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Ahuja N, Mahmood A, Kedia S, Dillon PJ. Predictors of U.S. Adults' Opinion Toward an R-Rating Policy for Movies With Cigarette Smoking. Health Educ Behav 2024:10901981241239933. [PMID: 38519853 DOI: 10.1177/10901981241239933] [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: 03/25/2024]
Abstract
Recently, multiple health organizations and advocacy groups have pushed for giving an R-rating for movies depicting tobacco imagery. This study examined several predictors of U.S. adults' opinion toward an R-rating policy for movies depicting cigarette smoking. We used data from the Health Information National Trends Survey (2020 cycle), for a nationally representative sample of 3,865 US adults (aged ≥ 18). The outcome variable was opinion toward an R-rating policy (support, neutral, and oppose) for movies depicting cigarette smoking. A weighted adjusted multinomial logistic regression analysis with comparisons of support versus oppose, support versus neutral, and neutral versus oppose was performed. About 48.2% of respondents were supportive of, 31.1% were neutral toward, and 20.7% were opposed to an R-rating policy. Adults aged 50 to 64 years (adjusted odds ratio [aOR] = 2.28, p = .008) and ≥65 years (aOR = 4.54, p <.001) (vs. 18-34 years) were more likely to support the R-rating policy than oppose it. Non-Hispanic Black respondents (vs. non-Hispanic Whites) were 1.74 times more likely to support than oppose the policy (aOR = 1.74, p = .04), whereas adults with a household annual income of US$75,000 or more (vs. <$20,000) and those with moderate (vs. liberal) political viewpoints were more likely to be neutral than oppose the policy. Former and current e-cigarette users (vs. never users) were less likely to support than oppose the policy. Tailored messaging addressing the rationale behind R-rating policy should be directed towards communities based on age, race/ethnicity, household income, e-cigarette usage, and political ideologies.
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Affiliation(s)
- Nikhil Ahuja
- Slippery Rock University of Pennsylvania, Slippery Rock, PA, USA
| | - Asos Mahmood
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Satish Kedia
- The University of Memphis School of Public Health, Memphis, TN, USA
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Ahuja N, Kedia S, Ward KD, Jiang Y, Dillon PJ. Predictors of Adolescents' Transition Through the Stages of Change for Quitting E-Cigarettes: Findings From the Population Assessment of Tobacco and Health Study. Am J Health Promot 2024:8901171231222077. [PMID: 38258817 DOI: 10.1177/08901171231222077] [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: 01/24/2024]
Abstract
PURPOSE To identify predictive factors associated with US adolescents' transition through the stages of change for potentially quitting e-cigarettes using the Trans-theoretical model of behavior change. DESIGN Prospective cohort study. SETTING United States. SUBJECTS We utilized data from adolescents (12-17 years) in Wave 3 of the Population Assessment of Tobacco and Health study who used e-cigarettes exclusively over the past 30 days (n = 177) and were followed up with in Wave 4. MEASURES Outcome variables were 3 transition categories: those who remained stagnant, those who progressed, and those who regressed in their stage of quitting e-cigarettes. Predictor variables were socio-demographics, e-cigarette harm perception, e-cigarette use at home or by important people, social norms, e-cigarette and anti-tobacco advertisements, and e-cigarette health warnings. ANALYSIS Weighted-adjusted multinomial regression analysis was performed to determine the association between predictor and outcome variables. RESULTS From Wave 3 to Wave 4, 19% of adolescents remained stagnant; 73.3% progressed; and 7.7% regressed. Adolescents were less likely to progress in their stage of change if they perceived nicotine in e-cigarettes to be "not at all/slightly harmful" (AOR = .26 [95% CI: .25, .27], P < .001); reported important people's use of e-cigarettes (AOR = .18 [95% CI: .05, .65, P = .009); and "rarely" noticed e-cigarette health warnings (AOR = .28 [95% CI: .08, .98, P = .054). CONCLUSION Intervention efforts must target specific predictive factors that may help adolescents quit e-cigarettes.
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Affiliation(s)
- Nikhil Ahuja
- Department of Public Health, Slippery Rock University of Pennsylvania, Slippery Rock, PA, USA
| | - Satish Kedia
- Division of Social and Behavioral Sciences, University of Memphis, School of Public Health, Memphis, TN, USA
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, University of Memphis, School of Public Health, Memphis, TN, USA
| | - Yu Jiang
- Division of Epidemiology and Biostatistics, University of Memphis, School of Public Health, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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Mahmood A, Kim H, Chang CF, Kedia S, Arshad H, Dillon PJ. mHealth Apps Use and Their Associations With Healthcare Decision-Making and Health Communication Among Informal Caregivers: Evidence From the National Cancer Institute's Health Information National Trends Survey. Am J Health Promot 2024; 38:40-52. [PMID: 37708496 DOI: 10.1177/08901171231202861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
PURPOSE The current study investigates associations between mHealth apps and healthcare decision-making and health communication among informal caregivers in the US. DESIGN Cross-sectional study employing secondary data. SETTING The Health Information National Trends Survey (HINTS5, Cycles 2 through 4, 2018 - 2020). SAMPLE Self-identified informal caregivers (n = 1386; had mHealth apps = 61.3%, female = 63.2%, some college or more in education = 80.3%) who reported owning at least a smartphone or a tablet computer (i.e., ownership of a "smart device"). MEASURES Sociodemographic characteristics, reports of having mHealth apps, smart device utilization in healthcare decision-making and health communication. ANALYSIS Accounting for the complex design features of the HINTS data, we constructed multiple hierarchical logistic regressions to compute adjusted odds ratios (aOR) and their 95% confidence intervals (CI). RESULTS Compared to caregivers without mHealth apps, those with the apps had higher odds of utilizing their smart devices to make a health-related decision, such as how to treat a disease or a medical condition (aOR = 1.65; 95% CI: 1.13-2.39, P < .01), or engage in health-related discussions with a healthcare provider (aOR = 2.36; 95% CI: 1.54-3.61, P < .001). CONCLUSION Having mHealth apps was associated with a higher likelihood of using smart devices in healthcare decision-making and health communication by informal caregivers. Empowering caregivers to make informed health-related decisions and communicate effectively with healthcare providers are both crucial to health promotion and well-being. Future studies should investigate facilitators as well as barriers to using mHealth apps and smart devices in health-promoting strategies involving informal caregivers.
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Affiliation(s)
- Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Hyunmin Kim
- School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Cyril F Chang
- Fogelman College of Business and Economics, The University of Memphis, Memphis, TN, USA
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Hassan Arshad
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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Sasi A, Ahuja V, Das CJ, Arora U, Garg P, Razik A, Kedia S, Das P, Jadon RS, Soneja M, Wig N. Assessment of CT perfusion indices of the clinicoradiological response to anti-tubercular therapy in patients with intestinal tuberculosis. Clin Radiol 2023; 78:e1081-e1086. [PMID: 37839945 DOI: 10.1016/j.crad.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023]
Abstract
AIM To explore the possibility of using a novel technique, CT perfusion imaging, to monitor the response to anti-tubercular therapy (ATT) in patients with intestinal tuberculosis. MATERIALS AND METHODS A prospective observational study was performed in adults with treatment naive-intestinal tuberculosis. Clinical, endoscopic, and conventional radiological findings of patients were compared at baseline and post-ATT. CT perfusion imaging was performed with recording of six perfusion parameters (blood flow, blood volume, mean transit time, time to peak, maximum peak intensity, and permeability/blood flow extraction). RESULTS Twenty-two patients (13 women, 59%) with a median age of 25 years were recruited. The terminal ileum and ileocaecal junction were the most frequent sites of involvement (59%), with multiple segments of the intestine being involved in 16 patients (73%). Median duration of ATT was 6 months (range 6-10 months). Complete clinical response was observed in 22/22 (100%) patients, endoscopic response in 12/12 (100%) patients, and radiological response in 10/13 (76%) patients. There was a significant decrease in mean blood flow, blood volume, maximum peak intensity, and an increase in mean transit time and time to peak on follow-up CT perfusion imaging performed after 6 months of ATT. CONCLUSION Significant alterations in CT perfusion parameters were demonstrated following treatment, consistent with a decline in inflammation and vascularity. CT perfusion imaging of the bowel is a novel means to assess the radiological response to ATT in intestinal tuberculosis, although at the cost of a higher dose of radiation exposure.
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Affiliation(s)
- A Sasi
- Department of Medicine, AIIMS, Delhi, India
| | - V Ahuja
- Department of Gastroenterology and Human Nutrition, AIIMS, Delhi, India
| | - C J Das
- Department of Radiodiagnosis, AIIMS, Delhi, India
| | - U Arora
- Department of Medicine, AIIMS, Delhi, India
| | - P Garg
- Department of Medicine, AIIMS, Delhi, India
| | - A Razik
- Department of Radiodiagnosis, AIIMS, Delhi, India
| | - S Kedia
- Department of Gastroenterology and Human Nutrition, AIIMS, Delhi, India
| | - P Das
- Department of Pathology, AIIMS, Delhi, India
| | | | - M Soneja
- Department of Medicine, AIIMS, Delhi, India.
| | - N Wig
- Department of Medicine, AIIMS, Delhi, India
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Kedia S, Checker R, Sandur SK, Nilaya JP. Picosecond laser-induced hybrid groove structures on Ti-6Al-4V bio-alloy to accelerate osseointegration. J Biomed Mater Res B Appl Biomater 2023. [PMID: 37272699 DOI: 10.1002/jbm.b.35284] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/03/2023] [Accepted: 05/18/2023] [Indexed: 06/06/2023]
Abstract
Regulating cell growth, extracellular matrix deposition and mineralization of artificial implants are some important parameters that decide the longevity of implants in the body. Picosecond laser-induced hybrid groove structures have been shown to improve these properties of the Ti-6Al-4V bio-alloy. Two hybrid structures containing groove patterns with periodic and non-periodic substructures therein were generated on Ti-6Al-4V by varying the extent of laser pulse overlapping on sample surface. Laser-induced alteration in surface topography, chemical composition and wettability of Ti-6Al-4V resulted in 3-fold increase in the rate of hydroxyapatite growth, 2.5-fold increment in protein adsorption and 2-fold enhancement in cell adhesion in comparison to pristine sample. While the periodic substructure was found to guide cell growth, the nonperiodic sub structure offered homogenous growth leading to higher overall cell density on the substrate surface.
