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Besharati S, Su E, Mohammadzadeh V, Mohammadi M, Caprioli J, Weiss RE, Nouri-Mahdavi K. Detecting Fast Progressors: Comparing a Bayesian Longitudinal Model to Linear Regression for Detecting Structural Changes in Glaucoma. Am J Ophthalmol 2024; 261:85-94. [PMID: 38281568 DOI: 10.1016/j.ajo.2024.01.024] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Demonstrate that a novel Bayesian hierarchical spatial longitudinal (HSL) model identifies macular superpixels with rapidly deteriorating ganglion cell complex (GCC) thickness more efficiently than simple linear regression (SLR). DESIGN Prospective cohort study. SETTING Tertiary Glaucoma Center. SUBJECTS One hundred eleven eyes (111 patients) with moderate to severe glaucoma at baseline and ≥4 macular optical coherence tomography scans and ≥2 years of follow-up. OBSERVATION PROCEDURE Superpixel-patient-specific GCC slopes and their posterior variances in 49 superpixels were derived from our latest Bayesian HSL model and Bayesian SLR. A simulation cohort was created with known intercepts, slopes, and residual variances in individual superpixels. MAIN OUTCOME MEASURES We compared HSL and SLR in the fastest progressing deciles on (1) proportion of superpixels identified as significantly progressing in the simulation study and compared to SLR slopes in cohort data; (2) root mean square error (RMSE), and SLR/HSL RMSE ratios. RESULTS Cohort- In the fastest decile of slopes per SLR, 77% and 80% of superpixels progressed significantly according to SLR and HSL, respectively. The SLR/HSL posterior SD ratio had a median of 1.83, with 90% of ratios favoring HSL. Simulation- HSL identified 89% significant negative slopes in the fastest progressing decile vs 64% for SLR. SLR/HSL RMSE ratio was 1.36 for the fastest decile of slopes, with 83% of RMSE ratios favoring HSL. CONCLUSION The Bayesian HSL model improves the estimation efficiency of local GCC rates of change regardless of underlying true rates of change, particularly in fast progressors.
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Affiliation(s)
- Sajad Besharati
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Erica Su
- Department of Biostatistics (R.E.W.), Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Vahid Mohammadzadeh
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Massood Mohammadi
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Caprioli
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics (R.E.W.), Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
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Su E, Mohammadzadeh V, Mohammadi M, Shi L, Law SK, Coleman AL, Caprioli J, Weiss RE, Nouri-Mahdavi K. A Bayesian Hierarchical Spatial Longitudinal Model Improves Estimation of Local Macular Rates of Change in Glaucomatous Eyes. Transl Vis Sci Technol 2024; 13:26. [PMID: 38285459 PMCID: PMC10829804 DOI: 10.1167/tvst.13.1.26] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/06/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose Demonstrate that a novel Bayesian hierarchical spatial longitudinal (HSL) model improves estimation of local macular ganglion cell complex (GCC) rates of change compared to simple linear regression (SLR) and a conditional autoregressive (CAR) model. Methods We analyzed GCC thickness measurements within 49 macular superpixels in 111 eyes (111 patients) with four or more macular optical coherence tomography scans and two or more years of follow-up. We compared superpixel-patient-specific estimates and their posterior variances derived from the latest version of a recently developed Bayesian HSL model, CAR, and SLR. We performed a simulation study to compare the accuracy of intercept and slope estimates in individual superpixels. Results HSL identified a significantly higher proportion of significant negative slopes in 13/49 superpixels and a significantly lower proportion of significant positive slopes in 21/49 superpixels than SLR. In the simulation study, the median (tenth, ninetieth percentile) ratio of mean squared error of SLR [CAR] over HSL for intercepts and slopes were 1.91 (1.23, 2.75) [1.51 (1.05, 2.20)] and 3.25 (1.40, 10.14) [2.36 (1.17, 5.56)], respectively. Conclusions A novel Bayesian HSL model improves estimation accuracy of patient-specific local GCC rates of change. The proposed model is more than twice as efficient as SLR for estimating superpixel-patient slopes and identifies a higher proportion of deteriorating superpixels than SLR while minimizing false-positive detection rates. Translational Relevance The proposed HSL model can be used to model macular structural measurements to detect individual glaucoma progression earlier and more efficiently in clinical and research settings.
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Affiliation(s)
- Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Vahid Mohammadzadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Massood Mohammadi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Lynn Shi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Simon K Law
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Anne L Coleman
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Shi L, Mohammadi M, Mohammadzadeh V, Su E, Weiss RE, Caprioli J, Nouri-Mahdavi K. Comparing Rates of Change in Moderate to Advanced Glaucoma: Retinal Nerve Fiber Layer Versus Bruch Membrane Opening-Minimum Rim Width. Am J Ophthalmol 2023; 253:181-188. [PMID: 37150336 PMCID: PMC10859221 DOI: 10.1016/j.ajo.2023.05.003] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE To compare rates of change (RoC) of peripapillary retinal nerve fiber layer (RNFL) and Bruch membrane opening-based minimum rim width (BMO-MRW) thickness in moderate-to-advanced glaucoma. DESIGN Prospective cohort study. METHODS Longitudinal optical coherence tomography (OCT) optic nerve head volume scans of 113 eyes of 113 glaucoma patients with moderate-to-advanced or central damage were exported. This study estimated and compared global and sectoral RoC with linear mixed effects models and simple linear regression (SLR) of RNFL and BMO-MRW thickness. Permutation analyses were used to test significance of RoC in the SLR model. It also compared longitudinal signal-to-noise ratios (LSNR) defined as RoC divided by residual standard deviation (SD) between the two groups. RESULTS Mean (SD) follow-up and median (IQR) OCT scan sessions were 5.2 (1.3) years and 10 (8-11), respectively. Baseline average (SD) visual field mean deviation was -9.2 (5.8) dB. Based on SLR, a higher proportion of significant negative RNFL RoC was observed compared to BMO-MRW in the inferotemporal (35% vs 20%; P = .015) and inferonasal (42% vs 17%; P < .001) sectors. Permutation analyses also demonstrated a higher proportion of worsening RNFL RoC than BMO-MRW in the inferotemporal (P = .026) and inferonasal (P < .001) sectors along with overall lower positive RoC. Longitudinal signal-to-noise ratios for RNFL were significantly more negative than for BMO-MRW globally, and in the inferotemporal, inferonasal, and superonasal sectors (P ≤ .01). CONCLUSIONS Longitudinal RNFL OCT measurements are more likely to detect structural change and demonstrate better LSNR compared with BMO-MRW in eyes with central or moderate-to-advanced glaucoma damage at baseline.
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Affiliation(s)
- Lynn Shi
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Massood Mohammadi
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Vahid Mohammadzadeh
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA (E.S, R.E.W)
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA (E.S, R.E.W)
| | - Joseph Caprioli
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M)
| | - Kouros Nouri-Mahdavi
- From Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA (L.S, M.M, V.M, J.C, K.N-M).
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Li L, Weiss RE, Heller D. Fibroepithelial stromal polyp of bladder-a mimicker of sarcoma or angiomyxoma at uncommon location. Am J Clin Exp Urol 2023; 11:348-351. [PMID: 37645615 PMCID: PMC10461029] [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] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/17/2023] [Indexed: 08/31/2023]
Abstract
The fibroepithelial stromal polyp is a benign polypoid proliferation of the stroma with overlying epithelium. Because the lesion contains atypical stromal cells, sometimes it can be overdiagnosed as sarcoma or with myxoid stroma, it can be misdiagnosed as angiomyxoma. The reported locations are mainly in the lower female genital tract, urethra, and rarely extragenital sites, such as the breast, and are exceptionally rare in the bladder. We encountered a 65-year-old man who presented with two small velvety, erythematous patches on the posterior bladder wall. The final diagnosis is a fibroepithelial stromal polyp of the bladder. Familiarity with this lesion will prevent overinterpretation of this benign lesion as a malignancy.
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Affiliation(s)
- Liping Li
- Department of Pathology, Rutgers University New Jersey Medical SchoolNewark, NJ, USA
| | - Robert E Weiss
- Department of Surgery, Division of Urology, Rutgers University New Jersey Medical SchoolNewark, NJ, USA
| | - Debra Heller
- Department of Pathology, Rutgers University New Jersey Medical SchoolNewark, NJ, USA
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Li MJ, Chau B, Garland WH, Oksuzyan S, Weiss RE, Takada S, Kao U, Lee SJ, Shoptaw SJ. Racial, gender, and psychosocial disparities in viral suppression trends among people receiving coordinated HIV care in Los Angeles County. AIDS 2023; 37:1441-1449. [PMID: 37070545 PMCID: PMC10330081 DOI: 10.1097/qad.0000000000003578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To longitudinally evaluate differences in HIV viral suppression (<200 copies/ml) by intersections of race/ethnicity, gender, and psychosocial issues in people with HIV in the Los Angeles County Medical Care Coordination Program. DESIGN We analyzed 74 649 viral load measurements over 10 184 people with HIV enrolled in the Medical Care Coordination Program between January 1, 2013 and March 1, 2020.Methods: We fit Bayesian logistic hierarchical random effects models to test interactions between gender, race/ethnicity, and a psychosocial acuity score on viral suppression over time from 1 year prior to program enrollment to 24 months after enrollment. RESULTS The probability of viral suppression declined prior to enrollment, then increased and stabilized by 6 months after enrollment. Black/African American patients with low and moderate psychosocial acuity scores did not achieve the same increase in percentage of viral suppression as those in other racial/ethnic groups. Transgender women with high psychosocial acuity scores took longer (about 1 year) to achieve the same percentage of viral suppression as clients of other gender identities. CONCLUSIONS Some racial/ethnic and gender disparities in viral suppression persisted after enrollment in the Los Angeles County Medical Care Coordination Program while accounting for psychosocial acuity score, which may be explained by factors not assessed in the program.
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Affiliation(s)
- Michael J Li
- Center for HIV Identification, Prevention and Treatment Services
- Department of Family Medicine
| | - Brendon Chau
- Department of Family Medicine
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | - Wendy H Garland
- Division of HIV and STD Programs, Los Angeles County Department of Public Health
| | - Sona Oksuzyan
- Division of HIV and STD Programs, Los Angeles County Department of Public Health
| | - Robert E Weiss
- Center for HIV Identification, Prevention and Treatment Services
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | - Sae Takada
- Division of General Internal Medicine and Health Services Research
| | - Uyen Kao
- Center for HIV Identification, Prevention and Treatment Services
- Department of Family Medicine
| | - Sung-Jae Lee
- Center for HIV Identification, Prevention and Treatment Services
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Steven J Shoptaw
- Center for HIV Identification, Prevention and Treatment Services
- Department of Family Medicine
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Lichtbroun BJ, Shinder B, Sara TG, Srivastava A, Saraiya B, Mayer TM, Cristelli R, Sadimin E, Weiss RE, Singer EA. Chromophobe Renal Cell Carcinoma with Sarcomatoid Differentiation. J Kidney Cancer VHL 2023; 10:1-8. [PMID: 37441361 PMCID: PMC10334999 DOI: 10.15586/jkcvhl.v10i3.254] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
Chromophobe renal cell carcinoma (chRCC) is one of the less common types of kidney cancer and generally portends a more favorable prognosis. RCC with sarcomatoid differentiation has a more aggressive clinical course with poor outcomes. Four cases of chRCC with varying degrees of sarcomatoid differentiation were retrospectively reviewed at our institution, and clinicopathologic data as well as clinical courses were reported. Patients with higher degrees of sarcomatoid differentiation and larger tumors at presentation generally had and worse overall survival. chRCC with sarcomatoid differentiation portends a poor prognosis with limited data on systemic treatment options for metastatic disease.
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Affiliation(s)
- Benjamin J. Lichtbroun
- Section of Urologic Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Brian Shinder
- Section of Urologic Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Tina Gowda Sara
- Section of Urologic Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Arnav Srivastava
- Section of Urologic Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Biren Saraiya
- Division of Medical Oncology, Department of Medicine, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Tina M. Mayer
- Division of Medical Oncology, Department of Medicine, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ryan Cristelli
- Division of Urologic Pathology, Department of Pathology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Evita Sadimin
- Division of Urologic Pathology, Department of Pathology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Robert E. Weiss
- Section of Urologic Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Eric A. Singer
- Section of Urologic Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Andrade WS, Tang FHF, Mariotti ACH, Mancini MW, Duarte IX, Singer EA, Weiss RE, Pasqualini R, Arap W, Arap MA. Preclinical optimization of a diode laser-based clamp-free partial nephrectomy in a large animal model. Sci Rep 2023; 13:9237. [PMID: 37286592 DOI: 10.1038/s41598-023-35891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
Kidney cancer is a common urologic malignancy with either laparoscopic (LPN) or robotic partial nephrectomy as therapeutic options of choice for localized tumors. However, renal resection and suturing are challenging steps of the procedure that can lead to complications such as prolonged warm ischemia, bleeding, and urinary fistulas. LPN with a diode laser is an efficient technique due to its cutting and/or coagulation attributes. Surprisingly, key laser features such as wavelength and power remain undefined. Using a large porcine model, we evaluated the laser range of wavelength and power in a clamp-free LPN and compared it to the established gold-standard LPN technique (i.e., cold-cutting and suturing). By analyzing surgery duration, bleeding, presence of urine leak, tissue damage related to the resected renal fragment and the remaining organ, hemoglobin levels, and renal function, we show that an optimized experimental diode laser clamp-free LPN (wavelength, 980 nm; power, 15 W) had shorter surgery time with less bleeding, and better postoperative renal function recovery when compared to the well-established technique. Together, our data indicate that partial nephrectomy with a diode laser clamp-free LPN technique is an improved alternative to the gold-standard technique. Therefore, translational clinical trials towards human patient applications are readily feasible.
