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Wang B, Pineda-Reyes R, Nielsen MC, Baillargeon G, Baillargeon JG, McDougal AN. Single-center investigation on central-line-associated bloodstream infections and blood-culture contamination during the early months of the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2023; 44:1184-1186. [PMID: 35856260 PMCID: PMC10369219 DOI: 10.1017/ice.2022.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 11/07/2022]
Abstract
In this retrospective cohort study, we assessed central-line-associated bloodstream infections (CLABSIs) and blood-culture contamination frequency during the first pandemic wave. Coronavirus disease 2019 (COVID-19) was significantly associated with CLABSI and blood-culture contamination. In the COVID-19 cohort, malignancy was associated with CLABSI. Black race, end-stage renal disease, and obesity were associated with blood-culture contamination.
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Affiliation(s)
- Beilin Wang
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Roberto Pineda-Reyes
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | | | - Gwen Baillargeon
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas
| | - Jacques G. Baillargeon
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas
| | - April N. McDougal
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Department of Infection Control and Healthcare Epidemiology, University of Texas Medical Branch, Galveston, Texas
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Chaaban MR, Stuart J, Watley D, Baillargeon G, Kuo YF. Recurrent anaphylaxis in the United States: time of onset and risk factors. Int Forum Allergy Rhinol 2019; 10:320-327. [PMID: 31774625 DOI: 10.1002/alr.22502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Studies have not yet examined the trends and risk factors of biphasic and recurrent anaphylaxis in the United States using International Classification of Diseases, tenth revision (ICD-10) CM codes. The goal of this study is to examine the trends of biphasic and recurrent anaphylaxis in all patient care settings (inpatient, outpatient, emergency department, and observation). METHODS We used the Clinformatics database from 2015 to 2017. Our main outcome measure was recurrent anaphylactic events occurring within 1 year after the initial event. We used Cox proportional hazards modeling to assess the factors associated with recurrent anaphylaxis and the Kaplan-Meier method to estimate time to recurrence. RESULTS There were a total of 19,039 patients with incident anaphylaxis in 2016 and, of these, 2017 had a recurrent anaphylaxis event in the 12-month period after the index date (10.6%). The most common trigger for recurrent anaphylaxis is venom followed by food allergens. Pediatric patients aged <18 years were more likely to develop recurrent anaphylaxis compared with patients aged 18 to 64 years (hazard ratio [HR], 1.53). Patients with allergic rhinitis and asthma were more likely to develop recurrent anaphylaxis compared to those without these comorbidities (HR, 1.15 and 1.27, respectively). CONCLUSION This is the first national study using ICD-10 CM codes looking at rates of biphasic and recurrent anaphylaxis in all patient care settings. Recurrent anaphylaxis is more common in the first 3 days after the initial event, in younger patients (<18 years), and in patients with allergic rhinitis and/or asthma. Physicians need to prescribe epinephrine auto-injectors and educate their patients about the risk of recurrence.
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Affiliation(s)
- Mohamad R Chaaban
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX
| | - Jared Stuart
- School of Medicine, University of Texas Medical Branch, Galveston, TX
| | - Duncan Watley
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX
| | - Gwen Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
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Ferry AM, Wright AE, Baillargeon G, Kuo YF, Chaaban MR. Epidemiology and Trends of Hereditary Hemorrhagic Telangiectasia in the United States. Am J Rhinol Allergy 2019; 34:230-237. [DOI: 10.1177/1945892419886756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background To our knowledge, no national studies have investigated the epidemiology of hereditary hemorrhagic telangiectasia (HHT) in the United States since the incorporation of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10 CM). Objective Our objective is to analyze the epidemiology of HHT from 2013 to 2017 and to determine the relationships between epistaxis and other associated complications of this rare disease. Methods We analyzed the epidemiology of HHT between 2013 and 2017 by accessing data of 87 709 738 patients from the Clinformatics Data Mart using ICD-9 CM and ICD-10 CM codes. Variables analyzed included age, gender, region, clinical setting of diagnosis, hospitalizations, and complications. Bivariate analyses using generalized linear models were conducted to determine the likelihood of HHT patients with epistaxis enduring associated life-threatening complications such as cerebral hemorrhage, thrombosis, and pulmonary hemorrhage compared to HHT patients without epistaxis during the study period. Results The prevalence of HHT increased from 6.1 to 12.1 per 100 000 persons, with patients of ages 18 to 29 years and those older than 60 years seeing the greatest percent increase. The prevalence of HHT in the Southern United States saw a 147% increase. Compared to HHT patients without epistaxis, HHT patients with epistaxis were 3.4 times more likely to experience pulmonary hemorrhage, 3.3 times more likely to have pulmonary emboli, 2.8 times more likely to experience cerebral hemorrhage, and 2.0 times more likely to have thrombosis during the study period. Conclusion Our national study has provided the first incidence and prevalence rates of HHT in the United States since the incorporation of the ICD-10 CM. HHT patients with epistaxis require prompt multidisciplinary treatment of their condition due to their increased risk of life-threatening complications.
