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Alshakhs M, Goedecke PJ, Bailey JE, Madlock-Brown C. Racial differences in healthcare expenditures for prevalent multimorbidity combinations in the USA: a cross-sectional study. BMC Med 2023; 21:399. [PMID: 37867193 PMCID: PMC10591380 DOI: 10.1186/s12916-023-03084-2] [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] [Received: 04/26/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND We aimed to model total charges for the most prevalent multimorbidity combinations in the USA and assess model accuracy across Asian/Pacific Islander, African American, Biracial, Caucasian, Hispanic, and Native American populations. METHODS We used Cerner HealthFacts data from 2016 to 2017 to model the cost of previously identified prevalent multimorbidity combinations among 38 major diagnostic categories for cohorts stratified by age (45-64 and 65 +). Examples of prevalent multimorbidity combinations include lipedema with hypertension or hypertension with diabetes. We applied generalized linear models (GLM) with gamma distribution and log link function to total charges for all cohorts and assessed model accuracy using residual analysis. In addition to 38 major diagnostic categories, our adjusted model incorporated demographic, BMI, hospital, and census division information. RESULTS The mean ages were 55 (45-64 cohort, N = 333,094) and 75 (65 + cohort, N = 327,260), respectively. We found actual total charges to be highest for African Americans (means $78,544 [45-64], $176,274 [65 +]) and lowest for Hispanics (means $29,597 [45-64], $66,911 [65 +]). African American race was strongly predictive of higher costs (p < 0.05 [45-64]; p < 0.05 [65 +]). Each total charge model had a good fit. With African American as the index race, only Asian/Pacific Islander and Biracial were non-significant in the 45-64 cohort and Biracial in the 65 + cohort. Mean residuals were lowest for Hispanics in both cohorts, highest in African Americans for the 45-64 cohort, and highest in Caucasians for the 65 + cohort. Model accuracy varied substantially by race when multimorbidity grouping was considered. For example, costs were markedly overestimated for 65 + Caucasians with multimorbidity combinations that included heart disease (e.g., hypertension + heart disease and lipidemia + hypertension + heart disease). Additionally, model residuals varied by age/obesity status. For instance, model estimates for Hispanic patients were highly underestimated for most multimorbidity combinations in the 65 + with obesity cohort compared with other age/obesity status groupings. CONCLUSIONS Our finding demonstrates the need for more robust models to ensure the healthcare system can better serve all populations. Future cost modeling efforts will likely benefit from factoring in multimorbidity type stratified by race/ethnicity and age/obesity status.
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Affiliation(s)
- Manal Alshakhs
- Health Outcomes and Policy Program, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Patricia J Goedecke
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James E Bailey
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Charisse Madlock-Brown
- Health Outcomes and Policy Program, University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, 66 North Pauline St. Rm 221, Memphis, TN, 38163, USA.
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Rayford MA, Morris JM, Phinehas R, Schneider E, Lund A, Baxley S, Wan JY, Goedecke PJ, Levi-D'Ancona R. Telehealth Utilization in High-Risk Pregnancies During COVID-19. Telemed Rep 2023; 4:61-66. [PMID: 37283855 PMCID: PMC10240327 DOI: 10.1089/tmr.2023.0006] [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] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 06/08/2023]
Abstract
Purpose To determine how telehealth has influenced outcomes in high-risk obstetrics patients during the Coronavirus disease 2019 (COVID-19) pandemic. Methods A retrospective chart review was conducted to identify patterns in both telehealth and in-person clinic visits among patients of a Maternal Fetal Medicine (MFM) department from the onset of the COVID-19 pandemic from March 2020 until October 2021. For the descriptive analysis, p-values were calculated using Wilcoxon rank sum for continuous variables and chi-square or Fisher exact (where cell n < 5) for categorical variables. Variables of interest were then tested for their univariate association with telehealth utilization using logistic regression. Variables found to meet the criterion of p < 0.2 in the univariate case were introduced into a multivariable logistic model with a backward elimination for determining variable retention. We aimed to analyze whether telehealth visits significantly