1
|
Danesh DO, Peng J, Hammersmith KJ, Gowda C, Maciejewski H, Amini H, Wapner AW, Meyer BD. Impact on Dental Utilization of the Integration of Oral Health in Pediatric Primary Care Through Quality Improvement. J Public Health Manag Pract 2023; 29:186-195. [PMID: 36459615 DOI: 10.1097/phh.0000000000001689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To evaluate child-level dental utilization and expenditure outcomes based on if and where children received fluoride varnish (FV) at quality improvement (QI) medical practices, at non-QI medical practices, at dental practices, or those who never received FV from any practice. DESIGN Retrospective claims-based analysis cohort study. SETTING Children with Medicaid insurance through an Ohio pediatric accountable care organization. PARTICIPANTS Children aged 1 to 5 years with 1 or more well-child visits between 2015 and 2017. INTERVENTION FV receipt versus no FV. Among children who received FV, categorized if FV delivered by a QI-participating medical provider, a non-QI-participating medical provider, and a dental provider. MAIN OUTCOME MEASURE Dental claims from 2014 to 2019 were collected for preventive dental visits, caries-related treatment visits, dental general anesthesia (GA) visit, and emergency department visit for a dental problem to examine utilization patterns, expenditures, and dental outcomes. RESULTS The QI group had a significantly higher incidence of preventive dental visits than the dental (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI], 0.91-0.96) or non-QI groups (IRR = 0.86; 95% CI, 0.84-0.88). Compared with the QI group, the non-QI (adjusted odds ratio [aOR] = 2.6; 95% CI, 2.4-2.9) and dental (aOR = 2.9; 95% CI, 2.6-3.3) groups were significantly more likely to have caries-related treatment visits. The dental group children were significantly more likely to have dental treatment under GA than the QI group (aOR = 5.3; 95% CI, 2.0-14.4). CONCLUSIONS Children seen at QI practices appear to have an increased uptake of preventive dental services, which may explain the lower incidence of dental caries visits and GA treatment.
Collapse
Affiliation(s)
- David O Danesh
- Division of Pediatric Dentistry, College of Dentistry (Drs Danesh, Hammersmith, Amini, and Meyer), Department of Pediatrics, College of Medicine (Dr Gowda), and Division of Health Services Management and Policy, College of Public Health (Dr Wapner), The Ohio State University, Columbus, Ohio; Department of Dentistry (Drs Danesh, Peng, Hammersmith, Amini, and Meyer), Partners For Kids (Dr Gowda and Ms Maciejewski), Center for Clinical Excellence (Ms Maciejewski), Division of Emergency Medicine (Dr Wapner), and Information Technology Research and Innovation (Dr Peng), Nationwide Children's Hospital, Columbus, Ohio
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Honegger JR, Gowda C. Defer no more: advances in the treatment and prevention of chronic hepatitis C virus infection in children. Curr Opin Infect Dis 2022; 35:468-476. [PMID: 35852787 PMCID: PMC9474609 DOI: 10.1097/qco.0000000000000856] [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] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Direct-acting antiviral (DAA) regimens targeting hepatitis C virus (HCV) are now approved for young children. This review examines recent DAA experience in children, current treatment recommendations and challenges, and potential treatment-as-prevention strategies. RECENT FINDINGS In 2021, the US FDA extended approval of two pan-genotypic DAA regimens, glecaprevir/pibrentasvir and sofosbuvir/velpatasvir, to children as young as age 3 years based on high success rates and reassuring safety profiles in registry trials. Similar performance has been replicated with real-world DAA use in thousands of adolescents and in limited reports of children with high-risk conditions, including cirrhosis, cancer, thalassemia and HIV-coinfection. Treatment without delay is now recommended in the USA for viremic children aged 3 years and up to prevent disease progression and future spread. To date, treatment expansion is limited by high rates of undiagnosed paediatric infection. Universal prenatal screening will aid identification of perinatally exposed newborns, but new strategies are needed to boost testing of exposed infants and at-risk adolescents. Postpartum treatment programmes can prevent subsequent vertical transmission but are hampered by low rates of linkage to care and treatment completion. These challenges may be avoided by DAA use in pregnancy, and this warrants continued study. SUMMARY Paediatric HCV is now readily curable. Substantial clinical and public health effort is required to ensure widespread uptake of this therapeutic breakthrough.
Collapse
Affiliation(s)
- Jonathan R. Honegger
- Division of Pediatric Infectious Diseases, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Vaccines and Immunity, Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Charitha Gowda
- Division of Pediatric Infectious Diseases, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Partners For Kids, Nationwide Children’s Hospital, Columbus, Ohio, USA
| |
Collapse
|
3
|
Peng J, Townsend J, Casamassimo P, Coury DL, Gowda C, Meyer B. Dental Care Differences Among the Behavioral Health Population in an Accountable Care Organization: A Retrospective Cohort. Acad Pediatr 2022; 23:839-845. [PMID: 36055449 DOI: 10.1016/j.acap.2022.08.010] [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: 04/18/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare dental utilization and expenditures between children with and without behavioral health (BH) diagnoses in an accountable care organization. METHODS This retrospective cohort study used enrollment and claims data of Medicaid-enrolled children in Ohio. Children with 7 years of continuous enrollment from 2013 to 2019 were included. We calculated 5 dental utilization outcomes: 1) Diagnostic only visits, 2) Preventive visits, 3) Treatment visits, 4) Treatment visits under general anesthesia (GA), and 5) Orthodontic visits. Total 7-year cumulative expenditures were calculated for each outcome. Multivariable logistic regression models were run for each outcome adjusting for demographics and medical comorbidities. RESULTS Among 77,962 children, 23% had ≥1 BH diagnosis. No utilization differences were noted between children with and without BH for diagnostic only visits, treatment visits, and orthodontic visits. BH status modified the likelihood of having a preventive visit and dental GA visits based on medical comorbidity. For example, children with BH diagnoses had significantly lower odds of a preventive visit (eg, non-complex chronic comorbidity: odds ratio [OR] = 0.87, 95% confidence interval [CI]: 0.85-0.89), and significantly higher odds of a dental treatment under general anesthesia visit (eg, non-chronic comorbidity: OR = 3.69, 95% CI: 3.26-4.18). The total cumulative dental expenditures were $10.5M greater for children with BH. CONCLUSIONS Children with BH diagnoses were significantly less likely to have preventive visits and more likely to have dental GA visits, which was expensive. Early identification and intervention could alter treatment approaches, improve care, reduce risk of harm, and achieve cost-savings within a pediatric accountable care organization.
Collapse
Affiliation(s)
- Jin Peng
- Information Technology Research and Innovation (J Peng), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio
| | - Janice Townsend
- Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio; Division of Pediatric Dentistry (J Townsend and B Meyer), The Ohio State University, College of Dentistry; Columbus, Ohio
| | - Paul Casamassimo
- Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio
| | - Daniel L Coury
- Department of Developmental and Behavioral Pediatrics (DL Coury), Nationwide Children's Hospital; Columbus, Ohio
| | - Charitha Gowda
- Department of Infectious Diseases (C Gowda), Nationwide Children's Hospital; Columbus, Ohio; Partner's For Kids (C Gowda), Columbus, Ohio
| | - Beau Meyer
- Department of Dentistry (J Peng, J Townsend, P Casamassimo, and B Meyer), Nationwide Children's Hospital; Columbus, Ohio; Division of Pediatric Dentistry (J Townsend and B Meyer), The Ohio State University, College of Dentistry; Columbus, Ohio.
| |
Collapse
|
4
|
Aroza R, Raj E, Gowda C, Rodrigues G, Jisha BK, Rajesh V. Cefuroxime Induced Drug Eruptions: A Systematic Literature Review. Indian J Pharm Sci 2022. [DOI: 10.36468/pharmaceutical-sciences.917] [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: 11/22/2022] Open
|
5
|
Berlan E, Valenti O, Long W, Toth C, Abenaim A, Maciejewski H, Gowda C. Practice Facilitation Improves Adolescent Reproductive Health Preventive Services in Primary Care. Pediatrics 2022; 149:183863. [PMID: 34972227 DOI: 10.1542/peds.2020-035774] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Provision of reproductive health preventive services to adolescents is critical given their high rates of sexually transmitted infections and unintended pregnancies. Pediatricians are well positioned to provide these services but often face barriers. With this project, we aimed to build quality improvement (QI) capacity within pediatric practices to improve adherence to national guidelines for adolescent reproductive health preventive services. METHODS In 2016, an accountable care organization overseeing health care delivery for low-income children in the Midwestern United States used practice facilitation, a proven approach to improve health care quality, to support pediatric practices in implementing reproductive health QI projects. Interested practices pursued projects aimed at providing (1) sexual risk reduction and contraceptive counseling (reproductive health assessments [RHAs]) or (2) etonogestrel implants. QI specialists helped practices build key driver diagrams and implement interventions. Outcome measures included the proportion of well-care visits with RHAs completed and number of etonogestrel insertions performed monthly. RESULTS Between November 1, 2016, and December 31, 2019, 6 practices serving >7000 adolescents pursued QI projects. Among practices focused on RHAs, the proportion of well-care visits with completed RHAs per month increased from 0% to 65.8% (P < .001) within 18 months. Among practices focused on etonogestrel implant insertions, overall insertions per month increased from 0 to 8.5 (P < .001). CONCLUSIONS Practice facilitation is an effective way to increase adherence to national guidelines for adolescent reproductive health preventive services within primary care practices. Success was driven by practice-specific customization of interventions and ongoing, hands-on support.
