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Rogers CD, Kirabo A, McReynolds M, Sweetwyne MT, Wanjalla C, Benjamin J, Williams EM, Gaddy JA, Williams CR, Damo SM, Murray SA, Hinton A. The graduate school guide: How to prepare for the qualifying exam and assemble a thesis/graduate committee. J Cell Physiol 2024. [PMID: 38595027 DOI: 10.1002/jcp.31258] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 04/11/2024]
Abstract
Qualifying exams and thesis committees are crucial components of a PhD candidate's journey. However, many candidates have trouble navigating these milestones and knowing what to expect. This article provides advice on meeting the requirements of the qualifying exam, understanding its format and components, choosing effective preparation strategies, retaking the qualifying exam, if necessary, and selecting a thesis committee, all while maintaining one's mental health. This comprehensive guide addresses components of the graduate school process that are often neglected.
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Affiliation(s)
- Crystal D Rogers
- Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California, Davis, USA
| | - Annet Kirabo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melanie McReynolds
- Department of Biochemistry and Molecular Biology, The Huck Institute of the Life Sciences, State College, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Mariya T Sweetwyne
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Celestine Wanjalla
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Jazmine Benjamin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edith M Williams
- Department of Public Health Sciences (SMD), University of Rochester, New York, Rochester, USA
| | - Jennifer A Gaddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine Health and Society, Vanderbilt University, Nashville, Tennessee, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Veterans Affairs, Tennessee Valley Healthcare Systems, Nashville, Tennessee, USA
| | - Clintoria R Williams
- Department of Neuroscience, Cell Biology and Physiology, Wright State University, Dayton, Ohio, USA
| | - Steven M Damo
- Department of Life and Physical Sciences, Fisk University, Nashville, Tennessee, USA
- Center for Structural Biology, Vanderbilt University, Nashville, Tennessee, USA
| | - Sandra A Murray
- Department of Cell Biology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Antentor Hinton
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee, USA
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Benjamin J, Wanjalla CN, Gaddy JA, Kirabo A, Williams EM, Hinton A. Reimagining bioRxiv and preprint servers as platforms for academic learning. J Cell Physiol 2024. [PMID: 38457273 DOI: 10.1002/jcp.31234] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/10/2024]
Abstract
A popular preprint server, bioRxiv, is important as a tool for increased visibility for life science research. If used properly, however, bioRxiv can also be an important tool for training, as it may expose trainees (degree-seeking students undertaking research or internships directly related to their field of study) to the peer review process. Here, we offer a comprehensive guide to using bioRxiv as a training tool, as well as offer suggestions for improvements in bioRxiv, including confusion that may be caused by bioRxiv articles appearing on PubMed.
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Affiliation(s)
- Jazmine Benjamin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Celestine N Wanjalla
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer A Gaddy
- Department of Medicine Health and Society, Vanderbilt University, Nashville, Tennessee, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Veterans Affairs, Tennessee Valley Healthcare Systems, Nashville, Tennessee, USA
| | - Annet Kirabo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edith M Williams
- Department of Public Health Sciences (SMD), University of Rochester, Rochester, New York, USA
| | - Antentor Hinton
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee, USA
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Anandarajah AP, Yi L, Anandarajah AA, Shelton N, Feng C, Williams EM. Impact of COVID-19 pandemic on social isolation and loneliness among minority populations. Am J Med Sci 2024; 367:21-27. [PMID: 37769872 DOI: 10.1016/j.amjms.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/29/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The impact of social isolation and loneliness (SIL) was heightened during the COVID-19 pandemic. Although the pandemic disproportionately affected racial/ ethnic minorities, no studies have investigated the ramifications of the pandemic on SIL among these populations. This study aimed to determine the prevalence and pervasiveness of SIL during the COVID-19 pandemic on minority communities. MATERIALS AND METHODS This was a single center, cross sectional study conducted by scientists from the University of Rochester Medical Center (URMC) working in collaboration with members of the Rochester community. Adult patients presenting to the emergency department at URMC who identified themselves as belonging to minority communities were asked to complete a survey that comprised questions from the Lubben Social Network Scale-6 and questions from the Campaign to End Loneliness Measurement Tool. We analyzed the percentage of SIL and conducted linear regression models to study the association between these outcomes and race/ ethnicity, age, gender, chronic disease status and the frequency of hospitalizations. RESULTS A total of 1,029 subjects completed the survey. Social isolation was reported by 375 (37%) persons. Those of Latinx ethnicity had higher prevalence of social isolation (41%) compared to those of Black/African American race (36%) and also had higher degrees of isolation (14.8%) (15.42; p = 0.07). Loneliness was documented by 215 (21%) for the cohort with no differences based on race or ethnicity. CONCLUSIONS Social isolation was common among minority communities during the pandemic but loneliness was less pervasive. The study highlights the need to address the specific needs of these populations.
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Affiliation(s)
| | - Leta Yi
- University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Changyong Feng
- University of Rochester Medical Center, Rochester, NY, USA
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Williams EM, Nelson J, Francis D, Corbin K, Link G, Caldwell T, Gilkeson G. Formative research to promote lupus awareness and early screening at Historically Black College and University (HBCU) communities in South Carolina. BMC Rheumatol 2022; 6:92. [PMID: 36585733 PMCID: PMC9805239 DOI: 10.1186/s41927-022-00323-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/01/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus or lupus is a severe chronic autoimmune disorder that disproportionately impacts young African Americans. Increasing lupus awareness in this high-risk group may be an effective approach to ultimately improving lupus outcomes. To begin to address this disparity, this report describes qualitative data to be utilized in the development of a campaign to enhance awareness of lupus on Historically Black Colleges and University (HBCU) campuses. METHODS Two focus groups (N = 14) were held with African American students in the network of HBCU's in South Carolina to examine perspectives of focus group participants on knowledge, awareness, and experiences with lupus. RESULTS Five key emergent themes included: (1) Lupus Knowledge and Awareness, (2) Barriers for Not Seeking Healthcare, (3) Fatalism for Disease Burden, (4) Lifestyle Debilitation, and (5) Elevation of Education and Advocacy for Lupus. Additionally, five key recommendations emerged to improve lupus awareness and support, including: (1) remaining positive, (2) developing a supportive network, (3) the importance of increasing advocacy efficacy, and (4) messaging strategies around lupus, and (5) providing education to foster knowledge around the clinical impacts of lupus. CONCLUSION Participants in our study stressed the necessity of lupus education and awareness among African American youth and expressed the desire for resources that would enable them to advocate for themselves and their families. Given the early age of onset for lupus, it is therefore vital to include African American youth in increasing education and awareness about lupus.
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Affiliation(s)
- Edith M. Williams
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, CU 420708, Rochester, NY 14642 USA
| | - Joni Nelson
- James B. Edwards College of Dental Medicine, Medical University of South Carolina, 73 Ashley Ave, BSB 127, Charleston, SC 29425 USA
| | - Diane Francis
- Department of Communication, University of Kentucky, 343 S. Martin Luther King Blvd, Lexington, KY 40506 USA
| | - Keesha Corbin
- James B. Edwards College of Dental Medicine, Medical University of South Carolina, 73 Ashley Ave, BSB 127, Charleston, SC 29425 USA
| | - Gary Link
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425 USA
| | - Tomika Caldwell
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, CU 420708, Rochester, NY 14642 USA
| | - Gary Gilkeson
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425 USA
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Vara EL, Langefeld CD, Wolf BJ, Howard TD, Hawkins GA, Quet Q, Moultrie LH, Quinnette King L, Molano ID, Bray SL, Ueberroth LA, Lim SS, Williams EM, Kamen DL, Ramos PS. Social Factors, Epigenomics and Lupus in African American Women (SELA) Study: protocol for an observational mechanistic study examining the interplay of multiple individual and social factors on lupus outcomes in a health disparity population. Lupus Sci Med 2022; 9:9/1/e000698. [PMID: 35768168 PMCID: PMC9244713 DOI: 10.1136/lupus-2022-000698] [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: 03/15/2022] [Accepted: 06/14/2022] [Indexed: 11/08/2022]
Abstract
Introduction Despite the disproportional impact of SLE on historically marginalised communities, the individual and sociocultural factors underlying these health disparities remain elusive. We report the design and methods for a study aimed at identifying epigenetic biomarkers associated with racism and resiliency that affect gene function and thereby influence SLE in a health disparity population. Methods and analysis The Social Factors, Epigenomics and Lupus in African American Women (SELA) Study is a cross-sectional, case–control study. A total of 600 self-reported African American women will be invited to participate. All participants will respond to questionnaires that capture detailed sociodemographic and medical history, validated measures of racial discrimination, social support, as well as disease activity and damage for cases. Participants who wish will receive their genetic ancestry estimates and be involved in research. Blood samples are required to provide peripheral blood mononuclear cell counts, DNA and RNA. The primary goals of SELA are to identify variation in DNA methylation (DNAm) associated with self-reported exposure to racial discrimination and social support, to evaluate whether social DNAm sites affect gene expression, to identify the synergistic effects of social factors on DNAm changes on SLE and to develop a social factors-DNAm predictive model for disease outcomes. This study is conducted in cooperation with the Sea Island Families Project Citizen Advisory Committee. Discussion and dissemination SELA will respond to the pressing need to clarify the interplay and regulatory mechanism by which various positive and negative social exposures influence SLE. Results will be published and shared with patients and the community. Knowledge of the biological impact of social exposures on SLE, as informed by the results of this study, can be leveraged by advocacy efforts to develop psychosocial interventions that prevent or mitigate risk exposures, and services or interventions that promote positive exposures. Implementation of such interventions is paramount to the closure of the health disparities gap.
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Affiliation(s)
- Emily L Vara
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Bethany J Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Timothy D Howard
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gregory A Hawkins
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Queen Quet
- Gullah/Geechee Nation, St Helena Island, South Carolina, USA
| | - Lee H Moultrie
- Lee H Moultrie & Associates, North Charleston, South Carolina, USA
| | - L Quinnette King
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ivan D Molano
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie L Bray
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lori Ann Ueberroth
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - S Sam Lim
- Department of Medicine, Emory University, Atlanta, Georgia, USA.,Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Edith M Williams
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Diane L Kamen
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paula S Ramos
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA .,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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White AA, Neelon B, Martin RH, Cartmell KB, Korte JE, Roberts JR, Williams EM. Spatial patterns of HPV and Tdap vaccine dose administration and the association of health department clinic access in Georgia counties. Vaccine 2022; 40:1352-1360. [PMID: 35101264 DOI: 10.1016/j.vaccine.2021.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/04/2021] [Accepted: 12/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To characterize counties in GA by quantifying administered doses of the HPV and Tdap vaccines collected by the state health department immunization registry and indicators of Health Department (HD) clinic access. METHODS Using a cross sectional study design, secondary data were collected from public health data sources for the years 2016 to 2018 for 159 counties of Georgia. The study population was male and female adolescents aged 13-17. The number of administered HPV and Tdap vaccine doses were modeled in relation to number of private and public HD clinics, number of HD clinics registered in the VFC program and the availability of public transportation using Poisson regression, negative binomial regression, and Bayesian spatial analysis. RESULTS Choropleth maps showed similar clustering patterns between administered doses of the HPV vaccine and Tdap vaccine and increased counts of administered vaccine doses in counties with both public and private clinics. Administered doses of HPV and Tdap vaccines were found to exhibit spatial dependence across counties. Accounting for spatial dependence, the availability of public transit had a significant positive effect on administered HPV vaccine doses, while the number of private HD clinics had a significant positive effect on administered Tdap vaccine doses. CONCLUSIONS Maps at the county level show vaccination variability, clustering patterns and provide additional insights on the access to health care. Bayesian spatial models are needed to accurately identify and estimate factors associated with administering doses of the HPV and Tdap vaccines. Future work is needed to further examine the utilization of HPV vaccination services among urban groupings.
