUC) was observed for the R-warfarin enantiomer. Lesinurad had no meaningful clinical impact on anticoagulation activity as measured by prothrombin time, activated partial thromboplastin time, and international normalized ratio of prothrombin time and Factor VII clotting activity. Overall, the administration of warfarin in the presence of multiple-dose lesinurad was devoid of clinically significant drug-drug interaction.

The objectives of this study were to determine the absolute bioavailability of lesinurad and to characterized its disposition in humans.The oral bioavailability assessment was performed using a clinical design of simultaneous dosing of a therapeutic oral dose of lesinurad with an intravenous infusion of [14C]lesinurad microdose. The bioavailability of lesinurad was determined to be 100%.The disposition of lesinurad in humans involves hepatic oxidation and renal elimination following administration of oral [14C]lesinurad dose.Metabolism of lesinurad occurred post-systemically with low circulating levels of metabolites 14C]lesinurad microdose. The bioavailability of lesinurad was determined to be 100%. The disposition of lesinurad in humans involves hepatic oxidation and renal elimination following administration of oral [14C]lesinurad dose. Metabolism of lesinurad occurred post-systemically with low circulating levels of metabolites

Purpose College students frequently display references to substance use, including marijuana, on social media such as Facebook. The significance of displayed marijuana references on social media is unknown. The purpose of this longitudinal cohort study was to evaluate college students’ displayed marijuanareferences on Facebook and their association with self-reported marijuana use. Methods First-year students from two U.S. universities were randomly selected from registrar lists for recruitment. Data collection included 4years of monthly Facebook coding, and yearly phone interviews that each assessed lifetime and current marijuana use. We compared frequencies of displayed marijuana references on Facebook between marijuana users and nonusers using two-sample t-tests and Pearson's chi-squared tests. Generalized linear models were used to evaluate the likelihood of displayed marijuana references on Facebook. Results A total of 338 participants were recruited, 56.1% were female, 74.8% were Caucasian, and 58.8% were from the Midwest college. Prevalence of displayed marijuana references on Facebook profiles variedfrom 5% to 10% across 4 years. Displayed marijuana references included most “Actions” and “Locations” on the Facebook profile. Marijuana users were more likely to display marijuana references on Facebook compared to nonusers, though Likes were more common among nonusers. Predictors of displayed marijuana references included lifetime and current marijuana use. Conclusions The prevalence of displayed marijuana references on Facebook was consistent but uncommon; marijuana references included both information sharing and personal experiences. Marijuana users were more likely to display marijuana references, suggesting these displays could be leveraged for intervention efforts.

Objective. The aim of this study was to evaluate the pharmacodynamics (PDs), pharmacokinetics (PKs) and safety of lesinurad (selective uric acid reabsorption inhibitor) in combination with febuxostat (xanthine oxidase inhibitor) in patients with gout. Methods. This study was a phase IB, multicentre, open-label, multiple-dose study of gout patients with serum uric acid (sUA) >8 mg/dl following washout of urate-lowering therapy with colchicine flare prophylaxis. Febuxostat 40 or 80 mg/day was administered on days 121, lesinurad 400 mg/day was added on days 814 and then lesinurad was increased to 600 mg/day on days 1521. sUA, urine uric acid and PK profiles were evaluated at the end of each week. Safety was assessed by adverse events, laboratory tests and physical examinations. Results. Initial treatment with febuxostat 40 or 80 mg/day monotherapy resulted in 67% and 56% of subjects, respectively, achieving a sUA level

