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Metcalf CA, Johnson RL, Duffy KA, Freeman EW, Sammel MD, Epperson CN. Depressed, stressed, and inflamed: C-reactive protein linked with depression symptoms in midlife women with both childhood and current life stress. Stress Health 2024; 40:e3313. [PMID: 37679965 PMCID: PMC10918037 DOI: 10.1002/smi.3313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
To determine whether the relationship between inflammatory factors and clinically significant depression symptoms is moderated by high exposure to adverse childhood experiences and current life stressors in a longitudinal community cohort of midlife women. Methods: Participants from the Penn Ovarian Ageing Study community cohort (age at baseline: M = 45.3 [SD = 3.8]) were included in analyses if they had a blood sample measuring basal inflammatory markers during at least one visit where depression symptom severity and current stressful life events were also assessed (N = 142, average number of visits per participant = 1.75 [SD = 0.92]). Approximately annually over the course of 16 years, participants self-reported depression symptom severity using the Centre for Epidemiologic Studies Depression (CESD) Scale, provided menstrual diaries to determine menopause stage, and contributed blood samples. Residual blood samples were assayed for interleukin (IL)-6, IL 1-beta (IL-1β), tumour necrosis factor alpha (TNF-α), and high sensitivity C-reactive protein (hsCRP). Early life stress was quantified using the Adverse Childhood Experiences questionnaire (low [0-1 experience(s)] versus high [≥ 2 experiences]). Current stressful life events were assessed using a structured interview (low [0-1 events] vs. high [≥ 2 events]). Generalised estimating equation models were used to model associations with the outcome of interest-clinically significant depression symptoms (CESD ≥16)-and risk factors: inflammatory marker levels (log transformed), adverse childhood experiences group, and current life stressors group. Covariates included menopause stage, age at study baseline, body mass index, race, and smoking status. We found a significant three-way interaction between log hsCRP levels, adverse childhood experiences group, and current life stressors group on likelihood of experiencing clinically significant depression symptoms (OR: 4.33; 95% CI: 1.22, 15.46; p = 0.024) after adjusting for covariates. Solely for women with high adverse childhood experiences and with high current life stressors, higher hsCRP was associated with higher odds of having clinically significant depression symptoms (OR: 1.46; 95% CI 1.07, 1.98; p = 0.016). This three-way interaction was not significant for IL-6, IL-1β, or TNF-α. For women in midlife with exposure to high adverse childhood experiences and multiple current life stressors, elevated levels of CRP were uniquely associated with clinically significant depression symptoms. Early life adversity and current life stressors represent identifiable individual risk factors whose negative impact may be curtailed with inventions to target inflammation in midlife women.
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Affiliation(s)
- Christina A Metcalf
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel L Johnson
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Korrina A Duffy
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ellen W Freeman
- Department of Obstetrics/Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mary D Sammel
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Page CE, Soreth B, Metcalf CA, Johnson RL, Duffy KA, Sammel MD, Loughead J, Epperson CN. Natural vs. Surgical Postmenopause and Psychological Symptoms Confound the Effect of Menopause on Executive Functioning Domains of Cognitive Experience. Focus (Am Psychiatr Publ) 2024; 22:97-108. [PMID: 38694151 PMCID: PMC11058919 DOI: 10.1176/appi.focus.23021034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Objective The menopause transition is associated with difficulties in executive function. However, it is unclear whether these difficulties persist past perimenopause. This study investigated whether potential confounders, including natural vs. surgical postmenopause and menopause-related psychological symptoms, influence whether executive dysfunction persists into postmenopause. Study Design A cross-sectional sample of women aged 35-65 years (N = 1971) in one of four groups, premenopause, perimenopause, natural postmenopause, and surgical postmenopause, were surveyed. Participants self-reported executive functioning with the Brown Attention Deficit Disorder Scale (BADDS), anxiety symptom severity with the Generalized Anxiety Disorder Questionnaire (GAD-7), and depression symptom severity with the Center for Epidemiologic Studies Depression Scale (CES-D). Main Outcome Measures We analyzed the association between group and BADDS scores using linear regression models - first, by controlling for age, education, and self-reported attention deficit hyperactivity disorder (ADHD) diagnosis (Model #1) and, second, by further controlling for current difficulty sleeping, anxiety, and depression (Model #2). Results In both models, BADDS scores were significantly elevated (indicating more difficulties in executive function) among women in the perimenopausal and surgical postmenopausal groups compared with those in the premenopausal group. Likewise, the perimenopausal and surgical postmenopausal groups had the highest proportions of participants who reported difficulty sleeping and clinical levels of anxiety and depression. BADDS scores were significantly higher in natural postmenopausal vs. premenopausal women without controlling for difficulty sleeping, anxiety, and depression (Model #1), but not when adjusting for these variables (Model #2). Conclusions The type of menopause and psychological symptoms are important confounders of the relationship between the menopause transition and executive dysfunction, and help explain whether executive dysfunction persists or recovers in postmenopause.Reprinted from Maturitas 2023; 170:64-73, with permission from Elsevier. Copyright © 2023.