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Affiliation(s)
- Ashley A White
- Department of Health Services Administration, Xavier University, Cincinnati, OH 45207, USA.
| | - Brian Neelon
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Renee' H Martin
- Division of Biostatistics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | | | - Jeffrey E Korte
- Division of Environmental Health, Department of Public Health Sciences, Medical University of South Carolina, SC 29425, USA
| | - James R Roberts
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Edith M Williams
- Division of Epidemiology, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
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White AA, Smalls BL, Ba A, Faith TD, Ramakrishnan V, Johnson H, Rose J, Dismuke-Greer CL, Oates JC, Egede LE, Williams EM. The Effect of Travel Burden on Depression and Anxiety in African American Women Living with Systemic Lupus. Healthcare (Basel) 2021; 9:1507. [PMID: 34828553 PMCID: PMC8621308 DOI: 10.3390/healthcare9111507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/21/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
The United States has a deficit of rheumatology specialists. This leads to an increased burden in accessing care for patients requiring specialized care. Given that most rheumatologists are located in urban centers at large hospitals, many lupus patients must travel long distances for routine appointments. The present work aims to determine whether travel burden is associated with increased levels of depression and anxiety among these patients. Data for this study were collected from baseline visits of patients participating in a lupus study at MUSC. A travel/economic burden survey was assessed as well as the 8-item Patient Health Questionnaire (PHQ-8) and the 7-item Generalized Anxiety Disorder (GAD-7) survey as measures of depression and anxiety, respectively. Linear regression models were used to assess the relationship between travel burden and depression and anxiety. Frequency of healthcare visits was significantly associated with increased depression (β = 1.3, p = 0.02). Significant relationships were identified between anxiety and requiring time off from work for healthcare appointments (β = 4, p = 0.02), and anxiety and perceived difficulty in traveling to primary care providers (β = 3.1, p = 0.04). Results from this study provide evidence that travel burden can have an effect on lupus patients' anxiety and depression levels.
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Affiliation(s)
- Ashley A. White
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 301, Charleston, SC 29425, USA; (A.A.W.); (A.B.); (V.R.)
| | - Brittany L. Smalls
- Department of Family and Community Medicine, University of Kentucky College of Medicine, 2195 Harrodsburg Road, Suite 125, Lexington, KY 40504, USA;
| | - Aissatou Ba
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 301, Charleston, SC 29425, USA; (A.A.W.); (A.B.); (V.R.)
| | - Trevor D. Faith
- Biomedical Informatics Center, Medial University of South Carolina, 135 Cannon Street, Suite 101, Charleston, SC 29425, USA;
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 301, Charleston, SC 29425, USA; (A.A.W.); (A.B.); (V.R.)
| | | | - Jillian Rose
- Community Engagement, Diversity & Research, Department of Social Work Programs, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA;
| | - Clara L. Dismuke-Greer
- Health Economics Resource Center, Veterans Administration Palo Alto Health System, 795 Willow Road, Menlo Park, CA 94025, USA;
| | - Jim C. Oates
- Department of Medicine, Division of Rheumatology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA;
| | - Leonard E. Egede
- Division of General Internal Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Edith M. Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 301, Charleston, SC 29425, USA; (A.A.W.); (A.B.); (V.R.)
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White A, Faith TD, Ba A, Loftley A, Ramakrishnan V, Johnson H, Rose J, Dismuke-Greer CL, Oates JC, Egede LE, Williams EM. Support Methodologies for African American Women With Lupus - Comparing Three Methods' Effects on Patient Activation and Coping. Front Psychol 2021; 12:734390. [PMID: 34675844 PMCID: PMC8523887 DOI: 10.3389/fpsyg.2021.734390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/10/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease in which the immune system attacks healthy tissues. While pharmaceutical therapies are an important part of disease management, behavioral interventions have been implemented to increase patients' disease self-management skills, provide social support, and encourage patients to take a more active role in their care. Methods: Three interventions are considered in this study; peer-to-peer methodology, patient support group, and a patient navigator program that were implemented among largely African American women with SLE at the Medical University of South Carolina (MUSC). Outcomes of interest were patient activation and lupus self-efficacy. We used a Least Squares Means model to analyze change in total patient activation and lupus self-efficacy independently in each cohort. We adjusted for demographic variables of age, education, income, employment, and insurance. Results: In both unadjusted and adjusted models for patient activation, there were no statistically significant differences among the three intervention methodologies when comparing changes from baseline to post intervention. Differences in total coping score from baseline to post intervention in the patient navigator group (-101.23, p-value 0.04) and differences in scores comparing the patient navigator with the support group were statistically significant (116.96, p-value 0.038). However, only the difference in total coping from baseline to post intervention for the patient navigator program remained statistically significant (-98.78, p-value 0.04) in the adjusted model. Conclusion: Tailored interventions are a critical pathway toward improving disease self-management among SLE patients. Interventions should consider including patient navigation because this method was shown to be superior in improving self-efficacy (coping scores).
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Affiliation(s)
- Ashley White
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Trevor D. Faith
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, United States
| | - Aissatou Ba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Aundrea Loftley
- Division of Endocrinology and Diabetes, Medical University of South Carolina, Charleston, SC, United States
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | | | - Jillian Rose
- Community Engagement, Diversity and Research, Department of Social Work Programs, Hospital for Special Surgery, New York, NY, United States
| | - Clara L. Dismuke-Greer
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, United States
| | - Jim C. Oates
- Division of Rheumatology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Leonard E. Egede
- Division of General Internal Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Edith M. Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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Smalls BL, Faith TD, Johnson H, Williams EM. Feasibility and preliminary data for a State-wide South Carolina Lupus Registry. Lupus 2021; 30:1300-1305. [PMID: 33957794 DOI: 10.1177/09612033211014591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) or lupus is an autoimmune disorder whose cause and reason for disproportionate impact on minorities remains enigmatic. Furthermore, statistics describing lupus incidence and prevalence are outdated and often based on small samples. To begin to address this disparity this report describes preliminary data to be utilized in the development of a state-wide lupus registry in South Carolina. METHODS A prospective survey and retrospective data from the South Carolina Budget and Control Board Office of Research & Statistics were used to capture data pertaining to knowledge of lupus, prevalence, and access to lupus care. RESULTS Retrospective ORS data indicated there were 11,690 individuals living with lupus in 2014 with the average direct cost of $69,999.40 in medical care. Prospective surveys (N = 325), in over 16 locations in South Carolina, showed 31% knew someone with lupus, 16% had been diagnosed with lupus, and 50% did not know of a medical facility that treated lupus. CONCLUSION A lupus registry and repository will provide ongoing access for researchers on the impact of lupus on communities in South Carolina. Lupus is highly prevalent, but disproportionately represented in terms of patient information and participation in clinical trials, so it is also expected that this preliminary work will provide an ongoing process in which the medical community can better engage lupus patients.
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Affiliation(s)
- Brittany L Smalls
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY, USA
| | - Trevor D Faith
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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Roberts R, Borley A, Hanna L, Dolan G, Ganesh S, Williams EM. Identifying Risk Factors for Anthracycline Chemotherapy-induced Phlebitis in Women with Breast Cancer: An Observational Study. Clin Oncol (R Coll Radiol) 2020; 33:230-240. [PMID: 33308947 DOI: 10.1016/j.clon.2020.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/25/2020] [Accepted: 11/25/2020] [Indexed: 11/15/2022]
Abstract
AIMS Anthracycline chemotherapy administered via a peripheral cannula results in severe anthracycline chemotherapy-induced phlebitis (ACIP) in about 20-30% of patients. Administering chemotherapy via a central venous catheter (CVC) prevents ACIP. However, CVCs are associated with an increased risk of thrombosis and sepsis. Our aim was to identify risk factors associated with severe ACIP and to provide evidence about the individual risk of developing symptoms. MATERIALS AND METHODS A prospective observational study of 263 women with breast cancer receiving peripheral administration of anthracycline chemotherapy at a UK cancer centre was conducted between May 2016 and January 2018. Data were collected at baseline and every 3 weeks following each chemotherapy treatment, using both healthcare professional- and participant-reported symptom assessments. RESULTS After three cycles of chemotherapy, 27% of participants experienced severe ACIP. Factors associated with symptom severity were identified as: arm used for chemotherapy administration, epirubicin dose, age, pre-existing hypertension, comorbidity, ethnic group and pain during chemotherapy administration. The sequence of arm used for chemotherapy administration was the single most significant factor (P < 0.001). When alternating arms were used no other risk factor was influential. Where alternating arms were not used, younger age and higher dose were associated with higher-grade symptoms, with age being more influential than dose. The cumulative effect of increasing symptom severity with repeated cycles was also identified (P < 0.001). CONCLUSION It is recommended that a CVC is not routinely required for women with breast cancer who have not undergone an axillary node clearance and receive chemotherapy in alternate arms. The need for a CVC for women who are planned to receive all anthracycline chemotherapy cycles in the same arm should be assessed in the light of peripheral venous access assessment and the key risk factors of age, dose and number of cycles.
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Affiliation(s)
- R Roberts
- Velindre Cancer Centre, Whitchurch, Cardiff, UK.
| | - A Borley
- Velindre Cancer Centre, Whitchurch, Cardiff, UK
| | - L Hanna
- Velindre Cancer Centre, Whitchurch, Cardiff, UK
| | - G Dolan
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - S Ganesh
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - E M Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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Brown EA, Gebregziabher M, Kamen DL, White BM, Williams EM. Examining Racial Differences in Access to Primary Care for People Living with Lupus: Use of Ambulatory Care Sensitive Conditions to Measure Access. Ethn Dis 2020; 30:611-620. [PMID: 32989361 PMCID: PMC7518530 DOI: 10.18865/ed.30.4.611] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background People living with lupus may experience poor access to primary care and delayed specialty care. Purpose To identify characteristics that lead to increased odds of poor access to primary care for minorities hospitalized with lupus. Methods Cross-sectional design with 2011-2012 hospitalization data from South Carolina, North Carolina, and Florida. We used ICD-9 codes to identify lupus hospitalizations. Ambulatory care sensitive conditions were used to identify preventable lupus hospitalizations and measure access to primary care. Logistic regression was used to estimate the odds ratio for the association between predictors and having poor access to primary care. Sensitivity analysis excluded patients aged >65 years. Results There were 23,154 total lupus hospitalizations, and 2,094 (9.04%) were preventable. An adjusted model showed minorities aged ≥65 years (OR 2.501, CI 1.501, 4.169), minorities aged 40-64 years (OR 2.248, CI: 1.394, 3.627), minorities with Medicare insurance (OR 1.669, CI:1.353,2.059) and minorities with Medicaid (OR 1.662,CI:1.321, 2.092) had the highest odds for a preventable lupus hospitalization. Minorities with Medicare had significantly higher odds for ≥3 hospital days (OR 1.275, CI: 1.149, 1.415). Whites with Medicare (OR 1.291, CI: 1.164, 1.432) had the highest odds for ≥3 days. Conclusions Our data show that middle-aged minorities living with lupus and on public health insurance have a higher likelihood of poor access to primary care. Health care workers and policymakers should develop plans to identify patients, explore issues affecting access, and place patients with a community health worker or social worker to promote better access to primary care.