Collapse
Affiliation(s)
- Elise Berlan
- Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Olivia Valenti
- Nationwide Children's Hospital, Columbus, Ohio.,Partners For Kids, Columbus, Ohio
| | - William Long
- Nationwide Children's Hospital, Columbus, Ohio.,Partners For Kids, Columbus, Ohio
| | | | | | - Heather Maciejewski
- Nationwide Children's Hospital, Columbus, Ohio.,Partners For Kids, Columbus, Ohio
| | - Charitha Gowda
- Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and.,Partners For Kids, Columbus, Ohio
| |
Collapse
|
6
|
Gowda C, Smith S, Crim L, Moyer K, Sánchez PJ, Honegger JR. Nucleic Acid Testing for Diagnosis of Perinatally Acquired Hepatitis C Virus Infection in Early Infancy. Clin Infect Dis 2021; 73:e3340-e3346. [PMID: 32640018 PMCID: PMC8563185 DOI: 10.1093/cid/ciaa949] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 01/17/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Most US children with perinatal hepatitis C virus (HCV) exposure fail to receive the recommended anti-HCV antibody test at age ≥18 months. Earlier testing for viral RNA might facilitate increased screening, but sensitivity of this approach has not been established. We hypothesized that modern HCV-RNA RT-PCR platforms would adequately detect infected infants. METHODS Nationwide Children's Hospital electronic health records from 1/1/2008 to 30/6/2018 were reviewed to identify perinatally exposed infants tested by HCV-RNA RT-PCR at age 2-6 months. Diagnostic performance was determined using a composite case definition: (1) infected children had positive repeat HCV-RNA testing or positive anti-HCV at age ≥24 months; (2) uninfected children lacked these criteria and had negative anti-HCV at age ≥18 months. RESULTS 770 perinatally exposed infants underwent HCV-RNA testing at age 2-6 months. Of these, 28 (3.6%) tested positive; viremia was confirmed in all who underwent repeat testing (n = 27). Among 742 infants with negative HCV-RNA results, 226 received follow-up anti-HCV testing at age ≥18 months, of whom 223 tested negative. Three children had low-positive anti-HCV results at age 18-24 months that were negative upon retesting after age 24 months, possibly indicating waning maternal antibodies. Using the composite case definitions, early HCV-RNA screening demonstrated sensitivity of 100% (87.5-100%, Wilson-Brown 95% CI) and specificity of 100% (98.3-100%). CONCLUSIONS Modern HCV-RNA RT-PCR assays have excellent sensitivity for early diagnosis of perinatally acquired infection and could aid HCV surveillance given the substantial loss to follow-up at ≥18 months of age.
Collapse
Affiliation(s)
- Charitha Gowda
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
- Partners For Kids, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Stephanie Smith
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Linda Crim
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Katherine Moyer
- Division of Pediatric Infectious Diseases, Inova Children’s Hospital, Falls Church, Virginia USA
| | - Pablo J Sánchez
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
- Division of Neonatology, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Jonathan R Honegger
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Nationwide Children’s Hospital–The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| |
Collapse
|
7
|
Hayes EA, Hart SA, Gowda C, Nandi D. Hospitalizations for Respiratory Syncytial Virus and Vaccine Preventable Infections following Pediatric Heart Transplantation. J Pediatr 2021; 236:101-107.e3. [PMID: 34000283 DOI: 10.1016/j.jpeds.2021.05.025] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the risk factors for acquiring a respiratory syncytial virus (RSV) and vaccine-preventable infections (R/VPI) in pediatric heart transplant recipients and the associated morbidity and hospital resource use. STUDY DESIGN Patients <18 years who underwent heart transplantation from September 2003 to December 2018 at hospitals using the Pediatric Health Information System database were identified. Their transplant hospitalization and subsequent hospitalizations for R/VPI through December 2018 were analyzed. Risk factors for R/VPI hospitalizations were evaluated using negative regression binomial models adjusted for demographic and clinical confounders. Total hospital costs were adjusted for 2018 US$. RESULTS Of 3815 transplant recipients, 681 (17.9%) had an R/VPI hospitalization during 23 746 available person-years of follow-up. There were 984 R/VPIs diagnosed during 951 hospitalizations, and 440 (44.7%) occurred the first year after transplantation. The most common causes were RSV (n = 380; 38.6%), influenza (n = 265; 26.9%), and pneumococcus (n = 105; 10.7%). In adjusted analyses, there was an increased risk of R/VPI hospitalization in patients requiring mechanical circulatory support before transplantation, patients receiving induction with ≥2 immunosuppressive agents, and patients <2 years in the first year after transplantation. The median length of stay for an R/VPI hospitalization was 4 days (IQR, 2-8 days) with a median total cost of $11 081 (IQR, $6215-$24 322). CONCLUSIONS Hospitalization for R/VPIs occurred frequently after heart transplantation and were associated with significant costs. Potential strategies to minimize R/VPI include expanding vaccine use through accelerated immunization schedules, further studies of use of palivizumab beyond 2 years of age, and immunogenicity monitoring after vaccination with re-immunization based on guidelines.
Collapse
Affiliation(s)
- Emily A Hayes
- The Heart Center, Nationwide Children's Hospital, Columbus, OH.
| | - Stephen A Hart
- The Heart Center, Nationwide Children's Hospital, Columbus, OH
| | - Charitha Gowda
- Department of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH
| | - Deipanjan Nandi
- The Heart Center, Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
8
|
Gowda C, Hardy RY, Traylor S, Liu GC. Trends in healthcare utilisation for firearm-related injuries among a cohort of publicly insured children in Ohio. J Epidemiol Community Health 2021; 75:906-909. [PMID: 33637614 DOI: 10.1136/jech-2020-215940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/18/2021] [Accepted: 02/14/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine healthcare utilisation for all firearm-related injuries among publicly insured children. METHODS A retrospective analysis of firearm injury medical claims among paediatric (<21 years) Medicaid beneficiaries in Ohio from 2010 to 2018. Factors associated with unintentional and intentional firearm injury were explored using multivariable logistic regression. Average annual patient healthcare costs were determined in 2019 US$. RESULTS There were 1061 firearm injury-related claims (853 (80%) unintentional; 154 (15%) intentional; 54 (5%) unknown) occurring in 663 children over 2 736 517 available person-years. From 2010 to 2018, yearly total firearm claims rose from 19.7 to 31.3 per 100 000 persons (p=0.033). Urban children experienced a non-significant increase in firearm claims rate over time (26.1 vs 35.0/100 000; p=0.066) while the claims rate nearly tripled among those in rural areas (8.4 vs 24.0/100 000; p=0.012). Younger age, females and rural residence were associated with reduced odds of injury claims. The average annual costs for emergency department and inpatient visits, respectively, were $260 and $5735. CONCLUSION Risk and type of firearm injury claims among low-income children in Ohio varies by age, sex and residence. Prevention programmes should be tailored based on these demographics.
