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Lamb LE, Janicki JJ, Bartolone SN, Ward EP, Abraham N, Laudano M, Smith CP, Peters KM, Zwaans BMM, Chancellor MB. Risk Classification for Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) Using Machine Learning Based Predictions. Urology 2024:S0090-4295(24)00285-1. [PMID: 38677373 DOI: 10.1016/j.urology.2024.03.043] [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: 01/27/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES To improve diagnosis of IC/BPS(IC) we hereby developed an improved IC risk classification using machine learning algorithms. METHODS A national crowdsourcing resulted in 1,264 urine samples consisting of 536 IC (513 female, 21 male, 2 unspecified), and 728 age-matched controls (318 female, 402 male, 8 unspecified) with corresponding PRO pain and symptom scores. In addition, 296 urine samples were collected at three academic centers: 78 IC (71 female, 7 male) and 218 controls (148 female, 68 male, 2 unspecified). Urinary cytokine biomarker levels were determined using Luminex assay. A machine learning predictive classification model, termed the Interstitial Cystitis Personalized Inflammation Symptom (IC-PIS) Score, that utilizes PRO and cytokine levels, was generated and compared to a challenger model. RESULTS The top-performing model using biomarker measurements and PROs (AUC=0.87) was a support vector classifier, which scored better at predicting IC than PROs alone (AUC=0.83). While biomarkers alone (AUC=0.58) did not exhibit strong predictive performance, their combination with PROs produced an improved predictive effect. CONCLUSIONS IC-PIS represents a novel classification model designed to enhance the diagnostic accuracy of IC/BPS by integrating PROs and urine biomarkers. The innovative approach to sample collection logistics, coupled with one of the largest crowdsourced biomarker development studies utilizing ambient shipping methods across the US, underscores the robustness and scalability of our findings.
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Affiliation(s)
- Laura E Lamb
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA; Strata Oncology
| | | | - Sarah N Bartolone
- Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Elijah P Ward
- Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | | | | | | | - Kenneth M Peters
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA; Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA; Underactive Bladder Foundation, Pittsburgh, PA, USA
| | - Bernadette M M Zwaans
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA; Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Michael B Chancellor
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA; Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.
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Clearwater WL, Panushka K, Najor A, Laudano M, Fleischmann N. Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel. Urogynecology (Phila) 2024; 30:293-299. [PMID: 38484245 DOI: 10.1097/spv.0000000000001470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Urethral bulking is an alternative to synthetic midurethral sling for the treatment of stress urinary incontinence (SUI) in women. Urethral bulking agents, which are injected in the submucosal tissues of the proximal urethra/bladder neck, have demonstrated less adverse effects with similar satisfaction rates but lower subjective and objective cure rates when compared with midurethral sling. Cystoscopic Reconstruction of External Sphincter Technique (CREST) is a novel technique, which reinforces the natural closure mechanism of the external urinary sphincter (EUS). OBJECTIVE The aim of the study was to provide safety and efficacy data for injecting polyacrylamide hydrogel (PAHG) in the components of the female EUS. STUDY DESIGN This was a retrospective chart review of patients using CREST with PAHG as initial treatment for SUI by a single surgeon from January 2022 to October 2022. Exclusion criteria are as follows: younger than 18 years, prior SUI surgery, concomitant pelvic organ prolapse or reconstructive procedure, neurological conditions, or history of radiation. Subjective and objective cure rates were measured by patient-reported symptoms and cough stress test. Urinary retention, postoperative urinary infection, and de novo urinary urgency were assessed. RESULTS One hundred and thirteen consecutive patients met inclusion criteria with median follow-up of 3 months. Eighty-five percent of participants reported subjective improvement, 69% reported subjective cure, and 69% demonstrated objective cure. Nine patients reported transient postoperative retention, 8 reported postoperative urinary tract infections, and 5 reported de novo urgency. There were no serious adverse events. CONCLUSIONS CREST is a novel technique for injection of PAHG, into the EUS to treat SUI. Our data suggest that this technique could improve urethral injection outcomes with minimal complications.
