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Williams BD, Sisson SB, Bhattacharya S, Merchant C, Slawinski M, Hildebrand D, Stoner JA, Fortin-Miller S, Patel SM, Salvatore AL. Process Evaluation of Two Interventions to Improve Health Environments in Family Child Care Homes. Health Educ Behav 2023; 50:211-223. [PMID: 34963346 DOI: 10.1177/10901981211057537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Early care and education (ECE) environments influence children's lifelong health behaviors, growth, and development. Although the number of interventions to improve health in ECE environments is increasing, few have been designed for and tested in family child care homes (FCCHs). This study reports the process evaluation of two interventions to improve FCCH health environments, both part of Happy Healthy Homes, a matched-attention randomized-controlled intervention trial conducted in Oklahoma FCCHs. Participating child care providers received one of two multicomponent interventions: (a) an intervention focused on enhancing the quality of the nutrition environment, self-efficacy, and practices or (b) an intervention focused on improving providers' environmental health literacy, self-efficacy, and practices. Guided by "Implementation" constructs of the RE-AIM framework (i.e., reach, effectiveness, adoption, implementation, maintenance), intervention report forms and participant tracking were used to assess intervention dose delivered and interventionist-perceived challenges and successes to implementation. Interviews were conducted to obtain participant feedback after the intervention. Dose delivered was high for both interventions overall and across individual sessions, and provider feedback was positive. Implementation challenges and strengths identified for both interventions may be useful for further enhancing intervention appropriateness and success, particularly for interventions with FCCHs. Process evaluation findings indicate that the two Happy Healthy Home interventions can be conducted with high delivery and are well attended and considered to be valuable to FCCH providers.
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Affiliation(s)
- Bethany D Williams
- The University of Oklahoma Health Sciences Center, USA.,Washington State University Health Sciences Spokane, USA
| | | | | | - Cady Merchant
- The University of Oklahoma Health Sciences Center, USA
| | | | | | | | | | - Sarah M Patel
- The University of Oklahoma Health Sciences Center, USA
| | - Alicia L Salvatore
- The University of Oklahoma Health Sciences Center, USA.,Christiana Care Health System Value Institute, Newark, DE, USA
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Sisson SB, Eckart E, Williams BD, Patel SM, Kracht CL, Davis HA, Ward DS, Hildebrand D, Stoner JA, Stinner E, Kerr KE, Salvatore A. Family child care home providers' self-reported nutrition and physical activity practices, self-efficacy, barriers and knowledge: baseline findings from happy healthy homes. Public Health Nutr 2022; 25:1-14. [PMID: 35125128 PMCID: PMC9887682 DOI: 10.1017/s1368980022000337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Describe nutrition and physical activity practices, nutrition self-efficacy and barriers and food programme knowledge within Family Child Care Homes (FCCH) and differences by staffing. DESIGN Baseline, cross-sectional analyses of the Happy Healthy Homes randomised trial (NCT03560050). SETTING FCCH in Oklahoma, USA. PARTICIPANTS FCCH providers (n 49, 100 % women, 30·6 % Non-Hispanic Black, 2·0 % Hispanic, 4·1 % American Indian/Alaska Native, 51·0 % Non-Hispanic white, 44·2 ± 14·2 years of age. 53·1 % had additional staff) self-reported nutrition and physical activity practices and policies, nutrition self-efficacy and barriers and food programme knowledge. Differences between providers with and without additional staff were adjusted for multiple comparisons (P < 0·01). RESULTS The prevalence of meeting all nutrition and physical activity best practices ranged from 0·0-43·8 % to 4·1-16·7 %, respectively. Average nutrition and physical activity scores were 3·2 ± 0·3 and 3·0 ± 0·5 (max 4·0), respectively. Sum nutrition and physical activity scores were 137·5 ± 12·6 (max 172·0) and 48·4 ± 7·5 (max 64·0), respectively. Providers reported high nutrition self-efficacy and few barriers. The majority of providers (73·9-84·7 %) felt that they could meet food programme best practices; however, knowledge of food programme best practices was lower than anticipated (median 63-67 % accuracy). More providers with additional staff had higher self-efficacy in family-style meal service than did those who did not (P = 0·006). CONCLUSIONS Providers had high self-efficacy in meeting nutrition best practices and reported few barriers. While providers were successfully meeting some individual best practices, few met all. Few differences were observed between FCCH providers with and without additional staff. FCCH providers need additional nutrition training on implementation of best practices.
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Affiliation(s)
- Susan B Sisson
- Department of Nutrition Sciences, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, AHB 3057, Oklahoma City, OK73117-1215, USA
| | - Erin Eckart
- Department of Biostatics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bethany D Williams
- Department of Nutrition Sciences, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, AHB 3057, Oklahoma City, OK73117-1215, USA
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University Health Sciences Spokane, Spokane, WA, USA
| | - Sarah M Patel
- Department of Nutrition Sciences, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, AHB 3057, Oklahoma City, OK73117-1215, USA
| | - Chelsea L Kracht
- Department of Nutrition Sciences, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, AHB 3057, Oklahoma City, OK73117-1215, USA
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Holly A Davis
- Department of Nutrition Sciences, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, AHB 3057, Oklahoma City, OK73117-1215, USA
| | - Dianne S Ward
- University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | | | - Julie A Stoner
- Department of Biostatics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Emily Stinner
- Department of Nutrition Sciences, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, AHB 3057, Oklahoma City, OK73117-1215, USA
| | - Kelly E Kerr
- Department of Nutrition Sciences, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, AHB 3057, Oklahoma City, OK73117-1215, USA
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Abstract
Previous studies have shown disparities in health conditions and behaviors among different ethnic groups. Sampling designs that do not consider oversampling certain minority populations, such as American Indians or African Americans, may not produce sufficient sample sizes for estimating health parameters for minority populations. Oversampling is one of the most common approaches that researchers use to achieve required precision levels for small domain estimation. However, it has not been rigorously investigated in dual-frame survey settings. To take advantage of extra information for minority populations in the Marketing Systems Group database, we propose a novel optimal oversampling strategy that minimizes the domain variance subject to total cost restriction or vice versa. We further extend the method to oversample multiple minorities simultaneously. Empirical study using a population-based community survey shows the benefits of our proposed methods compared with traditional methods in terms of statistical efficiency and cost balance.
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Affiliation(s)
- Sixia Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Alexander Stubblefield
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Chen WJ, Davis EM, Stoner JA, Robledo C, Goodman JR, Garwe T, Janitz AE, Xu C, Hwang J, Peck JD. Urinary total arsenic and arsenic methylation capacity in pregnancy and gestational diabetes mellitus: A case-control study. Chemosphere 2021; 271:129828. [PMID: 33736216 PMCID: PMC8966639 DOI: 10.1016/j.chemosphere.2021.129828] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/18/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 05/12/2023]
Abstract
Previous studies suggest arsenic exposure may increase the risk of gestational diabetes mellitus (GDM). However, prior assessments of total arsenic concentrations have not distinguished between toxic and nontoxic species. Our study aimed to investigate the relationships between inorganic arsenic exposure, arsenic methylation capacity, and GDM. Sixty-four cases of GDM and 237 controls were analyzed for urinary concentrations of inorganic arsenic species and their metabolites (arsenite (As3), arsenate (As5), monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA)), and organic forms of arsenic. Inorganic arsenic exposure was defined as the sum of inorganic and methylated arsenic species (iSumAs). Methylation capacity indices were calculated as the percentage of inorganic arsenic species [iAs% = (As3 + As5)/iSumAs, MMA% = MMA/iSumAs, and DMA% = DMA/iSumAs]. Multivariable logistic regression was performed to evaluate the association between inorganic arsenic exposure, methylation capacity indices, and GDM. We did not observe evidence of a positive association between iSumAs and GDM. However, women with GDM had an increased odds of inefficient methylation capacity when comparing the highest and lowest tertiles of iAs% (adjusted odds ratio (aOR) = 1.48, 95% CI 0.58-3.77) and MMA% (aOR = 1.95 (95% CI 0.81-4.70) and a reduced odds of efficient methylation capacity as indicated by DMA% (aOR = 0.62 (95% CI 0.25-1.52), though the confidence intervals included the null value. While the observed associations with arsenic methylation indices were imprecise and warrant cautious interpretation, the direction and magnitude of the relative measures reflected a pattern of lower detoxification of inorganic arsenic exposures among women with GDM.
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Affiliation(s)
- Wei-Jen Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Erin M Davis
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Candace Robledo
- Department of Population Health and Biostatistics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Jean R Goodman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL, USA
| | - Tabitha Garwe
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Amanda E Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Chao Xu
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jooyeon Hwang
- Department of Occupational and Environmental Health, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Taitingfong R, Bloss CS, Triplett C, Cakici J, Garrison N, Cole S, Stoner JA, Ohno-Machado L. A systematic literature review of Native American and Pacific Islanders' perspectives on health data privacy in the United States. J Am Med Inform Assoc 2020; 27:1987-1998. [PMID: 33063114 PMCID: PMC7727344 DOI: 10.1093/jamia/ocaa235] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Privacy-related concerns can prevent equitable participation in health research by US Indigenous communities. However, studies focused on these communities' views regarding health data privacy, including systematic reviews, are lacking. METHODS We conducted a systematic literature review analyzing empirical, US-based studies involving American Indian/Alaska Native (AI/AN) and Native Hawaiian or other Pacific Islander (NHPI) perspectives on health data privacy, which we define as the practice of maintaining the security and confidentiality of an individual's personal health records and/or biological samples (including data derived from biological specimens, such as personal genetic information), as well as the secure and approved use of those data. RESULTS Twenty-one studies involving 3234 AI/AN and NHPI participants were eligible for review. The results of this review suggest that concerns about the privacy of health data are both prevalent and complex in AI/AN and NHPI communities. Many respondents raised concerns about the potential for misuse of their health data, including discrimination or stigma, confidentiality breaches, and undesirable or unknown uses of biological specimens. CONCLUSIONS Participants cited a variety of individual and community-level concerns about the privacy of their health data, and indicated that these deter their willingness to participate in health research. Future investigations should explore in more depth which health data privacy concerns are most salient to specific AI/AN and NHPI communities, and identify the practices that will make the collection and use of health data more trustworthy and transparent for participants.
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Affiliation(s)
- Riley Taitingfong
- Department of Communication, University of California San Diego, La Jolla, California, USA
| | - Cinnamon S Bloss
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, USA
- Center for Wireless and Population Health Systems, Calit2, University of California San Diego, La Jolla, California, USA
| | - Cynthia Triplett
- Qualcomm Institute Calit2, University of California San Diego, La Jolla, California, USA
| | - Julie Cakici
- San Diego Joint Doctoral Program in Public Health, San Diego State University/University of California, San Diego, California, USA
| | - Nanibaa’ Garrison
- Institute for Society and Genetics, University of California, Los Angeles, California, USA
- Institute for Precision Health, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Shelley Cole
- Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, School of Medicine, University of California, San Diego, La Jolla, California, USA
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Reinschmidt KM, Salvatore AL, Ji L, Finnell KJ, Giron Lopez AE, Bump ER, Philip TJ, Stoner JA. Diabetes among Hispanics in Oklahoma: Assessing Disparities to Guide Basic and Applied Research. J Okla State Med Assoc 2020; 113:160-166. [PMID: 36204352 PMCID: PMC9534285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND – Diabetes, a leading cause of morbidity and mortality in the United States, disproportionally affects minority populations. In 2015, Hispanics, the largest minority in the country, had the third highest rate of diabetes prevalence and the third highest age-adjusted rate of diabetes-related mortality. Substantial progress in understanding diabetes disparities nationally and in many areas of the country has been made. However, little is known about diabetes and related mortality among Hispanics in Oklahoma, which is known as a Hispanic "new Settlement" state due to the relatively recent and substantial growth of this population. METHODS – We used Oklahoma Behavioral and Risk Factor Surveillance Survey data (2011-2016) to calculate population estimates of diabetes prevalence and selected sociodemographic characteristics for Hispanic and Non-Hispanic adults in the state. We used Oklahoma Death Registry data to estimate diabetes-related mortality rates for Hispanic and Non-Hispanic adults for the same five-year period. We examined differences in diabetes prevalence and diabetes-related mortality across selected sociodemographic characteristics. RESULTS – Hispanics are the largest minority group in Oklahoma. Spanish is the most common non-English language spoken in the state. Hispanics are younger, poorer, less educated and experience less access to health care compared to other populations in Oklahoma. While Hispanics had the fifth highest reported diabetes prevalence rate during the five-year period examined, they had the third highest diabetes-related mortality rate in the state. DISCUSSION AND CONCLUSIONS – There is a need for community engagement and basic and applied research to help identify and reduce diabetes disparities in the growing Hispanic population in Oklahoma.