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Affiliation(s)
- Andrew M. Ferry
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Alex E. Wright
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Gwen Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Mohamad R. Chaaban
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas
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Chaaban MR, Warren Z, Baillargeon JG, Baillargeon G, Resto V, Kuo Y. Epidemiology and trends of anaphylaxis in the United States, 2004‐2016. Int Forum Allergy Rhinol 2019; 9:607-614. [DOI: 10.1002/alr.22293] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/04/2018] [Accepted: 12/13/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Mohamad R. Chaaban
- Department of OtolaryngologyUniversity of Texas Medical Branch Galveston TX
| | - Zachary Warren
- Department of OtolaryngologyUniversity of Texas Medical Branch Galveston TX
| | - Jacques G. Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Community HealthUniversity of Texas Medical Branch Galveston TX
| | - Gwen Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Community HealthUniversity of Texas Medical Branch Galveston TX
| | - Vicente Resto
- Department of OtolaryngologyUniversity of Texas Medical Branch Galveston TX
| | - Yong‐Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Community HealthUniversity of Texas Medical Branch Galveston TX
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Harzke AJ, Diaz M, Tong E, Baillargeon G, Zepeda S, Koranek A, Sandmann R. Substituting Generic Lamivudine for Emtricitabine in Virologically Suppressed HIV-Infected Patients. J Correct Health Care 2018; 24:371-381. [PMID: 30189786 DOI: 10.1177/1078345818792843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study evaluated the effectiveness of formulary substitution from products or regimens containing name brand emtricitabine to alternative regimens containing generic lamivudine among virologically suppressed HIV-infected patients in a correctional managed health care system. Results of this retrospective cohort study showed that 94.9% of patients switched from emtricitabine to lamivudine ( n = 447) and 93.0% of emtricitabine control patients ( n = 449) had an undetectable viral load at last available test over a 2-year period. The two groups also showed similar values for CD4 counts, compliance, discontinuation, and M184V mutation; however, a slightly greater proportion of lamivudine patients experienced respiratory symptoms. Nonetheless, this study demonstrates that switching virologically suppressed HIV-infected patients from name brand emtricitabine-containing regimens to generic lamivudine-based regimens may reduce costs without compromising safety or effectiveness in correctional managed health care systems with directly observed therapy.
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Affiliation(s)
- Amy Jo Harzke
- 1 Department of Preventive Medicine and Community Health and Correctional Managed Care, University of Texas Medical Branch, Galveston, TX, USA
| | - Maria Diaz
- 2 Douglas Ambulatory Clinic, CHRISTUS® Trinity Mother Frances Health System, Tyler, TX, USA
| | - Emily Tong
- 3 Envolve Pharmacy Solutions, Rancho Cordova, CA
| | - Gwen Baillargeon
- 4 Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Stephanie Zepeda
- 5 Department of Pharmacy, University of Texas Medical Branch, Galveston, TX, USA
| | - Angela Koranek
- 6 Correctional Managed Care Central Pharmacy, University of Texas Medical Branch, Huntsville, TX, USA
| | - Robert Sandmann
- 6 Correctional Managed Care Central Pharmacy, University of Texas Medical Branch, Huntsville, TX, USA
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Chaaban MR, Rana N, Baillargeon J, Baillargeon G, Resto V, Kuo YF. Outcomes and Complications of Balloon and Conventional Functional Endoscopic Sinus Surgery. Am J Rhinol Allergy 2018; 32:388-396. [DOI: 10.1177/1945892418782248] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Since the Food and Drug Administration approval of balloon sinuplasty (BSP) in 2005, no nationally representative population-based studies have examined the outcomes and adverse events of BSP. Objective To assess the rates of complications and revision surgery in patients who received BSP, functional endoscopic sinus surgery (FESS), or a hybrid procedure. Methods Using one of the nation’s largest commercial insurance databases, we conducted a retrospective cohort study of pediatric and adult patients diagnosed with chronic rhinosinusitis between 2011 and 2014 who underwent BSP, conventional FESS, or a hybrid procedure. The primary outcomes were surgical complication and revision rates within 6 months of initial surgery. Results A total of 16,040 patients who underwent sinus surgery were included. Overall, 2,851 patients underwent BSP, 11,955 underwent conventional FESS, and 1 234 underwent a hybrid procedure. BSP surgery was more likely to have been performed in an office setting (86.53%) compared to FESS (0.74%). The complication rate was 5.26% for BSP and 7.35% for conventional FESS. Revision rates were 7.89% for BSP, 16.85% for FESS, and 15.15% for a hybrid procedure. Conclusion Despite the low overall risk, major complications occur with BSP including cerebrospinal fluid leak, pneumocephalus, orbital complications, and severe bleeding. Otolaryngologists should discuss these risks with their patients. Prospective studies are still needed to compare outcomes of BSP with those of FESS.