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Affiliation(s)
| | | | - Anna Najor
- Urology, Albert Einstein College of Medicine, Montefiore Hospital
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Babar M, Loloi J, Labagnara K, Watts KL, Laudano M. Implementation of a shared research database to increase medical student awareness and involvement in urology research A pilot study. Can Urol Assoc J 2024; 18:E26-E31. [PMID: 37812792 PMCID: PMC10766337 DOI: 10.5489/cuaj.8468] [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: 10/11/2023]
Abstract
INTRODUCTION We aimed to assess the effect of a shared institutional research database on medical students' scholarly work, perceived research competency, and self-reported satisfaction. METHODS An institutional inventory database was created on Google Sheets with a listing of available mentors and a description of their ongoing research projects. The inventory database was shared with interested students and faculty. Students who agreed to participate were surveyed pre- and post-inventory. Survey questions assessed student demographics, prior research experience, and their perception of research competency and satisfaction. The number of presentations, publications, and articles pre- and post-inventory were also abstracted. Survey responses were compared using the Mann-Whitney U test. RESULTS A total of 20 students were surveyed pre-inventory and at a median followup of six months (5-7) post-inventory. There was a significant increase in scholarly presentations and publications post-inventory (p<0.05 for all). Furthermore, post-inventory, students reported feeling more confident in establishing an academic career, finding good mentors, managing their relationship with their mentor, managing professional challenges, and effectively showcasing themselves professionally and describing their research (p<0.05 for all). More than 65% of students agreed or strongly agreed that the database was easy to use, accessible, transparent, and would like a similar database created for other specialty departments. CONCLUSIONS After performing mentorship-guided research through an institutional research database, medical students felt more confident in their ability to perform research and produced more scholarly work. Therefore, we recommend a research database be created across all institutional departments to foster interest in conducting research.
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Affiliation(s)
- Mustufa Babar
- Albert Einstein College of Medicine, Bronx, NY , United States
| | - Justin Loloi
- Montefiore Medical Center, Department of Urology, Bronx, NY , United States
| | - Kevin Labagnara
- Albert Einstein College of Medicine, Bronx, NY , United States
| | - Kara L. Watts
- Montefiore Medical Center, Department of Urology, Bronx, NY , United States
| | - Melissa Laudano
- Montefiore Medical Center, Department of Urology, Bronx, NY , United States
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Kessler L, Illinsky D, Laudano M, Abraham NE. Do patients experience decisional regret after sacral neuromodulation for refractory overactive bladder? Neurourol Urodyn 2024; 43:22-30. [PMID: 37830272 DOI: 10.1002/nau.25286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/15/2023] [Accepted: 09/05/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Success following urological procedures is traditionally defined through objective endpoints. This approach may not capture the impact on patient satisfaction. There is a paucity of literature evaluating patient-centered metrics such as satisfaction and decisional regret in the field of urology. This study investigates long-term satisfaction and decisional regret amongst patients who underwent sacral neuromodulation (SNM) for the treatment of refractory overactive bladder (OAB). MATERIALS AND METHODS This study retrospectively reviewed patients who underwent SNM for refractory OAB from 2015 to 2022 at a single institution serving an ethnically diverse and underrepresented community. Demographic data were collected through chart review and surveys conducted via telephone calls. Patient satisfaction and decisional regret was measured with the validated modified SDS-DRS scale (satisfaction with decision scale-decision regret scale). Descriptive statistics, Wilcoxan rank sum, and median regression analyses were performed using STATA 15.0 with p < 0.05 as significant. RESULTS Out of 191 patients who underwent SNM, 63 were unreachable (wrong number in chart, number not in service, patient did not answer, deceased). Eighty-nine out of 128 patients reached agreed to participate (70% response rate). The mean time since surgery was 37.3 ±25.2 months. The median satisfaction with decision score was 4.0 (IQR: 3.7-4.7) with a score of 1 correlating with low satisfaction and a score of 5 correlating with high satisfaction. The median decisional regret score was 2.0 (IQR: 1.2-2.9) with a score of 1 correlating with low decisional regret and a score of 5 correlating with strong decisional regret. Ten patients reported complications after surgery, which was significantly associated with lower SDS and higher DRS scores (p < 0.01), and persisted after adjusting for age, body mass index, sex, and comorbidities (SDS β coef: -0.84, 95% CI: -1.5 to 0.15, p = 0.02; DRS β coef: 1.48, 95% CI: 0.55-2.41, p < 0.01). CONCLUSIONS Patients who underwent SNM for refractory OAB overall had low regret and high satisfaction with their decision at an average 3 years of follow-up. As expected, those who developed postoperative complications had worse scores. The inclusion of patient-centric outcomes is imperative when determining the success of a surgical procedure and is useful for shared decision-making when advancing to third-line therapy for OAB. Longer-term follow-up is necessary to assess durability of high satisfaction and low regret over time.
