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Bubu OM, Kaur SS, Mbah AK, Umasabor-Bubu OQ, Cejudo JR, Debure L, Mullins AE, Parekh A, Kam K, Osakwe ZT, Williams ET, Turner AD, Glodzik L, Rapoport DM, Ogedegbe G, Fieremans E, de Leon MJ, Ayappa I, Jean-Louis G, Masurkar AV, Varga AW, Osorio RS. Obstructive Sleep Apnea and Hypertension with Longitudinal Amyloid-β Burden and Cognitive Changes. Am J Respir Crit Care Med 2022; 206:632-636. [PMID: 35550019 PMCID: PMC9716897 DOI: 10.1164/rccm.202201-0107le] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Ankit Parekh
- Icahn School of Medicine at Mount SinaiNew York, New York
| | - Korey Kam
- Icahn School of Medicine at Mount SinaiNew York, New York
| | | | | | | | | | | | | | | | | | - Indu Ayappa
- Icahn School of Medicine at Mount SinaiNew York, New York
| | | | | | | | - Ricardo S. Osorio
- New York UniversityNew York, New York
- Nathan S. Kline Institute for Psychiatric ResearchOrangeburg, New York
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2
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Bubu OM, Williams ET, Umasabor-Bubu OQ, Kaur SS, Turner AD, Blanc J, Cejudo JR, Mullins AE, Parekh A, Kam K, Osakwe ZT, Nguyen AW, Trammell AR, Mbah AK, de Leon M, Rapoport DM, Ayappa I, Ogedegbe G, Jean-Louis G, Masurkar AV, Varga AW, Osorio RS. Interactive Associations of Neuropsychiatry Inventory-Questionnaire Assessed Sleep Disturbance and Vascular Risk on Alzheimer's Disease Stage Progression in Clinically Normal Older Adults. Front Aging Neurosci 2021; 13:763264. [PMID: 34955813 PMCID: PMC8704133 DOI: 10.3389/fnagi.2021.763264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To determine whether sleep disturbance (SD) and vascular-risk interact to promote Alzheimer's disease (AD) stage-progression in normal, community-dwelling older adults and evaluate their combined risk beyond that of established AD biomarkers. Methods: Longitudinal data from the National Alzheimer's Coordinating Center Uniform-Dataset. SD data (i.e., SD+ vs. SD-), as characterized by the Neuropsychiatric Inventory-Questionnaire, were derived from 10,600 participants at baseline, with at-least one follow-up visit. A subset (n = 361) had baseline cerebrospinal fluid (CSF) biomarkers and MRI data. The Framingham heart study general cardiovascular disease (FHS-CVD) risk-score was used to quantify vascular risk. Amnestic mild cognitive impairment (aMCI) diagnosis during follow-up characterized AD stage-progression. Logistic mixed-effects models with random intercept and slope examined the interaction of SD and vascular risk on prospective aMCI diagnosis. Results: Of the 10,600 participants, 1,017 (9.6%) reported SD and 6,572 (62%) were female. The overall mean (SD) age was 70.5 (6.5), and follow-up time was 5.1 (2.7) years. SD and the FHS-CVD risk-score were each associated with incident aMCI (aOR: 1.42 and aOR: 2.11, p < 0.01 for both). The interaction of SD and FHS-CVD risk-score with time was significant (aOR: 2.87, p < 0.01), suggesting a synergistic effect. SD and FHS-CVD risk-score estimates remained significantly associated with incident aMCI even after adjusting for CSF (Aβ, T-tau, P-tau) and hippocampal volume (n = 361) (aOR: 2.55, p < 0.01), and approximated risk-estimates of each biomarker in the sample where data was available. Conclusions: Clinical measures of sleep and vascular risk may complement current AD biomarkers in assessing risk of cognitive decline in older adults.
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Affiliation(s)
- Omonigho M Bubu
- Department of Psychiatry, Center for Sleep and Brain Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Population Health, Center for Healthful Behavior Change, NYU Grossman School of Medicine, New York, NY, United States
| | - Ellita T Williams
- Department of Population Health, Center for Healthful Behavior Change, NYU Grossman School of Medicine, New York, NY, United States
| | - Ogie Q Umasabor-Bubu
- Division of Epidemiology and Infection Control, State University New York (SUNY) Downstate Medical Center, Brooklyn, NY, United States
| | - Sonya S Kaur
- Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Arlener D Turner
- Department of Psychiatry and Behavioral Sciences, Center for Translational Sleep and Circadian Sciences (TSCS), University of Miami Miller School of Medicine, Miami, FL, United States
| | - Judite Blanc
- Department of Psychiatry and Behavioral Sciences, Center for Translational Sleep and Circadian Sciences (TSCS), University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jaime Ramos Cejudo
- Department of Psychiatry, Center for Sleep and Brain Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Anna E Mullins
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ankit Parekh
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Korey Kam
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Zainab T Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, NY, United States
| | - Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Antoine R Trammell
- Division of General Medicine and Geriatrics, Department of Medicine, Emory Brain Health Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Alfred K Mbah
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, United States
| | - Mony de Leon
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - David M Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavior Change, NYU Grossman School of Medicine, New York, NY, United States
| | - Girardin Jean-Louis
- Department of Psychiatry, Center for Sleep and Brain Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry and Behavioral Sciences, Center for Translational Sleep and Circadian Sciences (TSCS), University of Miami Miller School of Medicine, Miami, FL, United States
| | - Arjun V Masurkar
- Department of Neurology, Center for Cognitive Neurology, New York University School of Medicine, New York, NY, United States
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ricardo S Osorio
- Department of Psychiatry, Center for Sleep and Brain Health, NYU Grossman School of Medicine, New York, NY, United States.,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
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Umasabor-Bubu OQ, Bubu OM, Mbah AK, Nakeshbandi M, Taylor TN. Association between Influenza Vaccination and severe COVID-19 outcomes at a designated COVID-only hospital in Brooklyn. Am J Infect Control 2021; 49:1327-1330. [PMID: 33891988 PMCID: PMC8056988 DOI: 10.1016/j.ajic.2021.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/22/2022]
Abstract
Maintaining influenza vaccination at high coverage has the potential to prevent a proportion of COVID-19 morbidity and mortality. We examined whether flu-vaccination is associated with severe corona virus disease 2019 (COVID-19) disease, as measured by intensive care unit (ICU)-admission, ventilator-use, and mortality. Other outcome measures included hospital length of stay and total ICU days. Our findings showed that flu-vaccination was associated with a significantly reduced likelihood of an ICU admission especially among aged <65 and non-obese patients. Public health promotion of flu-vaccination may help mitigate the overwhelming demand for critical COVID-19 care pending the large-scale availability of COVID-19 vaccines.
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Bubu OM, Umasabor-Bubu OQ, Turner AD, Parekh A, Mullins A, Kam K, Birckbichler M, Fahad M, Mbah AK, Williams NJ, Rapoport DM, de Leon M, Jean-Louis G, Ayappa I, Varga AW, Osorio RS. Self-reported obstructive sleep apnea, amyloid and tau burden, and Alzheimer's disease time-dependent progression. Alzheimers Dement 2020; 17:10.1002/alz.12184. [PMID: 33090679 PMCID: PMC8026765 DOI: 10.1002/alz.12184] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is associated with Alzheimer's disease (AD) biomarkers in cognitively normal (CN) and mild cognitive impaired (MCI) participants. However, independent and combined effects of OSA, amyloid beta (Aβ) and tau-accumulation on AD time-dependent progression risk is unclear. METHODS Study participants grouped by biomarker profile, as described by the A/T/N scheme, where "A" refers to aggregated Aβ, "T" aggregated tau, and "N" to neurodegeneration, included 258 CN (OSA-positive [OSA+] [A+TN+ n = 10, A+/TN- n = 6, A-/TN+ n = 10, A-/TN- n = 6 and OSA-negative [OSA-] [A+TN+ n = 84, A+/TN- n = 11, A-/TN+ n = 96, A-/TN- n = 36]) and 785 MCI (OSA+ [A+TN+ n = 35, A+/TN- n = 15, A-/TN+ n = 25, A-/TN- n = 16] and OSA- [A+TN+ n = 388, A+/TN- n = 28, A-/TN+ n = 164, A-/TN- n = 114]) older-adults from the Alzheimer's Disease Neuroimaging Initiative cohort. Cox proportional hazards regression models estimated the relative hazard of progression from CN-to-MCI and MCI-to-AD, among baseline OSA CN and MCI patients, respectively. Multi-level logistic mixed-effects models with random intercept and slope investigated the synergistic associations of self-reported OSA, Aβ, and tau burden with prospective cognitive decline. RESULTS Independent of TN-status (CN and MCI), OSA+/Aβ+ participants were approximately two to four times more likely to progress to MCI/AD (P < .001) and progressed 6 to 18 months earlier (P < .001), compared to other participants combined (ie, OSA+/Aβ-, OSA-/Aβ+, and OSA-/Aβ-). Notably, OSA+/Aβ- versus OSA-/Aβ- (CN and MCI) and OSA+/TN- versus OSA-/TN- (CN) participants showed no difference in the risk and time-to-MCI/AD progression. Mixed effects models demonstrated OSA synergism with Aβ (CN and MCI [β = 1.13, 95% confidence interval (CI), 0.74 to 1.52, and β = 1.18, 95%CI, 0.82 to 1.54]) respectively, and with tau (MCI [β = 1.31, 95% CI, 0.87 to 1.47]), P < .001 for all. DISCUSSION OSA acts in synergism with Aβ and with tau, and all three acting together result in synergistic neurodegenerative mechanisms especially as Aβ and tau accumulation becomes increasingly abnormal, thus leading to shorter progression time to MCI/AD in CN and MCI-OSA patients, respectively.