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Affiliation(s)
- Kerstin M. Reinschmidt
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Alicia L. Salvatore
- Value Institute, ChristianaCare, Previous Affiliation: Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Li Ji
- Kapili Services, LLC – Contractor, Immunization Information Systems Support Branch (IISSB), Centers for Disease Control and Prevention, Previous Affiliation: Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Karla J. Finnell
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Angel E. Giron Lopez
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Eric R. Bump
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Timothy J. Philip
- OUHSC College of Medicine, Previous Affiliation: Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Julie A. Stoner
- Previous Affiliation: Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center
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Chain JL, Alvarez K, Mascaro-Blanco A, Reim S, Bentley R, Hommer R, Grant P, Leckman JF, Kawikova I, Williams K, Stoner JA, Swedo SE, Cunningham MW. Autoantibody Biomarkers for Basal Ganglia Encephalitis in Sydenham Chorea and Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infections. Front Psychiatry 2020; 11:564. [PMID: 32670106 PMCID: PMC7328706 DOI: 10.3389/fpsyt.2020.00564] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/02/2020] [Indexed: 12/21/2022] Open
Abstract
Movement, behavioral, and neuropsychiatric disorders in children have been linked to infections and a group of anti-neuronal autoantibodies, implying dopamine receptor-mediated encephalitis within the basal ganglia. The purpose of this study was to determine if anti-neuronal biomarkers, when used as a group, confirmed the acute disease in Sydenham chorea (SC) and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). IgG autoantibodies against four neuronal autoantigens (tubulin, lysoganglioside GM1, and dopamine receptors D1 and D2) were detected in SC sera (N=8), sera and/or cerebrospinal fluid (CSF) from two groups of PANDAS cases (N=25 first group and N=35 second group), sera from Tourette's syndrome (N=18), obsessive-compulsive disorder (N=25), attention deficit hyperactivity disorder (N=18), and healthy controls (N=28) by direct enzyme-linked immunosorbent assay (ELISA). IgG specific for neuronal autoantigens was significantly elevated during the acute symptomatic phase, and the activity of calcium/calmodulin-dependent protein kinase II (CaMKII) pathway was significantly elevated in human neuronal cells. Five assays confirmed the disease in SC and in two groups of children with PANDAS. In 35 acute onset PANDAS patients, 32 sera (91.4%) were positive for one or more of the anti-neuronal autoantibodies compared with 9 of 28 healthy controls (32.1%, p<0.0001). Importantly, CSF of 32 (91.4%) PANDAS patients had one or more detectable anti-neuronal autoantibody titers and CaMKII activation. Among healthy control subjects with elevated serum autoantibody titers for individual antigens, none (0%) were positively associated with elevated positive CaMKII activation, which was a striking contrast to the sera of PANDAS subjects, who had 76-89% positive association with elevated individual autoantibody titers and positive CaMKII activity. At 6 months follow-up, symptoms improved for more than 80% of PANDAS subjects, and serum autoantibody titers also significantly decreased. Results reported herein and previously published studies in our laboratory suggest the antibody biomarkers may be a useful adjunct to clinical diagnosis of SC, PANDAS, and related disorders and are the first known group of autoantibodies detecting dopamine receptor-mediated encephalitis in children.
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Affiliation(s)
- Jennifer L. Chain
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Kathy Alvarez
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adita Mascaro-Blanco
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sean Reim
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Rebecca Bentley
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Rebecca Hommer
- Section on Behavioral Pediatrics, National Institute of Mental Health (NIMH), Bethesda, MD, United States
| | - Paul Grant
- Section on Behavioral Pediatrics, National Institute of Mental Health (NIMH), Bethesda, MD, United States
| | - James F. Leckman
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Ivana Kawikova
- Section of Pediatric Neurology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Kyle Williams
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Julie A. Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Susan E. Swedo
- Section on Behavioral Pediatrics, National Institute of Mental Health (NIMH), Bethesda, MD, United States
| | - Madeleine W. Cunningham
- Departments of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Janitz AE, Dao HD, Campbell JE, Stoner JA, Peck JD. Distribution of congenital anomalies by race/ethnicity and geospatial location in Oklahoma, 1997-2009. Birth Defects Res 2020; 112:262-269. [PMID: 31820848 PMCID: PMC7057226 DOI: 10.1002/bdr2.1631] [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: 09/09/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Congenital anomalies were the leading cause of infant mortality, responsible for 23 and 21% of deaths in Oklahoma and the USA, respectively, in 2016. We aimed to determine the prevalence by race/ethnicity and spatial distribution of congenital anomalies to identify geographic and racial/ethnic disparities, particularly among American Indian/Alaska Natives (AI/AN). METHODS We evaluated the prevalence of anomalies by type and race/ethnicity among 648,074 live births in Oklahoma from 1997 to 2009. Prevalence proportion ratios (PPRs) and 95% confidence intervals (CIs) were calculated using Poisson regression. We used Moran's I and Getis-Ord Gi* to evaluate spatial clustering for neural tube defects, critical congenital heart defects (CCHDs), and oral clefts among births whose residence geocoded to the ZIP code or finer level. RESULTS Overall prevalence of anomalies among live births was 3.9%. Non-Hispanic (NH) African American (PPR: 0.87, 95% CI: 0.83, 0.91), Asian/Pacific Islander (PPR: 0.70, 95% CI: 0.63, 0.78), and Hispanic (PPR: 0.87, 95% CI: 0.83, 0.91) children had a lower prevalence of anomalies compared to NH whites. The prevalence in NH AI/AN children was similar to NH whites (PPR: 1.01, 95% CI: 0.97, 1.05). However, differences in specific types of anomalies were observed by race/ethnicity. We observed no spatial autocorrelation for CCHD and oral clefts. Neural tube defects demonstrated spatial autocorrelation (p < .0001). Local hot spots varied by anomaly. DISCUSSION The prevalence of anomalies by race/ethnicity and geography differed by race/ethnicity and region, though this varied by anomaly. Additional research is needed to identify behavioral or environmental factors to target for prevention.
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Hanh Dung Dao
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Muller CJ, Noonan CJ, MacLehose RF, Stoner JA, Lee ET, Best LG, Calhoun D, Jolly SE, Devereux RB, Howard BV. Trends in Cardiovascular Disease Morbidity and Mortality in American Indians Over 25 Years: The Strong Heart Study. J Am Heart Assoc 2019; 8:e012289. [PMID: 31648583 PMCID: PMC6898852 DOI: 10.1161/jaha.119.012289] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background American Indians experience high rates of cardiovascular disease. We evaluated whether cardiovascular disease incidence, mortality, and prevalence changed over 25 years among American Indians aged 30 to 85. Methods and Results The SHS (Strong Heart Study) and SHFS (Strong Heart Family Study) are prospective studies of cardiovascular disease in American Indians. Participants enrolled in 1989 to 1990 or 2000 to 2003 with birth years from 1915 to 1984 were followed for cardiovascular disease events through 2013. We used Poisson regression to analyze data for 5627 individuals aged 30 to 85 years during follow-up. Outcomes reflect change in age-specific cardiovascular disease incidence, mortality, and prevalence, stratified by sex. To illustrate generational change, 5-year relative risk compared most recent birth years for ages 45, 55, 65, and 75 to same-aged counterparts born 1 generation (23-25 years) earlier. At all ages, cardiovascular disease incidence was lower for people with more recent birth years. Cardiovascular disease mortality declined consistently among men, while prevalence declined among women. Generational comparisons were similar for women aged 45 to 75 (relative risk, 0.39-0.46), but among men magnitudes strengthened from age 45 to 75 (relative risk, 0.91-0.39). For cardiovascular disease mortality, risk was lower in the most recent versus the earliest birth years for women (relative risk, 0.56-0.83) and men (relative risk, 0.40-0.54), but results for women were inconclusive. Conclusions Cardiovascular disease incidence declined over a generation in an American Indian cohort. Mortality declined more for men, while prevalence declined more for women. These trends might reflect more improvement in case survival among men compared with women.
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Affiliation(s)
- Clemma J Muller
- Elson S. Floyd College of Medicine Washington State University Seattle WA
| | - Carolyn J Noonan
- Elson S. Floyd College of Medicine Washington State University Seattle WA
| | - Richard F MacLehose
- Department of Epidemiology and Community Health University of Minnesota Minneapolis MN
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology University of Oklahoma Health Sciences Center Oklahoma City OK
| | - Elisa T Lee
- Department of Biostatistics and Epidemiology University of Oklahoma Health Sciences Center Oklahoma City OK
| | - Lyle G Best
- Missouri Breaks Industries Research Inc. Eagle Butte SD
| | - Darren Calhoun
- Phoenix Field Office MedStar Health Research Institute Phoenix AZ
| | - Stacey E Jolly
- Cleveland Clinic Lerner College of Medicine Cleveland OH.,Cleveland Clinic Department of General Internal Medicine Cleveland OH
| | | | - Barbara V Howard
- MedStar Health Research Institute Georgetown/Howard University Center for Clinical and Translational Sciences Hyattsville MD
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Kirkpatrick AC, Stoner JA, Dale GL, Rabadi M, Prodan CI. Higher Coated-Platelet Levels in Acute Stroke are Associated with Lower Cognitive Scores at Three Months Post Infarction. J Stroke Cerebrovasc Dis 2019; 28:2398-2406. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/14/2019] [Accepted: 06/24/2019] [Indexed: 12/24/2022] Open
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Sisson SB, Salvatore AL, Hildebrand D, Poe T, Merchant C, Slawinski M, Kracht CL, Stoner JA, Alcala Lazarte N, Schneider LAF, Weber J, Jones F, Ward D. Interventions to promote healthy environments in family child care homes in Oklahoma-Happy Healthy Homes: study protocol for a randomized controlled trial. Trials 2019; 20:541. [PMID: 31470886 PMCID: PMC6716934 DOI: 10.1186/s13063-019-3616-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 07/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early childhood is a critical period of development. Caregivers, including providers of early care and education (ECE), have a substantial influence on the health of young children. Family child care homes (FCCHs), which are small, licensed ECE businesses operated out of the residences of providers, are important settings for promoting child health. However, to date, few interventions to promote the health of children have been developed for FCCHs. The purpose of this article is to describe the protocol for Happy Healthy Homes, a pilot interdisciplinary, community-based study to improve FCCH environments and the health of children in Oklahoma. We describe the development and evaluation of two interventions to be tested in a matched attention randomized controlled trial: 1) a nutrition intervention aimed at enhancing the nutritional quality of meals served to young children, incorporating the Child and Adult Care Food Program best practices, and improving nutritional self-efficacy of providers; and 2) an environmental intervention aimed at increasing providers' environmental health literacy, self-efficacy for integrated pest management (IPM), and awareness of less toxic cleaning practices and FCCH provider cleaning behaviors. METHODS Both interventions are informed by common theoretical principles and are matched in attention (i.e., 6 h), format (i.e., two individual 90-min educational home visits and a 3-h small group class) and materials (i.e., tool kit of educational materials and supplies tailored to the allocated intervention). A randomized trial of both interventions is currently underway with 52 FCCH providers in the Oklahoma City metropolitan area who participate in the Child and Adult Care Food Program. Observed and self-reported measures will be collected at baseline, and 3 months and 12 months after baseline measurements. Randomization to one of the two interventions will occur after baseline data collection. DISCUSSION This study aims to support FCCH providers in creating healthier FCCH environments for nutrition and environmental health. Successful completion will provide critical information about the nutritional quality and the environmental health of children in FCCHs, as well as much needed evidence about the efficacy of two community-based interventions to improve the nutrition and environmental health of children in home-based ECE settings. TRIAL REGISTRATION Clinicaltrials.gov, NCT03560050 . Retrospectively registered on 23 May 2018.
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Affiliation(s)
- Susan B. Sisson
- Behavioral Nutrition and Physical Activity Laboratory, Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, AHB 3057, Oklahoma City, OK 73117-1215 USA
| | - Alicia L. Salvatore
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, Oklahoma City, OK 73104 USA
- Christiana Care Health System, 4755 Ogletown-Stanton Road, Newark, Delaware 19718 USA
| | - Deana Hildebrand
- Department of Nutritional Sciences, Oklahoma State University, Oklahoma City, USA
| | - Tiffany Poe
- School of Hospitality and Tourism Management, Oklahoma State University, Stillwater, USA
| | - Cady Merchant
- Behavioral Nutrition and Physical Activity Laboratory, Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, AHB 3057, Oklahoma City, OK 73117-1215 USA
| | - Megan Slawinski
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Chelsea L. Kracht
- Behavioral Nutrition and Physical Activity Laboratory, Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, AHB 3057, Oklahoma City, OK 73117-1215 USA
| | - Julie A. Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Naneida Alcala Lazarte
- Division of Research and Data Analysis, State Department of Education, Oklahoma City, USA
| | | | - Jennifer Weber
- Division of Child Nutrition, Oklahoma State Department of Education, Oklahoma City, USA
| | - Felecia Jones
- Mrs. Felecia’s Playhouse Preschool, Oklahoma City, USA
| | - Dianne Ward
- Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, USA
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12
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Garwe T, Stewart KE, Newgard CD, Stoner JA, Sacra JC, Cody P, Oluborode B, Albrecht RM. Survival Benefit of Treatment at or Transfer to a Tertiary Trauma Center among Injured Older Adults. PREHOSP EMERG CARE 2019; 24:245-256. [PMID: 31211622 DOI: 10.1080/10903127.2019.1632997] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: It is well established that seriously injured older adults are under-triaged to tertiary trauma centers. However, the survival benefit of tertiary trauma centers (TC) compared to a non-tertiary trauma centers (Non-TCs) remains unclear for this patient population. Using improved methodology and a larger sample, we hypothesized that there was a difference in hospital mortality between injured older adults treated at TCs and those treated at Non-TCs. Methods: This was a retrospective cohort study of injured older adults (> =55 years) reported to the Oklahoma statewide trauma registry between 2005 and 2014. The outcome of interest was 30-day in-hospital mortality and the exposure variable of interest was level of definitive trauma care (TC vs Non-TC). Overall survival benefit of treatment at a TC as well as the survival benefit of transferring injured older adults to a TC were evaluated using multivariable survival analyses as well as propensity score-adjusted analyses. Results: Of the 25,288 patients eligible for analysis, 43% (10,927) were treated at TCs. Multivariable Cox regression analyses revealed effect modification by age group and time. After adjusting for potential confounders within the age strata, overall, patients treated at TCs were significantly less likely to die within 7 days of admission and this effect was stronger for patients aged 55-64 years (HR 0.41, 95% CI 0.31-0.52) compared to those > =65 years (HR 0.62, 95% CI 0.55-0.70). Overall survival benefit of TCs beyond 7 days was also observed (HR 0.68, 95% CI 0.56-0.83). Similarly, for the survival benefit of transferring injured older adults, after adjusting for the propensity to be transferred and other confounders, transfer to a TC was associated with lower 30-day mortality both for patients less than 65 years old (HR 0.36, 95% CI: 0.27-0.49) and those 65 years and older (HR 0.55, 95% CI: 0.48-0.64). Conclusions: Our results suggest a survival benefit for injured older adults treated at TCs. This benefit was also observed for patients transferred from non-tertiary trauma centers. Further research should focus on identifying specific subgroups of patients who would especially benefit from this level of care to minimize trauma triage inefficiencies.
