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Saygin D, Kim H, Douglas C, Erman B, Wilkerson J, McGrath JA, Oddis CV, Lundberg IE, Amato AA, García-De La Torre I, Chinoy H, Fiorentino D, Chung L, Song YW, Miller FW, Ruperto N, Vencovsky J, Aggarwal R, Rider LG. Performance of the 2016 ACR-EULAR Myositis Response Criteria in adult dermatomyositis/polymyositis therapeutic trials and consensus profiles. Rheumatology (Oxford) 2023; 62:3672-3679. [PMID: 36929923 PMCID: PMC10629785 DOI: 10.1093/rheumatology/kead110] [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: 11/23/2022] [Revised: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE The ACR-EULAR Myositis Response Criteria (MRC) were developed as a composite measure using absolute percentage change in six core set measures (CSMs). We aimed to further validate the MRC by assessing the contribution of each CSM, frequency of strength vs extramuscular activity improvement, representation of patient-reported outcome measures (PROM), and frequency of CSM worsening. METHODS Data from adult dermatomyositis/polymyositis patients in the rituximab (n = 147), etanercept (n = 14), and abatacept (n = 19) trials, and consensus patient profiles (n = 232) were evaluated. The Total Improvement Score (TIS), number of improving vs worsening CSMs, frequency of improvement with and without muscle-related CSMs, and contribution of PROM were evaluated by MRC category. Regression analysis was performed to assess contribution of each CSM to the MRC. RESULTS Of 412 adults with dermatomyositis/polymyositis, there were 37%, 24%, 25%, and 14% with no, minimal, moderate, and major MRC improvement, respectively. The number of improving CSMs and absolute percentage change in all CSMs increased by improvement category. In minimal-moderate improvement, only physician-reported disease activity contributed significantly more than expected by MRC. Of patients with at least minimal improvement, 95% had improvement in muscle-related measures and a majority (84%) had improvement in PROM. Patients with minimal improvement had worsening in a median of 1 CSM, and most patients with moderate-major improvement had no worsening CSMs. Physician assessment of change generally agreed with MRC improvement categories. CONCLUSION The ACR-EULAR MRC performs consistently across multiple studies, further supporting its use as an efficacy end point in future myositis therapeutic trials.
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Affiliation(s)
- Didem Saygin
- Section of Rheumatology at University of Chicago and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hanna Kim
- Juvenile Myositis Pathogenesis and Therapeutics Unit, National Institute of Arthritis Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - Brian Erman
- Social & Scientific Systems, Inc, Durham, NC, USA
| | | | | | - Chester V Oddis
- Section of Rheumatology at University of Chicago and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anthony A Amato
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ignacio García-De La Torre
- Hospital General de Occidente de la Secretaría de Salud and Universidad de Guadalajara, Department of Immunology and Rheumatology, Mexico
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Division of Musculoskeletal and Dermatological Sciences, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Lorinda Chung
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Yeong-Wook Song
- Medical Research Center, Institute of Human-Environment Interface Biology, Department of Internal Medicine, Seoul National University
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, UOSID Centro Trial, Reumatologia, Pediatria II, PRINTO, Genoa, Italy
| | - Jiri Vencovsky
- Department of Rheumatology, 1st Medical Faculty, Institute of Rheumatology; Charles University, Prague, Czech Republic
| | - Rohit Aggarwal
- Section of Rheumatology at University of Chicago and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
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Kim H, Saygin D, Douglas C, Wilkerson J, Erman B, Pistorio A, McGrath JA, Reed AM, Oddis CV, Bracaglia C, van Royen-Kerkhof A, Bica B, Dolezalova P, Ferriani VPL, Flato B, Bernard-Medina AG, Herlin T, Miller FW, Vencovsky J, Ruperto N, Aggarwal R, Rider LG. Performance of the 2016 ACR-EULAR myositis response criteria in juvenile dermatomyositis therapeutic trials and consensus profiles. Rheumatology (Oxford) 2023; 62:3680-3689. [PMID: 36929918 PMCID: PMC10629769 DOI: 10.1093/rheumatology/kead111] [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: 12/14/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES The 2016 ACR-EULAR Response Criteria for JDM was developed as a composite measure with differential weights of six core set measures (CSMs) to calculate a Total Improvement Score (TIS). We assessed the contribution of each CSM, representation of muscle-related and patient-reported CSMs towards improvement, and frequency of CSM worsening across myositis response criteria (MRC) categories in validation of MRC. METHODS Data from JDM patients in the Rituximab in Myositis trial (n = 48), PRINTO JDM trial (n = 139), and consensus patient profiles (n = 273) were included. Observed vs expected CSM contributions were compared using Sign test. Characteristics of MRC categories were compared by Wilcoxon tests with Bonferroni adjustment. Spearman correlation of changes in TIS and individual CSMs were examined. Agreement between physician-assessed change and MRC categories was evaluated by weighted Cohen's kappa. RESULTS Of 457 JDM patients with IMACS CSMs and 380 with PRINTO CSMs, 9-13% had minimal, 19-23% had moderate and 41-50% had major improvement. The number of improved and absolute percentage change of CSMs increased by MRC improvement level. Patients with minimal improvement by MRC had a median of 0-1 CSM worsened, and those with moderate/major improvement had a median of zero worsening CSMs. Of patients improved by MRC, 94-95% had improvement in muscle strength and 93-95% had improvement in ≥1 patient-reported CSM. IMACS and PRINTO CSMs performed similarly. Physician-rated change and MRC improvement categories had moderate-to-substantial agreement (Kappa 0.5-0.7). CONCLUSION The ACR-EULAR MRC perform consistently across multiple studies, supporting its further use as an efficacy end point in JDM trials.
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Affiliation(s)
- Hanna Kim
- Juvenile Myositis Pathogenesis and Therapeutics Unit, National Institute of Arthritis Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Didem Saygin
- Section of Rheumatology, Department of Medicine, University of Chicago, Chicago, IL, USA
- School of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Brian Erman
- Social & Scientific Systems, Inc, Durham, NC, USA
| | - Angela Pistorio
- IRCCS Istituto Giannina Gaslini, Direzione Scientifica, Genoa, Italy
| | | | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Chester V Oddis
- School of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Claudia Bracaglia
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Annet van Royen-Kerkhof
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Blanca Bica
- Section of Rheumatology, Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pavla Dolezalova
- General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Virginia P L Ferriani
- Department of Pediatrics; Division of Rheumatology, Ribeirao Preto Medical School- Sao Paulo University, Ribeirao Preto, Brazil
| | - Berit Flato
- Department of Rheumatology, Oslo University Hospital, Norway and Institute of clinical medicine, University of Oslo, Oslo, Norway
| | | | - Troels Herlin
- Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
| | - Jiri Vencovsky
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Nicolino Ruperto
- UOSID Centro Trial, PRINTO, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Rohit Aggarwal
- School of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
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MacNell N, Feinstein L, Wilkerson J, Salo PM, Molsberry SA, Fessler MB, Thorne PS, Motsinger-Reif AA, Zeldin DC. Implementing machine learning methods with complex survey data: Lessons learned on the impacts of accounting sampling weights in gradient boosting. PLoS One 2023; 18:e0280387. [PMID: 36638125 PMCID: PMC9838837 DOI: 10.1371/journal.pone.0280387] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
Despite the prominent use of complex survey data and the growing popularity of machine learning methods in epidemiologic research, few machine learning software implementations offer options for handling complex samples. A major challenge impeding the broader incorporation of machine learning into epidemiologic research is incomplete guidance for analyzing complex survey data, including the importance of sampling weights for valid prediction in target populations. Using data from 15, 820 participants in the 1988-1994 National Health and Nutrition Examination Survey cohort, we determined whether ignoring weights in gradient boosting models of all-cause mortality affected prediction, as measured by the F1 score and corresponding 95% confidence intervals. In simulations, we additionally assessed the impact of sample size, weight variability, predictor strength, and model dimensionality. In the National Health and Nutrition Examination Survey data, unweighted model performance was inflated compared to the weighted model (F1 score 81.9% [95% confidence interval: 81.2%, 82.7%] vs 77.4% [95% confidence interval: 76.1%, 78.6%]). However, the error was mitigated if the F1 score was subsequently recalculated with observed outcomes from the weighted dataset (F1: 77.0%; 95% confidence interval: 75.7%, 78.4%). In simulations, this finding held in the largest sample size (N = 10,000) under all analytic conditions assessed. For sample sizes <5,000, sampling weights had little impact in simulations that more closely resembled a simple random sample (low weight variability) or in models with strong predictors, but findings were inconsistent under other analytic scenarios. Failing to account for sampling weights in gradient boosting models may limit generalizability for data from complex surveys, dependent on sample size and other analytic properties. In the absence of software for configuring weighted algorithms, post-hoc re-calculations of unweighted model performance using weighted observed outcomes may more accurately reflect model prediction in target populations than ignoring weights entirely.