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Affiliation(s)
- Elizabeth A. Brown
- Department of Health Professions, College of Health Professions, Medical University of South Carolina (MUSC), Charleston, SC
| | | | - Diane L. Kamen
- Department of Medicine, College of Medicine, MUSC, Charleston, SC
| | - Brandi M. White
- Division of Health Sciences, Education, and Research, College of Health Sciences, University of Kentucky, Lexington, KY
| | - Edith M. Williams
- Department of Public Health Sciences, College of Medicine, MUSC, Charleston, SC
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Goodson AMC, Parmar S, Ganesh S, Zakai D, Shafi A, Wicks C, O'Connor R, Yeung E, Khalid F, Tahim A, Gowrishankar S, Hills A, Williams EM. Printed titanium implants in UK craniomaxillofacial surgery. Part I: access to digital planning and perceived scope for use in common procedures. Br J Oral Maxillofac Surg 2020; 59:312-319. [PMID: 33280946 DOI: 10.1016/j.bjoms.2020.08.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Abstract
This first part of a two-part study examines perceived applications for and barriers to using printed titanium in light of current caseloads, funding pathways, and use of digital planning. It aims to demonstrate the scope for printed titanium in modern practice and to guide industry about the needs of UK surgeons. A cross-sectional study over 14 weeks was performed electronically with support from the British Association of Oral and Maxillofacial Surgeons (BAOMS) and a national trainee-led recruitment team. Ethics approval was obtained at the lead centre. A total of 132 participants joined the study (70% consultants, 25% specialty registrars, and 5% other), approximating a 29% response rate from consultant/registrar BAOMS members throughout mainland UK. Eighty-eight per cent used CAD-CAM design, with highly variable funding/access, design/manufacturing workflows (in-house/outsourced). Eighty-eight per cent were involved with trauma, 61% with orthognathic, and 52% with oncology-reconstruction surgery. Favourite applications for printed titanium were orbital floor repair (89%) and free-flap jaw reconstruction (87%). Most participants also cited maxillary/zygomatic osteotomies and cranioplasty (range 61%-73%). Although a popular application (78%), the evidence base in temporomandibular joint surgery is limited. Those performing orthognathic surgery perceived more indications than those who did not (p=0.013). Key barriers included cost, turnaround time and logistics, and the need to be trained in traditional techniques. Printed titanium was useful for both common and niche procedures, but was specifically limited in emergency trauma. Most surgeons had experience in CAD-CAM surgery but technical understanding appeared unclear. Limiting factors included variable funding and production pathways, perceived costs, and logistics, but in-house design can minimise them. In part II, we quantify perceived benefits and limitations and whether surgeons' understanding and knowledge are sufficient to rationalise them.
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Affiliation(s)
- A M C Goodson
- Faculty of Life Sciences and Education, University of South Wales, Cemetery Road, Glyntaff, Pontypridd, CF37 4BD, United Kingdom.
| | - S Parmar
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
| | - S Ganesh
- Faculty of Life Sciences and Education, University of South Wales, Cemetery Road, Glyntaff, Pontypridd, CF37 4BD, United Kingdom.
| | - D Zakai
- Health Education England (West Midlands), 213 Hagley Road, Edgbaston, Birmingham, B16 9RG, United Kingdom.
| | - A Shafi
- NHS Education for Scotland, Westport 102, West Port, Edinburgh, EH3 9DN, United Kingdom.
| | - C Wicks
- Health Education England (South West), Park House, Newbrick Rd, Stoke Gifford, Bristol BS34 8YU, United Kingdom.
| | - R O'Connor
- Health Education England (East Midlands), Westbridge Place, 1 Westbridge Close, Leicester, LE3 5DR, United Kingdom.
| | - E Yeung
- Health Education England (South London), 4, Stewart House, 32 Russell Square, Bloomsbury, London WC1B 5DN, United Kingdom.
| | - F Khalid
- Health Education England (North West), 3 Piccadilly Place, Manchester, M1 3BN, United Kingdom.
| | - A Tahim
- Health Education England (North Central and East London, North West London), 4, Stewart House, 32 Russell Square, Bloomsbury, London WC1B 5DN, United Kingdom.
| | - S Gowrishankar
- Health Education England (Thames Valley), Chancellor Court, John Smith Drive, Oxford Business Park, Oxford, OX4 2GX, United Kingdom.
| | - A Hills
- Health Education England (Kent, Surrey & Sussex), 7 Bermondsey Street, London, SE1 2DD, United Kingdom.
| | - E M Williams
- Faculty of Life Sciences and Education, University of South Wales, Cemetery Road, Glyntaff, Pontypridd, CF37 4BD, United Kingdom.
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13
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Goodson AMC, Parmar S, Ganesh S, Zakai D, Shafi A, Wicks C, O'Connor R, Yeung E, Khalid F, Tahim A, Gowrishankar S, Hills A, Williams EM. Printed titanium implants in UK craniomaxillofacial surgery. Part II: perceived performance (outcomes, logistics, and costs). Br J Oral Maxillofac Surg 2020; 59:320-328. [PMID: 33280945 DOI: 10.1016/j.bjoms.2020.08.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
This second part explores perceptions and understanding of clinical performance, turnaround, and costs for printed titanium implants or plates in common procedures, evaluating both 'in-house' and 'outsourced' CAD-CAM pathways. A cross-sectional study, supported by the British Association of Oral and Maxillofacial Surgeons (BAOMS) and a national trainee-led recruitment team, was conducted over 14 weeks. A total of 132 participants took part (demographic data is reported in Part I). For fibular-flap mandibular reconstruction, most participants (69% - 91%) perceived printed titanium as superior to intraoperatively or preoperatively hand-bent plates for surgical duration, accuracy, dental restorability, and aesthetics. There was less agreement about complications and plate-failure risks. Most perceived printed plates to be superior to traditional wafer-based maxillary osteotomy for surgical duration (61%) and maxillary positioning (60%). For orbital floor repair, most perceived improvements in surgical duration (83%, especially higher-volume operators p=0.009), precision (84%), and ease of placement (69%). Rarely (less than 5%) was any outcome rated inferior to traditional techniques for any procedure. Perceived turnaround times and costs were variable, but the greatest consensus was for two-segment fibular-flap reconstructions and orbital floor repair. Industry estimates were generally consistent between two company representatives, but manufacturing-only costs differed when using in-house (departmental) designers. Costs and turnaround times are questionable barriers since few understand 'real-world' figures. Designing in-house can dramatically alter costs. Improved accuracy and surgical duration are common themes but biomechanical benefits are less-well understood. This study paints a picture of the potentially routine applications and benefits of printed titanium, capacity for uptake, understanding amongst surgeons, and areas for improvement.
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Affiliation(s)
- A M C Goodson
- Faculty of Life Sciences and Education, University of South Wales, Cemetery Road, Glyntaff, Pontypridd, CF37 4BD, United Kingdom.
| | - S Parmar
- University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom.
| | - S Ganesh
- Faculty of Life Sciences and Education, University of South Wales, Cemetery Road, Glyntaff, Pontypridd, CF37 4BD, United Kingdom.
| | - D Zakai
- Health Education England (West Midlands), 213 Hagley Road, Edgbaston, Birmingham, B16 9RG, United Kingdom.
| | - A Shafi
- NHS Education for Scotland, Westport 102, West Port, Edinburgh, EH3 9DN, United Kingdom.
| | - C Wicks
- Health Education England (South West), Park House, Newbrick Rd, Stoke Gifford, Bristol BS34 8YU, United Kingdom.
| | - R O'Connor
- Health Education England (East Midlands), Westbridge Place, 1 Westbridge Close, Leicester, LE3 5DR, United Kingdom.
| | - E Yeung
- Health Education England (South London), 4, Stewart House, 32 Russell Square, Bloomsbury, London WC1B 5DN, United Kingdom.
| | - F Khalid
- Health Education England (North West), 3 Piccadilly Place, Manchester, M1 3BN, United Kingdom.
| | - A Tahim
- Health Education England (North Central and East London, North West London), 4, Stewart House, 32 Russell Square, Bloomsbury, London WC1B 5DN, United Kingdom.
| | - S Gowrishankar
- Health Education England (Thames Valley), Chancellor Court, John Smith Drive, Oxford Business Park, Oxford, OX4 2GX, United Kingdom.
| | - A Hills
- Health Education England (Kent, Surrey & Sussex), 7 Bermondsey Street, London, SE1 2DD, United Kingdom.
| | - E M Williams
- Faculty of Life Sciences and Education, University of South Wales, Cemetery Road, Glyntaff, Pontypridd, CF37 4BD, United Kingdom.
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Rodgers W, Williams EM, Smalls BL, Singleton T, Tennessee A, Kamen D, Gilkeson G. Treating Systemic Lupus Erythematosus (SLE): The Impact of Historical Environmental Context on Healthcare Perceptions and Decision-Making in Charleston, South Carolina. Int J Environ Res Public Health 2020; 17:E2285. [PMID: 32231129 PMCID: PMC7177628 DOI: 10.3390/ijerph17072285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/14/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Over 400,000 slaves were taken from Africa and brought to Charleston, South Carolina, as part of the transatlantic slave trade during the 18th and 19th centuries. Due to these negative historical events, the healthcare of African Americans in Charleston may be compromised in regard to chronic illnesses and other conditions affecting minorities, such as lupus. MATERIALS AND METHODS The current study used an ethnographic approach to obtain the perspectives of lupus patients with the goal of identifying gaps within current research. In addition to patient perspectives, the geographical location of Charleston, South Carolina was considered through inquiries around culture, community, advocacy, and client/patient interaction to establish a narrative for the themes that emerged. RESULTS The eleven major themes identified were connectedness, knowledge, experience with lupus, compliance, clinical trial participation, career and planning for the future, visits, access to resources, lifestyle, transition from child to adult care, and an overarching theme of self-management. CONCLUSION Understanding healthcare perceptions and decision-making among culturally diverse populations, particularly those who have been defined by centuries of substandard care, marginalization, exploitation, and distrust, is critical to the development of culturally tailored interventions designed to improve patient outcomes and reduce health disparities.
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Affiliation(s)
- Wendy Rodgers
- Division of Rheumatology and Immunology, Department of General Internal Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA; (W.R.); (D.K.); (G.G.)
| | - Edith M. Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303D, Charleston, SC 29425, USA;
| | - Brittany L. Smalls
- Department of Family and Community Medicine, University of Kentucky College of Medicine, 2195 Harrodsburg Road, Lexington, KY 40504, USA;
- Center for Health Equity Transformation, University of Kentucky College of Medicine, 760 Press Avenue, Lexington, KY 40508, USA
| | - Tyler Singleton
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303D, Charleston, SC 29425, USA;
| | - Ashley Tennessee
- College of Health Professions, Medical University of South Carolina, 151-A Rutledge Avenue, Charleston, SC 29403, USA;
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of General Internal Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA; (W.R.); (D.K.); (G.G.)
| | - Gary Gilkeson
- Division of Rheumatology and Immunology, Department of General Internal Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA; (W.R.); (D.K.); (G.G.)
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Brown EA, Dismuke-Greer CE, Ramakrishnan V, Faith TD, Williams EM. Impact of the Affordable Care Act Medicaid Expansion on Access to Care and Hospitalization Charges for Lupus Patients. Arthritis Care Res (Hoboken) 2020; 72:208-215. [PMID: 31562794 DOI: 10.1002/acr.24080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/24/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the impact of the Affordable Care Act on preventable hospitalizations and associated charges for patients living with systemic lupus erythematosus, before and after Medicaid expansion. METHODS A retrospective, quasi-experimental study, using an interrupted time series research design, was conducted to analyze data for 8 states from the Healthcare Cost and Utilization Project state inpatient databases. Lupus hospitalizations with a principal diagnosis of predetermined ambulatory-care sensitive (ACS) conditions were the unit of primary analysis. The primary outcome variable was access to care measured by preventable hospitalizations caused by an ACS condition. RESULTS There were 204,150 lupus hospitalizations in the final analysis, with the majority (53.5%) of lupus hospitalizations in states that did not expand Medicaid. In unadjusted analysis, Medicaid expansion states had significantly lower odds of having preventable lupus hospitalizations (odds ratio [OR] 0.958); however, after adjusting for several covariates, Medicaid expansion states had increased odds of having preventable lupus hospitalizations (OR 1.302). Adjusted analysis showed that those individuals with increased age, public insurance (Medicare or Medicaid), no health insurance, rural residence, or low income had significantly higher odds of having a preventable lupus hospitalization. States that expanded Medicaid had $523 significantly more charges than states that did not expand Medicaid. Older age and rural residence were associated with significantly higher charges. CONCLUSION Our findings suggest that while Medicaid expansion increased health insurance coverage, it did not address other issues related to access to care that could reduce the number of preventable hospitalizations.
