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Masoud SS, Escareño JT, Flores B, Lesser J, Choi BY, White CL. Project ECHO Brain Health: Assessing the Impact of a Pilot Program to Promote Self-Efficacy Among Community Health Workers. Fam Community Health 2024:00003727-990000000-00035. [PMID: 38742867 DOI: 10.1097/fch.0000000000000404] [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] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
This mixed-methods study sought to examine the impact of the Project ECHO Brain Health program on participating community health workers' (CHWs') self-efficacy to address dementia, promote brain health, and advocate for research among Latinx South Texas communities. Using an explanatory sequential design, quantitative data collected from pre- and post-program surveys were analyzed to inform the collection of qualitative data, followed by an interpretation of all findings to better understand the impact of the program on self-efficacy. Pre- and post-surveys were collected from 25 CHWs, 13 of whom later participated in individual interviews. There was a statistically significant increase in mean self-efficacy scores between the pre- and post-surveys among participants. Three categories reflecting the experiences of participants were identified from the qualitative data: addressing training needs; impact on CHWs and their practice; and community of learning. The findings suggest that Project ECHO Brain Health program is a timely intervention that may facilitate increased self-efficacy among CHWs as they navigate the impacts of dementia in their communities.
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Affiliation(s)
- Sara S Masoud
- School of Nursing (Drs Masoud, Lesser and White), Department of Population Health Sciences (Dr Choi), University of Texas Health Science Center at San Antonio, San Antonio, Texas; Lower Rio Grande Valley Area Health Education Center (Ms Escareño, Harlingen, Texas); and South Coastal Area Health Education Center (Ms Flores), Corpus Christi, Texas
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Choi BY. Propensity score analysis for health care disparities: a deweighting approach. BMC Med Res Methodol 2024; 24:106. [PMID: 38702648 PMCID: PMC11067258 DOI: 10.1186/s12874-024-02230-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Propensity score weighting is a useful tool to make causal or unconfounded comparisons between groups. According to the definition by the Institute of Medicine (IOM), estimates of health care disparities should be adjusted for health-status factors but not for socioeconomic status (SES) variables. There have been attempts to use propensity score weighting to generate estimates that are concordant with IOM's definition. However, the existing propensity score methods do not preserve SES distributions in minority and majority groups unless SES variables are independent of health status variables. METHODS The present study introduces a deweighting method that uses two types of propensity scores. One is a function of all covariates of health status and SES variables and is used to weight study subjects to adjust for them. The other is a function of only the SES variables and is used to deweight the subjects to preserve the original SES distributions. RESULTS The procedure of deweighting is illustrated using a dataset from a right heart catheterization (RHC) study, where it was used to examine whether there was a disparity between black and white patients in receiving RHC. The empirical example provided promising evidence that the deweighting method successfully preserved the marginal SES distributions for both racial groups but balanced the conditional distributions of health status given SES. CONCLUSIONS Deweighting is a promising tool for implementing the IOM-definition of health care disparities. The method is expected to be broadly applied to quantitative research on health care disparities.
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Affiliation(s)
- Byeong Yeob Choi
- Department of Population Health Sciences, UT Health San Antonio, 7703 Floyd Curl Drive, Mail Code 7933, San Antonio, 78229, TX, USA.
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Craven CK, Highfield L, Basit M, Bernstam EV, Choi BY, Ferrer RL, Gelfond JA, Pruitt SL, Kannan V, Shireman PK, Spratt H, Morales KJT, Wang CP, Wang Z, Zozus MN, Sankary EC, Schmidt S. Erratum: Toward standardization, harmonization, and integration of social determinants of health data: A Texas Clinical and Translational Science Award institutions collaboration - CORRIGENDUM. J Clin Transl Sci 2024; 8:e62. [PMID: 38655452 PMCID: PMC11036420 DOI: 10.1017/cts.2024.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
[This corrects the article DOI: 10.1017/cts.2024.2.].
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Craven CK, Highfield L, Basit M, Bernstam EV, Choi BY, Ferrer RL, Gelfond JA, Pruitt SL, Kannan V, Shireman PK, Spratt H, Morales KJT, Wang CP, Wang Z, Zozus MN, Sankary EC, Schmidt S. Toward standardization, harmonization, and integration of social determinants of health data: A Texas Clinical and Translational Science Award institutions collaboration. J Clin Transl Sci 2024; 8:e17. [PMID: 38384919 PMCID: PMC10880009 DOI: 10.1017/cts.2024.2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction The focus on social determinants of health (SDOH) and their impact on health outcomes is evident in U.S. federal actions by Centers for Medicare & Medicaid Services and Office of National Coordinator for Health Information Technology. The disproportionate impact of COVID-19 on minorities and communities of color heightened awareness of health inequities and the need for more robust SDOH data collection. Four Clinical and Translational Science Award (CTSA) hubs comprising the Texas Regional CTSA Consortium (TRCC) undertook an inventory to understand what contextual-level SDOH datasets are offered centrally and which individual-level SDOH are collected in structured fields in each electronic health record (EHR) system potentially for all patients. Methods Hub teams identified American Community Survey (ACS) datasets available via their enterprise data warehouses for research. Each hub's EHR analyst team identified structured fields available in their EHR for SDOH using a collection instrument based on a 2021 PCORnet survey and conducted an SDOH field completion rate analysis. Results One hub offered ACS datasets centrally. All hubs collected eleven SDOH elements in structured EHR fields. Two collected Homeless and Veteran statuses. Completeness at four hubs was 80%-98%: Ethnicity, Race; < 10%: Education, Financial Strain, Food Insecurity, Housing Security/Stability, Interpersonal Violence, Social Isolation, Stress, Transportation. Conclusion Completeness levels for SDOH data in EHR at TRCC hubs varied and were low for most measures. Multiple system-level discussions may be necessary to increase standardized SDOH EHR-based data collection and harmonization to drive effective value-based care, health disparities research, translational interventions, and evidence-based policy.
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Affiliation(s)
- Catherine K. Craven
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Linda Highfield
- University of Texas Health Science Center at Houston, School of Public Health, San Antonio, TX, USA
| | - Mujeeb Basit
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elmer V. Bernstam
- D. Bradley McWilliams School of Biomedical Informatics and Division of General Internal Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Byeong Yeob Choi
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Robert L. Ferrer
- Department of Community and Family Medicine, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Jonathan A. Gelfond
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Sandi L. Pruitt
- University of Texas Southwestern Medical Center, Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | | | - Paula K. Shireman
- Department of Surgery, Division of Vascular and Endovascular Surgery, Texas A&M University School of Medicine, Bryan, TX, USA
- Departments of Primary Care & Rural Medicine and Medical Physiology, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Heidi Spratt
- Department of Biostatistics and Data Science, University of Texas Medical Branch Galveston, Galveston, TX, USA
| | - Kayla J. Torres Morales
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Chen-Pin Wang
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Biostatistics Division, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Zhan Wang
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Meredith N. Zozus
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
- Division of Clinical Research Informatics, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Edward C. Sankary
- University of Texas Health Science Center San Antonio, UT Health Physicians, San Antonio, TX, USA
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
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Choi BY, Grace AR, Tsai J. Heterogeneity of COVID-19 symptoms and associated factors: Longitudinal analysis of laboratory-confirmed COVID-19 cases in San Antonio. PLoS One 2023; 18:e0295418. [PMID: 38064447 PMCID: PMC10707584 DOI: 10.1371/journal.pone.0295418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Few studies have examined heterogeneous associations of risk factors with Coronavirus Disease-2019 (COVID-19) symptoms by type. The objectives of this study were to estimate the prevalence of and risk factors associated with COVID-19 symptoms and to investigate whether the associations differ by the type of symptoms. This study obtained longitudinal data over 6 months from laboratory-confirmed COVID-19 cases in a citywide sample in San Antonio. Sixteen symptoms of COVID-19 infection, measured at baseline and three follow-up times (1, 3, and 6 months), were analyzed using generalized estimating equations (GEE) to investigate potential risk factors while accounting for the repeated measurements. The risk factors included time in months, sociodemographic characteristics, and past or current medical and psychiatric conditions. To obtain interpretable results, we categorized these sixteen symptoms into five categories (cardiopulmonary, neuro-psychological, naso-oropharyngeal, musculoskeletal, and miscellaneous). We fitted GEE models with a logit link using each category as the outcome variable. Our study demonstrated that the associations were heterogeneous by the categories of symptoms. The time effects were the strongest for naso-oropharyngeal symptoms but the weakest for neuro-psychological symptoms. Female gender was associated with increased odds of most of the symptoms. Hispanic ethnicity was also associated with higher odds of neuro-psychological, musculoskeletal, and miscellaneous symptoms. Depression was the most robust psychiatric condition contributing to most of the symptoms. Different medical conditions seemed to contribute to different symptom expressions of COVID-19 infection.
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Affiliation(s)
- Byeong Yeob Choi
- Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, United States of America
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Abigail R. Grace
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Jack Tsai
- School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
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Choi BY, Brookhart MA. Effects of Adjusting for Instrumental Variables on the Bias and Precision of Propensity Score Weighted Estimators: Analysis Under Complete, Near, and No Positivity Violations. Clin Epidemiol 2023; 15:1055-1068. [PMID: 38025839 PMCID: PMC10644870 DOI: 10.2147/clep.s427933] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To demonstrate that using an instrumental variable (IV) with monotonicity reduces the accuracy of propensity score (PS) weighted estimators for the average treatment effect (ATE). Methods Monotonicity in the relationship between a binary IV and a binary treatment variable is an important assumption to identify the ATE for compliers who would only take treatment when encouraged by the IV. We perform theoretical and numerical investigations to study the impact of using the IV that satisfies monotonicity on the PS of treatment in terms of the positivity assumption, which requires that the PS be strictly between 0 and 1, and the accuracy of PS weighted estimators. Two versions of monotonicity that result in one-sided or two-sided noncompliance are considered. Results The PS adjusting for the IV always violates the positivity assumption when noncompliance occurs in one direction (one-sided noncompliance) and is more extreme than without the IV under two-sided noncompliance. These results are valid if the probability of being encouraged to get treatment and the compliance score, the probability of being a complier, are strictly between 0 and 1. Conclusion Using a binary IV with monotonicity as a covariate for the PS model makes the estimated PSs unnecessarily extreme, reducing the accuracy of the PS weighted estimators.
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Affiliation(s)
- Byeong Yeob Choi
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, USA
| | - M Alan Brookhart
- Department of Population Health Sciences, Duke University, Durham, NC, USA
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Du Y, Li YY, Choi BY, Fernadez R, Su KJ, Sharma K, Qi L, Yin Z, Zhao Q, Shen H, Qiu C, Zhao LJ, Luo Z, Wu L, Tian Q, Deng HW. Metabolomic profiles associated with physical activity in White and African American adult men. PLoS One 2023; 18:e0289077. [PMID: 37943870 PMCID: PMC10635561 DOI: 10.1371/journal.pone.0289077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/11/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Physical activity (PA) is associated with various health benefits, especially in improving chronic health conditions. However, the metabolic changes in host metabolism in response to PA remain unclear, especially in racially/ethnically diverse populations. OBJECTIVE This study is to assess the metabolic profiles associated with the frequency of PA in White and African American (AA) men. METHODS Using the untargeted metabolomics data collected from 698 White and AA participants (mean age: 38.0±8.0, age range: 20-50) from the Louisiana Osteoporosis Study (LOS), we conducted linear regression models to examine metabolites that are associated with PA levels (assessed by self-reported regular exercise frequency levels: 0, 1-2, and ≥3 times per week) in White and AA men, respectively, as well as in the pooled sample. Covariates considered for statistical adjustments included race (only for the pooled sample), age, BMI, waist circumstance, smoking status, and alcohol drinking. RESULTS Of the 1133 untargeted compounds, we identified 7 metabolites associated with PA levels in the pooled sample after covariate adjustment with a false discovery rate of 0.15. Specifically, compared to participants who did not exercise, those who exercised at a frequency ≥3 times/week showed higher abundances in uracil, orotate, 1-(1-enyl-palmitoyl)-2-oleoyl-GPE (P-16:0/18:1) (GPE), threonate, and glycerate, but lower abundances in salicyluric glucuronide and adenine in the pooled sample. However, in Whites, salicyluric glucuronide and orotate were not significant. Adenine, GPE, and threonate were not significant in AAs. In addition, the seven metabolites were not significantly different between participants who exercised ≥3 times/week and 1-2 times/week, nor significantly different between participants with 1-2 times/week and 0/week in the pooled sample and respective White and AA groups. CONCLUSIONS Metabolite responses to PA are dose sensitive and may differ between White and AA populations. The identified metabolites may help advance our knowledge of guiding precision PA interventions. Studies with rigorous study designs are warranted to elucidate the relationship between PA and metabolites.
