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Lee King PA, Lee S, Weiss D, Aaby D, Milan-Alexander T, Borders AE. Implementation of Perinatal Quality Collaborative Statewide Initiative Improves Obstetric Opioid Use Disorder Care and Outcomes. Am J Obstet Gynecol 2024:S0002-9378(24)00521-0. [PMID: 38642696 DOI: 10.1016/j.ajog.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Maternal deaths resulting from opioid use disorder (OUD) have been rising across the United States. OUD among pregnant persons is associated with adverse pregnancy outcomes including preterm birth along with racial disparities in optimal OUD care. OBJECTIVE We aimed to evaluate whether the Illinois Perinatal Quality Collaborative's (ILPQC) implementation of the Mothers and Newborns affected by Opioids - Obstetric quality improvement initiative was associated with improvement of OUD identification, provision of optimal OUD care for birthing patients, and reduction in racial gaps of optimal OUD care. STUDY DESIGN Using a prospective cohort design, hospitals reported monthly key measures for all patients with OUD at delivery between July 2018 - December 2020. ILPQC facilitated collaborative learning opportunities, rapid-response data, and quality improvement (QI) support. Generalized linear mixed effects regression models were used to evaluate improvement in optimal OUD care including increases in linkages to medication assisted treatment, recovery treatment services and naloxone counseling across time; and to determine whether optimal OUD care was associated with positive outcomes such as lower odds of preterm birth. RESULTS Ninety- one hospitals submitted data on 2,095 pregnant persons with OUD. For the primary outcomes, the rates of patients receiving Medication Assisted Treatment (MAT) and recovery treatment services improved across the initiative from 41 to 78% and 48 to 67% respectively. For the secondary outcomes, the receipt of recovery treatment services and both recovery treatment services / MAT provided prenatally before delivery admission was associated with lower odds of preterm birth (aOR (95% CI) 0.67 (0.50, 0.91) and 0.49 (0.31, 0.75), respectively). During the first quarter of the initiative, Black patients with OUD were less likely to be linked to MAT (23% vs. 48%); however, an increase in MAT rates across the initiative occurred for all patients, with the greatest improvement for Black patients with an associated reduction in this disparity gap with greater than 70% of both Black and White patients linked to MAT. CONCLUSION The MNO-OB initiative is associated with improvements in optimal OUD care for pregnant patients across Illinois hospitals, while racial disparity in OUD care was reduced across the MNO OB initiative. The findings further implicate how optimal OUD care can improve pregnancy outcomes and close persistent racial gaps in pregnant individuals with OUD.
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Affiliation(s)
- Patricia A Lee King
- Northwestern University, Feinberg School of Medicine, Center for HealthCare Studies, Chicago, IL, United States; Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago IL, United States
| | - SuYeon Lee
- Northwestern University, Feinberg School of Medicine, Center for HealthCare Studies, Chicago, IL, United States
| | - Dan Weiss
- Maternal-Fetal Medicine, NorthShore University Health System, Evanston, IL, United States
| | - David Aaby
- Northwestern University, Feinberg School of Medicine, Biostatistics Collaboration Center, Chicago, IL, United States
| | | | - Ann Eb Borders
- Northwestern University, Feinberg School of Medicine, Center for HealthCare Studies, Chicago, IL, United States; Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago IL, United States; Maternal-Fetal Medicine, NorthShore University Health System, Evanston, IL, United States.
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Peyton C, Aaby D, Millman R, Rodriguez S, Boswell L, Gaebler-Spira D, de Regnier RA, Barbosa VM, Sukal-Moulton T. Stability of the Motor Optimality Score Revised (MOS-R) in medically complex infants. Early Hum Dev 2024; 192:106008. [PMID: 38615539 DOI: 10.1016/j.earlhumdev.2024.106008] [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: 03/18/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The Motor Optimality Score-Revised (MOS-R) is a clinical test of infant spontaneous movement at 3-5 months of age and has been associated with neurodevelopmental outcomes in infants with medical complexity. However the stability of the MOS-R tested at different developmental ages is not yet known. AIM To determine if the repeated scoring of the MOS-R remained consistent when tested at two developmental ages in young infants. STUDY DESIGN In this prospective cohort study, infants were tested twice with the MOS-R between 12 and 13 weeks corrected age (CA) and 14-16 weeks CA. Bland Altman Plots were used to calculate agreement between the scores. Infants were grouped as having higher or lower medical complexity. MOS-R threshold scores were analyzed to assess changes over time within each group using Fisher's exact test. SUBJECTS 85 infants with history of hospitalization in a neonatal intensive care unit (NICU). RESULTS The MOS-R scores had a high agreement with negligible bias (0.058) between timepoints (95 % CI -1.10, 1.22). Using a MOS-R cut point of 19, infants with higher medical complexity were more likely to change groups between timepoints than infants with lower medical complexity (p = 0.008), but this was not significantly different using cut points of 20 or 21. CONCLUSION The MOS-R scores were stable when measured repeatedly in infants who were hospitalized in a NICU. Infants with high medical complexity had less stable MOS-R scores using certain cut points than infants with lower medical complexity.
