1
|
Gross M, Schwartz SW, Sebastião YV, Alman A, Salemi JL, Ghimire-Aryal P, Foulis P. LDL Reduction and Risk of Diabetes in Veteran Statin Users. Ann Pharmacother 2023; 57:283-291. [PMID: 35912948 DOI: 10.1177/10600280221115816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND While statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) reduce cardiovascular morbidity and mortality, there is controversy regarding a potentially causal link with incident diabetes mellitus (DM). This association may partially be due to confounding by indication; since prescription guidelines encourage statin use among those diagnosed with DM, this may encourage their prescription among those with elevated blood glucose in the absence of DM diagnosis. OBJECTIVE The study examined the association between low-density lipoprotein (LDL) reduction following initiation of statin use and new-onset DM among veterans. METHODS We conducted a retrospective cohort study using data from the James A. Haley Veteran's Hospital in Tampa, Florida. Patients with a visit between January 2007 and December 2011 were selected from the Veterans Information Systems and Technology Architecture system. Individuals were classified into categories of statin usage based on LDL reduction percentages and frequency-matched with controls. The primary outcome of interest was incident DM. RESULTS There was a significant association between LDL reduction and DM which was higher in lower LDL reduction groups (low response hazard ratio [HR]: 2.12, 95% CI: 1.62, 2.79; moderate response HR: 1.85, 95% CI: 1.40, 2.45; high response HR: 1.24, 95% CI: 0.74, 2.07). CONCLUSION AND RELEVANCE This association may partially be explained by potential lifestyle modifications individuals may make when prescribed a statin which may reduce their risk of DM independent of the statin usage. This research has demonstrated a protective association between greater LDL reduction and DM at the individual level while reenforcing the evidence of an association between statin usage and DM.
Collapse
Affiliation(s)
- Michaela Gross
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Skai W Schwartz
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Yuri V Sebastião
- Division of Global Women's Health, School of Medicine, The University of North Carolina at Chapel Hill North, Chapel Hill, NC, USA
| | - Amy Alman
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Jason L Salemi
- College of Public Health, University of South Florida, Tampa, FL, USA
| | | | | |
Collapse
|
2
|
Desch J, Mansuri F, Tran D, Schwartz SW, Bakour C. The association between adverse childhood experiences and depression trajectories in the Add Health study. Child Abuse Negl 2023; 137:106034. [PMID: 36706612 DOI: 10.1016/j.chiabu.2023.106034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/28/2022] [Accepted: 01/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are potentially traumatic experiences that occur before age 18. ACEs are linked to depression in adulthood, but little is known about the association between ACEs and depression trajectories across the lifespan. OBJECTIVE To examine the association between specific types of ACEs, cumulative ACE scores, and depression trajectories from adolescence to adulthood. PARTICIPANTS AND SETTING Waves 1-4 of the National Longitudinal Study of Adolescent to Adult Health (N = 12,888), spanning ages 12 years to 43 years. METHODS We constructed trajectories of depression scores using a modified 9-item Center for Epidemiologic Studies Depression Scale (CES-D-9). We used weighted logistic regression to calculate odds ratios and confidence intervals for each ACE and ACE score and depression trajectories after adjusting for confounders. RESULTS We found 75.3 % experienced at least one ACE and 14.7 % experienced 4+ ACEs. We identified three CES-D-9 trajectories: consistently low (Group 1), decreasing (Group 2), and increasing (Group 3) depression scores. All types of abuse, neglect, and community violence were significantly associated with trajectory Groups 2 and 3 vs 1 (p < .05). Foster home placement, poverty, and parental incarceration were associated with Group 2 vs 1. ACE scores showed a dose-response association with Group 3 vs 1 [aORs for 1ACE = 1.43 (0.93-2.20); 2-3ACEs = 1.97 (1.30-3.00); 4+ACEs = 3.08 (1.86-5.09)], and Group 2 vs 1 [aORs for 1ACE = 1.26 (0.87-1.83); 2-3ACEs = 1.93 (1.36-2.74); 4+ACES = 2.70 (1.90-3.84)]. CONCLUSIONS ACEs can have a lasting impact on depression through adulthood, highlighting the need to mitigate their impact to prevent depression-associated morbidity and mortality.
Collapse
Affiliation(s)
- Jill Desch
- College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Fahad Mansuri
- College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Dieu Tran
- College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Skai W Schwartz
- College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Chighaf Bakour
- College of Public Health, University of South Florida, Tampa, FL, USA.
| |
Collapse
|
3
|
Taylor KA, Schwartz SW, Alman AC, Goode AP, Dagne GA, Sebastião YV, Foulis PR. Nightmare disorder and low back pain in veterans: cross-sectional association and effect over time. Sleep Adv 2022; 3:zpac030. [PMID: 36387301 PMCID: PMC9648406 DOI: 10.1093/sleepadvances/zpac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/29/2022] [Indexed: 12/15/2022]
Abstract
Low back pain (LBP) disproportionately impacts US military veterans compared with nonveterans. Although the effect of psychological conditions on LBP is regularly studied, there is little published to date investigating nightmare disorder (NMD) and LBP. The purpose of this study was to (1) investigate whether an association exists between NMD and LBP and (2) estimate the effect of NMD diagnosis on time to LBP. We used a retrospective cohort design with oversampling of those with NMD from the Veterans Health Administration (n = 15 983). We used logistic regression to assess for a cross-sectional association between NMD and LBP and survival analysis to estimate the effect of NMD on time to LBP, up to 60-month follow-up, conditioning on age, sex, race, index year, Charlson Comorbidity Index, depression, anxiety, insomnia, combat exposure, and prisoner of war history to address confounding. Odds ratios (with 95% confidence intervals [CIs]) indicated a cross-sectional association of 1.35 (1.13 to 1.60) and 1.21 (1.02 to 1.42) for NMD and LBP within 6 months and 12 months pre- or post-NMD diagnosis, respectively. Hazard ratios (HRs) indicated the effect of NMD on time to LBP that was time-dependent-HR (with 95% CIs) 1.27 (1.02 to 1.59), 1.23 (1.03 to 1.48), 1.19 (1.01 to 1.40), and 1.10 (0.94 to 1.29) in the first 3, 6, 9, and 12 months post-diagnosis, respectively-approximating the null (1.00) at >12 months. The estimated effect of NMD on LBP suggests that improved screening for NMD among veterans may help clinicians and researchers predict (or intervene to reduce) risk of future back pain.
