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Lee S, Harris LM, Miller AC, Cavanaugh JE, Nizar JM, Simmering JE, Abou Alaiwa MH, Polgreen LA, Polgreen PM. Risk for Dehydration and Fluid and Electrolyte Disorders Among Cystic Fibrosis Carriers. Am J Kidney Dis 2024; 83:695-697. [PMID: 37951339 PMCID: PMC11068020 DOI: 10.1053/j.ajkd.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Sulyun Lee
- Department of Computer Science, University of Iowa, Iowa City, Iowa
| | - Logan M Harris
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Aaron C Miller
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | | | - Jonathan M Nizar
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Jacob E Simmering
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Mahmoud H Abou Alaiwa
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Linnea A Polgreen
- Division of Health Sciences Research, Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa
| | - Philip M Polgreen
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa.
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Hart AA, Swenson A, Narayanan NS, Simmering JE. Rurality modifies the association between symptoms and the diagnosis of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-11. [PMID: 38353166 DOI: 10.1080/21678421.2024.2315185] [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: 10/17/2023] [Accepted: 01/28/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE We utilized national claims-based data to identify the change in odds of diagnosis of ALS following possible-ALS-symptoms-and whether the change varies in urban/rural areas. METHODS Insurance claims were obtained from the Merative MarketScan databases, 2001-2021 in the United States. Individuals with incident ALS were identified and matched on age, sex, and enrollment period to individuals without ALS. For all individuals, claims for 8 possible-ALS-symptoms in the time before any ALS diagnosis were identified. We then used conditional logistic regression to estimate the odds of being diagnosed with ALS following these symptoms and whether the association varied by urban/rural location. RESULTS 19,226 individuals with ALS were matched to 96,126 controls. Patients with ALS were more likely to live in an urban area (87.0% vs 84.5%). Of those with ALS 84% had 1+ of our 8 possible-ALS-symptom compared to 51% of controls. After adjustment for confounders, having possible-ALS-symptoms increased the odds of a future ALS diagnosis by nearly 5-fold. A dose-response pattern was present with increasing odds as the number of symptoms increased. In all models, urban areas were associated with increased odds of diagnosis with ALS while the effect of having a symptom was smaller in urban places. Urban cases of ALS are diagnosed at younger ages. CONCLUSIONS These results suggest symptoms may appear and be noted years before the diagnosis of ALS. Additionally, rural patients are diagnosed at later ages with a greater dependence on symptoms than urban patients. These results highlight potential improvements for screening for ALS.
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Affiliation(s)
- Alexander A Hart
- Department of Neurology, University of Michigan, Ann Arbor, MI,, USA
| | - Andrea Swenson
- Department of Neurology, University of Iowa, Iowa City, IA, , USA, and
| | | | - Jacob E Simmering
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
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Arakkal AT, Polgreen LA, Chapman CG, Simmering JE, Cavanaugh JE, Polgreen PM, Miller AC. Association between household opioid prescriptions and risk for overdose among family members not prescribed opioids. Pharmacotherapy 2024; 44:110-121. [PMID: 37926925 DOI: 10.1002/phar.2891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Prescription opioids have contributed to the rise in opioid-related overdoses and deaths. The presence of opioids within households may increase the risk of overdose among family members who were not prescribed an opioid themselves. Larger quantities of opioids may further increase risk. OBJECTIVES To determine the risk of opioid overdose among individuals who were not prescribed an opioid but were exposed to opioids prescribed to other family members in the household, and evaluate the risk in relation to the total morphine milligram equivalents (MMEs) present in the household. METHODS We conducted a cohort study using a large database of commercial insurance claims from 2001 to 2021. For inclusion in the cohort, we identified individuals not prescribed an opioid in the prior 90 days from households with two or more family members, and determined the total MMEs prescribed to other family members. Individuals were stratified into monthly enrollment strata defined by household opioid exposure and other confounders. A generalized linear model was used to estimate incidence rate ratios (IRRs) for overdose. RESULTS Overall, the incidence of overdose among enrollees in households where a family member was prescribed an opioid was 1.73 (95% confidence interval [CI]: 1.67-1.78) times greater than households without opioid prescriptions. The risk of overdose increased continuously with the level of potential MMEs in the household from an IRR of 1.23 (95% CI: 1.16-1.32) for 1-100 MMEs to 4.67 (95% CI: 4.18-5.22) for >12,000 MMEs. The risk of overdose associated with household opioid exposure was greatest for ages 1-2 years (IRR: 3.46 [95% CI: 2.98-4.01]) and 3-5 years (IRR: 3.31 [95% CI: 2.75-3.99]). CONCLUSIONS The presence of opioids in a household significantly increases the risk of overdose among other family members who were not prescribed an opioid. Higher levels of MMEs, either in terms of opioid strength or quantity, were associated with increased levels of risk. Risk estimates may reflect accidental poisonings among younger family members.
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Affiliation(s)
- Alan T Arakkal
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | | | - Cole G Chapman
- College of Pharmacy, University of Iowa, Iowa City, Iowa, USA
| | - Jacob E Simmering
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | - Philip M Polgreen
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Aaron C Miller
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
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Weber MA, Sivakumar K, Tabakovic EE, Oya M, Aldridge GM, Zhang Q, Simmering JE, Narayanan NS. Glycolysis-enhancing α 1-adrenergic antagonists modify cognitive symptoms related to Parkinson's disease. NPJ Parkinsons Dis 2023; 9:32. [PMID: 36864060 PMCID: PMC9981768 DOI: 10.1038/s41531-023-00477-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 02/20/2023] [Indexed: 03/04/2023] Open
Abstract
Terazosin is an α1-adrenergic receptor antagonist that enhances glycolysis and increases cellular ATP by binding to the enzyme phosphoglycerate kinase 1 (PGK1). Recent work has shown that terazosin is protective against motor dysfunction in rodent models of Parkinson's disease (PD) and is associated with slowed motor symptom progression in PD patients. However, PD is also characterized by profound cognitive symptoms. We tested the hypothesis that terazosin protects against cognitive symptoms associated with PD. We report two main results. First, in rodents with ventral tegmental area (VTA) dopamine depletion modeling aspects of PD-related cognitive dysfunction, we found that terazosin preserved cognitive function. Second, we found that after matching for demographics, comorbidities, and disease duration, PD patients newly started on terazosin, alfuzosin, or doxazosin had a lower hazard of being diagnosed with dementia compared to tamsulosin, an α1-adrenergic receptor antagonist that does not enhance glycolysis. Together, these findings suggest that in addition to slowing motor symptom progression, glycolysis-enhancing drugs protect against cognitive symptoms of PD.
