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The ABCD‐GENE score was developed to predict poor response to clopidogrel and includes Age, Body mass index, Chronic kidney disease (CKD; estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2), Diabetes, and CYP2C19 GENE variants; a score ≥ 10 is predictive of reduced clopidogrel effectiveness after percutaneous coronary intervention (PCI). Estimation of GFR without a race variable via the CKD‐EPI Scr 2021 equation is now recommended. We examined the impact of using the CKD‐EPI Scr 2021 vs. 2009 equation on the ABCD‐GENE score for post‐PCI patients. A total of 4335 adult patients (n = 925 Black) who underwent PCI and CYP2C19 genotyping were included, with GFR estimated for each patient via the CKD‐EPI Scr 2021 and CKD‐EPI 2009 equations. The ABCD‐GENE score, calculated based on each GFR estimation, was compared. With the CKD‐EPI Scr 2021 vs. 2009 equation, median (IQR) eGFR was lower (74 [55–94] vs. 81 [60–103] mL/min/1.73 m2, P < 0.001), and CKD prevalence was higher (31% vs. 25%, P < 0.001) among Black patients, whereas eGFR was higher (85 [65–99] vs. 80 [61–94] mL/min/1.73m2, P < 0.001), and CKD prevalence was lower (20% vs. 24%, P < 0.001) in non‐Black patients. This led to 12 (1%) Black patients being reclassified from low to high risk of poor clopidogrel response and 30 (1%) non‐Black patients being recategorized from high to low risk (P < 0.001 for both comparisons). Removal of the race variable from GFR estimation significantly impacted the prediction of clopidogrel effectiveness via the ABCD‐GENE score. [ABSTRACT FROM AUTHOR]

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor (clopidogrel, prasugrel, or ticagrelor) is indicated after percutaneous coronary intervention (PCI) to reduce the risk of atherothrombotic events. Approximately 30% of the US population has a CYP2C19 no‐function allele that reduces the effectiveness of clopidogrel, but not prasugrel or ticagrelor, after PCI. We have shown improved outcomes with the integration of CYP2C19 genotyping into clinical care to guide the selection of prasugrel or ticagrelor in CYP2C19 no‐function allele carriers. However, the influence of patient‐specific demographic, clinical, and other genetic factors on outcomes with genotype‐guided DAPT has not been defined. In addition, the impact of genotype‐guided de‐escalation from prasugrel or ticagrelor to clopidogrel in patients without a CYP2C19 no‐function allele has not been investigated in a diverse, real‐world clinical setting. The Precision Antiplatelet Therapy after Percutaneous Coronary Intervention (Precision PCI) Registry is a multicenter US registry of patients who underwent PCI and clinical CYP2C19 testing. The registry is enrolling a diverse population, assessing atherothrombotic and bleeding events over 12 months, collecting DNA samples, and conducting platelet function testing in a subset of patients. The registry aims to define the influence of African ancestry and other patient‐specific factors on clinical outcomes with CYP2C19‐guided DAPT, evaluate the safety and effectiveness of CYP2C19‐guided DAPT de‐escalation following PCI in a real‐world setting, and identify additional genetic influences of clopidogrel response after PCI, with the ultimate goal of establishing optimal strategies for individualized antiplatelet therapy that improves outcomes in a diverse, real‐world population. [ABSTRACT FROM AUTHOR]

Rationale: Existing literature describing differences in survival following percutaneous coronary intervention (PCI) by patient sex, race‐ethnicity and the role of socioeconomic characteristics (SEC) is limited. Aims and Objectives: Evaluate differences in 1‐year survival after PCI by sex and race‐ethnicity, and explore the contribution of SEC to observed differences. Methods: Using a 20% sample of Medicare claims data for beneficiaries aged 65+, we identified fee‐for‐service patients who received PCI from 2007 to 2015. We performed logistic regression to assess how sex and race‐ethnicity relate to procedural indication, inpatient versus outpatient setting, and 1‐year mortality. We evaluated whether these relationships are moderated by sequentially controlling for factors including age, comorbidities, presence of acute myocardial infarction (AMI), county SEC, medical resource availability and inpatient versus outpatient procedural status. Results: We identified 300,491 PCI procedures, of which 94,863 (31.6%) were outpatient. There was a significant transition to outpatient PCI during the study period, especially for men compared with women and White patients compared with Black patients. Black patients were 3.50 percentage points (p < 0.001) and women were 3.41 percentage points (p < 0.001) more likely than White and male patients to undergo PCI at the time of AMI, which typically occurs in the inpatient setting. Controlling for age and calendar year, Black patients were 2.87 percentage points more likely than non‐Hispanic White patients to die within 1 year after PCI. After controlling for Black–White differences in comorbidities, the differences in 1‐year mortality decreased to 0.95 percentage points, which then became nonsignificant when further controlling for county resources and state of residence. Conclusion: Women were more likely to experience PCI in the setting of AMI and had less transition to outpatient care during the period. Black patients experienced higher 1‐year mortality following PCI, which is explained by differences in baseline comorbidities, county medical resources, and state of residence. [ABSTRACT FROM AUTHOR]