Collapse
Affiliation(s)
- Charitha Gowda
- Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Rose Y Hardy
- Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Gilbert C Liu
- Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| |
Collapse
|
9
|
Rose M, Maciejewski H, Nowack J, Stamm B, Liu G, Gowda C. Promoting Pediatric Preventive Visits Through Quality Improvement Initiatives in the Primary Care Setting. J Pediatr 2021; 228:220-227.e3. [PMID: 32890582 DOI: 10.1016/j.jpeds.2020.08.081] [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: 05/01/2020] [Revised: 07/13/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate whether quality improvement (QI) capacity-building in affiliated primary care practices could increase well care visit uptake. STUDY DESIGN Partners For Kids (PFK) is an accountable care organization caring for pediatric Medicaid beneficiaries in Ohio. PFK QI specialists recruited practices to develop QI projects around increasing well care visit rates (proportion of eligible children with well care visits during calendar year) for children aged 3-6 years and adolescents. The QI specialists supported practice teams in implementing interventions and collecting data through monthly or bimonthly practice visits. RESULTS Ten practices, serving more than 26 000 children, participated in QI projects for a median of 8.5 months (IQR 5.3-17.6). Well care visit rates in the QI-engaged practices significantly improved from 2016 to 2018 (P < .001 for both age groups). Over time, well care visit rates for 3- to 6-year-old children increased by 11.8% (95% CI 5.4%-18.2%) in QI-engaged practices, compared with 4.1% (95% CI 0.1%-7.4%) in non-engaged practices (P = .233). For adolescents, well care visit rates increased 14.3% (95% CI -2.6% to 31.2%) compared with 5.4% (95% CI 1.8%-9.0%) in QI-engaged vs non-engaged practices over the same period (P = .215). Although not statistically significant, QI-engaged practices had greater magnitudes of rate increases for both age groups. CONCLUSIONS Through practice facilitation, PFK helped a diverse group of community practices substantially improve preventive visit uptake over time. QI programs in primary care can reach patients early to promote preventive services that potentially avoid costly downstream care.
Collapse
Affiliation(s)
- Megan Rose
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Heather Maciejewski
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Joshua Nowack
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Brad Stamm
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Gilbert Liu
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Charitha Gowda
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.
| |
Collapse
|
10
|
Bode SM, Gowda C, Mangini M, Kemper AR. COVID-19 and Primary Measles Vaccination Rates in a Large Primary Care Network. Pediatrics 2021; 147:peds.2020-035576. [PMID: 33214332 DOI: 10.1542/peds.2020-035576] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Melissa Mangini
- Data Resource Center, Nationwide Children's Hospital, Columbus, Ohio
| | | |
Collapse
|
11
|
Giafaglione J, Morrison A, Gowda C, Gajarski R, Nandi D. Pediatric donor heart allocation in the United States, 2006-2017: Current patterns and potential for improvement. Pediatr Transplant 2020; 24:e13743. [PMID: 32426917 DOI: 10.1111/petr.13743] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/09/2020] [Accepted: 04/24/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To understand current donor heart allocation practices for pediatric transplantation. BACKGROUND Despite high waitlist mortality rates among pediatric patients awaiting transplant, a substantial proportion of donor hearts go unused. Analysis of UNOS match run data may identify opportunities to optimize organ utilization. METHODS Using UNOS/OPTN data, we evaluated all match runs for pediatric (<18 years) donor hearts from 1/1/2006 to 3/31/2017. We assessed final disposition of donor hearts, reasons for donor refusal, and other match run characteristics. Variation in total offers made per organ, and refusal rates by OPOs were also evaluated. RESULTS Of 7585 pediatric potential donor hearts, 2226 (29.3%) were refused. Hearts accepted underwent a median of 2 offers (IQR: 1-5), compared to 11 (IQR: 5-24) for refused donor hearts. Organ refusal rates decreased from 36.9% in 2006-2009 to 22.3% in 2014-2017 (P < .001). Reasons for refusal included quality (80.9%), size mismatch (57.5%), and known/suspected crossmatch positivity (39.1%). Among 1800 hearts deemed "poor quality" by ≥1 transplant program, less than half (46.6%) were coded "poor quality" by multiple refusing programs. Organ refusal rates ranged from 13.5% to 83.3% across OPOs, and there was no correlation between refusal rates and median number of offers made by the OPO. CONCLUSION Although more organs are being used over time, 1 in 5 available pediatric donor hearts are still discarded. The lack of donor evaluation consensus and wide variability in donor refusal rates indicates a need for standardization of donor assessment and match run processes across OPOs.
Collapse
Affiliation(s)
- Jaclyn Giafaglione
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Adam Morrison
- Sanger Heart & Vascular Institute, Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Charitha Gowda
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Robert Gajarski
- Division of Cardiology, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Deipanjan Nandi
- Division of Cardiology, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
12
|
Giafaglione J, Morrison A, Gowda C, Gajarski R, Nandi D. PEDIATRIC DONOR HEART ALLOCATION IN THE UNITED STATES, 2006-2017: CURRENT PATTERNS AND POTENTIAL FOR IMPROVEMENT. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31278-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
13
|
Honegger J, Crim L, Gowda C, Sanchez PJ. 2215. Polymerase Chain Reaction (PCR) for Detection of Vertically Acquired Hepatitis C Virus (HCV) Infection in Early Infancy. Open Forum Infect Dis 2018. [PMCID: PMC6254897 DOI: 10.1093/ofid/ofy210.1868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Many children born to HCV-infected mothers in the U.S. never receive recommended anti-HCV antibody (Ab) screening at age ≥ 18 months. Earlier testing by HCV-RNA PCR might facilitate increased screening, though prior studies using older PCR assays reported unacceptably low sensitivity of one-time PCR testing in infants. We hypothesized that testing at age 2–6 months using modern blood HCV-RNA PCR platforms with enhanced analytical sensitivity and reliability will adequately detect infected infants. Methods Medical records of vertically exposed infants tested for HCV-RNA at age 2–6 months at Nationwide Children’s Hospital from January 1, 2008 to December 31, 2017 were reviewed. HCV-RNA tests included qualitative (in-house) and quantitative (ARUP reference lab) Cobas Taqman RT-PCR assays (Roche) with lower limits of detection of 1.2–1.9 log10 IU/mL. Diagnostic performance of early PCR screening was determined using a composite gold standard: (1) infected children had ≥ 2 positive PCRs or persistently positive Ab after age 24 months; (2) uninfected children lacked these criteria and required documentation of a negative Ab at a point after age 18 months. Results During the study period, 639 vertically exposed infants underwent HCV-RNA testing at age 2–6 months. Of these, 24 (3.8%) tested positive, consistent with prior estimates of the vertical transmission rate. Blood HCV-RNA levels were high at screening (median 6.7 log10 IU/mL, range 5.2–7.8 log10 IU/mL), and confirmatory PCR tests were positive in all who had repeat testing (n = 22). Among 615 infants with negative PCR screening, 444 had reached age ≥ 18 months, of whom 144 had undergone Ab testing. Ab tests were negative in 142, while two children had low positive Ab results at 18 months. In both cases, repeat PCR and repeat Ab after age 24 months were negative, suggesting waning maternal Ab rather than true infection. Using the composite gold standard there were 22 true positive, 0 false-positive, 144 true negative, and 0 false negative cases, yielding a sensitivity of 100% (95% CI: 85–100% [Wilson-Brown]). Conclusion These findings demonstrate that modern blood HCV-RNA PCR assays have excellent sensitivity for detecting vertically infected infants as early as 2–6 months of age and may improve HCV surveillance given the substantial number of children lost to follow-up prior to 18 months Ab screening. ![]()
Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- Jonathan Honegger
- Pediatrics, Division of Infectious Diseases, Nationwide Children’s Hospital - Ohio State University College of Medicine, Columbus, Ohio
| | - Linda Crim
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Charitha Gowda
- Pediatrics, Division of Infectious Diseases, Nationwide Children’s Hospital - Ohio State University College of Medicine, Columbus, Ohio
| | - Pablo J Sanchez
- Pediatrics, Divisions of Pediatric Infectious Diseases and Neonatology, Nationwide Children’s Hospital – Ohio State University College of Medicine, Columbus, Ohio
| |
Collapse
|
14
|
Morrison AK, Gowda C, Tumin D, Phelps CM, Hayes D, Tobias J, Gajarski RJ, Nandi D. Pediatric marginal donor hearts: Trends in US national use, 2005-2014. Pediatr Transplant 2018; 22:e13216. [PMID: 29774622 DOI: 10.1111/petr.13216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 03/23/2018] [Indexed: 11/28/2022]
Abstract
Pediatric patients awaiting heart transplant face high mortality rates due to donor organ shortages, including non-use of marginal donor hearts. We examined national trends in pediatric marginal donor heart use over time. UNOS data were queried for heart donors <18 years from 2005 to 2014. The proportion of donor hearts considered marginal was determined using previously cited marginal characteristics: left ventricular ejection fraction (LVEF) <50%, use of ≥2 inotropes, cerebrovascular death, CDC high-risk status, and eGFR < 30 mL/min/1.73 m2 . Disposition of donor hearts was determined and stratified by marginal donor status. Of 6778 pediatric hearts offered from 2005 to 2014, 2373 (35.0%) were considered marginal. Non-use of marginal donor hearts was significantly higher than that of donor hearts without any marginal characteristics (59.5% vs 20.3%, P < .001). In particular, LVEF < 50% and donor inotropes were associated with high rates of organ non-use among pediatric donors. Yet, non-use of marginal donor organs decreased from 67% to 48% from 2005 to 2014 (P < .001). Although the proportion of pediatric donor hearts used for pediatric patients has increased, more than half of donor hearts are declined for use in pediatric recipients due, in part, to perceived marginal status.