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Affiliation(s)
- Nathaniel MacNell
- Social & Scientific Systems, a DLH Holdings Company, Durham, North Carolina, United States of America
| | - Lydia Feinstein
- Social & Scientific Systems, a DLH Holdings Company, Durham, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jesse Wilkerson
- Social & Scientific Systems, a DLH Holdings Company, Durham, North Carolina, United States of America
| | - Pӓivi M. Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina, United States of America
| | - Samantha A. Molsberry
- Social & Scientific Systems, a DLH Holdings Company, Durham, North Carolina, United States of America
| | - Michael B. Fessler
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina, United States of America
| | - Peter S. Thorne
- Department of Occupational and Environmental Health, University of Iowa, College of Public Health, Iowa City, Iowa, United States of America
| | - Alison A. Motsinger-Reif
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina, United States of America
| | - Darryl C. Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, North Carolina, United States of America
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Dinse GE, Parks CG, Weinberg CR, Co CA, Wilkerson J, Zeldin DC, Chan EK, Miller FW. Increasing Prevalence of Antinuclear Antibodies in the United States. Arthritis Rheumatol 2022; 74:2032-2041. [PMID: 36054084 PMCID: PMC10947520 DOI: 10.1002/art.42330] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/11/2022] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Growing evidence suggests increasing frequencies of autoimmunity and autoimmune diseases, but findings are limited by the lack of systematic data and evolving approaches and definitions. This study was undertaken to investigate whether the prevalence of antinuclear antibodies (ANA), the most common biomarker of autoimmunity, changed over a recent 25-year span in the US. METHODS Serum ANA were measured by standard indirect immunofluorescence assays on HEp-2 cells in 13,519 participants age ≥12 years from the National Health and Nutrition Examination Survey, with approximately one-third from each of 3 time periods: 1988-1991, 1999-2004, and 2011-2012. We used logistic regression adjusted for sex, age, race/ethnicity, and survey design variables to estimate changes in ANA prevalence across the time periods. RESULTS The prevalence of ANA was 11.0% (95% confidence interval [95% CI] 9.7-12.6%) in 1988-1991, 11.4% (95% CI 10.2-12.8%) in 1999-2004, and 16.1% (95% CI 14.4-18.0%) in 2011-2012 (P for trend <0.0001), corresponding to ~22.3 million, ~26.6 million, and ~41.5 million affected individuals, respectively. Among adolescents age 12-19 years, ANA prevalence increased substantially, with odds ratios of 2.07 (95% CI 1.18-3.64) and 2.77 (95% CI 1.56-4.91) in the second and third time periods relative to the first (P for trend = 0.0004). ANA prevalence increased in both sexes (especially in men), older adults (age ≥50 years), and non-Hispanic white individuals. These increases in ANA prevalence were not explained by concurrent trends in weight (obesity/overweight), smoking exposure, or alcohol consumption. CONCLUSION The prevalence of ANA in the US has increased considerably in recent years. Additional studies to determine factors underlying these increases in ANA prevalence could elucidate causes of autoimmunity and enable the development of preventative measures.
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Affiliation(s)
- Gregg E. Dinse
- Data Sciences & Analytics, Social & Scientific Systems, Durham, NC, U.S.A
| | - Christine G. Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, U.S.A
| | - Clarice R. Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, U.S.A
| | - Caroll A. Co
- Data Sciences & Analytics, Social & Scientific Systems, Durham, NC, U.S.A
| | - Jesse Wilkerson
- Data Sciences & Analytics, Social & Scientific Systems, Durham, NC, U.S.A
| | - Darryl C. Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, U.S.A
| | - Edward K.L. Chan
- University of Florida Health Science Center, Gainesville, FL, U.S.A
| | - Frederick W. Miller
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, U.S.A
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Parks CG, Meier HCS, Jusko TA, Wilkerson J, Miller FW, Sandler DP. Benzophenone-3 and antinuclear antibodies in U.S. adolescents and adults ages 12-39 years. Front Immunol 2022; 13:958527. [PMID: 36177040 PMCID: PMC9513228 DOI: 10.3389/fimmu.2022.958527] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022] Open
Abstract
Background Between 1988 and 2012, prevalence of antinuclear antibodies (ANA) increased in the U.S., especially in adolescents and non-Hispanic Whites. Female predominance of ANA suggests a role for hormonal factors, including xenobiotic exposures that may disrupt endocrine signaling. Benzophenone-3 (BP-3) is one such chemical with increasing exposure through sunscreen use. We investigated whether urinary BP-3 levels were related to ANA in adolescents and young adults. Methods In a sample of 1,785 individuals ages 12-39 years in the National Health and Nutrition Examination Survey (NHANES; 2003-4, 2011-12), we examined cross-sectional associations of ANA (N=192; 3+ or 4+ at the 1:80 dilution, measured by HEp-2 immunofluorescence) with urinary BP-3, and other phenols bisphenol-A, triclosan, and parabens. Adjusted prevalence odds ratios (POR) were calculated in season-stratified models [winter (November-April) and summer (May-October)], given differences in sunscreen use and BP-3 concentrations. Results BP-3 concentrations (detected in >98.5% of individuals) did not differ by ANA positivity in the summer (geometric mean, GM 30.6 ng/ml ANA-positive vs. 35.3 ANA-negative; GM ratio 1.15), but in winter were higher among ANA-positives (50.2 vs. 20.1 ANA-negative; GM ratio 2.50). ANA was associated with log10BP-3 in winter (POR 1.57; 95%CI 1.07-2.30 per unit increase) but not summer (0.94; 0.61, 1.44; interaction p=0.09). Triclosan, parabens, and bisphenol-A levels were unrelated to ANA overall or by season (ORs 0.64 to 1.33). Conclusions The association of urinary BP-3 with ANA in the winter may reflect different exposure patterns or unmeasured confounders. Findings warrant replication in prospective studies and including past and year-round exposures.
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Affiliation(s)
- Christine G. Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, United States
- *Correspondence: Christine G. Parks,
| | - Helen C. S. Meier
- Population, Neurodevelopment and Genetics Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Todd A. Jusko
- Departments of Public Health Sciences, Environmental Medicine, and Pediatrics University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | | | - Frederick W. Miller
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, United States
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, United States
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Salo PM, Mendy A, Wilkerson J, Molsberry SA, Feinstein L, London SJ, Fessler MB, Thorne PS, Zeldin DC. Serum antioxidant vitamins and respiratory morbidity and mortality: a pooled analysis. Respir Res 2022; 23:150. [PMID: 35681205 PMCID: PMC9178544 DOI: 10.1186/s12931-022-02059-w] [Citation(s) in RCA: 11] [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: 11/15/2021] [Accepted: 05/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Oxidative stress plays a key role in the pathogenesis of respiratory diseases; however, studies on antioxidant vitamins and respiratory outcomes have been conflicting. We evaluated whether lower serum levels of vitamins A, C, D, and E are associated with respiratory morbidity and mortality in the U.S. adult population. Methods We conducted a pooled analysis of data from the 1988–1994 and 1999–2006 National Health and Nutrition Examination Survey (participants aged ≥ 20 years). We estimated covariate-adjusted odds ratios (aOR) per interquartile decrease in each serum vitamin level to quantify associations with respiratory morbidity, and covariate-adjusted hazard ratios (aHR) to quantify associations with respiratory mortality assessed prospectively through 2015. Vitamin supplementation and smoking were evaluated as potential effect modifiers. Results Lower serum vitamin C increased the odds of wheeze among all participants (overall aOR: 1.08, 95% CI: 1.01–1.16). Among smokers, lower serum α-tocopherol vitamin E increased the odds of wheeze (aOR: 1.11, 95% CI: 1.04–1.19) and chronic bronchitis/emphysema (aOR: 1.13, 95% CI: 1.03–1.24). Conversely, lower serum γ-tocopherol vitamin E was associated with lower odds of wheeze and chronic bronchitis/emphysema (overall aORs: 0.85, 95% CI: 0.79–0.92 and 0.85, 95% CI: 0.76–0.95, respectively). Lower serum vitamin C was associated with increased chronic lower respiratory disease (CLRD) mortality in all participants (overall aHR: 1.27, 95% CI: 1.07–1.51), whereas lower serum 25-hydroxyvitamin D (25-OHD) tended to increase mortality from CLRD and influenza/pneumonia among smokers (aHR range: 1.33–1.75). Mortality from influenza/ pneumonia increased with decreasing serum vitamin A levels in all participants (overall aHR: 1.21, 95% CI: 0.99–1.48). In pooled analysis, vitamin C deficiency and 25-OHD insufficiency were associated with mortality from influenza/pneumonia, increasing mortality risk up to twofold. Conclusions Our analysis of nationally representative data on over 34,000 participants showed that lower serum levels of vitamins A, C, D, and α-tocopherol vitamin E are associated with increased respiratory morbidity and/or mortality in U.S. adults. The results underscore the importance of antioxidant vitamins in respiratory health. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02059-w.
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Affiliation(s)
- Paivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Angelico Mendy
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA.,Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | - Stephanie J London
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Michael B Fessler
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, IA, USA
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA.
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Rider LG, Parks CG, Wilkerson J, Schiffenbauer AI, Kwok RK, Noroozi Farhadi P, Nazir S, Ritter R, Sirotich E, Kennedy K, Larche MJ, Levine M, Sattui SE, Liew JW, Harrison CO, Moni TT, Miller AK, Putman M, Hausmann J, Simard JF, Sparks JA, Miller FW. Baseline Factors Associated with Self-reported Disease Flares Following COVID-19 Vaccination among Adults with Systemic Rheumatic Disease: Results from the COVID-19 Global Rheumatology Alliance Vaccine Survey. Rheumatology (Oxford) 2022; 61:SI143-SI150. [PMID: 35460240 DOI: 10.1093/rheumatology/keac249] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [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: 02/03/2022] [Revised: 03/30/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine the frequency of, and risk factors for, disease flare following COVID-19 vaccination in patients with systemic rheumatic disease (SRD). METHODS An international study was conducted from April 2 to August 16, 2021, using an online survey of 5619 adults with SRD for adverse events following COVID-19 vaccination, including flares of disease requiring a change in treatment. We examined risk factors identified a priori based on published associations with SRD activity and SARS-CoV-2 severity, including demographics, SRD type, comorbidities, vaccine type, cessation of immunosuppressive medications around vaccination, and history of reactions to non-COVID-19 vaccines, using multivariable logistic regression. RESULTS Flares requiring a change in treatment following COVID-19 vaccination were reported by 4.9% of patients. Compared with rheumatoid arthritis, certain SRD, including systemic lupus erythematosus (OR 1.51, 95%CI 1.03, 2.20), psoriatic arthritis (OR 1.95, 95%CI 1.20, 3.18), and polymyalgia rheumatica (OR 1.94, 95%CI 1.08, 2.48) were associated with higher odds of flare, while idiopathic inflammatory myopathies were associated with lower odds for flare (OR 0.54, 95%CI 0.31-0.96). The Oxford-AstraZeneca vaccine was associated with higher odds of flare relative to the Pfizer-BioNTech vaccine (OR 1.44, 95%CI 1.07, 1.95), as were a prior reaction to a non-COVID-19 vaccine (OR 2.50, 95%CI 1.76, 3.54) and female sex (OR 2.71, 95%CI 1.55, 4.72). CONCLUSION SRD flares requiring changes in treatment following COVID-19 vaccination were uncommon in this large international study. Several potential risk factors, as well as differences by disease type, warrant further examination in prospective cohorts.