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Affiliation(s)
- Leia Kessler
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Illinsky
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Melissa Laudano
- Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Nitya E Abraham
- Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
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Janicki JJ, Ward EP, Bartolone SN, Lamb LE, Abraham N, Laudano M, Smith CP, Peters KM, Zwaans BM, Chancellor MB. Comparing online crowdsourcing with clinic patient enrollment: Findings from the IP4IC Study on interstitial cystitis/bladder pain syndrome. Digit Health 2023; 9:20552076231216280. [PMID: 38025103 PMCID: PMC10664419 DOI: 10.1177/20552076231216280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Interstitial cystitis/bladder pain syndrome (IC/BPS) manifests as urinary symptoms including urgency, frequency, and pain. The IP4IC Study aimed to establish a urine-based biomarker score for diagnosing IC/BPS. To accomplish this objective, we investigated the parallels and variances between patients enrolled via physician/hospital clinics and those recruited through online crowdsourcing. Methods Through a nationwide crowdsource effort, we collected surveys from patients with history of IC/BPS. Study participants were asked to complete the validated instruments of Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), as well as provide demographic information. We then compared the survey responses of patients recruited through crowdsourcing with those recruited from three specialized tertiary care urology clinics engaged in clinical research. Results Survey responses of 1300 participants were collected from all 50 states of the USA via crowdsourcing and 319 from a clinical setting. ICSI and ICPI were similar for IC/BPS patients diagnosed by the physicians in clinic and self-reported by subjects via crowdsourcing stating they have a history of previous physician diagnosis of IC/BPS. Surprisingly, ICSI and ICPI were significantly lower in crowdsourced control than in-clinic control subjects. Conclusion The IP4IC Study provides valuable insights into the similarities and differences between patients recruited through clinics and those recruited through online crowdsourcing. There were no significant differences in disease symptoms among these groups. Individuals who express an interest in digital health research and self-identify as having been previously diagnosed by physicians with IC/BPS can be regarded as reliable candidates for crowdsourcing research.
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Affiliation(s)
- Joseph J. Janicki
- Department of Urology, Underactive Bladder Foundation, Pittsburgh, PA, USA
| | - Elijah P. Ward
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Sarah N. Bartolone
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Laura E. Lamb
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nitya Abraham
- Department of Urology, Montefiore Medical Center, The Bronx, NY, USA
| | - Melissa Laudano
- Department of Urology, Montefiore Medical Center, The Bronx, NY, USA
| | | | - Kenneth M. Peters
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Bernadette M.M. Zwaans
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Michael B. Chancellor
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
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Sharma P, Lamb LE, Bartolone SN, Ward EP, Janicki JJ, Peters KM, Abraham N, Laudano M, Smith CP, Zwaans B, Chancellor MB. A Cost, Time, and Demographic Analysis of Participant Recruitment and Urine Sample Collection Through Social Media Optimization. Urol Pract 2022; 9:561-566. [PMID: 37145804 DOI: 10.1097/upj.0000000000000339] [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] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Clinical research can be expensive and time consuming due to high associated costs and/or duration of the study. We hypothesized that urine sample collection using online recruitment and engagement of research participants via social medial has the potential to reach a large population in a small timeframe, at a reasonable cost. METHODS We performed a retrospective cost analysis of a cohort study comparing cost per sample and time per sample for both online and clinically recruited participants for urine sample collection. During this time, cost data were collected based on study associated costs from invoices and budget spreadsheets. The data were subsequently analyzed using descriptive statistics. RESULTS Each sample collection kit contained 3 urine cups, 1 for the disease sample and 2 for control samples. Out of the 3,576 (1,192 disease + 2,384 control) total sample cups mailed, 1,254 (695 control) samples were returned. Comparatively, the 2 clinical sites collected 305 samples. Although the initial startup cost of online recruitment was higher, cost per sample for online recruited was found to be $81.45 compared to $398.14 for clinic sample. CONCLUSIONS We conducted a nationwide, contactless, urine sample collection through online recruitment in the midst of the COVID-19 pandemic. Results were compared with the samples collected in the clinical setting. Online recruitment can be utilized to collect urine samples rapidly, efficiently, and at a cost per sample that was 20% of an in-person clinic, and without risk of COVID-19 exposure.