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Affiliation(s)
| | - Fenny H F Tang
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
- Division of Cancer Biology, Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Marilia W Mancini
- Research and Education Center for Phototherapy in Health Sciences (NUPEN), São Carlos, SP, Brazil
| | | | - Eric A Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Section of Urologic Oncology, Division of Urology, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Robert E Weiss
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
- Division of Urology, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Renata Pasqualini
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
- Division of Cancer Biology, Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wadih Arap
- Rutgers Cancer Institute of New Jersey, Newark, NJ, USA.
- Division of Hematology/Oncology, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Marco A Arap
- Hospital Sírio-Libanês, São Paulo, SP, Brazil.
- Department of Urology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
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Hwang T, Weiss RE. EDITORIAL COMMENT. Urology 2023; 174:116-117. [PMID: 37030904 DOI: 10.1016/j.urology.2022.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/18/2022] [Indexed: 04/09/2023]
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Mohammadzadeh V, Su E, Mohammadi M, Law SK, Coleman AL, Caprioli J, Weiss RE, Nouri-Mahdavi K. Association of Blood Pressure With Rates of Macular Ganglion Cell Complex Thinning in Patients With Glaucoma. JAMA Ophthalmol 2023; 141:251-257. [PMID: 36757702 PMCID: PMC9912170 DOI: 10.1001/jamaophthalmol.2022.6092] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/25/2022] [Indexed: 02/10/2023]
Abstract
Importance There are scarce data on the association of blood pressure measures with subsequent macular structural rates of change in patients with glaucoma. Objective To investigate the association of baseline blood pressure measures with rates of change of the macular ganglion cell complex in patients with central or moderate to advanced glaucoma damage at baseline. Design, Setting, and Participants This prospective cohort study, conducted from August 2021 to August 2022, used data from patients in the Advanced Glaucoma Progression Study at the University of California, Los Angeles. Participants were between 39 and 80 years of age and had more than 4 macular imaging tests and 2 or more years of follow-up. Exposures A diagnosis of glaucoma with either central damage or a visual field mean deviation worse than -6 dB. Main Outcomes and Measures The main outcome was the association of blood pressure measures with ganglion cell complex rates of change. Macular ganglion cell complex thickness rates of change were estimated with a bayesian hierarchical model. This model included relevant demographic and clinical factors. Blood pressure measures, intraocular pressure, and their interactions were added to the model to assess the association of baseline blood pressure measures with global ganglion cell complex rates of change. Results The cohort included 105 eyes from 105 participants. The mean (SD) age, 10-2 visual field mean deviation, and follow-up time were 66.9 (8.5) years, -8.3 (5.3) dB, and 3.6 (0.4) years, respectively, and 67 patients (63.8%) were female. The racial and ethnic makeup of the cohort was 15 African American (14.3%), 23 Asian (21.9%), 12 Hispanic (11.4%), and 55 White (52.4%) individuals based on patient self-report. In multivariable analyses, female sex, history of taking blood pressure medications, higher intraocular pressure, thicker central corneal thickness, shorter axial length, higher contrast sensitivity at 12 cycles per degree, and higher baseline 10-2 visual field mean deviation were associated with faster ganglion cell complex thinning. Lower diastolic blood pressure was associated with faster rates of ganglion cell complex thinning at higher intraocular pressures. For intraocular pressures of 8 and of 16 mm Hg (10% and 90% quantiles, respectively), every 10 mm Hg-lower increment of diastolic blood pressure was associated with 0.011 μm/y slower and -0.130 μm/y faster rates of ganglion cell complex thinning, respectively. Conclusions and Relevance In this cohort study, a combination of lower diastolic blood pressure and higher intraocular pressure at baseline was associated with faster rates of ganglion cell complex thinning. These findings support consideration of evaluating and addressing diastolic blood pressure as a therapeutic measure in patients with glaucoma if supported by appropriate clinical trials.
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Affiliation(s)
- Vahid Mohammadzadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | - Massood Mohammadi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Simon K. Law
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Anne L. Coleman
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Robert E. Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
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Mohammadi M, Su E, Chew L, Mohammadzadeh V, Caprioli J, Weiss RE, Nouri-Mahdavi K. Comparison of Ganglion Cell Layer and Inner Plexiform Layer Rates of Change in Suspected and Established Glaucoma. Am J Ophthalmol 2022; 249:12-20. [PMID: 36516918 PMCID: PMC10106372 DOI: 10.1016/j.ajo.2022.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE We compared ganglion cell layer (GCL) and inner plexiform layer (IPL) rates of change (RoC) in patients with glaucoma suspect (GS) and established glaucoma (EG) to test the hypothesis that IPL thickness changes would occur earlier than GCL changes in eyes with early damage. DESIGN Prospective, cohort study. METHODS A total of 64 GS eyes (46 patients) and 112 EG eyes (112 patients) with ≥2 years of follow-up and ≥3 macular optical coherence tomography scans were included. GCL and IPL superpixel thickness measurements were exported. A Bayesian hierarchical model with random intercepts/slopes and random residual variances was fitted to estimate RoC in individual superpixels. Normalized RoC and proportions of superpixels with significantly negative and positive GCL and IPL RoC were compared within the groups. RESULTS The average (SD) follow-up time and number of scans were 3.5 (0.7) years and 4.2 (1.0), respectively, in the GS group and 3.6 (0.4) years and 7.3 (1.1) in the EG group. Mean (SD) normalized RoC was faster for GCL than IPL (-0.69 [0.05] vs -0.33 [0.04]) in the GS group, whereas it was faster for IPL (-0.47 [0.03] vs -0.28 [0.02]) in EG eyes. GCL RoC were significantly negative in 24 of 36 superpixels compared with 8 of 36 for IPL (P < .001) in GS eyes. In the EG group, 23 of 36 superpixels had significant negative IPL RoC compared with 13 of 36 superpixels for GCL (P = .006). CONCLUSIONS GCL thickness is more likely to demonstrate change over time compared with IPL in glaucoma suspects. There is no evidence of preferential IPL thinning in eyes with suspected early glaucoma damage.
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Affiliation(s)
- Massood Mohammadi
- From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (M.M., L.C., V.M., J.C., K.N-M.), University of California Los Angeles, Los Angeles, California, USA
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health (E.S., R.E.W.), University of California Los Angeles, Los Angeles, California, USA
| | - Leila Chew
- From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (M.M., L.C., V.M., J.C., K.N-M.), University of California Los Angeles, Los Angeles, California, USA
| | - Vahid Mohammadzadeh
- From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (M.M., L.C., V.M., J.C., K.N-M.), University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Caprioli
- From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (M.M., L.C., V.M., J.C., K.N-M.), University of California Los Angeles, Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health (E.S., R.E.W.), University of California Los Angeles, Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (M.M., L.C., V.M., J.C., K.N-M.), University of California Los Angeles, Los Angeles, California, USA.
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11
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Marlow M, Skeen S, Hunt X, Sundin P, Weiss RE, Mofokeng S, Makhetha M, Cluver L, Sherr L, Tomlinson M. Depression, anxiety, and psychological distress among caregivers of young children in rural Lesotho: Associations with food insecurity, household death and parenting stress. SSM - Mental Health 2022. [DOI: 10.1016/j.ssmmh.2022.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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12
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Wang J, Weiss RE. Local and global topics in text modeling of web pages nested in web sites. Comput Stat Data Anal 2022. [DOI: 10.1016/j.csda.2022.107518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Deb PQ, Weiss RE, Heller DS. Angiosarcoma of the Uterus: A Systematic Review. Int J Gynecol Pathol 2022; 41:496-502. [PMID: 34723849 DOI: 10.1097/pgp.0000000000000833] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary uterine angiosarcoma is an extremely rare neoplasm. Due to its rarity, knowledge regarding this malignancy is limited to a few scattered case reports. To better understand the prognostic factors and optimal management of these neoplasms, we have performed a systematic analysis of the disease. A systematic literature search of this entity yielded 25 reported cases of this entity. In addition, we searched the National Cancer Institute Surveillance, Epidemiology, and End Results database to find 4 additional cases and added a case diagnosed in our institution. We analyzed the patients' demographic characteristics and the different treatment protocols utilized to treat this malignancy. Patients were primarily treated by surgery with or without adjuvant chemotherapy and radiotherapy. Survival analysis was performed to examine the role of various factors in the outcome for the patients. There was no correlation with age of diagnosis, or treatment modality used, however, better outcomes were seen in patients presenting with smaller sized tumors. Our study is the first attempt to systematically study this rare malignancy in hopes of leading to a more standardized, evidence-based, and improved treatment protocol.
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14
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Mohammadzadeh V, Su E, Shi L, Coleman AL, Law SK, Caprioli J, Weiss RE, Nouri-Mahdavi K. Multivariate Longitudinal Modeling of Macular Ganglion Cell Complex: Spatiotemporal Correlations and Patterns of Longitudinal Change. Ophthalmol Sci 2022; 2:100187. [PMID: 36245763 PMCID: PMC9559093 DOI: 10.1016/j.xops.2022.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 05/20/2022] [Accepted: 06/09/2022] [Indexed: 01/11/2023]
Abstract
Purpose To investigate spatiotemporal correlations among ganglion cell complex (GCC) superpixel thickness measurements and explore underlying patterns of longitudinal change across the macular region. Design Longitudinal cohort study. Subjects One hundred eleven eyes from 111 subjects from the Advanced Glaucoma Progression Study with ≥ 4 visits and ≥ 2 years of follow-up. Methods We further developed our proposed Bayesian hierarchical model for studying longitudinal GCC thickness changes across macular superpixels in a cohort of glaucoma patients. Global priors were introduced for macular superpixel parameters to combine data across superpixels and better estimate population slopes and intercepts. Main Outcome Measures Bayesian residual analysis to inspect cross-superpixel correlations for subject random effects and residuals. Principal component analysis (PCA) to explore underlying patterns of longitudinal macular change. Results Average (standard deviation [SD]) follow-up and baseline 10-2 visual field mean deviation were 3.6 (0.4) years and -8.9 (5.9) dB, respectively. Superpixel-level random effects and residuals had the greatest correlations with nearest neighbors; correlations were higher in the superior than in the inferior region and strongest among random intercepts, followed by random slopes, residuals, and residual SDs. PCA of random intercepts showed a first large principal component (PC) across superpixels that approximated a global intercept, a second PC that contrasted the superior and inferior macula, and a third PC, contrasting inner and nasal superpixels with temporal and peripheral superpixels. PCs for slopes, residual SDs, and residuals were remarkably similar to those of random intercepts. Conclusions Introduction of cross-superpixel random intercepts and slopes is expected to improve estimation of population and subject parameters. Further model enhancement may be possible by including cross-superpixel random effects and correlations to address spatiotemporal relationships in longitudinal data sets.
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Affiliation(s)
- Vahid Mohammadzadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Lynn Shi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Anne L. Coleman
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Simon K. Law
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Robert E. Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California,Correspondence: Kouros Nouri-Mahdavi, MD, MS, 100 Stein Plaza, Los Angeles, CA, 90095.
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15
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du Fay de Lavallaz J, Zimmermann T, Badertscher P, Lopez-Ayala P, Nestelberger T, Miró Ò, Salgado E, Zaytseva X, Gafner MS, Christ M, Cullen L, Than M, Martin-Sanchez FJ, Di Somma S, Peacock WF, Keller DI, Costabel JP, Sigal A, Puelacher C, Wussler D, Koechlin L, Strebel I, Schuler S, Manka R, Bilici M, Lohrmann J, Kühne M, Breidthardt T, Clark CL, Probst M, Gibson TA, Weiss RE, Sun BC, Mueller C. Performance of the American Heart Association/American College of Cardiology/Heart Rhythm Society versus European Society of Cardiology guideline criteria for hospital admission of patients with syncope. Heart Rhythm 2022; 19:1712-1722. [PMID: 35644354 DOI: 10.1016/j.hrthm.2022.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) and European Society of Cardiology (ESC) guidelines recommend different strategies to avoid low-yield admissions in patients with syncope. OBJECTIVE The purpose of this study was to directly compare the safety and efficacy of applying admission criteria of both guidelines to patients presenting with syncope to the emergency department in 2 multicenter studies. METHODS The international BASEL IX (BAsel Syncope EvaLuation) study (median age 71 years) and the U.S. SRS (Improving Syncope Risk Stratification in Older Adults) study (median age 72 years) were investigated. Primary endpoints were sensitivity/specificity for the adjudicated diagnosis of cardiac syncope (BASEL IX only) and 30-day major adverse cardiovascular events (30d-MACE). RESULTS Among 2560 patients in the BASEL IX and 2085 in SRS studies, ACC/AHA/HRS and ESC criteria recommended admission for a comparable number of patients in BASEL IX (27% vs 28%), but ACC/AHA/HRS criteria less often in SRS (19% vs 32%; P <.01). Recommendations were discordant in ∼25% of patients. In BASEL IX, sensitivity for cardiac syncope and 30d-MACE among patients without admission criteria was comparable for ACC/AHA/HRS and ESC criteria (64% vs 65%, P = .86; and 67% vs 71%, P = .15, respectively). In SRS, sensitivity for 30d-MACE was lower with ACC/AHA/HRS (54%) vs ESC criteria (88%; P <.001). Similarly, specificity for cardiac syncope and 30d-MACE in BASEL IX was comparable for both guidelines, but in SRS the ACC/AHA/HRS guidelines showed a higher specificity for 30d-MACE than the ESC guidelines. CONCLUSION ACC/AHA/HRS and ESC guidelines showed disagreement regarding admission for 1 in 4 patients and had only modest sensitivity, all indicating possible opportunities for improvements.
