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Cole ES, Hollander MAG, Ennis M, Donohue JM, James AE, Roberts ET. Do Medicaid Expenditures Increase After Adults Exit Permanent Supportive Housing? Hous Policy Debate 2022; 34:148-155. [PMID: 38616891 PMCID: PMC11008701 DOI: 10.1080/10511482.2022.2112609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/04/2022] [Indexed: 04/16/2024]
Abstract
The effects of homelessness and permanent supportive housing (PSH) on health care utilization have been well documented. Prior research on the association between PSH entry and Medicaid expenditures have indicated that such housing support could result in savings to Medicaid programs; however, whether changes occur in health care use and expenditures after individuals exit PSH is unknown. If efficiency gains from PSH persist after the individual leaves PSH, the savings to payers such as Medicaid may continue even after the costs to provide housing for a PSH recipient have ended. We used linked Medicaid and housing data from Pennsylvania to examine changes in the level and composition of Medicaid expenditures for 580 adult enrollees during the 12 months before and after exit from PSH adjusting for relevant covariates. In adjusted analyses, we estimated that monthly spending declined by $200.32 (95% CI: $323.50, $75.15) in the first quarter post-exit and by $267.63 (95% CI: $406.10, $127.10) in the third quarter. Our findings suggest that PSH may have sustained budgetary benefits to state Medicaid agencies even for beneficiaries exiting the program. However, more research is needed to understand if these reductions in expenditures last beyond 12 months and do not reflect under-use of care that may be important for managing health over the long-term.
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Affiliation(s)
- Evan S. Cole
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mara A. G. Hollander
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Molly Ennis
- Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julie M. Donohue
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - A. Everette James
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric T. Roberts
- Department of Health Policy and Management, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
BACKGROUND The Caregiver Advise, Record, Enable (CARE) Act encourages inclusion of family caregivers in the hospitalization process for patients. Translating the state laws into meaningful changes within the health care delivery system can be challenging and requires time. This study sought to examine early compliance with and implementation of the CARE Act reported by hospitals in the Commonwealth of Pennsylvania. METHODS We sent an online survey to hospital executives in Pennsylvania in 2017. Descriptive statistics were computed to examine hospital characteristics and used to assess compliance and implementation of the CARE Act tenets. RESULTS Most hospitals reported that changes have been and are being made to comply with the CARE Act (90.9%). Hospital executives reported that the family caregiver designation is available in 63.6% of the hospitals and notification of patient discharge is available in 45.5%. Hospital executives reported that family caregiver education and instruction is occurring in 31.8% of all inpatient stays. Hospital executives indicated that they are still developing processes to comply with the legislation and to integrate family caregivers into hospital systems and processes. CONCLUSIONS Our findings suggest that hospitals are complying with the legislation, while fully operationalizing the components of the CARE Act is a work in progress.
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Affiliation(s)
- Juleen Rodakowski
- Departments of Occupational Therapy, School of Health and Rehabilitation Sciences (Dr Rodakowski) and Acute and Tertiary Care, School of Nursing (Dr Martsolf), University of Pittsburgh, Pittsburgh, Pennsylvania; Clinical and Translational Science Institute, Pittsburgh, Pennsylvania (Dr Rodakowski); AmeriHealth Caritas Family of Companies, Philadelphia, Pennsylvania (Dr Leighton); RAND Corporation, Pittsburgh, Pennsylvania (Dr Martsolf); and Health Policy Management, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr James)
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Affiliation(s)
- Eric T Roberts
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health in Pittsburgh, PA (ETR, AEJ, LMS) in Pittsburgh, PA
| | - A Everette James
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health in Pittsburgh, PA (ETR, AEJ, LMS) in Pittsburgh, PA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health in Pittsburgh, PA (ETR, AEJ, LMS) in Pittsburgh, PA
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4
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Jarlenski MP, Krans EE, Kim JY, Donohue JM, James AE, Kelley D, Stein BD, Bogen DL. Five-Year Outcomes Among Medicaid-Enrolled Children With In Utero Opioid Exposure. Health Aff (Millwood) 2021; 39:247-255. [PMID: 32011940 DOI: 10.1377/hlthaff.2019.00740] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 02/03/2023]
Abstract
The health of women and children affected by opioid use disorder is a priority for state Medicaid programs. Little is known about longer-term outcomes among Medicaid-enrolled children exposed to opioids in utero. We examined well-child visit use and diagnoses of pediatric complex chronic conditions in the first five years of life among children with opioid exposure, tobacco exposure, or neither exposure in utero. The sample consisted of 82,329 maternal-child dyads in the Pennsylvania Medicaid program in which the children were born in the period 2008-11 and followed up for five years. Children with in utero opioid exposure had a lower predicted probability of recommended well-child visit use at age fifteen months (42.1 percent) compared to those with tobacco exposure (54.1 percent) and those with neither exposure (55.7 percent). Children with in utero opioid exposure had a predicted probability of being diagnosed with a pediatric complex chronic condition similar to that among children with tobacco exposure and those with neither exposure (20.4 percent, 18.7 percent, and 20.2 percent, respectively). Our findings were consistent when we examined a subgroup of opioid-exposed children identified as having neonatal opioid withdrawal symptoms.
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Affiliation(s)
- Marian P Jarlenski
- Marian P. Jarlenski ( marian. jarlenski@pitt. edu ) is an assistant professor in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, in Pennsylvania
| | - Elizabeth E Krans
- Elizabeth E. Krans is an assistant professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, and at the Magee-Womens Research Institute, in Pittsburgh
| | - Joo Yeon Kim
- Joo Yeon Kim is a senior data analyst in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health
| | - Julie M Donohue
- Julie M. Donohue is a professor in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health
| | - A Everette James
- A. Everette James III is a professor in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health
| | - David Kelley
- David Kelley is senior medical director in the Pennsylvania Department of Human Services, in Harrisburg
| | - Bradley D Stein
- Bradley D. Stein is a senior physician policy researcher at the RAND Corporation in Pittsburgh
| | - Debra L Bogen
- Debra L. Bogen is a professor in the Department of Pediatrics, University of Pittsburgh School of Medicine
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Roberts ET, Nimgaonkar A, Aarons J, Tomko H, Shartzer A, Zuckerman SB, Everette James A. New evidence of state variation in Medicaid payment policies for dual Medicare-Medicaid enrollees. Health Serv Res 2021; 55:701-709. [PMID: 33460128 DOI: 10.1111/1475-6773.13545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To develop the first longitudinal database of state Medicaid policies for paying the cost sharing in Medicare Part B for services provided to dual Medicare-Medicaid enrollees ("duals") and an index summarizing the impact of these policies on payments for physician office services. DATA SOURCES Medicaid policy data collected from electronic sources and inquiries with states. STUDY DESIGN We constructed a national database of Medicaid payment policies for the period 2004-2018, consolidating information from online Medicaid policy documents, state laws, and policy data reported to us by state Medicaid programs. Using this database and state Medicaid fee schedules, we constructed a Medicaid payment index for duals. This index represented the proportion of the Medicare allowed amount that physicians would expect to be paid from Medicare and Medicaid for a subset of physician office services (evaluation and management services) based on annual state payment policies and Medicaid fee schedules. PRINCIPAL FINDINGS In 2018, 42 states had policies to limit Medicaid payments of Medicare cost sharing when Medicaid's fee schedule was lower than Medicare's-an increase from 36 such states in 2004. In the preponderance of states with these policies, combined Medicare and Medicaid payments for evaluation and management services provided to duals averaged 78 percent of the Medicare allowed amount for these services, reflecting relatively low Medicaid fee schedules in these states. In 2013 and 2014, physicians who qualified for the Affordable Care Act's Medicaid "fee bump" were paid 100 percent of the Medicare allowed amount for these services. CONCLUSIONS Medicaid programs vary across states and over time in their payments of cost sharing for physician office services provided to duals. Our database and index can facilitate monitoring of these policies and research on the consequences of policy changes for duals.
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Affiliation(s)
- Eric T Roberts
- Department of Health Policy and Management, University of Pittsburgh Graduate Schools of Public Health, Pittsburgh, Pennsylvania
| | | | | | - Heather Tomko
- Department of Health Policy and Management, University of Pittsburgh Graduate Schools of Public Health, Pittsburgh, Pennsylvania
| | - Adele Shartzer
- Department of Health Policy and Management, University of Pittsburgh Graduate Schools of Public Health, Pittsburgh, Pennsylvania
| | | | - A Everette James
- Department of Health Policy and Management, University of Pittsburgh Graduate Schools of Public Health, Pittsburgh, Pennsylvania
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Colditz JB, Tulikangas MC, Sidani JE, Dodson ZM, Woods MS, James AE, Primack BA. Vape Shop Proliferation and Noncompliance in Pennsylvania: A Pre- and Post-tax Analysis. Tob Use Insights 2021; 14:1179173X20927389. [PMID: 33746518 PMCID: PMC7905483 DOI: 10.1177/1179173x20927389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/26/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The growing use of electronic nicotine delivery systems (ENDS) among
adolescents is a public health concern. Taxation of these products is a
viable approach to reduce ENDS use, particularly among adolescents.