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Affiliation(s)
- Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1100, Chicago, IL, 60611, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - David Aaby
- Department of Research Services, Northwestern University Libraries, Chicago, IL, USA; Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan Millman
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1100, Chicago, IL, 60611, USA
| | - Sarah Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL, USA
| | - Lynn Boswell
- Ann and Robert H Lurie Children's Hospital, Chicago, IL, USA
| | - Deborah Gaebler-Spira
- Ann and Robert H Lurie Children's Hospital, Chicago, IL, USA; Shirley Ryan AbilityLab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
| | - Raye-Ann de Regnier
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Ann and Robert H Lurie Children's Hospital, Chicago, IL, USA
| | | | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Suite 1100, Chicago, IL, 60611, USA; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Peyton C, Frazier M, Aaby D, Millman R, Rodriguez S, Boswell L, Msall ME, Spittle A, de Regnier RA, Barbosa VM, Sukal-Moulton T. Assessing Neonatal Intensive Care Unit (NICU) Graduates Across Varied Settings: A Study on the Feasibility of the Baby Moves App. J Pediatr 2024; 269:113979. [PMID: 38387754 DOI: 10.1016/j.jpeds.2024.113979] [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: 11/05/2023] [Revised: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024]
Abstract
We assessed the feasibility of obtaining parent-collected General Movement Assessment videos using the Baby Moves app. Among 261 participants from 4 Chicago NICUs, 70% submitted videos. Families living in higher areas of childhood opportunity used the app more than those from areas of lower opportunity.
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Affiliation(s)
- Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago IL; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Mech Frazier
- Department of Research Services, Northwestern University Libraries, Chicago, IL
| | - David Aaby
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - Ryan Millman
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Sarah Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, IL
| | - Lynn Boswell
- Ann and Robert H Lurie Children's Hospital, Chicago IL
| | - Michael E Msall
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Alicia Spittle
- Victorian Infant Brain Studies (VIBeS), Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Raye-Ann de Regnier
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Ann and Robert H Lurie Children's Hospital, Chicago IL
| | | | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago IL; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Taporoski TP, Beijamini F, Alexandria S, Aaby D, von Schantz M, Pereira AC, Knutson KL. Gender differences in the relationship between sleep and age in a Brazilian cohort: the Baependi Heart Study. J Sleep Res 2024:e14154. [PMID: 38286415 DOI: 10.1111/jsr.14154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/07/2023] [Accepted: 01/13/2024] [Indexed: 01/31/2024]
Abstract
Gender and age are well-established determinants of health and sleep health that influence overall health, which also often varies by gender and age. Sleep architecture is an important component of sleep health. The goal of this analysis was to examine whether associations between age and sleep stages differ by gender in the absence of moderate-severe obstructive sleep apnea (OSA) in a rural setting in Brazil. This study conducted polysomnography recordings in the Baependi Heart Study, a cohort of Brazilian adults. Our sample included 584 women and 309 men whose apnea-hypopnea index was ≤15 events/h. We used splines to distinguish non-linear associations between age, total sleep time, wake after sleep onset (WASO), N2, N3, and rapid-eye-movement sleep. The mean (standard deviation; range) age was 47 (14; 18-89) years. All sleep outcomes were associated with age. Compared to men, women had more N3 sleep and less WASO after adjusting for age. Model-based comparisons between genders at specific ages showed statistically higher mean WASO for men at ages 60 (+13.6 min) and 70 years (+19.5 min) and less N3 for men at ages 50 (-13.2 min), 60 (-19.0 min), and 70 years (-19.5 min) but no differences at 20, 30, 40 or 80 years. The other sleep measures did not differ by gender at any age. Thus, even in the absence of moderate-severe OSA, sleep architecture was associated with age across adulthood, and there were gender differences in WASO and N3 at older ages in this rural community.
