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Harding CC, Goldstein KM, Goldstein SA, Wheeler SM, Mitchell NS, Copeland LA. Maternal chronic hypertension in women veterans. Health Serv Res 2024; 59:e14277. [PMID: 38234056 PMCID: PMC10915474 DOI: 10.1111/1475-6773.14277] [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] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To describe the prevalence of maternal chronic hypertension (MCH), assess how frequently blood pressure is controlled before pregnancy among those with MCH, and explore management practices for antihypertensive medications (AHM) during the pre-pregnancy and pregnancy periods. DATA SOURCES, STUDY SETTING, AND STUDY DESIGN We conducted a descriptive observational study using data abstracted from the Veterans Health Administration (VA) inclusive of approximately 11 million Veterans utilizing the VA in fiscal years 2010-2019. DATA COLLECTION/EXTRACTION METHODS Veterans aged 18-50 were included if they had a diagnosis of chronic hypertension before a documented pregnancy in the VA EMR. We identified chronic hypertension and pregnancy with diagnosis codes and defined uncontrolled blood pressure as ≥140/90 mm Hg on at least one measurement in the year before pregnancy. Sensitivity models were conducted for individuals with at least two blood pressure measurements in the year prior to pregnancy. Multivariable logistic regression explored the association of covariates with recommended and non-recommended AHMs received 0-6 months before pregnancy and during pregnancy. PRINCIPAL FINDINGS In total, 8% (3767/46,178) of Veterans with a documented pregnancy in VA data had MCH. Among 2750 with MCH meeting inclusion criteria, 60% (n = 1626) had uncontrolled blood pressure on at least one BP reading and 31% (n = 846) had uncontrolled blood pressure on at least two BP readings in the year before pregnancy. For medications, 16% (n = 437) received a non-recommended AHM during pregnancy. Chronic kidney disease (OR = 3.2; 1.6-6.4) and diabetes (OR = 2.3; 1.7-3.0) were most strongly associated with use of a non-recommended AHM during pregnancy. CONCLUSIONS Interventions are needed to decrease the prevalence of MCH, improve preconception blood pressure control, and ensure optimal pharmacologic antihypertensive management among Veterans of childbearing potential.
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Affiliation(s)
- Ceshae C. Harding
- Department of Medicine, Division of General Internal MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Karen M. Goldstein
- Department of Medicine, Division of General Internal MedicineDuke UniversityDurhamNorth CarolinaUSA
- Durham VA Health Care SystemDurhamNorth CarolinaUSA
| | - Sarah A. Goldstein
- Department of Medicine, Division of Cardiovascular MedicineYale New Haven Health SystemNew HavenConnecticutUSA
| | - Sarahn M. Wheeler
- Department of Obstetrics and Gynecology, Division of Maternal‐Fetal MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Nia S. Mitchell
- Department of Medicine, Division of General Internal MedicineDuke UniversityDurhamNorth CarolinaUSA
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Dorfman CS, Fisher HM, Thomas S, Kelleher SA, Winger JG, Mitchell NS, Miller SN, Somers TJ. Breast cancer survivors with pain: an examination of the relationships between body mass index, physical activity, and symptom burden. Support Care Cancer 2023; 31:604. [PMID: 37782420 PMCID: PMC10721211 DOI: 10.1007/s00520-023-08064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Overweight and obesity are common for breast cancer survivors and associated with high symptom burden (i.e., pain, fatigue, depressive symptoms). Physical activity may protect breast cancer survivors with higher body mass indexes (BMI) from increased symptoms. However, the role of physical activity in buffering the relationship between higher BMI and greater symptoms is unclear. METHODS Baseline data from a randomized trial investigating Pain Coping Skills Training among breast cancer survivors (N = 327) with pain were used to examine the relationship between self-reported BMI (kg/m2) and physical activity level (Rapid Assessment of Physical Activity; suboptimal vs. optimal) with pain (Brief Pain Inventory; severity and interference), fatigue (PROMIS-Fatigue short form), and depressive symptoms (Center for Epidemiological Studies Depression Scale). Analyses were conducted in SPSS. Hayes PROCESS macro (Model 1) assessed whether physical activity moderated the relationship between BMI and symptoms. RESULTS Lower BMI (B = .06, p < .01) and optimal physical activity (B = - .69, p < .01) were independently associated with lower pain interference. Lower BMI was also associated with lower pain severity (B = .04, p < .001). Neither BMI nor physical activity was associated with fatigue or depressive symptoms. Physical activity did not moderate the relationship between BMI and symptoms. CONCLUSIONS Among breast cancer survivors experiencing pain, higher BMI and being less physically active were related to greater pain (i.e., severity and/or interference). Physical activity did not buffer the relationships between BMI and pain, fatigue, and depressive symptoms, suggesting that physical activity alone may not be sufficient to influence the strength of the relationships between BMI and symptoms.