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Affiliation(s)
- Chloe E Page
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - Brianna Soreth
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - Christina A Metcalf
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - Rachel L Johnson
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - Korrina A Duffy
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - Mary D Sammel
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - James Loughead
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
| | - C Neill Epperson
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Page, Metcalf, Duffy, Sammel, Epperson); Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States (Johnson, Sammel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Soreth, Loughead); Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States (Epperson)
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Millar AM, Doria AM, Choi LM, McGladrey L, Duffy KA, Berkowitz SJ. Past the Pandemic: a virtual intervention supporting the well-being of healthcare workers through the COVID-19 pandemic. Front Psychol 2023; 14:1227895. [PMID: 38022930 PMCID: PMC10650594 DOI: 10.3389/fpsyg.2023.1227895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
To decrease burnout and improve mental health and resiliency among doctors, nurses, and hospital staff during the COVID-19 pandemic, the University of Colorado partnered with ECHO Colorado to offer the state's healthcare workforce an interactive, psychoeducational, and online intervention that encouraged connection and support. The series utilized the Stress Continuum Model as its underlying conceptual framework. Between July 2020 and February 2022, 495 healthcare workers in Colorado participated in the series across eight cohorts. One-way repeated measures ANOVAs were performed to test for differences in pretest and posttest scores on series' objectives. Healthcare workers showed significant improvement from pretest to posttest in (1) knowing when and how to obtain mental health resources, F(1, 111) = 46.497, p < 0.001, (2) recognizing of the importance of being socially connected in managing COVID-related stress, F(1, 123) = 111.159, p < 0.001, (3) managing worries, F(1, 123) = 94.941, p < 0.001, (4) feeling prepared to manage stressors related to the pandemic, F(1, 111) = 100.275, p < 0.001, (5) feeling capable in dealing with challenges that occur daily, F(1, 111) = 87.928, p < 0.001, and (6) understanding the Stress Continuum Model F(1, 123) = 271.049, p < 0.001. This virtual series showed efficacy in improving the well-being of healthcare workers during a pandemic and could serve as a model for mental health support for healthcare workers in other emergency response scenarios.
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Affiliation(s)
- Amanda M. Millar
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
| | - Amanda M. Doria
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
| | - Leslie M. Choi
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
| | - Laura McGladrey
- College of Nursing, University of Colorado School of Medicine, Aurora, CO, United States
| | - Korrina A. Duffy
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
| | - Steven J. Berkowitz
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
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Abstract
PURPOSE OF REVIEW To review recent research regarding cognitive problems during perimenopause, including which menopause-related symptoms, demographic variables, stress exposures, and neural biomarkers are associated with cognitive problems and which interventions demonstrate efficacy at improving cognitive performance. RECENT FINDINGS Cognitive problems are common during perimenopause and have a significant impact on a substantial proportion of women. Evidence continues to indicate that verbal learning and verbal memory are the cognitive functions that are most negatively affected during perimenopause, and new research suggests that perimenopause may also be associated with deficits in processing speed, attention, and working memory. Recent research suggests that the cognitive profiles of women transitioning through perimenopause are heterogenous - with some showing strengths and others demonstrating weaknesses in particular cognitive domains. Depression, sleep problems, and vasomotor symptoms in perimenopause may be associated with cognitive difficulties. Recent neuroimaging studies are identifying changes in activity patterns within brain regions that correlate with cognitive performance in perimenopause, but future causal studies are needed to understand the neural mechanisms of cognitive problems during this time. Although clinical treatment studies for cognitive concerns have historically focused on postmenopause, some small trials in perimenopausal samples have been conducted recently but are frequently underpowered. Current guidelines from the North American Menopause Society do not support the use of hormone therapy at any age for cognitive problems. Animal research demonstrates that estradiol and levonorgestrel combined may alleviate working memory problems. Much progress has been made in understanding how perimenopause impacts cognition, and more research is needed to better identify who is at highest risk and how to meaningfully prevent and alleviate cognitive problems during this reproductive stage. Larger-scale randomized intervention trials specifically during perimenopause are urgently needed to address cognitive concerns in this population of women. More consistent reproductive staging, inclusion of covariates, and analyses examining perimenopause specifically would improve study quality and the ability to draw clear conclusions from this research.
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Affiliation(s)
- Christina A Metcalf
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA.
| | - Korrina A Duffy
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA
| | - Chloe E Page
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA
| | - Andrew M Novick
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, 1890 N. Revere Court MS F546, Aurora, CO, 80045, USA
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Page CE, Soreth B, Metcalf CA, Johnson RL, Duffy KA, Sammel MD, Loughead J, Epperson CN. Natural vs. surgical postmenopause and psychological symptoms confound the effect of menopause on executive functioning domains of cognitive experience. Maturitas 2023; 170:64-73. [PMID: 36806931 DOI: 10.1016/j.maturitas.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/23/2022] [Accepted: 01/06/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The menopause transition is associated with difficulties in executive function. However, it is unclear whether these difficulties persist past perimenopause. This study investigated whether potential confounders, including natural vs. surgical postmenopause and menopause-related psychological symptoms, influence whether executive dysfunction persists into postmenopause. STUDY DESIGN A cross-sectional sample of women aged 35-65 years (N = 1971) in one of four groups, premenopause, perimenopause, natural postmenopause, and surgical postmenopause, were surveyed. Participants self-reported executive functioning with the Brown Attention Deficit Disorder Scale (BADDS), anxiety symptom severity with the Generalized Anxiety Disorder Questionnaire (GAD-7), and depression symptom severity with the Center for Epidemiologic Studies Depression Scale (CESD). MAIN OUTCOME MEASURES We analyzed the association between group and BADDS scores using linear regression models - first, by controlling for age, education, and self-reported attention deficit hyperactivity disorder (ADHD) diagnosis (Model #1) and, second, by further controlling for current difficulty sleeping, anxiety, and depression (Model #2). RESULTS In both models, BADDS scores were significantly elevated (indicating more difficulties in executive function) among women in the perimenopausal and surgical postmenopausal groups compared with those in the premenopausal group. Likewise, the perimenopausal and surgical postmenopausal groups had the highest proportions of participants who reported difficulty sleeping and clinical levels of anxiety and depression. BADDS scores were significantly higher in natural postmenopausal vs. premenopausal women without controlling for difficulty sleeping, anxiety, and depression (Model #1), but not when adjusting for these variables (Model #2). CONCLUSIONS The type of menopause and psychological symptoms are important confounders of the relationship between the menopause transition and executive dysfunction, and help explain whether executive dysfunction persists or recovers in postmenopause.