Opponents of taxation posit that it puts specialty retailers (ie, vape
shops) out of business, thereby reducing availability of ENDS for adult
smokers seeking harm reduction. Pennsylvania enacted substantial ENDS taxes
in October 2016. This study sought to examine (1) the prevalence of
Pennsylvania vape shops before and after ENDS taxes were enacted and (2)
ENDS retail licensing compliance among vape shops. Methods: We employed standardized searches for vape shops in Pennsylvania on the Yelp
business-listing platform a month prior to and for 18 consecutive months
following the imposition of ENDS taxes. We then compared listings to a
public database of ENDS-related retail licenses to determine compliance
status. Results: The number of listed vape shops increased in a linear fashion by a magnitude
of 23%. In addition, when we compared a final listing of retailers to data
from the state tax authority, we found roughly a quarter (22%-29%) of vape
shops to be noncompliant with maintaining a valid ENDS retail license. Conclusions: Overall, ENDS taxation in Pennsylvania has not appeared to reduce prevalence
of vape shops as anticipated. However, stricter enforcement of the tax law
is necessary to ensure compliance among retailers. These findings have
implications for implementation and enforcement of ENDS tax policy
nationwide, including states that currently lack such policies.
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Affiliation(s)
- Jason B Colditz
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Megan C Tulikangas
- Bureau of Public Policy and Community Relations, Allegheny County Health Department, Pittsburgh, PA, USA
| | - Jaime E Sidani
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Zan M Dodson
- American Association of Geographers, Washington, DC, USA
| | - Michelle S Woods
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - A Everette James
- Health Policy Institute, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Brian A Primack
- College of Education and Health Professions, University of Arkansas, Fayetteville, AR, USA
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Degenholtz HB, Bear T, Cole E, James AE. Home- and Community-Based Provider Preparation for Pennsylvania's Managed Long-term Services and Supports. J Aging Soc Policy 2021; 33:268-284. [PMID: 33461429 DOI: 10.1080/08959420.2020.1824537] [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: 10/22/2022]
Abstract
As Pennsylvania implements its managed long-term services and supports program, we explore how home- and community-based providers are preparing for and perceiving the transition through an online survey. We summarize responses and conduct chi-square analysis to measure differences between select provider groups. Despite high levels of uncertainty about program impact, over 84% of respondents plan to participate. We found that providers in the first implementation phase had more strategic and operational discussions with MCOs than the other two phases (p < .03). As program rollout continues, we anticipate changes in MCO-provider conversation frequency and topics based upon implementation zone.
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Affiliation(s)
- Howard B Degenholtz
- Department of Health Policy and Management, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Todd Bear
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Evan Cole
- Department of Health Policy and Management, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - A Everette James
- Department of Health Policy and Management, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.,Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Leighton C, Fields B, Rodakowski JL, Feiler C, Hawk M, Bellon JE, James AE. A Multisite Case Study of Caregiver Advise, Record, Enable Act Implementation. Gerontologist 2020; 60:776-786. [PMID: 30726908 DOI: 10.1093/geront/gnz011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 10/03/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Commonwealth of Pennsylvania passed the Caregiver Advise, Record, Enable (CARE) Act on April 20, 2016. We designed a study to explore early implementation at a large, integrated delivery financing system. Our goal was to assess the effects of system-level decisions on unit implementation and the incorporation of the CARE Act's three components into routine care delivery. RESEARCH DESIGN AND METHODS We conducted a multisite, ethnographic case study at three different hospitals' medical-surgical units. We conducted observations and semi-structured interview to understand the implementation process and the approach to caregiver identification, notification, and education. We used thematic analysis to code interviews and observations and linked findings to the Promoting Action on Research Implementation in Health Services framework. RESULTS Organizational context and electronic health record capability were instrumental to the CARE Act implementation and integration into workflow. The implementation team used a decentralized strategy and a variety of communication modes, relying on local hospital units to train staff and make the changes. We found that the system facilitated the CARE Act implementation by placing emphasis on the documentation and charting to demonstrate compliance with the legal requirements. DISCUSSION AND IMPLICATIONS General acute hospitals will be making or have made similar decisions on how to operationalize the regulatory components and demonstrate compliance with the CARE Act. This study can help to inform others as they design and improve their compliance and implementation strategies.
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Affiliation(s)
- Cassandra Leighton
- Department of Health Policy and Management, University of Pittsburgh, Pennsylvania
- Health Policy Institute, University of Pittsburgh, Pennsylvania
| | - Beth Fields
- Health Policy Institute, University of Pittsburgh, Pennsylvania
- Center for Health Equity and Research Promotion, Pittsburgh, Pennsylvania
| | - Juleen L Rodakowski
- Department of Occupational Therapy, University of Pittsburgh, Pennsylvania
- Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania
| | | | - Mary Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania
| | | | - A Everette James
- Department of Health Policy and Management, University of Pittsburgh, Pennsylvania
- Health Policy Institute, University of Pittsburgh, Pennsylvania
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Sidani JE, Colditz JB, Barrett EL, Chu KH, James AE, Primack BA. JUUL on Twitter: Analyzing Tweets About Use of a New Nicotine Delivery System. J Sch Health 2020; 90:135-142. [PMID: 31828791 PMCID: PMC7034811 DOI: 10.1111/josh.12858] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/18/2018] [Revised: 02/21/2019] [Accepted: 05/11/2019] [Indexed: 05/14/2023]
Abstract
BACKGROUND Initial reports suggest that JUUL, a popular e-cigarette, is being used in schools and other locations in which cigarette smoking is illegal or discouraged. However, there is little scholarly research documenting this. We aimed to make a systematic analysis of JUUL use themes and sentiment on Twitter. METHODS Data were collected from Twitter's Filtered Streams Application Programming Interface from April 12, 2018 to May 10, 2018. This yielded 67,934 tweets, from which a random sample of 2% was selected for coding. The final dataset included 1209 tweets. Inter-rater reliability ranged κ = 0.64-0.85. RESULTS The majority (71.5%) of tweets expressed positive sentiment toward JUUL. JUUL use in places where cigarette smoking is illegal or discouraged appeared in 111 tweets (9.2%); approximately one-third of these tweets referring to using the device in school. Nearly 20% of tweets mentioned using the device at home and/or directly in front of responsible adults. CONCLUSIONS This study confirms anecdotal reports of JUUL use in places where cigarette smoking is illegal or discouraged. Positive sentiment about use of JUUL suggests that the product is being normalized among young people. It may be valuable for educators to discuss the addictive nature of nicotine delivered through JUUL with younger populations.
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Affiliation(s)
- Jaime E Sidani
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - Jason B Colditz
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - Erica L Barrett
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - Kar-Hai Chu
- Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213
| | - A Everette James
- Health Policy Institute, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261
| | - Brian A Primack
- University of Arkansas College of Education and Health Professions, 1 University of Arkansas, Fayetteville, AR, 72701
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10
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Martsolf GR, Kandrack R, Rodakowski J, Friedman EM, Beach S, Folb B, James AE. Work Performance Among Informal Caregivers: A Review of the Literature. J Aging Health 2019; 32:1017-1028. [DOI: 10.1177/0898264319895374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To examine the association between informal caregiving and caregiver work performance. Method: A systematized review of the literature. Results: We found that caregiving has an adverse impact on work performance: caregivers experience substantial work disruptions and negative work performance outcomes, and these findings were consistent across measures. Our synthesis suggests that caregivers miss a significant amount of work and have reductions in productivity due to their caregiving responsibilities. However, significant methodological limitations with the reviewed studies make systematic interpretations and causal determinations challenging. Discussion: Examining the effect of caregiving on work performance is critical to better understand the full impact of caregiving, especially as demand for caregivers increases as the population ages. This comprehensive review suggests that caregiving has a significant negative impact on work performance, although methodological challenges remain in this area of science. These findings should inform both public policy development and workplace benefits design.