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Affiliation(s)
- Omonigho M. Bubu
- Center for Sleep and Brain Health, Department of
Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
- Center for Healthful Behavior Change, Department of
Population Health, New York Grossman School of Medicine, New York, USA
| | - Ogie Q. Umasabor-Bubu
- Department of Epidemiology and Infection Control, State
University New York Downstate Medical Center, Brooklyn, NY, USA
| | - Arlener D Turner
- Center for Sleep and Brain Health, Department of
Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Ankit Parekh
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anna Mullins
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Korey Kam
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Mukhtar Fahad
- Department of Epidemiology and Biostatistics, College of
Public Health, University of South Florida, Tampa, FL, USA
| | - Alfred K Mbah
- Department of Epidemiology and Biostatistics, College of
Public Health, University of South Florida, Tampa, FL, USA
| | - Natasha J. Williams
- Center for Healthful Behavior Change, Department of
Population Health, New York Grossman School of Medicine, New York, USA
| | - David M. Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mony de Leon
- Brain Health Imaging Institute, Department of Radiology,
Weill Cornell Medicine, New York, NY, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of
Population Health, New York Grossman School of Medicine, New York, USA
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew W. Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at
the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo S. Osorio
- Center for Sleep and Brain Health, Department of
Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, New York, USA
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5
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Eirene O, Bubu OM, Donley T, Blanc J, Madera C, Turner A, Mbah AK, Williams NJ, Youngstedt S, Shochat T, Seixas AA, Osorio RS, Jean-Louis G. 0864 Race/ethnicity And Sex-dependent Effects Of Metabolic Burden Across Different Age-categories On Trends In Self-reported Sleep Duration: Findings From The National Health Interview Survey, 2004-2013. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
We examined race and sex-dependent effects of metabolic burden across different age-categories on trends in self-reported sleep duration for the U.S. non-institutionalized civilian population.
Methods
We analyzed data from the National Health Interview Survey (NHIS) adults aged 18-85 from 2004 to 2013 (N=258,158). Metabolic burden was characterized by obesity (BMI>30), dyslipidemia, diabetes, and hypertension morbidity burden levels. Racial/ethnic categories included non-Hispanic Whites (NHW), Blacks/African Americans (AAs) and Hispanics. Sleep duration within a 24-hour period on average was categorized as short sleep (≤ 6hrs), adequate sleep (7-8 hrs.), and long sleep (≥ 9hrs). Age was categorized as 18 - <26, 26 - <65 and 65 - 85. Adjusted multinomial logistic regression models stratified by race, sex and age-categories examined effects of metabolic burden on trends in self-reported sleep duration.
Results
The prevalence of short sleep duration was relatively stable from 2004-2012 for NHW and all females. However, AA and Hispanic males showed consistent increase in the rates of short sleepers beginning in 2007 through 2013 especially for ages 18 - <26, and 26 - <65 (P <.001 for trend). For all racial/ethnic categories, compared to individuals aged 18 - <26, individuals aged 26 - <65 were more likely to report short sleep (aOR: 1.55, 95% CI: 1.50-1.61) and individuals aged 65 - 85 were more likely to be long sleepers (aOR: 1.95, 95% CI: 1.86-2.05). Interestingly, the rate of short sleep increased as the metabolic burden increased (P <.001 for trend). This trend was more pronounced among AA and Hispanic males aged 65 - 85 with ≥ 2 metabolic conditions who were more likely to report short sleep (aOR: 1.77, 95% CI: 1.44-2.19 and aOR: 1.45, 95% CI: 1.17-1.93 respectively), compared to NHW males.
Conclusion
Increased metabolic burden among minority populations and especially in the elderly male, affect sleep and may have consequences for treating these populations.
Support
NIH/NIA/NHLBI (L30-AG064670, CIRAD P30AG059303 Pilot, T32HL129953, R01AG056531, R25HL105444, R25NS094093, K07AG05268503, R01HL142066, K23HL125939)
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Affiliation(s)
- O Eirene
- NYU School of Medicine, New York, NY
| | - O M Bubu
- NYU School of Medicine, New York, NY
| | - T Donley
- NYU School of Medicine, New York, NY
| | - J Blanc
- NYU School of Medicine, New York, NY
| | - C Madera
- NYU School of Medicine, New York, NY
| | - A Turner
- NYU School of Medicine, New York, NY
| | - A K Mbah
- University of South Florida, Tampa, FL
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Christina M, Bubu OM, Donley T, Blanc J, Oji E, Turner AD, Mbah AK, Williams NJ, Youngstedt S, Shochat T, Azizi SA, Osorio RS, Jean-Louis G. 0863 Age-categorized Trends In Self-reported Sleep Duration For The Non-institutionalized U.s. Civilian Population From 2004-2013: Considerations Of Racial/ethnic Variations. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
We examined age-categorized trends in self-reported sleep duration using data from the National Health Interview Survey (NHIS) 2004-2013 and explored how these trends may vary based on individuals’ race/ethnicity.
Methods
Study participants were aged 18-85 (N=258,158). Sleep duration within a 24-hour period on average was categorized as ≤ 6hrs (short-sleep), 7-8 hours (adequate-sleep), and ≥ 9hrs (long-sleep). Age was categorized as 18 - <26, 26 - <65 and 65 - 85. Racial categories included non-Hispanic Whites (NHW), Blacks/African Americans (AAs) and Hispanics. Adjusted multinomial logistic regression models examined trends in self-reported sleep duration across age-categories and assessed race/ethnic differences in these trends.
Results
Mean sleep duration (hrs.) across all years was 7.4, 7.0, and 7.5, for ages 18 - <26, 26 - <65 and 65 - 85, respectively and was relatively stable from 2004-2013. However, compared to individuals ages 18 - <26, those categorized as ages 26 - <65 were 55% more likely to be short sleepers while those ages 65 - 85 were 20% less likely to be short sleepers (P < .001 for all). Mean sleep duration was 7.2hrs, for NHW and 7.1hrs for AAs and Hispanics, and showed increasing trend toward short sleep beginning in 2007 through 2013 (P <.01 for trend). In the age 18 - <26 category, compared to whites, blacks and Hispanics were 35% and 29% more likely to be short sleepers, respectively. In the age 26 - <65 category, compared to whites, blacks and Hispanics were 35% and 21% more likely to be short sleepers, respectively. In the age 65 - 85 category, compared to whites, blacks were 19% more likely to be short sleepers (P < .001 for all).
Conclusion
Continued surveillance of population-level sleep trends among minority populations is essential as growing race/ethnic (age specific) disparities in self-reported sleep duration may have consequences for racial/ethnic health disparities.
Support
NIH/NIA/NHLBI (L30-AG064670, CIRAD P30AG059303 Pilot, T32HL129953, R01AG056531, R25HL105444, R25NS094093, K07AG05268503, R01HL142066, K23HL125939)
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Affiliation(s)
| | - O M Bubu
- NYU School of Medicine, New York, NY
| | - T Donley
- NYU School of Medicine, New York, NY
| | - J Blanc
- NYU School of Medicine, New York, NY
| | - E Oji
- NYU School of Medicine, New York, NY
| | | | - A K Mbah
- University of South Florida, Tampa, FL
| | | | | | | | - S A Azizi
- NYU School of Medicine, New York, NY
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Bubu OM, Turner AD, Parekh A, Mullins A, Kam K, Umasabor-Bubu OQ, Mbah AK, Williams NJ, Varga AW, Rapoport DM, Ayappa I, Jean-Louis G, Osorio RS. 1150 Obstructive Sleep Apnea-dependent Racial/ethnic And Sex-specific Mechanisms Underlying Alzheimer’s Disease Risk: A Retrospective Cohort Analysis Of In-lab PSG Sleep Study Data. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
We examined race and sex-specific biologic mechanisms of the relationship between obstructive sleep apnea (OSA) and incident AD.
Methods
Retrospective cohort analysis utilizing in-lab PSG sleep study data conducted among older adults between 2001 and 2005. OSA was defined using AHI4%. Participants had no history of cognitive decline or AD at baseline and included 663 (284 Non-Hispanic White (NHW), 207 Black/African-American (AA) and 172 Hispanic) OSA-patients matched on age, sex, race, BMI, 1:1 ratio to 663 (unexposed cohort I from sleep clinic) and 1:4 ratio to 2652 (unexposed cohort II from non-sleep clinics) non-OSA individuals. Incident AD was assessed annually from 2001-2013 with ICD-9-CM code 331.0. Adjusted cox proportional hazard regression models examined race and sex-specific biologic mechanisms including hypoxia, fragmentation and duration measures of OSA and AD risk.
Results
Of the 3,978 participants, 2,148 (54%) were women. Mean age at baseline was 72.6 (7.3) years. Over a mean follow-up time of 8.6 (1.4) years, 358 (9%) individuals (212 female) developed AD (119 NHW, 134 AAs, and 105 Hispanics). Relative to non-OSA individuals, OSA-patients had a higher risk of incident AD, with AAs and females showing stronger risk estimates (aHR: 2.24, 1.83, and 1.73, P <.001 for all, for AAs, Hispanics and NHW respectively; and aHR: 2.38, and 1.37, P <.001 for all, for female and male respectively). Measures of hypoxia, sleep fragmentation and sleep duration were associated with increase AD risk (P <.01 for all). Relative to NHW, AAs and Hispanics demonstrated up to 20% stronger effects/estimates on hypoxia and sleep duration measures. Relative to males, females demonstrated up to 25% stronger effects/estimates on sleep fragmentation measures, and 15% weaker effects/estimates on hypoxia measures (P <.01 for all).
Conclusion
Among OSA-patients, mechanisms related to hypoxia, sleep fragmentation and duration measures increase AD risk and may underlie race/ethnicity and sex disparities in AD.