Collapse
Affiliation(s)
- Kenneth A Taylor
- Corresponding author. Kenneth A. Taylor, Duke Clinical Research Institute, 300 West Morgan Street, Ste 800, Durham, NC 27701, USA.
| | - Skai W Schwartz
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Amy C Alman
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Adam P Goode
- Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA,Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Getachew A Dagne
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Yuri V Sebastião
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip R Foulis
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA,Pathology and Laboratory Medicine, James A. Haley Veterans’ Hospital, Tampa, FL, USA
| |
Collapse
|
4
|
Sebastião YV, Bakour C, Schwartz SW. Restating Well-Known Determinants for Blood Pressure: Do Classification Trees Help? Am J Hypertens 2021; 34:1031-1033. [PMID: 34270673 DOI: 10.1093/ajh/hpab113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yuri V Sebastião
- Division of Global Women’s Health, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Chighaf Bakour
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Skai W Schwartz
- College of Public Health, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
5
|
Bakour C, Desch J, Mansuri F, Schwartz SW. 331 Adverse Childhood Experience and Sleep Quality in Adulthood. Sleep 2021. [DOI: 10.1093/sleep/zsab072.330] [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: 11/15/2022] Open
Abstract
Abstract
Introduction
Poor sleep quality, a risk factor for many negative health outcomes, may result from physical or emotional disturbance including chronic stress. Adverse childhood experiences (ACEs) have been linked with chronic stress, and may therefore be associated with poor sleep quality in adulthood. This study examines the longitudinal association between specific ACEs and the number of ACEs and sleep quality in adulthood.
Methods
Using data from the National Longitudinal Study of Adolescent to Adult Health, we examined the association between ACEs and trouble falling asleep or staying asleep (rarely or never, sometimes, frequently) in waves 1 (age 12–18), 4 (age 24–32), and 5 (age 33–43). We examined ten ACEs (physical, sexual, or emotional abuse; neglect; parental death, incarceration, alcoholism, divorce or separation; foster home placement; poverty; and exposure to community violence) and the number of ACEs (0, 1, 2–3, 4+), using weighted logistic regression to calculate odds ratios and confidence intervals for each of the ACEs and ACE score and each of the outcomes after adjusting for relevant confounders.
Results
The analysis included 12,768 participants, 75.3% of whom experienced at least one ACE, including 14.7% who experienced 4 or more. Physical and emotional abuse were associated with frequent sleep complaints at waves 1, 4, and 5. Sexual abuse, neglect and community violence were associated with frequent complaints in two waves, while parental alcoholism, parental incarceration, and foster home placement were associated with frequent complaints in one wave. The number of ACEs experienced showed a dose-response association with frequent sleep complaints in wave 1 ([1 ACE: aOR=2.12 (1.16, 3.9), 2–3 ACEs: aOR=2.86 (1.70, 4.82), 4+ ACEs: aOR=4.17 (2.33, 7.48)], wave 4 [1 ACE: aOR=1.02 (0.77, 1.36); 2–3 ACEs: aOR= 1.66 (1.30, 2.10); 4+ ACEs: aOR=2.68 (1.99, 3.61) and in wave 5 [1 ACE: aOR=1.22 (0.93, 1.60)), 2–3 ACEs: aOR=1.42 (1.11, 1.81), 4+ ACEs: aOR=1.88 (1.40, 2.53)]
Conclusion
Certain adverse childhood experiences such as physical, sexual, and emotional abuse and neglect have a lasting impact on sleep quality in adulthood, highlighting the need to mitigate their impact to prevent negative health outcomes associated with poor sleep quality
Support (if any):
Collapse
|
6
|
Bakour C, Schwartz SW, Wang W, Sappenfield WM, Couluris M, Chen H, O'Rourke K. Sleep duration patterns from adolescence to young adulthood and the risk of asthma. Ann Epidemiol 2020; 49:20-26. [PMID: 32681981 DOI: 10.1016/j.annepidem.2020.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE This study examined the association between sleep duration trajectories from adolescence to young adulthood and the risk of asthma into young adulthood. METHODS Using data from 10,362 participants in the National Longitudinal Study of Adolescent to Adult Health (Add Health) free of asthma at baseline, we constructed trajectories of sleep duration from adolescence (age 13-18 years) to young adulthood (age 24-32 years) and used them to examine the association between sleep duration patterns and the risk of new-onset asthma using a log-binomial regression model after adjusting for potential confounders. RESULTS The results revealed that 14.4% of nonasthmatic participants had persistent short sleep duration, whereas 80.0% had adequate sleep duration from adolescence through young adulthood. Consistently short-sleepers had 1.52 times the risk of new-onset asthma by age 32 years (95% CI 1.11, 2.10) compared with consistently adequate sleepers. The association was stronger in those with a family history of asthma (aRR = 2.43, 95% CI 1.15, 5.13) than in those without such history (aRR = 1.43, 95% CI 1.05, 1.95). CONCLUSIONS We conclude that persistent short sleep duration is associated with an increased risk of new-onset asthma in young adults. This association may be more pronounced among those at high risk of asthma because of family history.
Collapse
Affiliation(s)
- Chighaf Bakour
- College of Public Health, University of South Florida, Tampa, FL; The Chiles Center for Healthy Mothers and Babies, College of Public Health, University of South Florida, Tampa, FL.
| | - Skai W Schwartz
- College of Public Health, University of South Florida, Tampa, FL
| | - Wei Wang
- College of Public Health, University of South Florida, Tampa, FL; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - William M Sappenfield
- College of Public Health, University of South Florida, Tampa, FL; The Chiles Center for Healthy Mothers and Babies, College of Public Health, University of South Florida, Tampa, FL
| | - Marisa Couluris
- Department of Pediatrics, College of Medicine, University of South Florida, Tampa, FL
| | - Henian Chen
- College of Public Health, University of South Florida, Tampa, FL
| | | |
Collapse
|
7
|
Gross M, Patel R, Schwartz SW, Sebastião YV, Foulis P, Scheer D, Taylor KA, Anderson W. 0806 Prescription Correlates of Nightmare Disorder Among Veterans. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.802] [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
Introduction
In the James A. Haley Veterans Administration (JAHVA) Vista database, the ICD-9 code 307.47 for Nightmare disorder (ND) is infrequently used and appears independently of codes for PTSD. We wanted to determine if certain drugs that may affect sleep are associated with ND.
Methods
All patients with ND visiting JAHVA between 2007 and 2011 were selected along with control patients who visited JAHVA on one of 20 random days, one day each quarter year. Controls were assigned an index date reflecting their selection quarter. Associations with prescriptions for opioids, antidepressants (SSRI’s, SSNI’s, Tricyclics), antihistamines and benzodiazepine/Z-drugs were initially investigated. Two analyses were performed: risk factor analysis- patients with ND diagnosis dates (cases) or index dates (controls) prior to 2008 were excluded and only prescription dates that preceded the ND diagnosis or index date were considered; treatment analysis- cases and controls with a ND diagnosis date or index date after 2010 were excluded and only prescription dates that were subsequent to the ND diagnosis or index date respectively were considered. Logistic regression adjusting for age, gender, race and Hispanic ethnicity was used to determine the association between drug groups and ND.
Results
In risk factor analysis (667 cases, 14,739 controls), opioids and antihistamines were significantly less prevalent among would-be ND patients than controls (OR=0.627 and 0.610 respectively); no drug group was predictive of ND. In contrast, all drug groups were significantly associated with ND in treatment analysis (803 cases, 15,530 controls). The strongest associations were seen with benzodiazepine (OR=3.026; 95% CI: 2.472, 3.703) and SSRI (OR=2.789; 95% CI=2.316, 3.358) prescriptions.