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Williams EM, Egede L, Oates JC, Dismuke CL, Ramakrishnan V, Faith TD, Johnson H, Rose J. Peer approaches to self-management (PALS): comparing a peer mentoring approach for disease self-management in African American women with lupus with a social support control: study protocol for a randomized controlled trial. Trials 2019; 20:529. [PMID: 31443732 PMCID: PMC6708151 DOI: 10.1186/s13063-019-3580-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE or lupus) is a chronic autoimmune disease that is associated with increased morbidity, mortality, healthcare costs and decreased quality of life. African Americans in the USA have three to four times greater prevalence of SLE, risk of developing SLE at an earlier age, and SLE-related disease activity, damage, and mortality compared with Caucasians, with the highest rates experienced by African American women. There is strong evidence that patient-level factors are associated with outcomes, which justifies targeting them with intervention. While evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function, and delayed disability among patients with SLE, African Americans and women are still disproportionately impacted by SLE. Peer mentoring interventions are effective in other chronic conditions that disproportionately affect minorities, such as diabetes mellitus, HIV, and kidney disease, but there is currently no empirically tested peer mentoring intervention developed for patients with SLE. Preliminary data from our group suggest that peer mentoring improves self-management, reduces disease activity, and improves health-related quality of life (HRQOL) in African American women with SLE. METHODS This study will test an innovative, manualized peer mentorship program designed to provide modeling and reinforcement by peers (mentors) to other African American women with SLE (mentees) to encourage them to engage in activities that promote disease self-management. Through a randomized, "mentored" or "support group" controlled design, we will assess the efficacy and mechanism(s) of this intervention in self-management, disease activity, and HRQOL. DISCUSSION This is the first study to test peer mentorship as an alternative strategy to improve outcomes in African American women with SLE. This could result in a model for other programs that aim to improve disease self-management, disease activity, and HRQOL in African American women suffering from chronic illness. The peer mentoring approach is uniquely fitted to African Americans, and this intervention has the potential to lead to health improvements for African American women with SLE that have not been attainable with other interventions. This would significantly reduce disparities and have considerable public health impact. TRIAL REGISTRATION ClinicalTrials.gov, NCT03734055 . Registered on 27 November 2018.
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Affiliation(s)
- Edith M. Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303D, Charleston, SC 29425 USA
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA
| | - Jim C. Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425 USA
- Rheumatology Section, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401 USA
| | - Clara L. Dismuke
- Heath Economics Resource Center (HERC), VA Palo Alto Medical Care System, 795 Willow Road (152 MPD), Menlo Park, CA 94025 USA
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303D, Charleston, SC 29425 USA
| | - Trevor D. Faith
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425 USA
| | - Hetlena Johnson
- Lupus Columbia SC, 1900 Kathleen Drive, Columbia, SC 29210 USA
| | - Jillian Rose
- Department of Social Work Programs, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Williams EM, Dismuke CL, Faith TD, Smalls BL, Brown E, Oates JC, Egede LE. Cost-effectiveness of a peer mentoring intervention to improve disease self-management practices and self-efficacy among African American women with systemic lupus erythematosus: analysis of the Peer Approaches to Lupus Self-management (PALS) pilot study. Lupus 2019; 28:937-944. [PMID: 31166867 PMCID: PMC6597273 DOI: 10.1177/0961203319851559] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Peer Approaches to Lupus Self-management (PALS) program was developed as a peer mentoring tool to improve health behaviors, beliefs, and outcomes in African American women with systemic lupus erythematosus (SLE). This study aims to assess the cost of the PALS intervention and determine its effectiveness when compared to existing treatments. METHODS Peer mentors and mentees were paired on shared criteria such as life stage, marital status, or whether they were mothers. This 12-week program consisted of a weekly peer mentoring session by telephone. Cost of healthcare utilization was evaluated by assessing the healthcare costs pre- and post-intervention. Validated measures of quality of life, self-management, disease activity, depression, and anxiety were collected. Total direct program costs per participant were totaled and used to determine average per unit improvement in outcome measures. The benefit-cost ratio and pre- versus post-intervention hospital charges were examined. RESULTS A total of 20 mentees and 7 mentors were enrolled in the PALS program. All PALS pairs completed 12 sessions lasting an average of 54 minutes. Mentees reported statistically significant decreases in patient-reported disease activity, depression, and anxiety, with improved trends in patient activation or patient engagement in their disease and management. The total cost per patient was $1291.50, which was $107.62 per patient per week. There was a savings of $23,417 per individual receiving the intervention with a benefit-cost ratio of 18.13 per patient. CONCLUSION These findings suggest that the PALS intervention was effective in improving patient-level factors and was cost-effective. Future research will need to validate these findings in a larger sample.
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Affiliation(s)
- Edith M. Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA
| | - Clara L. Dismuke
- Veterans Health Administration, Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC 29401, USA
- College of Medicine, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Ave, Suite 280, Charleston, SC 29425, USA
| | - Trevor D. Faith
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA
| | - Brittany L. Smalls
- Center for Health Services Research, College of Medicine, University of Kentucky, 740 S. Limestone Street, Suite J530, Lexington, KY 40536, USA
| | - Elizabeth Brown
- Division of Healthcare Studies, Department of Health Professions, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave, Charleston, SC 29425, USA
| | - James C. Oates
- Division of Rheumatology and Immunology, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Leonard E. Egede
- Division of General Internal Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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Faith TD, Flournoy-Floyd M, Ortiz K, Egede LE, Oates JC, Williams EM. My life with lupus: contextual responses of African-American women with systemic lupus participating in a peer mentoring intervention to improve disease self-management. BMJ Open 2018; 8:e022701. [PMID: 30413505 PMCID: PMC6231552 DOI: 10.1136/bmjopen-2018-022701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The current article seeks to examine the ways in which African-American women with systemic lupus erythematosus (SLE) describe their disease experience and how they cope with their disease. This qualitative study provides deeper insight into whether experiences of African-American women with SLE differ from previous qualitative study findings. METHODS Qualitative data were gathered using interviews and a focus group, from participants in the Peer Approaches to Lupus Self-management (PALS) programme. Data were analysed for themes related to disease experience and how participants cope with their disease. Twenty-seven African-American women with SLE were recruited into the peer mentoring programme, of which 7 served as mentors and 20 served as mentees. A 12-week peer mentoring intervention delivered by phone and based on the Chronic Disease Self-Management and Arthritis Self-Management Programs. RESULTS Three categories encompassing a total of 10 subcategories emerged from analyses: (A) interpersonal, familialandromantic relationships; (B) individual experiences of living with SLE; and (C) physician-patient relationships. CONCLUSION We gained insight on several issues related to patient perspectives of African-American women with SLE, and the context surrounding their thoughts and feelings related to lupus, including their providers, families and other social support networks. Additional research efforts could explore and address the thematic domains and respective subthemes identified here. Although limited due to the preliminary nature of the study, this information can be used to create future evidence-based interventions to decrease the impact of SLE on African-American patients.
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Affiliation(s)
- Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Minnjuan Flournoy-Floyd
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, Maryland, USA
| | - Kasim Ortiz
- Department of Sociology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Leonard E Egede
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jim C Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
- Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Williams EM, Hyer JM, Viswanathan R, Faith TD, Voronca D, Gebregziabher M, Oates JC, Egede L. Peer-to-Peer Mentoring for African American Women With Lupus: A Feasibility Pilot. Arthritis Care Res (Hoboken) 2018; 70:908-917. [PMID: 29161471 DOI: 10.1002/acr.23412] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 09/05/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the feasibility and potential benefits of peer mentoring to improve the disease self-management and quality of life of individuals with systemic lupus erythematosus (SLE). METHODS Peer mentors were trained and paired with up to 3 mentees to receive self-management education and support by telephone over 12 weeks. This study took place at an academic teaching hospital in Charleston, South Carolina. Seven quads consisting of 1 peer mentor and 3 mentees were matched, based on factors such as age, area of residence, and marital and work status. Mentee outcomes of self-management, health-related quality of life, and disease activity were measured using validated tools at baseline, mid-intervention, and post-intervention. Descriptive statistics and effect sizes were calculated to determine clinically important (>0.3) changes from baseline. RESULTS Mentees showed trends toward lower disease activity (P = 0.004) and improved health-related quality of life, in the form of decreased anxiety (P = 0.018) and decreased depression (P = 0.057). Other improvements in health-related quality of life were observed with effect sizes >0.3, but did not reach statistical significance. In addition, both mentees and mentors gave very high scores for perceived treatment credibility and service delivery. CONCLUSION The intervention was well received. Training, the peer-mentoring program, and outcome measures were demonstrated to be feasible with modifications. This result provides preliminary support for the efficacy, acceptability, and perceived credibility of a peer-mentoring approach to improve disease self-management and health-related quality of life in African American women with SLE. Peer mentoring may augment current rheumatologic care.
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Affiliation(s)
| | | | | | | | | | | | - Jim C Oates
- Medical University of South Carolina and Ralph H. Johnson VA Medical Center, Charleston
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Flournoy-Floyd M, Ortiz K, Egede L, Oates JC, Faith TD, Williams EM. "We Would Still Find Things to Talk About": Assessment of Mentor Perspectives in a Systemic Lupus Erythematosus Intervention to Improve Disease Self-Management, Empowering SLE Patients. J Natl Med Assoc 2018; 110:182-189. [PMID: 29580453 PMCID: PMC6931279 DOI: 10.1016/j.jnma.2017.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder with significant disparate impact on African American women. The current study sought to highlight how the Peer Approaches to Lupus Self-management (PALS) intervention worked bi-directionally wherein both women with SLE leading the disease self-management program (mentors), and those participants who served as mentees, were empowered toward greater disease self-efficacy. METHODS Data was captured for this study in two formats from the seven mentors participating in the pilot study: 1) mentor logs and 2) mentor interviews with the principle investigator. This information was then analyzed for themes relating to their experience within the study. RESULTS We found that empowerment was facilitated by mentors taking their mentorship responsibilities seriously and seeking several avenues for collaboratively developing success with their mentees. Mentors reported that although challenges arose, their desire for success resulted in multiple approaches to be flexible and responsive to the needs of their mentees. Additionally, reciprocity was found to be a vital element of the program. CONCLUSIONS Key thematic areas supported our ability to demonstrate the usefulness of a peer mentoring program for SLE disease self-management on evoking empowerment through reciprocal relationships among mentors and mentees within our study population. Furthermore the feedback from PALS participants yielded very rich and contextual information that can be used as a thematic guide for developing and refining evidence-based interventions that seek to incorporate empowerment into disease self-management efforts for women suffering from SLE.
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Affiliation(s)
- Minnjuan Flournoy-Floyd
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857, USA
| | - Kasim Ortiz
- University of New Mexico, Department of Sociology, MSC05 3080 1915 Roma NE Ste. 1103, Albuquerque NM 87131-0001, USA
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Clinical Cancer Center Building, 5th Floor, Suite C5400, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA
| | - Jim C Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425, USA; Rheumatology Section, Ralph H. Johnson VA Medical Center 109 Bee Street, Charleston, SC 29401, USA
| | - Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA
| | - Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC 29425, USA.