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Affiliation(s)
- Tâmara P Taporoski
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Shaina Alexandria
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David Aaby
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Malcolm von Schantz
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Alexandre C Pereira
- Incor, University of São Paulo School of Medicine, São Paulo, Brazil
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristen L Knutson
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Andreoli M, Mackie MA, Aaby D, Tate MC. White matter tracts contribute selectively to cognitive functioning in patients with glioma. Front Oncol 2023; 13:1221753. [PMID: 37927476 PMCID: PMC10623310 DOI: 10.3389/fonc.2023.1221753] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Objective The functional organization of white matter (WM) tracts is not well characterized, especially in patients with intrinsic brain tumors where complex patterns of tissue injury, compression, and neuroplasticity may be present. This study uses diffusion tensor imaging (DTI) to investigate the relationships between WM tract disruption and cognitive deficits in glioma patients. Methods Seventy-nine patients with glioma underwent preoperative DTI and neuropsychological testing. Thirteen WM tracts were reconstructed bilaterally. Fractional anisotropy and streamline number were obtained for each tract as indices of connectivity. Univariate regression models were used to model the association between WM tract connectivity and neuropsychological outcomes. Results Glioma patients exhibited variable injury to WM tracts and variable cognitive deficits on validated neuropsychological tests. We identified 16 age-adjusted associations between WM tract integrity and neuropsychological function. The left inferior frontal-occipital fasciculus (IFOF) predicted list learning and dominant-hand fine motor dexterity. The right IFOF predicted non-dominant-hand fine motor dexterity and visuospatial index scores. The left inferior longitudinal fasciculus (ILF) predicted immediate memory list learning and index scores. The right ILF predicted non-dominant-hand fine motor dexterity and backward digit span scores. The left superior longitudinal fasciculus (SLF) I predicted processing speed. The left SLF III predicted list learning, immediate memory index scores, phonemic fluency, and verbal abstract reasoning. The left cingulum predicted processing speed. The right anterior AF predicted verbal abstract reasoning. Conclusion WM tract disruption predicts cognitive dysfunction in glioma patients. By improving knowledge of WM tract organization, this analysis may guide maximum surgical resection and functional preservation in glioma patients.
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Affiliation(s)
- Mia Andreoli
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Melissa-Ann Mackie
- Department of Neuropsychology, Northwestern Memorial Hospital, Chicago, IL, United States
| | - David Aaby
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Matthew C. Tate
- Department of Neurological Surgery and Neurology, Northwestern Memorial Hospital, Chicago, IL, United States
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Voss S, Adighibe A, Sanders E, Aaby D, Kravitt R, Clark G, Breen K, Barry A, Forrest GF, Kirshblum SC, Perez MA, Kalsi-Ryan S, Kocherginsky M, Rymer WZ, Sandhu MS. Development of a Remote Version of the Graded Redefined Assessment of Strength, Sensation, and Prehension (GRASSP): Validity and Reliability. Neurorehabil Neural Repair 2023; 37:83-93. [PMID: 36987396 PMCID: PMC10939131 DOI: 10.1177/15459683231162830] [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: 03/30/2023]
Abstract
BACKGROUND The Graded Redefined Assessment of Strength, Sensation, and Prehension (GRASSP V1.0) was developed in 2010 as a 3-domain assessment for upper extremity function after tetraplegia (domains: Strength, Sensibility, and Prehension). A remote version (rGRASSP) was created in response to the growing needs of the field of Telemedicine. OBJECTIVE The purpose of this study was to assess the psychometric properties of rGRASSP, establishing concurrent validity and inter-rater reliability. METHODS Individuals with tetraplegia (n = 61) completed 2 visits: 1 in-person and 1 remote. The first visit was completed in-person to administer the GRASSP, and the second visit was conducted remotely to administer the rGRASSP. The rGRASSP was scored both by the administrator of the rGRASSP (Examiner 1), and a second assessor (Examiner 2) to establish inter-rater reliability. Agreement between the in-person and remote GRASSP evaluations was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman agreement plots. RESULTS The remote GRASSP demonstrated excellent concurrent validity with the GRASSP (left hand intraclass correlation coefficient (ICC) = .96, right ICC = .96). Concurrent validity for the domains was excellent for strength (left ICC = .96, right ICC = .95), prehension ability (left ICC = .94, right ICC = .95), and prehension performance (left ICC = .92, right ICC = .93), and moderate for sensibility (left ICC = .59, right ICC = .68). Inter-rater reliability for rGRASSP total score was high (ICC = .99), and remained high for all 4 domains. Bland-Altman plots and limits of agreements support these findings. CONCLUSIONS The rGRASSP shows strong concurrent validity and inter-rater reliability, providing a psychometrically sound remote assessment for the upper extremity in individuals with tetraplegia.
