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Cohen GH, Wang R, Rosenberg SB, Sampson L, Lowe SR, Cabral H, Ruggiero K, Galea S. Neighborhood-level economic characteristics and depression and PTSD symptoms among Houstonians who have experienced Hurricane Harvey and COVID-19. Psychiatry Res 2024; 333:115766. [PMID: 38335779 PMCID: PMC10964477 DOI: 10.1016/j.psychres.2024.115766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Little is known about how neighborhood economic characteristics relate to risk of depression and Posttraumatic Stress Disorder (PTSD) in the context of multiple disasters. We sampled 88 super neighborhoods in Houston, Texas and surveyed 872 residents who were living in Houston during Hurricane Harvey and COVID-19 and lived in the same residence since Hurricane Harvey, about their demographics and symptoms of depression and PTSD. Using data from the American Community Survey, we estimated neighborhood-level unemployment, median income, and income inequality (i.e., Gini coefficient). We investigated whether these underlying neighborhood socioeconomic factors were associated with the mental health consequences of mass traumatic events. We examined associations between neighborhood-level constructs and individual-level depression and PTSD, using multilevel linear models. Partially adjusted multilevel models showed that lower neighborhood median income was associated with higher symptom scores of PTSD, while greater neighborhood income inequality was associated with higher symptom scores of depression and PTSD. However, fully adjusted models showed that these associations are better accounted for by event-specific stressors and traumas. These findings suggest that in the context of multiple large scale traumatic events, neighborhood socioeconomic context may structure individual-level exposure to stressful and traumatic events.
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Affiliation(s)
- Gregory H Cohen
- Boston University School of Public Health, Department of Epidemiology 715 Albany St., Boston, MA 02118, United States.
| | - Ruochen Wang
- Boston University School of Public Health, Department of Epidemiology 715 Albany St., Boston, MA 02118, United States
| | - Samuel B Rosenberg
- Boston University School of Public Health, Department of Epidemiology 715 Albany St., Boston, MA 02118, United States
| | - Laura Sampson
- Renaissance School of Medicine, Stony Brook University, Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook, New York, United States
| | - Sarah R Lowe
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, Connecticut, United States
| | - Howard Cabral
- Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts, United States
| | - Kenneth Ruggiero
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina, United States
| | - Sandro Galea
- Boston University School of Public Health, Dean's Office, Boston, Massachusetts, United States
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2
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Cheng K, Lee C, Garniene R, Cabral H, Weber HC. Epidemiology of Irritable Bowel Syndrome in a Large Academic Safety-Net Hospital. J Clin Med 2024; 13:1314. [PMID: 38592187 PMCID: PMC10932219 DOI: 10.3390/jcm13051314] [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: 12/11/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut-brain interaction (DGBI) that is known to reduce the quality of life and raise healthcare costs. The aim of this study was to describe the epidemiology of IBS in a large multiracial academic safety-net hospital. (2) Methods: An electronic query was performed using ICD-9 codes to identify 740 IBS outpatients seen at the Boston Medical Center (BMC) between 1 January 2005 and 30 September 2007. Demographic data were collected from electronic medical records. Bivariate analyses using chi-square tests and ANOVA were used to calculate the significance of categorical and continuous dependent variables, respectively. (3) Results: Compared with the general BMC outpatient population, the IBS cohort consisted of significantly higher proportions of White and Asian patients and lower proportions of Black and Hispanic patients (p < 0.0001). White and Asian patients predominantly had private insurance, while Black and Hispanic patients mostly had government/state-funded or no insurance (p < 0.0001). The IBS subgroup frequencies were similar across racial groups; however, Hispanic patients had IBS with constipation (32%, p < 0.02) more often compared to non-Hispanic patients. (4) Conclusions: Significant differences were found across the racial groups studied in this large outpatient IBS cohort. These findings are likely attributed to racial and socioeconomic disparities in healthcare access and utilization.
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Affiliation(s)
- Kathleen Cheng
- Department of Medicine, Boston Medical Center, Boston, MA 02118, USA
| | - Christina Lee
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02118, USA
| | | | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Horst Christian Weber
- Department of Medicine, Boston Medical Center, Boston, MA 02118, USA
- Section of Gastroenterology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA 02218, USA
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3
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Dia M, Albrecht MM, Sanayei N, Cabral H, Martin DC, Subramanian ML, Ness S, Siegel NH, Desai M, Chen X. Patient Satisfaction with the Hybrid Telemedicine Model for Ophthalmology. Telemed J E Health 2024; 30:499-508. [PMID: 37651189 DOI: 10.1089/tmj.2023.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background: The purpose of this research was to compare patient satisfaction between hybrid ophthalmology telemedicine and standard-of-care in-person visits. A retrospective, cross-sectional, case-control analysis of patient satisfaction based on survey data was used. Methods: Responses to the National Research Council Health Patient Survey were retrieved for randomly sampled hybrid ophthalmology telemedicine and in-person visits between March 11, 2020 and December 31, 2021 at a hospital-based eye clinic in Boston, Massachusetts. The primary outcome was based on the question "How likely would you be to recommend this provider to your family and friends?" (0-10 scale) with a score of 9 or 10 coded as satisfied. Two-sample t-tests, Pearson's chi-square tests, and bivariate logistic regressions were used to compare patient satisfaction scores between the hybrid and in-person cohorts. Demographic data, including age, sex, language, and self-reported race and ethnicity, were used as potential predictors of patient satisfaction in a multivariable logistic regression model. Results: There were 49 surveys from hybrid visits and 3,390 surveys from in-person visits. Hybrid visit patients reported high satisfaction scores without significant differences compared to in-person visit patients (hybrid 79% satisfied, in-person 82% satisfied, p = 0.728). Age was significantly associated with satisfaction in the hybrid cohort with the 65+ age group reporting lower satisfaction (below 65 years 100% satisfied, 65+ years 60% satisfied, p = 0.003). No association with age was observed in the in-person cohort. Conclusions: The hybrid ophthalmology telemedicine model can provide effective care without sacrificing patient satisfaction. Older patients may benefit from targeted interventions in future telemedicine models.
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Affiliation(s)
- Manal Dia
- Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Nedda Sanayei
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Diana C Martin
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Manju L Subramanian
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Steven Ness
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nicole H Siegel
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Manishi Desai
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Xuejing Chen
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts, USA
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4
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Schulte PJ, Goldberg JD, Oster RA, Ambrosius WT, Bonner LB, Cabral H, Carter RE, Chen Y, Desai M, Li D, Lindsell CJ, Pomann GM, Slade E, Tosteson TD, Yu F, Spratt H. Peer review of clinical and translational research manuscripts: Perspectives from statistical collaborators. J Clin Transl Sci 2024; 8:e20. [PMID: 38384899 PMCID: PMC10879991 DOI: 10.1017/cts.2023.707] [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: 08/23/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 02/23/2024] Open
Abstract
Research articles in the clinical and translational science literature commonly use quantitative data to inform evaluation of interventions, learn about the etiology of disease, or develop methods for diagnostic testing or risk prediction of future events. The peer review process must evaluate the methodology used therein, including use of quantitative statistical methods. In this manuscript, we provide guidance for peer reviewers tasked with assessing quantitative methodology, intended to complement guidelines and recommendations that exist for manuscript authors. We describe components of clinical and translational science research manuscripts that require assessment including study design and hypothesis evaluation, sampling and data acquisition, interventions (for studies that include an intervention), measurement of data, statistical analysis methods, presentation of the study results, and interpretation of the study results. For each component, we describe what reviewers should look for and assess; how reviewers should provide helpful comments for fixable errors or omissions; and how reviewers should communicate uncorrectable and irreparable errors. We then discuss the critical concepts of transparency and acceptance/revision guidelines when communicating with responsible journal editors.
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Affiliation(s)
- Phillip J. Schulte
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Judith D. Goldberg
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Robert A. Oster
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Walter T. Ambrosius
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lauren Balmert Bonner
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Rickey E. Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Ye Chen
- Biostatistics, Epidemiology and Research Design (BERD), Tufts Clinical and Translational Science Institute (CTSI), Boston, MA, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Departments of Medicine, Biomedical Data Science, and Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Dongmei Li
- Department of Clinical and Translational Research, Obstetrics and Gynecology and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Gina-Maria Pomann
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Emily Slade
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Tor D. Tosteson
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Fang Yu
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Heidi Spratt
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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Vazirani A, Rodriguez A, Pavesi F, McDermott S, Cabral H, Billatos E, Suzuki K. Black race and lower age at surgery are associated with smoking relapse in a safety-net setting after surgery for stage I non-small cell lung cancer. J Thorac Dis 2023; 15:4757-4764. [PMID: 37868906 PMCID: PMC10586932 DOI: 10.21037/jtd-23-392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/21/2023] [Indexed: 10/24/2023]
Abstract
Background Smoking relapse after surgical resection for lung cancer (LC) remains a health concern. This study aims to determine various factors associated with postoperative smoking relapse in patients undergoing surgical resection for stage I non-small cell lung cancer (NSCLC) at an urban safety net hospital. Methods We analyzed the demographic and clinical variables of all patients who underwent surgical resection for stage I NSCLC from 2002 to 2016 at our institution. Based on the post-operative smoking history, we segregated the cohort into two groups: relapse and abstinent. Chi-squared and analysis of variance tests were used to identify the variables that registered a significant difference between the two groups. Further, we used univariable and multivariable logistic regression to determine association between variables and smoking relapse. Results We analyzed data from 168 patients, excluding those with inadequate smoking history and never smokers. In total, 64 (38.1%) patients experienced smoking relapse, and 104 (61.9%) remained abstinent. The age, annual income, and race showed significant differences between the two groups. Multivariable logistic regression reflected that black patients had higher odds of relapse than white patients [odds ratio (OR) =3.26, confidence interval (CI): 1.54-6.89, P=0.002] and the chances of relapse decreased as the age increased (5-year age gap, OR =0.70, CI: 0.58-0.85, P<0.001). Conclusions Black race and younger age at the time of surgery are associated with smoking relapse after surgery for stage I NSCLC. Targeted smoking cessation programs catered towards these patient groups may help reduce the prevalence of post-operative smoking.
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Affiliation(s)
- Aniket Vazirani
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Flaminio Pavesi
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Shannon McDermott
- Department of Computational Biomedicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ehab Billatos
- Department of Pulmonary Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Kei Suzuki
- Department of Surgery, Thoracic Surgery, Inova, Fairfax, VA, USA
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Mottl-Santiago J, Dukhovny D, Cabral H, Rodrigues D, Spencer L, Valle EA, Feinberg E. Effectiveness of an Enhanced Community Doula Intervention in a Safety Net Setting: A Randomized Controlled Trial. Health Equity 2023; 7:466-476. [PMID: 37731785 PMCID: PMC10507922 DOI: 10.1089/heq.2022.0200] [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] [Accepted: 07/10/2023] [Indexed: 09/22/2023] Open
Abstract
Background Racial inequities in maternal health outcomes, the result of systemic racism and social determinants of health, require maternity care systems to implement interventions that reduce disparities. One such approach may be support from a community doula, a health worker who provides emotional support, peer education, navigation, and advocacy for pregnant, birthing, and postpartum people who share similar racial identities, cultural backgrounds, and/or lived experiences. While community support during birth has a long tradition within communities of Black Indigenous and People of Color (BIPOC), the reframing of community doula support as a social intervention that reduces disparities in clinical outcomes is recent. Methods We conducted a pragmatic randomized trial at an urban safety net hospital, comparing standard maternity care with standard care plus enhanced community doula support. We tested the effectiveness of a community doula program embedded in a safety net hospital in improving birth outcomes and explored the association between community doula support and health equity. Participants were nulliparous, insured by publicly funded health plans, and had lower risk pregnancies. The primary outcome was cesarean birth. Secondary outcomes included preterm birth and breastfeeding outcomes. Exploratory subgroup analysis was conducted by race-ethnicity. Results Three hundred sixty-seven participants were included in the primary analysis. In the intent-to-treat analysis, outcomes were similar between groups. There was a trend toward increased breastfeeding initiation (p=0.08). There was a statistically nonsignificant 12% absolute reduction in cesarean birth and 11.5% increase in exclusive breastfeeding during delivery hospitalization among Black non-Hispanic participants. Discussion While outcomes for the study sample were similar between randomization groups, health outcomes were improved for Black birthing people in cesarean and breastfeeding rates. Conclusion This study demonstrates the need for larger studies of community doula support for Black birthing people. Clinicaltrials.gov ID: NCT02550730.
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Affiliation(s)
- Julie Mottl-Santiago
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts, USA
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Dona Rodrigues
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts, USA
| | - Linda Spencer
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts, USA
| | - Eduardo A. Valle
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts, USA
| | - Emily Feinberg
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
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7
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Idrees N, Haroon S, Zhang Y, Mangio JC, Siracuse JJ, Francis JM, Ganguli S, Daly K, Diamond M, Vilvendhan R, Cabral H, Dember LM, Farber A, Kolachalama VB, Chitalia VC. Contrast Venography Versus Intravenous Ultrasound in Hemodialysis Arteriovenous Access Dysfunction. Kidney Int Rep 2023; 8:1887-1891. [PMID: 37705907 PMCID: PMC10496077 DOI: 10.1016/j.ekir.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Najia Idrees
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Veterans Affairs Boston Healthcare System, Boston MA 02118, USA
| | - Samir Haroon
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Yichi Zhang
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Joanna Crisa Mangio
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jeffrey J. Siracuse
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jean M. Francis
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Suvranu Ganguli
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kevin Daly
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Matthew Diamond
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rajendran Vilvendhan
- Department of Radiology, Interventional Radiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Howard Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Laura M. Dember
- Renal-Electrolyte and Hypertension Division, Department of Medicine; Center for Clinical Epidemiology and Biostatistics; and Department of Biostatistics, Epidemiology and Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Vijaya B. Kolachalama
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, Massachusetts, USA
| | - Vipul C. Chitalia
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Veterans Affairs Boston Healthcare System, Boston MA 02118, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
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8
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Cohen GH, Wang R, Sampson L, Lowe SR, Ettman CK, Abdalla SM, Wellenius GA, Cabral H, Ruggiero K, Galea S. Depression and PTSD among Houston Residents who Experienced Hurricane Harvey and COVID-19: Implications for Urban Areas Affected by Multiple Disasters. J Urban Health 2023; 100:860-869. [PMID: 37550501 PMCID: PMC10447846 DOI: 10.1007/s11524-023-00767-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/09/2023]
Abstract
Little is known about the combined impact of the COVID-19 pandemic and other major disasters on mental health. Hurricane Harvey hit the Gulf Coast in 2017, resulting in substantial costs, significant levels of displacement, and approximately 100 deaths, and was followed in 2020 by the COVID-19 pandemic. We randomly sampled 1167 Houstonians from 88 designated super-neighborhoods and surveyed them about their demographics, event-specific traumas and stressors, and symptoms of current depression and post-traumatic stress disorder (PTSD). We estimated the prevalence of depression (5.8%) and PTSD (12.6%) more than three years after Hurricane Harvey, and assessed the relative influence of event-specific stressors and traumas on current mental health. Overall, we observed evidence for two key findings that are salient for residents of urban environments in the context of multiple disasters. First, stressors were primary influences on depression, whereas both stressors and traumas influenced PTSD. Second, the influences of stressors and traumas on depression and PTSD symptoms faded with time.