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Affiliation(s)
- Mohamad R. Chaaban
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas
| | - Nikunj Rana
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas
| | - Jacques Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Gwen Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Vicente Resto
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
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Chaaban MR, Baillargeon JG, Baillargeon G, Resto V, Kuo YF. Use of balloon sinuplasty in patients with chronic rhinosinusitis in the United States. Int Forum Allergy Rhinol 2017; 7:600-608. [DOI: 10.1002/alr.21939] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Mohamad R. Chaaban
- Department of Otolaryngology; University of Texas Medical Branch; Galveston TX
| | - Jacques G. Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Community Health; University of Texas Medical Branch; Galveston TX
| | - Gwen Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Community Health; University of Texas Medical Branch; Galveston TX
| | - Vicente Resto
- Department of Otolaryngology; University of Texas Medical Branch; Galveston TX
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Community Health; University of Texas Medical Branch; Galveston TX
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Baillargeon J, Pulvino JS, Leonardson JE, Linthicum LC, Williams B, Penn J, Williams RS, Baillargeon G, Murray OJ. The changing epidemiology of HIV in the criminal justice system. Int J STD AIDS 2017; 28:1335-1340. [PMID: 28449629 DOI: 10.1177/0956462417705530] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although the rate of HIV infection among US prison inmates is considerably higher than that of the general population, little is known about age-related changes in HIV-infected inmates over the last decade. This study of the nation's largest state prison system examined (1) whether the mean age of the HIV-infected inmate increased over the last decade, and (2) whether the prevalence of HIV and associated comorbidities varied according to age. The study population included all 230,103 inmates incarcerated in the Texas prison system for any duration during 2014. A separate analysis was conducted on all HIV-infected inmates incarcerated between 2004 and 2014. Information on medical conditions and demographic factors was obtained from an institution-wide electronic medical record system. From 2004 to 2014, the mean age of HIV-infected inmates in the prison system increased from 39.3 to 42.5 years, compared to an increase of 36.1-37.9 for all Texas prison inmates. Multivariable logistic regression was used to assess the independent contributions of multiple demographic and clinical covariates in predicting the binary outcome, HIV infection. The model showed that, in 2014, HIV infection was elevated in inmates who were aged 40-49 years (OR = 3.1; 95% CI 2.7-3.3), aged 50-59 years (OR = 2.4; 95% CI 2.1-2.7), African American (OR = 3.0; 95% CI 2.8-3.3), and in those with several chronic diseases, including chronic obstructive pulmonary disease (OR = 1.7; 95% CI 1.5-1.9), hepatitis C (OR = 2.7; 95% CI 2.5-3.1), major depressive disorder (OR = 1.7; 95% CI 1.5-2.1), bipolar disorder (OR = 2.3; 95% CI 1.8-2.8), and schizophrenia (OR = 1.5; 95% CI 1.3-1.8). Among HIV-infected inmates (n = 2960), the percentage with comorbid disease increased in a linear fashion according to age (p < .01). Correctional health systems must adapt to address the evolving epidemiology of HIV among inmate populations.
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Affiliation(s)
- Jacques Baillargeon
- 1 Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA.,2 Correctional Managed Care Division, University of Texas Medical Branch, Galveston, TX, USA
| | - John S Pulvino
- 2 Correctional Managed Care Division, University of Texas Medical Branch, Galveston, TX, USA
| | - Jane E Leonardson
- 2 Correctional Managed Care Division, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Brie Williams
- 4 Division of Geriatrics, University of California at San Francisco, San Francisco, CA, USA
| | - Joseph Penn
- 2 Correctional Managed Care Division, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Gwen Baillargeon
- 1 Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA.,2 Correctional Managed Care Division, University of Texas Medical Branch, Galveston, TX, USA
| | - Owen J Murray
- 1 Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA.,2 Correctional Managed Care Division, University of Texas Medical Branch, Galveston, TX, USA
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Baillargeon J, Al Snih S, Raji MA, Urban RJ, Sharma G, Sheffield-Moore M, Lopez DS, Baillargeon G, Kuo YF. Hypogonadism and the risk of rheumatic autoimmune disease. Clin Rheumatol 2016; 35:2983-2987. [PMID: 27325124 DOI: 10.1007/s10067-016-3330-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 04/28/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 02/05/2023]
Abstract
Testosterone deficiency has been linked with autoimmune disease and an increase in inflammatory markers, such as C-reactive protein (CRP), tumor necrosis factor, and interleukin-6 (IL-6). However, no large-scale longitudinal studies have examined this association. We examined whether untreated hypogonadism was associated with an increased risk of rheumatic autoimmune disease in a large nationally representative cohort. Using one of the nation's largest commercial insurance databases, we conducted a retrospective cohort study in which we identified 123,460 men diagnosed with hypogonadism between January 1, 2002 and December 31, 2014 and with no prior history of rheumatic autoimmune disease. We matched this cohort to 370,380 men without hypogonadism, at a 1 to 3 ratio, on age and index/diagnosis date. All patients were followed until December 31, 2014 or until they lost insurance coverage or were diagnosed with a rheumatic autoimmune disease. Cox proportional hazards regression was used to calculate adjusted hazard ratios (aHRs). Untreated hypogonadism was associated with an increased risk of developing any rheumatic autoimmune disease (HR = 1.33, 95 % CI = 1.28, 1.38), rheumatoid arthritis (HR = 1.31, 95 % CI = 1.22, 1.44), and lupus (HR = 1.58, 95 % CI = 1.28, 1.94). These findings persisted using latency periods of 1 and 2 years. Hypogonadism was not associated with the control outcome, epilepsy (HR = 1.04, 95 % CI = 0.96, 1.15). Patients diagnosed with hypogonadism who were not treated with testosterone had an increased risk of developing any rheumatic autoimmune disease, rheumatoid arthritis, and lupus. Future research should further examine this association, with particular attention to underlying mechanisms.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA. .,Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA. .,Department of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA.