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Affiliation(s)
- Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
| | - Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Samantha Thomas
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Nia S Mitchell
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Shannon N Miller
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Bhavsar NA, Yang LZ, Phelan M, Shepherd-Banigan M, Goldstein BA, Peskoe S, Palta P, Hirsch JA, Mitchell NS, Hirsch AG, Lunyera J, Mohottige D, Diamantidis CJ, Maciejewski ML, Boulware LE. Association between Gentrification and Health and Healthcare Utilization. J Urban Health 2022; 99:984-997. [PMID: 36367672 PMCID: PMC9727003 DOI: 10.1007/s11524-022-00692-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/13/2022]
Abstract
There is tremendous interest in understanding how neighborhoods impact health by linking extant social and environmental drivers of health (SDOH) data with electronic health record (EHR) data. Studies quantifying such associations often use static neighborhood measures. Little research examines the impact of gentrification-a measure of neighborhood change-on the health of long-term neighborhood residents using EHR data, which may have a more generalizable population than traditional approaches. We quantified associations between gentrification and health and healthcare utilization by linking longitudinal socioeconomic data from the American Community Survey with EHR data across two health systems accessed by long-term residents of Durham County, NC, from 2007 to 2017. Census block group-level neighborhoods were eligible to be gentrified if they had low socioeconomic status relative to the county average. Gentrification was defined using socioeconomic data from 2006 to 2010 and 2011-2015, with the Steinmetz-Wood definition. Multivariable logistic and Poisson regression models estimated associations between gentrification and development of health indicators (cardiovascular disease, hypertension, diabetes, obesity, asthma, depression) or healthcare encounters (emergency department [ED], inpatient, or outpatient). Sensitivity analyses examined two alternative gentrification measures. Of the 99 block groups within the city of Durham, 28 were eligible (N = 10,807; median age = 42; 83% Black; 55% female) and 5 gentrified. Individuals in gentrifying neighborhoods had lower odds of obesity (odds ratio [OR] = 0.89; 95% confidence interval [CI]: 0.81-0.99), higher odds of an ED encounter (OR = 1.10; 95% CI: 1.01-1.20), and lower risk for outpatient encounters (incidence rate ratio = 0.93; 95% CI: 0.87-1.00) compared with non-gentrifying neighborhoods. The association between gentrification and health and healthcare utilization was sensitive to gentrification definition.
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Affiliation(s)
- Nrupen A Bhavsar
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
| | | | | | - Megan Shepherd-Banigan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham VA Medical Center, Durham, NC, USA
| | - Benjamin A Goldstein
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Sarah Peskoe
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Priya Palta
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Department of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Jana A Hirsch
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Nia S Mitchell
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Annemarie G Hirsch
- Department of Epidemiology and Health Services Research, Geisinger, Danville, PA, USA
| | - Joseph Lunyera
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Clarissa J Diamantidis
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham VA Medical Center, Durham, NC, USA
| | - Matthew L Maciejewski
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham VA Medical Center, Durham, NC, USA
| | - L Ebony Boulware
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Ostendorf DM, Blankenship JM, Grau L, Arbet J, Mitchell NS, Creasy SA, Caldwell AE, Melanson EL, Phelan S, Bessesen DH, Catenacci VA. Predictors of long-term weight loss trajectories during a behavioral weight loss intervention: An exploratory analysis. Obes Sci Pract 2021; 7:569-582. [PMID: 34631135 PMCID: PMC8488452 DOI: 10.1002/osp4.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Substantial interindividual variability in response to behavioral weight loss interventions remains a critical challenge in obesity treatment. An improved understanding of the complex factors that contribute to this variability may improve obesity treatment outcomes. OBJECTIVE To identify weight change trajectories during a behavioral weight loss intervention and to explore differences between trajectory groups in sociodemographic, biologic, behavioral, and psychosocial factors. METHODS Adults (n = 170, 40 ± 9 years, BMI 34 ± 4 kg/m2, 84% female) participated in an 18-month behavioral weight loss intervention. Weight was measured at 0, 3, 6, 9, 12, 15, 18, and 24 months. Among participants with at least two weights after baseline (n = 140), clusters of longitudinal trajectories of changes in weight were identified using a latent class growth mixture model. The association between baseline factors or changes in factors over time and trajectory group was examined. RESULTS Two weight change trajectories were identified: "weight regainers" (n = 91) and "weight loss maintainers" (n = 49). Black participants (90%, 19/21) were more likely than non-Black participants to be regainers versus maintainers (p < 0.01). Maintainers demonstrated greater increases in device-measured physical activity, autonomous motivation for exercise, diet self-efficacy, cognitive restraint, and engagement in weight management behaviors and greater reductions in barriers for exercise, disinhibition, and depressive symptoms over 24 months versus regainers (p < 0.05). CONCLUSION Maintainers and regainers appear to be distinct trajectories that are associated with specific sociodemographic, behavioral, and psychosocial factors. Study results suggest potential targets for more tailored, multifaceted interventions to improve obesity treatment outcomes.
