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Antonio-Aguirre B, Block SS, Asare AO, Baldanado K, Ciner EB, Coulter RA, DeCarlo DK, Drews-Botsch C, Fishman D, Hartmann EE, Killeen OJ, Yuen J, Collins ME. Association of Sociodemographic Characteristics with Pediatric Vision Screening and Eye Care: An Analysis of the 2021 National Survey of Children's Health. Ophthalmology 2024; 131:611-621. [PMID: 38086435 DOI: 10.1016/j.ophtha.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Vision screening and regular eye care can help detect and treat potentially irreversible vision impairment. This study aims to investigate the associations between sociodemographic and health characteristics and the receipt of eye care among children aged 17 years and younger in the United States. DESIGN This cross-sectional study used data from the National Survey of Children's Health (NSCH), a nationally representative and population-based survey of randomly sampled households. PARTICIPANTS Participants were children aged 0 to 17 years, residing in all 50 states and the District of Columbia, whose caregivers or parents answered an address-based survey by mail or online. METHODS Weighted prevalence calculations were applied to analyze the data, and logistic regression was performed to explore associations between reported eye care and demographic, health, and parent-related variables. MAIN OUTCOME MEASURES Caregiver-reported vision screenings, referral to an eye doctor after vision screening, eye doctor visits, and prescription of corrective lenses. RESULTS Caregivers reported that 53.2% of children had a vision screening at least once (if child ≤ 5 years) or within the past 2 years (if child > 5 years). Of those screened, 26.9% were referred to an eye doctor. Overall, 38.6% of all children had a previous eye doctor visit, and among them, 55.4% were prescribed corrective lenses during the visit. Factors associated with decreased odds of vision screening included younger age, lack of health care visits, no insurance coverage, parent education high school or less, and lower household income. Non-White ethnicities, households with a non-English primary language, and lower incomes were more likely to be referred to an eye doctor after vision screening. Lower rates of eye doctor visits were associated with younger age, lack of insurance coverage, and primary household languages other than English. CONCLUSIONS Children from disadvantaged backgrounds are less likely to receive vision screening and eye care. Targeted strategies are needed to increase vision screening and access to eye care services in these vulnerable groups. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
| | | | - Afua O Asare
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, Spencer Fox Eccles School of Medicine at the University of Utah Health, Salt Lake City, Utah
| | | | - Elise B Ciner
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania
| | | | - Dawn K DeCarlo
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | - Jenay Yuen
- University of Southern California, Los Angeles, California
| | - Megan E Collins
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
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Harris ST, Schieve LA, Drews-Botsch C, DiGuiseppi C, Tian LH, Soke GN, Bradley CB, Windham GC. Pregnancy Planning and its Association with Autism Spectrum Disorder: Findings from the Study to Explore Early Development. Matern Child Health J 2024; 28:949-958. [PMID: 38198102 PMCID: PMC11001519 DOI: 10.1007/s10995-023-03877-0] [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] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES To examine associations between pregnancy planning and autism spectrum disorder (ASD) in offspring. METHODS The Study to Explore Early Development (SEED), a multi-site case-control study, enrolled preschool-aged children with ASD, other DDs, and from the general population (POP). Some children with DDs had ASD symptoms but did not meet the ASD case definition. We examined associations between mother's report of trying to get pregnant (pregnancy planning) and (1) ASD and (2) ASD symptomatology (ASD group, plus DD with ASD symptoms group combined) (each vs. POP group). We computed odds ratios adjusted for demographic, maternal, health, and perinatal health factors (aORs) via logistic regression. Due to differential associations by race-ethnicity, final analyses were stratified by race-ethnicity. RESULTS Pregnancy planning was reported by 66.4%, 64.8%, and 76.6% of non-Hispanic White (NHW) mothers in the ASD, ASD symptomatology, and POP groups, respectively. Among NHW mother-child pairs, pregnancy planning was inversely associated with ASD (aOR = 0.71 [95% confidence interval 0.56-0.91]) and ASD symptomatology (aOR = 0.67 [0.54-0.84]). Pregnancy planning was much less common among non-Hispanic Black mothers (28-32% depending on study group) and Hispanic mothers (49-56%) and was not associated with ASD or ASD symptomatology in these two race-ethnicity groups. CONCLUSION Pregnancy planning was inversely associated with ASD and ASD symptomatology in NHW mother-child pairs. The findings were not explained by several adverse maternal or perinatal health factors. The associations observed in NHW mother-child pairs did not extend to other race-ethnicity groups, for whom pregnancy planning was lower overall.
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Affiliation(s)
- Shericka T Harris
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S106-4, Atlanta, GA, 30341, USA.
| | - Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S106-4, Atlanta, GA, 30341, USA
| | - Carolyn Drews-Botsch
- Department of Global and Community Health, College of Health and Human Services, George Mason University, 4400 University Drive, MS: 5B7, Fairfax, VA, 22030, USA
| | - Carolyn DiGuiseppi
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 80045, Aurora, CO, USA
| | - Lin H Tian
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S106-4, Atlanta, GA, 30341, USA
| | - Gnakub N Soke
- Center for Global Health, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Chyrise B Bradley
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Gayle C Windham
- California Department of Public Health, Environmental Health Investigations Branch, Richmond, CA, 94804, USA
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Drews-Botsch C, Cotsonis G, Celano M, Hartmann EE, Zaidi J, Lambert SR. Patching in Children With Unilateral Congenital Cataract and Child Functioning and Parenting Stress. JAMA Ophthalmol 2024:2817342. [PMID: 38635258 DOI: 10.1001/jamaophthalmol.2024.0800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Importance Parents may be concerned about the adverse outcomes of occlusion therapy in children treated for unilateral congenital cataract (UCC). Objective To determine whether occlusion therapy in children treated for UCC with poor visual outcomes is negatively associated with poorer child and/or family functioning. Design, Setting, and Participants This cohort study was conducted in 2023 using data collected between 2006 and 2016 in the Infant Aphakia Treatment Study (IATS). IATS participants with a visual acuity (VA) of 20/200 or worse were included. Statistical analysis was performed from July 2022 to October 2023. Exposure Caregivers reported the mean daily minutes of patching during the 12 months prior to the VA assessment at 4.5 years of age. Patching was categorized as minimal (<15 minutes per day), moderate (15 to <120 minutes per day), or extensive (≥120 minutes per day). Main Outcome Measures At 4.25 and 10.5 years of age, caregivers reported stress associated with the parenting role using the Parenting Stress Index and the Ocular Treatment Index and child behavior problems using the Achenbach Child Behavior Checklist. Motor skills were assessed at age 54 months using the Movement Assessment Battery for Children-Second Edition. Children completed the Harter Self-Perception Profile for Children at age 10.5 years. One-way analysis of variance and χ2 tests were used to compare outcomes by amount of patching. Results Patching data were available for 47 of 53 children (88.7%) with a VA of 20/200 or worse. Among these 47 children with patching data included in the study, 20 (42.5%) were female, 27 (57.5%) were male, 12 (25.5%) were reported to have been patched fewer than 15 minutes per day, 11 (23.4%) were patched 16 to 119 minutes per day, and 24 (51.1%) were patched at least 120 minutes per day. Parenting stress, child behavior problems, motor functioning, and child self-perception were similar in all groups. For example, after adjusting for gender and insurance status, there was a nonsignificant difference between mean stress scores of 11.0 (95% CI, -4.5 to 26.5) points for parents who reported minimal patching vs parents who reported patching at least 120 minutes per day, and there was no significant difference in children's report of their global self-worth (0.0 [95% CI, -0.4 to 0.3] points). Conclusions and Relevance Occlusion therapy was not negatively associated with family or child functioning. Although the sample size was limited, these results do not support changes to the current practice guidelines.
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Affiliation(s)
- Carolyn Drews-Botsch
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Marianne Celano
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - E Eugenie Hartmann
- Rebecca D. Considine Research Institute and Vision Center, Akron Children's Hospital, Akron, Ohio
| | - Jaffer Zaidi
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Labgold K, Howards PP, Drews-Botsch C, Dunlop AL, Bryan JM, Ruddock T, Johnston S, Kramer MR. Decomposing the Black-White Racial Disparity in Severe Maternal Morbidity Risk: The Role of Hypertensive Disorders of Pregnancy. Epidemiology 2024; 35:94-102. [PMID: 37793115 DOI: 10.1097/ede.0000000000001683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND To our knowledge, no studies have explicitly studied the role of hypertensive disorders of pregnancy (HDP) in racial disparities in severe maternal morbidity (SMM). METHODS Using causal mediation models, we estimated the proportion of the non-Hispanic (NH) Black-White racial disparity in risk of SMM that is explained through the pathway of HDP. We linked 2006-2019 Georgia hospital discharge records with vital statistics birth and fetal death records for NH Black and NH White birthing persons. We used G-estimation of a structural nested mean model to decompose the absolute racial disparity in the incidence of SMM into pathways operating through HDP. RESULTS NH Black birthing people experienced an excess 56 SMM events (95% confidence interval [CI] = 52, 59) per 10,000 delivery hospitalizations compared with NH White birthing people. If counterfactual disparity measure estimation assumptions hold, the estimated absolute disparity remaining after blocking the causal pathways through HDP was 41 SMM events per 10,000 deliveries (95% CI = 38, 44), suggesting that 26% (95% CI = 12, 40) of the absolute racial disparity would be eliminated if there was no contribution of HDP to SMM risk. CONCLUSION Our results are consistent with the hypothesis that intervening to prevent HDP is an important (yet incomplete) pathway for reducing the excess risk among NH Black pregnancies compared with NH White pregnancies.
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Affiliation(s)
- Katie Labgold
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Penelope P Howards
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Carolyn Drews-Botsch
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Global and Community Health, School of Health and Human Services, George Mason University, Fairfax, VA
| | - Anne L Dunlop
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA
| | | | | | | | - Michael R Kramer
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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McCracken C, Shantha JG, Yeh S, Jenkins K, Rouster-Stevens KA, Lambert SR, Prahalad S, Drews-Botsch C, Angeles-Han ST. Relapse and Remission in Children With Chronic Noninfectious Uveitis Treated With Methotrexate. J Rheumatol 2022; 49:1289-1291. [PMID: 35970521 PMCID: PMC10151125 DOI: 10.3899/jrheum.220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pediatric chronic noninfectious uveitis (NIU) can lead to sight-threatening complications and often requires long-term immunosuppression. Uveitis occurs in isolation (ie, idiopathic NIU), or is associated with systemic diseases, most commonly juvenile idiopathic arthritis (JIA).
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Affiliation(s)
- Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Francis I. Proctor Foundation for Research in Ophthalmology, and Department of Ophthalmology University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska; Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Ophthalmology, Stanford University, Stanford, California; Department of Genetics, Emory University School of Medicine, Atlanta, Georgia; Department of Global and Community Health, George Mason University, Fairfax, Virginia; Division of Rheumatology and Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.C. McCracken and J.G. Shantha contributed equally to this work. Research reported in this manuscript was supported by the National Eye Institute (NEI) Award Number K23EY021760 (STAH), K23EY030159 ( JGS), and the Rheumatology Research Foundation. STAH is also supported by NEI R01EY030521. SP is supported in part by a grant from the Marcus Foundation Inc., Atlanta. SY is a consultant for Santen and Clearside Biomedical, unrelated to this study. KARS is a consultant for Accordant, unrelated to this study. SP serves on the Macrophage Activation Syndrome Adjudication Committee for Novartis and is a Doximity Op-Med Fellow for 2021-22, unrelated to this study. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.T. Angeles-Han, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA.
| | - Jessica G Shantha
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Francis I. Proctor Foundation for Research in Ophthalmology, and Department of Ophthalmology University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska; Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Ophthalmology, Stanford University, Stanford, California; Department of Genetics, Emory University School of Medicine, Atlanta, Georgia; Department of Global and Community Health, George Mason University, Fairfax, Virginia; Division of Rheumatology and Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.C. McCracken and J.G. Shantha contributed equally to this work. Research reported in this manuscript was supported by the National Eye Institute (NEI) Award Number K23EY021760 (STAH), K23EY030159 ( JGS), and the Rheumatology Research Foundation. STAH is also supported by NEI R01EY030521. SP is supported in part by a grant from the Marcus Foundation Inc., Atlanta. SY is a consultant for Santen and Clearside Biomedical, unrelated to this study. KARS is a consultant for Accordant, unrelated to this study. SP serves on the Macrophage Activation Syndrome Adjudication Committee for Novartis and is a Doximity Op-Med Fellow for 2021-22, unrelated to this study. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.T. Angeles-Han, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA.
| | - Steven Yeh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Francis I. Proctor Foundation for Research in Ophthalmology, and Department of Ophthalmology University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska; Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Ophthalmology, Stanford University, Stanford, California; Department of Genetics, Emory University School of Medicine, Atlanta, Georgia; Department of Global and Community Health, George Mason University, Fairfax, Virginia; Division of Rheumatology and Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.C. McCracken and J.G. Shantha contributed equally to this work. Research reported in this manuscript was supported by the National Eye Institute (NEI) Award Number K23EY021760 (STAH), K23EY030159 ( JGS), and the Rheumatology Research Foundation. STAH is also supported by NEI R01EY030521. SP is supported in part by a grant from the Marcus Foundation Inc., Atlanta. SY is a consultant for Santen and Clearside Biomedical, unrelated to this study. KARS is a consultant for Accordant, unrelated to this study. SP serves on the Macrophage Activation Syndrome Adjudication Committee for Novartis and is a Doximity Op-Med Fellow for 2021-22, unrelated to this study. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.T. Angeles-Han, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA.