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Affiliation(s)
- S Kedia
- Laser & Plasma Technology Division, Bhabha Atomic Research Centre, Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
| | - R Checker
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Bio-Organic Division, Bhabha Atomic Research Centre, Mumbai, India
| | - S K Sandur
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
- Bio-Organic Division, Bhabha Atomic Research Centre, Mumbai, India
| | - J P Nilaya
- Laser & Plasma Technology Division, Bhabha Atomic Research Centre, Mumbai, India
- Homi Bhabha National Institute, Training School Complex, Mumbai, India
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Kedia S, Mahmood A, Xie L, Jiang Y, Dillon P, Ahuja N, Arshad H, Entwistle C. Driving under the influence of substances and motor vehicle fatalities among older adults in the United States. Traffic Inj Prev 2023; 24:379-386. [PMID: 37106483 DOI: 10.1080/15389588.2023.2188435] [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] [Received: 08/07/2021] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE This study examines contribution of substance use (including alcohol, cannabinoids, stimulants, narcotics, depressants, and hallucinogens) on the probability of drivers being at-fault for a crash on U.S. public roads, with specific emphasis on older adult drivers. METHODS Data from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (FARS) for the years 2010-2018 were employed for 87,060 drivers (43,530 two-vehicle crash pairs) involved in two moving vehicle crashes. The quasi-induced exposure (QIE) method was used to compute the relative crash involvement ratios (CIRs) for each relevant substance and illicit drug. Mixed-effect generalized linear regression models were fit to examine the effect of substance use on the probability of a driver being at-fault for a crash. RESULTS There were 75.51% males and 73.88% Non-Hispanic Whites in our sample. The CIR for those aged 70-79 years was 1.17, and more than double (2.56) for the ≥80 years old drivers, while being relatively low among drivers of ages 20 to 69. Substance use, in general, disproportionately increased the probability of being at-fault during a crash, regardless of driver's age. Though older drivers are less likely than other age groups to report substance use, presence of substances among older drivers increased the probability of their being at-fault two to four times during a crash across almost all substances. The regression models, after adjusting for driver's sex, road grade, weather, light conditions, distraction, and speeding at time of crash, revealed that older drug-impaired drivers were twice as likely to be at fault in a fatal crash (aOR = 1.947; 95% CI = 1.821, 2.082; <0.0001) compared to their middle-aged counterparts. Similarly, most substance use categories were responsible for the probabilities of higher CIRs among the drivers. CONCLUSION These findings necessitate continued efforts to bring awareness to the deadly consequences of "drugged driving," especially among older adult drivers.
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Affiliation(s)
- Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Lu Xie
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Yu Jiang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Patrick Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, Ohio
| | - Nikhil Ahuja
- Department of Public Health, Slippery Rock University of Pennsylvania, Slippery Rock, Pennsylvania
| | - Hassan Arshad
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Coree Entwistle
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
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Mahmood A, Kedia S, Dillon PJ, Kim H, Arshad H, Ray M. Food security status and breast cancer screening among women in the United States: Evidence from the Health and Retirement Study and Health Care and Nutrition Study. Cancer Causes Control 2023; 34:321-335. [PMID: 36695824 DOI: 10.1007/s10552-023-01667-1] [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: 01/26/2021] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE To assess the impact of food insecurity on biennial breast cancer screenings (i.e., mammography or breast X-ray) among older women in the United States (US). METHODS Data from the 2014 and 2016 waves of the Health and Retirement Study and the 2013 Health Care and Nutrition Study were used. The analyses were limited to a nationally representative sample of 2,861 women between 50 and 74 years of age, residing in the US. We employed a propensity score weighting method to balance observed confounders between food-secure and food-insecure women and fit a binary logistic regression to investigate population-level estimates for the association between food security and breast cancer screening. RESULTS Food insecurity was significantly associated with failure to obtain a mammogram or breast X-ray within the past two years. Food-insecure women had 54% lower odds of reporting breast cancer screening in the past 2 years (adjusted OR = 0.46; 95% CI 0.30-0.70, p-value < 0.001) as compared to food-secure women. Additional factors associated with a higher likelihood of receiving breast cancer screenings included greater educational attainment, higher household income, regular access to health care/advice, not smoking, and not being physically disabled or experiencing depressive symptoms. CONCLUSION Results demonstrate a socioeconomic gradient existing in regard to the utilization of regular breast cancer screenings among women. Those who tend to have lower education, lower income, and lack of reliable healthcare access are more likely to be food insecure. Thus, more likely to face the financial, logistical, or environmental barriers in obtaining screening services that accompany food insecurity.
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Affiliation(s)
- Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, 956 Court Avenue, Coleman A218A, Memphis, TN, 38163, USA. .,Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Hyunmin Kim
- School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Hassan Arshad
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Meredith Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USA
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Mahmood A, Kedia S, Dobalian A, Chang CF, Ahn S. Longitudinal associations between time-varying insomnia symptoms and all-cause health care services utilization among middle-aged and older adults in the United States. Health Serv Res 2022; 57:1247-1260. [PMID: 35344596 PMCID: PMC9643080 DOI: 10.1111/1475-6773.13971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To examine longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle-aged and older adults. DATA SOURCES The Health and Retirement Study (HRS), a nationwide, population-representative survey of primarily middle-aged and older adults in the United States. STUDY DESIGN This study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged ≥50 years; females = 57.7%). Study participants were followed for 16 years. This study focuses on the associations between time-varying insomnia symptoms, both cumulatively and independently, and repeated HSUs. A marginal structural modeling approach was used to capture time-varying biological, psycho-cognitive, and behavioral health factors, and to adjust for selection bias such as differential loss to follow-up. Generalized estimating equations were employed to compute average marginal effects and their 95% confidence intervals. DATA COLLECTION/EXTRACTION METHODS We extracted longitudinal data from 2002 through 2018 waves of the HRS. PRINCIPAL FINDINGS Experiencing higher numbers of insomnia symptoms on a cumulative scale was associated with higher probabilities of HSU. For instance, the likelihood of overnight hospital stays for individuals reporting one symptom increased from 4.7 percentage points on average (95% CI: 3.7-5.6, p < 0.001), to 13.9 percentage points (95% CI: 10.3-17.5, p < 0.001) for those reporting four symptoms, relative to individuals experiencing no insomnia symptoms. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU when compared to those not experiencing the symptoms. CONCLUSIONS The results demonstrate the potential consequences and adverse impacts of insomnia symptoms on HSU among middle-aged and older adults. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.
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Affiliation(s)
- Asos Mahmood
- Division of Health Systems Management and Policy, School of Public HealthUniversity of MemphisMemphisTennesseeUSA
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public HealthUniversity of MemphisMemphisTennesseeUSA
| | - Aram Dobalian
- Division of Health Systems Management and Policy, School of Public HealthUniversity of MemphisMemphisTennesseeUSA
| | - Cyril F. Chang
- Fogelman College of Business and EconomicsUniversity of MemphisMemphisTennesseeUSA
| | - SangNam Ahn
- Division of Health Systems Management and Policy, School of Public HealthUniversity of MemphisMemphisTennesseeUSA
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Mahmood A, Kim H, Kedia S, Dillon P. Wearable Activity Tracker Use and Physical Activity Among Informal Caregivers in the United States: Quantitative Study. JMIR Mhealth Uhealth 2022; 10:e40391. [PMID: 36422886 PMCID: PMC9732754 DOI: 10.2196/40391] [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: 08/05/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND With an increase in aging population and chronic medical conditions in the United States, the role of informal caregivers has become paramount as they engage in the care of their loved ones. Mounting evidence suggests that such responsibilities place substantial burden on informal caregivers and can negatively impact their health. New wearable health and activity trackers (wearables) are increasingly being used to facilitate and monitor healthy behaviors and to improve health outcomes. Although prior studies have examined the efficacy of wearables in improving health and well-being in the general population, little is known about their benefits among informal caregivers. OBJECTIVE This study aimed to examine the association between use of wearables and levels of physical activity (PA) among informal caregivers in the United States. METHODS We used data from the National Cancer Institute's Health Information National Trends Survey 5 (cycle 3, 2019 and cycle 4, 2020) for a nationally representative sample of 1273 community-dwelling informal caregivers-aged ≥18 years, 60% (757/1273) female, 75.7% (990/1273) had some college or more in education, and 67.3% (885/1273) had ≥1 chronic medical condition-in the United States. Using jackknife replicate weights, a multivariable logistic regression was fit to assess an independent association between the use of wearables and a binary outcome: meeting or not meeting the current World Health Organization's recommendation of PA for adults (≥150 minutes of at least moderate-intensity PA per week). RESULTS More than one-third (466/1273, 37.8%) of the informal caregivers met the recommendations for adult PA. However, those who reported using wearables (390/1273, 31.7%) had slightly higher odds of meeting PA recommendations (adjusted odds ratios 1.1, 95% CI 1.04-1.77; P=.04) compared with those who did not use wearables. CONCLUSIONS The results demonstrated a positive association between the use of wearables and levels of PA among informal caregivers in the United States. Therefore, efforts to incorporate wearable technology into the development of health-promoting programs or interventions for informal caregivers could potentially improve their health and well-being. However, any such effort should address the disparities in access to innovative digital technologies, including wearables, to promote health equity. Future longitudinal studies are required to further support the current findings of this study.
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Affiliation(s)
- Asos Mahmood
- Center for Health System Improvement, University of Tennessee Health Science Center, Memphis, TN, United States
- Department of Medicine, General Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Hyunmin Kim
- School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, United States
| | - Satish Kedia
- School of Public Health, The University of Memphis, Memphis, TN, United States
| | - Patrick Dillon
- School of Communication Studies, Kent State University, North Canton, OH, United States
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Kedia S, Ahuja N, Hammal F, Asfar T, Eissenberg T, Maziak W, Ward KD. "Waterpipe Is Like a Wife": Qualitative Assessment of Perspectives on Waterpipe Smoking Dependence. Addict Health 2022; 14:268-278. [PMID: 37559789 PMCID: PMC10408748 DOI: 10.34172/ahj.2022.1377] [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] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/08/2022] [Indexed: 08/11/2023]
Abstract
BACKGROUND Waterpipe (WP) smoking has become a global public health problem in recent decades and growing evidence indicates that it can cause nicotine dependence. Most evidence on WP dependence to date has been derived from survey- or laboratory-based studies. This study employed qualitative methods to explore WP users' perceptions of dependence in Aleppo, Syria. METHODS A total of 15 focus groups were conducted with 64 adult WP smokers (51 males and 13 females) using a semi-structured interview. All focus group discussions were audiotaped, transcribed, and coded using directed content analysis. FINDINGS Several WP dependence features were consistent with those commonly reported by cigarette smokers. These included positively reinforced features, such as smoking's association with social gatherings and cultural connectedness, and negatively reinforced features including relief of withdrawal symptoms, stress, and boredom. Although interest in quitting was low, many users perceived quitting WP to be difficult and an indicator of loss of control over smoking, a common marker of dependence. Several observed dependence features were specific to WP, including transitioning from social smoking to smoking alone, and adapting one's behavior to the considerable effort normally required to engage in WP smoking despite inconvenience or cost, and often at the expense of other reinforcers such as social interaction. CONCLUSION The general and specific features of WP dependence need to be considered in developing instruments to measure WP dependence, in clinical assessment of WP dependence, and in developing cessation programs.