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Affiliation(s)
- Matthew A Weber
- Department of Neurology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Kartik Sivakumar
- Department of Neurology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ervina E Tabakovic
- Department of Neurology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Mayu Oya
- Department of Neurology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Georgina M Aldridge
- Department of Neurology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Qiang Zhang
- Department of Neurology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jacob E Simmering
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Nandakumar S Narayanan
- Department of Neurology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Simmering JE, Welsh MJ, Schultz J, Narayanan NS. Use of Glycolysis-Enhancing Drugs and Risk of Parkinson's Disease. Mov Disord 2022; 37:2210-2216. [PMID: 36054705 PMCID: PMC9669185 DOI: 10.1002/mds.29184] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Terazosin (TZ) and closely related α1-adrenergic receptor antagonists (doxazosin [DZ] and alfuzosin [AZ]) enhance glycolysis and reduce neurodegeneration in animal models. Observational evidence in humans from several databases supports this finding; however, a recent study has suggested that tamsulosin, the comparator medication, increases the risk of Parkinson's disease. AIMS We consider a different comparison group of men taking 5α-reductase inhibitors (5ARIs) as a new, independent comparison allowing us to both obtain new estimates of the association between TZ/DZ/AZ and Parkinson's disease outcomes and validate tamsulosin as an active comparator. METHODS Using the Truven Health Analytics Marketscan database, we identified men without Parkinson's disease, newly started on TZ/DZ/AZ, tamsulosin, or 5ARIs. We followed these matched cohorts to compare the hazard of developing Parkinson's disease. We conducted sensitivity analyses using variable duration of lead-in to mitigate biases introduced by prodromal disease. RESULTS We found that men taking TZ/DZ/AZ had a lower hazard of Parkinson's disease than men taking tamsulosin (hazard ratio (HR) = 0.71, 95% CI [confidence interval]: 0.65-0.77, n = 239,888) and lower than men taking 5ARIs (HR = 0.84, 95% CI: 0.75-0.94, n = 129,116). We found the TZ/DZ/AZ versus tamsulosin HR to be essentially unchanged with up to 5 years of lead-in time; however, the TZ/DZ/AZ versus 5ARI effect became attenuated with longer lead-in durations. CONCLUSIONS These data suggest that men using TZ/DZ/AZ have a somewhat lower risk of developing Parkinson's disease than those using tamsulosin and a slightly lower risk than those using 5ARIs. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jacob E. Simmering
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA,Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA
| | - Michael J. Welsh
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA,Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA,Department of Molecular Physiology and Biophysics, Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA,Department of Neurology, Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA,Howard Hughes Medical Institute, University of IowaIowa CityIowaUSA
| | - Jordan Schultz
- Department of Neurology, Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA,Department of Psychiatry, Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA,Division of Pharmacy Practice and Sciences, College of PharmacyUniversity of IowaIowa CityIowaUSA
| | - Nandakumar S. Narayanan
- Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA,Department of Neurology, Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA
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Abstract
IMPORTANCE Acute appendicitis is a common cause of abdominal pain and the most common reason for emergency surgery in several countries. Increased cases during summer months have been reported. OBJECTIVE To investigate the incidence of acute appendicitis by considering local temperature patterns in geographic regions with different climate over several years. DESIGN, SETTING, AND PARTICIPANTS This cohort study used insurance claims data from the MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental and Coordination of Benefits Database from January 1, 2001, to December 31, 2017. The cohort included individuals at risk for appendicitis who were enrolled in US insurance plans that contribute data to the MarketScan databases. Cases of appendicitis in the inpatient, outpatient, and emergency department settings were identified using International Classification of Diseases, Ninth Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. Local weather data were obtained for individuals living in a metropolitan statistical area (MSA) from the Integrated Surface Database. Associations were characterized using a fixed-effects generalized linear model based on a negative binomial distribution. The model was adjusted for age, sex, and day of week and included fixed effects for year and MSA. The generalized linear model was fit with a piecewise linear model by searching each 0.56 °C in temperature for change points. To further isolate the role of temperature, observed temperature was replaced with the expected temperature and the deviation of the observed temperature from the expected temperature for a given city on a given day of year. Data were analyzed from October 1, 2021, to July 31, 2022. MAIN OUTCOMES AND MEASURES The primary outcome was the daily number of appendicitis cases in a given city stratified by age and sex, with mean temperature in the MSA over the previous 7 days as the independent variable. RESULTS A total of 450 723 744 person-years at risk and 689 917 patients with appendicitis (mean [SD] age, 35 [18] years; 347 473 male [50.4%] individuals) were included. Every 5.56 °C increase in temperature was associated with a 1.3% increase in the incidence of appendicitis (incidence rate ratio [IRR], 1.01; 95% CI, 1.01-1.02) when temperatures were 10.56 °C or lower and a 2.9% increase in incidence (IRR, 1.03; 95% CI, 1.03-1.03) for temperatures higher than 10.56 °C. In terms of temperature deviations, a higher-than-expected temperature increase greater than 5.56 °C was associated with a 3.3% (95% CI, 1.0%-5.7%) increase in the incidence of appendicitis compared with days with near-0 deviations. CONCLUSIONS AND RELEVANCE Results of this cohort study observed seasonality in the incidence of appendicitis and found an association between increased incidence and warmer weather. These results could help elucidate the mechanism of appendicitis.
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Affiliation(s)
| | - Linnea A. Polgreen
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City
| | - David A. Talan
- Ronald Reagan UCLA (University of California, Los Angeles) Medical Center, Department of Emergency Medicine, UCLA
| | | | - Philip M. Polgreen
- Department of Internal Medicine, University of Iowa, Iowa City
- Department of Epidemiology, University of Iowa, Iowa City
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Schultz JL, Brinker AN, Xu J, Ernst SE, Tayyari F, Liu L, Uc EY, Taylor EB, Simmering JE, Magnotta VA, Welsh MJ, Narayanan NS, Narayanan NS. A pilot to assess target engagement of terazosin in Parkinson's disease. Parkinsonism Relat Disord 2022; 94:79-83. [PMID: 34894470 PMCID: PMC8862665 DOI: 10.1016/j.parkreldis.2021.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/12/2021] [Accepted: 11/21/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Impaired brain energy metabolism is a key feature of Parkinson's disease (PD). Terazosin (TZ) binds phosphoglycerate kinase 1 and stimulates its activity, which enhances glycolysis and increases ATP levels. Preclinical and epidemiologic data suggest that TZ may be neuroprotective in PD. We aimed to assess target engagement and safety of TZ in people with PD. METHODS We performed a 12-week pilot study in people with PD. Participants were randomized to receive 5 mg TZ or placebo. Participants and study personnel were blinded. We assessed TZ target engagement by measuring brain ATP with 31P-magnetic resonance spectroscopy (MRS) and whole blood ATP with a luminescence assay. Robust linear regression models compared changes between groups controlling for baseline brain and blood ATP levels, respectively. We also assessed clinical measures of PD and adverse events. RESULTS Thirteen participants were randomized. Mild dizziness/lightheadedness was more common in the TZ group, and three participants taking TZ dropped out because of dizziness and/or orthostatic hypotension. Compared to the placebo group, the TZ group had a significant increase in the ratio of βATP to inorganic phosphate in the brain. The TZ group also had a significant increase in blood ATP levels compared to the placebo group (p < 0.01). CONCLUSIONS This pilot study suggests that TZ may engage its target and change ATP levels in the brain and blood of people with PD. Further studies may be warranted to test the disease-modifying potential of TZ.