| | - Kirsten Jenkins
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Francis I. Proctor Foundation for Research in Ophthalmology, and Department of Ophthalmology University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska; Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Ophthalmology, Stanford University, Stanford, California; Department of Genetics, Emory University School of Medicine, Atlanta, Georgia; Department of Global and Community Health, George Mason University, Fairfax, Virginia; Division of Rheumatology and Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.C. McCracken and J.G. Shantha contributed equally to this work. Research reported in this manuscript was supported by the National Eye Institute (NEI) Award Number K23EY021760 (STAH), K23EY030159 ( JGS), and the Rheumatology Research Foundation. STAH is also supported by NEI R01EY030521. SP is supported in part by a grant from the Marcus Foundation Inc., Atlanta. SY is a consultant for Santen and Clearside Biomedical, unrelated to this study. KARS is a consultant for Accordant, unrelated to this study. SP serves on the Macrophage Activation Syndrome Adjudication Committee for Novartis and is a Doximity Op-Med Fellow for 2021-22, unrelated to this study. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.T. Angeles-Han, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA.
| | - Kelly A Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Francis I. Proctor Foundation for Research in Ophthalmology, and Department of Ophthalmology University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska; Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Ophthalmology, Stanford University, Stanford, California; Department of Genetics, Emory University School of Medicine, Atlanta, Georgia; Department of Global and Community Health, George Mason University, Fairfax, Virginia; Division of Rheumatology and Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.C. McCracken and J.G. Shantha contributed equally to this work. Research reported in this manuscript was supported by the National Eye Institute (NEI) Award Number K23EY021760 (STAH), K23EY030159 ( JGS), and the Rheumatology Research Foundation. STAH is also supported by NEI R01EY030521. SP is supported in part by a grant from the Marcus Foundation Inc., Atlanta. SY is a consultant for Santen and Clearside Biomedical, unrelated to this study. KARS is a consultant for Accordant, unrelated to this study. SP serves on the Macrophage Activation Syndrome Adjudication Committee for Novartis and is a Doximity Op-Med Fellow for 2021-22, unrelated to this study. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.T. Angeles-Han, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA.
| | - Scott R Lambert
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Francis I. Proctor Foundation for Research in Ophthalmology, and Department of Ophthalmology University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska; Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Ophthalmology, Stanford University, Stanford, California; Department of Genetics, Emory University School of Medicine, Atlanta, Georgia; Department of Global and Community Health, George Mason University, Fairfax, Virginia; Division of Rheumatology and Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.C. McCracken and J.G. Shantha contributed equally to this work. Research reported in this manuscript was supported by the National Eye Institute (NEI) Award Number K23EY021760 (STAH), K23EY030159 ( JGS), and the Rheumatology Research Foundation. STAH is also supported by NEI R01EY030521. SP is supported in part by a grant from the Marcus Foundation Inc., Atlanta. SY is a consultant for Santen and Clearside Biomedical, unrelated to this study. KARS is a consultant for Accordant, unrelated to this study. SP serves on the Macrophage Activation Syndrome Adjudication Committee for Novartis and is a Doximity Op-Med Fellow for 2021-22, unrelated to this study. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.T. Angeles-Han, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA.
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Francis I. Proctor Foundation for Research in Ophthalmology, and Department of Ophthalmology University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska; Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Ophthalmology, Stanford University, Stanford, California; Department of Genetics, Emory University School of Medicine, Atlanta, Georgia; Department of Global and Community Health, George Mason University, Fairfax, Virginia; Division of Rheumatology and Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.C. McCracken and J.G. Shantha contributed equally to this work. Research reported in this manuscript was supported by the National Eye Institute (NEI) Award Number K23EY021760 (STAH), K23EY030159 ( JGS), and the Rheumatology Research Foundation. STAH is also supported by NEI R01EY030521. SP is supported in part by a grant from the Marcus Foundation Inc., Atlanta. SY is a consultant for Santen and Clearside Biomedical, unrelated to this study. KARS is a consultant for Accordant, unrelated to this study. SP serves on the Macrophage Activation Syndrome Adjudication Committee for Novartis and is a Doximity Op-Med Fellow for 2021-22, unrelated to this study. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.T. Angeles-Han, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA.
| | - Carolyn Drews-Botsch
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Francis I. Proctor Foundation for Research in Ophthalmology, and Department of Ophthalmology University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska; Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Ophthalmology, Stanford University, Stanford, California; Department of Genetics, Emory University School of Medicine, Atlanta, Georgia; Department of Global and Community Health, George Mason University, Fairfax, Virginia; Division of Rheumatology and Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.C. McCracken and J.G. Shantha contributed equally to this work. Research reported in this manuscript was supported by the National Eye Institute (NEI) Award Number K23EY021760 (STAH), K23EY030159 ( JGS), and the Rheumatology Research Foundation. STAH is also supported by NEI R01EY030521. SP is supported in part by a grant from the Marcus Foundation Inc., Atlanta. SY is a consultant for Santen and Clearside Biomedical, unrelated to this study. KARS is a consultant for Accordant, unrelated to this study. SP serves on the Macrophage Activation Syndrome Adjudication Committee for Novartis and is a Doximity Op-Med Fellow for 2021-22, unrelated to this study. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.T. Angeles-Han, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA.
| | - Sheila T Angeles-Han
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Francis I. Proctor Foundation for Research in Ophthalmology, and Department of Ophthalmology University of California, San Francisco, San Francisco, California; Department of Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska; Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Ophthalmology, Stanford University, Stanford, California; Department of Genetics, Emory University School of Medicine, Atlanta, Georgia; Department of Global and Community Health, George Mason University, Fairfax, Virginia; Division of Rheumatology and Pediatric Ophthalmology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.C. McCracken and J.G. Shantha contributed equally to this work. Research reported in this manuscript was supported by the National Eye Institute (NEI) Award Number K23EY021760 (STAH), K23EY030159 ( JGS), and the Rheumatology Research Foundation. STAH is also supported by NEI R01EY030521. SP is supported in part by a grant from the Marcus Foundation Inc., Atlanta. SY is a consultant for Santen and Clearside Biomedical, unrelated to this study. KARS is a consultant for Accordant, unrelated to this study. SP serves on the Macrophage Activation Syndrome Adjudication Committee for Novartis and is a Doximity Op-Med Fellow for 2021-22, unrelated to this study. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S.T. Angeles-Han, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA.
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Angley M, Drews-Botsch C, Lewis TT, Badell M, Lim SS, Howards PP. Adverse Perinatal Outcomes Before and After Diagnosis with Systemic Lupus Erythematosus Among African American Women. Arthritis Care Res (Hoboken) 2021; 74:904-911. [PMID: 34931482 DOI: 10.1002/acr.24848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/01/2021] [Accepted: 12/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Women with systemic lupus erythematosus (SLE) may experience adverse perinatal outcomes in the years before an SLE diagnosis. Overall, there is limited research on perinatal outcomes among African American women with SLE. METHODS Women with SLE identified from the Georgia Lupus Registry and the Georgians Organized Against Lupus Cohort were linked with birth certificates by the Georgia Department of Public Health. Births were categorized into occurring more than 3 years before SLE diagnosis, 0-3 years before SLE diagnosis, 0-3 years after SLE diagnosis or more than 3 years after SLE diagnosis. Comparison births certificates to African American women in the same geographic area were obtained from the National Center for Health Statistics. We used log-risk models to compare the risk of preterm birth or small-for-gestational age among SLE births in each diagnosis timing category to the general population, adjusting for maternal age and education and parity. RESULTS Births to women with SLE were more likely to occur preterm 0-3 years before SLE diagnosis (risk ratio [RR]: 1.71, 95% confidence interval [CI]: 1.24, 2.35), 0-3 years after SLE diagnosis (RR: 2.29, 95% CI: 1.70, 3.09) and 3 or more years after diagnosis (RR: 2.83, 95% CI: 2.36, 3.38), but not 3 or more years before SLE diagnosis compared to the general population (RR: 1.03, 95% CI: 0.77, 1.38). Similar results were observed for small-for-gestational age births. CONCLUSION Our analysis, conducted among African American women, demonstrates an increased risk of adverse perinatal outcomes even before a clinical diagnosis of SLE.
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Affiliation(s)
- Meghan Angley
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | | | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University
| | - Martina Badell
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Emory University School of Medicine
| | - S Sam Lim
- Department of Epidemiology, Rollins School of Public Health, Emory University.,Department of Medicine, Division of Rheumatology, Emory University School of Medicine
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University
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7
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Shantha JG, Auld SC, Anthony C, Ward L, Adelman MW, Maier CL, Price KW, Jacob J, Fashina T, Randleman C, Xu LT, Barnett J, Sadan O, Kandiah PA, Varkey JB, Kraft CS, Rouphael N, Linderman S, Ahmed R, Drews-Botsch C, Waggoner JJ, Weinmann M, Murphy DJ, Yeh S. Retinopathy and Systemic Disease Morbidity in Severe COVID-19. Ocul Immunol Inflamm 2021; 29:743-750. [PMID: 34464544 PMCID: PMC8562588 DOI: 10.1080/09273948.2021.1952278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/17/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To assess the prevalence of retinopathy and its association with systemic morbidity and laboratory indices of coagulation and inflammatory dysfunction in severe COVID-19. DESIGN Retrospective, observational cohort study. METHODS Adult patients hospitalized with severe COVID-19 who underwent ophthalmic examination from April to July 2020 were reviewed. Retinopathy was defined as one of the following: 1) Retinal hemorrhage; 2) Cotton wool spots; 3) Retinal vascular occlusion. We analyzed medical comorbidities, sequential organ failure assessment (SOFA) scores, clinical outcomes, and laboratory values for their association with retinopathy. RESULTS Thirty-seven patients with severe COVID-19 were reviewed, the majority of whom were female (n = 23, 62%), Black (n = 26, 69%), and admitted to the intensive care unit (n = 35, 95%). Fourteen patients had retinopathy (38%) with retinal hemorrhage in 7 (19%), cotton wool spots in 8 (22%), and a branch retinal artery occlusion in 1 (3%) patient. Patients with retinopathy had higher SOFA scores than those without retinopathy (8.0 vs. 5.3, p = .03), higher rates of respiratory failure requiring invasive mechanical ventilation and shock requiring vasopressors (p < .01). Peak D-dimer levels were 28,971 ng/mL in patients with retinopathy compared to 12,575 ng/mL in those without retinopathy (p = .03). Peak CRP was higher in patients with cotton wool spots versus those without cotton wool spots (354 mg/dL vs. 268 mg/dL, p = .03). Multivariate logistic regression modeling showed an increased risk of retinopathy with higher peak D-dimers (aOR 1.32, 95% CI 1.01-1.73, p = .04) and male sex (aOR 9.6, 95% CI 1.2-75.5, p = .04). CONCLUSION Retinopathy in severe COVID-19 was associated with greater systemic disease morbidity involving multiple organs. Given its association with coagulopathy and inflammation, retinopathy may offer insight into disease pathogenesis in patients with severe COVID-19.
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Affiliation(s)
| | - Sara C Auld
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Casey Anthony
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Laura Ward
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Max W. Adelman
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Cheryl L. Maier
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kenneth W. Price
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Jesse Jacob
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Tolu Fashina
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Casey Randleman
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Lucy T. Xu
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Joshua Barnett
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
| | - Ofer Sadan
- Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, GA
| | - Prem A. Kandiah
- Department of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, GA
| | - Jay B. Varkey
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Colleen S. Kraft
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Nadine Rouphael
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Susanne Linderman
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA
| | - Carolyn Drews-Botsch
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA
| | - Jesse J. Waggoner
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Max Weinmann
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
| | - David J. Murphy
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA
| | - Steven Yeh
- Emory Eye Center, Emory University School of Medicine, Atlanta, GA
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE
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8
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McDonald J, Cassedy A, Altaye M, Andringa J, Cooper AM, Drews-Botsch C, Engelhard G, Hennard T, Holland GN, Jenkins K, Lambert SR, Lipscomb J, McCracken C, McCurdy DK, Mwase N, Prahalad S, Shantha J, Stahl E, Miraldi Utz V, Walker AA, Yeh S, Angeles-Han ST. Comprehensive assessment of quality of life, functioning and mental health in children with juvenile idiopathic arthritis and non-infectious uveitis. Arthritis Care Res (Hoboken) 2021; 74:1311-1320. [PMID: 33421338 PMCID: PMC8267048 DOI: 10.1002/acr.24551] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pediatric uveitis can lead to sight-threatening complications and impact quality of life (QOL) and functioning. We aim to examine health-related QOL (HRQOL), mental health, physical disability, vision-related functioning (VRF), and vision-related QOL (VRQOL) in children with juvenile idiopathic arthritis (JIA), JIA-associated uveitis (JIA-U), and other non-infectious uveitis. We hypothesize that there will be differences based on the presence of eye disease. METHODS A multicenter cross-sectional study was conducted at four sites. Patients with JIA, JIA-U, or non-infectious uveitis were enrolled. Patients and parents completed the PedsQL (HRQOL), RCADS (anxiety/depression), CHAQ (physical disability), and EYE-Q (VRF/VRQOL). Clinical characteristics and patient-reported outcome measures (PROMs) were compared by diagnosis. RESULTS Of 549 patients, 332 had JIA, 124 JIA-U, and 93 other uveitis. Children with JIA-U had worse EYE-Q scores compared to JIA only. In children with uveitis, those with anterior uveitis (JIA-U and uveitis only) had less ocular complications, better EYE-Q scores, and worse CHAQ and PedsQL physical summary scores compared to those with non-anterior disease. In children with anterior uveitis, those with JIA-U had worse PedsQL physical summary and CHAQ scores than anterior uveitis only. Further, EYE-Q scores were worse in children with bilateral uveitis and more visual impairment. There were no differences in RCADS scores among groups. CONCLUSION We provide a comprehensive outcome assessment of children with JIA, JIA-U, and other uveitis diagnoses. Differences in QOL and function were noted based on underlying disease. Our results support the addition of a vision-specific measure to better understand the impact of uveitis.