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Affiliation(s)
- Chloe E Page
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States
| | - Brianna Soreth
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Christina A Metcalf
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States
| | - Korrina A Duffy
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mary D Sammel
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biostatistics and Informatics, Anschutz Medical Campus, University of Colorado School of Public Health, Aurora, CO, United States
| | - James Loughead
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - C Neill Epperson
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States; Department of Family Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, United States.
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Phimphasone-Brady P, Page CE, Ali DA, Haller HC, Duffy KA. Racial and ethnic disparities in women's mental health: a narrative synthesis of systematic reviews and meta-analyses of the US-based samples. Fertil Steril 2023; 119:364-374. [PMID: 36702342 PMCID: PMC10754063 DOI: 10.1016/j.fertnstert.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
Over 2 decades of research indicate the significance of racial or ethnic disparities in mental illness in the United States. However, minoritized racial or ethnic groups tend to report overall lower prevalence rates of psychiatric disorders than White adults, although this varies depending on gender and race or ethnicity. We conducted a rigorous and systematic narrative synthesis on the differences in the prevalence rates and symptoms that differ across racial or ethnic women in depression, anxiety, eating disorders, and premenstrual syndrome or premenstrual dysphoric disorder. Seven systematic reviews and meta-analyses that examined racial/ethnic differences in depression and eating disorders were included. No review that examined racial/ethnic differences in anxiety or premenstrual syndrome or premenstrual dysphoric disorder met inclusion criteria. Methodological quality of the reviews, which was determined by the Assessment of Multiple Systematic Reviews criteria, revealed that the results of 5 reviews were rated as critically low confidence, one review was rated as low confidence, and one review was rated as high confidence. Findings were inconsistent across systematic reviews and meta-analyses because of the methodological differences in the original studies. Overall, racially or ethnically minoritized women generally report lower prevalence rates in depressive and eating disorders than the White women; however, they exhibit different or greater symptom presentation that could influence prevalence estimates depending on the diagnostic criteria followed. Methodological considerations are provided to strengthen the literature on racial or ethnic mental health disparities in women.
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Affiliation(s)
- Phoutdavone Phimphasone-Brady
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.
| | - Chloe E Page
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Diab A Ali
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Heinrich C Haller
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Korrina A Duffy
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
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Duffy KA, Sammel MD, Johnson RL, Kim DR, Wang EY, Ewing G, Hantsoo L, Kornfield SL, Bale TL, Epperson CN. Maternal adverse childhood experiences impact fetal adrenal volume in a sex-specific manner. Biol Sex Differ 2023; 14:7. [PMID: 36803442 PMCID: PMC9936707 DOI: 10.1186/s13293-023-00492-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The mechanisms by which parental early life stress can be transmitted to the next generation, in some cases in a sex-specific manner, are unclear. Maternal preconception stress may increase susceptibility to suboptimal health outcomes via in utero programming of the fetal hypothalamic-pituitary-adrenal (HPA) axis. METHODS We recruited healthy pregnant women (N = 147), dichotomized into low (0 or 1) and high (2+) adverse childhood experience (ACE) groups based on the ACE Questionnaire, to test the hypothesis that maternal ACE history influences fetal adrenal development in a sex-specific manner. At a mean (standard deviation) of 21.5 (1.4) and 29.5 (1.4) weeks gestation, participants underwent three-dimensional ultrasounds to measure fetal adrenal volume, adjusting for fetal body weight (waFAV). RESULTS At ultrasound 1, waFAV was smaller in high versus low ACE males (b = - 0.17; z = - 3.75; p < .001), but females did not differ significantly by maternal ACE group (b = 0.09; z = 1.72; p = .086). Compared to low ACE males, waFAV was smaller for low (b = - 0.20; z = - 4.10; p < .001) and high ACE females (b = - 0.11; z = 2.16; p = .031); however, high ACE males did not differ from low (b = 0.03; z = .57; p = .570) or high ACE females (b = - 0.06; z = - 1.29; p = .196). At ultrasound 2, waFAV did not differ significantly between any maternal ACE/offspring sex subgroups (ps ≥ .055). Perceived stress did not differ between maternal ACE groups at baseline, ultrasound 1, or ultrasound 2 (ps ≥ .148). CONCLUSIONS We observed a significant impact of high maternal ACE history on waFAV, a proxy for fetal adrenal development, but only in males. Our observation that the waFAV in males of mothers with a high ACE history did not differ from the waFAV of females extends preclinical research demonstrating a dysmasculinizing effect of gestational stress on a range of offspring outcomes. Future studies investigating intergenerational transmission of stress should consider the influence of maternal preconception stress on offspring outcomes.
