General Medicine
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21712
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Browsing General Medicine by Author "Franks, Susan"
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Item Anxiety in Obese Individuals is Associated With Leptin Concentration(2016-03-23) Franks, Susan; Sarker, Marjana; Breuer, GillianBackground: Obese individuals suffer from increased incidence of depression and anxiety. Recently research has suggested that appetite regulating hormones may modulate emotions. Although contradictory thus far, some studies suggest that leptin may play a role in mediating anxiety. Obese individuals have higher leptin concentrations primarily due to augmentation of adipose tissue. In addition to leptin’s role in regulating appetite, leptin receptors are also present in non-hypothalamic regions such as the amygdala and hippocampus that modulate emotional function. Obesity is well-known to confer leptin resistance, bringing into question its potential to contribute to emotional dysregulation. Hypothesis: The following hypotheses were examined: (1) Obese subjects (OB) will have higher anxiety than normal weight controls (NW); (2) Leptin will be positively associated with anxiety independent of obesity status. Methods: Bariatric candidates (OB) (n=71) (Mean age = 44.6 years and Mean BMI = 43 kg/m2 ) underwent pre-surgical assessment. Normal weight controls (NW) (n=30) were assessed for comparison. State anxiety was measured using the State-Trait Anxiety Inventory. Fasting blood samples were taken to analyze serum leptin. Difference in anxiety between OB and NW was analyzed using ANOVA. Logistic regressions were performed to ascertain the effects of leptin with and without obesity status on the likelihood that subjects would have high anxiety. Results: There was a significant correlation between anxiety and leptin (r=.202, p=.004). Anxiety was higher for OB compared to NW (F=7.446, p=.008). Logistic regression for fasting leptin was statistically significant (X2=8.600, p=.003); explaining 12% of the variance in anxiety and correctly classifying 65.3% of the cases. Increasing leptin was significantly associated with increasing likelihood of anxiety. The model for leptin and obesity status was statistically significant (X2=9.566, p=.008). When leptin was adjusted for, the association between the anxiety and obesity was no longer significant. This shows that the relationship between obesity, leptin and anxiety was present in the obese, bariatric candidate sample but not in the NM control group. Conclusion: Bariatric candidates have higher anxiety compared to NW counterparts. The association between leptin and anxiety is not independent of obesity status as it was observed in the obese, bariatric candidate group only. While the cause of anxiety is likely multifactorial further, the association between anxiety and leptin should be further explored. Acknowledgements: This study was supported by NIH grants H75/CCH224064, HL04297 and HL64913 and approved by the IRB at the University of North Texas Health Science Center.Item Executive Cognitive Dysfunction Associated with Total Serum Protein and Bilirubin in Severe Obesity(2016-03-23) Franks, Susan; Bell, StephenBackground: Obesity confers increased risk for several major chronic medical conditions. Studies also have suggested that obesity may carryincreased riskfor future dementia. Recent research has pointed toward obesity’s role in acceleratingage-related cognitive dysfunction; however the underlying process has not been elucidated. The purpose of this study was to explore psychological and biological parameters that may be associated with cognitive dysfunction in severe obesity. Hypothesis: Obese subjects (OB) will have greater deficits in executive cognitive function (EXE) than normal weight controls (NW). Common psychological and biological markers that may predict EXE were explored. Methods: Secondary data analysis of a one-year prospective study in a communitybariatricsurgical setting. OB (n=71) (Mean age=44.6 years, Mean BMI=43 kg/m2) underwent pre- and post-surgical assessments. NW matched for age and gender (n=30) were assessed for comparison.Self-report surveyassessed indicators of psychological dysfunction. Fasting blood samples were taken to analyze common clinical indicators. TheStrooptest was used to determine EXE.Independent t-testwas used to analyze EXE between OB and NW. Relationships between EXE with biological and psychological indicators were explored using Pearson correlation.Significantlycorrelated variables were used in logistic regression to ascertain their ability to predict high or low EXE. Repeated measure t-tests were used to compare changes for OB in EXE at one-year post-surgery. Results: OB hadsignificantly lower EXEthan NW at baseline (t=-2.491, p=.017). EXE was significantly correlated with Total Protein (r=-.279, p=.015) and Total Bilirubin (r=.327, p=.004). Logistic regression for Protein and Bilirubin was significant in predicting cognitive status (X2=8.117, p=.017). Individually each approached significance (Protein p=.060, Bilirubin p=.059). EXE was improved for OB at one year post-surgery EXE (t=-3.216, p=.004). Conclusion: Increases in Total Protein and decreases in Total Bilirubin may be earlybiomarkersof executive dysfunction in severe obesity. These associations may represent distal markers of higher inflammation and lower antioxidant status and are consistent with other work on possible mechanisms for neuropsychiatric sequelae of obesity. Weight loss may ameliorate cognitive risk.Item Internet Accessibility and Perceptions for Possible Online Interventions(2016-03-23) Fulda, Kimberly; Franks, Susan; Cung, TamInternet Accessibility and Perceptions for Possible Online Interventions Tam Cung, DO1; Kimberly Fulda, DRPH1,2; Susan Franks, PHD1,2 1Plaza Medical Center; 2Department of Family Medicine, University of North Texas Health Science Center Fort Worth, TX 76107 BACKGROUND: Healthcare costs are a serious escalating burden, especially within Medicare/Medicaid populations. The Internet and social media have made the flow of information cheaper and more efficient. Previous studies have shown increasing internet penetration into lower social economic households creating a potential opportunity to improve health outcomes. HYPOTHESIS: The primary aim was to evaluate internet accessibility of patients of an urban clinic with large Medicare/Medicaid populations. The secondary aim was to evaluate racial/ethnic differences in preferences for using various formats with healthcare information. METHODS: Patients in a family medicine clinic completed a 25-item survey. Logistic regression was performed to assess the association between race/ethnicity (Caucasian, Hispanic, African American, and Other) and likeliness to use selected formats for healthcare information (very unlikely/unlikely, likely/very likely) while controlling for gender, age, and income. A regression model was run for the following formats: online video, 3-4 page handout, and online chat/forum. Odds ratios and 95% confidence intervals were calculated. RESULTS: A total 107 participants with the mean age of 45 (SD=16) completed the survey. Approximately 67% were females, 85% had internet access, 61% were on Medicare/Medicaid. Racial/ethnic distributions were 32% Hispanic, 33% Caucasian, 25% African-American, and 10% Other. All racial/ethnic groups connected to the internet using a phone more than a laptop, desktop, or tablet. Caucasians (70.0%) and Hispanics (59.3%) selected online video more often than other formats. African-Americans (57.1%) and Others (66.7%) were more likely to select handout than other formats. Adjusted analyses showed racial/ethnic differences in the likelihood of using selected formats to receive healthcare information. African-Americans were less likely than Caucasians to select online video (OR=0.18: 95% CI:0.05-0.69). Hispanics were less likely than Caucasians to select handout (OR=0.15: 95% CI:0.04-0.56) and online chat/forum (OR=0.14; 95% CI:0.03-0.61). CONCLUSIONS: Medicaid/Medicare patients are interested in online interventions, but it is best individualized towards each patient in consideration of culturally related preferences. Future studies should further explore sociocultural differences in format preference given equal accessibility, and compare online interventions directly to traditional resources. ACKNOWLEDGEMENTS: Material cost of the survey was funded by UNTHSC. This study was approved by the IRB at UNTHSC. IRB # 2015-125