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Affiliation(s)
- Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS, National Institutes of Health (NIH), Bethesda, MD, USA)
| | | | | | - Adam I Schiffenbauer
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS, National Institutes of Health (NIH), Bethesda, MD, USA)
| | - Richard K Kwok
- Office of the Director, NIEHS, NIH, Research Triangle Park, NC, USA
| | - Payam Noroozi Farhadi
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS, National Institutes of Health (NIH), Bethesda, MD, USA)
| | - Sarvar Nazir
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS, National Institutes of Health (NIH), Bethesda, MD, USA)
| | | | | | - Kevin Kennedy
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | | | - Mitchell Levine
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jean W Liew
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | | | - Tarin T Moni
- Department of Biochemistry and Biomedical Sciences, McMaster University Faculty of Science, Hamilton, ON, Canada
| | - Aubrey K Miller
- Office of the Director, NIEHS, NIH, Research Triangle Park, NC, USA
| | | | - Jonathan Hausmann
- Program in Rheumatology, Boston Children's Hospital, Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - Julia F Simard
- Department of Epidemiology and Population Health, and Immunology and Rheumatology (Department of Medicine), Stanford University School of Medicine, USA
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS, National Institutes of Health (NIH), Bethesda, MD, USA)
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Hossain MM, Wilkerson J, McGrath JA, Farhadi PN, Brokamp C, Khan MTF, Goldberg B, Brunner HI, Macaluso M, Miller FW, Rider LG. The Geospatial Distribution of Myositis and Its Phenotypes in the United States and Associations With Roadways: Findings From a National Myositis Patient Registry. Front Med (Lausanne) 2022; 9:842586. [PMID: 35372396 PMCID: PMC8966380 DOI: 10.3389/fmed.2022.842586] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Little is known about the spatial distribution of idiopathic inflammatory myopathies (IIM) in the United States (U.S.), or their geospatial associations. Methods We studied a national myositis patient registry, with cases diagnosed in the contiguous U.S. from 1985–2011 and comprised of dermatomyositis (DM, n = 484), polymyositis (PM, n = 358), and inclusion body myositis (IBM, n = 318) patients. To assess the association of myositis prevalence with distance from roads, we employed log-Gaussian Cox process models, offset with population density. Results The U.S. IIM case distribution demonstrated a higher concentration in the Northest. DM, IBM, and cases with lung disease were more common in the East, whereas PM cases were more common in the Southeast. One area in the West and one area in the South had a significant excess in cases of DM relative to PM and of cases with lung disease relative to those without lung disease, respectively. IIM cases tended to cluster, with between-points interactions more intense in the Northeast and less in the South. There was a trend of a higher prevalence of IIM and its major phenotypes among people living within 50 m of a roadway relative to living beyond 200 m. Demographic characteristics, rural-urban commuting area, and female percentage were significantly associated with the prevalence of IIM and with major phenotypes. Conclusions Using a large U.S. database to evaluate the spatial distribution of IIM and its phenotypes, this study suggests clustering in some regions of the U.S. and a possible association of proximity to roadways.
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Affiliation(s)
- Md M Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jesse Wilkerson
- Social and Scientific Systems, A DLH Holdings Corp Company, Durham, NC, United States
| | - John A McGrath
- Social and Scientific Systems, A DLH Holdings Corp Company, Durham, NC, United States
| | - Payam N Farhadi
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, United States.,Kelly Government Solutions, Rockville, MD, United States
| | - Cole Brokamp
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Md T F Khan
- Division of Biostatistics and Bioinformatics, University of Cincinnati, Cincinnati, OH, United States
| | - Bob Goldberg
- The Myositis Association, Alexandria, VA, United States
| | - Hermine I Brunner
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Maurizio Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, United States
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, United States
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9
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Meier HCS, Sandler DP, Wilkerson J, Miller FW, Dinse GE, Parks CG. Hygiene Hypothesis Indicators and Prevalence of Antinuclear Antibodies in US Adolescents. Front Immunol 2022; 13:789379. [PMID: 35154106 PMCID: PMC8832391 DOI: 10.3389/fimmu.2022.789379] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Autoimmunity prevalence, as measured by antinuclear antibodies (ANA), is increasing in U.S. adolescents. Improved hygiene and cleaner environments in childhood may reduce exposure to infections and other immune challenges, resulting in improper immune responses to later-life exposures. We examined associations of hygiene hypothesis indicators, including asthma, allergies, and antibodies to infectious agents, with ANA prevalence, measured by HEp-2 immunofluorescence, in adolescents (aged 12-19 years) over a 25-year time span in the National Health and Nutrition Examination Survey (NHANES) (N=2,709), adjusting for age, sex, race/ethnicity, body mass index, education and survey cycle, overall and within individual time periods, using logistic regression. Prevalence of ANA in adolescents increased from 5.0% in 1988-1991 to 12.8% in 2011-2012. ANA were positively associated with diagnosis of asthma in early childhood (OR: 2.07, CI: 1.09-3.99) and the effect estimate for current hay fever was elevated but not statistically significant (OR: 1.55, CI: 0.85-2.84). Fewer than 2% of those with ANA in 1988-1991 had been diagnosed with asthma, compared with 18% in 1999-2000, and 27% in 2003-2004 and 2011-2012. ANA trended negatively with Helicobacter pylori antibodies (OR: 0.49, CI: 0.24-0.99). ANA may be useful as an additional indicator of inadequate immune education in adolescence, a critical period of growth and development.
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Affiliation(s)
- Helen C S Meier
- Population, Neurodevelopment and Genetics Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), Durham, NC, United States
| | - Jesse Wilkerson
- Public Health & Scientific Research, Social and Scientific Systems, Durham, NC, United States
| | - Frederick W Miller
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences (NIEHS), Durham, NC, United States
| | - Gregg E Dinse
- Public Health & Scientific Research, Social and Scientific Systems, Durham, NC, United States
| | - Christine G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), Durham, NC, United States
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10
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Mendy A, Salo PM, Wilkerson J, Feinstein L, Fessler MB, Thorne PS, Zeldin DC. Albuminuria as a Predictor of Mortality from Chronic Lower Respiratory Disease and from Influenza and Pneumonia. Ann Am Thorac Soc 2021; 18:2093-2095. [PMID: 33979561 PMCID: PMC8641818 DOI: 10.1513/annalsats.202009-1226rl] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- Angelico Mendy
- National Institute of Environmental Health SciencesResearch Triangle Park, North Carolina
- University of Cincinnati College of Medicine,Cincinnati, Ohio
| | - Päivi M. Salo
- National Institute of Environmental Health SciencesResearch Triangle Park, North Carolina
| | | | | | - Michael B. Fessler
- National Institute of Environmental Health SciencesResearch Triangle Park, North Carolina
| | | | - Darryl C. Zeldin
- National Institute of Environmental Health SciencesResearch Triangle Park, North Carolina
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11
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Prado M, Wilkerson J, Schneider L, Krawczel P. Influence of milk feeding levels and calf housing on subsequent performance of Holstein heifers. JDS Commun 2021; 2:277-281. [PMID: 36338389 PMCID: PMC9623668 DOI: 10.3168/jdsc.2021-0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/21/2021] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to investigate the effects of increased milk feeding levels or social housing during the preweaning stage of Holstein dairy heifers on subsequent weight gain, health, and reproductive parameters over time. A total of 210 heifers were grouped by calving date in groups of 10 and randomly assigned to one of 3 treatments: low-milk individual housing (LMI; 4 L of milk/d), high-milk individual housing (HMI; 8 L of milk/d), or low-milk social housing (LMS; 4 L of milk/d). Data collected included passive transfer status, disease events, weight gain at different time periods, age at first calving, calving intervals, and milk yield over the first 3 lactations. Passive transfer was successful in 189 calves, and, overall, disease events were low in this herd. The average daily gain for heifers in the HMI group (0.79 ± 0.05 kg/d) was significantly higher (F 2, 9 = 4.76) during the preweaning treatment period compared with the other groups (LMI: 0.59 ± 0.05 kg/d; LMS: 0.68 ± 0.04 kg/d). Although treatment groups did not differ with respect to age at first calving, the LMS and HMI heifers calved (22 and 15 d, respectively) earlier than the LMI heifers. Milk yield over 3 lactations was similar among the treatment groups. This suggests that both nutrition and social dynamics can influence performance of preweaned calves. Further investigation is needed to understand the mechanisms driving increased weight gain in socially housed calves.