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Affiliation(s)
- Jordan L. Schultz
- Department of Psychiatry, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Division of Pharmacy Practice and Sciences, College of Pharmacy, University of Iowa, Iowa City, IA 52242,Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Alivia N. Brinker
- Department of Psychiatry, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Jia Xu
- Department of Radiology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Sarah E. Ernst
- Department of Internal Medicine, Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Howard Hughes Medical Institute, University of Iowa, Iowa City, IA 52242
| | - Fariba Tayyari
- Department of Molecular Physiology and Biophysics, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242
| | - Lei Liu
- Department of Biochemistry and Molecular Biology, Capital Medical University School of Basic Medicine, Beijing, 100069, China
| | - Ergun Y. Uc
- Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Veteran’s Affairs Medical Center, 601 US-6 W, Iowa City, IA 52246
| | - Eric B. Taylor
- Department of Molecular Physiology and Biophysics, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242, (EBT, JES, VAM, MJW, NSN)
| | - Jacob E. Simmering
- Department of Internal Medicine, Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242, (EBT, JES, VAM, MJW, NSN)
| | - Vincent A. Magnotta
- Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242, (EBT, JES, VAM, MJW, NSN)
| | - Michael J. Welsh
- Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Department of Internal Medicine, Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Department of Molecular Physiology and Biophysics, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242, (EBT, JES, VAM, MJW, NSN),Howard Hughes Medical Institute, University of Iowa, Iowa City, IA 52242
| | - Nandakumar S. Narayanan
- Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242,Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA 52242, (EBT, JES, VAM, MJW, NSN)
| | - Nandakumar S Narayanan
- Department of Neurology, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA; Pappajohn Biomedical Institute, Roy J and Lucille A Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
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Abstract
Previous studies have identified dementia as a risk factor for death from coronavirus disease 2019 (COVID-19). However, it is unclear whether Alzheimer's disease (AD) is an independent risk factor for COVID-19 case fatality rate. In a retrospective cohort study, we identified 387,841 COVID-19 patients through TriNetX. After adjusting for demographics and comorbidities, we found that AD patients had higher odds of dying from COVID-19 compared to patients without AD (Odds Ratio: 1.20, 95%confidence interval: 1.09-1.32, p < 0.001). Interestingly, we did not observe increased mortality from COVID-19 among patients with vascular dementia. These data are relevant to the evolving COVID-19 pandemic.
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Affiliation(s)
- Qiang Zhang
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | - Jordan L Schultz
- Department of Neurology, University of Iowa, Iowa City, IA, USA.,Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | | | - Jacob E Simmering
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Youngcho Kim
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | - Amy C Ogilvie
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
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Francis SL, Simmering JE, Polgreen LA, Evans NJ, Hosteng KR, Carr LJ, Cremer JF, Coe S, Cavanaugh JE, Segre AM, Polgreen PM. Gamifying accelerometer use increases physical activity levels of individuals pre-disposed to type II diabetes. Prev Med Rep 2021; 23:101426. [PMID: 34178586 PMCID: PMC8209749 DOI: 10.1016/j.pmedr.2021.101426] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 01/03/2023] Open
Abstract
Physical activity is important for preventing obesity and diabetes, but most obese and pre-diabetic patients are not physically active. We developed a Fitbit-based game called MapTrek that promotes walking. We recruited obese and pre-diabetic patients. Half were randomly assigned to the control group and given a Fitbit alone. The others were given a Fitbit plus MapTrek. The MapTrek group participated in 6 months of weekly virtual races. Each week, participants were placed in a race with 9 others who achieved a similar number of steps in the previous week's race. Participants moved along the virtual route by the steps recorded on their Fitbit and received daily walking challenges via text message. Text messages also had links to the race map and leaderboard. We used a Bayesian mixed effects model to analyze the number of steps taken during the intervention. A total of 192 (89%) participants in the control group and 196 (91%) in the MapTrek group were included in the analyses. MapTrek significantly increased step counts when it began: MapTrek participants walked almost 1,700 steps more than the control group on the first day of the intervention. We estimate that there is a 97% probability that the effect of MapTrek is at least 1,000 additional steps per day throughout the course of the 6-month intervention and that MapTrek participants would have walked an additional 81 miles, on average, before the effect ended. Our MapTrek intervention led to significant extra walking by the MapTrek participants.