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Affiliation(s)
- Grant R. Martsolf
- RAND Corporation, Pittsburgh, PA, USA
- University of Pittsburgh, PA, USA
| | - Ryan Kandrack
- RAND Corporation, Pittsburgh, PA, USA
- The University of North Carolina at Chapel Hill, USA
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11
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Sidani JE, Colditz JB, Barrett EL, Shensa A, Chu KH, James AE, Primack BA. I wake up and hit the JUUL: Analyzing Twitter for JUUL nicotine effects and dependence. Drug Alcohol Depend 2019; 204:107500. [PMID: 31499242 PMCID: PMC6878169 DOI: 10.1016/j.drugalcdep.2019.06.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND JUUL-a novel electronic nicotine delivery system (ENDS)-comprises most of the ENDS market share. Additionally, JUUL has a high nicotine content and utilizes a patented nicotine salt formulation aimed to speed absorption. Many JUUL users are not aware of the nicotine content and therefore may not be expecting acute nicotine effects or potential for dependence. This study sought to analyze Twitter messages ("tweets") regarding nicotine, symptoms of dependence, and withdrawal related to JUUL use. METHODS Data were collected from Twitter's Filtered Streams interface 4/11-6/16/2018 by retrieving tweets matching the terms "juul," "juuls," and "juuling" that also used words consistent with nicotine effects, symptoms of dependence, and withdrawal. A random 5% subsample (n = 1986) was coded by 2 independent coders. Cohen's κ for inter-rater reliability ranged 0.62-1.00 for all coded variables. Tweets were assessed using a qualitative content analysis approach. RESULTS A total of 335 tweets mentioned dependence-related themes, including use upon waking and compulsion to use. A total of 189 tweets mentioned themes related to nicotine, with almost 15% of these tweets describing physical effects. Additionally, 42 tweets mentioned themes related to quitting JUUL and/or withdrawal from JUUL. DISCUSSION This qualitative analysis suggests that users of JUUL are experiencing symptoms of nicotine exposure and dependence. Considering the high nicotine content of JUUL and the rising popularity among young people, more research around initiation of and dependence on JUUL, as well as the impact of recent FDA policy changes, should be conducted.
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Affiliation(s)
- Jaime E Sidani
- Center for Research on Media, Technology, and Health, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, United States.
| | - Jason B Colditz
- Center for Research on Media, Technology, and Health, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, United States
| | - Erica L Barrett
- Center for Research on Media, Technology, and Health, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, United States
| | - Ariel Shensa
- Center for Research on Media, Technology, and Health, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, United States
| | - Kar-Hai Chu
- Center for Research on Media, Technology, and Health, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, United States
| | - A Everette James
- Health Policy Institute, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, United States
| | - Brian A Primack
- College of Education and Health Professions, University of Arkansas, 324 Graduate Education Building, Fayetteville, AR, 72701, United States
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12
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Friedman EM, Rodakowski J, Schulz R, Beach SR, Martsolf GR, James AE. Do Family Caregivers Offset Healthcare Costs for Older Adults? A Mapping Review on the Costs of Care for Older Adults With Versus Without Caregivers. Gerontologist 2019; 59:e535-e551. [PMID: 30945725 DOI: 10.1093/geront/gny182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Older adults face significant long-term care and health care costs. But some of these costs can potentially be offset through family caregivers who may serve as substitutes for formal care or directly improve the care recipient's health and reduce health care utilization and expenditures. This article reviews the current literature to determine whether it is possible through existing work to compare the costs of care for individuals with versus without family caregivers and, if not, where the data, measurement, and other methodological challenges lie. RESEARCH DESIGN AND METHODS A mapping review of published works containing information on health care utilization and expenditures and caregiving was conducted. A narrative approach was used to review and identify methodological challenges in the literature. RESULTS Our review identified 47 articles that met our criteria and had information on caregiving and health care costs or utilization. Although findings were mixed, for the most part, having a family caregiver was associated with reduced health care utilization and a decreased risk of institutionalization however, the precise difference in health care expenditures for individuals with caregivers compared to those without was rarely examined, and findings were inconsistent across articles reviewed. DISCUSSION AND IMPLICATIONS The number of family caregivers providing care to loved ones is expected to grow with the aging of the Baby Boomers. Various programs and policies have been proposed to support these caregivers, but they could be costly. These costs can potentially be offset if family caregivers reduce health care spending. More research is needed, however, to quantify the savings stemming from family caregiving.
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Affiliation(s)
| | - Juleen Rodakowski
- Department of Occupational Therapy, University of Pittsburgh, Pennsylvania
| | - Richard Schulz
- Department of Psychiatry, University of Pittsburgh, Pennsylvania
| | - Scott R Beach
- University Center for Social and Urban Research, University of Pittsburgh, Pennsylvania
| | - Grant R Martsolf
- RAND Corporation, Santa Monica, California.,School of Nursing, University of Pittsburgh, Pennsylvania
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Leighton C, Cole E, James AE, Driessen J. Medicare Shared Savings Program ACO network comprehensiveness and patient panel stability. Am J Manag Care 2019; 25:e267-e273. [PMID: 31518098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The current Medicare Shared Savings Program (MSSP) accountable care organization (ACO) attribution methodology creates unpredictability for ACOs that are developing and deploying strategic initiatives aimed at improving value. The goal of this study is to determine if ACO network comprehensiveness is associated with the stability of assigned Medicare beneficiaries from 2013 to 2014. STUDY DESIGN We utilized a beneficiary-level logistic regression model to determine association of network comprehensiveness with stable attribution to an MSSP ACO. METHODS Using 2013 and 2014 Medicare fee-for-service beneficiary and provider files, we developed a measure of network comprehensiveness based on 2013 provider contracts, determined beneficiary attribution, and generated market-level measures. Additional population and quality measures were obtained from the US Census and the ACO Public Use File. RESULTS Of the 1,317,858 observed beneficiaries, 84.38% were attributed to the same ACO in 2013 and 2014, and mean (SD) ACO network comprehensiveness was 0.30 (0.20). We found that a 0.10 increase in network comprehensiveness score significantly increased the odds of remaining attributed to the same ACO by 4.5% (P = .001). Patient panel stability was significantly associated with improved diabetes (P = .01) and hypertension (P = .02) control, timely access to care (P = .001), and delivery of health education (P = .03) over the 2-year period. CONCLUSIONS The comprehensiveness of an MSSP ACO's contracted provider network is associated with stable patient assignment year to year. Patient panel stability may aid in the longitudinal management of some conditions.
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Affiliation(s)
- Cassandra Leighton
- Health Policy Institute, University of Pittsburgh, Scaife Hall, Ste S310, 3550 Terrace St, Pittsburgh, PA 15261.
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14
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Fields B, Rodakowski J, James AE, Beach S. Caregiver health literacy predicting healthcare communication and system navigation difficulty. Fam Syst Health 2018; 36:482-492. [PMID: 30148377 DOI: 10.1037/fsh0000368] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The role of caregiver health literacy in predicting difficulty communicating with health care professionals and navigating services and supports for older adults was examined and informed by the health literacy skills framework (Squiers, Peinade, Berkman, Boudewyns, & McCormack, 2012). METHOD Secondary analyses of cross-sectional data from the Pittsburgh Regional Caregivers Survey in 2017 were conducted. A total of 761 caregivers of older adults reported communicating with health care providers and accessing services and supports. Health care provider communication and navigation of services and supports (HCNS) was assessed through self-report questions on communication about needs of the care recipient and caregiver, and the ability to locate and arrange services and supports for the care recipient. Health literacy was assessed with self-report questions on confidence filling out forms, need for help with reading information, and comprehension with written information. A logistic regression was conducted to determine the relationship between health literacy and high HCNS difficulty while controlling for demographic and contextual caregiving characteristics. RESULTS A fifth of the caregivers demonstrated low health literacy (n = 150, 19.7%). For a caregiver with low health literacy, the odds of having high levels of difficulty with HCNS was 2.52 times larger than the odds for a caregiver with adequate health literacy while controlling for demographic and contextual caregiving factors (odds ratio = 2.52, 95% confidence interval [1.57, 4.06]; p < .001). DISCUSSION Findings demonstrate that poor caregiver health literacy is an important factor associated with HCNS difficulty. The health literacy of caregivers should be considered for assessments and interventions designed to identify and reduce the difficulty caregivers experience with HCNS. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Stepansky KE, Sethi A, Toto P, Everette James A, Leighton C, Bendixen R. Caregiver Preparedness Training Within Inpatient Brain Injury Rehabilitation: A Scoping Review. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Escobar-Viera CG, Shensa A, Bowman ND, Sidani JE, Knight J, James AE, Primack BA. Passive and Active Social Media Use and Depressive Symptoms Among United States Adults. Cyberpsychology, Behavior, and Social Networking 2018; 21:437-443. [DOI: 10.1089/cyber.2017.0668] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- César G. Escobar-Viera
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ariel Shensa
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nicholas D. Bowman
- Department of Communication Studies, West Virginia University, Morgantown, West Virginia
| | - Jaime E. Sidani
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer Knight
- Department of Communication Studies, West Virginia University, Morgantown, West Virginia
| | - A. Everette James
- Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brian A. Primack
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Colditz JB, Chu KH, Emery SL, Larkin CR, James AE, Welling J, Primack BA. Toward Real-Time Infoveillance of Twitter Health Messages. Am J Public Health 2018; 108:1009-1014. [PMID: 29927648 DOI: 10.2105/ajph.2018.304497] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
There is growing interest in conducting public health research using data from social media. In particular, Twitter "infoveillance" has demonstrated utility across health contexts. However, rigorous and reproducible methodologies for using Twitter data in public health are not yet well articulated, particularly those related to content analysis, which is a highly popular approach. In 2014, we gathered an interdisciplinary team of health science researchers, computer scientists, and methodologists to begin implementing an open-source framework for real-time infoveillance of Twitter health messages (RITHM). Through this process, we documented common challenges and novel solutions to inform future work in real-time Twitter data collection and subsequent human coding. The RITHM framework allows researchers and practitioners to use well-planned and reproducible processes in retrieving, storing, filtering, subsampling, and formatting data for health topics of interest. Further considerations for human coding of Twitter data include coder selection and training, data representation, codebook development and refinement, and monitoring coding accuracy and productivity. We illustrate methodological considerations through practical examples from formative work related to hookah tobacco smoking, and we reference essential methods literature related to understanding and using Twitter data.