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Affiliation(s)
- Gregory H Cohen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Ruochen Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Laura Sampson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Catherine K Ettman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Salma M Abdalla
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Kenneth Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Dean's Office, Boston University School of Public Health, Boston, MA, USA
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9
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Meadows AR, Cabral H, Liu CL, Cui X, Amutah-Onukagha N, Diop H, Declercq ER. Preconception and perinatal hospitalizations as indicators of risk for severe maternal morbidity in primiparas. Am J Obstet Gynecol MFM 2023; 5:101014. [PMID: 37178717 PMCID: PMC10367434 DOI: 10.1016/j.ajogmf.2023.101014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Severe maternal morbidity includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman's health. A statewide longitudinally linked database was used to examine hospitalization during and before pregnancy for birthing people with severe maternal morbidity at delivery. OBJECTIVE This study aimed to examine the association between hospital visits during pregnancy and 1 to 5 years before pregnancy and severe maternal morbidity at delivery. STUDY DESIGN This study was a retrospective, population-based cohort analysis of the Massachusetts Pregnancy to Early Life Longitudinal database between January 1, 2004, and December 31, 2018. Nonbirth hospital visits, including emergency department visits, observational stays, and hospital admissions during pregnancy and 5 years before pregnancy, were identified. The diagnoses for hospitalizations were categorized. We compared medical conditions leading to antecedent, nonbirth hospital visits among primiparous birthing individuals with singleton births with and without severe maternal morbidity, excluding transfusions. RESULTS Of 235,398 birthing individuals, 2120 had severe maternal morbidity, a rate of 90.1 cases per 10,000 deliveries, and 233,278 did not have severe maternal morbidity. Compared with 4.3% of patients without severe maternal morbidity, 10.4% of patients with severe maternal morbidity were hospitalized during pregnancy. In multivariable analysis, there was a 31% increased risk of hospital admission during the prenatal period, a 60% increased risk of hospital admission in the year before pregnancy, and a 41% increased risk of hospital admission in 2 to 5 years before pregnancy. Compared with 9.8% of non-Hispanic White birthing people, 14.9% of non-Hispanic Black birthing people with severe maternal morbidity experienced a hospital admission during pregnancy. For those with severe maternal morbidity, prenatal hospitalization was most common for those with endocrine (3.6%) or hematologic (3.3%) conditions, with the largest differences between those with and without severe maternal morbidity for musculoskeletal (relative risk, 9.82; 95% confidence interval, 7.06-13.64) and cardiovascular (relative risk, 9.73; 95% confidence interval, 7.26-13.03) conditions. CONCLUSION This study found a strong association between previous nonbirth hospitalizations and the likelihood of severe maternal morbidity at delivery.
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Affiliation(s)
- Audra R Meadows
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, San Diego, CA (Dr Meadows)
| | - Howard Cabral
- Boston University School of Public Health, Boston, MA (Drs Cabral and Declercq)
| | | | - Xiaohui Cui
- Massachusetts Department of Public Health, Boston, MA (Drs Cui and Diop)
| | | | - Hafsatou Diop
- Massachusetts Department of Public Health, Boston, MA (Drs Cui and Diop)
| | - Eugene R Declercq
- Boston University School of Public Health, Boston, MA (Drs Cabral and Declercq).
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10
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Streed CG, King D, Grasso C, Reisner SL, Mayer KH, Jasuja GK, Poteat T, Mukherjee M, Shapira-Daniels A, Cabral H, Tangpricha V, Paasche-Orlow MK, Benjamin EJ. Validation of an administrative algorithm for transgender and gender diverse persons against self-report data in electronic health records. J Am Med Inform Assoc 2023; 30:1047-1055. [PMID: 36921287 PMCID: PMC10198536 DOI: 10.1093/jamia/ocad039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE To adapt and validate an algorithm to ascertain transgender and gender diverse (TGD) patients within electronic health record (EHR) data. METHODS Using a previously unvalidated algorithm of identifying TGD persons within administrative claims data in a multistep, hierarchical process, we validated this algorithm in an EHR data set with self-reported gender identity. RESULTS Within an EHR data set of 52 746 adults with self-reported gender identity (gold standard) a previously unvalidated algorithm to identify TGD persons via TGD-related diagnosis and procedure codes, and gender-affirming hormone therapy prescription data had a sensitivity of 87.3% (95% confidence interval [CI] 86.4-88.2), specificity of 98.7% (95% CI 98.6-98.8), positive predictive value (PPV) of 88.7% (95% CI 87.9-89.4), and negative predictive value (NPV) of 98.5% (95% CI 98.4-98.6). The area under the curve (AUC) was 0.930 (95% CI 0.925-0.935). Steps to further categorize patients as presumably TGD men versus women based on prescription data performed well: sensitivity of 97.6%, specificity of 92.7%, PPV of 93.2%, and NPV of 97.4%. The AUC was 0.95 (95% CI 0.94-0.96). CONCLUSIONS In the absence of self-reported gender identity data, an algorithm to identify TGD patients in administrative data using TGD-related diagnosis and procedure codes, and gender-affirming hormone prescriptions performs well.
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Affiliation(s)
- Carl G Streed
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Guneet K Jasuja
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Howard Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Emelia J Benjamin
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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11
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Elansary M, Kistin CJ, Antonio J, Fernández-Pastrana I, Lee-Parritz A, Cabral H, Miller ES, Silverstein M. Effect of Immediate Referral vs a Brief Problem-solving Intervention for Screen-Detected Peripartum Depression: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2313151. [PMID: 37171819 PMCID: PMC10182435 DOI: 10.1001/jamanetworkopen.2023.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance The US Preventive Services Task Force recommends screening adults for depression in settings with programs in place to ensure receipt of appropriate care. Best practices regarding how to ensure such care are unknown, particularly for pregnant and postpartum persons. Objective To compare the effectiveness of 2 strategies for the initial management of screen-detected peripartum depressive symptoms. Design, Setting, and Participants This randomized comparative effectiveness trial was performed from February 1, 2018, to June 30, 2020, at the prenatal clinic, postpartum unit, and pediatric clinic within an urban safety-net hospital. Participants included peripartum persons with positive depression screen results. Data were analyzed from July 6, 2020, to September 21, 2022, based on intention to treat. Interventions Engagement-focused care coordination (EFCC), which used shared decision-making and motivational techniques to refer patients to outside mental health services, and problem-solving education (PSE), a brief cognitive-behavioral program delivered at the screening site. Main Outcomes and Measures The primary outcome consisted of severity of depressive symptoms; secondary outcomes included severity of anxiety symptoms and engagement with care, each measured bimonthly over 12 months. Rates of symptom elevations were modeled using negative binomial regression; rates of symptom trajectories were modeled using treatment × time interactions. Results Among the 230 participants (mean [SD] age, 29.8 [5.8] years), 125 (54.3%) were Black and 101 (43.9%) were Hispanic or Latina. At baseline, 117 participants (50.9%) reported at least moderately severe depressive symptoms (Quick Inventory of Depressive Symptomatology score ≥11), and 56 (24.3%) reported clinically significant anxiety symptoms (Beck Anxiety Inventory score ≥21). Across 6 assessment time points, the mean (SD) number of moderately severe depressive symptom episodes in EFCC was 2.2 (2.2), compared with 2.2 (2.1) in PSE, for an adjusted rate ratio (aRR) of 0.95 (95% CI, 0.77-1.17). The mean (SD) number of anxiety symptom elevations in EFCC was 1.1 (1.8), compared to 1.1 (1.6) in PSE, for an aRR of 0.98 (95% CI, 0.69-1.39). There were significant treatment × time interactions relative to mean depressive symptom scores (-0.34 [95% CI, -0.60 to -0.08]; P = .009 for interaction term), favoring EFCC. There were no differences in engagement with care. Conclusions and Relevance In this randomized comparative effectiveness trial, there were no differences in depressive or anxiety symptom burden across comparators; however, the evidence suggested improved depressive symptom trajectory with immediate referral. Further work is necessary to guide approaches to management following depression screening for peripartum persons. Trial Registration ClinicalTrials.gov Identifier: NCT03221556.
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Affiliation(s)
- Mei Elansary
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Caroline J Kistin
- Brown University School of Public Health and Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| | - Jocelyn Antonio
- Brown University School of Public Health and Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| | - Ivys Fernández-Pastrana
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Aviva Lee-Parritz
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael Silverstein
- Brown University School of Public Health and Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
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12
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Zeng K, Cabral H, Ness S, Subramanian M, Siegel N, Chen X. Effect of Lens Status on Diabetic Vitreous Hemorrhage Resolution. Journal of VitreoRetinal Diseases 2023; 7:220-225. [PMID: 37188215 PMCID: PMC10170618 DOI: 10.1177/24741264231163394] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Purpose: To determine the effect of lens status (pseudophakic vs phakic) on diabetic vitreous hemorrhage (VH) resolution time. Methods: Medical records were reviewed retrospectively for each case of diabetic VH until resolution, pars plana vitrectomy (PPV), or loss to follow-up. Univariate and multivariate Cox regression models were used to determine predictors of diabetic VH resolution time through estimated hazard ratios (HRs). Kaplan-Meier survival analysis compared differences in the resolution rate by lens status and other significant factors. Results: Overall, 243 eyes were included. Pseudophakia (HR, 1.76; 95% CI, 1.07-2.90; P = .03) and prior PPV (HR, 3.28; 95% CI, 1.77-6.07; P < .001) were significant factors for faster resolution. Pseudophakic eyes resolved in 5.5 months (median, 25.1 weeks; 95% CI, 19.3-31.0) and phakic eyes in 10 months (median, 43.0 weeks; 95% CI, 36.0-50.0) (P = .001). More pseudophakic eyes than phakic eyes resolved without PPV (44.2% vs 24.8%) (P = .001). Eyes without prior PPV resolved in 9.5 months (median, 41.0 weeks; 95% CI, 35.7-46.3) compared with 5 months (median, 22.3 weeks; 95% CI, 9.8-34.8) in vitrectomized eyes (P < .001). Age, treatment with antivascular endothelial growth factor injections or panretinal photocoagulation, intraocular pressure medications, and glaucoma history were not significant predictors. Conclusions: Diabetic VH resolved almost twice as fast in pseudophakic eyes than in phakic eyes. Eyes with a history of PPV resolved 3 times quicker than those without PPV. A better understanding of VH resolution can help personalize the decision on when to proceed with PPV.
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Affiliation(s)
- Ke Zeng
- Boston University School of Medicine, Boston, MA, USA
| | - Howard Cabral
- Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Steven Ness
- Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Manju Subramanian
- Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Nicole Siegel
- Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Xuejing Chen
- Boston University School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
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13
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Jindachomthong KK, Cabral H, Subramanian ML, Ness S, Siegel NH, Chhablani J, Hsu SX, Chen X. Incidence and Risk Factors for Delayed Retinal Tears after an Acute, Symptomatic Posterior Vitreous Detachment. Ophthalmol Retina 2023; 7:318-324. [PMID: 36307014 DOI: 10.1016/j.oret.2022.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 04/24/2023]
Abstract
PURPOSE To determine the long-term incidence of and risk factors for delayed retinal tears after acute, symptomatic posterior vitreous detachment (PVD) without concurrent retinal tears. DESIGN Retrospective, observational case series. SUBJECTS Patients diagnosed with an acute, symptomatic PVD without concurrent retinal tears at a tertiary eye center between 2013 and 2018. METHODS This is a retrospective, consecutive, and observational case series. Acute and symptomatic PVD was defined as experiencing flashes or floaters for 1 month or less at the time of diagnosis. Patients with a retinal tear or detachment at or before the time of diagnosis were not included. The occurrence and timing of subsequent retinal tears after initial PVD diagnosis were recorded. The age, sex, race, refractive error, lens status, lattice degeneration status, and type of physician (retina specialist vs. nonretina specialist) who saw the patient were also recorded. MAIN OUTCOME MEASURES Time to the development of a delayed retinal tear. RESULTS A total of 389 eyes from 389 patients had acute and symptomatic PVDs without concurrent retinal tears or detachments at diagnosis. Kaplan-Meier analysis showed that 7.39% of eyes developed delayed retinal tears by 6.24 years after initial PVD diagnosis. Of these tears, 50% occurred within 4.63 months of PVD diagnosis, and 63.46% occurred within 1 year of PVD diagnosis. Cox-Mantel log-rank analysis showed that those who were younger (age < 60 years), myopic, or had lattice degeneration were more likely to develop tears. A multivariate Cox proportional-hazards models controlling for other significant risk factors supported lattice degeneration as a likely risk factor for delayed retinal tear. CONCLUSIONS This study demonstrates that 7.39% of patients with acute, symptomatic PVD without concurrent retinal tears develop delayed retinal tears by 6.24 years after PVD diagnosis, with many developing tears well after a typical 6-week follow-up time for PVD. Lattice degeneration is a significant risk factor for delayed tears. These findings can guide clinicians in establishing optimal follow-up protocols for patients with acute, symptomatic PVD. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Manju L Subramanian
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Steven Ness
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Nicole H Siegel
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Samuel X Hsu
- Boston University School of Medicine, Boston, Massachusetts
| | - Xuejing Chen
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts.
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14
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Thurman AR, Moench TR, Hoke M, Politch JA, Cabral H, Mausser E, Nador E, Morton J, Hamorsky K, Swope K, Bratcher B, Anderson DJ, Whaley KJ. ZB-06, a vaginal film containing an engineered human contraceptive antibody (HC4-N), demonstrates safety and efficacy in a phase 1 postcoital test and safety study. Am J Obstet Gynecol 2023:S0002-9378(23)00139-4. [PMID: 36870409 DOI: 10.1016/j.ajog.2023.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/14/2022] [Revised: 01/31/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND With an unplanned pregnancy rate of 50% or more in many countries, there is an urgent need for contraceptives that are more accessible and acceptable. To meet the growing demand for new contraceptives, ZabBio developed ZB-06, a vaginal film containing HC4-N, a human contraceptive antibody (HCA) that inactivates sperm. OBJECTIVES To assess the potential contraceptive activity of the ZB-06 film using a surrogate assessment for contraceptive efficacy, the postcoital test (PCT). We also assessed clinical safety of film use among healthy heterosexual couples. Serum, cervical mucus (CM) and vaginal fluid HC4-N antibody concentrations and sperm agglutination potency were determined after single film use. Changes in the concentration of soluble pro-inflammatory cytokines and vaginal Nugent score after film use were measured as sub-clinical safety endpoints. STUDY DESIGN Phase I first-in-woman, open-label, proof-of-concept, PCT and safety study. RESULTS Twenty healthy women were enrolled in the study and 8 heterosexual couples completed all study visits. The product was safe for both female participants and their male sexual partners. The PCT performed on ovulatory CM at baseline (no product use), revealed a mean of 25.9 (± 30.6) progressively motile sperm (PMS) per high power field (hpf). After use of a single ZB-06 film prior to intercourse, this number dropped to 0.04 (± 0.06) PMS/hpf (p<0.0001). At the follow up PCT visit approximately one month later (no product use), a mean of 47.4 (± 37.4) PMS/hpf was observed, indicating contraceptive reversibility. CONCLUSIONS A single dose of the ZB-06 film applied prior to intercourse was safe and met efficacy surrogate benchmarks of excluding progressively motile sperm from ovulatory CM. These data indicate that ZB-06 is a viable contraceptive candidate warranting further development and testing.