Conclusion
Our data suggest that some JAHVA providers may be treating ND with medication, most notably with benzodiazepines/Z-drugs and antidepressants. The role of anti-histamine and opioid prescriptions needs further elucidation. The ramifications of these treatment decisions should be explored.
Support
This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.
Collapse
Affiliation(s)
- M Gross
- University of South Florida, College of Public Health, Tampa, FL
| | - R Patel
- University of South Florida, College of Public Health, Tampa, FL
- James A. Haley Veteran’s Hospital, Tampa, FL
| | - S W Schwartz
- University of South Florida, College of Public Health, Tampa, FL
| | | | - P Foulis
- University of South Florida, College of Public Health, Tampa, FL
- James A. Haley Veteran’s Hospital, Tampa, FL
| | - D Scheer
- University of South Florida, College of Public Health, Tampa, FL
- Biotech Research Group Inc., Tampa, FL
| | - K A Taylor
- University of South Florida, College of Public Health, Tampa, FL
- Gannon University, Ruskin, FL
| | - W Anderson
- University of South Florida, College of Public Health, Tampa, FL
- James A. Haley Veteran’s Hospital, Tampa, FL
| |
Collapse
|
8
|
Taylor KA, Schwartz SW, Sebastião YV, Anderson WM, Foulis PR. 0667 Positive Airway Pressure Non-Adherence Interacts With Post-Traumatic Stress Disorder to Increase Risk of Back Pain. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.663] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Altered sleep, as is associated with obstructive sleep apnea (OSA), may increase the risk of back pain (BP). However, little to no evidence regarding the effect of OSA on musculoskeletal pain is currently available, let alone the effect of positive airway pressure (PAP) treatment non-adherence. The purpose of this analysis is to investigate the effect of PAP non-adherence on future BP diagnosis.
Methods
A sample of 1,662 veterans who had a sleep study between January 2003 and October 2006 and receiving PAP treatment for OSA were used for analysis. Measures at baseline included demographic and OSA symptom severity data. Up to 3 weeks of PAP adherence data were collected and patient chart data was collected through May 2010 to determine outcomes. Time was calculated from PAP treatment start to BP diagnosis or censoring, which occurred at date of death or last recorded encounter. Survival analysis was conducted to obtain the hazard ratios (HR) for the effect of PAP non-adherence on BP diagnosis and to investigate whether post-traumatic stress disorder (PTSD) is an effect modifier of this relationship.
Results
PAP treatment non-adherence significantly increased the risk of BP diagnosis (HR 1.88 [95% CI: 1.08, 3.27]) among veterans with PTSD, while non-adherence among veterans without PTSD was not a statistically significant risk factor. Relative excess risk due to interaction (RERI) was 0.97 (95% CI: -0.07, 2.02; p-value=0.068). These estimates are independent of age, sex, race, body mass index, apnea severity (based on Apnea-Hypopnea Index), PTSD diagnosis, income level, and marital status.
Conclusion
PAP treatment non-adherence among veterans with PTSD appears to result in a significant increase in risk of future BP diagnosis. The interaction between PAP non-adherence and PTSD appears to be borderline synergistic. Therefore, improving PAP adherence among veterans with PTSD may decrease risk of future BP diagnosis.
Support
This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.
Collapse
Affiliation(s)
- K A Taylor
- University of South Florida, Tampa, FL
- Gannon University, Ruskin, FL
| | | | | | - W M Anderson
- University of South Florida, Tampa, FL
- James A. Haley Veterans’ Hospital, Tampa, FL
| | - P R Foulis
- James A. Haley Veterans’ Hospital, Tampa, FL
- University of South Florida, Tampa, FL
| |
Collapse
|
9
|
Patel RK, Schwartz SW, Sebastiao YV, Andrews A, Foulis PR, Anderson WM. 0816 Sleep Correlates Of Nightmares Among Veterans. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.812] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
There is an increased prevalence of Nightmare disorder (ND) among patients with obstructive sleep apnea (OSA). A further investigation of objectively measured sleep parameters among patients with and without ND could inform on potential comorbidities. We hypothesize ND correlates with Epworth sleepiness scale (ESS), apnea hypopnea index (AHI), Trough 02% (Sp02 nadir), and periodic limb movement (PLM) index.
Methods
Data presented herein are interim results from an IRB approved study to determine correlates and sequelae of nightmares. A cohort of all patients with ND visiting James A Haley Veterans Hospital between 2007 and 2011 was defined along with a random cohort of control patients. Demographic and outpatient visit data between January 2006 and April 2016 was pulled from VISTA for both the ND and control cohorts, and patients who had undergone a sleep study were identified. To date, sleep summary data has been individually extracted for 111 ND patients and 835 control patients. Logistic regression (SAS 9.4) was used to compare ESS, AHI, Sp02 nadir, and PLM Index.
Results
Mean age for ND was significantly lower at 49.7 ± 14, compared to 58.4 ± 12 for controls. Other demographic measures were similar including gender, race, and marital status. PLM index was significantly lower in ND compared to controls, however this relationship disappeared after adjusting for age. There were neither significant differences between other polysomnographic (PSG) variables, specifically AHI and Sp02 nadir, nor did OSA severity significantly different between ND and controls.
Conclusion
Among veterans undergoing a PSG, there were no significant differences between measured sleep parameters. Our results contradict our hypothesis that ND correlates with ESS, AHI, Sp02 nadir, and PLM index.
Support
This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.
Collapse
Affiliation(s)
- R K Patel
- University of South Florida, Tampa, FL
- James A. Haley Veterans Hospital, Tampa, FL
| | | | | | - A Andrews
- University of South Florida, Tampa, FL
- James A. Haley Veterans Hospital, Tampa, FL
| | - P R Foulis
- University of South Florida, Tampa, FL
- James A. Haley Veterans Hospital, Tampa, FL
| | - W M Anderson
- University of South Florida, Tampa, FL
- James A. Haley Veterans Hospital, Tampa, FL
| |
Collapse
|
10
|
Scheer D, Schwartz SW, Parr M, Zgibor J, Sanchez-Anguiano A, Rajaram L. Prevalence and incidence of narcolepsy in a US health care claims database, 2008-2010. Sleep 2020; 42:5475508. [PMID: 31004158 DOI: 10.1093/sleep/zsz091] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/12/2019] [Indexed: 01/03/2023] Open
Abstract
STUDY OBJECTIVES To determine the prevalence and incidence of narcolepsy using a large US health care claims database. METHODS The Truven Health MarketScan Commercial Dissertation Database (THMCDD) was used to estimate prevalence and incidence of narcolepsy, with and without cataplexy, by age groups, gender, and region among patients under age 66 years with continuous enrollment for years 2008-2010. THMCDD contains health claims information for more than 18 million people. Prevalence was expressed as cases/100 000 persons. Average annual incidence (using varying criteria for latency between the diagnostic tests, polysomnograph coupled with multiple sleep latency test [MSLT], and the diagnosis) was expressed as new cases/100 000 persons/year. RESULTS There were 8 444 517 continuously enrolled patients and 6703 diagnosed with narcolepsy (prevalence overall: 79.4/100 000; without cataplexy: 65.4/100 000; with cataplexy: 14.0/100 000). On the basis of the three definitions of incidence, overall average annual incidence was 7.67, 7.13, and 4.87/100 000 persons/year. Incidence for narcolepsy without cataplexy was generally several times higher than narcolepsy with cataplexy. Prevalence and incidence were approximately 50% greater for females compared to males across most age groups. Prevalence was highest among the 21-30 years age group, with incidence highest among enrollees in their early 20s and late teens. Regionally, the North Central United States had the highest prevalence and incidence, whereas the West was the lowest. CONCLUSION We found greater prevalence and incidence of narcolepsy (including without cataplexy) than most previous studies. The increased proportions in females, enrollees in their early 20s, and US regional differences require further study. Increased awareness and early identification is critical in the management of this burdensome condition.