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Affiliation(s)
- Joseph McDonald
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Andringa
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Ashley M Cooper
- Division of Rheumatology, Children's Mercy Hospital, Kansas City, MO, United States.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Carolyn Drews-Botsch
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - George Engelhard
- Division of Educational Psychology, The University of Georgia, Athens, GA, United States
| | - Theresa Hennard
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Gary N Holland
- UCLA Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | | | - Scott R Lambert
- Department of Ophthalmology, Stanford University, Stanford, United States
| | - Jessi Lipscomb
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Deborah K McCurdy
- Department of Pediatrics and David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Najima Mwase
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Childrens Healthcare of Atlanta, Athens, GA, United States
| | - Jessica Shantha
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Erin Stahl
- Section of Pediatric Ophthalmology, Children's Mercy Hospital, Kansas City, MO, United States.,Department of Ophthalmology, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Virginia Miraldi Utz
- Division of Ophthalmology, Cincinnati Children's Hospital Medical Center, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, United States
| | | | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Sheila T Angeles-Han
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.,Section of Pediatric Ophthalmology, Children's Mercy Hospital, Kansas City, MO, United States
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9
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Lambert SR, Cotsonis G, DuBois L, Nizam Ms A, Kruger SJ, Hartmann EE, Weakley DR, Drews-Botsch C. Long-term Effect of Intraocular Lens vs Contact Lens Correction on Visual Acuity After Cataract Surgery During Infancy: A Randomized Clinical Trial. JAMA Ophthalmol 2020; 138:365-372. [PMID: 32077909 DOI: 10.1001/jamaophthalmol.2020.0006] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Although intraocular lenses (IOLs) are often implanted in children, little is known whether primary IOL implantation or aphakia and contact lens correction results in better long-term visual outcomes after unilateral cataract surgery during infancy. Objective To compare long-term visual outcomes with contact lens vs IOL correction following unilateral cataract surgery during infancy. Design, Setting, and Participants This multicenter randomized clinical trial enrolled 114 infants with a unilateral congenital cataract who underwent cataract surgery with or without primary IOL implantation between 1 and 6 months of age. Data on long-term visual outcomes were collected when the children were age 10.5 years (July 14, 2015, to July 12, 2019) and analyzed from March 30 through August 6, 2019. Interventions Intraocular lens implantation at the time of cataract surgery. Main Outcomes and Measures Best-corrected visual acuity using the electronic Early Treatment Diabetic Retinopathy Study (E-ETDRS) testing protocol. Analysis was performed on an intention-to-treat basis. Results Best-corrected visual acuity was measured at age 10.5 years for 110 of the 114 patients (96%) enrolled as infants. The participants included 58 girls (53%) and 52 boys (47%). Overall, 27 of the children (25%) had good (logMAR 0.30 [Snellen equivalent, 20/40] or better) visual acuity in the treated eye (12 [22%] in the IOL group and 15 [27%] in the aphakia group), but 50 children (44%) had a visual acuity of logMAR 1.00 (Snellen equivalent, 20/200) or worse (25 [44%] in the IOL group and 25 [44%] in the aphakia group). The median logMAR acuity in the treated eye was similar in children randomized to receive an IOL at the time of cataract extraction (0.89; interquartile range [IQR], 0.33-1.43 [Snellen equivalent, 20/159]) and those who remained aphakic (0.86; IQR, 0.30-1.46 [Snellen equivalent, 20/145]) (IQR, 0.30-1.46; P = .82). Although the overall difference in median visual acuity between the 2 groups was small, the estimate was imprecise (99% CI for the difference in medians was -0.54 to 0.47). Conclusions and Relevance As in previous phases of the study, visual acuity outcomes were highly variable with only 27 children (25%) achieving excellent visual acuity in their treated eye and 50 children (44%) having poor vision in the treated eye. Implanting an IOL at the time of cataract extraction was neither beneficial nor detrimental to the visual outcome. Trial Registration ClinicalTrials.gov Identifier: NCT00212134.
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Affiliation(s)
- Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
| | - George Cotsonis
- Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Lindreth DuBois
- Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Azhar Nizam Ms
- Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Stacey J Kruger
- Department of Ophthalmology, Northwell Health, Great Neck, New York
| | - E Eugenie Hartmann
- Rebecca D. Considine Research Institute and Vision Center, Akron Children's Hospital, Akron, Ohio
| | - David R Weakley
- Department of Ophthalmology, University of Texas, Southwestern Medical Center, Dallas
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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10
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Cassedy A, Altaye M, Andringa J, Cooper AM, Drews-Botsch C, Engelhard G, Hennard T, Holland GN, Jenkins K, Lambert SR, Lipscomb J, McCracken C, McCurdy DK, McDonald J, Mwase N, Prahalad S, Stahl E, Miraldi Utz V, Walker AA, Yeh S, Angeles-Han ST. Assessing the validity and reliability of the Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) questionnaire among children with uveitis. Arthritis Care Res (Hoboken) 2020; 74:355-363. [PMID: 33085849 DOI: 10.1002/acr.24491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 11/05/2022]
Abstract
PURPOSE The Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) questionnaire measures vision-related functioning (VRF) and vision-related quality of life (VRQOL) in children with uveitis. Our aim was to revise the Alpha version of the EYE-Q to refine VRF and VRQOL subscales and assess the validity of the EYE-Q. METHODS Children with juvenile idiopathic arthritis (JIA), JIA-associated uveitis, and other non-infectious uveitis were enrolled. Patients and parents completed the EYE-Q, PedsQL (overall QOL), and CHAQ (physical functioning). The Development site completed the Alpha version of the EYE-Q, and the Composite sites completed the Beta version. We compared item-subscale correlations, internal consistency, construct and discriminant validity amongst the different versions. RESULTS Of the 644 patients enrolled, 61.6% completed the Alpha version, and 38.4% the Beta version of the EYE-Q. Mean patient age was 11.1 (SD = 4.2) years, and 70% were female. Fewer white patients (73.5%) completed the Alpha version compared to the Beta version (86.2%, p <0.001). With the exception of patient-reported VRF, both versions had similar item-subscale correlations. Version comparisons on scale internal consistencies indicated significant differences for parent- and patient-reported VRF, but each scale had a Cronbach's Alpha >0.80 Beta. When data were combined, the EYE-Q showed significant differences between JIA-only and uveitis patients on all parent and patient scores, except for patient-reported VRF. CONCLUSION The EYE-Q appears to be a valid measure of VRF and VRQOL in pediatric uveitis. Our results suggest it may be used as an outcome measure in multi-center pediatric uveitis studies.
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Affiliation(s)
- Amy Cassedy
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Mekibib Altaye
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Andringa
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | | | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - George Engelhard
- Division of Educational Psychology, The University of Georgia, Athens, GA, United States
| | - Theresa Hennard
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Gary N Holland
- UCLA Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | | | | | - Jessi Lipscomb
- Division of Biostatistics and Epidemiology and Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Deborah K McCurdy
- Department of Pediatrics and David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Joseph McDonald
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Najima Mwase
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.,Childrens Healthcare of Atlanta
| | - Erin Stahl
- Children's Mercy Hospital, Kansas City, MO, United States
| | - Virginia Miraldi Utz
- Division of Ophthalmology, Cincinnati Children's Hospital Medical Center, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, United States
| | | | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - Sheila T Angeles-Han
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.,Division of Ophthalmology, Cincinnati Children's Hospital Medical Center, Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, United States
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11
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Jiang VS, Marsidi AM, Violette C, Gaskins AJ, Spencer JB, Drews-Botsch C. DIFFERENCES IN EARLY ULTRASOUND AND FETAL GROWTH KINETICS BETWEEN NON-HISPANIC WHITE AND BLACK WOMEN. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Gibbins KJ, Pinar H, Reddy UM, Saade GR, Goldenberg RL, Dudley DJ, Drews-Botsch C, Freedman AA, Daniels LM, Parker CB, Thorsten V, Bukowski R, Silver RM. Findings in Stillbirths Associated with Placental Disease. Am J Perinatol 2020; 37:708-715. [PMID: 31087311 PMCID: PMC6854286 DOI: 10.1055/s-0039-1688472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Placental disease is a leading cause of stillbirth. Our purpose was to characterize stillbirths associated with placental disease. STUDY DESIGN The Stillbirth Collaborative Research Network conducted a prospective, case-control study of stillbirths and live births from 2006 to 2008. This analysis includes 512 stillbirths with cause of death assignment and a comparison group of live births. We compared exposures between women with stillbirth due to placental disease and those due to other causes as well as between women with term (≥ 37 weeks) stillbirth due to placental disease and term live births. RESULTS A total of 121 (23.6%) out of 512 stillbirths had a probable or possible cause of death due to placental disease by Initial Causes of Fetal Death. Characteristics were similar between stillbirths due to placental disease and other stillbirths. When comparing term live births to stillbirths due to placental disease, women with non-Hispanic black race, Hispanic ethnicity, lack of insurance, or who were born outside of the United States had higher odds of stillbirth due to placental disease. Nulliparity and antenatal bleeding also increased risk of stillbirth due to placental disease. CONCLUSION Multiple discrete exposures were associated with stillbirth caused by placental disease. The relationship between these factors and utility of surveillance warrants further study.
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Affiliation(s)
| | - Halit Pinar
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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13
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Cromelin CH, Drews-Botsch C, Russell B, Lambert SR. Association of Contact Lens Adherence With Visual Outcome in the Infant Aphakia Treatment Study: A Secondary Analysis of a Randomized Clinical Trial. JAMA Ophthalmol 2019; 136:279-285. [PMID: 29423513 DOI: 10.1001/jamaophthalmol.2017.6691] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although contact lenses have been used for decades to optically correct eyes in children after cataract surgery, there has never been a prospective study looking at contact lens adherence in children with aphakia, to our knowledge. Objective To evaluate contact lens adherence and its association with visual outcome in a cohort of children treated for unilateral cataract surgery. Design, Setting, and Participants Secondary analysis of a multicenter randomized clinical trial of 57 infants born from August 22, 2004, to April 25, 2008, who were randomized to 1 of 2 treatments and followed up to age 5 years. Data analysis was performed from August 9, 2016, to December 7, 2017. Interventions Unilateral cataract extraction and randomization to implantation of an intraocular lens vs contact lens to correct aphakia. Main Outcomes and Measures Contact lens adherence was assessed by a 48-hour recall telephone interview that was administered every 3 months starting 3 months after surgery to age 5 years. A traveling examiner assessed visual acuity in patients at aged 4.5 years. Adherence to prescribed contact lens use was estimated as the mean percentage of waking hours as reported in 2 or more interviews for each year of life. Results Of 57 infants who were randomized to contact lens treatment, 32 (56%) were girls, and 49 (86%) were white. A total of 872 telephone interviews were completed. In year 1, a median of 95% participants wore their contacts lenses nearly all waking hours (interquartile range [IQR], 84%-100%); year 2, 93% (IQR, 85%-99%); year 3, 93% (IQR, 85%-99%); year 4, 93% (IQR, 75%-99%); and year 5, 89% (IQR, 71%-97%). There was a tendency for poorer reported adherence at older ages (F = 3.86, P < .001). No differences were identified when the results were analyzed by sex, insurance coverage, or age at cataract surgery. Using linear regression, children who wore the contact lens for a greater proportion of waking hours during the entire study period tended to have better visual acuity at age 4.5 years, even after accounting for adherence to patching (partial correlation = -0.026; P = .08). Conclusions and Relevance These results confirm that it is possible to achieve a high level of aphakic contact lens adherence over a 5-year period in children. Trial Registration clinicaltrials.gov Identifier: NCT00212134.
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Affiliation(s)
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Buddy Russell
- Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, California
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14
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Freedman AA, Silver RM, Gibbins KJ, Hogue CJ, Goldenberg RL, Dudley DJ, Pinar H, Drews-Botsch C. The association of stillbirth with placental abnormalities in growth-restricted and normally grown fetuses. Paediatr Perinat Epidemiol 2019; 33:274-383. [PMID: 31347723 PMCID: PMC6662619 DOI: 10.1111/ppe.12563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/26/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stillbirth, defined as foetal death ≥20 weeks' gestation, is associated with poor foetal growth and is often attributed to placental abnormalities, which are also associated with poor foetal growth. Evaluating inter-relationships between placental abnormalities, poor foetal growth, and stillbirth may improve our understanding of the underlying mechanisms for some causes of stillbirth. OBJECTIVE Our primary objective was to determine whether poor foetal growth, operationalised as small for gestational age (SGA), mediates the relationship between placental abnormalities and stillbirth. METHODS We used data from the Stillbirth Collaborative Research Network study, a population-based case-control study conducted from 2006-2008. Our analysis included 266 stillbirths and 1135 livebirths. We evaluated associations of stillbirth with five types of placental characteristics (developmental disorders, maternal and foetal inflammatory responses, and maternal and foetal circulatory disorders) and examined mediation of these relationships by SGA. We also assessed exposure-mediator interaction. Models were adjusted for maternal age, race/ethnicity, education, body mass index, parity, and smoking status. RESULTS All five placental abnormalities were more prevalent in cases than controls. After adjustment for potential confounders, maternal inflammatory response (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.77, 3.75), maternal circulatory disorders OR 4.14, 95% CI 2.93, 5.84, and foetal circulatory disorders OR 4.58, 95% CI 3.11, 6.74 were strongly associated with stillbirth, and the relationships did not appear to be mediated by SGA status. Associations for developmental disorders and foetal inflammatory response diverged for SGA and non-SGA births, and strong associations were only observed when SGA was not present. CONCLUSIONS Foetal growth did not mediate the relationships between placental abnormalities and stillbirth. The relationships of stillbirth with maternal and foetal circulatory disorders and maternal inflammatory response appear to be independent of poor foetal growth, while developmental disorders and foetal inflammatory response likely interact with foetal growth to affect stillbirth risk.
