1
|
Palzer EF, Safo SE. mvlearnR and Shiny App for multiview learning. Bioinform Adv 2024; 4:vbae005. [PMID: 38304121 PMCID: PMC10833139 DOI: 10.1093/bioadv/vbae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/20/2023] [Accepted: 01/14/2024] [Indexed: 02/03/2024]
Abstract
Summary The package mvlearnR and accompanying Shiny App is intended for integrating data from multiple sources or views or modalities (e.g. genomics, proteomics, clinical, and demographic data). Most existing software packages for multiview learning are decentralized and offer limited capabilities, making it difficult for users to perform comprehensive integrative analysis. The new package wraps statistical and machine learning methods and graphical tools, providing a convenient and easy data integration workflow. For users with limited programming language, we provide a Shiny Application to facilitate data integration anywhere and on any device. The methods have potential to offer deeper insights into complex disease mechanisms. Availability and implementation mvlearnR is available from the following GitHub repository: https://github.com/lasandrall/mvlearnR. The web application is hosted on shinyapps.io and available at: https://multi-viewlearn.shinyapps.io/MultiView_Modeling/.
Collapse
Affiliation(s)
- Elise F Palzer
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota 55414, United States
| | - Sandra E Safo
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota 55414, United States
| |
Collapse
|
2
|
Beamish AJ, Dengel OH, Palzer EF, Gronowitz E, Kelly AS, Dengel DR, Rudser KD, Brissman M, Olbers T, Dahlgren J, Flodmark CE, Marcus C, Ryder JR. Changes in adipose tissue distribution and relation to cardiometabolic risk factors after Roux-en-Y gastric bypass in adolescents. Surg Obes Relat Dis 2023; 19:1154-1161. [PMID: 37296018 DOI: 10.1016/j.soard.2023.04.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) among adolescents with obesity results in significant weight loss; however, depot-specific changes have been understudied. OBJECTIVE We hypothesized that visceral adipose tissue (VAT) reduction in adolescents undergoing RYGB would be greater than other depots and associated with improvement in cardiometabolic risk factors. SETTING Three specialized treatment centers in Sweden. METHODS Fifty-nine adolescents underwent dual x-ray absorptiometry before surgery and at 1, 2, and 5 years after RYGB. Changes in body composition in multiple depots (total fat, lean body, gynoid fat, android fat, subcutaneous adipose tissue, and VAT) and cardiometabolic risk factors were assessed using multiple linear regression analysis and generalized estimating equations adjusting for age, sex, and baseline risk factor levels. Data are presented as percent change (95% CI) with regression models showing slopes and estimated P values. RESULTS At 1 year post-RYGB, a significant reduction was observed across all body composition measures (P < .001) with the greatest reduction observed in VAT (-65.1% [-68.7, -61.8]). From year 1 to 5 years post-RYGB, a regain was observed in all depots except lean body mass (1.2% [.3, 2.7], P = .105). A sex-specific difference in overall trajectories was only observed in lean body mass with males consistently having higher mean levels. Change in VAT at 1 year correlated with change in triglycerides (slope: .21 mg/dL/kg, P = .034) and fasting plasma insulin (slope: 44 pmol/L/kg, P = .027). CONCLUSIONS Adiposity measures all decreased after RYGB but poorly predicted change in cardiometabolic risk. Despite significant reductions at 1 year, a steady regain was observed out to 5 years, with values still well below baseline. Further research should consider control group comparison and extended follow-up.