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Affiliation(s)
- Prasun Sharma
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Laura E Lamb
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | | | - Elijah P Ward
- Beaumont Health Spectrum Health System, Royal Oak, Michigan
| | | | | | - Nitya Abraham
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Melissa Laudano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Christopher P Smith
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Bernadette Zwaans
- Beaumont Health Spectrum Health System, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Michael B Chancellor
- Beaumont Health Spectrum Health System, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Loloi J, Gottlieb J, MacDonald SM, Aboumohamed A, Ricci JA, Laudano M, Watts K. Case - Testicular thigh pouches for severe Fournier's gangrene: A how-to guide. Can Urol Assoc J 2022; 16:374-376. [PMID: 35621290 PMCID: PMC9565065 DOI: 10.5489/cuaj.7901] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Fournier’s gangrene is a surgical emergency that requires prompt debridement of infected tissue. When the majority of scrotum has been resected, placing the testicles into thigh pouches can allow for improved wound granulation/contracture prior to definitive tissue reconstruction. We present a surgical guide on how to create testicular thigh pouches without the use of thigh counter-incisions, and its utility in delayed wound healing for large scrotal wounds. This technique may serve as a valuable adjunct in the urologist’s and plastic surgeon’s armamentarium to optimize testicular coverage and subsequent genital reconstruction.
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Affiliation(s)
- Justin Loloi
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Josh Gottlieb
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Susan M. MacDonald
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Ahmed Aboumohamed
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Joseph A. Ricci
- Department of Plastic and Reconstructive Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Melissa Laudano
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Kara Watts
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
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Babar M, Zhu D, Loloi J, Laudano M, Ohmann E, Abraham N, Small AC, Watts KL. Comparison of Patient Satisfaction and Safety Outcomes for Postoperative Telemedicine vs Face-to-Face Visits in Urology: Results of the Randomized Evaluation and Metrics Observing Telemedicine Efficacy (REMOTE) Trial. Urol Pract 2022; 9:371-378. [PMID: 37145727 DOI: 10.1097/upj.0000000000000323] [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: 03/22/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There is a need to better understand the role of postoperative care via telemedicine (TM). We evaluated patient satisfaction and outcomes of postoperative face-to-face (F2F) versus TM visits for adult ambulatory urological surgeries in an urban academic center. Methods:This was a prospective, randomized controlled trial. At surgery, patients undergoing ambulatory endoscopic procedures or open surgery were randomized 1:1 to a postoperative F2F or TM visit. After the visit, a telephone survey assessing satisfaction was administered. Primary outcome was patient satisfaction; secondary outcomes were time and cost savings, and 30-day safety outcomes. Results:A total of 197 patients were approached; 165 (83%) consented and were randomized-76 (45%) to F2F and 89 (54%) to TM cohorts. There were no significant differences in baseline demographics between the cohorts. Both cohorts were equally satisfied with their postoperative visit (F2F 98.6% vs TM 94.1%, p=0.28) and found their visit to be an acceptable form of health care (F2F 100% vs TM 92.7%, p=0.06). The TM cohort saved a significant amount of time (TM 66.2% spent <15 minutes vs F2F 43.1% spent 1-2 hours, p <0.0001) and money (44.1% TM saved $5-$25 vs 43.1% F2F spent $5-$25, p=0.041) associated with travel. There were no significant differences in 30-day safety outcomes between the cohorts. Conclusions:TM for postoperative visits after ambulatory adult urological surgery saves patients time and money without compromising satisfaction or safety. TM should be offered as an alternative to F2F for routine postoperative care for certain ambulatory urological surgeries.
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Affiliation(s)
- Mustufa Babar
- Albert Einstein College of Medicine, Bronx, New York
| | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, New York
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Melissa Laudano
- Albert Einstein College of Medicine, Bronx, New York
- Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Erin Ohmann
- Albert Einstein College of Medicine, Bronx, New York
- Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Nitya Abraham
- Albert Einstein College of Medicine, Bronx, New York
- Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Alexander C Small
- Albert Einstein College of Medicine, Bronx, New York
- Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Kara L Watts
- Albert Einstein College of Medicine, Bronx, New York
- Department of Urology, Montefiore Medical Center, Bronx, New York
