1
|
Rogerson C, Owora A, Tu W, Mendonca E. The influence of social and environmental determinants of health on hospitalizations for pediatric asthma. J Asthma 2024; 61:453-462. [PMID: 38010826 DOI: 10.1080/02770903.2023.2288323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Asthma is the most common chronic disease of childhood, and has several social, environmental, and demographic factors potentially influential to its disease burden. This study sought to determine the influence of these factors on hospital admissions and readmissions for pediatric asthma. METHODS This was a retrospective cohort study using data from the Indiana Network for Patient Care, a state-wide health information exchange in the United States. Study participants were children 2-18 years old admitted to the hospital with a respiratory diagnostic code between 2010 and 2021. Clinical variables were obtained from electronic health record data, and social and environmental determinants of health data were obtained from the Indiana Social Assets and Vulnerabilities Indicators using geocoding systems. Negative binomial models were used to examine community level social and environmental risk factors modifying the relationship between patient characteristics and the risk of asthma-related hospitalizations and 30-day readmissions. RESULTS The study sample included 25,063 patients with an average follow-up of 9 (SD = 5) years. Of these, there were 17,816 asthma-related admissions. There were a total of 1,037 asthma-related 30-day readmissions, with an incidence rate of readmissions relative to total visits of 0.028 per person-year. A high social vulnerability index (SVI) was associated with an increased rate of hospital admissions (Proportion attributable ratio: 1.09, 95%CI (1.03,1.15), p < 0.05). No environmental determinants of health were significantly associated with hospitalization rate. CONCLUSION High SVI was significantly associated with increased risk of total hospital admissions for pediatric asthma.
Collapse
Affiliation(s)
- Colin Rogerson
- Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Arthur Owora
- Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Wanzhu Tu
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eneida Mendonca
- Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| |
Collapse
|
2
|
Aguree S, Owora A, Hawkins M, Gletsu Miller N. EXPRESS: Obesity modifies the association between diabetes and iron biomarkers and red cell indices in reproductive-aged women in the US. J Investig Med 2024:10815589241240059. [PMID: 38445643 DOI: 10.1177/10815589241240059] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Obesity and diabetes are associated with impaired iron metabolism. We aimed to examine the independent relationship between diabetes and iron after controlling for body weight (or obesity) in women aged 20-49 y. Data from the 2015-2018 NHANES was used in this investigation. Body composition data, HbAc1, and iron biomarkers (serum ferritin (SF), soluble transferrin receptor (sTfR), and body iron index (BII)), mean corpuscular volume (MCV), mean hemoglobin concentration (MCH), and red cell distribution width (RDW), and hemoglobin were used. Linear regression models were used to examine how and to what extent BMI modified the relationship between diabetes and iron status biomarkers. A total of 1585 women aged 20-49 were included in the analysis with a mean (SD) age of 32 .2 ± 6.1 y and BMI of 29.5 ± 6.9 kg/m2. The mean SF (p=0.014) and BII (p<0.001) were lower, while sTfR (p<0.001) was higher in women with diabetes than those with no diabetes. Mean estimates for MCV and MCH were lower, while RDW (p=0.001) was higher in diabetes patients (all p<0.001). Women with diabetes were more likely to have iron deficiency, anemia, and iron deficiency anemia than those without diabetes (18.1% vs. 8.6%, p<0.001), (24.4% vs. 8.4%, p<0.001) and (14.8% vs. 5.2%, p<0.001), respectively. Among women with obesity, those with diabetes had lower predicted ferritin (β=-0.19, p=0.016), BII (β=-0.99, p=0.016), and hemoglobin (β=-0.27, p=0.042) than those without diabetes. The study shows that diabetes is linked to lower iron stores, this is exacerbated in those with obesity.
Collapse
Affiliation(s)
- Sixtus Aguree
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN
| | - Arthur Owora
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN
| | - Misty Hawkins
- Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, IN
| | - Nana Gletsu Miller
- Department of Applied Health Science, Indiana University School of Public Health- Bloomington, Bloomington, IN
| |
Collapse
|
3
|
Holler E, Du Y, Barboi C, Owora A. Prognostic models for predicting insomnia treatment outcomes: A systematic review. J Psychiatr Res 2024; 170:147-157. [PMID: 38141325 DOI: 10.1016/j.jpsychires.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To identify and critically evaluate models predicting insomnia treatment response in adult populations. METHODS Pubmed, EMBASE, and PsychInfo databases were searched from January 2000 to January 2023 to identify studies reporting the development or validation of multivariable models predicting insomnia treatment outcomes in adults. Data were extracted according to CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) guidelines and study quality was assessed using the Prediction model study Risk Of Bias Assessment Tool (PROBAST). RESULTS Eleven studies describing 53 prediction models were included and appraised. Treatment response was most frequently assessed using wake after sleep onset (n = 10; 18.9%), insomnia severity index (n = 10; 18.9%), and sleep onset latency (n = 9, 17%). Dysfunctional Beliefs About Sleep (DBAS) score was the most common predictor in final models (n = 33). R2 values ranged from 0.06 to 0.80 for models predicting continuous response and area under the curve (AUC) ranged from 0.73 to 0.87 for classification models. Only two models were internally validated, and none were externally validated. All models were rated as having a high risk of bias according to PROBAST, which was largely driven by the analysis domain. CONCLUSION Prediction models may be a useful tool to assist clinicians in selecting the optimal treatment strategy for patients with insomnia. However, no externally validated models currently exist. These results highlight an important gap in the literature and underscore the need for the development and validation of modern, methodologically rigorous models.
Collapse
Affiliation(s)
- Emma Holler
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, USA.
| | - Yu Du
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, USA
| | - Cristina Barboi
- Indiana University School of Medicine, Dept of Anesthesiology and Critical Care Medicine, Indianapolis, IN, USA
| | - Arthur Owora
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, IN, USA
| |
Collapse
|
4
|
Rodriguez MJ, Kercher VM, Jordan EJ, Savoy A, Hill JR, Werner N, Owora A, Castelluccio P, Boustani MA, Holden RJ. Technology caregiver intervention for Alzheimer's disease (I-CARE): Feasibility and preliminary efficacy of Brain CareNotes. J Am Geriatr Soc 2023; 71:3836-3847. [PMID: 37706540 PMCID: PMC10841172 DOI: 10.1111/jgs.18591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/07/2023] [Accepted: 08/19/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND The primary aim of the current pilot study was to examine enrollment rate, data completion, usability, acceptance and use of a mobile telehealth application, Brain CareNotes. A secondary aim was to estimate the application's effect in reducing caregiver burden and behavioral and psychological symptoms related to dementia (BPSD). METHODS Patient-caregiver dyads (n = 53) were recruited and randomized to intervention and control groups. Assessment of usability, acceptance, BPSD symptoms, and caregiver burden were collected at baseline, 3- and 6-month follow-up. RESULTS The enrollment rate was acceptable despite pandemic related challenges (53/60 target recruitment sample). Among randomized individuals, there was a retention rate of 85% and data completion was attained for 81.5% of those allocated to usual care and 88.5% of those allocated to Brain CareNotes. Mean caregiver-reported app usability at 6 months was 72.5 (IQR 70.0-90.0) on the System Usability Scale-considered "Good to Excellent"-and user acceptance was reasonable as indicated by 85%-90% of caregivers reporting they would intend to use the app to some degree in the next 6 months, if able. Regarding intervention effect, although differences in outcome measures between the groups were not statistically significant, compared to baseline, we found a reduction of caregiver burden (NPI-Caregiver Distress) of 1.0 at 3 months and 0.7 at 6 months for those in the intervention group. BPSD (NPI Total Score) was also reduced from baseline by 4.0 at 3 months and by 0.5 at 6 months. CONCLUSIONS Brain CareNotes is a highly scalable, usable and acceptable mobile caregiver intervention. Future studies should focus on testing Brain CareNotes on a larger sample size to examine efficacy of reducing caregiver burden and BPSD.