| | - Soham Al Snih
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.,Department of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Mukaila A Raji
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.,Department of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA.,Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Randall J Urban
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Gulshan Sharma
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Melinda Sheffield-Moore
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.,Department of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA.,Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - David S Lopez
- Division of Epidemiology, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - Gwen Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.,Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.,Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
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10
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Hill AJ, Sanders A, Baillargeon G, Menon R. Association of group B streptococcus colonization with early term births. J Perinat Med 2015; 43:559-64. [PMID: 25178902 DOI: 10.1515/jpm-2014-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/25/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to reproduce and validate the association of group B streptococcus (GBS) colonization resulting in early-term birth (370/7-386/7 weeks' gestation) and lower birth weight, reported in African-American and Caucasian populations, in a Hispanic cohort. METHODS GBS status of women 18-40 years of age with uncomplicated pregnancies who experienced spontaneous labor and vaginal delivery between 370/7 and 420/7 weeks' gestation over 5 years were identified. Bivariate analysis was conducted on stratified data (GBS+ vs. GBS-) to assess relationship to early versus late-term delivery. Chi-square, Fisher's exact, and Student's t-tests were used for analysis. RESULTS Our cohort was 86% Hispanic, with a GBS+ rate of 10%. No difference for mean gestational age at delivery for GBS+ (275.9 days±6.8) vs. GBS- (275.6 days±6.9) was seen (P-value=0.61). Birth weight for GBS+ and GBS- groups were similar (3388.5 g±388.6 vs. 3395.1 g±401.7, P-value=0.86). CONCLUSIONS In specific evaluation of Hispanic women experiencing spontaneous, term, vaginal delivery, GBS colonization does not result in early-term delivery. This is not consistent with prior data in the African-American and Caucasian population suggesting racial disparity in outcomes related to GBS colonization.
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Abstract
OBJECTIVE To examine the risk of venous thromboembolism (VTE) associated with exposure to testosterone therapy in middle-aged and older men. PATIENTS AND METHODS We conducted a case-control study of 30,572 men 40 years and older who were enrolled in one of the nation's largest commercial insurance programs between January 1, 2007, and December 31, 2012. Cases were defined as men who had a primary diagnosis of VTE and received an anticoagulant drug in the 60 days after their diagnoses. Cases were matched with 3 controls on event/index month, age, geographic region, diagnosis of hypogonadism, and diagnosis of any underlying prothrombotic condition. Conditional logistic regression analysis was used to calculate adjusted odds ratios (aORs) and 95% CIs for the risk of VTE associated with previous exposure to testosterone therapy. RESULTS Exposure to testosterone therapy in the 15 days before the event/index date was not associated with an increased risk of VTE (aOR, 0.90; 95% CI, 0.73-1.12). None of the specific routes of administration examined were associated with an increased risk of VTE (topical [aOR, 0.80; 95% CI, 0.61-10.41], transdermal [aOR, 0.91; 95% CI, 0.38-2.16], and intramuscular [aOR, 1.15; 95% CI, 0.80-1.64]). These findings persisted using exposure windows that extended to 30 and 60 days before the event/index date. CONCLUSION Having filled a prescription for testosterone therapy was not associated with an increased risk of VTE in commercially insured middle-aged and older men. These findings may provide clinically relevant information about the benefit-risk assessment for men with testosterone deficiency considering treatment.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX; Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX.
| | - Randall J Urban
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | | | | | - Gwen Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Gulshan Sharma
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX; Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX
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Bonkovsky HL, Maddukuri VC, Yazici C, Anderson KE, Bissell DM, Bloomer JR, Phillips JD, Naik H, Peter I, Baillargeon G, Bossi K, Gandolfo L, Light C, Bishop D, Desnick RJ. Acute porphyrias in the USA: features of 108 subjects from porphyrias consortium. Am J Med 2014; 127:1233-41. [PMID: 25016127 PMCID: PMC4563803 DOI: 10.1016/j.amjmed.2014.06.036] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent descriptions of the clinical and laboratory features of subjects with acute porphyrias in the US are lacking. Our aim was to describe clinical, biochemical, and genetic features of 108 subjects. METHODS Between September 2010 and December 2012, 108 subjects with acute porphyrias (90 acute intermittent porphyrias, 9 hereditary coproporphyrias, 9 variegate porphyrias) were enrolled into an observational study. Genetic testing was performed at a central genetic testing laboratory and clinical information entered into a central database. Selected features were compared with data for adults in the US. RESULTS Most subjects (88/108, 81%) were female, with self-reported onset of symptoms in the second through fourth decades of life. The most common symptom was abdominal pain. Appendectomies and cholecystectomies were common before a diagnosis of porphyria. The diagnosis was delayed by a mean of 15 years. Anxiety and depression were common, and 18% complained of chronic symptoms, especially neuropathic and other pains. The incidences of systemic arterial hypertension, chronic kidney disease, seizure disorders, and psychiatric conditions were markedly increased. Mutations of the known causative genes were found in 102/105 of those tested, with novel mutations being found in 37, including in 7/8 subjects with hereditary coproporphyria. Therapy with intravenous hematin was the most effective therapy both for treatment of acute attacks and for prevention of recurrent attacks. CONCLUSIONS Acute porphyrias often remain undiagnosed for more than a decade after first symptoms develop. Intravenous hematin is the treatment of choice, both for treatment of acute attacks and for prevention of recurrent attacks.