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Affiliation(s)
- Andrea R Thurman
- CONRAD, Department of Obstetrics/Gynecology, Eastern Virginia Medical School, Norfolk, VA.
| | | | | | - Joseph A Politch
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Emilie Mausser
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Ellena Nador
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | | | | | | | | | - Deborah J Anderson
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Kevin J Whaley
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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15
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Peterkin AF, Jawa R, Menezes K, You J, Cabral H, Ruiz-Mercado G, Park TW, Kehoe J, Taylor JL, Weinstein ZM. Pre-Paid Phone Distribution: A Tool for Improving Healthcare Engagement for People with Substance Use Disorder. Subst Use Misuse 2023; 58:585-589. [PMID: 36695079 PMCID: PMC10557432 DOI: 10.1080/10826084.2023.2170184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic drove significant disruptions in access to substance use disorder (SUD) treatment and harm reduction services. Healthcare delivery via telemedicine has increasingly become the norm, rendering access to a phone essential for engagement in care. METHODS Adult patients with SUD who lacked phones (n = 181) received a free, pre-paid phone during encounters with inpatient and outpatient SUD programs. We evaluated changes in healthcare engagement including completed in-person and telemedicine outpatient visits and telephone encounters 30 days before and after phone receipt. We used descriptive statistics, where appropriate, and paired t-tests to assess the change in healthcare engagement measures. RESULTS Patients were predominantly male (64%) and white (62%) with high rates of homelessness (81%) and opioid use disorder (89%). When comparing 30 days before to 30 days after phone receipt, there was a significant increased change in number of telemedicine visits by 0.3 (95% CL [0.1,0.4], p < 0.001) and telephone encounters by 0.2 (95% CL [0.1,0.3], p = 0.004). There was no statistically significant change in in-person outpatient visits observed. CONCLUSIONS Pre-paid phone distribution to patients with SUD was associated with an increased healthcare engagement including telemedicine visits and encounters.
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Affiliation(s)
- Alyssa F. Peterkin
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Raagini Jawa
- Department of General Internal Medicine and Center for Research on Healthcare, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kalil Menezes
- Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Jacqueline You
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Glorimar Ruiz-Mercado
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of General Internal Medicine and Center for Research on Healthcare, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tae Woo Park
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessica Kehoe
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts, USA
| | - Jessica L. Taylor
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Zoe M. Weinstein
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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16
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Szalaj D, Silva A, Ré P, Cabral H. Predictions of sardine and the Portuguese continental shelf ecosystem dynamics under future fishing, forced-biomass and SST scenarios. Mar Pollut Bull 2022; 178:113594. [PMID: 35398691 DOI: 10.1016/j.marpolbul.2022.113594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 03/09/2022] [Accepted: 03/19/2022] [Indexed: 06/14/2023]
Abstract
We used the Ecopath with Ecosim ecosystem model to assess the future effects of multiple stressors on sardine and the Portuguese continental shelf ecosystem. We assessed individual and combined impacts of changes in sardine fishing pressure, biomass of sardine competitors and predators and sea surface temperature (SST). This study demonstrated that the greatest impact on sardine stock is caused by projected SST rise whose effect is dominant and detrimental to sardine stock regardless of other conditions, including sardine fishing at maximum sustainable yield (FMSY). The largest impact on ecosystem stability, maturity and diversity of flows was observed under the forced-biomass scenarios that simulate changes in biomass of sardine predators and competitors. Moreover, these stressors alongside FMSY are projected to play an important role in the future evolution of the sardine stock. Results presented in this study can assist long-term and strategic management of the Iberian sardine stock.
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Affiliation(s)
- D Szalaj
- Marine and Environmental Sciences Centre (MARE), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal; Instituto Português do Mar e da Atmosfera (IPMA), Rua Alfredo Magalhães Ramalho, 6, 1495-006 Lisboa, Portugal; Instituto Dom Luiz (IDL), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal.
| | - A Silva
- Marine and Environmental Sciences Centre (MARE), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal; Instituto Português do Mar e da Atmosfera (IPMA), Rua Alfredo Magalhães Ramalho, 6, 1495-006 Lisboa, Portugal
| | - P Ré
- Marine and Environmental Sciences Centre (MARE), Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal
| | - H Cabral
- INRAE, UR EABX, Centre Nouvelle-Aquitaine Bordeaux 50, Avenue de Verdun, 33612 Cestas, France
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17
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Samman M, Kaye E, Cabral H, Scott T, Sohn W. Diet drinks and dental caries among U.S. adults: cluster analysis. Community Dent Health 2022; 39:33-39. [PMID: 34862864 DOI: 10.1922/cdh_00154samman07] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND In recent years, the consumption of sugar sweetened beverages has been declining, while low calorie sweetener and diet beverage consumption is increasing. Evidence about the effect of diet drinks on dental caries is insufficient, and has not accounted for the complexity of beverage consumption patterns. Therefore, the aim of this study is to examine the association between consuming diet drinks and dental caries among US adults. METHODS We analyzed 2011-2014 NHANES dietary data of adults using cluster analysis, with individuals grouped based on their beverage consumption. Clusters were identified based on the R-square statistic and the local peak of the pseudo F statistic. Survey procedure and sample weights were used to account for the complex NHANES sampling design. RESULTS Four beverage consumption patterns were identified: "high soda", "high diet drinks", "high coffee/tea" and "high water". The "High soda" cluster was the only one associated with higher DMFT after controlling for confounders (β=1.02, 95% CI=0.42 - 1.63), whereas DT was associated with "high soda" (β=0.45, 95% CI=0.25 - 0.64) and "high coffee/tea" (β=0.24, 95% CI=0.01 - 0.47). On the other hand, the "high diet drinks" cluster was neither associated with DMFT (β=0.69, 95% CI=0.51 - -0.35) nor DT (β=0.07, 95% CI=-0.21 - 0.35). CONCLUSION Diet drinks consumption may not be associated with increased risk of dental caries. However, more studies should be conducted in order to confirm this finding.
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Affiliation(s)
- M Samman
- Dental Public Health, King Abulaziz University, Faculty of Dentistry, Saudi Arabia
| | - E Kaye
- Health Policy & Health Services Research, Boston University, Henry M Goldman School of Dental Medicine, United States
| | - H Cabral
- Biostatistics, Boston University School of Public Health, United States
| | - T Scott
- Health Policy & Health Services Research, Boston University, Henry M Goldman School of Dental Medicine, United States
| | - W Sohn
- Population Oral Health, University of Sydney, School of Dentistry, Faculty of Medicine and Health, Australia
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18
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Farland LV, Stern JE, Hwang SS, Liu CL, Cabral H, Knowlton R, Gershman ST, Coddington CC, Missmer SA. History of cancer and fertility treatment outcomes: a registry linkage study in Massachusetts. J Assist Reprod Genet 2022; 39:517-526. [PMID: 35037166 PMCID: PMC8956755 DOI: 10.1007/s10815-021-02376-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate assisted reproductive technology (ART) outcomes among adolescent and young-adult female cancer survivors. METHODS The Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) data were linked to the Massachusetts Cancer Registry for 90,928 ART cycles in Massachusetts to women ≥ 18 years old from 2004 to 2013. To estimate relative risks (RR) and 95% confidence intervals (CI), we used generalized estimating equations with a log link that accounted for multiple cycles per woman and a priori adjusted for maternal age and cycle year. The main outcomes of interest were ART treatment patterns; number of autologous oocytes retrieved, fertilized, and transferred; and rates of implantation, clinical intrauterine gestation (CIG), live birth, and pregnancy loss. RESULTS We saw no difference in number of oocytes retrieved (aRR: 0.95 (0.89-1.02)) or proportion of autologous oocytes fertilized (aRR: 0.99 (0.95-1.03)) between autologous cycles with and without a history of cancer; however, cancer survivors required a higher total FSH administered (aRR: 1.12 (1.06-1.19)). Among autologous cycle starts, cycles in women with a history of cancer were less likely to result in CIG compared to no history of cancer (aRR: 0.73 (0.65-0.83)); this relationship was absent from donor cycles (aRR: 1.01 (0.85-1.20)). Once achieving CIG, donor cycles for women with a history of cancer were two times more likely to result in pregnancy loss (aRR: 1.99 (1.26-3.16)). CONCLUSIONS Our analysis suggests that cancer may influence ovarian stimulation response, requiring more FSH and resulting in lower CIG among cycle starts.
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Affiliation(s)
- Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
| | - Judy E Stern
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock, Lebanon, NH, USA
| | - Sunah S Hwang
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Chia-Ling Liu
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Richard Knowlton
- Massachusetts Cancer Registry, Office of Data Management and Outcomes Assessment, Office of Population Health, Massachusetts Department of Public Health, Boston, MA, USA
| | - Susan T Gershman
- Massachusetts Cancer Registry, Office of Data Management and Outcomes Assessment, Office of Population Health, Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Stacey A Missmer
- Department of Obstetrics and Gynecology, Carolinas Medical Center/Atrium Health, Charlotte, NC, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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19
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Bloore K, Song Y, Cabral H, Massaro J, LaValley M. Use of the likelihood reduction factor in a path analysis framework to quantify surrogacy in clinical trials. Stat Med 2021; 40:6373-6386. [PMID: 34545969 DOI: 10.1002/sim.9188] [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: 08/25/2020] [Revised: 08/05/2021] [Accepted: 08/15/2021] [Indexed: 11/07/2022]
Abstract
In clinical trials, surrogate endpoints are useful when the endpoint of interest is difficult to measure or requires a long follow-up time. Current methodology for validating surrogate endpoints encounters challenges in the presence of collinearity between the treatment and surrogate endpoint, which is often present in clinical trials. The proposed methods adapt current methodology in the structural framework of path analysis to quantify the validity of a surrogate endpoint. The path analysis framework provides an improved interpretation of treatment effect. Through derivation and simulation we show the proposed path likelihood reduction factor (LRF P ), is less biased and more robust than current methodology in cases of collinearity between the treatment and surrogate endpoint, with notable improvement when surrogacy is weak or moderate. LRF P can be expanded to evaluate multiple correlated surrogate endpoints, which as shown through simulation, is also less biased and more robust than current methodology in the case of collinearity between the treatment and surrogate endpoint.
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Affiliation(s)
- Katherine Bloore
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.,Department of Biometrics, Vertex Pharmaceuticals, Boston, Massachusetts, USA
| | - Yang Song
- Department of Biometrics, Vertex Pharmaceuticals, Boston, Massachusetts, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joseph Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michael LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
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20
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Abstract
OBJECTIVE The aim of this study is to examine the effect of diet drinks on dental erosion among a representative sample of US adults. METHODS Adult dietary and dental data were analyzed from the 2003-2004 cycle of the National Health and Nutrition Examination Survey. Erosion was measured with a modified tooth wear index and was analyzed as a dichotomous variable. Cluster analysis was performed, and the cluster number was based on having a separate diet drink cluster and the R2 values. Survey procedure and sample weights were used. RESULTS Most of the population (80%) had some form of dental erosive lesions. When compared with the total sample, people with erosion were more likely to be male (52.5%) and older. People with no erosive lesions were younger (42.3%) and non-Hispanic Black (21.2%). Cluster analysis resulted in 4 distinct clusters: high water, high diet drinks, high coffee/tea, and high soda. The respective percentage of individuals in each cluster who had erosion was 78.9%, 85%, 83.9%, and 76.2%, where the "high diet drinks" cluster showed the highest erosion (P = 0.28). Logistic regression modeling showed that the "high diet drinks" cluster had increased odds of erosion (odds ratio = 1.27; 95% CI = 0.58 to 2.77) when compared with the "high water" cluster, but the relationship was not statistically significant. CONCLUSION High diet drinks consumption slightly increased the odds of dental erosion among US adults, although this relationship was not statistically significant. It is thus not yet clear that dentists should recommend diet drinks, as they might be linked to systemic diseases. Further research is needed to explore more about risk factors of erosion. KNOWLEDGE TRANSFER STATEMENT The findings of this study are suggestive, though not significantly, that diet drinks may increase risk for dental erosion. While further research is needed, it is not clear that dentists should recommend these drinks as healthy substitutes for sugary drinks.
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Affiliation(s)
- M Samman
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - E Kaye
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - H Cabral
- Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - T Scott
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - W Sohn
- The University of Sydney School of Dentistry, Westmead, Australia
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21
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Wang C, Paasche-Orlow MK, Bowen DJ, Cabral H, Winter MR, Norkunas Cunningham T, Trevino-Talbot M, Toledo DM, Cortes DE, Campion M, Bickmore T. Utility of a virtual counselor (VICKY) to collect family health histories among vulnerable patient populations: A randomized controlled trial. Patient Educ Couns 2021; 104:979-988. [PMID: 33750594 PMCID: PMC8113103 DOI: 10.1016/j.pec.2021.02.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 01/25/2021] [Accepted: 02/16/2021] [Indexed: 05/29/2023]
Abstract
OBJECTIVES This study is a randomized controlled trial comparing the efficacy of a virtual counselor (VICKY) to the My Family Health Portrait (MFHP) tool for collecting family health history (FHx). METHODS A total of 279 participants were recruited from a large safety-net hospital and block randomized by health literacy to use one of the digital FHx tools, followed by a genetic counselor interview. A final sample of 273 participants were included for analyses of primary study aims pertaining to tool concordance, which assessed agreement between tool and genetic counselor. RESULTS Tool completion differed significantly between tools (VICKY = 97%, MFHP = 51%; p < .0001). Concordance between tool and genetic counselor was significantly greater for participants randomized to VICKY compared to MFHP for ascertaining first- and second-degree relatives (ps<.0001), and most health conditions examined. There was significant interaction by health literacy, with greater differences in concordance observed between tools among those with limited literacy. CONCLUSIONS A virtual counselor overcomes many of the literacy-related barriers to using traditional digital tools and highlights an approach that may be important to consider when collecting health histories from vulnerable populations. PRACTICE IMPLICATIONS The usability of digital health history tools will have important implications for the quality of the data collected and its downstream clinical utility.