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Affiliation(s)
- Shelby L Francis
- Departments of Internal Medicine and Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Jacob E Simmering
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA, USA
| | - Nicholas J Evans
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Katie R Hosteng
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - Lucas J Carr
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
| | - James F Cremer
- Department of Computer Science, University of Iowa, Iowa City, IA, USA
| | - Sarah Coe
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Joe E Cavanaugh
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Alberto M Segre
- Department of Computer Science, University of Iowa, Iowa City, IA, USA
| | - Philip M Polgreen
- Departments of Internal Medicine and Epidemiology, University of Iowa, Iowa City, IA, USA
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Justice SA, Sewell DK, Miller AC, Simmering JE, Polgreen PM. Inferring patient transfer networks between healthcare facilities. Health Serv Outcomes Res Method 2021. [DOI: 10.1007/s10742-021-00249-5] [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: 12/01/2022]
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Simmering JE, Welsh MJ, Liu L, Narayanan NS, Pottegård A. Association of Glycolysis-Enhancing α-1 Blockers With Risk of Developing Parkinson Disease. JAMA Neurol 2021; 78:407-413. [PMID: 33523098 PMCID: PMC7851758 DOI: 10.1001/jamaneurol.2020.5157] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Question Is use of glycolysis-enhancing drugs, such as terazosin, doxazosin, and alfuzosin, associated with decreased risk of Parkinson disease compared with use of tamsulosin, a drug prescribed for similar indications but which does not enhance glycolysis? Findings In this cohort study of 147 248 propensity score–matched pairs of terazosin/doxazosin/alfuzosin users and tamsulosin users from Danish nationwide health registries and the Truven Health Analytics MarketScan, the use of terazosin/doxazosin/alfuzosin was associated with a 12% to 37% decrease in Parkinson disease risk compared with use of tamsulosin. Meaning Use of terazosin/doxazosin/alfuzosin may lower the risk of developing Parkinson disease. Importance Parkinson disease (PD) is a common neurodegenerative disease. A treatment that prevents or delays development of PD is a critical unmet need. Terazosin and closely related drugs were recently discovered to enhance glycolysis and reduce PD progression in animal models and human clinical databases. Objective To determine whether use of terazosin, doxazosin, and alfuzosin is associated with a decreased risk of developing PD. Design, Setting, and Participants This cohort study used active comparator control and propensity score–matched data from Danish nationwide health registries, including the Danish National Prescription Registry, the Danish National Patient Registry, and the Danish Civil Registration System, from January 1996 to December 2017 and data from the Truven Health Analytics MarketScan database from January 2001 to December 2017. Men without PD who newly initiated terazosin/doxazosin/alfuzosin therapy or tamsulosin therapy, which is used for a similar indication (benign prostatic hyperplasia or unspecified urinary problems) but does not enhance glycolysis, and had at least 1 year of follow-up after medication start were included. In Denmark, the database included all residents, while the Truven database is a compilation of insurance claims across the US. Data were analyzed from February 2019 to July 2020. Exposures Patients who used terazosin/doxazosin/alfuzosin vs tamsulosin. Additional dose-response analyses were carried out. Main Outcomes and Measures Differences in the hazard of developing PD identified by diagnoses or use of PD-specific medications between patients who ever used terazosin/doxazosin/alfuzosin or tamsulosin. Results A cohort of 52 365 propensity score–matched pairs of terazosin/doxazosin/alfuzosin and tamsulosin users were identified in the Danish registries, of which all were male and the mean (SD) age was 67.9 (10.4) years, and 94 883 propensity score–matched pairs were identified in the Truven database, of which all were male and the mean (SD) age was 63.8 (11.1) years. Patients in the Danish cohort who used terazosin/doxazosin/alfuzosin had a hazard ratio (HR) for developing PD of 0.88 (95% CI, 0.81-0.98), and patients in the Truven cohort had an HR of 0.63 (95% CI, 0.58-0.69). There was a dose-response association with short-duration, medium-duration, and long-duration use of terazosin/doxazosin/alfuzosin users having a decreasing HR in both the Danish cohort (short: HR, 0.95; 95% CI, 0.84-1.07; medium: HR, 0.88; 95% CI, 0.77-1.01; long: HR, 0.79; 95% CI, 0.66-0.95) and Truven cohort (short: HR, 0.70; 95% CI, 0.64-0.76; medium: HR, 0.58; 95% CI, 0.52-0.64; long: HR, 0.46; 95% CI, 0.36-0.57). Conclusions and Relevance These data suggest that users of terazosin/doxazosin/alfuzosin are at lower hazard of developing PD compared with users of tamsulosin. Future work is needed to further assess this association.
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Affiliation(s)
- Jacob E Simmering
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City
| | - Michael J Welsh
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City.,Department of Neurology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City.,Department of Molecular Physiology and Biophysics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City.,Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City.,Howard Hughes Medical Institute, University of Iowa, Iowa City
| | - Lei Liu
- Center of Stroke, Beijing Institute for Brain Disorders, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Nandakumar S Narayanan
- Department of Neurology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City
| | - Anton Pottegård
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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12
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Zhang Q, Schultz JL, Aldridge GM, Simmering JE, Narayanan NS. Coronavirus Disease 2019 Case Fatality and Parkinson's Disease. Mov Disord 2020; 35:1914-1915. [PMID: 32954522 PMCID: PMC7537245 DOI: 10.1002/mds.28325] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Qiang Zhang
- Department of NeurologyUniversity of IowaIowa CityIowaUSA
| | - Jordan L. Schultz
- Department of NeurologyUniversity of IowaIowa CityIowaUSA
- Department of PsychiatryUniversity of IowaIowa CityIowaUSA
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13
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Stapleton EM, Simmering JE, Manges RB, Chipara O, Stone EA, Zabner J, Peters TM, Herman T, Polgreen PM, Comellas AP. Continuous in-home PM 2.5 concentrations of smokers with and without a history of respiratory exacerbations in Iowa, during and after an air purifier intervention. J Expo Sci Environ Epidemiol 2020; 30:778-784. [PMID: 32461549 PMCID: PMC7483738 DOI: 10.1038/s41370-020-0235-1] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/27/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Americans spend most of their time indoors. Indoor particulate matter (PM) 2.5 µm and smaller (PM2.5) concentrations often exceed ambient concentrations. Therefore, we tested whether the use of an air purifying device (electrostatic precipitator, ESP) could reduce PM2.5 in homes of smokers with and without respiratory exacerbations, compared with baseline. METHODS We assessed PM2.5 concentrations in homes of subjects with and without a recent (≤3 years) history of respiratory exacerbation. We compared PM2.5 concentrations during 1 month of ESP use with those during 1 month without ESP use. RESULTS Our study included 19 subjects (53-80 years old), nine with a history of respiratory exacerbation. Geometric mean (GM) PM2.5 and median GM daily peak PM2.5 were significantly lower during ESP deployment compared with the equivalent time-period without the ESP (GSD = 0.50 and 0.37 µg/m3, respectively, p < 0.001). PM2.5 in homes of respiratory exacerbators tended (p < 0.14) to be higher than PM2.5 in homes of those without a history of respiratory exacerbation. CONCLUSIONS Subjects with a history of respiratory exacerbation tended to have higher mean, median, and mean peak PM2.5 concentrations compared with homes of subjects without a history of exacerbations. The ESP intervention reduced in-home PM2.5 concentrations, demonstrating its utility in reducing indoor exposures. NOVELTY OF STUDY Our work characterizes PM air pollution concentrations in homes of study subjects with and without respiratory exacerbations. We demonstrate that PM concentrations tend to be higher in homes of participants with respiratory exacerbations, and that the use of an inexpensive air purifier resulted in significantly lower daily average PM concentrations than when the purifier was not present. Our results provide a helpful intervention strategy for purifying indoor air and may be useful for susceptible populations.