Collapse
Affiliation(s)
- Miriam Jocelyn Rodriguez
- Department of Health and Wellness Design, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Vanessa Martinez Kercher
- Department of Health and Wellness Design, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Evan J Jordan
- Department of Health and Wellness Design, Indiana University Bloomington, Bloomington, Indiana, USA
| | - April Savoy
- Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Jordan R Hill
- Department of Health and Wellness Design, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Nicole Werner
- Department of Health and Wellness Design, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Arthur Owora
- Department of Health and Wellness Design, Indiana University Bloomington, Bloomington, Indiana, USA
| | | | - Malaz A Boustani
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Richard J Holden
- Department of Health and Wellness Design, Indiana University Bloomington, Bloomington, Indiana, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
5
|
Rogerson C, Owora A, He T, Carroll A, Schleyer T, AbuSultaneh S, Tu W, Mendonca E. High flow nasal cannula use is associated with increased hospital length of stay for pediatric asthma. Pediatr Pulmonol 2023; 58:3046-3053. [PMID: 37530483 DOI: 10.1002/ppul.26617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND High flow nasal cannula (HFNC) is a respiratory device increasingly used to treat asthma. Recent mechanistic studies have shown that nebulized medications may have reduced delivery with HFNC, which may impair asthma treatment. This study evaluated the association between HFNC use for pediatric asthma and hospital length of stay (LOS). METHODS This was a retrospective matched cohort study. Cases included patients aged 2-18 years hospitalized between January 2010 and December 2021 with asthma and received HFNC treatment. Controls were selected using logistic regression propensity score matching based on demographics, vital signs, medications, imaging, and social and environmental determinants of health. The primary outcome was hospital LOS. RESULTS A total of 23,659 encounters met eligibility criteria, and of these 1766 cases included HFNC treatment with a suitable matched control. Cases were well-matched in demographics, social and environmental determinants of health, and clinical characteristics including use of adjunctive asthma therapies. The median hospital LOS for study cases was significantly higher at 87 h (interquartile range [IQR]: 61-145) compared to 66 h (IQR: 43-105) in the matched controls (p < 0.01). There was no significant difference in the rate of intubation and mechanical ventilation (8.9% vs. 7.6%, p = .18); however, the use of NIV was significantly higher in the cases than the control group (21.3% vs. 6.7%, p < .01). CONCLUSION In this study of children hospitalized for asthma, HFNC use was associated with increased hospital LOS compared to matched controls. Further research using more granular data and additional relevant variables is needed to validate these findings.
Collapse
Affiliation(s)
- Colin Rogerson
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Biostatistics, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Arthur Owora
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tian He
- Regenstrief Institute, Center for Biomedical Informatics, Indianapolis, Indiana, USA
| | - Aaron Carroll
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Titus Schleyer
- Department of Biostatistics, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | | | - Wanzhu Tu
- Regenstrief Institute, Center for Biomedical Informatics, Indianapolis, Indiana, USA
| | - Eneida Mendonca
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
6
|
Vinjimoor S, Vieira C, Rogerson C, Owora A, Mendonca EA. Social risk factors for pediatric asthma exacerbations: A systematic review. medRxiv 2023:2023.09.19.23295732. [PMID: 37790526 PMCID: PMC10543039 DOI: 10.1101/2023.09.19.23295732] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Objective This systematic review aims to identify social risk factors that influence pediatric asthma exacerbations. Methods Cohort studies published between 2010 and 2020 were systematically searched on the OVID Medline, Embase, and PsycInfo databases. Using our established phased inclusion and exclusion criteria, studies that did not address a pediatric population, social risk factors, and asthma exacerbations were excluded. Out of a total of 707 initially retrieved articles, 3 prospective cohort and 6 retrospective cohort studies were included. Results Upon analysis of our retrieved studies, two overarching domains of social determinants, as defined by Healthy People 2030, were identified as major risk factors for pediatric asthma exacerbations: Social/Community Context and Neighborhood/Built Environment. Social/Community factors including African American race and inadequate caregiver perceptions were associated with increased risk for asthma exacerbations. Patients in high-risk neighborhoods, defined by lower levels of education, housing, and employment, had higher rates of emergency department readmissions and extended duration of stay. Additionally, a synergistic interaction between the two domains was found such that patients with public or no health insurance and residence in high-risk neighborhoods were associated with excess hospital utilization attributable to pediatric asthma exacerbations. Conclusion Social risk factors play a significant role in influencing the frequency and severity of pediatric asthma exacerbations.
Collapse
Affiliation(s)
- Shriya Vinjimoor
- Indiana University School of Medicine
- Regenstrief Institute for Biomedical Informatics
| | - Caroline Vieira
- Indiana University Bloomington
- Regenstrief Institute for Biomedical Informatics
| | - Colin Rogerson
- Indiana University School of Medicine
- Regenstrief Institute for Biomedical Informatics
| | - Arthur Owora
- Regenstrief Institute for Biomedical Informatics
- Indiana University School of Public Health
| | - Eneida A Mendonca
- Indiana University School of Medicine
- Regenstrief Institute for Biomedical Informatics
| |
Collapse
|
7
|
Aguree S, Zolnoori M, Atwood TP, Owora A. Association between choline supplementation and Alzheimer's disease risk: a systematic review protocol. Front Aging Neurosci 2023; 15:1242853. [PMID: 37700814 PMCID: PMC10493398 DOI: 10.3389/fnagi.2023.1242853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
Background and aims There is growing evidence suggesting choline intake might have beneficial effects on cognitive function in the elderly. However, some studies report no relationship between choline intake and cognitive function or improvement in Alzheimer's disease patients. This protocol is for a systematic review of choline intake and Alzheimer's disease that aims to assess the comparative clinical effectiveness of choline supplementation on Alzheimer's disease risk. Methods and analysis literature search will be performed in PubMed, MEDLINE, EMBASE, CINAHL, Scopus, Cochrane, and the Web of Science electronic databases from inception until October 2023. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies will be included if they compared two different time points of choline biomarkers measures in men or women (65+) with Alzheimer's Disease. The risk of bias in the included studies will be assessed within the Covidence data-management software. Results This review will summarize the clinical trial and quasi-experimental evidence of choline intake on Alzheimer's disease risk for adults aged 65+. The results from all eligible studies included in the analysis will be presented in tables, text, and figures. A descriptive synthesis will present the characteristics of included studies (e.g., age, sex of participants, type, length of intervention and comparator, and outcome measures), critical appraisal results, and descriptions of the main findings. Discussion This systematic review will summarize the existing evidence on the association between Choline intake and AD and to make recommendations if appropriate. The results of this review will be considered with respect to whether there is enough evidence of benefit to merit a more definitive randomized controlled trial. The results will be disseminated through peer-reviewed journals population. Conclusion This protocol outlines the methodology for a systematic review of choline intake and AD. The resulting systematic review from this protocol will form an evidence-based foundation to advance nutrition care for individuals with AD or poor cognitive function. Systematic review registration http://www.crd.york.ac.uk/PROSPERO, identifier CRD42023395004.