Collapse
Affiliation(s)
- Adam K Morrison
- Division of Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Charitha Gowda
- Department of Infectious Disease, Nationwide Children's Hospital, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christina M Phelps
- Division of Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Don Hayes
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph Tobias
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Robert J Gajarski
- Division of Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Deipanjan Nandi
- Division of Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
15
|
Gowda C, Kennedy S, Glover C, Prasad MR, Wang L, Honegger JR. Enhanced identification of maternal hepatitis C virus infection using existing public health surveillance systems. Paediatr Perinat Epidemiol 2018; 32:401-410. [PMID: 29972246 PMCID: PMC6512319 DOI: 10.1111/ppe.12481] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/03/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is under-recognized among US adults and children. Prenatal HCV screening may help close the diagnosis gap among women while also identifying at-risk infants. Current surveillance efforts for maternal HCV rely primarily on birth certificate data. We sought a more accurate assessment of HCV prevalence among pregnant women in Ohio by combining existing public health surveillance data. METHODS Vital Statistics (VS) birth certificate data and Ohio Disease Reporting System (ODRS) HCV case data, both available through the Ohio Department of Health, were linked to determine rates of past or present HCV infection among women giving birth from 2012 to 2015 in Ohio, overall and by county. Among women with available test results, the proportion with present HCV infection indicated by detectable viraemia during pregnancy was calculated. RESULTS Birth certificate data identified 4695 deliveries to women with past/present HCV infection during the study period. Linkage to ODRS revealed an additional 1778 deliveries to women with past/present infection, including 355 with confirmed viraemia during pregnancy. The prevalence of past/present HCV among pregnant women in Ohio rose from 0.82% in 2012 to 1.54% in 2015. CONCLUSIONS Maternal HCV infection is under-recognized and increasing in prevalence. Current case identification processes are inadequate in pregnancy, even among women with prior positive HCV testing. Alternative approaches, including enhanced risk factor-based screening or universal prenatal screening in high prevalence settings, are needed to improve rates of HCV recognition among reproductive-aged women and newborns at risk of vertical transmission.
Collapse
Affiliation(s)
- Charitha Gowda
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA,Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Nationwide Children’s Hospital, Partners for Kids, Columbus, OH, USA
| | - Samuel Kennedy
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Catherine Glover
- The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Mona R. Prasad
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ling Wang
- Nationwide Children’s Hospital, Partners for Kids, Columbus, OH, USA
| | - Jonathan R. Honegger
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA,The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| |
Collapse
|
16
|
Gowda C, Lott S, Grigorian M, Carbonari DM, Saine ME, Trooskin S, Roy JA, Kostman JR, Urick P, Lo Re V. Absolute Insurer Denial of Direct-Acting Antiviral Therapy for Hepatitis C: A National Specialty Pharmacy Cohort Study. Open Forum Infect Dis 2018; 5:ofy076. [PMID: 29977955 PMCID: PMC6016397 DOI: 10.1093/ofid/ofy076] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/11/2018] [Indexed: 12/21/2022] Open
Abstract
Background Despite the availability of new direct-acting antiviral (DAA) regimens, changes in DAA reimbursement criteria, and a public health focus on hepatitis C virus (HCV) elimination, it remains unclear if public and private insurers have increased access to these therapies over time. We evaluated changes in the incidence of absolute denial of DAA therapy over time and by insurance type. Methods We conducted a prospective cohort study among patients who had a DAA prescription submitted from January 2016 to April 2017 to Diplomat Pharmacy, Inc., which provides HCV pharmacy services across the United States. The main outcome was absolute denial of DAA prescription, defined as lack of fill approval by the insurer. We calculated the incidence of absolute denial, overall and by insurance type (Medicaid, Medicare, commercial), for the 16-month study period and each quarter. Results Among 9025 patients from 45 states prescribed a DAA regimen (4702 covered by Medicaid, 1821 Medicare, 2502 commercial insurance), 3200 (35.5%; 95% confidence interval, 34.5%–36.5%) were absolutely denied treatment. Absolute denial was more common among patients covered by commercial insurance (52.4%) than Medicaid (34.5%, P < .001) or Medicare (14.7%, P < .001). The incidence of absolute denial increased across each quarter of the study period, overall (27.7% in first quarter to 43.8% in last quarter; test for trend, P < .001) and for each insurance type (test for trend, P < .001 for each type). Conclusions Despite the availability of new DAA regimens and changes in restrictions of these therapies, absolute denials of DAA regimens by insurers have remained high and increased over time, regardless of insurance type.
Collapse
Affiliation(s)
- Charitha Gowda
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Department of Medicine, Philadelphia, Pennsylvania
| | | | | | - Dena M Carbonari
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Philadelphia, Pennsylvania
| | - M Elle Saine
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Philadelphia, Pennsylvania
| | - Stacey Trooskin
- Penn Center for AIDS Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Philadelphia Field Initiating Group for HIV Trials, Philadelphia, Pennsylvania
| | - Jason A Roy
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Philadelphia, Pennsylvania
| | - Jay R Kostman
- Penn Center for AIDS Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Philadelphia Field Initiating Group for HIV Trials, Philadelphia, Pennsylvania
| | | | - Vincent Lo Re
- Department of Medicine, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Philadelphia, Pennsylvania
- Correspondence: V. Lo Re, MD, MSCE, Center for Clinical Epidemiology and Biostatistics, 836 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021 ()
| |
Collapse
|
17
|
Lopez NL, Gowda C, Backes CH, Nandi D, Miller-Tate H, Fichtner S, Allen R, Stewart J, Cua CL. Differences in midterm outcomes in infants with hypoplastic left heart syndrome diagnosed with necrotizing enterocolitis: NPCQIC database analysis. CONGENIT HEART DIS 2018. [DOI: 10.1111/chd.12602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/21/2023]
Affiliation(s)
| | | | | | | | | | | | - Robin Allen
- Nationwide Children's Hospital; Columbus Ohio USA
| | | | | |
Collapse
|
18
|
Gowda C, Sheikh U, Maier AW, Chang KM, Kaplan DE, Re VL, Amorosa VK. Strategies to Improve Hepatocellular Carcinoma Surveillance in Veterans With Hepatitis B Infection. Fed Pract 2017; 34:S30-S39. [PMID: 30766308 PMCID: PMC6375474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Attitudes of patients as well as infectious disease, gastroenterology, and primary care providers need to be addressed to improve surveillance rates for high-risk patients with chronic hepatitis B infections.