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Affiliation(s)
- Emma M Stapleton
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Jacob E Simmering
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Robert B Manges
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Octav Chipara
- Department of Computer Science, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, USA
| | - Elizabeth A Stone
- Department of Chemistry, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, USA
| | - Joseph Zabner
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Thomas M Peters
- Department of Occupational and Environmental Health, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, USA
| | - Ted Herman
- Department of Computer Science, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, USA
| | - Phil M Polgreen
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Alejandro P Comellas
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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14
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Simmering JE, Polgreen LA, Polgreen PM, Teske RE, Comellas AP, Carter BL. The Cardiovascular Effects of Treatment with Hydroxychloroquine and Azithromycin. Pharmacotherapy 2020; 40:978-983. [PMID: 32677113 PMCID: PMC7404845 DOI: 10.1002/phar.2445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hydroxychloroquine combined with azithromycin has been investigated for activity against coronavirus disease 2019 (COVID-19), but concerns about adverse cardiovascular (CV) effects have been raised. This study evaluated claims data to determine if risks for CV events were increased with hydroxychloroquine alone or combined with azithromycin. We identified data from 43,752 enrollees that qualified for analysis. The number of CV events increased by 25 (95% confidence interval [CI]: 8, 42, p=0.005) per 1000 people per year of treatment with hydroxychloroquine alone compared with pretreatment levels and by 201 (95% CI: 145, 256, p<0.001) events per 1000 people per year when individuals took hydroxychloroquine and azithromycin. These rates translate to an additional 0.34 (95% CI: 0.11, 0.58) CV events per 1000 patients placed on a 5-day treatment with hydroxychloroquine monotherapy and 2.75 (95% CI: 1.99, 3.51) per 1000 patients on a 5-day treatment with both hydroxychloroquine and azithromycin. The rate of adverse events increased with age following exposure to hydroxychloroquine alone and combined with azithromycin. For females aged 60 to 79 years prescribed hydroxychloroquine, the rate of adverse CV events was 0.92 per 1000 patients on 5 days of therapy, but it increased to 4.78 per 1000 patients when azithromycin was added. The rate of adverse CV events did not differ significantly from zero for patients 60 years of age or younger. These data suggest that hydroxychloroquine with or without azithromycin is likely safe in individuals under 60 years of age if they do not have additional CV risks. However, the combination of hydroxychloroquine and azithromycin should be used with extreme caution in older patients.
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Affiliation(s)
- Jacob E Simmering
- Health Ventures Signal Center for Healthcare Innovation, University of Iowa, Iowa City, Iowa, USA
| | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA
| | - Philip M Polgreen
- Department of Internal Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, USA.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Rebecca E Teske
- Department of Internal Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Alejandro P Comellas
- Department of Internal Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Barry L Carter
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA.,Department of Family Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, USA
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15
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Cai R, Zhang Y, Simmering JE, Schultz JL, Li Y, Fernandez-Carasa I, Consiglio A, Raya A, Polgreen PM, Narayanan NS, Yuan Y, Chen Z, Su W, Han Y, Zhao C, Gao L, Ji X, Welsh MJ, Liu L. Enhancing glycolysis attenuates Parkinson's disease progression in models and clinical databases. J Clin Invest 2020; 129:4539-4549. [PMID: 31524631 DOI: 10.1172/jci129987] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/23/2019] [Indexed: 01/01/2023] Open
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease that lacks therapies to prevent progressive neurodegeneration. Impaired energy metabolism and reduced ATP levels are common features of PD. Previous studies revealed that terazosin (TZ) enhances the activity of phosphoglycerate kinase 1 (PGK1), thereby stimulating glycolysis and increasing cellular ATP levels. Therefore, we asked whether enhancement of PGK1 activity would change the course of PD. In toxin-induced and genetic PD models in mice, rats, flies, and induced pluripotent stem cells, TZ increased brain ATP levels and slowed or prevented neuron loss. The drug increased dopamine levels and partially restored motor function. Because TZ is prescribed clinically, we also interrogated 2 distinct human databases. We found slower disease progression, decreased PD-related complications, and a reduced frequency of PD diagnoses in individuals taking TZ and related drugs. These findings suggest that enhancing PGK1 activity and increasing glycolysis may slow neurodegeneration in PD.
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Affiliation(s)
- Rong Cai
- Institute of Hypoxia Medicine, Xuanwu Hospital and Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, and.,Center of Stroke, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Yu Zhang
- State Key Laboratory of Membrane Biology, School of Life Sciences, Peking University, Beijing, China
| | | | - Jordan L Schultz
- Departments of Pharmaceutical Care and Neurology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Yuhong Li
- Center of Stroke, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Irene Fernandez-Carasa
- Department of Pathology and Experimental Therapeutics, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat and Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain
| | - Antonella Consiglio
- Department of Pathology and Experimental Therapeutics, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat and Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Angel Raya
- Center of Regenerative Medicine in Barcelona (CMRB) and Networking Biomedical Research Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | | | - Nandakumar S Narayanan
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Yanpeng Yuan
- Institute of Hypoxia Medicine, Xuanwu Hospital and Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, and
| | - Zhiguo Chen
- Institute of Hypoxia Medicine, Xuanwu Hospital and Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, and
| | - Wenting Su
- Center of Stroke, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Yanping Han
- Institute of Hypoxia Medicine, Xuanwu Hospital and Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, and
| | - Chunyue Zhao
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
| | - Lifang Gao
- Center of Stroke, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Xunming Ji
- Institute of Hypoxia Medicine, Xuanwu Hospital and Key Laboratory for Neurodegenerative Diseases of the Ministry of Education, and.,Center of Stroke, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Michael J Welsh
- Howard Hughes Medical Institute, Departments of Internal Medicine, Neurology, and Molecular Physiology and Biophysics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Lei Liu
- Center of Stroke, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
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16
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Foster K, Simmering JE, Polgreen PM, Polgreen LA. 1463. The Rates of UTI Outpatient and Inpatient Visits from 2001 to 2015 Among an Insured Population. Open Forum Infect Dis 2019. [PMCID: PMC6809107 DOI: 10.1093/ofid/ofz360.1327] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hospitalizations attributable to urinary tract infections (UTI) have increased in recent years. One possible reason for the increase in admissions is a lack of effective oral agents, due to increasing rates of antimicrobial resistance, necessitating treatment with IV antibiotics. Our objective was to compare the rates of inpatient vs. outpatient treatment for UTIs.
Methods
We used the MarketScan database to identify UTI inpatient and outpatient visits from January 2001 through September 2015. Incidence rates for inpatient and outpatient visits were determined as a function of people at risk for UTIs. A difference-in-difference model with a change point in 2007 was used.
Results
During our study period, we identified 32,521,146 outpatient visits for UTI and 297,470 inpatient UTI visits. Rates for inpatient and outpatient visits were rising at similar rates before 2007. After 2007, the slopes differed, and the incidence of outpatient visits increased statistically (P = 0.023) when compared with inpatient visits.
Conclusion
Incidence of UTI hospitalizations is increasing but not as quickly as UTI outpatient visits. Since 2007, patients are more likely to be treated in the outpatient setting rather than in the inpatient setting.
Disclosures
All authors: No reported disclosures.