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Faith TD, Egede L, Williams EM. Research Ethics in Behavioral Interventions Among Special Populations: Lessons From the Peer Approaches to Lupus Self-Management Study. Am J Med Sci 2018; 355:104-112. [PMID: 29406037 PMCID: PMC5896319 DOI: 10.1016/j.amjms.2017.08.021] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Research involving a homogenous cohort of participants belonging to a special population must make considerations to recruit and protect the subjects. This study analyses the ethical considerations made in the peer approaches to lupus self-management project which pilot tested a peer mentoring intervention for African American women with systemic lupus erythematosus. METHODS Considerations made at the outset of the project are described and their justifications and reasoning are given. Through analysis of feedback from a postintervention focus group and mentors' logs, implications on program outcomes and participant satisfaction are discussed. RESULTS Feedback indicated the importance of recruiting and training capable mentors, consistent contact from study staff to avert adverse events and avert fear or mistrust and careful consideration that must go into the pairing of mentors and mentees. Participant feedback also indicated that sensitive topics must be addressed carefully to prevent distress and dissatisfaction. CONCLUSIONS Applying the lessons learned from this work as well as the considerations that proved successful may improve the contextualization and ethical conduct of behavioral interventions in special populations resulting in improved tailoring and acceptability toward historically underserved individuals.
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Affiliation(s)
- Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Applyrs DL, Williams EM, Faith TD, Kamen DL, Vazques E, Jurkowski JM. Cultural and quality-of-life considerations when administering corticosteroids as a therapeutic strategy for African American women living with systemic lupus erythematosus. Patient Prefer Adherence 2018; 12:1007-1014. [PMID: 29928116 PMCID: PMC6003291 DOI: 10.2147/ppa.s156457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study investigated the association among corticosteroids, emotional health, physical health, and work/regular activities of daily living in an ethnically diverse sample of women with systemic lupus erythematosus. METHODS A secondary analysis of data from the Medical University of South Carolina Lupus Database was conducted between confirmed cases of lupus (n = 224) and controls (n = 60). The sample comprised 57 Caucasian Americans, 141 Gullah African Americans (a subpopulation of African Americans from the Sea Islands of South Carolina and Georgia), and 86 non-Gullah African Americans. RESULTS Emotional health outcomes were better for women with systemic lupus erythematosus compared with controls. High emotional health scores may be influenced by cultural factors such as masking emotion, disease-coping mechanisms, religion, and strong familial and social support. Although a significant association was not detected between emotional health and work/regular activities of daily living, relationships were significant after adjusting for corticosteroid use. CONCLUSION These findings suggest corticosteroid use does influence the strength of the association between emotional health and work/regular activities of daily living.
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Affiliation(s)
| | - Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Correspondence: Edith M Williams, Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303D, Charleston, SC 29425, USA, Tel +1 843 876 1519, Email
| | - Trevor D Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Diane L Kamen
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth Vazques
- Department of Epidemiology and Biostatistics, State University of New York at Albany, One University Place, Rensselaer, NY, USA
| | - Janine M Jurkowski
- Department of Health Policy, Management, and Behavior, State University of New York at Albany, One University Place, Rensselaer, NY, USA
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Williams EM, Egede L, Faith T, Oates J. Effective Self-Management Interventions for Patients With Lupus: Potential Impact of Peer Mentoring. Am J Med Sci 2017; 353:580-592. [PMID: 28641721 PMCID: PMC6249683 DOI: 10.1016/j.amjms.2017.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/28/2016] [Accepted: 01/20/2017] [Indexed: 01/22/2023]
Abstract
Systemic lupus erythematosus (SLE) is associated with significant mortality, morbidity and cost for the individual patient and society. In the United States, African Americans (AAs) have 3-4 times greater prevalence of lupus, risk of developing lupus at an earlier age and lupus-related disease activity, organ damage and mortality compared with whites. Evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function and delayed disability among patients with lupus. However, AAs and women are still disproportionately affected by lupus. This article presents the argument that peer mentoring may be an especially effective intervention approach for AA women with SLE. SLE peers with a track record of success in lupus management and have a personal perspective that clinicians often lack. This commonality and credibility can establish trust, increase communication and, in turn, decrease disparities in healthcare outcomes.
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Affiliation(s)
- Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Trevor Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - James Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina; Rheumatology Section, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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Williams EM, Walker RJ, Faith T, Egede LE. The impact of arthritis and joint pain on individual healthcare expenditures: findings from the Medical Expenditure Panel Survey (MEPS), 2011. Arthritis Res Ther 2017; 19:38. [PMID: 28245879 PMCID: PMC5331686 DOI: 10.1186/s13075-017-1230-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Joint pain, including back pain, and arthritis are common conditions in the United States, affecting more than 100 million individuals and costing upwards of $200 billion each year. Although activity limitations associated with these disorders impose a substantial economic burden, this relationship has not been explored in a large U.S. cohort. METHODS In this study, we used the Medical Expenditures Panel Survey to investigate whether functional limitations explain the difference in medical expenditures between patients with arthritis and joint pain and those without. We used sequential explanatory linear models to investigate this relationship and accounted for various covariates. RESULTS Unadjusted mean expenditures were $10,587 for those with joint pain or arthritis, compared with $3813 for those without. In a fully adjusted model accounting also for functional limitations, those with joint pain or arthritis paid $1638 more than those without, a statistically significant difference. CONCLUSIONS The growing economic and public health burden of arthritis and joint pain, as well as the corresponding complications of functional, activity, and sensory limitations, calls for an interdisciplinary approach and heightened awareness among providers to identify strategies that meet the needs of high-risk patients in order to prevent and delay disease progression.
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Affiliation(s)
- Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC, 29425, USA.,Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Room 280H, Charleston, SC, 29425, USA
| | - Rebekah J Walker
- Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Room 280H, Charleston, SC, 29425, USA.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, Charleston, SC, 29425, USA.,Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC, 29401, USA
| | - Trevor Faith
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite CS303, Charleston, SC, 29425, USA
| | - Leonard E Egede
- Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Room 280H, Charleston, SC, 29425, USA. .,Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, Charleston, SC, 29425, USA. .,Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC, 29401, USA.
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Laska D, Vahey G, Faith T, Vena J, Williams EM. Seafood consumption habits of South Carolina shrimp baiters. J Toxicol Environ Health A 2017; 80:129-136. [PMID: 28095123 DOI: 10.1080/15287394.2016.1261747] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
Shrimp baiting is a fishing technique used by many South Carolinians and has been regulated in the state since the late 1980s. A postcard survey was developed and included with 400 South Carolina Department of Natural Resources (SCDNR) annual surveys of registered shrimp baiters over a two-year period. The survey contained questions concerning frequency, portion size, baiting locations, and preparation techniques for shrimp as well as other species consumed and demographic information. An overall response rate of 37% was received. The majority of respondents were men over the age of 55 years. Charleston and Beaufort counties were the most common locations for shrimp baiting. Almost half (45.9%) of respondents reported eating locally caught shrimp at least 2-3 times per month. The most common portion size was ½ pound (8 oz. or 277 g), with 44.8% of respondents reporting this as their typical amount of shrimp ingested at one meal. Only 3.7% of respondents reported typically eating the whole shrimp, while all other respondents ingested shrimp with the head removed. The most commonly consumed species besides shrimp were blue crab, oysters, and flounder. According to the US Food and Drug Administration mercury (Hg) guidelines, the majority (97%) of our respondents were not at risk for consuming unsafe levels of Hg from locally caught shrimp. However, this does not take into account other local seafood eaten or other contaminants of concern. These consumption results may be used in conjunction with data on contaminant levels in shrimp to determine potential adverse health risks associated with consumption of locally caught shrimp.
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Affiliation(s)
- Deborah Laska
- a National Oceanic and Atmospheric Administration, National Ocean Service , Center for Coastal Environmental Health and Biomolecular Research , Charleston , South Carolina , USA
| | - Grace Vahey
- b Department of Public Health Sciences , Medical University of South Carolina , Charleston , South Carolina , USA
| | - Trevor Faith
- b Department of Public Health Sciences , Medical University of South Carolina , Charleston , South Carolina , USA
| | - John Vena
- b Department of Public Health Sciences , Medical University of South Carolina , Charleston , South Carolina , USA
| | - Edith M Williams
- b Department of Public Health Sciences , Medical University of South Carolina , Charleston , South Carolina , USA
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Williams EM, Bruner L, Adkins A, Vrana C, Logan A, Kamen D, Oates JC. I too, am America: a review of research on systemic lupus erythematosus in African-Americans. Lupus Sci Med 2016; 3:e000144. [PMID: 27651918 PMCID: PMC5013381 DOI: 10.1136/lupus-2015-000144] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 12/21/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder that can cause significant morbidity and mortality. A large body of evidence has shown that African-Americans experience the disease more severely than other racial-ethnic groups. Relevant literature for the years 2000 to August 2015 were obtained from systematic searches of PubMed, Scopus, and the EBSCOHost platform that includes MEDLINE, CINAHL, etc. to evaluate research focused on SLE in African-Americans. Thirty-six of the 1502 articles were classified according to their level of evidence. The systematic review of the literature reported a wide range of adverse outcomes in African-American SLE patients and risk factors observed in other mono and multi-ethnic investigations. Studies limited to African-Americans with SLE identified novel methods for more precise ascertainment of risk and observed novel findings that hadn't been previously reported in African-Americans with SLE. Both environmental and genetic studies included in this review have highlighted unique African-American populations in an attempt to isolate risk attributable to African ancestry and observed increased genetic influence on overall disease in this cohort. The review also revealed emerging research in areas of quality of life, race-tailored interventions, and self-management. This review reemphasizes the importance of additional studies to better elucidate the natural history of SLE in African-Americans and optimize therapeutic strategies for those who are identified as being at high risk.
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Affiliation(s)
- Edith M Williams
- Division of Rheumatology, Department of Public Health Sciences, Medicine, MUSC Center for Health Disparities Research, Medical University of South Carolina , Charleston, South Carolina , USA
| | - Larisa Bruner
- Arnold School of Public Health, University of South Carolina , Columbia, South Carolina , USA
| | - Alyssa Adkins
- University of South Carolina , Columbia, South Carolina , USA
| | - Caroline Vrana
- Department of Public Health Sciences , Medical University of South Carolina , Charleston, South Carolina , USA
| | - Ayaba Logan
- The Department of Public Health and Programs in Nurse Anesthesia , Liaison for College of Nursing, Medical University of South Carolina Library , Charleston, South Carolina , USA
| | - Diane Kamen
- Department of Rheumatology and Immunology , Medical University of South Carolina , Charleston, South Carolina , USA
| | - James C Oates
- Department of Medicine, Division of Rheumatology, Medical University of South Carolina , Charleston, South Carolina , USA
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Williams EM, Lorig K, Glover S, Kamen D, Back S, Merchant A, Zhang J, Oates JC. Intervention to Improve Quality of life for African-AmericaN lupus patients (IQAN): study protocol for a randomized controlled trial of a unique a la carte intervention approach to self-management of lupus in African Americans. BMC Health Serv Res 2016; 16:339. [PMID: 27485509 PMCID: PMC4971708 DOI: 10.1186/s12913-016-1580-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic Lupus Erythematosus (lupus) is a chronic autoimmune disease that can impact any organ system and result in life-threatening complications. African-Americans are at increased risk for morbidity and mortality from lupus. Self-management programs have demonstrated significant improvements in health distress, self-reported global health, and activity limitation among people with lupus. Despite benefits, arthritis self-management education has reached only a limited number of people. Self-selection of program could improve such trends. The aim of the current study is to test a novel intervention to improve quality of life, decrease indicators of depression, and reduce perceived and biological indicators of stress in African-American lupus patients in South Carolina. METHODS/DESIGN In a three armed randomized, wait list controlled trial, we will evaluate the effectiveness of a patient-centered 'a-la-carte' approach that offers subjects a variety of modes of interaction from which they can choose as many or few as they wish, compared to a 'set menu' approach and usual care. This unique 'a-la-carte' self-management program will be offered to 50 African-American lupus patients participating in a longitudinal observational web-based SLE Database at the Medical University of South Carolina. Each individualized intervention plan will include 1-4 options, including a mail-delivered arthritis kit, addition and access to an online message board, participation in a support group, and enrollment in a local self-management program. A 'set menu' control group of 50 lupus patients will be offered a standardized chronic disease self-management program only, and a control group of 50 lupus patients will receive usual care. Outcomes will include changes in (a) health behaviors, (b) health status, (c) health care utilization, and (d) biological markers (urinary catecholamines). DISCUSSION Such a culturally sensitive educational intervention which includes self-selection of program components has the potential to improve disparate trends in quality of life, disease activity, depression, and stress among African-American lupus patients, as better outcomes have been documented when participants are able to choose/dictate the content and/or pace of the respective treatment/intervention program. Since there is currently no "gold standard" self-management program specifically for lupus, this project may have a considerable impact on future research and policy decisions. TRIAL REGISTRATION NCT01837875 ; April 18, 2013.