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Affiliation(s)
- Yan Du
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Yuan-Yuan Li
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill School of Public Health, Kannapolis, North Carolina, United States of America
| | - Byeong Yeob Choi
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Roman Fernadez
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Kuan-Jui Su
- Tulane Center for Biomedical Informatics and Genomics, School of Medicine, Tulane University; New Orleans, LA, United States of America
| | - Kumar Sharma
- Center for Precision Medicine, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University; New Orleans, LA, United States of America
| | - Zenong Yin
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, United States of America
| | - Qi Zhao
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Hui Shen
- Tulane Center for Biomedical Informatics and Genomics, School of Medicine, Tulane University; New Orleans, LA, United States of America
| | - Chuan Qiu
- Tulane Center for Biomedical Informatics and Genomics, School of Medicine, Tulane University; New Orleans, LA, United States of America
| | - Lan-Juan Zhao
- Tulane Center for Biomedical Informatics and Genomics, School of Medicine, Tulane University; New Orleans, LA, United States of America
| | - Zhe Luo
- Tulane Center for Biomedical Informatics and Genomics, School of Medicine, Tulane University; New Orleans, LA, United States of America
| | - Li Wu
- Tulane Center for Biomedical Informatics and Genomics, School of Medicine, Tulane University; New Orleans, LA, United States of America
| | - Qing Tian
- Tulane Center for Biomedical Informatics and Genomics, School of Medicine, Tulane University; New Orleans, LA, United States of America
| | - Hong-Wen Deng
- Tulane Center for Biomedical Informatics and Genomics, School of Medicine, Tulane University; New Orleans, LA, United States of America
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Sharma K, Zhang G, Hansen J, Bjornstad P, Lee HJ, Menon R, Hejazi L, Liu JJ, Franzone A, Looker HC, Choi BY, Fernandez R, Venkatachalam MA, Kugathasan L, Sridhar VS, Natarajan L, Zhang J, Sharma VS, Kwan B, Waikar SS, Himmelfarb J, Tuttle KR, Kestenbaum B, Fuhrer T, Feldman HI, de Boer IH, Tucci FC, Sedor J, Heerspink HL, Schaub J, Otto EA, Hodgin JB, Kretzler M, Anderton CR, Alexandrov T, Cherney D, Lim SC, Nelson RG, Gelfond J, Iyengar R. Endogenous adenine mediates kidney injury in diabetic models and predicts diabetic kidney disease in patients. J Clin Invest 2023; 133:e170341. [PMID: 37616058 PMCID: PMC10575723 DOI: 10.1172/jci170341] [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: 03/09/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
Diabetic kidney disease (DKD) can lead to end-stage kidney disease (ESKD) and mortality; however, few mechanistic biomarkers are available for high-risk patients, especially those without macroalbuminuria. Urine from participants with diabetes from the Chronic Renal Insufficiency Cohort (CRIC) study, the Singapore Study of Macro-angiopathy and Micro-vascular Reactivity in Type 2 Diabetes (SMART2D), and the American Indian Study determined whether urine adenine/creatinine ratio (UAdCR) could be a mechanistic biomarker for ESKD. ESKD and mortality were associated with the highest UAdCR tertile in the CRIC study and SMART2D. ESKD was associated with the highest UAdCR tertile in patients without macroalbuminuria in the CRIC study, SMART2D, and the American Indian study. Empagliflozin lowered UAdCR in nonmacroalbuminuric participants. Spatial metabolomics localized adenine to kidney pathology, and single-cell transcriptomics identified ribonucleoprotein biogenesis as a top pathway in proximal tubules of patients without macroalbuminuria, implicating mTOR. Adenine stimulated matrix in tubular cells via mTOR and stimulated mTOR in mouse kidneys. A specific inhibitor of adenine production was found to reduce kidney hypertrophy and kidney injury in diabetic mice. We propose that endogenous adenine may be a causative factor in DKD.
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Affiliation(s)
- Kumar Sharma
- Center for Precision Medicine and
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Guanshi Zhang
- Center for Precision Medicine and
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Jens Hansen
- Department of Pharmacological Sciences and Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Petter Bjornstad
- Division of Nephrology, Department of Medicine and Section of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hak Joo Lee
- Center for Precision Medicine and
- Division of Nephrology, Department of Medicine, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Rajasree Menon
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Leila Hejazi
- Center for Precision Medicine and
- SygnaMap Inc., San Antonio, Texas, USA
| | - Jian-Jun Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | | | - Helen C. Looker
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Byeong Yeob Choi
- Center for Precision Medicine and
- Department of Population Health Sciences and
| | | | - Manjeri A. Venkatachalam
- Center for Precision Medicine and
- Department of Pathology, University of Texas Health Science Center at San Antonio, Texas, USA
| | - Luxcia Kugathasan
- Department of Medicine, Division of Nephrology, University Health Network, Toronto, Ontario, Canada. Department of Physiology and Cardiovascular Sciences Collaborative Specialization, University of Toronto, Toronto, Canada
| | - Vikas S. Sridhar
- Department of Medicine, Division of Nephrology, University Health Network, Toronto, Ontario, Canada. Department of Physiology and Cardiovascular Sciences Collaborative Specialization, University of Toronto, Toronto, Canada
| | - Loki Natarajan
- Herbert Wertheim School of Public Health and
- Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Jing Zhang
- Moores Cancer Center, University of California, San Diego, La Jolla, California, USA
| | - Varun S. Sharma
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Brian Kwan
- Department of Health Science, California State University, Long Beach, Long Beach, California, USA
| | - Sushrut S. Waikar
- Section of Nephrology, Department of Medicine, Boston Medical Center and Boston University, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Jonathan Himmelfarb
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Katherine R. Tuttle
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Bryan Kestenbaum
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | - Tobias Fuhrer
- Institute of Molecular Systems Biology, ETH Zurich, Zurich, Switzerland
| | - Harold I. Feldman
- Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Ian H. de Boer
- Department of Medicine, Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | | | | | - Hiddo Lambers Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, Netherlands
- The George Institute for Global Health, Sydney, Australia
| | - Jennifer Schaub
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Edgar A. Otto
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey B. Hodgin
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthias Kretzler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher R. Anderton
- Center for Precision Medicine and
- Environmental Molecular Sciences Laboratory, Pacific Northwest National Laboratory, Richland, Washington, USA
| | - Theodore Alexandrov
- Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - David Cherney
- Department of Medicine, Division of Nephrology, University Health Network, Toronto, Ontario, Canada. Department of Physiology and Cardiovascular Sciences Collaborative Specialization, University of Toronto, Toronto, Canada
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
- Diabetes Center, Admiralty Medical Center, Khoo Teck Puat Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Robert G. Nelson
- Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - Jonathan Gelfond
- Center for Precision Medicine and
- Department of Population Health Sciences and
| | - Ravi Iyengar
- Department of Pharmacological Sciences and Institute for Systems Biomedicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Choi BY, Park H, Kim J, Wang S, Lee J, Lee Y, Shim D. BLZ8 activates a plastidial peroxiredoxin and a ferredoxin to protect Chlamydomonas reinhardtii against oxidative stress. Plant Biol (Stuttg) 2023; 25:915-923. [PMID: 37338124 DOI: 10.1111/plb.13552] [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] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
Reactive oxygen species (ROS) cause damage to various cellular processes in almost all organisms, in particular photosynthetic organisms that depend on the electron transfer chain for CO2 fixation. However, the detoxifying process to mitigate ROS damage has not been studied intensively in microalgae. Here, we characterized the ROS detoxifying role of a bZIP transcription factor, BLZ8, in Chlamydomonas reinhardtii. To identify downstream targets of BLZ8, we carried out comparative genome-wide transcriptomic profiling of BLZ8 OX and its parental CC-4533 under oxidative stress conditions. Luciferase reporter activity assays and RT-qPCR were performed to test whether BLZ8 regulates downstream genes. We performed an in silico functional gene network analysis and an in vivo immunoprecipitation assay to identify the interaction between downstream targets of BLZ8. Comparative transcriptomic analysis and RT-qPCR revealed that overexpression of BLZ8 increased the expression levels of plastid peroxiredoxin1 (PRX1) and ferredoxin-5 (FDX5) under oxidative stress conditions. BLZ8 alone could activate the transcriptional activity of FDX5 and required bZIP2 to activate transcriptional activity of PRX1. Functional gene network analysis using FDX5 and PRX1 orthologs in A. thaliana suggested that these two genes were functionally associated. Indeed, our immunoprecipitation assay revealed the physical interaction between PRX1 and FDX5. Furthermore, the complemented strain, fdx5 (FDX5), recovered growth retardation of the fdx5 mutant under oxidative stress conditions, indicating that FDX5 contributes to oxidative stress tolerance. These results suggest that BLZ8 activates PRX1 and FDX5 expression, resulting in the detoxification of ROS to confer oxidative stress tolerance in microalgae.
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Affiliation(s)
- B Y Choi
- Department of Biological Sciences, Chungnam National University, Daejeon, Korea
| | - H Park
- Department of Biological Sciences, Chungnam National University, Daejeon, Korea
| | - J Kim
- Department of Biological Sciences, Chungnam National University, Daejeon, Korea
| | - S Wang
- Division of Natural and Applied Sciences, Duke Kunshan University, Suzhou, China
| | - J Lee
- Division of Natural and Applied Sciences, Duke Kunshan University, Suzhou, China
| | - Y Lee
- Department of Life Science, Pohang University of Science and Technology (POSTECH), Pohang, Korea
| | - D Shim
- Department of Biological Sciences, Chungnam National University, Daejeon, Korea
- Center for Genome Engineering, Institute for Basic Science, Daejeon, Korea
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10
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Zozus MN, Choi BY, Garza MY, Facile R, Lanham HJ, Wang Z, Sanns B, Maallah M, Wei HG, Cramer AN, Eisenstein EL. Collaborative Program to Evaluate Real World Data for Use in Clinical Studies and Regulatory Decision Making. AMIA Jt Summits Transl Sci Proc 2023; 2023:632-641. [PMID: 37350921 PMCID: PMC10283122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
The 21st Century Cures Act allows the US Food and Drug Administration to consider real world data (RWD) for new indications or post approval study requirements. However, there is limited guidance as to the relative quality of different RWD types. The ACE-RWD program will compare the quality of EHR clinical data, EHR billing data, and linked healthcare claims data to traditional clinical trial data collection methods. ACE-RWD is being conducted alongside 5-10 ancillary studies, with five sponsors, across multiple therapeutic areas. Each ancillary study will be conducted after or in parallel with its parent clinical study at a minimum of two clinical sites. Although not required, it is anticipated that EHR clinical and EHR billing data will be obtained via EHR-to-eCRF mechanisms that are based on the Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR®) standard.