Collapse
Affiliation(s)
- Darren Scheer
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL.,Department of Epidemiology and Pharmacovigilance, Biotech Research Group Corp., Tampa, FL.,Pharmaceutical Development Group Inc., Tampa, FL.,Pharmacovigilance and Epidemiology, Spotline Inc., San Jose, CA
| | - Skai W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Maria Parr
- EviCore Healthcare, Department of Sleep Medicine, Franklin, TN
| | - Janice Zgibor
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Aurora Sanchez-Anguiano
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| | - Lakshminarayan Rajaram
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL
| |
Collapse
|
11
|
Taylor KA, Schwartz SW, Sebastião YV, Anderson WM, Foulis PR. 0866 Does Obstructive Sleep Apnea Mediate the Relationship Between Post-Traumatic Stress Disorder and Low Back Pain in Veterans? Sleep 2019. [DOI: 10.1093/sleep/zsz067.864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Low back pain (LBP) is a common complaint among veterans, leading to notable limits in function, quality of life, and an increase in healthcare cost. The incidence and prevalence of LBP have been increasing in the veterans over the past several years. Obstructive sleep apnea (OSA) has been shown to be associated with LBP and there are notable associations among post-traumatic stress disorder (PTSD), OSA and LBP in this population.
Methods
A random sample of veterans stratified by quarter was taken between 2007 and 2011 (index date), collecting records from 2006 to 2016. Veterans were excluded if they had a prevalent case of LBP, and/or OSA in the year of or year before to their index date (index period), or PTSD, OSA and/or LBP prior to the index period. Associations among the PTSD, LBP, and OSA were calculated using SAS PROC LOGISTIC. SAS PROC PHREG was used to calculate hazard ratios (HR) for mediation analysis and the percent of 4-year LBP risk explained by OSA in those with PTSD.
Results
PTSD predicted LBP diagnosis (OR 1.52 [95% CI: 1.27, 1.83]) and OSA diagnosis (OR 2.06 [1.48, 2.88]). Additionally, OSA diagnosis was predictive of LBP diagnosis (OR 8.99 [95% CI: 7.07, 11.35]). The HR for the effect of PTSD on the risk LBP diagnosis was 1.47 (95% CI: 1.25, 1.74) without adjustment for OSA. The HR for the effect of PTSD on the risk LBP diagnosis adjusted for the mediator was 1.35 (95% CI: 1.15, 1.60). The resulting percent of excess LBP risk explained by OSA is 25.5% (95% CI: 19.6%,31.1%). All analyses were adjusted for potential confounders.
Conclusion
OSA may mediate a significant amount of the risk of LBP diagnosis in veterans with PTSD. Prevention of OSA among veterans with PTSD may significantly reduce the risk of future LBP in veterans with PTSD.
Support (If Any)
This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital.
Collapse
Affiliation(s)
- Kenneth A Taylor
- Doctor of Physical Therapy Program, Gannon University, Ruskin, FL, USA
- University of South Florida, Tampa, FL, USA
| | | | - Yuri V Sebastião
- Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH, USA
| | - William McD Anderson
- University of South Florida, Tampa, FL, USA
- James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Phillip R Foulis
- James A. Haley Veterans' Hospital, Tampa, FL, USA
- University of South Florida, Tampa, FL, USA
| |
Collapse
|
12
|
Schwartz SW, Ghimire-Aryal P, Scheer D, Taylor K, Anderson WM, Rosas J, Foulis PR. 0515 Interaction Of Apnea Severity And Comorbidity With CPAP Adherence. Sleep 2019. [DOI: 10.1093/sleep/zsz067.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Skai W Schwartz
- Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA
| | | | - Darren Scheer
- Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA
| | - Kenneth Taylor
- Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA
| | - W M Anderson
- James A Haley Veteran's Hospital, Tampa, FL, USA
| | - Julie Rosas
- James A Haley Veteran's Hospital, Tampa, FL, USA
| | - P R Foulis
- James A Haley Veteran's Hospital, Tampa, FL, USA
| |
Collapse
|
13
|
Ghimire-Aryal P, Schwartz SW, Sebastião YV, Anderson WM, Scheer D, Foulis PR. 0850 The Role Of Sleeping Pills In The Development Of Shingles In Veterans. Sleep 2019. [DOI: 10.1093/sleep/zsz067.848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Skai W Schwartz
- Epidemology and Biostatistics, University of South Florida, Tampa, FL, USA
| | | | | | - Darren Scheer
- Epidemology and Biostatistics, University of South Florida, Tampa, FL, USA
| | - P R Foulis
- James A Haley Veteran's Hospital, Tampa, FL, USA
| |
Collapse
|
14
|
Patel RK, Schwartz SW, Sebastião YV, Andrews A, Foulis PR, Anderson WM. 0932 Sleep Correlates of Nightmares Among Veterans. Sleep 2018. [DOI: 10.1093/sleep/zsy061.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R K Patel
- University of South Florida, Tampa, FL
- James A Haley Veterans Hospital, Tampa, FL
| | - S W Schwartz
- University of South Florida, Tampa, FL
- James A Haley Veterans Hospital, Tampa, FL
| | | | - A Andrews
- University of South Florida, Tampa, FL
- James A Haley Veterans Hospital, Tampa, FL
| | - P R Foulis
- University of South Florida, Tampa, FL
- James A Haley Veterans Hospital, Tampa, FL
| | - W M Anderson
- University of South Florida, Tampa, FL
- James A Haley Veterans Hospital, Tampa, FL
| |
Collapse
|
15
|
Abstract
SummaryThere has been growing interest in studying the biological effects of certain drugs and their potential to reduce the risk of various cancers. One study reported a decrease in the incidence of urogenital cancers in a trial with patients who received warfarin for treatment of venous thromboembolism, but a limitation to this study of urogenital cancers was the very small number of bladder cancer cases that developed following warfarin therapy. The objective of the present study is to measure the association between warfarin use and bladder cancer. A total of 330 cases with bladder cancer were identified at the James A. Haley Veterans’ Administration (VA) Hospital in Tampa, Florida, using a combination of computerized pathology records and inpatient and outpatient diagnoses. Controls were randomly selected from the VA computerized administrative database and 1293 controls were included for analysis. Unconditional logistic regression analysis was performed to assess the risk of bladder cancer after adjusting for age, gender, and cigarette smoking. Among warfarin users, although there was a 27% elevation in risk, it did not differ significantly from nonusers (OR = 1.27, 95% CI = 0.85, 1.89). No durationresponse relationship was observed between anticoagulant use and risk of bladder cancer. The results suggest that warfarin does not protect against bladder cancer, at least in male smokers, the highest risk population for bladder cancer.
