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Adkins-Jackson PB, Kim B, Higgins Tejera C, Ford TN, Gobaud AN, Sherman-Wilkins KJ, Turney IC, Avila-Rieger JF, Sims KD, Okoye SM, Belsky DW, Hill-Jarrett TG, Samuel L, Solomon G, Cleeve JH, Gee G, Thorpe RJ, Crews DC, Hardeman RR, Bailey ZD, Szanton SL, Manly JJ. "Hang Ups, Let Downs, Bad Breaks, Setbacks": Impact of Structural Socioeconomic Racism and Resilience on Cognitive Change Over Time for Persons Racialized as Black. Health Equity 2024; 8:254-268. [PMID: 38665381 PMCID: PMC11043623 DOI: 10.1089/heq.2023.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 04/28/2024] Open
Abstract
Introduction Older adults racialized as Black experience higher rates of dementia than those racialized as White. Structural racism produces socioeconomic challenges, described by artist Marvin Gaye as "hang ups, let downs, bad breaks, setbacks" that likely contribute to dementia disparities. Robust dementia literature suggests socioeconomic factors may also be key resiliencies. Methods We linked state-level data reflecting the racialized landscape of economic opportunity across the 20th Century from the U.S. Census (1930-2010) with individual-level data on cognitive outcomes from the U.S. Health and Retirement Study participants racialized as Black. A purposive sample of participants born after the Brown v. Board ruling (born 1954-59) were selected who completed the modified Telephone Interview for Cognitive Status between 2010 and 2020 (N=1381). We tested associations of exposure to structural racism and resilience before birth, and during childhood, young-adulthood, and midlife with cognitive trajectories in mid-late life using mixed-effects regression models. Results Older adults born in places with higher state-level structural socioeconomic racism experienced a more rapid cognitive decline in later life compared to those with lower levels of exposure. In addition, participants born in places with higher levels of state-level structural socioeconomic resilience experienced slower cognitive change over time than their counterparts. Discussion These findings reveal the impact of racist U.S. policies enacted in the past that influence cognitive health over time and dementia risk later in life.
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Affiliation(s)
- Paris B. Adkins-Jackson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Boeun Kim
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - César Higgins Tejera
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Tiffany N. Ford
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- The Brookings Institution, Washington, District of Columbia, USA
| | - Ariana N. Gobaud
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Indira C. Turney
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
| | - Justina F. Avila-Rieger
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
| | - Kendra D. Sims
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Safiyyah M. Okoye
- Department of Graduate Nursing, College of Nursing and Health Professions and Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Health Management and Policy, College of Nursing and Health Professions and Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Daniel W. Belsky
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Tanisha G. Hill-Jarrett
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Laura Samuel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gabriella Solomon
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jack H. Cleeve
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Gilbert Gee
- Department of Community Health Sciences, University of California at Los Angeles, Los Angeles, California, USA
| | - Roland J. Thorpe
- Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deidra C. Crews
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachel R. Hardeman
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Zinzi D. Bailey
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sarah L. Szanton
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer J. Manly
- Department of Neurology, Vagelos College of Physicians & Surgeons, Taub Institute for Research on Alzheimer's Disease & The Aging Brain, Columbia University, New York, New York, USA
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Li M, Huang J, Budhathoki C, Li Q, Samuel L, Szanton SL, Schrack JA, Li J. Social Factors and Older Adults' Use of Wearable Activity Trackers: Before and During the First Wave of the COVID-19 Pandemic. J Appl Gerontol 2024; 43:182-193. [PMID: 37863099 DOI: 10.1177/07334648231205417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Wearable activity trackers (WAT) have shown high potential to improve health in the aging population. Evidence links various social factors with WAT use in older adults, but mainly within small samples and the prevalence of their WAT use during the COVID-19 is unknown. We reported WAT use prevalence before and during the first wave of COVID-19 and examined social factors associated with WAT use frequency using a nationally representative sample of 3302 U.S. older adults. We used Multinomial Logistic Regression to identify social factors associated with WAT use frequency. Only 10.3% of pre-COVID-19 and 10.9% of first-wave subsamples were frequent WAT users. Older adults aged 75 and above and those with low incomes were less likely to frequently use WATs. Our findings suggest socioeconomic and age disparities in WAT use among older Americans. Future studies should focus on enhancing low-income older adults' WAT adoption to enable equal access to WAT-related health benefits.
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Affiliation(s)
- Mengchi Li
- Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Jing Huang
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Qiwei Li
- California State University, Baltimore, MD, USA
| | | | | | | | - Junxin Li
- Johns Hopkins University, Baltimore, MD, USA
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Piasecki RJ, Hunt EA, Perrin N, Spaulding EM, Winters B, Samuel L, Davidson PM, Chandra Strobos N, Churpek M, Himmelfarb CR. Using rapid response system trigger clusters to characterize patterns of clinical deterioration among hospitalized adult patients. Resuscitation 2024; 194:110041. [PMID: 37952578 PMCID: PMC10842078 DOI: 10.1016/j.resuscitation.2023.110041] [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: 06/22/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Many rapid response system (RRS) events are activated using multiple triggers. However, the patterns in which multiple RRS triggers occur together to activate RRS events are unknown. The purpose of this study was to identify these patterns (RRS trigger clusters) and determine their association with outcomes among hospitalized adult patients. METHODS RRS events among adult patients from January 2015 to December 2019 in the Get With The Guidelines- Resuscitation registry's MET module were examined (n = 134,406). Cluster analysis methods were performed to identify RRS trigger clusters. Pearson's chi-squared and ANOVA tests were used to examine differences in patient characteristics across RRS trigger clusters. Multilevel logistic regressions were used to examine the associations between RRS trigger clusters and outcomes. RESULTS Six RRS trigger clusters were identified. Predominant RRS triggers for each cluster were: tachypnea, new onset difficulty in breathing, decreased oxygen saturation (Cluster 1); tachypnea, decreased oxygen saturation, staff concern (Cluster 2); respiratory depression, decreased oxygen saturation, mental status changes (Cluster 3); tachycardia, staff concern (Cluster 4); mental status changes (Cluster 5); hypotension, staff concern (Cluster 6). Significant differences in patient characteristics were observed across clusters. Patients in Clusters 3 and 6 had an increased likelihood of in-hospital cardiac arrest (p < 0.01). All clusters had an increased risk of mortality (p < 0.01). CONCLUSIONS We discovered six novel RRS trigger clusters with differing relationships to adverse patient outcomes. RRS trigger clusters may prove crucial in clarifying the associations between RRS events and adverse outcomes and aiding in clinician decision-making during RRS events.
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Affiliation(s)
- Rebecca J Piasecki
- Johns Hopkins University, 3400 N. Charles St., Baltimore, MD 21218, United States.
| | - Elizabeth A Hunt
- Johns Hopkins University, 3400 N. Charles St., Baltimore, MD 21218, United States
| | - Nancy Perrin
- Johns Hopkins University, 3400 N. Charles St., Baltimore, MD 21218, United States
| | - Erin M Spaulding
- Johns Hopkins University, 3400 N. Charles St., Baltimore, MD 21218, United States
| | - Bradford Winters
- Johns Hopkins University, 3400 N. Charles St., Baltimore, MD 21218, United States
| | - Laura Samuel
- Johns Hopkins University, 3400 N. Charles St., Baltimore, MD 21218, United States
| | - Patricia M Davidson
- University of Wollongong Australia, Northfields Ave., Wollongong, NSW 2522, Australia
| | | | - Matthew Churpek
- University of Wisconsin-Madison, Union South, 1308 W. Dayton St., Madison, WI 53715, United States
| | - Cheryl R Himmelfarb
- Johns Hopkins University, 3400 N. Charles St., Baltimore, MD 21218, United States
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4
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Kumar P, Brinson J, Wang J, Samuel L, Swenor BK, Scott AW, Varadaraj V. Self-Reported Vision Impairment and Food Insecurity in the US: National Health Interview Survey, 2011-2018. Ophthalmic Epidemiol 2023; 30:468-476. [PMID: 36204819 PMCID: PMC10987945 DOI: 10.1080/09286586.2022.2129698] [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: 07/20/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE To determine if vision impairment (VI) is associated with food insecurity among the United States (US) adults. METHODS This is a cross-sectional study of US adults ≥18 years below a threshold of 150% poverty from the National Health Interview Survey (NHIS), years 2011-2018. Outcome measures included food insecurity status, based on response to the NHIS adult (10-item) food insecurity tool, either as a binary (food secure or insecure) or ordinal (high, marginal, low, and very low) variable. VI was defined as self-reported trouble seeing, even when wearing glasses or contact lenses. Multivariable logistic regression analyses adjusted for potential confounders examined associations between VI and food insecurity. RESULTS Participants (N = 62075) were majority female (57%), White (62%), and non-Hispanic (74%). Of them, 16% reported VI and 28% were food insecure. In fully adjusted logistic regression models, adults with VI had 216% higher odds (95% CI = 2.01-2.31) of being food insecure than adults without VI. Further, there was a dose-response relationship between VI and food insecurity noted in a multinomial model: VI predicted 159% higher risk of marginal food security (95% CI = 1.44-1.75), 197% higher risk of low food security (95% CI = 1.80-2.16), and 295% higher risk of very low food security (95% CI = 2.69-3.22), as compared to high food security. CONCLUSION VI is associated with food insecurity, increasingly so among adults with highest levels of food insecurity in this national sample of low-income US adults. This data highlights the need for targeted interventions to address and reduce the burden of food insecurity among US adults with VI.