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Affiliation(s)
- Danielle M. Ostendorf
- Department of MedicineAnschutz Health and Wellness CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Jennifer M. Blankenship
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Laura Grau
- Department of Biostatistics and InformaticsColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Jaron Arbet
- Department of Biostatistics and InformaticsColorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Nia S. Mitchell
- Department of MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Seth A. Creasy
- Department of MedicineAnschutz Health and Wellness CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Ann E. Caldwell
- Department of MedicineAnschutz Health and Wellness CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Edward L. Melanson
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Geriatric MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical CenterDenverColoradoUSA
| | - Suzanne Phelan
- Department of Kinesiology & Public HealthCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Daniel H. Bessesen
- Department of MedicineAnschutz Health and Wellness CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Victoria A. Catenacci
- Department of MedicineAnschutz Health and Wellness CenterUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineDivision of Endocrinology, Metabolism, and DiabetesUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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Mitchell NS, Batch BC, Tyson CC. Retrospective cohort study of changes in estimated glomerular filtration rate for patients prescribed a low carb diet. Curr Opin Endocrinol Diabetes Obes 2021; 28:480-487. [PMID: 34392262 DOI: 10.1097/med.0000000000000673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Obesity and diabetes contribute to chronic kidney disease (CKD) and accelerate the loss of kidney function. Low carbohydrate diets (LCDs) are associated with weight loss and improved diabetes control. Compared to the typical Western diet, LCDs contain more protein, so individuals with CKD are not included in studies of LCDs. Therefore, there are no studies of LCDs for weight loss and their effects on kidney function. RECENT FINDINGS Obesity, hyperglycemia, and hyperinsulinemia can be detrimental to kidney function. LCDs may improve kidney function in patients with obesity and diabetes because they are associated with weight loss, improve blood sugar control, and decrease endogenous insulin production and exogenous insulin requirements. SUMMARY In this study, for patients with mildly reduced and moderately to severely reduced kidney function who were prescribed an LCD, their estimated glomerular filtration rate (eGFR) was either unchanged or improved. For those with normal or elevated eGFR, their kidney function was slightly decreased. For those without diabetes, greater weight loss was associated with improved eGFR. Future studies should prospectively measure low carbohydrate dietary adherence and physical activity and directly measure changes in GFR and albuminuria for participants with CKD before and during that diet.
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Affiliation(s)
- Nia S Mitchell
- Duke University Department of Medicine, Division of General Internal Medicine
| | - Bryan C Batch
- Duke University Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition
| | - Crystal C Tyson
- Duke University Department of Medicine, Division of Nephrology, Durham, North Carolina, USA
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6
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Jones DW, Whelton PK, Allen N, Clark D, Gidding SS, Muntner P, Nesbitt S, Mitchell NS, Townsend R, Falkner B. Management of Stage 1 Hypertension in Adults With a Low 10-Year Risk for Cardiovascular Disease: Filling a Guidance Gap: A Scientific Statement From the American Heart Association. Hypertension 2021; 77:e58-e67. [PMID: 33910363 DOI: 10.1161/hyp.0000000000000195] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
High blood pressure (BP) is the leading cause of worldwide cardiovascular disease morbidity and mortality. Patients and clinicians dealing with hypertension have benefited from the evidence of event-based randomized controlled clinical trials. One result from those trials has been the development of evidence-based guidelines. The commitment to using evidence from these event-based randomized trials has been a cornerstone in the development of guideline treatment recommendations. However, in some situations, evidence from event-based trials is not available to guideline writers or clinicians for assistance in treatment decision making. Such is the case for the management of many patients with stage 1 hypertension. The purpose of this scientific statement is to provide information complementary to the 2017 Hypertension Clinical Practice Guidelines for the patient with untreated stage 1 hypertension (systolic BP/diastolic BP, 130-139/80-89 mm Hg) with a 10-year risk for atherosclerotic cardiovascular disease <10% who fails to meet the systolic BP/diastolic goal (<130/80 mm Hg) after 6 months of guideline-recommended lifestyle therapy. This statement provides evidence from sources other than event-based randomized controlled clinical trials and offers therapy options for consideration by clinicians.