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Chancellor M, Lamb L, Ward E, Bartolone S, Carabulea A, Sharma P, Janicki J, Smith C, Laudano M, Abraham N, M. Zwaans B. Comparing concentration of urinary inflammatory cytokines in interstitial cystitis, overactive bladder, urinary tract infection, and bladder cancer. Urol Sci 2022. [DOI: 10.4103/uros.uros_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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English K, Maiman R, Laudano M, Abraham N. Urodynamics less likely to change diagnosis and management in uncomplicated overactive bladder. Can J Urol 2020; 27:10244-10249. [PMID: 32544048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Given the invasive nature of urodynamics and its unclear impact on altering patient management, we aimed to determine whether performing a urodynamic study (UDS) resulted in a change in either patient diagnosis or treatment offered in women with uncomplicated urinary incontinence. MATERIALS AND METHODS A retrospective review was performed of all female patients who underwent UDS for urinary incontinence at our practice between January 2014 and 2017. Patients with neurogenic lower urinary tract dysfunction, incomplete emptying, urinary retention, or prior anti-incontinence surgery were excluded. We compared the ICD-10 diagnosis and primary treatment offered in the absence of UDS to their post-UDS diagnosis and recommended therapy. Descriptive statistics, chi-squared, and multivariable analyses were performed. RESULTS A total of 141 patient charts were analyzed. The indications for UDS were mixed urinary incontinence (MUI) (45.3%), stress urinary incontinence (SUI) (29.1%), and overactive bladder (OAB) (25.5%). A change in diagnosis following UDS was seen in 40.4% of the entire cohort including 53.1% of patients with MUI and 48.8% of those with SUI compared to 8.3% of those with OAB. A change in treatment was seen in 32.6% of patients including 54.9% with MUI, 41.7% with SUI, and 10% with OAB. When compared to patients with SUI on adjusted multivariate logistic regression, those with OAB were less likely to have a change in either diagnosis (OR 0.06 (0.01-0.31)) or management (OR 0.15 (0.04-0.62)). CONCLUSIONS Diagnosis and management are unlikely to change after UDS in patients presenting with uncomplicated OAB. Conversely, UDS provided important diagnostic information that often changed management in those presenting with MUI and SUI. Our results suggest that UDS may be omitted in patients with uncomplicated refractory OAB in favor of earlier initiation of third line therapies.
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Affiliation(s)
- Keara English
- Albert Einstein College of Medicine, Bronx, New York, USA
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Tellechea* L, Urban-Maldonado M, Laudano M, Suadicani S. MP54-06 PANNEXIN 1 CHANNELS INVOLVEMENT IN MECHANISM OF STRESS-INDUCED PELVIC PAIN AND URINARY SYMPTOMS IN MICE. J Urol 2020. [DOI: 10.1097/ju.0000000000000916.06] [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: 11/25/2022]
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Pincus JB, Laudano M, Leegant A, Downing K. AUTHOR REPLY. Urology 2019; 128:46. [PMID: 31101305 DOI: 10.1016/j.urology.2018.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/04/2018] [Indexed: 10/26/2022]
Affiliation(s)
- Joseph B Pincus
- Division of Urogynecology, Department of Obstetrics and Gynecology, Northshore University Health System, Skokie, IL
| | - Melissa Laudano
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Ava Leegant
- Division of Urogynecology, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Keith Downing
- Division of Female Pelvic Medicine and Reconstructive Surgery, Good Samaritan Hospital Medical Center of Catholic Health Services of Long Island, West Islip, NY
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Pincus JB, Laudano M, Leegant A, Downing K. Female Urethral Diverticula: Diagnosis, Pathology, and Surgical Outcomes at an Academic, Urban Medical Center. Urology 2019; 128:42-46. [PMID: 30844385 DOI: 10.1016/j.urology.2018.12.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the outcomes of a series of women diagnosed with a urethral diverticulum at an urban tertiary care center. METHODS An Institutional Review Board-approved review of a series of 78 women with a diagnosis of urethral diverticulum from 2009 to 2015 was performed. Clinical, radiographic, and pathologic data was collected by retrospective review of patient medical records. Data regarding treatment selection and postoperative outcomes were collected. A multivariable logistic regression was performed to identify preoperative variables that were associated with undergoing surgical resection. RESULTS Of the 78 patients reviewed, the median age was 45.5 years (interquartile range (IQR) 36.0-53.8), median body mass index was 30.4 (IQR 24.8-34.4). The most common presenting symptoms included: incontinence (39%), recurrent urinary tract infections (23%), dysuria (18%), discharge (13%), dyspareunia (12%), and hematuria (9%). Additionally, 16 (21%) women were asymptomatic. Of these 78 cases, 40 underwent surgical excision (51%). Of the remaining 38, 13 were symptomatic and lost to follow-up, 23 were managed expectantly, and 2 underwent surgery after the study period. Review of the pathology results revealed that the most common finding was squamous metaplasia (31%). There was 1 adenocarcinoma in the series (2.5%). Of the 40 patients who had surgery, 3 (7.5%) had a diverticular recurrence and 5 (12.5%) developed stress urinary incontinence. The median follow-up was 7.5 months (IQR 1-20.25 months). CONCLUSION A variety of presenting symptoms existed for women with a urethral diverticulum seeking medical care at an urban medical center. When controlling for age, body mass index, and race, the presence of preoperative symptoms was associated with undergoing surgical resection.