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Affiliation(s)
- Jeanne du Fay de Lavallaz
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network.
| | - Tobias Zimmermann
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network; Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Òscar Miró
- GREAT Network; Hospital Clinic, Barcelona, Catalonia, Spain
| | - Emilio Salgado
- GREAT Network; Hospital Clinic, Barcelona, Catalonia, Spain
| | - Xenia Zaytseva
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; University Hospital Zürich, Zürich, Switzerland
| | - Michele Sara Gafner
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network
| | - Michael Christ
- Department of Emergency Medicine, Kantonsspital Luzern, Lucerne, Switzerland
| | - Louise Cullen
- GREAT Network; Royal Brisbane & Women's Hospital, Herston, Australia
| | - Martin Than
- GREAT Network; Christchurch Hospital, Christchurch, New Zealand
| | | | - Salvatore Di Somma
- GREAT Network; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | - W Frank Peacock
- GREAT Network; Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | | | - Alan Sigal
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Christian Puelacher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network
| | - Luca Koechlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network; Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network
| | - Sereina Schuler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; University Hospital Zürich, Zürich, Switzerland
| | | | - Murat Bilici
- Department of Orthopedics and Traumatology, Basel University Hospital, Basel, Switzerland
| | - Jens Lohrmann
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Breidthardt
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network
| | - Carol L Clark
- Beaumont Health System-Royal Oak, Royal Oak, Michigan
| | - Marc Probst
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York
| | - Thomas A Gibson
- Department of Biostatistics, University of California Fielding School of Public Health, Los Angeles, California
| | - Robert E Weiss
- Department of Biostatistics, University of California Fielding School of Public Health, Los Angeles, California
| | - Benjamin C Sun
- Department of Emergency Medicine, Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network
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Christodoulou J, Jane Rotheram-Borus M, Hayati Rezvan P, Weiss RE, Tomlinson M. Association of Early Migration with Child Growth, Cognition and Behavior in South Africa. Trop Med Int Health 2022; 27:218-225. [PMID: 34997984 DOI: 10.1111/tmi.13719] [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: 11/29/2022]
Abstract
OBJECTIVE Examine the association of migration with child growth, cognition, and behavior in South Africa. METHODS Secondary analysis assessing effects of migration on child outcomes among a population cohort of women and children (n=1,238) recruited in Cape Town, South African townships and repeatedly assessed from birth to age eight. Logistic regression models analyzed sociodemographic predictors of migration and longitudinal models assessed the association of child migration, with or without their mother, on child growth, cognition, and behavioral outcomes. RESULTS By 8 years post-birth, 41% of children born in the townships in Cape Town had migrated to the rural Eastern Cape. Staying in Cape Town, or not migrating, was associated with having an older mother. Children who migrated with their mother were shorter and weighed less than those who did not migrate. Children who migrated had larger vocabularies and those who migrated with their mothers had fewer behavioral problems than children who stayed in Cape Town. CONCLUSION Migration in South Africa between peri-urban Cape Town and rural Eastern Cape areas during a child's early years is common and is associated with both positive and negative child outcomes.
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Affiliation(s)
- Joan Christodoulou
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, USA
| | - Panteha Hayati Rezvan
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
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Asarnow RF, Newman N, Su E, Weiss RE. Understanding Associations Between Attention-Deficit/Hyperactivity Disorder and Traumatic Brain Injury-Reply. JAMA Pediatr 2022; 176:102-103. [PMID: 34694335 DOI: 10.1001/jamapediatrics.2021.4281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Robert F Asarnow
- Department of Psychiatry, University of California, Los Angeles, Los Angeles.,Department of Psychology, University of California, Los Angeles, Los Angeles.,Brain Research Institute, University of California, Los Angeles, Los Angeles
| | - Nina Newman
- Fielding Graduate University, Playa Vista, California
| | - Erica Su
- Department of Biostatistics, University of California, Los Angeles, Fielding School of Public Health, Los Angeles
| | - Robert E Weiss
- Department of Biostatistics, University of California, Los Angeles, Fielding School of Public Health, Los Angeles
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18
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Park JW, Dobs AS, Ho KS, Palella FJ, Seaberg EC, Weiss RE, Detels R. Characteristics and Longitudinal Patterns of Erectile Dysfunction Drug Use Among Men Who Have Sex with Men in the U.S. Arch Sex Behav 2021; 50:2887-2896. [PMID: 34590217 PMCID: PMC8563532 DOI: 10.1007/s10508-021-02065-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 04/26/2021] [Accepted: 06/02/2021] [Indexed: 06/02/2023]
Abstract
We investigated the longitudinal relationship between erectile dysfunction (ED) drug use with behavioral factors, including substance use and sexual activities in men who have sex with men from the Multicenter AIDS Cohort Study during 1998-2016 (n = 1636). We used a bivariate random-intercept model to evaluate ED drug use along with other behavioral factors to assess relationships between the two outcomes over time on a population level and also at the individual level. Average ED drug use among men who have sex with men (MSM) with HIV was positively correlated with average use of marijuana (r = .19), poppers (r = .27), and stimulants (r = .25). In this group, testosterone use (r = .32), multiple partners (r = .41), insertive anal intercourse with condom (r = .40), and insertive anal intercourse without condom (r = .43) all showed moderate correlations over time with average ED use (p < .001). Associations among MSM without HIV were similar, with average marijuana use (r = .19) and stimulant use (r = .22) being positively correlated with average ED drug use, and were also correlated with having multiple partners (r = .36), insertive anal intercourse with condom (r = .22), and insertive anal intercourse without condom (r = .18) over time. Positive within-individual associations between ED drug use and multiple partners and insertive anal intercourse with and without condom were observed regardless of HIV serostatus. This study showed that MSM who reported use of ED drugs were also, on average, more likely to use recreational drugs and engage in sexual activities, such as having multiple partners and insertive anal intercourse. Within individuals, average ED drug use was also positively correlated with sexual behaviors.
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Affiliation(s)
- Jee Won Park
- Department of Epidemiology, 71-269 CHS, Fielding School of Public Health, University of California, Los Angeles, CA, 90095-1772, USA
| | - Adrian S Dobs
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ken S Ho
- Department of Medicine, University of Pittsburg, Pittsburgh, PA, USA
| | - Frank J Palella
- Division of Infectious Diseases, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Eric C Seaberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Roger Detels
- Department of Epidemiology, 71-269 CHS, Fielding School of Public Health, University of California, Los Angeles, CA, 90095-1772, USA.
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19
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Abstract
IMPORTANCE There are conflicting accounts about the risk for attention-deficit/hyperactivity disorder (ADHD) following traumatic brain injury (TBI), possibly owing to variations between studies in acute TBI severity or when ADHD was assessed postinjury. Analysis of these variations may aid in identifying the risk. OBJECTIVE To conduct a meta-analysis of studies assessing ADHD diagnoses in children between ages 4 and 18 years following concussions and mild, moderate, or severe TBI. DATA SOURCES PubMed, PsycInfo, and Cochrane Central Register of Controlled Trials (1981-December 19, 2019) were searched including the terms traumatic brain injury, brain injuries, closed head injury, blunt head trauma, concussion, attention deficit disorders, ADHD, and ADD in combination with childhood, adolescence, pediatric, infant, child, young adult, or teen. STUDY SELECTION Limited to English-language publications in peer-reviewed journals and patient age (4-18 years). Differences about inclusion were resolved through consensus of 3 authors. DATA EXTRACTION AND SYNTHESIS MOOSE guidelines for abstracting and assessing data quality and validity were used. Odds ratios with 95% credible intervals (CrIs) are reported. MAIN OUTCOMES AND MEASURES The planned study outcome was rate of ADHD diagnoses. RESULTS A total of 12 374 unique patients with TBI of all severity levels and 43 491 unique controls were included in the 24 studies in this review (predominantly male: TBI, 61.8%; noninjury control, 60.9%; other injury control, 66.1%). The rate of pre-TBI ADHD diagnoses was 16.0% (95% CrI, 11.3%-21.7%), which was significantly greater than the 10.8% (95% CrI, 10.2%-11.4%) incidence of ADHD in the general pediatric population. Compared with children without injuries, the odds for ADHD were not significantly increased following concussion (≤1 year: OR, 0.32; 95% CrI, 0.05-1.13), mild TBI (≤1 year: OR, 0.56; 0.16-1.43; >1 year: OR, 1.07; 95% CrI, 0.35-2.48), and moderate TBI (≤1 year: OR, 1.28; 95% CrI, 0.35-3.34; >1 year: OR, 3.67; 95% CrI, 0.83-10.56). The odds for ADHD also were not significantly increased compared with children with other injuries following mild TBI (≤1 year: OR, 1.07; 95% CrI, 0.33-2.47; >1 year: OR, 1.18; 95% CrI, 0.32-3.12) and moderate TBI (≤1 year: OR, 2.34; 95% CrI, 0.78-5.47; >1 year: OR, 3.78; 95% CrI, 0.93-10.33). In contrast, the odds for ADHD following severe TBI were increased at both time points following TBI compared with children with other injuries (≤1 year: OR, 4.81; 95% CrI, 1.66-11.03; >1 year: OR, 6.70; 95% CrI, 2.02-16.82) and noninjured controls (≤1 year: OR, 2.62; 95% CrI, 0.76-6.64; >1 year: OR, 6.25; 95% CrI, 2.06-15.06), as well as those with mild TBI (≤1 year OR, 5.69; 1.46-15.67: >1 year OR, 6.65; 2.14-16.44). Of 5920 children with severe TBI, 35.5% (95% CrI, 20.6%-53.2%) had ADHD more than 1 year postinjury. CONCLUSIONS AND RELEVANCE This study noted a significant association between TBI severity and ADHD diagnosis. In children with severe but not mild and moderate TBI, there was an association with an increase in risk for ADHD. The high rate of preinjury ADHD in children with TBI suggests that clinicians should carefully review functioning before a TBI before initiating treatment.
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Affiliation(s)
- Robert F. Asarnow
- Department of Psychiatry, University of California, Los Angeles,Department of Psychology, University of California, Los Angeles,Brain Research Institute, University of California, Los Angeles
| | - Nina Newman
- School of Psychology, Fielding Graduate University, Playa Vista, California
| | - Robert E. Weiss
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California
| | - Erica Su
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California
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20
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Mohammadzadeh V, Su E, Heydar Zadeh S, Law SK, Coleman AL, Caprioli J, Weiss RE, Nouri-Mahdavi K. Estimating Ganglion Cell Complex Rates of Change With Bayesian Hierarchical Models. Transl Vis Sci Technol 2021; 10:15. [PMID: 34003991 PMCID: PMC8054624 DOI: 10.1167/tvst.10.4.15] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Develop a hierarchical longitudinal regression model for estimating local rates of change of macular ganglion cell complex (GCC) measurements with optical coherence tomography (OCT). Methods We enrolled 112 eyes with four or more macular OCT images and ≥2 years of follow-up. GCC thickness measurements within central 6 × 6 superpixels were extracted from macular volume scans. We fit data from each superpixel separately with several hierarchical Bayesian random-effects models. Models were compared with the Watanabe–Akaike information criterion. For our preferred model, we estimated population and individual slopes and intercepts (baseline thickness) and their correlation. Results Mean (SD) follow-up time and median (interquartile range) baseline 24-2 visual field mean deviation were 3.6 (0.4) years and −6.8 (−12.2 to −4.3) dB, respectively. The random intercepts and slopes model with random residual variance was the preferred model. While more individual and population negative slopes were observed in the paracentral and papillomacular superpixels, superpixels in the superotemporal and inferior regions displayed the highest correlation between baseline thickness and rates of change (r = –0.43 to –0.50 for the top five correlations). Conclusions A Bayesian linear hierarchical model with random intercepts/slopes and random variances is an optimal initial model for estimating GCC slopes at population and individual levels. This novel model is an efficient method for estimating macular rates of change and probability of glaucoma progression locally. Translational Relevance The proposed Bayesian hierarchical model can be applied to various macular outcomes from different OCT devices and to superpixels of variable sizes to estimate local rates of change and progression probability.