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17
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Zahr RS, Anthony CA, Polgreen PM, Simmering JE, Goerdt CJ, Hoth AB, Miller ML, Suneja M, Segre AM, Carter BL, Cavanaugh JE, Polgreen LA. A texting-based blood pressure surveillance intervention. J Clin Hypertens (Greenwich) 2019; 21:1463-1470. [PMID: 31503408 DOI: 10.1111/jch.13674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/29/2019] [Accepted: 06/18/2019] [Indexed: 01/12/2023]
Abstract
The authors examined whether using home BP measurements collected via a custom-built bi-directional-texting platform incorporated into patients' electronic medical records would lead to treatment calibration and improved BP management. Patients were randomized to either the intervention group and collected home measurements based on reminders and reported via bi-directional texting, or to the control group, with home BP measurement reporting via standard practice (eg, phone, electronic medical record portal) and instructed to return 7 morning and 7 evening BP measurements. Outcomes included number of BP measurements submitted, the number of medication changes, reduction in BP, and BP control. 72% of the intervention group submitted at least 14 readings, compared with 45% of the control group. BP control improved in both groups. However, the authors found no statistically significant difference in BP or the number of BP-medication changes at 1, 3, or 6 months compared with the control group.
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Affiliation(s)
- Roula S Zahr
- Department of Internal Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Chris A Anthony
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA
| | - Philip M Polgreen
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Jacob E Simmering
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Angela B Hoth
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Michelle L Miller
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Manish Suneja
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Alberto M Segre
- Department of Computer Science, University of Iowa, Iowa City, IA, USA
| | - Barry L Carter
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA, USA.,Department of Family Practice, University of Iowa, Iowa City, IA, USA
| | | | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA, USA
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18
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Gremaud AL, Carr LJ, Simmering JE, Evans NJ, Cremer JF, Segre AM, Polgreen LA, Polgreen PM. Gamifying Accelerometer Use Increases Physical Activity Levels of Sedentary Office Workers. J Am Heart Assoc 2018; 7:JAHA.117.007735. [PMID: 29967221 PMCID: PMC6064890 DOI: 10.1161/jaha.117.007735] [Citation(s) in RCA: 31] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Sedentary work is hazardous. Over 80% of all US jobs are predominantly sedentary, placing full‐time office workers at increased risk for cardiovascular and metabolic morbidity and mortality. Thus, there is a critical need for effective workplace physical activity interventions. MapTrek is a mobile health platform that gamifies Fitbit use for the purpose of promoting physical activity. The purpose of this study was to test the efficacy of MapTrek for increasing daily steps and moderate‐intensity steps over 10 weeks in a sample of sedentary office workers. Methods and Results Participants included 146 full‐time sedentary office workers aged 21 to 65 who reported sitting at least 75% of their workday. Each participant received a Fitbit Zip to wear daily throughout the intervention. Participants were randomized to either a: (1) Fitbit‐only group or 2) Fitbit + MapTrek group. Physical activity outcomes and intervention compliance were measured with the Fitbit activity monitor. The Fitbit + MapTrek group significantly increased daily steps (+2092 steps per day) and active minutes (+11.2 min/day) compared to the Fitbit‐only arm, but, on average, participants’ steps declined during the study period. Conclusions MapTrek is an effective approach for increasing physical activity at a clinically meaningful level in sedentary office workers, but as with accelerometer use alone, the effect decreases over time. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT03109535.
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Affiliation(s)
- Allene L Gremaud
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA
| | - Lucas J Carr
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA
| | - Jacob E Simmering
- Signal Center for Health Innovation, University of Iowa Health Ventures, Iowa City, IA
| | - Nicholas J Evans
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA
| | - James F Cremer
- Department of Computer Science, University of Iowa, Iowa City, IA
| | - Alberto M Segre
- Department of Computer Science, University of Iowa, Iowa City, IA
| | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA
| | - Philip M Polgreen
- Signal Center for Health Innovation, University of Iowa Health Ventures, Iowa City, IA.,Department of Internal Medicine and Epidemiology, University of Iowa, Iowa City, IA
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Abstract
Using the Nationwide Inpatient Sample and US weather data, we estimated the probability of community-acquired pneumonia (CAP) being diagnosed as Legionnaires’ disease (LD). LD risk increases when weather is warm and humid. With warm weather, we found a dose-response relationship between relative humidity and the odds for LD. When the mean temperature was 60°–80°F with high humidity (>80.0%), the odds for CAP being diagnosed with LD were 3.1 times higher than with lower levels of humidity (<50.0%). Thus, in some regions (e.g., the Southwest), LD is rarely the cause of hospitalizations. In other regions and seasons (e.g., the mid-Atlantic in summer), LD is much more common. Thus, suspicion for LD should increase when weather is warm and humid. However, when weather is cold, dry, or extremely hot, empirically treating all CAP patients for LD might contribute to excessive antimicrobial drug use at a population level.
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20
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Polgreen LA, Anthony C, Carr L, Simmering JE, Evans NJ, Foster ED, Segre AM, Cremer JF, Polgreen PM. The effect of automated text messaging and goal setting on pedometer adherence and physical activity in patients with diabetes: A randomized controlled trial. PLoS One 2018; 13:e0195797. [PMID: 29718931 PMCID: PMC5931450 DOI: 10.1371/journal.pone.0195797] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 07/20/2017] [Accepted: 03/29/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Activity-monitoring devices may increase activity, but their effectiveness in sedentary, diseased, and less-motivated populations is unknown. METHODS Subjects with diabetes or pre-diabetes were given a Fitbit and randomized into three groups: Fitbit only, Fitbit with reminders, and Fitbit with both reminders and goal setting. Subjects in the reminders group were sent text-message reminders to wear their Fitbit. The goal-setting group was sent a daily text message asking for a step goal. All subjects had three in-person visits (baseline, 3 and 6 months). We modelled daily steps and goal setting using linear mixed-effects models. RESULTS 138 subjects participated with 48 in the Fitbit-only, 44 in the reminders, and 46 in the goal-setting groups. Daily steps decreased for all groups during the study. Average daily steps were 7123, 6906, and 6854 for the Fitbit-only, the goal-setting, and the reminders groups, respectively. The reminders group was 17.2 percentage points more likely to wear their Fitbit than the Fitbit-only group. Setting a goal was associated with a significant increase of 791 daily steps, but setting more goals did not lead to step increases. CONCLUSION In a population of patients with diabetes or pre-diabetes, individualized reminders to wear their Fitbit and elicit personal step goals did not lead to increases in daily steps, although daily steps were higher on days when goals were set. Our intervention improved engagement and data collection, important goals for activity surveillance. This study demonstrates that new, more-effective interventions for increasing activity in patients with pre-diabetes and diabetes are needed.