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Affiliation(s)
| | | | | | - David Aaby
- Department of Preventative Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Gina Clark
- Shirley Ryan Ability Lab, Chicago, IL, USA
| | | | | | - Gail F. Forrest
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Steve C. Kirshblum
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Monica A. Perez
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Edward Hines Jr. VA Hospital, Hines, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Masha Kocherginsky
- Department of Preventative Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - William Zev Rymer
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Milap S. Sandhu
- Shirley Ryan Ability Lab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Klock J, Radakrishnan A, Runge MA, Aaby D, Milad MP. Body Image and Sexual Function Improve after Both Myomectomy and Hysterectomy for Symptomatic Fibroids. South Med J 2021; 114:733-738. [PMID: 34853847 DOI: 10.14423/smj.0000000000001326] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine the factors that influence the choice of myomectomy, uterine fibroid embolization (UFE), or hysterectomy in women with symptomatic uterine fibroids and to assess women's perception of body image and sexual functioning before and after treatment. METHODS In this prospective observational cohort pilot study, women scheduled to undergo hysterectomy, myomectomy, or UFE were surveyed before surgery and again at 3 to 6 months after their procedure to assess body image and sexual function using the validated 10-item Body Image Scale and 19-item Female Sexual Function Index. Logistic regression was used to determine predictive factors for surgery choice and paired t tests were used to determine changes in perceived sexual function and body image. RESULTS Of the 71 women surveyed, 69 underwent their scheduled procedure and 68 participants completed the preoperative questionnaire completely (98%). A total of 33 participants completed the postoperative questionnaire (49%). The predictive factor for hysterectomy versus myomectomy/UFE was older age (odds ratio 1.13, P = 0.017, 95% confidence interval [CI] 1.02-1.24). Regardless of surgery type, there were significant improvements in perceived body image and sexual function, including an increase in the overall sexual satisfaction of the participant (mean difference 0.50, P = 0.021, 95% CI 0.92-0.08) and less likely to feel less sexually attractive because of their menstrual bleeding problem (P < 0.0001, 95% CI 0.637-1.675). CONCLUSIONS Women of older age are more likely to choose hysterectomy over myomectomy or UFE for the treatment of symptomatic uterine fibroids. In addition, women who underwent any treatment for fibroids have increases in perception of body image and sexual functioning after their procedure.
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Affiliation(s)
- Julie Klock
- From the Creighton School of Medicine, Omaha, Nebraska, the Department of Obstetrics and Gynecology, and the Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankitha Radakrishnan
- From the Creighton School of Medicine, Omaha, Nebraska, the Department of Obstetrics and Gynecology, and the Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan Ada Runge
- From the Creighton School of Medicine, Omaha, Nebraska, the Department of Obstetrics and Gynecology, and the Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David Aaby
- From the Creighton School of Medicine, Omaha, Nebraska, the Department of Obstetrics and Gynecology, and the Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Magdy P Milad
- From the Creighton School of Medicine, Omaha, Nebraska, the Department of Obstetrics and Gynecology, and the Department of Preventative Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Aaby D, Siddique J. Effects of differential measurement error in self-reported diet in longitudinal lifestyle intervention studies. Int J Behav Nutr Phys Act 2021; 18:125. [PMID: 34530859 PMCID: PMC8447716 DOI: 10.1186/s12966-021-01184-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 08/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Lifestyle intervention studies often use self-reported measures of diet as an outcome variable to measure changes in dietary intake. The presence of measurement error in self-reported diet due to participant failure to accurately report their diet is well known. Less familiar to researchers is differential measurement error, where the nature of measurement error differs by treatment group and/or time. Differential measurement error is often present in intervention studies and can result in biased estimates of the treatment effect and reduced power to detect treatment effects. Investigators need to be aware of the impact of differential measurement error when designing intervention studies that use self-reported measures. Methods We use simulation to assess the consequences of differential measurement error on the ability to estimate treatment effects in a two-arm randomized trial with two time points. We simulate data under a variety of scenarios, focusing on how different factors affect power to detect a treatment effect, bias of the treatment effect, and coverage of the 95% confidence interval of the treatment effect. Simulations use realistic scenarios based on data from the Trials of Hypertension Prevention Study. Simulated sample sizes ranged from 110-380 per group. Results Realistic differential measurement error seen in lifestyle intervention studies can require an increased sample size to achieve 80% power to detect a treatment effect and may result in a biased estimate of the treatment effect. Conclusions Investigators designing intervention studies that use self-reported measures should take differential measurement error into account by increasing their sample size, incorporating an internal validation study, and/or identifying statistical methods to correct for differential measurement error.
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Affiliation(s)
- David Aaby
- Department of Preventive Medicine, Northwestern University, Chicago, Israel.
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University, Chicago, Israel
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Showalter K, Hoffmann A, Richardson C, Aaby D, Lee J, Dematte J, Agrawal R, Savas H, Wu X, Chang RW, Hinchcliff M. Esophageal Dilation and Other Clinical Factors Associated with Pulmonary Function Decline in Patients with Systemic Sclerosis. J Rheumatol 2021; 48:1830-1838. [PMID: 34266985 DOI: 10.3899/jrheum.210533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify clinical factors, including esophageal dilation on chest high-resolution computed tomography (HRCT), that are associated with pulmonary function decline in patients with systemic sclerosis (SSc). METHODS Patients fulfilled 2013 SSc criteria and had ≥1 HRCT and ≥2 pulmonary function tests (PFTs). According to published methods, widest esophageal diameter (WED) and radiographic interstitial lung disease (ILD) were assessed, and WED was dichotomized as dilated (≥19mm) vs. not dilated (<19mm). Clinically meaningful PFT decline was defined as %-predicted change in forced vital capacity (FVC) ≥5 and/or diffusion capacity for carbon monoxide (DLCO) ≥15. Linear mixed effect models were used to model PFT change over time. RESULTS 138 SSc patients met study criteria: 100 (72%) had radiographic ILD; 49 (35%) demonstrated FVC decline (median follow-up 2.9y). Patients with Scl-70 autoantibodies had 5- year %-predicted FVC decline (-6.3; 95% CI -9.9, -2.8), while patients without Scl-70 autoantibodies demonstrated 5-year FVC stability (+1.78; 95% CI -0.6, 4.15). Esophageal diameter did not distinguish between those with vs. without FVC decline. Patients with esophageal dilation had statistically significant 5-year %-predicted DLCO decline (-5.6; 95% CI - 10.0, -1.2), but this decline was unlikely clinically significant. Similar results were observed in sub-analysis of patients with radiographic ILD. CONCLUSION In patients with SSc, Scl-70 positivity is a risk factor for %-predicted FVC decline at five years. Esophageal dilation on HRCT was associated with a minimal, non-clinically significant decline in DLCO and no change in FVC during 5-year follow-up. These results have prognostic implications for SSc-ILD patients with esophageal dilation.