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Affiliation(s)
- Priyanka Kumar
- Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore
| | - Jessica Brinson
- Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore
- Howard University Hospital
| | - Jiangxia Wang
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore
| | | | - Bonnielin K. Swenor
- Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore
- Johns Hopkins School of Nursing, Baltimore
- The Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore
| | - Adrienne W. Scott
- Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore
| | - Varshini Varadaraj
- Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore
- The Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore
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Mutlu L, Bermingham WH, Mohamed OE, Melchior C, Samuel L, Heslegrave J, Baretto R, Ekbote A, Huissoon A, Dedicoat M, Krishna MT. Management of suspected hypersensitivity reactions to anti-TB drugs. Int J Tuberc Lung Dis 2023; 27:570-573. [PMID: 37353875 DOI: 10.5588/ijtld.23.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Affiliation(s)
- L Mutlu
- Department of Allergy and Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - W H Bermingham
- Department of Allergy and Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - O E Mohamed
- Department of Allergy and Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Melchior
- Department of Allergy and Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - L Samuel
- Department of Allergy and Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Heslegrave
- Department of Allergy and Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Baretto
- Department of Allergy and Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Ekbote
- Department of Allergy and Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Huissoon
- Department of Allergy and Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Dedicoat
- Infectious Diseases Department, Birmingham Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - M T Krishna
- Department of Allergy and Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK, Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK
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6
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Piasecki RJ, Hunt EA, Perrin N, Spaulding EM, Winters B, Samuel L, Davidson PM, Strobos NC, Churpek M, Himmelfarb CR. Using rapid response system trigger clusters to characterize patterns of clinical deterioration among hospitalized adult patients. medRxiv 2023:2023.02.06.23285560. [PMID: 36798369 PMCID: PMC9934794 DOI: 10.1101/2023.02.06.23285560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Background Many rapid response system (RRS) events are activated using multiple triggers. However, the patterns in which RRS triggers co-occur to activate the medical emergency team (MET) to respond to RRS events is unknown. The purpose of this study was to identify and describe the patterns (RRS trigger clusters) in which RRS triggers co-occur when used to activate the MET and determine the association of these clusters with outcomes using a sample of hospitalized adult patients. Methods RRS events among adult patients from January 2015 to December 2019 in the Get With The Guidelines- Resuscitation registry's MET module were examined (n=134,406). A combination of cluster analyses methods was performed to group patients into RRS trigger clusters based on the triggers used to activate their RRS events. Pearson's chi-squared and ANOVA tests were used to examine differences in patient characteristics across RRS trigger clusters. Multilevel logistic regression was used to examine the associations between RRS trigger clusters and outcomes following RRS events. Results Six RRS trigger clusters were identified in the study sample. The RRS triggers that predominantly identified each cluster were as follows: tachypnea, new onset difficulty in breathing, and decreased oxygen saturation (Cluster 1); tachypnea, decreased oxygen saturation, and staff concern (Cluster 2); respiratory depression, decreased oxygen saturation, and mental status changes (Cluster 3); tachycardia and staff concern (Cluster 4); mental status changes (Cluster 5); hypotension and staff concern (Cluster 6). Significant differences in patient characteristics were observed across RRS trigger clusters. Patients in Clusters 3 and 6 were associated with an increased likelihood of in-hospital cardiac arrest (IHCA [p<0.01]), while Cluster 4 was associated with a decreased likelihood of IHCA (p<0.01). All clusters were associated with an increased risk of mortality (p<0.01). Conclusions We discovered six novel RRS trigger clusters with differing relationships to adverse patient outcomes following RRS events. RRS trigger clusters may prove crucial in clarifying the associations between RRS events and adverse outcomes and may aid in clinician decision-making during RRS events.
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Varadaraj V, Kumar P, Brinson J, Wang J, Samuel L, Scott A, Swenor B. RACIAL DISPARITIES IN THE ASSOCIATION BETWEEN VISION IMPAIRMENT AND FOOD INSECURITY IN THE US. Innov Aging 2022. [PMCID: PMC9765480 DOI: 10.1093/geroni/igac059.947] [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: 12/24/2022] Open
Abstract
We examined racial disparities in household food insecurity among low-income Americans with and without vision impairment in the National Health Interview Survey, years 2011-2018. Among 257,620 U.S. adults below a threshold of 150% poverty, 15% of White, 16% of Black, and 8% of Asian Americans, and 18% of American Indians and Inuits reported vision impairment. In analyses adjusted for sociodemographic variables, vision impairment was associated with >100% greater odds (95% CI=2.01-2.31) of 30-day food insecurity, as compared to no vision impairment. Further, odds of household food insecurity were higher among Black Americans (OR=1.37, 95% CI=1.29-1.47), and American Indians and Inuits (OR=1.38, 95% CI=1.15-1.66) than White Americans, while Asians had lower odds (OR=0.45, 95 %CI=0.36-0.57). These findings highlight that low-income adults with vision impairment and racial minorities experience food disparities and dietary inadequacy, an area of disadvantage that can influence overall health, in a nationally representative sample in the U.S.
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Affiliation(s)
| | - Priyanka Kumar
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jessica Brinson
- Howard University College of Medicine, Washington, District of Columbia, United States
| | - Jiangxia Wang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Laura Samuel
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Adrienne Scott
- The Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, United States
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Kim B, Szanton S, Thorpe, Jr. RJ, Crews D, Samuel L. FOOD INSECURITY AND COGNITIVE TRAJECTORIES IN COMMUNITY-DWELLING OLDER ADULTS. Innov Aging 2022. [PMCID: PMC9770319 DOI: 10.1093/geroni/igac059.528] [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: 12/24/2022] Open
Abstract
Food insecurity, defined as limited access to nutritionally adequate and safe foods due to social and economic conditions, has adverse effects on physical health and well-being. However, it remains unclear whether food insecurity accelerates cognitive decline in older adults. This study examined the association of food insecurity with cognitive decline. We analyzed data from 4,508 community-dwelling participants in the National Health and Aging Trends Study (NHATS) collected from 2011 to 2020, a prospective cohort study of a nationally representative sample of Medicare beneficiaries ages 65 years and older. Food insecurity was measured using 5 items within functional, social support, and financial limitations domains. Immediate and delayed recall were assessed by a 10-item word-list memory task (range: 0—10). Executive function was evaluated by the Clock Drawing Test (range: 0—5). Each year’s cognitive functions were linked to the prior year’s food insecurity values. Weighted linear mixed effect models were fitted. Prevalence of food insecurity at baseline was 3.5% (95% CI: 2.9 — 4.3). Persons with food insecurity were more likely to have Black race or Hispanic ethnicity, low income, and less than high school education. Food insecurity was associated with faster decline in executive function accounting for demographic and socioeconomic characteristics: the average difference, over 1-year, in executive function score between people exposed to and not exposed to food insecurity was 0.038 points (95% CI: -0.072 — -0.003). Food assistance programs or increasing healthy food access may reduce food insecurity and delay cognitive aging in community-dwelling older adults.
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Affiliation(s)
- Boeun Kim
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Sarah Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
| | | | - Deidra Crews
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Laura Samuel
- Johns Hopkins University, Baltimore, Maryland, United States
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Samuel L, Tang H, Basch CH. TikTok: a far-reaching opportunity for health professionals to address weight loss. Public Health 2022; 213:94-99. [PMID: 36402089 DOI: 10.1016/j.puhe.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Recent behavioral research indicates that social media may be successfully integrated into weight loss interventions to mitigate the obesity epidemic that has been linked with type two diabetes, cardiovascular diseases, cancers, as well as poor psychological health. This study aimed to examine the content and characteristics of 100 most trending TikTok videos related to weight loss. STUDY DESIGN This was a cross-sectional, descriptive study. METHODS Videos were analyzed for source, predominant theme, and inclusion of specific content. Independent two-tailed t-tests assessed the effect of content on number of comments, likes, and forwards garnered by the videos. RESULTS More than 90% of the videos were consumer generated, indicating a missed opportunity by health professionals to use social media to provide accurate information regarding weight loss. Less than one-fifth of the videos were informational but significantly influenced the number of comments (P < .001) and likes (P = .002). Videos mentioning benefits ((P < .001) and speed of weight loss (P = .003) significantly influenced the number of forwards, whereas those that mentioned recipes (P = .005) and how to lose weight (P = .003) significantly affected the number of comments. CONCLUSION The results underscore the need for further research to elucidate the effectiveness of social media in impacting weight loss, as well as how they may supplement traditional health promotion and behavior interventions for weight loss.
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Affiliation(s)
- L Samuel
- Associate Professor, Department of Health Promotion and Nutrition Sciences, Lehman College, The City University of New York, Bronx, NY, 10468, USA.
| | - H Tang
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY, 10027, USA
| | - C H Basch
- Professor and Chair, Department of Public Health, William Paterson University, Wayne, NJ, 07470, USA
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LaFave SE, Bandeen-Roche K, Gee G, Thorpe RJ, Li Q, Crews D, Samuel L, Cooke A, Hladek M, Szanton SL. Quantifying Older Black Americans' Exposure to Structural Racial Discrimination: How Can We Measure the Water In Which We Swim? J Urban Health 2022; 99:794-802. [PMID: 35486285 PMCID: PMC9561453 DOI: 10.1007/s11524-022-00626-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
The USA was built on legalized racism that started with enslavement and continues in the form of structural racial discrimination. This discrimination is difficult to measure because its many manifestations are hard to observe and dynamic. A useful tool would measure across settings, institutions, time periods in a person's life and the country's history. The purpose of this study was to design a measure of structural racial discrimination that meets those criteria and can be used in large national datasets. To do this, we started with an exploratory mixed-methods instrument design, including qualitative interviews with 15 older Black adults and focus groups with 38 discrimination researchers and other key stakeholders. We then identified 27 indicators of structural racial discrimination across nine theorized discrimination contexts. We matched these with historical administrative data sets to develop an instrument that could quantify older Black Americans' exposure to structural racial discrimination across contexts, the life course, and geographies. These can be mapped to the life course of structural discrimination based on the home addresses of those surveyed. Linking these to available indicators is a promising approach. It is a low burden for participants and enables increasingly multifaceted and focused measurement as more national datasets become available. A flexible, feasible comprehensive measure of structural discrimination could allow not only more thorough documentation of inequities but also allow informed decision making about policies and programs intended to promote racial equity. SIGNIFICANCE STATEMENT: To our knowledge, this is the first study that presents a framework for assessing structural racial discrimination across contexts, life course, and geography that is grounded in theory and in the lived experience of intended participants. Leading researchers and policy makers have called for improved measures of structural racism and discrimination and specifically for a lifecourse approach to measurement. This study is a step in that direction. CLASSIFICATION: Social Sciences.