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Mitchell NS, Seyoum EA, Bhavsar NA, Webb FJ. Continuous Engagement in a Weight-Loss Program Promotes Sustained Significant Weight Loss. WMJ 2020; 119:253-257. [PMID: 33428835 PMCID: PMC8274382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Significant weight loss improves health but regain is common. OBJECTIVE The objective of the study was to determine if 2,346 members of Take Off Pounds Sensibly-a national, low-cost, peer-led weight-loss program-achieved and maintained significant weight loss with 7 consecutive annual renewals. METHODS This study was a retrospective cohort design. For each renewal, the cumulative change from baseline weight was calculated. Weight change was placed into 1 of 3 categories: significant weight loss, loss ≥ 5%; weight stable, loss of 0 to < 5%; or weight gain, any amount above baseline weight. RESULTS The cohort included 2,346 individuals. Fifty-one percent (n=740) of participants were in the significant weight-loss category all 7 years; 256 (18%) were in the significant weight-loss category at year 1 but moved into at least 1 other category during years 2 through 6; 359 (25%) were in the weight stable category at year 1; and 98 (7%) were in the weight gain category at year 1. CONCLUSIONS Over 60% of the population achieved significant weight loss by year 7. Since continuous, long-term engagement in a weight-loss program can lead to significant weight loss, even if significant weight loss is not initially achieved, participation should be encouraged.
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Affiliation(s)
- Nia S Mitchell
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina,
| | | | - Nrupen A Bhavsar
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Fern J Webb
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Jacksonville, Florida
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Mitchell NS, Stolzmann K, Benning LV, Wormwood JB, Linsky AM. Effect of a Scoring Rubric on the Review of Scientific Meeting Abstracts. J Gen Intern Med 2020; 36:2483-2485. [PMID: 32748347 PMCID: PMC8342698 DOI: 10.1007/s11606-020-05960-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Nia S Mitchell
- Division of General Internal Medicine, Duke University School of Medicine, 200 Morris St., 3rd Floor, Durham, NC, USA.
- Center for Community and Population Health Improvement, Duke University School of Medicine, Durham, NC, USA.
| | - Kelly Stolzmann
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Lauren V Benning
- Family Medicine Residency, McLeod Regional Medical Center, Florence, SC, USA
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, USA
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, USA
| | - Amy M Linsky
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA
- Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
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Affiliation(s)
- William S Yancy
- Duke Diet and Fitness Center, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Center of Innovation to Accelerate Discovery and Practice Transformation, Department of Veterans Affairs, Durham, North Carolina
| | - Nia S Mitchell
- Duke Diet and Fitness Center, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Eric C Westman
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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10
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Mitchell NS, Scialla JJ, Yancy WS. Are low-carbohydrate diets safe in diabetic and nondiabetic chronic kidney disease? Ann N Y Acad Sci 2019; 1461:25-36. [PMID: 30644556 DOI: 10.1111/nyas.13997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/04/2018] [Accepted: 12/12/2018] [Indexed: 12/14/2022]
Abstract
Diabetes mellitus and obesity both contribute to chronic kidney disease (CKD) and diabetic kidney disease (DKD), and they can accelerate the loss of kidney function. Dietary intake can potentially have wide-reaching effects on the risk of CKD/DKD and their progression by reducing weight and blood pressure, improving glycemic control, reducing hyperfiltration, and modulating inflammation. Low-carbohydrate (LC) diets can reduce weight and improve glycemic control, but the relatively higher protein content also raises concern in CKD/DKD. Empiric evidence supporting the kidney-related benefits or risks of LC diets is needed to understand the balance of these potential harms and benefits for patients with DKD and is the subject of our review.