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Affiliation(s)
- Meredith N Zozus
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Byeong Yeob Choi
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Maryam Y Garza
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Rhonda Facile
- Clinical Data Interchange Standards Consortium, Austin, TX
| | - Holly J Lanham
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Zhan Wang
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Bill Sanns
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Muayad Maallah
- University of Texas Health Science Center San Antonio, San Antonio, TX
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11
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Choi BY. Profiling compliers and noncompliers for instrumental variable analysis with covariates: A weighting approach. PLoS One 2023; 18:e0283223. [PMID: 37319247 PMCID: PMC10270339 DOI: 10.1371/journal.pone.0283223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 03/03/2023] [Indexed: 06/17/2023] Open
Abstract
Instrumental variable (IV) estimation is an essential tool to estimate the causal effect of a treatment in randomized experiments when noncompliance exists. In such studies, standard statistical approaches can be biased because compliers and noncompliers can differ in unmeasured ways that affect both the compliance behavior and outcome. Based on a few assumptions such as monotonicity, the IV estimand represents the causal effect of compliers. Profiling compliers and noncompliers has important implications because the IV estimand applies only to compliers. A method for estimating the covariate means for compliers and noncompliers has recently been proposed in political sciences literature. However, this approach requires an assumption that the instrument is randomly assigned, which confines the application of this approach to randomized experiments. In this study, we present two weighting methods for profiling compliers and noncompliers when the instrument and compliance behavior are confounded by several covariates. The proposed approach can be used for both experimental and nonexperimental studies, and hence is more broadly applicable. For the development, an instrumental propensity score is adopted to account for confounded instruments. We demonstrate the utility of the proposed methods based on simulation and real data experiments.
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Affiliation(s)
- Byeong Yeob Choi
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, United States of America
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12
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Sharma K, Zhang G, Hansen J, Bjornstad P, Lee HJ, Menon R, Hejazi L, Liu JJ, Franzone A, Looker HC, Choi BY, Fernandez R, Venkatachalam MA, Kugathasan L, Sridhar VS, Natarajan L, Zhang J, Sharma V, Kwan B, Waikar S, Himmelfarb J, Tuttle K, Kestenbaum B, Fuhrer T, Feldman H, de Boer IH, Tucci FC, Sedor J, Heerspink HL, Schaub J, Otto E, Hodgin JB, Kretzler M, Anderton C, Alexandrov T, Cherney D, Lim SC, Nelson RG, Gelfond J, Iyengar R. Role of endogenous adenine in kidney failure and mortality with diabetes. medRxiv 2023:2023.05.31.23290681. [PMID: 37398187 PMCID: PMC10312877 DOI: 10.1101/2023.05.31.23290681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Diabetic kidney disease (DKD) can lead to end-stage kidney disease (ESKD) and mortality, however, few mechanistic biomarkers are available for high risk patients, especially those without macroalbuminuria. Urine from participants with diabetes from Chronic Renal Insufficiency Cohort (CRIC), Singapore Study of Macro-Angiopathy and Reactivity in Type 2 Diabetes (SMART2D), and the Pima Indian Study determined if urine adenine/creatinine ratio (UAdCR) could be a mechanistic biomarker for ESKD. ESKD and mortality were associated with the highest UAdCR tertile in CRIC (HR 1.57, 1.18, 2.10) and SMART2D (HR 1.77, 1.00, 3.12). ESKD was associated with the highest UAdCR tertile in patients without macroalbuminuria in CRIC (HR 2.36, 1.26, 4.39), SMART2D (HR 2.39, 1.08, 5.29), and Pima Indian study (HR 4.57, CI 1.37-13.34). Empagliflozin lowered UAdCR in non-macroalbuminuric participants. Spatial metabolomics localized adenine to kidney pathology and transcriptomics identified ribonucleoprotein biogenesis as a top pathway in proximal tubules of patients without macroalbuminuria, implicating mammalian target of rapamycin (mTOR). Adenine stimulated matrix in tubular cells via mTOR and stimulated mTOR in mouse kidneys. A specific inhibitor of adenine production was found to reduce kidney hypertrophy and kidney injury in diabetic mice. We propose that endogenous adenine may be a causative factor in DKD.
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13
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Vittner D, D'Agata A, Choi BY, McGrath J. Release of Oxytocin and Cortisol Is Associated With Neurobehavioral Patterns in Premature Infants. J Obstet Gynecol Neonatal Nurs 2023; 52:248-256. [PMID: 36965512 DOI: 10.1016/j.jogn.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/27/2023] Open
Abstract
OBJECTIVE To examine relationships among salivary oxytocin and cortisol levels in parents and preterm infants and neurobehavioral functioning in preterm infants after skin-to-skin contact. DESIGN A secondary analysis of a randomized crossover study. SETTING NICU. PARTICIPANTS Twenty-eight stable premature infants and their mothers and fathers. METHODS Participating infants contributed 108 saliva samples that we collected 45 minutes after skin-to-skin contact and tested for oxytocin and cortisol. We randomized data collection by whether the infant was held first by the mother or by the father. We conducted linear regression to test if summary scores on the NICU Network Neurobehavioral Scale were associated with salivary oxytocin and cortisol levels. RESULTS We found a significant negative relationship between infant oxytocin levels and the Stress scores (b = -0.07, p < .01) and the Excitability scores (b = -1.12, p = .04) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant oxytocin levels and the Self-Regulatory scores (b = 0.38, p = .05) among infants held skin-to-skin with their mothers. We found a significant positive relationship between infant cortisol level and the Stress scores (b = 0.05, p = .04), Excitability scores (b = 1.06, p = 0.05), and Asymmetrical Reflexes scores (b = 1.21, p = .03) among infants held skin-to-skin with their mothers. We only found a negative significant relationship between infant cortisol levels and the Stress scores (b = -0.03, p = .04) among infants held skin-to-skin with their fathers. CONCLUSION We found that oxytocin is an important biomarker that may improve infant neurobehavioral functioning. The data showed a difference in oxytocin responses after skin-to-skin contact with mothers compared to fathers.
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Choi BY. Instrumental variable estimation of weighted local average treatment effects. Stat Pap (Berl) 2023. [DOI: 10.1007/s00362-023-01415-2] [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: 03/06/2023]
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15
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Yang P, Crous Y, Balli-Borrero NA, Scott BL, Trujillo AM, Choi BY, Robles-Ramamurthy B. Antiracism Work in Schools: Using Dialectical Behavior Therapy Skills to Empower South Texas Educators. J Am Acad Child Adolesc Psychiatry 2022; 61:1296-1302. [PMID: 35429612 DOI: 10.1016/j.jaac.2022.03.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/01/2021] [Revised: 03/13/2022] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Implicit biases within school systems contribute to racist school cultures and policies. Black and Hispanic students are more likely to be over-policed in schools and to be penalized, especially by White teachers. Dialectical behavior therapy (DBT) skills can be taught to educators to support antiracist efforts in schools. METHOD A virtual 2-day Train-the-Trainer antiracism workshop incorporating DBT skills was delivered to South Texas educators. DBT skills were integrated as life skills in antiracism situational role play, small group discussions, and meta-cognitive activities. Participants also received books on antiracism and an educators' toolkit to DBT and antiracism. Descriptive analysis described results from the workshop application, pre/post-workshop survey, and 6-month follow-up survey. RESULTS Twelve educators completed the workshop application, with 10 educators reporting no history of antiracism trainings at their schools. Nine educators attended the workshop. Workshop feedback was overwhelmingly positive. A pre/post-workshop survey demonstrated growth in both teaching and use of all measured DBT skills and antiracism attitudes. Confidence in teaching and using DBT skills and changes in antiracism attitudes were sustained 6 months later. Five educators reported leading an antiracism initiative in their schools since the attendance of the workshop. CONCLUSION A DBT-centered Train-the-Trainer antiracism workshop instilled confidence in educators to lead antiracism efforts, which resulted in the initiation of several initiatives in South Texas schools. Training educators, including teachers, counselors, and administrators, encouraged systemic antiracist change in school systems. The virtual training format may facilitate accessibility to educators who lack access to trainings; however, it may also add difficulty in building community among participants.
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Affiliation(s)
- Phillip Yang
- Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, Texas.
| | - Yolanda Crous
- Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio, Texas
| | | | | | | | - Byeong Yeob Choi
- Graduate School of Biomedical Sciences, UT Health San Antonio, Texas
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16
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Du Y, Patel N, Hernandez A, Zamudio-Samano M, Li S, Zhang T, Fernandez R, Choi BY, Land WM, Ullevig S, Estrada Coats V, Moussavou JMM, Parra-Medina D, Yin Z. Examining the Delivery of a Tailored Chinese Mind-Body Exercise to Low-Income Community-Dwelling Older Latino Individuals for Healthy Aging: Feasibility and Acceptability Study. JMIR Form Res 2022; 6:e40046. [PMID: 35997685 PMCID: PMC9516366 DOI: 10.2196/40046] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/28/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Older Latino individuals are disproportionally affected by various chronic conditions including impairments in physical and cognitive functions, which are essential for healthy aging and independent living. Objective This study aimed to evaluate the feasibility and acceptability of FITxOlder, a 12-week mind-body exercise program, in community-dwelling low-income, predominantly older Latino individuals, and assess its preliminary effects on health parameters relevant to healthy aging and independent living. Methods This 12-week, single-arm, stage 1B feasibility study had a pre- and poststudy design. A total of 13 older adults (mean age 76.4, SD 7.9 years; 11/13, 85% Latino) of a congregate meal program in a senior center were enrolled. FITxOlder was a tailored Chinese mind-body exercise program using Five Animal Frolics led by a bilingual community health worker (CHW) participating twice a week at the senior center and facilitated by mobile health technology for practice at home, with incrementally increasing goals moving from once a week to at least 3 times a week. The feasibility and acceptability of the study were examined using both quantitative and qualitative data. Healthy aging–related outcomes (eg, physical and cognitive function) were assessed using paired 2-tailed t tests. Qualitative interview data were analyzed using thematic analysis. Results The attendance rate for the 24 exercise sessions was high (22.7/24, 95%), ranging from 93% (1.8/2) to 97% (1.9/2) over the 12 weeks. Participants were compliant with the incremental weekly exercise goals, with 69.2% (9/13) and 75.0% (9/12) meeting the home and program goals in the last 4 weeks, respectively. Approximately 83% (10/12) to 92% (11/12) of the participants provided favorable feedback on survey questions regarding the study and program implementation, such as program content and support, delivery by the CHW, enjoyment and appeal of the Five Animal Frolics, study burden and incentives, and safety concerns. The qualitative interview data revealed that FITxOlder was well accepted; participants reported enjoyment and health benefits and the desire to continue to practice and share it with others. The 5-time sit-to-stand test (mean change at posttest assessment=−1.62; P<.001; Cohen d=0.97) and 12-Item Short Form Health Survey physical component scores (mean change at post intervention=5.71; P=.01; Cohen d=0.88) exhibited changes with large effect sizes from baseline to 12 weeks; the other parameters showed small or medium effect sizes. Conclusions The research findings indicated that the CHW-led and mobile health–facilitated Chinese qigong exercise program is feasible and acceptable among low-income Latino older adults. The trending health benefits of the 12-week FITxOlder program suggest it is promising to promote physical activity engagement in underserved older populations to improve health outcomes for healthy aging and independent living. Future research with larger samples and longer interventions is warranted to assess the health benefits and suitability of FITxOlder.