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Affiliation(s)
- S E LaFave
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - K Bandeen-Roche
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G Gee
- UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - R J Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Q Li
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - D Crews
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - L Samuel
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - A Cooke
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - M Hladek
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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11
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Assi L, Deal JA, Samuel L, Reed NS, Ehrlich JR, Swenor BK. Access to food and health care during the COVID-19 pandemic by disability status in the United States. Disabil Health J 2022; 15:101271. [PMID: 35151597 PMCID: PMC8767932 DOI: 10.1016/j.dhjo.2022.101271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/03/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The COVID-19 pandemic has impacted people's access to food and health care. People with disabilities may be disproportionately affected by these outcomes due to structural and social barriers. OBJECTIVE/HYPOTHESIS To examine the relative prevalence of food insufficiency and unmet health care needs among the U.S. residents by vision, hearing, cognition, and mobility disability. METHODS We used data from the Household Pulse Survey wave conducted from April 14 to April 26, 2021, when questions about functional disability were first included. Participants were asked about difficulty seeing, hearing, remembering or concentrating, and walking or climbing stairs. The outcomes of interest were food insufficiency, delaying needed medical care and not getting needed medical care. Poisson regression models with robust variance adjusted for potential confounders were used to examine the prevalence ratio of each of these outcomes by disability status in separate models for each type of disability. RESULTS During April 14-26, 2021, 39.5% adults in the U.S. reported cognitive disability, 30.8% reported vision disability, 23.2% reported mobility disability, and 14.9% reported hearing disability. Adults with any type of disability were more likely than those without to experience food insufficiency (range of prevalence rate ratios [PRR]: 1.67-1.96), and delay (range of PRR: 1.48-1.87) or not get (range of PRR: 1.60-2.07) needed medical care. CONCLUSIONS These disparities suggest there is an urgent need to address the negative impact of the COVID-19 pandemic on people with disabilities. The prioritization of disability data collection is key in achieving that goal.
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Affiliation(s)
- Lama Assi
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer A Deal
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura Samuel
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Bonnielin K Swenor
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; The Disability Health Research Center, Johns Hopkins Bloomberg University, Baltimore, MD, USA.
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12
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Liu M, Xue QL, Samuel L, Gitlin LN, Guralnik J, Leff B, Szanton SL. Improvements of Disability Outcomes in CAPABLE Older Adults Differ by Financial Strain Status. J Appl Gerontol 2022; 41:471-477. [PMID: 33267710 PMCID: PMC8169719 DOI: 10.1177/0733464820975551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Community Aging in Place-Advancing Better Living for Elders (CAPABLE) program reduces disability in low-income older adults. In this study, we used CAPABLE baseline and 5-month data to examine whether its effects in reducing activities of daily living (ADLs) and instrumental ADLs (IADLs) difficulties differed by participants' financial strain status. At baseline, participants with financial strain were more likely to report higher scores on depression (p < .001), have low energy (p < .001), and usually feel tired (p = .004) compared with participants without financial strain, but did not differ in ADL/IADL scores. Participants with financial strain benefited from the program in reducing ADL (relative risk [RR]: 0.61, 95% confidence interval [CI]: 0.43, 0.86) and IADL disabilities (RR: 0.69, 95% CI: 0.54, 0.87), compared with those with financial strain receiving attention control. Individuals with financial strain benefited more from a home-based intervention on measures of disability than those without financial strain. Interventions that improve disability may be beneficial for financially strained older adults.
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Affiliation(s)
- Minhui Liu
- Central South University Xiangya School of Nursing, Changsha, China
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Qian-Li Xue
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura Samuel
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Laura N. Gitlin
- Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania
| | - Jack Guralnik
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah L. Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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13
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Cudjoe T, Li Q, Drazich B, Hladek M, Samuel L, latkin C, Boyd C. Loneliness and Behavioral Changes During the COVID-19 Pandemic. Innov Aging 2021. [PMCID: PMC8680804 DOI: 10.1093/geroni/igab046.2166] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Concerns for the health impact of loneliness, a risk factor for morbidity and mortality, have risen amid the COVID-19 pandemic. However, relationships between loneliness and behavioral changes remains unclear. Utilizing data from the National Health and Aging Trends Study COVID-19 Supplement, we examine the cross-sectional relationship between loneliness and self-reported increase in each of the following behaviors during the pandemic (n=2,924): walking, vigorous activity, eating, use of alcohol and tobacco, watching television and sleeping. Adjusting for age, race, education, activity of daily living limitations, and chronic conditions, loneliness was significantly associated with a higher odds of more eating (odds ratio- OR: 1.42, confidence intervals-CI: 1.24,1.62), sleeping (OR: 1.35, CI: 1.18,1.56), and watching television (OR: 1.45, CI: 1.30,1.61). These results indicate that during stressful times like our current pandemic, loneliness may lead to morbidity and mortality through sedentary behaviors.
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Affiliation(s)
- Thomas Cudjoe
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Qiwei Li
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Brittany Drazich
- University of Maryland, Baltimore, Baltimore, Maryland, United States
| | - Melissa Hladek
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Laura Samuel
- Johns Hopkins University, Baltimore, Maryland, United States
| | - carl latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Cynthia Boyd
- Johns Hopkins University, Baltimore, Maryland, United States
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14
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Okoye S, Samuel L, Szanton S, Wolff J. Factors Associated With Deficient Housing Among Community-Living Older Adults in the United States. Innov Aging 2021. [PMCID: PMC8679642 DOI: 10.1093/geroni/igab046.1836] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Housing quality is a recognized social determinant of health. Qualitative evidence suggests the ability of older adults to maintain their homes is affected by the domains of financial resources, social environment, and functional abilities, but this conceptualization has not been tested quantitatively. This cross-sectional study examined associations between financial resources (indicated by socioeconomic characteristics: education, racial-status, annual income, financial hardship, Medicaid eligibility), social environment (living arrangement, social integration), and functional abilities (lower extremity performance, self-care disability, independent-living disability, homebound-status, dementia, depression) with deficient housing among 6,489 community-living adults ≥ 65 years participating in the nationally representative 2015 National Health and Aging Trends Study. Sampling weights accounted for study design and non-response. An estimated 9.2% (3.2 million) older Americans lived in housing with ≥1 deficiency (any peeling paint, evidence of pests, flooring in disrepair, broken windows, crumbling foundation, missing siding, or roof problems). In bivariate logistic regressions, factors from all three domains were associated with deficient housing. In a multivariable model that included all variables above and adjusted for age and sex, indicators of financial resources and social environment remained associated with deficient housing (including financial hardship, adjusted odds ratio (aOR)=1.48, 95% confidence interval (CI): 1.10,1.98; and living with non-spousal others versus alone, aOR=1.48; 95% CI:1.09, 2.03), whereas indicators of functional abilities did not. To ensure quality housing for all community-dwelling older adults, efforts that increase financial resources and further examine the role of social environment in deficient housing are needed.
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Affiliation(s)
- Safiyyah Okoye
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Laura Samuel
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Sarah Szanton
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Jennifer Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
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15
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Drazich B, Li Q, Perrin N, Samuel L, Hladek MD, Szanton S, Cudjoe T, Taylor J. The Association Between Older Adult Technology Use and Mental Health During the COVID-19 Pandemic. Innov Aging 2021. [PMCID: PMC8681107 DOI: 10.1093/geroni/igab046.2168] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Drama therapy is a widely acknowledged way to explore life-stories in late life. This presentation will describe a new model for creative interventions, based on the results of four studies that provide multiple perspectives on the integration of life-review and drama therapy for community dwelling older adults. The results of two quantitative studies (n=55, aged 62-93; n=78, aged 63-96) suggest that the drama therapy interventions have robust therapeutic potential to enhance mental health while aging. The findings of two qualitative studies with therapists (n=8), participants (n=27; aged 63-96) and staff (n=13) provide a better understanding of the process, and support the mechanisms that lead to positive effects on mental health. Combining the results yielded a multidimensional model which points to three potential transformative routes: the evolution of the life-story, the evolution of improvised dramatic expression, and the expansion of social engagement.
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Affiliation(s)
- Brittany Drazich
- University of Maryland, Baltimore, Baltimore, Maryland, United States
| | - Qiwei Li
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
| | - Laura Samuel
- Johns Hopkins University, Baltimore, Maryland, United States
| | | | - Sarah Szanton
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Thomas Cudjoe
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Janiece Taylor
- Johns Hopkins University, Baltimore, Maryland, United States
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16
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Hladek M, Li Q, Samuel L, Drazich B, Cudjoe T, Szanton S. Hopefulness During COVID-19: Associations With Function, Sleep, and Loneliness in the NHATS. Innov Aging 2021. [PMCID: PMC8680837 DOI: 10.1093/geroni/igab046.2167] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The transition to residential care facility may symbolize the joining into the 'community of older people'. This may influence the ways men in late life construct their identities and the intersection of aging and masculinity. Due to some barriers, this experience may be difficult to express explicitly. Bibliotherapy aims to bridge this gap by using literature to address diverse issues in the form of reading and writing activities. In this presentation we will present "The Literary Parliament" project, in which bibliotherapy and poetry groups of men in late life were conducted in residential care facilities in Israel. We will present findings of a qualitative research which explored poems written by group participants, and the way these helped participants to express their perceptions and feelings of ageing and masculinity in the context of residential care. The use of bibliotherapy to encourage psychological discourse among men in late life will be discussed.