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Affiliation(s)
- Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
| | - Michael K Paasche-Orlow
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Deborah J Bowen
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | | | - Michelle Trevino-Talbot
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Diana M Toledo
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Dharma E Cortes
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
| | - MaryAnn Campion
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
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22
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Stern JE, Liu CL, Hwang SS, Dukhovny D, Farland LV, Diop H, Coddington CC, Cabral H. Influence of Placental Abnormalities and Pregnancy-Induced Hypertension in Prematurity Associated with Various Assisted Reproductive Technology Techniques. J Clin Med 2021; 10:1681. [PMID: 33919833 PMCID: PMC8070757 DOI: 10.3390/jcm10081681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Assisted reproductive technology (ART)-treated women exhibit increased risk of premature delivery compared to fertile women. We evaluated whether ART treatment modalities increase prematurity and whether placental abnormalities and pregnancy-induced hypertensive (PIH) disorders mediate these risks. METHOD(S) This retrospective study of ART-treated and fertile deliveries (2004-2017) used an ART-cycle database linked to Massachusetts birth certificates and hospital discharges. Outcomes of late preterm birth (LPTB: 34-36 weeks gestation) and early preterm birth (EPTB: <34 weeks gestation) were compared with term deliveries (≥37 weeks gestation) in ART-treated (linked to the ART database) and fertile (no indicators of infertility or ART) deliveries. ART treatments with autologous oocyte, donor oocyte, fresh or frozen embryo transfer (FET), intracytoplasmic sperm injection (ICSI) and no-ICSI were separately compared to the fertile group. Adjusted odds ratios (AOR) were calculated with multivariable logistic regression: placental abnormalities or PIH were quantified in the pathway as mediators. RESULTS There were 218,320 deliveries: 204,438 fertile and 13,882 ART-treated. All treatment types increased prematurity (AOR 1.31-1.58, LPTB; AOR 1.34-1.48, EPTB). Placental abnormalities mediated in approximately 22% and 38% of the association with LPTB and EPTB, respectively. PIH mediated 25% and 33% of the association with LPTB and EPTB in FET and donor oocyte cycles, more than other treatments (<10% LPTB and <13% EPTB). CONCLUSIONS ART-treatment and all ART modalities increased LPTB and EPTB when compared with fertile deliveries. Placental abnormalities modestly mediated associations approximately equally, while PIH was a stronger mediator in FET and donor oocyte cycles. Reasons for differences require exploration.
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Affiliation(s)
- Judy E. Stern
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock, Lebanon, NH 03756, USA
| | - Chia-ling Liu
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA 02108, USA;
| | - Sunah S. Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Dmitry Dukhovny
- Division of Neonatology, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Leslie V. Farland
- Epidemiology and Biostatistics Department, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Hafsatou Diop
- Division of Maternal and Child Health Research and Analysis, Bureau of Family Health and Nutrition Massachusetts Department of Public Health, Boston, MA 02108, USA;
| | - Charles C. Coddington
- Department of Obstetrics and Gynecology, University of North Carolina, Charlotte, NC 28204, USA;
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA;
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23
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Abstract
BACKGROUND AND PURPOSE Although there have been decreases noted in 30-day readmission rates for persons with heart failure since enactment of the Hospital Readmissions Reduction Program, costs related to heart failure readmissions remain high. Consequently, there is a need to better identify persons with heart failure who are at risk for 30-day hospital readmission. Therefore, this study aimed to compare the ability of measures of function and frailty to predict 30-day hospital readmissions for adults 65 years and older with heart failure. METHODS Secondary data analysis using the 2011 National Health and Aging Trends Study analysis merged with Medicare claims data. Logistic regression modeling was used to compare the ability of function (Short Physical Performance Battery) and frailty (Fried's Physical Frailty Phenotype) to predict 30-day readmission. Receiver operating characteristic curves were constructed to examine the ability of function and frailty to identify those who were readmitted. RESULTS AND DISCUSSION Frailty and function demonstrated comparable ability to predict 30-day readmissions (R2 = 0.087 and R2 = 0.087, respectively). Neither measure identified persons at risk for readmission (AUCSPPB = 0.608; AUCPFP = 0.587). CONCLUSIONS Functional assessment demonstrated comparable ability to predict 30-day readmissions in persons with heart failure compared with frailty. However, neither measure was able to identify persons at high risk for readmission. Although frailty status is emphasized in research for older adults with heart failure, functional status is an important patient-level factor associated with readmission.
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Affiliation(s)
- Tamra Keeney
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts
| | - Diane U Jette
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, Massachusetts
| | - Howard Cabral
- Boston University School of Public Health, Boston, Massachusetts
| | - Alan M Jette
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts
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24
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Feinberg E, Kuhn J, Eilenberg JS, Levinson J, Patts G, Cabral H, Broder-Fingert S. Improving Family Navigation for Children With Autism: A Comparison of Two Pilot Randomized Controlled Trials. Acad Pediatr 2021; 21:265-271. [PMID: 32302757 PMCID: PMC7554108 DOI: 10.1016/j.acap.2020.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Family navigation (FN), a care management strategy, helps families overcome systems and person-level barriers to care. We previously demonstrated FN's feasibility, acceptability, and potential efficacy for increasing access and reducing time to autism-related diagnostic services among low-income, minority children. In this paper, we describe modifications to FN in response to concerns raised in our first pilot randomized controlled trial (RCT), and then assess these modifications in a second pilot RCT. METHODS An advisory group recommended modifications to recruitment procedures and study conditions. Forty parent-child dyad participants with autism-related concerns were randomized to receive modified usual care (UC) or modified FN. We compared whether the first and second pilot RCTs differed in: participant enrollment, satisfaction with clinical care, and timely completion of the diagnostic assessment. RESULTS Recruitment improved under the modified protocol with significantly fewer potentially eligible families refusing (19.5% vs 4.8%, P < .05) or being excluded from study enrollment (43.6% vs 0%, P < .01). Comparing the first and second pilot RCTs, regardless of study arm, families in the second pilot were more likely to complete diagnostic assessment (UC: hazard ratio [HR] 3.41, 95% confidence intervals [CI 1.20, 9.68]; FN: HR 2.64, 95% CI [1.31, 5.30]) and report greater satisfaction with clinical care. In the second pilot, compared to UC, FN continued increase the likelihood of completing the diagnostic assessment (HR: 2.57; 95% CI [1.22, 5.40]). CONCLUSIONS Easy-to-implement system-level enhancements improved study recruitment, satisfaction with care, and completion of a diagnostic assessment. With enhancement, FN continued to confer benefits to families.
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Affiliation(s)
- Emily Feinberg
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine (E Feinberg, and S Broder-Fingert), Boston, Mass; Boston University School of Public Health (E Feinberg, JS Eilenberg, J Levinson, G Patts, and H Cabral), Boston, Mass.
| | - Jocelyn Kuhn
- Department of Pediatrics, Boston Medical Center, 801 Albany St, Boston, MA 02119
| | | | - Julia Levinson
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - Gregory Patts
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - Howard Cabral
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118
| | - Sarabeth Broder-Fingert
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 801 Albany St, Boston, MA 02119
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25
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Politch JA, Cu-Uvin S, Moench TR, Tashima KT, Marathe JG, Guthrie KM, Cabral H, Nyhuis T, Brennan M, Zeitlin L, Spiegel HML, Mayer KH, Whaley KJ, Anderson DJ. Safety, acceptability, and pharmacokinetics of a monoclonal antibody-based vaginal multipurpose prevention film (MB66): A Phase I randomized trial. PLoS Med 2021; 18:e1003495. [PMID: 33534791 PMCID: PMC7857576 DOI: 10.1371/journal.pmed.1003495] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND MB66 film is a multipurpose prevention technology (MPT) product with monoclonal antibodies (mAbs) against HIV-1 (VRC01-N) and HSV-1 and 2 (HSV8-N). The mAbs were produced by transient expression in Nicotiana benthamiana (N). We conducted a Phase I clinical trial to assess the safety, pharmacokinetics (PK), and ex vivo efficacy of single and repeated doses of MB66 when used intravaginally. METHODS AND FINDINGS The clinical trial enrolled healthy reproductive-aged, sexually abstinent women. In Segment A, 9 women received a single MB66 film which was inserted into the vaginal posterior fornix by a clinician. In Segment B, 29 women were randomly assigned to MB66 (Active) or Placebo film groups and were instructed to insert 1 film vaginally for 7 consecutive days. Visits and clinical sampling occurred predose and at various time points after single and repeated film doses. The primary endpoint was number of adverse events (AEs) Grade 2 or higher related to product use. Secondary endpoints included film dissolution rate, Nugent score (a Gram stain scoring system to diagnose bacterial vaginosis), vaginal pH, post-use survey results, cytokine concentrations in cervicovaginal lavage (CVL) specimens (assessed by Luminex assay), mAb concentrations in vaginal fluid collected from 4 sites (assessed by ELISA), and HIV and HSV neutralization activity of CVL samples ex vivo (assessed by TZM-bl and plaque reduction assay, respectively). The product was generally safe and well tolerated, with no serious AEs recorded in either segment. The AEs in this study were primarily genitourinary in nature with the most commonly reported AE being asymptomatic microscopic hematuria. There were no differences in vaginal pH or Nugent scores or significant increases in levels of proinflammatory cytokines for up to 7 days after film insertion in either segment or between Active and Placebo groups. Acceptability and willingness to use the product were judged to be high by post-use surveys. Concentrations of VRC01-N and HSV8-N in vaginal secretions were assessed over time to generate pharmacokinetic curves. Antibody levels peaked 1 hour postdosing with Active film (median: 35 μg/mL) and remained significantly elevated at 24 hours post first and seventh film (median: 1.8 μg/mL). Correcting for sample dilution (1:20), VRC01-N concentrations ranged from 36 to 700 μg/mL at the 24-hour time point, greater than 100-fold the IC50 for VRC01 (0.32 μg/mL); HSV8-N concentrations ranged from 80 to 601 μg/mL, well above the IC50 of 0.1 μg/m. CVL samples collected 24 hours after MB66 insertion significantly neutralized both HIV-1 and HSV-2 ex vivo. Study limitations include the small size of the study cohort, and the fact that no samples were collected between 24 hours and 7 days for pharmacokinetic evaluation. CONCLUSIONS Single and repeated intravaginal applications of MB66 film were safe, well tolerated, and acceptable. Concentrations and ex vivo bioactivity of both mAbs in vaginal secretions were significantly elevated and thus could provide protection for at least 24 hours postdose. However, further research is needed to evaluate the efficacy of MB66 film in women at risk for HIV and HSV infection. Additional antibodies could be added to this platform to provide protection against other sexually transmitted infections (STIs) and contraception. TRIAL REGISTRATION ClinicalTrials.gov NCT02579083.
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Affiliation(s)
- Joseph A. Politch
- Boston University School of Medicine, Department of Medicine, Boston, Massachusetts, United States of America
- * E-mail: ,
| | - Susan Cu-Uvin
- Alpert Medical School of Brown University, Department of Obstetrics and Gynecology and Medicine, Providence, Rhode Island, United States of America
| | - Thomas R. Moench
- Mapp Biopharmaceutical Inc., San Diego, California, United States of America
| | - Karen T. Tashima
- Division of Infectious Diseases, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Jai G. Marathe
- Boston University School of Medicine, Department of Medicine, Boston, Massachusetts, United States of America
| | - Kate M. Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Tara Nyhuis
- Mapp Biopharmaceutical Inc., San Diego, California, United States of America
| | - Miles Brennan
- Mapp Biopharmaceutical Inc., San Diego, California, United States of America
| | - Larry Zeitlin
- Mapp Biopharmaceutical Inc., San Diego, California, United States of America
| | - Hans M. L. Spiegel
- Kelly Government Solutions, Contractor to National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland, United States of America
| | - Kenneth H. Mayer
- Harvard Medical School, Department of Medicine, Boston, Massachusetts, United States of America
| | - Kevin J. Whaley
- Mapp Biopharmaceutical Inc., San Diego, California, United States of America
| | - Deborah J. Anderson
- Boston University School of Medicine, Department of Medicine, Boston, Massachusetts, United States of America
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26
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Hwang SS, Dukhovny D, Gopal D, Cabral H, Farland LV, Stern JE. Sex differences in infant health following ART-treated, subfertile, and fertile deliveries. J Assist Reprod Genet 2020; 38:211-218. [PMID: 33185819 DOI: 10.1007/s10815-020-02004-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/02/2020] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Among infants following ART-treated, subfertile, and fertile deliveries to determine (1) the presence and magnitude of sex differences in health outcomes and (2) whether the presence of sex differences varied among maternal fertility groups. METHODS Retrospective cohort analysis of infants born in Massachusetts (MA) in 2004-2013 who were conceived by ART. The Society for Assisted Reproductive Technology Clinic Outcome Reporting System was linked to the Pregnancy to Early Life Longitudinal data system, which links birth certificates to hospital discharge records for MA mothers and infants. Included were singletons born via ART-treated, subfertile, and fertile deliveries. Multivariable logistic regression was used to model the association between infant sex and health outcomes, controlling for maternal demographic and health characteristics. RESULTS A total of 16,034 ART-treated, 13,277 subfertile, and 620,375 fertile singleton live births were included. For all three groups, males had greater odds of being preterm (AOR range 1.15-1.2), having birth defects (AOR range 1.31-1.71), experiencing respiratory (AOR range 1.33-1.35) and neurologic (AOR range 1.24-1.3) conditions, and prolonged hospital stay (AOR range 1.19-1.25) compared to females. The interaction between maternal fertility group and infant sex for all infant outcomes was nonsignificant, denoting that the presence of sex differences among fertile, subfertile, and ART groups did not vary. CONCLUSION Sex differences in birth outcomes of infants following ART-treated, subfertile, and fertile deliveries exist but the magnitude of these differences does not vary among these maternal fertility groups.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, 13121 East 17th Avenue, Education 2 South, Mailstop 8402, Aurora, CO, 80045, USA.
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Daksha Gopal
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Leslie V Farland
- Departmet of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Judy E Stern
- Department of Obstetrics and Gynecology and Pathology, Dartmouth-Hitchcock, Lebanon, NH, USA
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27
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Samman M, Kaye E, Cabral H, Scott T, Sohn W. The effect of diet drinks on caries among US children: Cluster analysis. J Am Dent Assoc 2020; 151:502-509. [PMID: 32593352 DOI: 10.1016/j.adaj.2020.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/01/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The effect of sugared beverages on dental caries has been widely studied in dental literature. A major limitation of these studies was examining the beverages as a single source. To overcome this limitation, a few studies used cluster analysis to group people into similar beverage consumption patterns. These studies did not differentiate between sugared beverages and diet drinks. Therefore the aim of this study is to examine the effect of consuming diet drinks on dental caries among US children by using cluster analysis. METHODS In this cross-sectional study, the authors analyzed the dietary data of children aged 3 through 10 years, using 2 24-hour recall interviews in the 2011-2014 National Health and Nutrition Examination Survey data. Cluster analysis has been used to overcome the limitations of examining the beverages as a single source. Clusters were identified based on the R2 statistic and the local peak of pseudo-F statistics. Survey procedure and sample weights were used to account for the complex National Health and Nutrition Examination Survey sampling design. RESULTS Six beverage consumption clusters were identified: high soda, high 100% juice, high juice drinks, high diet drinks, high milk, and high water. Regression analysis showed that the high soda cluster had a tendency to increase caries risk (odds ratio [OR], 1.69, 95% confidence interval [CI], 0.9 to 3.1), while the high diet drinks cluster had neutral effect compared with the high water cluster (OR, 0.94, 95% CI, 0.5 to 1.8). CONCLUSIONS The results of this study suggest that diet drinks have no adverse effect on teeth among US children. Additional well-designed longitudinal studies should be conducted to establish the effect of diet drinks on caries when consumed during childhood. PRACTICAL IMPLICATIONS Although this study did not show an association between caries and diet drinks, dental practitioners should be cautious about recommending these drinks, as they have been linked to systemic diseases. In addition, the American Academy of Pediatrics and National Academy of Medicine do not recommend that children consume these beverages.