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Affiliation(s)
- Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Nikhil Ahuja
- Department of Public Health and Social Work, Slippery Rock University, PA, USA
| | - Fadi Hammal
- School of Public Health, University of Alberta, Edmonton, Canada
- Syrian Center for Tobacco Studies, Aleppo, Syria
| | - Taghrid Asfar
- Syrian Center for Tobacco Studies, Aleppo, Syria
- Department of Public Health Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Aleppo, Syria
- Center for the Study of Tobacco Products and Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Wasim Maziak
- Syrian Center for Tobacco Studies, Aleppo, Syria
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Kenneth D. Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
- Syrian Center for Tobacco Studies, Aleppo, Syria
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Marwah V, Dutta S, Kedia S, Mittal P. Total laparoscopic hysterectomy (TLH) with endosuturing compared with conventional technique using energy sources. Facts Views Vis Obgyn 2021; 13:149-158. [PMID: 34184844 PMCID: PMC8291987 DOI: 10.52054/fvvo.13.2.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The aim of the study was to demonstrate the technique of total laparoscopic hysterectomy (TLH) with intra-corporeal endosuturing using simple sutures and basic surgical instruments and compare with TLH using electric coagulation equipment i.e. energy sources with regard to operative time, blood loss, postoperative stay and pain scores. Methods A retrospective study was undertaken, in Max Super Specialty Hospital Saket, from June 2015 to May 2018, which included 586 cases of TLH (for benign gynecological conditions), of which 287 were performed using intra-corporeal endosuturing (Group 1) and 299 were performed using energy sources (Group 2). To avoid bias, baseline matching was done for body mass index (BMI), indications for surgery, size of uterus, previous abdominal surgeries and comorbidities like diabetes and hypertension after which there were 172 patients in each group. Results The mean age of patients was 48.24 ± 6.76 years. All operative outcomes including operative time (104.1 ± 22.6 vs 107.6 ± 32.6 mins, p=0.25), blood loss (78.9 ± 101.6 vs 99.7 ± 177.6 ml, p=0.19), pain score (2.5 ± 1.3 vs 2.7 ± 1.2, p=0.13) and post-operative stay (2.05 ± 0.2 vs 2.07 ± 0.3 days, p=0.36) were similar between the two groups. Uterine size was the major determinant of operative time and operative blood loss. Conclusion TLH with intracorporeal endosuturing can be performed safely and gives results comparable with TLH performed using energy sources. Advancement in suturing devices can decrease operative time further and potentially make it easier and more acceptable.
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Mahmood A, Kim H, Kabir U, Kedia S, Ray M. Food Insecurity and Influenza and Pneumonia Vaccines Uptake Among Community-Dwelling Older Adults in the United States. J Community Health 2021; 45:943-953. [PMID: 32219711 DOI: 10.1007/s10900-020-00812-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Influenza and pneumonia vaccines can reduce morbidities and mortality associated with infectious diseases among older adults. Food security, good nutrition, and high-quality diets are critical for the wellbeing of older adults. However, little is known about the relationship between food insecurity and use of preventive health services, such as influenza and pneumonia vaccinations, among older adults. In this study, we analyzed data on 40,555 adults aged ≥ 65 years from the 2014-2018 National Health Interview Survey in the United States. Through multiple hierarchical logistic regression models, we investigated the associations between food insecurity and influenza and pneumonia vaccines uptake in this population. We found that, during 2014-2018, about 12.6 million (5.3%) adults aged ≥ 65 years lived in food-insecure households in the United States. Of those, 60.6% reported getting an influenza vaccine in the past 12 months, and 54.2% reported ever getting a pneumonia vaccine. Compared to food-secure older adults, food-insecure individuals were not significantly different in terms of influenza vaccine uptake. However, they were 25% less likely to have ever gotten a pneumonia vaccine (adjusted odds ratio = 0.75, 95% CI 0.65-0.86, P < .001). Efforts should be made to develop strategies to improve immunization rates among food-insecure older adults. Healthcare providers could routinely assess their vaccination status and screen them for food insecurity. Also, community level screening and intervention programs should target food-insecure older adults, who often face structural disadvantages. Future studies could explore and identify the underlying predictive factors contributing to low pneumonia vaccination rates among food-insecure older adults.
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Affiliation(s)
- Asos Mahmood
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Robison Hall, 3825 E DeSoto Avenue, Office #136C, Memphis, TN, 38152-3530, USA.
| | - Hyunmin Kim
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Robison Hall, 3825 E DeSoto Avenue, Office #136C, Memphis, TN, 38152-3530, USA.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Umar Kabir
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Robison Hall, 3825 E DeSoto Avenue, Office #136C, Memphis, TN, 38152-3530, USA
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Meredith Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, TN, USA
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Satapathy SK, Tran QT, Kovalic AJ, Bontha SV, Jiang Y, Kedia S, Karri S, Mupparaju V, Podila PSB, Verma R, Maluf D, Mas V, Nair S, Eason JD, Bridges D, Kleiner DE. Clinical and Genetic Risk Factors of Recurrent Nonalcoholic Fatty Liver Disease After Liver Transplantation. Clin Transl Gastroenterol 2021; 12:e00302. [PMID: 33555168 PMCID: PMC7864756 DOI: 10.14309/ctg.0000000000000302] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) has been increasingly reported among recipients of liver transplantation (LT). We aimed to identify clinical and genetic risk factors responsible for the development of early recurrent NAFLD in nonalcoholic steatohepatitis transplant recipients. METHODS Forty-six total single nucleotide polymorphisms with known association with NAFLD were tested among both recipient and donor liver samples in 66 LT recipients with nonalcoholic steatohepatitis to characterize influences on NAFLD recurrence at ∼1 year post-LT (median interval from LT to biopsy: 377 days). RESULTS Recurrent NAFLD was identified in 43 (65.2%) patients, 20 (30.3%) with mild recurrence, and 23 (34.8%) with moderate to severe NAFLD. On adjusted analysis, change in the body mass index (BMI) (ΔBMI) was significantly associated with NAFLD recurrence, whereas post-LT diabetes mellitus was associated with increased severity of NAFLD recurrence. ADIPOR1 rs10920533 in the recipient was associated with increased risk of moderate to severe NAFLD recurrence, whereas the minor allele of SOD2 rs4880 in the recipient was associated with reduced risk. Similar reduced risk was noted in the presence of donor SOD2 rs4880 and HSD17B13 rs6834314 polymorphism. DISCUSSION Increased BMI post-LT is strongly associated with NAFLD recurrence, whereas post-LT diabetes mellitus was associated with increased severity of NAFLD recurrence. Both donor and recipient SOD2 rs4880 and donor HSD17B13 rs6834314 single nucleotide polymorphisms may be associated with reduced risk of early NAFLD recurrence, whereas presence of the minor allele form of ADIPOR1 rs10920533 in the recipient is associated with increased severity NAFLD recurrence.
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Affiliation(s)
- Sanjaya K. Satapathy
- Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases, Northwell Health, Manhasset, New York, USA
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Quynh T. Tran
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, College of Medicine, Memphis, Tennessee, USA
| | - Alexander J. Kovalic
- Department of Internal Medicine, University of Tennessee Health Sciences Center, College of Medicine, Memphis, Tennessee, USA
| | - Sai Vineela Bontha
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
| | - Yu Jiang
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Satish Kedia
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Saradashri Karri
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Vamsee Mupparaju
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
| | - Pradeep S. B. Podila
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
| | - Rajanshu Verma
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Daniel Maluf
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Valeria Mas
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
| | - Satheesh Nair
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - James D. Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Dave Bridges
- Department of Nutritional Sciences University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - David E. Kleiner
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
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14
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Kim H, Mahmood A, Goldsmith JV, Chang H, Kedia S, Chang CF. Access to Broadband Internet and its Utilization for Health Information Seeking and Health Communication among Informal Caregivers in the United States. J Med Syst 2021; 45:24. [PMID: 33452625 DOI: 10.1007/s10916-021-01708-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 08/15/2019] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
Informal caregivers provide unpaid care to their physically or mentally ill loved ones and play a critical role in the healthcare delivery. eHealth tools, including the broadband internet, can facilitate care processes and impact the caregiving burden through seeking health information and health communication. This study examines the predictors of access to broadband internet and the factors associated with health information seeking and health communication among informal caregivers with broadband internet. We used data from cycles 1 and 2 of the Health Information National Trends Survey (HINTS 5) and employed generalized linear regression models with the maximum likelihood estimation. Specifically, we performed a two-part model: (1) a logistic regression model of broadband internet access among all caregivers (n = 929) and (2) a logistic regression model of health information seeking and health communication among caregivers with broadband internet access (n = 404). We found that caregivers who were younger (18-34 years versus 45+ years), female (versus male), and those who were divorced/widowed/separated (versus singles) were less likely to have broadband internet access. While those who were married/living as married (versus singles), with higher incomes (≥$100,000 versus <$35,000), and those living in metropolitan areas were more likely to have broadband internet access. Among caregivers with broadband internet access, younger, female, non-Hispanic white caregivers, and those with higher levels of education and income, as well as those who cared for cancer patients, were more likely to seek health information for someone else. Additionally, caregivers aged 35-39 years and those with more education were more likely to look for health information for themselves than their counterparts. Furthermore, caregivers who were aged 40-44 years, females, divorced/widowed/separated, those with higher incomes, and those who cared for patients with Alzheimer's, confusion, and dementia were more likely to communicate electronically with a provider. The results suggest disparities in broadband internet access and indicate variations in factors associated with health information seeking and health communication. The findings underscore the need to address barriers attributed to the digital divide among informal caregiving groups.