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Affiliation(s)
- M.E. Prado
- Department of Animal Science, University of Tennessee, Knoxville 37996
| | - J. Wilkerson
- Department of Biosystems Engineering and Soil Sciences, University of Tennessee, Knoxville 37996
| | - L.G. Schneider
- Department of Animal Science, University of Tennessee, Knoxville 37996
| | - P.D. Krawczel
- Department of Animal Science, University of Tennessee, Knoxville 37996
- Department of Agricultural Sciences, Faculty of Agricultural and Forestry, University of Helsinki, 00014, Helsinki, Finland
- Research Centre for Animal Welfare, Department of Production Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, 00014, Helsinki, Finland
- Helsinki One Health, University of Helsinki, 00014, Helsinki, Finland
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12
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Parks CG, Wilkerson J, Rose KM, Faiq A, Noroozi Farhadi P, Long CS, Bayat N, Brunner HI, Goldberg B, McGrath JA, Miller FW, Rider LG. Association of Ultraviolet Radiation Exposure With Dermatomyositis in a National Myositis Patient Registry. Arthritis Care Res (Hoboken) 2020; 72:1636-1644. [PMID: 31478597 DOI: 10.1002/acr.24059] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/27/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Dermatomyositis (DM) has been associated with geospatial differences in ultraviolet (UV) radiation, but the role of individual determinants of UV exposure prior to diagnosis is unknown. The objective was to examine the role of those individual determinants. METHODS We analyzed questionnaire data from 1,350 adults in a US national myositis registry (638 with DM, 422 with polymyositis [PM], and 290 with inclusion body myositis [IBM] diagnosed at ages 18-65 years), examining the likelihood of DM compared with PM and IBM diagnosis, in relation to self-reported sunburn history and job- and hobby-related sun exposures in the year prior to diagnosis. We estimated odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression adjusted for age, skin tone, and sex, to determine the association of individual UV exposures with DM diagnosis. We also evaluated the proportion of DM by maximum daily ambient UV exposure, based on UVB erythemal irradiances for participant residence in the year prior to diagnosis. RESULTS DM was associated with sunburn in the year before diagnosis (2 or more sunburns OR 1.77 [95% CI 1.28-2.43] versus PM/IBM; 1 sunburn OR 1.44 [95% CI 1.06-1.95]) and with having elevated job- or hobby-related sun exposure (high exposure OR 1.64 [95% CI 1.08-2.49] or moderate exposure OR 1.35 [95% CI 1.02-1.78] versus low or no exposure). Ambient UV intensity was associated with DM in females (β = 3.97, P = 0.046), but not overall. CONCLUSION Our findings suggest that high or moderate personal exposure to intense sunlight is associated with developing DM compared with other types of myositis. Prospective research on UV exposure as a modifiable risk factor for DM is warranted.
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Affiliation(s)
- Christine G Parks
- National Institute of Environmental Health Sciences/NIH, Durham, North Carolina
| | | | | | - Abdullah Faiq
- National Institute of Environmental Health Sciences/NIH,, Bethesda, Maryland
| | | | - Craig S Long
- National Oceanic and Atmospheric Administration/National Weather Service, National Centers for Environmental Prediction Climate Prediction Center, College Park, Maryland
| | - Nastaran Bayat
- National Institute of Environmental Health Sciences/NIH,, Bethesda, Maryland
| | | | | | | | - Frederick W Miller
- National Institute of Environmental Health Sciences/NIH,, Bethesda, Maryland
| | - Lisa G Rider
- National Institute of Environmental Health Sciences/NIH,, Bethesda, Maryland
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13
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Dinse GE, Parks CG, Weinberg CR, Co CA, Wilkerson J, Zeldin DC, Chan EKL, Miller FW. Increasing Prevalence of Antinuclear Antibodies in the United States. Arthritis Rheumatol 2020; 72:1026-1035. [PMID: 32266792 DOI: 10.1002/art.41214] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/24/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Growing evidence suggests increasing frequencies of autoimmunity and certain autoimmune diseases, but findings are limited by the lack of systematic data and evolving approaches and definitions. This study was undertaken to investigate whether the prevalence of antinuclear antibodies (ANA), the most common biomarker of autoimmunity, changed over a recent 25-year span in the US. METHODS Serum ANA were measured by standard indirect immunofluorescence assays on HEp-2 cells in 14,211 participants age ≥12 years from the National Health and Nutrition Examination Survey, with approximately one-third from each of 3 time periods: 1988-1991, 1999-2004, and 2011-2012. We used logistic regression adjusted for sex, age, race/ethnicity, and survey design variables to estimate changes in ANA prevalence across the time periods. RESULTS The prevalence of ANA was 11.0% (95% confidence interval [95% CI] 9.7-12.6%) in 1988-1991, 11.5% (95% CI 10.3-12.8%) in 1999-2004, and 15.9% (95% CI 14.3-17.6%) in 2011-2012 (P for trend < 0.0001), which corresponds to ~22 million, ~27 million, and ~41 million affected individuals, respectively. Among adolescents age 12-19 years, ANA prevalence increased substantially, with odds ratios (ORs) of 2.02 (95% CI 1.16-3.53) and 2.88 (95% CI 1.64-5.04) in the second and third time periods relative to the first (P for trend < 0.0001). ANA prevalence increased in both sexes (especially in men), older adults (age ≥50 years), and non-Hispanic whites. These increases in ANA prevalence were not explained by concurrent trends in weight (obesity/overweight), smoking exposure, or alcohol consumption. CONCLUSION The prevalence of ANA in the US has increased considerably in recent years. Additional studies to determine factors underlying these increases in ANA prevalence could elucidate causes of autoimmunity and enable the development of preventative measures.
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Affiliation(s)
| | - Christine G Parks
- National Institute of Environmental Health Sciences, NIH, Research Triangle Park, North Carolina
| | - Clarice R Weinberg
- National Institute of Environmental Health Sciences, NIH, Research Triangle Park, North Carolina
| | - Caroll A Co
- Social& Scientific Systems, Durham, North Carolina
| | | | - Darryl C Zeldin
- National Institute of Environmental Health Sciences, NIH, Research Triangle Park, North Carolina
| | | | - Frederick W Miller
- National Institute of Environmental Health Sciences, NIH, Research Triangle Park, North Carolina
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14
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Mendy A, Salo PM, Wilkerson J, Feinstein L, Ferguson KK, Fessler MB, Thorne PS, Zeldin DC. Association of urinary levels of bisphenols F and S used as bisphenol A substitutes with asthma and hay fever outcomes. Environ Res 2020; 183:108944. [PMID: 31911000 PMCID: PMC7167336 DOI: 10.1016/j.envres.2019.108944] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 10/10/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Bisphenols F (BPF) and S (BPS) are bisphenol A (BPA) analogs used as substitutes in consumer products. Despite previous reports of BPA's association with asthma, no studies have examined its structural analogs in relation to asthma and allergy outcomes. OBJECTIVE To examine the association of urinary BPF, BPS, and BPA with asthma and hay fever in a US representative sample. METHODS We analyzed data from 3,538 participants aged 12 years or older in the 2013-2016 National Health and Nutrition Examination Survey (NHANES). Children aged 6-11 years (N = 738), who did not have all covariate data available, were analyzed separately. Covariate-adjusted logistic regression was used to assess the association of the exposures with the outcomes. RESULTS BPF, BPS, and BPA were detected in 57.1%, 88.4%, and 94.8% of the urine samples, respectively. Urinary BPF detection was positively associated with current asthma (odds ratio [OR]: 1.54, 95% confidence interval [CI]: 1.16-2.04) and hay fever (OR: 1.66, 95% CI: 1.12-2.46). Urinary BPS was associated with increased odds of current asthma in men (OR: 1.64, 95% CI: 1.13-2.40) and urinary BPA was associated with increased odds of asthma without hay fever in children aged 6-11 years (OR: 2.65, 95% CI: 1.05-6.68). CONCLUSION Our nationally-representative findings document that BPF and BPS exposure is common in the US and that exposure to these BPA analogs is associated with asthma and/or hay fever. Our results suggest that BPF and BPS may not be safe alternatives to BPA; however, prospective studies should be conducted to confirm these results.
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Affiliation(s)
- Angelico Mendy
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Pӓivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | | | | | - Kelly K Ferguson
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Michael B Fessler
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA.
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15
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Mendy A, Wilkerson J, Salo PM, Zeldin DC, Thorne PS. Endotoxin clustering with allergens in house dust and asthma outcomes in a U.S. national study. Environ Health 2020; 19:35. [PMID: 32178682 PMCID: PMC7077112 DOI: 10.1186/s12940-020-00585-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/28/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Endotoxin is ubiquitous in the environment, but its clustering with indoor allergens is not well characterized. This study examined the clustering patterns of endotoxin with allergens in house dust and their association with asthma outcomes. METHODS We analyzed data from 6963 participants of the 2005-2006 National Health and Nutrition Examination Survey. House dust sampled from bedroom floor and bedding was evaluated for endotoxin and allergens from fungi, cockroach, dog, cat, mites, and rodents. Two-step cluster analysis and logistic regressions were performed to identify the clustering patterns and their associations with current asthma and wheeze in the past 12 months, adjusting for covariates. RESULTS Of the homes, 17.8% had low endotoxin and allergen levels in house dust (Cluster 1). High endotoxin level clustered with Alternaria and pet allergens in the homes of participants with a high socioeconomic status who own pets (Cluster 2) (48.9%). High endotoxin clustered with Aspergillus, dust mites, cockroach, and rodent allergens in the homes of participants with low socioeconomic status (Cluster 3) (33.3%). Compared to Cluster 1, Cluster 2 was associated with higher asthma prevalence (OR 1.42, 95% CI: 1.06-1.91) and wheeze (OR 1.32, 95% CI: 1.07-1.63). Cluster 3 was positively associated with wheeze only in participants sensitized to inhalant allergens (OR 1.42, 95% CI: 1.06-1.91) or exposed to tobacco smoke (OR 1.72, 95% CI: 1.15-2.60). CONCLUSIONS The clustering of endotoxin with allergens in dust from homes with pets or of people with low socioeconomic status is associated with asthma and wheeze.
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Affiliation(s)
- Angelico Mendy
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
| | | | - Pӓivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, NIH Research Triangle Park, Durham, North Carolina, USA
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, NIH Research Triangle Park, Durham, North Carolina, USA
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA.
- University of Iowa College of Public Health, 100 CPHB, S341A, 145 N Riverside Dr, Iowa City, IA, 52242-2207, USA.