Collapse
Affiliation(s)
- William A Blumentals
- Procter & Gamble Pharmaceuticals, HCRC - Box 2207, 8700 Mason-Montgomery Road, Mason, OH 45040-9462, USA.
| | | | | | | |
Collapse
|
16
|
Garzon-Villalba XP, Mbah A, Wu Y, Hiles M, Moore H, Schwartz SW, Bernard TE. Exertional heat illness and acute injury related to ambient wet bulb globe temperature. Am J Ind Med 2016; 59:1169-1176. [PMID: 27779310 DOI: 10.1002/ajim.22650] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Deepwater Horizon disaster cleanup effort provided an opportunity to examine the effects of ambient thermal conditions on exertional heat illness (EHI) and acute injury (AI). METHODS The outcomes were daily person-based frequencies of EHI and AI. Exposures were maximum estimated WBGT (WBGTmax) and severity. Previous day's cumulative effect was assessed by introducing previous day's WBGTmax into the model. RESULTS EHI and AI were higher in workers exposed above a WBGTmax of 20°C (RR 1.40 and RR 1.06/°C, respectively). Exposures above 28°C-WBGTmax on the day of the EHI and/or the day before were associated with higher risk of EHI due to an interaction between previous day's environmental conditions and the current day (RRs from 1.0-10.4). CONCLUSIONS The risk for EHI and AI were higher with increasing WBGTmax. There was evidence of a cumulative effect from the prior day's WBGTmax for EHI. Am. J. Ind. Med. 59:1169-1176, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | - Alfred Mbah
- College of Public Health; University of South Florida; Tampa Florida
| | - Yougui Wu
- College of Public Health; University of South Florida; Tampa Florida
| | - Michael Hiles
- College of Public Health; University of South Florida; Tampa Florida
| | - Hanna Moore
- College of Public Health; University of South Florida; Tampa Florida
| | - Skai W. Schwartz
- College of Public Health; University of South Florida; Tampa Florida
| | - Thomas E. Bernard
- College of Public Health; University of South Florida; Tampa Florida
| |
Collapse
|
17
|
Bradstreet TE, Belliel SL, Berman RS, Copenhaver MD, Hesney M, Holder D, Hufnagel KE, Kersh LL, Liss CL, Neafus RP, Payne JE, Schwartz SW, Snavely DB, Suchower LJ, Walton-Bowen KL. A Statistics Appreciation Course for Clinical Research Personnel. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009286159202600104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas E. Bradstreet
- Clinical Pharmacology Statistics, Merck Sharp and Dohme Research Labs, West Point, PA
| | | | - Rayanne S. Berman
- Clinical Biostatistics, Merck Sharp and Dohme Research Labs, West Point, PA
| | | | - Michael Hesney
- Clinical Pharmacology Statistics, Merck Sharp and Dohme Research Labs, West Point, PA
| | - Daniel Holder
- Clinical Pharmacology Statistics, Merck Sharp and Dohme Research Labs, West Point, PA
| | - Karen E. Hufnagel
- Clinical Biostatistics, Merck Sharp and Dohme Research Labs, West Point, PA
| | - Louisa L. Kersh
- Clinical Biostatistics, Merck Sharp and Dohme Research Labs, West Point, PA
| | - Charles L. Liss
- Health Economics, Merck Sharp and Dohme Research Labs, West Point, PA
| | - Richard P. Neafus
- Clinical Pharmacology Statistics, Merck Sharp and Dohme Research Labs, West Point, PA
| | | | - Skai W. Schwartz
- Epidemiology, Merck Sharp and Dohme Research Labs, West Point, PA
| | - Duane B. Snavely
- Clinical Biostatistics, Merck Sharp and Dohme Research Labs, West Point, PA
| | - Lisa J. Suchower
- Clinical Biostatistics, Merck Sharp and Dohme Research Labs, West Point, PA
| | | |
Collapse
|
18
|
Rumbak DM, Mowrey W, W Schwartz S, Sarwahi V, Djukic A, Killinger JS, Katyal C. Spinal Fusion for Scoliosis in Rett Syndrome With an Emphasis on Respiratory Failure and Opioid Usage. J Child Neurol 2016; 31:153-8. [PMID: 25991642 DOI: 10.1177/0883073815585352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 01/02/2015] [Accepted: 04/06/2015] [Indexed: 11/17/2022]
Abstract
Our objective was to characterize our experience with 8 patients with Rett syndrome undergoing scoliosis surgery in regard to rates of respiratory failure and rates of ventilator-acquired pneumonia in comparison to patients with neurologic scoliosis and adolescent idiopathic scoliosis. This study was a retrospective chart review of patients undergoing scoliosis surgery at a tertiary children's hospital. Patients were divided into 3 groups: (1) adolescent idiopathic scoliosis, (2) neurologic scoliosis, and (3) Rett syndrome. There were 133 patients with adolescent idiopathic scoliosis, 48 patients with neurologic scoliosis, and 8 patients with Rett syndrome. We found that patients with Rett syndrome undergoing scoliosis surgery have higher rates of respiratory failure and longer ventilation times in the postoperative period when compared with both adolescent idiopathic scoliosis and neurologic scoliosis patients. There is insufficient evidence to suggest a difference in the incidence of ventilator-acquired pneumonia between the Rett syndrome and the neurologic scoliosis group. We believe our findings are the first in the literature to show a statistically significant difference between these 3 groups in regard to incidence of respiratory failure.
Collapse
Affiliation(s)
- Dania M Rumbak
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, USA Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Wenzhu Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Skai W Schwartz
- Department of Epidemiology and Biostatistics, University of South Florida College of Public Health, Tampa, FL, USA
| | - Vishal Sarwahi
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Aleksandra Djukic
- Division of Neurology and Tri-State Rett Syndrome Center, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA
| | - James S Killinger
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, USA Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Chhavi Katyal
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, USA
| |
Collapse
|
19
|
Schwartz SW, Sebastião Y, Rosas J, Iannacone MR, Foulis PR, Anderson WM. Racial disparity in adherence to positive airway pressure among US veterans. Sleep Breath 2016; 20:947-55. [PMID: 26810493 DOI: 10.1007/s11325-016-1316-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 06/27/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite advances in continuous positive airway pressure (CPAP) technology, compliance with CPAP therapy remains suboptimal. Studies conducted since the advent of objective CPAP recording have noted that African Americans (AA) may use CPAP less than Whites. We sought to confirm this finding among a large sample of veterans and examine effect modifiers of the differential usage. METHODS A retrospective cohort of 233 AA and 1939 White Veterans Administration (VA) patients who had a sleep study between January 2003 and October 2006 and received CPAP therapy by the end of 2007. CPAP compliance was summarized at 2 weeks and 6 months post CPAP receipt. RESULTS AAs were significantly less adherent than Whites even when controlling for age, gender, marital status, median household income for zip code, BMI, comorbidities, and obstructive sleep apnea (OSA) severity. AAs with severe OSA were 3 times more likely to use CPAP than AAs with mild/moderate OSA (p ≤ 0.001); a much smaller but still statistically significant difference was seen for Whites. CONCLUSIONS CPAP compliance is considerably lower in AAs than in Whites, though severity of OSA modifies this association. These findings are not readily explained by differences in demographics or comorbidity.