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Affiliation(s)
- Kimberly Showalter
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Aileen Hoffmann
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Carrie Richardson
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - David Aaby
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Jungwha Lee
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Jane Dematte
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Rishi Agrawal
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Hatice Savas
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Xiaoping Wu
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Rowland W Chang
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
| | - Monique Hinchcliff
- Northwestern University Feinberg School of Medicine Department of Medicine 240 E. Huron Street, Suite 1-200 Chicago, IL 60611; Hospital for Special Surgery Department of Medicine, Division of Rheumatology 535 E. 70th Street New York, NY 10021; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Rheumatology 240 E. Huron Street Suite M-300 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Preventive Medicine 680 N. Lake Shore Drive Suite 1400 Chicago, IL 60611; Northwestern University Feinberg School of Medicine Institute for Public Health and Medicine 633 N St. Clair 18th Floor Chicago, IL 60611; Northwestern University Feinberg School of Medicine Department of Medicine, Division of Pulmonary and Critical Care Medicine 240 E Huron, McGaw M-300; Northwestern University Feinberg School of Medicine Department of Radiology 251 E. Huron Street, 4th Floor Chicago, IL 60611; hNew York Presbyterian/Weill Cornell Department of Medicine, Division of Pulmonary and Critical Care Medicine 1305 York Ave, 10th floor, Y-1053 New York, NY 10065; Yale School of Medicine Department of Medicine, Section of Rheumatology, Allergy & Immunology The Anlyan Center 300 Cedar Street PO Box 208031 New Haven, CT 06520. Financial support: Research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers K23 AR059763 (MH), R01 AR073270 (MH), P60 AR064464 (RWC, KK, JL), and P30 AR072579 (RWC, JL) and National Center for Advancing Translational Sciences-Clinical and Translational Science Award Number UL1 TR000150 (JL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Rheumatology Research Foundation (KS), Scleroderma Foundation (KS), and the Scleroderma Research Foundation (MH) also supported this work. Corresponding author: Monique Hinchcliff, MD MS, Associate Professor of Medicine, Yale School of Medicine, Department of Medicine, Section of Allergy, Rheumatology & Immunology, The Anlyan Center, 300 Cedar Street, PO Box 208031, New Haven, CT 06520.
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10
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Siddique J, Welch WA, Aaby D, Sternfeld B, Pettee Gabriel K, Carnethon MR, Rana JS, Sidney S. Relative-Intensity Physical Activity and Its Association With Cardiometabolic Disease. J Am Heart Assoc 2021; 10:e019174. [PMID: 34259009 PMCID: PMC8483457 DOI: 10.1161/jaha.120.019174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Juned Siddique
- Department of Preventive Medicine Northwestern University Chicago IL
| | - Whitney A Welch
- Department of Preventive Medicine Northwestern University Chicago IL
| | - David Aaby
- Department of Preventive Medicine Northwestern University Chicago IL
| | - Barbara Sternfeld
- Division of Research Kaiser Permanente Northern California Oakland CA
| | | | | | - Jamal S Rana
- Division of Research Kaiser Permanente Northern California Oakland CA.,Department of Cardiology Kaiser Permanente Northern California Oakland CA
| | - Stephen Sidney
- Division of Research Kaiser Permanente Northern California Oakland CA
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11
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Lin AW, Baik SH, Aaby D, Tello L, Linville T, Alshurafa N, Spring B. eHealth Practices in Cancer Survivors With BMI in Overweight or Obese Categories: Latent Class Analysis Study. JMIR Cancer 2020; 6:e24137. [PMID: 33156810 PMCID: PMC7746487 DOI: 10.2196/24137] [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] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022] Open
Abstract
Background eHealth technologies have been found to facilitate health-promoting practices among cancer survivors with BMI in overweight or obese categories; however, little is known about their engagement with eHealth to promote weight management and facilitate patient-clinician communication. Objective The objective of this study was to determine whether eHealth use was associated with sociodemographic characteristics, as well as medical history and experiences (ie, patient-related factors) among cancer survivors with BMI in overweight or obese categories. Methods Data were analyzed from a nationally representative cross-sectional survey (National Cancer Institute’s Health Information National Trends Survey). Latent class analysis was used to derive distinct classes among cancer survivors based on sociodemographic characteristics, medical attributes, and medical experiences. Logistic regression was used to examine whether class membership was associated with different eHealth practices. Results Three distinct classes of cancer survivors with BMI in overweight or obese categories emerged: younger with no comorbidities, younger with comorbidities, and older with comorbidities. Compared to the other classes, the younger with comorbidities class had the highest probability of identifying as female (73%) and Hispanic (46%) and feeling that clinicians did not address their concerns (75%). The older with comorbidities class was 6.5 times more likely than the younger with comorbidities class to share eHealth data with a clinician (odds ratio [OR] 6.53, 95% CI 1.08-39.43). In contrast, the younger with no comorbidities class had a higher likelihood of using a computer to look for health information (OR 1.93, 95% CI 1.10-3.38), using an electronic device to track progress toward a health-related goal (OR 2.02, 95% CI 1.08-3.79), and using the internet to watch health-related YouTube videos (OR 2.70, 95% CI 1.52-4.81) than the older with comorbidities class. Conclusions Class membership was associated with different patterns of eHealth engagement, indicating the importance of tailored digital strategies for delivering effective care. Future eHealth weight loss interventions should investigate strategies to engage younger cancer survivors with comorbidities and address racial and ethnic disparities in eHealth use.