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Affiliation(s)
- Korrina A. Duffy
- grid.430503.10000 0001 0703 675XDepartment of Psychiatry, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO USA ,grid.430503.10000 0001 0703 675XDepartment of Psychiatry, University of Colorado – Anschutz Medical Campus, 1890 N. Revere Court, Aurora, CO 80045 USA
| | - Mary D. Sammel
- grid.430503.10000 0001 0703 675XDepartment of Psychiatry, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO USA ,grid.430503.10000 0001 0703 675XDepartment of Biostatistics and Informatics, University of Colorado School of Public Health – Anschutz Medical Campus, Aurora, CO USA
| | - Rachel L. Johnson
- grid.430503.10000 0001 0703 675XDepartment of Biostatistics and Informatics, University of Colorado School of Public Health – Anschutz Medical Campus, Aurora, CO USA
| | - Deborah R. Kim
- grid.25879.310000 0004 1936 8972Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Eileen Y. Wang
- grid.25879.310000 0004 1936 8972Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Grace Ewing
- grid.266826.e0000 0000 9216 5478University of New England College of Osteopathic Medicine, Biddeford, ME USA
| | - Liisa Hantsoo
- grid.21107.350000 0001 2171 9311Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Sara L. Kornfield
- grid.25879.310000 0004 1936 8972Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Tracy L. Bale
- grid.430503.10000 0001 0703 675XDepartment of Psychiatry, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO USA
| | - C. Neill Epperson
- grid.430503.10000 0001 0703 675XDepartment of Psychiatry, University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO USA ,grid.430503.10000 0001 0703 675XDepartment of Family Medicine, University of Colorado School of Medicine – Anschutz Medical Campus, Aurora, CO USA
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Novick AM, Stoddard J, Johnson RL, Duffy KA, Berkowitz L, Costa VD, Sammel MD, Epperson CN. Adverse childhood experiences and hormonal contraception: Interactive impact on sexual reward function. PLoS One 2023; 18:e0279764. [PMID: 36649369 PMCID: PMC9844925 DOI: 10.1371/journal.pone.0279764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023] Open
Abstract
The current literature suggests that some women are uniquely vulnerable to negative effects of hormonal contraception (HC) on affective processes. However, little data exists as to which factors contribute to such vulnerability. The present study evaluated the impact of prepubertal adverse childhood experiences (ACEs) on reward processing in women taking HC (N = 541) compared to naturally cycling women (N = 488). Participants completed an online survey assessing current and past HC use and exposure to 10 different adverse childhood experiences (ACEs) before puberty (ACE Questionnaire), with participants categorized into groups of low (0-1) versus high (≥2) prepubertal ACE exposure. Participants then completed a reward task rating their expected and experienced valence for images that were either erotic, pleasant (non-erotic), or neutral. Significant interactions emerged between prepubertal ACE exposure and HC use on expected (p = 0.028) and experienced (p = 0.025) valence ratings of erotic images but not pleasant or neutral images. Importantly, follow-up analyses considering whether women experienced HC-induced decreases in sexual desire informed the significant interaction for expected valence ratings of erotic images. For current HC users, prepubertal ACEs interacted with HC-induced decreased sexual desire (p = 0.008), such that high ACE women reporting decreased sexual desire on HC showed substantially decreased ratings for anticipated erotic images compared to both high prepubertal ACE women without decreased sexual desire (p < 0.001) and low prepubertal ACE women also reporting decreased sexual desire (p = 0.010). The interaction was not significant in naturally cycling women reporting previous HC use, suggesting that current HC use could be impacting anticipatory reward processing of sexual stimuli among certain women (e.g., high prepubertal ACE women reporting HC-induced decreases in sexual desire). The study provides rationale for future randomized, controlled trials to account for prepubertal ACE exposure to promote contraceptive selection informed by behavioral evidence.
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Affiliation(s)
- Andrew M. Novick
- Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado, United States of America
- * E-mail:
| | - Joel Stoddard
- Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - Rachel L. Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado, United States of America
| | - Korrina A. Duffy
- Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - Lily Berkowitz
- Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - Vincent D. Costa
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Mary D. Sammel
- Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado, United States of America
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado, United States of America
| | - C. Neill Epperson
- Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado, United States of America
- Department of Family Medicine, School of Medicine, University of Colorado, Aurora, Colorado, United States of America
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Hantsoo L, Duffy KA, Sammel M, Johnson RL, Kim D, Grillon C, Epperson CN. Enduring impact of childhood adversity: Affective modulation of acoustic startle response during pregnancy and postpartum. Physiol Behav 2023; 258:114031. [PMID: 36402424 PMCID: PMC9762518 DOI: 10.1016/j.physbeh.2022.114031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/09/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Women with a history of adverse childhood experiences (ACEs) enter pregnancy and the postpartum with a physiologic system programmed by early life stress, potentially reflected in psychophysiologic reactivity. METHODS We enrolled pregnant, psychiatrically healthy women ≥18 years old. Using the ACE Questionnaire, women were categorized as high (≥2 ACEs; n = 77) or low ACE (<2 ACEs; n = 72). Participants completed an affective modulation of acoustic startle response (ASR) task during pregnancy and postpartum, in which ASR magnitude was measured while participants viewed pleasant, unpleasant, and neutral pictures. Two types of control trials were included (habituation trials presented at baseline and intertrial interval trials presented when no picture was present). RESULTS Among high ACE women, ASR was significantly higher postpartum compared with pregnancy in the unpleasant (p = 0.002, β = 0.46, 95% CI [0.18, 0.74], χ2 = 10.12, z = 3.18) and intertrial interval trials (p = 0.002, β = 0.44, 95% CI [0.16, 0.73], χ2 = 9.25, z = 3.04), accounting for multiple comparisons using a Bonferroni correction at p < 0.005. Among low ACE women, ASR was similar in pregnancy and postpartum. CONCLUSIONS Physiological reactivity increased in high ACE women from pregnancy to postpartum, but no change was observed in low ACE women.
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Affiliation(s)
- Liisa Hantsoo
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway Street, Baltimore, MD, United States.