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16
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Mendy A, Wilkerson J, Salo PM, Weir CH, Feinstein L, Zeldin DC, Thorne PS. Synergistic Association of House Endotoxin Exposure and Ambient Air Pollution with Asthma Outcomes. Am J Respir Crit Care Med 2020; 200:712-720. [PMID: 30965018 DOI: 10.1164/rccm.201809-1733oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Rationale: House endotoxin and ambient air pollution are risk factors for asthma; however, the effects of their coexposure on asthma are not well characterized.Objectives: To examine potential synergistic associations of coexposure to house dust endotoxin and ambient air pollutants with asthma outcomes.Methods: We analyzed data of 6,488 participants in the National Health and Nutrition Examination Survey 2005-2006. Dust from bedding and bedroom floor was analyzed for endotoxin content. The Community Multiscale Air Quality Modeling System (CMAQ) and Downscaler Model data were used to determine annual average particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) exposures at participants' residential locations. The associations of the coexposures with asthma outcomes were assessed and tested for synergistic interaction.Measurements and Main Results: In adjusted analysis, PM2.5 (CMAQ) (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.07-1.18), O3 (Downscaler Model) (OR, 1.07; 95% CI, 1.02-1.13), and log10 NO2 (CMAQ) (OR, 3.15; 95% CI, 1.33-7.45) were positively associated with emergency room visits for asthma in the past 12 months. Coexposure to elevated concentrations of house dust endotoxin and PM2.5 (CMAQ) was synergistically associated with the outcome, increasing the odds by fivefold (OR, 5.01; 95% CI, 2.54-9.87). A synergistic association was also found for coexposure to higher concentrations of endotoxin and NO2 in children (OR, 3.45; 95% CI, 1.65-7.18).Conclusions: Coexposure to elevated concentrations of residential endotoxin and ambient PM2.5 in all participants and NO2 in children is synergistically associated with increased emergency room visits for asthma. Therefore, decreasing exposure to both endotoxin and air pollution may help reduce asthma morbidity.
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Affiliation(s)
- Angelico Mendy
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa
| | | | - Pӓivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina; and
| | - Charles H Weir
- Office of Emergency Management, U.S. Department of Health and Human Services, Atlanta, Georgia
| | | | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina; and
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa
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17
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Mendy A, Salo PM, Cohn RD, Wilkerson J, Zeldin DC, Thorne PS. House Dust Endotoxin Association with Chronic Bronchitis and Emphysema. Environ Health Perspect 2018; 126:037007. [PMID: 29578323 PMCID: PMC6071737 DOI: 10.1289/ehp2452] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 05/15/2023]
Abstract
BACKGROUND Endotoxin has been reported to be associated with chronic bronchitis or emphysema (CBE) at high occupational exposures. However, whether levels found in domestic environments have similar effects is unknown. OBJECTIVES We aimed to study the association between house dust endotoxin and CBE in a sample representative of the U.S. population. METHODS We analyzed data from 3,393 participants ≥20 y old from the National Health and Nutrition Examination Survey (NHANES) 2005-2006. House dust from bedding and from bedroom floors was analyzed for endotoxin content. NHANES participants received questionnaires and underwent examination as well as extensive laboratory testing. Logistic regression was used to examine the association of endotoxin levels with CBE diagnosis and symptoms, adjusting for covariates. The survey design and weights were applied so that estimates were nationally representative and so that statistical inferences were made appropriately. RESULTS The median endotoxin concentration in house dust was 14.61 EU/mg dust, and CBE was reported by 8.2% of participants. In the adjusted analysis, one unit (EU/mg) increase in log10-transformed endotoxin concentrations was associated with a 27% increase in the odds of CBE diagnosis [OR=1.27 (95% CI: 1.00, 1.61)] and a 78% increase in the odds of chronic bronchitis symptoms (defined as cough and phlegm for ≥3 mo in a year for ≥2 y) [OR=1.78 (95% CI: 1.01, 3.12)]. Sensitization to inhalant allergens (p=0.001) modified the relationship between endotoxin and CBE diagnosis, with stronger associations observed in sensitized participants [OR=2.46 (95% CI: 1.72, 3.50) for a unit increase in log10-endotoxin]. CONCLUSIONS In a population-based sample of U.S. adults, endotoxin levels in homes were associated with a self-reported history of CBE diagnosis and chronic bronchitis symptoms, with stronger associations among people sensitized to inhalant allergens. https://doi.org/10.1289/EHP2452.
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Affiliation(s)
- Angelico Mendy
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
| | - Päivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Richard D Cohn
- Social & Scientific Systems, Inc., Durham, North Carolina, USA
| | - Jesse Wilkerson
- Social & Scientific Systems, Inc., Durham, North Carolina, USA
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
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18
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Mendy A, Wilkerson J, Salo PM, Cohn RD, Zeldin DC, Thorne PS. Endotoxin predictors and associated respiratory outcomes differ with climate regions in the U.S. Environ Int 2018; 112:218-226. [PMID: 29277065 PMCID: PMC5899028 DOI: 10.1016/j.envint.2017.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 05/24/2023]
Abstract
RATIONALE Although endotoxin is a recognized cause of environmental lung disease, how its relationship with respiratory outcomes varies with climate is unknown. OBJECTIVE To examine the endotoxin predictors as well as endotoxin association with asthma, wheeze, and sensitization to inhalant allergens in various US climate regions. METHODS We analyzed data on 6963 participants in the National Health and Nutrition Examination Survey. Endotoxin measurements of house dust from bedroom floor and bedding were performed at the University of Iowa. Linear and logistic regression analyses were used to identify endotoxin predictors and assess endotoxin association with health outcomes. RESULTS The overall median house dust endotoxin was 16.2 EU/mg; it was higher in mixed-dry/hot-dry regions (19.7 EU/mg) and lower in mixed-humid/marine areas (14.8 EU/mg). Endotoxin predictors and endotoxin association with health outcomes significantly differed across climate regions. In subarctic/very cold/cold regions, log10-endotoxin was significantly associated with higher prevalence of wheeze outcomes (OR:1.48, 95% CI:1.19-1.85 for any wheeze, OR:1.48, 95% CI:1.22-1.80 for exercise-induced wheeze, OR:1.50, 95% CI:1.13-1.98 for prescription medication for wheeze, and OR:1.95, 95% CI:1.50-2.54 for doctor/ER visit for wheeze). In hot-humid regions, log10-endotoxin was positively associated with any wheeze (OR:1.66, 95% CI:1.04-2.65) and current asthma (OR:1.56, 95% CI:1.11-2.18), but negatively with sensitization to any inhalant allergens (OR:0.83, 95% CI:0.74-0.92). CONCLUSION Endotoxin predictors and endotoxin association with asthma and wheeze differ across U.S. climate regions. Endotoxin is associated positively with wheeze or asthma in cold and hot-humid regions, but negatively with sensitization to inhalant allergens in hot-humid climates.
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Affiliation(s)
- Angelico Mendy
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States
| | - Jesse Wilkerson
- Social & Scientific Systems, Inc., Durham, NC, United States
| | - Pӓivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, NIH Research Triangle Park, NC, United States
| | - Richard D Cohn
- Social & Scientific Systems, Inc., Durham, NC, United States
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, NIH Research Triangle Park, NC, United States
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States.
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Salo PM, Wilkerson J, Rose KM, Cohn RD, Calatroni A, Mitchell HE, Sever ML, Gergen PJ, Thorne PS, Zeldin DC. Bedroom allergen exposures in US households. J Allergy Clin Immunol 2017; 141:1870-1879.e14. [PMID: 29198587 DOI: 10.1016/j.jaci.2017.08.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 08/16/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bedroom allergen exposures contribute to allergic disease morbidity because people spend considerable time in bedrooms, where they come into close contact with allergen reservoirs. OBJECTIVE We investigated participant and housing characteristics, including sociodemographic, regional, and climatic factors, associated with bedroom allergen exposures in a nationally representative sample of the US population. METHODS Data were obtained from National Health and Nutrition Examination Survey 2005-2006. Information on participant and housing characteristics was collected by using questionnaires and environmental assessments. Concentrations of 8 indoor allergens (Alt a 1, Bla g 1, Can f 1, Fel d 1, Der f 1, Der p 1, Mus m 1, and Rat n 1) in dust vacuumed from nearly 7000 bedrooms were measured by using immunoassays. Exposure levels were classified as increased based on percentile (75th/90th) cutoffs. We estimated the burden of exposure to multiple allergens and used multivariable logistic regression to identify independent predictors for each allergen and household allergen burden. RESULTS Almost all participants (>99%) had at least 1 and 74.2% had 3 to 6 allergens detected. More than two thirds of participants (72.9%) had at least 1 allergen and 18.2% had 3 or more allergens exceeding increased levels. Although exposure variability showed significant racial/ethnic and regional differences, high exposure burden to multiple allergens was most consistently associated with the presence of pets and pests, living in mobile homes/trailers and older and rental homes, and living in nonmetropolitan areas. CONCLUSIONS Exposure to multiple allergens is common. Despite highly variable exposures, bedroom allergen burden is strongly associated with the presence of pets and pests.