Collapse
Affiliation(s)
- Skai W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA.
| | - Yuri Sebastião
- Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA
| | - Julie Rosas
- Medical Service, James A. Haley VA Hospital, Tampa, FL, USA
| | - Michelle R Iannacone
- Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA
| | - Philip R Foulis
- Laboratory Service, James A. Haley VA Hospital, Tampa, FL, USA
- Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA
| | - W McDowell Anderson
- Medical Service, James A. Haley VA Hospital, Tampa, FL, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, University of South Florida, Tampa, FL, USA
| |
Collapse
|
20
|
Bakour C, O'Rourke K, Schwartz SW, Wang W, Sappenfield WM, Couluris M. Sleep Duration, Obesity, and Asthma in Florida High School Students: Analysis of the Florida Youth Risk Behavior Survey (2009-2013). Ann Epidemiol 2015. [DOI: 10.1016/j.annepidem.2015.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Schwartz SW, Rosas J, Iannacone MR, Foulis PR, Anderson WM. Correlates of a prescription for Bilevel positive airway pressure for treatment of obstructive sleep apnea among veterans. J Clin Sleep Med 2013; 9:327-35. [PMID: 23585747 DOI: 10.5664/jcsm.2580] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The acceptance of portable home-based polysomnography together with auto-titrating CPAP has bypassed the need for a laboratory polysomnography. Since bilevel airway pressure (BPAP) is titrated in the sleep lab, patients diagnosed using portable home-based polysomnography may not have the opportunity to receive BPAP. It is unknown whether the patients who would have ordinarily received a BPAP would benefit from it. We determine correlates of receiving BPAP and of being switched from BPAP to CPAP. We examine whether patients with these correlates have better adherence to BPAP versus CPAP. METHODS Retrospective Cohort Study (Correlates at baseline) of 2,513 VA patients with a sleep study between January 2003 and October 2006 and receiving continuous or bilevel positive airway pressure (CPAP [N = 2,251]) or BPAP [N = 262]) by the end of 2007. PAP adherence up to 30 months was assessed. RESULTS Significant correlates of BPAP were older age (p < 0.001), higher BMI and CHF (p < 0.01), COPD (p < 0.001), higher blood CO₂ (p < 0.05), higher AHI and OSA severity (p < 0.001), lower nadir SpO₂ (p < 0.001), and greater sleepiness (ESS) (p < 0.01). Patients on BPAP were more adherent to PAP therapy (p < 0.01), but the association largely disappeared following adjustment for BPAP correlates. There was preliminary evidence that these correlates predict long-term adherence to PAP therapy regardless of mode. CONCLUSIONS We identified baseline factors that can help clinicians decide whether to prescribe an auto-BPAP as first-line therapy and that predict good long-term PAP adherence.
Collapse
Affiliation(s)
- Skai W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA.
| | | | | | | | | |
Collapse
|
22
|
Hill OT, Mason TJ, Schwartz SW, Foulis PR. Improving prostate cancer detection in veterans through the development of a clinical decision rule for prostate biopsy. BMC Urol 2013; 13:6. [PMID: 23356551 PMCID: PMC3567946 DOI: 10.1186/1471-2490-13-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 12/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We sought to improve prostate cancer (PC) detection through developing a prostate biopsy clinical decision rule (PBCDR), based on an elevated PSA and laboratory biomarkers. This decision rule could be used after initial PC screening, providing the patient and clinician information to consider prior to biopsy. METHODS This case-control study evaluated men from the Tampa, Florida, James A. Haley (JH) Veteran's Administration (VA) (N = 1,378), from January 1, 1998, through April 15, 2005. To assess the PBCDR we did all of the following: 1) Identified biomarkers that are related to PC and have the capability of improving the efficiency of PC screening; 2) Developed statistical models to determine which can best predict the probability of PC; 3) Compared each potential model to PSA alone using Receiver Operator Characteristic (ROC) curves, to evaluate for improved overall effectiveness in PC detection and reduction in (negative) biopsies; and 4) Evaluated dose-response relationships between specified lab biomarkers (surrogates for extra-prostatic disease development) and PC progression. RESULTS The following biomarkers were related to PC: hemoglobin (HGB) (OR = 1.42 95% CI 1.27, 1.59); red blood cell (RBC) count (OR = 2.52 95% CI 1.67, 3.78); PSA (OR = 1.04 95% CI 1.03, 1.05); and, creatinine (OR = 1.55 95% CI 1.12, 2.15). Comparing all PC stages versus non-cancerous conditions, the ROC curve area under the curve (AUC) enlarged (increasing the probability of correctly classifying PC): PSA (alone) 0.59 (95% CI 0.55, 0.61); PBCDR model 0.68 (95% CI 0.65, 0.71), and the positive predictive value (PPV) increased: PSA 44.7%; PBCDR model 61.8%. Comparing PC (stages II, III, IV) vs. other, the ROC AUC increased: PSA (alone) 0.63 (95% CI 0.58, 0.66); PBCDR model 0.72 (95% CI 0.68, 0.75), and the PPV increased: 20.6% (PSA); PBCDR model 55.3%. CONCLUSIONS These results suggest evaluating certain common biomarkers in conjunction with PSA may improve PC prediction prior to biopsy. Moreover, these biomarkers may be more helpful in detecting clinically relevant PC. Follow-up studies should begin with replicating the study on different U.S. VA patients involving multiple practices.
Collapse
Affiliation(s)
- Owen T Hill
- Injury Epidemiology Research Section, Military Performance Division, United States Army Institute of Environmental Medicine, Natick, MA, USA.
| | | | | | | |
Collapse
|
23
|
|
24
|
Bernard TE, Caravello V, Schwartz SW, Ashley CD. WBGT clothing adjustment factors for four clothing ensembles and the effects of metabolic demands. J Occup Environ Hyg 2008; 5:1-5; quiz d21-3. [PMID: 17999329 DOI: 10.1080/15459620701732355] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study measured the clothing adjustment factors (CAFs) for four clothing ensembles (Cotton Coveralls, Tyvek 1427 Coveralls, NexGen Coveralls, and Tychem QC Coveralls; all coveralls were worn without hoods) against a baseline of cotton work clothes to determine whether the CAFs would be affected by the metabolic rate. Fifteen participants wore one of the five ensembles while walking on a treadmill at low, moderate, and high rates of work in an environment maintained at 50% relative humidity. A climatic chamber was used to slowly increase the level of heat stress by increasing air temperature. When the participant's core temperature reached a steady-state, the dry bulb temperature was increased. The point at which the core temperature began to increase was defined as the inflection point, and the WBGT recorded 5 min before the inflection point was the critical WBGT for each ensemble. A three-way mixed effects linear model with ensemble by metabolic rate category interactions demonstrated that the CAF did not change with metabolic rate, so CAFs can be used over a wide range of metabolic rates. The data at the moderate metabolic rate were combined with data on 14 participants from a previous study under the same conditions. The CAFs in degrees C WBGT were 0 for cotton coveralls, 1.0 for Tyvek 1422A, and 2.5 for NexGen. Although the value of 7.5 for Tychem QC was found, the recommendation remained at 10 to account for the effects of humidity. The standard error for the determination of WBGT crit at 50% relative humidity was 1.60 degrees C WBGT.