Collapse
Affiliation(s)
- Sixtus Aguree
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
| | - Maryam Zolnoori
- Columbia University Irving Medical Center, New York, NY, United States
| | - Thea Patricia Atwood
- Department of Chemistry, Indiana University Bloomington, Bloomington, IN, United States
| | - Arthur Owora
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| |
Collapse
|
8
|
Jamshidi-Naeini Y, Roberts SB, Dickinson S, Owora A, Agley J, Zoh RS, Chen X, Allison DB. Factors associated with choice of behavioural weight loss program by adults with obesity. Clin Obes 2023; 13:e12591. [PMID: 37038768 PMCID: PMC10524530 DOI: 10.1111/cob.12591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/24/2023] [Accepted: 03/12/2023] [Indexed: 04/12/2023]
Abstract
We assessed the preference for two behavioural weight loss programs, Diabetes Prevention Program (DPP) and Healthy Weight for Living (HWL) in adults with obesity. A cross-sectional survey was fielded on the Amazon Mechanical Turk. Eligibility criteria included reporting BMI ≥30 and at least two chronic health conditions. Participants read about the programs, selected their preferred program, and answered follow-up questions. The estimated probability of choosing either program was not significantly different from .5 (N = 1005, 50.8% DPP and 49.2% HWL, p = .61). Participants' expectations about adherence, weight loss magnitude, and dropout likelihood were associated with their choice (p < .0001). Non-White participants (p = .040) and those with monthly income greater than $4999 (p = .002) were less likely to choose DPP. Participants who had postgraduate education (p = .007), did not report high serum cholesterol (p = .028), and reported not having tried losing weight before (p = .025) were more likely to choose DPP. Those who chose HWL were marginally more likely to report that being offered two different programs rather than one would likely affect their decision to enrol in one of the two (p = .052). The enrolment into DPP and HWL was balanced, but race, educational attainment, income, previous attempt to lose weight, and serum cholesterol levels had significant associations with the choice of weight loss program.
Collapse
Affiliation(s)
- Yasaman Jamshidi-Naeini
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Susan B. Roberts
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Stephanie Dickinson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Arthur Owora
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Jon Agley
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Roger S. Zoh
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - David B. Allison
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| |
Collapse
|
9
|
Aguree S, Owora A, Hawkins M, Reddy MB. Iron Deficiency and Iron Deficiency Anemia in Women with and without Obesity: NHANES 2001-2006. Nutrients 2023; 15:nu15102272. [PMID: 37242155 DOI: 10.3390/nu15102272] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Obesity has been linked to numerous health and nutritional problems, including impaired iron metabolism, a common cause of anemia. We aimed to determine the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among women aged 20-49 years based on body mass index (BMI) status. We used measures of iron status and body mass index from the 2001-2006 National Health and Nutrition Examination Survey (NHANES). Mean serum ferritin, erythrocyte protoporphyrin, and soluble transferrin receptor were higher, while those of serum iron, percent transferrin saturation, and mean cell volume (MCV) were lower in women with obesity than those with normal weight (all p < 0.016). ID based on the ferritin model was 12.5 ± 1.0% vs. 22.9 ± 1.6% (p < 0.001); 9.0 ± 0.9% vs. 20.0 ± 1.3% (p < 0.001) based on the MCV model; and 8.1 ± 1.0% vs. 10.5 ± 1.2% (p > 0.05) based on the BII model for women with normal weight and women with obesity, respectively. Anemia prevalence was 5.5 ± 0.8% (normal) vs. 9.3 ± 1.0% (obese) (p = 0.005). The IDA estimates based on the ferritin and MCV models were similar but higher than that from the BII model (p < 0.001). Generally, the prevalence rates of ID and anemia (and IDA) were higher for women with obesity, but the method used to define deficiency mattered. The choice of iron indices is important for estimating ID and IDA in populations with obesity.
Collapse
Affiliation(s)
- Sixtus Aguree
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Arthur Owora
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN 47405, USA
| | - Misty Hawkins
- Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, IN 47405, USA
| | - Manju B Reddy
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA 50011, USA
| |
Collapse
|
10
|
Holler E, Chekani F, Ai J, Meng W, Khandker RK, Ben Miled Z, Owora A, Dexter P, Campbell N, Solid C, Boustani M. Development and Temporal Validation of an Electronic Medical Record-Based Insomnia Prediction Model Using Data from a Statewide Health Information Exchange. J Clin Med 2023; 12:jcm12093286. [PMID: 37176726 PMCID: PMC10179562 DOI: 10.3390/jcm12093286] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
This study aimed to develop and temporally validate an electronic medical record (EMR)-based insomnia prediction model. In this nested case-control study, we analyzed EMR data from 2011-2018 obtained from a statewide health information exchange. The study sample included 19,843 insomnia cases and 19,843 controls matched by age, sex, and race. Models using different ML techniques were trained to predict insomnia using demographics, diagnosis, and medication order data from two surveillance periods: -1 to -365 days and -180 to -365 days before the first documentation of insomnia. Separate models were also trained with patient data from three time periods (2011-2013, 2011-2015, and 2011-2017). After selecting the best model, predictive performance was evaluated on holdout patients as well as patients from subsequent years to assess the temporal validity of the models. An extreme gradient boosting (XGBoost) model outperformed all other classifiers. XGboost models trained on 2011-2017 data from -1 to -365 and -180 to -365 days before index had AUCs of 0.80 (SD 0.005) and 0.70 (SD 0.006), respectively, on the holdout set. On patients with data from subsequent years, a drop of at most 4% in AUC is observed for all models, even when there is a five-year difference between the collection period of the training and the temporal validation data. The proposed EMR-based prediction models can be used to identify insomnia up to six months before clinical detection. These models may provide an inexpensive, scalable, and longitudinally viable method to screen for individuals at high risk of insomnia.