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Affiliation(s)
- Jason B Colditz
- Jason B. Colditz, Kar-Hai Chu, Chandler R. Larkin, and Brian A. Primack are with the Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA. Sherry L. Emery is with NORC, University of Chicago, Chicago, IL. A. Everette James is with the Health Policy Institute, University of Pittsburgh Graduate School of Public Health, Pittsburgh. Joel Welling is with the Pittsburgh Supercomputing Center, Pittsburgh
| | - Kar-Hai Chu
- Jason B. Colditz, Kar-Hai Chu, Chandler R. Larkin, and Brian A. Primack are with the Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA. Sherry L. Emery is with NORC, University of Chicago, Chicago, IL. A. Everette James is with the Health Policy Institute, University of Pittsburgh Graduate School of Public Health, Pittsburgh. Joel Welling is with the Pittsburgh Supercomputing Center, Pittsburgh
| | - Sherry L Emery
- Jason B. Colditz, Kar-Hai Chu, Chandler R. Larkin, and Brian A. Primack are with the Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA. Sherry L. Emery is with NORC, University of Chicago, Chicago, IL. A. Everette James is with the Health Policy Institute, University of Pittsburgh Graduate School of Public Health, Pittsburgh. Joel Welling is with the Pittsburgh Supercomputing Center, Pittsburgh
| | - Chandler R Larkin
- Jason B. Colditz, Kar-Hai Chu, Chandler R. Larkin, and Brian A. Primack are with the Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA. Sherry L. Emery is with NORC, University of Chicago, Chicago, IL. A. Everette James is with the Health Policy Institute, University of Pittsburgh Graduate School of Public Health, Pittsburgh. Joel Welling is with the Pittsburgh Supercomputing Center, Pittsburgh
| | - A Everette James
- Jason B. Colditz, Kar-Hai Chu, Chandler R. Larkin, and Brian A. Primack are with the Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA. Sherry L. Emery is with NORC, University of Chicago, Chicago, IL. A. Everette James is with the Health Policy Institute, University of Pittsburgh Graduate School of Public Health, Pittsburgh. Joel Welling is with the Pittsburgh Supercomputing Center, Pittsburgh
| | - Joel Welling
- Jason B. Colditz, Kar-Hai Chu, Chandler R. Larkin, and Brian A. Primack are with the Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA. Sherry L. Emery is with NORC, University of Chicago, Chicago, IL. A. Everette James is with the Health Policy Institute, University of Pittsburgh Graduate School of Public Health, Pittsburgh. Joel Welling is with the Pittsburgh Supercomputing Center, Pittsburgh
| | - Brian A Primack
- Jason B. Colditz, Kar-Hai Chu, Chandler R. Larkin, and Brian A. Primack are with the Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, PA. Sherry L. Emery is with NORC, University of Chicago, Chicago, IL. A. Everette James is with the Health Policy Institute, University of Pittsburgh Graduate School of Public Health, Pittsburgh. Joel Welling is with the Pittsburgh Supercomputing Center, Pittsburgh
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Primack BA, Shensa A, Sidani JE, Tulikangas MC, Roberts MS, Colditz JB, Mor MK, James AE, Fine M. Comparison of toxicant load from waterpipe and cigarette tobacco smoking among young adults in the USA. Tob Control 2018:tobaccocontrol-2017-054226. [PMID: 29773707 PMCID: PMC9299954 DOI: 10.1136/tobaccocontrol-2017-054226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/08/2018] [Accepted: 03/21/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To form population-level comparisons of total smoke volume, tar, carbon monoxide and nicotine consumed from waterpipe tobacco smoking (WTS) and cigarette smoking using data from a nationally representative sample of smokers and non-smokers aged 18-30 years. METHODS In March and April 2013, we surveyed a nationally representative sample of 3254 US young adults to assess the frequency and volume of WTS and cigarette smoking. We used Monte Carlo analyses with 5000 repetitions to estimate the proportions of toxicants originating from WTS and cigarette smoking. Analyses incorporated survey weights and used recent meta-analytic data to estimate toxicant exposures associated with WTS and cigarette smoking. RESULTS Compared with the additive estimates of WTS and cigarette smoking combined, 54.9% (95% CI 37.5% to 72.2%) of smoke volume was attributed to WTS. The proportions of tar attributable to WTS was 20.8% (95% CI 6.5% to 35.2%), carbon monoxide 10.3% (95% CI 3.3% to 17.3%) and nicotine 2.4% (95% CI 0.9% to 3.8%). CONCLUSIONS WTS accounted for over half of the tobacco smoke volume consumed among young US adult waterpipe and cigarette smokers. Toxicant exposures to tar, carbon monoxide and nicotine were lower, but still substantial, for WTS alone compared with WTS and cigarette smoking. Public health and policy interventions to reduce harm from tobacco smoking in young US adults should explicitly address WTS toxicant exposures.
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Affiliation(s)
- Brian A. Primack
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ariel Shensa
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jaime E. Sidani
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Megan C. Tulikangas
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Health Policy Institute, University of Pittsburgh, Pittsburgh, PA
| | - Mark S. Roberts
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Health Policy Institute, University of Pittsburgh, Pittsburgh, PA
- Center for Health Equity and Research Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Jason B. Colditz
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Maria K. Mor
- Center for Health Equity and Research Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - A. Everette James
- Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, PA
- Health Policy Institute, University of Pittsburgh, Pittsburgh, PA
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Michael Fine
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Health Equity and Research Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
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Hoffman BL, Tulikangas MC, James AE, Shensa A, Colditz JB, Sidani JE, Primack BA. Pennsylvania policymakers' knowledge, attitudes and likelihood for action regarding waterpipe tobacco smoking and electronic nicotine delivery systems. Tob Prev Cessat 2018; 4:14. [PMID: 32411842 PMCID: PMC7205063 DOI: 10.18332/tpc/89624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 10/11/2017] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Use of waterpipe tobacco smoking (WTS, or hookah smoking) and electronic nicotine delivery systems (ENDS, such as e-cigarettes) is rapidly increasing. However, legislatures have been slow to update policy measures related to them. Therefore, we aimed to assess knowledge, attitudes and likelihood to take future action regarding WTS and ENDS among Pennsylvania legislators. METHODS We approached all Standing Members of key Pennsylvania House and Senate health and welfare committees to complete a survey about substances of abuse, including WTS and ENDS. Closed-ended knowledge, attitude and action items used a 100-point scale. Responses to open-ended items were assessed using thematic analysis by three independently working researchers. RESULTS We received responses from 13 of 27 eligible policymakers (48%). Participants answered a mean of only 27% (SD=20%) of knowledge items correctly. When asked to rank by priority eight issues in substance abuse, WTS ranked eighth (least urgent) and ENDS ranked fifth. Participants reported low likelihood to introduce legislation on WTS (mean=29, median=25) and/or ENDS (mean=28, median=10). Thematic analysis revealed that participants readily acknowledged lack of understanding of WTS and ENDS, and were eager for additional information. CONCLUSIONS Policymakers exhibit a lack of knowledge concerning newer forms of tobacco and nicotine delivery systems and consider them to be relatively low legislative priorities. However, respondents expressed a desire for more information, suggesting the potential for public health entities to promote effective policy development via improved dissemination of information.
