Somatic Factors Predict On-Road Driving Skills in Older Drivers and Drivers with Mild Cognitive Impairment.

BACKGROUND: On-road driving skills can be impaired in older drivers and drivers with mild cognitive impairment (MCI) due to different driving-relevant deficits. Among these deficits, somatic factors have received little attention so far. METHODS: In a prospective observational on-road driving study, we examined whether somatic factors can predict on-road driving skills in a mixed sample of healthy older drivers and drivers with MCI (n = 99) and whether the inclusion of age explains additional variance. Somatic factors included the number of prescribed drugs, visual acuity, peripheral visual field integrity, mobility of the cervical spine, and hearing impairment. A hierarchical regression analysis was used to predict on-road driving skills by adding the somatic factors in the first step and age in the second step. RESULTS: Results revealed that the combination of somatic factors significantly predicted on-road driving skills (R2adjusted = 0.439). The inclusion of age led to a significant increase of explained variance (R2adjusted = 0.466). CONCLUSIONS: Our results suggest that somatic factors can accurately predict on-road driving skills in healthy older drivers and drivers with MCI. In addition, our results suggest that there is a significant but rather small effect of age beyond somatic changes.

Popular Musician Occupational Stress and Psychological Ill Health: An Exploratory Factor Analysis.

OBJECTIVE: Popular musicians are exposed to many occupational stressors, including unpredictable work schedules, touring and economic precarity, that have been associated in prior studies with psychological ill health. This study sought to identify occupational stressors most strongly associated with depression, anxiety, and alcohol misuse in popular musicians. METHODS: An online survey was completed by 317 popular musicians that included the Musician Occupational Stress Scale (MOSS), a validated measure of occupational stress in popular musicians. An exploratory principle-factor analysis (EFA) investigated the dimensions of response pat¬terns in the items comprising the MOSS. RESULTS: Four factors were identified that predicted 50% of musician occupational stress: Work Insecurity Stress, Tour Stress, Performance Stress, and Professional Relationship Stress. In addition to financial distress, each factor was significantly associated with depression and anxiety and Tour Stress also was associated with alcohol misuse. After adjusting for all other factors and financial distress, only Work Insecurity Stress remained associated with depression (odds ratio [OR]= 5.42; 95% confidence interval [CI] = 3.23-9.09) and anxiety (OR=5.95; 95% CI = 3.51-10.11). Tour Stress became inversely associated with depression (OR= 0.59; 95% CI = 0.40-0.89) and anxiety (OR=0.60; 95% CI = 0.40-0.89). After adjustment, alcohol misuse was associated with Professional Relationship Stress (OR=1.66; 95% CI = 1.04-2.65) but inversely correlated with Performance Stress (OR=0.60; 95% CI = 0.40-0.91). CONCLUSIONS: The four-factor model was shown to reliably simplify driving associations of occupational stressors that negatively impact psychological functioning in popular musicians. Dissemination of these findings could have practical implications in developing effective outreach messaging to promote psychological resilience and guide psychotherapeutic intervention strategies for this high-risk occupational group.

Pilot study assessing the effect of Fascial Manipulation on fascial densifications and associated pain.

We assessed effectiveness of Fascial Manipulation (FM) in reducing densification thickness and associated acute pain in normal humans. Fascial densifications were identified using palpation and measured with diagnostic ultrasound within self-reported painful somatic regions. Pain intensity ratings were obtained in response to deep palpation of the self-reported painful somatic region before and after a brief FM intervention. Brief FM resulted in reduced densification thickness as well pain intensity. Sex differences were found neither in densification thickness nor pain intensity at any time point. However, a statistically significant positive correlation between densification thickness and pain intensity was observed in females but not males at both pre-FM and post-FM time points. As such, FM may be an effective therapeutic approach for acute pain associated with fascial densifications. While males and females exhibited comparable densification thickness and pain intensity levels at both pre-FM and post-FM time points, only females showed a statistically significant relationship between pain and densification, suggesting that females may be better able to perceive subtle differences in the magnitude of noxious sensory input.

A Revised Occupational Stress Measure for Popular Musicians: Pilot Test of Validity and Reliability.

OBJECTIVE: Popular (i.e., nonclassical) musicians have higher rates of depression, anxiety, and suicide than the general population. Occupational and financial stress have been suggested to be social determinants of musician mental health burden. A pilot study was conducted to assess the internal consistency and test-retest reliability of a revised measure of popular musician occupational stress and compare the results to those of other, previously validated instruments used in the same survey. METHODS: An online survey was emailed to a convenience sample of 150 musicians who had formerly accessed mental health services through a non-profit organization in Austin, Texas. The survey included a revised Musician Occupational Stress Scale (MOSS), a measure of financial stress, and instruments to screen for clinically significant depression, anxiety, and alcohol misuse. RESULTS: Forty musicians (26.7%) completed the initial survey and 19 completed a repeat survey 2 weeks later for the test-retest comparison. Internal consistency coefficients for individual instruments ranged from 0.86-0.92. The piloted MOSS demonstrated good internal consistency (Cronbach's α=0.91; one-sided 95% CI ≥0.88) and test-retest reliability (r=0.86; p<0.0001). The MOSS also showed reasonable construct validity, correlating well with a single question of perceived occupational stress (ρ=0.46; p<0.001) over career satisfaction (ρ=-0.09; p>0.05). CONCLUSION: The individual, construct-specific measures included in this survey all demonstrated good internal consistency and test-retest reliability on examination. While the results are preliminary due to the small sample size, the MOSS psychometrically performed at a level equal to or better than other widely used and well-validated measures included in this survey.

Popular Musician Responses to Mental Health Treatment.