impacted pregnancy outcomes. Results Four hundred nineteen high-risk patients visited the clinic via in-person and/or telehealth appointments during the study period: 320 patients without telehealth visits and 99 patients with telehealth visits. Care provided by telehealth visits was not found to be related to self-reported race (p = 0.81), maternal body mass index (p = 1.0), or maternal age (p = 0.53). Patients with private insurance were more likely to have telehealth visits than patients with public insurance (79.9% vs. 65.5%, p < 0.01). In univariate logistic analyses, patients with diagnoses of anxiety (p < 0.01), asthma (p = 0.03), and depression (p < 0.01), at the time care was established, were more likely to have telehealth visits. Those patients with telehealth visits did not have any statistical differences in mode of delivery (p = 0.2) or pregnancy outcomes (p = 0.12), including fetal demise, preterm delivery, or delivery at term as compared with patients with all in-office visits. In multivariable analysis, patient conditions of anxiety (p < 0.01), maternal obesity (p < 0.01), and twin pregnancy (p = 0.04) were associated with higher rates of telehealth visits. Conclusion Patients with certain pregnancy complications elected to have more telehealth visits. Patients with private insurance were more likely to have telehealth visits than patients with public insurance. There are benefits for patients with certain pregnancy complications to incorporate telehealth visits in addition to regularly scheduled in-person clinic visits and may be suitable in a post-pandemic setting as well. Further research in this field is needed to better understand the impact of implementing telehealth in high-risk obstetrics patients.
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Affiliation(s)
- Margie A. Rayford
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Joshua M. Morris
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ramona Phinehas
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Elizabeth Schneider
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Amanda Lund
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sarah Baxley
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jim Y. Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Patricia J. Goedecke
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Roberto Levi-D'Ancona
- Department of Obstetrics and Gynecology, and University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Obstetrics and Gynecology, Southern Illinois University, Springfield, Illinois, USA
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3
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Taylor AP, Lee AS, Goedecke PJ, Tolley EA, Joyner AL, Heck DH. Conditional loss of Engrailed1/2 in Atoh1-derived excitatory cerebellar nuclear neurons impairs eupneic respiration in mice. Genes Brain Behav 2022; 21:e12788. [PMID: 35044072 PMCID: PMC8852233 DOI: 10.1111/gbb.12788] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 02/03/2023]
Abstract
Evidence for a cerebellar role during cardiopulmonary challenges has long been established, but studies of cerebellar involvement in eupneic breathing have been inconclusive. Here we investigated temporal aspects of eupneic respiration in the Atoh1-En1/2 mouse model of cerebellar neuropathology. Atoh1-En1/2 conditional knockout mice have conditional loss of the developmental patterning genes Engrailed1 and 2 in excitatory cerebellar nuclear neurons, which leads to loss of a subset of medial and intermediate excitatory cerebellar nuclear neurons. A sample of three Atoh1-derived extracerebellar nuclei showed no cell loss in the conditional knockout compared to control mice. We measured eupneic respiration in mutant animals and control littermates using whole-body unrestrained plethysmography and compared the average respiratory rate, coefficient of variation, and the CV2, a measure of intrinsic rhythmicity. Linear regression analyses revealed that Atoh1-En1/2 conditional knockouts have decreased overall variability (p = 0.021; b = -0.045) and increased intrinsic rhythmicity compared to their control littermates (p < 0.001; b = -0.037), but we found no effect of genotype on average respiratory rate (p = 0.064). Analysis also revealed modestly decreased respiratory rates (p = 0.025; b = -0.82), increased coefficient of variation (p = 0.0036; b = 0.060), and increased CV2 in female animals, independent of genotype (p = 0.024; b = 0.026). These results suggest a cerebellar involvement in eupneic breathing by controlling rhythmicity. We argue that the cerebellar involvement in controlling the CV2 of respiration is indicative of an involvement of coordinating respiration with other orofacial rhythms, such as swallowing.