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Affiliation(s)
- Melissa Hladek
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Qiwei Li
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Laura Samuel
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Brittany Drazich
- University of Maryland, Baltimore, Baltimore, Maryland, United States
| | - Thomas Cudjoe
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Sarah Szanton
- Johns Hopkins University, Baltimore, Maryland, United States
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17
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Li Q, Drazich B, Samuel L, Cudjoe T, Hladek M, Szanton S. Predicting Technology Use Among Older Adults During the COVID-19 Pandemic With Community Participation. Innov Aging 2021. [PMCID: PMC8680668 DOI: 10.1093/geroni/igab046.2169] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The social isolation imposed by the Covid-19 pandemic has significantly affected older adults, and has impacted both their physical and mental health. The pandemic has led to an increase in ageism associated with poorer mental health and a lower sense of dignity, self-esteem and contribution to society. This cross-cultural study involved 24 participants from Italy and Israel aged 79 to 92. The aim was to develop a brief art-based online intervention to enhance the participants’ sense of dignity and sense of meaning in life during this time of crisis. The process focused on the creation of digital photo-collages that captured the participants’ values through three perspectives: their past experiences, legacy, and future perspectives. It employed an arts-based research methodology to explore the participants’ experiences by analysing their relationship with the artistic expression, the photo collage, and its creative process.
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Affiliation(s)
- Qiwei Li
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Brittany Drazich
- University of Maryland, Baltimore, Baltimore, Maryland, United States
| | - Laura Samuel
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Thomas Cudjoe
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Melissa Hladek
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Sarah Szanton
- Johns Hopkins University, Baltimore, Maryland, United States
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18
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Samuel L, Hladek M, Cudjoe T, Drazich B, Li Q, Szanton S. Financial Changes and Health During COVID-19 in the National Health and Aging Trends Study. Innov Aging 2021. [DOI: 10.1093/geroni/igab046.2165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
This study tested associations between income decline and financial difficulty with mental health (lack of feeling anxious/depressed, recurring thoughts/nightmares, avoiding activities/thoughts, feeling jumpy/on guard) and sleep quality during COVID-19 among a national sample of 3,188 older adults. Approximately 8% of US older adults reported income decline and 6% reported financial difficulty. Although income decline and financial difficulty rates were both statistically significantly higher among those financially strained before COVID-19 (19% and 34%, respectively), income decline was more common among those with incomes ≥200% of the poverty threshold (9%) whereas financial difficulty was more common among those with incomes <200% poverty (10%). Adjusting for sociodemographic, health and depressive symptoms before COVID-19, financial difficulty was associated with worse mental health (b= -2.39, p<0.001) and sleep quality (b=-0.820, p<0.001), but income loss was not (b= -0.685, p=0.092 and b= -0.405, p=0.082, respectively). Timely interventions are needed for older adults reporting COVID-19 financial difficulty.
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Affiliation(s)
- Laura Samuel
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Melissa Hladek
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Thomas Cudjoe
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Brittany Drazich
- University of Maryland, Baltimore, Baltimore, Maryland, United States
| | - Qiwei Li
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Sarah Szanton
- Johns Hopkins University, Baltimore, Maryland, United States
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19
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Zia SQ, Mehrotra H, Tibbetts RJ, Samuel L. Correlation Of Pcr Ct Values With Symptom Onset Across Diagnostic Platforms For Sars-Cov-2. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.270] [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: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Following the definition of SARS-CoV2 outbreak as a pandemic by WHO, FDA gave EUA approval to the CDC real time polymerase chain reaction (PCR) assay and soon to other vendors to increase test availability. Most of testing platforms are PCR based, which test for multiple gene targets. We aimed to compare distribution of crossing threshold (cT) values of Diasorin (DIA), NeuMoDX (NDX) and Cepheid GenXpert (GX) for symptomatic and asymptomatic patients and assess performance of individual gene targets within the assays. We also correlated cT values with time from symptom onset.
Methods/Case Report
Retrospective review of medical and laboratory records of patients who tested positive for SARS-CoV2 between 08/01/2020 and 10/10/2020 on DIA, NDX, and GX platforms.
Results (if a Case Study enter NA)
We included 212 patients in our study. Days since symptom onset included 1 to 16 days. For DIA, mean Ct values for 46 symptomatic patients were 21.75 (S gene) and 22.74 (ORF1 gene); whereas 23.49 (S gene) and 25.49 (ORF1 gene) for 12 asymptomatic patients. Similarly, on NDX mean was 22.21 (N gene) and 23.13 (NSP2 gene) for 69 symptomatic, though 28.09 (N gene) and 28.61 (NSP2 gene) for 35 asymptomatic patients. GX manifested mean Ct value of 27.13 (E gene) and 31.22 (N2 gene) for 19 symptomatic; while 33.85 (E gene) and 36.42 (N2 gene) for 31 asymptomatic patients. Correlation coefficient for cT values versus days since symptom onset are DIA (r2 0.19), NDX (r2 0.22), and GX (r2 0.02).
Conclusion
The difference in cT values was statistically significant for symptomatic versus asymptomatic patients. There was positive correlation between days since symptom onset and cT values for DIA and NDX but not for GX, which may be due to difference in population tested in these platforms. These observations may be used to predict viral load and thus infectivity of patients who test positive for SARS-CoV2.
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Affiliation(s)
- S Q Zia
- Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, UNITED STATES
| | - H Mehrotra
- Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, UNITED STATES
| | - R J Tibbetts
- Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, UNITED STATES
| | - L Samuel
- Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, UNITED STATES
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20
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Perrott S, McDowell R, Murchie P, Cardwell C, Samuel L. SO-25 Global rise in early-onset colorectal cancer: An association with antibiotic consumption? Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Roberts L, Samuel L, Boyce D, Hladek M, LaFave S, Szanton S. The Home, Block, and Community Environments and Biomarkers of Aging in the National Health and Aging Trends Study. Innov Aging 2020. [PMCID: PMC7741000 DOI: 10.1093/geroni/igaa057.1976] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Prior studies have linked household and community conditions to the health and functioning of older adults. However, few studies have investigated associations between household, block, and community environmental conditions with biomarkers of aging. This study used NHATS Round 7 (2017) data on 3,283 community-dwelling older adults to test cross-sectional associations between interior and exterior household disorder, block disorder, community social cohesion, and four biomarkers: C-reactive protein, hemoglobin A1c, cytomegalovirus, and interleukin-6. Survey-weighted models adjusted for age, sex, race/ethnicity, income, education, homeownership, housing type, and metropolitan area; HbA1c was stratified by diabetes diagnosis. Greater interior household disorder was associated with higher IL-6 (β=0.06, SE=0.025, p=0.014) and, among diabetics, greater block disorder was associated with higher HbA1c (β=0.11, SE=0.05, p=0.046). These results link home and block environmental characteristics with biomarkers of aging, suggesting that modifiable aspects of older adults’ living environments may be related to disease and disability risk via physiologic dysregulation.
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Affiliation(s)
- Laken Roberts
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
| | - Laura Samuel
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Danielle Boyce
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
| | - Melissa Hladek
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Sarah LaFave
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Sarah Szanton
- Johns Hopkins University, Baltimore, Maryland, United States
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22
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Hladek M, Chung SE, Cudjoe TKM, Samuel L, Szanton S, Roth D. Greater Subjective Well-Being Associated With Lower Inflammatory Proteins in an Older Adult Sample From the NHATS. Innov Aging 2020. [PMCID: PMC7740239 DOI: 10.1093/geroni/igaa057.1977] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Subjective well-being (SWB), comprised of cognitive and affective evaluations of life, is associated with better health outcomes and lower mortality, but mechanisms are poorly understood. We examine the associations between SWB and its subscales with two biomarkers: Interleukin-6 (IL-6) and C-Reactive Protein (CRP), both common inflammatory indicators associated with mortality and increased cardiovascular disease. Dried blood spot data collected from 4,648 older adults NHATS participants in 2017 was used. After adjustment for age, sex, race/ethnicity, education, tobacco, body mass index and chronic disease, we found greater SWB and greater scores on subscales including positive affect, self-realization and personal mastery were all significantly associated with decreased IL-6 and CRP. Conversely, increases in negative affect was significantly associated with increased IL-6 and CRP values. This study adds evidence of a potential mechanistic mind-body connection pathway.
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Affiliation(s)
- Melissa Hladek
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Shang-En Chung
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Thomas K M Cudjoe
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Laura Samuel
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Sarah Szanton
- Johns Hopkins University, Baltimore, Maryland, United States
| | - David Roth
- Johns Hopkins University, Baltimore, Maryland, United States
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23
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Samuel L, Roberts L, Boyce D, Hladek M, LaFave S, Szanton S. Financial Resources and Biomarkers of Aging in the National Health and Aging Trends Study. Innov Aging 2020. [PMCID: PMC7743340 DOI: 10.1093/geroni/igaa057.1974] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Lower income and financial strain (i.e. difficulty making ends meet) are associated with worse aging biomarkers, but evidence among nationally representative samples is limited. This cross-sectional study tested whether income to poverty ratio (analyzed separately for those <500% vs. ≥500% poverty threshold) and financial strain are associated with biomarkers of aging among NHATS participants aged ≥65 years (n=4,648), adjusting for age, race/ethnicity, gender, smoking, BMI, and diabetes diagnosis for hemoglobin A1c. Sampling weights were applied. Among those with incomes <500% poverty, higher income was associated with lower hemoglobin A1c (b= -0.0196, p=0.007), CMV (b= -0.0689, p<0.001) and CRP (b= -0.0428, p=0.012). Among those with incomes ≥500%, higher income was associated with lower IL-6 (b= -0.0001, p=0.023) and lower CMV (b= -0.0001, p<0.001). Financial strain was not associated with biomarkers. Income is more strongly associated with biomarkers among the lower income group, calling for special attention to this vulnerable population.