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Affiliation(s)
- Alexa A. Freedman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Karen J. Gibbins
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Carol J. Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - Donald J. Dudley
- Department of Obstetrics and Gynecology, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Halit Pinar
- Department of Pathology and Laboratory Medicine, Brown University School of Medicine, Providence, Rhode Island, USA
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Lambert SR, DuBois L, Cotsonis G, Hartmann EE, Drews-Botsch C. Spectacle Adherence Among Four-Year-Old Children in the Infant Aphakia Treatment Study. Am J Ophthalmol 2019; 200:26-33. [PMID: 30633891 DOI: 10.1016/j.ajo.2018.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 08/03/2018] [Revised: 12/28/2018] [Accepted: 12/29/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate spectacle adherence with impact-resistant lenses among 4-year-old children after unilateral cataract surgery in the Infant Aphakia Treatment Study. DESIGN Retrospective cohort analysis of randomized clinical trial data. METHODS Setting: Multicenter. PATIENTS One hundred and fourteen children randomized to contact lens correction or intraocular lens implantation following unilateral cataract surgery during infancy. INTERVENTION One-week diaries completed annually and retrospective telephone interviews conducted every 3 months to age 5 years to assess spectacle adherence with impact-resistant lenses. Visual acuity was assessed by a traveling examiner at age 4.5 years. MAIN OUTCOME MEASURES Spectacle adherence between ages 4 and 5 years. RESULTS Children with 20/40 or better vision in their treated eye were more likely to wear spectacles ≥80% of their waking hours than children with vision worse than 20/40 (66% vs 42%, P = .034). Reported adherence to spectacle wear correlated with reported patching (r = 0.30, P = .002). Spectacle adherence did not correlate with sex, type of healthcare insurance, or the refractive error in the treated or fellow eye. Seven patients with reduced vision in their treated eye reported <10% spectacle adherence. CONCLUSIONS These results confirm that it is possible to achieve high levels of spectacle adherence among 4-year-old children after unilateral cataract surgery during infancy. However, children with vision worse than 20/40 in their worse eye, who needed eye protection the most, had the worst adherence.
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Affiliation(s)
- Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.
| | - Lindreth DuBois
- Department of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Freedman AA, Hogue CJ, Marsit CJ, Rajakumar A, Smith AK, Grantz KL, Goldenberg RL, Dudley DJ, Saade GR, Silver RM, Gibbins KJ, Bukowski R, Drews-Botsch C. Associations Between Features of Placental Morphology and Birth Weight in Dichorionic Twins. Am J Epidemiol 2019; 188:518-526. [PMID: 30452541 DOI: 10.1093/aje/kwy255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/14/2018] [Revised: 11/11/2018] [Accepted: 11/13/2018] [Indexed: 12/20/2022] Open
Abstract
Low birth weight is associated with perinatal and long-term morbidity and mortality, and may be a result of abnormal placental development and function. In studies of singletons, associations have been reported between features of placental morphology and birth weight. Evaluating similar associations within twin pairs offers a unique opportunity to control for key confounders shared within a twin pair, including gestational age, parental characteristics, and intrauterine environment. Data from 3 studies in the United States that were completed from 2012 to 2013, 2006 to 2008, and 1959 to 1966 were used in our analysis of 208 sets of dichorionic twins with unfused placentas. We used linear regression to model difference in birth weight within a twin pair as a function of differences in placental characteristics (i.e., thickness, 2-dimensional surface area, intraplacental difference in diameter). After controlling for sex discordance, a 75.3- cm2 difference in placental surface area, which reflects the interquartile range, was associated with a difference in birth weight of 142.1 g (95% confidence interval (CI): 62.9, 221.3). The magnitude of the association also may be larger for same-sex male pairs than same-sex female pairs (males: 265.8 g, 95% CI: 60.8, 470.8; females: 133.0 g, 95% CI: 15.7, 250.3). Strong associations between surface area and birth weight are consistent with reported results for singleton pregnancies.
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Affiliation(s)
- Alexa A Freedman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carol J Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carmen J Marsit
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Augustine Rajakumar
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Alicia K Smith
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Katherine L Grantz
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | - Donald J Dudley
- Department of Obstetrics and Gynecology, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, University of Texas, Galveston, Texas
| | - Robert M Silver
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Karen J Gibbins
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Radek Bukowski
- Department of Women’s Health, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Drews-Botsch C, Celano M, Cotsonis G, DuBois L, Lambert SR. Parenting Stress and Adherence to Occlusion Therapy in the Infant Aphakia Treatment Study: A Secondary Analysis of a Randomized Clinical Trial. Transl Vis Sci Technol 2019; 8:3. [PMID: 30627478 PMCID: PMC6322710 DOI: 10.1167/tvst.8.1.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/13/2018] [Accepted: 10/19/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Using data from the Infant Aphakia Treatment Study, we examined the relationship between adherence to patching and parenting stress. Methods Caregivers completed the Parenting Stress Index 3 months after surgery (n = 106), after a visual acuity assessment at 12 months of age (n = 97), and at 4.25 (n = 96) years of age. Patching was reported in quarterly telephone interviews and annual 7-day patching diaries, and averaged across all assessments prior to and in the 6 months following the first stress assessment, and for 6 months before and after the other two stress assessments. The association was assessed using linear regression. Results Caregivers reporting the highest stress levels 3 months after surgery (i.e., 75th percentile) subsequently reported approximately three-quarters (0.87, 95% confidence interval -1.3 to -0.34) of an hour a day less patching than caregivers reporting the least stress (i.e., the 25th percentile) after controlling for prior patching and other confounders. The association was in the same direction, but not statistically significant, after the second stress assessment and was not apparent at 4.25 years of age. In contrast to our hypothesis, we did not find evidence that higher levels of patching were associated with subsequent increases in parenting stress. Conclusions Three months after surgery, higher levels of parenting stress are associated with poorer adherence to patching, and thus stress may contribute to early adherence to patching. Translational Relevance Clinicians may wish to provide support to caregivers exhibiting high levels of stress since it may impact their ability to adhere to prescribed patching.
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Affiliation(s)
- Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Marianne Celano
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lindreth DuBois
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
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18
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Freedman AA, Hogue CJ, Marsit CJ, Rajakumar A, Smith AK, Goldenberg RL, Dudley DJ, Saade GR, Silver RM, Gibbins KJ, Stoll BJ, Bukowski R, Drews-Botsch C. Associations Between the Features of Gross Placental Morphology and Birthweight. Pediatr Dev Pathol 2019; 22:194-204. [PMID: 30012074 PMCID: PMC6335186 DOI: 10.1177/1093526618789310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The placenta plays a critical role in regulating fetal growth. Recent studies suggest that there may be sex-specific differences in placental development. The purpose of our study was to evaluate the associations between birthweight and placental morphology in models adjusted for covariates and to assess sex-specific differences in these associations. We analyzed data from the Stillbirth Collaborative Research Network's population-based case-control study conducted between 2006 and 2008, which recruited cases of stillbirth and population-based controls in 5 states. Our analysis was restricted to singleton live births with a placental examination (n = 1229). Characteristics of placental morphology evaluated include thickness, surface area, difference in diameters, shape, and umbilical cord insertion site. We used linear regression to model birthweight as a function of placental morphology and covariates. Surface area had the greatest association with birthweight; a reduction in surface area of 83 cm2, which reflects the interquartile range, is associated with a 260.2-g reduction in birthweight (95% confidence interval, -299.9 to -220.6), after adjustment for other features of placental morphology and covariates. Reduced placental thickness was also associated with lower birthweight. These associations did not differ between males and females. Our results suggest that reduced placental thickness and surface area are independently associated with lower birthweight and that these relationships are not related to sex.
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Affiliation(s)
- Alexa A Freedman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carol J Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carmen J Marsit
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Augustine Rajakumar
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Alicia K Smith
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | - Donald J Dudley
- Department of Obstetrics and Gynecology, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Robert M Silver
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Karen J Gibbins
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Barbara J Stoll
- McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Radek Bukowski
- Department of Women’s Health, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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19
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Pennington AF, Strickland MJ, Klein M, Drews-Botsch C, Hansen C, Darrow LA. Caesarean delivery, childhood asthma, and effect modification by sex: An observational study and meta-analysis. Paediatr Perinat Epidemiol 2018; 32:495-503. [PMID: 30266042 PMCID: PMC6261703 DOI: 10.1111/ppe.12510] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/08/2018] [Accepted: 08/25/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Numerous studies indicate caesarean delivery is associated with childhood asthma. Sex-specific associations were reported in four of these studies, and in all four studies, the estimated association between caesarean delivery and asthma was of greater magnitude among girls, although most report a lack of evidence of multiplicative interaction. METHODS We assessed potential effect modification by sex, on the additive and multiplicative scales, of the association between caesarean delivery and asthma by ages 2 through 6 in up to 17 075 racially diverse children from a retrospective birth cohort, the Kaiser Air Pollution and Pediatric Asthma (KAPPA) Study. We also conducted a random-effects meta-analysis, combining our sex-stratified results (using the odds ratio for compatibility with previous studies) with previously published results. RESULTS Adjusted risk differences for caesarean delivery and asthma in the KAPPA cohort were higher among girls than boys at every follow-up age. By age 5, caesarean delivery was associated with an absolute 3.8% (95% confidence interval [CI] 0.4%, 7.3%) higher asthma risk among girls and a 1.9% (95% CI -1.7, 5.4) higher risk among boys. The summary odds ratio from the meta-analysis for caesarean delivery and asthma among girls was 1.26 (95% CI 1.14, 1.39) and 1.08 (95% CI 0.98, 1.20) among boys (P = 0.036). CONCLUSIONS Higher, but imprecise, estimates for females across five studies should motivate investigators to estimate sex-specific associations for caesarean delivery and asthma and to explore biological mechanisms or sex-dependent biases that could explain this possible heterogeneity.
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Affiliation(s)
- Audrey Flak Pennington
- Department of Environmental Health, Rollins School of
Public Health, Emory University, Atlanta, GA
| | | | - Mitchel Klein
- Department of Environmental Health, Rollins School of
Public Health, Emory University, Atlanta, GA
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public
Health, Emory University, Atlanta, GA
| | - Craig Hansen
- Center for Clinical and Outcomes Research, Kaiser
Permanente Georgia, Atlanta, GA
| | - Lyndsey A. Darrow
- School of Community Health Sciences, University of Nevada
Reno, Reno, NV
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20
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Hartmann EE, Drews-Botsch C, DuBois LG, Cotsonis G, Lambert SR. Correlation of monocular grating acuity at age 12 months with recognition acuity at age 4.5 years: findings from the Infant Aphakia Treatment Study. J AAPOS 2018; 22:299-303.e2. [PMID: 30031874 PMCID: PMC7872073 DOI: 10.1016/j.jaapos.2018.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/18/2018] [Accepted: 03/24/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine whether grating acuity at age 12 months can be used to predict recognition acuity at age 4.5 years in children treated for unilateral congenital cataract enrolled in the Infant Aphakia Treatment Study (IATS). METHODS Traveling testers assessed monocular grating acuity at 12 months of age (Teller Acuity Card Test [TACT]) and recognition acuity at 4.5 years of age (Amblyopia Treatment Study Electronic Visual Acuity Testing, HOTV) in children treated for visually significant monocular cataract in the IATS. Spearman rank correlation was used to evaluate the relationship between visual acuities at the two ages in the treated eyes. RESULTS Visual acuity data at both ages were available for 109 of 114 children (96%). Grating acuity at 12 months of age and recognition acuity at 4.5 years of age were significantly correlated for the treated eyes (rspearman = 0.45; P = 0.001). At age 4.5 years, 67% of the subjects who had grating acuity at 12 months of age within the 95% predictive limits in their treated eye demonstrated recognition acuity better than 20/200. Similarly, at age 4.5 years 67% of the subjects who had grating acuity at age 12 months below the 95% predictive limits in their treated eye demonstrated recognition acuity of 20/200 or worse. CONCLUSIONS A single grating acuity assessment at age 12 months predicts recognition acuity in a child treated for unilateral congenital cataract in only two-thirds of cases. Clinicians should consider other factors, such as patching compliance and age at surgery, when using an early grating acuity assessment to modify treatment.
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Affiliation(s)
- E Eugenie Hartmann
- Department of Vision Sciences, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Carolyn Drews-Botsch
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lindreth G DuBois
- Department of Ophthalmology, School of Medicine, Emory University, Atlanta, Georgia
| | - George Cotsonis
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University, Stanford, California
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21
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Beauregard JL, Drews-Botsch C, Sales JM, Flanders WD, Kramer MR. Does Socioeconomic Status Modify the Association Between Preterm Birth and Children's Early Cognitive Ability and Kindergarten Academic Achievement in the United States? Am J Epidemiol 2018; 187:1704-1713. [PMID: 29757345 DOI: 10.1093/aje/kwy068] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 03/20/2018] [Indexed: 12/15/2022] Open
Abstract
Being born preterm and being raised in poverty are each linked with adverse cognitive outcomes. Using data from 5,250 singletons born in the United States in 2001 and enrolled in the Early Childhood Longitudinal Study, Birth Cohort, we examined whether household socioeconomic status (SES) modified the association between preterm birth (PTB) and children's scores on cognitive assessments at age 2 years and reading and mathematics assessments at kindergarten age. Gestational age was measured from birth certificates and categorized as early preterm, moderate preterm, late preterm, early term, and term. SES was measured at age 9 months using a composite of parental education, occupation, and income. PTB was associated with 0.1- to 0.6-standard deviation-deficits in 2-year cognitive ability and kindergarten mathematics scores and with 0.1- to 0.4-standard-deviation deficits in kindergarten reading scores. Children living in the lowest (versus highest) SES quintile scored 0.6 standard deviations lower on 2-year cognitive ability, 1.1 standard deviations lower on kindergarten reading, and 0.9 standard deviations lower on kindergarten mathematics. The association between PTB and cognitive outcomes did not differ by postnatal SES. However, children who were both born preterm and lived in lower-SES households had the poorest performance on all 3 outcomes and therefore may represent a uniquely high-risk group.