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Affiliation(s)
- Yan Du
- Center on Smart and Connected Health Technology, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Neela Patel
- Department of Family and Community Medicine, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Arthur Hernandez
- Dreeben School of Education, University of the Incarnate Word, San Antonio, TX, United States
| | | | - Shiyu Li
- Center on Smart and Connected Health Technology, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Tianou Zhang
- Department of Kinesiology, University of Texas at San Antonio, San Antonio, TX, United States
| | - Roman Fernandez
- Department of Population Health Science, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Byeong Yeob Choi
- Department of Population Health Science, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - William M Land
- Department of Kinesiology, University of Texas at San Antonio, San Antonio, TX, United States
| | - Sarah Ullevig
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, United States
| | - Vanessa Estrada Coats
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, United States
| | | | - Deborah Parra-Medina
- Latino Research Institute, Latino Studies, University of Texas at Austin, Austin, TX, United States
| | - Zenong Yin
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, United States
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17
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Soewito S, Wyatt R, Berenson E, Poullard N, Gessay S, Mette L, Marin E, Shelby K, Alvarez E, Choi BY, Aviles C, Pulido-Saldivar AM, Otto PM, Jatoi I, Ramamurthy C, Ignatius M, Kaklamani VG, Tomlinson GE. Disparities in Cancer Genetic Testing and Variants of Uncertain Significance in the Hispanic Population of South Texas. JCO Oncol Pract 2022; 18:e805-e813. [PMID: 35544645 PMCID: PMC10166383 DOI: 10.1200/op.22.00090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/08/2022] [Accepted: 03/31/2022] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Racial and ethnic disparities have included a lack of access to both genetic testing and research, resulting in poor understanding of the genomic architecture in under-represented populations. The South Texas population is primarily of Hispanic background and has been largely devoid of genetic services. We extended access to this underserved population and uncovered genetic variants previously not observed, emphasizing the need to continually improve both genomic databases and clarification of variant significance to provide meaningful patient counseling. METHODS This study consisted of a retrospective cohort review of patients seen through a cancer genetics education and service program across 24 counties in South Texas. In total, 1,595 individuals were identified as appropriate for cancer genetic counseling and 1,377 completed genetic testing. RESULTS Eighty percent of those receiving genetic counseling self-identified as Hispanic, 16% as non-Hispanic White (NHW), 3% as African American, and 1% as other race/ethnicity. Of reported variants, 18.8% were pathogenic and 13.7% were reported as a variant of uncertain significance (VUS). VUS was reported in 17.2% of the Hispanic individuals compared with 9% NHW (P = .005). CONCLUSION Individuals of Hispanic ethnicity were significantly more likely to harbor a VUS compared with NHW. The extended reach into our regional communities revealed a gap in the ability to accurately interpret genomic variation with implications for advising patients on screening, prevention, and management strategies. A higher percentage of VUS also emphasizes the challenge of continued follow-up amid existing barriers that led to disparities in access. As understanding of the variants develops, hopefully gaps in knowledge of the genomic landscape will be lessened with increased clarity to provide accurate cancer risk assessment and recommendations for implementing prevention initiatives.
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Affiliation(s)
| | - Rachel Wyatt
- Department of Pediatrics, UT Health San Antonio, San Antonio, TX
| | - Emily Berenson
- Department of Pediatrics, UT Health San Antonio, San Antonio, TX
| | | | - Shawn Gessay
- Department of Pediatrics, UT Health San Antonio, San Antonio, TX
- Mays Cancer Center, UT Health San Antonio, San Antonio, TX
- Present address: PreventionGenetics, Marshfield, WI
| | - Lindsey Mette
- Department of Pediatrics, UT Health San Antonio, San Antonio, TX
- Mays Cancer Center, UT Health San Antonio, San Antonio, TX
- Present address: Invitae, San Francisco, CA
| | - Elena Marin
- Greehey Children's Cancer Research Institute, UT Health San Antonio, TX
| | - Kristin Shelby
- Greehey Children's Cancer Research Institute, UT Health San Antonio, TX
| | - Elise Alvarez
- Mays Cancer Center, UT Health San Antonio, San Antonio, TX
| | - Byeong Yeob Choi
- Department of Population Health Sciences, UT Health San Antonio TX, San Antonio, TX
| | - Clarissa Aviles
- Greehey Children's Cancer Research Institute, UT Health San Antonio, TX
| | - Anna Maria Pulido-Saldivar
- Greehey Children's Cancer Research Institute, UT Health San Antonio, TX
- UT Laredo Campus, UT Health San Antonio, Laredo, TX
| | - Pamela M. Otto
- Department of Radiology, UT Health San Antonio, San Antonio, TX
| | - Ismail Jatoi
- Mays Cancer Center, UT Health San Antonio, San Antonio, TX
- Department of Surgical Oncology, UT Health San Antonio, San Antonio, TX
| | | | - Myron Ignatius
- Greehey Children's Cancer Research Institute, UT Health San Antonio, TX
| | | | - Gail E. Tomlinson
- Department of Pediatrics, UT Health San Antonio, San Antonio, TX
- Mays Cancer Center, UT Health San Antonio, San Antonio, TX
- Greehey Children's Cancer Research Institute, UT Health San Antonio, TX
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18
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Li S, Yin Z, Lesser J, Li C, Choi BY, Parra-Medina D, Flores B, Dennis B, Wang J. A Community Health Worker-Led mHealth-Enabled Diabetes Self-Management Education and Support Intervention in Rural Latino Adults: Single-Arm Feasibility Trial (Preprint). JMIR Diabetes 2022; 7:e37534. [PMID: 35635752 PMCID: PMC9153909 DOI: 10.2196/37534] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/19/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Latinos living in rural South Texas have a higher prevalence of diabetes, but their access to diabetes self-management education and support (DSMES) is limited. Objective We aimed to test the feasibility of a community health worker-led, mobile health (mHealth)-based DSMES intervention to reduce disparities in accessing DSMES in underserved rural Latino residents in South Texas. Methods This 12-week, single-arm, pre-post trial was delivered by trained community health workers to 15 adults with type 2 diabetes. The intervention consisted of digital diabetes education, self-monitoring, a cloud-based connected platform, and community health worker support. Feasibility was evaluated as retention, actual intervention use, program satisfaction, and barriers to implementation. We also explored the intervention’s effect on weight loss and hemoglobin A1c (HbA1c). Results All 15 participants were Latino (mean age 61.87 years, SD 10.67; 9/15 female, 60%). The retention rate at posttest was 14 of 15 (93%). On average, the participants completed 37 of 42 (88%) digital diabetes education lessons with 8 participants completing all lessons. Participants spent 81/91 days (89%) step tracking, 71/91 days (78%) food logging, 43/91 days (47%) blood glucose self-monitoring, and 74/91 days (81%) weight self-monitoring. The level of program satisfaction was high. On average, participants lost 3.5 (SD 3.2) kg of body weight (P=.001), while HbA1c level remained unchanged from baseline (6.91%, SD 1.28%) to posttest (7.04%, SD 1.66%; P=.668). Conclusions A community health worker-led mHealth-based intervention was feasible and acceptable to improve access to DSMES services for Latino adults living in rural communities. Future randomized controlled trials are needed to test intervention efficacy on weight loss and glycemic control.
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Affiliation(s)
- Shiyu Li
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Zenong Yin
- Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Janna Lesser
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Chengdong Li
- College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Byeong Yeob Choi
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Deborah Parra-Medina
- Latino Research Institute, The University of Texas at Austin, Austin, TX, United States
| | - Belinda Flores
- South Coastal Area Health Education Center, Corpus Christi, TX, United States
| | - Brittany Dennis
- Center on Smart and Connected Health Technologies, School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Jing Wang
- College of Nursing, Florida State University, Tallahassee, FL, United States
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Choi BY. Subclassification estimation of the weighted average treatment effect. Biom J 2021; 63:1706-1728. [PMID: 34270815 DOI: 10.1002/bimj.202000310] [Citation(s) in RCA: 2] [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] [Received: 10/16/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/25/2022]
Abstract
Weighting and subclassification are popular approaches using propensity scores (PSs) for estimation of causal effects. Weighting is appealing in that it gives consistent estimators for various causal estimands if appropriate weights are well defined and the PS model is correctly specified. Subclassification is known to be more robust to model misspecification than weighting, but its application to diverse causal estimands is limited. In this article, we propose generalized stratum weights to implement subclassification estimators for various causal estimands. These weights include stratum weights for the average treatment effect (ATE) of the overall population and those for the ATE of the treated as special cases. For this, we incorporate strata into the expression of the weighted average treatment effect (WATE). Particularly, we identify stratum weights for the ATE for the overlap population (ATO), for which the weighting estimator is known to be most efficient among the class of WATE estimators. We show that the identified stratum weights for ATO are equivalent to the optimal stratum weights, which are the inverse variances of the stratum-specific estimators. Simulation studies demonstrate that the proposed subclassification estimator for ATO is more robust to model misspecification than the weighting estimator for ATO. We also propose augmented subclassification estimators, which are shown to be less biased than the subclassification estimators when only the outcome model is correctly specified. The practical utility of the proposed methods is illustrated in a study of right heart catheterization.
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Affiliation(s)
- Byeong Yeob Choi
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
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Choi BY. Instrumental variable estimation of truncated local average treatment effects. PLoS One 2021; 16:e0249642. [PMID: 33819276 PMCID: PMC8021190 DOI: 10.1371/journal.pone.0249642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/22/2021] [Indexed: 11/29/2022] Open
Abstract
Instrumental variable (IV) analysis is used to address unmeasured confounding when comparing two nonrandomized treatment groups. The local average treatment effect (LATE) is a causal estimand that can be identified by an IV. The LATE approach is appealing because its identification relies on weaker assumptions than those in other IV approaches requiring a homogeneous treatment effect assumption. If the instrument is confounded by some covariates, then one can use a weighting estimator, for which the outcome and treatment are weighted by instrumental propensity scores. The weighting estimator for the LATE has a large variance when the IV is weak and the target population, i.e., the compliers, is relatively small. We propose a truncated LATE that can be estimated more reliably than the regular LATE in the presence of a weak IV. In our approach, subjects who contribute substantially to the weak IV are identified by their probabilities of being compliers, and they are removed based on a pre-specified threshold. We discuss interpretation of the proposed estimand and related inference method. Simulation and real data experiments demonstrate that the proposed truncated LATE can be estimated more precisely than the standard LATE.
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Affiliation(s)
- Byeong Yeob Choi
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX, United States of America
- * E-mail:
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Choi BY, Wang CP, Gelfond J. Machine learning outcome regression improves doubly robust estimation of average causal effects. Pharmacoepidemiol Drug Saf 2020; 29:1120-1133. [PMID: 32716126 PMCID: PMC8098857 DOI: 10.1002/pds.5074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/18/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Doubly robust estimation produces an unbiased estimator for the average treatment effect unless both propensity score (PS) and outcome models are incorrectly specified. Studies have shown that the doubly robust estimator is subject to more bias than the standard weighting estimator when both PS and outcome models are incorrectly specified. METHOD We evaluated whether various machine learning methods can be used for estimating conditional means of the potential outcomes to enhance the robustness of the doubly robust estimator to various degrees of model misspecification in terms of reducing bias and standard error. We considered four types of methods to predict the outcomes: least squares, tree-based methods, generalized additive models and shrinkage methods. We also considered an ensemble method called the Super Learner (SL), which is a linear combination of multiple learners. We conducted simulations considering different scenarios by the complexity of PS and outcome-generating models and some ranges of treatment prevalence. RESULTS The shrinkage methods performed well with robust doubly robust estimates in term of bias and mean squared error across the scenarios when the models became rich by including all 2-way interactions of the covariates. The SL performed similarly to the best method in each scenario. CONCLUSIONS Our findings indicate that machine learning methods such as the SL or the shrinkage methods using interaction models should be used for more accurate doubly robust estimators.