The purpose of this study was to investigate the emergence of displayed alcohol references on Facebook for first-year students from two universities. Graduated high school seniors who were planning to attend one of the two targeted study universities were recruited. Participants’ Facebook profiles were evaluated for displayed alcohol references at baseline and every four weeks throughout the first year of college. Profiles were categorized as Non-Displayers, Alcohol Displayers or Intoxication/Problem Drinking Displayers. Analyses included logistic regression, univariate and multivariate Cox proportional hazard analysis and multi-state Markov modeling. A total of 338 participants were recruited, 56.1% were female, 74.8% were Caucasian, and 58.8% were from University A. At baseline, 68 Facebook profiles (20.1%) included displayed alcohol references. During the first year of college, 135 (39.9%) profiles newly displayed alcohol. In multivariate Cox proportional hazard analysis, university (University B versus A, HR = 0.47, 95% CI: 0.28–0.77, p = 0.003), number of Facebook friends (HR = 1.19, 95% CI: 1.09–1.28, p < 0.001 for every 100 more friends), and average monthly status updates (HR = 1.03, 95% CI: 1.002–1.05, p = 0.033) were identified as independent predictors for new alcohol display. Findings contribute to understanding the patterns and predictors for displayed alcohol references on Facebook.

Michael Gillen,1 Shakti Valdez,2 Dongmei Zhou,2 Bradley Kerr,2 Caroline A Lee,2 Zancong Shen2 1AstraZeneca LP, Gaithersburg, MD, 2Ardea Biosciences, Inc., San Diego, CA, USA Introduction: Lesinurad is a selective uric acid reabsorption inhibitor approved for the treatment of gout in combination with a xanthine oxidase inhibitor (XOI) in patients who have not achieved target serum uric acid (sUA) levels with an XOI alone. Most people with gout have chronic kidney disease. The pharmacokinetics, pharmacodynamics, and safety of lesinurad were assessed in subjects with impaired renal function. Methods: Two Phase I, multicenter, open-label, single-dose studies enrolled subjects with normal renal function (estimated creatinine clearance [eCrCl] >90mL/min; N=12) or mild (eCrCl 60–89mL/min; N=8), moderate (eCrCl 30–59mL/min; N=16), or severe (eCrCl

Lesinurad is a novel selective uric acid reabsorption inhibitor approved for treatment of hyperuricemia associated with gout in combination with xanthine oxidase inhibitors (XOIs). Open-label pharmacokinetic studies were performed in volunteers or subjects with hyperuricemia (serum uric acid ≥ 8 mg/dL) to investigate interactions of lesinurad (with and without concurrent XOIs) with colchicine and 2 nonsteroidal anti-inflammatory drugs: naproxen and indomethacin. Colchicine studies included consecutive 7-day treatment periods of (1) allopurinol 300 mg, allopurinol 300 mg plus lesinurad 400 or 600 mg, and continued lesinurad 400 or 600 mg; or (2) febuxostat 40 or 80 mg, febuxostat 40 or 80 mg plus lesinurad 400 mg, and continued febuxostat 40 or 80 mg plus lesinurad 600 mg. Naproxen and indomethacin studies included lesinurad 400 mg on day 1, naproxen 250 mg twice daily or indomethacin 25 mg twice daily on days 2-6, and lesinurad 400 mg plus continued naproxen or indomethacin on days 7-13 and the morning of day 14. Lesinurad did not alter the pharmacokinetics of naproxen and modestly altered exposure to colchicine (AUC decrease of ≤ 25%) and indomethacin (AUC increase of ∼35%). Indomethacin did not alter the pharmacokinetics of lesinurad, whereas naproxen modestly decreased the C