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Stern JE, Liu CL, Hwang SS, Dukhovny D, Diop H, Cabral H. Contributions to prematurity of maternal health conditions, subfertility, and assisted reproductive technology. Fertil Steril 2020; 114:828-836. [PMID: 32624216 DOI: 10.1016/j.fertnstert.2020.03.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/20/2020] [Accepted: 03/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the maternal demographic, health, and fertility variables underlying prematurity. DESIGN Retrospective: Society for Assisted Reproductive Technology Clinic Outcome Reporting System data linked to Massachusetts birth certificates and hospital stays. SETTING Not applicable. PATIENTS We included 166,963 privately insured, singleton, first births to women ≥18 years of age between 2004 and 2013. Deliveries were as follows: assisted reproductive technology (ART) when linked to Society for Assisted Reproductive Technology Clinic Outcome Reporting System, medically assisted reproduction (MAR) when fertility treatment was indicated on the birth certificate, unassisted subfertile (USF) when there were indications of subfertility but no treatment, and fertile if none of the above. INTERVENTION None. MAIN OUTCOME MEASURES Late preterm birth (LPTB; 34-36 weeks) and early preterm birth (EPTB; <34 weeks) were compared with term deliveries (≥37 weeks). Covariates that statistically significantly influenced prematurity in binary analysis were modeled by using multinomial logistic regression. Backward elimination and mediation analysis were used to determine the influence of single parameters on outcomes of others. RESULTS LPTB was increased in the USF (adjusted odds ratio [AOR] 1.32, 95% confidence interval [CI] 1.06-1.65) and ART (AOR 1.42, 95% CI 1.30-1.56) but not MAR (AOR 1.16, 95% CI 0.98-1.37). ETPB was increased in all (USF: AOR 1.67, 95% CI 1.21-2.31; MAR: AOR 1.67, 95% CI 1.31-2.12; ART: AOR 1.40, 95% CI 1.21-1.61). The strongest effectors of prematurity were placental problems (LPTB: AOR 4.02; EPTB: AOR 10.28), pregnancy hypertension (LPTB: AOR 2.14; EPTB: AOR 2.88), and chronic hypertension (LPTB: AOR 1.85; EPTB: AOR 2.79). Mediation analysis demonstrated a statistically significant indirect effect of placental problems for ART and subfertility. CONCLUSION The greatest effectors of prematurity were placental problems and hypertensive disorders. ART and, to a lesser extent, subfertility were both associated with preterm birth directly and indirectly mediated by placenta problems.
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Affiliation(s)
- Judy E Stern
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock, Lebanon, New Hampshire.
| | - Chia-Ling Liu
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Sunah S Hwang
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Hafsatou Diop
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
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Singh S, Steiling K, Burks E, Moreira P, Cabral H, Buck A, Litle V, Suzuki K. REAPPRAISAL OF RISK FACTORS FOR LUNGRADS 4 IN A RACIALLY DIVERSE SCREENING COHORT. Chest 2020. [DOI: 10.1016/j.chest.2020.05.297] [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: 11/15/2022] Open
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30
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Greenlaw C, Nuss S, Camayd-Muñoz C, Jonas R, Rollins JV, Cabral H, Douglass LM. Clinical Implementation of a Parent Questionnaire to Identify Seizures in High-Risk Children. J Child Neurol 2020; 35:485-491. [PMID: 32207663 DOI: 10.1177/0883073820911505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study evaluated the effectiveness of a parent-completed questionnaire for detecting seizures in high-risk children. METHODS A 2-part seizure screen for children up to 12 years of age with suspected autism spectrum disorder, developmental delay, or seizure, was implemented in 12 Massachusetts clinics serving populations with high health disparities. Primary care providers and developmental behavioral pediatricians administered part 1, a brief highly sensitive screen. If the result was positive, a research assistant administered part 2, a more detailed screen with higher specificity. Positive part 2 results prompted a specialized assessment by a pediatric neurologist. Screening data were evaluated for detection of seizures or other diagnoses, reason for conducting the screen, and appointment outcomes. Data analysis included chi-squared tests, percentages for categorical variables, and means for numerical data. RESULTS Of 207 administered seizure questionnaires, 78% of children screened positive on part 1. Of those, 94% of families completed part 2 by telephone, and 64 individuals screened positive. The screen helped to detect 15 new seizure diagnoses and 35 other neurologic diagnoses. Average time to first scheduled appointment was 23.8 days. The no-show rate was 7%. CONCLUSIONS The seizure questionnaire effectively identified seizures and other disorders in a diverse population of high-risk children. Broader use of this low-cost screening tool could improve access to care for children with suspected seizures, increase seizure recognition, and help allocate resources more effectively.
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Affiliation(s)
| | - Sarah Nuss
- Division of Pediatric Neurology, Boston Medical Center, Boston, MA, USA
| | | | - Rinat Jonas
- Division of Pediatric Neurology, Boston Medical Center, Boston, MA, USA
| | - Julie Vanier Rollins
- Division of Neonatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Laurie M Douglass
- Boston University School of Medicine, Boston, MA, USA
- Division of Pediatric Neurology, Boston Medical Center, Boston, MA, USA
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Battaglia TA, Freund KM, Haas JS, Casanova N, Bak S, Cabral H, Freedman RA, White KB, Lemon SC. Translating research into practice: Protocol for a community-engaged, stepped wedge randomized trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative. Contemp Clin Trials 2020; 93:106007. [PMID: 32305457 PMCID: PMC7884078 DOI: 10.1016/j.cct.2020.106007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/10/2020] [Accepted: 04/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Racial and socioeconomic disparities in breast cancer mortality persist. In Boston, MA, Black, Non-Hispanic women and Medicaid-insured individuals are 2-3 times more likely to have delays in treatment compared to White or privately insured women. While evidence-based care coordination strategies for reducing delays exist, they are not systematically implemented across healthcare settings. METHODS Translating Research Into Practice (TRIP) utilizes community engaged research methods to address breast cancer care delivery disparities. Four Massachusetts Clinical and Translational Science Institute (CTSI) hubs collaborated with the Boston Breast Cancer Equity Coalition (The Coalition) to implement an evidence-based care coordination intervention for Boston residents at risk for delays in breast cancer care. The Coalition used a community-driven process to define the problem of care delivery disparities, identify the target population, and develop a rigorous pragmatic approach. We chose a cluster-randomized, stepped-wedge hybrid type I effectiveness-implementation study design. The intervention implements three evidence-based strategies: patient navigation services, a shared patient registry for use across academic medical centers, and a web-based social determinants of health platform to identify and address barriers to care. Primary clinical outcomes include time to first treatment and receipt of guideline-concordant treatment, which are captured through electronic health records abstraction. We will use mixed methods to collect the secondary implementation outcomes of acceptability, adoption/penetration, fidelity, sustainability and cost. CONCLUSION TRIP utilizes an innovative community-driven research strategy, focused on interdisciplinary collaborations, to design and implement a translational science study that aims to more efficiently integrate proven health services interventions into clinical practice.
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Affiliation(s)
- Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America.
| | - Karen M Freund
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Internal Medicine and Primary Care, Department of Medicine, Tufts Medical Center, Boston, MA, United States of America; Tufts University School of Medicine, Boston, MA, United States of America
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nicole Casanova
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Sharon Bak
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America; Boston University School of Medicine, Boston, MA, United States of America
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Rachel A Freedman
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, United States of America
| | - Karen Burns White
- Initiative to Eliminate Cancer Disparities, Dana Farber/Harvard Cancer Center, Boston, MA, United States of America
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
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LeClair A, Lemon S, Haas J, Friedman R, Cabral H, Burns-White K, Casanova N, Freund K, Battaglia T. Abstract B055: Translating research into practice: Early lessons from a pragmatic clinical trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-b055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Racial and socioeconomic disparities in breast cancer mortality persist; in Boston, Black women and Medicaid patients are 2-3 times more likely to have delays in initiating cancer treatment compared to their white and privately insured counterparts. Evidence-based strategies for combating delays exist but are not systematically implemented. Our primary research question is: can systematically implement evidence-based coordination of care across the city of Boston to reduce delays for the most vulnerable women? Translating Research Into Practice (TRIP) addresses racial and socio-economic disparities using the principals of community engaged research. Four of the Massachusetts Clinical and Translational Science Institutes (CTSI) have collaborated with the Boston Breast Cancer Equity Coalition, the Boston Patient Navigation Network, and a Clinical Advisory Panel to systematically implement an evidence-based coordination of care intervention in six Boston hospitals. Key components of the intervention include: patient navigation, a shared regional registry to track women across institutions and facilitate navigator coordination, systematic screening for social barriers to care and referral to free or low-cost community resources. The multi-component implementation strategy includes ongoing stakeholder engagement, navigator performance review and feedback, training and support and navigator peer learning. A stepped-wedge hybrid type I (n=536 post implementation, n=564 historical controls) effectiveness-implementation study design was launched in June 2018, with 6 sites entering intervention phase by December 2019. Primary clinical outcomes are time to first treatment and receipt of guideline concordant care. Secondary implementation outcomes are acceptability, adoption, cost, fidelity, penetration, and sustainability. To date, we have 59 women on study in the intervention phase. We are reaching our target population: 39% of women are Black, 32% of Hispanic ethnicity, 47% are non-English speaking and 81% have Medicaid. Lessons learned with implementing a community-engaged, regional pragmatic trial include: 1) Patient Navigators are eager to collaborate in the care of their patients and to identify best practices; 2) Engaging all stakeholders, including hospital administrators, is necessary to implement health systems programs; 3) Workflow variation across each health system requires significant customization to adapt the evidence and tools; 4) Tension for change exists among all sites because of existing established care coordination programs; and 5) Lack of integration of EHRs within and across health systems makes use of new data platforms challenging. Regional, community-engaged, interdisciplinary collaborations are important to reduce population disparities than often transcend a single institution. TRIP outlines a coordinated model to address disparities in breast cancer care that could be translated to other regions and disease conditions.
Citation Format: Amy LeClair, Stephenie Lemon, Jennifer Haas, Rachel Friedman, Howard Cabral, Karen Burns-White, Nicole Casanova, Karen Freund, Tracy Battaglia. Translating research into practice: Early lessons from a pragmatic clinical trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B055.
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Affiliation(s)
| | - Stephenie Lemon
- 2University of Massachusetts Medical School, Worcester, MA, USA,
| | | | | | - Howard Cabral
- 5Boston University School of Public Health, Boston, MA, USA,
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Louis CJ, Herrera CNS, Garrity BM, McDonough CM, Cabral H, Saper RB, Kazis LE. Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain. Arch Phys Med Rehabil 2020; 101:1407-1413. [PMID: 32437688 DOI: 10.1016/j.apmr.2020.04.002] [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: 08/28/2019] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine whether the initial care provider for neck pain was associated with opioid use for individuals with neck pain. DESIGN Retrospective cohort study. SETTING Marketscan research databases. PARTICIPANTS Patients (N=427,966) with new-onset neck pain from 2010-2014. MAIN OUTCOME MEASURES Opioid use was defined using retail pharmacy fills. We performed logistic regression analysis to assess the association between initial provider and opioid use. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using bootstrapping logistic models. We performed propensity score matching as a robustness check on our findings. RESULTS Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%-91% less likely to fill an opioid prescription in the first 30 days, and between 41%-87% less likely to continue filling prescriptions for 1 year. People with neck pain who initially saw emergency medicine physicians had the highest odds of opioid use during the first 30 days (OR, 3.58; 95% CI, 3.47-3.69; P<.001). CONCLUSIONS A patient's initial clinical contact for neck pain may be an important opportunity to influence subsequent opioid use. Understanding more about the roles that conservative therapists play in the treatment of neck pain may be key in unlocking new ways to lessen the burden of opioid use in the United States.
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Affiliation(s)
- Christopher J Louis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Carolina-Nicole S Herrera
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Brigid M Garrity
- Department of Health Law, Policy, and Management, Health Outcomes Unit, Boston University School of Public Health, Boston, Massachusetts
| | - Christine M McDonough
- Department of Physical Therapy and Orthopedic Surgery, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Robert B Saper
- Department of Family Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Lewis E Kazis
- Department of Health Law, Policy, and Management, Health Outcomes Unit, Boston University School of Public Health, Boston, Massachusetts.
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Tank A, Peterson HM, Pera V, Tabassum S, Leproux A, O'Sullivan T, Jones E, Cabral H, Ko N, Mehta RS, Tromberg BJ, Roblyer D. Diffuse optical spectroscopic imaging reveals distinct early breast tumor hemodynamic responses to metronomic and maximum tolerated dose regimens. Breast Cancer Res 2020; 22:29. [PMID: 32169100 PMCID: PMC7071774 DOI: 10.1186/s13058-020-01262-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 09/13/2019] [Accepted: 02/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Breast cancer patients with early-stage disease are increasingly administered neoadjuvant chemotherapy (NAC) to downstage their tumors prior to surgery. In this setting, approximately 31% of patients fail to respond to therapy. This demonstrates the need for techniques capable of providing personalized feedback about treatment response at the earliest stages of therapy to identify patients likely to benefit from changing treatment. Diffuse optical spectroscopic imaging (DOSI) has emerged as a promising functional imaging technique for NAC monitoring. DOSI uses non-ionizing near-infrared light to provide non-invasive measures of absolute concentrations of tissue chromophores such as oxyhemoglobin. In 2011, we reported a new DOSI prognostic marker, oxyhemoglobin flare: a transient increase in oxyhemoglobin capable of discriminating NAC responders within the first day of treatment. In this follow-up study, DOSI was used to confirm the presence of the flare as well as to investigate whether DOSI markers of NAC response are regimen dependent. Methods This dual-center study examined 54 breast tumors receiving NAC measured with DOSI before therapy and the first week following chemotherapy administration. Patients were treated with either a standard of care maximum tolerated dose (MTD) regimen or an investigational metronomic (MET) regimen. Changes in tumor chromophores were tracked throughout the first week and compared to pathologic response and treatment regimen at specific days utilizing generalized estimating equations (GEE). Results Within patients receiving MTD therapy, the oxyhemoglobin flare was confirmed as a prognostic DOSI marker for response appearing as soon as day 1 with post hoc GEE analysis demonstrating a difference of 48.77% between responders and non-responders (p < 0.0001). Flare was not observed in patients receiving MET therapy. Within all responding patients, the specific treatment was a significant predictor of day 1 changes in oxyhemoglobin, showing a difference of 39.45% (p = 0.0010) between patients receiving MTD and MET regimens. Conclusions DOSI optical biomarkers are differentially sensitive to MTD and MET regimens at early timepoints suggesting the specific treatment regimen should be considered in future DOSI studies. Additionally, DOSI may help to identify regimen-specific responses in a more personalized manner, potentially providing critical feedback necessary to implement adaptive changes to the treatment strategy.