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Affiliation(s)
- Vahid Mohammadzadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Sepideh Heydar Zadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Simon K Law
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Anne L Coleman
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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21
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Hunt X, Laurenzi C, Skeen S, Swartz L, Sundin P, Weiss RE, Tomlinson M. Family disability, poverty and parenting stress: Analysis of a cross-sectional study in Kenya. Afr J Disabil 2021; 10:744. [PMID: 34230880 PMCID: PMC8252132 DOI: 10.4102/ajod.v10i0.744] [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: 04/09/2020] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Households with a disabled member, be they a caregiver or a child, are poorer than households not affected by disability. Poverty, caregiving as a person with a disability and being the caregiver of a child with a disability can lead to increased parenting stress. OBJECTIVES The objective of this study was to examine whether parenting stress experienced by caregivers in a household with a disabled member is greater when the disabled member is the caregiver, or the child, and how much of these respective relationships is explained by poverty. METHOD We collected cross-sectional data using a demographic survey, the Washington Group Questions on adult disability, the 10 Questions on child disability and the Parenting Stress Index-Short Form, from 465 caregivers enrolled in a non-governmental child development programme in Kenya. RESULTS Households with a disabled member were poorer than households without a disabled member. Parenting stress of disabled caregivers was higher than parenting stress of non-disabled caregivers; however, this relationship disappeared when socio-economic status was controlled for. Caregivers of disabled children were more stressed than caregivers of non-disabled children, and this effect was not explained by differences in socio-economic status. CONCLUSION Our findings highlight the importance of developing a comprehensive understanding of the stressors facing households with a disabled member, particularly if that member is a child, so that supportive interventions can adequately cater to the needs of caregivers, and their children, in the context of poverty.
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Affiliation(s)
- Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Faculty of Health Sciences, Stellenbosch University, Bellville, South Africa
| | - Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Health Sciences, Stellenbosch University, Bellville, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Health Sciences, Stellenbosch University, Bellville, South Africa
| | - Leslie Swartz
- Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Phillip Sundin
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, United States of America
| | - Robert E. Weiss
- Department of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, United States of America
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Health Sciences, Stellenbosch University, Bellville, South Africa
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
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22
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Laurenzi CA, Hunt X, Skeen S, Sundin P, Weiss RE, Kosi V, Rotheram-Borus MJ, Tomlinson M. Associations between caregiver mental health and young children's behaviour in a rural Kenyan sample. Glob Health Action 2021; 14:1861909. [PMID: 33397222 PMCID: PMC7801103 DOI: 10.1080/16549716.2020.1861909] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Research shows that caregiver mental health problems have direct, significant effects on child behaviour. While these risks are amplified in low-resource settings, limited evidence exists from these places, especially sub-Saharan Africa. Objective: We measured associations between caregiver mental health and child behaviour in a rural Kenyan sample, hypothesizing that higher rates of caregiver mental health would be associated with increased child behavioural problems. We also sought to provide an overview of caregiver mental health symptoms in our sample. Method: Cross-sectional data were collected from caregivers of children ages 4–5 years old enrolled in a community-based early child development programme in western Kenya. 465 caregivers were recruited and assessed at baseline, and answered questions about child behaviour, mental health symptoms (depression, anxiety, stress), and help-seeking. A multivariate linear regression model was used to assess significance of each mental health factor. Results: Caregiver anxiety (p = 0.01) and parenting stress (p < 0.001) were significantly associated with child behavioural problems. 245 caregivers (52.9%) had high levels of symptoms of depression, anxiety, or both; furthermore, 101 caregivers (21.7%) scored above the cut-off for both of these scales. A high proportion of our sample (60.6%) reported seeking some formal or informal psychosocial support services; however, less than one-third of these caregivers were symptomatic (30.9%). Conclusion: Anxiety and stress were associated with poorer child behavioural outcomes. Our sample reflected a higher prevalence of caregiving adults with mental health symptomology than previous estimates from Kenya, with few high-symptom caregivers seeking support. We discuss further implications for programming and health services delivery.
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Affiliation(s)
- Christina A Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Phillip Sundin
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | | | - Mary Jane Rotheram-Borus
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,School of Nursing and Midwifery, Queens University , Belfast, UK
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23
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Bura E, Li B, Li L, Nachtsheim C, Pena D, Setodji C, Weiss RE. A Conversation with Dennis Cook. Stat Sci 2021. [DOI: 10.1214/20-sts801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Efstathia Bura
- Efstathia Bura is University Professor and Chair of the Applied Statistics Research Group, Institute of Statistics and Mathematical Methods in Economics, Faculty of Mathematics and Geoinformation, TU Wien, Vienna, Austria
| | - Bing Li
- Bing Li is Verne M. Willaman Professor of Statistics, Department of Statistics, Pennsylvania State University, University Park, Pennsylvania, 16802, USA
| | - Lexin Li
- Lexin Li is Professor, Department of Biostatistics and Epidemiology, and Helen Wills Neuroscience Institute, University of California, Berkeley, California, 94720, USA
| | - Christopher Nachtsheim
- Christopher Nachtsheim is the Frank A. Donaldson Chair of Operations Management, Carlson School of Management, University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Daniel Pena
- Daniel Pena is Professor of Statistics, Institute of Big Data and Department of Statistics, Universidad Carlos III de Madrid, Madrid 28903, Spain
| | - Claude Setodji
- Claude Setodji is the co-director of the RAND Center for Causal Inference, RAND Corporation, Pittsburgh, Pennsylvania, 15231, USA
| | - Robert E. Weiss
- Robert E. Weiss is Professor, Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, 90095, USA
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24
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Nouri-Mahdavi K, Weiss RE. Detection of Glaucoma Deterioration in the Macular Region with Optical Coherence Tomography: Challenges and Solutions. Am J Ophthalmol 2021; 222:277-284. [PMID: 32950510 DOI: 10.1016/j.ajo.2020.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Macular imaging with optical coherence tomography (OCT) measures the most critical retinal ganglion cells (RGCs) in the human eye. The goal of this perspective is to review the challenges to detection of glaucoma progression with macular OCT imaging and propose ways to enhance its performance. DESIGN Perspective with review of relevant literature. METHODS Review of challenges and issues related to detection of change on macular OCT images in glaucoma eyes. The primary outcome measures were confounding factors affecting the detection of change on macular OCT images. RESULTS The main challenges to detection of structural progression in the macula consist of the magnitude of and the variable amount of test-retest variability among patients, the confounding effect of aging, lack of a reliable and easy-to-measure functional outcome or external standard, the confounding effects of concurrent macular conditions including myopia, and the measurement floor of macular structural outcomes. Potential solutions to these challenges include controlling head tilt or torsion during imaging, estimating within-eye variability for individual patients, improved data visualization, the use of artificial intelligence methods, and the implementation of statistical approaches suitable for multidimensional longitudinal data. CONCLUSIONS Macular OCT imaging is a crucial structural imaging modality for assessing central RGCs. Addressing the current shortcomings in acquisition and analysis of macular volume scans can enhance its utility for measuring the health of central RGCs and therefore assist clinicians with timely institution of appropriate treatment.
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Affiliation(s)
- Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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25
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Mayeda ER, Mobley TM, Weiss RE, Murchland AR, Berkman LF, Sabbath EL. Association of work-family experience with mid- and late-life memory decline in US women. Neurology 2020; 95:e3072-e3080. [PMID: 33148811 PMCID: PMC7734924 DOI: 10.1212/wnl.0000000000010989] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that life course patterns of employment, marriage, and childrearing influence later-life rate of memory decline among women, we examined the relationship of work-family experiences between ages 16 and 50 years and memory decline after age 55 years among US women. METHODS Participants were women ages ≥55 years in the Health and Retirement Study. Participants reported employment, marital, and parenthood statuses between ages 16 and 50 years. Sequence analysis was used to group women with similar work-family life histories; we identified 5 profiles characterized by similar timing and transitions of combined work, marital, and parenthood statuses. Memory performance was assessed biennially from 1995 to 2016. We estimated associations between work-family profiles and later-life memory decline with linear mixed-effects models adjusted for practice effects, baseline age, race/ethnicity, birth region, childhood socioeconomic status, and educational attainment. RESULTS There were 6,189 study participants (n = 488 working nonmothers, n = 4,326 working married mothers, n = 530 working single mothers, n = 319 nonworking single mothers, n = 526 nonworking married mothers). Mean baseline age was 57.2 years; average follow-up was 12.3 years. Between ages 55 and 60, memory scores were similar across work-family profiles. After age 60, average rate of memory decline was more than 50% greater among women whose work-family profiles did not include working for pay after childbearing, compared with those who were working mothers. CONCLUSIONS Women who worked for pay in early adulthood and midlife experienced slower rates of later-life memory decline, regardless of marital and parenthood status, suggesting participation in the paid labor force may protect against later-life memory decline.
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Affiliation(s)
- Elizabeth Rose Mayeda
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA.
| | - Taylor M Mobley
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA
| | - Robert E Weiss
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA
| | - Audrey R Murchland
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA
| | - Lisa F Berkman
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA
| | - Erika L Sabbath
- From the Departments of Epidemiology (E.R.M., T.M.M.) and Biostatistics (R.E.W.), University of California, Los Angeles Fielding School of Public Health; Department of Epidemiology and Biostatistics (E.R.M., A.R.M.), University of California, San Francisco; Departments of Epidemiology (A.R.M., L.F.B.) and Social and Behavioral Sciences (L.F.B.), Harvard T.H. Chan School of Public Health, Boston; and School of Social Work (E.L.S.), Boston College, Chestnut Hill, MA
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26
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Sterling J, Rivera-Núñez Z, Patel HV, Farber NJ, Kim S, Radadia KD, Modi PK, Goyal S, Parikh R, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Factors Associated With Receipt of Partial Nephrectomy or Minimally Invasive Surgery for Patients With Clinical T1a and T1b Renal Masses: Implications for Regionalization of Care. Clin Genitourin Cancer 2020; 18:e643-e650. [PMID: 32389458 PMCID: PMC7502425 DOI: 10.1016/j.clgc.2020.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/13/2020] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To identify factors associated with receipt of partial nephrectomy (PN) and minimally invasive surgery (MIS) in patients with clinical T1 renal cell carcinoma (RCC) using the National Cancer Data Base (NCDB). METHODS We queried the NCDB from 2010 to 2014 identifying patients treated surgically for cT1a-bN0M0 RCC. Logistic regression was used to examine associations between socioeconomic, clinical, and treatment factors, and receipt of MIS or PN within the T1 patient population. RESULTS Our cohort included 69,694 patients (cT1a, n = 44,043; cT1b, n = 25,651). For cT1a tumors, 70% of patients received PN and 65% underwent MIS. For cT1b tumors, 32% of patients received PN and 62% underwent MIS. cT1a and cT1b patients with household income < $62,000, without private insurance, and treated outside academic centers were less likely to receive MIS or PN. cT1a patients traveling > 31 miles were more likely to undergo MIS. For both cT1a/b, the farther a patient traveled for treatment, the more likely a PN was performed. CONCLUSION Data showed an increase in utilization of MIS and PN from 2010 to 2014. However, patients in the lowest socioeconomic groups were less likely to travel and were more likely to receive more invasive treatments. On the basis of these findings, additional research is needed into how regionalization of RCC surgery affects treatment disparities.
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Affiliation(s)
- Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Zorimar Rivera-Núñez
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Kushan D Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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27
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Fischer H, Weiss RE, Friedman AN, Imam TH, Coleman KJ. The relationship between kidney function and body mass index before and after bariatric surgery in patients with chronic kidney disease. Surg Obes Relat Dis 2020; 17:508-515. [PMID: 33358080 DOI: 10.1016/j.soard.2020.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/29/2020] [Revised: 10/07/2020] [Accepted: 11/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Improvements in kidney function post-bariatric surgery may be related to weight loss-independent effects. OBJECTIVES To characterize the dynamic relationship between body mass index (BMI) and estimated glomerular filtration rate (eGFR) before and after bariatric surgery in patients with chronic kidney disease (CKD). SETTING Kaiser Permanente Southern California (KPSC) health system. METHODS We conducted an observational, retrospective cohort study of patients with CKD stage 3 or higher who received bariatric surgery at the KPSC health system between 2007-2015. Bariatric surgery procedures included primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) procedures. Outcomes consisted of mean trajectory estimates and correlations of BMI and eGFR taken between 2 years before and 3 years after surgery. Multivariate functional mixed models were used to estimate how BMI and eGFR trajectories evolved jointly. RESULTS A total of 619 RYGB and 474 SG patients were included in the final analytic sample. The measurements were available before surgery for a median time of 1.9 years for SG and 1.8 years for RYGB patients. Median follow-up times after surgery were 2.8 years for both SG and RYGB patients. The mean age at the time of surgery was 58 years; 77% of patients were women; 56% of patients were non-Hispanic White; the mean BMI was 44 kg/m2; 60% of patients had diabetes mellitus; and 84% of patients had hypertension. Compared to the presurgery eGFR declines, the postsurgery declines in eGFR were 57% slower (95% credible interval [CrI], 33%-81%) for RYGB patients and 55% slower (95% CrI, 25%-75%) for SG patients. The mean correlation between BMI and eGFR was negligible at all time points. CONCLUSION Though bariatric surgery slowed declines in eGFR up to 3 years after surgery, changes in eGFR tracked poorly with changes in BMI. This study provides evidence that the kidney-related benefits of bariatric surgery may be at least partly independent of weight loss. Confirming this hypothesis could lead to mechanistic insights and new treatment options for CKD.