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Affiliation(s)
- Hyunmin Kim
- Division of Health Systems Management and Policy, School of Public Health, University of Memphis, 3825 DeSoto Ave, Memphis, TN, 38152, USA.
| | - Asos Mahmood
- Division of Health Systems Management and Policy, School of Public Health, University of Memphis, 3825 DeSoto Ave, Memphis, TN, 38152, USA
| | - Joy V Goldsmith
- Department of Communication & Film, College of Communication and Fine Arts, University of Memphis, Memphis, TN, 38152, USA
| | - HyukJae Chang
- CONNECT-AI R&D center, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, 38152, USA
| | - Cyril F Chang
- The Methodist and Le Bonheur Center for Healthcare Economics, Memphis, TN, 38152, USA.,Department of Economics, the Fogelman College of Business and Economics, University of Memphis, Memphis, TN, 38152, USA
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15
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Ahuja N, Schmidt M, Dillon PJ, Alexander AC, Kedia S. Online Narratives of Methamphetamine Use and Risky Sexual Behavior: Can Shame-Free Guilt Aid in Recovery? Arch Sex Behav 2021; 50:323-332. [PMID: 32671499 DOI: 10.1007/s10508-020-01777-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 06/11/2023]
Abstract
Methamphetamine (meth) use is a recurring public health challenge in the U.S. In 2016, approximately 1.6 million Americans reported using meth. Meth use is associated with a number of adverse outcomes, including those associated with users' sexual health. In particular, meth use is linked to an increased risk for sexually transmitted infections and unplanned pregnancies. While studies have examined associations between substance use of various types-including meth use, and shame and guilt-few studies have examined relationships among substance use, sexual risk behaviors, and shame and guilt. No qualitative studies, to our knowledge, have studied all three of these phenomena in a sample of meth users. The present qualitative study explored the sexual risk behaviors and associated feelings of shame and guilt in relation to meth use. It draws from anonymous letters and stories (N = 202) posted to an online discussion forum by meth users and their family members. A grounded theory analysis of these narratives identified four primary themes pertaining to meth use and sexual behaviors: (1) feeling heightened sexual arousal and stimulation on meth, (2) experiencing sexual dissatisfaction on meth, (3) responding to sexual arousal and dissatisfaction, and (4) feeling ashamed and/or guilty. Ultimately, the present findings indicate that feelings of shame and guilt may arise more from the consequences of sexual risk behaviors stemming from meth use rather than meth use itself. The emotional toll of meth-induced sexual risk behaviors, particularly shame and guilt over the loss of meaningful relationships and self-respect due to multiple sexual partners, may provide an important opportunity for interventionists.
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Affiliation(s)
- Nikhil Ahuja
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Michael Schmidt
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Adam C Alexander
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA.
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16
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Bhuyan SS, Kabir UY, Escareno JM, Ector K, Palakodeti S, Wyant D, Kumar S, Levy M, Kedia S, Dasgupta D, Dobalian A. Transforming Healthcare Cybersecurity from Reactive to Proactive: Current Status and Future Recommendations. J Med Syst 2020; 44:98. [PMID: 32239357 DOI: 10.1007/s10916-019-1507-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 07/31/2018] [Accepted: 11/14/2019] [Indexed: 11/25/2022]
Abstract
The recent rise in cybersecurity breaches in healthcare organizations has put patients' privacy at a higher risk of being exposed. Despite this threat and the additional danger posed by such incidents to patients' safety, as well as operational and financial threats to healthcare organizations, very few studies have systematically examined the cybersecurity threats in healthcare. To lay a firm foundation for healthcare organizations and policymakers in better understanding the complexity of the issue of cybersecurity, this study explores the major type of cybersecurity threats for healthcare organizations and explains the roles of the four major players (cyber attackers, cyber defenders, developers, and end-users) in cybersecurity. Finally, the paper discusses a set of recommendations for the policymakers and healthcare organizations to strengthen cybersecurity in their organization.
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Affiliation(s)
- Soumitra Sudip Bhuyan
- Rutgers Urban and Civic Informatics Lab, Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, 07920, USA.
| | - Umar Y Kabir
- School of Public Health, The University of Memphis, Memphis, TN, 38152, USA
| | - Jessica M Escareno
- School of Public Health, The University of Memphis, Memphis, TN, 38152, USA
| | - Kenya Ector
- School of Public Health, The University of Memphis, Memphis, TN, 38152, USA
| | | | - David Wyant
- Jack C. Massey Graduate School of Business, Belmont University, Nashville, TN, 37212, USA
| | - Sajeesh Kumar
- Health Info & Info Management, University of Tennessee Health Sciences Center, Memphis, TN, 38104, USA
| | - Marian Levy
- School of Public Health, The University of Memphis, Memphis, TN, 38152, USA
| | - Satish Kedia
- School of Public Health, The University of Memphis, Memphis, TN, 38152, USA
| | - Dipankar Dasgupta
- Department of Computer Science, The University of Memphis, Memphis, TN, 38152, USA
| | - Aram Dobalian
- School of Public Health, The University of Memphis, Memphis, TN, 38152, USA
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17
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Kedia S, Ahuja N, Wyant DK, Dillon PJ, Akkus C, Relyea G. Compositional and contextual factors associated with drug overdose deaths in the United States. J Addict Dis 2020; 38:143-152. [PMID: 32195626 DOI: 10.1080/10550887.2020.1729079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: In 2017, the US Department of Health and Human Services declared the Opioid epidemic a public health emergency. In the US, emergency rooms treat more than 1,000 people each day for drug overdose, and 115 of them die. This study examines compositional and contextual factors associated with drug overdose deaths rates in the US. Methods: Local spatial autocorrelation statistics were used to estimate hot spot areas to identify census tracts with high risk of drug overdose death. Logistic regressions investigated the relationship between drug overdose death rates and various compositional and contextual variables across census tracks. Results: The adjusted logistic model shows that compositional variables: depression (OR = 2.47 [2.37-2.58]), poor mental health (OR = 1.71 [1.63-1.79]), median age 1.41 (1.36-1.47) and the percentage of people with a high school diploma (OR = 1.30 [1.24-1.35]) were positively associated with the rate of drug overdose deaths. On the other hand, contextual variables: the percentage having health insurance (OR = 0.66 [0.64-0.69]), the Theil's H index (OR = 0.69 [0.66-0.71]), population density (OR = 0.80 [0.77-0.84]), poverty (OR = 0.90 [0.86-0.95]), and median household income (OR = 0.91[0.86-0.96]) were negatively associated with drug overdose deaths. Discussion: The analysis reveals a consistently strong association between compositional mental health factors and census tract-level death rates from drug overdose.
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Affiliation(s)
- Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Nikhil Ahuja
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - David K Wyant
- Jack C. Massey College of Business, Belmont University, Nashville, Tennessee, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, Ohio, USA
| | - Cem Akkus
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - George Relyea
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
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18
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Mahmood A, Wyant DK, Kedia S, Ahn S, Powell MP, Jiang Y, Bhuyan SS. Self-Check-In Kiosks Utilization and Their Association With Wait Times in Emergency Departments in the United States. J Emerg Med 2020; 58:829-840. [PMID: 31924466 DOI: 10.1016/j.jemermed.2019.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/30/2019] [Accepted: 11/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Delayed care in emergency departments (EDs) is a serious problem in the United States. Patient wait time is considered a critical measure of delayed care in EDs. Several strategies have been employed by EDs to reduce wait time, including implementation of self-check-in kiosks. However, the effect of kiosks on wait time in EDs is understudied. OBJECTIVES To assess the association between patient wait time and utilization of self-check-in kiosks in EDs. To investigate a series of other patient-, ED-, and hospital-level predictors of wait time in EDs. METHODS Using data from the 2015 and 2016 National Hospital Ambulatory Medical Care Survey, we analyzed 40,528 ED visits by constructing a multivariable linear regression model of the log-transformed wait time data as an outcome, then computing percent changes in wait times. RESULTS During the study period, about 9% of EDs in the United States implemented kiosks. In our linear regression model, the wait time in EDs with kiosk self-check-in services was 56.8% shorter (95% confidence interval ̶ 130% to ̶ 6.4%, p < 0.05) compared with EDs without kiosk services. In addition to kiosks, patients' day of visit, arrival time, triage assessment, arrival by ambulance, chronic medical conditions, ED boarding, hospitals' full-capacity protocol, and hospitals' location were significant predictors of wait time. CONCLUSIONS Self-check-in kiosks are associated with shorter ED wait time in the United States. However, prolonged ED wait time continues to be a system-wide problem, and warrants multilayered interventions to address this challenge for those who are in acute need of immediate care.
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Affiliation(s)
- Asos Mahmood
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - David K Wyant
- The Jack C. Massey Graduate School of Business, Belmont University, Nashville, Tennessee
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - SangNam Ahn
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - M Paige Powell
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Yu Jiang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Soumitra S Bhuyan
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey
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Mahmood A, Kedia S, Wyant DK, Ahn S, Bhuyan SS. Use of mobile health applications for health-promoting behavior among individuals with chronic medical conditions. Digit Health 2019; 5:2055207619882181. [PMID: 31656632 PMCID: PMC6791047 DOI: 10.1177/2055207619882181] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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: 04/05/2019] [Accepted: 09/20/2019] [Indexed: 01/10/2023] Open
Abstract
Background Chronic medical conditions (CCs) are leading causes of morbidity and mortality in the United States. Strategies to control CCs include targeting unhealthy behaviors, often through the use of patient empowerment tools, such as mobile health (mHealth) technology. However, no conclusive evidence exists that mHealth applications (apps) are effective among individuals with CCs for chronic disease self-management. Methods We used data from the Health Information National Trends Survey (HINTS 5, Cycle 1, 2017). A sample of 1864 non-institutionalized US adults (≥18 years) who had a smartphone and/or a tablet computer and at least one CC was analyzed. Using multivariable logistic regressions, we assessed predisposing, enabling, and need predictors of three health-promoting behaviors (HPBs): tracking progress on a health-related goal, making a health-related decision, and health-related discussions with a care provider among smart device and mHealth apps owners. Results Compared to those without mHealth apps, individuals with mHealth apps had significantly higher odds of using their smart devices to track progress on a health-related goal (adjusted odds ratio (aOR) 8.74, 95% confidence interval (CI): 5.66–13.50, P < .001), to make a health-related decision (aOR 1.77, 95% CI: 1.16–2.71, P < .01) and in health-related discussions with care providers (aOR 2.0, 95% CI: 1.26–3.19, P < .01). Other significant factors of at least one type of HPB among smart device and mHealth apps users were age, gender, education, occupational status, having a regular provider, and self-rated general health. Conclusion mHealth apps are associated with increased rates of HPB among individuals with CCs. However, certain groups, like older adults, are most affected by a digital divide where they have lower access to mHealth apps and thus are not able to take advantage of these tools. Rigorous randomized clinical trials among various segments of the population and different health conditions are needed to establish the effectiveness of these mHealth apps. Healthcare providers should encourage validated mHealth apps for patients with CCs.