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Affiliation(s)
- Nia S Mitchell
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Diet and Fitness Center, Duke University Health System, Durham, North Carolina
| | - Julia J Scialla
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - William S Yancy
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Diet and Fitness Center, Duke University Health System, Durham, North Carolina.,Department of Veterans Affairs, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
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Mitchell NS, Furniss AL, Helmkamp LJ, Van Pelt RE. Factors Associated with Achievement of Clinically Significant Weight Loss by Women in a National Nonprofit Weight Loss Program. J Womens Health (Larchmt) 2017; 26:911-917. [PMID: 28686527 DOI: 10.1089/jwh.2016.6264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Clinically significant weight loss (CSWL) is ≥5% of initial weight. The purpose of the study is to determine factors associated with women achieving CSWL in Take Off Pounds Sensibly (TOPS), a national, nonprofit weight loss program. METHODS This is a retrospective analysis of 48,674 females who joined TOPS from 2005 to 2011 and had a birth date in the database. Predictors of CSWL were evaluated using log-binomial regression and adjusted relative risks [99% CI] for participant age, initial weight, number of members per chapter, and chapter age. RESULTS Older women were more likely to achieve CSWL, with women ≥70 years 1.23 (1.18, 1.28) times more likely to achieve CSWL compared to women 18 to <45 years. Women who weighed 113 to <136 kg and ≥136 kg were 1.06 (1.02, 1.10) and 1.07 (1.02, 1.14) times more likely to achieve CSWL compared to women <80 kg, respectively. Women in chapters with 25 to <35 members and ≥35 members more were 1.09 (1.05, 1.13) and 1.14 (1.10, 1.18) times more likely to achieve CSWL than those in chapters with less than 15 members. Women in older chapters were less likely to achieve CSWL, with women in chapters 10 to 20 years old 0.95 (0.92, 0.99) times as likely to lose weight as those in chapters less than 10 years old. CONCLUSIONS Women in TOPS were more likely to achieve CSWL if older, ≥113 kg, and in larger, newer chapters. Future studies should address ways to modify the program to improve achievement of CSWL.
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Affiliation(s)
- Nia S Mitchell
- 1 Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus , Anschutz Health and Wellness Center, Aurora, Colorado
| | - Anna L Furniss
- 2 Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Laura J Helmkamp
- 2 Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Rachael E Van Pelt
- 3 Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado
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Abstract
Despite decades of efficacy-based research on weight loss interventions, the obesity epidemic in the United States persists, especially in underserved populations. We used the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework to describe the limitations of the current paradigm of efficacy-based research for weight loss interventions. We also used RE-AIM to propose that existing weight loss interventions (community-based programs) such as Jenny Craig, Take Off Pounds Sensibly (TOPS), and Weight Watchers be studied to supplement the efficacy-based research approaches to achieve population-level impact on obesity.
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Affiliation(s)
- Nia S Mitchell
- Division of General Internal Medicine, Anschutz Health and Wellness Center, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Mail Stop C263, 12348 E Montview Blvd, Room 4110, Aurora, CO 80045.
| | - Allan V Prochazka
- Denver VA Medical Center, Denver, Colorado, and University of Colorado Anschutz Medical College, Aurora, Colorado
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Mitchell NS, Polsky S, Catenacci VA, Furniss AL, Prochazka AV. Up to 7 Years of Sustained Weight Loss for Weight-Loss Program Completers. Am J Prev Med 2015; 49:248-58. [PMID: 26033350 PMCID: PMC4811034 DOI: 10.1016/j.amepre.2015.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/05/2015] [Accepted: 02/23/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Two issues remain elusive in weight management programs: significant, long-term weight-loss maintenance and widely accessible programs that produce significant weight loss for reasonable costs. The purpose of this study is to determine the long-term weight loss of participants who consecutively renew their annual membership in Take Off Pounds Sensibly (TOPS), a national, nonprofit, low-cost, peer-led weight-loss program. METHODS This completers' analysis was a retrospective cohort study of overweight and obese men and women who joined TOPS in 2005-2011 and consecutively renewed their annual membership at least once. Data were analyzed from June to October 2013. TOPS participants' weights are sent to the national database when they join and at the time of their annual renewal; thus, follow-up weight is only available for those who renew their membership. Among 207,469 individuals who joined during the study period, 74,629 (35.9%) had at least one consecutive annual renewal and were included in the study. RESULTS Cumulative mean (95% CI) weight change as a percentage of initial weight ranged from -6.0% (-6.0%, -5.9%) for 74,629 participants who renewed at 1 year to -8.3% (-8.7%, -7.8%) for 2,289 participants with 7 years of consecutive annual renewal. CONCLUSIONS In the subset of individuals who choose to renew their program membership, TOPS can effectively promote maintenance of clinically significant weight loss for an extended period of time. RCTs are needed to further evaluate this low-cost, widely available program, which could be a viable option to treat overweight and obesity.