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Affiliation(s)
| | | | | | - Ariel Shensa
- University of Pittsburgh, Pittsburgh, United States
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Affiliation(s)
- Walid F Gellad
- From the Division of General Medicine and the Center for Pharmaceutical Policy and Prescribing (W.F.G.) and the Health Policy Institute and Department of Health Policy and Management, Graduate School of Public Health (A.E.J.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System (W.F.G.) - both in Pittsburgh
| | - A Everette James
- From the Division of General Medicine and the Center for Pharmaceutical Policy and Prescribing (W.F.G.) and the Health Policy Institute and Department of Health Policy and Management, Graduate School of Public Health (A.E.J.), University of Pittsburgh, and the Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System (W.F.G.) - both in Pittsburgh
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Schulz R, Beach SR, Friedman EM, Martsolf GR, Rodakowski J, James AE. Changing Structures and Processes to Support Family Caregivers of Seriously Ill Patients. J Palliat Med 2017; 21:S36-S42. [PMID: 29091533 DOI: 10.1089/jpm.2017.0437] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although family caregivers provide a significant portion of health and support services to adults with serious illness, they are often marginalized by existing healthcare systems and procedures. OBJECTIVE We examine the role of caregivers in existing systems of care, identify needed changes in structures and processes, and describe how these changes might be monitored and assessed and who should be accountable for implementing them. DESIGN Based on a broad assessment of the caregiving literature, the recent National Academy of Sciences Report on family caregiving, and descriptive data from two national surveys, we describe structural and process barriers that limit caregivers' ability to provide effective care. SUBJECTS To describe the unique challenges and impacts of caring for seriously ill patients, we report data from a nationally representative sample of older adults and their caregivers (National Health and Aging Trends Study [NHATS]; National Study of Caregiving [NSOC]) to identify the prevalence and impact on family caregivers of seriously ill patients who have high needs for support and are high cost to the healthcare system. MEASUREMENTS Standardized measures of patient status and caregiver roles and impacts are used. RESULTS Multiple structural and process barriers limit the ability of caregivers to provide effective care. These issues are exacerbated for the more than 13 million caregivers who provide care and support to 9 million seriously ill older adults. CONCLUSIONS Fundamental changes are needed in the way we identify, assess, and support caregivers. Educational and workforce development reforms are needed to enhance the competencies of healthcare and long-term service providers to effectively engage caregivers.
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Affiliation(s)
- Richard Schulz
- 1 Department of Psychiatry, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Scott R Beach
- 2 University Center for Social and Urban Research, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Esther M Friedman
- 3 Pardee RAND Graduate School, RAND Corporation , Santa Monica, California
| | - Grant R Martsolf
- 4 Pardee RAND Graduate School, RAND Corporation , Pittsburgh, Pennsylvania
| | - Juleen Rodakowski
- 5 Department of Occupational Therapy, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - A Everette James
- 6 Health Policy Institute, University of Pittsburgh , Pittsburgh, Pennsylvania
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Rodakowski J, Rocco PB, Ortiz M, Folb B, Schulz R, Morton SC, Leathers SC, Hu L, James AE. Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis. J Am Geriatr Soc 2017; 65:1748-1755. [PMID: 28369687 DOI: 10.1111/jgs.14873] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [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: 11/27/2022]
Abstract
OBJECTIVES To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. DESIGN A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all English-language articles published between 1990 and April 2016. SETTING Hospital or skilled nursing facility. PARTICIPANTS Older adults with informal caregivers discharged to a community setting. MEASUREMENTS Readmission rates, length of and time to post-discharge rehospitalizations, costs of postdischarge care. RESULTS Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62-0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64-0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. CONCLUSION For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission.
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Affiliation(s)
- Juleen Rodakowski
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Philip B Rocco
- Department of Political Science, Marquette University, Milwaukee, Wisconsin
| | - Maqui Ortiz
- Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Barbara Folb
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Richard Schulz
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sally C Morton
- College of Science, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Sally Caine Leathers
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Washington, District of Columbia
| | - Lu Hu
- School of Medicine, New York University, New York, New York
| | - A Everette James
- Health Policy Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Primack BA, Shensa A, Escobar-Viera CG, Barrett EL, Sidani JE, Colditz JB, James AE. Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among U.S. young adults. Computers in Human Behavior 2017. [DOI: 10.1016/j.chb.2016.11.013] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Access to paid sick days (PSD) differs by workplace size, race/ethnicity, gender, and income in the United States. It is not known to what extent decisions to stay home from work when sick with infectious illnesses such as influenza depend on PSD access, and whether access impacts certain demographic groups more than others. We examined demographic and workplace characteristics (including access to PSD) associated with employees' decisions to stay home from work for their own or a child's illness. Linking the 2009 Medical Expenditure Panel Survey (MEPS) consolidated data file to the medical conditions file, we used multivariate Poisson regression models with robust variance estimates to identify factors associated with missed work for an employee's own or a child's illness/injury, influenza-like-illness (ILI), and influenza. Controlling for gender, race/ethnicity, education, and income, access to PSD was associated with a higher probability of staying home for an employee's own illness/injury, ILI, or influenza, and for a child's illness/injury. Hispanic ethnicity was associated with a lower prevalence of staying home for the employee's own or a child's illness compared to non-Hispanic Whites. Access to PSD was associated with a significantly greater increase in the probability of staying home among Hispanics than among non-Hispanic Whites. Women had a significantly higher probability of staying home for their child's illness compared to men, suggesting that women remain the primary caregivers for ill children. Our results indicate that PSD access is important to encourage employees to stay home from work when sick with ILI or influenza. Also, PSD access may be important to enable stay-at-home behavior among Hispanics. We conclude that access to PSD is likely to reduce the spread of disease in workplaces by increasing the rate at which sick employees stay home from work, and reduce the economic burden of staying home on minorities, women, and families.
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Affiliation(s)
- Kaitlin Piper
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Ada Youk
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - A. Everette James
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Supriya Kumar
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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Kabiri M, Chhatwal J, Donohue JM, Roberts MS, James AE, Dunn MA, Gellad WF. Long-term disease and economic outcomes of prior authorization criteria for Hepatitis C treatment in Pennsylvania Medicaid. Healthc (Amst) 2016; 5:105-111. [PMID: 27932263 DOI: 10.1016/j.hjdsi.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 11/14/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Several highly effective but costly therapies for hepatitis C virus (HCV) are available. As a consequence of their high price, 36 state Medicaid programs limited treatment coverage to patients with more advanced HCV stages. States have only limited information available to predict the long-term impact of these decisions. METHODS We adapted a validated hepatitis C microsimulation model to the Pennsylvania Medicaid population to estimate the existing HCV prevalence in Pennsylvania Medicaid and estimate the impact of various HCV drug coverage policies on disease outcomes and costs. Outcome measures included rates of advanced-stage HCV outcomes and treatment and disease costs in both Medicaid and Medicare. RESULTS We estimated that 46,700 individuals in Pennsylvania Medicaid were infected with HCV in 2015, 33% of whom were still undiagnosed. By expanding treatment to include mild fibrosis stage (Metavir F2), Pennsylvania Medicaid will spend an additional $273 million on medications in the next decade with no substantial reduction in the incidence of liver cancer or liver-related death. Medicaid patients who are not eligible for treatment under restricted policies would get treatment once they transition to the Medicare program, which would incur 10% reduction in HCV-related costs due to early treatment in Medicaid. Further expanding treatment to patients with early fibrosis stages (F0 or F1) would cost Medicaid an additional $693 million during the next decade but would reduce the number of individuals in need of treatment in Medicare by 46% and decrease Medicare treatment costs by 23%. In some scenarios, outcomes could worsen with eligibility expansion if there is inadequate capacity to treat all patients. CONCLUSIONS AND RELEVANCE Expansion of HCV treatment coverage to less severe stages of liver disease may not substantially improve liver related outcomes for patients in Pennsylvania Medicaid in scenarios in which coverage through Medicare is widely available.