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Affiliation(s)
- Anup Tank
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA, 02215, USA
| | - Hannah M Peterson
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA, 02215, USA
| | - Vivian Pera
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA, 02215, USA
| | - Syeda Tabassum
- Department of Electrical Engineering, Boston University, Boston, MA, USA
| | - Anais Leproux
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, California, USA
| | - Thomas O'Sullivan
- Department of Electrical Engineering, University of Notre Dame, Notre Dame, IN, USA
| | - Eric Jones
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Naomi Ko
- Department of Hematology and Medical Oncology, Boston Medical Center, Boston, MA, USA
| | - Rita S Mehta
- Department of Medicine, University of California Irvine, Irvine, California, USA
| | - Bruce J Tromberg
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, California, USA
| | - Darren Roblyer
- Department of Biomedical Engineering, Boston University, 44 Cummington Mall, Boston, MA, 02215, USA.
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Coddington CC, Gopal D, Cui X, Cabral H, Diop H, Stern JE. Influence of subfertility and assisted reproductive technology treatment on mortality of women after delivery. Fertil Steril 2020; 113:569-577.e1. [PMID: 32044090 PMCID: PMC7088468 DOI: 10.1016/j.fertnstert.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare incidence, risk factors, and etiology of women's deaths in fertile, subfertile, and undergoing assisted reproductive technology (ART) in the years after delivery. DESIGN Retrospective cohort. SETTING University hospital. PATIENT(S) Women who had delivered in Massachusetts. INTERVENTION(S) This study used data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System linked to vital records, hospital stays, and the Massachusetts death file. Mortality of patients delivered from 2004-2013 was evaluated through 2015. The exposure groups, determined on the basis of the last delivery, were ART-treated (linked to Society for Assisted Reproductive Technology Clinic Outcome Reporting System), subfertile (no ART but with indicators of subfertility including birth certificate checkbox for fertility treatment, prior hospitalization for infertility [International Classification of Disease codes 9 628 or V23], and/or prior delivery with checkbox or ART), or fertile (neither ART nor subfertile). Numbers (per 100,000 women-years) and causes of death were obtained from the Massachusetts death file. MAIN OUTCOME MEASURE(S) Mortality of women after delivery in each of the three fertility groups and the most common etiology of death in each. RESULT(S) We included 483,547 women: 16,429 ART, 11,696 subfertile, and 455,422 fertile among whom there were 1,280 deaths with 21.1, 25.5, and 44.7 deaths, respectively, per 100,000 women-years. External causes (violence, accidents, and poisonings) were the most common reasons for death in the fertile group. Deaths occurred on average 46 months after delivery. When external causes of death were removed, there were 19.1, 17.0, and 25.6 deaths per 100,000 women-years and leading causes of death in all groups were cancer and circulatory problems. CONCLUSION(S) The study presents reassuring data that death rates within 5 years of delivery in ART-treated and subfertile women do not differ from those in fertile women.
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Affiliation(s)
- Charles C Coddington
- Department of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota; Atrium Health, Charlotte, North Carolina.
| | - Daksha Gopal
- Biostatistics, Boston University SPH, Boston, Massachusetts
| | - Xiaohui Cui
- Mass Department of Public Health, Boston, Massachusetts
| | - Howard Cabral
- Biostatistics, Boston University SPH, Boston, Massachusetts
| | - Hafsatou Diop
- Mass Department of Public Health, Boston, Massachusetts
| | - Judy E Stern
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Gardiner P, Bickmore T, Yinusa-Nyahkoon L, Reichert M, Julce C, Sidduri N, Martin-Howard J, Woodhams E, Aryan J, Zhang Z, Fernandez J, Loafman M, Srinivasan J, Cabral H, Jack BW. Using Health Information Technology to Engage African American Women on Nutrition and Supplement Use During the Preconception Period. Front Endocrinol (Lausanne) 2020; 11:571705. [PMID: 33584534 PMCID: PMC7874041 DOI: 10.3389/fendo.2020.571705] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE Healthy nutrition and appropriate supplementation during preconception have important implications for the health of the mother and newborn. The best way to deliver preconception care to address health risks related to nutrition is unknown. METHODS We conducted a secondary analysis of data from a randomized controlled trial designed to study the impact of conversational agent technology in 13 domains of preconception care among 528 non-pregnant African American and Black women. This analysis is restricted to those 480 women who reported at least one of the ten risks related to nutrition and dietary supplement use. INTERVENTIONS An online conversational agent, called "Gabby", assesses health risks and delivers 12 months of tailored dialogue for over 100 preconception health risks, including ten nutrition and supplement risks, using behavioral change techniques like shared decision making and motivational interviewing. The control group received a letter listing their preconception risks and encouraging them to talk to a health care provider. RESULTS After 6 months, women using Gabby (a) reported progressing forward on the stage of change scale for, on average, 52.9% (SD, 35.1%) of nutrition and supplement risks compared to 42.9% (SD, 35.4) in the control group (IRR 1.22, 95% CI 1.03-1.45, P = 0.019); and (b) reported achieving the action and maintenance stage of change for, on average, 52.8% (SD 37.1) of the nutrition and supplement risks compared to 42.8% (SD, 37.9) in the control group (IRR 1.26, 96% CI 1.08-1.48, P = 0.004). For subjects beginning the study at the contemplation stage of change, intervention subjects reported progressing forward on the stage of change scale for 75.0% (SD, 36.3%) of their health risks compared to 52.1% (SD, 47.1%) in the control group (P = 0.006). CONCLUSION The scalability of Gabby has the potential to improve women's nutritional health as an adjunct to clinical care or at the population health level. Further studies are needed to determine if improving nutrition and supplement risks can impact clinical outcomes including optimization of weight. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT01827215.
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine, University of Massachusetts Medical School, Worcester, MA, United States
- *Correspondence: Paula Gardiner,
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Leanne Yinusa-Nyahkoon
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Matthew Reichert
- Department of Government, Harvard University, Cambridge, MA, United States
| | - Clevanne Julce
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Nireesha Sidduri
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Jessica Martin-Howard
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
- Institute for Health Systems Innovation and Policy, Boston University, Boston, MA, United States
| | - Elisabeth Woodhams
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Jumana Aryan
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Zhe Zhang
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Juan Fernandez
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, United States
| | - Mark Loafman
- Department of Family Medicine, Cook County Health System, Chicago, IL, United States
| | - Jayakanth Srinivasan
- Institute for Health Systems Innovation and Policy, Boston University, Boston, MA, United States
- Department of Information Systems, Questrom School of Business, Boston, MA, United States
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Brian W. Jack
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
- Institute for Health Systems Innovation and Policy, Boston University, Boston, MA, United States
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Thomas DD, Stockman MC, Yu L, Meshulam T, McCarthy AC, Ionson A, Burritt N, Deeney J, Cabral H, Corkey B, Istfan N, Apovian CM. Effects of medium chain triglycerides supplementation on insulin sensitivity and beta cell function: A feasibility study. PLoS One 2019; 14:e0226200. [PMID: 31869355 PMCID: PMC6927614 DOI: 10.1371/journal.pone.0226200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/20/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Medium chain triglycerides (MCT) have unique metabolic properties which may improve insulin sensitivity (Si) and beta cell function but data in humans are limited. We conducted a 6-week clinical trial of MCT oil supplementation. Methods 22 subjects without diabetes (8 males, 14 females, mean ± standard error age 39±2.9 years, baseline BMI 27.0±1.4 kg/m2) were counseled to maintain their body weight and physical activity (PA) during the trial. Dietary intake, PA data, body composition, and resting energy expenditure (REE) were obtained through dietary recall, international PA questionnaire, dual x-ray absorptiometry, and indirect calorimetry, respectively. MCT prescriptions were given based on REE and PA to replace part of dietary fat with 30 grams of MCT per 2000 kcal daily. Insulin-modified frequently sampled intravenous glucose tolerance tests were performed before and after MCT to measure changes in Si, acute insulin response (AIR), disposition index (DI), and glucose effectiveness (Sg). Results MCT were well tolerated and weight remained stable (mean change 0.3 kg, p = 0.39). Fasting REE, respiratory quotient, and body composition were stable during the intervention. There were no significant changes in mean fasting glucose, insulin, insulin resistance, fasting total ketones, Si, AIR, DI, Sg, leptin, fructosamine, and proinsulin. The mean change in Si was 0.5 10−4 min-1 per mU/L (95% CI: -1.4, 2.4), corresponding to a 12% increase from baseline, and the range was -4.7 to 12.9 10−4 min-1 per mU/L. Mean total adiponectin decreased significantly from 22925 ng/mL at baseline to 17598 ng/mL at final visit (p = 0.02). The baseline clinical and laboratory parameters were not significantly associated with the change in Si. Discussion There were a wide range of changes in the minimal model parameters of glucose and insulin metabolism in subjects following 6 weeks of MCT as an isocaloric substitution for part of usual dietary fat intake. Since this was a single-arm non-randomized study without a control group, it cannot be certain whether these changes were due to MCT so further randomized controlled trials are warranted.
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Affiliation(s)
- Dylan D. Thomas
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
| | - Mary-Catherine Stockman
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition and Weight Management, Nutrition and Weight Management Center, Boston Medical Center, Boston, MA, United States of America
| | - Liqun Yu
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition and Weight Management, Nutrition and Weight Management Center, Boston Medical Center, Boston, MA, United States of America
| | - Tova Meshulam
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
| | - Ashley C. McCarthy
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
| | - Annaliese Ionson
- Boston University School of Medicine, Boston, MA, United States of America
| | - Nathan Burritt
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition and Weight Management, Nutrition and Weight Management Center, Boston Medical Center, Boston, MA, United States of America
| | - Jude Deeney
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Barbara Corkey
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
| | - Nawfal Istfan
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition and Weight Management, Nutrition and Weight Management Center, Boston Medical Center, Boston, MA, United States of America
| | - Caroline M. Apovian
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University, MA, United States of America
- Department of Medicine, Section of Endocrinology, Diabetes and Nutrition and Weight Management, Nutrition and Weight Management Center, Boston Medical Center, Boston, MA, United States of America
- * E-mail:
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Cerda Diez M, E. Cortés D, Trevino-Talbot M, Bangham C, Winter MR, Cabral H, Norkunas Cunningham T, M. Toledo D, J. Bowen D, K. Paasche-Orlow M, Bickmore T, Wang C. Designing and Evaluating a Digital Family Health History Tool for Spanish Speakers. Int J Environ Res Public Health 2019; 16:E4979. [PMID: 31817849 PMCID: PMC6950582 DOI: 10.3390/ijerph16244979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022]
Abstract
Digital family health history tools have been developed but few have been tested with non-English speakers and evaluated for acceptability and usability. This study describes the cultural and linguistic adaptation and evaluation of a family health history tool (VICKY: VIrtual Counselor for Knowing Your Family History) for Spanish speakers. In-depth interviews were conducted with 56 Spanish-speaking participants; a subset of 30 also participated in a qualitative component to evaluate the acceptability and usability of Spanish VICKY. Overall, agreement in family history assessment was moderate between VICKY and a genetic counselor (weighted kappa range: 0.4695 for stroke-0.6615 for heart disease), although this varied across disease subtypes. Participants felt comfortable using VICKY and noted that VICKY was very likeable and possessed human-like characteristics. They reported that VICKY was very easy to navigate, felt that the instructions were very clear, and thought that the time it took to use the tool was just right. Spanish VICKY may be useful as a tool to collect family health history and was viewed as acceptable and usable. The study results shed light on some cultural differences that may influence interactions with family history tools and inform future research aimed at designing and testing culturally and linguistically diverse digital systems.
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Affiliation(s)
- Maria Cerda Diez
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Dharma E. Cortés
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA 02141, USA;
- Department of Psychiatry, Harvard Medical School, Cambridge, MA 02139, USA
| | - Michelle Trevino-Talbot
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Candice Bangham
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA 02118, USA;
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Tricia Norkunas Cunningham
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Diana M. Toledo
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA;
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, School of Public Health, University of Washington, Seattle, WA 98195, USA;
| | | | - Timothy Bickmore
- College of Computer and Information Science, Northeastern University, Boston, MA 02115, USA;
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
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Radwin LE, Cabral H, Bokhour BG, Seibert MN, Stolzmann K, Annis A, Mohr DC. A scale to measure nurses' and providers' patient centered care in primary care settings. Patient Educ Couns 2019; 102:2302-2309. [PMID: 31351786 DOI: 10.1016/j.pec.2019.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/26/2019] [Accepted: 07/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES 1) Refine pilot scale measuring patients' experiences of outpatient nurses' and providers' care; 2) Determine variance explained by (a) pilot scale items and (b) "Survey of Health Experiences of Patients" (SHEP)/"Consumer Assessment of Health Care Providers and Systems" (CAHPS) scale items. METHODS Randomly selected Veteran patients with recent visits with primary care outpatient nurses and providers (n = 1192) completed scales: pilot "PCC in Primary Care: Nurses and Providers Scale" and SHEP/CAHPS scale items. Factor analyses conducted using structural equation modeling (SEM), variance measurement using regression strategies. RESULTS SEM generated scale comprised 17 items in 3 factors; 2 operationalized nurses' care; 1 providers' care. Fit statistics were acceptable. Variance explained for total PCC: nurses = 42%, providers = 56%. Combined pilot and SHEP/CAHPS item analyses yielded similarly structured scale. 70% of provider care variance explained by single item. CONCLUSION Appraisal of team, value-based care requires accrediting care to the appropriate clinician. The "PCC in Primary Care: Nurses and Providers Scale (PC2:NaPS)" provides a psychometrically sound measure for this purpose. PRACTICE IMPLICATIONS PC2:NaPS use would improve primary care leaders' and clinicians' analyses of patient centered care and associated outcomes in their settings, and thus enhance success of quality improvement and organizational projects.
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Affiliation(s)
- Laurel E Radwin
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Howard Cabral
- Boston University School of Public Health, Boston, MA, USA.
| | - Barbara G Bokhour
- Boston University School of Public Health, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, Bedford, MA, USA.
| | - Marjory Nealon Seibert
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Kelly Stolzmann
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.
| | - Ann Annis
- Michigan State University, East Lansing, MI, USA.
| | - David C Mohr
- Center for Health Care Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA.