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Affiliation(s)
- Angela P. Taylor
- Department of Anatomy and Neurobiology, College of MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Andrew S. Lee
- Developmental Biology ProgramSloan Kettering InstituteNew YorkNew YorkUSA
- Neuroscience ProgramWeill Cornell Graduate School of Medical SciencesNew YorkNew YorkUSA
| | - Patricia J. Goedecke
- Division of Biostatistics, Department of Preventive Medicine, College of MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Elizabeth A. Tolley
- Division of Biostatistics, Department of Preventive Medicine, College of MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Alexandra L. Joyner
- Developmental Biology ProgramSloan Kettering InstituteNew YorkNew YorkUSA
- Neuroscience ProgramWeill Cornell Graduate School of Medical SciencesNew YorkNew YorkUSA
- Biochemistry, Cell and Molecular Biology ProgramWeill Cornell Graduate School of Medical SciencesNew YorkNew YorkUSA
| | - Detlef H. Heck
- Department of Anatomy and Neurobiology, College of MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
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4
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Detti L, Francillon L, Christiansen ME, Peregrin-Alvarez I, Goedecke PJ, Bursac Z, Roman RA. Author Correction: Early pregnancy ultrasound measurements and prediction of first trimester pregnancy loss: A logistic model. Sci Rep 2021; 11:21598. [PMID: 34711901 PMCID: PMC8553926 DOI: 10.1038/s41598-021-01235-0] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Laura Detti
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, TN, USA. .,Cleveland Clinic, Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland, OH, USA.
| | - Ludwig Francillon
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, TN, USA
| | - Mary E Christiansen
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, TN, USA
| | - Irene Peregrin-Alvarez
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, TN, USA
| | - Patricia J Goedecke
- University of Tennessee Health Science Center, Division of Biostatistics, Department of Preventive Medicine, Memphis, TN, USA
| | - Zoran Bursac
- Cleveland Clinic, Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland, OH, USA.,Florida International University, Department of Biostatistics, Miami, FL, USA
| | - Robert A Roman
- University of Tennessee Health Science Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Memphis, TN, USA
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5
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Ost SR, Wells D, Goedecke PJ, Tolley EA, Kleinman M, Thompson NS. Relationship Between Standardized Test Scores and Board Certification Exams in a Combined Internal Medicine/Pediatrics Residency Program. Cureus 2021; 13:e13567. [PMID: 33815979 PMCID: PMC8008765 DOI: 10.7759/cureus.13567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Combined Internal Medicine/Pediatrics (Med/Peds) residencies rely on categorical program data to predict pass rates for the American Board of Internal Medicine Certifying Exam (ABIM-CE) and the American Board of Pediatrics Certifying Exam (ABP-CE). There is insufficient literature describing what best predicts a Med/Peds resident passing board exams. In this study, we aimed to determine how standardized test scores predict performance on ABIM-CE and ABP-CE for Med/Peds residents. Methodology We analyzed prior exam scores for 91/96 (95%) residents in a Med/Peds program from 2008 to 2017. Scores from the United States Medical Licensing Examination (USMLE) Steps 1 and 2 Clinical Knowledge (CK) and In-Training Exams in Internal Medicine (ITE-IM) and Pediatrics (ITE-P) were analyzed with the corresponding ABIM-CE and ABP-CE first-time scores. Linear and logistic regression were applied to predict board scores/passage. Results USMLE 1 and 2 CK, ITE-IM, and ITE-P scores had a linear relationship with both ABIM-CE and ABP-CE scores. In the linear regression, adjusted R2 values showed low-to-moderate predictive ability (R2 = 0.11-0.35), with the highest predictor of ABIM-CE and ABP-CE being USMLE Step 1 (0.35) and Postgraduate Year 1 (PGY-1) ITE-IM (0.33), respectively. Logistic regression showed odds ratios of passing board certifications ranging from 1.05 to 1.53 per point increase on the prior exam score. The PGY-3 ITE-IM was the best predictor of passing both certifying exams. Conclusions In one Med/Peds program, USMLE Steps 1 and 2 and all ITE-IM and ITE-P scores predicted certifying exam scores and passage. This provides Med/Peds-specific data to allow individualized resident counseling and guide programmatic improvements targeted to board performance.