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Affiliation(s)
- Mina Kabiri
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA; Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark S Roberts
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA
| | - A Everette James
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA; Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA; Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael A Dunn
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Walid F Gellad
- Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA; Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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Driessen J, Bellon JE, Stevans J, Forsythe RM, Reynolds BR, James AE. Perceived performance and impact of a non-physician-led interprofessional team in a trauma clinic setting. J Interprof Care 2016; 31:112-114. [PMID: 27880082 DOI: 10.1080/13561820.2016.1244177] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Faced with the challenge of meeting the wide degree of post-discharge needs in their trauma population, the University of Pittsburgh Medical Center (UPMC) developed a non-physician-led interprofessional team to provide follow-up care at its UPMC Falk Trauma Clinic. We assessed this model of care using a survey to gauge team member perceptions of this model, and used clinic visit documentation to apply a novel approach to assessing how this model improves the care received by clinic patients. The high level of perceived team performance and cohesion suggests that this model has been successful thus far from a provider perspective. Patients are seen most frequently by audiologists, while approximately half of physical therapy and speech language therapy consults generate a new therapy referral, which is interpreted as a potential change in the patient's care trajectory. The broader message of this analysis is that a collaborative, non-hierarchical team model incorporating rehabilitative specialists, who often operate independently of one another, can be successful in this setting, where patients appear to have a strong and previously under-attended need for rehabilitative intervention.
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Affiliation(s)
- Julia Driessen
- a Department of Health Policy and Management, Graduate School of Public Health , University of Pittsburgh , Pittsburgh , Pennsylvania , USA
| | - Johanna E Bellon
- b Health Services Division, Wolff Center , University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania , USA
| | - Joel Stevans
- c School of Health and Rehabilitation Sciences , University of Pittsburgh , Pittsburgh , Pennsylvania , USA
| | - Raquel M Forsythe
- d Division of General Surgery , University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania , USA
| | - Benjamin R Reynolds
- e The UPMC Office of Advanced Practice Providers , University of Pittsburgh Medical Center , Pittsburgh , Pennsylvania , USA
| | - A Everette James
- a Department of Health Policy and Management, Graduate School of Public Health , University of Pittsburgh , Pittsburgh , Pennsylvania , USA.,c School of Health and Rehabilitation Sciences , University of Pittsburgh , Pittsburgh , Pennsylvania , USA
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Colditz JB, Ton JN, James AE, Primack BA. Toward Effective Water Pipe Tobacco Control Policy in the United States: Synthesis of Federal, State, and Local Policy Texts. Am J Health Promot 2016; 31:302-309. [PMID: 26730559 DOI: 10.4278/ajhp.150218-qual-736] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Water pipe tobacco smoking (WTS) is growing in popularity among U.S. young adults and is associated with health risks similar to those of cigarette smoking. The purpose of this study is to examine existing tobacco control policies (TCPs) in order to investigate how they engage WTS. APPROACH A systematic synthesis of content and legal interactions among federal, state, and local TCP documents. SETTING Pennsylvania, which represents a politically and demographically diverse microcosm of the United States. PARTICIPANTS No human subjects. METHOD Federal and state TCPs were retrieved via public legal repositories. Local policy searches were conducted via county/municipal Web sites, inclusive of 13 localities that had autonomous health departments or existing TCPs based on a National Cancer Institute report. Full-text TCPs were double coded within a grounded theory framework for health policy analysis. Emergent codes were used to compare and contrast policy texts and to examine legal interactions among TCPs. RESULTS Examination of policy categories including youth access, use restrictions, and taxation revealed WTS as largely omitted from current TCPs. WTS was sometimes addressed as an "other" tobacco product under older TCPs, though ambiguities in language led to questionable enforceability. State preemptions have rolled back or prevented well-tailored reforms at the local level. Federal preemptions have likewise constrained state TCPs. CONCLUSION Outdated, preempted, and unclear policies limit the extent to which TCPs engage WTS. Health advocates might target these aspects of TCP reform.
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Affiliation(s)
- Jason B Colditz
- 1 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jessica N Ton
- 2 University of Pittsburgh Health Policy Institute, Pittsburgh, Pennsylvania
| | - A Everette James
- 2 University of Pittsburgh Health Policy Institute, Pittsburgh, Pennsylvania
| | - Brian A Primack
- 1 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Driessen J, Bellon JE, Stevans J, James AE, Minnier T, Reynolds BR, Zhang Y. Innovative approaches to interprofessional care at the University of Pittsburgh Medical Center. J Interprof Care 2015; 29:520-1. [PMID: 26171868 DOI: 10.3109/13561820.2015.1040114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The enactment of the Affordable Care Act expands coverage to millions of uninsured Americans and creates a new workforce landscape. Interprofessional Collaborative Practice (ICP) is no longer a choice but a necessity. In this paper, we describe four innovative approaches to interprofessional practice at the University of Pittsburgh Medical Center. These models demonstrate innovative applications of ICP to inpatient and outpatient care, relying on non-physician providers, training programs, and technology to deliver more appropriate care to specific patient groups. We also discuss the ongoing evaluation plans to assess the effects of these interprofessional practices on patient health, quality of care, and healthcare costs. We conclude that successful implementation of interprofessional teams involves more than just a reassignment of tasks, but also depends on structuring the environment and workflow in a way that facilitates team-based care.
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Affiliation(s)
- Julia Driessen
- a Graduate School of Public Health, Health Policy and Management, University of Pittsburgh , Pittsburgh , PA , USA .,b Health Policy Institute, University of Pittsburgh , Pittsburgh , PA , USA
| | - Johanna E Bellon
- a Graduate School of Public Health, Health Policy and Management, University of Pittsburgh , Pittsburgh , PA , USA .,b Health Policy Institute, University of Pittsburgh , Pittsburgh , PA , USA
| | - Joel Stevans
- b Health Policy Institute, University of Pittsburgh , Pittsburgh , PA , USA .,c School of Health and Rehabilitation Sciences, University of Pittsburgh , Pittsburgh , PA , USA
| | - A Everette James
- a Graduate School of Public Health, Health Policy and Management, University of Pittsburgh , Pittsburgh , PA , USA .,b Health Policy Institute, University of Pittsburgh , Pittsburgh , PA , USA
| | - Tami Minnier
- d University of Pittsburgh Medical Center , Pittsburgh , PA , USA , and
| | - Benjamin R Reynolds
- e Office of Advanced Practice Providers, University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Yuting Zhang
- a Graduate School of Public Health, Health Policy and Management, University of Pittsburgh , Pittsburgh , PA , USA .,b Health Policy Institute, University of Pittsburgh , Pittsburgh , PA , USA
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Bellon JE, Stevans JM, Cohen SM, James AE, Reynolds B, Zhang Y. Comparing Advanced Practice Providers and Physicians as Providers of e-Visits. Telemed J E Health 2015; 21:1019-26. [PMID: 26161623 DOI: 10.1089/tmj.2014.0248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although electronic delivery (electronic visits [e-visits]) of healthcare services by advanced practice providers (APPs) is growing, literature defining the roles of different providers and comparing outcomes is lacking. We analyzed two e-visit models at the University of Pittsburgh Medical Center (UPMC) to compare their providers (physicians and APPs) and associated outcomes. MATERIALS AND METHODS We identified all e-visits for the UPMC AnywhereCare Continuity (physician providers for existing patients) and Convenience (physician and APP providers for Pennsylvania residents) services (n=2,184) using Epic Systems (Verona, WI) MyChart data (November 2013-August 2014). We compared e-visits by service and provider type for patient characteristics, volume, response time, primary diagnoses, and number of prescriptions. We used statistical tests to determine differences in patient characteristics and an ordinary least square linear regression, controlling for patient characteristics, to determine differences in prescribing. RESULTS Of the completed e-visits (n=1,791), 72.5% were with APPs, and 27.5% were with physicians. APP patients were younger, higher income, and more likely to be unmarried. Sinusitis patients were more likely to use the Continuity service, whereas those with urinary tract or upper respiratory infections were more likely to use the Convenience service. Finally, provider type was significantly associated with prescribing, with APPs prescribing more. CONCLUSIONS Some demographic variation exists between users of APP versus physician e-visits. Provider response time seems more driven by service policy than provider type. Finally, variation exists between provider types in quantities of prescriptions written. As health systems and policymakers develop protocols and reimbursement strategies for e-visits, these model considerations will be important.
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Affiliation(s)
- Johanna E Bellon
- 1 Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Joel M Stevans
- 2 School of Rehabilitation and Health Sciences, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Susan M Cohen
- 3 School of Nursing, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - A Everette James
- 1 Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Benjamin Reynolds
- 4 Office of Advanced Practice Providers, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Yuting Zhang
- 1 Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
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Abstract
This special report describes the systematic approach the University of Pittsburgh and the University of Pittsburgh Medical Center (UPMC) undertook in creating an infrastructure for comparative effectiveness and patient-centered outcomes research resources. We specifically highlight the administrative structure, communication and training opportunities, stakeholder engagement resources, and support services offered.