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Affiliation(s)
- Laura Samuel
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Laken Roberts
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
| | - Danielle Boyce
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
| | - Melissa Hladek
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Sarah LaFave
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Sarah Szanton
- Johns Hopkins University, Baltimore, Maryland, United States
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24
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Lam J, Bridgewater J, Alani M, Mullamitha S, Braun M, Kunene V, Baijal S, Holden C, Aboud K, Chopra N, Escola CL, Rao A, Samuel L, Denton A, Grumett S, Melcher L, Muthuramalingam S, Sankey P, Saunders M, Shiu KK. 502P Nivolumab, alone or with ipilimumab, for mismatch repair deficient metastatic colorectal cancer: A United Kingdom multicentre analysis of patient outcomes. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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Samuel L, Szanton SL, Fedarko NS, Simonsick EM. Leveraging naturally occurring variation in financial stress to examine associations with inflammatory burden among older adults. J Epidemiol Community Health 2020; 74:892-897. [PMID: 32665370 DOI: 10.1136/jech-2020-213807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/27/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Financial strain is associated with earlier disability and mortality, but causal links are underexplored, partly because it is unethical to randomise people to financial stress. This study leverages naturally occurring random variation in days since monthly Social Security payment arrival among older adults to test associations with inflammatory biomarkers. METHODS Biomarker data, including tumour necrosis factor (TNF)-α, interleukin (IL)-6 and C reactive protein (CRP), was collected from 2155 non-working healthy adults aged 70-79 years, participating in the Health, Aging and Body Composition Study. Days since payment arrival was independent of all demographic, socioeconomic or health characteristics measured in this study. Restricted cubic spline models estimated associations separately for each week of the month, stratified by financial strain status (interaction term p value for TNF-α model <0.05). RESULTS Among financially strained older adults, more days since payment arrival was associated with higher TNF-α levels during the first week of the month (coefficient=0.102). Associations with IL-6 and CRP differed depending on the degree of financial strain (interaction term p values <0.05). Those with low, but not high, strain had lower levels of IL-6 (coefficient=-0.152) and CRP (coefficient=-0.179) during the first week. CONCLUSIONS Days since monthly payments were associated with inflammatory cytokines among older adults who have difficulty making ends meet financially and associations depended on financial strain severity, suggesting that results are attributable to monthly variation in financial stress. Future research should examine whether more frequent Social Security disbursement would modify financial strain and inflammatory biomarkers.
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Affiliation(s)
- Laura Samuel
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Neal S Fedarko
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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DePriest K, D'Aoust R, Samuel L, Commodore-Mensah Y, Hanson G, Slade EP. Nurse practitioners' workforce outcomes under implementation of full practice authority. Nurs Outlook 2020; 68:459-467. [PMID: 32593462 DOI: 10.1016/j.outlook.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/12/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Full practice authority laws that permit nurse practitioners (NPs) to practice independently and prescribe medications may influence NPs' workforce outcomes. PURPOSE To examine whether implementation of full practice authority laws affect NP self-employment, average earnings, and likelihood of residing in a primary care health professional shortage area (HPSA). METHODS A nationally representative U.S. sample of 9,782 NPs employed in health care during 2010 to 2018 was drawn from the American Community Survey. Difference-in-differences regression was used to estimate covariate-adjusted mean differences in NPs' workforce outcomes after full practice authority implementation. FINDINGS Among full-time employed NPs, full practice authority was associated with an increased probability of residing in a HPSA (adjusted odds ratio [aOR]:2.34, 95%CI 1.14, 4.83) and with a higher mean probability of self-employment (aOR:4.97, 95%CI 1.00, 24.86). DISCUSSION Full practice authority implementation improves access to primary care providers in health professional shortage areas and may increase practice ownership among NPs.
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Affiliation(s)
- Kelli DePriest
- Johns Hopkins University School of Nursing, Baltimore, MD.
| | - Rita D'Aoust
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - Laura Samuel
- Johns Hopkins University School of Nursing, Baltimore, MD
| | | | - Ginger Hanson
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - Eric P Slade
- Johns Hopkins University School of Nursing, Baltimore, MD
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Bower K, Samuel L, Gleason K, Thorpe RJ, Gaskin D. Disentangling Race, Poverty, and Place to Understand the Racial Disparity in Waist Circumference among Women. J Health Care Poor Underserved 2020; 31:153-170. [PMID: 32037324 PMCID: PMC7582235 DOI: 10.1353/hpu.2020.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the U.S., 54.8% of non-Hispanic Black women are obese, a rate that is 1.4 times greater than in White women. The drivers of this racial disparity are not yet clearly understood. We sought to disentangle race, household poverty, neighborhood racial composition, and neighborhood poverty to better understand the racial disparity in obesity among women. We used data from the 1999-2004 National Health and Nutrition Examination Survey and the 2000 U.S. Census to examine the role of individual race, individual poverty, neighborhood racial composition, and neighborhood poverty on women's risk of obesity. We found that individual race was the primary risk factor for obesity among women. Neighborhood effects did not account for the racial disparity. Understanding that race is a social, not a biologic construct, more work is needed to uncover what it is about race that produces racial disparities in obesity among women.
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Samuel L, Wright R, Spahr M, Roberts LC, Szanton SL. ROBBING PETER TO PAY PAUL: HANDLING FINANCIAL CHALLENGES AMONG LOW-INCOME OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6840147 DOI: 10.1093/geroni/igz038.017] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Low income older adults often face financial challenges which increase their risk for earlier disability and mortality. This study explored the social norms, beliefs and practices relevant to handling financial challenges among low-income community-dwelling older adults residing near Baltimore, MD whom we recruited using convenience and snowball sampling. Four vignette-based focus group sessions included 28 participants. Using hierarchical thematic analysis, three key themes emerged. First, the theme “Rob Peter to pay Paul” describes the consensus that individuals must prioritize financial needs, which required individuals to “work with a budget”, apply for aid, “cry for [aid]” and, when needed, “work something out” with landlords and lenders. One participant described the amount of work by saying “We’re retired but we’re working for ourselves.” Secondly, the theme “Your rent should be first” describes how low income older adults prioritize housing over food and other needs because “resources for housing is a problem” and because homelessness is both more permanent and socially stigmatizing than hunger - “Don’t nobody know you’re hungry unless you tell them, but everybody know when you outdoors.” Finally, the theme “We need to put the word out” describes the consensus that public benefits and community resources should be made more visible and accessible. Many individuals only know about resources because they seek information (“you go and you find out”), but “ it’s hard to ask for help. ” These results can inform the development and improvement of financial and community programs and policies for low-income older adults addressing financial challenges.
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Affiliation(s)
- Laura Samuel
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
| | - Rebecca Wright
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Melissa Spahr
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
| | - Laken C Roberts
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
| | - Sarah L Szanton
- Johns Hopkins School of Nursing, Baltimore, Maryland, United States
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Samuel L, Szanton SL, Fedarko N, Simonsick EM. NATURALLY OCCURRING VARIABILITY IN FINANCIAL STRESS AND INFLAMMATORY BIOMARKERS AMONG OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6840123 DOI: 10.1093/geroni/igz038.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Financial strain (i.e. difficulty making ends meet) is associated with earlier disability and mortality among older adults, but inflammatory response to financial stress is untested. This study leverages monthly increases in financial stress among older adults receiving Social Security payments monthly on the 3rd. The Health ABC Study randomly sampled black and white adults aged 70-79 free of disability from Memphis, TN and Pittsburgh, PA in 1997 and 1998. Baseline biomarkers included TNF α, IL-6, CRP, and soluble receptors were measured for about half the sample (IL-2, IL-6, and TNF α Type I and II). Days since Social Security payment was calculated using clinic visit date, which naturally varied in the sample. Restricted cubic spline models stratified by financial strain status tested hypothesized associations, adjusting for financial strain scores, food insecurity, employment status and monthly invariant potential confounders (age, gender, number of inflammatory conditions, waist circumference and anti-inflammatory medications). Among those with financial strain, each additional day since payment was associated with higher TNF-α levels during first week of the month (n=1,633, coefficient=0.0830, p=0.030) and higher IL-6 soluble receptor levels during the last week of the month (n=828, coefficient=12033.44, p=0.037), but not with other biomarkers nor during the middle of the month. Days since payment was not associated with biomarkers among those without financial strain. These results suggest upregulation of pro-inflammatory and not anti-inflammatory pathways during the beginning and end of the month among financially strained older adults. Financial strain is modifiable and these results call attention to addressing it.
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Affiliation(s)
- Laura Samuel
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
| | - Sarah L Szanton
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Neal Fedarko
- Johns Hopkins School of Medicine, Baltimore, Maryland, United States
| | - Eleanor M Simonsick
- Longitudinal Studies Section, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, United States
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Gleason KT, Dennison Himmelfarb CR, Ford DE, Lehmann H, Samuel L, Jain S, Naccarelli G, Aggarwal V, Nazarian S. Association of sex and atrial fibrillation therapies with patient-reported outcomes. Heart 2019; 105:1642-1648. [PMID: 31118198 DOI: 10.1136/heartjnl-2019-314881] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/08/2019] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Women report higher atrial fibrillation (AF) symptom severity and receive less AF therapies than their male counterparts. It is understudied if differences in AF therapies received explains sex differences in AF symptom severity. We investigate the impact of sex and AF therapies on patient-reported outcomes. METHODS Participants were recruited (n=953) across four academic medical centres with an AF diagnosis and age ≥18 years. Patient-reported outcomes (AF symptom severity, AF-related quality of life, functional status and emotional status) were determined by biannual surveys. We performed multiple linear regressions on propensity-matched cohorts to determine the association of AF therapies and sex on patient-reported outcomes. RESULTS Our study population (n=953) was 65% male (n=616), 93% white (n=890) and 72 (±10) years old. Individuals receiving rate control therapy reported comparatively lower AF-related quality of life (-7.22, 95% CI -11.51 to -2.92) and poorer functional status (-3.69, 95% CI -5.27 to -2.12). Individuals receiving rhythm control strategies did not report significantly different patient-reported outcomes. Women were more likely to report poorer functional status (-2.63, 95% CI -3.86 to -1.40) and poorer AF-related quality of life, higher anxiety (2.33, 95% CI 1.07 to 3.59), higher symptoms of depression (1.48, 95% CI 0.31 to 2.65) and AF symptom severity (0.29, 95% CI 0.07 to 0.52). CONCLUSIONS Female sex was associated with comparatively poorer AF symptom severity and quality of life, and this association remained after accounting for AF therapies received. Receiving rate control medication alone was associated with comparatively poorer AF-related quality of life and functional status.