Support
NIH/NIA/NHLBI (L30-AG064670, CIRAD P30AG059303 Pilot, T32HL129953, R01HL118624, R21AG049348, R21AG055002, R01AG056031, R01AG022374, R21AG059179, R01AG056682, R01AG056531, K07AG05268503, K23HL125939)
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Affiliation(s)
- O M Bubu
- NYU School of Medicine, New York, NY
| | | | - A Parekh
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - A Mullins
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Kam
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - A K Mbah
- University of South Florida, Tampa, FL
| | | | - A W Varga
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - D M Rapoport
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - I Ayappa
- Icahn School of Medicine at Mount Sinai, New York, NY
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8
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Bubu OM, Mbah AK, Williams NJ, Turner AD, Parekh A, Mullins AE, Kam K, Umasabor-Bubu OQ, Varga AW, Rapoport DM, Ayappa I, Jean-Louis G, Osorio RS. 1153 Association Of Nocturnal Sleep Disturbance And Prospective Cognitive Decline In Cognitive Normal Elderly: Findings From The National Alzheimer’s Coordinating Center Uniform Dataset. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
We determined whether nocturnal sleep disturbance (NSD) is associated with prospective cognitive decline in clinically normal older adults
Methods
Prospective longitudinal study utilizing data from the National Alzheimer’s Coordinating Center (NACC) Uniform Data set (UDS). NSD data, as characterized by the Neuropsychiatric Inventory Questionnaire (NPI-Q), were derived from 10,600 participants at baseline, with at least one UDS follow-up visit, from 32 National Institute of Aging Alzheimer’s Disease Research Centers (ADRC). Prospective cognitive decline was characterized as incident mild cognitive impairment (MCI) diagnosis during UDS follow-up. Logistic mixed-effects model with random intercept and slope examined associations between the NSD and longitudinal cognitive decline. All models included age at baseline, sex, years of education, APOE ε4 status and their interactions with time. Time was operationalized as years from baseline for each participant.
Results
Of the 10,600 cognitively normal participants at baseline, 1,017 (8.6%) had NSD. The proportion of males versus females with sleep problems was 10.1% vs. 9.3% respectively. For participants with NSD and no NSD, the mean (SD) age was 71 (7.3) and 70 (5.7) years and average follow-up time was 5.2 (2.6) and 4.9 (2.7) years, respectively. Participants with NSD were significantly more likely to develop incident MCI during UDS follow-up (OR: 1.42, p =.003). The interaction of NSD with time was significant (p< .001) suggesting an increase in the likelihood of conversion to MCI increased over time. Furthermore, there were significant differences in mean conversion rates to MCI in the NSD group when the previous time-point was compared to the next (p<01), with a time dependent dose response in the risk of conversion to MCI observed.
Conclusion
In elderly cognitive-normal individuals, nocturnal sleep disturbance is associated with a time-dependent progression risk to MCI. These findings are consistent with the role of disturbed sleep in the development of Alzheimer’s Disease.
Support
NIH/NIA/NHLBI (L30-AG064670, CIRAD P30AG059303 Pilot, T32HL129953, R01HL118624, R21AG049348, R21AG055002, R01AG056031, R01AG022374, R21AG059179, R01AG056682, R01AG056531, K07AG05268503, K23HL125939)
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Affiliation(s)
- O M Bubu
- NYU School of Medicine, New York, NY
| | - A K Mbah
- University of South Florida, Tampa, FL
| | | | | | - A Parekh
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - A E Mullins
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Kam
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - A W Varga
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - D M Rapoport
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - I Ayappa
- Icahn School of Medicine at Mount Sinai, New York, NY
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9
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Bubu OM, Pirraglia E, Andrade AG, Sharma RA, Gimenez-Badia S, Umasabor-Bubu OQ, Hogan MM, Shim AM, Mukhtar F, Sharma N, Mbah AK, Seixas AA, Kam K, Zizi F, Borenstein AR, Mortimer JA, Kip KE, Morgan D, Rosenzweig I, Ayappa I, Rapoport DM, Jean-Louis G, Varga AW, Osorio RS. Obstructive sleep apnea and longitudinal Alzheimer's disease biomarker changes. Sleep 2019; 42:zsz048. [PMID: 30794315 PMCID: PMC6765111 DOI: 10.1093/sleep/zsz048] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [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: 10/12/2018] [Revised: 01/11/2019] [Accepted: 02/19/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To determine the effect of self-reported clinical diagnosis of obstructive sleep apnea (OSA) on longitudinal changes in brain amyloid PET and CSF biomarkers (Aβ42, T-tau, and P-tau) in cognitively normal (NL), mild cognitive impairment (MCI), and Alzheimer's disease (AD) elderly. METHODS Longitudinal study with mean follow-up time of 2.52 ± 0.51 years. Data were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Participants included 516 NL, 798 MCI, and 325 AD elderly. Main outcomes were annual rate of change in brain amyloid burden (i.e. longitudinal increases in florbetapir PET uptake or decreases in CSF Aβ42 levels); and tau protein aggregation (i.e. longitudinal increases in CSF total tau [T-tau] and phosphorylated tau [P-tau]). Adjusted multilevel mixed effects linear regression models with randomly varying intercepts and slopes was used to test whether the rate of biomarker change differed between participants with and without OSA. RESULTS In NL and MCI groups, OSA+ subjects experienced faster annual increase in florbetapir uptake (B = .06, 95% CI = .02, .11 and B = .08, 95% CI = .05, .12, respectively) and decrease in CSF Aβ42 levels (B = -2.71, 95% CI = -3.11, -2.35 and B = -2.62, 95% CI = -3.23, -2.03, respectively); as well as increases in CSF T-tau (B = 3.68, 95% CI = 3.31, 4.07 and B = 2.21, 95% CI = 1.58, 2.86, respectively) and P-tau (B = 1.221, 95% CI = 1.02, 1.42 and B = 1.74, 95% CI = 1.22, 2.27, respectively); compared with OSA- participants. No significant variations in the biomarker changes over time were seen in the AD group. CONCLUSIONS In both NL and MCI, elderly, clinical interventions aimed to treat OSA are needed to test if OSA treatment may affect the progression of cognitive impairment due to AD.
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Affiliation(s)
- Omonigho M Bubu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - Elizabeth Pirraglia
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
| | - Andreia G Andrade
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
| | - Ram A Sharma
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
| | - Sandra Gimenez-Badia
- Multidisciplinary Sleep Unit - Respiratory Department, Hospital de la Santa Creu i Sant Pau. IIB Sant Pau Department of Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | | | - Megan M Hogan
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL
| | - Amanda M Shim
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL
| | - Fahad Mukhtar
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Nidhi Sharma
- Dipartmento Di Scienze Biochimica A. Rossi Fanelli, University of Rome, Rome, Italy
| | - Alfred K Mbah
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Azizi A Seixas
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - Korey Kam
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ferdinand Zizi
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - Amy R Borenstein
- Department of Family Medicine and Public Health, University of California—San Diego, San Diego, CA
| | - James A Mortimer
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Kevin E Kip
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - David Morgan
- Department of Molecular Science and Translational Medicine, Michigan State University, Grand Rapids, MI
- Byrd Alzheimer’s Disease Institute, College of Medicine, Psychiatry and Behavioral Neurosciences, University of South Florida Health, Tampa, FL
| | - Ivana Rosenzweig
- Sleep Disorders Centre, Guy’s Hospital, Great Maze Pond, London, UK
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King’s College London, London, UK
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - David M Rapoport
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Girardin Jean-Louis
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, NY
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
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Nguyen AH, Giuliano AR, Mbah AK, Sanchez-Anguiano A. HIV/sexually transmitted infections and intimate partner violence: Results from the Togo 2013-2014 Demographic and Health Survey. Int J STD AIDS 2017; 28:1380-1388. [PMID: 28457202 DOI: 10.1177/0956462417705970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Among clinic-based studies, intimate partner violence (IPV) has been shown to contribute to HIV/AIDS among young girls and women. Results from studies among the general population have been less consistent. This study evaluated the associations between HIV infection, any sexually transmitted infections (STIs), and IPV in a population-based sample of Togolese women. Data from the Togo 2013-2014 Demographic and Health Survey were utilized for these analyses. Women aged 15-49, who were currently married, had HIV test results, and answered the Domestic Violence Module were analyzed (n = 2386). Generalized linear mixed-models adjusting for sociodemographic variables, risk behaviors, and cluster effect were used to estimate HIV and STI risks with experience of IPV. HIV prevalence was 2.8%. Prevalence of IPV was 39% among HIV-positive women and 38% among HIV-negative women. Significant associations between IPV and HIV infection were not detected. Adjusted models found significant associations between experience of any IPV and having had STIs (OR 2.05, 95% CI 1.25-3.35). The high rates of violence in this setting warrant community-based interventions that address abuse and gender inequity. These interventions should also discuss the spectrum of STIs in relation to IPV.
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Affiliation(s)
- Anthony H Nguyen
- 1 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Anna R Giuliano
- 2 Center for Infection Research on Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Alfred K Mbah
- 1 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Aurora Sanchez-Anguiano
- 1 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
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de la Cruz CZ, Coulter M, O'Rourke K, Mbah AK, Salihu HM. Post-traumatic stress disorder following emergency peripartum hysterectomy. Arch Gynecol Obstet 2016; 294:681-8. [PMID: 26781263 DOI: 10.1007/s00404-016-4008-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 05/05/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Our objective was to explore if women who experience emergency peripartum hysterectomy (EPH), a type of severe maternal morbidity, are more likely to screen positive for post-traumatic stress disorder (PTSD) compared to women who did not experience EPH. METHODS Using a retrospective cohort design, women were sampled through online communities. Participants completed online screens for PTSD. Additionally, women provided sociodemographic, obstetric, psychiatric, and psychosocial information. We conducted bivariate and logistic regression analyses, then Monte Carlo simulation and propensity score matching to calculate the risk of screening positive for PTSD after EPH. RESULTS 74 exposed women (experienced EPH) and 335 non-exposed women (did not experience EPH) completed the survey. EPH survivors were nearly two times more likely to screen positive for PTSD (aOR: 1.90; 95 % CI: 1.57, 2.30), and nearly 2.5 times more likely to screen positive for PTSD at 6 months postpartum compared to women who were not EPH survivors (aOR: 2.46; 95 % CI: 1.92, 3.16). CONCLUSION The association of EPH and PTSD was statistically significant, indicating a need for further research, and the potential need for support services for these women following childbirth.