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MESH Headings
- Adult
- Anxiety/epidemiology
- Coproporphyria, Hereditary/diagnosis
- Coproporphyria, Hereditary/epidemiology
- Coproporphyria, Hereditary/genetics
- Delayed Diagnosis
- Depression/epidemiology
- Epilepsy/epidemiology
- Female
- Humans
- Hypertension/epidemiology
- Incidence
- Male
- Middle Aged
- Neuralgia/epidemiology
- Porphyria, Acute Intermittent/diagnosis
- Porphyria, Acute Intermittent/epidemiology
- Porphyria, Acute Intermittent/genetics
- Porphyria, Variegate/diagnosis
- Porphyria, Variegate/epidemiology
- Porphyria, Variegate/genetics
- Renal Insufficiency, Chronic/epidemiology
- Sex Distribution
- United States/epidemiology
- Young Adult
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Affiliation(s)
- Herbert L Bonkovsky
- The Liver-Biliary-Pancreatic Center, Carolinas HealthCare System, Charlotte, NC; Department of Medicine, Carolinas HealthCare System, Charlotte, NC; Department of Research, Carolinas HealthCare System, Charlotte, NC.
| | - Vinaya C Maddukuri
- The Liver-Biliary-Pancreatic Center, Carolinas HealthCare System, Charlotte, NC; Department of Medicine, Carolinas HealthCare System, Charlotte, NC; Department of Research, Carolinas HealthCare System, Charlotte, NC
| | - Cemal Yazici
- The Liver-Biliary-Pancreatic Center, Carolinas HealthCare System, Charlotte, NC; Department of Medicine, Carolinas HealthCare System, Charlotte, NC; Department of Research, Carolinas HealthCare System, Charlotte, NC
| | - Karl E Anderson
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | | | | | - John D Phillips
- Department of Medicine, University of Utah School of Medicine, Salt Lake City
| | - Hetanshi Naik
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Inga Peter
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gwen Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Krista Bossi
- Department of Research, Carolinas HealthCare System, Charlotte, NC
| | | | | | - David Bishop
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert J Desnick
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
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13
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Harzke AJ, Baillargeon J, Baillargeon G, Henry J, Olvera RL, Torrealday O, Penn JV, Parikh R. Prevalence of Psychiatric Disorders in the Texas Juvenile Correctional System. Journal of Correctional Health Care 2012; 18:143-57. [DOI: 10.1177/1078345811436000] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Amy Jo Harzke
- Division of Correctional Managed Care, University of Texas Medical Branch, Galveston, TX, USA
| | - Jacques Baillargeon
- Division of Correctional Managed Care, University of Texas Medical Branch, Galveston, TX, USA
| | - Gwen Baillargeon
- Division of Correctional Managed Care, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Rene L. Olvera
- Division of Child and Adolescent Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Ohiana Torrealday
- Division of Correctional Managed Care, University of Texas Medical Branch, Galveston, TX, USA
| | - Joseph V. Penn
- Division of Correctional Managed Care, University of Texas Medical Branch, Galveston, TX, USA
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14
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Baillargeon J, Giordano TP, Harzke AJ, Spaulding AC, Wu ZH, Grady JJ, Baillargeon G, Paar DP. Predictors of reincarceration and disease progression among released HIV-infected inmates. AIDS Patient Care STDS 2010; 24:389-94. [PMID: 20565323 DOI: 10.1089/apc.2009.0303] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We conducted a retrospective cohort study to determine the 3-year reincarceration rate of all HIV-infected inmates (n = 1917) released from the Texas prison system between January 2004 and March 2006. We also analyzed postrelease changes in HIV clinical status in the subgroup of inmates who were subsequently reincarcerated and had either CD4 lymphocyte counts (n = 119) or plasma HIV RNA levels (n = 122) recorded in their electronic medical record at both release and reincarceration. Multivariable analyses were performed to assess predictors of reincarceration and clinical changes in HIV status. Only 20% of all HIV-infected inmates were reincarcerated within 3 years of release. Female inmates (hazard ratio [HR] 0.63; 95% confidence interval [CI], 0.47, 0.84) and inmates taking antiretroviral therapy at the time of release (HR 0.31; 95% CI, 0.25, 0.39) were at decreased risk of reincarceration. African Americans (HR 1.58; 95% CI, 1.22, 2.05), inmates with a major psychiatric disorder (HR 1.82; 95% CI, 1.41, 2.34), and inmates released on parole (HR 2.86; 95% CI, 2.31, 3.55) were at increased risk of reincarceration. A subgroup of reincarcerated inmates had a mean decrease in CD4 cell count of 79.4 lymphocytes per microliter (p < 0.0003) and a mean increase in viral load of 1.5 log(10) copies per milliliter (p < 0.0001) in the period between release and reincarceration. Our findings, although substantially limited by selection bias, highlight the importance of developing discharge planning programs to improve linkage to community-based HIV care and reduce recidivism among released HIV-infected inmates.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Community Health Services, University of Texas Medical Branch, Galveston, Texas