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Affiliation(s)
- Joseph B Pincus
- Division of Urogynecology, Department of Obstetrics and Gynecology, Northshore University Health System/University of Chicago Pritzker School of Medicine, Skokie, IL.
| | - Melissa Laudano
- Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Ava Leegant
- Division of Urogynecology, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Keith Downing
- Division of Female Pelvic Medicine and Reconstructive Surgery, Good Samaritan Hospital Medical Center of Catholic Health Services of Long Island, West Islip, NY
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Laudano M, Urban-Maldonado M, Sun H, Thi M, Suadicani S. MP82-13 BLADDER DISTENSION REGULATES PANNEXIN 1 EXPRESSION IN THE BLADDER UROTHELIUM. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2560] [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: 10/19/2022]
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15
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Kadam-Halani P, Laudano M, Cui N, Harroche J, Carlos D, Fleischmann N, Fligelman T, Leegant A, Downing K. V2-06 CONSTRUCTION OF A VAGINAL VAULT MODEL TO EDUCATE RESIDENTS IN THE PELVIC ORGAN PROLAPSE QUANTIFICATION SYSTEM. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2660] [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: 11/16/2022]
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16
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Chughtai B, Laudano M, Dunphy C, Lee R, Kaplan SA, Te A. Corrigendum to “A pilot study of fesoterodine in the management of men with refractory overactive bladder symptoms after surgery for bladder outlet obstruction” [Urol Sci (2015) 38–40]. Urological Science 2015. [DOI: 10.1016/j.urols.2015.06.289] [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: 10/23/2022] Open
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17
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Wang L, Al Hussein Al Awamlh B, Schubert T, Laudano M, Lee D, Davidson W, Schulster M, Zhao F, Chughtai B, Lee R. MP32-16 TRENDS IN MESH USE IN PELVIC ORGAN PROLAPSE REPAIR. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1412] [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: 11/30/2022]
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18
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Chughtai B, Laudano M, Dunphy C, Lee R, Kaplan SA, Te A. A pilot study of the use of fesoterodine in the management of men with refractory overactive bladder symptoms after surgery for bladder outlet obstruction. Urological Science 2015. [DOI: 10.1016/j.urols.2014.06.003] [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: 10/24/2022] Open
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19
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Laudano M, Seklehner S, Te A, Kaplan SA, Chughtai B, Lee R. MP75-05 NATIONAL TRENDS IN THE USAGE OF SACRAL NERVE STIMULATION AMONG MEDICARE BENEFICIARIES. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2378] [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: 11/30/2022]
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20
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Seklehner S, Laudano M, Zhao F, Chughtai B, Lee R. MP38-15 A META-ANALYSIS COMPARING EFFICACY AND COMPLICATIONS AFTER RETROPUBIC MIDURETHRAL SLINGS AND TRANSOBTURATOR MIDURETHRAL SLINGS IN THE TREATMENT OF FEMALE STRESS URINARY INCONTINENCE. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1272] [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: 10/25/2022]
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21
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Laudano M, Osterberg EC, Sheth S, Ramasamy R, Sterling J, Mukherjee S, Robinson B, Parekattil S, Goldstein M, Li P, Schlegel P. V1583 MICROSURGICAL DENERVATION OF RAT SPERMATIC CORD: SAFETY AND EFFICACY DATA. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.3133] [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: 10/27/2022]
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Chughtai B, Lee R, Kurlander L, Yip-Bannicq M, Feliz M, Laudano M, Li P, Kaplan S, Te A. 2108 COMPARISON OF TECHNIQUES FOR TRANSURETHRAL LASER PROSTATECTOMY: STANDARD PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (PVP) VERSUS TRANSURETHRAL LASER ENUCLEATION OF THE PROSTATE (TLEP). J Urol 2011. [DOI: 10.1016/j.juro.2011.02.2304] [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: 11/16/2022]