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Affiliation(s)
- Cara Z de la Cruz
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA.
| | - Martha Coulter
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Kathleen O'Rourke
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Alfred K Mbah
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Hamisu M Salihu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA.,Baylor College of Medicine, 3701 Kirby Drive, Houston, TX, 77098, USA
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van Oostwaard MF, Langenveld J, Schuit E, Papatsonis DN, Brown MA, Byaruhanga RN, Bhattacharya S, Campbell DM, Chappell LC, Chiaffarino F, Crippa I, Facchinetti F, Ferrazzani S, Ferrazzi E, Figueiró-Filho EA, Gaugler-Senden IP, Haavaldsen C, Lykke JA, Mbah AK, Oliveira VM, Poston L, Redman CW, Salim R, Thilaganathan B, Vergani P, Zhang J, Steegers EA, Mol BWJ, Ganzevoort W. Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis. Am J Obstet Gynecol 2015; 212:624.e1-17. [PMID: 25582098 DOI: 10.1016/j.ajog.2015.01.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 11/10/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We performed an individual participant data (IPD) metaanalysis to calculate the recurrence risk of hypertensive disorders of pregnancy (HDP) and recurrence of individual hypertensive syndromes. STUDY DESIGN We performed an electronic literature search for cohort studies that reported on women experiencing HDP and who had a subsequent pregnancy. The principal investigators were contacted and informed of our study; we requested their original study data. The data were merged to form one combined database. The results will be presented as percentages with 95% confidence interval (CI) and odds ratios with 95% CI. RESULTS Of 94 eligible cohort studies, we obtained IPD of 22 studies, including a total of 99,415 women. Pooled data of 64 studies that used published data (IPD where available) showed a recurrence rate of 18.1% (n=152,213; 95% CI, 17.9-18.3%). In the 22 studies that are included in our IPD, the recurrence rate of a HDP was 20.7% (95% CI, 20.4-20.9%). Recurrence manifested as preeclampsia in 13.8% of the studies (95% CI,13.6-14.1%), gestational hypertension in 8.6% of the studies (95% CI, 8.4-8.8%) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome in 0.2% of the studies (95% CI, 0.16-0.25%). The delivery of a small-for-gestational-age child accompanied the recurrent HDP in 3.4% of the studies (95% CI, 3.2-3.6%). Concomitant HELLP syndrome or delivery of a small-for-gestational-age child increased the risk of recurrence of HDP. Recurrence increased with decreasing gestational age at delivery in the index pregnancy. If the HDP recurred, in general it was milder, regarding maximum diastolic blood pressure, proteinuria, the use of oral antihypertensive and anticonvulsive medication, the delivery of a small-for-gestational-age child, premature delivery, and perinatal death. Normotensive women experienced chronic hypertension after pregnancy more often after experiencing recurrence (odds ratio, 3.7; 95% CI, 2.3-6.1). CONCLUSION Among women that experience hypertension in pregnancy, the recurrence rate in a next pregnancy is relatively low, and the course of disease is milder for most women with recurrent disease. These reassuring data should be used for shared decision-making in women who consider a new pregnancy after a pregnancy that was complicated by hypertension.
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13
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August EM, Salihu HM, de la Cruz CZ, Mbah AK, Alio AP, Lo Berry E. A quasi-experimental design to assess the effectiveness of the federal healthy start in reducing preterm birth among obese mothers. J Prim Prev 2015; 36:205-12. [PMID: 25762508 DOI: 10.1007/s10935-015-0389-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We assessed the impact of Central Hillsborough Healthy Start (CHHS), a federally-funded program dedicated to improving maternal and infant outcomes in a population of high-risk obese mothers in the socio-economically challenged community of East Tampa in Florida on preterm birth and very preterm birth (VPTB). We utilized hospital discharge records linked to vital statistics data in Florida (2004-2007) to study obese women with a singleton birth, matching mothers in the CHHS catchment area with those from the rest of Florida. We conducted conditional logistic regression with the matched data. Obese mothers in the CHHS service area had a 61% lower likelihood of having a VPTB infant than obese mothers in the rest of the state (AOR = 0.39, 95% CI 0.21-0.70). Obese women of reproductive age may benefit from services from federal Healthy Start programs. Study findings underscore the need for further research to explore the impact of such programs.
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Affiliation(s)
- Euna M August
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs, MDC56, Tampa, FL, 33612, USA,
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14
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Wobb JL, Chen PY, Shah C, Moran MS, Shaitelman SF, Vicini FA, Mbah AK, Lyden M, Beitsch P. Nomogram for Predicting the Risk of Locoregional Recurrence in Patients Treated With Accelerated Partial-Breast Irradiation. Int J Radiat Oncol Biol Phys 2015; 91:312-8. [DOI: 10.1016/j.ijrobp.2014.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/04/2014] [Accepted: 09/22/2014] [Indexed: 12/12/2022]
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15
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Mbah AK, Hamisu I, Naik E, Salihu HM. Estimating benchmark exposure for air particulate matter using latent class models. Risk Anal 2014; 34:2053-2062. [PMID: 25082358 DOI: 10.1111/risa.12256] [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: 06/03/2023]
Abstract
We performed benchmark exposure (BME) calculations for particulate matter when multiple dichotomous outcome variables are involved using latent class modeling techniques and generated separate results for both the extra risk and additional risk. The use of latent class models in this study is advantageous because it combined several outcomes into just two classes (namely, a high-risk class and a low-risk class) and compared these two classes to obtain the BME levels. This novel approach addresses a key problem in risk estimation--namely, the multiple comparisons problem, where separate regression models are fitted for each outcome variable and the reference exposure will rely on the results of the best-fitting model. Because of the complex nature of the estimation process, the bootstrap approach was used to estimate the reference exposure level, thereby reducing uncertainty in the obtained values. The methodology developed in this article was applied to environmental data by identifying unmeasured class membership (e.g., morbidity vs. no morbidity class) among infants in utero using observed characteristics that included low birth weight, preterm birth, and small for gestational age.
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Affiliation(s)
- Alfred K Mbah
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA
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16
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Salemi JL, Whiteman VE, August EM, Chandler K, Mbah AK, Salihu HM. Maternal hepatitis B and hepatitis C infection and neonatal neurological outcomes. J Viral Hepat 2014; 21:e144-53. [PMID: 24666386 DOI: 10.1111/jvh.12250] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 10/30/2013] [Accepted: 01/12/2014] [Indexed: 12/13/2022]
Abstract
To examine the associations between maternal hepatitis B (HBV) and hepatitis C (HCV) infection status and selected infant neurological outcomes diagnosed at birth, we conducted a population-based, retrospective cohort study on singleton live births in Florida from 1998 to 2009. Primary exposures included maternal HBV and HCV monoinfection. The neurological outcomes included brachial plexus injury, cephalhematoma, foetal distress, feeding difficulties, intraventricular h aemorrhage and neonatal seizures. Multivariable logistic regression models were used to generate odds ratios (OR) and 95% confidence intervals (CI) that were adjusted for socio-demographic characteristics, risky behaviours, pregnancy complications and pre-existing medical conditions, and timing of delivery. The risk of an adverse neurological outcome was higher in infants born to mothers with hepatitis viral infection (7.2% for HCV, 5.0% for HBV), compared with infants of hepatitis virus-free mothers (4.2%). After adjusting for potential confounders, women with HBV were twice as likely to have infants who suffered from brachial plexus injury (OR = 2.04, 95% CI = 1.15-3.60), while those with HCV had an elevated odds of having an infant with feeding difficulties (OR: 1.32, 95% CI = 1.06-1.64) and a borderline increased likelihood for neonatal seizures (OR = 1.74, 95% CI = 0.98-3.10). Additionally, HCV+ mothers had a 22% increased odds of having an infant with some type of adverse neurological outcome (OR: 1.22, 95% CI = 1.03-1.44). Our findings add to current understanding of the association between maternal HBV/HCV infections and infant neurological outcomes. Further research evaluating the role of maternal HBV and HCV infections (including viraemia, treatment) on pregnancy outcomes is warranted.
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Affiliation(s)
- J L Salemi
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
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17
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Wobb J, Chen PY, Shah C, Moran MS, Shaitelman SF, Vicini FA, Mbah AK, Lyden M, Beitsch PD. Nomogram for predicting the risk of locoregional recurrence in patients treated with accelerated partial-breast irradiation. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.26_suppl.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
59 Background: There are limited tools to guide clinicians regarding the risk of locoregional recurrence (LRR) in patients wishing to pursue APBI. The purpose of this study was to develop a nomogram taking into account clinicopathologic features to predict LRR in patients treated with APBI for early stage breast cancer. Methods: A total of 2,000 breasts (1,990 women) were treated with APBI at William Beaumont Hospital (N=551) or on the ASBrS MammoSite Registry Trial (N=1,449). Techniques included multiplanar interstitial catheters (N=98), balloon-based brachytherapy (N=1,689), and 3D conformal radiotherapy (N=213). Clinicopathologic variables were gathered prospectively. A nomogram was formulated utilizing the Cox Proportional Hazards Regression model to predict for LRR. This was validated by generating a bias-corrected index and cross-validated with a C-index. Results: Median follow-up was 5.5 years (0.9 to 18.3). Of the 2,000 cases, 435 were excluded due to missing data. Univariate analysis found that age <50, pre/perimenopausal status, close/positive margins, ER negativity, and high grade were associated with a higher frequency of LRR. These five independent covariates were used to create adjusted estimates, weighting each on a scale of 0 to 100. The total score is identified on a points scale to obtain the probability of an LRR over the study period. The model demonstrated good concordance for predicting LRR with a C-index of 0.641. Conclusions: The formulation of a practical, easy-to-use nomogram for calculating the risk of LRR in patients undergoing APBI will help guide the appropriate selection of patients for off-protocol utilization of APBI.
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Affiliation(s)
- Jessica Wobb
- Oakland University William Beaumont School of Medicine, Beaumont Cancer Institute, Royal Oak, MI
| | | | - Chirag Shah
- Summa-Akron City/St. Thomas Hospitals, Akron, OH
| | | | - Simona Flora Shaitelman
- Radiation Therapy Oncology Group, The University of Texas MD Anderson Cancer Center, Houston, TX
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Salinas-Miranda AA, Nash MC, Salemi JL, Mbah AK, Salihu HM. Cutting-edge technology for public health workforce training in comparative effectiveness research. Health Informatics J 2014; 19:101-15. [PMID: 23715210 DOI: 10.1177/1460458212461366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A critical mass of public health practitioners with expertise in analytic techniques and best practices in comparative effectiveness research is needed to fuel informed decisions and improve the quality of health care. The purpose of this case study is to describe the development and formative evaluation of a technology-enhanced comparative effectiveness research learning curriculum and to assess its potential utility to improve core comparative effectiveness research competencies among the public health workforce. Selected public health experts formed a multidisciplinary research collaborative and participated in the development and evaluation of a blended 15-week comprehensive e-comparative effectiveness research training program, which incorporated an array of health informatics technologies. Results indicate that research-based organizations can use a systematic, flexible, and rapid means of instructing their workforce using technology-enhanced authoring tools, learning management systems, survey research software, online communities of practice, and mobile communication for effective and creative comparative effectiveness research training of the public health workforce.