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Affiliation(s)
- Byeong Yeob Choi
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, Texas, USA
| | - Chen-Pin Wang
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, Texas, USA
| | - Jonathan Gelfond
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, Texas, USA
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Yeob Choi B, Fine JP, Alan Brookhart M. Bias testing, bias correction, and confounder selection using an instrumental variable model. Stat Med 2020; 39:4386-4404. [PMID: 32854161 DOI: 10.1002/sim.8730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/09/2019] [Revised: 07/19/2020] [Accepted: 07/24/2020] [Indexed: 12/27/2022]
Abstract
Instrumental variable (IV) analysis can be used to address bias due to unobserved confounding when estimating the causal effect of a treatment on an outcome of interest. However, if a proposed IV is correlated with unmeasured confounders and/or weakly correlated with the treatment, the standard IV estimator may be more biased than an ordinary least squares (OLS) estimator. Several methods have been proposed that compare the bias of the IV and OLS estimators relying on the belief that measured covariates can be used as proxies for the unmeasured confounder. Despite these developments, there is lack of discussion about approaches that can be used to formally test whether the IV estimator may be less biased than the OLS estimator. Thus, we have developed a testing framework to compare the bias and a criterion to select informative measured covariates for bias comparison and regression adjustment. We also have developed a bias-correction method, which allows one to use an invalid IV to correct the bias of the OLS or IV estimator. Numerical studies demonstrate that the proposed methods perform well with realistic sample sizes.
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Affiliation(s)
- Byeong Yeob Choi
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Jason P Fine
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - M Alan Brookhart
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
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Ramirez AG, Choi BY, Munoz E, Perez A, Gallion KJ, Moreno PI, Penedo FJ. Assessing the effect of patient navigator assistance for psychosocial support services on health-related quality of life in a randomized clinical trial in Latino breast, prostate, and colorectal cancer survivors. Cancer 2020; 126:1112-1123. [PMID: 31743436 PMCID: PMC7021581 DOI: 10.1002/cncr.32626] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/10/2018] [Revised: 08/21/2019] [Accepted: 10/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND After a diagnosis of prostate, breast, or colorectal cancer, Latinos experience higher mortality rates and lower health-related quality of life (HRQOL) in comparison with other ethnic/racial groups. Patient navigation (PN) and lay community health workers or promotores are effective in increasing cancer screening and early-stage diagnosis among Latinos. However, little is known about the effect of PN on HRQOL among Latino cancer survivors. METHODS Latinos previously diagnosed with breast, prostate, or colorectal cancer (n = 288) were randomized to 1 of 2 conditions: 1) the Patient Navigator LIVESTRONG Cancer Navigation Services (PN-LCNS) survivor care program or 2) PN only. HRQOL was measured with the Functional Assessment of Cancer Therapy-General, and cancer-specific HRQOL was measured with the Functional Assessment of Cancer Therapy-Breast, the Functional Assessment of Cancer Therapy-Prostate, and the Functional Assessment of Cancer Therapy-Colorectal for breast, prostate, and colorectal cancer survivors, respectively, at the baseline and at 3 follow-up time points. Generalized estimating equation analyses were conducted to estimate the effect of condition on HRQOL with adjustments for covariates and baseline HRQOL. RESULTS PN-LCNS demonstrated a significant improvement in HRQOL in comparison with PN only for colorectal cancer survivors but not for breast and prostate cancer survivors. CONCLUSIONS Enhanced PN improves HRQOL among Latino colorectal cancer survivors. Future research should identify the best strategies for engaging Latino survivors in PN programs. PN programs should also be adapted to address HRQOL concerns among Latina breast cancer survivors.
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Affiliation(s)
- Amelie G. Ramirez
- Institute for Health Promotion Research, Department of Epidemiology and BiostatisticsLong School of MedicineUniversity of Texas Health San AntonioSan AntonioTexas
| | - Byeong Yeob Choi
- Department of Epidemiology and BiostatisticsLong School of MedicineUniversity of Texas Health San AntonioSan AntonioTexas
| | - Edgar Munoz
- Institute for Health Promotion Research, Department of Epidemiology and BiostatisticsLong School of MedicineUniversity of Texas Health San AntonioSan AntonioTexas
| | - Arely Perez
- Institute for Health Promotion Research, Department of Epidemiology and BiostatisticsLong School of MedicineUniversity of Texas Health San AntonioSan AntonioTexas
| | - Kipling J. Gallion
- Institute for Health Promotion Research, Department of Epidemiology and BiostatisticsLong School of MedicineUniversity of Texas Health San AntonioSan AntonioTexas
| | - Patricia I. Moreno
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Frank J. Penedo
- Department of MedicineMiller School of Medicine and College of Arts and SciencesUniversity of MiamiMiamiFlorida
- Department of PsychologyMiller School of Medicine and College of Arts and SciencesUniversity of MiamiMiamiFlorida
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Choi BY, Gelfond J. The validity of propensity score analysis using complete cases with partially observed covariates. Eur J Epidemiol 2020; 35:87-88. [PMID: 31346889 PMCID: PMC8098813 DOI: 10.1007/s10654-019-00538-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/17/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Byeong Yeob Choi
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX, 78229, USA.
| | - Jonathan Gelfond
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX, 78229, USA
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Kim JH, Choi BY, Kho AR, Lee SH, Jeong JH, Hong DK, Lee SH, Sohn M, Ryu OH, Choi MG, Suh SW. Acetylcholine precursor, citicoline (cytidine 5'-diphosphocholine), reduces hypoglycaemia-induced neuronal death in rats. J Neuroendocrinol 2018; 30. [PMID: 29247563 DOI: 10.1111/jne.12567] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 06/07/2017] [Revised: 11/23/2017] [Accepted: 12/11/2017] [Indexed: 01/21/2023]
Abstract
Citicoline (cytidine 5'-diphosphocholine) is an important precursor for the synthesis of neuronal plasma membrane phospholipids, mainly phosphatidylcholine. The administration of citicoline serves as a choline donor for the synthesis of acetylcholine. Citicoline has been shown to reduce the neuronal injury in animal models with cerebral ischaemia and in clinical trials of stroke patients. Citicoline is currently being investigated in a multicentre clinical trial. However, citicoline has not yet been examined the context of hypoglycaemia-induced neuronal death. To clarify the therapeutic impact of citicoline in hypoglycaemia-induced neuronal death, we used a rat model with insulin-induced hypoglycaemia. Acute hypoglycaemia was induced by i.p. injection of regular insulin (10 U kg-1 ) after overnight fasting, after which iso-electricity was maintained for 30 minutes. Citicoline injections (500 mg/kg, i.p.) were started immediately after glucose reperfusion. We found that post-treatment of citicoline resulted in significantly reduced neuronal death, oxidative injury and microglial activation in the hippocampus compared to vehicle-treated control groups at 7 days after induced hypoglycaemia. Citicoline administration after hypoglycaemia decreased immunoglobulin leakage via blood-brain barrier disruption in the hippocampus compared to the vehicle group. Citicoline increased choline acetyltransferase expression for phosphatidylcholine synthesis after hypoglycaemia. Altogether, the present findings suggest that neuronal membrane stabilisation by citicoline administration can save neurones from the degeneration process after hypoglycaemia, as seen in several studies of ischaemia. Therefore, the results suggest that citicoline may have therapeutic potential to reduce hypoglycaemia-induced neuronal death.
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Affiliation(s)
- J H Kim
- Department of Physiology, Hallym University, College of Medicine, Chuncheon, Korea
| | - B Y Choi
- Department of Physiology, Hallym University, College of Medicine, Chuncheon, Korea
| | - A R Kho
- Department of Physiology, Hallym University, College of Medicine, Chuncheon, Korea
| | - S H Lee
- Department of Physiology, Hallym University, College of Medicine, Chuncheon, Korea
| | - J H Jeong
- Department of Medical Life Science, College of Medicine, Hallym University, Chuncheon, Korea
| | - D K Hong
- Department of Physiology, Hallym University, College of Medicine, Chuncheon, Korea
| | - S H Lee
- Department of Physiology, Hallym University, College of Medicine, Chuncheon, Korea
| | - M Sohn
- Department of Nursing, Inha University, Incheon, Korea
| | - O H Ryu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University, College of Medicine, Chuncheon, Korea
| | - M-G Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University, College of Medicine, Chuncheon, Korea
| | - S W Suh
- Department of Physiology, Hallym University, College of Medicine, Chuncheon, Korea
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Oh JM, Woo HW, Kim MK, Lee YH, Shin DH, Shin MH, Choi BY. Dietary total, animal, vegetable calcium and type 2 diabetes incidence among Korean adults: The Korean Multi-Rural Communities Cohort (MRCohort). Nutr Metab Cardiovasc Dis 2017; 27:1152-1164. [PMID: 29167059 DOI: 10.1016/j.numecd.2017.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 04/27/2017] [Revised: 08/26/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Although a possible mechanism for developing type 2 diabetes in relation to calcium intake has been suggested, there is currently little epidemiological evidence on the association between dietary calcium and type 2 diabetes (T2D). This study aimed to evaluate the prospective association between dietary calcium and T2D incidence among adults 40 years of age or over, from the Multi-rural Communities Cohort (MRCohort), South Korea. METHODS AND RESULTS In total, 8313 participants (3033 men and 5280 women) who did not have diabetes at baseline were recruited between 2005 and 2013. The incidence rate ratio (IRR) was estimated using a modified Poisson regression model with a robust error estimator. During follow-up (31,570 person-years), 322 T2D cases were newly diagnosed. Dietary calcium (total and vegetable calcium) were inversely associated with the risk of T2D incidence among women (IRR = 0.61, 95% CI = 0.43-0.86, P for trend = 0.007 in third tertile of baseline total calcium intake comparing to the first tertile; IRR = 0.57, 95% CI = 0.39-0.84, P for trend = 0.006 for baseline vegetable calcium intake), not for men. The tendency of those inverse associations remained in both the normal fasting blood glucose group and the impaired fasting blood glucose group and were independent of obesity, smoking, and magnesium intake. CONCLUSIONS Total and vegetable calcium may be inversely associated with T2D incidence among women, regardless of impaired fasting blood glucose group or normal group. The associations may be potentially dose-responsive. Moderate dietary calcium may be related to lower risk of T2D incidence comparing to low intake group among women.
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Affiliation(s)
- J M Oh
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea
| | - H W Woo
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea
| | - M K Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea.
| | - Y-H Lee
- Department of Preventive Medicine, Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, South Korea
| | - D H Shin
- Department of Occupational and Environmental Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - M-H Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - B Y Choi
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea
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Abstract
Two-stage least squares estimation is popular for structural equation models with unmeasured confounders. In such models, both the outcome and the exposure are assumed to follow linear models conditional on the measured confounders and instrumental variable, which is related to the outcome only via its relation with the exposure. We consider data where both the outcome and the exposure may be incompletely observed, with particular attention to the case where both are censored event times. A general class of two-stage minimum distance estimators is proposed that separately fits linear models for the outcome and exposure and then uses a minimum distance criterion based on the reduced-form model for the outcome to estimate the regression parameters of interest. An optimal minimum distance estimator is identified which may be superior to the usual two-stage least squares estimator with fully observed data. Simulation studies demonstrate that the proposed methods perform well with realistic sample sizes. Their practical utility is illustrated in a study of the comparative effectiveness of colon cancer treatments, where the effect of chemotherapy on censored survival times may be confounded with patient status.