| | - Korrina A Duffy
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 80045, United States
| | - Mary Sammel
- Department of Biostatistics and Informatics, Colorado School of Public Health, 13001 E. 17(th) Place, Mail Stop B119, Aurora, CO, 80045, United States
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, 13001 E. 17(th) Place, Mail Stop B119, Aurora, CO, 80045, United States
| | - Deborah Kim
- Department of Psychiatry, The University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, United States
| | - Christian Grillon
- National Institute of Mental Health, 15K North Drive, Bethesda, MD, 20892, United States
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 80045, United States; Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, 80045, United States
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Novick AM, Duffy KA, Johnson RL, Sammel MD, Cao W, Strasser AA, Sofuoglu M, Kuzma A, Loughead J, Epperson CN. Progesterone Increases Nicotine Withdrawal and Anxiety in Male but Not Female Smokers During Brief Abstinence. Nicotine Tob Res 2022; 24:1898-1905. [PMID: 35713950 PMCID: PMC9653080 DOI: 10.1093/ntr/ntac146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 05/08/2022] [Accepted: 06/14/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Although exogenous progesterone may hold promise as a treatment for nicotine use disorders, it is unclear whether it is similarly effective in males and females. This study examined the effects of progesterone on nicotine use disorder comprehensively using behavioral, psychological, and neural measures in male and female smokers exposed to brief abstinence. AIMS AND METHODS Thirty-three male and 33 female non-treatment-seeking smokers participated in a double-blind, randomized, placebo-controlled crossover study of 200 mg of progesterone or placebo daily over a four-day abstinence period. Smoking behavior and subjective effects of nicotine were assessed at baseline and after final drug administration. Nicotine withdrawal, smoking urges, mood states, and neural response to smoking cues were measured at baseline, after the first drug administration, and after the final drug administration. RESULTS No main effect of drug (progesterone vs. placebo) emerged for any outcome. Significant sex by drug interactions emerged for nicotine withdrawal (p = .020), perceived strength of nicotine (p = .040), and perceived bad effects of nicotine (p = .029). Males receiving progesterone reported worse nicotine withdrawal (p = .046) and a trend towards decreased bad effects of nicotine (p = .070). Males on progesterone also reported greater tension and anxiety relative to placebo (p = .021). Females on progesterone perceived nicotine's effects as being stronger relative to placebo (p = .046). CONCLUSIONS Progesterone causes sex-dependent effects on smoking-related outcomes during brief abstinence. Specifically, progesterone in males may increase rather than decrease nicotine withdrawal and negative affect during abstinence, potentially hindering efforts to quit smoking. IMPLICATIONS In male and female smokers undergoing a brief period of abstinence, we examined the effects of progesterone on smoking outcomes. While progesterone had limited effects in female smokers, in males, it worsened nicotine withdrawal and negative affect. Our findings emphasize the importance of analyzing sex differences in future studies examining progesterone as a potential treatment and suggest that progesterone in males could potentially exacerbate aspects of nicotine dependence. CLINICALTRIALS.GOV REGISTRATION NCT01954966. https://clinicaltrials.gov/ct2/show/NCT01954966.
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Affiliation(s)
- Andrew M Novick
- Corresponding Author: Andrew M. Novick, MD, PhD, Department of Psychiatry, University of Colorado-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA. Telephone: 303-724-5656; Fax: 844-886-1892; E-mail:
| | - Korrina A Duffy
- Department of Psychiatry, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Mary D Sammel
- Department of Psychiatry, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Wen Cao
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Alexandra Kuzma
- Larner College of Medicine, University of Vermont, Burlington, VM, USA
| | - James Loughead
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - C Neill Epperson
- Department of Psychiatry, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
- Department of Family Medicine, School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
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Novick AM, Duffy KA, Johnson RL, Sammel MD, Cao W, Strasser AA, Sofuoglu M, Kuzma A, Loughead J, Morrow AL, Epperson CN. Effect of progesterone administration in male and female smokers on nicotine withdrawal and neural response to smoking cues: role of progesterone conversion to allopregnanolone. Biol Sex Differ 2022; 13:60. [PMID: 36274158 PMCID: PMC9590190 DOI: 10.1186/s13293-022-00472-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Progesterone administration has therapeutic effects in tobacco use disorder (TUD), with females benefiting more than males. Conversion of progesterone to the neurosteroid allopregnanolone is hypothesized to partly underlie the therapeutic effects of progesterone; however, this has not been investigated clinically. METHODS Smokers (n = 18 males, n = 21 females) participated in a randomized, double-blind, placebo-controlled crossover study of 200 mg progesterone daily across 4 days of abstinence. The ratio of allopregnanolone:progesterone was analyzed in relationship to nicotine withdrawal, smoking urges, mood states, subjective nicotine effects, and neural response to smoking cues. RESULTS Allopregnanolone:progesterone ratio interacted with sex to predict withdrawal symptoms (p = 0.047), such that females with higher allopregnanolone:progesterone ratios reported lower withdrawal severity (b = - 0.98 [- 1.95, - 0.01]; p = 0.048). In addition, allopregnanolone:progesterone ratio interacted with sex to predict confusion (p = 0.014) and fatigue (p = 0.034), such that females with higher allopregnanolone:progesterone ratios reported less confusion (b = - 0.45 [- 0.78, - 0.12]; p = 0.008) and marginally lower fatigue (b = - 0.50 [- 1.03, 0.02]; p = 0.062. Irrespective of sex, higher ratios of allopregnanolone:progesterone were associated with stronger "good effects" of nicotine (b = 8.39 [2.58, 14.20]); p = 0.005) and weaker "bad effects" of nicotine (b = - 7.13 [- 13.53, - 0.73]; p = 0.029). CONCLUSIONS Conversion of progesterone to allopregnanolone correlated with smoking-related outcomes in both sex-dependent and sex-independent ways. Sex-dependent effects suggest that conversion of progesterone to allopregnanolone may contribute to greater therapeutic benefits in females but not males with TUD. Trial registration Clinicaltrials.gov registration, retrospectively registered: NCT01954966; https://clinicaltrials.gov/ct2/show/NCT01954966 \.
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Affiliation(s)
- Andrew M Novick
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA.