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Affiliation(s)
- Nia S Mitchell
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Sarit Polsky
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Victoria A Catenacci
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna L Furniss
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Allan V Prochazka
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Denver Veterans Administration Medical Center, Denver, Colorado
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Cifuentes M, Polsky S, Mitchell NS. Perspectives of older African-American women on a community-based weight loss program: qualitative findings from the Senior Wellness Initiative and Take Off Pounds Sensibly (TOPS) Collaboration for Health. J Am Geriatr Soc 2014; 62:1996-8. [PMID: 25333543 DOI: 10.1111/jgs.13040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Maribel Cifuentes
- Department of Family Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Jensen-Otsu E, Ward EK, Mitchell B, Schoen JA, Rothchild K, Mitchell NS, Austin GL. The Effect of Medicaid Status on Weight Loss, Hospital Length of Stay, and 30-Day Readmission After Laparoscopic Roux-en-Y Gastric Bypass Surgery. Obes Surg 2014; 25:295-301. [DOI: 10.1007/s11695-014-1367-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mitchell NS, Polsky S. Innovative care delivery model to address obesity in older African-American women: Senior Wellness Initiative and Take Off Pounds Sensibly collaboration for health (SWITCH). J Am Geriatr Soc 2014; 61:1971-5. [PMID: 24219198 DOI: 10.1111/jgs.12444] [Citation(s) in RCA: 5] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the feasibility and acceptability of integrating Take Off Pounds Sensibly (TOPS), a national nonprofit weight-loss program through which people have lost a clinically significant amount of weight, into a community program that serves African Americans (AAs) and to determine weight change. DESIGN Single-group pilot design. SETTING Denver, Colorado. PARTICIPANTS Community-dwelling participants aged 51 to 85. INTERVENTION Participants were recruited through a program that serves AAs, and new TOPS chapters were started at a church, senior center, and senior residence for independent living. MEASUREMENTS Feasibility was measured by determining the ease of recruitment and acceptability was measured according to retention. The secondary outcome was weight change. RESULTS Sixty-four percent of people who were referred to the program or attended an information session participated in the study. The retention rate at 52 weeks was 79%. At 52 weeks, 16 of 48 participants had lost 5% or more of their initial weight, and 23 had lost 0% to 4.9% of their initial weight. CONCLUSIONS Recruiting AA women through the Center for African American Health was feasible, and the program was acceptable. One-third of participants lost a clinically significant amount of weight. TOPS may be one way to combat the health disparity of obesity in AA women.
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Affiliation(s)
- Nia S Mitchell
- Division of General Internal Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado; Anschutz Health and Wellness Center, Anschutz Medical Campus, University of Colorado, Aurora, Colorado; Colorado Health Outcomes, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
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Mitchell NS, Suh CA, Stroebele N, Hill JO, Tsai AG. Weight change in pediatric TennCare recipients referred to a commercial weight loss program. Acad Pediatr 2013; 13:152-8. [PMID: 23498082 PMCID: PMC4788091 DOI: 10.1016/j.acap.2012.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 12/04/2012] [Accepted: 12/07/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The epidemic of overweight and obesity in the United States is not limited to adults but also affects children and adolescents. Low-income children are disparately affected because they have an elevated risk for developing obesity. Effective interventions are urgently needed to prevent and treat obesity in children. In 2006, Tennessee Medicaid (TennCare) and Weight Watchers formed the TennCare Weight Watchers Partnership Program, which allowed pediatric recipients to attend Weight Watchers with no out-of-pocket cost. METHODS This study is a nonconcurrent prospective analysis of administrative data from the TennCare Weight Watchers Partnership Program. It examined the weight change of TennCare beneficiaries between the ages of 10 and 17 who participated in the program from January 2006 to January 2009 and compared the weight change to the recommendations of the Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Childhood and Adolescent Overweight and Obesity. RESULTS Fifty-three percent of participants either met or exceeded the recommendations of the panel on childhood obesity at the end of their involvement in the program. Participants who attended the program for more than 12 weeks and those who attended 10 or more meetings had a 5% decrease in their body mass index z score. CONCLUSIONS The TennCare Weight Watchers Partnership Program was successful in helping a majority of children and adolescents who participated to meet or exceed the Expert Committee's recommendations. This type of partnership can give children in low-income families the opportunity to participate in a structured program with a good chance of success.