Collapse
Affiliation(s)
- Emma Holler
- Department of Epidemiology and Biostatistics, Indiana University Bloomington School of Public Health, Bloomington, IN 47405, USA
| | | | - Jizhou Ai
- Merck & Co., Inc., Rahway, NJ 07033, USA
| | | | | | - Zina Ben Miled
- Department of Electrical and Computer Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
- Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Arthur Owora
- Department of Epidemiology and Biostatistics, Indiana University Bloomington School of Public Health, Bloomington, IN 47405, USA
| | - Paul Dexter
- Regenstrief Institute, Indianapolis, IN 46202, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Noll Campbell
- Regenstrief Institute, Indianapolis, IN 46202, USA
- College of Pharmacy and Health Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Craig Solid
- Solid Research Group, LLC, Saint Paul, MN 55104, USA
| | - Malaz Boustani
- Regenstrief Institute, Indianapolis, IN 46202, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| |
Collapse
|
11
|
Kleiman MJ, Plewes AD, Owora A, Grout RW, Dexter PR, Fowler NR, Galvin JE, Miled ZB, Boustani M. Digital detection of dementia (D 3): a study protocol for a pragmatic cluster-randomized trial examining the application of patient-reported outcomes and passive clinical decision support systems. Trials 2022; 23:868. [PMID: 36221141 PMCID: PMC9552361 DOI: 10.1186/s13063-022-06809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/30/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Early detection of Alzheimer's disease and related dementias (ADRD) in a primary care setting is challenging due to time constraints and stigma. The implementation of scalable, sustainable, and patient-driven processes may improve early detection of ADRD; however, there are competing approaches; information may be obtained either directly from a patient (e.g., through a questionnaire) or passively using electronic health record (EHR) data. In this study, we aim to identify the benefit of a combined approach using a pragmatic cluster-randomized clinical trial. METHODS We have developed a Passive Digital Marker (PDM), based on machine learning algorithms applied to EHR data, and paired it with a patient-reported outcome (the Quick Dementia Rating Scale or QDRS) to rapidly share an identified risk of impairment to a patient's physician. Clinics in both south Florida and Indiana will be randomly assigned to one of three study arms: 1200 patients in each of the two populations will be administered either the PDM, the PDM with the QDRS, or neither, for a total of 7200 patients across all clinics and populations. Both incidence of ADRD diagnosis and acceptance into ADRD diagnostic work-up regimens is hypothesized to increase when patients are administered both the PDM and QDRS. Physicians performing the work-up regimens will be blind to the study arm of the patient. DISCUSSION This study aims to test the accuracy and effectiveness of the two scalable approaches (PDM and QDRS) for the early detection of ADRD among older adults attending primary care practices. The data obtained in this study may lead to national early detection and management program for ADRD as an efficient and beneficial method of reducing the current and future burden of ADRD, as well as improving the annual rate of newly documented ADRD in primary care practices. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05231954 . Registered February 9, 2022.
Collapse
Affiliation(s)
- Michael J Kleiman
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, 7700 W Camino Real, Suite 200, Boca Raton, FL, 33433, USA.
| | - Abbi D Plewes
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN, 46202, USA
| | - Arthur Owora
- Indiana University Bloomington School of Public Health, Bloomington, IN, 47405, USA
| | - Randall W Grout
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN, 46202, USA
| | - Paul Richard Dexter
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN, 46202, USA
| | - Nicole R Fowler
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN, 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN, 46202, USA
- Indiana University Center for Aging Research, Indianapolis, IN, 46202, USA
| | - James E Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, 7700 W Camino Real, Suite 200, Boca Raton, FL, 33433, USA
| | - Zina Ben Miled
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Malaz Boustani
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN, 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN, 46202, USA
- Indiana University Center for Aging Research, Indianapolis, IN, 46202, USA
| |
Collapse
|
12
|
Tobias J, Olyaei A, Laraway B, Jordan BK, Dickinson SL, Golzarri-Arroyo L, Fialkowski E, Owora A, Scottoline B. Bifidobacteriumlongum subsp. infantis EVC001 Administration Is Associated with a Significant Reduction in the Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants. J Pediatr 2022; 244:64-71.e2. [PMID: 35032555 DOI: 10.1016/j.jpeds.2021.12.070] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 08/11/2021] [Revised: 12/05/2021] [Accepted: 12/15/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the effects of Bifidobacteriumlongum subsp. infantis EVC001 (Binfantis EVC001) administration on the incidence of necrotizing enterocolitis (NEC) in preterm infants in a single level IV neonatal intensive care unit (NICU). STUDY DESIGN Nonconcurrent retrospective analysis of 2 cohorts of very low birth weight (VLBW) infants not exposed and exposed to Binfantis EVC001 probiotic at Oregon Health & Science University from 2014 to 2020. Outcomes included NEC incidence and NEC-associated mortality, including subgroup analysis of extremely low birth weight (ELBW) infants. Log-binomial regression models were used to compare the incidence and risk of NEC-associated outcomes between the unexposed and exposed cohorts. RESULTS The cumulative incidence of NEC diagnoses decreased from 11.0% (n = 301) in the no EVC001 (unexposed) cohort to 2.7% (n = 182) in the EVC001 (exposed) cohort (P < .01). The EVC001 cohort had a 73% risk reduction of NEC compared with the no EVC001 cohort (adjusted risk ratio, 0.27; 95% CI, 0.094-0.614; P < .01) resulting in an adjusted number needed to treat of 13 (95% CI, 10.0-23.5) for Binfantis EVC001. NEC-associated mortality decreased from 2.7% in the no EVC001 cohort to 0% in the EVC001 cohort (P = .03). There were similar reductions in NEC incidence and risk for ELBW infants (19.2% vs 5.3% [P < .01]; adjusted risk ratio, 0.28; 95% CI, 0.085-0.698 [P = .02]) and mortality (5.6% vs 0%; P < .05) in the 2 cohorts. CONCLUSIONS In this observational study of 483 VLBW infants, Binfantis EVC001 administration was associated with significant reductions in the risk of NEC and NEC-related mortality. Binfantis EVC001 supplementation may be considered safe and effective for reducing morbidity and mortality in the NICU.
Collapse
Affiliation(s)
- Joseph Tobias
- Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Amy Olyaei
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | - Bryan Laraway
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR
| | - Brian K Jordan
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR
| | | | | | | | - Arthur Owora
- School of Public Health, Indiana University, Bloomington, IN
| | - Brian Scottoline
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR.
| |
Collapse
|
13
|
Anderson P, Coyle K, Guinosso S, Ferrand JL, Owora A, Houghton RF, Walsh-Buhi E. Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial. JMIR Res Protoc 2021; 10:e30499. [PMID: 34468330 PMCID: PMC8444045 DOI: 10.2196/30499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships. OBJECTIVE This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial. METHODS About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study-the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis. RESULTS This project (ClinicalTrials.gov #NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021. CONCLUSIONS About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition. TRIAL REGISTRATION ClinicalTrials.gov NCT03736876; https://clinicaltrials.gov/ct2/show/NCT03736876. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30499.