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Affiliation(s)
- Päivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | | | | | | | | | | | | | - Peter J Gergen
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Peter S Thorne
- University of Iowa College of Public Health, Iowa City, Iowa
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
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20
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Feldon M, Farhadi PN, Brunner HI, Itert L, Goldberg B, Faiq A, Wilkerson J, Rose KM, Rider LG, Miller FW, Giannini EH. Predictors of Reduced Health-Related Quality of Life in Adult Patients With Idiopathic Inflammatory Myopathies. Arthritis Care Res (Hoboken) 2017; 69:1743-1750. [PMID: 28118525 DOI: 10.1002/acr.23198] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/17/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Extensive studies on health-related quality of life (HRQoL) in idiopathic inflammatory myopathies (IIMs) are lacking. Our objective was to document HRQoL and to identify factors associated with a reduced HRQoL in patients with IIM. METHODS A total of 1,715 patients (median age 49.9 years, 70% female, 87% white) who met probable or definite Bohan and Peter criteria or Griggs criteria for myositis were included from the Myovision registry. HRQoL was ascertained using the Short Form 12 (SF-12) health survey questionnaire. HRQoL physical component summary (PCS) and mental component summary (MCS) scores in relation to different patient and disease characteristics were compared to scores from matched normative data from the US general population and rheumatoid arthritis (RA) patients. Bivariate and multiple linear regression analyses were performed to assess the association between HRQoL and patient and disease parameters. RESULTS The mean SF-12 summary scores were significantly lower in IIM patients than in the normative and RA populations. A diagnosis of inclusion body myositis, older age, patient-reported negative effect of disease on work, presence of another co-occurring autoimmune disease, polypharmacy, and IIM-associated lung disease and joint involvement were significantly associated with lower PCS scores. Lower MCS scores were associated with joint involvement and a negative effect of disease on work. CONCLUSION In this large study of patient-reported outcomes in IIM, an association was found between multiple disease characteristics and reduced HRQoL, mostly in the physical domain. In the US, the HRQoL of IIM patients was found to be lower than that of the general population and RA patients.
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Affiliation(s)
- Michal Feldon
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Payam Noroozi Farhadi
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland
| | | | - Lukasz Itert
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Abdullah Faiq
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland
| | | | | | - Lisa G Rider
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland
| | - Frederick W Miller
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland
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21
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Fessler MB, Carnes MU, Salo PM, Wilkerson J, Cohn RD, King D, Hoppin JA, Sandler DP, Travlos G, London S, Thorne P, Zeldin D. House Dust Endotoxin and Peripheral Leukocyte Counts: Results from Two Large Epidemiologic Studies. Environ Health Perspect 2017; 125:057010. [PMID: 28599265 PMCID: PMC5730525 DOI: 10.1289/ehp661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/13/2016] [Accepted: 09/27/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND The peripheral leukocyte count is a biomarker of inflammation and is associated with human all-cause mortality. Although causes of acute leukocytosis are well-described, chronic environmental determinants of leukocyte number are less well understood. OBJECTIVES We investigated the relationship between house dust endotoxin concentration and peripheral leukocyte counts in human subjects. METHODS The endotoxin–leukocyte relationship was evaluated by linear regression in the National Health and Nutrition Examination Survey (NHANES) 2005–2006 (n=6,254) and the Agricultural Lung Health Study (ALHS; n=1,708). In the ALHS, we tested for a gene [Toll-like Receptor 4 (TLR4), encoding the endotoxin receptor]-by-environment interaction in the endotoxin–leukocyte relationship using regression models with an interaction term. RESULTS There is a statistically significant, positive association between endotoxin concentration and total leukocyte number [estimated change, 0.186×103/μL (95% CI: 0.070, 0.301×103/μL) per 10-fold change in endotoxin; p=0.004) in the NHANES. Similar positive associations were found for monocytes, lymphocytes, and neutrophils. Stratified analyses revealed possible effect modification by asthma and chronic obstructive pulmonary disease. We observed similar associations in the ALHS. For total leukocytes, there was suggestive evidence in the ALHS of a gene-by-environment interaction for minor allele carrier status at the TLR4 haplotype defined by rs4986790 and rs4986791 (interaction p=0.15). CONCLUSIONS This is, to our knowledge, the first report of an association between house dust endotoxin and leukocyte count in a national survey. The finding was replicated in a farming population. Peripheral leukocyte count may be influenced by residential endotoxin exposure in diverse settings. https://doi.org/10.1289/EHP661.
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Affiliation(s)
- Michael B Fessler
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina, USA
| | - Megan U Carnes
- Epidemiology Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, USA
| | - Päivi M Salo
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina, USA
| | - Jesse Wilkerson
- Social & Scientific Systems, Inc., Durham, North Carolina, USA
| | - Richard D Cohn
- Social & Scientific Systems, Inc., Durham, North Carolina, USA
| | - Debra King
- Clinical Pathology Group, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, USA
| | - Jane A Hoppin
- Department of Biological Sciences and Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA
| | - Dale P Sandler
- Epidemiology Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, USA
| | - Greg Travlos
- Clinical Pathology Group, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, USA
| | - Stephanie London
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina, USA
- Epidemiology Branch, NIEHS, NIH, DHHS, Research Triangle Park, North Carolina, USA
| | - Peter Thorne
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa 52242, USA
| | - Darryl Zeldin
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, North Carolina, USA
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22
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Rider LG, Faiq A, Farhadi PN, Bayat N, Itert L, Chase M, Ulrey R, Malley K, Wilkerson J, Johnson A, Rose K, Morris R, Parks C, Giannini EH, Brunner H, Goldberg B, Miller FW. A58: Demographics, Clinical Features and Therapies of Patients with Juvenile Dermatomyositis Participating in a National Myositis Patient Registry. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lisa G Rider
- Environmental Autoimmunity Group, Program of Clinical Research, National Institute of Environmental Health Sciences, National Institutes of Health, US Department of Health and Human Services; Bethesda MD
| | | | | | | | - Lukasz Itert
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | | | | | | | | | - Anne Johnson
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | | | | | | | | | - Hermine Brunner
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
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Amiri-Kordestani L, Jawed I, Wilkerson J, Stein WD, Bates SE, Swain SM, Fojo AT. Determining the rate of tumor growth and decay in patients with metastatic breast cancer as an early efficacy endpoint: A study assessing ixabepilone efficacy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.246] [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: 11/20/2022] Open
Abstract
246 Background: Early efficacy assessment in drug development should help find new cancer therapies. We have developed a novel method to analyze tumor response to therapy by quantifying the rate of tumor regression (d) and growth (g). We have shown g is slower when pts are on effective therapy and that g correlates with survival (Stein et al, Oncologist 2008). We utilized this method to evaluate a phase III trial of capecitabine (CAP) ± IXA in second line therapy (Tomas et al, JCO 2007) and a three-cohort phase II trial in second and subsequent lines of therapy in pts with MBC consisting of (1) Daily X 5 IXA given to taxane (TAX)-naïve patients (Denduluri et al, JCO 2007); (2) Daily X 5 IXA in pts previously treated with TAX (Low et al, JCO 2005); and (3) Daily X 3 IXA in pts previously treated with TAX (Denduluri et al, Invest New Drug 2007). Methods: Using tumor measurements assessed by RECIST and a two-phase mathematical equation we determined d and g. Results: In the phase III study g was superior to PFS identifying a significant difference between the arms very early—before the 200th pt had enrolled. In an individual patient the g values could be estimated as early as the 3rd evaluation, long before tumor growth was observed clinically. IXA + CAP in second line (g = 0.0018) was more effective than CAP (g = 0.0023) at reducing g, and more effective (p=0.0085) than single agent IXA in the Phase II study (g = 0.0027). Single agent IXA was comparably effective (p=0.814) in reducing the g of tumors previously exposed to a TAX (g = 0.0032) as in reducing the g of TAX-naïve tumors (g = 0.0035), consistent with its development as an agent active in TAX-refractory disease. Unlike differences in g, the d of single agent IXA (0.118) was comparable to that of IXA+CAP (0.0074) suggesting differences were primarily driven by effect on the growth of residual tumor. Conclusions: Unlike PFS, an incremental measure of efficacy, g is a continuous variable and can more accurately assess differences between treatments. Because calculations of g are indifferent to assessment intervals, estimating a tumor’s g allows comparison of efficacy across trials.