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13
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Basu A, Bebu I, Jenkins AJ, Stoner JA, Zhang Y, Klein RL, Lopes-Virella MF, Garvey WT, Budoff MJ, Alaupovic P, Lyons TJ. Serum apolipoproteins and apolipoprotein-defined lipoprotein subclasses: a hypothesis-generating prospective study of cardiovascular events in T1D. J Lipid Res 2019; 60:1432-1439. [PMID: 31203233 DOI: 10.1194/jlr.p090647] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/29/2019] [Indexed: 12/26/2022] Open
Abstract
APOB, APOC3, and APOE and apolipoprotein-defined lipoprotein subclasses (ADLSs; based on qualitative apolipoprotein complement) have been associated with dyslipidemia and CVD. Our main objective was to define associations of serum apolipoproteins and ADLSs with "any CVD" and "major atherosclerotic cardiovascular events" (MACEs) in a prospective study of T1D. Serum apolipoproteins and ADLSs (14 biomarkers in total) were measured in sera (obtained between 1997 and 2000) from a subset (n = 465) of the Epidemiology of Diabetes Interventions and Complications cohort. Prospective associations of "any CVD" (myocardial infarction, stroke, confirmed angina, silent myocardial infarction, revascularization, or congestive heart failure) and MACEs (fatal or nonfatal myocardial infarction or stroke), over 5,943 and 6,180 patient-years follow-up, respectively, were investigated using Cox proportional hazards models that were unadjusted and adjusted for risk factors. During 15 years of follow-up, 50 "any CVD" events and 24 MACEs occurred. Nominally significant positive univariate associations with "any CVD" were APOB, APOC3 and its subfractions [heparin precipitate, heparin-soluble (HS)], and ADLS-defined Lp-B. In adjusted analyses, APOC3-HS remained nominally significant. Nominally significant positive univariate associations with MACEs were APOC3 and its subfractions and Lp-B:C; those with total APOC3 and APOC3-HS persisted in adjusted analyses. However, these associations did not reach significance after adjusting for multiple testing. There were no significant associations of APOA1, APOA2, APOE, or other ADLSs with either "any CVD" or MACEs. These hypothesis-generating data suggest that total serum APOC3 and APOC3 in HDL are potentially important predictive biomarkers for any CVD and MACEs in adults with T1D.
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Affiliation(s)
- Arpita Basu
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV
| | - Ionut Bebu
- The Biostatistics Center Milken Institute School of Public Health, The George Washington University, Rockville, MD
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre University of Sydney, Camperdown, Sydney, Australia
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Richard L Klein
- Division of Endocrinology Medical University of South Carolina, Charleston, SC.,The Ralph H. Johnson Veterans Affairs Medical Center Charleston, SC
| | - Maria F Lopes-Virella
- Division of Endocrinology Medical University of South Carolina, Charleston, SC.,The Ralph H. Johnson Veterans Affairs Medical Center Charleston, SC
| | - W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Matthew J Budoff
- Division of Cardiology Los Angeles Biomedical Research Institute, Torrance, CA
| | | | - Timothy J Lyons
- Division of Endocrinology Medical University of South Carolina, Charleston, SC
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14
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Thompson DM, Lee HM, Stoner JA, Golub LM, Nummikoski PV, Payne JB. Loss of alveolar bone density in postmenopausal, osteopenic women is associated with circulating levels of gelatinases. J Periodontal Res 2019; 54:525-532. [PMID: 31032961 DOI: 10.1111/jre.12656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/07/2019] [Accepted: 03/09/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether circulating levels of two matrix metalloproteinases, MMP-2 and MMP-9, are associated with loss of alveolar bone density (ABD) or height (ABH), or with progression of periodontitis (relative clinical attachment level [RCAL]), among postmenopausal women with local and systemic bone loss. BACKGROUND This study was planned as part of a 2-year randomized, double-blind, placebo-controlled, clinical trial examining efficacy/safety of subantimicrobial dose doxycycline (20 mg bid) in postmenopausal osteopenic women. This study examines whether serum levels of gelatinases are associated with local changes in the periodontium. METHODS A sample of 113 women received periodontal maintenance for moderate to advanced chronic periodontitis and consented to analysis of stored serum biomarkers. Posterior vertical bitewings were taken, and serum collected, at baseline, one, and 2 years. ABD was determined by computer-assisted densitometric image analysis (CADIA), ABH by the Hausmann et al (1992, J Periodontol 63, 657) method, and RCAL by Florida Probe (every 6 months). MMPs were measured densitometrically on gelatin zymograms using denatured type I collagen as substrate and purified MMP-2 (72 kDa) and MMP-9 (92 kDa) as standards. Evidence of worsening in the periodontium at a tooth site was defined as a change from baseline of, for ABD, at least 14 densitometric units (for subcrestal locations) or 17 units (for crestal locations); of at least 0.4 mm for ABH; and of at least 1.5 mm for RCAL. Logistic regression models, while accounting for clustering, compared the odds of worsening in ABD, ABH, or RCAL, after 2 years of observation, between groups defined by baseline and concurrent levels of serum gelatinases. RESULTS Changes in ABH and RCAL were not associated with circulating levels of MMP-2 or MMP-9. However, elevated odds of ABD loss over 24 months were associated, among smokers, with both baseline and concurrent levels of MMP-9 in the middle and highest tertile, and with concurrent levels of MMP-2 in the middle (but not the highest) tertile. Elevated odds of ABD loss were also associated, among women within 5 years of menopause, with baseline levels of MMP-2 in the highest tertile. CONCLUSION Among postmenopausal osteopenic women, loss of ABD was associated, in smokers, with elevated circulating levels of MMP-9 and MMP-2. In those within 5 years of menopause, ABD loss was associated with elevated circulating levels of MMP-2.
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Affiliation(s)
- David M Thompson
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Hsi-Ming Lee
- Department of Oral Biology and Pathology, Stony Brook University School of Dental Medicine, Stony Brook, New York
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Lorne M Golub
- Department of Oral Biology and Pathology, Stony Brook University School of Dental Medicine, Stony Brook, New York
| | - Pirkka V Nummikoski
- Longitudinal Radiographic Assessment Facility, University of Texas Health Science Center San Antonio Dental School, San Antonio, Texas
| | - Jeffrey B Payne
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, Nebraska.,Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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15
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Kirkpatrick AC, Stoner JA, Donna-Ferreira F, Malatinszky GC, Guthery LD, Scott J, Prodan CI. High rates of undiagnosed vascular cognitive impairment among American Indian veterans. GeroScience 2019; 41:69-76. [PMID: 30725354 DOI: 10.1007/s11357-019-00055-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/24/2019] [Indexed: 12/01/2022] Open
Abstract
As data on prevalence and etiology of dementia in American Indians are limited, we sought to determine rates and patterns of memory loss among American Indian veterans with vascular risk factors. Sixty consecutive outpatient American Indian veterans with a mean age of 64 years (range 50-86), without prior dementia or mild cognitive impairment (MCI), and with ≥ 2 vascular risk factors were enrolled. The Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory-II were used to screen for cognitive impairment and depression. Patients with MoCA scores < 26 were referred for additional evaluation, including imaging, serology, and neuropsychological testing. Overall rates, types, and distribution of cognitive impairment were determined. Most prevalent vascular risk factors included hypertension (92%), hyperlipidemia (88%), diabetes (47%), and smoking (78%). Eight patients (13%) with severe depression were excluded, leaving 23/52 with abnormal MoCA scores (44%, 95%CI 30%-59%). Fifteen completed additional evaluation for memory loss, including four with normal MoCA scores who requested evaluation based on symptoms. Results were adjudicated as normal (4), non-amnestic MCI (4), vascular MCI (5), and vascular dementia (2). These results show that rates of undiagnosed cognitive impairment among American Indian veterans with vascular risk factors exceed rates previously published in non-American Indian cohorts. The most common etiology is vascular. Our findings support the need to improve vascular risk reduction in this understudied population.
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Affiliation(s)
- Angelia C Kirkpatrick
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. .,Veterans Affairs Medical Center, 921 NE 13th Street, Oklahoma City, OK, 73104, USA.
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Fabiola Donna-Ferreira
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - George C Malatinszky
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Leslie D Guthery
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - James Scott
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Calin I Prodan
- Veterans Affairs Medical Center, 921 NE 13th Street, Oklahoma City, OK, 73104, USA.,Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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16
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Wang W, Lee ET, Howard BV, Devereux R, Zhang Y, Stoner JA. Large Cohort Data Based Cost-Effective Disease Prevention Design Strategy: Strong Heart Study. ACTA ACUST UNITED AC 2019; 8:588-601. [PMID: 30687583 PMCID: PMC6343848 DOI: 10.4236/wjcd.2018.812058] [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] [Indexed: 11/25/2022]
Abstract
Background and Objective: A multitude of large cohort studies have collected data on incidence and covariates/risk factors of various chronic diseases. However, approaches for utilization of these large data and translation of the valuable results to inform and guide clinical disease prevention practice are not well developed. In this paper, we proposed, based on large cohort study data, a novel conceptual cost-effective disease prevention design strategy for a target group when it is not affordable to include everyone in the target group for intervention. Methods and Results: Data from American Indian participants (n = 3516; 2056 women) aged 45 – 74 years in the Strong Heart Study, the diabetes risk prediction model from the study, a utility function, and regression models were used. A conceptual cost-effective disease prevention design strategy based on large cohort data was initiated. The application of the proposed strategy for diabetes prevention was illustrated. Discussion: The strategy may provide reasonable solutions to address cost-effective prevention design issues. These issues include complex associations of a disease with its significant risk factors, cost-effectively selecting individuals at high risk of developing disease to undergo intervention, individual differences in health conditions, choosing intervention risk factors and setting their appropriate, attainable, gradual and adaptive goal levels for different subgroups, and assessing effectiveness of the prevention program. Conclusions: The strategy and methods shown in the illustrative example can also be analogously adopted and applied to other diseases preventions. The proposed strategy provides a way to translate and apply epidemiological study results to clinical disease prevention practice.
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Affiliation(s)
- Wenyu Wang
- Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elisa T Lee
- Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Ying Zhang
- Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Julie A Stoner
- Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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17
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Janitz AE, Dao HD, Campbell JE, Stoner JA, Peck JD. The association between natural gas well activity and specific congenital anomalies in Oklahoma, 1997-2009. Environ Int 2019; 122:381-388. [PMID: 30551805 PMCID: PMC6328052 DOI: 10.1016/j.envint.2018.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 08/09/2018] [Revised: 11/11/2018] [Accepted: 12/04/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND Natural gas drilling may pose multiple health risks, including congenital anomalies, through air pollutant emissions and contaminated water. Two recent studies have evaluated the relationship between natural gas activity and congenital anomalies, with both observing a positive relationship. OBJECTIVES We aimed to evaluate whether residence near natural gas wells is associated with critical congenital heart defects (CCHD), neural tube defects (NTD), and oral clefts in Oklahoma, the third highest natural gas producing state in the US. METHODS We conducted a retrospective cohort study among singleton births in Oklahoma (n = 476,600) to evaluate natural gas activity and congenital anomalies. We calculated an inverse distance-squared weighted (IDW) score based on the number of actively producing wells within a two-mile radius of the maternal residence during the month of delivery. We used modified Poisson regression with robust error variance to estimate prevalence proportion ratios (PPR) and 95% confidence intervals (CI) for the association between tertiles of natural gas activity (compared to no wells) and CCHD, NTD, and oral clefts adjusted for maternal education. RESULTS We observed an increased, though imprecise, prevalence of NTDs among children with natural gas activity compared to children with no wells (2nd tertile PPR: 1.34, 95% CI: 0.93, 1.93; 3rd tertile PPR: 1.20, 95% CI: 0.82, 1.75). We observed no association with CCHD or oral clefts overall. Specific CCHDs of common truncus, transposition of the great arteries, pulmonary valve atresia and stenosis, tricuspid valve atresia and stenosis, interrupted aortic arch, and total anomalous pulmonary venous connection were increased among those living in areas with natural gas activity compared to those living in areas without activity, though not statistically significant. DISCUSSION Our results were similar to previous studies for NTDs and specific CCHDs. Future directions include evaluating the association between specific phases of the drilling process and congenital anomalies to better refine the relevant exposure period.