Collapse
Affiliation(s)
| | - Karin Coyle
- ETR Associates, Scotts Valley, CA, United States
| | | | - John L Ferrand
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Arthur Owora
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Rebecca F Houghton
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Eric Walsh-Buhi
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
- School of Public Health, San Diego State University, San Diego, CA, United States
| |
Collapse
|
14
|
Kibalama Ssemambo P, Nalubega-Mboowa MG, Owora A, Serunjogi R, Kironde S, Nakabuye S, Ssozi F, Nannyonga M, Musoke P, Barlow-Mosha L. Virologic response of treatment experienced HIV-infected Ugandan children and adolescents on NNRTI based first-line regimen, previously monitored without viral load. BMC Pediatr 2021; 21:139. [PMID: 33752636 PMCID: PMC7983217 DOI: 10.1186/s12887-021-02608-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 03/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Many HIV-infected African children gained access to antiretroviral treatment (ART) through expansion of PEPFAR programs since 2004 and introduction of “Test and Treat” WHO guidelines in 2015. As ART access increases and children transition from adolescence to adulthood, treatment failure is inevitable. Viral load (VL) monitoring in Uganda was introduced in 2016 replacing clinical monitoring. However, there’s limited data on the comparative effectiveness of these two strategies among HIV-infected children in resource-limited settings (RLS). Methods HIV-infected Ugandan children aged 1–12 years from HIV-care programs with > 1 year of first-line ART using only immunologic and clinical criteria to monitor response to treatment were screened in 2010. Eligible children were stratified by VL ≤ 400 and > 400 copies/ml randomized to clinical and immunological (control) versus clinical, immunological and VL monitoring to determine treatment failure with follow-up at 12, 24, 36, and 48 weeks. Plasma VL was analyzed retrospectively for controls. Mixed-effects logistic regression models were used to compare the prevalence of viral suppression between study arms and identify factors associated with viral suppression. Results At baseline all children (n = 142) were on NNRTI based ART (75% Nevirapine, 25% efavirenz). One third of ART-experienced children had detectable VL at baseline despite high CD4%. Median age was 6 years (interquartile range [IQR]: 5–9) and 43% were female. Overall, the odds of viral suppression were not different between study arms: (arm by week interaction, p = 0.63), adjusted odds ratio [aOR]: 1.07; 95%CI: 0.53, 2.17, p = 0.57) and did not change over time (aOR: 0 vs 24 week: 1.15; 95% CI: 0.91, 1.46, p = 0.24 and 0 vs 48 weeks: 1.26; 95%CI: 0.92, 1.74, p = 0.15). Longer duration of a child’s ART exposure was associated with lower odds of viral suppression (aOR: 0.61; 95% CI: 0.42, 0.87, p < .01). Only 13% (9/71) of children with virologic failure were switched to second-line ART, in spite of access to real-time VL. Conclusion With increasing ART exposure, viral load monitoring is critical for early detection of treatment failure in RLS. Clinicians need to make timely informed decisions to switch failing children to second-line ART. Trial registration ClinicalTrials.gov NCT04489953, 28 Jul 2020. Retrospectively registered. (https://register.clinicaltrials.gov).
Collapse
Affiliation(s)
- Phionah Kibalama Ssemambo
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.
| | - Mary Gorrethy Nalubega-Mboowa
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.,Nsambya Home Care Project (NHC), Kampala, Uganda.,Clarke International University (Formerly IHSU), Namuwongo, Kampala, Uganda
| | - Arthur Owora
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.,Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Indiana, USA
| | - Robert Serunjogi
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda
| | | | - Sarah Nakabuye
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda
| | | | | | - Philippa Musoke
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.,Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda
| |
Collapse
|
15
|
Riley EA, Owora A. Relationship Between Physiologically Measured Attention and Behavioral Task Engagement in Persons With Chronic Aphasia. J Speech Lang Hear Res 2020; 63:1430-1445. [PMID: 32324437 DOI: 10.1044/2020_jslhr-19-00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Persons with aphasia (PWAs) have been shown to have impaired attention skills that may interfere with their ability to successfully participate in speech and language therapy. Fluctuations in attention can be detected using physiological measures such as electroencephalography (EEG), but these measures can be impractical for clinical use. The primary purpose of this study was to investigate observable behavioral signs of attention as a means of measuring within-session fluctuations in attention by comparing behavioral ratings to physiological changes. Other aims were to understand the relationship between observable behaviors and task performance and to determine whether syntactic complexity influences behavioral attention. Method Ten PWAs and 10 neurologically healthy adults underwent a sentence-reading task with 45 active and 45 passive sentences while video/audio and EEG data were recorded continuously. EEG data for each trial were classified into one of four levels of attention using a classification algorithm (Berka et al., 2004), and video/audio data were scored for accuracy and behavioral engagement by two trained speech-language pathologist students using a behavioral rating scale of inattention (Whyte et al., 1996). Results Results showed that behavioral engagement was significantly correlated with task performance, with higher engagement scores associated with fewer errors. Behavioral engagement did not differ based on syntactic complexity for either group, but PWAs had significantly lower behavioral engagement scores when they were in lower/distracted states of physiologically measured vigilant attention. Conclusion Behavioral observation may provide an alternative means of detecting clinically significant lapses in attention during aphasia therapy.
Collapse
Affiliation(s)
- Ellyn A Riley
- Aphasia Lab, Department of Communication Sciences and Disorders, College of Arts & Sciences, Syracuse University, NY
| | - Arthur Owora
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington
| |
Collapse
|
16
|
Kmush BL, Mackowski M, Ehrlich J, Walia B, Owora A, Sanders S. Association of Professional Football Cumulative Head Impact Index Scores With All-Cause Mortality Among National Football League Players. JAMA Netw Open 2020; 3:e204442. [PMID: 32391891 PMCID: PMC7215260 DOI: 10.1001/jamanetworkopen.2020.4442] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/05/2020] [Indexed: 01/16/2023] Open
Abstract
Importance Long-term adverse health outcomes, particularly those associated with repetitive head impacts, are of growing concern among US-style football players in the US and Canada. Objective To assess whether exposure to repetitive head impacts during a professional football career is associated with an increase in the risk of all-cause mortality. Design, Setting, and Participants This retrospective cohort study included 13 912 players in the 1969 to 2017 National Football League (NFL) seasons. All cause-mortality up until July 1, 2018, was included. Data collection was performed from July 13, 2017, to July 1, 2018, as reported in the Pro Football Reference. Exposures The main exposure was a professional football cumulative head impact index (pfCHII). The pfCHII was measured by combining cumulative padded practice time and games played summed during seasons of play reported in the Pro Football Reference and a player position risk adjustment from helmet accelerometer studies. Main Outcomes and Measures Demographic characteristics except for the pfCHII were calculated for 14 366 players with complete follow-up. The pfCHII was calculated for 13 912 players (eliminating the 454 specials teams players). Cox proportional hazards regression was used to compare hazard ratios (HRs) of death by repetitive head impacts. Analyses were unadjusted and adjusted for birth year, body mass index, and height. Results Among 14 366 NFL players who had follow-up for analysis, the mean (SD) age was 47.3 (14.8) years, the mean (SD) body mass index was 29.6 (3.9), and 763 of 14 366 players (5.3%) had died. Among 13 912 players in the pfCHII analysis, the median pfCHII was 32.63 (interquartile range, 13.71-66.12). A 1-log increase in pfCHII was significantly associated with an increased hazard of death for the 1969 to 2017 seasons (HR, 2.02; 95% CI, 1.21-3.37; P = .01) after adjustment. The quadratic pfCHII was also statistically significant (HR, 0.91; 95% CI, 0.85-0.98; P = .01), indicating that the hazard of death increased at a decreasing rate, whereas the pfCHII increased. Conclusions and Relevance The findings suggest that an increase in repetitive head impacts is associated with an increased hazard of death among NFL players. Reduction in repetitive head impacts from playing football or other activities through additional rule and equipment changes may be associated with reduced mortality.