Collapse
Affiliation(s)
- Charitha Gowda
- is an infectious disease physician at the Nationwide Children's Hospital and assistant professor of pediatrics at the Ohio State University College of Medicine in Columbus, Ohio. is a medical student at the St. Louis University School of Medicine in Missouri. is assistant professor of clinical medicine, is associate professor of medicine, is assistant professor of medicine, and is associate professor of clinical medicine, all at Perelman School of Medicine in Philadelphia, Pennsylvania. is assistant professor of medicine and assistant professor of epidemiology in biostatistics and epidemiology at Penn Medicine in Philadelphia. Dr. Chang is associate chief of staff for research and associate dean for research, Dr. Kaplan is assistant professor of medicine, and Dr. Amorosa is an attending physician, all at the Corporal Michael J. Crescenz VAMC in Philadelphia
| | - Umar Sheikh
- is an infectious disease physician at the Nationwide Children's Hospital and assistant professor of pediatrics at the Ohio State University College of Medicine in Columbus, Ohio. is a medical student at the St. Louis University School of Medicine in Missouri. is assistant professor of clinical medicine, is associate professor of medicine, is assistant professor of medicine, and is associate professor of clinical medicine, all at Perelman School of Medicine in Philadelphia, Pennsylvania. is assistant professor of medicine and assistant professor of epidemiology in biostatistics and epidemiology at Penn Medicine in Philadelphia. Dr. Chang is associate chief of staff for research and associate dean for research, Dr. Kaplan is assistant professor of medicine, and Dr. Amorosa is an attending physician, all at the Corporal Michael J. Crescenz VAMC in Philadelphia
| | - Andrew W Maier
- is an infectious disease physician at the Nationwide Children's Hospital and assistant professor of pediatrics at the Ohio State University College of Medicine in Columbus, Ohio. is a medical student at the St. Louis University School of Medicine in Missouri. is assistant professor of clinical medicine, is associate professor of medicine, is assistant professor of medicine, and is associate professor of clinical medicine, all at Perelman School of Medicine in Philadelphia, Pennsylvania. is assistant professor of medicine and assistant professor of epidemiology in biostatistics and epidemiology at Penn Medicine in Philadelphia. Dr. Chang is associate chief of staff for research and associate dean for research, Dr. Kaplan is assistant professor of medicine, and Dr. Amorosa is an attending physician, all at the Corporal Michael J. Crescenz VAMC in Philadelphia
| | - Kyong-Mi Chang
- is an infectious disease physician at the Nationwide Children's Hospital and assistant professor of pediatrics at the Ohio State University College of Medicine in Columbus, Ohio. is a medical student at the St. Louis University School of Medicine in Missouri. is assistant professor of clinical medicine, is associate professor of medicine, is assistant professor of medicine, and is associate professor of clinical medicine, all at Perelman School of Medicine in Philadelphia, Pennsylvania. is assistant professor of medicine and assistant professor of epidemiology in biostatistics and epidemiology at Penn Medicine in Philadelphia. Dr. Chang is associate chief of staff for research and associate dean for research, Dr. Kaplan is assistant professor of medicine, and Dr. Amorosa is an attending physician, all at the Corporal Michael J. Crescenz VAMC in Philadelphia
| | - David E Kaplan
- is an infectious disease physician at the Nationwide Children's Hospital and assistant professor of pediatrics at the Ohio State University College of Medicine in Columbus, Ohio. is a medical student at the St. Louis University School of Medicine in Missouri. is assistant professor of clinical medicine, is associate professor of medicine, is assistant professor of medicine, and is associate professor of clinical medicine, all at Perelman School of Medicine in Philadelphia, Pennsylvania. is assistant professor of medicine and assistant professor of epidemiology in biostatistics and epidemiology at Penn Medicine in Philadelphia. Dr. Chang is associate chief of staff for research and associate dean for research, Dr. Kaplan is assistant professor of medicine, and Dr. Amorosa is an attending physician, all at the Corporal Michael J. Crescenz VAMC in Philadelphia
| | - Vincent Lo Re
- is an infectious disease physician at the Nationwide Children's Hospital and assistant professor of pediatrics at the Ohio State University College of Medicine in Columbus, Ohio. is a medical student at the St. Louis University School of Medicine in Missouri. is assistant professor of clinical medicine, is associate professor of medicine, is assistant professor of medicine, and is associate professor of clinical medicine, all at Perelman School of Medicine in Philadelphia, Pennsylvania. is assistant professor of medicine and assistant professor of epidemiology in biostatistics and epidemiology at Penn Medicine in Philadelphia. Dr. Chang is associate chief of staff for research and associate dean for research, Dr. Kaplan is assistant professor of medicine, and Dr. Amorosa is an attending physician, all at the Corporal Michael J. Crescenz VAMC in Philadelphia
| | - Valerianna K Amorosa
- is an infectious disease physician at the Nationwide Children's Hospital and assistant professor of pediatrics at the Ohio State University College of Medicine in Columbus, Ohio. is a medical student at the St. Louis University School of Medicine in Missouri. is assistant professor of clinical medicine, is associate professor of medicine, is assistant professor of medicine, and is associate professor of clinical medicine, all at Perelman School of Medicine in Philadelphia, Pennsylvania. is assistant professor of medicine and assistant professor of epidemiology in biostatistics and epidemiology at Penn Medicine in Philadelphia. Dr. Chang is associate chief of staff for research and associate dean for research, Dr. Kaplan is assistant professor of medicine, and Dr. Amorosa is an attending physician, all at the Corporal Michael J. Crescenz VAMC in Philadelphia
| |
Collapse
|
19
|
Gowda C, Newcomb CW, Liu Q, Carbonari DM, Lewis JD, Forde KA, Goldberg DS, Reddy KR, Roy JA, Marks AR, Schneider JL, Kostman JR, Tate JP, Lim JK, Justice AC, Goetz MB, Corley DA, Lo Re V. Risk of Acute Liver Injury With Antiretroviral Therapy by Viral Hepatitis Status. Open Forum Infect Dis 2017; 4:ofx012. [PMID: 28470014 PMCID: PMC5407218 DOI: 10.1093/ofid/ofx012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/18/2017] [Indexed: 12/16/2022] Open
Abstract
Background The risk of hepatotoxicity with antiretroviral therapy (ART) remains unknown. We determined the comparative risk of acute liver injury (ALI) for antiretroviral drugs, classes, and regimens, by viral hepatitis status. Methods We followed a cohort of 10 083 human immunodeficiency virus (HIV)-infected persons in Kaiser Permanente Northern California (n = 2099) from 2004 to 2010 and the Veterans Aging Cohort Study (n = 7984) from 2004 to 2012. Within the first year of ART, we determined occurrence of (1) liver aminotransferases >200 U/L and (2) severe ALI (coagulopathy with hyperbilirubinemia). We used Cox regression to determine hazard ratios (HRs) with 95% confidence intervals (CIs) of endpoints among initiators of nucleos(t)ide analogue combinations, antiretroviral classes, and ART regimens, all stratified by viral hepatitis status. Results Liver aminotransferases >200 U/L developed in 206 (2%) persons and occurred more frequently among HIV/viral hepatitis-coinfected than HIV-monoinfected persons (116.1 vs 20.7 events/1000 person-years; P < .001). No evidence of differential risk was found between initiators of abacavir/lamivudine versus tenofovir/emtricitabine among coinfected (HR, 0.68; 95% CI, .29–1.57) or HIV-monoinfected (HR, 1.19; 95% CI, .47–2.97) groups. Coinfected patients had a higher risk of aminotransferases >200 U/L after initiation with a protease inhibitor than nonnucleoside reverse-transcriptase inhibitor (HR, 2.01; 95% CI, 1.36–2.96). Severe ALI (30 events; 0.3%) occurred more frequently in coinfected persons (15.9 vs 3.1 events/1000 person-years; P < .001) but was too uncommon to evaluate in adjusted analyses. Conclusions Within the year after ART initiation, aminotransferase elevations were infrequently observed and rarely led to severe ALI. Protease inhibitor use was associated with a higher risk of aminotransferase elevations among viral hepatitis-coinfected patients.
Collapse
Affiliation(s)
- Charitha Gowda
- Division of Pediatric Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, Ohio State University College of Medicine, Columbus
| | - Craig W Newcomb
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Qing Liu
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Dena M Carbonari
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - James D Lewis
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kimberly A Forde
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David S Goldberg
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - K Rajender Reddy
- Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jason A Roy
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Amy R Marks
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | - Jay R Kostman
- Jonathan Lax Treatment Center, Philadelphia FIGHT, Pennsylvania
| | - Janet P Tate
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Joseph K Lim
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Amy C Justice
- VA Connecticut Healthcare System, West Haven, Connecticut.,Yale University School of Medicine, New Haven, Connecticut
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles, California; and
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Vincent Lo Re
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
20
|
Gowda C, Brown TT, Compher C, Forde KA, Kostman J, Shaw PA, Tien PC, Lo Re V. Prevalence and predictors of low muscle mass in HIV/viral hepatitis coinfection. AIDS 2016; 30:2519-2528. [PMID: 27490638 DOI: 10.1097/qad.0000000000001213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Low muscle mass is associated with reduced survival in HIV, possibly mediated by systemic inflammation. Viral hepatitis coinfection can induce additional inflammation and hepatic dysfunction that may exacerbate low muscle mass. We determined the prevalence of and risk factors for low muscle mass in HIV/viral hepatitis coinfection. DESIGN AND METHODS A cross-sectional study of participants in the Multicenter AIDS Cohort Study and Women's Interagency HIV Study with anthropometry performed after 1 January 2000. Viral hepatitis defined by positive hepatitis B virus surface antigen and/or hepatitis C virus RNA. Low muscle mass defined as less than 10th percentile of age-matched and sex-matched reference values for mid-upper arm circumference. Using multivariable logistic regression, we determined adjusted odds ratios with 95% confidence intervals (CIs) of the association of HIV/viral hepatitis coinfection with low muscle mass and factors associated with low muscle mass in coinfected persons. Analyses adjusted for age, race, BMI, alcohol use, and IDU (also, nadir CD4 cell count and HIV RNA where appropriate). RESULTS Among 3518 participants (164 HIV/viral hepatitis, 223 viral hepatitis alone, 1070 HIV alone, and 2061 uninfected), HIV/viral hepatitis-coinfected persons had a 3.50-fold (95% CI, 1.51-8.09), 1.93-fold (1.17-3.20), and 2.65-fold (1.62-4.35) higher odds of low muscle mass than viral hepatitis-monoinfected, HIV-monoinfected, and uninfected persons, respectively. Lack of HIV RNA suppression [odds ratio, 2.26 (95% CI, 1.10-4.63)] was the only factor associated with low muscle mass in coinfected persons. CONCLUSION HIV/viral hepatitis-coinfected persons have a higher likelihood of low muscle mass than those with viral hepatitis monoinfection, HIV monoinfection, or neither infection. HIV viremia is an important risk factor for low muscle mass among coinfected persons.