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Affiliation(s)
- Annie Wen Lin
- Department of Nutrition, Benedictine University, Lisle, IL, United States.,Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Sharon H Baik
- Department of Supportive Care Medicine, City of Hope Medical Cancer Center, Duarte, CA, United States.,Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - David Aaby
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Leslie Tello
- Department of Nutrition, Benedictine University, Lisle, IL, United States
| | - Twila Linville
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Nabil Alshurafa
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
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Lin E, Runge M, Aaby D, Traylor J, Nixon K, Chaudhari A, Tsai S, Trinkus V, DeStephano C, Milad M. Comparing Proficiency of Laparoscopic Vaginal Cuff Suturing in Naïve Learners after Training with Two Different Laparoscopic Simulators. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.304] [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: 10/23/2022]
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Lin E, Runge M, Aaby D, Duyar S, Traylor J, Nixon K, Chaudhari A, Tsai S, Trinkus V, DeStephano C, Milad M. Comparing Participant-Reported Confidence during Laparoscopic Vaginal Cuff Suturing after Training with Two Laparoscopic Simulators. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.593] [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: 10/23/2022]
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Guo XM, Runge M, Miller D, Aaby D, Milad M. A bundled intervention lowers surgical site infection in hysterectomy for benign and malignant indications. Int J Gynaecol Obstet 2020; 150:392-397. [DOI: 10.1002/ijgo.13257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/22/2020] [Accepted: 06/01/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Xiaoyue Mona Guo
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Megan Runge
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Deborah Miller
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - David Aaby
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Magdy Milad
- Department of Obstetrics and Gynecology Northwestern University Feinberg School of Medicine Chicago IL USA
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Barone Gibbs B, Aaby D, Siddique J, Reis JP, Sternfeld B, Whitaker K, Pettee Gabriel K. Bidirectional 10-year associations of accelerometer-measured sedentary behavior and activity categories with weight among middle-aged adults. Int J Obes (Lond) 2020; 44:559-567. [PMID: 31462688 PMCID: PMC7047540 DOI: 10.1038/s41366-019-0443-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/26/2019] [Accepted: 07/19/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although higher sedentary behavior (SB) with low light intensity (LPA) and moderate-to-vigorous intensity physical activity (MVPA) are thought to increase risk for obesity, other data suggest excess weight may precede these behaviors in the causal pathway. We aimed to investigate 10-year bidirectional associations between SB and activity with weight. METHODS Analysis included 886 CARDIA participants (aged 38-50 years, 62% female, 38% black) with weight and accelerometry ( ≥ 4 days with ≥ 10 h/day) collected in 2005-6 (ActiGraph 7164) and 2015-6 (ActiGraph wGT3X-BT). Accelerometer data were calibrated, harmonized, and expressed as counts per minute (cpm) and time-dependent intensity categories (min/day of SB, LPA, and MVPA; SB and MVPA were also separated into long-bout and short-bout categories). Linear regression models were constructed to estimate adjusted associations of baseline activity with 10-year change in weight and vice versa. When activity categories were the independent variables, standardized regression coefficients (βstd.) estimated associations of replacing SB with a one SD increase in other categories, adjusted for accelerometer wear time. RESULTS Over 10-years, weight increased by a mean 2.55 ± 8.05 kg and mean total activity decreased by 50 ± 153 cpm. In adjusted models, one SD higher baseline mean total activity (βstd. = -1.4 kg, p < 0.001), LPA (βstd. = -0.80 kg, p = 0.013), total MVPA (βstd. = -1.07 kg, p = 0.001), and long-bout MVPA (βstd. = -1.20 kg, p < 0.001) were associated with attenuated 10-year weight gain. Conversely, a one SD higher baseline weight was associated with unfavorable 10-year changes in daily activity profile including increases in SB (βstd. = 12.0 min, p < 0.001) and decreases in mean total activity (βstd. = 14.9 cpm, p = 0.004), LPA (βstd. = 8.9, p = 0.002), and MVPA (βstd. = 3.5 min, p = 0.001). Associations varied by race and gender. CONCLUSIONS Higher SB with lower activity and body weight were bidirectionally related. Interventions that work simultaneously to replace SB with LPA and long-bout MVPA while also using other methods to address excess weight may be optimal.