Collapse
Affiliation(s)
- Brittany L. Kmush
- Department of Public Health, Syracuse University, Syracuse, New York
| | | | - Justin Ehrlich
- Department of Sport Analytics, Syracuse University, Syracuse, New York
| | - Bhavneet Walia
- Department of Public Health, Syracuse University, Syracuse, New York
| | - Arthur Owora
- Department of Public Health, Syracuse University, Syracuse, New York
- Currently with Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington
| | - Shane Sanders
- Department of Sport Analytics, Syracuse University, Syracuse, New York
| |
Collapse
|
17
|
Affiliation(s)
- Meghan B Azad
- Developmental Origins of Chronic Diseases in Children Network, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arthur Owora
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington
| |
Collapse
|
18
|
Riley EA, Owora A, McCleary J, Anderson A. Sleepiness, Exertion Fatigue, Arousal, and Vigilant Attention in Persons With Chronic Aphasia. Am J Speech Lang Pathol 2019; 28:1491-1508. [PMID: 31437012 DOI: 10.1044/2019_ajslp-18-0301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Individuals in the acute and chronic stages of stroke recovery often report more daytime sleepiness (Sterr, Herron, Dijk, & Ellis, 2008) and fatigue that qualitatively differs from "normal" feelings of fatigue they experienced prestroke (De Doncker, Dantzer, Ormstad, & Kuppuswamy, 2018). Speech-language pathologists frequently observe signs of fatigue in their clients with aphasia and perceive that client fatigue impedes therapeutic interventions (Riley, 2017). The current study aimed to quantify daytime sleepiness, exertion fatigue, and physiologically measured arousal and vigilant attention in persons with aphasia. Method We measured sleepiness, exertion fatigue, arousal, and vigilant attention in 10 participants with aphasia and 10 neurologically healthy adults. Daytime sleepiness was measured using the Epworth Sleepiness Scale (Johns, 1991). Exertion fatigue was measured using the Visual Analog Fatigue Scale (B. Y. Tseng, Gajewski, & Kluding, 2010) before and after a 72-min computer-administered language task. Arousal was measured using heart rate and variability (Shaffer & Ginsberg, 2017). Vigilant attention was measured using electroencephalography and subsequently classified into 1 of 4 levels of vigilant attention using a classification algorithm (Berka et al., 2004). Results Persons with aphasia did not show significant differences from controls in reported amount of daytime sleepiness, exertion fatigue, or overall physiological arousal but demonstrated different patterns of electroencephalography-measured vigilant attention and error production as compared to controls. Conclusions Although overall sleepiness, exertion fatigue, and overall arousal did not differ between groups, physiological measures of vigilant attention may be more sensitive to differences and may explain feelings of fatigue that persons with chronic aphasia experience.
Collapse
Affiliation(s)
- Ellyn A Riley
- Aphasia Lab, Department of Communication Sciences and Disorders, College of Arts and Sciences, Syracuse University, NY
| | - Arthur Owora
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington
| | - Joshua McCleary
- Aphasia Lab, Department of Communication Sciences and Disorders, College of Arts and Sciences, Syracuse University, NY
| | - Alyssa Anderson
- Aphasia Lab, Department of Communication Sciences and Disorders, College of Arts and Sciences, Syracuse University, NY
| |
Collapse
|
19
|
Ridings LE, Beasley LO, Bohora SB, Daer JL, Owora A, Silovsky J. Longitudinal Investigation of Depression, Intimate Partner Violence, and Supports Among Vulnerable Families. J Interpers Violence 2018; 33:3749-3771. [PMID: 27021732 DOI: 10.1177/0886260516639262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intimate partner violence (IPV) affects nearly 12 million individuals and their families each year in the United States. Many negative outcomes are associated with IPV, with depression being one of the most prevalent mental health problems. Most previous studies on IPV have used cross-sectional designs to examine the potential protective effects of support on depression. The current study fills this gap by conducting a longitudinal investigation of the roles of social support and family resources on depression among caregivers of young children. The study sample consisted of 548 female caregivers. Findings suggest that among those with an IPV history, those with higher social support reported lower depressive symptoms than those with less social support. No significant interaction was found for family resources and IPV. Rather, family resources had a main effect on depressive symptoms with no differential impact based on IPV status. Findings suggest the importance of connecting vulnerable families to supports such as social support and family resources to help mitigate depressive symptoms. Future research should consider the underlying mechanisms of social support as a protective factor among IPV victims with depression.
Collapse
Affiliation(s)
| | | | - Som B Bohora
- 2 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Arthur Owora
- 2 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jane Silovsky
- 2 University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
20
|
Azad MB, Moossavi S, Owora A, Sepehri S. Early-Life Antibiotic Exposure, Gut Microbiota Development, and Predisposition to Obesity. Nestle Nutr Inst Workshop Ser 2017; 88:67-79. [PMID: 28346924 DOI: 10.1159/000455216] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Antibiotics are often prescribed inappropriately to infants and young children, with potentially adverse effects on the developing gut microbiota and related metabolic processes. We review evidence from 17 epidemiologic studies suggesting that antibiotic exposure during critical periods of early development may influence weight gain and the development of obesity. Complementary research in both humans and rodents indicates that gut microbiota play a key role in this process, although further research is needed to confirm and characterize the causal mechanisms involved. Obesity is a complex and multifactorial condition; thus, a multipronged prevention strategy will be required to curb the current obesity epidemic. Evidence to date suggests this strategy should include the judicious use of antibiotics, especially in early life when the developing gut microbiota is particularly susceptible to perturbations with long-lasting implications for metabolic programming and obesity risk.
Collapse
|
21
|
Owora A, Chaffin M, Nandyal R, Risch E, Bonner B, Carabin H. Medical Surveillance and Child Maltreatment Incidence Reporting among NICU Graduates. Soc Work Public Health 2016; 31:607-616. [PMID: 27314949 DOI: 10.1080/19371918.2016.1160348] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Objective of this study is to identify background infant and maternal characteristics that predict child maltreatment (CM) incidence reporting among Neonatal Intensive Care Unit (NICU) graduates by health care providers versus community sentinels with the goal of identifying ways to improve CM risk surveillance. Demographic, medical data including diagnoses and caregiving needs at discharge for infants treated in a NICU during 2005 to 2008 were obtained from the neonatology databases. CM outcome data was obtained from child welfare databases. Latent class analysis procedures were used to identify observable infant and maternal characteristics that define unobserved groups (latent classes) that predict NICU graduates CM incidence reporting among health care providers versus community sentinels. Medical surveillance (reports made by health care providers) accounted for only 37% of the CM reports made to child welfare. Infant health was more predictive of medical surveillance than maternal characteristics suggesting that health providers may assess risk differently than community sentinels. Based on a simple, two latent class model, the latent class with high infant health indicator membership probabilities was a better predictor of health care provider related reports than the class with lower membership probabilities (odds ratio = 2.72; 95% confidence interval [1.76, 4.20]). Health care providers may be keyed more to an infant's medical frailty than to caregiver (maternal) contextual characteristics and thus may miss an opportunity to identify and intervene to prevent CM among children with medical problems. Findings raise the question of whether increased attention to contextual factors can aid or increase early identification of infants at risk of child maltreatment in NICU settings.