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Affiliation(s)
- Asos Mahmood
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - David K Wyant
- The Jack C Massey Graduate School of Business, Belmont University, Nashville, TN, USA
| | - SangNam Ahn
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, TN, USA
| | - Soumitra S Bhuyan
- Edward J Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA
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20
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Nambirajan A, Gurung N, Sashidharan A, Sharma A, Kedia S, Garg A, Suri V, Sarkar C, Sharma M. P11.05 Reappraisal of CNS embryonal tumors, not otherwise specified and RELA fusion negative supratentorial ependymomas using immunohistochemistry and sequencing for BCOR. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.151] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
BCl2 co-repressor (BCOR) gene internal tandem duplications have recently been identified as the defining molecular alteration in a subset of central nervous system (CNS) high grade neuroepithelial tumors (CNS-HGNET). Their clinicopathological profile is yet to be fully elucidated with available data being largely derived from case reports and small case series. Reported cases presented in young children with a male preponderance, were located predominantly in the posterior fossa, and sometimes but not always showed an ependymoma-like morphology. BCOR protein overexpression and exon 15 internal tandem duplications were characteristic. These tumors associated with a poor overall survival.
MATERIAL AND METHODS
We designed a retrospective study (2002–2019) wherein all cases of CNS embryonal tumors, not otherwise specified (NOS), by definition lacking C19MC locus amplification and Lin28A protein expression, and supratentorial ependymomas (ST-EPN), NOS, lacking RELA and YAP1 fusions and L1CAM protein expression were retrieved and subject to immunohistochemistry for BCOR. Those tumors showing nuclear expression of BCOR were subject to sequencing of exon 15 of BCOR gene.
RESULTS
A total of 19 CNS embryonal tumors, NOS, constituting 86% of all CNS embryonal tumors other than medulloblastomas and atypical teratoid rhabdoid tumors, and 11 ST-EPN, NOS constituting 30% of all ST EPNs, were included. Diffuse nuclear staining for BCOR was seen in 6 tumors, including two patients with CNS embryonal tumor, NOS (10 year old male with spinal cord mass; 5-year-old female with left frontal mass) and 4 patients with ST-EPN-NOS (median age 15 years, ranging from 10–28 years, all females). While the CNS embryonal tumors showed high grade small round cell morphology, the remaining showed ependymoma-like morphology, but with increased cellularity and focal to diffuse membranous expression of epithelial membrane antigen and cytokeratins unlike ependymomas. Among these four patients, one was disease free at last follow-up at 17 months, while the remaining suffered recurrences within a median time duration of 26 months after diagnosis (24 months - 36 months).
CONCLUSION
The clinicopathological spectrum of BCOR-altered CNS tumors appears to be wider than that described in literature. We describe BCOR alterations in a subset of ependymoma-like tumors in older children and young adults with a striking female preponderance. BCOR alterations need to be studied on a broad spectrum of pediatric and adults CNS tumors to aid in better understanding of its true prevalence and biological significance.
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Affiliation(s)
- A Nambirajan
- All India Institute of Medical Sciences, New Delhi, India
| | - N Gurung
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sashidharan
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - S Kedia
- All India Institute of Medical Sciences, New Delhi, India
| | - A Garg
- All India Institute of Medical Sciences, New Delhi, India
| | - V Suri
- All India Institute of Medical Sciences, New Delhi, India
| | - C Sarkar
- All India Institute of Medical Sciences, New Delhi, India
| | - M Sharma
- All India Institute of Medical Sciences, New Delhi, India
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Molnar MZ, Joglekar K, Jiang Y, Cholankeril G, Abdul MKM, Kedia S, Gonzalez HC, Ahmed A, Singal A, Bhamidimarri KR, Aithal GP, Duseja A, Wong VWS, Gulnare A, Puri P, Nair S, Eason JD, Satapathy SK. Association of Pretransplant Renal Function With Liver Graft and Patient Survival After Liver Transplantation in Patients With Nonalcoholic Steatohepatitis. Liver Transpl 2019; 25:399-410. [PMID: 30369023 PMCID: PMC6709989 DOI: 10.1002/lt.25367] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 07/13/2018] [Accepted: 09/28/2018] [Indexed: 12/13/2022]
Abstract
Nonalcoholic steatohepatitis (NASH) is one of the top 3 indications for liver transplantation (LT) in Western countries. It is unknown whether renal dysfunction at the time of LT has any effect on post-LT outcomes in recipients with NASH. From the United Network for Organ Sharing-Standard Transplant Analysis and Research data set, we identified 4088 NASH recipients who received deceased donor LT. We divided our recipients a priori into 3 categories: group 1 with estimated glomerular filtration rate (eGFR) <30 mL/minute/1.73 m2 at the time of LT and/or received dialysis within 2 weeks preceding LT (n = 937); group 2 with recipients who had eGFR ≥30 mL/minute/1.73 m2 and who did not receive renal replacement therapy prior to LT (n = 2812); and group 3 with recipients who underwent simultaneous liver-kidney transplantation (n = 339). We examined the association of pretransplant renal dysfunction with death with a functioning graft, all-cause mortality, and graft loss using competing risk regression and Cox proportional hazards models. The mean ± standard deviation age of the cohort at baseline was 58 ± 8 years, 55% were male, 80% were Caucasian, and average exception Model for End-Stage Liver Disease score was 24 ± 9. The median follow-up period was 5 years (median, 1816 days; interquartile range, 1090-2723 days). Compared with group 1 recipients, group 2 recipients had 19% reduced trend for risk for death with a functioning graft (subhazard ratio [SHR], 0.81; 95% confidence interval [CI], 0.64-1.02) and similar risk for graft loss (SHR, 1.25; 95% CI, 0.59-2.62), whereas group 3 recipients had similar risk for death with a functioning graft (SHR, 1.23; 95% CI, 0.96-1.57) and graft loss (SHR, 0.18; 95% CI, 0.02-1.37) using an adjusted competing risk regression model. In conclusion, recipients with preserved renal function before LT showed a trend toward lower risk of death with a functioning graft compared with SLKT recipients and those with pretransplant severe renal dysfunction in patients with NASH.
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Affiliation(s)
- Miklos Z Molnar
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.,Department of Medicine, University of Tennessee Health Science Center, Memphis, TN.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Kiran Joglekar
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Yu Jiang
- School of Public Health, University of Memphis, Memphis, TN
| | - George Cholankeril
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA
| | | | - Satish Kedia
- School of Public Health, University of Memphis, Memphis, TN
| | - Humberto C Gonzalez
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA
| | - Ashwani Singal
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Guruprasad Padur Aithal
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals National Health Service Trust and University of Nottingham, Nottingham, United Kingdom
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Agayeva Gulnare
- Department of Internal Medicine, Grand Hospital, Baku, Azerbaijan
| | - Puneet Puri
- Division of Gastroenterology, Hepatology and Nutrition, McGuire Veterans Affairs Medical Center, Virginia Commonwealth University, Richmond, VA
| | - Satheesh Nair
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - James D Eason
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Sanjaya K Satapathy
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN.,Department of Surgery, University of Tennessee Health Science Center, Memphis, TN
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22
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Gupta S, Rout G, Patel AH, Mahanta M, Kalra N, Sahu P, Sethia R, Agarwal A, Ranjan G, Kedia S, Acharya SK, Nayak B, Shalimar. Efficacy of generic oral directly acting agents in patients with hepatitis C virus infection. J Viral Hepat 2018; 25:771-778. [PMID: 29377464 DOI: 10.1111/jvh.12870] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/15/2017] [Indexed: 12/13/2022]
Abstract
Novel direct-acting antivirals (DAAs) are now the standard of care for the management of hepatitis C virus (HCV) infection. Branded DAAs are associated with high sustained virological response at 12 weeks post-completion of therapy (SVR12), but are costly. We aimed to assess the efficacy of generic oral DAAs in a real-life clinical scenario. Consecutive patients with known HCV infection who were treated with generic-oral DAA regimens (May 2015 to January 2017) were included. Demographic details, prior therapy and SVR12 were documented. Four hundred and ninety patients (mean age: 38.9 ± 12.7 years) were treated with generic DAAs in the study time period. Their clinical presentations included chronic hepatitis (CHC) in 339 (69.2%) of cases, compensated cirrhosis in 120 (24.48%) cases and decompensated cirrhosis in 31 (6.32%) cases. Genotype 3 was most common (n = 372, 75.9%) followed by genotype 1 (n = 97, 19.8%). Treatment naïve and treatment-experienced (defined as having previous treatment with peginterferon and ribavirin) were 432 (88.2%) and 58 (11.8%), respectively. Generic DAA treatment regimens included sofosbuvir in combination with ribavirin (n = 175), daclatasvir alone (n = 149), ribavirin and peginterferon (n = 80), ledipasvir alone (n = 43), daclatasvir and ribavirin (n = 37), and ledipasvir and ribavirin (n = 6). Overall SVR12 was 95.9% (470/490) for all treatment regimens. SVR12 for treatment naïve and experienced patients was 97.0% (419/432) and 87.9% (51/58), respectively, P = .005. High SVR12 was observed with various regimens, irrespective of genotype and underlying liver disease status. There were no differences in SVR12 with 12 or 24 weeks therapy. No major adverse event occurred requiring treatment stoppage. Generic oral DAAs are associated with high SVR rates in patients with HCV infection in a real-life clinical scenario.
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Affiliation(s)
- S Gupta
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - G Rout
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - A H Patel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - M Mahanta
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - N Kalra
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - P Sahu
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - R Sethia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - A Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - G Ranjan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - B Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Khan SS, Banerjee P, Setua S, Higgins D, Kedia S, Jiang Y, Jaggi M, Chauhan S. Abstract 5138: Comparative profiling for bacterial inhabitance in pancreatic ductal adenocarcinoma and matched adjacent normal tissues. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-5138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: Composition of resident microbes of the human body is associated with different disease manifestations. The microbiome in bodily fluids and different organs is altered with diverse health outcomes including cancer. Microbiome composition is a potential source for identifying biomarkers in cancers. Studies have shown the association of specific bacterial communities with the occurrence of pancreatic ductal adenocarcinoma (PDAC). However, investigations for the altered microbiota in an individual with the emergence of the disease are not studied. So, this study presents a comparative profiling for bacterial inhabitance in cancer tissues with that of matched adjacent normal tissues. This association will enable discovery of potential microbial biomarker(s) for PDAC.