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Salihu HM, Salemi JL, Nash MC, Chandler K, Mbah AK, Alio AP. Assessing the Economic Impact of Paternal Involvement: A Comparison of the Generalized Linear Model Versus Decision Analysis Trees. Matern Child Health J 2013; 18:1380-90. [DOI: 10.1007/s10995-013-1372-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Salihu HM, Diamond E, August EM, Rahman S, Mogos MF, Mbah AK. Maternal pregnancy weight gain and the risk of placental abruption. Nutr Rev 2013; 71 Suppl 1:S9-17. [DOI: 10.1111/nure.12063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | - Elise Diamond
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
| | | | - Shams Rahman
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
| | - Mulubrhan F Mogos
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
| | - Alfred K Mbah
- University of South Florida; College of Public Health; Department of Epidemiology and Biostatistics; Tampa; Florida; USA
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Alio AP, Mbah AK, Shah K, August EM, Dejoy S, Adegoke K, Marty PJ, Salihu HM, Aliyu MH. Paternal involvement and fetal morbidity outcomes in HIV/AIDS: a population-based study. Am J Mens Health 2013; 9:6-14. [PMID: 23913897 DOI: 10.1177/1557988313498890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Prior research indicates that infants with absent fathers are vulnerable to unfavorable fetal birth outcomes. HIV is a recognized risk factor for adverse birth outcomes. However, the influence of paternal involvement on fetal morbidity outcomes in women with HIV remains poorly understood. Using linked hospital discharge data and vital statistics records for the state of Florida (1998-2007), the authors assessed the association between paternal involvement and fetal growth outcomes (i.e., low birth weight [LBW], very low birth weight [VLBW], preterm birth [PTB], very preterm birth [VPTB], and small for gestational age [SGA]) among HIV-positive mothers (N=4,719). Propensity score matching was used to match cases (absent fathers) to controls (fathers involved). Conditional logistic regression was employed to generate adjusted odds ratios (OR). Mothers of infants with absent fathers were more likely to be Black, younger (<35 years old), and unmarried with at least a high school education (p<.01). They were also more likely to have a history of drug (p<.01) and alcohol (p=.02) abuse. These differences disappeared after propensity score matching. Infants of HIV-positive mothers with absent paternal involvement during pregnancy had elevated risks for adverse fetal outcomes (LBW: OR=1.30, 95% confidence interval [CI]=1.05-1.60; VLBW: OR=1.72, 95% CI=1.05-2.82; PTB: OR=1.38, 95% CI=1.13-1.69; VPTB: OR=1.81, 95% CI=1.13-2.90). Absence of fathers increases the likelihood of adverse fetal morbidity outcomes in women with HIV infection. These findings underscore the importance of paternal involvement during pregnancy, especially as an important component of programs for prevention of mother-to-child transmission of HIV.
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Affiliation(s)
- Amina P Alio
- University of Rochester Medical School, Rochester, NY, USA
| | | | - Krupa Shah
- University of Rochester Medical School, Rochester, NY, USA
| | | | | | | | | | | | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Nashville, TN, USA
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Mbah AK, Salihu HM, Dagne G, Wilson RE, Bruder K. Exposure to environmental tobacco smoke and risk of antenatal depression: application of latent variable modeling. Arch Womens Ment Health 2013; 16:293-302. [PMID: 23615931 DOI: 10.1007/s00737-013-0347-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 03/27/2013] [Indexed: 11/29/2022]
Abstract
This study sought to determine the impact of passive smoking on the risk for depressive symptoms during pregnancy. In this prospective study, 236 pregnant women were recruited at less than 20 weeks of gestation from a university-affiliated obstetric clinic from November 2009 through July 2011. Tobacco use/exposure was measured using questionnaire and confirmed by salivary cotinine analysis. The Edinburgh Perinatal Depression Scale (EPDS) was employed to capture perinatal depressive symptomatology. Traditionally, a cutoff of 13 is utilized to indicate depressive symptoms in the perinatal population. However, this approach is vulnerable to measurement errors that are inherent in assessing depression using cutoff points. Therefore, in this analysis, we apply a flexible approach (latent variable modeling) that accounts for measurement errors thereby reducing bias in the estimates of association. Significant differences were observed in the mean EPDS scores across non-smokers (mean ± SD = 4.8 ± 4.8), passive smokers (5.3 ± 5.5) and active smokers (7.4 ± 6.1) [p value = 0.02]. For each itemized response of the EPDS, passive smokers demonstrated an increased risk for depressive symptoms with the greatest risk exhibited by items 8 and 9 of the questionnaire (feeling sad or miserable and feeling unhappy [and]crying, respectively). In addition, for each item of the EPDS, a dose-response pattern was revealed with non-smokers having the least risk of depressive symptoms during pregnancy and active smokers having the greatest risk. Women who are exposed to secondhand smoke are at elevated risk for depressive symptoms during pregnancy.
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Affiliation(s)
- Alfred K Mbah
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
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Abstract
Youth violence is a critical public health problem across races/ethnicities in the United States. Although the differential association between substance use and physical aggression has been empirically proven, no tests have assessed the moderating effects of sociocultural differences in such associations. The purpose of this study is to test the moderating impact of race/ethnicity-as an indicator of sociocultural differences--on the associations between substance use and adolescent aggression, by conducting a validity assessment of a physical aggression measure for high school students with emphasis on Hispanics and other minorities. A cross-sectional, secondary data analysis of the 2007 national Youth Risk Behavior Survey, with a representative sample of all U.S. high school students, was conducted. Contingency table and chi-square test evaluated the statistical relationship between substance use (alcohol, marijuana, either, or both) and self-reports of physical aggression, race/ethnicity, age, and sex of the respondent. Three logistic regression analyses assessed the effect of race/ethnicity on the likelihood of reporting physical aggression by overall substance use and type of substance use. Statistical significant associations were found between physical aggression and alcohol and/or marijuana use. The self-report of substance use (marijuana or alcohol) and alcohol use significantly increased the likelihood of physical aggression across races/ethnicities, highest among racial/ethnic minorities (Blacks > Hispanic > Others > Whites). The differential impact of substance use on physical aggression was confirmed, and such impact was moderated by the sociocultural context (race/ethnicity) of the adolescent. In-depth validity assessments are needed to confirm this study's predictive validity findings.
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Salihu HM, Ghaji N, Mbah AK, Alio AP, August EM, Boubakari I. Particulate pollutants and racial/ethnic disparity in feto-infant morbidity outcomes. Matern Child Health J 2013; 16:1679-87. [PMID: 21833758 DOI: 10.1007/s10995-011-0868-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We sought to assess the association between air particulate pollutants and feto-infant morbidity outcomes across racial/ethnic subgroups. This is a retrospective cohort study from 2000 through 2007 based on three linked databases: (1) The Florida Hospital Discharge database; (2) The vital statistics records of singleton live births in Florida; (3) Air pollution and meteorological data from the Environmental Protection Agency. Using computerized mathematical modeling, we assigned exposure values of the air pollutants of interest (PM(2.5), PM(10) and the PM coarse fraction [PM(10) - PM(2.5)]) to mothers over the period of pregnancy based on Euclidean minimum distance from the air pollution monitoring sites. The primary outcomes of interest were: low birth weight, very low birth weight, preterm birth, very preterm birth, and small for gestational age (SGA). We used adjusted odds ratios to approximate relative risks. We observed increased risk for overall feto-infant morbidity outcome in women exposed to any of the three particulate pollutants (values above the median). Exposed women had increased odds for low birth weight, very low birth weight and preterm birth with the greatest risk being that for very low birth weight (AOR = 1.27, 95% CI = 1.08-1.49). Black women exposed to any particulate pollutant had the greatest odds for all the morbidity outcomes, most pronounced for very low birth weight (AOR = 3.32, 95% CI = 2.56-4.30). Environmental particulate pollutants are associated with adverse feto-infant outcomes among exposed women, especially blacks. Black-white disparity in adverse fetal outcomes is widened in the presence of these pollutants, which provide a target for intervention.
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Affiliation(s)
- Hamisu M Salihu
- Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA.
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Salemi JL, Tanner JP, Bailey M, Mbah AK, Salihu HM. Creation and evaluation of a multi-layered maternal and child health database for comparative effectiveness research. J Registry Manag 2013; 40:14-28. [PMID: 23778693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND As high-speed computers and sophisticated software packages for data linkage become increasingly available, investigators from nearly every arena are creating massive databases for epidemiologic and comparative effectiveness research (CER). Decisions made during database construction have a major impact on the accuracy and completeness of the data. Considering their potential use in informing health-care decisions, it is vital that we increase transparency of these data, including a thorough understanding of the record linkage strategy implemented and an evaluation of linked and unlinked records so that potential biases can be addressed. METHODS Our target population included infants born to Florida-resident women from January 1, 1998 through December 31, 2009 with a valid birth certificate record. We used a stepwise deterministic record linkage strategy to link to any and all inpatient, ambulatory, and emergency department hospital visits from birth through December 31, 2010, and to identify deaths that occurred within the first year of life. Thus, each infant was followed up for at least 1 year after birth or until death, up to a maximum of 13 years. We investigated linkage rates and associations between linked status (linked vs unlinked) and a host of maternal and infant demographic and reproductive characteristics, all extracted from the birth certificate files. Bivariate county-level maps were created to describe the impact of both maternal race/ethnicity and maternal nativity on the geographic variation in linkage rates. RESULTS During the 13-year study period, there were 2,549,738 birth certificate records for infants born alive to Florida resident women, and with no indication of an adoption. We were able to link 2,347,738 (92.1 percent) birth certificate records to an infant birth hospitalization record. The highest crude unlinked rates were seen among infants who died during their first year of life (35.9 percent), births in which the documented principal source of payment was "self-pay" (28.1 percent), and infants born to mothers with less than a ninth-grade education (26.0 percent), who were foreign-born (12.9 percent), and who self-identified as Hispanic (12.8 percent). After adjusting for other related and potentially confounding variables, several of these infant and maternal characteristics were associated with increased odds of failure to link infant birth records. CONCLUSION Using a stepwise deterministic linkage approach, we achieved a high linkage rate of several data sources, and produced a reliable, multipurpose database that can be used for observational, comparative effectiveness, and health services research in maternal and child health (MCH) populations. Our findings underscore the importance of evaluating routinely collected health data and increasing clarity regarding the strengths and limitations of linked electronic data sources. The resultant database will be of immense utility to researchers, health planners, and policy makers as well as other stakeholders interested in MCH outcome studies.