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Affiliation(s)
- Heidi Fischer
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
| | - Robert E Weiss
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California
| | - Allon N Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Talha H Imam
- Department of Nephrology, Fontana Medical Center, Kaiser Permanente Southern California, Fontana, California
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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28
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Ramos AP, Flores MJ, Weiss RE. Leave no child behind: Using data from 1.7 million children from 67 developing countries to measure inequality within and between groups of births and to identify left behind populations. PLoS One 2020; 15:e0238847. [PMID: 33052926 PMCID: PMC7556530 DOI: 10.1371/journal.pone.0238847] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 08/25/2020] [Indexed: 11/25/2022] Open
Abstract
Background Goal 3.2 from the Sustainable Development Goals (SDG) calls for reductions in national averages of Under-5 Mortality. However, it is well known that within countries these reductions can coexist with left behind populations that have mortality rates higher than national averages. To measure inequality in under-5 mortality and to identify left behind populations, mortality rates are often disaggregated by socioeconomic status within countries. While socioeconomic disparities are important, this approach does not quantify within group variability since births from the same socioeconomic group may have different mortality risks. This is the case because mortality risk depends on several risk factors and their interactions and births from the same socioeconomic group may have different risk factor combinations. Therefore mortality risk can be highly variable within socioeconomic groups. We develop a comprehensive approach using information from multiple risk factors simultaneously to measure inequality in mortality and to identify left behind populations. Methods We use Demographic and Health Surveys (DHS) data on 1,691,039 births from 182 different surveys from 67 low and middle income countries, 51 of which had at least two surveys. We estimate mortality risk for each child in the data using a Bayesian hierarchical logistic regression model. We include commonly used risk factors for monitoring inequality in early life mortality for the SDG as well as their interactions. We quantify variability in mortality risk within and between socioeconomic groups and describe the highest risk sub-populations. Findings For all countries there is more variability in mortality within socioeconomic groups than between them. Within countries, socioeconomic membership usually explains less than 20% of the total variation in mortality risk. In contrast, country of birth explains 19% of the total variance in mortality risk. Targeting the 20% highest risk children based on our model better identifies under-5 deaths than targeting the 20% poorest. For all surveys, we report efficiency gains from 26% in Mali to 578% in Guyana. High risk births tend to be births from mothers who are in the lowest socioeconomic group, live in rural areas and/or have already experienced a prior death of a child. Interpretation While important, differences in under-5 mortality across socioeconomic groups do not explain most of overall inequality in mortality risk because births from the same socioeconomic groups have different mortality risks. Similarly, policy makers can reach the highest risk children by targeting births based on several risk factors (socioeconomic status, residing in rural areas, having a previous death of a child and more) instead of using a single risk factor such as socioeconomic status. We suggest that researchers and policy makers monitor inequality in under-5 mortality using multiple risk factors simultaneously, quantifying inequality as a function of several risk factors to identify left behind populations in need of policy interventions and to help monitor progress toward the SDG.
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Affiliation(s)
- Antonio P. Ramos
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, United States of America
- California Center for Population Research, UCLA, Los Angeles, CA, United States of America
- * E-mail:
| | - Martin J. Flores
- Department of General Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, United States of America
| | - Robert E. Weiss
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, United States of America
- California Center for Population Research, UCLA, Los Angeles, CA, United States of America
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29
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Edwards GG, Reback CJ, Cunningham WE, Hilliard CL, McWells C, Mukherjee S, Weiss RE, Harawa NT. Mobile-Enhanced Prevention Support Study for Men Who Have Sex With Men and Transgender Women Leaving Jail: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18106. [PMID: 32959786 PMCID: PMC7539160 DOI: 10.2196/18106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background Men who have sex with men (MSM) and transgender women, particularly those who have experienced criminal justice involvement, have particularly high HIV burdens, and a majority of those in jail have substance use disorders (SUDs). MSM and transgender women also experience elevated rates of incarceration. Once community re-entry occurs, individuals are in a critical period for addressing potential risks of HIV and sexually transmitted infection (STI) acquisition and negative sequelae of substance use. Further, the impact experienced by one’s social and sexual networks experienced at the time of detention and release have important health implications for MSM and transgender women. Objective The purpose of this study is to test a new intervention—Mobile-Enhanced Prevention Support (MEPS)—that involves a GPS-based mobile app called GeoPassport (referred to as GeoPass in practice), incentives, and peer support for promoting HIV prevention, substance use treatment, and use of related services. Methods A two-arm, unblinded, randomized controlled trial will seek to enroll 300 HIV-negative MSM and transgender women, aged 18-49 years, with SUDs, who are either in jail or have recently left jail. Participants will be enrolled by study staff and randomized to the MEPS intervention group or usual care group. The intervention group will receive customized wellness goals in addition to GeoPass, cash incentives, and the support of a trained peer mentor for 6 months. Data collection will consist of a baseline survey and three follow-up surveys at 3, 6, and 9 months postenrollment, either in person or by phone or videoconference when necessary. The primary outcomes include establishing a primary care provider; being prescribed and adhering to pre-exposure prophylaxis (PrEP) for HIV; screening for HIV, STIs, and hepatitis C virus; and engagement in recommended treatment for SUDs. Secondary outcomes include obtaining treatment for any identified infections and avoiding recidivism. Results Enrollment began in November 2019 and study completion is expected in 2023. Conclusions This study will advance our knowledge base on patient navigation and peer mentor interventions. Peer navigation services have been studied for the treatment of HIV, but less often in the context of HIV and STI prevention among sexual and gender minority populations at the time of re-entry into the community from jail. The MEPS study will examine the acceptability and feasibility of combining peer mentor services with a mobile app to facilitate service utilization and participant–peer mentor communication. MEPS will assess patterns of PrEP uptake and utilization in MSM and transgender women leaving jail. The study will provide heretofore unavailable data from persons leaving jail regarding HIV PrEP, STI screening, substance abuse treatment, and service utilization patterns and experiences, including geocoded data for those in the intervention arm. Trial Registration ClinicalTrials.gov (NCT04036396); https://www.clinicaltrials.gov/ct2/show/NCT04036396 International Registered Report Identifier (IRRID) PRR1-10.2196/18106
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Affiliation(s)
- Gabriel G Edwards
- Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cathy J Reback
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States.,Friends Research Institute, Los Angeles, CA, United States
| | - William E Cunningham
- Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States
| | - Charles L Hilliard
- Los Angeles Centers for Alcohol and Drug Abuse, Los Angeles, CA, United States
| | - Charles McWells
- Los Angeles Centers for Alcohol and Drug Abuse, Los Angeles, CA, United States
| | - Sukrit Mukherjee
- Department of Preventative and Social Medicine, Charles R Drew University, Los Angeles, CA, United States.,Center for Biomedical Informatics, Charles R Drew University, Los Angeles, CA, United States
| | - Robert E Weiss
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nina T Harawa
- Department of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry, Charles R Drew University, Los Angeles, CA, United States
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30
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Harawa NT, Schrode KM, McWells C, Weiss RE, Hilliard CL, Bluthenthal RN. Small Randomized Controlled Trial of the New Passport to Wellness HIV Prevention Intervention for Black Men Who Have Sex With Men (BMSM). AIDS Educ Prev 2020; 32:311-324. [PMID: 32897130 PMCID: PMC7685520 DOI: 10.1521/aeap.2020.32.4.311] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We developed and tested Passport to Wellness (PtW), a client-centered intervention to improve engagement in HIV/STI prevention and services to improve social determinants of health among Black men who have sex with men (BMSM) using incentives and peer support. We assessed PtW's impact on HIV/STI screening and pre/post-exposure prophylaxis (PrEP/PEP) knowledge/uptake using a randomized trial that compared the full intervention to one lacking peer support. We compared changes within groups surveyed at baseline and 6 months. We enrolled 80 eligible BMSM, among 399 screened. Among retained participants (34 peer-supported; 27 comparison), overall increases were observed in HIV (30% to 87%; p < .001) and STI (28% to 80%; p < .001) testing within the prior 6 months, as well as in PrEP and PEP awareness, and PrEP use. Statistically significant between group differences were not observed. Tailored prevention planning, incentives, and addressing social determinants may help move Black MSM along the HIV prevention continuum.
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Affiliation(s)
- Nina T Harawa
- David Geffen School of Medicine at the University of California Los Angeles (UCLA), Los Angeles, California
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles
| | - Katrina M Schrode
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles
| | | | | | - Charles L Hilliard
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles
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Srivastava A, Rivera-Núñez Z, Kim S, Sterling J, Farber NJ, Radadia KD, Patel HV, Modi PK, Goyal S, Parikh R, Mayer TM, Saraiya B, Sadimin ET, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Impact of pathologic lymph node-positive renal cell carcinoma on survival in patients without metastasis: Evidence in support of expanding the definition of stage IV kidney cancer. Cancer 2020; 126:2991-3001. [PMID: 32329899 DOI: 10.1002/cncr.32912] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/01/2020] [Accepted: 02/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stage III renal cell carcinoma (RCC) encompasses both lymph node-positive (pT1-3N1M0) and lymph node-negative (pT3N0M0) disease. However, prior institutional studies have indicated that among patients with stage III disease, those with lymph node disease have worse oncologic outcomes and experience survival that is similar to that of patients with American Joint Committee on Cancer (AJCC) stage IV disease. The objective of the current study was to validate these findings using a large, nationally representative sample of patients with kidney cancer. METHODS Patients with AJCC stage III or stage IV RCC were identified using the National Cancer Data Base (NCDB). Patients were categorized as having lymph node-positive stage III (pT1-3N1M0), lymph node-negative stage III (pT3N0M0), or stage IV metastatic (pT1-3 N0M1) disease. Cox proportional hazards models compared outcomes while adjusting for comorbidities. Kaplan-Meier estimates illustrated relative survival when comparing staging groups. RESULTS A total of 8988 patients met the inclusion criteria, with 6587 patients classified as having lymph node-negative stage III disease, 2218 as having lymph node-positive stage III disease, and 183 as having stage IV disease. Superior survival was noted among patients with lymph node-negative stage III disease, but similar survival was noted between patients with lymph node-positive stage III and stage IV RCC, with 5-year survival rates of 61.9% (95% confidence interval [95% CI], 60.3%-63.4%), 22.7% (95% CI, 20.6%-24.9%), and 15.6% (95% CI, 11.1%-23.8%), respectively. CONCLUSIONS Current RCC staging systems group pT1-3N1M0 and pT3N0M0 disease as stage III disease. However, the results of the current validation study suggest the need for further stratification and even placement of patients with pT1-3N1M0 disease into the stage IV category. Staging that accurately reflects oncologic prognosis may help clinicians better counsel and select patients who might derive the most benefit from lymphadenectomy, adjuvant systemic therapy, more rigorous imaging surveillance, and clinical trial participation.
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Affiliation(s)
- Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Zorimar Rivera-Núñez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Kushan D Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Tina M Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Biren Saraiya
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Evita T Sadimin
- Division of Genitourinary Pathology and Informatics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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32
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Moore AB, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Frequency of Abnormal and Critical Laboratory Results in Older Patients Presenting to the Emergency Department With Syncope. Acad Emerg Med 2020; 27:161-164. [PMID: 31837233 DOI: 10.1111/acem.13906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/02/2019] [Accepted: 12/11/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Andrew B. Moore
- From the Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath & Science University Portland OR
| | - Erica Su
- Department of Biostatistics University of California Los Angeles CA
| | - Robert E. Weiss
- Department of Biostatistics University of California Los Angeles CA
| | - Annick N. Yagapen
- From the Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath & Science University Portland OR
| | - Susan E. Malveau
- From the Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath & Science University Portland OR
| | - David H. Adler
- Department of Emergency Medicine University of Rochester Rochester NY
| | - Aveh Bastani
- Department of Emergency Medicine William Beaumont Hospital–Troy Troy MI
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Carol L. Clark
- Department of Emergency Medicine William Beaumont Hospital–Royal Oak Royal Oak MI
| | - Deborah B. Diercks
- Department of Emergency Medicine University of Texas‐Southwestern Dallas TX
| | - Judd E. Hollander
- Department of Emergency Medicine Thomas Jefferson University Hospital Philadelphia PA
| | - Bret A. Nicks
- Department of Emergency Medicine Wake Forest School of Medicine Winston Salem NC
| | | | - Manish N. Shah
- Department of Emergency Medicine University of Wisconsin–Madison Madison WI
| | - Kirk A. Stiffler
- Department of Emergency Medicine Northeast Ohio Medical University Rootstown OH
| | - Alan B. Storrow
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN
| | - Scott T. Wilber
- Department of Emergency Medicine Northeast Ohio Medical University Rootstown OH
| | - Benjamin C. Sun
- and the Department of Emergency Medicine University of Pennsylvania Philadelphia PA
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Goodman-Meza D, Weiss RE, Gamboa S, Gallegos A, Bui AAT, Goetz MB, Shoptaw S, Landovitz RJ. Long term surgical outcomes for infective endocarditis in people who inject drugs: a systematic review and meta-analysis. BMC Infect Dis 2019; 19:918. [PMID: 31699053 PMCID: PMC6839097 DOI: 10.1186/s12879-019-4558-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/11/2019] [Indexed: 02/18/2023] Open
Abstract
Background In recent years, the number of infective endocarditis (IE) cases associated with injection drug use has increased. Clinical guidelines suggest deferring surgery for IE in people who inject drugs (PWID) due to a concern for worse outcomes in comparison to non-injectors (non-PWID). We performed a systematic review and meta-analysis of long-term outcomes in PWID who underwent cardiac surgery and compared these outcomes to non-PWID. Methods We systematically searched for studies reported between 1965 and 2018. We used an algorithm to estimate individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined it with published individual patient data (IPD) to analyze long-term outcomes after cardiac surgery for IE in PWID. Our primary outcome was survival. Secondary outcomes were reoperation and mortality at 30-days, one-, five-, and 10-years. Random effects Cox regression was used for estimating survival. Results We included 27 studies in the systematic review and 19 provided data (KM or IPD) for the meta-analysis. PWID were younger and more likely to have S. aureus than non-PWID. Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and 56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID. PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05–2.05) and more than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25–4.50) than non-PWID. Conclusion PWID had shorter survival that non-PWID. Implementing evidence-based interventions and testing new modalities are urgently needed to improve outcomes in PWID after cardiac surgery.