Collapse
|
21
|
Abstract
People living with HIV (PLWH) engaged in medical care represent an accessible group to focus HIV prevention efforts. In an analysis of 1,883 PLWH from 2007 and 2015, we determined the proportion at risk of HIV transmission and identified factors associated with HIV transmission risk using multivariable mixed effects logistic regression models with random intercepts. HIV transmission risk was defined by an HIV viral load > 1,500 copies/mL and self-reported unprotected sex. We found that 174 (9.2%) individuals were at risk for HIV transmission at least once. Factors associated with HIV transmission risk included younger age (adjusted OR [95% CI] per decade decrease = 2.30 [1.84, 2.89]), illicit drug use (adjusted OR = 5.36 [3.02, 9.56]), depression (adjusted OR = 1.88 [1.10, 3.21]), and education <12th grade (adjusted OR = 2.05 [1.15, 3.67]). Thus, nearly 1 in 10 HIV-infected individuals engaged in care between 2007 and 2015 were potentially at risk of transmitting HIV. Behavioral interventions to decrease HIV transmission should focus on younger, less educated patients who are depressed and actively using illicit drugs.
Collapse
Affiliation(s)
- Charitha Gowda
- Division of Infectious Diseases, Nationwide Children's Hospital and the Department of Pediatrics, the Ohio State University College of Medicine, Columbus, Ohio
| | - Dagan Coppock
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Cristina Brickman
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco School of Medicine, San Francisco
| | - Pamela A Shaw
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robert Gross
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
22
|
Re VL, Gowda C, Urick PN, Halladay JT, Binkley A, Carbonari DM, Battista K, Peleckis C, Gilmore J, Roy JA, Doshi JA, Reese PP, Reddy KR, Kostman JR. Disparities in Absolute Denial of Modern Hepatitis C Therapy by Type of Insurance. Clin Gastroenterol Hepatol 2016; 14:1035-43. [PMID: 27062903 PMCID: PMC4912853 DOI: 10.1016/j.cgh.2016.03.040] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [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: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The high costs of direct-acting antiviral (DAA) agents to treat chronic hepatitis C virus (HCV) infection have resulted in denials of treatment, but it is not clear whether patients' access to these therapies differs with their type of insurance. METHODS We conducted a prospective cohort study among all patients who had a DAA prescription submitted between November 1, 2014 and April 30, 2015 to Burman's Specialty Pharmacy, which provides HCV pharmacy services to patients in Delaware, Maryland, New Jersey, and Pennsylvania. We determined the incidence of absolute denial of DAA prescription, defined as a lack of approval of a prescription fill by the insurer, according to type of insurance (US Medicaid, US Medicare, or commercial insurance). Multivariable Poisson regression was used to estimate adjusted relative risks of absolute denial associated with patient characteristics. RESULTS Among 2321 patients prescribed a DAA regimen (503 covered by Medicaid, 795 covered by Medicare, and 1023 covered by commercial insurance), 377 (16.2%) received an absolute denial. The most common reasons for absolute denial were insufficient information to assess medical need (134 [35.5%]) and lack of medical necessity (132 [35.0%]). A higher proportion of patients covered by Medicaid received an absolute denial (233 [46.3%]) than those covered by Medicare (40 [5.0%]; P < .001) or commercial insurance (104 [10.2%]; P < .001). Medicaid insurance (adjusted relative risk, 4.14; 95% confidence interval, 3.38-5.08) and absence of cirrhosis (adjusted relative risk, 1.96; 95% confidence interval, 1.53-2.50) were associated with absolute denial. CONCLUSIONS There are significant disparities in access to DAA-based treatments for HCV infection among patients with different types of insurance. Nearly half of Medicaid beneficiaries in Delaware, Maryland, New Jersey, and Pennsylvania were denied access to these drugs for chronic HCV infection.
Collapse
Affiliation(s)
- Vincent Lo Re
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Center for AIDS Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Charitha Gowda
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Center for AIDS Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Paul N. Urick
- Burman's Specialty Pharmacy, Diplomat Pharmacy, Inc., Brookhaven, PA
| | | | - Amanda Binkley
- Department of Pharmacy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dena M. Carbonari
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kathryn Battista
- Burman's Specialty Pharmacy, Diplomat Pharmacy, Inc., Brookhaven, PA
| | | | - Jody Gilmore
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jason A. Roy
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jalpa A. Doshi
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Center for AIDS Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Peter P. Reese
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - K. Rajender Reddy
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jay R. Kostman
- Center for AIDS Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,John Bell Health Center, Philadelphia FIGHT, Philadelphia, PA, USA
| |
Collapse
|
23
|
Song C, Pan X, Ge Z, Gowda C, Ding Y, Li H, Li Z, Yochum G, Muschen M, Li Q, Payne KJ, Dovat S. Epigenetic regulation of gene expression by Ikaros, HDAC1 and Casein Kinase II in leukemia. Leukemia 2016; 30:1436-40. [PMID: 26639180 PMCID: PMC4889471 DOI: 10.1038/leu.2015.331] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- C Song
- Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA, USA
| | - X Pan
- Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA, USA
| | - Z Ge
- Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA, USA
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - C Gowda
- Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA, USA
| | - Y Ding
- Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA, USA
| | - H Li
- Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA, USA
| | - Z Li
- Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA, USA
- Jilin Province Animal Embryo Engineering Key Laboratory, College of Animal Science and Veterinary Medicine, Jilin University, Changchun, China
| | - G Yochum
- Department of Biochemistry and Molecular Biology, Pennsylvania State University Medical College, Hershey, PA, USA
| | - M Muschen
- University of California San Francisco, San Francisco, CA, USA
| | - Q Li
- Department of Statistics, Pennsylvania State University, University Park, State College, PA, USA
| | - K J Payne
- Department of Pathology and Human Anatomy and Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA, USA
| | - S Dovat
- Department of Pediatrics, Pennsylvania State University Medical College, Hershey, PA, USA
| |
Collapse
|
24
|
Gowda C, Sheikh U, Maier A, Kaplan D, Chang KM, Lo Re V, Amorosa V. Identifying Barriers and Potential Strategies to Improve HCC Surveillance for HBV-Infected Veterans. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.758] [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: 11/12/2022] Open
|
25
|
Affiliation(s)
- Charitha Gowda
- Division of Infectious DiseasesUniversity of PennsylvaniaPhiladelphiaPA
| |
Collapse
|
26
|
Gowda C, Compher C, Amorosa VK, Re VL. Association between chronic hepatitis C virus infection and low muscle mass in US adults. J Viral Hepat 2014; 21:938-43. [PMID: 24989435 PMCID: PMC4236264 DOI: 10.1111/jvh.12273] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 05/17/2014] [Indexed: 12/15/2022]
Abstract
Given that low muscle mass can lead to worse health outcomes in patients with chronic infections, we assessed whether chronic hepatitis C virus (HCV) infection was associated with low muscle mass among US adults. We performed a cross-sectional study of the National Health Examination and Nutrition Study (1999-2010). Chronic HCV-infected patients had detectable HCV RNA. Low muscle mass was defined as <10th percentile for mid-upper arm circumference (MUAC). Multivariable logistic regression was used to determine adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of low muscle mass associated with chronic HCV. Among 18 513 adults, chronic HCV-infected patients (n = 303) had a higher prevalence of low muscle mass than uninfected persons (13.8% vs 6.7%; aOR, 2.22; 95% CI, 1.39-3.56), and this association remained when analyses were repeated among persons without significant liver fibrosis (aOR, 2.12; 95% CI, 1.30-3.47). This study demonstrates that chronic HCV infection is associated with low muscle mass, as assessed by MUAC measurements, even in the absence of advanced liver disease.