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Affiliation(s)
- Bethany Barone Gibbs
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA, USA.
| | - David Aaby
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Barbara Sternfeld
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Kara Whitaker
- Department of Health and Human Physiology, Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health- Austin Campus, and Department of Women's Health Dell Medical School, University of Texas at Austin, Austin, TX, USA
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Siddique J, Aaby D, Montag SE, Sidney S, Sternfeld B, Welch WA, Carnethon MR, Liu K, Craft LL, Gabriel KP, Gibbs BB, Reis JP, Freedson P. Individualized Relative-Intensity Physical Activity Accelerometer Cut Points. Med Sci Sports Exerc 2020; 52:398-407. [PMID: 31524826 PMCID: PMC6962549 DOI: 10.1249/mss.0000000000002153] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE Physical activity (PA) intensity is expressed as either absolute or relative intensity. Absolute intensity refers to the energy required to perform an activity. Relative intensity refers to a level of effort that takes into account how hard an individual is working relative to their maximum capacity. We sought to develop methods for obtaining individualized relative-intensity accelerometer cut points using data from a maximal graded exercise treadmill test (GXT) so that each individual has their own cut point. METHODS A total of 2363 men and women 38 to 50 yr old from the CARDIA fitness study wore ActiGraph 7164 accelerometers during a maximal GXT and for seven consecutive days in 2005-2006. Using mixed-effects regression models, we regressed accelerometer counts on heart rate as a percentage of maximum (%HRmax) and on RPE. Based on these two models, we obtained a moderate-intensity (%HRmax = 64% or RPE = 12) count cut point that is specific to each participant. We applied these subject-specific cut points to the available CARDIA accelerometer data. RESULTS Using RPE, the mean moderate-intensity accelerometer cut point was 4004 (SD = 1120) counts per minute. On average, cut points were higher for men (4189 counts per minute) versus women (3865 counts per minute) and were higher for Whites (4088 counts per minute) versus African Americans (3896 counts per minute). Cut points were correlated with body mass index (rho = -0.11) and GXT duration (rho = 0.33). Mean daily minutes of absolute- and relative-intensity moderate to vigorous PA were 34.1 (SD = 31.1) min·d and 9.1 (SD = 18.2) min·d, respectively. RPE cut points were higher than those based on %HRmax. This is likely due to some participants ending the GXT before achieving their HRmax. CONCLUSIONS Accelerometer-based relative-intensity PA may be a useful measure of intensity relative to maximal capacity.
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Affiliation(s)
- Juned Siddique
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Aaby
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Samantha E. Montag
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Barbara Sternfeld
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Whitney A. Welch
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mercedes R. Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Kelley Pettee Gabriel
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center, School of Public Health in Austin, Austin, TX
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
| | - Jared P. Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Patty Freedson
- Department of Kinesiology, University of Massachusetts-Amherst, Amherst, MA
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Quinn TD, Pettee Gabriel K, Siddique J, Aaby D, Whitaker KM, Lane-Cordova A, Sidney S, Sternfield B, Barone Gibbs B. Sedentary Time and Physical Activity Across Occupational Classifications. Am J Health Promot 2019; 34:247-256. [PMID: 31726849 DOI: 10.1177/0890117119885518] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To examine differences in activity patterns across employment and occupational classifications. DESIGN Cross-sectional. SETTING A 2005-2006 Coronary Artery Risk Development in Young Adults (CARDIA) study. SAMPLE Participants with valid accelerometry data (n = 2068). MEASURES Uniaxial accelerometry data (ActiGraph 7164), accumulated during waking hours, were summarized as mean activity counts (counts/min) and time spent (min/d) in long-bout sedentary (≥30 minutes, SED≥30), short-bout sedentary (<30 minutes, SED<30), light physical activity (LPA), short-bout moderate-to-vigorous physical activity (<10 minutes, MVPA<10), and long-bout MVPA (≥10 minutes, MVPA≥10) using Freedson cut-points. Employment status was self-reported as full time, part time, unemployed, keeping house, or raising children. Self-reported job duties were categorized into 23 major groups using the 2010 Standard Occupational Classification. ANALYSIS Omnibus differences were analyzed using adjusted analysis of covariance and repeated after stratification by race (black/white) and sex (female/male). RESULTS SED≥30, SED<30, LPA, and MVPA<10 differed significantly by employment and occupational categories (P ≤ .05), while MVPA≥10 did not (P ≥ .50). SED≥30, SED<30, and LPA differed by occupational classification in men, women, blacks, and whites (P < .05). Mean activity counts, MVPA<10, and MVPA≥10 were significantly different across occupational classifications in whites (P ≤ .05), but not in blacks (P > .05). Significant differences in mean activity counts and MVPA<10 across occupational classifications were found in males (P ≤ .001), but not in females (P > .05). CONCLUSION Time within activity intensity categories differs across employment and occupational classifications and by race and sex.