| | - Thomas P. Giordano
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey VA Medical Center Health Services Research and Development Center of Excellence, Houston, Texas
| | - Amy Jo Harzke
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Community Health Services, University of Texas Medical Branch, Galveston, Texas
| | | | - Z. Helen Wu
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - James J. Grady
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Gwen Baillargeon
- Community Health Services, University of Texas Medical Branch, Galveston, Texas
| | - David P. Paar
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Department of Medicine, University of Texas Medical Branch, Galveston, Texas
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15
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Baillargeon JG, Giordano TP, Harzke AJ, Baillargeon G, Rich JD, Paar DP. Enrollment in outpatient care among newly released prison inmates with HIV infection. Public Health Rep 2010; 125 Suppl 1:64-71. [PMID: 20408389 DOI: 10.1177/00333549101250s109] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Although many prisoners infected with human immunodeficiency virus (HIV) initiate and adhere to treatment regimens while incarcerated, the benefits of in-prison therapy are frequently lost after community reentry. Little information is available on the percentage of released inmates who establish community-based HIV outpatient treatment in a timely fashion. We sought to determine the proportion of HIV-infected Texas prison inmates who enrolled in an HIV clinic within 90 days after release and to identify variables associated with timely linkage to clinical care. METHODS This was a retrospective cohort study of 1,750 HIV-infected inmates who were released from the Texas Department of Criminal Justice (TDCJ) and returned to Harris County between January 2004 and December 2007. We obtained demographic and clinical data from centralized databases maintained by TDCJ and the Harris County Health District, and used logistic regression analysis to identify factors associated with linkage to post-release outpatient RESULTS Only 20% of released inmates enrolled in an HIV clinic within 30 days of release, and only 28% did so within 90 days. Released inmates > or = 30 years of age were more likely than their younger counterparts to have enrolled in care at the 30- and 90-day time points. Inmates diagnosed with schizophrenia were more likely to have initiated care within 30 days. Inmates who received antiretroviral therapy while incarcerated and those who received enhanced discharge planning were more likely to begin care at both time points. CONCLUSIONS A large proportion of HIV-infected inmates fail to establish outpatient care after their release from the Texas prison system. Implementation of intensive discharge planning programs may be necessary to ensure continuity of HIV care among newly released inmates.
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Affiliation(s)
- Jacques G Baillargeon
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
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16
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Baillargeon J, Williams BA, Mellow J, Harzke AJ, Hoge SK, Baillargeon G, Greifinger RB. Parole revocation among prison inmates with psychiatric and substance use disorders. Psychiatr Serv 2009; 60:1516-21. [PMID: 19880471 PMCID: PMC2981345 DOI: 10.1176/appi.ps.60.11.1516] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This retrospective cohort study examined the association between co-occurring serious mental illness and substance use disorders and parole revocation among inmates from the Texas Department of Criminal Justice, the nation's largest state prison system. METHODS The study population included all 8,149 inmates who were released under parole supervision between September 1, 2006, and November 31, 2006. An electronic database was used to identify inmates whose parole was revoked within 12 months of their release. The independent risk of parole revocation attributable to psychiatric disorders, substance use disorders, and other covariates was assessed with logistic regression analysis. RESULTS Parolees with a dual diagnosis of a major psychiatric disorder (major depressive disorder, bipolar disorder, schizophrenia, or other psychotic disorder) and a substance use disorder had a substantially increased risk of having their parole revoked because of either a technical violation (adjusted odds ratio [OR]=1.7, 95% confidence interval [CI]=1.4-2.4) or commission of a new criminal offense (OR=2.8, 95% CI=1.7-4.5) in the 12 months after their release. However, parolees with a diagnosis of either a major psychiatric disorder alone or a substance use disorder alone demonstrated no such increased risk. CONCLUSIONS These findings highlight the need for future investigations of specific social, behavioral, and other factors that underlie higher rates of parole revocation among individuals with co-occurring serious mental illness and substance use disorders.