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Barlow LJ, Korets R, Laudano M, Benson M, McKiernan J. Predicting renal functional outcomes after surgery for renal cortical tumours: a multifactorial analysis. BJU Int 2009; 106:489-92. [PMID: 20039869 DOI: 10.1111/j.1464-410x.2009.09147.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the functional outcomes after radical (RN) and partial nephrectomy (PN) stratified by variables before and after surgery, using estimated glomerular filtration rate (eGFR), as nephrectomy is the standard treatment for localized renal tumours, but the risk of developing chronic kidney disease (CKD) increases after surgery. PATIENTS AND METHODS We retrospectively analysed patients treated with PN or RN for renal cancer at one institution from 1988 to 2008. Chronic renal function before and after surgery was measured using the eGFR computed using the Modification of Diet in Renal Disease equation. Four outcomes were measured: (i) presence of new-onset renal insufficiency (eGFR <60 mL/min/1.73m(2)); (ii) the percentage change in eGFR; (iii) the change in CKD stage; and (iv) the presence of CKD upstaging. Regression models were used to determine the effect of surgical procedure (RN vs PN), access technique (open vs laparoscopic) and several preoperative characteristics on functional outcomes. RESULTS In all, 276 patients met the inclusion criteria (174 RN and 102 PN) of whom 209 had a preoperative eGFR of >60 mL/min/1.73m(2). After >or=3 months from surgery, 108/209 (52%) patients developed new-onset eGFR of <60 mL/min/1.73m(2). On multivariate analysis, preoperative CKD stage (P < 0.001) and procedure (P= 0.001) were both independent predictors of all four functional outcomes measured. Also, hypertension was an independent predictor of CKD upstaging (P= 0.02). Surgical access technique was not an independent predictor of any of the renal functional outcomes measured. CONCLUSION Patients undergoing renal surgery have a high rate of new-onset CKD afterward. After controlling for preoperative risk factors, patients undergoing RN are at greater risk of a decline in renal function. However, surgical access technique was not a significant predictor for renal impairment.
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Affiliation(s)
- Lamont J Barlow
- Department of Urology, Columbia University Medical Center, New York, NY, USA.
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Barlow L, Laudano M, Mann M, Desai M, Petrylak D, Benson M, McKiernan J. A combined phase I/II trial of intravesical nanoparticle albumin-bound paclitaxel in the treatment of refractory non–muscle- invasive transitional cell bladder cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16047 Background: Up to 50% of patients treated with intravesical agents for non-muscle-invasive bladder cancer will recur. Response rates to current second line intravesical therapies average less than 20%. For these high risk patients, novel agents are necessary. Our previously completed phase I trial showed docetaxel to be a safe and efficacious agent for intravesical therapy. Nanoparticle albumin-bound (nab-) paclitaxel has been shown to have increased solubility and lower toxicity compared to docetaxel in systemic therapy and is therefore an appropriate candidate for further investigation as an intravesical agent. Methods: The ongoing phase I component of this combined phase I/II trial began enrollment on 1/1/08 and has reached 72% accrual as of 1/1/09. Inclusion criteria include recurrent high grade (HG) Ta, T1 and Tis transitional cell carcinoma failing at least one prior regimen with any intravesical agent. In phase I, 6 weekly instillations of nab-paclitaxel were administered beginning at a dose of 150 mg with a dose escalation model used until a maximal tolerated dose (MTD) was achieved. The primary endpoints were dose- limiting toxicity (DLT) and MTD; the secondary endpoint was response rate. Efficacy was evaluated by cystoscopy with biopsy, cytology, and CT imaging. Results: 13/18 patients have enrolled in this phase I trial to date, and the distribution of stages included 5 patients with Tis, 4 patients with HGTa, and 4 patients with HGT1. No patient has had any systemic absorption of nab-paclitaxel as measured by HPLC assays, and no grade 3 or 4 DLT has been encountered. Fifty-four percent (7/13) patients were noted to experience grade 1 toxicities, with dysuria being the most common. Forty-two percent (5/12) of completed patients had no evidence of disease at their post-treatment cystoscopy. None of the patients who developed recurrent disease have had disease progression. Conclusions: Intravesical nab-paclitaxel has exhibited minimal toxicity and no systemic absorption in the first ever human intravesical dose escalation trial. Upon completion of this ongoing phase I trial, we plan to evaluate this agent in a larger phase II efficacy study. No significant financial relationships to disclose.