| | - Korrina A Duffy
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of CO-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Mary D Sammel
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of CO-Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Wen Cao
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, 06511, USA
| | - Alexandra Kuzma
- Larner College of Medicine, University of Vermont, Burlington, VM, 05405, USA
| | - James Loughead
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - A Leslie Morrow
- Departments of Psychiatry and Pharmacology and the Bowles Center for Alcohol Studies, University of North Carolina School of Medicine, Chapel Hill, NC, 27514, USA
| | - C Neill Epperson
- Department of Psychiatry, School of Medicine, University of CO-Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA
- Department of Family Medicine, School of Medicine, University of CO-Anschutz Medical Campus, Aurora, CO, 80045, USA
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Duffy KA, Bale TL, Epperson CN. Germ Cell Drivers: Transmission of Preconception Stress Across Generations. Front Hum Neurosci 2021; 15:642762. [PMID: 34322003 PMCID: PMC8311293 DOI: 10.3389/fnhum.2021.642762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
Exposure to stress can accelerate maturation and hasten reproduction. Although potentially adaptive, the trade-off is higher risk for morbidity and mortality. In humans, the intergenerational effects of stress have been demonstrated, but the precise mechanisms are unknown. Strikingly, even if parental stress occurs prior to conception, as adults, their offspring show worse mental and physical health. Emerging evidence primarily from preclinical models suggests that epigenetic programming may encode preconception stress exposures in germ cells, potentially impacting the phenotype of the offspring. In this narrative review, we evaluate the strength of the evidence for this mechanism across animals and humans in both males and females. The strongest evidence comes from studies of male mice, in which paternal preconception stress is associated with a host of phenotypic changes in the offspring and stress-induced changes in the small non-coding RNA content in sperm have been implicated. Two recent studies in men provide evidence that some small non-coding RNAs in sperm are responsive to past and current stress, including some of the same ones identified in mice. Although preliminary evidence suggests that findings from mice may map onto men, the next steps will be (1) considering whether stress type, severity, duration, and developmental timing affect germ cell epigenetic markers, (2) determining whether germ cell epigenetic markers contribute to disease risk in the offspring of stress-exposed parents, and (3) overcoming methodological challenges in order to extend this research to females.
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Affiliation(s)
- Korrina A. Duffy
- Colorado Center for Women’s Behavioral Health and Wellness, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
| | - Tracy L. Bale
- Center for Epigenetic Research in Child Health and Brain Development, Department of Pharmacology and Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - C. Neill Epperson
- Colorado Center for Women’s Behavioral Health and Wellness, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
- Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, CO, United States
- Helen and Arthur E. Johnson Depression Center, University of Colorado School of Medicine, Aurora, CO, United States
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Horowitz TS, Treviño M, Gooch IM, Duffy KA. Understanding the Profile of Cancer-Related Cognitive Impairments: A Critique of Meta-Analyses. J Natl Cancer Inst 2020; 111:1009-1015. [PMID: 31127940 DOI: 10.1093/jnci/djz100] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 04/19/2019] [Accepted: 05/16/2019] [Indexed: 11/12/2022] Open
Abstract
A large body of evidence indicates that cancer survivors who have undergone chemotherapy have cognitive impairments. Substantial disagreement exists regarding which cognitive domains are impaired in this population. We suggest that is in part due to inconsistency in how neuropsychological tests are assigned to cognitive domains. The purpose of this paper is to critically analyze the meta-analytic literature on cancer-related cognitive impairments (CRCI) to quantify this inconsistency. We identified all neuropsychological tests reported in seven meta-analyses of the CRCI literature. Although effect sizes were generally negative (indicating impairment), every domain was declared to be impaired in at least one meta-analysis and unimpaired in at least one other meta-analysis. We plotted summary effect sizes from all the meta-analyses and quantified disagreement by computing the observed and ideal distributions of the one-way χ2 statistic. The actual χ2 distributions were noticeably more peaked and shifted to the left than the ideal distributions, indicating substantial disagreement among the meta-analyses in how neuropsychological tests were categorized to domains. A better understanding of the profile of impairments in CRCI is essential for developing effective remediation methods. To accomplish this goal, the research field needs to promote better agreement on how to measure specific cognitive functions.
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Duffy KA, Ziolek TA, Epperson CN. Filling the Regulatory Gap: Potential Role of Institutional Review Boards in Promoting Consideration of Sex as a Biological Variable. J Womens Health (Larchmt) 2020; 29:868-875. [PMID: 32267784 PMCID: PMC7718845 DOI: 10.1089/jwh.2019.8084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Consideration of sex differences in biomedical research is crucial to ensure the safety and effectiveness of drugs and devices for both sexes and to improve the rigor and reproducibility of scientific discoveries. Historically, women were underrepresented in clinical research and sex differences typically were not considered. The U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH) have played a role in improving the representation of women in clinical trials and in encouraging the consideration of sex differences. As it is not appropriate for all studies to be reviewed by the FDA nor do all studies have NIH funding, this results in a regulatory gap. We propose that local institutional review boards (IRBs) and institutional animal care and use committees (IACUCs) provide greater oversight by encouraging researchers to consider sex as a biological variable (SABV) during protocol review. In this perspective article, we review how FDA and NIH policies have fostered change and highlight how IRBs and IACUCs could encourage investigators to consider SABV.
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Affiliation(s)
- Korrina A. Duffy
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Tracy A. Ziolek
- Office of Human Research Affairs, United HealthGroup, Boston, Massachusetts
| | - C. Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
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15
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Epperson CN, Duffy KA, Johnson RL, Sammel MD, Newman DK. Enduring impact of childhood adversity on lower urinary tract symptoms in adult women. Neurourol Urodyn 2020; 39:1472-1481. [PMID: 32368829 DOI: 10.1002/nau.24375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/22/2022]
Abstract
AIMS To determine whether childhood adversity is associated with self-reported lower urinary tract symptoms (LUTS) among older adult women. METHODS A convenience sample of women (≥55 years old) who presented to an academic urology practice or who had participated in a previous bladder health prevention study completed questionnaires including the LUTS Tool (on frequency and bother of LUTS), the Adverse Childhood Experiences (ACEs) Questionnaire, the Spielberger State-Trait Anxiety Inventory, and the Center for Epidemiologic Studies Depression Scale. RESULTS The average age (SD) of participants (N = 151) was 64.7 (6.9) years. The total number of ACEs predicted the total number of LUTS, β = .39 (95% confidence interval [CI] = 0.14, 0.64), P = .003, as well as LUTS frequency, β = .09 (95% CI = 0.04, 0.13), P < .001. ACEs predicted bother for nocturia, β = 0.12 (95% CI = 0.03, 0.22), P = .008. Negative affect symptoms did not mediate the relationship between the total number of ACEs and the total number of LUTS. Rather, ACEs predicted LUTS and negative affect symptoms through (at least partially) independent pathways. Analyses controlled for tobacco use, number of vaginal deliveries, hypertension, overactive bladder medication use, body mass index, income, and race because these variables were significantly associated with the total number of ACEs or total number of LUTS. CONCLUSIONS Childhood adversity has an enduring impact on risk for LUTS in adulthood even when controlling for potential confounds and this relationship cannot be explained by negative affect symptoms.