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Salihu HM, Stanley KM, August EM, Weldeselasse H, Mbah AK, Whiteman VE. The association between HIV/AIDS during pregnancy and fetal growth parameters in Florida: a population based study. Curr HIV Res 2012; 10:539-45. [PMID: 22716103 DOI: 10.2174/157016212802429839] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 05/19/2012] [Accepted: 06/08/2012] [Indexed: 11/22/2022]
Abstract
In this population-based retrospective study, we sought to investigate the association between HIV/AIDS during pregnancy and adverse birth outcomes, including low birth weight (LBW), very low birth weight (VLBW), preterm birth (PTB), very preterm birth (VPTB), and small for gestational age (SGA), among women in Florida by sociodemographic variables. Using data from Florida's maternally linked birth cohort files, we examined singleton live births in the state during 1998 to 2007 (N = 1,698,107). The study population was categorized based on the maternal HIV/AIDS status. Poisson regression models were used to generate adjusted rate ratios (ARR) to estimate the association between HIV/AIDS status and fetal growth parameters. The main outcome measures were fetal growth parameters, including LBW, VLBW, PTB, VPTB, and SGA. As compared to HIV/AIDS-negative women, mothers with HIV/AIDS had elevated risks for LBW (ARR = 1.40; 95% CI = 1.30-1.50), VLBW (ARR = 1.25; 95% CI = 1.04-1.51), SGA (ARR = 1.26; 95% CI = 1.17-1.35), PTB (ARR = 1.23; 95% CI = 1.03-1.47), and VPTB (ARR = 1.27; 95% CI = 1.20-1.36). Risk estimates for LBW and SGA were highest among Hispanics mothers with HIV/AIDS, while white mothers with HIV/AIDS had the highest risk levels for VLBW and PTB, compared to their HIV/AIDS negative counterparts. Our findings show that women with HIV/AIDS have elevated risks for inhibited fetal growth and shortened gestation with important racial/ethnic variation. This is the first known population-based study that reveals racial/ethnic differences in HIV/AIDS-related fetal growth morbidity outcomes.
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Affiliation(s)
- Hamisu M Salihu
- University of South Florida, College of Public Health, Department of Epidemiology and Biostatistics, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL 33612, USA.
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Mbah AK, Alio AP, Fombo DW, Bruder K, Dagne G, Salihu HM. Association between cocaine abuse in pregnancy and placenta-associated syndromes using propensity score matching approach. Early Hum Dev 2012; 88:333-7. [PMID: 21975278 DOI: 10.1016/j.earlhumdev.2011.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 08/18/2011] [Accepted: 09/06/2011] [Indexed: 10/17/2022]
Abstract
AIMS We used propensity scores matching techniques to assess the association between maternal cocaine abuse in pregnancy and the occurrence of placenta-associated syndromes (PAS). STUDY DESIGN Mothers who abused cocaine (n=5026) were matched to controls (n=5026) from a sample of 1,693,197, unexposed mothers in Florida from 1998 to 2007. Cocaine abuse was identified using the ICD-9 principal and secondary diagnosis codes (304.2 for cocaine dependence and 305.6 for cocaine abuse). The outcome of interest, PAS, was identified as any indication in diagnosis field of ICD-9-CM codes for: placental abruption (641.2), oligohydramnios (658.0), placental infarction (656.7, 656.8, 656.9), gestational hypertension (642.3, 642.9), preeclampsia (642.4, 642.5, and 642.7) or eclampsia (642.6). RESULTS Nearly 6% of mothers in the study sample experienced a condition associated with PAS prior to matching. Women who abused cocaine were 58% more likely to have PAS when compared to women who did not (OR=1.48, 95% confidence interval: 1.33, 1.66). Women who abused cocaine were at elevated odds for placental abruption, placenta infarction and preeclampsia with the most pronounced odds noted for placental abruption (OR=2.79, 95% confidence interval: 2.19, 3.55). CONCLUSIONS These findings indicate that cocaine abuse during pregnancy is associated with more placenta-related disorders than previously reported.
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Affiliation(s)
- Alfred K Mbah
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL 33612, United States
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Alio AP, Salihu HM, McIntosh C, August EM, Weldeselasse H, Sanchez E, Mbah AK. The effect of paternal age on fetal birth outcomes. Am J Mens Health 2012; 6:427-35. [PMID: 22564913 DOI: 10.1177/1557988312440718] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Research investigating the role of paternal age in adverse birth outcomes is limited. This population-based retrospective cohort study used the Missouri maternally linked data set from 1989 to 2005 to assess whether paternal age affects fetal birth outcomes: low birth weight (LBW), preterm birth (PTB), stillbirth, and small size for gestational age (SGA). We examined these outcomes among infants across seven paternal age-groups (<20, 20-24, 25-29, 30-34, 35-39, 40-45, and >45 years) using the generalized estimating equation framework. Compared with infants born to younger fathers (25-29 years), infants born to fathers aged 40 to 45 years had a 24% increased risk of stillbirth but a reduced risk of SGA. A 48% increased risk of late stillbirth was observed in infants born to advanced paternal age (>45 years). Moreover, advanced paternal age (>45 years) was observed to result in a 19%, 13%, and 29% greater risk for LBW, PTB, and VPTB (very preterm birth) infants, respectively. Infants born to fathers aged 30 to 39 years had a lower risk of LBW, PTB, and SGA, whereas those born to fathers aged 24 years or younger had an elevated likelihood of experiencing these same adverse outcomes. These findings demonstrate that paternal age influences birth outcomes and warrants further investigation.
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Salihu HM, August EM, Mbah AK, de Cuba RJ, Alio AP, Rowland-Mishkit V, Berry EL. The impact of birth spacing on subsequent feto-infant outcomes among community enrollees of a federal healthy start project. J Community Health 2012; 37:137-42. [PMID: 21656254 DOI: 10.1007/s10900-011-9427-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Numerous studies have shown an association between shorter birth intervals, and several adverse fetal outcomes, including low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). However, there is little evidence on the effectiveness of interconception care on fetal outcomes associated with sub-optimal interpregnancy interval (IPI). The purpose of this study is to examine the influence of the Federal Healthy Start's interconception care services on IPI and fetal growth outcomes. This is a retrospective cohort study used records from the Central Hillsborough Healthy Start program in Tampa, Florida linked to Florida vital statistics data covering the period 2002-2009. Only first and second pregnancies were considered, and interpregnancy interval (IPI), the exposure of interest, was categorized in months as 0-5, 6-17, 18-23, and ≥24. The following feto-infant morbidities were considered as primary outcomes: LBW, PTB, and SGA. A composite variable coding the presence of any of the aforementioned adverse fetal events was also created. Multivariate logistic regression modeling was applied Overall, mothers with the shortest IPI (0-5 months: AOR = 1.39, 95% CI 1.23-1.56) and longest IPI (≥60 months: AOR = 1.13, 95% CI 1.03-1.23) were at a greater risk for adverse fetal growth outcomes, compared to the referent category (18-23 months). Our findings support the need for inter conception care that addresses IPI and delayed childbearing among women.
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Affiliation(s)
- Hamisu M Salihu
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA.
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Mbah AK, Sharma PP, Alio AP, Fombo DW, Bruder K, Salihu HM. Previous cesarean section, gestational age at first delivery and subsequent risk of pre-eclampsia in obese mothers. Arch Gynecol Obstet 2011; 285:1375-81. [DOI: 10.1007/s00404-011-2161-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 11/23/2011] [Indexed: 10/14/2022]
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Alio AP, Mbah AK, Grunsten RA, Salihu HM. Teenage pregnancy and the influence of paternal involvement on fetal outcomes. J Pediatr Adolesc Gynecol 2011; 24:404-9. [PMID: 22099734 DOI: 10.1016/j.jpag.2011.07.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 07/11/2011] [Accepted: 07/11/2011] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE We sought to assess the impact of paternal involvement on adverse birth outcomes in teenage mothers. DESIGN Using vital records data, we generated odds ratios (OR) and 95% confidence intervals (CI) to assess the association between paternal involvement and fetal outcomes in 192,747 teenage mothers. Paternal involvement status was based on presence/absence of paternal first and/or last name on the birth certificate. SETTING Data were obtained from vital records data from singleton births in Florida between 1998 and 2007. PARTICIPANTS The study population consisted of 192,747 teenage mothers ≤ 20 years old with live single births in the State of Florida. MAIN OUTCOME MEASURES Low birth weight, very low birth weight, preterm birth, very preterm birth, small for gestational age (SGA), neonatal death, post-neonatal death, and infant death. RESULTS Risks of SGA (OR = 1.06; 95% CI: 1.03-1.10), low birth weight (OR = 1.19; 95% CI: 1.15-1.23), very low birth weight (OR = 1.53; 95% CI: 1.41-1.67), preterm birth (OR = 1.21; 95% CI: 1.17-1.25), and very preterm birth (OR = 1.49; 95% CI: 1.38-1.62) were elevated for mothers in the father-absent group. When results were stratified by race, black teenagers in the father-absent group had the highest risks of adverse birth outcomes when compared to white teenagers in the father-involved group. CONCLUSIONS Lack of paternal involvement is a risk factor for adverse birth outcomes among teenage mothers; risks are most pronounced among African-American teenagers. Our findings suggest that increased paternal involvement can have a positive impact on birth outcomes for teenage mothers, which may be important for decreasing the racial disparities in infant morbidities. More studies assessing the impact of greater paternal involvement on birth outcomes are needed.