Collapse
Affiliation(s)
- Andrew J Beamish
- Department of Gastrosurgical Research and Education, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg, Sweden; Swansea University Medical School, Swansea University, Swansea, United Kingdom; Research Department, Royal College of Surgeons of England, London, United Kingdom
| | - Olivia H Dengel
- College of Veterinary Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Elise F Palzer
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Eva Gronowitz
- Department of Pediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Donald R Dengel
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Kyle D Rudser
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota; Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Markus Brissman
- Department of Clinical Science, Intervention and Technology (CLINTEC), Glasgow, United Kingdom
| | - Torsten Olbers
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Glasgow, United Kingdom
| | - Justin R Ryder
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
3
|
Abstract
BACKGROUND Kidney donors have increased risk of postdonation gestational hypertension (gHTN) and preeclampsia. In the general population, pregnancy complications are associated with long-term maternal risk. However, little data exist on whether donors with postdonation pregnancy-related complications have similar increased long-term risks. We studied whether postdonation gHTN, preeclampsia/eclampsia, or gestational diabetes (gDM) was associated with increased risk of developing hypertension, DM, cardiovascular disease, or estimated glomerular filtration rate <45 mL/min/1.73 m 2 . METHODS Postdonation pregnancies with complications were matched to pregnancies without complications based on time from donation. Incidence of outcomes was compared using sequential Cox regression with robust standard errors. Donors with predonation pregnancy complications were excluded. Models were adjusted for age at pregnancy, gravidity, year of donation, and family history of hypertension, DM, and heart disease. RESULTS Of the 384 donors with postdonation pregnancies (median [quartiles] follow-up of 27.0 [14.2-36.2] y after donation), 39 experienced preeclampsia/eclampsia, 29 gHTN without preeclampsia, and 17 gDM. Median interval from donation to first pregnancy with preeclampsia was 5.1 (2.9-8.6) y; for gHTN, 3.7 (1.9-7.8) y; and for gDM, 7.3 (3.7-10.3) y. Preeclampsia/eclampsia (hazard ratio [HR] 2.70; 95% confidence interval [CI], 1.53-4.77) and gHTN (HR 2.39; 95% CI, 1.24-4.60) were associated with development of hypertension. Preeclampsia/eclampsia (HR 2.15; 95% CI, 1.11-4.16) and gDM (HR 5.60; 95% CI, 1.41-22.15) were associated with development of DM. Pregnancy-related complications were not associated with increased risk of cardiovascular disease or estimated glomerular filtration rate <45 mL/min/1.73 m 2 . CONCLUSIONS In our single-center study, postdonation preeclampsia, gHTN, or gDM was associated with long-term risk of hypertension or DM.
Collapse
Affiliation(s)
- Elise F. Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Erika S. Helgeson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - David M. Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Arthur J. Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN
| |
Collapse
|
4
|
Helgeson ES, Vempati S, Palzer EF, Mjoen G, Haugen AJ, Matas AJ. Development and Validation of a Hypertension Risk Calculator for Living Kidney Donors. Transplantation 2023; 107:1373-1379. [PMID: 36727726 PMCID: PMC10205650 DOI: 10.1097/tp.0000000000004505] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ideally, when deciding whether to donate, kidney donor candidates would understand their long-term risks. Using single-center data (N = 4055; median [quartiles] follow-up: 18 [9-28] y), we developed a calculator for postdonation hypertension and validated it using long-term data from an external single-center cohort (N = 1189, median [quartiles] follow-up: 9 [5-17] y). METHODS Risk factors considered were routinely obtained at evaluation from donor candidates. Two modeling approaches were evaluated: Cox proportional hazards and random survival forest models. Cross-validation prediction error and Harrell's concordance-index were used to compare accuracy for model development. Top-performing models were assessed in the validation cohort using the concordance-index and net reclassification improvement. RESULTS In the development cohort, 34% reported hypertension at a median (quartiles) of 16 (8-24) y postdonation; and in the validation cohort, 29% reported hypertension after 17 (10-22) y postdonation. The most accurate model was a Cox proportional hazards model with age, sex, race, estimated glomerular filtration rate, systolic and diastolic blood pressure, body mass index, glucose, smoking history, family history of hypertension, relationship with recipient, and hyperlipidemia (concordance-index, 0.72 in the development cohort and 0.82 in the validation cohort). CONCLUSIONS A postdonation hypertension calculator was developed and validated; it provides kidney donor candidates, their family, and care team a long-term projection of hypertension risk that can be incorporated into the informed consent process.