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Kazis LE, Ameli O, Rothendler J, Garrity B, Cabral H, McDonough C, Carey K, Stein M, Sanghavi D, Elton D, Fritz J, Saper R. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open 2019; 9:e028633. [PMID: 31542740 PMCID: PMC6756340 DOI: 10.1136/bmjopen-2018-028633] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study examined the association of initial provider treatment with early and long-term opioid use in a national sample of patients with new-onset low back pain (LBP). DESIGN A retrospective cohort study of patients with new-onset LBP from 2008 to 2013. SETTING The study evaluated outpatient and inpatient claims from patient visits, pharmacy claims and inpatient and outpatient procedures with initial providers seen for new-onset LBP. PARTICIPANTS 216 504 individuals aged 18 years or older across the USA who were diagnosed with new-onset LBP and were opioid-naïve were included. Participants had commercial or Medicare Advantage insurance. EXPOSURES The primary independent variable is type of initial healthcare provider including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists). MAIN OUTCOME MEASURES Short-term opioid use (within 30 days of the index visit) following new LBP visit and long-term opioid use (starting within 60 days of the index date and either 120 or more days' supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months). RESULTS Short-term use of opioids was 22%. Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians (PCPs) (adjusted OR (AOR) (95% CI) 0.10 (0.09 to 0.10) and 0.15 (0.13 to 0.17), respectively). Compared with PCP visits, initial chiropractic and physical therapy also were associated with decreased odds of long-term opioid use in a propensity score matched sample (AOR (95% CI) 0.21 (0.16 to 0.27) and 0.29 (0.12 to 0.69), respectively). CONCLUSIONS Initial visits to chiropractors or physical therapists is associated with substantially decreased early and long-term use of opioids. Incentivising use of conservative therapists may be a strategy to reduce risks of early and long-term opioid use.
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Affiliation(s)
- Lewis E Kazis
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Omid Ameli
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- OptumLabs, Cambridge, Massachusetts, USA
| | - James Rothendler
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Brigid Garrity
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Christine McDonough
- University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA
| | - Kathleen Carey
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michael Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | | | - Julie Fritz
- Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Robert Saper
- Boston University Medical Campus, Boston, Massachusetts, USA
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Farland LV, Stern JE, Liu CL, Cabral H, Knowlton R, Gershman ST, Diop H, Missmer SA. Art outcomes among pre-pregnancy cancer survivors: linkage of massachusetts SART CORS and cancer registry. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.354] [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: 10/25/2022]
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Hwang SS, Dukhovny D, Gopal D, Cabral H, Diop H, Coddington CC, Stern JE. Health outcomes for Massachusetts infants after fresh versus frozen embryo transfer. Fertil Steril 2019; 112:900-907. [PMID: 31466699 DOI: 10.1016/j.fertnstert.2019.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare neonatal health outcomes after fresh versus frozen ET (FET). DESIGN Retrospective analysis of a population-based database of linked clinically assisted reproductive technology (ART) data with state vital records. Multivariable logistic regression was used to model the association between deliveries from fresh versus FET and adverse health outcomes, controlling for maternal characteristics. SETTING Not applicable. PATIENT(S) Live-born singleton infants born to Massachusetts women who conceived by fresh or FET after ART using autologous oocytes between July 1, 2004, and December 31, 2013. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Preterm birth, low birth weight, neonatal mortality, birth defects, organ system conditions. RESULT(S) Compared with infants conceived from fresh embryos, those born to mothers who underwent FET were less likely to be small for gestational age (adjusted odds ratio [AOR] = 0.56; 95% confidence interval [CI], 0.44-0.70) and low birth weight (AOR = 0.72; 95% CI, 0.59-0.88) but more likely to be large for gestational age (AOR = 1.47; 95% CI, 1.26-1.70) and to experience greater odds of infectious disease (AOR = 1.46; 95% CI, 1.03-2.06), respiratory (AOR = 1.23; 95% CI, 1.07-1.41), and neurologic (AOR = 1.32; 95% CI, 1.04-1.68) conditions. There were no statistically significant differences in preterm birth, neonatal mortality, birth defects, cardiovascular, hematologic, and gastrointestinal/feeding conditions, and for infants ≥ 35 weeks, no statistically significant differences in prolonged hospital stay (>3 days for vaginal delivery, >5 days for cesarean). CONCLUSION(S) Compared with infants conceived from fresh ET, those born by FET have higher birth weight but increased odds of infectious disease, hematologic, respiratory, and neurologic abnormalities. These risks should be considered when making decisions on fresh versus FET.
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Affiliation(s)
- Sunah S Hwang
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
| | - Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Daksha Gopal
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Hafsatou Diop
- Office of Data Translation, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Charles C Coddington
- Division of Reproductive Medicine, Carolinas Medical Center/Atrium Health, Charlotte, North Carolina
| | - Judy E Stern
- Department of Obstetrics and Gynecology and Pathology, Dartmouth-Hitchcock
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Stern JE, Liu CL, Cabral H, Harvey E, Missmer SA, Diop H, Coddington CC. Hospitalization before and after delivery in fertile, subfertile, and ART-treated women. J Assist Reprod Genet 2019; 36:1989-1997. [PMID: 31414316 DOI: 10.1007/s10815-019-01562-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/08/2019] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Pre-pregnancy and post-delivery hospitalizations were compared as markers for health among women who conceived using assisted reproductive technology (ART), non-ART medically assisted reproduction (MAR), no treatment (unassisted subfertile), and who were fertile. METHODS We analyzed hospital discharge data linked to Massachusetts birth certificates from 2004 to 2013 within 5 years prior to pregnancy and 8-365 days post-delivery. ART deliveries were linked from a national ART database; MAR deliveries had fertility treatment but not ART; unassisted subfertile women had subfertility but no ART or MAR; and fertile women had none of these. Prevalence of diagnoses during hospitalization was quantified. Multivariable logistic regression models with fertile deliveries as reference were adjusted for maternal age, race, education, year, and plurality (post-delivery only) with results reported as adjusted odds ratios (AORs) and 95% confidence intervals (CI). RESULTS Of 170,605 privately insured, primiparous deliveries, 10,458 were ART, 3005 MAR, 1365 unassisted subfertile, and 155,777 fertile. Pre-pregnancy hospitalization occurred in 6.8% and post-delivery in 2.8% of fertile women. Subfertile groups had more pre-pregnancy hospitalizations (AOR, 95% CI: 1.84, 1.72-1.96 ART; 1.41, 1.24-1.60 MAR; 3.02, 2.62-3.47 unassisted subfertile) with endometriosis, reproductive organ disease, ectopic pregnancy/miscarriage, and disorders of menstruation, ovulation, and genital tract being common. Post-delivery hospitalizations were significantly more frequent in the ART (AOR 1.19, 95% CI 1.05-1.34) and unassisted subfertile (1.59, 1.23-2.07) groups with more digestive tract disorders, thyroid problems, and other grouped chronic disease conditions. CONCLUSIONS Greater likelihood of hospitalization in the ART, MAR, and unassisted subfertile groups is largely explained by admissions for conditions associated with subfertility.
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Affiliation(s)
- Judy E Stern
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Chia-Ling Liu
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA, USA
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth Harvey
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA, USA
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hafsatou Diop
- Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA, USA
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Carey K, Ameli O, Garrity B, Rothendler J, Cabral H, McDonough C, Stein M, Saper R, Kazis L. Health insurance design and conservative therapy for low back pain. Am J Manag Care 2019; 25:e182-e187. [PMID: 31211551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine the association of health insurance benefit design features with choice of early conservative therapy for patients with new-onset low back pain (LBP). STUDY DESIGN Observational study of 117,448 commercially insured adults 18 years or older presenting with an outpatient diagnosis of new-onset LBP between 2008 and 2013 as recorded in the OptumLabs Data Warehouse. METHODS We identified patients who chose a primary care physician (PCP), physical therapist, or chiropractor as their entry-point provider. The main analyses were logistic regression models that estimated the likelihood of choosing a physical therapist versus a PCP and choosing a chiropractor versus a PCP. Key independent variables were health plan type, co-payment, deductible, and participation in a health reimbursement account (HRA) or health savings account (HSA). Models controlled for patient demographic and clinical characteristics. RESULTS Selection of entry-point provider was moderately responsive to the incentives that patients faced. Those covered under plan types with greater restrictions on provider choice were less likely to choose conservative therapy compared with those covered under the least restrictive plan type. Results also indicated a general pattern of higher likelihood of treatment with physical therapy at lower levels of patient cost sharing. We did not observe consistent associations between participation in HRAs or HSAs and choice of conservative therapy. CONCLUSIONS Modification of health insurance benefit designs offers an opportunity for creating greater value in treatment of new-onset LBP by encouraging patients to choose noninvasive conservative management that will result in long-term economic and social benefits.
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Affiliation(s)
- Kathleen Carey
- Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118.
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Bagley SM, Cabral H, Saia K, Brown A, Lloyd-Travaglini C, Walley AY, Rose-Jacobs R. Frequency and associated risk factors of non-fatal overdose reported by pregnant women with opioid use disorder. Addict Sci Clin Pract 2018; 13:26. [PMID: 30547833 PMCID: PMC6295054 DOI: 10.1186/s13722-018-0126-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about opioid overdose or naloxone access among pregnant women. OBJECTIVES The objectives of this study were to determine the prevalence of non-fatal overdose, risk factors for overdose, and naloxone access among third trimester women in treatment for opioid use disorder. METHODS We collected baseline data from a case management parental-support intervention study. To explore the association of variables with past year overdose, we used Wilcoxon rank-sum test, Chi square or Fisher's exact tests. RESULTS Among 99 participants, 14% (95% CI 7-21%) reported past year overdose and 67% (95% CI 57-76%) had received overdose education and a naloxone kit. Younger age was the only variable associated with past year overdose. CONCLUSIONS In this sample, past year non-fatal overdose was common, younger age was a risk factor, and most participants had received a naloxone kit. Further work is needed to understand whether younger age is a risk factor in the general population of pregnant women with opioid use disorder and to identify other potential risk factors for overdose in this population.
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Affiliation(s)
- Sarah M Bagley
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, 02118, USA. .,Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, 02118, USA.
| | - Howard Cabral
- School of Public Health, Boston University, Boston, USA
| | - Kelley Saia
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston Medical Center, Boston, USA
| | - Alyssa Brown
- Northeastern University School of Public Health, Boston, USA
| | | | - Alexander Y Walley
- Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Ruth Rose-Jacobs
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, 02118, USA
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Marcus R, de Groot A, Bachman S, Chisolm N, Quadri Y, Cabral H, Rajabiun S. Longitudinal Determinants of Housing Stability Among People Living With HIV/AIDS Experiencing Homelessness. Am J Public Health 2018; 108:S552-S560. [PMID: 32941778 DOI: 10.2105/ajph.2018.304772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine patterns of and factors associated with housing stability over time among people living with HIV (PLWH) experiencing homelessness with co-occurring substance use and mental health disorders enrolled in a patient-centered medical home (PCMH) intervention.Methods. Between September 2013 and February 2017, we ascertained housing trajectories among PLWH in 9 sites in the United States by conducting interviews at baseline, 6, and 12 months after and dichotomized them as improved consistently versus did not improve consistently. We identified covariates affecting housing stability using the socioecological model.Results. Forty-three percent (n = 198) experienced consistent housing improvement. Participants with history of mental health diagnosis (adjusted odds ratio [AOR] = 1.55; 95% confidence interval [CI] = 1.02, 2.35; P = .04) or trauma (AOR = 1.72; 95% CI = 1.22, 2.41; P = .006) had improved housing status; those with recent injecting drug use (AOR = 0.41; 95% CI = 0.19, 0.90; P = .03) had less consistent housing improvement.Conclusions. Improved housing stability may possibly reflect the importance of PCMH interventions that integrate housing, health, and behavioral services with patient navigators to address complex needs of PLWH experiencing homelessness.
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Affiliation(s)
- Ruthanne Marcus
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Alexander de Groot
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Sara Bachman
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Nicole Chisolm
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Yasmeen Quadri
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Howard Cabral
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
| | - Serena Rajabiun
- Ruthanne Marcus is with the AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT. Alexander de Groot is with the Biostatistics and Epidemiology Data Analytics Center and Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA. Sara Bachman and Serena Rajabiun are with the Boston University School of Social Work, Boston. Serena Rajabiun is also a Guest Editor for this supplement issue. Nicole Chisolm is with Prism Health North Texas, Dallas. Yasmeen Quadri is with Health Care for the Homeless Program, Houston, TX
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Giordano TP, Gallagher K, Davich JAW, Rathore M, Borne D, Davies E, Altice FL, Cabral H. The Impact of Housing and HIV Treatment on Health-Related Quality of Life Among People With HIV Experiencing Homelessness or Unstable Housing. Am J Public Health 2018; 108:S531-S538. [PMID: 32941776 DOI: 10.2105/ajph.2018.304731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To determine the impact of improvements in housing and HIV clinical parameters on health-related quality of life (HRQOL) in persons with HIV infection experiencing homelessness.Methods. This prospective cohort study took place in 9 US sites. Local efforts sought to improve HIV and housing status. Longitudinal data analyses determined the impact of changes in housing status, HIV suppression, and CD4 cell counts on HRQOL at 12 months, measured as mental and physical component summary scores.Results. Among 909 participants enrolled from 2013 to 2016, 75.1% were homeless, 51.6% did not have HIV suppression, and 23.6% had a CD4 count less than 200 cells per cubic millimeter. Median mental and physical component summary scores were 35.4 and 38.9, respectively. These 5 parameters all improved by 6 months. In multivariate modeling, maintaining or achieving stable housing predicted higher PCS at 12 months, but CD4 count and HIV suppression improvements did not. Improvements in housing, CD4 count, and HIV suppression did not predict mental component score at 12 months.Conclusions. Housing and HIV treatment are necessary but not sufficient to improve HRQOL in this challenging population. The high prevalence of socioeconomic and mental health needs we found support the call for patient-centered comprehensive care.