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Affiliation(s)
- Byeong Yeob Choi
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, Texas 78229,
| | - Jason P Fine
- Department of Biostatistics, University of North Carolina, 3103B McGavran-Greenberg Hall, Chapel Hill, North Carolina 27599,
| | - M Alan Brookhart
- Department of Epidemiology, University of North Carolina, 2105F McGavran-Greenberg Hall, Chapel Hill, North Carolina 27599,
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Choi S, Jung E, Choi BY, Hur YJ, Ki M. High reproduction number of Middle East respiratory syndrome coronavirus in nosocomial outbreaks: mathematical modelling in Saudi Arabia and South Korea. J Hosp Infect 2017; 99:162-168. [PMID: 28958834 PMCID: PMC7114943 DOI: 10.1016/j.jhin.2017.09.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/20/2017] [Indexed: 11/18/2022]
Abstract
Background Effective countermeasures against emerging infectious diseases require an understanding of transmission rate and basic reproduction number (R0). R0 for severe acute respiratory syndrome is generally considered to be >1, whereas that for Middle East respiratory syndrome (MERS) is considered to be <1. However, this does not explain the large-scale outbreaks of MERS that occurred in Kingdom of Saudi Arabia (KSA) and South Korean hospitals. Aim: To estimate R0 in nosocomial outbreaks of MERS. Methods R0 was estimated using the incidence decay with an exponential adjustment model. The KSA and Korean outbreaks were compared using a line listing of MERS cases compiled using publicly available sources. Serial intervals to estimate R0 were assumed to be six to eight days. Study parameters [R0 and countermeasures (d)] were estimated by fitting a model to the cumulative incidence epidemic curves using Matlab. Findings The estimated R0 in Korea was 3.9 in the best-fit model, with a serial interval of six days. The first outbreak cluster in a hospital in Pyeongtaek had an R0 of 4.04, and the largest outbreak cluster in a hospital in Samsung had an R0 of 5.0. Assuming a six-day serial interval, the KSA outbreaks in Jeddah and Riyadh had R0 values of 3.9 and 1.9, respectively. Conclusion R0 for the nosocomial MERS outbreaks in KSA and South Korea was estimated to be in the range of 2–5, which is significantly higher than the previous estimate of <1. Therefore, more comprehensive countermeasures are needed to address these infections.
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Affiliation(s)
- S Choi
- Department of Preventive Medicine, Hanyang University Medical College, Seoul, South Korea; Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Centre, Goyang, South Korea
| | - E Jung
- Department of Mathematics, Konkuk University, Seoul, South Korea
| | - B Y Choi
- Department of Preventive Medicine, Hanyang University Medical College, Seoul, South Korea
| | - Y J Hur
- Centre for Infectious Disease Control, Korea Centre for Disease Control and Prevention, Cheongju, South Korea
| | - M Ki
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Centre, Goyang, South Korea.
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Jung S, Kim MK, Choi BY. The long-term relationship between dietary pantothenic acid (vitamin B 5) intake and C-reactive protein concentration in adults aged 40 years and older. Nutr Metab Cardiovasc Dis 2017; 27:806-816. [PMID: 28739188 DOI: 10.1016/j.numecd.2017.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 01/31/2017] [Revised: 04/28/2017] [Accepted: 05/24/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Low-grade inflammation, represented by minor C-reactive protein (CRP) elevation, has a critical role in the early stages of atherosclerosis, and pantothenic acid (PA) may have an antioxidant effect in inflammatory process. However, the long-term relationship between PA intake and CRP has not yet been studied. The objective of the present study was to evaluate the long-term relationship of PA intake to CRP concentration in healthy adults aged 40 years or older living in a rural area of South Korea. METHODS AND RESULTS A total of 908 subjects (349 men, 559 women) with repeated data on dietary PA intake and CRP concentration were included in the final analysis. To represent the long-term effect of PA intake, both PA intake at the baseline and average PA intake were used as the exposure, and CRP concentration at the third visit and its change from the baseline to the third visit were used as the outcome. After adjustment for potential confounders, a significant inverse relationship between PA intake and CRP concentration at the third visit was observed (P for trend = 0.001, β = -0.07 (P-value = 0.001) for PA baseline; P for trend = <0.0001, β = -0.11 (P-value = 0.0004) for PA average (baseline, 2nd, 3rd)). Higher PA intake was significantly related to lower or attenuated increase in CRP concentration (P for trend = 0.002, β = -0.24 (P-value = 0.002) for PA baseline; P for trend = 0.001, β = -0.35 (P-value = 0.001) for PA average (baseline, 2nd, 3rd)). CONCLUSIONS In conclusion, dietary PA intake was inversely related to subsequent CRP concentration in both men and women aged 40 years or older in South Korea.
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Affiliation(s)
- S Jung
- Health Care Research Department, Korea Institute for Health and Social Affairs, Sejong, South Korea; Institute for Health and Society, Hanyang University, Seoul, South Korea
| | - M K Kim
- Institute for Health and Society, Hanyang University, Seoul, South Korea; Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
| | - B Y Choi
- Institute for Health and Society, Hanyang University, Seoul, South Korea; Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea
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Choi BY, Yoon MJ, Shin K, Lee YJ, Song YW. Characteristics of pleural effusions in systemic lupus erythematosus: differential diagnosis of lupus pleuritis. Lupus 2014; 24:321-6. [PMID: 25318967 DOI: 10.1177/0961203314555171] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 12/18/2022]
Abstract
We investigated the clinical characteristics of pleural effusion in systemic lupus erythematosus (SLE). A prospective analysis of 17 SLE patients with pleural effusion (seven lupus pleuritis, eight transudative effusions and two parapneumonic effusions) was performed. Thirty non-SLE patients with pleural effusion were recruited as controls. A pleural fluid ANA titer ≥1:160 was found in 8/17 (47.1%) SLE patients and none of the 30 non-SLE patients (p = 0.0001). Pleural fluid to serum C3 ratios were significantly lower in SLE than in non-SLE (median (minimum-maximum) 0.29 (0.03-0.43) versus 0.52 (0.26-0.73), p = 0.0002). Among SLE patients, pleural fluid ANA titers ≥1:160 were more frequently found in patients with lupus pleuritis than in those with pleural effusion from causes other than lupus itself (85.7% versus 20.0%, p = 0.0152). Serum CRP levels were significantly increased in patients with lupus pleuritis compared with SLE patients with transudative pleural effusion (2.30 (0.30-5.66) versus 0.7 (0.12-1.47) mg/dl, p = 0.0062). In conclusion, pleural fluid ANA titer and serum CRP levels are significantly increased in lupus pleuritis.
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Affiliation(s)
- B Y Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - M J Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - K Shin
- Department of Internal Medicine, Seoul National University Borame Medical Center, Seoul, Korea
| | - Y J Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Y W Song
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Molecular Medicine and Biopharmaceutical Sciences, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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Choi BY, Chang SH, Cho HJ, Kang EH, Shin K, Song YW, Lee YJ. The association of radiographic progression with serum R-spondin 1 (RSPO1) levels or Dickkopf-1 (DKK1)/RSPO1 ratios in rheumatoid arthritis patients: clinical evidence for reciprocal inhibition between DKK1 and RSPO1. Scand J Rheumatol 2014; 43:453-61. [PMID: 25178409 DOI: 10.3109/03009742.2014.905629] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To investigate the clinical implications of serum levels of R-spondin 1 (RSPO1), a natural antagonist for Dickkopf-1 (DKK1), and of DKK1/RSPO1 ratios in rheumatoid arthritis (RA) patients. METHOD Serum DKK1 and RSPO1 levels were measured in 102 RA patients and 39 age- and gender-matched healthy controls. In addition, DKK1 and RSPO1 levels were determined prior to and 3 months after anti-tumour necrosis factor alpha (anti-TNF-α) therapy in 15 RA patients. Clinical and laboratory data and baseline radiographs of the hands and feet were obtained. Serial radiographs were evaluated in 83 RA patients. Radiographic joint damage was assessed by the modified Sharp/van der Heijde score (SHS). RESULTS Serum RSPO1 levels were significantly reduced whereas serum DKK1 levels and DKK1/RSPO1 ratios were significantly increased in RA patients compared with controls (all p < 0.0001). Anti-TNF-α treatment significantly suppressed DKK1/RSPO1 ratios (p < 0.01). In contrast to DKK1 or RSPO1 levels, the ratios were significantly associated with erosive disease, elevated acute phase reactants, Disease Activity Score in 28 joints (DAS28) > 3.2, and radiographic progression rate (all p < 0.05). Although the RA patients with radiographic progression exhibited significantly increased DKK1 and reduced RSPO1 levels (p < 0.05), only the DKK1/RSPO1 ratio (log-transformed) was found to be a significant predictor of subsequent radiographic progression [odds ratio (OR) 2.07, p < 0.01]. CONCLUSIONS In this study, the presence of RSPO1 in the circulation was shown for the first time. Our results suggest that the serum DKK1/RSPO1 ratio represents a better predictor of structural progression than either DKK1 or RSPO1 levels alone in RA patients.
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Affiliation(s)
- B Y Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam-si, Seoul , South Korea
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Kim MK, Shin J, Kweon SS, Shin DH, Lee YH, Chun BY, Choi BY. Harmful and beneficial relationships between alcohol consumption and subclinical atherosclerosis. Nutr Metab Cardiovasc Dis 2014; 24:767-776. [PMID: 24694837 DOI: 10.1016/j.numecd.2014.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 08/24/2012] [Revised: 01/20/2014] [Accepted: 02/03/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Arterial stiffness and increased intima-media wall thickness are two of the main predictors of cardiovascular disease (CVD). We evaluated whether brachial-ankle pulse wave velocity (baPWV) and common carotid artery intima-media wall thickness (CCA-IMT) are correlated with alcohol consumption in a cross-sectional study among Korean men and women aged 40 years and over. METHODS AND RESULTS All 5539 subjects (2121 men and 3418 women) were participants in the Multi-Rural Communities cohort (MRcohort) study, a part of the Korean Genome Epidemiology Study (KoGES). The baPWV was positively correlated with alcohol consumption in men (p for trend <0.0001). Age (middle-aged versus elderly) modified the effect of alcohol consumption on PWV. On the other hand CCA-IMT decreased with alcohol consumption in men. There was no favorable zone of alcohol consumption in terms of baPWV and CCA-IMT. Adjustment for lipid profiles substantially attenuated the relationship between alcohol consumption and CCA-IMT. There was no clear relation between alcohol consumption and baPWV/CCA-IMT in women. CONCLUSIONS Along with a linear harmful relationship between alcohol consumption and arterial stiffness in men there may also be a beneficial relationship between alcohol consumption and carotid intima-wall thickness. The effect of alcohol on arterial stiffness may be slightly stronger in elderly men, and the effect of alcohol on CCA-IMT may be mediated by lipid factors.
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Affiliation(s)
- M K Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
| | - J Shin
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - S-S Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea; Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - D H Shin
- Department of Occupational and Environmental Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Y-H Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, South Korea
| | - B-Y Chun
- Department of Preventive Medicine, School of Medicine, and Health Promotion Research Center, Kyungpook National University, Daegu, South Korea
| | - B Y Choi
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea
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Cho JH, Chang SH, Shin NH, Choi BY, Oh HJ, Yoon MJ, Lee EY, Lee EB, Lee TJ, Song YW. Costs of illness and quality of life in patients with systemic lupus erythematosus in South Korea. Lupus 2014; 23:949-57. [PMID: 24563501 DOI: 10.1177/0961203314524849] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 07/05/2013] [Accepted: 01/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the costs of illness, health-related quality of life (HRQOL) and their associated factors in patients with systemic lupus erythematosus (SLE) in South Korea. METHOD Two hundred and one patients with SLE were enrolled at the Rheumatology clinic of Seoul National University Hospital. Direct, indirect and total costs and HRQOL were measured using hospital electronic data and face-to-face interview. Socio-demographic and clinical factors associated with cost of illness and HRQOL were analyzed using multiple regression and multivariate logistic regression. RESULTS The average total cost of illness was estimated to be KRW 9.82 million (US $ 8993) per year, of which 41.6% was accounted for by direct costs and 58.4% by indirect costs. In multivariate regression, patients with renal involvement and those with depression incurred an average increment in annual total costs of 37.6% (p = 0.050) and 49.1% (p = 0.024), respectively, and an average increment in annual direct costs of 26.4% (p = 0.050) and 43.3% (p = 0.002), respectively, compared with patients without renal involvement and depression, respectively. In addition, disease damage was positively associated with an average increment in annual total and direct costs (55.3%, p = 0.006; 33.3%, p = 0.013, respectively), and the occurrence of indirect costs (OR 2.21, 1.09-4.88). There was no significant difference in HRQOL between patients with and without renal involvement (0.655 vs. 0.693, p = 0.203) CONCLUSION: Renal involvement, depression, and disease damage were major factors associated with higher total and medical costs for patients with SLE in South Korea. Effective treatment of renal disorders and depression may reduce the high economic burden of SLE.