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Affiliation(s)
- Amina P Alio
- Department of Community and Preventive Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY 14642, USA.
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August EM, Salihu HM, Weldeselasse H, Biroscak BJ, Mbah AK, Alio AP. Infant mortality and subsequent risk of stillbirth: a retrospective cohort study. BJOG 2011; 118:1636-45. [DOI: 10.1111/j.1471-0528.2011.03137.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Alio AP, Clayton HB, Garba M, Mbah AK, Daley E, Salihu HM. Spousal concordance in attitudes toward violence and reported physical abuse in African couples. J Interpers Violence 2011; 26:2790-2810. [PMID: 21156681 DOI: 10.1177/0886260510390951] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE We examined the potential association between African couples' concordance on attitudes toward violence (ATV) and risk for intimate partner violence (IPV). METHOD Analyses included 13,837 couples from Demographic and Health Surveys conducted between 2003 and 2007, from six African countries. Concordance on ATV was defined as both spouses justifying physical abuse, and IPV was defined as incidence of a physically violent act against the wife. We constructed a concordance measure from the surveys to assess overall and country-level differences in couple's ATV concordance rates and assessed the association between concordance in ATV and IPV using hierarchical regression modeling that adjusted for multilevel influences on risk estimates. Negative concordance (perfect agreement in negative ATV) was used as referent category in all analyses. FINDINGS Overall, spousal ATV concordance was associated with higher likelihood for IPV (adjusted odds ratio [AOR] = 2.27, 95% confidence interval [CI] = [2.01, 2.56]). The level of wealth, educational attainment, rural/urban residence, presence of a cowife, religion, maternal age, and parity were characteristics that predicted the occurrence of IPV within couples. Spousal ATV concordance was significantly associated with violence in every African nation included in the analysis except Rwanda. CONCLUSIONS African couples with high rates of ATV concor- dance experience higher risks for IPV, with some variation in magnitude of risk across countries. In African settings, ATV positive concordance could serve as a supplemental screening tool to detect spousal violence. Understanding ATV could potentially enhance our ability to formulate public health intervention to detect and prevent spousal abuse.
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Affiliation(s)
- Amina P Alio
- University of South Florida, Tampa, FL 33612, USA.
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Abstract
BACKGROUND AND AIMS To examine the association between maternal hepatitis B and C mono- and co-infections with singleton pregnancy outcomes in the state of Florida. METHODS We analysed all Florida births from 1998 to 2007 using birth certificate records linked to hospital discharge data. The main outcomes of interest were selected pregnancy outcomes including preterm birth, low birth weight (LBW), small for gestational age (SGA), fetal distress, neonatal jaundice and congenital anomaly. RESULTS The study sample consisted of 1,670,369 records. Human immunodeficiency virus co-infection and all forms of substance abuse were more frequent in mothers with hepatitis B and C infection. After using multivariable modelling to adjust for important socio-demographical variables and obstetric complications, women with hepatitis C infection were more likely to have infants born preterm [odds ratio (OR), 1.40; 95% confidence intervals (CI), 1.15-1.72], with LBW (OR, 1.39; 95% CI, 1.11-1.74) and congenital anomaly (OR, 1.55; 95% CI, 1.14-2.11). In addition, women with hepatitis B infection were less likely to have infants born SGA (OR, 0.79; 95% CI, 0.66-0.95). CONCLUSIONS Our findings provide further understanding of the association between maternal hepatitis B or C carrier status and perinatal outcomes. Infants born to women with hepatitis C infection appear to be at risk for poor birth outcomes, including preterm birth, LBW and congenital anomaly.
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Affiliation(s)
- Laura E Connell
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA
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Salihu HM, August EM, Weldeselasse HE, Biroscak BJ, Mbah AK. Stillbirth as a risk factor for subsequent infant mortality. Early Hum Dev 2011; 87:641-6. [PMID: 21605952 DOI: 10.1016/j.earlhumdev.2011.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 04/26/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Infant mortality is an important indicator of the health and wellness of a society. Multiple risk factors for infant mortality have been identified and investigated; however, the influence of prior pregnancy experience on subsequent infant mortality is under-researched. AIMS To examine the association between stillbirth in the first pregnancy and risk for infant mortality in the second pregnancy in a large population-based dataset. STUDY DESIGN Population-based, retrospective cohort study SUBJECTS Missouri maternally linked cohort data files were utilized from 1989 through 2005. Analyses were restricted to women who had two singleton pregnancies during the study period. OUTCOME MEASURES The exposure was stillbirth in the first pregnancy, while the primary outcome was infant mortality in the second pregnancy. RESULTS Women who experienced stillbirth in their first pregnancy were more likely to be of advanced age, black, and obese and had higher rates of pregnancy-related complications (p<0.01). Previous stillbirth was associated with an elevated risk for subsequent infant mortality (AHR=2.51, 95% CI: 1.73-3.65) and neonatal mortality (AHR=3.04, 95% CI: 1.99-4.65), after adjustment for socio-demographic variables and pregnancy complications. Risk estimates for mortality in the second pregnancy were most profound among black mothers with a history of stillbirth in the first pregnancy [risk for infant mortality: (AHR=2.68, 95% CI: 1.41-5.09) and neonatal death: (AHR=4.25, 95% CI: 2.34-7.60)]. CONCLUSIONS Women with prior stillbirth bear elevated risks for subsequent infant mortality. Women's previous childbearing experiences could serve as important criteria in determining appropriate interconception strategies to improve subsequent feto-infant health and survival.
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Affiliation(s)
- Hamisu M Salihu
- University of South Florida, College of Public Health, Department of Epidemiology and Biostatistics, Tampa, FL 33612, USA.
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Salihu HM, August EM, Mbah AK, Alio AP, de Cuba R, Jaward FM, Berry EL. Effectiveness of a Federal Healthy Start Program in Reducing the Impact of Particulate Air Pollutants on Feto-Infant Morbidity Outcomes. Matern Child Health J 2011; 16:1602-11. [DOI: 10.1007/s10995-011-0854-1] [Citation(s) in RCA: 5] [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: 01/21/2023]
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Salihu HM, August EM, Jeffers DF, Mbah AK, Alio AP, Berry E. Effectiveness of a Federal Healthy Start program in reducing primary and repeat teen pregnancies: our experience over the decade. J Pediatr Adolesc Gynecol 2011; 24:153-60. [PMID: 21397532 DOI: 10.1016/j.jpag.2011.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 01/12/2011] [Accepted: 01/12/2011] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To evaluate the effectiveness of a Federal Healthy Start program in reducing primary and repeat teen pregnancies in a disadvantaged community. DESIGN An ecological study that compares trends in teen pregnancy in the catchment area in which the community-based intervention was administered with two ecologic controls: the county (Hillsborough) and the state (Florida). SETTING Our catchment area is East Tampa, a socio-economically disadvantaged community in Hillsborough County, Florida. PARTICIPANTS Preconception care targeted teenagers between the ages of 10 and 19 years. Interconception care involved young mothers under the age of 20 with a previous birth. The population was comprised primarily of African Americans. INTERVENTION Preconception care services for primary teen pregnancy reduction offered sex education, family planning, drug and violence prevention education, and communication and negotiation skills acquisition. Interconception care service offered young women health education through monthly home visitation or monthly peer support group meetings addressing a range of topics using the life course perspective as framework. MAIN OUTCOME MEASURE Reduction in primary teen pregnancy and repeat teen pregnancy among adolescents. RESULTS The decline in primary teen pregnancy in the catchment area was 60% and 80% greater than the reduction experienced at the county level and at the state level respectively over the period of the study. However, efforts to prevent repeat pregnancy were not successful. CONCLUSION The Federal Healthy Start Preconception Care program, in collaboration with community partners, contributed to the prevention of first-time teen pregnancy in a community faced with significant social and economic challenges.
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Affiliation(s)
- Hamisu M Salihu
- Center for Research and Evaluation, Lawton & Rhea Chiles Center for Healthy Mothers and Babies, University of South Florida, Tampa, Florida, USA.
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Mbah AK, Alio AP, Marty PJ, Bruder K, Wilson R, Salihu HM. Recurrent versus isolated pre-eclampsia and risk of feto-infant morbidity outcomes: racial/ethnic disparity. Eur J Obstet Gynecol Reprod Biol 2011; 156:23-8. [DOI: 10.1016/j.ejogrb.2010.12.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/13/2010] [Accepted: 12/30/2010] [Indexed: 10/18/2022]
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Salihu HM, Duan J, Nabukera SK, Mbah AK, Alio AP. Younger maternal age (at initiation of childbearing) and recurrent perinatal mortality. Eur J Obstet Gynecol Reprod Biol 2011; 154:31-6. [DOI: 10.1016/j.ejogrb.2010.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 07/18/2010] [Accepted: 08/11/2010] [Indexed: 10/19/2022]
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Alio AP, Salihu HM, Mbah AK, Marty PJ. Fathers’ contribution to feto-infant health. Journal of Men's Health 2010. [DOI: 10.1016/j.jomh.2010.09.088] [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: 11/28/2022] Open
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Mbah AK, Kornosky JL, Kristensen S, August EM, Alio AP, Marty PJ, Belogolovkin V, Bruder K, Salihu HM. Super-obesity and risk for early and late pre-eclampsia. BJOG 2010; 117:997-1004. [PMID: 20482533 DOI: 10.1111/j.1471-0528.2010.02593.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the association between obesity subtypes and risk of early and late pre-eclampsia. DESIGN Population-based retrospective study. SETTING State of Missouri maternally linked birth cohort files. POPULATION All singleton live births in the state of Missouri from 1989 to 2005. METHODS The body mass index (BMI) was used to classify women as normal weight (BMI = 18.5-24.9 kg/m(2)), class I obesity (BMI = 30-34.9 kg/m(2)), class II obesity (BMI = 35-39.9 kg/m(2)), class III obesity (BMI = 40-49.9 kg/m(2)) or super-obesity (BMI > or = 50 kg/m(2)). Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between obesity and the risk of pre-eclampsia were obtained from logistic regression models with adjustment for intracluster correlation. RESULTS The rate of pre-eclampsia increased with increasing BMI, with super-obese women having the highest incidence (13.4%). Compared with normal weight women, obese women (BMI > or = 30 kg/m(2)) had a higher risk for pre-eclampsia (OR = 2.59, 95% CI = 2.87-3.01). This risk remained approximately the same for late-onset pre-eclampsia (pre-eclampsia occurring at 34 weeks or more of gestation) and was slightly reduced for early-onset pre-eclampsia (pre-eclampsia occurring at 34 weeks or less of gestation). Within each BMI category, the risk of pre-eclampsia increased with the rate of weight gain. Compared with normal weight mothers with moderate weight gain, super-obese women with a high rate of weight gain had the greatest risk for pre-eclampsia (OR = 7.52, 95% CI = 2.70-21.0). CONCLUSION BMI and rate of weight gain are synergistic risk factors that amplify the burden of pre-eclampsia among super-obese women.
