探索全球前沿学术脉络

Validating Field-Feasible Measures of Recent Khat Use: A Diagnostic Accuracy Study Comparing Amphetamine Immunoassay and Assisted Self-Report Against HPLC in an Ethiopian Male Cohort

Background: Khat (Catha edulis) is a widely consumed natural amphetamine-analog used across East Africa and the Arabian Peninsula. Accurate field-feasible measurement of recent khat use is a prerequisite for large-scale epidemiological research; yet no validated alternatives to laboratory reference methods have been identified in the scientific literature. This nested validation study evaluated the diagnostic accuracy of two point-of-care measures, a commercial amphetamine immunoassay and a Timeline Followback (TLFB) Assisted Self-Report (ASR), against high-performance liquid chromatography (HPLC) quantification of urinary norephedrine (NE), while additionally assessing agreement between the two field measures. Methods: A prospective, random sub-sample of 119 male participants aged 18-40 years from the Gilgel Gibe Field Research Center (GGFRC) longitudinal cohort, Ethiopia (validation timepoint T2, 2015), was used. Three index-reference comparisons were conducted: (1) amphetamine immunoassay (nal von minden, Drug-Screen AMP test, 300 ng/mL cutoff) vs. HPLC; (2) binary ASR (past-week use) vs. HPLC; and (3) binary ASR vs. immunoassay. Sensitivity (positive percent agreement, PPA), specificity (negative percent agreement, NPA), positive predictive value (PPV), negative predictive value (NPV), overall accuracy (overall percent agreement, OPA), and Cohen's kappa were calculated with 95% confidence intervals. Pre-specified secondary analyses applied three pharmacokinetically-informed recall windows (0-2, 3-5, and 6-7 days prior to interview) to ASR. Results: Against HPLC (77 positive, 42 negative), the immunoassay showed perfect specificity (1.0 [0.916-1.0]) and PPV (1.0 [0.91-1.0]) but low sensitivity (0.52 [0.40-0.64]), NPV (0.53 [0.42-0.65]), overall accuracy (0.69 [0.60-0.77]), and weak kappa (0.43 [0.34-0.52]). Binary ASR showed high sensitivity (0.96 [0.89-0.99]), specificity of 0.60 [0.433-0.74], PPV (0.81 [0.72-0.89]), NPV (0.89 [0.72-0.98]), with overall accuracy 0.83 [0.75-0.89] and moderate kappa (0.60 [0.51,0.69]). Restricting ASR to use within 0-2 days improved specificity to 0.69 [0.52-0.84], PPV to 0.86 [0.77-0.93], overall accuracy to 0.87 [0.79-0.93], and kappa to 0.69 [0.61-0.78] (moderate), while sensitivity (0.96 [0.89-0.99]) and NPV (0.89 [0.72-0.98]) remained stable. Against the immunoassay, ASR achieved high PPA of (1.0 [0.91-1.0]), NPA of 0.35 [0.25-0.47], OPA of 0.57 [0.48-0.66], and minimal kappa (0.27 [0.19-0.35]). Conclusions: Time-stratified ASR (0-2 days) is a valid, scalable alternative to biological testing for recent khat use in resource-limited settings. The immunoassay's 300 ng/mL cutoff functions as a marker of heavy or recent high-dose khat use rather than any-use detection. Its perfect specificity and PPV make it valuable as a confirmatory test for substantial exposure, while its lower sensitivity reflects calibration to amphetamine rather than to khat-derived cathinone metabolite. Keywords: khat; Catha edulis; diagnostic accuracy; STARD; self-report; immunoassay; HPLC; Ethiopia; substance use measurement

Genetic overlap with schizophrenia and Parkinson's reveals psychomotor basis of physical activity

Background Physical activity levels are altered across neuropsychiatric disorders. While these traits are heritable, the genetic overlap between normal variation in activity levels and neuropsychiatric disorders that involve motor dysfunction such as schizophrenia and Parkinson's disease (PD) remains unexplored. Objectives To investigate the genetic overlap between physical activity, schizophrenia, and PD. Methods Multi-Trait Analysis of genome-wide association studies (GWAS) was used to boost the GWAS power for objectively measured physical activity (n=89,683) by leveraging three GWAS of self-reported activity (n=124,842-377,234). Genetic overlap between the activity, schizophrenia and PD was characterized using linkage disequilibrium score regression, causal mixture modeling, and local genetic correlations. Pleiotropic variants were identified using the conjunctional false discovery rate, annotated to genes, and investigated for enrichment of biological processes, tissue types and association with GWAS-catalog traits. Results Genetic correlations of physical activity with schizophrenia and PD were negligible (rg=-0.02-0.02, p>0.05), but polygenic overlap was substantial, reflecting mixed effect directions. We identified 32 independent variants shared with schizophrenia and 11 with PD, including CRHR1, MAPT and KANSL1 within the 17q21.31 region. Schizophrenia-shared variants mapped to genes differentially expressed in subcortical regions, especially amygdala and basal ganglia. Gene-set analyses revealed enrichment for mental health and cognitive-behavioural traits (schizophrenia-shared genes) versus structural brain phenotypes and neurodegenerative disorders (PD-shared genes). Conclusions Despite negligible genetic correlations, physical activity shares substantial genetic architecture with schizophrenia and PD. Shared genes implicated brain regions and traits spanning motor and cognitive-affective function, consistent with the psychomotor nature of physical activity.