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Affiliation(s)
- J H Cho
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - S H Chang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - N H Shin
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - B Y Choi
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - H J Oh
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - M J Yoon
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - E Y Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - E B Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - T J Lee
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Y W Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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Jung SK, Kim MK, Shin J, Choi BY. A cross-sectional analysis of the relationship between daily alcohol consumption and serum adiponectin levels among adults aged 40 years or more in a rural area of Korea. Eur J Clin Nutr 2013; 67:841-7. [PMID: 23612511 DOI: 10.1038/ejcn.2013.74] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 03/11/2013] [Accepted: 03/11/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES Light-to-moderate alcohol consumption has been proposed to raise serum adiponectin levels, but this view is controversial. There is little information on the effect of heavy drinking. The aim of this study was to examine the relationship between alcohol consumption and serum adiponectin levels in healthy Koreans. SUBJECTS/METHODS The design of the study was cross-sectional, using data from the Korean Multi-Rural Communities Cohort Study (MRCohort), which is a part of the Korean Genome Epidemiology Study (KoGES). The subjects were 1542 individuals (635 men and 907 women) aged ≥ 40 years who were recruited in Yangpyeong-Gun, Kyunggi province, South Korea, in 2005 and 2006. Daily alcohol consumption was calculated from average frequency of alcohol consumption and the amount of alcohol consumed per occasion using a structured questionnaire and serum adiponectin levels were measured. RESULTS Although adiponectin levels appeared to be higher in those consuming moderate levels of alcohol than in nondrinkers, the difference was not statistically significant. Heavy drinking (≥ 90.0 g/day) was significantly related to reduced serum adiponectin levels (P=0.003), although the significance of the relationship was reduced after adjusting for potential confounders (P=0.061) such as age, waist/hip ratio, blood pressure, fasting blood glucose, current smoker, higher education, protein intake, vitamin C intake and vitamin E intake in men. The relation seemed to be stronger in individuals consuming alcohol in the form of takju (Korean rice wine; P=0.022). CONCLUSIONS Heavy alcohol drinking (≥ 90.0 g/day) may be related to lower serum adiponectin levels in Korean men.
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Affiliation(s)
- S K Jung
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Choi BY, Fine JP, Brookhart MA. Practicable confidence intervals for current status data. Stat Med 2012; 32:1419-28. [DOI: 10.1002/sim.5609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 08/01/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Byeong Yeob Choi
- Department of Biostatistics; University of North Carolina; Chapel Hill U.S.A
| | - Jason P. Fine
- Department of Biostatistics; University of North Carolina; Chapel Hill U.S.A
| | - M. Alan Brookhart
- Department of Epidemiology; University of North Carolina; Chapel Hill U.S.A
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Kim N, Kim K, Choi BY, Lee D, Shin YS, Bang KH, Cha SW, Lee JW, Choi HK, Jang DS, Lee D. Metabolomic approach for age discrimination of Panax ginseng using UPLC-Q-Tof MS. J Agric Food Chem 2011; 59:10435-10441. [PMID: 21916514 DOI: 10.1021/jf201718r] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An ultraperformance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-Tof MS)-based metabolomic technique was applied for metabolite profiling of 60 Panax ginseng samples aged from 1 to 6 years. Multivariate statistical methods such as principal component analysis and hierarchical clustering analysis were used to compare the derived patterns among the samples. The data set was subsequently applied to various metabolite selection methods for sophisticated classification with the optimal number of metabolites. The results showed variations in accuracy among the classification methods for the samples of different ages, especially for those aged 4, 5, and 6 years. This proposed analytical method coupled with multivariate analysis is fast, accurate, and reliable for discriminating the cultivation ages of P. ginseng samples and is a potential tool to standardize quality control in the P. ginseng industry.
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Affiliation(s)
- Nahyun Kim
- School of Life Sciences and Biotechnology and ‡Department of Statistics, Korea University , Seoul 136-713, Korea
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Shin A, Park S, Shin HR, Park EH, Park SK, Oh JK, Lim MK, Choi BY, Boniol M, Boffetta P. Population attributable fraction of infection-related cancers in Korea. Ann Oncol 2011; 22:1435-1442. [PMID: 20974652 DOI: 10.1093/annonc/mdq592] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- A Shin
- Cancer Epidemiology Branch, Division of Cancer Epidemiology and Management
| | - S Park
- Cancer Registration and Statistics Branch, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si, Korea
| | - H R Shin
- Cancer Registration and Statistics Branch, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si, Korea; Data Analysis and Interpretation Group, Biostatistics and Epidemiology Cluster, International Agency for Research on Cancer, Lyon, France.
| | - E-H Park
- Cancer Registration and Statistics Branch, Division of Cancer Registration and Surveillance, National Cancer Center, Goyang-si, Korea
| | - S K Park
- Department of Preventive Medicine; Cancer Research Institute; Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul
| | - J-K Oh
- Cancer Risk Appraisal and Prevention Branch, National Cancer Information Center, National Cancer Center, Goyang-si
| | - M-K Lim
- Cancer Risk Appraisal and Prevention Branch, National Cancer Information Center, National Cancer Center, Goyang-si
| | - B Y Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - M Boniol
- Data Analysis and Interpretation Group, Biostatistics and Epidemiology Cluster, International Agency for Research on Cancer, Lyon, France
| | - P Boffetta
- Data Analysis and Interpretation Group, Biostatistics and Epidemiology Cluster, International Agency for Research on Cancer, Lyon, France
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Chung JY, Hong SM, Choi BY, Cho H, Yu E, Hewitt SM. The expression of phospho-AKT, phospho-mTOR, and PTEN in extrahepatic cholangiocarcinoma. Clin Cancer Res 2009; 15:660-7. [PMID: 19147772 DOI: 10.1158/1078-0432.ccr-08-1084] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The protein kinase B (AKT) pathway plays a key role in the regulation of cellular survival, apoptosis, and protein translation, and has been shown to have prognostic significance in a number of cancers. We sought to define its role in extrahepatic cholangiocarcinoma. EXPERIMENTAL DESIGN Two hundred twenty-one extrahepatic cholangiocarcinoma patients with clinicopathologic data, including survival, were arrayed into tissue microarrays. Phosphorylated AKT (p-AKT), phosphorylated mammalian target of rapamycin (p-mTOR), and total phosphatase and tensin homolog deleted on chromosome 10 (PTEN) protein expressions were studied with multiplex tissue immunoblotting assay. RESULTS Expressions of p-AKT and p-mTOR were significantly increased in extrahepatic cholangiocarcinoma cases compared with normal and dysplastic bile duct epithelium (P < 0.05 both). Decreased PTEN expression was observed in patients with increasing depth of invasion (P < 0.05), T classification (P < 0.05), and stage grouping (P < 0.05), and the presence of invasion of the pancreas (P < 0.05) and duodenum (P < 0.05). Decreased PTEN expression (P = 0.004) as well as decreased PTEN/p-AKT (P = 0.003) and PTEN/p-mTOR (P = 0.009) expression showed shorter survival by univariate but not by multivariate analysis. CONCLUSIONS The AKT pathway is activated in a subset of extrahepatic cholangiocarcinoma. Elevated PTEN expression correlates with longer survival. Quantitative data obtained by multiplex tissue immunoblotting may provide additional information than assessment of immunohistochemistry alone. Quantitative analysis of PTEN, PTEN/p-AKT and PTEN/p-mTOR shows differences in survival by univariate analysis.
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Affiliation(s)
- Joon-Yong Chung
- Tissue Array Research Program, Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, Maryland, USA
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Choi BY, Madeo AC, King KA, Zalewski CK, Pryor SP, Muskett JA, Nance WE, Butman JA, Brewer CC, Griffith AJ. Segregation of enlarged vestibular aqueducts in families with non-diagnostic SLC26A4 genotypes. J Med Genet 2009; 46:856-61. [PMID: 19578036 DOI: 10.1136/jmg.2009.067892] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hearing loss with enlarged vestibular aqueduct (EVA) can be inherited as an autosomal recessive trait caused by bi-allelic mutations of SLC26A4. However, many EVA patients have non-diagnostic SLC26A4 genotypes with only one or no detectable mutant alleles. METHODS AND RESULTS In this study, the authors were unable to detect occult SLC26A4 mutations in EVA patients with non-diagnostic genotypes by custom comparative genomic hybridisation (CGH) microarray analysis or by sequence analysis of conserved non-coding regions. The authors sought to compare the segregation of EVA among 71 families with two (M2), one (M1) or no (M0) detectable mutant alleles of SLC26A4. The segregation ratios of EVA in the M1 and M2 groups were similar, but the segregation ratio for M1 was significantly higher than in the M0 group. Haplotype analyses of SLC26A4-linked STR markers in M0 and M1 families revealed discordant segregation of EVA with these markers in eight of 24 M0 families. CONCLUSION The results support the hypothesis of a second, undetected SLC26A4 mutation that accounts for EVA in the M1 patients, in contrast to non-genetic factors, complex inheritance, or aetiologic heterogeneity in the M0 group of patients. These results will be helpful for counselling EVA families with non-diagnostic SLC26A4 genotypes.
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Choi BY, Ahmed ZM, Riazuddin S, Bhinder MA, Shahzad M, Husnain T, Riazuddin S, Griffith AJ, Friedman TB. Identities and frequencies of mutations of the otoferlin gene (OTOF) causing DFNB9 deafness in Pakistan. Clin Genet 2009; 75:237-43. [PMID: 19250381 DOI: 10.1111/j.1399-0004.2008.01128.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mutations in OTOF, encoding otoferlin, cause non-syndromic recessive hearing loss. The goal of our study was to define the identities and frequencies of OTOF mutations in a model population. We screened a cohort of 557 large consanguineous Pakistani families segregating recessive, severe-to-profound, prelingual-onset deafness for linkage to DFNB9. There were 13 families segregating deafness consistent with linkage to markers for DFNB9. We analyzed the genomic nucleotide sequence of OTOF and detected probable pathogenic sequence variants among all 13 families. These include the previously reported nonsense mutation p.R708X and 10 novel variants: 3 nonsense mutations (p.R425X, p.W536X, and p.Y1603X), 1 frameshift (c.1103_1104delinsC), 1 single amino acid deletion (p.E766del) and 5 missense substitutions of conserved residues (p.L573R, p.A1090E, p.E1733K, p.R1856Q and p.R1939W). OTOF mutations thus account for deafness in 13 (2.3%) of 557 Pakistani families. This overall prevalence is similar, but the mutation spectrum is different from those for Western populations. In addition, we demonstrate the existence of an alternative splice isoform of OTOF expressed in the human cochlea. This isoform must be required for human hearing because it encodes a unique alternative C-terminus affected by some DFNB9 mutations.