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Affiliation(s)
- Edith M. Williams
- Department of Public Health Sciences, Department of Medicine, Division of Rheumatology, Core Investigator, MUSC Center for Health Disparities Research, Medical University of South Carolina, 135 Cannon Street, Suite 303, MSC835, Charleston, SC 29425 USA
| | - Kate Lorig
- Department of Medicine, Stanford University, 291 Campus Drive, Room LK3C02, Stanford, CA 94305 USA
| | - Saundra Glover
- Institute of Health Disparities, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210 USA
| | - Diane Kamen
- Department of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 912, Charleston, SC 29425 USA
| | - Sudie Back
- Department of Psychiatry/Behavioral Science, Division of Clinical Neuroscience, Medical University of South Carolina, 67 President Street, Charleston, SC 29425 USA
| | - Anwar Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, 800 Sumter Street, Room 211, Columbia, SC 29208 USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene Street, Columbia, SC 29208 USA
| | - James C. Oates
- Department of Medicine, Division of Rheumatology, Medical University of South Carolina, 114 Doughty Street, Room 425-C, Charleston, SC 29414 USA
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Williams EM, Terrell J, Anderson J, Tumiel-Berhalter L. A Case Study of Community Involvement Influence on Policy Decisions: Victories of a Community-Based Participatory Research Partnership. Int J Environ Res Public Health 2016; 13:E515. [PMID: 27213418 PMCID: PMC4881140 DOI: 10.3390/ijerph13050515] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/06/2016] [Accepted: 05/13/2016] [Indexed: 11/21/2022]
Abstract
The Buffalo Lupus Project was a community-university partnership that investigated associations between exposure to a local waste site and high rates of lupus and other autoimmune diseases. The partnership's major accomplishment was successful advocacy for containment and clean-up of the site. As a result of community education, the remediation plan suggested by the community was adopted. Additionally, when a local childhood lead poisoning testing program was canceled, community members signed a letter to legislators urging them to replace the funding, which was restored within one week. This demonstrated how coordinated community-based capacity-building efforts can influence health policy.
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Affiliation(s)
- Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina (MUSC), 135 Cannon Street, Charleston, SC 29425, USA.
| | - Julien Terrell
- The Brotherhood/Sister Sol (Bro/Sis), 512 West 143rd Street, New York, NY 10031, USA.
| | - Judith Anderson
- Environmental Justice Action Group (EJAG) of Western NY, Buffalo, NY 14203, USA.
| | - Laurene Tumiel-Berhalter
- Primary Care Research Institute, University at Buffalo, UB Gateway Building, 77 Goodell St, Suite 220, Buffalo, NY 14203, USA.
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Williams EM, Ortiz K, Zhang J, Zhou J, Kamen D. The systemic lupus erythematosus travel burden survey: baseline data among a South Carolina cohort. BMC Res Notes 2016; 9:246. [PMID: 27129590 PMCID: PMC4850711 DOI: 10.1186/s13104-016-2060-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 08/06/2015] [Accepted: 04/21/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Many studies on the impact of systemic lupus erythematosus or lupus have identified patient travel costs as being problematic. We administered a survey that examined the impact of self-rated travel burden on lupus patients. The systemic lupus erythematosus travel burden survey included 41 patients enrolled in the systemic lupus erythematosus database project at the Medical University of South Carolina. RESULTS Most participants reported that travel caused medications to be discontinued or appointments to be missed. In unadjusted logistic regressions of the relationship between these outcomes and medical travel burden, both distance to rheumatologists and time to lupus medical care were significant. CONCLUSIONS Our findings suggest that more research is needed to examine the influence of travel burden among this population, but data from this report could help to inform physicians, academic researchers, and other health professionals in South Carolina and other areas with significant rural populations on how travel burden may impact patients receiving care for lupus and provide an opportunity for the development of interventions aimed at assisting lupus patients with management of stressors related to travel burden.
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Affiliation(s)
- Edith M Williams
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 303, Charleston, SC, USA.
| | - Kasim Ortiz
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Jie Zhou
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Perkinson MT, Faith TD, Vahey GM, Vena JE, Williams EM. Quantifying the Seafood Consumption Patterns of Recreational Anglers in Charleston and Berkeley Counties, South Carolina. Environ Health Insights 2016; 10:201-210. [PMID: 27891049 PMCID: PMC5113856 DOI: 10.4137/ehi.s40668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 05/11/2023]
Abstract
This study was designed to provide self-reported data on the frequency of fish consumption and shellfish consumption in Charleston and Berkeley (CB) counties, South Carolina. While commercial fishing and recreational fishing have played an important role in the culture and history of the area, information on the specific patterns of consumption by recreational anglers has been previously unavailable. The pilot data presented here will help determine the feasibility of a large-scale survey of seafood consumption in coastal South Carolina. The study's sampling frame consisted of CB county anglers who had purchased a recreational saltwater fishing license for the 2005/2006 year with oversampling in North Charleston. Survey recipients were asked to provide information on fish consumption and shellfish consumption, general angling habits, perception of water and fishing quality, and demographics. Of the 2500 individuals who were sent questionnaires, about one-fourth responded. Respondents were generally white, middle, or upper class and highly educated. The majority fished by boat and most often ate flounder, spotted sea trout, and red drum. Most respondents ate shrimp several times a month and also supplemented their recreational catch with seafood purchased from grocery stores, markets, and restaurants. Almost all respondents had eaten some seafood in the last year, and more than one-fourth ate seafood twice a week or more. Most anglers responded positively about the area's fishing and water qualities, but many referred to areas where they would hesitate to eat their catch. Further research may need to incorporate direct distribution of surveys to underrepresented groups and financial incentives to encompass a more diverse population of anglers.
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Affiliation(s)
- Matthew T. Perkinson
- Marine Resources Research Institute, South Carolina Department of Natural Resources, Charleston, SC, USA
| | - Trevor D. Faith
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Grace M. Vahey
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Edith M. Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- CORRESPONDENCE:
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Williams EM, Ortiz K, Flournoy-Floyd M, Bruner L, Kamen D. Systemic lupus erythematosus observations of travel burden: A qualitative inquiry. Int J Rheum Dis 2015; 18:751-60. [PMID: 26176174 DOI: 10.1111/1756-185x.12614] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 11/28/2022]
Abstract
AIMS Explorations of travel impediments among patients suffering from rheumatic diseases have been very limited. Research has consistently indicated a shortage of rheumatologists, resulting in patients potentially having to travel long distances for care. The purpose of our study was to explore how systemic lupus erythematosus (SLE) patients experience travel issues differentially by race and socio-economic status. METHODS We conducted semi-structured interviews and a brief demographic survey with 10 patients diagnosed with SLE. Interview transcripts were coded and analyzed using NVivo Analysis Software to facilitate the reporting of recurrent themes and supporting quotations, and an initial codebook was independently developed by two researchers on the study team and then verified together. RESULTS Patients described three major areas of concern with respect to travel burden in accessing their rheumatologists: reliance on caregivers; meeting financial priorities; and pain and physical limitations. CONCLUSIONS Our data suggest general traveling challenges interfering with medical appointment compliance for several participants and the importance of socio-economic issues when considering travel issues. This study highlights an important area with implications for adherence to medical appointments and participation in research among patients with SLE.
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Affiliation(s)
- Edith M Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Kasim Ortiz
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Minnjuan Flournoy-Floyd
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Larisa Bruner
- Office of Public Health Practice, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Williams EM. Cellular basis of cardiac dysrhythmias. Adv Cardiol 2015; 12:256-65. [PMID: 4151858 DOI: 10.1159/000395470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Williams EM, Bruner L, Penfield M, Kamen D, Oates JC. Stress and Depression in Relation to Functional Health Behaviors in African American Patients with Systemic Lupus Erythematosus. Rheumatology (Sunnyvale) 2014; 2014:005. [PMID: 26618072 PMCID: PMC4662575 DOI: 10.4172/2161-1149.s4-005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE While increased psychological distress in SLE has been clinically and empirically reported, the relationship between emotional distress, treatment adherence, and disease activity are complex and even more unclear in African American lupus patients. In an effort to elucidate this phenomenon in these patients, this exploratory study aimed to investigate relationships between stress, depression, and various health behaviors in this group. METHODS Thirty patients invited to participate in this study were African American systemic lupus erythematosus (SLE) patients attending rheumatology clinics at the Medical University of South Carolina (MUSC). This study was part of a larger interventional pilot study, the Balancing Lupus Experiences with Stress Strategies (BLESS) study, that included a comprehensive battery of psychosocial, quality of life, and behavior change measures. RESULTS When looking at the association between anxiety/stress and functionality, levels of reported stress had strong effects upon functionality, especially between health distress and functionality. When looking at the association between depressive symptoms and functionality, depressive symptoms had moderate effects upon social/role limitations and nights spent in the hospital. CONCLUSION Not only did the larger pilot project demonstrate significant reductions in stress and depression as a result of workshop participation; this nested study also showed that those improvements were positively associated with improved health behaviors. These results could have implications for developing interventions to improve disease experience and quality of life in SLE patients with stress and depression.
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Affiliation(s)
- Edith M. Williams
- Institute for Partnerships to Eliminate Health Disparities, University of South Carolina; Columbia, SC, USA
| | - Larisa Bruner
- Office of Public Health Practice, University of South Carolina; Columbia, SC, USA
| | - Megan Penfield
- Institutional Assessment and Compliance, University of South Carolina; Columbia, SC, USA
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
| | - James C. Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina; Charleston, SC, USA
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Copp JN, Williams EM, Rich MH, Patterson AV, Smaill JB, Ackerley DF. Toward a high-throughput screening platform for directed evolution of enzymes that activate genotoxic prodrugs. Protein Eng Des Sel 2014; 27:399-403. [PMID: 24996412 DOI: 10.1093/protein/gzu025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Engineering of enzymes to more efficiently activate genotoxic prodrugs holds great potential for improving anticancer gene or antibody therapies. We report the development of a new, GFP-based, high-throughput screening platform to enable engineering of prodrug-activating enzymes by directed evolution. By fusing an inducible SOS promoter to an engineered GFP reporter gene, we were able to measure levels of DNA damage in intact Escherichia coli and separate cell populations by fluorescence activating cell sorting (FACS). In two FACS iterations, we were able to achieve a 90,000-fold enrichment of a functional prodrug-activating nitroreductase from a null library background.