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Affiliation(s)
- L. Amiri-Kordestani
- National Cancer Institute, National Institutes of Health, Bethesda, MD; Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Hebrew University, Jerusalem, Israel; Center for Cancer Research, National Cancer Institute, Bethesda, MD; National Surgical Adjuvant Breast and Bowel Project; Washington Cancer Institute, Washington Hospital Center, Washington, DC
| | - I. Jawed
- National Cancer Institute, National Institutes of Health, Bethesda, MD; Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Hebrew University, Jerusalem, Israel; Center for Cancer Research, National Cancer Institute, Bethesda, MD; National Surgical Adjuvant Breast and Bowel Project; Washington Cancer Institute, Washington Hospital Center, Washington, DC
| | - J. Wilkerson
- National Cancer Institute, National Institutes of Health, Bethesda, MD; Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Hebrew University, Jerusalem, Israel; Center for Cancer Research, National Cancer Institute, Bethesda, MD; National Surgical Adjuvant Breast and Bowel Project; Washington Cancer Institute, Washington Hospital Center, Washington, DC
| | - W. D. Stein
- National Cancer Institute, National Institutes of Health, Bethesda, MD; Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Hebrew University, Jerusalem, Israel; Center for Cancer Research, National Cancer Institute, Bethesda, MD; National Surgical Adjuvant Breast and Bowel Project; Washington Cancer Institute, Washington Hospital Center, Washington, DC
| | - S. E. Bates
- National Cancer Institute, National Institutes of Health, Bethesda, MD; Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Hebrew University, Jerusalem, Israel; Center for Cancer Research, National Cancer Institute, Bethesda, MD; National Surgical Adjuvant Breast and Bowel Project; Washington Cancer Institute, Washington Hospital Center, Washington, DC
| | - S. M. Swain
- National Cancer Institute, National Institutes of Health, Bethesda, MD; Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Hebrew University, Jerusalem, Israel; Center for Cancer Research, National Cancer Institute, Bethesda, MD; National Surgical Adjuvant Breast and Bowel Project; Washington Cancer Institute, Washington Hospital Center, Washington, DC
| | - A. T. Fojo
- National Cancer Institute, National Institutes of Health, Bethesda, MD; Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Hebrew University, Jerusalem, Israel; Center for Cancer Research, National Cancer Institute, Bethesda, MD; National Surgical Adjuvant Breast and Bowel Project; Washington Cancer Institute, Washington Hospital Center, Washington, DC
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Blagoev KB, Wilkerson J, Stein WD, Motzer RJ, Bates SE, Fojo AT. Effect of sunitinib (SU) administration on post-treatment survival in patients with metastatic renal cell carcinoma (mRCC) treated on the upfront randomized phase III trial of sunitinib or interferon alfa (IFN). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4634] [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: 11/20/2022] Open
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25
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Amiri-Kordestani L, Jawed I, Wilkerson J, Stein WD, Fojo AT, Swain SM, Bates SE. Early assessment of efficacy of ixabepilone (IXA) by analysis of the rate of tumor growth and decay using data from phase II and phase III clinical trials in metastatic breast cancer (MBC) patients (Pts). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2527] [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: 11/20/2022] Open
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Young C, Di Croce FA, Roper D, Harris J, Rohrbach N, Wilkerson J, Schrick FN. 25 EFFECT OF REPRODUCTIVE TRACT SIZE ON CONCEPTION RATES IN LACTATING DAIRY COWS UTILIZING A REPRODUCTIVE TRACT SCORING SYSTEM. Reprod Fertil Dev 2011. [DOI: 10.1071/rdv23n1ab25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Reproductive tract scoring (RTS) systems have been effective in evaluating fertility of heifers. A similar RTS system has not been reported in lactating dairy cows pertaining to conception rates following artificial insemination. Objectives of this study include development of a RTS system for lactating dairy cows and determining if RTS had an effect on artificial insemination (AI) success with various types of semen [conventional (CS), sexed (SS)]. During pre-breeding examinations (typically 30–60 DIM) by trained personnel, cows were assigned a RTS (1, 2, or 3) based on size and length of the cervix and uterine horns, but not including status of the ovaries. Tracts for RTS 1 were small, compact uterine horns resting within the pelvic cavity, RTS 2 were intermediate in size with uterine horns resting partially outside the pelvic cavity, and RTS 3 were large, deep tracts resting entirely outside the pelvis into the abdominal cavity. Additionally, cows were evaluated for RTS at a local abattoir before harvest, and tracts collected for volume and length measurements. Volume measurements were collected using Foley catheters and measuring water displaced in the uterine horns at a constant pressure. Length of the vagina, cervix, and uterine horns were measured using a flexible tape. Insemination data analysis was performed using mixed model analysis of variance in Glimmix SAS 9.2 (SAS Institute Inc., Cary, NC, USA). Insemination data included 613, 308, and 572 scores in first, second, and third+ lactation cows, respectively. First-lactation cows had 65.25% with RTS 1, 30.02% RTS 2, and 4.73% RTS 3. Second-lactation cows had 53.25% RTS 1, 39.29% RTS 2, and 7.47% RTS 3. Cows with 3+ lactations had 43.18% RTS 1, 43.88% RTS 2, and 12.94% RTS 3. Cows were artificially inseminated (n = 2401 inseminations) with either CS (n = 1981) or SS (n = 420). Conception rates for CS were 38.65%, 34.26%, and 24.41% for RTS 1, 2, and 3, respectively (P = 0.0154 for RTS 1 v. 3). Conception rates for CS (38.65%, RTS 1; 34.26%, RTS 2) were higher compared to SS (21.37%, RTS 1 (P = 0.0001); 20.72%, RTS 2 (P = 0.0186)). No differences were detected between CS (24.40%) and SS (22.35%) within RTS 3; however, observations were limited for SS inseminations with RTS 3. Preliminary data regarding total length (vagina, cervix, and uterine horns; RTS 1, 2, 3 = 103.1 cm, 114.9 cm, 134 cm, respectively) and volume (RTS 1, 2, 3 = 102 mL, 131 mL, 133.3 mL, respectively) suggest both increase as RTS increases but limited observations prevent conclusions at this time. Conception rates indicate smaller reproductive tracts have improved fertility in lactating dairy cows when using CS. Identification of larger reproductive tracts will allow for more economically efficient AI programs by utilising inexpensive, high fertility semen.
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Wilkerson J, Stein WD, Kim ST, Huang X, Motzer RJ, Fojo AT, Bates SE. Validation of a kinetic analysis of renal cancer regression and growth following treatment with sunitinib and interferon-alfa (IFN-α): Analysis of the pivotal randomized trial. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Fojo AT, Stein WD, Wilkerson J, Bates SE. Kinetic analysis of breast tumor decay and growth following ixabepilone plus capecitabine (IXA + CAP) versus capecitabine alone (CAP) to discern whether the superiority of the combination is a result of slower growth, enhanced tumor cell kill, or both. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vidaurre T, Wilkerson J, Bates SE, Simon R, Fojo AT. Value of stable disease (SD) in drug development of targeted therapies (TGT). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2509] [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: 11/20/2022] Open
Abstract
2509 It has been widely asserted that the efficacy of TGT cannot be assessed by traditional response measures since they are not expected to cause tumor shrinkage. Despite the lack of substantiating data, this idea has become conventional wisdom, often guiding clinical trial design. Aware the acceptance of SD as a measure of activity led to its being increasingly reported with traditional cytotoxic agents (CTX), we set about to methodically compare the occurrence of SD in phase II trials of TGT and CTX. We systematically catalogued response assessments in 147 phase II studies reported between 10/06 and 3/08 in 5 journals (Cancer, BJC, CCR, JCO, and Lancet Oncology). Eighty used CTX, 59 used TGT and 8 used both “classes” of agents. Thirty-eight properties including CR, PR, SD, PFS, and OS were recorded for each study. CTX and TGT studies were comparable with similar distribution of histologies and similar PFS and OS in these patients with refractory tumors. For CTX vs. TGT, the median numbers of pts/study was 47.1 vs. 51.9; median PFS, 5.55 vs. 4.54 mos; and median OS, 12.55 vs. 12.88 mos. SD was defined by duration in only 31% of studies, a median duration of 9.5 weeks. SD rates were nearly identical for the two therapy groups - 34.6% for CTX and 33.1% for TGT- and their distribution by histology was similar, suggesting properties other than therapy are responsible for SD. Correlations or lack thereof between %SD and PFS or OS were similar for both CTX and TGT. The overall response rate (CR + PR) was higher with CTX than with TGT (29.4% vs. 13.3%) and demonstrated a strong correlation (p<0.0001) of uncertain importance with PFS and OS for all therapies. Examination of 33 NSCLC studies (16 CTX/17 TGT) found similar results. We conclude that SD as currently defined and measured in not a property of TGT but of the phase II patient population and is similarly found with CTX. Responses are observed with TGT as with CTX, and this analysis suggests that even for TGT it is a measure of activity that should be sought. Assertions that SD is a particular characteristic of TGT should be replaced by definitions that seek clinically meaningful SD. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | - R. Simon
- National Cancer Institute, Bethesda, MD
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30
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Kevil CG, Pruitt H, Kavanagh TJ, Wilkerson J, Farin F, Moellering D, Darley-Usmar VM, Bullard DC, Patel RP. Regulation of endothelial glutathione by ICAM‐1: implications for inflammation. FASEB J 2004; 18:1321-3. [PMID: 15180961 DOI: 10.1096/fj.03-1401fje] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The role of glutathione (GSH) in inflammation is largely discussed from the context of providing reducing equivalents to detoxify reactive oxygen and nitrogen species. Inflammation is now recognized to be an underlying cause of many vascular diseases including atherosclerosis, a disease in which endothelial GSH concentrations are decreased. However, mechanisms that control GSH levels are poorly understood. Key players in the inflammatory process are endothelial adhesion molecules, including intercellular adhesion molecule-1 (ICAM-1). This adhesion molecule is present constitutively and can be induced by a variety of inflammatory stimuli. In this study, using mouse aortic endothelial cells (MAEC) deficient in ICAM-1, we demonstrate a novel interplay between constitutive ICAM-1 and cellular GSH. Deficiency of ICAM-1 was associated with an approximately twofold increase in total GSH content. Inhibiting glutamate-cysteine ligase (GCL), the enzyme that catalyses the rate-limiting step in GSH biosynthesis, prevented the increase in GSH. In addition, the catalytic subunit of GCL was increased (approximately 1.6-fold) in ICAM-1 deficient relative to wild-type cells, suggesting that constitutive ICAM-1 represses GCL expression. Furthermore, the ratio of reduced (GSH) to oxidized (GSSG) glutathione was also increased suggesting a role for ICAM-1 in modulating cellular redox status. Interestingly, increasing cytosolic GSH in wild-type mouse endothelial cells decreased constitutive ICAM-1, suggesting the presence of an inverse and reciprocal pathway. To test the effects of inducible ICAM-1 on GSH, cells were stimulated with the proinflammatory cytokine TNF-alpha. TNF-alpha stimulated production of ICAM-1, which was however not associated with induction of GSH. In contrast, supplementation of endothelial cells with GSH before TNF-alpha addition, inhibited induction of ICAM-1. These data suggest a novel regulatory pathway between constitutive ICAM-1 and GSH synthesis in the endothelium and are discussed in the context of modulating the inflammatory response.
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Affiliation(s)
- C G Kevil
- Department of Pathology, Louisiana State University, Shreveport, Shreveport, Louisiana, USA
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Abstract
This study investigated prostate cancer screening practices using prostate specific antigen testing (PSA), digital rectal examination (DRE), and transrectal ultrasonography (TRUS) by primary care physicians in Missouri. In 1993, a mail survey was sent to a stratified random sample of 750 physicians whose primary specialty was general practice, family practice, or internal medicine. Three separate mailings resulted in an overall adjusted response rate of 60 percent. Ninety-five percent of physicians were more inclined to use PSA compared with three years previously, with only 45 percent of physicians more inclined to use DRE. An increase in the use of PSA following a negative DRE was reported by 85 percent and a greater inclination to use TRUS following a positive PSA was reported by 90 percent Eighty-six percent agreed with the American Cancer Society (ACS) guidelines on prostate cancer screening. Using logistic regression adjusted across levels of demographic and practice factors, prevalence odds ratios were derived with results indicating that agreement with ACS guidelines and being in private practice are strong predictors of a physician's inclination to routinely screen asymptomatic patients for prostate cancer. Our findings have provided baseline information on prostate cancer screening in Missouri and suggest that primary care physicians view PSA testing as a useful procedure and appear to be using it in a manner similar to the general pattern seen across the country.