Collapse
Affiliation(s)
- Thomas E Bernard
- College of Public Health, University of South Florida, Tampa, Florida 33612-3805, USA.
| | | | | | | |
Collapse
|
25
|
Bernard TE, Luecke CL, Schwartz SW, Kirkland KS, Ashley CD. WBGT clothing adjustments for four clothing ensembles under three relative humidity levels. J Occup Environ Hyg 2005; 2:251-6. [PMID: 15804982 DOI: 10.1080/15459620590934224] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Threshold limit values for heat stress and strain are based on an upper limit wet bulb globe temperature (WBGT) for ordinary work clothes, with clothing adjustment factors (CAF) for other clothing ensembles. The purpose of this study was to determine the CAF for four clothing ensembles (Cotton Coveralls, Tyvek 1424 Coveralls, NexGen Coveralls, and Tychem QC Coveralls) against a baseline of cotton work clothes and to determine what effect relative humidity may have. A climatic chamber was used to slowly increase the level of heat stress by increasing air temperature at three levels of relative humidity (20%, 50%, and 70%). Study participants wore one of the five ensembles while walking on a treadmill at a moderate metabolic rate of 155 W m-2 (about 300 W). Physiological data and environmental data were collected. When the participant's core temperature reached a steady state, the dry bulb temperature was increased at constant relative humidity. The point at which the core temperature began to increase was defined as the inflection point. The environmental temperature recorded 5 min before the inflection point was used to calculate the critical WBGT for each ensemble. A three-way analysis of variance with ensemble by humidity protocol interactions and a multiple comparison test were used to make comparisons among the mean values. Only the vapor-barrier ensemble (Tychem QC) demonstrated an interaction with humidity level. The following CAFs are proposed: Cotton Coveralls (0 degrees C-WBGT), Tyvek 1424 Coveralls (+1), NexGen Coveralls (+2), and Tychem QC Coveralls (+10).
Collapse
Affiliation(s)
- Thomas E Bernard
- University of South Florida, College of Public Health, Tampa, Florida 33612, USA.
| | | | | | | | | |
Collapse
|
26
|
Schwartz SW, Rosenberg DM, Wang CP, Sanchez-Anguiano A, Ahmed S. Demographic Differences in Injuries among the Elderly: An Analysis of Emergency Department Visits. ACTA ACUST UNITED AC 2005; 58:346-52. [PMID: 15706199 DOI: 10.1097/00005373-200502000-00020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An understanding of demographic differences in injury types among the elderly will help in targeting interventions. METHODS Rates were calculated from the 1997 to 1999 National Hospital Ambulatory Medical Care Surveys by dividing the estimated number of visits by census population estimates. Age-adjusted standardized morbidity ratios were calculated to facilitate comparison between genders and between races. RESULTS Although men had fewer fractures than expected on the basis of the rate for women (standardized morbidity ratio = 0.57), they had more open wounds (standardized morbidity ratio = 1.785, p < 0.001). Blacks had fewer fractures than expected, based on the rates for whites (standardized morbidity ratio = 0.601, p = 0.004) but had higher visit rates than expected for less severe injuries such as contusions, strains, and sprains. CONCLUSION The trends noted in the present analysis suggest interventions for improved machinery safety targeted at elderly men and a continuing focus on access to primary care for minority elderly.
Collapse
Affiliation(s)
- Skai W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, James A. Haley Veterans Hospital, Tampa, FL 33612, USA.
| | | | | | | | | |
Collapse
|
27
|
Blumentals WA, Foulis PR, Schwartz SW, Mason TJ. Analgesic therapy and the prevention of bladder cancer. Urol Oncol 2004; 22:11-5. [PMID: 14969797 DOI: 10.1016/s1078-1439(03)00100-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 01/27/2003] [Revised: 05/18/2003] [Accepted: 05/30/2003] [Indexed: 01/31/2023]
Abstract
The aim of this study was to measure the association between analgesic use and risk of bladder cancer among patients seen at the James A. Haley Veterans' Administration (VA) Hospital in Tampa, FL. A total of 330 cases were obtained using a combination of computerized pathology records, and inpatient and outpatient diagnoses. Controls were randomly selected from the VA computerized administrative database, and 1293 controls were included for analysis. Unconditional logistic regression analysis was performed to assess the risk of bladder cancer after adjusting for age, gender, and cigarette smoking. Among analgesic users, we were able to identify a nearly 20% reduction in risk potentially consistent with a protective role (OR = 0.81, 95% CI = 0.63, 1.05). Nonsmokers had a 43% decrease in risk (OR = 0.57, 95% CI = 0.33, 0.98). While smoking is a strong and recognized cause of bladder cancer, 50% of bladder cancer cases are not attributable to tobacco consumption. Given that nonsmokers prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) were observed to have a 43% reduction in risk, it is important to study whether nonsmokers may benefit from therapy with NSAIDs.
Collapse
Affiliation(s)
- William A Blumentals
- Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, USA.
| | | | | | | |
Collapse
|
28
|
Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 2004; 32:1689-94. [PMID: 15286545 DOI: 10.1097/01.ccm.0000134835.05161.b6] [Citation(s) in RCA: 500] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The timing of tracheotomy in patients requiring mechanical ventilation is unknown. The effects of early percutaneous dilational tracheotomy compared with delayed tracheotomy in critically ill medical patients needing prolonged mechanical ventilation were assessed. DESIGN Prospective, randomized study. SETTING Medical intensive care units. PATIENTS One hundred and twenty patients projected to need ventilation >14 days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients were prospectively randomized to either early percutaneous tracheotomy within 48 hrs or delayed tracheotomy at days 14-16. Time in the intensive care unit and on mechanical ventilation and the cumulative frequency of pneumonia, mortality, and accidental extubation were documented. The airway was assessed for oral, labial, laryngeal, and tracheal damage. Early group showed significantly less mortality (31.7% vs. 61.7%), pneumonia (5% vs. 25%), and accidental extubations compared with the prolonged translaryngeal group (0 vs. 6). The early tracheotomy group spent less time in the intensive care unit (4.8 +/- 1.4 vs. 16.2 +/- 3.8 days) and on mechanical ventilation (7.6 +/- 2.0 vs. 17.4 +/- 5.3 days). There was also significantly more damage to mouth and larynx in the prolonged translaryngeal intubation group. CONCLUSIONS This study demonstrates that the benefits of early tracheotomy outweigh the risks of prolonged translaryngeal intubation. It gives credence to the practice of subjecting this group of critically ill medical patients to early tracheotomy rather than delayed tracheotomy.