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Mitchell NS, Dickinson LM, Kempe A, Tsai AG. Determining the effectiveness of Take Off Pounds Sensibly (TOPS), a nationally available nonprofit weight loss program. Obesity (Silver Spring) 2011; 19:568-73. [PMID: 20864948 DOI: 10.1038/oby.2010.202] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Obesity is a major public health issue in the United States. Many commercial weight loss programs are available, but their costs prohibit some people from participating. This study evaluated the effectiveness of Take Off Pounds Sensibly (TOPS), a low-cost, nonprofit weight loss program. Longitudinal mixed-effects repeated-measures modeling of the TOPS national database was used to model changes in weight for TOPS participants who joined in 2005, 2006, and 2007 and had at least one annual renewal between 2006 and 2008. Separate analyses were performed on individuals with consecutive annual renewal and those with nonconsecutive annual renewal. During the study period, 42,481 individuals renewed their membership at least once, including 2,427 individuals with nonconsecutive renewals. Individuals with consecutive renewals in TOPS lost 5.9-7.1% of their initial weight over a period of 1-3 years. People who remained in the program lost ~6% of initial weight in the first year and maintained that weight loss for up to 3 years. TOPS participants with nonconsecutive renewal generally lost less weight than those with consecutive renewal. TOPS is associated with moderate weight loss among participants who remain in the program for at least 1 year. This degree of weight loss is likely to be clinically important for many individuals. TOPS is available at substantially lower cost than commercial weight loss programs, with similar results. Head-to-head trials of TOPS and popular commercial programs are needed.
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Affiliation(s)
- Nia S Mitchell
- Department of Internal Medicine, Division of General Internal Medicine, Colorado Health Outcomes, Center for Human Nutrition, University of Colorado Denver, Denver, Colorado, USA.
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Abstract
Magnetic resonance imaging has been used to visualize size-based protein separations inside operating chromatography columns. The effects of flow nonuniformity have been observed and analyzed quantitatively through concentration profiles of tracers measured inside the column. Analysis of these profiles provides local and averaged intracolumn plate height values for characterization of dispersion and flow nonuniformity. The magnetic resonance measurements compare favorably with conventional chromatographic measurements of column efficiency and provide more detailed insights into nonideal column performance.
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Affiliation(s)
- N S Mitchell
- Department of Chemical Engineering, University of Virginia, Charlottesville 22903, USA
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Mitchell NS, Kaplow M, McDougall C. The surgeon's ego: moulding the demon to the needs of the '90s. Can J Surg 1994; 37:8-9. [PMID: 8306227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Stein LA, Endicott AN, Sampalis JS, Kaplow MA, Patel MD, Mitchell NS. Motion of the patella during walking: a video digital-fluoroscopic study in healthy volunteers. AJR Am J Roentgenol 1993; 161:617-20. [PMID: 8352119 DOI: 10.2214/ajr.161.3.8352119] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The alignment of the quadriceps muscle and patella suggests that the patella should deviate laterally out of the patellar groove as the quadriceps muscle contracts during walking. The surgical treatment of patellar subluxation has been based on this presumption. The purpose of this study was to determine the movements of the patella in relation to the other bones of the knee joint during normal walking. This is the first study we know of that uses radiographs to show these movements. SUBJECTS AND METHODS Eight healthy adult volunteers with no previous complaints referable to the knee walked on a slowly moving treadmill while their patellae were imaged fluoroscopically in the anteroposterior plane with a Toshiba C-arm. Images were retrieved, transferred to radiographic film, and randomized to prevent the observers from knowing the order of images. The position of the patella was measured and plotted in relation to fixed points of the knee. RESULTS In each of the subjects at every gait cycle, the patella was observed to move vertically first, followed by a sudden shift to the medial side before returning to its original position. CONCLUSION Contrary to conventional understanding, our results show that the patella deviates medially rather than laterally during walking. This occurs because of differential contraction of the components of the quadriceps muscle during walking. The management of painful and subluxated patellae must be reevaluated in light of this finding.
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Affiliation(s)
- L A Stein
- Department of Radiology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada
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Mitchell NS. Fear of flying and surgery. Can J Surg 1991; 34:9. [PMID: 1997154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Abstract
Troubled by variations in the descriptions of shape, appearance, and content of matrix vesicles and the conflicting reports of increased numbers of vesicles in the mineralizing regions of the growth plate contrasted with larger numbers in the resting zone, we embarked on a review of matrix vesicles in the growth plate using a comparison of different fixation techniques. We found matrix vesicles resembling cell debris at all levels of the growth plate, with no particular association with mineral. Lipid bodies surrounded by a membrane of proteoglycan have also been seen in large numbers. The cell debris-like matrix vesicles have been the common finding in reports of digested centrifuged cartilage and may represent cytoplasmic processes. Lipid bodies surrounded by proteoglycan may be similar to the membrane-bound vesicle described by Ali (Fed. Proc., 35:135-142, 1987) and by Bonucci (Clin. Orthod., 78:108-133, 1971).