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Affiliation(s)
- L. Barlow
- Columbia University College of Physicians and Surgeons, New York, NY
| | - M. Laudano
- Columbia University College of Physicians and Surgeons, New York, NY
| | - M. Mann
- Columbia University College of Physicians and Surgeons, New York, NY
| | - M. Desai
- Columbia University College of Physicians and Surgeons, New York, NY
| | - D. Petrylak
- Columbia University College of Physicians and Surgeons, New York, NY
| | - M. Benson
- Columbia University College of Physicians and Surgeons, New York, NY
| | - J. McKiernan
- Columbia University College of Physicians and Surgeons, New York, NY
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Korets R, Barlow L, Laudano M, Benson M, McKiernan J. Predicting renal functional outcomes after surgery for renal cortical tumors: A multifactorial retrospective analysis. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16005 Background: Nephrectomy (Nx) is the standard of care for localized renal tumors. The risk of developing chronic renal insufficiency (CRI) increases after renal surgery. This study examines the functional outcomes for radical and partial Nx stratified by pre- and perioperative variables using estimated GFR. Methods: Using the Columbia Urologic Oncology Database, a retrospective analysis of patients treated with partial or radical Nx for renal cancer from 1988 to 2008 was conducted. Postoperative chronic renal function was measured using GFR as estimated by the MDRD study equation. Three primary outcomes were measured: 1) presence of new onset postoperative CRI (defined as GFR lower than 60 mL/min per 1.73 m2), 2) percent change in postoperative GFR from preoperative value, and 3) change in CRI stage postoperatively. Regression models were used to determine the effect of surgical procedure (radical vs partial Nx), approach, and multiple preoperative characteristics on functional outcomes. Results: 174 patients met the criteria for analysis after radical Nx and 102 after partial Nx for a total of 276 patients. 209 patients had preoperative GFR > 60, 67 had preoperative GFR < 60, and 6 had preoperative GFR < 30. After a minimum of 3 months postoperatively, 108/209 (52%) and 2/209 (1%) patients developed new-onset GFR <60 and <30, respectively. On multivariate analysis controlling for age, sex, race, diabetes and hypertension, preoperative CKD stage (p<0.001) and procedure (p<0.001) were both independent predictors of GFR progression to <60; similarly, preoperative CKD stage (p<0.001) and procedure (p<0.01) were independent predictors of percent change in postoperative GFR. Patient with worsened preoperative CRI stage were less likely to have further progression of CRI postoperatively (p<0.001) independent of the surgical procedure. Surgical approach was not an independent predictor of any renal functional outcomes measured. Conclusions: Patients undergoing renal surgery have a high rate of new-onset postoperative renal failure. After controlling for preoperative risk factors, patients undergoing radical Nx are at higher risk for decline in renal function. Surgical approach, however, was not a significant predictor for the development of CRI. No significant financial relationships to disclose.
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Affiliation(s)
- R. Korets
- Columbia University Medical Center, New York, NY
| | - L. Barlow
- Columbia University Medical Center, New York, NY
| | - M. Laudano
- Columbia University Medical Center, New York, NY
| | - M. Benson
- Columbia University Medical Center, New York, NY
| | - J. McKiernan
- Columbia University Medical Center, New York, NY
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Giardina EGV, Laudano M, Hurstak E, Saroff A, Fleck E, Sciacca R, Boden-Albala B, Cassetta J. Physical activity participation among Caribbean Hispanic women living in New York: relation to education, income, and age. J Womens Health (Larchmt) 2009; 18:187-93. [PMID: 19183090 PMCID: PMC2945715 DOI: 10.1089/jwh.2008.0946] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Inadequate participation in physical activity is a serious public health issue in the United States, with significant disparities among population groups. In particular, there is a scarcity of information about physical activity among Caribbean Hispanics, a group on the rise. METHODS Our goal was to accumulate data on physical activity among Caribbean Hispanic women living in New York and determine the relation between physical activity and age, marital status, education, income, primary language, and children in the household. To this end, a survey adapted from the National Health Interview Survey of the National Center for Health Statistics assessing type, frequency, and duration of physical activity was administered. RESULTS There were 318 self-identified Hispanic women who participated. Total activity time, mean 385 +/- 26 minutes, and education (r = 0.14, p < 0.01) were significantly related. Women who had attended some college had greater total activity time than those with some high school education (p = 0.046) or < 8th grade education (p = 0.022). Walking as a form of transportation was the most frequent pursuit, 285 +/- 21 minutes. Age (r = -0.34, p < 0.001) and education (r = 0.25, p < 0.001) correlated with nonwalking activity time (leisure time). Nonwalking activity times were greater in younger, that is, 18-29 years (p < 0.001) and college-educated women (p < 0.001). Physical activity recommendations were met by 11%; and 17% reported no physical activity. CONCLUSIONS Among Caribbean Hispanic women living in New York City, the current recommendations for physical activity are met by 11%, and physical activity and education are significantly related. Our observation that education is a critical factor related to physical activity suggests that programs to address the promotion of a physically active lifestyle are needed.
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Affiliation(s)
- Elsa-Grace V Giardina
- Center for Women's Health, Division of Cardiology, Columbia University Medical Center, New York, New York, USA.
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