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Affiliation(s)
- Jennifer L Beauregard
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jessica M Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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22
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Cheung P, Franks P, Kramer M, Drews-Botsch C, Welsh J, Kay C, Weiss P, Gazmararian J. Impact of a Georgia elementary school-based intervention on physical activity opportunities: A quasi-experimental study. J Sci Med Sport 2018; 22:191-195. [PMID: 30126698 DOI: 10.1016/j.jsams.2018.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/25/2017] [Revised: 04/21/2018] [Accepted: 07/16/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the impact of Power Up for 30, a flexible, Comprehensive School Physical Activity Program-based state-wide elementary school initiative, on school physical activity opportunities (physical education, recess, in-class physical activity, before-school physical activity, and after-school physical activity) one year after Power Up for 30 training. DESIGN Quasi-experimental. METHODS In 2013, all 1333 public Georgia elementary schools were invited to complete the School Physical Activity Survey which assessed school physical activity opportunities. Upon survey completion, schools were invited to attend training. Of the 719 (54%) schools meeting survey response criteria, 300 schools attended training by 9/2014 and 419 schools did not. Between 3/2015-5/2015, 79 trained and 80 untrained schools were randomly selected to receive a follow-up survey assessing the frequency and duration of physical activity opportunities. Analyses, adjusted for baseline physical activity opportunities and school characteristics, compared weekly minutes of physical activity opportunities at follow-up between trained and untrained schools. RESULTS In adjusted analyses at follow-up, trained schools provided 36 more minutes of weekly physical activity opportunities than untrained schools (99% confidence interval: 16-56), particularly during recess (mean difference: 8min per week; 99% confidence interval: 0-17), during in-class breaks (mean difference: 11min per week, 99% confidence interval: 3-20), and before school (mean difference: 8min per week, 99% confidence interval: 4-12). CONCLUSIONS Flexible, multi-component interventions like Power Up for 30 increase physical activity opportunities. If future studies identify that school physical activity opportunities positively impact student physical activity, this model may be a feasible strategy for broad-scale implementation.
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Affiliation(s)
- Patricia Cheung
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA.
| | | | - Michael Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA
| | - Jean Welsh
- Emory University School of Medicine, USA; Children's Healthcare of Atlanta, USA
| | | | - Paul Weiss
- Department of Biostatistics and Informatics, Rollins School of Public Health, Emory University, USA
| | - Julie Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA
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Freedman AA, Kipling LM, Labgold K, Marsit CJ, Hogue CJ, Rajakumar A, Smith AK, Pinar H, Conway DL, Bukowski R, Varner MW, Goldenberg RL, Dudley DJ, Drews-Botsch C. Comparison of diameter-based and image-based measures of surface area from gross placental pathology for use in epidemiologic studies. Placenta 2018; 69:82-85. [PMID: 30213489 DOI: 10.1016/j.placenta.2018.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/25/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
Placental surface area is often estimated using diameter measurements. However, as many placentas are not elliptical, we were interested in the validity of these estimates. We compared placental surface area from images for 491 singletons from the Stillbirth Collaborative Research Network (SCRN) Study (416 live births, 75 stillbirths) to estimates obtained using diameter measurements. Placental images and diameters were obtained from pathologic assessments conducted for the SCRN Study and images were analyzed using ImageJ software. On average, diameter-based measures underestimated surface area by -5.58% (95% confidence interval: -30.23, 19.07); results were consistent for normal and abnormal shapes. The association between surface area and birthweight was similar for both measures. Thus, diameter-based surface area can be used to estimate placental surface area.
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Affiliation(s)
- Alexa A Freedman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Lauren M Kipling
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Katie Labgold
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Carmen J Marsit
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Carol J Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Augustine Rajakumar
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Alicia K Smith
- Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Halit Pinar
- Department of Pathology and Laboratory Medicine, Brown University School of Medicine, Providence, RI, USA
| | - Deborah L Conway
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Radek Bukowski
- Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Michael W Varner
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Donald J Dudley
- Department of Obstetrics and Gynecology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Pennington AF, Strickland MJ, Klein M, Zhai X, Bates JT, Drews-Botsch C, Hansen C, Russell AG, Tolbert PE, Darrow LA. Exposure to Mobile Source Air Pollution in Early-life and Childhood Asthma Incidence: The Kaiser Air Pollution and Pediatric Asthma Study. Epidemiology 2018; 29:22-30. [PMID: 28926373 DOI: 10.1097/ede.0000000000000754] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early-life exposure to traffic-related air pollution exacerbates childhood asthma, but it is unclear what role it plays in asthma development. METHODS The association between exposure to primary mobile source pollutants during pregnancy and during infancy and asthma incidence by ages 2 through 6 was examined in the Kaiser Air Pollution and Pediatric Asthma Study, a racially diverse birth cohort of 24,608 children born between 2000 and 2010 and insured by Kaiser Permanente Georgia. We estimated concentrations of mobile source fine particulate matter (PM2.5, µg/m), nitrogen oxides (NOX, ppb), and carbon monoxide (CO, ppm) at the maternal and child residence using a Research LINE source dispersion model for near-surface releases. Asthma was defined using diagnoses and medication dispensings from medical records. We used binomial generalized linear regression to model the impact of exposure continuously and by quintiles on asthma risk. RESULTS Controlling for covariates and modeling log-transformed exposure, a 2.7-fold increase in first year of life PM2.5 was associated with an absolute 4.1% (95% confidence interval, 1.6%, 6.6%) increase in risk of asthma by age 5. Quintile analysis showed an increase in risk from the first to second quintile, but similar risk across quintiles 2-5. Risk differences increased with follow-up age. Results were similar for NOX and CO and for exposure during pregnancy and the first year of life owing to high correlation. CONCLUSIONS Results provide limited evidence for an association of early-life mobile source air pollution with childhood asthma incidence with a steeper concentration-response relationship observed at lower levels of exposure.
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Angley M, Thorsten VR, Drews-Botsch C, Dudley DJ, Goldenberg RL, Silver RM, Stoll BJ, Pinar H, Hogue CJR. Association of participation in a supplemental nutrition program with stillbirth by race, ethnicity, and maternal characteristics. BMC Pregnancy Childbirth 2018; 18:306. [PMID: 30041624 PMCID: PMC6056947 DOI: 10.1186/s12884-018-1920-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has been associated with lower risk of stillbirth. We hypothesized that such an association would differ by race/ethnicity because of factors associated with WIC participation that confound the association. METHODS We conducted a secondary analysis of the Stillbirth Collaborative Research Network's population-based case-control study of stillbirths and live-born controls, enrolled at delivery between March 2006 and September 2008. Weighting accounted for study design and differential consent. Five nested models using multivariable logistic regression examined whether the WIC participation/stillbirth associations were attenuated after sequential adjustment for sociodemographic, health, healthcare, socioeconomic, and behavioral factors. Models also included an interaction term for race/ethnicity x WIC. RESULTS In the final model, WIC participation was associated with lower adjusted odds (aOR) of stillbirth among non-Hispanic Black women (aOR: 0.34; 95% CI 0.16, 0.72) but not among non-Hispanic White (aOR: 1.69; 95% CI: 0.89, 3.20) or Hispanic women (aOR: 0.91; 95% CI 0.52, 1.52). CONCLUSIONS Contrary to our hypotheses, control for potential confounding factors did not explain disparate findings by race/ethnicity. Rather, WIC may be most beneficial to women with the greatest risk factors for stillbirth. WIC-eligible, higher-risk women who do not participate may be missing the potential health associated benefits afforded by WIC.
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Affiliation(s)
- Meghan Angley
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - Vanessa R. Thorsten
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, North, Carolina USA
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - Donald J. Dudley
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY USA
| | - Robert M. Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, UT USA
| | - Barbara J. Stoll
- McGovern Medical School, University of Texas Health Science Center, Houston, TX USA
| | - Halit Pinar
- The Warren Alpert School of Medicine, Brown University, Providence, RI USA
| | - Carol J. R. Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
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26
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Schieve LA, Drews-Botsch C, Harris S, Newschaffer C, Daniels J, DiGuiseppi C, Croen LA, Windham GC. Maternal and Paternal Infertility Disorders and Treatments and Autism Spectrum Disorder: Findings from the Study to Explore Early Development. J Autism Dev Disord 2018; 47:3994-4005. [PMID: 28900768 DOI: 10.1007/s10803-017-3283-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 12/12/2022]
Abstract
Previous studies of associations between ASD and conception using assisted reproductive technology (ART) are inconsistent and few studies have examined associations with other infertility treatments or infertility disorders. We examined associations between ASD and maternal/paternal infertility disorders and numerous maternal treatments among 1538 mother-child pairs in the Study to Explore Early Development, a population-based case-control study. ASD was associated with any female infertility diagnosis and several specific diagnoses: blocked tubes, endometriosis, uterine-factor infertility, and polycystic ovarian syndrome. Stratified analyses suggested associations were limited to/much stronger among second or later births. The findings were not explained by sociodemographic factors such as maternal age or education or multiple or preterm birth. ASD was not associated with ART or non-ART infertility treatments.
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Affiliation(s)
- Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Mailstop E-86, 4770 Buford Hwy NE, Atlanta, GA, 30341, USA.
| | | | - Shericka Harris
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Mailstop E-86, 4770 Buford Hwy NE, Atlanta, GA, 30341, USA
| | - Craig Newschaffer
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Julie Daniels
- Gillings Scholl of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Carolyn DiGuiseppi
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | | | - Gayle C Windham
- California Department of Public Health, Richmond, CA, 94804, USA
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27
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Drews-Botsch C, Basso O. Society for Paediatric and Perinatal Epidemiology 30th Annual Meeting: Present and Future. Paediatr Perinat Epidemiol 2018; 32:e1-e3. [PMID: 28841749 PMCID: PMC6561473 DOI: 10.1111/ppe.12397] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Olga Basso
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada,Department of Epidemiology, Biostatistics, and Occupational Heath, McGill University Health Centre, Montreal, QC, Canada
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Abstract
BACKGROUND Preterm birth and childhood poverty each adversely impact children's cognitive development and academic outcomes. In this study, we investigated whether the relationships between preterm and early term birth and children's cognitive scores at 3, 5, and 7 years old were modified by childhood poverty. METHODS This study was conducted by using data on singletons born at 24 to 40 weeks' gestation enrolled in the Millennium Cohort Study in the United Kingdom. Linear regression models were used to test independent and joint associations of gestational age (early or moderate preterm, late preterm, or early term compared with term) and childhood poverty (<60% of median UK income) with children's cognitive scores. Presence of additive interaction between gestational age and poverty was tested by using interaction terms. RESULTS Children born preterm (<37 weeks) or early term (37-38 weeks) tended to score more poorly on cognitive assessments than children born at term (39-40 weeks). The estimated deficits were ∼0.2 to 0.3 SD for early or moderate preterm, 0.1 SD for late preterm, and 0.05 SD for early term compared with term. Children living in poverty scored 0.3 to 0.4 SD worse than children not living in poverty on all assessments. For most assessments, the estimated effects of the 2 factors were approximately additive, with little or no evidence of interaction between gestational age and poverty. CONCLUSIONS Although children born preterm who lived in poverty had the poorest cognitive outcomes, living in poverty did not magnify the adverse effect of being preterm on cognitive development.
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Affiliation(s)
| | | | - Jessica M Sales
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
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29
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Schieve LA, Tian LH, Drews-Botsch C, Windham GC, Newschaffer C, Daniels JL, Lee LC, Croen LA, Danielle Fallin M. Autism spectrum disorder and birth spacing: Findings from the study to explore early development (SEED). Autism Res 2017; 11:81-94. [PMID: 29164825 DOI: 10.1002/aur.1887] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/08/2017] [Accepted: 09/29/2017] [Indexed: 12/21/2022]
Abstract
Previous studies of autism spectrum disorder (ASD) and birth spacing had limitations; few examined phenotypic case subtypes or explored underlying mechanisms for associations and none assessed whether other (non-ASD) developmental disabilities (DDs) were associated with birth spacing. We assessed associations between inter-pregnancy interval (IPI) and both ASD and other DDs using data from the Study to Explore Early Development, a multi-site case-control study with rigorous case-finding and case-classification methods and detailed data collection on maternal reproductive history. Our sample included 356 ASD cases, 627 DD cases, and 524 population (POP) controls born in second or later births. ASD and DD cases were further sub-divided according to whether the child had intellectual disability (ID). ASD cases were also sub-divided by ASD symptom severity, and DD cases were subdivided by presence of some ASD symptoms (indicated on an autism screener). Odds ratios, adjusted for maternal-child sociodemographic factors, (aORs) and 95% confidence intervals were derived from logistic regression models. Among term births, ASD was associated with both IPI <18 months (aOR 1.5 [1.1-2.2]) and ≥60 months (1.5 [0.99-2.4]). Both short and long IPI associations were stronger among ASD cases with high severity scores (aORs 2.0 [1.3-3.3] and 1.8 [0.99-3.2], respectively). Associations were unchanged after adding several factors potentially related to the causal pathway to regression models. DD was not associated with either short or long IPI-overall, among term births, or in any subgroup examined. These findings extend those from previous studies and further inform recommendations on optimal pregnancy spacing. Autism Res 2018, 11: 81-94. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY We investigated whether the amount of time between pregnancies was associated autism spectrum disorder (ASD) or other developmental disabilities (DD) in children. ASD was increased in second and later-born children who were conceived less than 18 months or 60 or more months after the mother's previous birth. Other DDs were not associated with birth spacing.