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Affiliation(s)
- Monica R Costlow
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
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Affiliation(s)
- A Everette James
- Health Policy Institute, Schools of the Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania2Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Walid F Gellad
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania4VA Pittsburgh Healthcare System and RAND Corporation, Pittsburgh, Pennsylvania
| | - Brian A Primack
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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James AE. Painting collections in hospitals: humanity in medicine. J Am Coll Radiol 2012; 9:767-8. [PMID: 23122339 DOI: 10.1016/j.jacr.2012.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 11/30/2022]
Affiliation(s)
- A Everette James
- Vanderbilt Medical School, Department of Radiology and Radiological Sciences, Nashville, TN 37205, USA.
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Finkel DJ, James AE, Felix RA, Wegner GJ. P3-18-07: Multiplex RTK Inhibitor Screening Utilizing a Plate-Based Immunoassay with Near-Infrared Detection. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-18-07] [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
Receptor-tyrosine kinases (RTKs) are transmembrane proteins that have been implicated in various cancers and are considered therapeutic targets. The phosphorylation of RTKs on tyrosine residues leads to their activation. We have previously used the Proteome Profiler™ 96 Human Phospho-RTK Antibody Array, a plate-based multiplex immunoassay, to determine the phospho-tyrosine profile of RTKs in MDA-MB-453 breast cancer cells. Most notably, the ErbB family of RTKs were shown to be hyperactivated in this cell line. In this study, we use the same multiplex assay to screen a small molecule kinase inhibitor library (TOCRIS, Catalog # 3514) to identify inhibitors with selectivity towards the ErbB receptors. MDA-MB-453 cells were treated with the kinase inhibitor library prior to treatment with ligands to stimulate ErbB receptor tyrosine phosphorylation and subsequently lysed. The lysates were analyzed with the Proteome Profiler 96 Human Phospho-RTK Antibody Array using near-infrared fluorescent detection. Ligand-dependent tyrosine phosphorylation of all four ErbB receptors was monitored simultaneously and the effects of different kinase inhibitors were determined. While several known ErbB inhibitors blocked ErbB phosphorylation, our screen also identified several inhibitors reported to be selective for other kinases that effectively inhibited ErbB activation. The activation of ErbB2 was selectively inhibited by NH 125, GF 109203X, SB 202190, SB 216763, and ZM 306416 hydrochloride. The results obtained with this multiplex assay were confirmed by singleplex ELISA for ErbB receptors. Hence, the data collected with our multiplex assay provides a rapid method for the analysis of inhibitor effects on a defined signaling pathway. This may facilitate a faster identification of selective kinase inhibitors that have therapeutic potential for treating ErbB-overexpressing cancers.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-18-07.
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Affiliation(s)
- DJ Finkel
- 1R&D Systems Inc., Minneapolis, MN; Tocris Bioscience, Bristol, United Kingdom
| | - AE James
- 1R&D Systems Inc., Minneapolis, MN; Tocris Bioscience, Bristol, United Kingdom
| | - RA Felix
- 1R&D Systems Inc., Minneapolis, MN; Tocris Bioscience, Bristol, United Kingdom
| | - GJ Wegner
- 1R&D Systems Inc., Minneapolis, MN; Tocris Bioscience, Bristol, United Kingdom
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James AE, Sperber E, Strecker EP, Digel C, Novak G, Bush M. Use of serial cisternograms to document dynamic changes in the development of communicating hydrocephalus: a clinical and experimental study. Acta Neurol Scand 2009; 50:153-70. [PMID: 4835618 DOI: 10.1111/j.1600-0404.1974.tb02769.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Chan BCL, Ching AKK, To KF, Leung JCK, Chen S, Li Q, Lai PBS, Tang NLS, Shaw PC, Chan JYH, James AE, Lai KN, Lim PL, Lee KKH, Chui YL. BRE is an antiapoptotic protein in vivo and overexpressed in human hepatocellular carcinoma. Oncogene 2007; 27:1208-17. [PMID: 17704801 DOI: 10.1038/sj.onc.1210733] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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: 12/16/2022]
Abstract
BRE binds to the cytoplasmic domains of tumor necrosis factor receptor-1 and Fas, and in cell lines can attenuate death receptor-initiated apoptosis by inhibiting t-BID-induced activation of the mitochondrial apoptotic pathway. Overexpression of BRE by transfection can also attenuate intrinsic apoptosis and promote growth of the transfected Lewis lung carcinoma line in mice. There is, however, a complete lack of in vivo data about the protein. Here, we report that by using our BRE-specific monoclonal antibody on the immunohistochemistry of 123 specimens of human hepatocellular carcinoma (HCC), significant differences in BRE expression levels between the paired tumoral and non-tumoral regions (P<2.2e-16) were found. Marked overexpression of BRE was detected in majority of the tumors, whereas most non-tumoral regions expressed the same low level of the protein as in normal livers. To investigate whether BRE overexpression could promote cell survival in vivo, liver-specific transgenic BRE mice were generated and found to be significantly resistant to Fas-mediated lethal hepatic apoptosis. The transgenic model also revealed post-transcriptional regulation of Bre level in the liver, which was not observed in HCC and non-HCC cell lines. Indeed, all cell lines analysed express high levels of BRE. In conclusion, BRE is antiapoptotic in vivo, and may promote tumorigenesis when overexpressed.
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Affiliation(s)
- B C-L Chan
- Clinical Immunology Unit and Sir YK Pao Centre for Cancer, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
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Osterman FA, James AE, Heshiki A, Ryan JM, Novak G, Rao GUV, Bush M. Xeroradiography in Veterinary Radiography: A Preliminary Study. ACTA ACUST UNITED AC 2005. [DOI: 10.1111/j.1740-8261.1975.tb00695.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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James AE, Osterman FO, Bush RM, Sheehan T, Novak G, Wight D, Sanders RC. The Use of Compound B-Mode Ultrasound in Abdominal Disease of Animals. ACTA ACUST UNITED AC 2005. [DOI: 10.1111/j.1740-8261.1976.tb00560.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Li K, Lee SM, Su RJ, Zhang XB, Yuen PMP, Li CK, Yang M, Tsang KS, James AE, Tse YHJ, Ng LYW, Fok TF. Multipotent neural precursors express neural and hematopoietic factors, and enhance ex vivo expansion of cord blood CD34+ cells, colony forming units and NOD/SCID-repopulating cells in contact and noncontact cultures. Leukemia 2004; 19:91-7. [PMID: 15496976 DOI: 10.1038/sj.leu.2403542] [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: 11/08/2022]
Abstract
In view of the possible crosstalks between hematopoiesis and neuropoiesis, we evaluated two microenvironments, murine neonatal neural cell line C17.2 and primary embryonic aorta-gonad-mesonephros (AGM) stromal cells, on the ex vivo expansion of CD34+ cells from human cord blood. In a contact culture system, C17.2 or AGM cells significantly enhanced the expansion of CD34+ cells to a panel of early and committed hematopoietic progenitor cells. In a noncontact transwell system, pre-established C17.2 cells significantly increased the expansion of total nucleated cells, CD34+ cells and multilineage colony forming cells (P<0.01). Expanded cells were infused into nonobese diabetic/severe-combined immunodeficient mice. The engraftment of human (hu)CD45+ cells in the bone marrow of these mice was consistently higher in all the 10 experiments conducted with the support of C17.2 cells when compared with those in respective control groups (11.9 vs 2.43%, P=0.03). Using RT-PCR and Southern blot analysis, we showed that AGM and C17.2 cells expressed a panel of hematopoietic, bone morphogenetic and neurotrophic factors. Our data provided the first evidence on the promoting effects of a neural progenitor cell line on hematopoiesis at a noncontact condition. The mechanism could be mediated by the expression of multilineage regulatory factors.