Collapse
Affiliation(s)
- Erika S. Helgeson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Shruti Vempati
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Elise F. Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Geir Mjoen
- Department of Transplant Medicine, Oslo University Hospital, Oslo Norway
| | - Anders J. Haugen
- Deptartment of Internal Medicine, Bærum Hospital, Sandvika Norway
| | - Arthur J. Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN
| |
Collapse
|
5
|
Sharma M, Do TH, Palzer EF, Huling JD, Chen CC. Comparable safety profile between neuro-oncology procedures involving stereotactic needle biopsy (SNB) followed by laser interstitial thermal therapy (LITT) and LITT alone procedures. J Neurooncol 2023; 162:147-156. [PMID: 36920678 DOI: 10.1007/s11060-023-04275-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Tissue diagnosis through stereotactic needle biopsy (SNB) is often needed prior to laser interstitial thermal therapy (LITT). Whether these procedures should be performed in the same surgery or in separate settings remain unclear. As a first step to address this question, we assess safety profile of procedures involving LITT alone versus SNB + LITT. METHODS Using International Classification of Disease (ICD) codes, we queried the National Readmissions Database (NRD, 2010-2018) for malignant brain tumor patients who underwent either (1) LITT alone or (2) elective LITT in combination with SNB (SNB + LITT). Survey regression methods were utilized. Additionally, the procedural outcome of LITT or SNB + LITT performed by the senior surgeon (2014-2022) were reviewed. RESULTS During the study period, an estimated 678 malignant brain tumor patients underwent LITT alone versus 373 patients that underwent SNB + LITT. Patients undergoing LITT and SNB + LITT exhibited statistically comparable median lengths of hospital stay (IQR; LITT = 2 day [1, 3]; SNB + LITT = 1 day [1, 3]; p = 0.405) and likelihood of routine discharge (LITT = 73.5%; SNB + LITT = 81.1%; p = 0.068). The odds of 30-day medical or neurological readmissions were comparable between LITT and SNB + LITT treated patients (all p ≥ 0.793). In the single surgeon experience of 218 procedures performed over an eight year period (2014-2022), the complications (LITT = 3.9%; SNB + LITT = 2.6%, p = 0.709), discharge within 48 h (LITT = 84.5%; SNB + LITT = 87.8%; p = 0.556), routine discharge (LITT = 91.3%; SNB + LITT = 93.9%; p = 0.604), and unplanned 30-day readmission (LITT = 3.9%; SNB + LITT = 1.7%; p = 0.423) were similarly comparable between LITT and SNB + LITT. CONCLUSION The length of hospital stay, the likelihood of routine discharge, and 30-day readmission for malignant brain tumor patients who underwent LITT and SNB + LITT were comparable.
Collapse
Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Minnesota, 420 Delaware St, Minneapolis, MN, 55455, USA
| | - Truong H Do
- Department of Neurosurgery, University of Minnesota, 420 Delaware St, Minneapolis, MN, 55455, USA
| | - Elise F Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Jared D Huling
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, 420 Delaware St, Minneapolis, MN, 55455, USA. .,University of Minnesota Neurosurgery, D429 Mayo Memorial Building 420 Delaware St. S. E., MMC96, Minneapolis, MN, 55455, USA.
