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BACKGROUND: Genomic risk profiling involves the analysis of genetic variations linked through statistical associations to a range of disease states. There is considerable controversy as to how, and even whether, to incorporate these tests into routine medical care. OBJECTIVE: To assess physician attitudes and uptake of genomic risk profiling among an 'early adopter' practice group. DESIGN: We surveyed members of MDVIP, a national group of primary care physicians (PCPs), currently offering genomic risk profiling as part of their practice. POPULATION: All physicians in the MDVIP network (N =356) RESULTS: We obtained a 44% response rate. One third of respondents had ordered a test for themselves and 42% for a patient. The odds of having ordered personal testing were 10.51-fold higher for those who felt well-informed about genomic risk testing (p < 0.0001). Of those who had not ordered a test for themselves, 60% expressed concerns for patients regarding discrimination by life and longterm/disability insurers, 61% about test cost, and 62% about clinical utility. The odds of ordering testing for their patients was 8.29-fold higher among respondents who had ordered testing for themselves (p < 0.0001). Of those who had ordered testing for patients, concerns about insurance coverage (p = 0.014) and uncertain clinical utility (p = 0.034) were associated with a lower relative frequency of intention to order testing again in the future. CONCLUSIONS: Our findings demonstrate that respondent familiarity was a key predictor of physician ordering behavior and clinical utility was a primary concern for genomic risk profiling. Educational and interpretive support may enhance uptake of genomic risk profiling.

Purpose The rationale for choosing a final group‐based trajectory modeling (GBTM) specification and evaluations of patient adherence patterns within groups are often omitted in the GBTM medication adherence literature. We aimed to (1) reveal the complexity of GBTM and (2) assess model discrimination of patient medication adherence patterns. Methods Medicare administrative claims were used to measure statin medication adherence as a continuous value in the 6 months before an acute myocardial infarction (AMI) hospitalization. Different GBTM specifications beyond default settings were constructed and compared with the Bayesian information criterion. Spaghetti plots were used to compare individual adherence patterns with group averages. Results Overall, 113,296 prevalent statin users met eligibility criteria. Four adherence groups were identified: persistently adherent, moderately adherent, progressively nonadherent, and persistently nonadherent. Spaghetti plots showed the persistently adherent and persistently nonadherent groups had relatively homogeneous adherence patterns that matched predicted trajectories well. Spaghetti plots also showed that, while adherence patterns in the progressively nonadherent group were not as homogeneous, most patients in this group appeared to be discontinuing statin therapy pre‐AMI. Conclusions Subjective decisions are necessary to identify a final trajectory model. Greater transparency and disclosure of these decisions in the medication adherence literature are needed. Individual patient adherence patterns from spaghetti plots provided additional diagnostic information about trajectory models beyond standard model‐fit assessments to determine if group‐average adherence estimates represent homogeneous patterns of medication adherence.

Background Maltreatment by an adult or caregiver during childhood is a prevalent and important predictor of antisocial behaviors in adulthood. A functional promoter polymorphism in the monoamine oxidase A (MAOA) gene has been implicated as a moderating factor in the relationship between childhood maltreatment and antisocial behaviors. Although there have been numerous attempts at replicating this observation, results remain inconclusive. Methods We examined this gene-environment interaction hypothesis in a sample of 3356 White and 960 Black males (ages 24 to 34) participating in the National Longitudinal Study of Adolescent Health (Add Health). Results Primary analysis indicated that childhood maltreatment was a significant risk factor for later behaviors that violate rules and the rights of others (p < 0.05), there were no main effects of MAOA genotype, and MAOA genotype was not a significant moderator of the relationship between maltreatment and antisocial behaviors in our White sample. Post-hoc analyses identified a similar pattern of results among our Black sample, where, maltreatment was not a significant predictor of antisocial behavior. Post-hoc analyses also revealed a main effect of MAOA genotype on having a disposition towards violence in both samples and for violent convictions among our Black sample. None of these post-hoc findings, though, survived correction for multiple testing (p > 0.05). Power analyses indicated that these results were not due to insufficient statistical power. Discussion We could not confirm the hypothesis that MAOA genotype moderates the relationship between childhood maltreatment and adult antisocial behaviors.

BackgroundHospitalizations for acute myocardial infarctions (AMIs) are associated with changes in statin adherence. It is unclear to what extent adherence changes, which patients are likely to change, and how post‐discharge follow‐up is associated with statin adherence change.Methods and ResultsThis retrospective study used Medicare data for all fee‐for‐service beneficiaries 66 years and older with an AMI hospitalization in 2008–2010 and statin use before their index AMI. Multivariable multinomial logistic regression models (odds ratio [OR] and 99% confidence interval [CI]) were applied to assess associations between both patient characteristics and follow‐up with a primary care provider and/or cardiologist with the outcome of statin adherence change (increase or decrease) from the 6‐month pre‐ to 6‐month post‐AMI periods. Of 113 296 patients, 64.0% had no change in adherence, while 19.7% had increased and 16.3% had decreased adherence after AMI hospitalization. Black and Hispanic patients were more likely to have either increased or decreased adherence than white patients. Patients who required coronary artery bypass graft surgery (OR, 1.34; 99% CI, 1.21–1.49) or percutaneous transluminal coronary angioplasty/stent procedure (OR, 1.25; 99% CI, 1.17–1.32) during their index hospitalization were more likely to have increased adherence. Follow‐up with a primary care provider was only mildly associated with increased adherence (OR, 1.08; 99% CI, 1.00–1.16), while follow‐up with a cardiologist (OR, 1.15; 99% CI, 1.05–1.25) or both provider types (OR, 1.21; 99% CI, 1.12–1.30) had stronger associations with increased adherence.ConclusionsPost‐AMI changes in statin adherence varied by patient characteristics, and improved adherence was associated with post‐discharge follow‐up care, particularly with a cardiologist or both a primary care provider and a cardiologist.