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Affiliation(s)
- Tyler D Quinn
- Department of Health and Physical Activity, University of Pittsburgh, PA, USA
| | | | - Juned Siddique
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Aaby
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kara M Whitaker
- Department of Health and Human Physiology, University of Iowa, IA, USA
| | - Abbi Lane-Cordova
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Barbara Sternfield
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Quinn TD, Pettee Gabriel K, Siddique J, Aaby D, Whitaker K, Lane-Cordova A, Sidney S, Sternfield B, Gibbs BB. Accelerometer-determined Sedentary Time And Physical Activity Across Standard Occupational Categories In CARDIA. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562121.25474.3a] [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: 11/21/2022]
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Showalter K, Hoffmann A, Rouleau G, Aaby D, Lee J, Richardson C, Dematte J, Agrawal R, Chang RW, Hinchcliff M. Performance of Forced Vital Capacity and Lung Diffusion Cutpoints for Associated Radiographic Interstitial Lung Disease in Systemic Sclerosis. J Rheumatol 2018; 45:1572-1576. [PMID: 30275265 DOI: 10.3899/jrheum.171362] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Forced vital capacity (FVC) and DLCO are used for screening of systemic sclerosis-associated interstitial lung disease (SSc-ILD). The study purpose was to determine the sensitivity, specificity, and negative predictive value (NPV) (proportion of true negative screening tests) of FVC and DLCO thresholds for SSc-ILD on chest high-resolution computed tomography (HRCT) scans. METHODS Patients fulfilling American College of Rheumatology 2013 SSc criteria with a chest HRCT scan and pulmonary function tests (PFT) were studied. A thoracic radiologist quantified radiographic ILD. Optimal FVC and DLCO % predicted thresholds for ILD were identified using receiver-operating characteristic curves. The FVC and DLCO combinations with greatest sensitivity and specificity were also determined. Subanalysis was performed in patients with positive Scl-70 autoantibodies. RESULTS The study included 265 patients. Of 188 (71%) with radiographic ILD, 59 (31%) had "normal" FVC (≥ 80% predicted), and 65 out of 151 (43%) had "normal" DLCO (≥ 60% predicted). FVC < 80% (sensitivity 0.69, specificity 0.73), and DLCO < 62% (sensitivity 0.60, specificity 0.70) were optimal thresholds for radiographic SSc-ILD. All FVC and DLCO threshold combinations evaluated had NPV < 0.70. The NPV for radiographic ILD for FVC < 80% was lower in patients with positive Scl-70 autoantibody (NPV = 0.05) compared to negative Scl-70 autoantibody (NPV = 0.57). CONCLUSION Radiographic ILD is prevalent in SSc despite "normal" PFT. No % predicted FVC or DLCO threshold combinations yielded high NPV for SSc-ILD screening. "Normal" FVC and DLCO in patients with SSc, especially those with positive Scl-70 autoantibodies, should not obviate consideration of HRCT for ILD evaluation.
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Affiliation(s)
- Kimberly Showalter
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Aileen Hoffmann
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Gerald Rouleau
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - David Aaby
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Jungwha Lee
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Carrie Richardson
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Jane Dematte
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Rishi Agrawal
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Rowland W Chang
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine
| | - Monique Hinchcliff
- From the Department of Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care Medicine, Department of Preventive Medicine, Institute for Public Health and Medicine, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. .,K. Showalter, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; A. Hoffmann, MS, Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine; G. Rouleau, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; D. Aaby, MS, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine; J. Lee, PhD, MPH, Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; C. Richardson, MD, Department of Medicine, Northwestern University Feinberg School of Medicine; J. Dematte, MD, MBA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine; R. Agrawal, MD, Department of Radiology, Northwestern University Feinberg School of Medicine; R.W. Chang, MD, MPH, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine; M. Hinchcliff, MD, MS, Department of Medicine, Division of Rheumatology, and Department of Preventive Medicine, and Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine.
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