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Affiliation(s)
- Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lin H Tian
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Craig Newschaffer
- Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Julie L Daniels
- Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC
| | - Li-Ching Lee
- Kaiser Permanente Division of Research, Oakland, CA
| | - Lisa A Croen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - M Danielle Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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30
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Freedman AA, Hogue CJ, Dudley DJ, Silver RM, Stoll BJ, Pinar H, Goldenberg RL, Drews-Botsch C. Associations between Maternal and Fetal Inherited Thrombophilias, Placental Characteristics Associated with Vascular Malperfusion, and Fetal Growth. TH Open 2017; 1:e43-e55. [PMID: 31249910 PMCID: PMC6524835 DOI: 10.1055/s-0037-1603925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 11/30/2022] Open
Abstract
Pregnancy results in alterations in coagulation processes, which may increase the risk of thrombosis. Inherited thrombophilia mutations may further increase this risk, possibly through alterations in the placenta, which may result in pregnancy complications such as poor fetal growth. The purpose of our study is to evaluate the association of fetal growth, approximated by birth weight for gestational age percentile, with genetic markers of thrombophilia and placental characteristics related to vascular malperfusion. We analyzed data from the Stillbirth Collaborative Research Network's population-based case–control study conducted in 2006–2008. Study recruitment occurred in five states: Rhode Island and counties in Massachusetts, Georgia, Texas, and Utah. The analysis was restricted to singleton, nonanomalous live births ≤42 weeks' gestation with a complete placental examination and successful testing for ≥1 thrombophilia marker (858 mothers, 902 infants). Data were weighted to account for oversampling, differential consent, and availability of placental examination. We evaluated five thrombophilia markers: factor V Leiden, factor II prothrombin, methylenetetrahydrofolate reductase A1298C and C677T, and plasminogen activator inhibitor type 1 in both maternal blood and placenta/cord blood. We modeled maternal and fetal thrombophilia markers separately using linear regression. Maternal factor V Leiden mutation was associated with a 13.16-point decrease in adjusted birth weight percentile (95% confidence interval: −25.50, −0.82). Adjustment for placental abnormalities related to vascular malperfusion did not affect the observed association. No other maternal or fetal thrombophilia markers were significantly associated with birth weight percentile. Maternal factor V Leiden may be associated with fetal growth independent of placental characteristics.
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Affiliation(s)
- Alexa A Freedman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Carol J Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Donald J Dudley
- Department of Obstetrics and Gynecology, School of Medicine, University of Virginia, Charlottesville, Virginia, United States
| | - Robert M Silver
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Barbara J Stoll
- McGovern Medical School, University of Texas Health Science Center, Houston, Texas, United States
| | - Halit Pinar
- Department of Pathology and Laboratory Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, United States
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, United States
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
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31
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Burke RM, Rebolledo PA, Fabiszewski de Aceituno AM, Revollo R, Iñiguez V, Klein M, Drews-Botsch C, Leon JS, Suchdev PS. Early deterioration of iron status among a cohort of Bolivian infants. Matern Child Nutr 2016; 13. [PMID: 27928891 DOI: 10.1111/mcn.12404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/18/2016] [Accepted: 10/25/2016] [Indexed: 01/12/2023]
Abstract
Iron deficiency (ID) and iron deficiency anemia (IDA) are major contributors to infant and maternal morbidity worldwide. There is limited longitudinal data on iron status in young infants and on methods to adjust iron biomarkers for inflammation. We aimed to quantify the prevalence of inflammation-adjusted ID, anemia, and IDA over the first year in a cohort of Bolivian infants and their mothers. Healthy mother-infant dyads were recruited from two peri-urban hospitals. Infants provided three blood draws (2, 6-8, and 12-18 months; N = 160); mothers provided two blood draws (1 and 6-8 months postpartum [plus third anemia measurement at 12-18 months]; N = 250). Blood was analyzed for hemoglobin, ferritin, soluble transferrin receptor, C-reactive protein (CRP), and alpha(1)-acid glycoprotein (AGP). Iron biomarkers were adjusted for inflammation using CRP and AGP; hemoglobin cutoffs were adjusted for altitude. Inflammation (elevated CRP or AGP) was 17% among toddlers 12-18 months of age. ID (inflammation-adjusted ferritin) increased with age (<1%, 56%, and 79% at each blood draw), as did anemia and IDA (anemia: 70%, 76%, and 81%; IDA: <1%, 46%, and 68%). Maternal ID declined from the first to second assessment (39% vs. 27%). Inflammation-adjusted ID prevalence was up to 15 percentage points higher than unadjusted estimates. The high prevalence of ID, anemia, and IDA in this cohort of Bolivian infants beginning at 6-8 months of age suggests that early interventions may be necessary in vulnerable populations.
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Affiliation(s)
- Rachel M Burke
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Paulina A Rebolledo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Emory School of Medicine, Atlanta, Georgia, USA
| | | | - Rita Revollo
- Servicio Departamental de Salud, La Paz, Bolivia
| | - Volga Iñiguez
- Instituto de Biotecnología y Microbiología, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - Mitchel Klein
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Juan S Leon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Parminder S Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Emory School of Medicine, Atlanta, Georgia, USA.,Nutrition Branch, Centers for Disease Control & Prevention, Atlanta, Georgia, USA
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32
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Richards JL, Drews-Botsch C, Sales JM, Flanders WD, Kramer MR. Describing the Shape of the Relationship Between Gestational Age at Birth and Cognitive Development in a Nationally Representative U.S. Birth Cohort. Paediatr Perinat Epidemiol 2016; 30:571-582. [PMID: 27781289 PMCID: PMC5134736 DOI: 10.1111/ppe.12319] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preterm children face higher risk of cognitive and academic deficits compared with their full-term peers. The objective of this study was to describe early childhood cognitive ability and kindergarten academic achievement across gestational age at birth in a population-based longitudinal cohort. METHODS The study population included singletons born at 24-42 weeks gestation enrolled in the Early Childhood Longitudinal Study-Birth Cohort (n = 6150 for 2-year outcome, n = 4450 for kindergarten outcome). Home-based assessments measured cognitive ability at 2 years and reading and mathematics achievement at kindergarten age. Linear regression models estimated the association between gestational age and cognitive and academic scores using four different ways of modelling gestational age: continuous variable in linear and quadratic terms; categories for individual weeks; and clinical categories for early preterm, moderate preterm, late preterm, early term, full term, late term, and post-term. RESULTS Children born at early preterm (24-27 weeks), moderate preterm (28-33 weeks), and late preterm (34-36 weeks) scored significantly worse than full-term (39-40 weeks) peers on 2-year and kindergarten assessments; however, no deficits were observed for early term (37-38 weeks). These categories were a clinically useful and parsimonious approach to stratifying risk of adverse cognitive and academic outcomes. CONCLUSIONS This study estimated the relative performance of children born at 24-42 weeks in a population-based birth cohort using multiple approaches to modelling gestational age, providing a more rigorous understanding of the relationships between the full spectrum of gestational age and cognitive and academic outcomes in early childhood and at school age.
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Affiliation(s)
- Jennifer L. Richards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jessica M. Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - W. Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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33
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Pennington AF, Strickland MJ, Freedle KA, Klein M, Drews-Botsch C, Hansen C, Darrow LA. Evaluating early-life asthma definitions as a marker for subsequent asthma in an electronic medical record setting. Pediatr Allergy Immunol 2016; 27:591-6. [PMID: 27116587 PMCID: PMC4995117 DOI: 10.1111/pai.12586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Case definitions for asthma incidence in early life vary between studies using medical records to define disease. This study assessed the impact of different approaches to using medical records on estimates of asthma incidence by age 3 and determined the validity of early-life asthma case definitions in predicting school-age asthma. METHODS Asthma diagnoses and medications by age 3 were used to classify 7103 children enrolled in Kaiser Permanente Georgia according to 14 definitions of asthma. School-age asthma was defined as an asthma diagnosis between ages 5 and 8. Sensitivity (probability of asthma by age 3 given school-age asthma), specificity (probability of no asthma by age 3 given no school-age asthma), positive and negative predictive values (probability of (no) school-age asthma given (no) asthma by age 3), and likelihood ratios (combining sensitivity and specificity) were used to determine predictive ability. RESULTS 9.0-35.2% of children were classified as asthmatic by age 3 depending on asthma case definition. Early-life asthma classifications were more specific than sensitive and were better at identifying children who would not have school-age asthma (negative predictive values: 80.7-86.6%) than at predicting children who would have school-age asthma (positive predictive values: 43.5-71.5%). CONCLUSIONS Choice of case definition had a large impact on the estimate of asthma incidence. While ability to predict school-age asthma was limited, several case definitions performed similarly to clinical asthma prediction tools used in previous asthma research (e.g., the Asthma Predictive Index).
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Affiliation(s)
- Audrey Flak Pennington
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA, USA.,Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Matthew J Strickland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,School of Community Health Sciences, University of Nevada Reno, Reno, NV, USA
| | - Karen A Freedle
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Mitchel Klein
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Craig Hansen
- Kaiser Permanente Georgia Center for Clinical and Outcomes Research, Atlanta, GA, USA.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada Reno, Reno, NV, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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34
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Burke RM, Suchdev PS, Rebolledo PA, de Aceituno AMF, Revollo R, Iñiguez V, Klein M, Drews-Botsch C, Leon JS. Predictors of Inflammation in a Cohort of Bolivian Infants and Toddlers. Am J Trop Med Hyg 2016; 95:954-963. [PMID: 27527627 DOI: 10.4269/ajtmh.16-0292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/06/2016] [Indexed: 12/28/2022] Open
Abstract
Inflammation has been associated with cardiovascular disease and other health outcomes in children and adults, yet few longitudinal data are available on prevalence and predictors of inflammation in infants. We aimed to identify the prevalence of inflammation in a cohort of Bolivian infants and estimate its association with acute (recent illnesses) and chronic (overweight, stunting) morbidities and potential pathogen exposure (represented by water, sanitation, and hygiene [WASH] resources). We measured plasma concentrations of two acute phase proteins (C-reactive protein [CRP], marking acute inflammation, and alpha(1)-acid-glycoprotein [AGP], marking chronic inflammation) at three time points (target 2, 6-8, and 12-18 months). Of 451 singleton infants enrolled in the parent study, 272 had the first blood draw and complete data. Anthropometry and sociodemographic and recent illness data (2-week recall of cough, diarrhea, and fever) were collected at each visit. Inflammation was defined as CRP > 5 mg/L or AGP > 1 g/L. The prevalence of inflammation increased from early infancy (3% at first blood draw) to later infancy (15-22% at later blood draws). Recent cough, recent fever, and age in months were significantly associated with relative increases in CRP (7-44%) and AGP (5-23%), whereas recent diarrhea was only significantly associated with an increase in CRP (48%). Neither anthropometry nor WASH was significantly associated with inflammation. Results confirm the role of recent acute illness in inflammation in infants, and indicate that adiposity and WASH are not as important to inflammation in this age category.
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Affiliation(s)
- Rachel M Burke
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Parminder S Suchdev
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia. Emory School of Medicine, Atlanta, Georgia. Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paulina A Rebolledo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia. Emory School of Medicine, Atlanta, Georgia
| | | | - Rita Revollo
- Servicio Departamental de Salud, La Paz, Bolivia
| | - Volga Iñiguez
- Instituto de Biología Molecular y Biotecnología, Universidad Mayor de San Andrés, La Paz, Bolivia
| | - Mitchel Klein
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carolyn Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Juan S Leon
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
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35
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Drews-Botsch C, Celano M, Cotsonis G, Hartmann EE, Lambert SR. Association Between Occlusion Therapy and Optotype Visual Acuity in Children Using Data From the Infant Aphakia Treatment Study: A Secondary Analysis of a Randomized Clinical Trial. JAMA Ophthalmol 2016; 134:863-9. [PMID: 27228110 PMCID: PMC4982828 DOI: 10.1001/jamaophthalmol.2016.1365] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Patching has been a mainstay in treating unilateral congenital cataract. However, its efficacy has not been rigorously assessed. OBJECTIVE To examine the association between patching and visual acuity in a cohort of children treated for unilateral congenital cataract. DESIGN, SETTING, AND PARTICIPANTS This study was a secondary analysis of a randomized clinical trial (Infant Aphakia Treatment Study) of infants born from August 1, 2004, through December 31, 2008, who were treated with 1 of 2 treatments for unilateral congenital cataract and followed up to 5 years of age. Data analysis was performed from March 1, 2013, to March 1, 2016. INTERVENTIONS Cataract extraction and randomization to receipt of an intraocular lens vs being left aphakic for the first 5 years of life. MAIN OUTCOMES AND MEASURES Caregivers reported patching in the previous 48 hours in quarterly semistructured telephone interviews. The mean number of hours of patching per day was calculated from surgery to the first birthday (n = 92) and between 12 and 48 months of age (n = 102). Monocular optotype acuity was assessed at 4½ years of age by a traveling examiner using the Aphakia Treatment Study HOTV protocol. RESULTS The Infant Aphakia Treatment Study enrolled 114 children; 57 were randomized to each treatment group. At 4½ years of age, optotype visual acuity was assessed in 112 children. The current analyses exclude an additional 3 children (2 who had adverse events that limited visual potential and 1 who had Stickler syndrome), leaving 109 total children analyzed (59 female [54.1%] and 92 white [84.4%]). Caregivers reported patching their children a mean (SD) of 3.73 (1.47) hours per day in the first year of life and 3.43 (2.04) hours per day thereafter. An association between reported patching and treatment was not identified (mean difference in first year, -0.29 hours per day; 95% CI, -0.90 to 0.33 hours per day; mean difference between 12 and 48 months of age, -0.40 hours per day; 95% CI, -1.20 to 0.40 hours per day). Visual acuity was associated with reported hours of patching in the first year of life (r = -0.32; 95% CI, -0.49 to -0.13) and between 12 and 48 months of age (r = -0.36; 95% CI, -0.52 to -0.18). However, patching accounted for less than 15% of the variance in logMAR acuity at 4½ years of age. CONCLUSIONS AND RELEVANCE These results support the association of occlusion throughout the preschool years with improved visual acuity in infants treated for unilateral congenital cataract. However, similar visual outcomes were achieved with varying amounts of patching. These conclusions should be interpreted in the context of limitations related to generalizability from incomplete data collected in a clinical trial. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00212134.