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Affiliation(s)
- Shelley R Ost
- General Internal Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, USA
| | - Daniel Wells
- General Pediatrics, University of Tennessee Health Science Center College of Medicine, Memphis, USA
| | - Patricia J Goedecke
- Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, USA
| | - Elizabeth A Tolley
- Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, USA
| | - Michael Kleinman
- General Internal Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, USA
| | - Natascha S Thompson
- General Internal Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, USA
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6
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Duncan JR, Schenone C, Dorset KM, Goedecke PJ, Tobiasz AM, Meyer NL, Schenone MH. Estimated fetal weight accuracy in pregnancies with preterm prelabor rupture of membranes by the Hadlock method. J Matern Fetal Neonatal Med 2020; 35:1754-1758. [PMID: 32441170 DOI: 10.1080/14767058.2020.1769593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: We aimed to assess the accuracy of the estimated fetal weight (EFW) to predict the birthweigth (BW) in pregnancies complicated by PPROM.Study design: This study was a secondary analysis of a prospective cohort of pregnancies with PPROM. We included singleton pregnancies from 23 to 36 + 6 weeks, mothers from 13 to 46 years of age, and those with an EFW within two weeks of delivery. We excluded pregnancies with complex fetal anomalies and fetal demise. The accuracy of the EFW was determined by the absolute percent difference between BW and EFW ([BW-EFW]/BW*100%). T tests and linear regression were performed for statistical analysis.Results: The mean percent difference of BW vs. EFW was 8.72 ± 6.94%. The EFW was more accurate (8.24 ± 6.81 vs. 13.31 ± 6.88%, p = .027) and had more measurements with a absolute difference < 10% (70% vs. 30%; p = .034) when performed within seven days of delivery. The EFW accuracy decreased with anhydramnios (11.37 ± 7.06 vs. 7.69 ± 6.77%, p = .020), but the measurements with an absolute difference <10% was not significantly different (p = .27) with anhydramnios.Conclusion: In PPROM, the EFW within seven days to delivery by Hadlock accurately predicts the birthweight with a mean absolute difference of 8.2%.Brief rationale: There are a limited number of studies evaluating the accuracy of the EFW in pregnancies with PPROM in the last four decades.
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Affiliation(s)
- Jose R Duncan
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Obstetrics & Gynecology, University of South Florida, Tampa, FL, USA
| | - Claudio Schenone
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Katherine M Dorset
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Patricia J Goedecke
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ana M Tobiasz
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA.,Sanford Medical Center, Department of Obstetrics & Gynecology. Bismarck, ND, USA
| | - Norman L Meyer
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mauro H Schenone
- Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
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7
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Detti L, Roman RA, Goedecke PJ, Christiansen ME, Peregrin-Alvarez I, Ikwuezunma G, Francillon L. Pilot study establishing a nomogram of yolk sac growth during the first trimester of pregnancy. J Obstet Gynaecol Res 2019; 46:223-228. [PMID: 31814235 DOI: 10.1111/jog.14173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 11/15/2019] [Indexed: 11/29/2022]
Abstract
AIM The yolk sac (YS) has been reported as a reliable predictor of adverse pregnancy outcomes, however, it has always been evaluated cross-sectionally with a single ultrasound per patient. We sought to validate the use of YS dimensions in serial ultrasounds throughout the first 10 weeks of singleton and multiple gestations. METHODS This was a prospective cohort study where YS diameters were serially obtained with 2D ultrasound in singleton and multiple gestations from 5 to 11 weeks. Nonparametric test were used for comparisons with P < 0.05 indicating significance. RESULTS One hundred ninety-three patients were included, 42 twins (3 monochorionic and 39 dichorionic), 2 triplets (monochorionic twins plus a singleton) and 148 singleton pregnancies (238 total fetuses). There was no difference in YS dimensions in singleton versus multiple pregnancies. Starting at 5 weeks' gestation, the YS increased 0.4 mm (95% CI 0.3-0.5 mm) per week until 10 weeks' gestation. Forty-five fetuses were lost in the first trimester. The risk of pregnancy loss was higher with a large YS until 8 weeks (P ≤ 0.001), while after 8 weeks it was higher with a small YS (P < 0.005). CONCLUSION We established a nomogram of YS development during the first 10 weeks of pregnancy. The YS reliably detected pregnancies that ended in loss as early as 6 weeks' gestation. The YS was either smaller or larger than in ongoing pregnancies. While all pregnancies with large YS were lost within 10 weeks, those with smaller YS were lost beyond the first 10 weeks.