Collapse
Affiliation(s)
- Mark J Rumbak
- Department of Medicine, Division of Pulmonary, Critical Care and Occupation Medicine, Tampa General Hospital University of South Florida Health Science Center, Tampa, FL 33612, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Schwartz SW, Carlucci C, Chambless LE, Rosamond WD. Synergism between smoking and vital exhaustion in the risk of Ischemic stroke: evidence from the ARIC study. Ann Epidemiol 2004; 14:416-24. [PMID: 15246330 DOI: 10.1016/j.annepidem.2003.10.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2003] [Accepted: 10/28/2003] [Indexed: 01/17/2023]
Abstract
PURPOSE To examine the synergism between vital exhaustion and cigarette smoking in producing ischemic stroke. Vital exhaustion (VE), a state characterized by unusual fatigue, irritability, and feelings of demoralization, is measured by the Maastricht questionnaire (MQ), a 21-item inventory of symptoms. METHODS The Atherosclerosis Risk in Communities (ARIC) Study is an ongoing cohort study, initiated in 1987. The MQ was administered at the second follow-up visit (1990-1992), and participants were subsequently followed for an average of 6.27 years. Four US communities (Minneapolis, Minnesota; Washington County, Maryland; Forsyth County, North Carolina; and Jackson, Mississippi). 13,066 participants aged 48 to 67 years at baseline (Visit 2) with no history of stroke. Validated hospitalized ischemic stroke. RESULTS During the follow-up period, there were 202 incident ischemic strokes. After multivariate adjustment, current smoking, and high VE were independent risk factors for incident stroke: (smoking vs. non-smoking HR=1.76, p < 0.01; high VE vs. low VE HR=1.94, p < 0.01). For persons with both VE and smoking vs. persons with neither, HR=2.71 (p < 0.001). The proportion of stroke disease burden due to VE and smoking that could be attributed to their interaction was 81 to 93 percent. CONCLUSIONS The combination of cigarette smoking and VE is synergistic in the production of stroke.
Collapse
Affiliation(s)
- Skai W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA.
| | | | | | | |
Collapse
|
30
|
Nordbrock IE, Schwartz SW, Schocken DD. A comparison of two measures of quality-of life for congestive heart failure. J Card Fail 1998. [DOI: 10.1016/s1071-9164(98)90222-6] [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]
|
31
|
Abstract
PURPOSE To investigate whether subjective sleep complaints are an independent predictor of myocardial infarction (MI) in a community of older adults and to gain clues as to why the association between sleep complaints and incident MI exists. METHODS Using longitudinal data from the Piedmont study on 2960 adults aged 65 or older who were free of symptomatic heart disease at baseline, we screened 19 potential confounders to determine if any, alone or in combination, could explain the observed relationship between incident MI and sleep complaints. RESULTS During the three-year follow-up period, there were 152 incident MIs. Restless sleep (incidence density ratio (IDR) = 1.58, 95% confidence interval (CI) = 1.11, 2.24) and trouble falling asleep (IDR = 1.68, 95% CI = 1.09, 2.60) predicted incident MI after adjusting for age, gender, and race. IDRs were not substantially impacted by controlling for smoking, blood pressure, diabetes or obesity. After adjustment for education, number of prescription medicines, self-rated health, and depression score, all IDRs were nullified. In particular, self-rated health and depression were strong independent risk factors for MI. CONCLUSIONS A subjective sleep complaint increases the likelihood of a first MI in older adults without overt coronary heart disease (CHD) independently of classic coronary risk factors and appears to be a marker for a syndrome of depression and malaise that may have a causal relationship to MI.
Collapse
Affiliation(s)
- S W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa 33612-3805, USA
| | | | | | | | | | | |
Collapse
|
32
|
Schwartz SW, Chambless LE, Baker WH, Broderick JP, Howard G. Consistency of Doppler parameters in predicting arteriographically confirmed carotid stenosis. Asymptomatic Carotid Atherosclerosis Study Investigators. Stroke 1997; 28:343-7. [PMID: 9040687 DOI: 10.1161/01.str.28.2.343] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE While internal carotid peak systolic velocity (IPSV) is reportedly the best Doppler parameter for predicting lower grades of carotid artery stenosis, the internal carotid end-diastolic velocity (IEDV) or the ratio of IPSV to common carotid end-diastolic velocity (CEDV) is helpful in increasing prediction of higher grade stenoses. It is important to examine the consistency of these findings across machine and technician. METHODS Using data from 10 devices from the Asymptomatic Carotid Atherosclerosis Study, we examined the predictive ability of seven Doppler parameters: IPSV, IEDV, CEDV, common carotid peak systolic velocity (CPSV), and the ratios of IPSV/ CEDV, IEDV/CEDV, and IEDV/CEDV. To assess the agreement between Doppler and arteriography in classifying percent stenosis above or below a given criterion, sensitivity, specificity, area under the receiver operating curve, and kappa statistics were obtained from logistic models. The single best Doppler parameter for each of two grades of stenosis (60% and 80%) was determined, and its predictive ability was compared with that of IPSV. The usefulness of IEDV or IPSV/CEDV in addition to IPSV to determine higher grade stenosis was examined. RESULTS IPSV was the best predictor in 9 of 10 devices at 60% and in 4 devices at 80% stenosis. When another parameter was better than IPSV, the improvement was minimal. Including IEDV or IPSV/CEDV in addition to IPSV did not notably improve predictive ability. CONCLUSIONS IPSV is the single best Doppler parameter for distinguishing severe (> 80%) from less severe carotid stenosis. Information from other Doppler parameters in addition to IPSV is unlikely to be helpful.
Collapse
Affiliation(s)
- S W Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health of University of South Florida, Tampa, USA
| | | | | | | | | |
Collapse
|
33
|
Epstein RS, Deverka PA, Chute CG, Lieber MM, Oesterling JE, Panser L, Schwartz SW, Guess HA, Patrick D. Urinary symptom and quality of life questions indicative of obstructive benign prostatic hyperplasia. Results of a pilot study. Urology 1991; 38:20-6. [PMID: 1714654 DOI: 10.1016/0090-4295(91)80194-c] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a pilot study of a urinary symptom and health-related quality-of-life questionnaire for benign prostatic hyperplasia (BPH), responses from 64 Mayo Clinic patients with cystoscopic evidence of obstructive BPH were compared with those of 14 men with no cystoscopic evidence of BPH and a community sample of 64 comparably aged men with no medical history of prostate enlargement. Questions which best discriminated between the groups were those dealing with urinary symptom frequency, bother due to urinary symptoms, and worry and concern about urinary problems. The results suggest that urinary-symptom-bother and worry due to urinary symptoms may be important additions to the more usual questions asked about urinary frequency in the identification of men with BPH. These findings are preliminary, however, and will be verified in an ongoing natural history study of BPH.
Collapse
Affiliation(s)
- R S Epstein
- Department of Epidemiology and Preventive Medicine, University of Maryland Medical School, Baltimore
| | | | | | | | | | | | | | | | | |
Collapse
|