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Affiliation(s)
- C Neill Epperson
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, Colorado.,Department of Family Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Korrina A Duffy
- Department of Psychiatry, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Rachel L Johnson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Mary D Sammel
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Batt MM, Duffy KA, Novick AM, Metcalf CA, Epperson CN. Is Postpartum Depression Different From Depression Occurring Outside of the Perinatal Period? A Review of the Evidence. Focus (Am Psychiatr Publ) 2020; 18:106-119. [PMID: 33162848 DOI: 10.1176/appi.focus.20190045] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whether a major depressive episode occurring in the postpartum period (i.e., postpartum depression [PPD]) is sufficiently distinct from major depressive episodes occurring at other times (i.e., major depressive disorder) to warrant a separate diagnosis is a point of debate with substantial clinical significance. The evidence for and against diagnostic distinction for PPD is reviewed with respect to epidemiology, etiology, and treatment. Overall, evidence that PPD is distinct from major depressive disorder is mixed and is largely affected by how the postpartum period is defined. For depression occurring in the early postpartum period (variably defined, but typically with onset in the first 8 weeks), symptom severity, heritability, and epigenetic data suggest that PPD may be distinct, whereas depression occurring in the later postpartum period may be more similar to major depressive disorder occurring outside of the perinatal period. The clinical significance of this debate is considerable given that PPD, the most common complication of childbirth, is associated with immediate and enduring adverse effects on maternal and offspring morbidity and mortality. Future research investigating the distinctiveness of PPD from major depressive disorder in general should focus on the early postpartum period when the rapid decline in hormones contributes to a withdrawal state, requiring profound adjustments in central nervous system function.
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Affiliation(s)
- Melissa M Batt
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Korrina A Duffy
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Andrew M Novick
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Christina A Metcalf
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - C Neill Epperson
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
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Duffy KA, Green PA, Chartrand TL. Mimicry and Modeling of Health(-Risk) Behaviors: How Others Impact Our Health(-Risk) Behaviors Without Our Awareness. J Nonverbal Behav 2019. [DOI: 10.1007/s10919-019-00318-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Duffy KA, Luber B, Adcock RA, Chartrand TL. Enhancing activation in the right temporoparietal junction using theta-burst stimulation: Disambiguating between two hypotheses of top-down control of behavioral mimicry. PLoS One 2019; 14:e0211279. [PMID: 30682141 PMCID: PMC6347431 DOI: 10.1371/journal.pone.0211279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/10/2019] [Indexed: 12/31/2022] Open
Abstract
Whereas previous research has focused on the role of the rTPJ when consciously inhibiting mimicry, we test the role of the rTPJ on mimicry within a social interaction, during which mimicking occurs nonconsciously. We wanted to determine whether higher rTPJ activation always inhibits the tendency to imitate (regardless of the context) or whether it facilitates mimicry during social interactions (when mimicking is an adaptive response). Participants received either active or sham intermittent theta-burst stimulation (iTBS: a type of stimulation that increases cortical activation) to the rTPJ. Next, we measured how much participants mimicked the hair and face touching of another person. Participants in the active stimulation condition engaged in significantly less mimicry than those in the sham stimulation condition. This finding suggests that even in a context in which mimicking is adaptive, rTPJ inhibits mimicry rather than facilitating it, supporting the hypothesis that rTPJ enhances representations of self over other regardless of the goals within a given context.
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Affiliation(s)
- Korrina A. Duffy
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America
| | - Bruce Luber
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - R. Alison Adcock
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
- Department of Neurobiology, Duke University, Durham, North Carolina, United States of America
| | - Tanya L. Chartrand
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America
- Fuqua School of Business, Duke University, Durham, North Carolina, United States of America
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Duffy KA, McLaughlin KA, Green PA. Early life adversity and health-risk behaviors: proposed psychological and neural mechanisms. Ann N Y Acad Sci 2018; 1428:151-169. [PMID: 30011075 PMCID: PMC6158062 DOI: 10.1111/nyas.13928] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 12/18/2022]
Abstract
Early life adversity (ELA) is associated with poorer health in adulthood, an association explained, at least in part, by increased engagement in health-risk behaviors (HRBs). In this review, we make the case that ELA influences brain development in ways that increase the likelihood of engaging in HRBs. We argue that ELA alters neural circuitry underpinning cognitive control as well as emotional processing, including networks involved in processing threat and reward. These neural changes are associated psychologically and behaviorally with heightened emotional reactivity, blunted reward responsivity, poorer emotion regulation, and greater delay discounting. We then demonstrate that these adaptations to ELA are associated with an increased risk of smoking cigarettes, drinking alcohol, and eating high-fat, high-sugar foods. Furthermore, we explore how HRBs affect the brain in ways that reinforce addiction and further explain clustering of HRBs.
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Affiliation(s)
- Korrina A. Duffy
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Paige A. Green
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Duffy KA, Helzer EG, Hoyle RH, Fukukura Helzer J, Chartrand TL. Pessimistic expectations and poorer experiences: The role of (low) extraversion in anticipated and experienced enjoyment of social interaction. PLoS One 2018; 13:e0199146. [PMID: 29975736 PMCID: PMC6033406 DOI: 10.1371/journal.pone.0199146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 06/03/2018] [Indexed: 11/19/2022] Open
Abstract
Given research suggesting that social interactions are beneficial, it is unclear why individuals lower in extraversion engage less in social interactions. In this study, we test whether individuals lower in extraversion reap fewer hedonic rewards from social interactions and explore social psychological processes that explain their experiences. Before participants socialized, we measured extraversion, state positive affect, cognitive capacity, and expectations about the social interactions. After participants socialized with one another, we measured state positive affect and cognitive capacity again as well as fear of negative evaluation and belief in limited cognitive capacity. Participants also rated the social skillfulness of each interaction partner. We found that less extraverted individuals expect to feel worse after socializing. However, all but those extremely low in extraversion (17% of sample) actually experience an increase in positive affect after socializing. Surprisingly, those low in extraversion did not show reduced cognitive capacity after socializing. Although they are more likely to believe that cognitive capacity is limited and to be fearful of negative evaluation, these characteristics did not explain the social experience of those low in extraversion.