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Affiliation(s)
- David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA. .,Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | | | - Abel Gallegos
- Universidad Autónoma de Baja California, Tijuana, USA
| | - Alex A T Bui
- Medical Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, CA, USA
| | - Matthew B Goetz
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA.,Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Raphael J Landovitz
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave (Room 37-121CHS), Los Angeles, CA, 90095-1688, USA.,UCLA Center for Clinical AIDS Research & Education, David Geffen School of Medicine, Los Angeles, CA, USA
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Laurenzi CA, Skeen S, Sundin P, Hunt X, Weiss RE, Rotheram-Borus MJ, Tomlinson M. Associations between young children's exposure to household violence and behavioural problems: Evidence from a rural Kenyan sample. Glob Public Health 2019; 15:173-184. [PMID: 31426702 DOI: 10.1080/17441692.2019.1656274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n = 497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient = 1.35, SE = 0.54, p = 0.01) and harsh psychological child discipline (regression coefficient = 0.74, SE = 0.22, p = 0.001), but not physical discipline (regression coefficient = 0.42, SE = 0.24, p = 0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences.
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Affiliation(s)
- Christina A Laurenzi
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa
| | - Sarah Skeen
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa
| | - Phillip Sundin
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Xanthe Hunt
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa
| | - Robert E Weiss
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Mary Jane Rotheram-Borus
- Global Center for Children and Families, Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, CA, USA
| | - Mark Tomlinson
- Department of Global Health, Faculty of Medicine and Health Sciences, Institute for Life Course Health Research, Stellenbosch University, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
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King AJ, Weiss RE. A general semiparametric Bayesian discrete-time recurrent events model. Biostatistics 2019; 22:266-282. [PMID: 31373358 DOI: 10.1093/biostatistics/kxz029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 07/06/2019] [Accepted: 07/07/2019] [Indexed: 11/14/2022] Open
Abstract
Event time variables are often recorded in a discrete fashion, especially in the case of patient-reported outcomes. This work is motivated by a study of illicit drug users, in which time to drug use cessation has been recorded as a number of whole months. Existing approaches for handling such discrete data include treating the survival times as continuous (with adjustments for inevitable tied outcomes), or using discrete models that omit important features like random effects. We provide a general Bayesian discrete-time proportional hazards model, incorporating a number of features popular in continuous-time models such as competing risks and frailties. Our model also provides flexible baseline hazards for time effects, as well as generalized additive models style semiparametric incorporation of other time-varying covariates. Our specific modeling choices enable efficient Markov chain Monte Carlo inference algorithms, which we provide to the user in the form of a freely available R package called $\texttt{brea}$. We demonstrate that our model performs better on our motivating substance abuse application than existing approaches. We also present a reproducible application of the $\texttt{brea}$ software to a freely available data set from a clinical trial of anesthesia administration methods.
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Affiliation(s)
- Adam J King
- Department of Mathematics & Statistics, California State Polytechnic University, Pomona, 3801 West Temple Ave., Pomona, CA, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E. Young Dr. South, Los Angeles, CA, USA
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36
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Radadia KD, Rivera-Núñez Z, Kim S, Farber NJ, Sterling J, Falkiewicz M, Modi PK, Goyal S, Parikh R, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Accuracy of clinical nodal staging and factors associated with receipt of lymph node dissection at the time of surgery for nonmetastatic renal cell carcinoma. Urol Oncol 2019; 37:577.e17-577.e25. [PMID: 31280982 DOI: 10.1016/j.urolonc.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/27/2019] [Accepted: 06/05/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The benefit of lymph node dissection (LND) in renal cell carcinoma (RCC) remains poorly defined. Despite this uncertainty, the American Urological Association (AUA) guideline on localized renal cancer recommends that LND be performed for staging purposes when there is suspicion of regional lymphadenopathy on imaging. Using the National Cancer Database (NCDB), we sought to determine how much of a departure the new AUA guideline is from current practice. We hypothesized that practice patterns would reflect the "Expert Opinion" recommendation and that patients who are clinical lymph node (cLN) positive would receive a LND more often than those who are cLN negative. Additionally, we sought to determine factors that would trigger a LND as well the accuracy of clinical staging by examining the relationship between cLN and pathologic lymph node (pLN) status of patients who received a LND. MATERIALS AND METHODS The NCDB was queried for patients with nonmetastatic RCC who underwent partial nephrectomy or nephrectomy from 2010 to 2014. Patient sociodemographic and clinical characteristics were extracted. Frequency distributions were calculated for patients with both cLN and pLN status available. Of patients who received a LND, sensitivity, specificity, and positive/negative predictive values (PPV/NPV) of cLN status for pLN positivity were calculated. Logistic regression models were used to examine association between clinical and socioeconomic factors and receipt of LND. Propensity score matching was used in sensitivity analyses to examine potential for reporting bias in NCDB data. RESULTS We identified 110,963 patients who underwent surgery for RCC, of whom 11,867 (11%) had LND performed at the time of surgery. cLN and pLN information were available in 11,300 patients, of which 1,725 were preoperatively staged as having positive cLN. More LNDs were performed per year for patients who were cLN negative than cLN positive. Of patients who received a LND, the majority of patients were cLN negative across all clinical T (cT) stages. Multivariable analysis showed that all patients who had care at an academic/research institution (odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.43-1.74) and had to travel >12.5 to 31.0 miles and >31.0 miles to a treatment center (OR: 1.08, 95%CI: 1.01-1.15 and OR: 1.28, 95%CI: 1.20-1.36, respectively) were more likely to get a LND. As cT stage increased from cT2-4, the risk of LND increased (OR range: 4.7-7.90, respectively). Patients who were cLN positive were more likely to receive a LND at the time of surgery (OR: 18.68, 95%CI: 16.62-21.00). Of the patients who received a LND, clinical staging was more specific than sensitive. CONCLUSION More patients received a LND who were cLN negative compared to patients who were cLN positive. Patients who were cLN positive were more likely to receive a LND. Treatment center type, distance to treatment center, cT stage, and cLN positivity were factors associated with LND receipt.
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Affiliation(s)
- Kushan D Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Zorimar Rivera-Núñez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey and Rutgers School of Public Health, New Brunswick, NJ
| | - Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Marissa Falkiewicz
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
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Probst MA, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis. Ann Emerg Med 2019; 74:260-269. [PMID: 31080027 DOI: 10.1016/j.annemergmed.2019.03.031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE Many adults with syncope are hospitalized solely for observation and testing. We seek to determine whether hospitalization versus outpatient management for older adults with unexplained syncope is associated with a reduction in postdisposition serious adverse events at 30 days. METHODS We performed a propensity score analysis using data from a prospective, observational study of older adults with unexplained syncope or near syncope who presented to 11 emergency departments (EDs) in the United States. We enrolled adults (≥60 years) who presented with syncope or near syncope. We excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data were collected on all patients. The primary outcome was rate of post-ED serious adverse events at 30 days. RESULTS We enrolled 2,492 older adults with syncope and no serious ED diagnosis from April 2013 to September 2016. Mean age was 73 years (SD 8.9 years), and 51% were women. The incidence of serious adverse events within 30 days after the index visit was 7.4% for hospitalized patients and 3.19% for discharged patients, representing an unadjusted difference of 4.2% (95% confidence interval 2.38% to 6.02%). After propensity score matching on risk of hospitalization, there was no statistically significant difference in serious adverse events at 30 days between the hospitalized group (4.89%) and the discharged group (2.82%) (risk difference 2.07%; 95% confidence interval -0.24% to 4.38%). CONCLUSION In our propensity-matched sample of older adults with unexplained syncope, for those with clinical characteristics similar to that of the discharged cohort, hospitalization was not associated with improvement in 30-day serious adverse event rates.
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Affiliation(s)
- Marc A Probst
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Annick N Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Susan E Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, Rochester, NY
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI
| | | | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carol L Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Bret A Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Daniel K Nishijima
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI
| | - Kirk A Stiffler
- Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Scott T Wilber
- Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH
| | - Benjamin C Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
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38
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Clark CL, Gibson TA, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Do High-sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope? Acad Emerg Med 2019; 26:528-538. [PMID: 30721554 DOI: 10.1111/acem.13709] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES An estimated 1.2 million annual emergency department (ED) visits for syncope/near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and natriuretic peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/serious cardiac outcomes in adult patients presenting with syncope. METHODS A prespecified secondary analysis of a prospective, observational trial enrolling participants ≥ age 60 presenting with syncope, at 11 United States hospitals, was conducted between April 2013 and September 2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow-up. Within 3 hours of consent, hscTnT and NT-proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT and 2010 Cobas, respectively. Primary outcome was combined 30-day all-cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistic regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods. RESULTS The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT-proBNP levels. HscTnT levels ≤ 5 ng/L were associated with a 4% (95% confidence interval [CI] = 3%-5%) outcome risk, and hscTnT > 50 ng/L, a 29% (95% CI = 26%-33%) risk. NT-proBNP levels ≤ 125 ng/L were associated with a 4% (95% CI = 4%-5%) risk, and NT-proBNP > 2,000 ng/L a 29% (95% CI = 25%-32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings. CONCLUSIONS hscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope.
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Affiliation(s)
- Carol L. Clark
- Department of Emergency Medicine William Beaumont Hospital‐Royal Oak Royal Oak MI
| | - Thomas A. Gibson
- Department of Biostatistics University of California Los Angeles, Fielding School of Public Health Los Angeles CA
| | - Robert E. Weiss
- Department of Biostatistics University of California Los Angeles, Fielding School of Public Health Los Angeles CA
| | - Annick N. Yagapen
- Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath, & Science University Portland OR
| | - Susan E. Malveau
- Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath, & Science University Portland OR
| | - David H. Adler
- Department of Emergency Medicine University of Rochester Rochester NY
| | - Aveh Bastani
- Department of Emergency Medicine William Beaumont Hospital–TroyTroy MI
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine The Ohio State University Wexner Medical Center Columbus OH
| | - Deborah B. Diercks
- Department of Emergency Medicine University of Texas–Southwestern Dallas TX
| | - Judd E. Hollander
- Department of Emergency Medicine Thomas Jefferson University Hospital Philadelphia PA
| | - Bret A. Nicks
- Department of Emergency Medicine Wake Forest School of Medicine Winston Salem NC
| | | | - Manish N. Shah
- Department of Emergency Medicine University of Wisconsin–Madison Madison WI
| | - Kirk A. Stiffler
- Department of Emergency Medicine Northeast Ohio Medical University Rootstown OH
| | - Alan B. Storrow
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN
| | - Scott T. Wilber
- Department of Emergency Medicine Northeast Ohio Medical University Rootstown OH
| | - Benjamin C. Sun
- Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Heath, & Science University Portland OR
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White JL, Chang AM, Hollander JE, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. QTc prolongation as a marker of 30-day serious outcomes in older patients with syncope presenting to the Emergency Department. Am J Emerg Med 2019; 37:685-689. [DOI: 10.1016/j.ajem.2018.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022] Open
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White JL, Hollander JE, Chang AM, Nishijima DK, Lin AL, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Nicks BA, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Orthostatic vital signs do not predict 30 day serious outcomes in older emergency department patients with syncope: A multicenter observational study. Am J Emerg Med 2019; 37:2215-2223. [PMID: 30928476 DOI: 10.1016/j.ajem.2019.03.036] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/20/2019] [Accepted: 03/24/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Syncope is a common chief complaint among older adults in the Emergency Department (ED), and orthostatic vital signs are often a part of their evaluation. We assessed whether abnormal orthostatic vital signs in the ED are associated with composite 30-day serious outcomes in older adults presenting with syncope. METHODS We performed a secondary analysis of a prospective, observational study at 11 EDs in adults ≥ 60 years who presented with syncope or near syncope. We excluded patients lost to follow up. We used the standard definition of abnormal orthostatic vital signs or subjective symptoms of lightheadedness upon standing to define orthostasis. We determined the rate of composite 30-day serious outcomes, including those during the index ED visit, such as cardiac arrhythmias, myocardial infarction, cardiac intervention, new diagnosis of structural heart disease, stroke, pulmonary embolism, aortic dissection, subarachnoid hemorrhage, cardiopulmonary resuscitation, hemorrhage/anemia requiring transfusion, with major traumatic injury from fall, recurrent syncope, and death) between the groups with normal and abnormal orthostatic vital signs. RESULTS The study cohort included 1974 patients, of whom 51.2% were male and 725 patients (37.7%) had abnormal orthostatic vital signs. Comparing those with abnormal to those with normal orthostatic vital signs, we did not find a difference in composite 30-serious outcomes (111/725 (15.3%) vs 184/1249 (14.7%); unadjusted odds ratio, 1.05 [95%CI, 0.81-1.35], p = 0.73). After adjustment for gender, coronary artery disease, congestive heart failure (CHF), history of arrhythmia, dyspnea, hypotension, any abnormal ECG, physician risk assessment, medication classes and disposition, there was no association with composite 30-serious outcomes (adjusted odds ratio, 0.82 [95%CI, 0.62-1.09], p = 0.18). CONCLUSIONS In a cohort of older adult patients presenting with syncope who were able to have orthostatic vital signs evaluated, abnormal orthostatic vital signs did not independently predict composite 30-day serious outcomes.