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Affiliation(s)
- Linnea A. Polgreen
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
| | - Christopher Anthony
- Department of Orthopedic Surgery, University of Iowa, Iowa City, Iowa, United States of America
| | - Lucas Carr
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Jacob E. Simmering
- Signal Center for Healthcare Innovation, University of Iowa Health Systems, Iowa City, Iowa, United States of America
| | - Nicholas J. Evans
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Eric D. Foster
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, United States of America
| | - Alberto M. Segre
- Department of Computer Science, University of Iowa, Iowa City, Iowa, United States of America
| | - James F. Cremer
- Department of Computer Science, University of Iowa, Iowa City, Iowa, United States of America
| | - Philip M. Polgreen
- Signal Center for Healthcare Innovation, University of Iowa Health Systems, Iowa City, Iowa, United States of America
- Departments of Internal Medicine and Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
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21
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Metcalf KM, Simmering JE, Levy SM, Janz KF. Accelerometer Positioning Issues and Implications for Contemporary Analysis Methods. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536049.59631.5a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Francis SL, Janz KF, Simmering JE. Using an Accelerometer to Predict Mechanical Load of Physical Activities in Adults. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536478.42968.eb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Anthony CA, Peterson RA, Sewell DK, Polgreen LA, Simmering JE, Callaghan JJ, Polgreen PM. The Seasonal Variability of Surgical Site Infections in Knee and Hip Arthroplasty. J Arthroplasty 2018; 33:510-514.e1. [PMID: 29157786 PMCID: PMC5988362 DOI: 10.1016/j.arth.2017.10.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) after total knee (TKA) and total hip (THA) arthroplasty are devastating to patients and costly to healthcare systems. The purpose of this study is to investigate the seasonality of TKA and THA SSIs at a national level. METHODS All data were extracted from the National Readmission Database for 2013 and 2014. Patients were included if they had undergone TKA or THA. We modeled the odds of having a primary diagnosis of SSI as a function of discharge date by month, payer status, hospital size, and various patient co-morbidities. SSI status was defined as patients who were readmitted to the hospital with a primary diagnosis of SSI within 30 days of their arthroplasty procedure. RESULTS There were 760,283 procedures (TKA 424,104, THA 336,179) in our sample. Our models indicate that SSI risk was highest for patients discharged from their surgery in June and lowest for December discharges. For TKA, the odds of a 30-day readmission for SSI were 30.5% higher at the peak compared to the nadir time (95% confidence interval [CI] 20-42). For THA, the seasonal increase in SSI was 19% (95% CI 9-30). Compared to Medicare, patients with Medicaid as the primary payer had a 49% higher odds of 30-day SSI after TKA (95% CI 32-68). CONCLUSION SSIs following TKA and THA are seasonal peaking in summer months. Payer status was also a significant risk factor for SSIs. Future studies should investigate potential factors that could relate to the associations demonstrated in this study.
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Affiliation(s)
- Chris A. Anthony
- The Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
- Signal Center, University of Iowa Hospitals and Clinics
| | - Ryan A. Peterson
- The Department of Biostatistics, University of Iowa, 135 N. Riverside Drive, Iowa City, IA 52242, USA
- Signal Center, University of Iowa Hospitals and Clinics
| | - Daniel K. Sewell
- The Department of Biostatistics, University of Iowa, 135 N. Riverside Drive, Iowa City, IA 52242, USA
| | - Linnea A. Polgreen
- The Department of Pharmacy Practice and Science, University of Iowa, 115 S. Grand Ave., Iowa City, IA 52242, USA
| | | | - John J. Callaghan
- The Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
| | - Philip M. Polgreen
- Departments of Internal Medicine and Epidemiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
- Signal Center, University of Iowa Hospitals and Clinics
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Simmering JE, Tang F, Cavanaugh JE, Polgreen LA, Polgreen PM. The Increase in Hospitalizations for Urinary Tract Infections and the Associated Costs in the United States, 1998-2011. Open Forum Infect Dis 2017; 4:ofw281. [PMID: 28480273 PMCID: PMC5414046 DOI: 10.1093/ofid/ofw281] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background Outpatient therapies for urinary tract infections (UTIs) are becoming limited due to antimicrobial resistance. The purpose of this paper is to report how the incidence of hospitalizations for UTIs have varied over time in both men and women and across age groups. We also explore how the severity for UTI hospitalizations has changed and describe the seasonality of UTI hospitalizations. Methods Using the Nationwide Inpatient Sample, we compute a time-series of UTI incidence and subdivide the series by age and sex. We fit a collection of time-series models to explore how the trend and seasonal intensity varies by age and sex. We modeled changes in severity using regression with available confounders. Results In 2011, there were approximately 400000 hospitalizations for UTIs with an estimated cost of $2.8 billion. Incidence increased by 52% between 1998 and 2011. The rate of increase was larger among both women and older patients. We found that the seasonal intensity (summer peaks and winter troughs) increased over time among women while decreasing among men. For both men and women, seasonality decreased with advancing age. Relative to controls and adjusted for demographics, we found that costs among UTI patients grew more slowly, patients left the hospital earlier, and patients had lower odds of death. Conclusions Incidence of UTI hospitalization is increasing and is seasonal, peaking in the summer. However, the severity of UTI admissions seems to be decreasing, indicating that patients previously treated as outpatients may now be admitted to the hospital due to increasing antimicrobial resistance.
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Affiliation(s)
- Jacob E Simmering
- University of Iowa Health Venture's Signal Center for Health Innovation, Iowa City
| | - Fan Tang
- Genentech, San Francisco, California
| | | | - Linnea A Polgreen
- Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City
| | - Philip M Polgreen
- Internal Medicine, College of Medicine, and Epidemiology, College of Public Health, University of Iowa, University of Iowa Health Venture's Signal Center for Health Innovation, Iowa City
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Simmering JE, Polgreen LA, Comellas AP, Cavanaugh JE, Polgreen PM. Identifying Patients With COPD at High Risk of Readmission. Chronic Obstr Pulm Dis 2016; 3:729-738. [PMID: 28848899 DOI: 10.15326/jcopdf.3.4.2016.0136] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Readmission within 30 days of a COPD hospitalization is a common measure of performance for COPD care. However, most studies of COPD readmission risk have been constrained to a single data source, private payer claims, or Medicare claims data, making it difficult to generalize results from these studies to other populations. The purpose of this study was to examine the risk for readmission within 30 days from time of discharge in patients with COPD using the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database for California for the years 2005-2011. This statewide dataset allows us to consider all readmissions for COPD regardless of age or payer status. Methods: The total dataset included 28,265,070 visits among 17,918,374 patients over 480 hospitals. We identified patients with a hospitalization, a primary diagnosis related to COPD, age 40 or older, and discharged alive. We found 286,313 hospitalizations that matched this definition and included information on covariates such as comorbidities, age, and insurance status. To characterize the joint associations of these covariates with readmission within 30 days, we used a generalized linear model. Results: Patients aged 40-64 are more likely to be readmitted to the hospital within 30 days of a COPD-related hospitalization than patients 65 and older. This effect persists after adjustment for patient severity, comorbidities, payer, and demographics. Our model featured an interaction of age with insurance type. We found that younger patients (aged 40-64) on public insurance have the highest readmission rates: 14.77% for Medicare and 16.27% for Medicaid. However, younger patients with private insurance have the lowest readmission rates at 8.25%. Additional significant covariates included whether or not the patient left against medical advice, and diagnoses of congestive heart failure and diabetes. In addition, we found that although admissions for COPD were highest in the winter, this is not true for COPD readmissions, which peak in summer. Also, inpatient mortality for patients admitted for COPD decreased from approximately 3% to 1.25% over the study period. Conclusion: Our results demonstrate that many of the risk factors for readmission may be dependent on the data source used. Furthermore, many of the strongest predictors are clearly related to the patients themselves. This observation may help explain why prior programs to reduce readmissions have had limited success.