Methods: Fresh frozen cancer and matched adjacent normal (N= 20 each) tissues were collected from PDAC patients. Genomic DNA was extracted by MO BIO PowerSoil DNA Isolation kit and enriched using NEBNext Microbiome DNA Enrichment kit. Next-generation sequencing (NGS) method, pyrosequencing of 16S rRNA was used to assess the diversity of the tissue-associated microbiota. Operational Taxonomic Units (OTUs) were defined at >97% similarity followed by taxonomic classification using BLASTn against a curated GreenGenes/NCBI/RDP derived database (bTEFAP®). The Bray-Curtis coefficient was used to quantify the compositional dissimilarity between microbiome profiles. Statistical analysis was done using “R” and NCSS 2010. Alpha and beta diversity analyses were conducted to cluster samples by their microbiome profiles. Overall associations between PDAC and microbiome compositions were assessed based on weighted or unweighted UniFrac distances using PERMANOVA.
Results: 16S taxonomic profiling reveal 10 and 11 dominant bacterial genera associated with normal and cancer lesion, respectively. Prominent genera that are only found in cancer lesions include Bacteroides, Enhydrobacter, Lautropia, Mycobacterium, and Phascolarctobacterium, whereas Fusobacterium, Acinetobacter, Propionibacterium, and Pseudomonas are the genera with high relative abundance in both cancer lesion and adjacent normal tissues. The most prevalent bacterial species in all observed samples are Propionibacterium acnes and Pseudomonas pseudoalcaligenes. We found Fusobacterium nucleatum in 4 samples (2 each in tumor and adjacent normal) in our preliminary work (10% prevalence). The PCoA multidimensional plot showed clustering of “tumor” samples, indicating the microbiota of these specimens is distinct from normal adjacent tissues.
Conclusion: This study suggests a plethora of distinct bacterial community structure in PDAC lesions that is significantly different from that of matched adjacent normal tissues. Additionally, it suggests that the tissue-associated microbiota can serve as a useful biomarker for PDAC.
Citation Format: Sheema S. Khan, Pratik Banerjee, Saini Setua, Daleniece Higgins, Satish Kedia, Yu Jiang, Meena Jaggi, Subhash Chauhan. Comparative profiling for bacterial inhabitance in pancreatic ductal adenocarcinoma and matched adjacent normal tissues [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5138.
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Affiliation(s)
| | | | - Saini Setua
- 1Univ. of Tennessee Health Science Ctr., Memphis, TN
| | | | | | - Yu Jiang
- 2University of Memphis, Memphis, TN
| | - Meena Jaggi
- 1Univ. of Tennessee Health Science Ctr., Memphis, TN
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Pratap Mouli V, Kedia S, Ahuja V. Letter: mucosal response in discriminating intestinal tuberculosis from Crohn's disease-when to look for it? Authors' reply. Aliment Pharmacol Ther 2018; 47:860-861. [PMID: 29446137 DOI: 10.1111/apt.14535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- V Pratap Mouli
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - S Kedia
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - V Ahuja
- Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
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25
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Pratap Mouli V, Munot K, Ananthakrishnan A, Kedia S, Addagalla S, Garg SK, Benjamin J, Singla V, Dhingra R, Tiwari V, Bopanna S, Hutfless S, Makharia G, Ahuja V. Endoscopic and clinical responses to anti-tubercular therapy can differentiate intestinal tuberculosis from Crohn's disease. Aliment Pharmacol Ther 2017; 45:27-36. [PMID: 27813111 DOI: 10.1111/apt.13840] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [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: 06/16/2016] [Revised: 07/15/2016] [Accepted: 10/03/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Differentiation between intestinal tuberculosis and Crohn's disease is difficult and may require therapeutic trial with anti-tubercular therapy in tuberculosis-endemic regions. AIM To evaluate the role of therapeutic trial with anti-tubercular therapy in patients with diagnostic confusion between intestinal tuberculosis and Crohn's disease. METHODS We performed retrospective-comparative (n = 288: 131 patients who received anti-tubercular therapy before being diagnosed as Crohn's disease and 157 intestinal tuberculosis patients) and prospective-validation study (n = 55 patients with diagnostic confusion of intestinal tuberculosis/Crohn's disease). Outcomes assessed were global symptomatic response and endoscopic mucosal healing. RESULTS In the derivation cohort, among those eventually diagnosed as Crohn's disease, global symptomatic response with anti-tubercular therapy was seen in 38% at 3 months and in 37% who completed 6 months of anti-tubercular therapy. Ninety-four per cent of intestinal tuberculosis patients showed global symptomatic response by 3 months. Endoscopic mucosal healing was seen in only 5% of patients with Crohn's disease compared with 100% of intestinal tuberculosis patients. In the validation cohort, all the patients with intestinal tuberculosis had symptomatic response and endoscopic mucosal healing after 6 months of anti-tubercular therapy. Among the patients with an eventual diagnosis of Crohn's disease, symptomatic response was seen in 64% at 2 months and in 31% who completed 6 months of anti-tubercular therapy, none had mucosal healing. CONCLUSIONS Disproportionately lower mucosal healing rate despite an overall symptom response with 6 months of anti-tubercular therapy in patients with Crohn's disease suggests a need for repeat colonoscopy for diagnosing Crohn's disease. Patients with intestinal tuberculosis showing significant symptomatic response after 2-3 months of anti-tubercular therapy, suggest that symptom persistence after a therapeutic trial of 3 months of anti-tubercular therapy may indicate the diagnosis of Crohn's disease.
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Affiliation(s)
- V Pratap Mouli
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - K Munot
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - A Ananthakrishnan
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA
| | - S Kedia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - S Addagalla
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - S K Garg
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - J Benjamin
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - V Singla
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - R Dhingra
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - V Tiwari
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - S Bopanna
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - S Hutfless
- Division of Gastroenterology, Johns Hopkins University, Baltimore, MA, USA
| | - G Makharia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - V Ahuja
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
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Pradhan S, Raj P, Prasad U, Ghate M, Khristi Y, Panchal A, Bhavsar D, Banudha M, Kedia S, Sharma A, Kanabar D, Parghi B. Design, Development & Functional Validation of Magnets system in support of 42 GHz Gyrotron in India. EPJ Web Conf 2017. [DOI: 10.1051/epjconf/201714704005] [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: 11/14/2022] Open
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27
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Bhuyan SS, Shiyanbola O, Kedia S, Chandak A, Wang Y, Isehunwa OO, Anunobi N, Ebuenyi I, Deka P, Ahn S, Chang CF. Does Cost-Related Medication Nonadherence among Cardiovascular Disease Patients Vary by Gender? Evidence from a Nationally Representative Sample. Womens Health Issues 2017; 27:108-115. [DOI: 10.1016/j.whi.2016.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 10/07/2016] [Accepted: 10/13/2016] [Indexed: 11/24/2022]
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Acharya SK, Shalimar, Kedia S. Editorial: short-length stenoses of hepatic venous outflow tract - an Asian specificity? Authors' reply. Aliment Pharmacol Ther 2016; 44:201-2. [PMID: 27296683 DOI: 10.1111/apt.13668] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- S K Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Shalimar, Kumar A, Kedia S, Sharma H, Gamanagatti SR, Gulati GS, Nayak B, Thakur B, Acharya SK. Hepatic venous outflow tract obstruction: treatment outcomes and development of a new prognostic score. Aliment Pharmacol Ther 2016; 43:1154-67. [PMID: 27060876 DOI: 10.1111/apt.13604] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 01/12/2016] [Revised: 01/29/2016] [Accepted: 03/10/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Results of endovascular interventions in hepatic venous outflow tract obstruction (HVOTO) have been reported from limited studies. Treatment outcomes and prognostic scores need further validation. AIM To evaluate treatment outcomes and prognostic scores for hepatic venous outflow tract obstruction in an Indian population. METHODS Consecutive patients with hepatic venous outflow tract obstruction diagnosed at a tertiary centre were included. Technical success and clinical response after endovascular interventional therapy were documented. Predictors of survival were assessed with Cox-proportional model. A new score was derived from the factors significant on multivariate analysis and compared with Child-Turcotte-Pugh, model for end-stage liver disease (MELD), Rotterdam prognostic index (PI) and Budd-Chiari syndrome-transjugular intrahepatic portosystemic shunt ( BCS-TIPSS) PI. RESULTS Three hundred and thirty-four patients (56.6% males), median age 24 (3-62) years were included. Hepatic vein was the commonest site of block-isolated hepatic vonous block in 48%, combined hepatic venous-inferior vena cava block in 46%. Endovascular interventional therapy was performed in 233/334 (70%) with 90% technical success. Clinical response was complete in 166 (71.2%), partial in 58 (24.9%) and no response in nine (3.9%). Majority of cases with HV block did not require TIPSS and could be treated with angioplasty (with/without stenting). On Cox-proportional multivariate analysis, Child class C and response to intervention were independent predictors of outcome and used to derive the All India Institute of Medical Sciences (AIIMS) hepatic venous outflow tract obstruction score. The 5-year survival was 92% (95% CI, 81-97%) for score ≤3, 79% (95%CI, 63-88%) for score >3 and ≤4, and 39% (95% CI, 21-57%) for score >4. The performance of AIIMS hepatic venous outflow obstruction score was superior to other prognostic indices. CONCLUSIONS Advanced Child class and no response to intervention are associated with poor outcomes. The All India Institute of Medical Sciences hepatic venous outflow tract obstruction score predicts survival better than other prognostic scores.
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Affiliation(s)
- Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - A Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - S Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - H Sharma
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - S R Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - G S Gulati
- Department of Cardiovascular and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - B Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - B Thakur
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - S K Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Kedia S, Ward KD, Collins CA, Digney SA, Jackson BM, Rugless Stewart FE, Faris NR, Roark KS, Osarogiagbon RU. Physicians’ perspectives on multidisciplinary (MD) lung cancer care in a community-based hospital setting. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.6544] [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: 11/20/2022] Open
Affiliation(s)
| | - Kenneth Daniel Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN
| | | | - Siri Alicia Digney
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN
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Bhuyan SS, Lu N, Chandak A, Kim H, Wyant D, Bhatt J, Kedia S, Chang CF. Use of Mobile Health Applications for Health-Seeking Behavior Among US Adults. J Med Syst 2016; 40:153. [DOI: 10.1007/s10916-016-0492-7] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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Walker CM, Likes W, Bernard M, Kedia S, Tolley E. Risk of Anal Cancer in People Living with HIV: Addressing Anal Health in the HIV Primary Care Setting. J Assoc Nurses AIDS Care 2016; 27:563-73. [PMID: 27080925 DOI: 10.1016/j.jana.2016.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/17/2016] [Indexed: 11/25/2022]
Abstract
Anal health and anal cancer are rarely addressed in HIV primary care. We sought to understand factors that impeded or promoted addressing anal health in HIV primary care from providers' perspectives. In this exploratory study, HIV primary care providers from the Mid-South region of the United States participated in brief individual interviews. We analyzed transcribed data to identify barriers and facilitators to addressing anal health. Our study sample included five physicians and four nurse practitioners. The data revealed a number of barriers such as perception of patient embarrassment, provider embarrassment, external issues such as time constraints, demand of other priorities, lack of anal complaints, lack of resources, and gender discordance. Facilitators included awareness, advantageous circumstances, and the patient-provider relationship. Anal health education should be prioritized for HIV primary care providers. Preventive health visits should be considered to mitigate time constraints, demands for other priorities, and unequal gender opportunities.