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Affiliation(s)
- Jennifer L White
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America; Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, United States of America.
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Daniel K Nishijima
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - Amber L Lin
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - Erica Su
- Department of Biostatistics, University of California, Los Angeles, CA, United States of America
| | - Robert E Weiss
- Department of Biostatistics, University of California, Los Angeles, CA, United States of America
| | - Annick N Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - Susan E Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, NY, United States of America
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI, United States of America
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, United States of America
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Carol L Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI, United States of America
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX, United States of America
| | - Bret A Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States of America
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Kirk A Stiffler
- Department of Emergency Medicine, Summa Health System, Akron, OH, United States of America
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Scott T Wilber
- Department of Emergency Medicine, Summa Health System, Akron, OH, United States of America
| | - Benjamin C Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
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Makgoeng SB, Bolanos RS, Jeon CY, Weiss RE, Arah OA, Breen EC, Martínez-Maza O, Hussain SK. Markers of Immune Activation and Inflammation, and Non-Hodgkin Lymphoma: A Meta-Analysis of Prospective Studies. JNCI Cancer Spectr 2019; 2:pky082. [PMID: 30873511 PMCID: PMC6400235 DOI: 10.1093/jncics/pky082] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/08/2018] [Accepted: 12/21/2018] [Indexed: 12/12/2022] Open
Abstract
Background Chronic inflammation and immune activation are reported to play a key role in the etiology of non-Hodgkin lymphoma (NHL). We conducted a meta-analysis on the associations between prediagnosis circulating levels of immune stimulatory markers, interleukin 6 (IL-6), IL-10, tumor necrosis factor α (TNF-α), CXCL13, soluble CD23 (sCD23), sCD27, sCD30, and the risk of NHL. Methods Relevant studies were identified from PubMed, EMBASE, and Web of Science up to January 1, 2017. We calculated summary odds ratio (OR) estimates for the association between one natural log increase in concentration of each biomarker and NHL using random-effects models for NHL as a composite outcome and for several histological subtypes of NHL. Results Seventeen nested case control studies were included. Elevated levels of several biomarkers were more strongly associated with increased odds of NHL: TNF-α, OR = 1.18 (95% confidence interval [CI] = 1.04 to 1.34); CXCL13, OR = 1.47 (95% CI = 1.03 to 2.08); sCD23, OR = 1.57 (95% CI = 1.21 to 2.05); sCD27, OR = 2.18 (95% CI = 1.20 to 3.98); sCD30, OR = 1.65 (95% CI = 1.22 to 2.22). In stratified analyses, IL-6, TNF-α, sCD27, and sCD30 were more strongly associated with NHL in HIV-infected individuals compared to HIV-uninfected individuals. Between-study heterogeneity was observed across multiple biomarkers for overall NHL and by subtypes. Conclusion This meta-analysis provides evidence that elevated circulating levels of TNF-α, CXCL13, sCD23, sCD27, and sCD30 are consistently associated with an increased risk of NHL, suggesting the potential utility of these biomarkers in population risk stratification and prediction.
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Affiliation(s)
- Solomon B Makgoeng
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), CA
| | - Rachel S Bolanos
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), CA
| | - Christie Y Jeon
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), CA.,Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), CA
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles
| | - Otoniel Martínez-Maza
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), CA.,Departments of Obstetrics and Gynecology and Microbiology, Immunology and Molecular Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Shehnaz K Hussain
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), CA.,Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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Radadia KD, Rivera-Nunez Z, Kim S, Farber N, Sterling J, Modi PK, Sharad G, Rahul P, Weiss RE, Kim I, Elsamra S, Jang T, Singer E. Factors linked with receiving a lymph node dissection during surgery for nonmetastatic renal cell carcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
672 Background: The benefit of a lymph node dissection (LND) in renal cell carcinoma (RCC) remains poorly defined. Despite this uncertainty, the American Urological Association (AUA) guideline on localized renal cancer recommends that LND be performed for staging purposes when there is suspicion of regional lymphadenopathy on imaging. Using the National Cancer Database (NCDB), we examined factors associated with the receipt of LND at the time of renal surgery. Methods: The NCDB was queried for non-metastatic patients who underwent partial nephrectomy or nephrectomy for RCC from 2010 to 2014. Patient socio-demographics, clinical characteristics, and treatment factors were extracted. Logistic regression models were used to examine factors associated with the receipt of LND. Results: We identified 110,963 patients who underwent surgery for RCC, of whom 11,867 (11%) had LND performed at the time of surgery. Clinical lymph node (cLN) and pathologic lymph node (pLN) information were available in 11,300 patients, of which 1,725 were preoperatively staged as having positive cLN. In the entire study population, patients who were cLN positive were approximately 19 times more likely to receive a LND at the time of surgery (OR: 18.68, 95%CI: 16.62-21.00). Factors associated with a LND in patients who are cLN negative (n = 106,370) were assessed. Clinical T (cT) stage was the strongest indicator of LND (cT2-4, OR range: 4.87-11.1). Among both cohorts, patients who received surgery at an academic/research institution or traveled farther ( > 31 miles) to a treatment center were more likely to undergo a LND. Patients from both cohorts who underwent robotic or laparoscopic surgery were less likely to receive a LND compared to open surgery. Conclusions: The greatest predictor of LND receipt is being cLN positive. Among patients who are cLN negative, the greatest predictor of LND is cT stage. Predictors of undergoing LND in all patients and those who are cLN negative include treatment center type and distance to the treatment center. Additional studies to determine the accuracy of clinical staging and assess novel preoperative imaging modalities that evaluate nodal involvement are indicated.
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Affiliation(s)
- Kushan Dilip Radadia
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Zorimar Rivera-Nunez
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Sinae Kim
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Nicholas Farber
- Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Joshua Sterling
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Parth K. Modi
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Goyal Sharad
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Parikh Rahul
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Robert E. Weiss
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Kim
- Rutgers Cancer Institute of New Jersey, Piscataway, NJ
| | - Sammy Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Sterling J, Rivera-Nunez Z, Farber N, Modi PK, Radadia KD, Kim S, Sharad G, Rahul P, Weiss RE, Kim I, Elsamra S, Jang T, Singer E. Treatment disparities among patients in the National Cancer Database (NCDB) with clinical TIa and TIb renal masses. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
648 Background: AUA guidelines on the management of renal cell carcinoma (RCC) recommend prioritizing partial nephrectomy (PN) for the treatment of clinical T1a (cT1a) tumors, using PN for clinical T1b (cT1b) tumors when feasible, and performing minimally invasive surgery (MIS) when possible. Since cT1 RCC is a heterogeneous disease, we evaluated patterns of care in this population to examine factors associated with receipt of PN and MIS. Methods: We queried the NCDB from 2010-2014 to identify patients treated surgically for cT1N0M0 RCC. Patient socio-demographics, clinical characteristics, and treatment parameters were compared between cT1a and cT1b patients. Logistic regression models examined factors associated with receiving MIS. Results: Our population included 69,694 patients (44,043 cT1a and 25,651 cT1b). For cT1a tumors, 70% of patients received PN, while 30% received RN; 35% of patients underwent an open procedure and 65% underwent MIS. For cT1b tumors, 32% of patients received PN and 68% received RN; 38% of patients underwent an open operation and 62% underwent MIS. In both cohorts, African Americans and those earning <$62,000 were less likely to have MIS. Distance to treatment was not significant in cT1b patients, but cT1a patients who traveled >31 miles were more likely to undergo MIS. Patients treated at a community hospital were less likely to receive MIS compared to those treated at academic centers (cT1a OR: 0.48, 95% CI: 0.44-0.53 and cT1b OR: 0.63, 95% CI: 0.56-0.7). cT1a patients without private insurance were less likely to receive MIS (OR range: 0.58-0.93). However, only uninsured cT1b patients were less likely to undergo MIS (OR: 0.74, 95% CI: 0.64-0.86). Conclusions: PN occurred more frequently for cT1a (70%) vs. cT1b (32%) tumors. Most cT1 tumors received MIS; 35% of cT1a patients and 38% of cT1b patients underwent an open procedure, presenting an opportunity for improvement. cT1a and cT1b patients with lower household income, without private insurance, and those treated outside academic centers were less likely to receive MIS. Based on these findings additional research on the impact of regionalization of RCC surgery on utilization of PN vs. RN, receipt of MIS, and outcomes is warranted.
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Affiliation(s)
- Joshua Sterling
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Zorimar Rivera-Nunez
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Nicholas Farber
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Parth K. Modi
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Kushan Dilip Radadia
- Rutgers Robert Wood Johnson Medical School, Division of Urology, New Brunswick, NJ
| | - Sinae Kim
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Goyal Sharad
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Parikh Rahul
- Rutgers Cancer Institute of New Jersey, Division of Radiation Oncology, New Brunswick, NJ
| | - Robert E. Weiss
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Isaac Kim
- Rutgers Cancer Institute of New Jersey, Piscataway, NJ
| | - Sammy Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Bastani A, Su E, Adler DH, Baugh C, Caterino JM, Clark CL, Diercks DB, Hollander JE, Malveau SE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Yagapen AN, Weiss RE, Sun BC. Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope. Ann Emerg Med 2018; 73:274-280. [PMID: 30529112 DOI: 10.1016/j.annemergmed.2018.10.032] [Citation(s) in RCA: 6] [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: 07/09/2018] [Revised: 10/19/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE Controversy remains in regard to the risk of adverse events for patients presenting with syncope compared with near-syncope. The purpose of our study is to describe the difference in outcomes between these groups in a large multicenter cohort of older emergency department (ED) patients. METHODS From April 28, 2013, to September 21, 2016, we conducted a prospective, observational study across 11 EDs in adults (≥60 years) with syncope or near-syncope. A standardized data extraction tool was used to collect information during their index visit and at 30-day follow-up. Our primary outcome was the incidence of 30-day death or serious clinical events. Data were analyzed with descriptive statistics and multivariate logistic regression analysis adjusting for relevant demographic or historical variables. RESULTS A total of 3,581 patients (mean age 72.8 years; 51.6% men) were enrolled in the study. There were 1,380 patients (39%) presenting with near-syncope and 2,201 (61%) presenting with syncope. Baseline characteristics revealed a greater incidence of congestive heart failure, coronary artery disease, previous arrhythmia, nonwhite race, and presenting dyspnea in the near-syncope compared with syncope cohort. There were no differences in the primary outcome between the groups (near-syncope 18.7% versus syncope 18.2%). A multivariate logistic regression analysis identified no difference in 30-day serious outcomes for patients with near-syncope (odds ratio 0.94; 95% confidence interval 0.78 to 1.14) compared with syncope. CONCLUSION Near-syncope confers risk to patients similar to that of syncope for the composite outcome of 30-day death or serious clinical event.
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Affiliation(s)
- Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI.
| | - Erica Su
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, Rochester, NY
| | | | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carol L Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Susan E Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Bret A Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Daniel K Nishijima
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA
| | - Manish N Shah
- Department of Emergency Medicine, University of Rochester, Rochester, NY
| | - Kirk A Stiffler
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Scott T Wilber
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Annick N Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
| | - Robert E Weiss
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - Benjamin C Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR
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Probst MA, Gibson TA, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Predictors of Clinically Significant Echocardiography Findings in Older Adults with Syncope: A Secondary Analysis. J Hosp Med 2018; 13:823-828. [PMID: 30255862 PMCID: PMC6343846 DOI: 10.12788/jhm.3082] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Syncope is a common reason for visiting the emergency department (ED) and is associated with significant healthcare resource utilization. OBJECTIVE To develop a risk-stratification tool for clinically significant findings on echocardiography among older adults presenting to the ED with syncope or nearsyncope. DESIGN Prospective, observational cohort study from April 2013 to September 2016. SETTING Eleven EDs in the United States. PATIENTS We enrolled adults (=60 years) who presented to the ED with syncope or near-syncope who underwent transthoracic echocardiography (TTE). MEASUREMENTS The primary outcome was a clinically significant finding on TTE. Clinical, electrocardiogram, and laboratory variables were also collected. Multivariable logistic regression analysis was used to identify predictors of significant findings on echocardiography. RESULTS A total of 3,686 patients were enrolled. Of these, 995 (27%) received echocardiography, and 215 (22%) had a significant finding on echocardiography. Regression analysis identified five predictors of significant finding: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%). CONCLUSIONS If validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography. REGISTRATION ClinicalTrials.gov Identifier NCT01802398.