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Affiliation(s)
- Korrina A. Duffy
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America
| | - Erik G. Helzer
- The Johns Hopkins Carey Business School, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Rick H. Hoyle
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America
| | | | - Tanya L. Chartrand
- Fuqua School of Business, Duke University, Durham, North Carolina, United States of America
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Cielo CM, Kalish JM, Duffy KA, Taylor JA, Marcus CL. 0873 OBSTRUCTIVE SLEEP APNEA IN CHILDREN WITH BECKWITH-WIEDEMANN SYNDROME. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Duffy KA, Harris LT, Chartrand TL, Stanton SJ. Women recovering from social rejection: The effect of the person and the situation on a hormonal mechanism of affiliation. Psychoneuroendocrinology 2017; 76:174-182. [PMID: 27940371 DOI: 10.1016/j.psyneuen.2016.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 01/16/2023]
Abstract
Rejection can motivate either affiliation or withdrawal. In order to study how personality and situational variables influence whether women will be motivated to affiliate versus withdraw, we manipulate social feedback (rejection vs. acceptance) and opportunity for face-to-face interaction (blocked vs. face-to-face) and measure the individual difference variables rejection sensitivity and social anxiety. We test how these variables affect endogenous progesterone and cortisol concentrations, which are presumed to signal motivational responses to rejection. We find that three-way interactions involving social feedback, opportunity for face-to-face interactions, and either social anxiety or rejection sensitivity significantly predict progesterone change, but not cortisol change. Both interactions are driven by sharp progesterone decreases for women high in social anxiety/rejection sensitivity who have been rejected and who have no opportunity to reaffiliate in a face-to-face interaction. This progesterone change may be a physiological marker of motivation for social avoidance following rejection for women who cannot reaffiliate and who are particularly socially anxious or sensitive to rejection.
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Affiliation(s)
- Korrina A Duffy
- Department of Psychology & Neuroscience, Duke University, United States.
| | - Lasana T Harris
- Department of Experimental Psychology, University College London, United Kingdom
| | - Tanya L Chartrand
- Department of Psychology & Neuroscience, Duke University, United States; Fuqua School of Business, Duke University, United States
| | - Steven J Stanton
- Department of Management & Marketing, Oakland University, United States
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Duffy KA, Chartrand TL. The Extravert Advantage: How and When Extraverts Build Rapport With Other People. Psychol Sci 2015; 26:1795-802. [PMID: 26408038 DOI: 10.1177/0956797615600890] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 07/23/2015] [Indexed: 11/16/2022] Open
Abstract
Extraverts are better than introverts at building rapport, but it remains unknown what they do behaviorally to better connect with other individuals. We hypothesized that extraverts mimic more than introverts as a way to build rapport; however, we predicted that this social skillfulness of extraverts emerges only when they are motivated to affiliate. In Study 1, we found that extraversion predicted increased mimicry when an affiliation goal was present, but not when an affiliation goal was absent. In Study 2, we found that mimicry mediates the relationship between extraversion and rapport, but only when an affiliation goal is present. Our findings are the first to identify a behavior that extraverts engage in that helps them build rapport. Furthermore, our studies show that this skillfulness of extraverts emerges only when they are motivated to affiliate, providing evidence in favor of the reward-sensitivity-as-core model of extraversion over the sociability-as-core model of extraversion.
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Affiliation(s)
| | - Tanya L Chartrand
- Department of Psychology & Neuroscience Fuqua School of Business, Duke University
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Binley KM, Radcliffe PA, Trevethick J, Duffy KA, Sudbery PE. The yeast PRS3 gene is required for cell integrity, cell cycle arrest upon nutrient deprivation, ion homeostasis and the proper organization of the actin cytoskeleton. Yeast 1999; 15:1459-69. [PMID: 10514564 DOI: 10.1002/(sici)1097-0061(199910)15:14<1459::aid-yea472>3.0.co;2-a] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PRS3 is one of a family of five genes encoding phosphoribosylpyrophosphate synthetase, an enzyme which catalyses the first step in a variety of biosynthetic pathways, including purine and pyrimidine biosynthesis. We report here that prs3Delta mutants have a number of phenotypes that suggest an unexpected role for PRS3 in linking nutrient availability to cell cycle progression, cell integrity and the actin cytoskeleton. Upon nutrient limitation, prs3Delta mutants fail to arrest in G(1)-cells remain budded and a significant fraction have a G(2) DNA content. Furthermore, in such conditions, prs3Delta mutants have a disorganized actin cytoskeleton: actin accumulates in one or two intensely staining clumps per cell. Prs3Delta mutants also show defects in ion homeostasis and cell integrity. They fail to grow on medium containing 1.0 M NaCl, 5 mM caffeine or when incubated at 37 degrees C. The caffeine and temperature sensitivity are rescued by supplementing the growth medium with 1.0 M sorbitol. These phenotypes resemble those of whi2Delta mutations and indeed, a prs3 allele was recovered in a colony-sectoring screen for mutations that are co-lethal with whi2Delta. However, further investigation showed that the prs3Delta whi2Delta double mutant was viable, with no obvious growth defect compared to either single mutant. In the same colony-sectoring assay, an mpk1 allele was also recovered. Multicopy PRS3 rescued the caffeine sensitivity of this mpk1 allele.
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Affiliation(s)
- K M Binley
- Department of Molecular Biology and Biotechnology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK
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