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Clayton M, McDonald S, Homayouni R, Kedia S, Ullmann G, Mayfield B, Collins C, Alexander A, Schmidt M, Akkus C, Williams C, Ward K. FitKids: A Web-Based, mHealth Tool to Enhance Parents' Participation in Improving Child Health. J Acad Nutr Diet 2015. [DOI: 10.1016/j.jand.2015.06.343] [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: 11/16/2022]
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Abstract
Engagement in social and leisure activities is an indicator of quality of life and well-being in nursing homes. There are few studies in which nursing home residents with dementia self-reported their experiences in activity engagement. This qualitative study describes types of current activity involvement and barriers to activities as perceived by nursing home residents with dementia. Thirty-one residents participated in short, open-ended interviews and six in in-depth interviews. Thematic content analysis showed that participants primarily depended on activities organized by their nursing homes. Few participants engaged in self-directed activities such as walking, visiting other residents and family members, and attending in church services. Many residents felt they had limited opportunities and motivation for activities. They missed past hobbies greatly but could not continue them due to lack of accommodation and limitation in physical function. Environmental factors, along with fixed activity schedule, further prevented them from engaging in activities. Residents with dementia should be invited to participate in activity planning and have necessary assistance and accommodation in order to engage in activities that matter to them. Based on the findings, a checklist for individualizing and evaluating activities for persons with dementia is detailed.
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Affiliation(s)
- Sunghee H. Tak
- Professor, Chair of Excellence, Associate Dean for Research, Loewenberg School of Nursing, The University of Memphis,102 Newport Hall, Memphis, TN 38152
| | - Satish Kedia
- Professor, School of Public Health, The University of Memphis, 205 Robison Hall, Memphis, TN 38152
| | - Tera Marie Tongumpun
- Research Assistant, School of Public Health, The University of Memphis, 120 Robison Hall, Memphis, TN 38152
| | - Song Hee Hong
- Associate Professor, College of Pharmacy, The University of Tennessee Health Science Center, 881 Madison Ave. Memphis, TN 38163
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Kedia S, Ward KD, Digney SA, Jackson BM, Roark KS, Boyd SW, Osarogiagbon RU. Organizational barriers to receiving quality health care: A qualitative study among lung cancer patients and caregivers. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.30_suppl.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
76 Background: For lung cancer patients and caregivers, navigating the healthcare system while coping with the complexities of the illness is challenging. We explored organizational barriers to receiving quality healthcare from the perspectives of these stakeholders. Methods: A qualitative study involving 10 focus groups (5 of patients, 5 of caregivers) was conducted. Discussions were guided by a standardized script, recorded for transcription, and analyzed using Dedoose software. Results: 22 patients (10 Males/12 Females; 15 Caucasians and 7 African Americans) and 24 caregivers (6 Males /18 Females; 17 Caucasians and 7 African Americans) shared their experiences. Content analysis showed 5 recurring themes: (1) Insurance Issues: Delays in diagnosis or treatment were reported due to lack of insurance, lag time in insurance approvals and care processing, uncertainty about coverage, and caps for tests and/or office visits. (2) Appointment Scheduling: Participants reported appointment delays and rescheduling, long wait times, cancellations by providers, and inflexibility to accommodate schedules. (3) Provider Communication: Communication was lacking at times in initial diagnosis disclosure, prognosis and treatment preparation, willingness to answer questions in lay terms, and time dedicated to patients during appointments. (4) Patient Education: Participants had inadequate knowledge about lung cancer, treatment options and duration, prognosis, and relied on providers to educate and direct them to credible resources. Many felt confused, frustrated, anxious, or fatalistic. (5) Healthcare System Support: Participants found support within the healthcare system extremely beneficial, when available, for coping with lung cancer, expediting appointments, seeking information, connecting with physicians, and receiving timely diagnosis and treatments. Conclusions: These findings offer valuable insight into lung cancer patients’ and caregivers’ perspectives on organizational barriers to receiving quality care. By identifying these barriers for lung cancer patients and caregivers, better planning and management of effective cancer services can be developed.
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Affiliation(s)
- Satish Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN
| | - Kenneth Daniel Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN
| | - Siri Alicia Digney
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN
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Jia C, James W, Kedia S. Relationship of racial composition and cancer risks from air toxics exposure in Memphis, Tennessee, U.S.A. Int J Environ Res Public Health 2014; 11:7713-24. [PMID: 25089776 PMCID: PMC4143828 DOI: 10.3390/ijerph110807713] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/11/2014] [Accepted: 07/24/2014] [Indexed: 11/25/2022]
Abstract
African Americans in the U.S. often live in poverty and segregated urban neighborhoods, many of which have dense industrial facilities resulting in high exposure to harmful air toxics. This study aims to explore the relationship between racial composition and cancer risks from air toxics exposure in Memphis/Shelby County, Tennessee, U.S.A. Air toxics data were obtained from 2005 National Air Toxics Assessment (NATA), and the demographic data, including racial composition, were extracted from the 2000 United States Census. The association was examined using multivariable geographically weighted regression (GWR) analysis. The risk difference between African American and White concentrated areas was defined as the absolute disparity, and the percent difference as the relative disparity. GWR analyses show that cancer risks increase with respect to increasing percent of African Americans at the census tract level. Individuals in African American concentrated tracts bear 6% more cancer risk burden than in White concentrated tracts. The distribution of major roads causes the largest absolute disparity and the distribution of industrial facilities causes the largest relative disparity. Effective strategies for reduction in environmental disparity should especially target sources of large absolute disparities.
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Affiliation(s)
- Chunrong Jia
- School of Public Health, University of Memphis, Memphis, TN 38152, USA.
| | - Wesley James
- Department of Sociology, University of Memphis, Memphis, TN 38152, USA.
| | - Satish Kedia
- School of Public Health, University of Memphis, Memphis, TN 38152, USA.
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Kedia S, Ward KD, Nellum AL, Digney SA, Roark KS, Kyle TR, Clark S, Boyd SW, Crossley FJ, Osborne OT, Osarogiagbon RU. Lung cancer (LC) patient (Pt) and caregiver (CG) perceptions of multidisciplinary (multiD) care. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e17684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Satish Kedia
- School of Public Health, University of Memphis, Memphis, TN
| | | | - April L Nellum
- University of Memphis, School of Public Health, Memphis, TN
| | - Siri A Digney
- University of Memphis, School of Public Health, Memphis, TN
| | | | - Tessa R Kyle
- University of Memphis, School of Public Health, Memphis, TN
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Rahman M, Bari R, Ali AA, Sharmin M, Raij A, Hovsepian K, Hossain SM, Ertin E, Kennedy A, Epstein DH, Preston KL, Jobes M, Beck JG, Kedia S, Ward KD, al'Absi M, Kumar S. Are We There Yet? Feasibility of Continuous Stress Assessment via Wireless Physiological Sensors. ACM BCB 2014; 2014:479-488. [PMID: 25821861 PMCID: PMC4374173 DOI: 10.1145/2649387.2649433] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Stress can lead to headaches and fatigue, precipitate addictive behaviors (e.g., smoking, alcohol and drug use), and lead to cardiovascular diseases and cancer. Continuous assessment of stress from sensors can be used for timely delivery of a variety of interventions to reduce or avoid stress. We investigate the feasibility of continuous stress measurement via two field studies using wireless physiological sensors - a four-week study with illicit drug users (n = 40), and a one-week study with daily smokers and social drinkers (n = 30). We find that 11+ hours/day of usable data can be obtained in a 4-week study. Significant learning effect is observed after the first week and data yield is seen to be increasing over time even in the fourth week. We propose a framework to analyze sensor data yield and find that losses in wireless channel is negligible; the main hurdle in further improving data yield is the attachment constraint. We show the feasibility of measuring stress minutes preceding events of interest and observe the sensor-derived stress to be rising prior to self-reported stress and smoking events.
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Ward KD, Kedia S, Webb L, Relyea GE. Nicotine dependence among clients receiving publicly funded substance abuse treatment. Drug Alcohol Depend 2012; 125:95-102. [PMID: 22542293 DOI: 10.1016/j.drugalcdep.2012.03.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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: 01/14/2012] [Revised: 02/26/2012] [Accepted: 03/26/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Smoking and nicotine dependence (ND) are prevalent among substance abusers but little is known about characteristics of ND in this population. This information would help identify those most in need of smoking cessation programs. This study evaluated the associations of socio-demographic, tobacco- and substance use-related, and health/mental health factors to ND in adults receiving publicly funded substance abuse treatment in Tennessee. METHODS All Tennessee residents who received federal block grant-funded substance abuse treatment during July-December, 2004 were invited to participate in a 6 month post-intake telephone follow-up interview. Socio-demographic characteristics, perceived health and mental health, tobacco use history and patterns, and ND, assessed by the Fagerstrom Test of Nicotine Dependence (FTND), were obtained at follow-up. Alcohol and illicit drug use and smoking status prior to treatment were assessed at intake. This paper analyzes data for 855 clients who were current cigarette smokers at both intake and follow-up. RESULTS Sixty three percent of smokers were ND (FTND score ≥ 4). Correlates of ND included older age, poorer self-rated overall health, earlier age of onset of cigarette smoking and substance abuse, fewer smoking quit attempts in past year, single substance use (alcohol or illicit drug, vs. multiple substances) at intake, use of opiates/narcotics and sedatives, and past month self-reported depression. CONCLUSION ND was highly prevalent and correlated with specific types and patterns of substance abuse and depression. These results suggest that intensive smoking cessation interventions, involving behavioral support, pharmacotherapy, and mood management, are needed to effectively assist this population.
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Affiliation(s)
- Kenneth D Ward
- School of Public Health, The University of Memphis, Memphis, TN, United States.