| |
Collapse
|
6
|
George PE, Gamble AV, Palzer EF, Brearley AM, Johnson DE, Eckerle JK. Health of Post-Institutionalized Haitian Children Adopted to the United States. Matern Child Health J 2023:10.1007/s10995-022-03574-4. [PMID: 36737526 PMCID: PMC9897990 DOI: 10.1007/s10995-022-03574-4] [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] [Received: 04/24/2022] [Revised: 11/06/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Haiti remains a principal placement country for intercountry adoptees to the United States. This project reports the health status of children adopted from Haiti arriving to the U.S. and compares them to intercountry adoptees from other regions. METHODS A retrospective chart review was conducted of adoptees placed in the U.S. from Haiti (n=87), age and sex matched with intercountry adoptees placed in the U.S. from Asia (n=87) and Latin America (n=87) between January 2010 and November 2019. Data on immunization status, contagious diseases, and nutrition and growth were analyzed via linear, logistic, and multinomial regression. RESULTS After adjusting for age, sex, and standardized height, children adopted from Haiti, compared to adoptees from Latin America and Asia, demonstrated a lack of immunity to hepatitis B (OR=5.89;6.87), increased immunity to hepatitis A (OR=0.38;0.30), infection by two or more parasites (OR=8.43;38.48), high lead levels (OR=23.79;7.04), and anemia (OR=15.25;9.18). Unexpectedly, children adopted from Haiti had greater standardized height (-1.28 vs. -1.82 and -2.13) and standardized weight (-0.32 vs. -0.57 and -1.57) than their counterparts from Latin America and Asia. CONCLUSIONS Children adopted from Haiti face complex medical challenges undoubtedly related to the country's low socioeconomic status (SES) and the impact of recurrent natural disasters and governmental neglect on public health infrastructure. Appropriate care is critical in preventing and avoiding transmission of infectious diseases in adoptees and family members. The high incidence of anemia and elevated lead levels may further exacerbate the developmental effects of early institutional deprivation.
Collapse
Affiliation(s)
- Priya E. George
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN USA
| | - Anna V. Gamble
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN USA
| | - Elise F. Palzer
- Division of Biostatistics, School of Public Health and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN USA
| | - Ann M. Brearley
- Division of Biostatistics, School of Public Health and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN USA
| | - Dana E. Johnson
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN USA
| | - Judith K. Eckerle
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN USA
| |
Collapse
|
7
|
Do TH, Lu J, Palzer EF, Cramer SW, Huling JD, Johnson RA, Zhu P, Jean JN, Howard MA, Sabal LT, Hanson JT, Jonason AB, Sun KW, McGovern RA, Chen CC. Rates of operative intervention for infection after synthetic or autologous cranioplasty: a National Readmissions Database analysis. J Neurosurg 2023; 138:514-521. [PMID: 35901766 DOI: 10.3171/2022.4.jns22301] [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] [Received: 02/04/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to characterize the clinical utilization and associated charges of autologous bone flap (ABF) versus synthetic flap (SF) cranioplasty and to characterize the postoperative infection risk of SF versus ABF using the National Readmissions Database (NRD). METHODS The authors used the publicly available NRD to identify index hospitalizations from October 2015 to December 2018 involving elective ABF or SF cranioplasty after traumatic brain injury (TBI) or stroke. Subsequent readmissions were further characterized if patients underwent neurosurgical intervention for treatment of infection or suspected infection. Survey Cox proportional hazards models were used to assess risk of readmission. RESULTS An estimated 2295 SF and 2072 ABF cranioplasties were performed from October 2015 to December 2018 in the United States. While the total number of cranioplasty operations decreased during the study period, the proportion of cranioplasties utilizing SF increased (p < 0.001), particularly in male patients (p = 0.011) and those with TBI (vs stroke, p = 0.012). The median total hospital charge for SF cranioplasty was $31,200 more costly than ABF cranioplasty (p < 0.001). Of all first-time readmissions, 20% involved surgical treatment for infectious reasons. Overall, 122 SF patients (5.3%) underwent surgical treatment of infection compared with 70 ABF patients (3.4%) on readmission. After accounting for confounders using a multivariable Cox model, female patients (vs male, p = 0.003), those discharged nonroutinely (vs discharge to home or self-care, p < 0.001), and patients who underwent SF cranioplasty (vs ABF, p = 0.011) were more likely to be readmitted for reoperation. Patients undergoing cranioplasty during more recent years (e.g., 2018 vs 2015) were less likely to be readmitted for reoperation because of infection (p = 0.024). CONCLUSIONS SFs are increasingly replacing ABFs as the material of choice for cranioplasty, despite their association with increased hospital charges. Female sex, nonroutine discharge, and SF cranioplasty are associated with increased risk for reoperation after cranioplasty.