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Affiliation(s)
- J N Copp
- School of Biological Sciences, Victoria University of Wellington, Wellington 6012, New Zealand Centre for Biodiscovery, Victoria University of Wellington, Wellington 6012, New Zealand Present address: Michael Smith Laboratories, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - E M Williams
- School of Biological Sciences, Victoria University of Wellington, Wellington 6012, New Zealand Centre for Biodiscovery, Victoria University of Wellington, Wellington 6012, New Zealand
| | - M H Rich
- School of Biological Sciences, Victoria University of Wellington, Wellington 6012, New Zealand Centre for Biodiscovery, Victoria University of Wellington, Wellington 6012, New Zealand
| | - A V Patterson
- Maurice Wilkins Centre for Molecular Biodiscovery, School of Biological Sciences, University of Auckland, Auckland 1010, New Zealand Auckland Cancer Society Research Centre, University of Auckland, Grafton, Auckland 1023, New Zealand
| | - J B Smaill
- Maurice Wilkins Centre for Molecular Biodiscovery, School of Biological Sciences, University of Auckland, Auckland 1010, New Zealand Auckland Cancer Society Research Centre, University of Auckland, Grafton, Auckland 1023, New Zealand
| | - D F Ackerley
- School of Biological Sciences, Victoria University of Wellington, Wellington 6012, New Zealand Centre for Biodiscovery, Victoria University of Wellington, Wellington 6012, New Zealand Maurice Wilkins Centre for Molecular Biodiscovery, School of Biological Sciences, University of Auckland, Auckland 1010, New Zealand
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Williams EM, Gordon AD, Richmond BG. Biomechanical strategies for accuracy and force generation during stone tool production. J Hum Evol 2014; 72:52-63. [PMID: 24746547 DOI: 10.1016/j.jhevol.2014.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 03/14/2014] [Accepted: 03/15/2014] [Indexed: 12/01/2022]
Abstract
Multiple hominin species used and produced stone tools, and the archaeological record provides evidence that stone tool behaviors intensified among later members of the genus Homo. This intensification is widely thought to be the product of cognitive and anatomical adaptations that enabled later Homo taxa to produce stone tools more efficiently relative to earlier hominin species. This study builds upon recent investigations of the knapping motions of modern humans to test whether aspects of our upper limb anatomy contribute to accuracy and/or efficiency. Knapping kinematics were captured from eight experienced knappers using a Vicon motion capture system. Each subject produced a series of Oldowan bifacial choppers under two conditions: with normal wrist mobility and while wearing a brace that reduced wrist extension (∼30°-35°), simulating one aspect of the likely primitive hominin condition. Under normal conditions, subjects employed a variant of the proximal-to-distal joint sequence common to throwing activities: subjects initiated down-swing upper limb motion at the shoulder and proceeded distally, increasing peak linear and angular velocities from the shoulder to the elbow to the wrist. At the wrist, subjects utilized the 'dart-thrower's arc,' the most stable plane of radiocarpal motion, during which wrist extension is coupled with radial deviation and flexion with ulnar deviation. With an unrestrained wrist, subjects achieved significantly greater target accuracy, wrist angular velocities, and hand linear velocities compared with the braced condition. Additionally, the modern wrist's ability to reach high degrees of extension (≥28.5°) following strike may decrease risk of carpal and ligamentous damage caused by hyperextension. These results suggest that wrist extension in humans contributes significantly to stone tool-making performance.
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Affiliation(s)
- E M Williams
- Department of Biology, Buhl Hall, Chatham University, Woodland Road, Pittsburgh, PA 15232, USA.
| | - A D Gordon
- Department of Anthropology, University at Albany - SUNY, 1400 Washington Avenue, Albany, NY 12222, USA.
| | - B G Richmond
- Center for the Advanced Study of Hominid Paleobiology, Department of Anthropology, The George Washington University, 2110 G St. NW, Washington, DC 20052, USA; Human Origins Program, National Museum of Natural History, Smithsonian Institution, Washington, DC 20560, USA.
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Svendsen ER, Reynolds S, Ogunsakin OA, Williams EM, Fraser-Rahim H, Zhang H, Wilson SM. Assessment of Particulate Matter Levels in Vulnerable Communities in North Charleston, South Carolina prior to Port Expansion. Environ Health Insights 2014; 8:5-14. [PMID: 24653648 PMCID: PMC3956811 DOI: 10.4137/ehi.s12814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/20/2013] [Accepted: 11/21/2013] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The Port of Charleston, one of the busiest US ports, currently operates five terminals. The fifth terminal is being planned for expansion to accommodate container ships from the proposed Panama Canal expansion. Such expansion is expected to increase traffic within local vulnerable North Charleston neck communities by at least 7,000 diesel truck trips per day, more than a 70% increase from the present average rate of 10,000 trucks per day. Our objective was to measure the current particulate matter (PM) concentrations in North Charleston communities as a baseline to contrast against future air pollution after the proposed port expansion. METHODS Saturation study was performed to determine spatial variability of PM in local Charleston neck communities. In addition, the temporal trends in particulate air pollution within the region were determined across several decades. With the BGI sampler, PM samples were collected for 24 hours comparable to the federal reference method protocol. Gravimetric analysis of the PM filter samples was conducted following EPA protocol. RESULTS The range of the PM10 annual average across the region from 1982 to 2006 was 17.0-55.0 μg/m3. On only two occasions were the records of PM10 averaged above the 50.0 μg/m3 national standard. In the case of PM2.5, the annual average for 1999-2006 ranged from 11.0 to 13.5 μg/m3 and no annual average exceeded the 15.0 μg/m3 PM2.5 annual standard. CONCLUSIONS Although ambient PM levels have fallen in the Charleston region since the 1960s due to aggressive monitoring by the stakeholders against air pollution, local air pollution sources within the North Charleston neck communities have consistently contributed to the PM levels in the region for several decades. This baseline assessment of ambient PM will allow for comparisons with future assessments to ascertain the impact of the increased truck and port traffic on PM concentrations.
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Affiliation(s)
- Erik R Svendsen
- Tulane University School of Public Health and Tropical Medicine, USA
| | - Scott Reynolds
- South Carolina Department of Health and Environmental Control, USA
| | | | - Edith M Williams
- University of South Carolina’s Arnold School of Public Health, USA
| | | | | | - Sacoby M Wilson
- University of Maryland Institute for Applied Environmental Health, USA
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Williams EM, Zhang J, Zhou J, Kamen D, Oates JC. Predictors of non-response and non-compliance in African American lupus patients: Findings from the Balancing Lupus Experiences with Stress Strategies (BLESS) Study. Int J Med Biomed Sci 2014; 2:6-19. [PMID: 25664344 PMCID: PMC4319671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Arthritis self-management education has demonstrated significant improvements in health distress, self-reported global health, and activity limitation, with trends toward improvement in self efficacy and mental stress management. Consequently, numerous national agencies have recommended arthritis self-management education to complement medical care. Despite these recommendations, arthritis self-management education has reached only a limited number of people. Compliance is also a persistent problem in standardized programs. As part of the Balancing Lupus Experiences with Stress Strategies (BLESS) Study, a validated psychosocial stress intervention was piloted among a cohort of African American lupus patients participating in an SLE database project at the Medical University of South Carolina (MUSC). Recruitment attempts were made with the 330 database participants who met eligibility requirements for the study. While enrollment was limited to 30 participants (n=15 controls and n=15 intervention), two of the participants assigned to the intervention group did not attend any intervention sessions and several participants did not complete post-intervention questionnaires. Therefore, data were analyzed on 30 participants at baseline, 25 (n=13 controls and n=12 intervention) at post-intervention, and 22 (n=12 controls and n=10 intervention) at four months post-intervention. In an effort to characterize those who fully participated in the study and those who were non-compliant or non-responsive to recruitment attempts, we obtained descriptive data from African-American Lupus patients participating in the SLE Clinic Database Project. This information can be used to develop and refine future intervention activities.
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Affiliation(s)
- Edith M. Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210, (803) 251-2225, (803) 251-6327
| | - Jiajia Zhang
- Epidemiology and Biostatistics, University of South Carolina, 800 Sumter Street, Suite 205, Columbia, SC 29208
| | - Jie Zhou
- Epidemiology and Biostatistics, University of South Carolina, 800 Sumter Street, Suite 205, Columbia, SC 29208
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425
| | - James C. Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425 and Medical Service, Ralph H. Johnson VA Medical Center, Charleston, SC
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Bowen SA, Williams EM, Stoneberg-Cooper CM, Glover SH, Williams MS, Byrd MD. Effects of social injustice on breast health-seeking behaviors of low-income women. Am J Health Promot 2014; 27:222-30. [PMID: 23448411 DOI: 10.4278/ajhp.110505-qual-189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The study uses qualitative research to gain a better understanding of what occurs after low-income women receive an abnormal breast screening and the factors that influence their decisions and behavior. A heuristic model is presented for understanding this complexity. DESIGN Qualitative research methods used to elicited social and cultural themes related to breast cancer screening follow-up. SETTING Individual telephone interviews were conducted with 16 women with confirmed breast anomaly. PARTICIPANTS Low-income women screened through a national breast cancer early detection program. METHOD Grounded theory using selective coding was employed to elicit factors that influenced the understanding and follow-up of an abnormal breast screening result. Interviews were digitally recorded, transcribed, and uploaded into NVivo 8, a qualitative management and analysis software package. RESULTS For women (16, or 72% of case management referrals) below 250% of the poverty level, the impact of social and economic inequities creates a psychosocial context underlined by structural and cultural barriers to treatment that forecasts the mechanism that generates differences in health outcomes. The absence of insurance due to underemployment and unemployment and inadequate public infrastructure intensified emotional stress impacting participants' health decisions. CONCLUSION The findings that emerged offer explanations of how consistent patterns of social injustice impact treatment decisions in a high-risk vulnerable population that have implications for health promotion research and systems-level program improvement and development.
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Affiliation(s)
- Shelly-Ann Bowen
- Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, SC 29208, USA.
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Williams EM, Ortiz K, Browne T. Social Determinants of Health, the Chronic Care Model, and Systemic Lupus Erythematosus. Int J Chronic Dis 2014; 2014:361792. [PMID: 26464854 PMCID: PMC4590929 DOI: 10.1155/2014/361792] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/09/2013] [Accepted: 12/09/2013] [Indexed: 11/17/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions.
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Affiliation(s)
- Edith M. Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210, USA
| | - Kasim Ortiz
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210, USA
| | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, SC 29208, USA
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Williams EM, Penfield M, Kamen D, Oates JC. An Intervention to Reduce Psychosocial and Biological Indicators of Stress in African American Lupus Patients: The Balancing Lupus Experiences with Stress Strategies Study. ACTA ACUST UNITED AC 2014; 4:22-31. [PMID: 24999444 DOI: 10.4236/ojpm.2014.41005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Very little is known about the impact of psychosocial stress on African American lupus patients. Due to the exposure of African Americans to a unique trajectory of stressors throughout life, it may be critical to understand the relationship between psychosocial stress and underlying biological mechanisms that influence disease activity and pathology in this high risk group. METHODS The Balancing Lupus Experiences with Stress Strategies (BLESS) study piloted the validated "Better Choices, Better Health" Chronic Disease Self-Management Program (CDSMP) in 30 African-American lupus patients participating in the SLE Clinic Database Project at the Medical University of South Carolina (MUSC). Measures of psychosocial and biological indicators of stress were collected in all of the patients in each of the study conditions before and after intervention activities, as well as four months post-intervention, to assess the effectiveness of the program in reducing perceived and biological indicators of stress. RESULTS Participation in the workshops had large effects upon depression (d=1.63 and d = 1.68), social/role activities limitations (d =1.15), health distress (d =1.13 and d = 0.78), fatigue (d =1.03), pain (d =0.96), and lupus self-efficacy (d =0.85). Neither the differences in cortisol or DHEA levels pre- and post-intervention were found to be significantly different between intervention participants and controls. CONCLUSION The intervention workshops acted to reduce perceived stress and improve quality of life. Our findings imply that comparable, if not more significant gains in relevant health indicators are possible in African American patients when provided the opportunity to participate in CDSMP's.