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Affiliation(s)
| | | | | | - Harold Lehmann
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Laura Samuel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sandeep Jain
- Heart and Vascular Institute, University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gerald Naccarelli
- Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Vikas Aggarwal
- Division of Cardiology, Department of Internal Medicine, University of Michigan Health System, Ann Harbor, Michigan, USA
| | - Saman Nazarian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gleason KT, Dennison Himmelfarb CR, Ford DE, Lehmann H, Samuel L, Han HR, Jain SK, Naccarelli GV, Aggarwal V, Nazarian S. Association of sex, age and education level with patient reported outcomes in atrial fibrillation. BMC Cardiovasc Disord 2019; 19:85. [PMID: 30953478 PMCID: PMC6451250 DOI: 10.1186/s12872-019-1059-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 03/21/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In atrial fibrillation (AF), there are known sex and sociodemographic disparities in clinical outcomes such as stroke. We investigate whether disparities also exist with respect to patient-reported outcomes. We explored the association of sex, age, and education level with patient-reported outcomes (AF-related quality of life, symptom severity, and emotional and functional status). METHODS The PaTH AF cohort study recruited participants (N = 953) with an AF diagnosis and age ≥ 18 years across 4 academic medical centers. We performed longitudinal multiple regression with random effects to determine if individual characteristics were associated with patient-reported outcomes. RESULTS Women reported poorer functional status (β - 2.23, 95% CI: -3.52, - 0.94) and AF-related quality of life (β - 4.12, 95% CI: -8.10, - 0.14), and higher symptoms of anxiety (β 2.08, 95% CI: 0.76, 3.40), depression (β 1.44, 95% CI: 0.25, 2.63), and AF (β 0.29, 95% CI: 0.08, 0.50). Individuals < 60 years were significantly (p < 0.05) more likely to report higher symptoms of depression, anxiety, and AF, and poorer AF-related quality of life. Lack of college education was associated with reporting higher symptoms of AF (β 0.42, 95% CI: 0.17, 0.68), anxiety (β 1.86, 95% CI: 0.26, 3.45), and depression (β 1.11, 95% CI: 0.15, 2.38), and lower AF-related quality of life (β - 4.41, 95% CI: -8.25, - 0.57) and functional status. CONCLUSION Women, younger adults, and individuals with lower levels of education reported comparatively poor patient-reported outcomes. These findings highlight the importance of understanding why individuals experience AF differently based on certain characteristics.
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Affiliation(s)
- Kelly T Gleason
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA.
| | | | - Daniel E Ford
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Harold Lehmann
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Laura Samuel
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Hae Ra Han
- School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Sandeep K Jain
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Gerald V Naccarelli
- Penn State Milton S. Hershey Medical Center, State College, Hershey, PA, USA
| | - Vikas Aggarwal
- University of Michigan Health System/Frankel Cardiovascular Center, Ann Harbor, MI, USA
| | - Saman Nazarian
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Allen WL, Dunne PD, McDade S, Scanlon E, Loughrey M, Coleman H, McCann C, McLaughlin K, Nemeth Z, Syed N, Jithesh P, Arthur K, Wilson R, Coyle V, McArt D, Murray GI, Samuel L, Nuciforo P, Jimenez J, Argiles G, Dienstmann R, Tabernero J, Messerini L, Nobili S, Mini E, Sheahan K, Ryan E, Johnston PG, Van Schaeybroeck S, Lawler M, Longley DB. Transcriptional subtyping and CD8 immunohistochemistry identifies poor prognosis stage II/III colorectal cancer patients who benefit from adjuvant chemotherapy. JCO Precis Oncol 2018; 2018. [PMID: 30088816 PMCID: PMC6040635 DOI: 10.1200/po.17.00241] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose Transcriptomic profiling of colorectal cancer (CRC) has led to the identification of four consensus molecular subtypes (CMS1 to 4) that have prognostic value in stage II and III disease. More recently, the Colorectal Cancer Intrinsic Subtypes (CRIS) classification system has helped to define the biology specific to the epithelial component of colorectal tumors; however, the clinical value of these classification systems in the prediction of response to standard-of-care adjuvant chemotherapy remains unknown. Patients and Methods Using samples from four European sites, we assembled a novel cohort of patients with stage II and III CRC (n = 156 samples) and performed transcriptomic profiling and targeted sequencing and generated a tissue microarray to enable integrated multiomics analyses. We also accessed data from two published cohorts of patients with stage II and III CRC: GSE39582 and GSE14333 (n = 479 and n = 185 samples, respectively). Results The epithelial-rich CMS2 subtype of CRC benefitted significantly from treatment with adjuvant chemotherapy in both stage II and III disease (P = .02 and P < .001, respectively), whereas the CMS3 subtype significantly benefitted in stage III only (P = .001). After CRIS substratification of CMS2, we observed that only the CRIS-C subtype significantly benefitted from treatment with adjuvant chemotherapy in stage II and III disease (P = .0081 and P < .001, respectively), whereas the CRIS-D subtype significantly benefitted in stage III only (P = .0034). We also observed that CRIS-C patients with low levels of CD8+ tumor-infiltrating lymphocytes were most at risk for relapse in both stage II and III disease (log-rank P = .0031; hazard ratio, 12.18 [95% CI, 1.51 to 98.58]). Conclusion Patient stratification using a combination of transcriptional subtyping and CD8 immunohistochemistry analyses is capable of identifying patients with poor prognostic stage II and III disease who benefit from adjuvant standard-of-care chemotherapy. These findings are particularly relevant for patients with stage II disease, where the overall benefit of adjuvant chemotherapy is marginal.
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Affiliation(s)
- W L Allen
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - P D Dunne
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - S McDade
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - E Scanlon
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - M Loughrey
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - H Coleman
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - C McCann
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - K McLaughlin
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - Z Nemeth
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - N Syed
- Sidra Medical and Research Center, Qatar
| | - P Jithesh
- Sidra Medical and Research Center, Qatar
| | - K Arthur
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - R Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - V Coyle
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - D McArt
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | | | | | - P Nuciforo
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - J Jimenez
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - G Argiles
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - R Dienstmann
- University Hospital Vall d'Hebron, Barcelona, Spain
| | - J Tabernero
- University Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - E Mini
- University of Florence, Italy
| | - K Sheahan
- School of Medicine and Medical Science, University College Dublin
| | - E Ryan
- School of Medicine and Medical Science, University College Dublin
| | - P G Johnston
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - S Van Schaeybroeck
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - M Lawler
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
| | - D B Longley
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, UK
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Samuel L, Granbom M, Hupp C, Szanton S. AN EXPLORATION OF THE FINANCIAL SITUATIONS FACED BY LOW-INCOME OLDER ADULTS AND STRATEGIES FOR HANDLING FINANCES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1167] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Samuel
- Johns Hopkins University School of Nursing
| | - M Granbom
- Johns Hopkins University School of Nursing
| | - C Hupp
- Johns Hopkins University School of Nursing
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Kler S, Samuel L, Thomas K. SRPP Section Student Poster Award Finalists. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1208] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Kler
- Warren Alpert Medical School at Brown University
| | - L Samuel
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing
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Parker LJ, Taylor JL, Samuel L, Szanton SL, Gitlin LN. DISCRIMINATION AND EXECUTIVE FUNCTIONING AMONG A RACIALLY DIVERSE SAMPLE OF COMMUNITY-DWELLING ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2943] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- L J Parker
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - J L Taylor
- RN Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - L Samuel
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - S L Szanton
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - L N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA
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Samuel L, Roberts L, Thorpe R, Szanton S. FINANCIAL STRAIN PREDICTS INCIDENT DISABILITY IN OLDER ADULTS IN THE NATIONAL HEALTH AND AGING TRENDS STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1250] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Samuel
- Johns Hopkins University School of Nursing
| | - L Roberts
- Johns Hopkins University School of Nursing
| | - R Thorpe
- Johns Hopkins Bloomberg School of Public Health
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Samuel L, Al-Hajri T, Findlay E, Wells L. EP-1478: Anal cancer VMAT: Lumbosacral plexus DVHs with standard & escalated doses proposed in the ACT5 study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31787-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Samuel L, Szanton S. LOW INCOME OLDER SNAP PARTICIPANTS DO NOT HAVE LARGER WAIST CIRCUMFERENCE THAN NONPARTICIPANTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1840] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- L. Samuel
- Johns Hopkins University School of Nursing,
Baltimore, Maryland
| | - S.L. Szanton
- Johns Hopkins University School of Nursing,
Baltimore, Maryland
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Adams R, Brown E, Brown L, Butler R, Falk S, Fisher D, Kaplan R, Quirke P, Richman S, Samuel L, Seligmann J, Seymour M, Shiu K, Wasan H, Wilson R, Maughan T. FOCUS4-D: Results from a randomised, placebo controlled trial (RCT) of AZD8931 (an inhibitor of signalling by HER1, 2, and 3) in patients (pts) with advanced or metastatic colorectal cancer (aCRC) in tumours that are wildtype (wt) for BRAF, PIK3CA, KRAS & NRAS. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Subashini D, Dinesha T, Gomathi S, Boobalan J, Swathirajan C, Samuel L, Poongulali S, Chitra D, Srirama R, Mothi S, Solomon S, Solomon S, Saravanan S, Balakrishnan P. Mitochondrial dysfunction among HIV-1 infected patients of South India and evaluation of mitochondrial DNA as a biomarker of mitochondrial toxicity. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.601] [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: 11/24/2022] Open
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Parnaby CN, Scott NW, Ramsay G, MacKay C, Samuel L, Murray GI, Loudon MA. Prognostic value of lymph node ratio and extramural vascular invasion on survival for patients undergoing curative colon cancer resection. Br J Cancer 2015; 113:212-9. [PMID: 26079302 PMCID: PMC4506392 DOI: 10.1038/bjc.2015.211] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 04/20/2015] [Accepted: 05/14/2015] [Indexed: 02/06/2023] Open
Abstract
Background: Increasing lymph node ratio (LNR) (ratio of metastatic lymph nodes to the total number of harvested lymph nodes) and extramural vascular invasion (EMVI) have been proposed as adverse prognostic indicators in colorectal cancer, although their use remains variable and controversial. The aim of the present study was to assess the prognostic value of LNR and EMVI in predicting survival for patients undergoing curative colon cancer resection. Methods: Between 2006 and 2012, 922 patients underwent curative colon cancer resection. Surgical technique and pathological assessment did not change during the study period. Clinical and pathological data were collected from a prospectively maintained database. The primary outcome measure was overall survival and disease-free survival. LNR was separated into five categories based on three previously calculated cutoff values: LNR 0 (no lymph nodes involved), LNR 1 (ratio 0.01<0.17), LNR 2 (ratio 0.18–0.41), LNR 3 (ratio 0.42–0.69), and LNR 4 (ratio >0.70). Results: Nine hundred and twenty-two patients underwent colon cancer resection. The median follow-up for survivors was 52.8 months (IQR 34.6–77.6). The median total number of lymph nodes harvested was 16 (IQR13-22). On multivariate analysis, both pN and LNR were strongly associated with overall and disease-free survival. Using the Akaike information criterion (AIC), LNR had greater prognostic value compared with pN. For overall survival, compared with patients in LNR category 0, hazard ratios (95% CI) for those in categories 1, 2, 3 and 4 were 1.37 (1.03,1.82), 2.37 (1.70,3.30), 2.40 (1.57,3.65) and 5.51 (3.16,9.58), respectively. For disease-free survival, patients had hazard ratios (95% CI) of 1.78 (1.25,2.52), 3.79 (2.56,5.61), 2.60 (1.50,4.48) and 4.76 (2.21,10.27), respectively. The presence of EMVI was a significant predictor of decreased overall and disease-free survival (P<0.001). Conclusions: This study demonstrated, in the presence of high surgical, oncology and pathological standards, EMVI and increasing LNR were independent predictors of decreased overall and disease-free survival for patients undergoing curative colon cancer resection. LNR was superior to pN stage in predicting overall and disease-free survival.