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Affiliation(s)
- N S Mitchell
- Electron Microscopy Unit, Shriners Hospital, Montreal, Quebec, Canada
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Howson MP, Shepard NL, Mitchell NS. Colloidal chromic phosphate 32P synovectomy in antigen-induced arthritis in the rabbit. Clin Orthop Relat Res 1988:283-93. [PMID: 3349688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Radioisotopes have been employed in the therapy of chronic arthritis, in particular, rheumatoid arthritis for many years. A variety of isotopes have been popularized, and in the last ten years a colloidal solution of radioactive chromic phosphate 32P has been in use apparently with equivalent efficacy to others such as 169erbium, 90yttrium, and 165dysprosium. No controlled studies on this modality have been reported and few animal studies were found. The efficacy of therapeutic doses of 32P as a medical synovectomy and its effect on rabbit joints with antigen-induced arthritis were observed in 62 arthritic knee joints in 31 adult rabbits treated on one side with 0.1 microCi of 32P, the opposite serving as control. The animals were observed over a period of 11 months and examined by histologic and biochemical means. The synovium showed no evidence of radiation necrosis in treated joints. Cartilage of treated and control joints showed similar changes consistent with chronic arthritis, persistent synovitis, progressive chondrocyte degeneration, and decreased matrix metachromasia. The radiosynovectomy had neither removed synovium nor protected the cartilage. Its efficacy in humans is therefore questionable.
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Affiliation(s)
- M P Howson
- Duke University Medical Center, Durham, North Carolina
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Robbins KR, Hitchcock JP, Mitchell NS. Potassium-induced changes in muscle free amino acid concentrations in chicks. J Nutr 1982; 112:2122-9. [PMID: 6813438 DOI: 10.1093/jn/112.11.2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Two experiments with purified crystalline amino acid diets were conducted to determine the effect of dietary potassium level on chick breast muscle free amino acid concentrations. In both experiments, concentrations of muscle free glutamine, lysine and arginine increased as dietary potassium increased from 0.12 to 0.18% and decreased as dietary potassium exceeded 0.18%. As dietary potassium increased, muscle potassium concentration increased linearly with an equivalent linear decrease in muscle sodium concentration. Peak concentration of muscle free glutamine, lysine and arginine occurred in muscle with a K+:Na+ ratio of approximately 1:4. Concentrations of the three amino acids were less in muscle with K4:Na+ ratios either less than or greater than 1.4. Breast muscle concentrations of free histidine decreased slightly, while muscle free carnosine increased substantially when dietary potassium exceeded 0.18%.
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Mitchell NS, Shepard N. Changes in proteoglycan and collagen in cartilage in rheumatoid arthritis. J Bone Joint Surg Am 1978; 60:342-8. [PMID: 77275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Articular cartilage from thirteen patients with rheumatoid arthritis was studied by both light and electron microscopy using recently developed staining techniques for proteoglycan. Normally proteoglycan is concentrated about active chondrocytes, but in the cartilage from these patients it was found to be diminished about most of the chondrocytes while it was increased around a few. Fragmentation of collagen and phagocytosis of the fragments by chondrocytes were also noted. This dissolution of collagen was associated with loss of proteoglycan in the matrix. These findings are consistent with the variable nature of the rheumatoid destructive process and appear to be morphological reflections of biochemical changes which formerly were thought to occur in this disease only at the cartilage-pannus junction.
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Mitchell NS. Leg amputation. Can J Surg 1978; 21:96-8. [PMID: 630471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Mitchell NS, Cruess RL. Classification of degenerative arthritis. Can Med Assoc J 1977; 117:763-5. [PMID: 907947 PMCID: PMC1880054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
It is suggested that the former division of degenerative arthritis into idiopathic types and those secondary to some disease process is no longer valid. Recent studies have indicated that abnormal concentrations of force on cartilage lead to the development of this disease. A classification is presented that is based on the assumption that the process is initiated by abnormal concentrations of force on normal cartilage matrix, normal concentrations of force on abnormal cartilage matrix or normal concentrations of force on normal cartilage matrix that is supported by bone of abnormal consistency.
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Mitchell NS, Shepard N. The effect of synovectomy on synovium and cartilage in early rheumatoid arthritis. Orthop Clin North Am 1973; 4:1057-84. [PMID: 4126722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Mitchell NS, Cruess RL. The effect of synovectomy on articular cartilage. J Bone Joint Surg Am 1967; 49:1099-108. [PMID: 4166924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Mitchell NS, Cruess RL. Synovial regeneration after synovectomy. Can J Surg 1967; 10:234-9. [PMID: 6020056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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