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Affiliation(s)
- Jacques Baillargeon
- Dr. Baillargeon and Ms. Harzke are with the Department of Preventive Medicine and Ms. Baillargeon is with the Department of Correctional Managed Care, Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555 (). Dr. Williams is with the Department of Medicine, University of California, San Francisco. Dr. Mellow is with the Department of Law, Police, Science, and Criminal Justice and Dr. Greifinger is with the Center for Research and Evaluation, John Jay College, City University of New York, New York, NY 10019. Dr. Hoge is in private practice, New York, NY, 10019
| | - Brie A. Williams
- Dr. Baillargeon and Ms. Harzke are with the Department of Preventive Medicine and Ms. Baillargeon is with the Department of Correctional Managed Care, Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555 (). Dr. Williams is with the Department of Medicine, University of California, San Francisco. Dr. Mellow is with the Department of Law, Police, Science, and Criminal Justice and Dr. Greifinger is with the Center for Research and Evaluation, John Jay College, City University of New York, New York, NY 10019. Dr. Hoge is in private practice, New York, NY, 10019
| | - Jeff Mellow
- Dr. Baillargeon and Ms. Harzke are with the Department of Preventive Medicine and Ms. Baillargeon is with the Department of Correctional Managed Care, Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555 (). Dr. Williams is with the Department of Medicine, University of California, San Francisco. Dr. Mellow is with the Department of Law, Police, Science, and Criminal Justice and Dr. Greifinger is with the Center for Research and Evaluation, John Jay College, City University of New York, New York, NY 10019. Dr. Hoge is in private practice, New York, NY, 10019
| | - Amy Jo Harzke
- Dr. Baillargeon and Ms. Harzke are with the Department of Preventive Medicine and Ms. Baillargeon is with the Department of Correctional Managed Care, Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555 (). Dr. Williams is with the Department of Medicine, University of California, San Francisco. Dr. Mellow is with the Department of Law, Police, Science, and Criminal Justice and Dr. Greifinger is with the Center for Research and Evaluation, John Jay College, City University of New York, New York, NY 10019. Dr. Hoge is in private practice, New York, NY, 10019
| | - Steven K. Hoge
- Dr. Baillargeon and Ms. Harzke are with the Department of Preventive Medicine and Ms. Baillargeon is with the Department of Correctional Managed Care, Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555 (). Dr. Williams is with the Department of Medicine, University of California, San Francisco. Dr. Mellow is with the Department of Law, Police, Science, and Criminal Justice and Dr. Greifinger is with the Center for Research and Evaluation, John Jay College, City University of New York, New York, NY 10019. Dr. Hoge is in private practice, New York, NY, 10019
| | - Gwen Baillargeon
- Dr. Baillargeon and Ms. Harzke are with the Department of Preventive Medicine and Ms. Baillargeon is with the Department of Correctional Managed Care, Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555 (). Dr. Williams is with the Department of Medicine, University of California, San Francisco. Dr. Mellow is with the Department of Law, Police, Science, and Criminal Justice and Dr. Greifinger is with the Center for Research and Evaluation, John Jay College, City University of New York, New York, NY 10019. Dr. Hoge is in private practice, New York, NY, 10019
| | - Robert B. Greifinger
- Dr. Baillargeon and Ms. Harzke are with the Department of Preventive Medicine and Ms. Baillargeon is with the Department of Correctional Managed Care, Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555 (). Dr. Williams is with the Department of Medicine, University of California, San Francisco. Dr. Mellow is with the Department of Law, Police, Science, and Criminal Justice and Dr. Greifinger is with the Center for Research and Evaluation, John Jay College, City University of New York, New York, NY 10019. Dr. Hoge is in private practice, New York, NY, 10019
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Baillargeon J, Snyder N, Soloway RD, Paar D, Baillargeon G, Spaulding AC, Pollock BH, Arcari CM, Williams BA, Raimer BG. Hepatocellular carcinoma prevalence and mortality in a male state prison population. Public Health Rep 2009; 124:120-6. [PMID: 19413034 DOI: 10.1177/003335490912400115] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The incidence of hepatocellular carcinoma (HCC) in the United States has increased dramatically over the last two decades, largely because of an increase in the number of people with advanced hepatitis C virus (HCV) infection. U.S. prisoners are at high risk for HCC, given their elevated rates of HCV infection, comorbid hepatitis B virus (HBV) infection, and alcoholic liver disease. The purpose of our study was to examine the prevalence and mortality of HCC in the nation's largest state prison system. METHODS The study population consisted of 325,477 male Texas Department of Criminal Justice (TDCJ) inmates who were incarcerated between January 1, 2003, and July 31, 2006. Information on medical conditions and demographic characteristics was obtained from an institution-wide medical information system. RESULTS During the 3.5-year study period, 176 male TDCJ inmates (54 per 100,000) were diagnosed with HCC and 108 (33 per 100,000) died as a result of HCC. Inmates who were Hispanic, older, and infected with HCV, HBV, or human immunodeficiency virus had elevated rates of both HCC prevalence and mortality. After adjusting for all study covariates, HCC prevalence, but not mortality, was modestly elevated among inmates with diabetes. CONCLUSIONS Our study showed that the Texas male prison population had a sevenfold higher prevalence of HCC than the general U.S. male population and a fourfold higher death rate from HCC. These findings likely reflect the high concentration of HCC-related risk factors, particularly HCV, among prisoners.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
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Baillargeon J, Penn JV, Thomas CR, Temple JR, Baillargeon G, Murray OJ. Psychiatric disorders and suicide in the nation's largest state prison system. J Am Acad Psychiatry Law 2009; 37:188-193. [PMID: 19535556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study examined the relationship between the overall rate of psychiatric disorders and suicides in the nation's largest state prison population. Data from 234,031 Texas Department of Criminal Justice inmates who were incarcerated for any duration between September 2006 and September 2007 were analyzed by Poisson regression, to assess the independent associations of major psychiatric disorders and demographic characteristics with suicide. Across the entire study cohort, 41 inmates (18 per 100,000) were reported to have committed suicide during the 12-month follow-up period; 21 of them had a diagnosis of a serious mental illness. An elevated risk of suicide was observed among inmates with major depressive disorder (relative risk [RR] = 5.1, 95% confidence interval [CI] = 1.9-13.8), bipolar disorder (RR = 4.6, CI = 1.3-15.9), and schizophrenia (RR = 7.3, CI = 1.7-15.9). The highest overall risk was present in those inmates with a nonschizophrenic psychotic disorder (RR = 13.8, CI = 5.8-32.9). These findings highlight the importance of maintaining suicide prevention programs in correctional settings, with particular emphasis on screening and monitoring of patients with severe psychiatric disorders.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston TX 77555, USA.