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Affiliation(s)
- C N Parnaby
- Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - N W Scott
- Medical Statistics Team, University of Aberdeen, Aberdeen, UK
| | - G Ramsay
- Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - C MacKay
- Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - L Samuel
- Department of Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - G I Murray
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - M A Loudon
- Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
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Murchie P, Raja E, Lee A, Brewster D, Campbell N, Gray N, Ritchie L, Robertson R, Samuel L. Effect of longer health service provider delays on stage at diagnosis and mortality in symptomatic breast cancer. Breast 2015; 24:248-55. [DOI: 10.1016/j.breast.2015.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/09/2015] [Accepted: 02/14/2015] [Indexed: 10/23/2022] Open
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Samuel L, Basch CH, Ethan D, Hammond R, Chiazzese K. An analysis of sodium, total fat and saturated fat contents of packaged food products advertised in Bronx-based supermarket circulars. J Community Health 2015; 39:775-82. [PMID: 24488648 DOI: 10.1007/s10900-014-9829-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Americans' consumption of sodium, fat, and saturated fat exceed federally recommended limits for these nutrients and has been identified as a preventable leading cause of hypertension and cardiovascular disease. More than 40% of the Bronx population comprises African-Americans, who have increased risk and earlier onset of hypertension and are also genetically predisposed to salt-sensitive hypertension. This study analyzed nutrition information for packaged foods advertised in Bronx-based supermarket circulars. Federally recommended limits for sodium, saturated fat and total fat contents were used to identify foods that were high in these nutrients. The proportion of these products with respect to the total number of packaged foods was calculated. More than a third (35%) and almost a quarter (24%) of the 898 advertised packaged foods were high in saturated fat and sodium respectively. Such foods predominantly included processed meat and fish products, fast foods, meals, entrees and side dishes. Dairy and egg products were the greatest contributors of high saturated fat. Pork and beef products, fast foods, meals, entrees and side dishes had the highest median values for sodium, total fat and saturated fat content. The high proportion of packaged foods that are high in sodium and/or saturated fat promoted through supermarket circulars highlights the need for nutrition education among consumers as well as collaborative public health measures by the food industry, community and government agencies to reduce the amounts of sodium and saturated fat in these products and limit the promotion of foods that are high in these nutrients.
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Affiliation(s)
- L Samuel
- Dietetics, Foods, and Nutrition, Department of Health Sciences, Lehman College, The City University of New York, 250 Bedford Park Blvd. W., Bronx, NY, 10468, USA,
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Miceli MH, Gonulalan M, Perri MB, Samuel L, Al Fares MA, Brown K, Bruno DA, Zervos M, Ramesh M, Alangaden G. Transmission of infection to liver transplant recipients from donors with infective endocarditis: lessons learned. Transpl Infect Dis 2015; 17:140-6. [PMID: 25586791 DOI: 10.1111/tid.12330] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/25/2014] [Accepted: 10/07/2014] [Indexed: 12/16/2022]
Abstract
Donors not meeting standard criteria, such as those with bacteremia, are now being used in response to the increasing need for organs for transplantation. Recommended strategies to prevent the occurrence of donor-derived bacteremia include the use of directed antibiotic prophylaxis. However, this approach does not eliminate the risk of infection transmission. Similarly, the management of organ recipients from donors with infective endocarditis (IE) remains uncharacterized. We report 2 cases of donor-derived bacterial infections in liver transplant recipients despite pathogen-specific antibiotic prophylaxis. In both instances, the donors had documented IE treated with appropriate antimicrobial therapy and clearance of bacteremia. Recipients had very distinctive clinical outcomes likely related to pathogen virulence and the extent of donor infection. Persistent infection in the transplanted liver should be suspected in organ recipients of a liver from donors with IE, despite the absence of bacteremia at the time of death and organ procurement. For eradication, recipients may require prolonged pathogen-directed antimicrobial therapy, such as is used for endovascular infections. Prompt recognition of donors with IE, appropriate notification, and prolonged antibiotic prophylaxis are key to reducing the risk of such donor-derived infections.
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Affiliation(s)
- M H Miceli
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
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Gollins S, Sherman T, Byers H, Bowes J, Myint A, Susnerwala S, Haylock B, Wise M, Saunders M, Essapen S, Samuel L, Latif M, Azam F, Ryder D, Newman W. Relationship of Ugt1A and Abc Genetic Variants to Toxicity and Response in Preoperative Chemoradiation (Crt) with Concurrent Irinotecan for Locally Advanced Rectal Cancer (Larc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Glynne-Jones R, Kadalayil L, Meadows HM, Cunningham D, Samuel L, Geh JI, Lowdell C, James R, Beare S, Begum R, Ledermann JA, Sebag-Montefiore D. Tumour- and treatment-related colostomy rates following mitomycin C or cisplatin chemoradiation with or without maintenance chemotherapy in squamous cell carcinoma of the anus in the ACT II trial. Ann Oncol 2014; 25:1616-22. [PMID: 24827136 DOI: 10.1093/annonc/mdu188] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Squamous cell carcinoma of the anus (SCCA) is highly sensitive to chemoradiation (CRT) which achieves good loco-regional control and preserves anal function. However, some patients require permanent stoma formation either as a result of surgery on relapse, poor anal function or treatment-related symptoms. Our aim was to determine patient, tumour and treatment-related colostomy rates following CRT and maintenance chemotherapy in the ACT II trial. PATIENTS AND METHODS The ACT II trial recruited 940 patients comparing 5FU-based CRT using cisplatin (CisP) or mitomycin C (MMC) with or without additional maintenance chemotherapy. We investigated the association between colostomy-free survival (CFS) and progression-free survival (PFS) with age, gender, T-stage, N-stage, treatment and baseline haemoglobin. RESULTS The median follow-up was 5.1 years (n = 884 evaluable/940); tumour site canal (84%), margin (14%); stage T1/T2 (52%), T3/T4 (46%); N+ (32%), N0 (62%). Twenty out of 118 (17%) colostomies fashioned before CRT were reversed within 8 months. One hundred and twelve patients had a post-treatment colostomy due to persistent disease (98) or morbidity (14). Fifty-two per cent (61/118) of all pre-treatment colostomies were never reversed. The 5-year CFS rates were 68% MMC/Maint, 70% CisP/Maint, 68% MMC/No-maint and 65% CisP/No-maint. CRT with CisP did not improve CFS when compared with MMC (hazard ratio: 1.04, 95% confidence interval: 0.82-1.31, P = 0.74). The 5-year CFS rates were higher for T1/T2 (79%) than T3/T4 (54%) tumours and higher for node-negative (72%) than node-positive (60%) patients. Significant predictors of CFS were gender, T-stage and haemoglobin, while treatment factors had no impact on outcome. Similar associations were found between PFS and tumour/treatment-related factors. CONCLUSIONS The majority (52%) of pre-treatment colostomies were never reversed. Neither CRT with 5FU/CisP nor maintenance chemotherapy impacted on CFS. The low risk of colostomy for late effects (1.7%) is likely to be associated with the modest total radiotherapy dose. The predictive factors for CFS were T-stage, gender and baseline haemoglobin. CLINICAL TRIAL REGISTRATION NUMBER ISRCTN 26715889.