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Affiliation(s)
- Edith M Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 208, Columbia, SC 29210
| | - Megan Penfield
- Institutional Assessment and Compliance, University of South Carolina, 1710 College Street, Suite 205, Columbia, SC 29208
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425
| | - James C Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425; Medical Service, Ralph H. Johnson VA Medical Center, Charleston, SC
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Williams EM, Kamen D, Penfield M, Oates JC. Stress Intervention and Disease in African American Lupus Patients: The Balancing Lupus Experiences with Stress Strategies (BLESS) Study. Health (London) 2014; 6:71-79. [PMID: 24932382 PMCID: PMC4052946 DOI: 10.4236/health.2014.61011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Edith M Williams
- Institute for Partnerships to Eliminate Health Disparities, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210
| | - Diane Kamen
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425
| | - Megan Penfield
- Institutional Assessment and Compliance, University of South Carolina, 1710 College Street, Suite 205, Columbia, SC 29208
| | - James C Oates
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 816, Charleston, SC 29425 and Medical Service, Ralph H. Johnson VA Medical Center, Charleston, SC
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Williams EM, Powell T, Eriksen M, Neill P, Colasanti R. A pilot study quantifying the shape of tidal breathing waveforms using centroids in health and COPD. J Clin Monit Comput 2013; 28:67-74. [PMID: 23881418 DOI: 10.1007/s10877-013-9497-7] [Citation(s) in RCA: 11] [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] [Received: 12/10/2012] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Abstract
During resting tidal breathing the shape of the expiratory airflow waveform differs with age and respiratory disease. While most studies quantifying these changes report time or volume specific metrics, few have concentrated on waveform shape or area parameters. The aim of this study was to derive and compare the centroid co-ordinates (the geometric centre) of inspiratory and expiratory flow-time and flow-volume waveforms collected from participants with or without COPD. The study does not aim to test the diagnostic potential of these metrics as an age matched control group would be required. Twenty-four participants with COPD and thirteen healthy participants who underwent spirometry had their resting tidal breathing recorded. The flow-time data was analysed using a Monte Carlo simulation to derive the inspiratory and expiratory flow-time and flow-volume centroid for each breath. A comparison of airflow waveforms show that in COPD, the breathing rate is faster (17 ± 4 vs 14 ± 3 min(-1)) and the time to reach peak expiratory flow shorter (0.6 ± 0.2 and 1.0 ± 0.4 s). The expiratory flow-time and flow-volume centroid is left-shifted with the increasing asymmetry of the expired airflow pattern induced by airway obstruction. This study shows that the degree of skew in expiratory airflow waveforms can be quantified using centroids.
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Affiliation(s)
- E M Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK,
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Pickerd N, Williams EM, Kotecha S. Electromagnetic inductance plethysmography to measure tidal breathing in preterm and term infants. Pediatr Pulmonol 2013; 48:160-7. [PMID: 22588967 DOI: 10.1002/ppul.22584] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 03/14/2012] [Indexed: 11/06/2022]
Abstract
Tidal breathing measurements which provide a non-invasive measure of lung function in preterm and term infants are particularly useful to guide respiratory support. We used a new technique of electromagnetic inductance plethysmography (EIP) to measure tidal breathing in infants between 32 and 42 weeks postconceptional age (PCA). Tidal breathing was measured in 49 healthy spontaneously breathing infants between 32 and 42 weeks PCA. The weight-corrected tidal volume (V(T) ) and minute volume (MV) decreased with advancing PCA (V(T) 6.5 ± 1.5 ml/kg and MV 0.44 ± 0.04 L/kg/min at 32-33 weeks, respectively; 6.3 ± 0.9 ml/kg and 0.38 ± 0.02 L/kg/min at 34-36 weeks; and 5.1 ± 1.1 ml/kg and 0.28 ± 0.02 L/kg/min at term, V(T) P < 0.001 and MV P < 0.01 for 32-33 weeks PCA vs. term; V(T) P = 0.016 and MV P = 0.015 for 34-36 weeks PCA vs. term). Respiratory frequency and the phase angle decreased significantly with advancing PCA but the flow parameter t(PTEF) /t(E) did not change significantly. Using a new technique to measure tidal breathing parameters in newborn infants, our data confirms its usability in clinical practice and establishes normative data which can guide future respiratory management of newborn infants.
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Affiliation(s)
- N Pickerd
- Department of Child Health, Cardiff University, Cardiff, UK
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Piper CN, Elder K, Olatosi B, Onsomu E, Williams EM, Sebastian N, Ogbuano C, Lee W, Glover SH. Beliefs and perception of risks of HIV among women that have never been tested for HIV in the United States. J Natl Med Assoc 2013; 104:441-8. [PMID: 23342818 DOI: 10.1016/s0027-9684(15)30198-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess women's attitudes, beliefs, characteristics, the perception of risks, and their relationships with not utilizing human immunodeficiency virus (HIV) testing services. METHODS This study is a retrospective study and secondary data analysis of the 2006 National Health Interview Survey. Parametric testing using univariate, bivariate, and multivariate analyses was performed to examine perception of HIV acquisition and the relationship with not utilizing HIV testing services among women in the United States. RESULTS More than half of the women in this study had never been tested for HIV (52.26%). In the multivariate analysis, using SAS callable SUDAAN, women who had not been tested for HIV that believed they had no risk of getting HIV were more likely to have never been married (odds ratio [OR], 0.37; 95% CI, 0.31-28.73; p = .0013). In addition, women who had never been tested for HIV that believed they had no risk of getting HIV were more likely to have less than a high school diploma (OR, 0.35; 95% CI, 0.15-0.78; p = .0022). CONCLUSION Findings from this study can lend themselves to the development of more efficient and sustainable interventions to prevent HIV infection and decrease high-risk behaviors among more susceptible populations and for the development of HIV testing policy.
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Affiliation(s)
- Crystal N Piper
- Public Health Sciences Department, University of North Carolina at Charlotte, Charlotte, NC 28223, USA.
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Crowley SK, Wilkinson LL, Burroughs EL, Muraca ST, Wigfall LT, Louis-Nance T, Williams EM, Glover SH, Youngstedt SD. Sleep During Basic Combat Training: A Qualitative Study. Mil Med 2012; 177:823-8. [DOI: 10.7205/milmed-d-12-00022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Beverley CS, Probst J, Williams EM, Rivers P, Glover SH. Differences in Electronic Medical Record Implementation and Use According to Geographical Location and Organizational Characteristics of US Federally Qualified Health Centers. International Journal of Healthcare Information Systems and Informatics 2012. [DOI: 10.4018/jhisi.2012070101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electronic medical records (EMRs) are at the forefront of the national healthcare agenda and this paper examines EMR implementation and usage based on data from the 2009 Commonwealth Fund National Survey of Federally Qualified Health Centers (FQHC). Chi-square analysis was used to examine differences in EMR implementation and usage. Logistic regression analysis was used to understand the adjusted associations between EMR implementation and usage. A significant finding of this study was that simple EMRs were implemented in more than half of FQHCs in the Northeast, Southern, and Western regions of the United States and EMRs in more than half of the FQHCs in the Southern and Western regions are not even utilized. These findings indicate simple EMR usage and full EMR implementation need improvement to meet the requirements of the American Recovery and Reinvestment Act by 2014, or face reduction in Medicare and Medicaid reimbursements.
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Adams SA, Butler WM, Fulton J, Heiney SP, Williams EM, Delage AF, Khang L, Hebert JR. Racial disparities in breast cancer mortality in a multiethnic cohort in the Southeast. Cancer 2012; 118:2693-9. [PMID: 21953316 PMCID: PMC3269560 DOI: 10.1002/cncr.26570] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 07/28/2011] [Accepted: 08/24/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although much has been done to examine those factors associated with higher mortality among African American women, there is a paucity of literature that examines disparities among rural African Americans in South Carolina. The purpose of this investigation was to examine the association of race and mortality among breast cancer patients in a large cohort residing in South Carolina for which treatment regimens are standardized for all patients. METHODS Subjects included 1209 women diagnosed with breast cancer between 2000 and 2002 at a large, local hospital containing a comprehensive breast center. Kaplan-Meier survival curves were calculated to determine survival rates among African American and European American women, stratified by disease stage or other prognostic characteristics. Adjusting for various characteristics, Cox multivariate survival models were used to estimate the hazard ratio (HR). RESULTS The 5-year overall all-cause mortality survival proportion was ∼78% for African American women and ∼89% for European American women, P < 0.01. In analyses of subpopulations of women with identical disease characteristics, African American women had significantly higher mortality than European American women for the same type of breast cancer disease. In multivariate models, African American women had significantly higher mortality than European American women for both breast cancer-specific death (HR, 2.41; 95% confidence interval [CI], 1.21-4.79) and all-cause mortality (HR, 1.42; 95% CI, 1.06-1.89). CONCLUSIONS African American women residing in rural South Carolina had lower survival for breast cancer even after adjustment for disease-related prognostic characteristics. These findings support health interventions among African American breast cancer patients aimed at tertiary prevention strategies or further down-staging of disease at diagnosis.
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Affiliation(s)
- Swann Arp Adams
- College of Nursing, University of South Carolina, Columbia, SC, USA.
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Williams EM, Pickerd N, Eriksen M, Øygarden K, Kotecha S. Estimation of tidal ventilation in preterm and term newborn infants using electromagnetic inductance plethysmography. Physiol Meas 2012; 32:1833-45. [PMID: 22027661 DOI: 10.1088/0967-3334/32/11/001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tidal volume (VT) measurements in newborn infants remain largely a research tool. Tidal ventilation and breathing pattern were measured using a new device, FloRight, which uses electromagnetic inductive plethysmography,and compared simultaneously with pneumotachography in 43 infants either receiving no respiratory support or continuous positive airway pressure (CPAP).Twenty-three infants were receiving CPAP (gestational age 28 ± 2 weeks, mean ± SD) and 20 were breathing spontaneously (gestational age 34 ± 4 weeks). The two methods were in reasonable agreement, with VT (r2 = 0.69) ranging from 5 to 23 ml (4–11 ml kg−1) with a mean difference of 0.4 ml and limit of agreement of −4.7 to + 5.5 ml. For respiratory rate, minute ventilation,peak flow and breathing pattern indices, the mean difference between the two methods ranged between 0.7% and 5.8%. The facemask increased the respiratory rate (P < 0.001) in both groups with the change in VT being more pronounced in the infants receiving no respiratory support. Thus, FloRight provides an easy to use technique to measure term and preterm infants in the clinical environment without altering the infant's breathing pattern.
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Affiliation(s)
- E M Williams
- Faculty of Health Sport and Science, University of Glamorgan, Pontypridd, UK
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Williams EM, Lee MD, Preston G, Williams A, Wigfall LT, Wilkinson L, Hatala J, Hassan R, Glover SH. Development of the Soldier Health Promotion to Examine and Reduce Health Disparities (SHPERHD) Project Coordinating Center: challenges and opportunities within a university/community partnership. Mil Med 2012; 176:757-62. [PMID: 22128716 DOI: 10.7205/milmed-d-10-00465] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The Soldier Health Promotion to Examine and Reduce Health Disparities (SHPERHD) Project was designed to be a partnership between the Institute for Partnerships to Eliminate Health Disparities at the University of South Carolina and the Fort Jackson United States Army Base located in Columbia, South Carolina. SHPERHD Project researchers are studying problems related to obesity and weight management, musculoskeletal injuries and infection, and mental health issues during recruitment, basic training, and post-deployment. In order to successfully develop targeted interventions to prevent and lower the incidence of injury, promote healthy nutrition, and decrease mental health issues, at the same time also reducing disparity gaps, the SHPERHD Project comprises a professional, technical, and administrative staff with specific competence in the operation of a Coordinating Center to handle the wide variety of areas related to military studies. This article discusses the procedures and processes that were implemented in the development of the SHPERHD Project Coordinating Center.
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Affiliation(s)
- Edith M Williams
- Institute for Partnerships to Eliminate Health Disparities, University of South Carolina, 220 Stoneridge Drive, Suite 208, Columbia, SC 29210, USA
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