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Baillargeon J, Kelley MF, Leach CT, Baillargeon G, Pollock BH. Methicillin-Resistant Staphylococcus aureus Infection in the Texas Prison System. Clin Infect Dis 2004; 38:e92-5. [PMID: 15127360 DOI: 10.1086/383146] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Accepted: 12/21/2003] [Indexed: 11/03/2022] Open
Abstract
Recent reports indicate that correctional facility inmates may be at elevated risk for contracting methicillin-resistant Staphylococcus aureus (MRSA) infection because of overcrowding, poor hygiene, and high rates of diseases causing immunosuppression. The present study of 299,179 Texas inmates who were incarcerated between 1999-2001 indicated an incidence of 12 MRSA infections/1000 person-years. Inmates with circulatory disease, cardiovascular disease, diabetes, end-stage liver disease, end-stage renal disease, human immunodeficiency virus infection or acquired immunodeficiency syndrome, and skin diseases all exhibited elevated rates of MRSA infection.
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Affiliation(s)
- Jacques Baillargeon
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, Texas 78284-7802, USA.
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Onorato M, Borucki MJ, Baillargeon G, Paar DP, Freeman DH, Cole CP, Mayhall CG. Risk factors for colonization or infection due to methicillin-resistant Staphylococcus aureus in HIV-positive patients: a retrospective case-control study. Infect Control Hosp Epidemiol 1999; 20:26-30. [PMID: 9927262 DOI: 10.1086/501556] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the risk factors for colonization or infection with methicillin-resistant Staphylococcus aureus in human immunodeficiency virus (HIV)-infected patients. DESIGN Retrospective matched-pair case-control study. SETTING Continuity clinic and inpatient HIV service of a university medical center. POPULATION Patients with HIV infection from the general population of eastern and coastal Texas and from the Texas Department of Criminal Justice. DATA COLLECTION Patient charts and the AIDS Care and Clinical Research Program Database were reviewed for the following: age, race, number of admissions, total hospital days, presence of a central venous catheter, serum albumin, total white blood cell count and absolute neutrophil count, invasive or surgical procedures, any cultures positive for S. aureus, and a history of opportunistic illnesses, diabetes, or dermatologic diagnoses. Data also were collected on the administration of antibiotics, antiretroviral therapy, steroids, cancer chemotherapy, and subcutaneous medications. RESULTS In the univariate analysis, the presence of a central venous catheter, an underlying dermatologic disease, lower serum albumin, prior steroid therapy, and prior antibiotic therapy, particularly antistaphylococcal therapy or multiple courses of antibiotics, were associated with increased risk for colonization or infection with methicillin-resistant S. aureus. Multivariate analysis yielded a model that included presence of a central venous catheter, underlying dermatologic disease, broad-spectrum antibiotic exposure, and number of hospital days as independent risk factors for colonization or infection with methicillin-resistant S. aureus. CONCLUSIONS In our HIV-infected patient population, prior hospitalization, exposure to broad-spectrum antibiotics, presence of a central venous catheter, and dermatologic disease were risk factors for acquisition of methicillin-resistant S. aureus.
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Affiliation(s)
- M Onorato
- Department of Internal Medicine, University of Texas Medical Branch Hospitals and Clinics, Galveston 77555-0835, USA
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Baillargeon J, Wilkinson G, Rudkin L, Baillargeon G, Ray L. Characteristics of the healthy worker effect: a comparison of male and female occupational cohorts. J Occup Environ Med 1998; 40:368-73. [PMID: 9571529 DOI: 10.1097/00043764-199804000-00012] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The healthy worker effect (HWE) poses a serious methodological problem to investigators of occupational cohorts in that it may mask mortality excesses that result from occupational exposures. This problem is further complicated by the fact that the strength of the HWE generally varies according to sociodemographic, employment, and time-related factors. While the HWE has been well documented among numerous cohorts of male workers, little is known about its expression among female occupational workers. Follow-up mortality data on 44,154 employees from the Hanford nuclear facility for the period of 1944-1986 were examined using standardized mortality ratio (SMR) analysis to assess whether modifiers of the HWE were expressed differently in females than in males. Results of this analysis show that while the HWE was modified by race, age at hire, occupational class, and length of follow-up in both male and female cohorts, different patterns of modification emerged across the two subgroups. Learning about how gender differentiates expression of the HWE will help investigators more precisely assess the confounding effect of the HWE in studies of working cohorts. Therefore, this study's findings are relevant for designing and interpreting future occupational cohort studies.
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Affiliation(s)
- J Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston 77755-0836, USA
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