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Affiliation(s)
- R Glynne-Jones
- Department of Medical Oncology, Mount Vernon Centre for Cancer Treatment, Northwood
| | - L Kadalayil
- Cancer Research UK and University College London Cancer Trials Centre, London
| | - H M Meadows
- Cancer Research UK and University College London Cancer Trials Centre, London
| | | | - L Samuel
- Department of Clinical Oncology, Aberdeen Royal Infirmary, Aberdeen
| | - J I Geh
- Department of Oncology, Queen Elizabeth Hospital, Birmingham
| | - C Lowdell
- Department of Oncology, Imperial College Healthcare NHS Trust, London
| | - R James
- The Kent Cancer Centre, Tonbridge, Maidstone
| | - S Beare
- Cancer Research UK and University College London Cancer Trials Centre, London
| | - R Begum
- Cancer Research UK and University College London Cancer Trials Centre, London
| | - J A Ledermann
- Cancer Research UK and University College London Cancer Trials Centre, London
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Murchie P, Raja EA, Brewster DH, Campbell NC, Ritchie LD, Robertson R, Samuel L, Gray N, Lee AJ. Time from first presentation in primary care to treatment of symptomatic colorectal cancer: effect on disease stage and survival. Br J Cancer 2014; 111:461-9. [PMID: 24992583 PMCID: PMC4119995 DOI: 10.1038/bjc.2014.352] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/12/2014] [Accepted: 05/30/2014] [Indexed: 01/03/2023] Open
Abstract
Background: British 5-year survival from colorectal cancer (CRC) is below the European average, but the reasons are unclear. This study explored if longer provider delays (time from presentation to treatment) were associated with more advanced stage disease at diagnosis and poorer survival. Methods: Data on 958 people with CRC were linked with the Scottish Cancer Registry, the Scottish Death Registry and the acute hospital discharge (SMR01) dataset. Time from first presentation in primary care to first treatment, disease stage at diagnosis and survival time from date of first presentation in primary care were determined. Logistic regression and Cox survival analyses, both with a restricted cubic spline, were used to model stage and survival, respectively, following sequential adjustment of patient and tumour factors. Results: On univariate analysis, those with <4 weeks from first presentation in primary care to treatment had more advanced disease at diagnosis and the poorest prognosis. Treatment delays between 4 and 34 weeks were associated with earlier stage (with the lowest odds ratio occurring at 20 weeks) and better survival (with the lowest hazard ratio occurring at 16 weeks). Provider delays beyond 34 weeks were associated with more advanced disease at diagnosis, but not increased mortality. Following adjustment for patient, tumour factors, emergency admissions and symptoms and signs, no significant relationship between provider delay and stage at diagnosis or survival from CRC was found. Conclusions: Although allowing for a nonlinear relationship and important confounders, moderately long provider delays did not impact adversely on cancer outcomes. Delays are undesirable because they cause anxiety; this may be fuelled by government targets and health campaigns stressing the importance of very prompt cancer diagnosis. Our findings should reassure patients. They suggest that a health service's primary emphasis should be on quality and outcomes rather than on time to treatment.
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Affiliation(s)
- P Murchie
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - E A Raja
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - D H Brewster
- Scottish Cancer Registry, Information Services Division of NHS National Services Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, UK
| | - N C Campbell
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - L D Ritchie
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - R Robertson
- Scottish Collaboration for Public Health Research and Policy (SCPHRP), 20 West Richmond Street, Edinburgh EH8 9DX, UK
| | - L Samuel
- Department of Oncology, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZN, UK
| | - N Gray
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - A J Lee
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
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Hassan S, Mittal C, Amer S, Khalid F, Patel A, Delbusto R, Samuel L, Alangaden G, Ramesh M. Currently recommended BK virus (BKV) plasma viral load cutoff of ≥4 log10/mL underestimates the diagnosis of BKV-associated nephropathy: a single transplant center experience. Transpl Infect Dis 2013; 16:55-60. [PMID: 24283677 DOI: 10.1111/tid.12164] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [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: 12/22/2012] [Revised: 02/16/2013] [Accepted: 05/13/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND BK virus (BKV)-associated nephropathy (BKVAN) is a major cause of renal dysfunction and graft loss in renal transplant recipients. Monitoring plasma BK viral load (BKVL) is the recommended screening tool to predict BKVAN. American Society of Transplantation (AST) guidelines define a BKVL of ≥4 log10/mL (10,000 copies) as presumptive BKVAN and recommend reduction in immunosuppression. We evaluated the clinical sensitivity of the quantitative BKV DNA assay in predicting risk for BKVAN using the AST-recommended BKVL cutoff. METHODS In a retrospective, single-center study, all patients who underwent renal transplant at Henry Ford Hospital from January 2008 to August 2011 were analyzed (n = 490). Plasma BKVL Assay A (commercial large T antigen-based polymerase chain reaction [PCR]) was done in all patients. Renal biopsy was done if there was a rise in serum creatinine ≥0.5 mg from baseline. BKVAN was confirmed by biopsy. As a subset to this study, from the same cohort, data for a set of 20 consecutive Assays A and B (in-house VP1-based PCR assay) from 15 patients over a period of 3 months were collected. Differences in physicians' clinical decision-making (CDM) were analyzed between the 2 assays using chi-square test. RESULTS A total of 413 patients met the inclusion criteria, of which 222 patients had BK viremia. Among the 248 patients who had a renal biopsy done, 31 (12.5%) were found to have BKVAN. Eleven of the 31 (35%) patients had BKVL consistently <4 log10/mL, and thus were not diagnosed to have BKVAN using the AST-recommended BKVL cutoff of ≥4 log10/mL. A total of 8 patients lost their graft owing to BKVAN, including 3 patients with BKVL <4 log10/mL. Using a cutoff point of plasma BKVL of ≥4 log10/mL, the sensitivity, specificity, positive predictive value, and negative predicative value of the PCR Assay A for the diagnosis of biopsy-proven BKVAN were 64.5%, 98.4%, 87.0%, and 94.5%, respectively, and for the diagnosis of presumptive nephropathy were found to be 76.6%, 99.4%, 95.8%, and 96.4%, respectively. In the second part of the study, presumptive nephropathy was detected in 8 samples using Assay A and 14 samples using Assay B. Six samples in Assay A would have led to no changes in the CDM in terms of reduction in immunosuppression. Kidney biopsy was carried out in 5 patients, 4 of whom had BKVAN and had Assay B log count of ≥5. If Assay A had been used in CDM, BKVAN would have been missed in 1 patient. CONCLUSION Utilizing the current AST guideline cutoff of ≥4 log10 /mL, the PCR Assay A underestimated the diagnosis of BKVAN. Urgent standardization of the various BKVL assays and establishment of universal cutoff points is imperative to avoid BKVAN-related graft loss.
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Affiliation(s)
- S Hassan
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
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Siebert MW, Nolting SP, Hendrix W, Dhavala S, Craig C, Leonard BR, Stewart SD, All J, Musser FR, Buntin GD, Samuel L. Evaluation of corn hybrids expressing Cry1F, cry1A.105, Cry2Ab2, Cry34Ab1/Cry35Ab1, and Cry3Bb1 against southern United States insect pests. J Econ Entomol 2012; 105:1825-34. [PMID: 23156183 DOI: 10.1603/ec12155] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Studies were conducted across the southern United States to characterize the efficacy of multiple Bacillus thuringiensis (Bt) events in a field corn, Zea mays L., hybrid for control of common lepidopteran and coleopteran pests. Cry1F protein in event TC1507 and Cry1A.105 + Cry2Ab2 proteins in event MON 89034 were evaluated against pests infesting corn on above-ground plant tissue including foliage, stalks, and ears. Cry34Ab1/Cry35Ab1 proteins in event DAS-59122-7 and Cry3Bb1 in event MON 88017 were evaluated against the larvae of Mexican corn rootworm, Diabrotica virgifera zeae Krysan and Smith, which occur below-ground. Field corn hybrids containing Cry1F, Cry1A.105 + Cry2Ab2, Cry34Ab1/Cry35Ab1, and Cry3Bb1 insecticidal proteins (SmartStax) consistently demonstrated reductions in plant injury and/or reduced larval survivorship as compared with a non-Bt field corn hybrid. Efficacy provided by a field corn hybrid with multiple Bt proteins was statistically equal to or significantly better than corn hybrids containing a single event active against target pests. Single event field corn hybrids provided very high levels of control of southwestern corn borer, Diatraea grandiosella (Dyar), lesser cornstalk borer, Elasmopalpus lignosellus (Zeller), and fall armyworm, Spodoptera frugiperda (J.E. Smith), and were not significantly different than field corn hybrids with multiple events. Significant increases in efficacy were observed for a field corn hybrid with multiple Bt events for sugarcane borer, Diatraea saccharalis (F.), beet armyworm, Spodoptera exigua (Hübner), corn earworm, Helicoverpa zea (Boddie), and Mexican corn rootworm. Utilization of field corn hybrids containing multiple Bt events provides a means for managing insect resistance to Bt proteins and reduces non-Bt corn refuge requirements.
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Affiliation(s)
- M W Siebert
- Dow AgroSciences LLC, 753 HWY 438, Greenville, MS 38701, USA.
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Gray NM, Hall SJ, Browne S, Macleod U, Mitchell E, Lee AJ, Johnston M, Wyke S, Samuel L, Weller D, Campbell NC. Modifiable and fixed factors predicting quality of life in people with colorectal cancer. Br J Cancer 2011; 104:1697-703. [PMID: 21559017 PMCID: PMC3111166 DOI: 10.1038/bjc.2011.155] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: People with colorectal cancer have impaired quality of life (QoL). We investigated what factors were most highly associated with it. Methods: Four hundred and ninety-six people with colorectal cancer completed questionnaires about QoL, functioning, symptoms, co-morbidity, cognitions and personal and social factors. Disease, treatment and co-morbidity data were abstracted from case notes. Multiple linear regression identified modifiable and unmodifiable factors independently predictive of global quality of life (EORTC-QLQ-C30). Results: Of unmodifiable factors, female sex (P<0.001), more self-reported co-morbidities (P=0.006) and metastases at diagnosis (P=0.036) significantly predicted poorer QoL, but explained little of the variability in the model (R2=0.064). Adding modifiable factors, poorer role (P<0.001) and social functioning (P=0.003), fatigue (P=0.001), dyspnoea (P=0.001), anorexia (P<0.001), depression (P<0.001) and worse perceived consequences (P=0.013) improved the model fit considerably (R2=0.574). Omitting functioning subscales resulted in recent diagnosis (P=0.002), lower perceived personal control (P=0.020) and travel difficulties (P<0.001) becoming significant predictors. Conclusion: Most factors affecting QoL are modifiable, especially symptoms (fatigue, anorexia, dyspnoea) and depression. Beliefs about illness are also important. Unmodifiable factors, including metastatic (or unstaged) disease at diagnosis, have less impact. There appears to be potential for interventions to improve QoL in patients with colorectal cancer.
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Affiliation(s)
- N M Gray
- Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK.
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