Collapse
Affiliation(s)
- Charitha Gowda
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (C.G., V.K.A., V.L.R.), Department of Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (C.G., V.L.R.)
| | - Charlene Compher
- Department of Nutrition, University of Pennsylvania School of Nursing, Philadelphia, PA (C.C.)
| | - Valerianna K. Amorosa
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (C.G., V.K.A., V.L.R.), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA (V.K.A.)
| | - Vincent Lo Re
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (C.G., V.K.A., V.L.R.), Department of Biostatistics and Epidemiology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (C.G., V.L.R.)
| |
Collapse
|
27
|
Gowda C, Dong S, Potter RC, Dombkowski KJ, Stokley S, Dempsey AF. A systematic evaluation of different methods for calculating adolescent vaccination levels using immunization information system data. Public Health Rep 2014; 128:489-97. [PMID: 24179260 DOI: 10.1177/003335491312800608] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Immunization information systems (IISs) are valuable surveillance tools; however, population relocation may introduce bias when determining immunization coverage. We explored alternative methods for estimating the vaccine-eligible population when calculating adolescent immunization levels using a statewide IIS. METHODS We performed a retrospective analysis of the Michigan State Care Improvement Registry (MCIR) for all adolescents aged 11-18 years registered in the MCIR as of October 2010. We explored four methods for determining denominators: (1) including all adolescents with MCIR records, (2) excluding adolescents with out-of-state residence, (3) further excluding those without MCIR activity ≥ 10 years prior to the evaluation date, and (4) using a denominator based on U.S. Census data. We estimated state- and county-specific coverage levels for four adolescent vaccines. RESULTS We found a 20% difference in estimated vaccination coverage between the most inclusive and restrictive denominator populations. Although there was some variability among the four methods in vaccination at the state level (2%-11%), greater variation occurred at the county level (up to 21%). This variation was substantial enough to potentially impact public health assessments of immunization programs. Generally, vaccines with higher coverage levels had greater absolute variation, as did counties with smaller populations. CONCLUSION At the county level, using the four denominator calculation methods resulted in substantial differences in estimated adolescent immunization rates that were less apparent when aggregated at the state level. Further research is needed to ascertain the most appropriate method for estimating vaccine coverage levels using IIS data.
Collapse
Affiliation(s)
- Charitha Gowda
- University of Michigan, Department of Pediatrics, Child Health Evaluation and Research Unit, Ann Arbor, MI
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
Parental vaccine hesitancy is a growing problem affecting the health of children and the larger population. This article describes the evolution of the vaccine hesitancy movement and the individual, vaccine-specific and societal factors contributing to this phenomenon. In addition, potential strategies to mitigate the rising tide of parent vaccine reluctance and refusal are discussed.
Collapse
Affiliation(s)
- Charitha Gowda
- Division of Infectious Diseases; University of Pennsylvania; Philadelphia, PA USA
| | | |
Collapse
|
29
|
Gowda C, Hadley C, Aiello AE. Gowda et al. Respond. Am J Public Health 2013; 103:e6. [DOI: 10.2105/ajph.2012.301187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Charitha Gowda
- Charitha Gowda is with the Division of Infectious Diseases, University of Pennsylvania, Philadelphia. Craig Hadley is with the Department of Anthropology, Emory University, Atlanta, GA. Allison E. Aiello is with the Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor
| | - Craig Hadley
- Charitha Gowda is with the Division of Infectious Diseases, University of Pennsylvania, Philadelphia. Craig Hadley is with the Department of Anthropology, Emory University, Atlanta, GA. Allison E. Aiello is with the Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor
| | - Allison E. Aiello
- Charitha Gowda is with the Division of Infectious Diseases, University of Pennsylvania, Philadelphia. Craig Hadley is with the Department of Anthropology, Emory University, Atlanta, GA. Allison E. Aiello is with the Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor
| |
Collapse
|
30
|
Dovat S, Song C, Gowda C, Petrovic-Dovat L, Payne J. Inhibition of Casein Kinase II (CK2) Enhances Ikaros Tumor Suppressor Activity and Shows Therapeutic Efficacy in a Preclinical Leukemia Model. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt045.6] [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: 11/14/2022] Open
|
31
|
Koronkiewicz M, Romiszewska A, Kazimierczuk Z, Chilmonczyk Z, Neto MDS, Ramos SP, Curvello R, Bin M, Domingues NLC, Rinaldi AW, de Souza ACS, Dyshlovoy SA, Venz S, Guzii A, Makarieva T, Tabakmakher K, Stonik V, Balabanov S, Bokemeyer C, Honecker F, Flis S, Flis K, Statkiewicz M, Curvello R, Neto MDS, Ramos SP, Bin MEL, Shishido SM, de Souza ACS, Dovat S, Song C, Gowda C, Petrovic-Dovat L, Payne J, Chen LT, Tsai HJ, Kuo SH, Cheng AL, Chen J, Fu L, Kwong D, Guan X, Zalietok S, Samoylenko O, Zhuravel O, Gulua L, Orlovsky O, Chekhun V, Chekhun V, Zalietok S, Gulua L, Orlovsky O, Milinevska V, Karnaushenko O, Priya S, Reshma RS, Rakesh SN, Sreelatha KH, Veena S, Nand K, Gupta JC, Panda AK, Jain SK, Talwar GP, Riva P, Oreal P, Lima RT, Sousa D, Choosang K, Pakkong P, Palmeira A, Paiva AM, Seca H, Cerqueira F, Pedro M, Pinto MM, Sousa E, Vasconcelos MH. Poster session 3. Drug profiles - preclinical. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt045] [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: 11/13/2022] Open
|
32
|
Gowda C, Schaffer SE, Kopec K, Markel A, Dempsey AF. A pilot study on the effects of individually tailored education for MMR vaccine-hesitant parents on MMR vaccination intention. Hum Vaccin Immunother 2013; 9:437-45. [PMID: 23291937 DOI: 10.4161/hv.22821] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Healthcare providers need strategies to better address the concerns of vaccine-hesitant parents. We studied whether individually tailored education was more effective than untailored education at improving vaccination intention among MMR vaccine-hesitant parents. In an intervention pilot study of parents (n = 77) of children < 6 y who screened as hesitant to vaccinate against MMR (first or second dose), parents were randomly assigned to receive either (1) educational web pages that were individually tailored to address their specific vaccine concerns; or (2) web pages similar in appearance to the intervention but containing untailored information. The main outcome, change in vaccination intention before and after the intervention, was assessed using an 11-pt scale (higher values indicated greater intent). We found that a greater proportion of parents in the tailored than untailored arm had positive vaccination intentions after viewing educational information (58% vs. 46%). Furthermore, parents in the tailored group had a greater magnitude of change in vaccination intention (1.08 vs. 0.49 points) than participants in the untailored group. However, neither of these results was statistically significant. From this pilot study we conclude message tailoring may be an effective way to improve vaccine compliance among vaccine hesitant parents. However, larger studies are warranted to further investigate the efficacy of providing tailored education for increasing vaccine acceptance among parents with diverse beliefs.
Collapse
Affiliation(s)
- Charitha Gowda
- Child Health Evaluation and Research Unit; Department of Pediatrics; University of Michigan; Ann Arbor, MI USA
| | | | | | | | | |
Collapse
|
33
|
Gowda C, Hadley C, Aiello AE. Gowda et al. respond. Am J Public Health 2013; 103:e4-5. [PMID: 23153161 PMCID: PMC3518326 DOI: 10.2105/ajph.2012.301099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 04/08/2024]
|
34
|
Gowda C, Schaffer SE, Kopec K, Markel A, Dempsey AF. Does the relative importance of MMR vaccine concerns differ by degree of parental vaccine hesitancy?: An exploratory study. Hum Vaccin Immunother 2012; 9:430-6. [PMID: 23032161 DOI: 10.4161/hv.22065] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There has been a rise in the number of vaccine-hesitant parents (VHPs) in the US, many of whom express reservations about administering the MMR vaccine to their children. We studied the relative importance of attitudinal barriers to MMR vaccination among VHPs with differing levels of MMR vaccine-hesitancy. METHODS We performed a cross-sectional exploratory analysis of a parental survey that assessed common vaccination barriers among MMR vaccine-hesitant parents in Michigan. The outcome of interest was parental MMR vaccination intention, measured on an 11-point scale, with higher numbers corresponding to greater intent. The relative importance of identified barriers to MMR vaccination was assessed across levels of vaccine hesitancy. Exploratory factor analysis was performed to identify underlying attitudinal constructs and assess if these constructs' importance varied depending on the degree of parental vaccine hesitancy. RESULTS Our study population included 79 Michigan parents who initially screened positive for MMR vaccine-hesitancy. Within this sample, 47% of parents were unsure about their vaccination intentions and 20% expressed negative intentions, while a third (33%) of parents had positive vaccination intentions when further questioned. After grouping the barriers in our study into four underlying factors, parents with negative vaccination intentions had statistically significant higher factor score for the factor "risks versus benefits" and a statistically significant lower mean score for "vaccine importance," compared with parents with unsure or positive intentions. CONCLUSIONS In this exploratory study we found that vaccine-specific concerns have varying salience for parents based on their vaccination intention. Thus, future educational programs likely should tailor messages based on the degree of vaccine hesitancy expressed in their target populations in order to improve their overall effectiveness.