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Affiliation(s)
- Marc A. Probst
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Tommy A. Gibson
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Robert E. Weiss
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Annick N. Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, USA
| | - Susan E. Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, USA
| | | | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI, USA
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carol L. Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI, USA
| | - Deborah B. Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX, USA, USA
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Bret A. Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, N, USA
| | - Daniel K. Nishijima
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, USA
| | - Manish N. Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Kirk A. Stiffler
- Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA
| | - Scott T. Wilber
- Department of Emergency Medicine, Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Benjamin C. Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, USA
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46
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Goodman-Meza D, Weiss RE, Gamboa S, Gallegos A, Landovitz RJ, Bui AAT, Goetz MB, Shoptaw S. 1082. Meta-Analysis of Survival Outcomes in People Who Inject Drugs After Cardiac Surgery for Infective Endocarditis. Open Forum Infect Dis 2018. [PMCID: PMC6255531 DOI: 10.1093/ofid/ofy210.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The United States’ opioid epidemic has led to an increase in people who inject drugs (PWID) and opioid-associated infections, including infectious endocarditis (IE). Cardiac surgery is often indicated in IE to improve outcomes but is controversial in PWID due to the concerns about continued injection drug use leading to risk for reinfection and decreased survival. In response, we assessed the long-term survival after cardiac valve surgery in PWID compared with people who do not inject drugs (non-PWID) in the published literature. Methods We performed a systematic review and meta-analysis (MA) of studies that reported survival data after surgery for IE in PWID. We searched PUBMED up to April 2018. We extracted Kaplan–Meier (KM) curves from included studies. From the KM curves, we used an algorithm to estimate individual participant data (eIPD). In a one-step approach, we ran a Cox proportional hazards (CPH) model analysis of the eIPD with study random effects. In a two-step approach, we fitted CPH models by individual study; then, we ran a mixed-effects MA model of the log hazard ratios (HR) and standard errors. Results We identified 11 retrospective studies. Of these, six reported comparisons of PWID vs. non-PWID, and five reported results for PWID only. Based on eIPD, we included 407 PWID and 1,877 non-PWID. Mean age for PWID was 36.7 years (95% CI 34.4–39.1) and for non-PWID was 52.0 years (95% CI 45.3–59.4). There were 144 deaths (35.3%) in PWID and 559 (29.8%) deaths in non-PWID. We present by study and by group KM curves of eIPD (Figures 1 and 2). In one-step MA (included all 11 studies), the HR for PWID was 1.13 (95% CI 0.92–1.39). In two-step MA (included six comparison studies), heterogeneity was high (I2 = 72%); and there was no significant between-group difference (HR 1.29, 95% CI 0.80–2.07) (Figure 3). Conclusion Survival time post-surgery of PWID was similar to that of non-PWID. These estimates are concerning, as PWID on average are much younger than non-PWID with IE. Future studies should explore interventions to improve outcomes in PWID after surgery, including treatment of addiction during and after the index hospitalization and provision of naloxone at the time of discharge. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, California
| | | | - Abel Gallegos
- Universidad Autonoma de Baja California, Tijuana, Mexico
| | - Raphael J Landovitz
- UCLA Center for Clinical AIDS Research & Education, University of California Los Angeles, Los Angeles, California
| | - Alex A T Bui
- Medical Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, California
| | - Matthew B Goetz
- Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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47
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Farber NJ, Rivera-Núñez Z, Kim S, Shinder B, Radadia K, Sterling J, Modi PK, Goyal S, Parikh R, Mayer TM, Weiss RE, Kim IY, Elsamra SE, Jang TL, Singer EA. Trends and outcomes of lymphadenectomy for nonmetastatic renal cell carcinoma: A propensity score-weighted analysis of the National Cancer Database. Urol Oncol 2018; 37:26-32. [PMID: 30446458 DOI: 10.1016/j.urolonc.2018.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/25/2018] [Accepted: 10/01/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE Lymph node (LN) involvement in renal cell carcinoma (RCC) is associated with a poor prognosis. While lymph node dissection (LND) may provide diagnostic information, its therapeutic benefit remains controversial. Thus, the aim of our study is to analyze survival outcomes after LND for nonmetastatic RCC and to characterize contemporary practice patterns. MATERIALS AND METHODS The National Cancer Database was queried for patients with nonmetastatic RCC who underwent either partial or radical nephrectomy from 2010 to 2014. A total of 11,867 underwent surgery and LND. Chi-square tests were used to examine differences in patient demographics. To minimize selection bias, propensity score matching (PSM) was used to select one control for each LND case (n = 19,500). Cox regression analyses were conducted to examine overall survival (OS) in patients who received LND compared to those who did not. RESULTS Of all patients undergoing LND for RCC (n = 11,867), 5%, 23%, 31%, 47% were performed for tumors of clinical T stage 1, 2, 3, and 4, respectively. Proportions of LND have not significantly changed from 2010 to 2014. No significant improvement in median OS for patients undergoing LND compared to no LND was shown (34.7 vs. 34.9 months, respectively; P = 0.98). Similarly, no significant improvement in median OS was found for clinically LN positive patients undergoing LND compared to no LND (P = 0.90). On Cox regression analysis, LND dissection was not associated with an OS benefit (hazard ratio: 1.00; 95% confidence interval 0.97 to 1.04). CONCLUSIONS Among all RCC patients, LNDs are often performed for low stage disease, suggesting a potential overutilization of LND. No OS benefit was seen in any subgroup of patients undergoing LND. Further investigation is needed to determine which patient populations may benefit most from LND.
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Affiliation(s)
- Nicholas J Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Zorimar Rivera-Núñez
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sinae Kim
- Division of Biometrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Brian Shinder
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Kushan Radadia
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Joshua Sterling
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Parth K Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Rahul Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Tina M Mayer
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Isaac Y Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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48
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Bantjes J, Tomlinson M, Weiss RE, Yen PK, Goldstone D, Stewart J, Qondela T, Rabie S, Rotheram-Borus MJ. Non-fatal suicidal behaviour, depression and poverty among young men living in low-resource communities in South Africa. BMC Public Health 2018; 18:1195. [PMID: 30348143 PMCID: PMC6198370 DOI: 10.1186/s12889-018-6104-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/10/2018] [Indexed: 12/04/2022] Open
Abstract
Background Suicide is a serious public health problem in low- and middle-income countries. Understanding the context- and gender-specific risk factors for non-fatal suicidal behaviour is the cornerstone of evidence-based public health interventions to reduce suicide. Poverty and symptoms of depression are well established risk factors for suicidal behaviour. However, little is understood about how proximal economic factors (such as losing one’s job, or food insecurity) may confound the effects of symptoms of depression to increase the risk of non-fatal suicidal behaviour in vulnerable populations, such as young men living under conditions of endemic poverty. The aim of this study was to explore the extent to which a wide range of poverty-related variables account for non-fatal suicidal behaviour independent of, or in addition to, symptoms of depression among young men living in low-resource communities in South Africa (SA). Methods Data were collected from a clustered sample of 647 young men living in low-resource communities in the Western Cape province of SA. Multivariate regressions were used to identify the associations between poverty-related measures, symptoms of depression, and past-month prevalence of non-fatal suicidal behaviour. Results Non-fatal suicidal behaviour in the last month was reported by 47 (6.13%) participants: suicidal ideation (n = 43; 5.97%); suicide plan (n = 5; 0.77%); suicide attempt (n = 4; 0.62%), and deliberate self-harm without intent to die (n = 4; 0.62%). Past-month prevalence of non-fatal suicidal behaviour was significantly associated with particular dimensions of poverty (living in a home without a toilet on the premises, having previously been fired, and food insecurity), but not with other dimensions of poverty (such as prolonged unemployment and low levels of income). However, symptoms of depression were a more significant predictor of non-fatal suicidal behaviour than any measure of poverty (aOR=1.093, 95% CI=1.058-1.129, p < .000). Conclusions Depressive symptoms are more strongly associated with non-fatal suicidal behaviour than a range of proximal and distal economic factors among young men living under conditions of endemic poverty in South Africa. This has important public health implications and highlights the importance of increasing young men’s access to psychiatric services and targeting depression as an integral component of suicide prevention in low resource communities. Electronic supplementary material The online version of this article (10.1186/s12889-018-6104-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Bantjes
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602, South Africa.
| | - M Tomlinson
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602, South Africa
| | - R E Weiss
- Department of Biostatistics, University of California Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - P K Yen
- Department of Biostatistics, University of California Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - D Goldstone
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602, South Africa
| | - J Stewart
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602, South Africa
| | - T Qondela
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602, South Africa
| | - S Rabie
- Department of Psychology, Stellenbosch University, PO Box X1, Matieland, 7602, South Africa
| | - M-J Rotheram-Borus
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California Los Angeles, Los Angeles, CA, USA
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49
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Gabayan GZ, Gould MK, Weiss RE, Chiu VY, Sarkisian CA. A Risk Score to Predict Short-term Outcomes Following Emergency Department Discharge. West J Emerg Med 2018; 19:842-848. [PMID: 30202497 PMCID: PMC6123082 DOI: 10.5811/westjem.2018.7.37945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 02/16/2018] [Revised: 06/06/2018] [Accepted: 07/20/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction The emergency department (ED) is an inherently high-risk setting. Risk scores can help practitioners understand the risk of ED patients for developing poor outcomes after discharge. Our objective was to develop two risk scores that predict either general inpatient admission or death/intensive care unit (ICU) admission within seven days of ED discharge. Methods We conducted a retrospective cohort study of patients age > 65 years using clinical data from a regional, integrated health system for years 2009–2010 to create risk scores to predict two outcomes, a general inpatient admission or death/ICU admission. We used logistic regression to predict the two outcomes based on age, body mass index, vital signs, Charlson comorbidity index (CCI), ED length of stay (LOS), and prior inpatient admission. Results Of 104,025 ED visit discharges, 4,638 (4.5%) experienced a general inpatient admission and 531 (0.5%) death or ICU admission within seven days of discharge. Risk factors with the greatest point value for either outcome were high CCI score and a prolonged ED LOS. The C-statistic was 0.68 and 0.76 for the two models. Conclusion Risk scores were successfully created for both outcomes from an integrated health system, inpatient admission or death/ICU admission. Patients who accrued the highest number of points and greatest risk present to the ED with a high number of comorbidities and require prolonged ED evaluations.
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Affiliation(s)
- Gelareh Z Gabayan
- University of California, Los Angeles, Department of Emergency Medicine, Los Angeles, California
| | - Michael K Gould
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California
| | - Robert E Weiss
- University of California, Los Angeles, Fielding School of Public Health, Department of Biostatistics, Los Angeles, California
| | - Vicki Y Chiu
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, California
| | - Catherine A Sarkisian
- University of California, Los Angeles, Department of Medicine, Los Angeles, California.,Greater Los Angeles Veterans Affairs Healthcare System, Department of Medicine, Los Angeles, California
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50
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Chang AM, Hollander JE, Su E, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes. Am J Emerg Med 2018; 37:869-872. [PMID: 30361153 DOI: 10.1016/j.ajem.2018.08.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/04/2018] [Indexed: 12/22/2022] Open
Abstract
Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode. METHODS This study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60 years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of 30-day serious outcome. The secondary outcome was 30-day serious cardiac arrhythmia. In multivariate analysis, we assessed whether prior syncope was an independent predictor of 30-day serious events. RESULTS The study cohort included 3580 patients: 1281 (35.8%) had prior syncope and 2299 (64.2%) were presenting with first episode of syncope. 498 (13.9%) patients had 1 prior episode while 771 (21.5%) had >1 prior episode. Those with recurrent syncope were more likely to have congestive heart failure, coronary artery disease, previous diagnosis of arrhythmia, and an abnormal ECG. Overall, 657 (18.4%) of the cohort had a serious outcome by 30 days after index ED visit. In multivariate analysis, we found no significant difference in risk of events (adjusted odds ratio 1.09; 95% confidence interval 0.90-1.31; p = 0.387). CONCLUSION In older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events.
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Affiliation(s)
- Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America.
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Erica Su
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Robert E Weiss
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, United States of America
| | - Annick N Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - Susan E Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
| | - David H Adler
- Department of Emergency Medicine, University of Rochester, NY, United States of America
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI, United States of America
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, United States of America
| | - Jeffrey M Caterino
- Department of Emergency Medicine, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Carol L Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI, United States of America
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX, United States of America
| | - Bret A Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Daniel K Nishijima
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, United States of America
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Kirk A Stiffler
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH, United States of America
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN, United States of America
| | - Scott T Wilber
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH, United States of America
| | - Benjamin C Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR, United States of America
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