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Affiliation(s)
- Jacob E Simmering
- University of Iowa, Department of Pharmacy Practice and Science, Iowa City
| | - Linnea A Polgreen
- University of Iowa, Department of Pharmacy Practice and Science, Iowa City
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Simmering JE, Polgreen LA, Cavanaugh JE, Polgreen PM. Are well-child visits a risk factor for subsequent influenza-like illness visits? Infect Control Hosp Epidemiol 2015; 35:251-6. [PMID: 24521589 DOI: 10.1086/675281] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether well-child visits are a risk factor for subsequent influenza-like illness (ILI) visits within a child's family. DESIGN Retrospective cohort. METHODS Using data from the Medical Expenditure Panel Survey from the years 1996-2008, we identified 84,595 families. For each family, we determined those weeks in which a well-child visit or an ILI visit occurred. We identified 23,776 well-child-visit weeks and 97,250 ILI-visit weeks. We fitted a logistic regression model, where the binary dependent variable indicated an ILI clinic visit in a particular week. Independent variables included binary indicators to denote a well-child visit in the concurrent week or one of the previous 2 weeks, the occurrence of the ILI visit during the influenza season, and the presence of children in the family in each of the age groups 0-3, 4-7, and 8-17 years. Socioeconomic variables were also included. We also estimated the overall cost of well-child-exam-related ILI using data from 2008. RESULTS We found that an ILI office visit by a family member was positively associated with a well-child visit in the same or one of the previous 2 weeks (odds ratio, 1.54). This additional risk translates to potentially 778,974 excess cases of ILI per year in the United States, with a cost of $500 million annually. CONCLUSIONS Our results should encourage ambulatory clinics to strictly enforce infection control recommendations. In addition, clinics could consider time-shifting of well-child visits so as not to coincide with the peak of the influenza season.
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Affiliation(s)
- Jacob E Simmering
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa
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Simmering JE, Polgreen LA, Polgreen PM. Web search query volume as a measure of pharmaceutical utilization and changes in prescribing patterns. Res Social Adm Pharm 2014; 10:896-903. [PMID: 24603135 DOI: 10.1016/j.sapharm.2014.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/16/2014] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Monitoring prescription drug utilization is important for both drug safety and drug marketing purposes. However, access to utilization data is often expensive, limited and not timely. OBJECTIVES To demonstrate and validate the use of web search engine queries as a method for timely monitoring of drug utilization and changes in prescribing behaviors. METHODS Drug utilization time series were obtained from the Medical Expenditure Panel Survey and normalized search volume was obtained from Google Trends. Correlation between the series was estimated using a cross-correlation function. Changes in the search volume following knowledge events were detected using a cumulative sums changepoint method. RESULTS Search volume tracks closely with the utilization rates of several seasonal prescription drugs. Additionally, search volume exhibits changes following known major knowledge events, such as the publication of new information. CONCLUSIONS Search volume provides a first order approximation to pharmaceutical utilization in the community and can be used to detect changes in prescribing behavior.
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Affiliation(s)
- Jacob E Simmering
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA 52242, USA
| | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA 52242, USA.
| | - Philip M Polgreen
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA; Department of Epidemiology, University of Iowa, Iowa City, IA, USA
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Simmering JE, Polgreen LA, Polgreen PM. Using Search Volume for Surveillance of Medication Prescribing. Online J Public Health Inform 2013. [PMCID: PMC3692764] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective Introduction Methods Results Conclusions
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O'Brien AM, Hanson BM, Farina SA, Wu JY, Simmering JE, Wardyn SE, Forshey BM, Kulick ME, Wallinga DB, Smith TC. MRSA in conventional and alternative retail pork products. PLoS One 2012; 7:e30092. [PMID: 22276147 PMCID: PMC3261874 DOI: 10.1371/journal.pone.0030092] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 12/09/2011] [Indexed: 02/07/2023] Open
Abstract
In order to examine the prevalence of Staphylococcus aureus on retail pork, three hundred ninety-five pork samples were collected from a total of 36 stores in Iowa, Minnesota, and New Jersey. S. aureus was isolated from 256 samples (64.8%, 95% confidence interval [CI] 59.9%–69.5%). S. aureus was isolated from 67.3% (202/300) of conventional pork samples and from 56.8% (54/95) of alternative pork samples (labeled “raised without antibiotics” or “raised without antibiotic growth promotants”). Two hundred and thirty samples (58.2%, 95% CI 53.2%–63.1%) were found to carry methicillin-sensitive S. aureus (MSSA). MSSA was isolated from 61.0% (183/300) of conventional samples and from 49.5% (47/95) of alternative samples. Twenty-six pork samples (6.6%, 95% CI 4.3%–9.5%) carried methicillin-resistant S. aureus (MRSA). No statistically significant differences were observed for the prevalence of S. aureus in general, or MSSA or MRSA specifically, when comparing pork products from conventionally raised swine and swine raised without antibiotics, a finding that contrasts with a prior study from the Netherlands examining both conventional and “biologic” meat products. In our study spa types associated with “livestock-associated” ST398 (t034, t011) were found in 26.9% of the MRSA isolates, while 46.2% were spa types t002 and t008—common human types of MRSA that also have been found in live swine. The study represents the largest sampling of raw meat products for MRSA contamination to date in the U.S. MRSA prevalence on pork products was higher than in previous U.S.-conducted studies, although similar to that in Canadian studies.
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Affiliation(s)
- Ashley M. O'Brien
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, Coralville, Iowa, United States of America
| | - Blake M. Hanson
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, Coralville, Iowa, United States of America
| | - Sarah A. Farina
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, Coralville, Iowa, United States of America
| | - James Y. Wu
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, Coralville, Iowa, United States of America
| | - Jacob E. Simmering
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, Coralville, Iowa, United States of America
| | - Shylo E. Wardyn
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, Coralville, Iowa, United States of America
| | - Brett M. Forshey
- Center for Emerging Infectious Diseases, Coralville, Iowa, United States of America
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Marie E. Kulick
- Institute for Agriculture and Trade Policy, Minneapolis, Minnesota, United States of America
| | - David B. Wallinga
- Institute for Agriculture and Trade Policy, Minneapolis, Minnesota, United States of America
| | - Tara C. Smith
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, Coralville, Iowa, United States of America
- * E-mail:
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