Key Points Question How often are recreational marijuana companies adhering to the state of Washington Administrative Code regulations when posting product promotion messages on social media? Findings This cross-sectional content analysis of 1027 posts on Facebook and Twitter platforms evaluated the social media content of business pages from 6 recreational marijuana companies. Violations of regulations regarding prohibited content were present for between 2% and 13% posts across regulation categories; required warnings were present on only 11% of posts. Meaning Social media are influential and accessible platforms for youths in which recreational marijuana companies promote prohibited content and avoid required health warning messages., Importance Recreational marijuana use was legalized in the state of Washington in 2012, and the Washington Administrative Code (WAC) 314-55-155 was implemented to limit the exposure of youths to marijuana advertisements. Objectives To evaluate the content of social media posts by marijuana companies and to assess the compliance of these posts with WAC regulations. Design, Setting, and Participants In a cross-sectional study, a content analysis of 1027 social media posts was conducted to identify and assess compliance of WAC regulations with the business pages of recreational marijuana companies located on Facebook and Twitter platforms in the state of Washington from December 1, 2015, through November 30, 2016. Main Outcomes and Measures Application of coding based on WAC regulations to focus on the prohibition of language that promoted the overconsumption of marijuana, that described its curative or therapeutic benefits, or that was designed to appeal to youths; and the requirements for warnings about intoxication, driving, health risks, and age restrictions for marijuana. Results Of the 1027 posts on Facebook and Twitter from business pages of 6 marijuana companies, Facebook followers ranged from 342 to 1592 persons and Twitter followers ranged from 374 to 2915 persons per company. Findings for WAC regulations included 17 posts (1.7%) that encouraged overconsumption; 137 posts (13.3%) that promoted therapeutic benefits; and 9 posts (0.01%) that appealed to youths. Requirements for warnings addressing intoxication, driving, health risks, and age restrictions were present on 110 posts (10.7%). Some businesses repeatedly violated particular regulations; 7 of 17 (41.2%) posts encouraging overconsumption derived from 1 marijuana company. Conclusions and Relevance Most social media posts by marijuana companies were consistent with WAC regulations that prohibit particular messages, but few companies provided required warning messages. Findings can be used toward implementation strategies for marijuana prevention to address these influential media messages., This cross-sectional content analysis assesses adherence of social media content of recreational marijuana companies in the state of Washington to Washington Administrative Code regulations.

Comorbidity between major depressive disorder (MDD), anxiety (generalized anxiety, panic disorder, social anxiety disorder) and pain is a major complicating factor in the diagnosis and treatment of psychiatric and neurological disorders. Although numerous neurotransmitters and/or neuromodulators may be involved, abnormalities in the GABAergic and glutamatergic systems seem to be a common factor in all these disorders. Neuroactive steroids (NASs) have been the object of considerable interest in this area in recent years since they appear to act predominantly on GABA-A and glutamate NMDA receptors. An overview of the possible involvement of NASs in MDD, anxiety and pain is provided in this chapter.

Although it is well known that there is a high degree of comorbidity between chronic pain and mood and anxiety disorders, the mechanisms involved in these co-occurrences are not clear. It appears that numerous neurotransmitters and neuromodulators are involved, and this chapter focuses on the monoamine neurotransmitters noradrenaline, 5-hydroxytryptamine (5-HT, serotonin), and dopamine and the amino acid neurotransmitters GABA (γ-aminobutyric acid) and glutamate in chronic pain and depression. Numerous preclinical and clinical neurochemical, neuroanatomical, pharmacological and molecular biological studies as well as clinical pharmacological treatment investigations implicate noradrenaline, 5-HT and, to a lesser extent, dopamine in the etiology of pain and depression. Similarly, preclinical and clinical studies on GABAergic and glutamatergic mechanisms as well as reports on the actions of neuroactive steroids suggest that GABA and glutamate play an important role in the etiology of pain and depression and may contribute to comorbidity.

Given the prevalence of social media, a nascent but important area of research is the effect of social media posting on one’s own self. It is possible that an individual’s social media posts may have predictive capacity, especially in relation to health behavior. Researchers have long used concepts from the theory of reasoned action to predict health behaviors. The theory does not account for social media, which may influence or predict health behaviors. The purpose of this study was to test a model including Facebook alcohol displays and constructs from the theory of reasoned action to predict binge drinking. Incoming college freshmen from two schools (312 participants between 18 and 19 years old) were interviewed prior to (T1) and 1 year into college (T2), and their Facebook profiles were evaluated for displayed alcohol content. Path modeling was used to evaluate direct and indirect paths predicting binge drinking. Path analysis suggested that Facebook alcohol displays at T1 directly predict binge drinking at T2, while alcohol attitude both directly and indirectly predicts binge drinking. Based on these results, a preliminary model of social media presentation and action is discussed.