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Hanh Dung Dao
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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18
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Tolma EL, Stoner JA, Thomas C, Engelman K, Li J, Dichkov A, Neely N. Conducting a formative evaluation of an intervention promoting mammography screening in an American Indian community: The Native Women's Health Project. Am J Health Educ 2018; 50:52-65. [PMID: 31289604 PMCID: PMC6615737 DOI: 10.1080/19325037.2018.1552216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women. However, there are very few published studies describing the evaluation of breast health promotion programs among AI/AN women. PURPOSE To describe the formative evaluation of a multi-component intervention to promote mammography screening in an AI community in rural Oklahoma. METHODS A comprehensive process evaluation plan with emphasis on context, reach, dose received, dose delivered, and fidelity was developed. Data collection included mixed research methodology and impact was assessed via one group pre/post research design. Data analysis consisted of descriptive statistical analysis and content analysis. The study utilized a community-based participatory research (CBPR) approach. RESULTS Process evaluation revealed a relatively high reach within the priority population for both components (clinic and community) and a moderate implementation. Focus group research showed that participants were overall satisfied with program implementation. The intervention was feasible to implement in real-world settings. TRANSLATION TO HEALTH EDUCATION PRACTICE Community-based evaluation of breast health promotion programs among AI communities is challenging, as one has to balance methodological rigor with practical constraints. The use of an evaluation plan, mixed methods and a collaborative approach are useful tools in conducting the evaluation.
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Affiliation(s)
- Eleni L Tolma
- Department of Social and Behavioral Sciences, Faculty of Public Health, Kuwait University Health Sciences Center, P.O. Box 24923, Safat, 13110 Kuwait
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, CHB 309, Oklahoma City, OK 73126, x 49480
| | - Cara Thomas
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126
| | - Kimberly Engelman
- Preventive Medicine and Public Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66160
| | - Ji Li
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, CHB 203, Oklahoma City, OK 73104, x 30126
| | - Aleksandar Dichkov
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126
| | - Norma Neely
- American Indian Institute, University of Oklahoma, 1639 Cross Center Drive, Norman, OK 73019
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19
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Zhang M, Gillaspy AF, Gipson JR, Cassidy BR, Nave JL, Brewer MF, Stoner JA, Chen J, Drevets DA. Neuroinvasive Listeria monocytogenes Infection Triggers IFN-Activation of Microglia and Upregulates Microglial miR-155. Front Immunol 2018; 9:2751. [PMID: 30538705 PMCID: PMC6277692 DOI: 10.3389/fimmu.2018.02751] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022] Open
Abstract
MicroRNA (miR) miR-155 modulates microglial activation and polarization, but its role in activation of microglia during bacterial brain infection is unclear. We studied miR-155 expression in brains of C57BL/6 (B6.WT) mice infected i.p. with the neuro-invasive bacterial pathogen Listeria monocytogenes (L. monocytogenes). Infected mice were treated with ampicillin starting 2 days (d) post-infection (p.i.) and analyzed 3d, 7d, and 14d p.i. Virulent L. monocytogenes strains EGD and 10403s upregulated miR-155 in whole brain 7 d p.i. whereas infection with avirulent, non-neurotropic Δhly or ΔactA L. monocytogenes mutants did not. Similarly, infection with virulent but not mutated bacteria upregulated IFN-γ mRNA in the brain at 7 d p.i. Upregulation of miR-155 in microglia was confirmed by qPCR of flow cytometry-sorted CD45intCD11bpos brain cells. Subsequently, brain leukocyte influxes and gene expression in sorted microglia were compared in L. monocytogenes-infected B6.WT and B6.Cg-Mir155tm1.1Rsky/J (B6.miR-155−/−) mice. Brain influxes of Ly-6Chigh monocytes and upregulation of IFN-related genes in microglia were similar to B6.WT mice at 3 d p.i. In contrast, by d 7 p.i. expressions of microglial IFN-related genes, including markers of M1 polarization, were significantly lower in B6.miR-155−/− mice and by 14 d p.i., influxes of activated T-lymphocytes were markedly reduced. Notably, CD45highCD11bpos brain cells from B6.miR-155−/− mice isolated at 7 d p.i. expressed 2-fold fewer IFN-γ transcripts than did cells from B6.WT mice suggesting reduced IFN-γ stimulation contributed to dampened gene expression in B6.miR-155−/− microglia. Lastly, in vitro stimulation of 7 d p.i. brain cells with heat-killed L. monocytogenes induced greater production of TNF in B6.miR-155−/− microglia than in B6.WT microglia. Thus, miR-155 affects brain inflammation by multiple mechanisms during neuroinvasive L. monocytogenes infection. Peripheral miR-155 promotes brain inflammation through its required role in optimal development of IFN-γ-secreting lymphocytes that enter the brain and activate microglia. Microglial miR-155 promotes M1 polarization, and also inhibits inflammatory responses to stimulation by heat-killed L. monocytogenes, perhaps by targeting Tab2.
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Affiliation(s)
- Miao Zhang
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Allison F Gillaspy
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.,Laboratory for Molecular Biology and Cytometry Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Jenny R Gipson
- Laboratory for Molecular Biology and Cytometry Research, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Benjamin R Cassidy
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Jessica L Nave
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Misty F Brewer
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Jie Chen
- Histology and Immunohistochemistry Core, Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Douglas A Drevets
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.,Department of Veterans Affairs Medical Center, Oklahoma City, OK, United States
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Wang W, Lee ET, Howard BV, Devereux R, Zhang Y, Stoner JA. Large Cohort Data Based Group or Community Disease Prevention Design Strategy: Strong Heart Study. ACTA ACUST UNITED AC 2018; 8:196-207. [PMID: 30283726 PMCID: PMC6167019 DOI: 10.4236/wjcd.2018.83019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background and Objective A multitude of large cohort studies have data on incidence rates and predictors of various chronic diseases. However, approaches for utilization of these costly collected data and translation of these valuable results to inform and guide clinical disease prevention practice are not well developed. In this paper we proposed a novel conceptual group/community disease prevention design strategy based on large cohort study data. Methods and Results The data from participants (n = 3516; 2056 women) aged 45 to 74 years and the diabetes risk prediction model from Strong Heart Study were used. The Strong Heart Study is a population-based cohort study of cardiovascular disease and its risk factors in American Indians. A conceptual group/community disease prevention design strategy based on large cohort data was initiated. The application of the proposed strategy for group diabetes prevention was illustrated. Discussion The strategy may provide reasonable solutions to the prevention design issues. These issues include complex associations of a disease with its combined and correlated risk factors, individual differences, choosing intervention risk factors and setting their appropriate, attainable, gradual and adaptive goal levels for different subgroups, and assessing effectiveness of the prevention program. Conclusions The strategy and methods shown in the illustration example can be analogously adopted and applied for other diseases preventions. The proposed strategy for a target group/community in a population provides a way to translate and apply epidemiological study results to clinical disease prevention practice.
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Affiliation(s)
- Wenyu Wang
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elisa T Lee
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Ying Zhang
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Julie A Stoner
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA.
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1681 Campus Delivery, Fort Collins, CO 80523, USA
| | - Anne Pate
- School of Nursing and Allied Health Sciences, Southwestern Oklahoma State University, 100 E Campus Dr, Weatherford, OK 73096, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA
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Janitz AE, Dao HD, Campbell JE, Stoner JA, Peck JD. Association between benzene and congenital anomalies in Oklahoma, 1997-2009. Occup Environ Med 2018; 75:822-829. [PMID: 30032102 DOI: 10.1136/oemed-2018-105054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/23/2018] [Accepted: 07/07/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Although the most common cause of death in infants, little is known about the aetiology of congenital anomalies. Recent studies have increasingly focused on environmental exposures, including benzene. While benzene is known to affect the central nervous system, the effects on the developing fetus are unclear. METHODS We conducted a retrospective cohort study to evaluate the association between ambient benzene exposure and the prevalence of congenital anomalies among 628 121 singleton births in Oklahoma from 1997 to 2009. We obtained benzene from the Environmental Protection Agency's 2005 National-Scale Air Toxics Assessment for the census tract of the birth residence. We used modified Poisson regression with robust SEs to calculate prevalence proportion ratios (PPRs) and 95% CIs between quartiles of benzene exposure and critical congenital heart defects (CCHDs), neural tube defects (NTDs) and oral clefts adjusted for maternal education and tobacco use. RESULTS Median benzene exposure concentration in Oklahoma was 0.57 µg/m3. We observed no association between benzene exposure and oral clefts, CCHDs or NTDs. When specific anomalies were examined, we observed an increased prevalence of cleft lip among those exposed to the second quartile of benzene compared with the first (PPR 1.50, 95% CI 1.05 to 2.13), though no association with higher levels of exposure. CONCLUSIONS Our findings do not provide support for an increased prevalence of anomalies in areas more highly exposed to benzene. Future studies would benefit from pooling data from multiple states to increase statistical power and precision in studies of air pollutants and specific anomalies.
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Hanh Dung Dao
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Chou AF, Homco JB, Nagykaldi Z, Mold JW, Daniel Duffy F, Crawford S, Stoner JA. Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma. BMC Health Serv Res 2018; 18:404. [PMID: 29866120 PMCID: PMC5987433 DOI: 10.1186/s12913-018-3189-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/04/2018] [Indexed: 02/03/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death in the US and incurs high health care costs. While many initiatives promote the implementation of ABCS (aspirin therapy, blood pressure control, cholesterol management, and smoking cessation) measures, most primary care practices (PCPs) lack quality improvement (QI) support and resources to achieve meaningful targets. The Healthy Hearts for Oklahoma (H2O) Study proposes to build a QI infrastructure by (1) constructing a sustainable Oklahoma Primary Healthcare Improvement Collaborative (OPHIC) to support dissemination and implementation (D&I) of QI methods; (2) providing QI support in PCPs to better manage patients at risk for CVD events. Parallel to infrastructure building, H2O aims to conduct a comprehensive evaluation of the QI support D&I in primary care and assess the relationship between QI support uptake and changes in ABCS measures. Methods H2O has partnered with public health agencies and communities to build OPHIC and facilitate QI. H2O has 263 small primary care practices across Oklahoma that receive the bundled QI intervention to improve ABCS performance. A stepped-wedge designed is used to evaluate D&I of QI support. Changes in ABCS measures will be estimated as a function of various components of the QI support and capacity and readiness of PCPs to change. Notes from academic detailing and practice facilitation sessions will be analyzed to help interpret findings on ABCS performance. Discussion H2O program is designed to improve cardiovascular health and outcomes for more than 1.25 million Oklahomans. The infrastructure established as a result of this funding will help reach medically underserved Oklahomans, particularly among rural and tribal populations. Lessons learned from this project will guide future strategies for D&I of evidence-based practices in PCPs. Trained practice facilitators will continue to serve as critical resource to assists small, rural PCPs in adapting to the ever-changing health environment and continue to deliver quality care to their communities. Electronic supplementary material The online version of this article (10.1186/s12913-018-3189-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ann F Chou
- College of Medicine, Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, 900 NE 10th St, Oklahoma City, OK, 73104, USA.
| | - Juell B Homco
- School of Community Medicine, The University of Oklahoma Health Sciences Center, 4502 E 41st St, Tulsa, OK, 74135, USA
| | - Zsolt Nagykaldi
- College of Medicine, Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, 900 NE 10th St, Oklahoma City, OK, 73104, USA
| | - James W Mold
- College of Medicine, Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, 900 NE 10th St, Oklahoma City, OK, 73104, USA
| | - F Daniel Duffy
- School of Community Medicine, The University of Oklahoma Health Sciences Center, 4502 E 41st St, Tulsa, OK, 74135, USA
| | - Steven Crawford
- College of Medicine, Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, 900 NE 10th St, Oklahoma City, OK, 73104, USA
| | - Julie A Stoner
- College of Public Health, The University of Oklahoma Health Sciences Center, 801 NE 13th St, Oklahoma City, OK, 73104, USA
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Chen X, Stoner JA, Gardner AW. Reply. J Vasc Surg 2018; 67:1634-1635. [PMID: 29685255 DOI: 10.1016/j.jvs.2018.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/13/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Xi Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Andrew W Gardner
- Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla; Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa
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Basu A, Jenkins AJ, Stoner JA, Zhang Y, Klein RL, Lopes-Virella MF, Garvey WT, Schade DS, Wood J, Alaupovic P, Lyons TJ. Apolipoprotein-defined lipoprotein subclasses, serum apolipoproteins, and carotid intima-media thickness in T1D. J Lipid Res 2018; 59:872-883. [PMID: 29576550 DOI: 10.1194/jlr.p080143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/15/2018] [Indexed: 01/24/2023] Open
Abstract
Circulating apolipoprotein-defined lipoprotein subclasses (ADLS) and apolipoproteins predict vascular events in the general and type 2 diabetes populations, but data in T1D are limited. We examined associations of ADLS, serum apolipoproteins, and conventional lipids with carotid intima-media thickness (IMT) measured contemporaneously and 6 years later in 417 T1D participants [men: n = 269, age 42 ± 6 y (mean ± SD); women: n = 148, age 39 ± 8 y] in the Epidemiology of Diabetes Interventions and Complications study, the follow-up of the Diabetes Control and Complications Trial (DCCT). Date were analyzed by multiple linear regression stratified by sex, and adjusted for time-averaged hemoglobin A1C, diabetes duration, hypertension, BMI, albuminuria, DCCT randomization, smoking, statin treatment, and ultrasound devices. In cross-sectional analyses, lipoprotein B (Lp-B), Lp-B:C, Lp-B:E+Lp-B:C:E, Apo-A-II, Apo-B, Apo-C-III-HP (heparin precipitate; i.e., Apo-C-III in Apo-B-containing lipoproteins), and Apo-E were positively associated with common and/or internal carotid IMT in men, but only Apo-C-III (total) was (positively) associated with internal carotid IMT in women. In prospective analyses, Lp-B, Apo-B, and Apo-C-III-HP were positively associated with common and/or internal carotid IMT in men, while Lp-A1:AII and Apo-A1 were inversely associated with internal carotid IMT in women. The only significant prospective association between conventional lipids and IMT was between triacylglycerols and internal carotid IMT in men. ADLS and apolipoprotein concentrations may provide sex-specific biomarkers and suggest mechanisms for IMT in people with T1D.