Collapse
Affiliation(s)
- Truong H Do
- 1Department of Neurological Surgery, University of Minnesota
| | - Jinci Lu
- 3University of Minnesota Medical School, Minneapolis, Minnesota
| | - Elise F Palzer
- 2School of Public Health, Division of Biostatistics, University of Minnesota; and
| | - Samuel W Cramer
- 1Department of Neurological Surgery, University of Minnesota
| | - Jared D Huling
- 2School of Public Health, Division of Biostatistics, University of Minnesota; and
| | - Reid A Johnson
- 3University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ping Zhu
- 1Department of Neurological Surgery, University of Minnesota
| | - James N Jean
- 1Department of Neurological Surgery, University of Minnesota
| | | | - Luke T Sabal
- 3University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jacob T Hanson
- 1Department of Neurological Surgery, University of Minnesota
| | - Alec B Jonason
- 1Department of Neurological Surgery, University of Minnesota
| | - Kevin W Sun
- 1Department of Neurological Surgery, University of Minnesota
| | | | - Clark C Chen
- 1Department of Neurological Surgery, University of Minnesota
| |
Collapse
|
8
|
Jang S, Palzer EF, Rudser KD, Fox CK, Hebbel RP, Dengel DR, Milbauer L, Kelly AS, Ryder JR. Relationship of Endothelial Microparticles to Obesity and Cardiovascular Disease Risk in Children and Adolescents. J Am Heart Assoc 2022; 11:e026430. [DOI: 10.1161/jaha.122.026430] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background
Microparticles and endothelial microparticles (EMPs) are implicated in accelerating cardiovascular disease (CVD); however, data in pediatrics are limited. We examined the relationship of microparticles and EMPs with adiposity and subclinical CVD risk measures in a pediatric population to determine their potential as biomarkers of CVD risk.
Methods and Results
A cross‐sectional study of youth (n=280; ages 8–20 years) with a range of body mass index categories was used. Microparticles, EMPs, and activated EMPs were measured by flow cytometry. %Body fat and %visceral adipose tissue were measured by dual X‐ray absorptiometry. Measures of arterial stiffness and vascular wall structure were obtained. Linear regression (with log‐transformed outcomes) and logistic regression were used to evaluate associations and all results were exponentiated. Youth with overweight/obesity and severe obesity had 2.50 (95% CI, 1.56–4.01) and 3.42 (95% CI, 2.15–5.43) times the geometric means of the total number of microparticles, respectively, compared with those with normal weight. Youth with overweight/obesity and severe obesity had 1.97 (95% CI, 1.09–3.55) and 2.34 (95% CI, 1.31–4.19) times the geometric means of the total number of EMPs, respectively, compared with those with normal weight. There were positive associations between the levels of both microparticles and EMPs with higher adiposity measures and poor CVD risk measures. Youth with higher adiposity showed 1.84 times the odds of having high levels of activated EMPs (%) (odds ratio, 1.84; 95% CI, 1.08–3.14) compared with those with normal weight.
Conclusions
Levels of microparticles, EMPs, and activated EMPs were positively associated with adiposity and poor subclinical CVD risk in a pediatric population.