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Affiliation(s)
- Thomas P Giordano
- Thomas P. Giordano is with the Department of Medicine, Baylor College of Medicine, the Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center; and Thomas Street Health Center, Harris Health System, Houston, TX. Kerrin Gallagher is with Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA. Jo Ann Whitlock Davich is with Multnomah County Health Department, Portland, OR. Mobeen Rathore is with University of Florida Center for HIV/AIDS Research, Education, and Service, University of Florida, Jacksonville, FL. Deborah Borne is with the San Francisco Department of Public Health, San Francisco, CA. Erika Davies is with the City of Pasadena Public Health Department, Pasadena, CA. Frederick L. Altice is with the Department of Internal Medicine, Yale University School of Medicine, Yale School of Epidemiology and Public Health, New Haven, CT. Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health
| | - Kerrin Gallagher
- Thomas P. Giordano is with the Department of Medicine, Baylor College of Medicine, the Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center; and Thomas Street Health Center, Harris Health System, Houston, TX. Kerrin Gallagher is with Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA. Jo Ann Whitlock Davich is with Multnomah County Health Department, Portland, OR. Mobeen Rathore is with University of Florida Center for HIV/AIDS Research, Education, and Service, University of Florida, Jacksonville, FL. Deborah Borne is with the San Francisco Department of Public Health, San Francisco, CA. Erika Davies is with the City of Pasadena Public Health Department, Pasadena, CA. Frederick L. Altice is with the Department of Internal Medicine, Yale University School of Medicine, Yale School of Epidemiology and Public Health, New Haven, CT. Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health
| | - Jo Ann Whitlock Davich
- Thomas P. Giordano is with the Department of Medicine, Baylor College of Medicine, the Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center; and Thomas Street Health Center, Harris Health System, Houston, TX. Kerrin Gallagher is with Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA. Jo Ann Whitlock Davich is with Multnomah County Health Department, Portland, OR. Mobeen Rathore is with University of Florida Center for HIV/AIDS Research, Education, and Service, University of Florida, Jacksonville, FL. Deborah Borne is with the San Francisco Department of Public Health, San Francisco, CA. Erika Davies is with the City of Pasadena Public Health Department, Pasadena, CA. Frederick L. Altice is with the Department of Internal Medicine, Yale University School of Medicine, Yale School of Epidemiology and Public Health, New Haven, CT. Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health
| | - Mobeen Rathore
- Thomas P. Giordano is with the Department of Medicine, Baylor College of Medicine, the Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center; and Thomas Street Health Center, Harris Health System, Houston, TX. Kerrin Gallagher is with Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA. Jo Ann Whitlock Davich is with Multnomah County Health Department, Portland, OR. Mobeen Rathore is with University of Florida Center for HIV/AIDS Research, Education, and Service, University of Florida, Jacksonville, FL. Deborah Borne is with the San Francisco Department of Public Health, San Francisco, CA. Erika Davies is with the City of Pasadena Public Health Department, Pasadena, CA. Frederick L. Altice is with the Department of Internal Medicine, Yale University School of Medicine, Yale School of Epidemiology and Public Health, New Haven, CT. Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health
| | - Deborah Borne
- Thomas P. Giordano is with the Department of Medicine, Baylor College of Medicine, the Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center; and Thomas Street Health Center, Harris Health System, Houston, TX. Kerrin Gallagher is with Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA. Jo Ann Whitlock Davich is with Multnomah County Health Department, Portland, OR. Mobeen Rathore is with University of Florida Center for HIV/AIDS Research, Education, and Service, University of Florida, Jacksonville, FL. Deborah Borne is with the San Francisco Department of Public Health, San Francisco, CA. Erika Davies is with the City of Pasadena Public Health Department, Pasadena, CA. Frederick L. Altice is with the Department of Internal Medicine, Yale University School of Medicine, Yale School of Epidemiology and Public Health, New Haven, CT. Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health
| | - Erika Davies
- Thomas P. Giordano is with the Department of Medicine, Baylor College of Medicine, the Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center; and Thomas Street Health Center, Harris Health System, Houston, TX. Kerrin Gallagher is with Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA. Jo Ann Whitlock Davich is with Multnomah County Health Department, Portland, OR. Mobeen Rathore is with University of Florida Center for HIV/AIDS Research, Education, and Service, University of Florida, Jacksonville, FL. Deborah Borne is with the San Francisco Department of Public Health, San Francisco, CA. Erika Davies is with the City of Pasadena Public Health Department, Pasadena, CA. Frederick L. Altice is with the Department of Internal Medicine, Yale University School of Medicine, Yale School of Epidemiology and Public Health, New Haven, CT. Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health
| | - Frederick L Altice
- Thomas P. Giordano is with the Department of Medicine, Baylor College of Medicine, the Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center; and Thomas Street Health Center, Harris Health System, Houston, TX. Kerrin Gallagher is with Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA. Jo Ann Whitlock Davich is with Multnomah County Health Department, Portland, OR. Mobeen Rathore is with University of Florida Center for HIV/AIDS Research, Education, and Service, University of Florida, Jacksonville, FL. Deborah Borne is with the San Francisco Department of Public Health, San Francisco, CA. Erika Davies is with the City of Pasadena Public Health Department, Pasadena, CA. Frederick L. Altice is with the Department of Internal Medicine, Yale University School of Medicine, Yale School of Epidemiology and Public Health, New Haven, CT. Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health
| | - Howard Cabral
- Thomas P. Giordano is with the Department of Medicine, Baylor College of Medicine, the Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center; and Thomas Street Health Center, Harris Health System, Houston, TX. Kerrin Gallagher is with Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA. Jo Ann Whitlock Davich is with Multnomah County Health Department, Portland, OR. Mobeen Rathore is with University of Florida Center for HIV/AIDS Research, Education, and Service, University of Florida, Jacksonville, FL. Deborah Borne is with the San Francisco Department of Public Health, San Francisco, CA. Erika Davies is with the City of Pasadena Public Health Department, Pasadena, CA. Frederick L. Altice is with the Department of Internal Medicine, Yale University School of Medicine, Yale School of Epidemiology and Public Health, New Haven, CT. Howard Cabral is with the Department of Biostatistics, Boston University School of Public Health
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Silverstein M, Diaz-Linhart Y, Cabral H, Beardslee W, Broder-Fingert S, Kistin CJ, Patts G, Feinberg E. Engaging Mothers With Depressive Symptoms in Care: Results of a Randomized Controlled Trial in Head Start. Psychiatr Serv 2018; 69:1175-1180. [PMID: 30256184 DOI: 10.1176/appi.ps.201800173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors sought to determine whether a multicomponent, community-based program for preventing maternal depression also promotes engagement with mental health services for individuals with persistent symptoms. METHODS Mothers of children enrolled in Head Start were randomly assigned between February 2011 and May 2016 to Problem-Solving Education (PSE) (N=111) or usual services (N=119) and assessed every two months for 12 months. RESULTS Among 230 participants, 66% were Hispanic; 223 participants were included in the analysis. For all PSE participants, engagement with specialty mental health services increased from approximately 10% to 21% between two and 12 months. The PSE group was more likely than the control group to be engaged in specialty services at 12 months (adjusted odds ratio [AOR]=2.36, 95% confidence interval [CI]=1.07-5.20), and the rate of engagement with specialty services over time (treatment × time interaction) favored PSE (p=.016). Among PSE participants with persistent depressive symptoms over the follow-up period, engagement with specialty services increased from 12% (two months) to approximately 46% (12 months), whereas among control group participants, engagement fluctuated between 24% and 33%, without a clear trajectory pattern. At 12 months, PSE participants with persistent symptoms were more likely to engage with specialty care compared with their counterparts in the control group (AOR=6.95, CI=1.50-32.19). The treatment × time interaction was significant for the persistently symptomatic subgroup (p=.029) but not for the episodically symptomatic or the asymptomatic subgroups. CONCLUSIONS Embedding mental health programs in Head Start is a promising strategy to engage parents with depressive symptoms in care, especially those with persistent symptoms.
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Affiliation(s)
- Michael Silverstein
- Dr. Silverstein, Dr. Broder-Fingert, Dr. Kistin, and Dr. Feinberg are with the Department of Pediatrics, Boston Medical Center, and the Department of Pediatrics, Boston University School of Medicine, Boston. Dr. Feinberg is also with the Boston University School of Public Health, Boston, where Dr. Cabral and Mr. Patts are affiliated, Dr. Feinberg with the Department of Community Health Sciences, Dr. Cabral with the Department of Biostatistics, and Mr. Patts with the Biostatistics and Epidemiology Data Analytics Center. Ms. Diaz-Linhart was with Boston Medical Center at the time of the study and is now with the Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Beardslee is with the Department of Psychiatry, Children's Hospital Boston, Harvard Medical School, Boston
| | - Yaminette Diaz-Linhart
- Dr. Silverstein, Dr. Broder-Fingert, Dr. Kistin, and Dr. Feinberg are with the Department of Pediatrics, Boston Medical Center, and the Department of Pediatrics, Boston University School of Medicine, Boston. Dr. Feinberg is also with the Boston University School of Public Health, Boston, where Dr. Cabral and Mr. Patts are affiliated, Dr. Feinberg with the Department of Community Health Sciences, Dr. Cabral with the Department of Biostatistics, and Mr. Patts with the Biostatistics and Epidemiology Data Analytics Center. Ms. Diaz-Linhart was with Boston Medical Center at the time of the study and is now with the Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Beardslee is with the Department of Psychiatry, Children's Hospital Boston, Harvard Medical School, Boston
| | - Howard Cabral
- Dr. Silverstein, Dr. Broder-Fingert, Dr. Kistin, and Dr. Feinberg are with the Department of Pediatrics, Boston Medical Center, and the Department of Pediatrics, Boston University School of Medicine, Boston. Dr. Feinberg is also with the Boston University School of Public Health, Boston, where Dr. Cabral and Mr. Patts are affiliated, Dr. Feinberg with the Department of Community Health Sciences, Dr. Cabral with the Department of Biostatistics, and Mr. Patts with the Biostatistics and Epidemiology Data Analytics Center. Ms. Diaz-Linhart was with Boston Medical Center at the time of the study and is now with the Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Beardslee is with the Department of Psychiatry, Children's Hospital Boston, Harvard Medical School, Boston
| | - William Beardslee
- Dr. Silverstein, Dr. Broder-Fingert, Dr. Kistin, and Dr. Feinberg are with the Department of Pediatrics, Boston Medical Center, and the Department of Pediatrics, Boston University School of Medicine, Boston. Dr. Feinberg is also with the Boston University School of Public Health, Boston, where Dr. Cabral and Mr. Patts are affiliated, Dr. Feinberg with the Department of Community Health Sciences, Dr. Cabral with the Department of Biostatistics, and Mr. Patts with the Biostatistics and Epidemiology Data Analytics Center. Ms. Diaz-Linhart was with Boston Medical Center at the time of the study and is now with the Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Beardslee is with the Department of Psychiatry, Children's Hospital Boston, Harvard Medical School, Boston
| | - Sarabeth Broder-Fingert
- Dr. Silverstein, Dr. Broder-Fingert, Dr. Kistin, and Dr. Feinberg are with the Department of Pediatrics, Boston Medical Center, and the Department of Pediatrics, Boston University School of Medicine, Boston. Dr. Feinberg is also with the Boston University School of Public Health, Boston, where Dr. Cabral and Mr. Patts are affiliated, Dr. Feinberg with the Department of Community Health Sciences, Dr. Cabral with the Department of Biostatistics, and Mr. Patts with the Biostatistics and Epidemiology Data Analytics Center. Ms. Diaz-Linhart was with Boston Medical Center at the time of the study and is now with the Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Beardslee is with the Department of Psychiatry, Children's Hospital Boston, Harvard Medical School, Boston
| | - Caroline J Kistin
- Dr. Silverstein, Dr. Broder-Fingert, Dr. Kistin, and Dr. Feinberg are with the Department of Pediatrics, Boston Medical Center, and the Department of Pediatrics, Boston University School of Medicine, Boston. Dr. Feinberg is also with the Boston University School of Public Health, Boston, where Dr. Cabral and Mr. Patts are affiliated, Dr. Feinberg with the Department of Community Health Sciences, Dr. Cabral with the Department of Biostatistics, and Mr. Patts with the Biostatistics and Epidemiology Data Analytics Center. Ms. Diaz-Linhart was with Boston Medical Center at the time of the study and is now with the Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Beardslee is with the Department of Psychiatry, Children's Hospital Boston, Harvard Medical School, Boston
| | - Gregory Patts
- Dr. Silverstein, Dr. Broder-Fingert, Dr. Kistin, and Dr. Feinberg are with the Department of Pediatrics, Boston Medical Center, and the Department of Pediatrics, Boston University School of Medicine, Boston. Dr. Feinberg is also with the Boston University School of Public Health, Boston, where Dr. Cabral and Mr. Patts are affiliated, Dr. Feinberg with the Department of Community Health Sciences, Dr. Cabral with the Department of Biostatistics, and Mr. Patts with the Biostatistics and Epidemiology Data Analytics Center. Ms. Diaz-Linhart was with Boston Medical Center at the time of the study and is now with the Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Beardslee is with the Department of Psychiatry, Children's Hospital Boston, Harvard Medical School, Boston
| | - Emily Feinberg
- Dr. Silverstein, Dr. Broder-Fingert, Dr. Kistin, and Dr. Feinberg are with the Department of Pediatrics, Boston Medical Center, and the Department of Pediatrics, Boston University School of Medicine, Boston. Dr. Feinberg is also with the Boston University School of Public Health, Boston, where Dr. Cabral and Mr. Patts are affiliated, Dr. Feinberg with the Department of Community Health Sciences, Dr. Cabral with the Department of Biostatistics, and Mr. Patts with the Biostatistics and Epidemiology Data Analytics Center. Ms. Diaz-Linhart was with Boston Medical Center at the time of the study and is now with the Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Beardslee is with the Department of Psychiatry, Children's Hospital Boston, Harvard Medical School, Boston
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49
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Dukhovny D, Hwang SS, Gopal D, Cabral H, Missmer S, Diop H, Declercq E, Stern JE. Length of stay and cost of birth hospitalization: effects of subfertility and ART. J Perinatol 2018; 38:1457-1465. [PMID: 30166621 PMCID: PMC6217794 DOI: 10.1038/s41372-018-0205-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to measure delivery length of stay (LOS) and cost as proxies for infant morbidity in assisted reproductive technology (ART) and subfertile deliveries. STUDY DESIGN Massachusetts singleton births, ≥ 23 weeks gestational age (GA) between 2004 and 2010, were linked with ART data, vital records, and hospital discharges. LOS and costs (2010 US dollars) of infants born to fertile (no ART or indicators of infertility), subfertile (indicators of infertility but no ART), and ART-treated (linked to ART data) deliveries were compared. Least-square means and SE were calculated. RESULTS Of 345,756 singletons (fertile n = 332,481, subfertile n = 4987, and ART-treated n = 8288), overall LOS was 3.79 ± 0.01, 4.32 ± 0.15, and 4.90 ± 0.04 days, and costs were $2980 ± 6, $3217 ± 58, and $4483 ± 62, respectively. GA and birthweight predicted much of the intergroup difference. CONCLUSION Maternal fertility group was not an independent predictor of infant LOS and costs. Prematurity and birthweight were driving factors in resource utilization.
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Affiliation(s)
- Dmitry Dukhovny
- Department of Pediatrics, Oregon Health and Science University, Portland, USA.
| | - Sunah S. Hwang
- Section of Neonatology, Department of Pediatrics,
University of Colorado School of Medicine
| | - Daksha Gopal
- Department of Biostatistics, Boston University School of
Public Health
| | - Howard Cabral
- Department of Biostatistics, Boston University School of
Public Health
| | - Stacey Missmer
- Department of Obstetrics, Gynecology, and Reproductive
Biology, Michigan State University
| | | | - Eugene Declercq
- Department of Community Health Sciences, Boston University
School of Public Health
| | - Judy E. Stern
- Department of Obstetrics and Gynecology and Pathology,
Dartmouth-Hitchcock
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50
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Yuan Y, Louis C, Cabral H, Schneider JC, Ryan CM, Kazis LE. Socioeconomic and Geographic Disparities in Accessing Nursing Homes With High Star Ratings. J Am Med Dir Assoc 2018; 19:852-859.e2. [DOI: 10.1016/j.jamda.2018.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/26/2018] [Accepted: 05/21/2018] [Indexed: 10/28/2022]
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