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Affiliation(s)
- Arpita Basu
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, NV
| | - Alicia J Jenkins
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Richard L Klein
- Division of Endocrinology, Medical University of South Carolina, Charleston, SC.,The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Maria F Lopes-Virella
- Division of Endocrinology, Medical University of South Carolina, Charleston, SC.,The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - David S Schade
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Jamie Wood
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Timothy J Lyons
- Division of Endocrinology, Medical University of South Carolina, Charleston, SC
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Kirkpatrick A, Stoner JA, Mathews E, Dale GL, Prodan CI. Abstract TP415: Coated-Platelet Levels Are Elevated Among Native American Veterans With Vascular Risk Factors and Silent Brain Infarction. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Coated-platelets, a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin, are elevated in patients with incident and recurrent stroke/TIA and mild cognitive impairment. We now report the association between coated-platelets and brain imaging correlates of vascular cognitive impairment in a pilot study of cognitive impairment among Native Americans Veterans.
Methods:
Coated-platelets, reported as percentage of cells converted to coated-platelets, were assayed in 60 Native American veterans with ≥2 vascular risk factors. The Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory-II were administered to screen for cognitive impairment and depression. Brain CT or MRI performed within 12 months of enrollment were reviewed for silent brain infarction (SBI), small vessel disease and/or atrophy. SBI was defined as focal, ≥ 3mm, cavitary lesion with T1 hypointensity and T2 hyperintensity features on MRI or hypodense on CT and not associated with stroke history or focal neurologic findings. Differences in mean coated-platelet levels by imaging results were determined using the Kruskal-Wallis test.
Results:
MoCA scores were abnormal (<26) in 23 of 51 subjects (44%, 95%CI: 30%-59%) after excluding 9 with depression. Brain imaging was available for 36 subjects (97% male, mean age 63 range 50-86). Twelve (33%, 95%CI: 19%-51%) had normal results, 19 (53%, 35%-70%) had small vessel disease and/or atrophy, and 5 (14%, 5%-30%) had SBI. Median coated-platelets were significantly higher among those with SBI (51%, IQR 48%-59%) versus those without SBI having either normal results (36.5%, IQR 30.5%-48.1%) or small vessel disease and/or atrophy (33.6%, IQR 24.4%-47.3%), overall p=0.045.
Conclusion:
Platelet procoagulant potential is increased among Native American veterans with vascular risk factors and SBI versus those with normal scans or with small vessel disease and/or atrophy. These results suggest a role for coated-platelets as a biomarker of SBI in vascular cognitive impairment, and are consistent with previous findings of increased risk of ischemic stroke among non-Native Americans. Further studies are warranted to confirm these results and explore mechanisms involved.
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Kirkpatrick A, Vincent AS, Stoner JA, Mathews E, Dale GL, Prodan CI. Abstract TP113: Elevated Coated-Platelets and SSRI Use Are Associated with Silent Brain Infarction in Asymptomatic Carotid Artery Stenosis. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Silent brain infarction (SBI) is a marker of stroke risk in asymptomatic carotid stenosis. Increased SBI burden downstream of stenosis has not been consistently shown, emphasizing that mechanisms of SBI formation in carotid stenosis remain unclear. Coated-platelets are a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin, and elevated levels are associated with TIA/stroke in asymptomatic carotid stenosis. We now examine if coated-platelet levels are associated with SBI in asymptomatic carotid stenosis.
Methods:
Consecutive asymptomatic ≥50% carotid stenosis patients were enrolled and coated-platelets assayed. Brain MRI or CT scans within 12 months of enrollment were reviewed by a blinded neurologist for SBI, defined as a focal, ≥ 3mm, cavitary lesion with T1 hypointensity and T2 hyperintensity features on MRI or hypodense on CT. Demographics, medications and comorbidities were recorded. The optimal coated-platelet cutoff was determined by ROC analysis. Logistic regression analysis included variables having significant (p<.05) bivariate correlations with SBI as potential predictors. Variables with p<0.05 were retained in the final model.
Results:
Brain imaging was available for 64 subjects. The optimal coated-platelet cutoff for predicting SBI was 52.7% (p=0.0002) by ROC analysis. Both elevated coated-platelets (OR=10.4, p=0.043) and SSRI use (OR=3.8, p=0.027) were associated with increased odds of SBI (p=0.005). Stenosis ≥70% was associated with presence (p=0.0005) and number (p<0.0001) of downstream SBI on bivariate analysis, but was no longer significant in the multivariate model (p=0.14).
Conclusions:
Elevated coated-platelets and SSRI use were associated with SBI in this asymptomatic carotid stenosis cohort. Interestingly, presence of ≥70% stenosis was no longer significantly associated with SBI after accounting for coated-platelet levels and SSRI use by multivariate analysis. SSRI use has been linked to recurrent stroke previously, although results have varied. Our findings are the first showing a strong association between platelet procoagulant potential and SBI and warrant further study to confirm our results and explore mechanisms involved.
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Abstract
BACKGROUND Although childhood cancer is a leading cause of childhood mortality in the US, evidence regarding the etiology is lacking. The goal of this study was to evaluate the association between benzene, a known carcinogen, and childhood acute leukemia. METHODS We conducted a case-control study including cases diagnosed with acute leukemia between 1997 and 2012 (n = 307) from the Oklahoma Central Cancer Registry and controls matched on week of birth from birth certificates (n = 1013). We used conditional logistic regression to evaluate the association between benzene, measured with the 2005 National-Scale Air Toxics Assessment (NATA) at census tract of the birth residence, and childhood acute leukemia. RESULTS We observed no differences in benzene exposure overall between cases and controls. However, when stratified by year of birth, cases born from 2005 to 2010 had a three-fold increased unadjusted odds of elevated exposure compared to controls born in this same time period (4th Quartile OR: 3.53, 95% CI: 1.35, 9.27). Furthermore, the estimates for children with acute myeloid leukemia (AML) were stronger than those with acute lymphoid leukemia, though not statistically significant. CONCLUSIONS While we did not observe an association between benzene and childhood leukemia overall, our results suggest that acute leukemia is associated with increased benzene exposure among more recent births, and children with AML may have increased benzene exposure at birth. Using the NATA estimates allowed us to assess a specific pollutant at the census tract level, providing an advantage over monitor or point source data. Our study, however, cannot rule out the possibility that benzene may be a marker of other traffic-related exposures and temporal misclassification may explain the lack of an association among earlier births.
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA.
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA.
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1681 Campus Delivery, Fort Collins, CO 80523, USA.
| | - Anne Pate
- School of Nursing and Allied Health Sciences, Southwestern Oklahoma State University, 100 E Campus Dr, Weatherford, OK 73096, USA.
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA.
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA.
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Abstract
BACKGROUND Rock climbing first evolved as a sport in the late 18th century. With its growing popularity, the number of rock climbing-related injuries has potential to increase, spurring a rise in the number of articles associated with it. Despite the available literature, there remains a paucity of information about upper extremity injuries sustained by rock climbers, and no studies to date have focused on gender-specific injuries. METHODS A 24-question online survey was distributed to rock climbers about upper extremity injuries sustained during rock climbing. Statistical analysis was used to study association between participants' demographics and injuries. RESULTS A total of 397 participants responded to the survey. Mean age was 32.5 years with males comprising 85%. No significant differences in demographics or climbing behaviors were found between males and females. Ninety percent of participants reported sustaining an upper extremity injury. Fingers were the most common injury followed by shoulder/arm and elbow/forearm. Our study found females to be more likely to report a rock climbing-related injury, and more likely to undergo surgery for it. CONCLUSION Female rock climbers were significantly more likely to report a shoulder/upper arm injury and were also more likely to report undergoing surgery compared with males, where these differences were not due to age or climbing behaviors. Further investigation is warranted into the association between shoulder injuries and female athletes to determine how the gender differences relate to extent of injury as well as health service utilization behaviors.
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Affiliation(s)
| | - Ghazi M. Rayan
- INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA,Ghazi M. Rayan, Hand Surgery Division, INTEGRIS Baptist Medical Center, 3366 NW Expressway, Ste. 700, Oklahoma City, OK 73112, USA.
| | | | - Kai Ding
- University of Oklahoma, Oklahoma City, USA
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Chen X, Stoner JA, Montgomery PS, Casanegra AI, Silva-Palacios F, Chen S, Janitz AE, Gardner AW. Prediction of 6-minute walk performance in patients with peripheral artery disease. J Vasc Surg 2017. [PMID: 28647194 DOI: 10.1016/j.jvs.2017.03.438] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is a highly prevalent disease that impairs walking ability. Walking tests, such as the 6-minute walk test (6MWT) and 4-meter walk test, are commonly used to assess exercise endurance and ambulatory function over a short distance, respectively. The 6MWT performance is predictive of PAD severity and disease outcomes, but it is not feasible in many clinical settings because it requires a long walkway to serve as the test route and lengthens clinic visits. As an alternative, the 4-meter walk test is convenient, inexpensive, and repeatable, but whether it accurately predicts endurance performance in the long-distance 6MWT is not known. The goal of this study was to develop a statistical model to predict 6MWT gait speed from 4-meter walk test results and clinical characteristics among patients with PAD. METHODS Measures of 6MWT gait speed were derived from 183 patients with symptomatic PAD who were evaluated at the University of Oklahoma Health Sciences Center (2004-2012). The testing procedures and research personnel remained constant throughout the duration of the study. Independent variables included demographic and clinical information and 4-meter walk test gait speed. Fivefold cross validation and manual backward selection were used for model selection. Adjusted R2 and corrected Akaike information criterion were applied to quantify the predictive performance of the regression models. RESULTS A total of 183 people (54% male; mean age, 65 [standard deviation (SD), 10] years) with moderate PAD severity (ankle-brachial index [ABI]; mean, 0.72 [SD, 0.24]) performed the walking tests. Participants covered an average distance of 335 (SD, 97) m distance in the 6MWT. The 4-meter walk gait speed, ABI, and dyspnea were independent predictors of 6MWT speed in the multivariate model (adjusted R2 = 0.55). The model resulted in 95% prediction interval widths of 30 m for mean and 260 m for individual predicted 6MWT distance measures. CONCLUSIONS Slower 4-meter walking speed, lower ABI, and presence of dyspnea all predict slower 6MWT gait speed, which corresponds to shorter 6MWT distance. Prediction of group means is reasonably precise; however, prediction of individual patient 6MWT performance is imprecise relative to between-group differences that are clinically important.
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Affiliation(s)
- Xi Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla.
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Polly S Montgomery
- Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Ana I Casanegra
- Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Federico Silva-Palacios
- Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Amanda E Janitz
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla
| | - Andrew W Gardner
- Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Okla; Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pa
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Wang W, Zhang Y, Lee ET, Howard BV, Devereux RB, Cole SA, Best LG, Welty TK, Rhoades E, Yeh J, Ali T, Kizer JR, Kamel H, Shara N, Wiebers DO, Stoner JA. Risk Factors and Prediction of Stroke in a Population with High Prevalence of Diabetes: The Strong Heart Study. ACTA ACUST UNITED AC 2017; 7:145-162. [PMID: 28775914 PMCID: PMC5538319 DOI: 10.4236/wjcd.2017.75014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE American Indians have a high prevalence of diabetes and higher incidence of stroke than that of whites and blacks in the U.S. Stroke risk prediction models based on data from American Indians would be of clinical and public health value. METHODS AND RESULTS A total of 3483 (2043 women) Strong Heart Study participants free of stroke at baseline were followed from 1989 to 2010 for incident stroke. Overall, 297 stroke cases (179 women) were identified. Cox models with stroke-free time and risk factors recorded at baseline were used to develop stroke risk prediction models. Assessment of the developed stroke risk prediction models regarding discrimination and calibration was performed by an analogous C-statistic (C) and a version of the Hosmer-Lemeshow statistic (HL), respectively, and validated internally through use of Bootstrapping methods. RESULTS Age, smoking status, alcohol consumption, waist circumference, hypertension status, an-tihypertensive therapy, fasting plasma glucose, diabetes medications, high/low density lipoproteins, urinary albumin/creatinine ratio, history of coronary heart disease/heart failure, atrial fibrillation, or Left ventricular hypertrophy, and parental history of stroke were identified as the significant optimal risk factors for incident stroke. DISCUSSION The models produced a C = 0.761 and HL = 4.668 (p = 0.792) for women, and a C = 0.765 and HL = 9.171 (p = 0.328) for men, showing good discrimination and calibration. CONCLUSIONS Our stroke risk prediction models provide a mechanism for stroke risk assessment designed for American Indians. The models may be also useful to other populations with high prevalence of obesity and/or diabetes for screening individuals for risk of incident stroke and designing prevention programs.