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Affiliation(s)
- D A Lawson
- School of Public Health, Saint Louis University, MO 63108-3342, USA
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Abstract
OBJECTIVES This study examined the activities and influence of public health interest groups and coalitions on the national health care reform debates in the 103rd Congress. METHODS Congressional staff and representatives of public health interest groups, coalitions, and government health agencies were interviewed. Content analysis of eight leading national health care reform bills was performed. RESULTS The public health community coalesced around public health in health care reform; nearly all the major interest groups and government health agencies joined two or more public health or prevention coalitions, and half joined three or more. The most effective influence on health care reform legislation was early, sustained personal contact with Congress members and their staffs, accompanied by succinct written materials summarizing key points. Media campaigns and grassroots mobilization were less effective. Seven of the eight leading health care reform bills included one or more of the priorities supported by public health advocates. CONCLUSIONS The public health community played an important role in increasing awareness and support for public health programs in the health care reform bills of the 103rd Congress.
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Affiliation(s)
- H Schauffler
- Joint Program in Public Policy and Public Health, School of Public Health, University of California, Berkeley 94720-7360, USA
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Dorfman L, Schauffler HH, Wilkerson J, Feinson J. Local television news coverage of President Clinton's introduction of the Health Security Act. JAMA 1996; 275:1201-5. [PMID: 8609691] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate how local television news reported on health system reform during the week President Clinton presented his health system reform bill. DESIGN Retrospective content analysis of the 1342-page Health Security Act of 1993, the printed text of President Clinton's speech before Congress on September 22, 1993, and a sample of local television news stories on health system reform broadcast during the week of September 19 through 25, 1993. SETTING The state of California. RESULTS During the week, 316 television news stories on health system reform were aired during the 166 local news broadcasts sampled. Health system reform was the second most frequently reported topic, second to stories on violent crime. News stories on health system reform averaged 1 minute 38 seconds in length, compared with 57 seconds for violent crime. Fifty-seven percent of the local news stories focused on interest group politics. Compared with the content of the Health Security Act, local news broadcasts devoted a significantly greater portion of their stories to financing, eligibility, and preventive services. Local news stories gave significantly less attention to cost-saving mechanisms, long-term care benefits, and changes in Medicare and Medicaid, and less than 2% of stories mentioned quality assurance mechanisms, malpractice reform, or new public health initiatives. Of the 316 televised news stories, 53 reported on the president's speech, covering many of the same topics emphasized in the speech (financing, organization and administration, and eligibility) and de-emphasizing many of the same topics (Medicare and Medicaid, quality assurance, and malpractice reform). Two percent of the president's speech covered partisan politics; 45% of the local news stories on the speech featured challenges from partisan politicians. CONCLUSIONS Although health system reform was the focus of a large number of local television news stories during the week, in-depth explanation was scarce. In general, the news stories provided superficial coverage framed largely in terms of the risks and costs of reform to specific stakeholders.
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Affiliation(s)
- L Dorfman
- Berkeley Media Studies Group, Berkeley, CA 94704, USA
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34
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Ashton JT, Wilkerson J. Establishing a team-based coaching process. Nurs Manag (Harrow) 1996; 27:48N-48Q. [PMID: 8700492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
As our organization moved toward implementing self-managed work teams and decreased management hierarchy, the need arose to revise our performance development structure. A team-based coaching process has been implemented successfully on all patient care units and is being modified for use in other areas.
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Abstract
A plaque-purified isolate of the Holland strain of Anatid herpesvirus (AHV-ppc3) was purified by differential and buoyant density sedimentation. The virus buoyant density was 1.215 g/cm3 in sucrose. AHV-ppc3 DNA was analyzed by sedimentation velocity studies in neutral or alkaline sucrose gradients. Based upon a comparison with T4 DNA, the DNA of AHV-ppc3 was found to have a sedimentation coefficient of 59.7 S and a molecular mass of 1.19 x 10(8) daltons. Between 15 and 22 bands were observed in agarose gel electrophoresis with AHV DNA cut by BamHI, EcoRI, PstI or BglII. The possibility of isometric forms is indicated by the finding of restriction fragments having molar ratios differing from 1.0. The mean molecular mass calculated from the fragments was 1.18 x 10(8) daltons. Terminal fragments were identified using exonuclease II and BgII. In alkaline sucrose gradients, AHV DNA fragments with the largest of the most abundant species have a sedimentation coefficient of 69 S and a calculated mass of 6.0 x 10(7) daltons. The buoyant density of AHV-ppc3 DNA in cesium chloride was 1.723 g/cm3 corresponding to a % G + C content of 64.3. This finding was supported by thermal melts of the DNA in SSC/10 in which the thermal melting point was 82.7 degrees. The data support a model for AHV in which the viral duplex DNA is linear, without covalently closed termini or significant base modifications, but with single strand nicks or gaps. The % G + C content of AHV DNA is the highest reported for any avian herpesvirus in the alpha-herpesvirinea subgroup.
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Affiliation(s)
- R Gardner
- Department of Biology, Drake University, Des Moines, Iowa
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Chinworth S, Wilkerson J, Hinrichs R, Jackson A. 793 GROUND REACTION FORCES AND ANKLE AND KNEE MOMENTS DURING ROPE SKIPPING. Med Sci Sports Exerc 1990. [DOI: 10.1249/00005768-199004000-00792] [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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Kamen G, Bredle D, Brown G, Wilkerson J. MUSCLE ELECTROMECHANICAL PROPERTIES FOLLOWING EXERCISE TRAINING AND ANABOLIC STEROID TREATMENT IN MALE AND FEMALE RATS. Med Sci Sports Exerc 1985. [DOI: 10.1249/00005768-198504000-00065] [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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38
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Tishler JM, Omura E, Wilkerson J. Skin eruption and weight loss in a 57-year-old woman. Invest Radiol 1984; 19:71-5. [PMID: 6099833 DOI: 10.1097/00004424-198403000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Krueger SK, Rakes S, Wilkerson J, Stuber RR, McMillen JJ. Temporary pacemaking by general internists. Arch Intern Med 1983; 143:1531-3. [PMID: 6870435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The medical records of 126 patients requiring 129 temporary pacemakers were viewed retrospectively. The pacemakers were inserted by general internists using venous access from subclavian and internal jugular veins under ECG guidances. Fluoroscopy was not used. There was 14% incidence of pacemaker electrode malfunction and a 4% risk of complication with no pacemaker-related mortality. These results compare favorably with reports from university cardiology services. Temporary pacemakers can be safely inserted by general internists without fluoroscopy.
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Abstract
This study investigated the effects of group Rational Therapy in promoting rational thinking and self-enhancing emotions among 24 college students. Each subject was administered the Sixteen Personality Factor Questionnaire as a pre- and post-test measurement. Results reveal that some aspects of personality are affected by Rational Therapy group programs while others are not.
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Mitchell JK, Fonzi WA, Wilkerson J, Opheim DJ. A particulate form of alkaline phosphatase in the yeast, Saccharomyces cerevisiae. Biochim Biophys Acta 1981; 657:482-94. [PMID: 7011403 DOI: 10.1016/0005-2744(81)90333-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A new form of alkaline phosphatase (orthophosphoric-monoester phosphohydrolase (alkaline optimum), EC 3.1.3.1) has been identified in the yeast Saccharomyces cerevisiae. Utilizing either synthetic or natural substrates, the enzyme exhibited a broad pH activity curve with maximum activity between 8.5 and 9.0. The enzyme was nonspecific with respect to substrate, attacking a variety of compounds containing phosphomonoester linkages, but has no detectable activity against polyphosphate, pyrophosphate or phosphodiester linkages. The enzyme exhibited an apparent Km of 0.25 mM with respect to p-nitrophenyl phosphate, 0.38 mM with respect to alpha-naphthyl phosphate, and 1.0 mM with respect to 5'AMP. The enzyme is regulated in a constitutive manner and its activity does not increase during phosphate starvation or sporulation, as does the repressible alkaline phosphatase. The enzyme is tightly bound to a particulate fraction of the cell, tentatively identified as the tonoplast membrane. It is not solubilized by treatment with high concentrations of NaCl, KH2PO4 or chaotropic agents. Triton X-100 (0.1%) solubilizes 12% of the particulate activity. This enzyme is differentiated from the other alkaline phosphatases found in yeast by its chromatographic elution DEAE-cellulose, kinetic parameters, heat stability and pH stability, as well as its particulate nature. This particulate alkaline phosphatase was found in every strain examined. It has a significantly lower specific activity in the phoH mutant and a higher activity in the acid phosphatase constitutive mutant A137.
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Henson PL, Cooper J, Wilkerson J, Henson PL. PACE AND GRADE RELATED TO THE OXYGEN AND ENERGY REQUIREMENTS, AND THE MECHANICS OF TREADMILL RUNNING. Med Sci Sports Exerc 1977. [DOI: 10.1249/00005768-197721000-00072] [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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Wilkerson J. HORMONAL AND ELECTROLYTE CHANGES DURING STEDY STEATE AND EXHAUSTIVE EXERCISE IN SWINE. Med Sci Sports Exerc 1975. [DOI: 10.1249/00005768-197500710-00062] [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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45
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46
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Urizar RE, Tinglof B, McIntosh R, Litman N, Barnett E, Wilkerson J, Smith F, Vernier RL. Immunosuppressive therapy of proliferative glomerulonephritis in children. Am J Dis Child 1969; 118:411-25. [PMID: 4896973 DOI: 10.1001/archpedi.1969.02100040413001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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