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Affiliation(s)
- Laura Detti
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Robert A Roman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Patricia J Goedecke
- Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mary E Christiansen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Irene Peregrin-Alvarez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Gini Ikwuezunma
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ludwig Francillon
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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8
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Henkel JE, Aziz MM, Reynolds CO, Goedecke PJ, Schenone MH. 763: Predicting fetal acidemia with continuous fetal monitoring in extreme preterm birth. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.786] [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: 10/27/2022]
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9
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Abstract
Reading aloud to children encourages language development. Pediatricians promote reading practices through Reach Out and Read (ROR) and other methods. This exploratory study sought to examine the value that supplemental materials promoting "Touch, Talk, Read, Play" (TTRP) might provide in addition to ROR. This study was a pre- and postintervention design to assess response to the TTRP curriculum. Caregivers of children ages 12 to 24 months completed the communication portion of the Ages and Stages Questionnaire-Third Edition and a Literacy Education Survey to assess current literacy practices. The caregiver and child were then introduced to the TTRP materials. Data were obtained on 98 subjects preintervention with follow-up data collected on 30 participants 6 months later. Significant differences were found in the Ages and Stages Questionnaire scores and parent-reported importance of reading and conversing frequently with their child. TTRP provides an effective curriculum for literacy promotion in a ROR program.
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Affiliation(s)
- Jason Yaun
- 1 University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mimi Bach
- 1 University of Tennessee Health Science Center, Memphis, TN, USA
| | - Josh Bakke
- 1 University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | - Marion Hare
- 1 University of Tennessee Health Science Center, Memphis, TN, USA
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10
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Little MA, Klesges RC, Bursac Z, Ebbert JO, Halbert JP, Dunkle AN, Colvin L, Goedecke PJ, Weksler B. Why Don't Cancer Survivors Quit Smoking? An Evaluation of Readiness for Smoking Cessation in Cancer Survivors. J Cancer Prev 2018; 23:44-50. [PMID: 29629348 PMCID: PMC5886494 DOI: 10.15430/jcp.2018.23.1.44] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 12/30/2022] Open
Abstract
Background Cancer survivors have a high rate of participation in cigarette-smoking cessation programs but their smoking-abstinence rates remain low. In the current study, we evaluated the readiness to quit smoking in a cancer-survivor population. Methods Cross-sectional data survey conducted among 112 adult cancer survivors who smoked cigarettes in Tennessee. Analyses were conducted using a two-sample t-test, χ2 test, Fishers Exact test, and multivariable logistic regression with smoker’s readiness to quit as the dependent variable. We operationally defined a smoker not ready to quit as anyone interested in quitting smoking beyond the next 6 months or longer (or not at all), as compared to those that are ready to quit within the next 6 months. Results Thirty-three percent of participants displayed a readiness to quit smoking in the next 30 days. Smokers ready to quit were more likely to display high confidence in their ability to quit (OR = 4.6; 95% CI, 2.1–9.7; P < 0.0001) than those not ready to quit. Those ready to quit were nearly five times more likely to believe smoking contributed to their cancer diagnosis (OR = 4.9; 95% CI, 1.1–22.6; P = 0.0432). Those ready to quit were also much more likely to attempt smoking cessation when diagnosed with cancer (OR = 8.9; 95% CI, 1.8–44.3; P = 0.0076) than smokers not ready to quit. Finally, those ready to quit were more likely to endorse smoking more in the morning than other times of the day, compared to those not ready to quit (OR = 7.9; 95% CI, 1.5–42,3; P = 0.0148), which increased odds of readiness to quit within the next 6 months. Conclusions Despite high participation in smoking-cessation programs for cancer survivors, only one-third of participants were ready to quit. Future research is needed to develop programs targeting effective strategies promoting smoking cessation among cancer survivors who are both ready and not ready to quit smoking.
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Affiliation(s)
- Melissa A Little
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Lackland AFB, TX, USA
| | - Robert C Klesges
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Charlottesville, VA, USA
| | - Zoran Bursac
- Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Jennifer P Halbert
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Charlottesville, VA, USA
| | - Andrew N Dunkle
- Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, USA
| | | | - Patricia J Goedecke
- Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Benny Weksler
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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