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Affiliation(s)
- Wenyu Wang
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ying Zhang
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elisa T Lee
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Shelley A Cole
- Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Lyle G Best
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - Thomas K Welty
- Aberdeen Area Tribal Chairmen's Health Board, Rapid City, SD, USA
| | - Everett Rhoades
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jeunliang Yeh
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tauqeer Ali
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Hooman Kamel
- Weill Cornell Medical College, New York, NY, USA
| | - Nawar Shara
- MedStar Health Research Institute, Hyattsville, MD, USA
| | | | - Julie A Stoner
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Kirkpatrick AC, Stoner JA, Donna-Ferreira FM, Malatinszky GC, Elias AM, Guthery LD, Garcia-Martino DA, Makharoblidze E, Prodan CI. Abstract TP436: Native American Veterans With Vascular Risk Factors Have High Rates of Vascular Cognitive Impairment. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Rates of cardiovascular disease and stroke are elevated in Native Americans, and a greater propensity to develop vascular cognitive impairment (VCI) rather than Alzheimer-type dementia has been inferred, supporting a need for further research in VCI in this population. We determined rates and patterns of memory loss among Native American veterans with multiple vascular risk factors.
Methods:
Native American veterans ≥50 years old with ≥2 vascular risk factors, including smoking history, hyperlipidemia, diabetes, coronary artery disease, or peripheral arterial disease, were recruited between September 2015 and May 2016. The Montreal Cognitive Assessment (MoCA) and the Beck Depression Inventory-II were used to screen for cognitive impairment and depression. Patients with MoCA scores <26 were referred for imaging studies, memory loss serology, neuropsychiatric testing and clinical assessment by a memory loss physician. Final cognitive status was assigned by blinded adjudication.
Results:
We recruited 60 Native Americans aged 50-86 (mean±SD: 64±7.1 years); 90% were male, 95% had at least high-school education, and 69% had some college or advanced degrees. Risk factors included hypertension (92%), hyperlipidemia (88%), diabetes (47%), and prior/current smoking (78%). Eight (13%) with severe depression were excluded, leaving 23/51 with abnormal MoCA scores (44%, 95%CI 30%-59%). All with cognitive impairment were male compared to 83% among non-impaired subjects (p=0.059). Fifteen completed additional evaluation for memory loss, including 4/15 with normal MoCA scores who requested evaluation based on symptoms. Results were adjudicated as normal (4), or as having non-amnestic MCI (4), vascular MCI (5), and vascular dementia (2). MoCA correctly identified cognitive status in 86% (Kappa 0.66, 95%CI 0.23-1.00).
Conclusions:
Native American veterans have high rates of vascular cognitive impairment, which exceed rates of cognitive impairment documented in previously published older non-Native American cohorts. These results highlight the need for improved vascular risk reduction among Native American veterans. Further study is needed to identify ways to improve care in this underserved and understudied population.
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Affiliation(s)
| | - Julie A Stoner
- Biostatistics and Epidemiology, Univ of Oklahoma Health Sciences Cntr, Oklahoma City, OK
| | | | | | - Adreinne M Elias
- Medicine, Univ of Oklahoma Health Sciences Cntr, Oklahoma City, OK
| | - Leslie D Guthery
- Neurology, Univ of Oklahoma Health Sciences Cntr, Oklahoma City, OK
| | | | | | - Calin I Prodan
- Neurology, Univ of Oklahoma Health Sciences Cntr, Oklahoma City, OK
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Chenoweth BA, O'Mahony GD, Fitzgerald C, Stoner JA, O'Donoghue DL, Rayan GM. Efficacy of Dorsoradial Capsulodesis for Trapeziometacarpal Joint Instability: A Cadaver Study. J Hand Surg Am 2017; 42:e25-e31. [PMID: 28052834 DOI: 10.1016/j.jhsa.2016.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 09/02/2016] [Accepted: 11/04/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To test the biomechanical properties of the dorsoradial capsulodesis procedure. METHODS Six cadaveric hands were used. After exposing the trapeziometacarpal (TMC) joint, we placed Kirschner wires in the distal radius and thumb metacarpal. The rotation shear test was then performed to test the joint axial laxity, and angular measurements using Kirschner wires as reference points were documented. The dorsoradial (DR) ligament and capsule were released, followed by the intermetacarpal (IM) ligament; angular measurements were obtained. Finally, the DR capsulodesis procedure was performed, and final measurements were obtained. Comparisons were made among the various stages of ligament integrity to determine the amount of stability provided by DR capsulodesis. RESULTS All cadavers demonstrated axial laxity with transection of the DR ligament; an increase in stability was obtained after DR capsulodesis. Transection of the capsule and IM ligament caused increased laxity relative to the native joint (median, 24° and 35°, respectively, on rotational testing). After we performed DR capsulodesis, rotational stability improved by a median of 41° compared with DR ligament transection, 49° compared with DR and IM ligament transection, and 18° relative to the native joint. CONCLUSIONS Dorsoradial capsulodesis restores rotational stability for TMC joint after division of the DR and IM ligaments. The stability achieved was statistically significant compared with both an intact native TMC joint and induced laxity of the TMC joint. CLINICAL RELEVANCE The DR capsulodesis procedure may improve rotational stability to the TMC joint.
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Affiliation(s)
- Brian A Chenoweth
- Department of Orthopedic Surgery, College of Medicine, University of Oklahoma, Oklahoma City, OK
| | - Gavin D O'Mahony
- Department of Orthopedic Surgery, College of Medicine, University of Oklahoma, Oklahoma City, OK
| | - Casey Fitzgerald
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Oklahoma City, OK
| | - Daniel L O'Donoghue
- Department of Cell Biology, University of Oklahoma Health Sciences Center, University of Oklahoma, Oklahoma City, OK
| | - Ghazi M Rayan
- Hand Surgery Division, INTEGRIS Baptist Medical Center, Oklahoma City, OK.
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Tolma EL, Engelman K, Stoner JA, Thomas C, Joseph S, Li J, Blackwater C, Henderson JN, Carson LD, Neely N, Edwards T. The Design of a Multi-component Intervention to Promote Screening Mammography in an American Indian Community: The Native Women's Health Project. AIMS Public Health 2016; 3:933-955. [PMID: 29546205 PMCID: PMC5690415 DOI: 10.3934/publichealth.2016.4.933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women in the US. This article describes the design and implementation of a culturally sensitive intervention to promote breast health among AI/AN women through a hybrid model that incorporates clinical and community-based approaches. This is one of the first studies using this model addressing breast cancer disparities among AI/AN populations in the US. METHODS The Theory of Planned Behavior was used as the guiding framework of the intervention and Community Based Participatory Research was the primary vehicle for the intervention planning and implementation. Three preliminary studies took place that aimed to identify qualitatively and quantitatively what deterred or encouraged AI women to get past or future mammograms. The research results were shared with community members who, through a prioritization process, identified the theoretical focus of the intervention and its corresponding activities. The priority population consisted of AI women ages 40-74, with no recent mammogram, and no breast cancer history. RESULTS The intervention centered on the promotion of social modeling and physician recommendation. The main corresponding activities included enhancing patient-physician communication about screening mammography through a structured dialogue, receipt of a breast cancer brochure, participation in an inter-generational discussion group, and a congratulatory bracelet upon receipt of a mammogram. Environmental and policy related changes also were developed. CONCLUSION Creating a theory-based, culturally-sensitive intervention through tribal participatory research is a challenging approach towards eliminating breast cancer disparities among hard-to-reach populations.
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Affiliation(s)
- Eleni L. Tolma
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kimberly Engelman
- Department of Preventive Medicine and Public Health, University of Kansas, Kansas City, KS, USA
| | - Julie A. Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cara Thomas
- Tecumseh Early Head Start, Tecumseh, OK, USA
| | - Stephanie Joseph
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ji Li
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - J. Neil Henderson
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - L. D. Carson
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Norma Neely
- American Indian Institute, University of Oklahoma, Norman, OK, USA
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Stavrakis S, Stoner JA, Kardokus J, Garabelli PJ, Po SS, Lazzara R. Intermittent vs. Continuous Anticoagulation theRapy in patiEnts with Atrial Fibrillation (iCARE-AF): a randomized pilot study. J Interv Card Electrophysiol 2016; 48:51-60. [PMID: 27696012 DOI: 10.1007/s10840-016-0192-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/16/2016] [Indexed: 01/15/2023]
Abstract
PURPOSE We hypothesized that intermittent anticoagulation based on daily rhythm monitoring using the novel oral anticoagulants (NOACs) is feasible and safe among patients with paroxysmal atrial fibrillation (AF). METHODS Patients with paroxysmal AF and ≥1 risk factors for stroke were randomized to either intermittent or continuous anticoagulation. Those in the intermittent group were instructed to transmit a daily ECG using an iPhone-based rhythm monitoring device. If AF was detected, patients received one of the NOACs for 48 h-1 week. Patients who failed to transmit an ECG for three consecutive days or more than 7 days total were crossed over to continuous anticoagulation. Patients in the continuous group received one of the NOACs. RESULTS Fifty-eight patients were randomized to either intermittent (n = 29) or continuous anticoagulation (n = 29). Over a median follow-up of 20 months, 20 patients in the intermittent group failed to submit a daily ECG at least once (median three failed submissions). Four patients (14 %) crossed over to continuous anticoagulation due to failure to submit an ECG for three consecutive days. One stroke (continuous group) occurred during the study. Major bleeding occurred in two patients in the continuous and one patient in the intermittent group, after crossing over to continuous anticoagulation. In a prespecified per-protocol analysis, gastrointestinal bleeding was more frequent in the continuous group (16 vs. 0 %; p = 0.047). CONCLUSIONS Intermittent anticoagulation based on daily rhythm monitoring is feasible and may decrease bleeding in low-risk patients with paroxysmal AF. A larger trial, adequately powered to detect clinical outcomes, is warranted.
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Affiliation(s)
- Stavros Stavrakis
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1200 Everett Drive, TCH 6E103, Oklahoma City, OK, 73104, USA.
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Joel Kardokus
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paul J Garabelli
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1200 Everett Drive, TCH 6E103, Oklahoma City, OK, 73104, USA
| | - Sunny S Po
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1200 Everett Drive, TCH 6E103, Oklahoma City, OK, 73104, USA
| | - Ralph Lazzara
- Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1200 Everett Drive, TCH 6E103, Oklahoma City, OK, 73104, USA
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Nelson CE, Rayan GM, Judd DI, Ding K, Stoner JA. Survey of Hand and Upper-Extremity Injuries among Rock Climbers. Wilderness Environ Med 2016. [DOI: 10.1016/j.wem.2016.06.006] [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: 11/30/2022]
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Janitz AE, Campbell JE, Magzamen S, Pate A, Stoner JA, Peck JD. Traffic-related air pollution and childhood acute leukemia in Oklahoma. Environ Res 2016; 148:102-111. [PMID: 27038831 PMCID: PMC4874884 DOI: 10.1016/j.envres.2016.03.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 01/22/2016] [Revised: 03/24/2016] [Accepted: 03/26/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND While many studies have evaluated the association between acute childhood leukemia and environmental factors, knowledge is limited. Ambient air pollution has been classified as a Group 1 carcinogen, but studies have not established whether traffic-related air pollution is associated with leukemia. The goal of our study was to determine if children with acute leukemia had higher odds of exposure to traffic-related air pollution at birth compared to controls. METHODS We conducted a case-control study using the Oklahoma Central Cancer Registry to identify cases of acute leukemia in children diagnosed before 20 years of age between 1997 and 2012 (n=307). Controls were selected from birth certificates and matched to cases on week of birth (n=1013). Using a novel satellite-based land-use regression model of nitrogen dioxide (NO2) and estimating road density based on the 2010 US Census, we evaluated the association between traffic-related air pollution and childhood leukemia using conditional logistic regression. RESULTS The odds of exposure to the fourth quartile of NO2 (11.19-19.89ppb) were similar in cases compared to controls after adjustment for maternal education (OR: 1.08, 95% CI: 0.75, 1.55). These estimates were stronger among children with acute myeloid leukemia (AML) than acute lymphoid leukemia, with a positive association observed among urban children with AML (4th quartile odds ratio: 5.25, 95% confidence interval: 1.09, 25.26). While we observed no significant association with road density, male cases had an elevated odds of exposure to roads at 500m from the birth residence compared to controls (OR: 1.39, 95% CI: 0.93, 2.10), which was slightly attenuated at 750m. CONCLUSIONS Although we observed no association overall between NO2 or road density, this was the first study to observe an elevated odds of exposure to NO2 among children with AML compared to controls suggesting further exploration of traffic-related air pollution and AML is warranted.
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA.
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA.
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 1681 Campus Delivery, Fort Collins, CO 80523, USA.
| | - Anne Pate
- School of Nursing and Allied Health Sciences, Southwestern Oklahoma State University, 100 E. Campus Dr., Weatherford, OK 73096, USA.
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA.
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 309, Oklahoma City, OK 73104, USA.