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Affiliation(s)
- B Y Choi
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, MD 20850, USA
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Kimura A, Takahashi M, Choi BY, Bae SW, Hohta S, Sasaoka T, Nakahara KI, Chida K, Sawabe M, Yasunami M, Naruse T, Izumi T, Park JE. Lack of association between LTA and LGALS2 polymorphisms and myocardial infarction in Japanese and Korean populations. ACTA ACUST UNITED AC 2007; 69:265-9. [PMID: 17493152 DOI: 10.1111/j.1399-0039.2006.00798.x] [Citation(s) in RCA: 24] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To investigate the recently reported associations of polymorphisms in lymphotoxin-alpha (LTA) and galectin-2 (LGALS2) with myocardial infarction (MI), we analyzed a single nucleotide polymorphism of LTA (LTA 252A>G in LTA intron 1) and that of LGALS2 (LGALS2 3279C>T in LGALS2 intron 1) in Japanese and Korean populations. Although significant associations with MI were not observed in either population, we found that LTA 252GG was significantly associated with the severity of the disease for both the Japanese and Korean populations (P=0.017 and P=0.001, respectively). On the other hand, the polymorphism of LGALS2 was not associated with the severity of coronary atherosclerosis. These observations showed that, while the LTA 252GG genotype might modify the development of coronary atherosclerosis, the relation of LTA and LGALS2 to MI itself remained much less certain.
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Affiliation(s)
- A Kimura
- Department of Molecular Pathogenesis, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.
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Kim KR, Kim MK, Shin YJ, Choi BY. Relationship between the change in overweight status from childhood to adolescence and metabolic syndrome phenotypes: a 9-year retrospective study. Eur J Clin Nutr 2007; 62:748-53. [PMID: 17522616 DOI: 10.1038/sj.ejcn.1602783] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate how the changes in overweight status from childhood to adolescence are related to metabolic syndrome phenotypes in adolescents. SUBJECTS AND METHODS A total 375 adolescents aged 16 years. The overweight status from childhood to adolescence (from 7 years of age to 16 years) was determined by body mass index (BMI, kg/m(2)) calculated from records of the School Physical Examination data. The change in body weight was classified into four groups: normal weight to normal weight (NW-NW); overweight to normal (OW-NW); normal to overweight (NW-OW); overweight to overweight (OW-OW). Metabolic syndrome phenotypes were examined from a cross-sectional survey. RESULTS The mean values of all phenotypes except for body fatness (BMI and waist) and the cluster score of phenotypes at 16 years of age were not different between the NW-NW group and the OW-NW group, nor between the NW-OW group and the OW-OW group. However, the score as well as the level of body fatness and blood glucose were significantly different between current overweight and normal adolescents regardless of overweight status during childhood (P<0.05). CONCLUSION There was a linear relationship between overweight status during childhood and metabolic syndrome phenotypes in adolescence but current overweight status (adolescence overweight) was more closely related to the adolescent risk of metabolic syndrome than childhood overweight status.
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Affiliation(s)
- K R Kim
- Department of Preventive Medicine, Hanyang University, College of Medicine, Seoul, Republic of Korea
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Kim MH, Kim MK, Choi BY, Shin YJ. 547: Educational Disparities in the Metabolic Syndrome in a Rapidly Changing Society, the Case of South Korea. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s137b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M H Kim
- Eulji University, Daejeon, 301832, Korea
| | - M K Kim
- Eulji University, Daejeon, 301832, Korea
| | - B Y Choi
- Eulji University, Daejeon, 301832, Korea
| | - Y J Shin
- Eulji University, Daejeon, 301832, Korea
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Jee YM, Cheon DS, Kim KS, Lee SH, Yoon JD, Lee SW, Go U, Yang BK, Ki MR, Choi BY, Cho HW. A seroprevalence study of poliovirus antibody among primary schoolchildren in Korea. Epidemiol Infect 2004; 132:351-5. [PMID: 15061511 PMCID: PMC2870112 DOI: 10.1017/s0950268803001663] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We aimed to determine the seroprevalence of poliovirus antibody in Korea by using the cell culture neutralization method recommended by the WHO. A total of 500 sera collected from children at eight primary schools in Kyunggi province were used for this study. We found that 82.2% of children were positive for all three types of poliovirus and antibody-positive rates for types I, II and III were 94.4, 96.6 and 86.8% respectively, indicating that seropositive rates for types I and II were considerably higher than for type III (P<0.0001). This result implies that the type III component of the oral polio vaccine should be evaluated further. Although a greater number of children, including young infants, need to be tested for seroprevalence, this study still provides us with valuable information on the effectiveness of vaccination against polioviruses in Korea.
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Affiliation(s)
- Y M Jee
- Laboratory of Enteroviruses, Department of Virology, National Institute of Health, Seoul, Korea
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Abstract
We followed students in eight elementary schools for rubella antibody from 1993 to 1996 (602 pairs) and 1996-9 (588 pairs) in Gyeonggi Province, Korea. We tested rubella IgG and administered rubella vaccine to the children with the titres < 10 IU/ml. The loss rates of rubella IgG during the follow-up periods were 14.3 and 15.8%, respectively. Among vaccinated groups, the loss rate was 18.8%, which was significantly higher than 13.8% of the mixture of natural and vaccine-induced immunity groups. The group that had the lower preceding antibody titre had a higher loss rate of 24.8% compared to 7.2% for the group whose titre was 40 IU/ml or above. In a multivariate analysis, age and gender were not related to antibody loss rate. Under this higher rubella antibody loss rate, in order to prevent congenital rubella syndrome, the immunization for women at childbearing age appears necessary until rubella can be eliminated or controlled.
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Affiliation(s)
- M Ki
- Department of Preventive Medicine, Eulji University School of Medicine, Daejon, Korea
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Abstract
Floating beads were prepared from a sodium alginate solution containing CaCO(3) or NaHCO(3) as gas-forming agents. The solution was dropped to 1% CaCl(2) solution containing 10% acetic acid for CO(2) gas and gel formation. The effects of gas-forming agents on bead size and floating properties were investigated. As gas-forming agents increased, the size and floating properties increased. Bead porosity and volume average pore size, as well as the surface and cross-sectional morphology of the beads were examined with Mercury porosimetry and Scanning Electron Microscopy. NaHCO(3) significantly increased porosity and pore diameter than CaCO(3). Incorporation of CaCO(3) into alginate solution resulted in smoother beads than those produced with NaHCO(3). Gel strength analysis indicated that bead strength decreased with increasing gas-forming agent from 9 to 4 N. Beads incorporating CaCO(3) exhibited significantly increased gel strength over control and NaHCO(3)-containing samples. Release characteristics of riboflavin as a model drug were studied in vitro. Release rate of riboflavin increased proportionally with addition of NaHCO(3). However, increasing weight ratios of CaCO(3) did not appreciably accelerate drug release. The results of these studies indicate that CaCO(3) is superior to NaHCO(3) as a gas forming agent in alginate bead preparations. The enhanced buoyancy and sustained release properties of CaCO(3)-containing beads make them an excellent candidate for floating drug dosage systems (FDDS).
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Affiliation(s)
- B Y Choi
- Graduate School of Biotechnology, Korea University, Seoul 136-701, South Korea
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Abstract
Multicenter Study on the Prevalence of Perennial Allergic Rhinitis and Allergy-Associated Disorders This study was aimed to determine the prevalence of perennial allergic rhinitis (PAR) using the skin test, radioallergosorbent test (RAST), or multiple allergosorbent test (MAST) and to clarify the clinical aspects of the patients diagnosed as having PAR by the questionnaire survey and rhinologic examination. The 71,120 subjects who had visited the 23 otolaryngology clinics at the randomly selected tertiary referral hospitals in Korea between November 1, 1999 and April 30, 2000 were studied. PAR was diagnosed when subjects complained of two or more associated symptoms and the skin test, RAST, or MAST using perennial inhalant allergens was positive. The questionnaire survey and rhinologic examination were performed in subjects with PAR. The prevalence of PAR was 3.93%. We could find no significant difference in the prevalence of PAR between the two sexes. However, there was a significant difference in the prevalence of PAR between the child and adult groups. The chief complaints were, in order of decreasing frequency, nasal obstruction, watery rhinorrhea, and sneezing. There was a family history of PAR in 40.2% of the subjects. The 39.6% of the subjects had associated allergic diseases, being atopic dermatitis most common. In conclusion, the prevalence of PAR in tertiary referral hospitals in Korea is 3.93%. Many subjects with PAR have family history and appear to be associated with other allergic diseases.
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Affiliation(s)
- Y G Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Chang WK, Kim HY, Kim DJ, Lee J, Park CK, Yoo JY, Kim HJ, Kim MK, Choi BY, Choi HS, Park KN. Association between Helicobacter pylori infection and the risk of gastric cancer in the Korean population: prospective case-controlled study. J Gastroenterol 2001; 36:816-22. [PMID: 11777209 DOI: 10.1007/s005350170003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastric cancer is still the most common malignant tumor in Koreans. Although many reports have supported the association of Helicobacter pylori infection and the development of gastric cancer, few studies have been adjusted by variable factors such as age. sex, education, and economic status. Furthermore, most results from areas with a high incidence of gastric cancer, such as China and Korea, have failed to document any relationship between H. pylori infection and gastric cancer. We conducted a prospective case-controlled study, with controls matched for and adjusted by age, sex, education, and economic status, to evaluate the causal relationship between H. pylori infection and gastric cancer in Korean people. METHODS From March 1997 to October 1998, 136 consecutive patients with gastric cancer, diagnosed by endoscopic histology, and 136 age- and sex-matched control subjects, confirmed to be free of gastric cancer by endoscopy during the same period, were enrolled in the study. The presence of H. pylori infection was determined by enzyme immunoassay (EIA) serology test. RESULTS Seventy-two of the 136 gastric cancer patients (53%) were positive for H. pylori infection and 54 of the 136 control subjects (40%) were positive for H. pylori infection. The odds ratio (OR), adjusted by variable risk factors, such as age, sex, education, and economic status, for gastric cancer in H. pylori-infected patients was 1.82 (95% confidence internal [CI], 1.10-3.00; P = 0.019). The age- and sex-matched OR by conditional logistic regression was 1.6 (95% CI., 1.01-2.53; P = 0.043). CONCLUSIONS H. pylori infection may be one of the important risk factors for the development of gastric cancer in Korea, an area of high prevalence of H. pylori infection and a high incidence of gastric cancer.
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Affiliation(s)
- W K Chang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
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Abstract
PURPOSE Some patients bedridden from various causes such as stroke or spinal cord injury experience poor control of bowel movement. This causes fecal leakage and diarrhea, increases the risk of perianal excoriation and bed sores, and is a burden on caregivers. To evaluate the efficacy of fecal evacuation and the prevention and treatment of skin complications in intractable diarrhea patients using a new device. METHODS A continent anal plug (US Patent No. 5 569 216) comprises an inner balloon surrounded by an outer balloon, both of which are mounted on a silicone tube containing a pair of air passages and an enema fluid inlet. The tube is secured in place in the rectum by the inflatable outer balloon and is designed to drain fecal matter through a thin collapsible hose situated in the anal canal. Thirty-two patients (21 male; median age 61 (range, 28-76) years) were evaluated after fully informed consent. Median duration was 12 (range, 3-37) days. RESULTS The continent anal plug evacuated efficiently in those patients with loose or watery stools who only required irrigation once daily or not at all. Skin excoriations improved in three to seven days. Minimal leakage was seen around the anus. There was no anorectal mucosal injury noted over 37 days. CONCLUSIONS The continent anal plug is an efficient method of treating patients with loss of bowel control and incontinence because it enables controlled fecal evacuation and helps reduce skin complications without causing anorectal mucosal injury.
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Affiliation(s)
- J Kim
- Department of General Surgery, College of Medicine, Yeungnam University Hospital, 317-1, Dae-Myung Dong, Nam Gu, Tae-Gu City, 705-717 Korea
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