Collapse
Affiliation(s)
- Arthur Owora
- a Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
- b College of Public Health, University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - Mark Chaffin
- a Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - Raja Nandyal
- a Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - Elizabeth Risch
- a Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - Barbara Bonner
- a Department of Pediatrics , University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| | - Hélène Carabin
- b College of Public Health, University of Oklahoma Health Sciences Center , Oklahoma City , Oklahoma , USA
| |
Collapse
|
22
|
L. Keast S, Owora A, Nesser N, Farmer K. Evaluation of Abuse-Deterrent or Tamper-Resistant Opioid Formulations on Overall Health Care Expenditures in a State Medicaid Program. J Manag Care Spec Pharm 2016; 22:347-56. [PMID: 27023688 PMCID: PMC10398165 DOI: 10.18553/jmcp.2016.22.4.347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The development of abuse-deterrent opioid prescription medications is a priority at the national level. Pharmaceutical manufacturers have begun marketing new formulations of currently available opioids that meet higher abuse resistance standards. Little information is available regarding the impact of these formulations on overall health care expenditures. OBJECTIVES To (a) examine the relationship between health care expenditures and use of brand abuse-deterrent or tamper-resistant (ADTR) extended-release opioids versus standard dosage form (SDF) extended-release opioids in a state Medicaid population, and (b) determine whether this relationship was influenced by member-specific characteristics. METHODS The study is a cross-sectional review of Oklahoma Medicaid members (aged ≥ 21 years) with at least 1 paid pharmacy claim for long-acting opioids between September 2013 and August 2014. Members who were adherent to extended-release opioid products were classified into ADTR and SDF opioid groups. The relationship between health care expenditures (prescription, medical, and overall) and opioid groups was examined using multiple linear regression models. The impact of member-specific characteristics (age, sex, race, urban classifications, and various comorbidities) on this relationship was examined. RESULTS Prescription spending ($9,265,554) accounted for 35% of overall health care expenditures ($26,304,693) among 938 members during the 12-month reference period. Total prescription expenditures were higher among ADTR than SDF user groups, and the difference in median expenditures between these 2 groups was larger among members with more comorbidities, as measured by the Charlson Comorbidity Index score. Overall, ADTR users had higher median total health care and medical expenditures, and the difference in median expenditures was dependent on whether a member had comorbidities of addiction or not (higher expenditures were observed among members with comorbidities of addiction). CONCLUSIONS The abuse and misuse of medically prescribed opioid products is a growing health epidemic. A variety of attempts have been made to reduce the potential of abuse and misuse of these products, including changes to product formulations. The results of this study indicate that both prescription spending and physician and pharmacy spending combined may be increased with the use of these new products because of higher pricing. Study findings also suggest that the use of ADTR opioids among members with comorbidities of addiction may be related to slightly lower overall health care and medical expenditures than those among members without comorbidities of addiction. Further research is required to answer questions regarding the comparative effectiveness of existing opioid prescription formulations. DISCLOSURES No outside funding supported this research. Nesser is employed by the Oklahoma Health Care Authority, and Keast is a contractual employee for the Oklahoma Health Care Authority. The authors declare no other conflicts of interest. Study design was primarily contributed by Keast, along with Nesser and Farmer. Keast took the lead in data collection, while data interpretation was primarily performed by Owora, along with Keast and assisted by Nesser and Farmer. The manuscript was written and revised by all authors equally.
Collapse
|
23
|
Beasley LO, Silovsky JF, Owora A, Burris L, Hecht D, DeMoraes-Huffine P, Cruz I, Tolma E. Mixed-methods feasibility study on the cultural adaptation of a child abuse prevention model. Child Abuse Negl 2014; 38:1496-1507. [PMID: 24835206 DOI: 10.1016/j.chiabu.2014.04.017] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 04/10/2014] [Accepted: 04/23/2014] [Indexed: 06/03/2023]
Abstract
The current study utilized mixed-methods analyses to examine the process of adapting a home-based parenting program for a local Latino community. The study examined the: (a) acceptability and cultural congruence of the adapted SafeCare® protocol, (b) adherence to the core components of SafeCare® while adapting to local community culture, and (c) social validity of the new model in addressing SafeCare® target areas (parenting, home safety, and child health). Participants were 28 Latino mothers and eight providers. After training in the adapted model, providers demonstrated improved knowledge and skills. All providers reached national certification standards for SafeCare®, demonstrating fidelity to the core components of the original model. Positive consumer-provider relationships were developed as reflected by the results on the Working Alliance (collaboration between caregivers and parents). Themes from the integrated results of the social validity measures and individual interviews with parents were perceived benefits of the program on targeted areas and cultural congruency of the approach. Recommendations are to consider using adaptation guidelines as outlined to promote local culturally congruent practices.
Collapse
Affiliation(s)
- Lana O Beasley
- Oklahoma State University, 116 N. Murray, Stillwater, OK 74078, USA; University of Oklahoma Health Sciences Center, 940 NE 13th Street, Oklahoma City, OK 73104, USA
| | - Jane F Silovsky
- University of Oklahoma Health Sciences Center, 940 NE 13th Street, Oklahoma City, OK 73104, USA
| | - Arthur Owora
- University of Oklahoma Health Sciences Center, 940 NE 13th Street, Oklahoma City, OK 73104, USA
| | - Lorena Burris
- University of Oklahoma Health Sciences Center, 940 NE 13th Street, Oklahoma City, OK 73104, USA.
| | - Debra Hecht
- University of Oklahoma Health Sciences Center, 940 NE 13th Street, Oklahoma City, OK 73104, USA
| | - Patty DeMoraes-Huffine
- Oklahoma Latino Community Development Agency, 420 S.W. 10th Street, Oklahoma City, OK 73109, USA
| | - Ivelisse Cruz
- Oklahoma Latino Community Development Agency, 420 S.W. 10th Street, Oklahoma City, OK 73109, USA
| | - Eleni Tolma
- University of Oklahoma Health Sciences Center, College of Public Health, 801 NE 13th Street, Oklahoma City, OK 73126, USA
| |
Collapse
|
24
|
Risch EC, Owora A, Nandyal R, Chaffin M, Bonner BL. Risk for Child Maltreatment Among Infants Discharged From a Neonatal Intensive Care Unit: A Sibling Comparison. Child Maltreat 2014; 19:92-100. [PMID: 24920246 DOI: 10.1177/1077559514539387] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Studies suggest that neonatal illness may cause increased risk for child maltreatment (CM), but these findings may be biased by observed and unobserved confounding factors (social, family, and maternal characteristics) including increased surveillance by health care providers. This study expands on previous research by examining and controlling for these potential study biases and confounders using a sibling discordance retrospective cohort study design. Infants born in a Level IV neonatal intensive care unit (NICU) were matched with non-NICU born sibling controls. Cox proportional hazard models with shared frailty terms were used to account for clustering and heterogeneity in CM survival time (time to CM event). Potentially key covariates were selected using the directed acyclic graph approach, and surveillance reports were identified and systematically included or excluded from analyses. Managing these sources of bias reduced but did not eliminate the association between neonatal illness and CM report risk. Risk was especially high during the first year of the NICU infant's life and among families with multiple well-known CM risk factors.