Introduction: Although integrated primary care (IPC) is growing, several barriers remain. Better understanding of behavioral health professionals' (BHPs') readiness for and engagement in IPC behaviors could improve IPC research and training. This study developed measures of IPC behaviors and stage of change. Method: The sample included 319 licensed, practicing BHPs with a range of interests and experience with IPC. Sequential measurement development procedures, with split-half cross-validation were conducted. Results: Exploratory principal components analyses (N = 152) and confirmatory factor analyses (N = 167) yielded a 12-item scale with 2 factors: consultation/practice management (CPM) and intervention/knowledge (IK). A higher-order Integrated Primary Care Behavior Scale (IPCBS) model showed good fit to the data, and excellent internal consistencies. The multivariate analysis of variance (MANOVA) on the IPCBS demonstrated significant large-sized differences across stage and behavior groups. Discussion: The IPCBS demonstrated good psychometric properties and external validation, advancing research, education, and training for IPC practice. Keywords: integrated primary care, behavioral health professionals, TTM, stage of change, integrated care, Integrated primary care (IPC) is the integration of behavioral health and primary care medical services, provided together, onsite and in collaboration by both behavioral health professionals (BHPs) and primary care [...]

Objective: This study developed and examined the psychometric properties of a newly formed measure designed to assess professor/instructor bullying, as well as teacher bullying occurring prior to college. Additionally, prevalence of instructor bullying and characteristics related to victims of instructor bullying were examined. Participants: Participants were 337 college students recruited in 2012 from a northeastern university. Methods: An online questionnaire was administered to college students. A split-half, cross-validation approach was employed for measurement development. Results: The measure demonstrated strong criterion validity and internal consistency. Approximately half of students reported witnessing professor/instructor bullying and 18% reported being bullied by a professor/instructor. Report of teacher bullying occurring prior to college was related to professor/instructor bullying in college, and sex was a moderating variable. Conclusion: College students perceive instructor bullying as occurring but may not know how to properly address it. Prevention efforts should be made by university administrators, faculty, and staff.

Objective: To evaluate stimulant medication on symptoms and functioning for college students with ADHD using double-blind, placebo-controlled, crossover design. Method: Participants included 24 college students with ADHD and 26 college students without psychopathology. Lisdexamfetamine dimesylate (LDX) was examined for ADHD participants over five weekly phases (no-drug baseline, placebo, 30-, 50-, and 70-mg LDX per day). Self-report rating scales of functioning and direct assessment of ADHD symptoms, verbal learning/memory, and adverse side effects were collected (baseline only for control students). Results: LDX was associated with large reductions in ADHD symptoms and improvement in executive functioning along with smaller effects for psychosocial functioning. Reduction in ADHD symptoms was found for 86.4% of participants; however, large differences in symptoms and executive functioning remained relative to controls. Conclusion: LDX is a safe, efficacious treatment for symptom relief in college students with ADHD. Research documenting medication effects on academic functioning and evaluating psychosocial/educational interventions is needed. (Contains 5 figures and 3 tables.)

American Indian (AI) adolescents experience disproportionate alcohol-related consequences. The present study evaluated the psychometric properties and application of the American Drug and Alcohol Survey (ADAS™) alcohol-related consequence scale for AI adolescents through a secondary analysis of a large population-based sample of adolescents living on or near AI reservations. We found support for the ADAS alcohol-related consequence scale as a one-factor model, invariant discretely across race, sex assigned at birth, and age, and with good internal consistency. Evidence for construct validity was found through significant positive correlations between frequency of past 12 months of drinking, frequency of past 12 months of intoxication, and lifetime alcohol-related consequences. AI adolescents were significantly more likely to report more alcohol-related consequences than their non-Hispanic White peers. Race significantly interacted with frequency of drinking in predicting alcohol-related consequences such that these associations were stronger for AI adolescents. However, race did not significantly interact with frequency of intoxication in predicting alcohol-related consequences. Results from this study demonstrate the utility of the ADAS alcohol-related consequence scale for use across demographic groups with little risk of measurement bias. [ABSTRACT FROM AUTHOR]

Examined whether stages of change of exercise adoption appropriately addressed strenuous, moderate, and mild intensities of physical activity. Secondary analysis of four data sets (adolescents, college students, adults, and seniors) investigated transtheoretical model constructs for exercise adoption. Results supported the construct validity of the stages of change for strenuous and moderate intensity physical activity. (SM)