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Kedia S, Sell MA, Relyea G. Mono- versus polydrug abuse patterns among publicly funded clients. Subst Abuse Treat Prev Policy 2007; 2:33. [PMID: 17996066 PMCID: PMC2211290 DOI: 10.1186/1747-597x-2-33] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Accepted: 11/08/2007] [Indexed: 11/16/2022]
Abstract
To examine patterns of mono- versus polydrug abuse, data were obtained from intake records of 69,891 admissions to publicly funded treatment programs in Tennessee between 1998 and 2004. While descriptive statistics were employed to report frequency and patterns of mono- and polydrug abuse by demographic variables and by study years, bivariate logistic regression was applied to assess the probability of being a mono- or polydrug abuser for a number of demographic variables. The researchers found that during the study period 51.3% of admissions reported monodrug abuse and 48.7% reported polydrug abuse. Alcohol, cocaine, and marijuana were the most commonly abused substances, both alone and in combination. Odds ratio favored polydrug abuse for all but one drug category–other drugs. Gender did not affect drug abuse patterns; however, admissions for African Americans and those living in urban areas exhibited higher probabilities of polydrug abuse. Age group also appeared to affect drug abuse patterns, with higher odds of monodrug abuse among minors and adults over 45 years old. The discernable prevalence of polydrug abuse suggests a need for developing effective prevention strategies and treatment plans specific to polydrug abuse.
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Affiliation(s)
- Satish Kedia
- Institute for Substance Abuse Treatment Evaluation (I-SATE), The University of Memphis, 316 Manning Hall, Memphis, Tennessee 38152, USA.
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41
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Kedia S. Engaging anthropology: the case for a public presence ? By Thomas Hylland Eriksen. J Royal Anthropological Inst 2007. [DOI: 10.1111/j.1467-9655.2007.00439_40.x] [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: 11/28/2022]
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Petersen MC, Kedia S, Davis P, Newman L, Temple C. Eating and feeding are not the same: caregivers' perceptions of gastrostomy feeding for children with cerebral palsy. Dev Med Child Neurol 2006; 48:713-7. [PMID: 16904015 DOI: 10.1017/s0012162206001538] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [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] [Accepted: 03/13/2006] [Indexed: 11/06/2022]
Abstract
Using a semi-structured questionnaire, this descriptive study examined perceptions of feeding and adherence to feeding recommendations for caregivers (26 females; mean age 32y 7mo [SD 9.4y], range 20-59y) of children with cerebral palsy (CP) and a gastrostomy tube (GT). Children in the study (15 females, 11 males; mean age 4y 8mo [SD 3y 11mo], range 8mo-16y) had had a GT in place for at least 1 month and been assessed at Level II (n=2), Level III (n=2), Level IV (n=5), and Level V (n=17) of the Gross Motor Function Classification System. A negative response was reported by 18 caregivers when the GT was recommended; however, 21 caregivers reported improvement in the children following placement. All children received formula through the GT that was adequate for complete nutrition, yet 14 caregivers gave other foods through the GT (e.g. juice, cereal, soup, or table food). Of the 17 children receiving oral feedings, meals were an unpleasant experience for over half. Of the remaining nine children, in spite of a strict nil by mouth recommendation by physicians, five continued to receive some oral feedings. Generally, caregivers perceived GT feeding as 'unnatural'. Understanding these perceptions will help clinicians to develop effective, family-centered, patient-appropriate intervention and adherence strategies for GT-fed children with CP.
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Affiliation(s)
- Mario C Petersen
- Le Bonheur Children's Medical Center and Boling Center for Developmental Disabilities, Memphis, Tennessee, USA.
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Kedia S, Khanna S. Tribal Health and Medicines:Tribal Health and Medicines. Med Anthropol Q 2006. [DOI: 10.1525/maq.2006.20.2.268] [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: 11/17/2022]
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Warry W, Kedia S, Willigen JV. Applied Anthropology: Domains of Application. Anthropologica 2006. [DOI: 10.2307/25605322] [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: 11/10/2022] Open
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Kedia S, Perry SW. Factors associated with client-collateral agreement in substance abuse post-treatment self-reports. Addict Behav 2005; 30:1086-99. [PMID: 15925119 DOI: 10.1016/j.addbeh.2004.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Revised: 09/20/2004] [Accepted: 10/11/2004] [Indexed: 11/29/2022]
Abstract
This study examined levels of agreement and directionality of disagreement between the post-treatment self-reports of substance abuse clients and their collaterals. The study population comprised 1252 clients with a primary or secondary diagnosis of substance abuse or dependence whose treatment was publicly funded in Tennessee. Client and collateral responses to 13 questions were analyzed for levels of agreement, revealing the following: (a) levels of client-collateral agreement were high, at least 75% agreement on all 13 questions and at least 88% agreement on 10 variables; (b) a Simple Kappa Test confirmed that 11 out of 13 items had moderate to excellent nonchance agreement; (c) there was no consistent trend in directionality, that is, clients neither reported information more positively nor more negatively than their collaterals did; (d) on average, those collaterals who were spouses, parents, and children agreed more with clients compared to other types of collaterals; and (e) those collaterals who saw the clients more frequently and more recently had higher agreement than those who saw the clients less frequently. This research reaffirms that collaterals are a valuable source for verifying the accuracy of clients' self-reports and that this approach continues to hold considerable promise for substance abuse post-treatment assessment.
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Affiliation(s)
- Satish Kedia
- Institute for Substance Abuse Treatment Evaluation, The University of Memphis, 316 Manning Hall, Memphis, TN 38152-3390, USA.
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Abstract
The authors systematically studied the emergence of restless legs syndrome (RLS) after subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson disease (PD). Postoperatively, 11 of 195 patients with STN DBS reported new problematic symptoms of RLS. The mean reduction in antiparkinsonian medication was 74%. The mean RLS score at diagnosis was 15 (+/-5.9) of a possible 24 points and after symptomatic drug therapy 4.3 (+/-3.1) points. Reduction of antiparkinsonian medication during STN DBS may unmask symptoms of RLS and complicate therapy of both RLS and PD.
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Affiliation(s)
- S Kedia
- University of Colorado Health Sciences Center, Denver, USA
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47
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Kedia S. Social Aging in a Delhi Neighborhood:Social Aging in a Delhi Neighborhood. American Anthropologist 2003. [DOI: 10.1525/aa.2003.105.3.676] [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: 11/17/2022]
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Kedia S, Perry SW. Substance abuse treatment effectiveness of publicly funded clients in Tennessee. J Natl Med Assoc 2003; 95:270-7. [PMID: 12749617 PMCID: PMC2594606] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The Tennessee Outcomes for Alcohol and Drug Services (TOADS) in collaboration with the Bureau of Alcohol and Drug Abuse Services at the Tennessee Department of Health evaluated the effectiveness of publicly funded substance abuse treatment programs in Tennessee by collecting and analyzing data from clients treated between 1998 and 2000. Using a structured questionnaire, TOADS staff conducted telephone interviews with clients 6 months after their admission to treatment facilities. The sample populations for these follow-up interviews ranged from 1,150 to 1,350 clients over the 3 years, and each year, post-treatment abstinence rates were around 60%, which suggests that treatment in Tennessee has been successful in reducing substance abuse. In addition, the follow-up interview data suggest that treatment also helped drastically reduce both unemployment and arrests among clients. These findings in Tennessee are comparable to treatment outcomes in other states. In addition to the positive effects that treatment has on clients, treatment is also cost-effective for state budgets since treatment reduces many of the burdens substance abuse places on the criminal justice system, the healthcare system, and other state-supported services.
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Affiliation(s)
- Satish Kedia
- Tennessee Outcomes for Alcohol and Drug Services, The University of Memphis and Bureau of Alcohol and Drug Abuse Services, Tennessee Department of Health, 38152, USA.
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Abstract
In planning and implementing programs to treat substance abuse, it is important to understand which factors influence post-treatment abstinence. This article identifies and analyzes several variables important in predicting the likelihood of abstinence among substance abuse clients. The data used in this study was collected from 1,350 clients treated for alcohol or drug abuse in residential, halfway house, or outpatient facilities in Tennessee. We analyzed 22 variables as possible treatment outcome predictors by using two statistical procedures: stepwise logistic regression analysis and Quick, Unbiased, Efficient, Statistical Tree (QUEST) analysis, a tree-structured classification algorithm analysis. We found one pretreatment, five in-treatment, and three post-treatment variables to be significant predictors of treatment outcome: previous treatment history, perceived helpfulness of the treatment, simultaneous treatment for mental health, number of days in treatment,completion of treatment, special skills training during treatment, obtaining healthcare services for major physical health problem after treatment, living with someone using alcohol or drugs post treatment, and arrest record since treatment.
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Affiliation(s)
- Satish Kedia
- Department of Anthropology, The University of Memphis, Tennessee 38152, USA.
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Ponsky LE, Sharma S, Pandrangi L, Kedia S, Nelson D, Agarwal A, Zippe CD. Screening and monitoring for bladder cancer: refining the use of NMP22. J Urol 2001; 166:75-8. [PMID: 11435827] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
PURPOSE While detecting bladder cancer, bladder tumor markers demonstrate improved sensitivity compared with urinary cytology but the current limitation is the low specificity and positive predictive value, that is high false-positive rate. We examined the clinical categories of the false-positive results, established relative exclusion criteria, and recalculated the specificity and positive predictive value of this assay with these criteria. MATERIALS AND METHODS A total of 608 patients considered at risk for bladder cancer presented to a urology clinic and submitted a single urine sample. Of the 608 patients 529 (87%) presented with de novo hematuria or chronic voiding symptoms without a diagnosis of bladder cancer. There were 79 (13.0%) patients being monitored with a known history of bladder cancer. Each urine sample was examined via cytology, urinalysis, culture and NMP22 protein assay. All patients underwent office cystoscopy, and transurethral resection and/or biopsy if a bladder tumor was suspected. RESULTS Of the 608 patients 226 (37.2%) presented with microscopic hematuria, 143 (23.5%) with gross hematuria and 239 (39.3%) had chronic symptoms of urinary frequency or dysuria. There were 52 (8.6%) patients who had histologically confirmed bladder cancer. Of these 52 cancers NMP22 detected 46 (88.5%), whereas cytology identified only 16 (30.8%). When atypical cytology was considered positive, cytology detected 32 (61.5%) cases. In the 135 patients with increased NMP22 values the 46 identified tumors were accompanied by 89 false-positive values yielding a specificity of 83.9% and a positive predictive value of 34.1%. These false-positive results were divided into 6 clinical categories. Exclusion of these categories improved the specificity and positive predictive value of NMP22 to 99.2% and 92.0%, respectively, yielding results similar to urinary cytology (99.8% and 94.1%). CONCLUSIONS Awareness and exclusion of the categories of false-positive results can increase the specificity and positive predictive value of NMP22, enhancing the clinical use of this urinary tumor marker.
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Affiliation(s)
- L E Ponsky
- Cleveland Clinic Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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