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Affiliation(s)
- K Li
- Department of Paediatrics, The Chinese University of Hong Kong, 6th Floor Clinical Sciences Block, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Zhang XB, Li K, Fok TF, Li CK, James AE, Lam AC, Lee SM, Yuen PMP. Cobblestone area-forming cells, long-term culture-initiating cells and NOD/SCID repopulating cells in human neonatal blood: a comparison with umbilical cord blood. Bone Marrow Transplant 2002; 30:557-64. [PMID: 12407429 DOI: 10.1038/sj.bmt.1703714] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 03/15/2002] [Accepted: 06/30/2002] [Indexed: 11/09/2022]
Abstract
Our prior study demonstrated that neonatal blood (NB) contained hematopoietic stem and progenitor cells that declined rapidly after birth. To validate that NB is a source of functional stem cells, we characterized this population in terms of cobblestone area-forming cells (CAFC), long-term culture-initiating cells (LTC-IC) and NOD/SCID mouse repopulating cells (SRC) in NB and umbilical cord blood (CB). Our data demonstrated that the frequencies of CAFC (30.2 vs 37.1, P = 0.14) and LTC-IC (28.6 vs 31.0, P = 0.49) in 1 x 10(5) mononuclear cells (MNC) of NB and CB were similar, suggesting that these cells were preserved in the circulation of the neonates shortly after birth. Sublethally irradiated NOD/SCID mice were transplanted with CD34(+) cells enriched from thawed NB and CB. At 6 weeks post transplant, human (hu)CD45(+) cells were detected in the bone marrow (BM), spleen and peripheral blood (PB) of the mice as demonstrated by flow cytometric and DNA analysis. Levels of huCD45(+)cells and colony forming units (CFU) appeared to be dependent on the infusion cell dose and were higher in animals receiving CB cells when compared with those of the NB group. The transplanted cells were capable of differentiation into multi-lineage progenitor cells (CD34(+) cells and differential CFU), as well as mature myeloid (CD14(+), CD33(+)), B lymphoid (CD19(+)) and megakaryocytic (CD61(+)) cells in the recipients. NB cells, subjected to ex vivo culture in an optimized preclinical condition, were significantly expanded to early and committed progenitor cells. Expanded NB contained SRC at a reduced quantity but with high proportions of CD14(+) cells and CD33(+) cells. Our study confirms that NB contains pluripotent hematopoietic stem and progenitor cells capable of homing and engrafting the NOD/SCID mice.
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Affiliation(s)
- X B Zhang
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
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Lam AC, Li K, Zhang XB, Li CK, Fok TF, Chang AM, James AE, Tsang KS, Yuen PM. Preclinical ex vivo expansion of cord blood hematopoietic stem and progenitor cells: duration of culture; the media, serum supplements, and growth factors used; and engraftment in NOD/SCID mice. Transfusion 2001; 41:1567-76. [PMID: 11778074 DOI: 10.1046/j.1537-2995.2001.41121567.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ex vivo expansion of cord blood (CB) hematopoietic stem and progenitor cells increases cell dose and may reduce the severity and duration of neutropenia and thrombocytopenia after transplantation. This study's purpose was to establish a clinically applicable culture system by investigating the use of cytokines, serum-free media, and autologous plasma for the expansion of CB cells and the engraftment of expanded product in nonobese diabetic/severe combined immunodeficient (NOD/SCID) mice. STUDY DESIGN AND METHODS Enriched CB CD34+ cells were cultured in four media (Iscove's modified Dulbecco's medium with FCS, Gibco; X-Vivo-10, BioWhittaker; QBSF-60, Quality Biological; and StemSpan SFEM, Stem Cell Technologies) with four cytokine combinations (thrombopoietin [TPO], SCF, Flt-3 ligand [FL] with and without G-CSF, and/or IL-6). The effect of autologous CB plasma was also investigated. The read-out measures were evaluated on Days 8 and 12. After expansion at the optimized condition, cultured cells were transplanted into sublethally irradiated NOD/SCID mice. The engraftment of human CD45+ cells and subsets in the bone marrow, spleen, and peripheral blood was determined. RESULTS QBSF-60 or StemSpan SFEM supported high yields of early progenitors (CD34+ cells, <or= 64.8-fold; CD34+CD38- cells, 330-fold; CFU-granulocyte erythroid macrophage megakaryocyte [GEMM], 248-fold) and CFUs of the myeloid (CFU-GM, 407-fold) and erythroid (BFU/CFU-E, 144-fold) lineages. The expansion of the megakaryocytic lineage was consistently higher in X-Vivo-10 (CFU-megakaryocyte, 684-fold). Autologous plasma promoted colony formation but reduced CD34+ cells and CFU-GEMM. The addition of G-CSF or IL-6 improved cell yields; G-CSF was more effective for committed progenitors. Expansion products from cultures in QBSF-60 with the cytokines engrafted and differentiated into the myeloid and lymphoid lineages in NOD/SCID mice. CONCLUSION The data supported the strategy of expansion. The optimized condition may be applicable to clinical expansion for the abrogation or reduction of posttransplant cytopenia.
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Affiliation(s)
- A C Lam
- Department of Paediatrics, Laboratory Animal Services Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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Abstract
BACKGROUND Inhalational agents have been widely used for anesthesia in laboratory animals. However, the safe use of inhalational agents in small laboratory animals has been limited by the lack of a suitable and effective scavenging system for the removal of waste anesthetic gases. The aim of the present study is to develop an anesthetic system that can be manufactured using common household and laboratory items. MATERIALS AND METHODS An anesthetic system was designed for rats weighing from 300 to 350 g. A face mask for the rat was made by cutting off the distal part of a 50-ml centrifuge tube. A scavenging hood was made from a transparent plastic food storage box. Exhaust of anesthetic gases from the scavenger hood was facilitated by fitting an outlet connected to a pump. Four experienced researchers or technicians tested the scavenger hood. RESULTS In 79.2% of the trials the participants could smell halothane when the pump from the scavenger system was not operational. However, when the pump was switched on, halothane was detected only 16.7% of the time (P < 0.001). CONCLUSION We have developed a simple and effective method of delivering inhalational anesthesia to small laboratory animals and of removing waste anesthetic gases.
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Affiliation(s)
- W Li
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China
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James AE, Price RR, Sloan F, Zaner R, Chapman J. Certain social considerations in abandoning high technology medical imaging. Health Matrix 2001; 5:31-4. [PMID: 10302081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The growth in medical costs has created significant public concern and has appeared to mandate health care policy changes of great magnitude. These important policy decisions will evoke changes that could alter the traditional relationship in health care and will significantly affect the activities of both consumers and providers. This article will address one of the major areas affected by these recently instituted health care policies, medical imaging technology.
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James AE, Fleischer AC, James JC, James E, Boehm F, Bundy A. The concepts of wrongful birth and wrongful life and their relation to medical imaging. Health Matrix 2001; 7:54-7. [PMID: 10293299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Although often used interchangeably, "wrongful birth" and "wrongful life" are distinct legal concepts. Wrongful birth involves the physician's duty to impart to expectant parents information about potential fetal defects. Wrongful life suits reflect the child's right to recovery for life-long suffering as a result of the physician's inadequate pre- or peri-natal care. Modern medical imaging techniques can play a major role in the diagnosis of interuterine malformations; this article explores the legal duties which may be imposed upon physicians who interpret such tests.
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James AE. Nonhuman Primates in Biomedical Research, Diseases. Aust Vet J 1999. [DOI: 10.1111/j.1751-0813.1999.tb13162.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: 11/29/2022]
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James AE. Handbook of Animal & Welfare. Aust Vet J 1999. [DOI: 10.1111/avj.1999.77.8.538] [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: 11/27/2022]
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Haines CJ, James AE, Panesar NS, Ngai TJ, Sahota DS, Jones RL, Chang AM. The effect of percutaneous oestradiol on atheroma formation in ovariectomized cholesterol-fed rabbits. Atherosclerosis 1999; 143:369-75. [PMID: 10217366 DOI: 10.1016/s0021-9150(98)00327-x] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effect of percutaneous oestradiol on the lipid profile and on atheroma formation using an animal model. METHODS The study was of 12 weeks duration. Fifty sexually mature female New Zealand White rabbits were divided into five groups of equal size. Two groups acted as controls and received normal rabbit chow. Rabbits in one of these groups were ovariectomized. The remaining three groups were ovariectomized but received 1% cholesterol enriched rabbit chow. One of these cholesterol-fed groups received 0.3 mg/kg percutaneous oestradiol daily whilst another received 0.1 mg/kg oral oestradiol daily. Measurements of concentrations of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were made at the beginning and end of the study. Aortic atheroma formation was measured using computerized image analysis of uptake of Sudan III staining. RESULTS After 12 weeks there were significant increases in the mean concentrations of TC in the three cholesterol-fed groups compared with controls (P < 0.001). Changes in HDL-C and TG concentrations were less consistent. The mean area of aortic atheroma formation was significantly less in both the percutaneous oestradiol group (4.9%) and the oral oestradiol group (8.6%) compared with the non-oestrogen-treated cholesterol-fed group (19.5%) (P < 0.001, < 0.01 respectively). CONCLUSION These results suggest that percutaneous oestradiol has a direct protective effect on atheroma formation independent of serum concentrations of total cholesterol.
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Affiliation(s)
- C J Haines
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong and The Prince of Wales Hospital, Shatin, New Territories.
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Affiliation(s)
- A E James
- Johns-Hopkins Medical Institution, USA
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