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Myers JM, Cooper LT, Kem DC, Stavrakis S, Kosanke SD, Shevach EM, Fairweather D, Stoner JA, Cox CJ, Cunningham MW. Cardiac myosin-Th17 responses promote heart failure in human myocarditis. JCI Insight 2016; 1:85851. [PMID: 27366791 PMCID: PMC4924810 DOI: 10.1172/jci.insight.85851] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In human myocarditis and its sequela dilated cardiomyopathy (DCM), the mechanisms and immune phenotype governing disease and subsequent heart failure are not known. Here, we identified a Th17 cell immunophenotype of human myocarditis/DCM with elevated CD4+IL17+ T cells and Th17-promoting cytokines IL-6, TGF-β, and IL-23 as well as GM-CSF-secreting CD4+ T cells. The Th17 phenotype was linked with the effects of cardiac myosin on CD14+ monocytes, TLR2, and heart failure. Persistent heart failure was associated with high percentages of IL-17-producing T cells and IL-17-promoting cytokines, and the myocarditis/DCM phenotype included significantly low percentages of FOXP3+ Tregs, which may contribute to disease severity. We demonstrate a potentially novel mechanism in human myocarditis/DCM in which TLR2 peptide ligands from human cardiac myosin stimulated exaggerated Th17-related cytokines including TGF-β, IL-6, and IL-23 from myocarditic CD14+ monocytes in vitro, and an anti-TLR2 antibody abrogated the cytokine response. Our translational study explains how an immune phenotype may be initiated by cardiac myosin TLR ligand stimulation of monocytes to generate Th17-promoting cytokines and development of pathogenic Th17 cells in human myocarditis and heart failure, and provides a rationale for targeting IL-17A as a therapeutic option.
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Affiliation(s)
- Jennifer M Myers
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Leslie T Cooper
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Stanley D Kosanke
- Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ethan M Shevach
- Laboratory of Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - DeLisa Fairweather
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Carol J Cox
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Madeleine W Cunningham
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Sisson SB, Li J, Stoner JA, Lora KR, Campbell JE, Arnold SH, DeGrace B, Horm D, Stephens L. Obesogenic environments in tribally-affiliated childcare centers and corresponding obesity rates in preschool children. Prev Med Rep 2016; 3:151-8. [PMID: 27419008 PMCID: PMC4929137 DOI: 10.1016/j.pmedr.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Determine the relationship between obesogenic characteristics of childcare and child adiposity in tribally-affiliated centers in Oklahoma. METHODS The two-day Environment and Policy Assessment and Observation (EPAO) included a total environment (TE), nutrition (N), and physical activity (PA) score and took place in 11 centers across Oklahoma. Eighty-two preschool children (3-5 years) participated. Child height and weight were measured and overweight status (≥ 85th percentile for age and sex) was determined. Regression models, fit using Generalized Estimating Equations methodology to account for clustering by center were used and adjusted for center characteristics. RESULTS Participants were 3.8 (0.8) years old, 55% male, 67% American Indian (AI) and 38% overweight. A healthier TE and PA was associated with a reduced odds of overweight, which remained significant after adjusting for some center characteristics, but not all. A healthier TE, N, and PA was associated with lower BMI percentile, which remained significant after some center-level adjustments, but not all. Lower sedentary opportunity and sedentary time were no longer associated with reduced odds of overweight following adjustment. Lower opportunity for high sugar and high fat foods and minutes of active play were associated with reduced odds of overweight in some adjusted models. CONCLUSIONS Collectively unadjusted and adjusted models demonstrate that some aspects of a healthier childcare center environment are associated with reduced odds of overweight and lower BMI percentile in preschool children attending tribally-affiliated childcare in Oklahoma. Future research should examine the association of childcare and health behaviors and further explore the role of potential confounders.
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Affiliation(s)
- Susan B. Sisson
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ji Li
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Julie A. Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Oklahoma Shared Clinical and Translational Resources, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Karina R. Lora
- Department of Nutritional Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Janis E. Campbell
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Sandra H. Arnold
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Beth DeGrace
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Diane Horm
- Early Chyildhood Education Institute, University of Oklahoma, Tulsa, OK, United States
| | - Lancer Stephens
- Oklahoma Shared Clinical and Translational Resources, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- American Indian Diabetes Prevention Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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Srour SA, Stoner JA. Pemetrexed in combination with cisplatin versus carboplatin as first-line therapy in patients with advanced-stage malignant pleural mesothelioma (MPM): A systematic review and meta-analysis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.8554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Samer Ali Srour
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Julie A. Stoner
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Casanegra AI, Stoner JA, Tafur AJ, Pereira HA, Rathbun SW, Gardner AW. Differences in galectin-3, a biomarker of fibrosis, between participants with peripheral artery disease and participants with normal ankle-brachial index. Vasc Med 2016; 21:437-444. [PMID: 27155290 DOI: 10.1177/1358863x16644059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine if galectin-3 levels were different between participants with peripheral artery disease (PAD) and controls, and to describe its relationship with markers of early atherosclerosis. Sixty participants were recruited into two groups: a PAD group (n=31), ankle-brachial index (ABI) ⩽0.90 and a normal ABI group (n=29), ABI 1.0-1.4. PAD participants were older (68.6 vs 61.8 years, p=0.037), more commonly men (68% vs 38%, p=0.02), and with more cardiovascular risk factors (p<0.001). Galectin-3 was 22% higher in PAD participants (mean±SD: 17.6±4.7 vs 14.4±4.1 ng/mL, p<0.01). The odds ratio for galectin-3 in PAD to be 1 ng/mL higher than the participants with normal ABI was 1.19, after adjusting by age and gender (p=0.014). High-sensitivity C-reactive protein (hs-CRP) and homeostatic model assessment (HOMA) were positively associated with galectin-3 in the age- and gender-adjusted model, while arterial elasticity and microalbuminuria were not. In conclusion, galectin-3 levels were higher in participants with PAD.
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Affiliation(s)
- Ana I Casanegra
- Vascular Medicine Program, Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Alfonso J Tafur
- Vascular Medicine, Northshore University Health System, Evanston, IL, USA
| | - H Anne Pereira
- Department of Pharmaceutical Sciences, Department of Cell Biology and Department of Pathology, Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Suman W Rathbun
- Vascular Medicine Program, Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
| | - Andrew W Gardner
- Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, OK, USA
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Casanegra AI, Stoner JA, Tafur AJ, Pereira A, Rathbun S, Gardner AW. Abstract 313: Differences in Galectin-3, a Biomarker of Fibrosis, Between Subjects With Peripheral Artery Disease and Controls. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Galectin-3 (G3) mediates vascular fibrosis. It can be detected in blood but it is unknown whether G3 is a marker of peripheral artery disease (PAD) or correlates with early atherosclerosis markers.
Objectives/Aims:
To determine if G3 plasma levels are different between subjects with PAD and controls without PAD.
Secondary aim:
To describe the relationship between G3 plasma levels and markers of early atherosclerosis (arterial elasticity, high-sensitivity C-reactive protein [HS-CRP], homeostatic model assessment [HOMA], and urinary albumin/creatinine ratio [UACR]) in a sample of subjects with PAD and controls.
Methods:
Consecutive subjects (n=60) were recruited in 2 groups: (1) a PAD group (n=31), with ankle/brachial index (ABI) <0.90, and (2) non-PAD controls (n=29) with ABI 1-1.4. G3 was measured by ELISA. Demographics, cardiovascular risk factors and markers of early atherosclerosis were compared between groups using t-tests, Chi-square tests and logistic regression and the association between G3 and markers of early atherosclerosis was investigated using linear regression analysis.
Results:
Compared to controls, participants with PAD were older (mean 68.6 vs. 61.8 years, p=0.02), had a higher percentage of men (68% vs. 38%, p=0.02), and had more smokers, diabetics, and subjects with hypertension and dyslipidemia (p<0.001 for all). G3 was higher in PAD (mean ± SD: 17.6±4.7 vs. 14.4±4.1 ng/mL, p<0.01). The odds ratio for G3 in the PAD group to be 1 ng/mL higher than the control group was 1.19, after adjusting by age (≥65 years) and gender, (95% CI 1.036-1.37, p=0.014). when HS-CRP was included in the model the association between PAD and G3 was not significant. HS-CRP (p=0.005) and HOMA (p=0.016) were positively associated with G3 in the adjusted model. Arterial elasticity (p=0.4) and UACR (p=0.09) were not associated with G3 in the adjusted model.
Conclusion:
After adjustment for age and gender, mean G3 levels were 22% higher in PAD participants compared to controls and G3 was positively associated with HS-CRP. Future studies are warranted to determine if G3 is an accurate prognostic biomarker or screening tool to detect PAD and atherosclerosis.
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Affiliation(s)
- Ana I Casanegra
- Internal Medicine, Cardiovascular section, Univ of Oklahoma, Oklahoma City, OK
| | - Julie A Stoner
- Dept of Biostatistics and Epidemiology, Univ of Oklahoma, Oklahoma City, OK
| | - Alfonso J Tafur
- Vascuar Medicine, Northshore Univ Health System, Evanston, IL
| | - Anne Pereira
- Dept of Pharmaceutical Sciences, Dept of Cell Biology, Dept of Pathology, & Oklah, Univ of Oklahoma, Oklahoma City, OK
| | - Suman Rathbun
- Internal Medicine, Cardiovascular section, Univ of Oklahoma, Oklahoma City, OK
| | - Andrew W Gardner
- Reynolds Oklahoma Cntr on Aging, Donald W. Reynolds Dept of Geriatric Medicine, Univ of Oklahoma, Oklahoma City, OK
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Janitz AE, Neas BR, Campbell JE, Pate AE, Stoner JA, Magzamen SL, Peck JD. Childhood cancer in children with congenital anomalies in Oklahoma, 1997 to 2009. ACTA ACUST UNITED AC 2016; 106:633-42. [PMID: 26945683 DOI: 10.1002/bdra.23494] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/01/2016] [Accepted: 02/09/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data-linkage studies have reported an association between congenital anomalies and childhood cancer. However, few studies have focused on the differences in the effect of congenital anomalies on cancer as a function of attained age. We aimed to examine associations between anomalies and childhood cancer as a function of attained age among children born in Oklahoma. METHODS Data were obtained from the Oklahoma State Department of Health from 1997 to 2009 (n = 591,235). We linked Vital Statistics records for singleton deliveries to the Oklahoma Birth Defects Registry and the Oklahoma Central Cancer Registry using name and birth date. To assess the relation between anomalies and childhood cancer, we used Cox regression analysis allowing for a nonproportional hazards for anomalies as a function of age. RESULTS There were 23,368 (4.0%) children with anomalies and 531 (0.1%) children with cancer. When considering 3-year age intervals, we detected an increased hazard of any childhood cancer in children with anomalies compared with those without anomalies before 1 year of age (hazard ratio, 14.1; 95% confidence interval, 8.3-23.7) and at 3 years of age (hazard ratio, 2.3; 95% confidence interval, 1.6-3.2). The increased hazard declined with increasing time since birth, with the effect diminished by 6 years of age. CONCLUSION Our results were consistent with previous studies indicating an increased rate of childhood cancer among children with anomalies at younger ages. Furthermore, our study added a methodological refinement of assessing the effect of anomalies as a function of attained age. Birth Defects Research (Part A) 106:633-642, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Barbara R Neas
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Anne E Pate
- School of Nursing and Allied Health Sciences, Southwestern Oklahoma State University, Weatherford, Oklahoma
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sheryl L Magzamen
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Jennifer D Peck
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Kirkpatrick AC, Stoner JA, Mathews E, Dale GL, Prodan CI. Abstract TP459: Higher Coated-Platelet Levels in Patients with Acute Stroke are Associated with Lower Cognitive Performance at 3 Months. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Coated-platelets, a subset of procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin, support a robust prothrombinase activity and provide a unique measure of platelet thrombotic potential. Coated-platelet levels are increased in non-lacunar stroke compared to healthy controls, and higher levels are associated with stroke recurrence. In prior studies, we have shown that coated-platelet levels in patients with carotid atherosclerosis and cognitive impairment are elevated as compared to those with normal cognition.
Hypothesis:
To examine whether coated-platelet levels measured at the time of the stroke correlate with cognitive performance at 3 months following the brain infarction.
Methods:
Consecutive patients with a diagnosis of non-lacunar stroke were enrolled in this pilot study over 12 months. Coated-platelets were determined at the time of the stroke and reported as percent of platelets converted to coated-platelets. Cognitive screening was performed using the Mini-Mental State Examination (MMSE) during a stroke clinic visit 3 months after hospital discharge. Patients with prior dementia or significant aphasia were excluded. The linear correlation between initial coated-platelet levels and MMSE scores at 3 months was examined using the Pearson correlation coefficient.
Results:
We enrolled 66 patients, 97% male, with a mean age of 66.7 years (range 49-88) and mean NIHSS score of 4.4 points (range 0-11). Mean MMSE was 26.3 points (range 18-30) and mean coated-platelet levels were 41.4% (range 15.4-76.2). 34 patients (52%) had MMSE scores of ≤26, suggestive of a degree of cognitive impairment. An inverse relationship was found between coated-platelet levels and MMSE score, with higher levels seen in patients with lower MMSE scores (r=-0.45, R
2
=0.21, p=0.0001). This association remained despite adjustment for presence of large-artery disease and stroke severity.
Conclusions:
Higher initial coated-platelet levels are associated with lower cognitive performance at 3 months post stroke. These findings support a link between increased platelet procoagulant potential and development of vascular cognitive impairment following cerebral infarction.