Collapse
Affiliation(s)
- Charitha Gowda
- Division of Infectious Diseases; University of Pennsylvania; Philadelphia, PA USA
| | | | | | | | | |
Collapse
|
35
|
Gowda C, Schaffer SE, Dombkowski KJ, Dempsey AF. Understanding attitudes toward adolescent vaccination and the decision-making dynamic among adolescents, parents and providers. BMC Public Health 2012; 12:509. [PMID: 22768870 PMCID: PMC3406969 DOI: 10.1186/1471-2458-12-509] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 07/07/2012] [Indexed: 01/02/2023] Open
Abstract
Background With several new vaccine recommendations specifically targeting adolescents, improving adolescent vaccination rates has become a major health priority. Vaccination attitudes are an important, modifiable target for new interventions. Prior research has examined primarily the attitudes and beliefs of adolescents, parents or healthcare providers separately without exploring the decision-making dynamic among these stakeholders. We sought to identify potentially modifiable barriers in the vaccine decision process among adolescents, parents and healthcare providers that could be addressed through interventions implemented within the adolescent’s medical home. Methods We conducted a qualitative study of adolescents, their parents and healthcare providers, recruited from four primary care practices in Michigan. For each practice, three separate focus group discussions (adolescents, parents and healthcare providers, for a total of 12 focus groups) were conducted to explore vaccination attitudes, possible interventions to improve vaccine uptake and access to and use of technology for vaccination interventions. Themes that emerged from the focus group discussions were categorized using an inductive, iterative process, and analysis focused on highlighting similarities and differences among the three perspectives. Results Participants included 32 adolescents, 33 parents and 28 providers. The majority of parents and adolescents were female. Lack of knowledge about recommended adolescent vaccinations was universally recognized among the three groups and was perceived to be the underlying driver of low immunization rates. Notably, each group did not appear to fully appreciate the challenges faced by the other stakeholders with respect to adolescent vaccination. Adolescents were seen as having a greater role in the vaccine decision-making dynamic than previously suggested. Provider-based interventions such as educational tools and reminder-recall notices were identified as important components of any immunization program. Overall, there was high receptivity among all stakeholders toward integrating technology such as email and Internet into new vaccination interventions. Conclusions We identified potentially modifiable attitudinal barriers to adolescent vaccination among the three key stakeholders. However, there were notable differences in attitudes and preferences across the three perspectives, indicating that for an intervention to be successful it will require a dynamic partnership with the target audiences.
Collapse
Affiliation(s)
- Charitha Gowda
- Child Health Evaluation and Research Unit, Department of Pediatrics, University of Michigan, 300 North Ingalls Building, Ann Arbor, MI, 48109-5456, USA.
| | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVES To expand the understanding of potential pathways through which food insecurity is associated with adverse health outcomes, we investigated whether food insecurity is associated with nutritional levels, inflammatory response, and altered immune function. METHODS We performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (1999-2006) with 12,191 participants. We assessed food insecurity using the US Department of Agriculture food security scale module and measured clinical biomarkers from blood samples obtained during participants' visits to mobile examination centers. RESULTS Of the study population, 21.5% was food insecure. Food insecurity was associated with higher levels of C-reactive protein (adjusted odds ratio [AOR]=1.21; 95% confidence interval [CI]=1.04, 1.40) and of white blood cell count (AOR=1.36; 95% CI=1.11, 1.67). White blood cell count partly mediated the association between food insecurity and C-reactive protein. CONCLUSIONS These findings show that food insecurity is associated with increased inflammation, a correlate of chronic diseases. Immune response also appears to be a potential mediator in this pathway.
Collapse
Affiliation(s)
- Charitha Gowda
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | | | | |
Collapse
|
37
|
Gowda C, Dempsey AF. Medicaid reimbursement and the uptake of adolescent vaccines. Vaccine 2012; 30:1682-9. [PMID: 22226859 DOI: 10.1016/j.vaccine.2011.12.097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 12/14/2011] [Accepted: 12/20/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND In light of low adolescent vaccination rates, state-level policies that could improve vaccine coverage should be evaluated. Approximately 1/3 of adolescents are eligible, primarily through Medicaid enrollment, to receive vaccines from state-administered Vaccines for Children (VFC) programs. We investigated whether Medicaid reimbursement, the scope of implementation of VFC programs (i.e. limited or universal purchase), and/or presence of school-based vaccine mandates were associated with adolescent vaccination levels. METHODS We performed a cross-sectional analysis of state-level associations between these policies and 2009 National Immunization Survey-TEEN vaccination rates for tetanus-containing, meningococcal conjugate (MCV4), and among females only, human papillomavirus (HPV) vaccines. RESULTS Medicaid reimbursement was not associated with vaccine coverage rates after adjusting for presence of vaccine-related school mandates, type of VFC program, proportion of adolescents attending preventive care visits, and state-specific distribution of insurance coverage. Participation in a more expansive VFC program (universal or universal-select) was significantly associated with HPV vaccine coverage, but not tetanus-containing vaccine or MCV4, among states that had mandates for any vaccines. CONCLUSIONS Our results suggest that, contrary to what has been shown for childhood vaccines, raising Medicaid reimbursement rates may not improve adolescent vaccine utilization. Instead, other policy changes may be more effective, such as expansion of VFC programs into universal purchase programs, further implementation of school-based vaccine mandates and efforts to raise preventive care visits among adolescents.
Collapse
Affiliation(s)
- Charitha Gowda
- Child Health Evaluation and Research Unit, University of Michigan, Department of Pediatrics, Ann Arbor, MI 48109-5456, USA
| | | |
Collapse
|
38
|
Gowda C, Seth R, Biswas N. Beneficial reuse of precast concrete industry sludge to produce alkaline stabilized biosolids. Water Sci Technol 2008; 57:217-223. [PMID: 18235174 DOI: 10.2166/wst.2008.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The precast concrete industry generates waste called concrete sludge during routine mixer tank washing. It is highly alkaline and hazardous, and typically disposed of by landfilling. This study examined the stabilization of municipal sewage sludge using concrete sludge as an alkaline agent. Sewage sludge was amended with 10 to 40% of concrete sludge by wet weight, and 10 and 20% of lime by dry weight of the sludge mix. Mixes containing 30 and 40% of concrete sludge with 20% lime fulfilled the primary requirements of Category 1 and 2 (Canada) biosolids of maintaining a pH of 12 for at least 72 hours. The heavy metals were below Category 1 regulatory limits. The 40% concrete sludge mix was incubated at 52 degrees C for 12 of the 72 hours to achieve the Category 1 and 2 regulations of less than 1000 fecal coliform/g solids. The nutrient content of the biosolids was 8.2, 10 and 0.6 g/kg of nitrogen, phosphorus and potassium respectively. It can be used as a top soil or augmented with potassium for use as fertilizer. The study demonstrates that concrete sludge waste can be beneficially reused to produce biosolids, providing a long-term sustainable waste management solution for the concrete industry.
Collapse
Affiliation(s)
- C Gowda
- Lower Thames Valley Conservation Authority, Chatham, Ontario, Canada
| | | | | |
Collapse
|
39
|
Umesh TK, Anasuya SJ, Gowda C, Gowda R. Photoeffect cross sections of several rare-earth elements for 323-keV photons. Phys Rev A 1992; 45:2101-2103. [PMID: 9907207 DOI: 10.1103/physreva.45.2101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
40
|
Gowda C. Assay of sulphur compounds with 1-chlorobenzotriazole. Talanta 1991; 38:1427-30. [DOI: 10.1016/0039-9140(91)80291-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/1991] [Revised: 05/29/1991] [Accepted: 06/13/1991] [Indexed: 10/18/2022]
|
41
|
Affiliation(s)
- A Nicol
- University of Alabama, School of Medicine, Birmingham
| | | | | |
Collapse
|