OBJECTIVE: Popular (i.e., nonclassical) musicians have higher rates of mental health disorders and mental health service utilization than the general population. Little is known, however, about how popular musicians perceive mental health interventions in terms of overall satisfaction and therapeutic benefit. METHODS: An online client satisfaction survey was sent to all musicians and family members who received mental health services through a nonprofit mental health organization in Austin, Texas, between July 2014 and June 2015 (n=628). RESULTS: 260 individuals (41.4%) responded to the survey, of whom 94% (n=244) were musicians. A majority of musician respondents were male (60%) and white (82%). 87% received counseling, 32% received psychiatric medication treatment, and 8% received addiction recovery services. 97% of musicians (205/211) rated their counselor as 'very good' or 'excellent,' 88% (64/79) rated their psychiatric providers as 'very good' or 'excellent,' and 94% (17/19) rated their addiction recovery specialists as 'very good' or 'excellent' (nonsignificant between all categories, p>0.05). 89% of musicians receiving counseling, 84% receiving psychiatric medication treatment, and 95% receiving addiction recovery services agreed or strongly agreed that their symptoms and overall functioning improved as a result of their treatment (nonsignificant between all categories, p>0.05). CONCLUSION: Popular musicians express strong provider satisfaction and overall benefit when mental health interventions are accessible, affordable, and delivered by professionals familiar with their concerns. More research is needed to understand the unique psychosocial stresses popular musicians face to inform treatment planning for this high-risk, underserved population.

Relation of Mental Health to Alcohol and Substance Use Among Texas College Students.

We examined the effect of mental health problems and difficulties on alcohol, tobacco, and other drug (ATOD) use among college students by using the 2013 Texas College Survey of Substance Use (n=11,216), which includes the K6 screening scale for severe mental illness (SMI). Students' K6 scores were used to classify them into 3 groups: those likely to have SMI (9% with scores ≥ 13), those with some mental health problems (36%), and those without mental health issues (55% with scores ≤ 4). Questions regarding ATOD use were analyzed using these 3 groups. Alcohol use was not significantly associated with K6 scores, although problematic alcohol behaviors as measured by the CAGE test were. Higher cigarette use was significantly associated with higher K6 scores. Finally, both higher marijuana and higher drug use (across 9 other individual drugs) were significantly associated with higher K6 scores. Although higher K6 scores were associated with higher rates of drug use, most students with high K6 scores did not use drugs. However, given the higher level of risk, drug and alcohol interventions should be made available for those students who receive mental health counseling.

Venous thromboembolism following initiation of atypical antipsychotics in two geriatric patients.

BACKGROUND: Although not formally highlighted as a risk factor in current practice guidelines, several observational studies have reported a possible association between antipsychotic use and development of venous thromboembolism (VTE). However, it is unclear to what extent the risk is elevated. CASE REPORT: Described are 2 cases of VTE following recent initiation of second-generation antipsychotics in elderly patients. Ms A was a 65-year-old woman with newly diagnosed bipolar I disorder who was hospitalized for acute mania and psychosis. She was treated with risperidone along with traditional mood stabilizers and developed a pulmonary embolism shortly after treatment initiation. Ms B was a 77-year-old woman with newly diagnosed bipolar I disorder who was hospitalized for depression and psychosis. She was treated with quetiapine and electroconvulsive therapy and developed a pulmonary embolism and deep vein thrombosis within 2 months of starting treatment. Risk assessment tools were not able to definitively predict the VTEs that developed in our patients. CONCLUSION: The association between antipsychotic medication and VTE has shown the highest risk with atypical antipsychotics, high dosages, and initiation within the past 3 months. Risk assessment tools may assist in assessing the risk of VTE in patients on antipsychotic therapy, although patients who are deemed by these tools to have minimal risk can still develop a VTE. Discussing VTE risk with patients when considering antipsychotic usage may help clinicians and patients safely determine the most appropriate treatment for their psychiatric illnesses while mitigating potential adverse effects.

Can Genetic Analysis of Putative Blood Alzheimer's Disease Biomarkers Lead to Identification of Susceptibility Loci?

Although 24 Alzheimer's disease (AD) risk loci have been reliably identified, a large portion of the predicted heritability for AD remains unexplained. It is expected that additional loci of small effect will be identified with an increased sample size. However, the cost of a significant increase in Case-Control sample size is prohibitive. The current study tests whether exploring the genetic basis of endophenotypes, in this case based on putative blood biomarkers for AD, can accelerate the identification of susceptibility loci using modest sample sizes. Each endophenotype was used as the outcome variable in an independent GWAS. Endophenotypes were based on circulating concentrations of proteins that contributed significantly to a published blood-based predictive algorithm for AD. Endophenotypes included Monocyte Chemoattractant Protein 1 (MCP1), Vascular Cell Adhesion Molecule 1 (VCAM1), Pancreatic Polypeptide (PP), Beta2 Microglobulin (B2M), Factor VII (F7), Adiponectin (ADN) and Tenascin C (TN-C). Across the seven endophenotypes, 47 SNPs were associated with outcome with a p-value ≤1x10(-7). Each signal was further characterized with respect to known genetic loci associated with AD. Signals for several endophenotypes were observed in the vicinity of CR1, MS4A6A/MS4A4E, PICALM, CLU, and PTK2B. The strongest signal was observed in association with Factor VII levels and was located within the F7 gene. Additional signals were observed in MAP3K13, ZNF320, ATP9B and TREM1. Conditional regression analyses suggested that the SNPs contributed to variation in protein concentration independent of AD status. The identification of two putatively novel AD loci (in the Factor VII and ATP9B genes), which have not been located in previous studies despite massive sample sizes, highlights the benefits of an endophenotypic approach for resolving the genetic basis for complex diseases. The coincidence of several of the endophenotypic signals with known AD loci may point to novel genetic interactions and should be further investigated.