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Affiliation(s)
| | - Marianne Celano
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University
| | | | - Scott R. Lambert
- Department of Ophthalmology, Emory University School of Medicine
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Celano M, Cotsonis GA, Hartmann EE, Drews-Botsch C. Behaviors of children with unilateral vision impairment in the Infant Aphakia Treatment Study. J AAPOS 2016; 20:320-5. [PMID: 27424046 PMCID: PMC5003720 DOI: 10.1016/j.jaapos.2016.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/22/2016] [Accepted: 04/30/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine whether behavioral functioning of 4.5-year-olds differs between two treatments for unilateral cataract and whether behavioral functioning is predicted by visual acuity in the treated eye. METHODS The Infant Aphakia Treatment Study is a multicenter clinical trial in which 114 infants with unilateral congenital cataracts were randomized to undergo cataract extraction with contact lens correction or implantation of an intraocular lens. Patching data were collected during the year preceding a visit at age 4.5 years, when both visual acuity and caregiver-reported behavioral functioning were assessed for 109 participants. Caregiver stress was assessed with the Parenting Stress Index at 4.25 years. RESULTS There were no treatment group differences in behavioral functioning as measured by the Child Behavior Checklist. Poorer visual acuity was associated with more externalizing behavior problems (attention problems and aggressive behavior) and total behavior problems in regression models that did not include caregiver stress. Both caregiver stress and dichotomized visual acuity significantly predicted externalizing problems. CONCLUSIONS Treatment assignment did not affect caregiver-reported behavior. Poor visual acuity may confer risk for problems with attention and aggressive behavior in preschoolers treated for unilateral cataract.
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Lambert SR, DuBois L, Cotsonis G, Hartmann EE, Drews-Botsch C. Factors associated with stereopsis and a good visual acuity outcome among children in the Infant Aphakia Treatment Study. Eye (Lond) 2016; 30:1221-8. [PMID: 27472216 DOI: 10.1038/eye.2016.164] [Citation(s) in RCA: 10] [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: 06/08/2016] [Accepted: 07/01/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo identify factors associated with stereopsis in children with good visual acuity after unilateral congenital cataract surgery in the Infant Aphakia Treatment Study.Patients and methodsInfants with a unilateral congenital cataract (n=114) were randomized to IOL implantation or contact lens correction after cataract surgery. At age 4.5 years, a masked examiner assessed HOTV acuity and stereopsis. Adherence to patching was assessed using 48-h recall telephone interviews and 7-day diaries throughout the first 5 years of life. Ocular motility was evaluated at age 5 years. Baseline, postoperative, and adherence findings were compared between patients with 20/40 or better acuity in their treated eyes with or without stereopsis.ResultsThirty (27%) of 112 patients who were evaluated at age 4.5 years had 20/40 or better acuity in their treated eye. Stereopsis was present on one or more tests in 15 of these 30 (50%) children. Baseline characteristics and postoperative findings did not differ between patients with or without stereopsis. Children with stereopsis were more likely to be orthotropic at distance (P=0.003) and were patched for fewer hours per day throughout the first 5 years of life and the difference increased over time (P<0.001). On average children with stereopsis were patched for 3.4 h/day during the first year of life and patching steadily decreased to 1.8 h/day by age 4 years.ConclusionAmong children with good vision following unilateral congenital cataract surgery, orthophoria and fewer hours of patching, particularly during years 2, 3, and 4, are associated with some evidence of stereopsis.
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Affiliation(s)
- S R Lambert
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA
| | - L DuBois
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA
| | - G Cotsonis
- Department of Biostatistics and Bioinformatics, Atlanta, GA, USA
| | | | - C Drews-Botsch
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Kaar JL, Markovic N, Amsden LB, Gilliland J, Shorter CF, Peters B, Nachreiner NM, Garel M, Nicholas W, Skarpness B, Drews-Botsch C, Hogue CJ, Dabelea D. The Experience of Direct Outreach Recruitment in the National Children's Study. Pediatrics 2016; 137 Suppl 4:S258-64. [PMID: 27251872 PMCID: PMC4878110 DOI: 10.1542/peds.2015-4410g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Few studies have reported the outcome of direct outreach methods for recruitment of research participants in population-based samples. We describe the relationship of outreach strategies that are tailored to specific community factors to recruitment and consent outcomes in 10 National Children's Study direct outreach study locations (all were single counties). METHODS Each study center collected data from a target population of women who resided in selected county segments that were sampled based on a geographic area probability sampling design. Based on county characteristics of the 10 study locations, each study center used site-specific marketing approaches (direct mail, mass media, provider referrals, social networking) to recruit study participants. Recruitment success was measured by the number of recruited women as well as by a qualitative assessment of the effectiveness of various recruitment methods. RESULTS The number of women who consented varied from 67 to 792. The majority of women were pregnant at the time of consent. Community awareness varied from <1% to 70%. Although no significant associations were found between community characteristics and recruitment success, we found that certain types of outreach strategies enhanced recruitment. CONCLUSIONS In a small sample of 10 US counties, recruitment success was not associated with community characteristics. It was, however, associated with certain types of outreach strategies that may be more effective in close-knit communities.
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Drews-Botsch C, Cotsonis G, Celano M, Lambert SR. Assessment of Adherence to Visual Correction and Occlusion Therapy in the Infant Aphakia Treatment Study. Contemp Clin Trials Commun 2016; 3:158-166. [PMID: 27981259 PMCID: PMC5152926 DOI: 10.1016/j.conctc.2016.05.009] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Occlusion therapy throughout early childhood is believed to be efficacious in treating deprivation amblyopia but has not been rigorously assessed in clinical trials. Further, tools to assess adherence to such therapy over an extended period of time are lacking. Using data from the Infant Aphakia Treatment Study, a randomized clinical trial of treatment for unilateral congenital cataract, we examined the use of quarterly 48-h recall interviews and annual 7-day prospective diaries to assess reported hours of patching in 114 children throughout the first 5 years of life. Consistency of data reported was assessed using correlation coefficients and intraclass correlation coefficients. Both interview and diary data showed excellent consistency with Cronbach’s Alpha’s ranging from 0.69 to 0.88 for hours of patching and 0.60 to 0.73 for hours of sleep. However, caregivers reported somewhat more adherence in prospective diaries than retrospective interviews. Completion rates, on the other hand, were substantially higher for telephone interviews than prospective diaries. For example, four years after surgery response rates to telephone interviews exceeded 75% versus completion rates of only 54% for diaries. In situations where occlusion dose monitors cannot be used for assessing adherence to occlusion therapy, such as in infants or over an extended period of time, quantitative assessments of occlusion therapy can be obtained by parental report, either as a series of prospective diaries or a series of recall interviews.
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Affiliation(s)
| | - George Cotsonis
- Department of Biostatistics, Rollins School of Public Health, Emory University
| | - Marianne Celano
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Scott R Lambert
- Department of Ophthalmology, Emory University School of Medicine
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Angeles-Han ST, Yeh S, McCracken C, Jenkins K, Stryker D, Myoung E, Vogler LB, Rouster-Stevens K, Lambert SR, Harrison MJ, Prahalad S, Drews-Botsch C. Using the Effects of Youngsters' Eyesight on Quality of Life Questionnaire to Measure Visual Outcomes in Children With Uveitis. Arthritis Care Res (Hoboken) 2016; 67:1513-20. [PMID: 26037544 DOI: 10.1002/acr.22627] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/07/2015] [Accepted: 05/19/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The Effects of Youngsters' Eyesight on Quality of Life (EYE-Q) is a novel measure of vision-related quality of life (QOL) and function in children. We aim to determine the validity of the EYE-Q in childhood uveitis. METHODS We abstracted medical record data on arthritis and uveitis in a convenience sample of children with juvenile idiopathic arthritis (JIA) and/or uveitis. In addition to the EYE-Q, parents and patients completed questionnaires on overall QOL (Pediatric Quality of Life Inventory [PedsQL]), and physical functioning (Childhood Health Assessment Questionnaire [C-HAQ]). RESULTS Among 57 children (8 JIA, 24 JIA and uveitis, 25 uveitis alone), 102 ocular examinations were performed within 1 month of completing questionnaires. Uveitis patients had bilateral disease (69%), anterior involvement (78%), synechiae (51%), and cataracts (49%). Children with vision loss in their better eye (visual acuity [VA] 20/50 or worse) had worse EYE-Q (P = 0.006) and PedsQL (P = 0.028) scores, but not C-HAQ scores. The EYE-Q moderately correlated with logMAR VA (rs = -0.43), PedsQL (rs = 0.43), and C-HAQ (rs = -0.45), but was not correlated with anterior chamber cells or intraocular pressure. The PedsQL and C-HAQ did not correlate with VA or cells. There were strong correlations between the parent and child EYE-Q (rs = 0.62). Cronbach's α for the child report was 0.91. The EYE-Q had strong test-retest reliability (rs = 0.75). CONCLUSION The EYE-Q may be an important tool in the assessment of visual outcomes in childhood uveitis and an improvement over general measures in detecting changes in vision-related function.
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Affiliation(s)
- Sheila T Angeles-Han
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Steven Yeh
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | - Erica Myoung
- Emory University School of Medicine, Atlanta, Georgia
| | - Larry B Vogler
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kelly Rouster-Stevens
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | | | - Sampath Prahalad
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Carolyn Drews-Botsch
- Emory University School of Medicine and Rollins School of Public Health, Emory University, Atlanta, Georgia
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Celano M, Hartmann EE, DuBois LG, Drews-Botsch C. Motor skills of children with unilateral visual impairment in the Infant Aphakia Treatment Study. Dev Med Child Neurol 2016; 58:154-9. [PMID: 26084944 PMCID: PMC4869970 DOI: 10.1111/dmcn.12832] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2015] [Indexed: 11/30/2022]
Abstract
AIM To assess motor functioning in children aged 4 years 6 months enrolled in the Infant Aphakia Treatment Study, and to determine contributions of visual acuity and stereopsis to measured motor skills. METHOD One hundred and four children (53% female) with unilateral aphakia randomized to intraocular lens or contact lens treatment were evaluated at 4 years 6 months (age range 4y 6mo-4y 11mo) for monocular recognition visual acuity, motor skills, and stereopsis by a traveling examiner masked to treatment condition. Motor skills were assessed with the Movement Assessment Battery for Children--Second Edition (MABC-2). Visual acuity was operationalized as log10 of the minimum angle of resolution (logMAR) value for treated eye, best logMAR value for either eye, and intraocular logMAR difference. RESULTS Student's t-tests showed no significant differences in MABC-2 scores between the intraocular lens and contact lens groups. The mean total score was low (6.43; 18th centile) compared with the normative reference group. Motor functioning was not related to visual acuity in the treated eye or to intraocular logMAR difference, but was predicted in a regression model by the better visual acuity of either eye (usually the fellow eye), even after accounting for the influence of age at surgery, examiner, orthotropic ocular alignment, and stereopsis. INTERPRETATION Children with unilateral congenital cataract may have delayed motor functioning at 4 years 6 months, which may adversely affect their social and academic functioning.
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Angeles-Han ST, McCracken C, Yeh S, Jenkins K, Stryker D, Travers C, Rouster-Stevens K, Vogler LB, Lambert SR, Drews-Botsch C, Prahalad S. The Association of Race With Childhood Uveitis. Am J Ophthalmol 2015; 160:919-928.e1. [PMID: 26255577 DOI: 10.1016/j.ajo.2015.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 03/19/2015] [Revised: 08/01/2015] [Accepted: 08/02/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE To identify risk factors for a severe uveitis course among children with noninfectious uveitis. DESIGN Retrospective cohort study. METHOD This was a retrospective analysis of a prospectively collected database. Records of 94 children with uveitis were reviewed at enrollment and every 3-6 months (2011-2015). Severe uveitis was defined as a history of ocular complications or a visual acuity (VA) of ≤20/200. Children were compared by disease, VA, complications, and race. Regression models were used to model risk factors for severe disease. When examining race, we focused on non-Hispanic African-American and non-Hispanic white children only. RESULTS Of 85 children with uveitis and complete ocular examinations, 27 (32%) had a history of a VA of ≤20/200. A subanalysis of non-Hispanic African-American and white children showed an increased prevalence of VA ≤20/200 in non-Hispanic African-Americans (18/25; 72% vs 4/43; 9%). Non-Hispanic African-Americans were more likely to be diagnosed at an older age (P = .030) and to have intermediate uveitis (P = .026), bilateral disease (P = .032), a history of VA ≤20/50 (P = .002), VA ≤20/200 (P < .001), and a higher rate of complications (P < .001). On multivariable analysis, non-Hispanic African-American race was a significant predictor of blindness (OR = 31.6, 95% CI 5.9-168.5, P < .001), after controlling for uveitis duration. Non-Hispanic African-Americans also developed 2.2 times more unique complications per year of disease than non-Hispanic whites when controlling for uveitis type and duration. CONCLUSIONS There appear to be racial differences in the outcomes of children with uveitis. Non-Hispanic African-American children with non-juvenile idiopathic arthritis-associated uveitis may have worse visual outcomes with increased vision loss and ocular complications. These findings highlight the need for future studies in minority populations.