Collapse
Affiliation(s)
- Elizabeth C Risch
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Arthur Owora
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Raja Nandyal
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mark Chaffin
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Barbara L Bonner
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
25
|
Balachova T, Bonner B, Bard D, Chaffin M, Isurina G, Owora A, Tsvetkova L, Volkova E. Women's receptivity to Fetal Alcohol Spectrum Disorders prevention approaches: A case study of two regions in Russia. Int J Alcohol Drug Res 2014; 3:5-15. [PMID: 28936273 PMCID: PMC5605141 DOI: 10.7895/ijadr.v3i1.158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIMS This study obtained data to inform the development of programs for prevention of Fetal Alcohol Spectrum Disorders (FASD) by examining Russian women's perceptions about the determinants of their decisions regarding alcohol consumption during pregnancy; the importance of educating professionals and community about FASD; and the credibility of various sources of information. DESIGN Cross-sectional survey. SETTING Seven women's clinics in St. Petersburg and the Nizhny Novgorod region in Russia. PARTICIPANTS Six hundred and forty-eight pregnant and non-pregnant women of childbearing age. MEASURES A face-to-face structured interview assessed demographic characteristics, pregnancy status, alcohol consumption, and level of trust in and receptivity to FASD prevention messages. FINDINGS The most influential contributor to women's decisions regarding alcohol consumption during pregnancy was their own knowledge, followed by information from an obstetrician/gynecologist or nurse. It was most important to women that obstetrics and gynecology professionals and husbands or partners were knowledgeable about the effects of drinking during pregnancy. Physicians' recommendations and research data were regarded by the women as the most credible sources of information. There were significant variations in responses by socio-demographic characteristics and alcohol consumption levels. Younger women were more likely to report the contributions of husbands, mothers, and friends or coworkers to their decisions about alcohol consumption and indicated the importance of educating these people. Women at risk for alcohol use during pregnancy reported greater influence of husbands or partners and warning labels on containers on their alcohol consumption. CONCLUSIONS This study emphasizes the importance of broadly disseminating information about FASD, particularly research data, through education of health professionals and the general public in Russia. Women's socio-demographic characteristics and alcohol consumption levels should be considered in designing prevention programs.
Collapse
Affiliation(s)
- Tatiana Balachova
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Barbara Bonner
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - David Bard
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Mark Chaffin
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | | | - Arthur Owora
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | | | - Elena Volkova
- Nizhny Novgorod State Pedagogical University, Nizhny Novgorod, Russia
| |
Collapse
|
26
|
Nandyal R, Owora A, Risch E, Bard D, Bonner B, Chaffin M. Special care needs and risk for child maltreatment reports among babies that graduated from the Neonatal Intensive Care. Child Abuse Negl 2013; 37:1114-1121. [PMID: 23768935 DOI: 10.1016/j.chiabu.2013.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 04/10/2013] [Accepted: 04/13/2013] [Indexed: 06/02/2023]
Abstract
Newborns discharged from intensive care are at elevated risk for child welfare reports, especially for child neglect. This study investigates the role of caregiving burden as a risk predictor among the NICU graduate population. Discharge data were captured for 2,463 infants graduating from a Neonatal Intensive Care Unit (NICU) during 2005-2008, then linked to child welfare reports at a median 3.2 year follow-up. Survival analyses were used to examine child welfare report outcomes conditional on caregiving burden and its moderating relationships with other family risk factors. Caregiving burden was associated primarily with an increased risk of child welfare reporting during the first few months to first year of life, after which risk was similar to NICU graduates without caregiving burden. Caregiving burden effects were potentiated by having three or more siblings in the family. A history of prior child welfare reports predicted very high risk, regardless of caregiving burden. Young maternal age increased risk. The findings suggest that the immediate months after NICU discharge may be an important window of child neglect prevention opportunity among newborns with special caregiving needs. This may be a key time to provide caregiver support and monitoring, particularly when caregivers have multiple children.
Collapse
Affiliation(s)
- Raja Nandyal
- Department of Pediatrics, University of Oklahoma Health Sciences Center, USA
| | - Arthur Owora
- Department of Pediatrics, University of Oklahoma Health Sciences Center, USA
| | - Elizabeth Risch
- Department of Pediatrics, University of Oklahoma Health Sciences Center, USA
| | - David Bard
- Department of Pediatrics, University of Oklahoma Health Sciences Center, USA
| | - Barbara Bonner
- Department of Pediatrics, University of Oklahoma Health Sciences Center, USA
| | - Mark Chaffin
- Department of Pediatrics, University of Oklahoma Health Sciences Center, USA
| |
Collapse
|
27
|
Patel JH, Stoner JA, Owora A, Mathew ST, Thadani U. Evidence for using clopidogrel alone or in addition to aspirin in post coronary artery bypass surgery patients. Am J Cardiol 2009; 103:1687-93. [PMID: 19539077 DOI: 10.1016/j.amjcard.2009.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 02/05/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
Abstract
Clopidogrel is recommended with aspirin for patients who undergo coronary artery bypass grafting (CABG) after non-ST elevation myocardial infarctions. Cardiothoracic surgeons widely use clopidogrel in addition to aspirin for post-CABG patients, including those with stable coronary artery disease. The aim of this study was to systematically review the published research to determine whether clopidogrel use after CABG is based on good trial data. Studies reporting safety and/or efficacy data for clopidogrel use with or without aspirin after on- or off-pump CABG were included. Fourteen studies met the inclusion criteria, of which 11 were reported trials and 3 are ongoing trials. Subgroup retrospective analyses of previously reported large trials of patients presenting with acute coronary syndromes (n = 1) or patients with stable coronary artery disease (n = 3) did not show a clear clinical benefit of clopidogrel when given in addition to aspirin after CABG. In contrast, there was a trend toward increased major and minor bleeding after the use of clopidogrel plus aspirin. Two small prospective trials providing data on surrogate end points and 5 small trials involving off-pump CABG patients were not of good quality to draw meaningful conclusions. In conclusion, summarized data based on subgroup analyses, surrogate end points, and observational cohort studies fail to demonstrate a clear beneficial effect of clopidogrel alone or in combination with aspirin on clinical outcomes after CABG.
Collapse
|