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Affiliation(s)
- A K Mbah
- Center for Research and Evaluation, The Chiles Center, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL 33613, USA
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Salihu H, Mbah AK, Alio AP, Kornosky JL, Whiteman VE, Belogolovkin V, Rubin LP. Nulliparity and preterm birth in the era of obesity epidemic. J Matern Fetal Neonatal Med 2010; 23:1444-50. [PMID: 20482286 DOI: 10.3109/14767051003678044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the impact of obesity on preterm birth among nulliparous women. METHODS Retrospective cohort study of nulliparous mothers delivering infants in Florida between 2004 and 2007. Women were classified as non-obese (pre-pregnancy body mass index (BMI) <30) or obese (BMI ≥ 30). The main outcomes assessed were preterm birth, very preterm birth and extremely preterm birth. Risk estimates were obtained using logistic regression. Multiparous non-obese mothers were the referent group for all analyses. RESULTS As compared to multiparous women, nulliparous mothers had an increased risk of very preterm and extremely preterm birth with the highest risk observed for extremely preterm birth (odds ratios (OR) = 1.37, 95% CI = 1.28, 1.47) (p for trend <0.01). Obese nulliparous mothers had an elevated risk of preterm, very preterm and extremely preterm birth, with the risk of extremely preterm birth being the most pronounced (OR=1.97, 95% CI=1.75-2.22) [p for trend <0.05]. The heightened risk associated with obesity among nulliparous women was observed across all racial/ethnic sub-populations, with black nulliparous obese mothers being at greatest risk of all preterm birth-subtypes. CONCLUSIONS Obesity is a risk marker for preterm, very preterm and extremely preterm birth among first-time mothers and particularly among blacks and Hispanics.
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Affiliation(s)
- Hamisu Salihu
- The Chiles Center for Healthy Mothers and Babies, University of South Florida, Tampa, FL 33613, USA.
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Mbah AK, Alio AP, Marty PJ, Bruder K, Whiteman VE, Salihu HM. Pre-eclampsia in the first pregnancy and subsequent risk of stillbirth in black and white gravidas. Eur J Obstet Gynecol Reprod Biol 2010; 149:165-9. [DOI: 10.1016/j.ejogrb.2009.12.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 12/21/2009] [Accepted: 12/23/2009] [Indexed: 10/20/2022]
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Luke S, Salihu HM, Alio AP, Mbah AK, Jeffers D, Berry EL, Mishkit VR. Risk factors for major antenatal depression among low-income African American women. J Womens Health (Larchmt) 2010; 18:1841-6. [PMID: 19951220 DOI: 10.1089/jwh.2008.1261] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Data on risk factors for major antenatal depression among African American women are scant. In this study, we seek to determine the prevalence and risk factors for major antenatal depression among low-income African American women receiving prenatal services through the Central Hillsborough Healthy Start (CHHS). METHODS Women were screened using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff of > or =13 as positive for risk of major antenatal depression. In total, 546 African American women were included in the analysis. We used logistic regression to identify risk factors for major antenatal depression. RESULTS The prevalence of depressive symptomatology consistent with major antenatal depression was 25%. Maternal age was identified as the main risk factor for major antenatal depression. The association between maternal age and risk for major antenatal depression was biphasic, with a linear trend component lasting until age 30, at which point the slope changed markedly tracing a more pronounced likelihood for major depression with advancing age. Women aged > or =30 were about 5 times as likely to suffer from symptoms of major antenatal depression as teen mothers (OR = 4.62, 95% CI 2.23-9.95). CONCLUSIONS The risk for major antenatal depression increases about 5-fold among low-income African American women from age 30 as compared to teen mothers. The results are consistent with the weathering effect resulting from years of cumulative stress burden due to socioeconomic marginalization and discrimination. Older African American mothers may benefit from routine antenatal depression screening for early diagnosis and intervention.
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Affiliation(s)
- Sabrina Luke
- The Chiles Center for Healthy Mothers and Babies, University of South Florida, Tampa, Florida, USA
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Salihu HM, Luke S, Alio AP, Wathington D, Mbah AK, Marty PJ, Whiteman V. The Superobese Mother and Ethnic Disparities in Preterm Birth. J Natl Med Assoc 2009; 101:1125-31. [DOI: 10.1016/s0027-9684(15)31108-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Salihu HM, Lynch O, Alio AP, Mbah AK, Kornosky JL, Marty PJ. Extreme maternal underweight and feto-infant morbidity outcomes: a population-based study. J Matern Fetal Neonatal Med 2009; 22:428-34. [PMID: 19530001 DOI: 10.1080/14767050802385764] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We sought to estimate the association between severity of maternal pre-pregnancy underweight and feto-infant morbidity outcomes. METHODS Missouri maternally linked cohort records from 1989 to 1997 inclusive were analysed. Using pre-pregnancy maternal body mass index (BMI), we classified study participants into: Normal (18.5-24.9) [referent group], mild thinness (17.0-18.5), moderate thinness (16.0-16.9) and severe thinness (<16.0). We estimated the association between pre-pregnancy underweight, underweight subtypes and feto-infant morbidity outcomes using adjusted odds ratios to approximate relative risks with correction for intra-cluster correlations. RESULTS Fetal growth curve trajectories for the two groups became divergent as from 30 gestational weeks. Underweight mothers were at increased risk for low birthweight (OR = 1.82; 95% CI = 1.77-1.88), very low birthweight (OR = 1.41; 95% CI = 1.31-1.51), small for gestational age (OR = 1.80; 95% CI = 1.76-1.84), preterm (OR = 1.37; 95% CI = 1.33-1.40) and very preterm (OR = 1.42; 95% CI = 1.34-1.50). These risk estimates increased in a dose-effect fashion with increasing severity of underweight status except for very preterm (p for trend < 0.01). CONCLUSION Pre-pregnancy underweight is a risk factor for a spectrum of feto-infant morbidity outcomes, with risk estimates being most pronounced among extremely underweight mothers.
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Affiliation(s)
- Hamisu M Salihu
- The Chiles Centre for Healthy Mothers and Babies, University of South Florida, Tampa, Florida 33613, USA.
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Alio AP, Kornosky JL, Mbah AK, Marty PJ, Salihu HM. The impact of paternal involvement on feto-infant morbidity among Whites, Blacks and Hispanics. Matern Child Health J 2009; 14:735-741. [PMID: 19526333 DOI: 10.1007/s10995-009-0482-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 06/02/2009] [Indexed: 11/29/2022]
Abstract
Few studies have examined paternal involvement in relation to feto-infant health; therefore we aim to assess the impact of absence of the father on birth outcomes among racial-ethnic subgroups. Florida vital statistics records for singleton births occurring between 1998 and 2005 were used for this study. Births to women less than 20 years of age and births outside the gestational age range of 20-44 weeks were excluded. Adjusted and unadjusted odds ratios and 95% confidence intervals were generated to examine the impact of paternal involvement, as defined by presence of paternal information on the birth certificate, on feto-infant morbidity across racial-ethnic sub-populations. There were higher rates of low birth weight, very low birth weight, preterm birth, very preterm birth, and small for gestational age (SGA) among father-absent births. Within each racial-ethnic subgroup, women with absent fathers had higher risks of poor birth outcomes than their counterparts with involved fathers. Black women with absent fathers had the highest risk of low birth weight, very low birth weight, preterm birth, very preterm birth, and SGA. Promoting paternal involvement during the perinatal period may provide a means to decrease the proportion of infants born of very low birth weight or very preterm, thus potentially reducing the black-white disparity in infant mortality.
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Affiliation(s)
- Amina P Alio
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., MDC 56, Tampa, FL, 33612-3805, USA. .,Center for Research and Evaluation, The Chiles Center, University of South Florida, Tampa, FL, USA.
| | - Jennifer L Kornosky
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA
| | - Alfred K Mbah
- Center for Research and Evaluation, The Chiles Center, University of South Florida, Tampa, FL, USA
| | - Phillip J Marty
- Center for Research and Evaluation, The Chiles Center, University of South Florida, Tampa, FL, USA
| | - Hamisu M Salihu
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA.,Center for Research and Evaluation, The Chiles Center, University of South Florida, Tampa, FL, USA
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Salihu HM, Mbah AK, Alio AP, Clayton HB, Lynch O. Low pre-pregnancy body mass index and risk of medically indicated versus spontaneous preterm singleton birth. Eur J Obstet Gynecol Reprod Biol 2009; 144:119-23. [PMID: 19328619 DOI: 10.1016/j.ejogrb.2009.02.047] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 10/01/2008] [Accepted: 02/22/2009] [Indexed: 11/30/2022]
Affiliation(s)
- H M Salihu
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL 33613, USA.
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Salihu HM, Mbah AK, Alio AP, Lynch O, Wathington D, Kornosky JL. Maternal Prepregnancy Underweight and Risk of Early and Late Stillbirth in Black and White Gravidas. J Natl Med Assoc 2009; 101:582-7. [DOI: 10.1016/s0027-9684(15)30944-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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