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Affiliation(s)
- Sheila T Angeles-Han
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Steven Yeh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Daneka Stryker
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Curtis Travers
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kelly Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Larry B Vogler
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Scott R Lambert
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia
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Cammack A, Hogue C, Drews-Botsch C, Kramer M, Pearce B, Newport DJ. Maternal Exposure to Child Abuse, Preterm Birth, and Very Preterm Birth in Nulliparas. Ann Epidemiol 2015. [DOI: 10.1016/j.annepidem.2015.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Angeles-Han ST, McCracken C, Yeh S, Jenkins K, Stryker D, Rouster-Stevens K, Vogler LB, Lambert SR, Drews-Botsch C, Prahalad S. Characteristics of a cohort of children with Juvenile Idiopathic Arthritis and JIA-associated Uveitis. Pediatr Rheumatol Online J 2015; 13:19. [PMID: 26031738 PMCID: PMC4450472 DOI: 10.1186/s12969-015-0018-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/22/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis-associated uveitis (JIA-U) can lead to poor visual outcomes and impact a child's quality of life (QOL) and function. Our aim is to identify risk markers of JIA-U and examine differences in the QOL of children with JIA and JIA-U. METHODS Rheumatology and ophthalmology record reviews and questionnaires were completed every 4-6 months on 287 children with JIA. We collected arthritis, uveitis, and QOL data. We examined data through last study visit. RESULTS There were 52/287 (18%) children with JIA-U who were younger at arthritis diagnosis, had oligoarticular persistent JIA, and ANA positive. Confirmed uveitis predictors were age at JIA diagnosis (OR = 0.86) and oligoarticular subtype (OR = 5.92). They had worse vision specific QOL and function, but similar general QOL. Blindness occurred in 17.5% of children but was more common in African American children compared to non-Hispanic Caucasian children ((5/7 (71%) vs. 2/29 (7%), p <0.001) despite a similar uveitis prevalence (22% vs. 16%). Both races had similar complications, although band keratopathy was more frequent in African Americans (75% vs. 15.6%, p = 0.003). CONCLUSIONS We confirm young age at JIA diagnosis and the oligoarticular JIA subtype as predictors of uveitis development. Although we were unable to identify predictors of ocular complications or blindness, AA children appeared to have a more severe disease course manifested by increased ocular complications, vision loss and blindness. Potential causes that warrant additional study include underlying disease severity, access to medical care and referral bias. Further investigation of the risk factors for vision-compromising uveitis and its' long-term effects should be conducted in a large racially diverse population.
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Affiliation(s)
- Sheila T. Angeles-Han
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322 USA ,Children’s Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA 30329 USA ,Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Rd, Atlanta, GA 30322 USA
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA.
| | - Steven Yeh
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA. .,Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Rd, Atlanta, GA, 30322, USA.
| | - Kirsten Jenkins
- Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30329, USA.
| | - Daneka Stryker
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA.
| | - Kelly Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA. .,Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30329, USA.
| | - Larry B. Vogler
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322 USA ,Children’s Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA 30329 USA
| | - Scott R. Lambert
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322 USA ,Department of Ophthalmology, Emory University School of Medicine, 1365-B Clifton Rd, Atlanta, GA 30322 USA
| | - Carolyn Drews-Botsch
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30322, USA. .,Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30329, USA. .,Department of Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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Plager DA, Lynn MJ, Buckley EG, Wilson ME, Lambert SR, Plager DA, Lynn MJ, Buckley EG, Wilson ME, Lambert SR, Lambert SR, DuBois L, Lambert SR, Buckley EG, Plager DA, Wilson ME, Lynn M, DuBois L, Drews-Botsch C, Hartmann EE, Everett DF, Russell B, Ward M, Hardy R, Birch E, Cheng K, Hertle R, Kollman C, Yeargin-Allsopp M, McDowell C, Everett DF, Lynn M, Bridgman B, Celano M, Cleveland J, Cotsonis G, Drews-Botsch C, Freret N, Lu L, Swanson S, Tutu-Gxashe T, Busettini C, Hayley S, Felius J, Beck A, Everett DF, Hartmann EE, Carrigan AK, Edwards C, Wilson ME, Bozic M, Vanderveen DK, Mansfield TA, Miller KB, Christiansen SP, Bothun ED, Holleschau A, Jedlicka J, Winters P, Lang J, Traboulsi EI, Crowe S, Cimino HH, Yen KG, Castanes M, Sanchez A, York S, Lambert SR, Hutchinson AK, Dubois L, Robb R, Shainberg MJ, Wheeler DT, Stout AU, Rauch P, Beaudet K, Berg P, Buckley EG, Freedman SF, Duncan L, Phillips B, Petrowski JT, Morrison D, Owings S, Biernacki R, Franklin C, Plager DA, Neely DE, Whitaker M, Bates D, Donaldson D, Kruger S, Tibi C, Vega S, Weakley DR, Stager DR, Felius J, Dias C, Sager DL, Brantley T, Orge F. Complications in the first 5 years following cataract surgery in infants with and without intraocular lens implantation in the Infant Aphakia Treatment Study. Am J Ophthalmol 2014; 158:892-8. [PMID: 25077835 DOI: 10.1016/j.ajo.2014.07.031] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/17/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To compare rates and severity of complications between infants undergoing cataract surgery with and without intraocular lens (IOL) implantation. DESIGN Prospective randomized clinical trial. METHODS A total of 114 infants were enrolled in the Infant Aphakia Treatment Study, a randomized, multi-center (12) clinical trial comparing the treatment of unilateral aphakia in patients under 7 months of age with a primary IOL implant or contact lens. The rate, character, and severity of intraoperative complications, adverse events, and additional intraocular surgeries during the first 5 postoperative years in the 2 groups were examined. RESULTS There were more patients with intraoperative complications (28% vs 11%, P = .031), adverse events (81% vs 56%, P = .008), and more additional intraocular surgeries (72% vs 16%, P < .0001) in the IOL group than in the contact lens group. However, the number of patients with adverse events in the contact lens group increased (15 to 24) in postoperative years 2-5 compared to the first postoperative year, while it decreased (44 to 14) in years 2-5 compared to the first postoperative year in the IOL group. If only one half of the patients in the contact lens (aphakic) group eventually undergo secondary IOL implantation, the number of additional intraocular surgeries in the 2 groups will be approximately equal. CONCLUSION The increased rate of complications, adverse events, and additional intraocular surgeries associated with IOL implantation in infants <7 months of age militates toward leaving babies aphakic if it is considered likely that the family will be successful with contact lens correction.
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Lambert SR, Lynn MJ, Hartmann EE, DuBois L, Drews-Botsch C, Freedman SF, Plager DA, Buckley EG, Wilson ME. Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: a randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years. JAMA Ophthalmol 2014; 132:676-82. [PMID: 24604348 DOI: 10.1001/jamaophthalmol.2014.531] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The efficacy and safety of primary intraocular lens (IOL) implantation during early infancy is unknown. OBJECTIVE To compare the visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. DESIGN, SETTING, AND PARTICIPANTS The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years. INTERVENTIONS Cataract surgery with or without primary IOL implantation. Contact lenses were used to correct aphakia in patients who did not receive IOLs. Treatment was determined through random assignment. MAIN OUTCOMES AND MEASURES HOTV optotype visual acuity at 4.5 years of age. RESULTS The median logMAR visual acuity was not significantly different between the treated eyes in the 2 treatment groups (both, 0.90 [20/159]; P = .54). About 50% of treated eyes in both groups had visual acuity less than or equal to 20/200. Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%; P = .02). The most common adverse events in the IOL group were lens reproliferation into the visual axis, pupillary membranes, and corectopia. Glaucoma/glaucoma suspect occurred in 35% of treated eyes in the contact lens group vs 28% of eyes in the IOL group (P = .55). Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%; P < .001). CONCLUSIONS AND RELEVANCE There was no significant difference between the median visual acuity of operated eyes in children who underwent primary IOL implantation and those left aphakic. However, there were significantly more adverse events and additional intraoperative procedures in the IOL group. When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. Primary IOL implantation should be reserved for those infants where, in the opinion of the surgeon, the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00212134
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Christensen DL, Schieve LA, Devine O, Drews-Botsch C. Socioeconomic status, child enrichment factors, and cognitive performance among preschool-age children: results from the Follow-Up of Growth and Development Experiences study. Res Dev Disabil 2014; 35:1789-1801. [PMID: 24679548 PMCID: PMC4997613 DOI: 10.1016/j.ridd.2014.02.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 02/04/2014] [Accepted: 02/05/2014] [Indexed: 05/31/2023]
Abstract
Lower cognitive performance is associated with poorer health and functioning throughout the lifespan and disproportionately affects children from lower socioeconomic status (SES) populations. Previous studies reporting positive associations between child home enrichment and cognitive performance generally had a limited distribution of SES. We evaluated the associations of SES and child enrichment with cognitive performance in a population with a wide range of SES, particularly whether enrichment attenuates associations with SES. Children were sampled from a case-control study of small-for-gestational-age (SGA) conducted in a public hospital serving a low SES population (final n=198) and a private hospital serving a middle-to-high SES population (final n=253). SES (maternal education and income) and perinatal factors (SGA, maternal smoking and drinking) were obtained from maternal birth interview. Five child home enrichment factors (e.g. books in home) and preschool attendance were obtained from follow-up interview at age 4.5 years. Cognitive performance was assessed with the Differential Ability Scales (DAS), a standardized psychometric test administered at follow-up. SES and enrichment scores were created by combining individual factors. Analyses were adjusted for perinatal factors. Children from the public birth hospital had a significantly lower mean DAS general cognitive ability (GCA) score than children born at the private birth hospital (adjusted mean difference -21.4, 95% CI: -24.0, -18.7); this was substantially attenuated by adjustment for individual SES, child enrichment factors, and preschool attendance (adjusted mean difference -5.1, 95% CI: -9.5, -0.7). Individual-level SES score was associated with DAS score, beyond the general SES effect associated with hospital of birth. Adjustment for preschool attendance and home enrichment score attenuated the association between individual SES score and adjusted mean DAS-GCA among children born at both of the hospitals. The effect of being in the lower compared to the middle tertile of SES score was reduced by approximately a quarter; the effect of being in the upper compared to the middle tertile of SES score was reduced by nearly half, but this comparison was possible only for children born at the private hospital. A child's individual SES was associated with cognitive performance within advantaged and disadvantaged populations. Child enrichment was associated with better cognitive performance and attenuated the SES influence. Health care providers should reinforce guidelines for home enrichment and refer children with delays to early intervention and education, particularly children from disadvantaged populations.
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Affiliation(s)
- Deborah L Christensen
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Laura A Schieve
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Owen Devine
- Office of the Director, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Angeles-Han ST, McCracken C, Jenkins K, Myoung E, Stryker D, Ponder L, Stevens KR, Vogler LB, Kennedy C, Yeh S, Drews-Botsch C, Prahalad S. A41: The Effects of Youngsters' Eyesight on Quality of Life as a Measure of Uveitis Activity, Visual Function and Vision Related Quality of Life in Childhood Uveitis. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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]
Affiliation(s)
| | | | | | | | | | - Lori Ponder
- Children's Healthcare of Atlanta; Atlanta GA
| | | | | | | | - Steven Yeh
- Emory University School of Medicine; Atlanta GA
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Angeles-Han ST, Pelajo CF, Vogler LB, Rouster-Stevens K, Kennedy C, Ponder L, McCracken C, Lopez-Benitez J, Drews-Botsch C, Prahalad S. Risk markers of juvenile idiopathic arthritis-associated uveitis in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. J Rheumatol 2013; 40:2088-96. [PMID: 24187099 DOI: 10.3899/jrheum.130302] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To characterize the epidemiology and clinical course of children with juvenile idiopathic arthritis-associated uveitis (JIA-U) in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry and explore differences between African American (AA) and non-Hispanic white (NHW) children. METHODS There were 4983 children with JIA enrolled in the CARRA Registry. Of those, 3967 NHW and AA children were included in this study. Demographic and disease-related data were collected from diagnosis to enrollment. Children with JIA were compared to those with JIA-U. Children with JIA-U were also compared by race. RESULTS There were 459/3967 children (11.6%) with JIA-U in our cohort with a mean age (SD) of 11.4 years (± 4.5) at enrollment. Compared to children with JIA, they were younger at arthritis onset, more likely to be female, had < 5 joints involved, had oligoarticular JIA, and were antinuclear antibody (ANA)-positive, rheumatoid factor (RF)-negative, and anticitrullinated protein antibody-negative. Predictors of uveitis development included female sex, early age of arthritis onset, and oligoarticular JIA. Polyarticular RF-positive JIA subtype was protective. Nearly 3% of children with JIA-U were AA. However, of the 220 AA children with JIA, 6% had uveitis; in contrast, 12% of the 3721 NHW children with JIA had uveitis. CONCLUSION In the CARRA registry, the prevalence of JIA-U in AA and NHW children is 11.6%. We confirmed known uveitis risk markers (ANA positivity, younger age at arthritis onset, and oligoarticular JIA). We describe a decreased likelihood of uveitis in AA children and recommend further exploration of race as a risk factor in a larger population of AA children.
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Affiliation(s)
- Sheila T Angeles-Han
- From the Department of Pediatrics, and Rollins School of Public Health, Emory University, Atlanta, Georgia; Department of Pediatric Rheumatology, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Angeles-Han ST, Prahalad S, Ponder L, Fields K, Robb R, Shainberg M, Vogler LB, Lenhart P, Hutchinson A, Srivastava SK, Lambert SR, Drews-Botsch C. Concordance between child and parent-proxy report on a new self-report tool of vision related quality of life for children with JIA-associated uveitis – “Effects of Youngsters’ Eyesight on QOL -EYE-Q”. Pediatr Rheumatol Online J 2012. [PMCID: PMC3402947 DOI: 10.1186/1546-0096-10-s1-a43] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | | | | | - Rachel Robb
- Emory University School of Medicine, Atlanta, GA, USA
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