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Affiliation(s)
| | - Julie A Stoner
- Univ of Oklahoma Health Sciences Cntr, Oklahoma City, OK
| | | | - George L Dale
- Univ of Oklahoma Health Sciences Cntr, Oklahoma City, OK
| | - Calin I Prodan
- Univ of Oklahoma Health Sciences Cntr, Oklahoma City, OK
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Zhang Y, Jenkins AJ, Basu A, Stoner JA, Lopes-Virella MF, Klein RL, Lyons TJ. Associations between intensive diabetes therapy and NMR-determined lipoprotein subclass profiles in type 1 diabetes. J Lipid Res 2015; 57:310-7. [PMID: 26658239 DOI: 10.1194/jlr.p060657] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Indexed: 11/20/2022] Open
Abstract
Our objective is to define differences in circulating lipoprotein subclasses between intensive versus conventional management of type 1 diabetes during the randomization phase of the Diabetes Control and Complications Trial (DCCT). NMR-determined lipoprotein subclass profiles (NMR-LSPs), which estimate molar subclass concentrations and mean particle diameters, were determined in 1,294 DCCT subjects after a median of 5 years (interquartile range: 4-6 years) of randomization to intensive or conventional diabetes management. In cross-sectional analyses, we compared standard lipids and NMR-LSPs between treatment groups. Standard total, LDL, and HDL cholesterol levels were similar between randomization groups, while triglyceride levels were lower in the intensively treated group. NMR-LSPs showed that intensive therapy was associated with larger LDL diameter (20.7 vs. 20.6 nm, P = 0.01) and lower levels of small LDL (median: 465 vs. 552 nmol/l, P = 0.007), total IDL/LDL (mean: 1,000 vs. 1,053 nmol/l, P = 0.01), and small HDL (mean: 17.3 vs. 18.6 μmol/l, P < 0.0001), the latter accounting for reduced total HDL (mean: 33.8 vs. 34.8 μmol/l, P = 0.01). In conclusion, intensive diabetes therapy was associated with potentially favorable changes in LDL and HDL subclasses in sera. Further research will determine whether these changes contribute to the beneficial effects of intensive diabetes management on vascular complications.
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Affiliation(s)
- Ying Zhang
- Department of Biostatistics and Epidemiology University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Alicia J Jenkins
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, Sydney, NSW, Australia Centre for Experimental Medicine, Queen's University of Belfast, Northern Ireland, UK
| | - Arpita Basu
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Maria F Lopes-Virella
- Division of Endocrinology, Medical University of South Carolina, Charleston, SC Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Richard L Klein
- Division of Endocrinology, Medical University of South Carolina, Charleston, SC Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | | | - Timothy J Lyons
- Centre for Experimental Medicine, Queen's University of Belfast, Northern Ireland, UK Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Prodan CI, Stoner JA, Dale GL. Acute hemorrhagic complications are associated with lower coated-platelet levels in non-lacunar brain infarction. J Thromb Haemost 2015; 13:2233-9. [PMID: 26426364 DOI: 10.1111/jth.13160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/21/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Coated platelets are procoagulant platelets observed upon dual agonist stimulation with collagen and thrombin. Coated-platelet levels are elevated in patients with non-lacunar ischemic stroke and decreased in patients with spontaneous intracerebral hemorrhage as compared with controls. OBJECTIVE To investigate whether acute hemorrhagic complications occurring during the initial hospital admission for non-lacunar ischemic stroke are associated with lower coated-platelet levels. PATIENTS/METHODS Coated-platelet levels were determined in 385 consecutive patients with non-lacunar stroke. Hemorrhagic complications were defined as either intracranial hemorrhage or significant extracranial bleeding (drop in hemoglobin of ≥ 2 g dL(-1) ). The rate of acute hemorrhagic complication was compared among subjects categorized into tertiles of coated-platelet levels using an exact Cochrane-Armitage trend test. Logistic regression was used to estimate the adjusted odds of hemorrhagic complication associated with coated-platelet levels. RESULTS Hemorrhagic complications were present in 15 (3.9%) cases. Of these, four had intracranial hemorrhage and 11 had extracranial hemorrhage. The occurrence of hemorrhagic complications differed among the coated-platelet tertiles: 10.2% for the first tertile (coated-platelet levels < 35.5%), 1.5% for the second tertile and 0% for the third tertile (coated-platelet levels ≥ 47.5%, trend test). Logistic regression showed that the odds of hemorrhagic complication in those with levels < 35.5% were 14.59 times the odds for patients with levels ≥ 35.5% (95% CI: 3.24-65.7). CONCLUSIONS Lower levels of procoagulant platelets are associated with acute hemorrhagic complications following non-lacunar ischemic stroke. These results suggest a role for coated-platelets in risk/benefit assessment in the early stages of stroke.
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Affiliation(s)
- C I Prodan
- Department of Neurology, University of Oklahoma Health Sciences Center and Veterans Affairs Medical Center, Oklahoma City, OK, USA
- University of Oklahoma Health Sciences Center and Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - J A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - G L Dale
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Tafur AJ, Dale G, Cherry M, Wren JD, Mansfield AS, Comp P, Rathbun S, Stoner JA. Prospective evaluation of protein C and factor VIII in prediction of cancer-associated thrombosis. Thromb Res 2015; 136:1120-5. [PMID: 26475410 PMCID: PMC4679511 DOI: 10.1016/j.thromres.2015.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 06/12/2015] [Revised: 10/02/2015] [Accepted: 10/04/2015] [Indexed: 12/12/2022]
Abstract
Venous thromboembolism (VTE) is a preventable disease, yet it is one of the leading causes of death among patients with cancer. Improving risk stratification mechanisms will allow us to personalize thrombo-prophylaxis strategies. We sought to evaluate Collagen and Thrombin Activated Platelets (COAT-platelets) as well as protein C and factor VIII as biomarkers predictive of cancer-associated thrombosis in a prospective cohort of patients with cancer. Protein C was selected as a candidate based on bioinformatics prediction. Blood samples were collected before chemotherapy. All specimen processing was blinded to clinical data. Surveillance and adjudication of the main outcome of VTE was performed for up to 1 year. We used Cox proportional hazard regression to measure the association of biomarkers and incident events using SAS 9.2 for all statistical analysis. Death was modeled as a competing event. Among 241 patients followed for an average of 10.4 months, 15% died and 13% developed a VTE. COAT-platelets were not predictive of VTE. Low levels of pre-chemotherapy protein C (<118%) (HR 2.5; 95% CI 1.1-5.5) and high baseline factor VIII (>261% I) (HR 3.0; 95% CI 1.1-8.0) were predictive of VTE after adjusting for age, Khorana prediction risk, metastatic disease and D dimer. In addition, low protein C was predictive of overall mortality independent of age, metastatic disease and functional status (HR 2.8; 95% CI 1.3-6.0). Addition of these biomarkers to cancer-VTE risk prediction models may add to risk stratification and patient selection to optimize thrombo-prophylaxis.
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Affiliation(s)
- A J Tafur
- Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States.
| | - G Dale
- Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States
| | - M Cherry
- Department of Medicine - Hematology-Oncology section, University of Oklahoma Health Sciences Center, United States
| | - J D Wren
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, United States
| | - A S Mansfield
- Department of Oncology, Division of Medical Oncology, Mayo Clinic Rochester, United States
| | - P Comp
- Department of Medicine - Hematology-Oncology section, University of Oklahoma Health Sciences Center, United States
| | - S Rathbun
- Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States
| | - J A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, United States
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Basu A, Jenkins AJ, Zhang Y, Stoner JA, Klein RL, Lopes-Virella MF, Timothy Garvey W, Lyons TJ. Data on carotid intima-media thickness and lipoprotein subclasses in type 1 diabetes from the Diabetes Control and Complications Trial and the Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC). Data Brief 2015; 6:33-8. [PMID: 26759826 PMCID: PMC4683326 DOI: 10.1016/j.dib.2015.11.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/09/2015] [Accepted: 11/16/2015] [Indexed: 11/30/2022] Open
Abstract
Type 1 diabetes (T1DM) is associated with increased risk of macrovascular complications. We examined longitudinal associations of serum conventional lipids and nuclear magnetic resonance (NMR)-determined lipoprotein subclasses with carotid intima-media thickness (IMT) in adults with T1DM (n=455) enrolled in the Diabetes Control and Complications Trial (DCCT). Data on serum lipids and lipoproteins were collected at DCCT baseline (1983-89) and were correlated with common and internal carotid IMT determined by ultrasonography during the observational follow-up of the DCCT, the Epidemiology of Diabetes Interventions and Complications (EDIC) study, at EDIC 'Year 1' (199-1996) and EDIC 'Year 6' (1998-2000). This article contains data on the associations of DCCT baseline lipoprotein profiles (NMR-based VLDL & chylomicrons, IDL/LDL and HDL subclasses and 'conventional' total, LDL-, HDL-, non-HDL-cholesterol and triglycerides) with carotid IMT at EDIC Years 1 and 6, stratified by gender. The data are supplemental to our original research article describing detailed associations of DCCT baseline lipids and lipoprotein profiles with EDIC Year 12 carotid IMT (Basu et al. in press) [1].
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Affiliation(s)
- Arpita Basu
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Alicia J Jenkins
- Section of Endocrinology & Diabetes, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; University of Sydney, NHMRC Clinical Trials Centre, Camperdown, Sydney, NSW, Australia
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Richard L Klein
- Division of Endocrinology, Medical University of South Carolina, Charleston, SC, USA; The Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Maria F Lopes-Virella
- Division of Endocrinology, Medical University of South Carolina, Charleston, SC, USA; The Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy J Lyons
- Section of Endocrinology & Diabetes, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Centre for Experimental Medicine, Queen's University of Belfast, Belfast, UK
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Basu A, Jenkins AJ, Zhang Y, Stoner JA, Klein RL, Lopes-Virella MF, Garvey WT, Lyons TJ. Nuclear magnetic resonance-determined lipoprotein subclasses and carotid intima-media thickness in type 1 diabetes. Atherosclerosis 2015; 244:93-100. [PMID: 26600440 DOI: 10.1016/j.atherosclerosis.2015.10.106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 10/23/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dyslipidemia has been linked to vascular complications of Type 1 diabetes (T1DM). We investigated the prospective associations of nuclear magnetic resonance-determined lipoprotein subclass profiles (NMR-LSP) and conventional lipid profiles with carotid intima-media thickness (IMT) in T1DM. METHODS NMR-LSP and conventional lipids were measured in a subset of Diabetes Control and Complications Trial (DCCT) participants (n = 455) at study entry ('baseline', 1983-89), and were related to carotid IMT determined by ultrasonography during the observational follow-up of the DCCT, the Epidemiology of Diabetes Interventions and Complications (EDIC) study, at EDIC Year 12 (2004-2006). Associations were defined using multiple linear regression stratified by gender, and following adjustment for HbA1c, diabetes duration, body mass index, albuminuria, DCCT randomization group, smoking status, statin use, and ultrasound devices. RESULTS In men, significant positive associations were observed between some baseline NMR-subclasses of LDL (total IDL/LDL and large LDL) and common and/or internal carotid IMT, and between conventional total- and LDL-cholesterol and non-HDL-cholesterol and common carotid IMT, at EDIC Year 12; these persisted in adjusted analyses (p < 0.05). Large LDL particles and conventional triglycerides were positively associated with common carotid IMT changes over 12 years (p < 0.05). Inverse associations of mean HDL diameter and large HDL concentrations, and positive associations of small LDL with common and/or internal carotid IMT (all p < 0.05) were found, but did not persist in adjusted analyses. No significant associations were observed in women. CONCLUSION NMR-LSP-derived LDL particles, in addition to conventional lipid profiles, may help in identifying men with T1DM at highest risk for vascular disease.
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Affiliation(s)
- Arpita Basu
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Alicia J Jenkins
- Section of Endocrinology & Diabetes, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; University of Sydney, NHMRC Clinical Trials Centre, Camperdown, Sydney, NSW, Australia
| | - Ying Zhang
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Richard L Klein
- Division of Endocrinology, Medical University of South Carolina, Charleston, SC, USA; The Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Maria F Lopes-Virella
- Division of Endocrinology, Medical University of South Carolina, Charleston, SC, USA; The Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - W Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Timothy J Lyons
- Section of Endocrinology & Diabetes, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Centre for Experimental Medicine, Queen's University of Belfast, Belfast, UK.
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Garwe T, Albrecht RM, Stoner JA, Mitchell S, Motghare P. Hypoalbuminemia at admission is associated with increased incidence of in-hospital complications in geriatric trauma patients. Am J Surg 2015; 212:109-15. [PMID: 26414690 DOI: 10.1016/j.amjsurg.2015.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/21/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Elderly patients are at an increased risk of protein-energy malnutrition (PEM) which increases the risk of morbidity/mortality. We evaluated the association between hypoalbuminemia at the time of emergency department (ED) admission and in-hospital complications among geriatric trauma patients. METHODS This was an ambidirectional cohort study of geriatric (≥55 years) trauma patients treated at a Level I trauma center between May 2013 and March 2014. The exposure of interest was albumin level at ED admission (<3.6 g/dL [PEM] or ≥3.6 g/dL (No PEM)]. The outcome of interest was 30-day incidence of complications. RESULTS A total of 130 patients met study eligibility. Of these, 85 (65%) patients were in the PEM group. After adjusting for tube feeding and injury severity score, PEM at admission was associated with a 2-fold increase in the risk of 30-day overall hospital complications (hazard ratio 2.1, 95% confidence interval 1.1 to 3.8). CONCLUSION Serum albumin level at ED admission, but not prealbumin level, is a significant predictor of in-hospital complications in geriatric trauma patients.
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Affiliation(s)
- Tabitha Garwe
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA.
| | - Roxie M Albrecht
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA
| | - Stephanie Mitchell
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Prasenjeet Motghare
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA
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