Collapse
Affiliation(s)
- Subin Jang
- Division of Epidemiology, School of Public Health University of Minnesota Minneapolis MN
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN
- Department of Pediatrics University of Minnesota Medical School Minneapolis MN
| | - Elise F. Palzer
- Division of Biostatistics, School of Public Health University of Minnesota Minneapolis MN
| | - Kyle D. Rudser
- Division of Biostatistics, School of Public Health University of Minnesota Minneapolis MN
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN
| | - Claudia K. Fox
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN
- Department of Pediatrics University of Minnesota Medical School Minneapolis MN
| | - Robert P. Hebbel
- Vascular Biology Center, Division of Hematology, Oncology & Transplantation University of Minnesota Medical School Minneapolis MN
- Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Donald R. Dengel
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN
- Department of Pediatrics University of Minnesota Medical School Minneapolis MN
- School of Kinesiology University of Minnesota Minneapolis MN
| | - Liming Milbauer
- Department of Biochemistry University of Minnesota Minneapolis MN
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN
- Department of Pediatrics University of Minnesota Medical School Minneapolis MN
| | - Justin R. Ryder
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN
- Department of Pediatrics University of Minnesota Medical School Minneapolis MN
| |
Collapse
|
9
|
Palzer EF, Wendt CH, Bowler RP, Hersh CP, Safo SE, Lock EF. sJIVE: Supervised Joint and Individual Variation Explained. Comput Stat Data Anal 2022; 175:107547. [PMID: 36119152 PMCID: PMC9481062 DOI: 10.1016/j.csda.2022.107547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Analyzing multi-source data, which are multiple views of data on the same subjects, has become increasingly common in molecular biomedical research. Recent methods have sought to uncover underlying structure and relationships within and/or between the data sources, and other methods have sought to build a predictive model for an outcome using all sources. However, existing methods that do both are presently limited because they either (1) only consider data structure shared by all datasets while ignoring structures unique to each source, or (2) they extract underlying structures first without consideration to the outcome. The proposed method, supervised joint and individual variation explained (sJIVE), can simultaneously (1) identify shared (joint) and source-specific (individual) underlying structure and (2) build a linear prediction model for an outcome using these structures. These two components are weighted to compromise between explaining variation in the multi-source data and in the outcome. Simulations show sJIVE to outperform existing methods when large amounts of noise are present in the multi-source data. An application to data from the COPDGene study explores gene expression and proteomic patterns associated with lung function.
Collapse
Affiliation(s)
- Elise F. Palzer
- Division of Biostatistics, University of Minnesota, Minneapolis, 55455, USA
| | - Christine H. Wendt
- Division of Pulmonary, Allergy and Critical Care, University of Minnesota, Minneapolis, 55455, USA
| | - Russell P. Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Craig P. Hersh
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandra E. Safo
- Division of Biostatistics, University of Minnesota, Minneapolis, 55455, USA
| | - Eric F. Lock
- Division of Biostatistics, University of Minnesota, Minneapolis, 55455, USA
| |
Collapse
|
10
|
Abstract
BACKGROUND Hypertension and diabetes are contraindications for living kidney donation in young candidates. However, little is known about the long-term outcomes of women who had these pregnancy-related complications and subsequently became donors. In the general population, gestational hypertension (GHtn), preeclampsia/eclampsia, and gestational diabetes (GDM) are associated with long-term risks. METHODS Donors with the specified predonation complication were matched to contemporary control donors with pregnancies without the complication using nearest neighbor propensity score matching. Propensity scores were estimated using logistic regression with covariates for gravidity, blood pressure, glucose, body mass index, age, and creatinine at donation, donation year, race, relationship with recipient, and family history of disease. Long-term incidence of hypertension, diabetes, cardiovascular disease, and reduced renal function (estimated glomerular filtration rate [eGFR] <30, eGFR <45 mL/min/1.73 m 2 ) were compared between groups using proportional hazards models. RESULTS Of 1862 donors with predonation pregnancies, 48 had preeclampsia/eclampsia, 49 had GHtn without preeclampsia, and 43 had GDM. Donors had a long interval between first pregnancy and donation (median, 18.5 y; interquartile range, 10.6-27.5) and a long postdonation follow-up time (median, 18.0; interquartile range, 9.2-27.7 y). GHtn was associated with the development of hypertension (hazard ratio, 1.89; 95% confidence interval, 1.26-2.83); GDM was associated with diabetes (hazard ratio, 3.04; 95% confidence interval, 1.33-6.99). Pregnancy complications were not associated with eGFR <30 or eGFR <45 mL/min/1.73 m 2 . CONCLUSIONS Our data suggest that women with predonation pregnancy-related complications have long-term risks even with a normal donor evaluation. Donor candidates with a history of pregnancy-related complications should be counseled about these risks.
Collapse
Affiliation(s)
- Erika S. Helgeson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Elise F. Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - David M. Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Paige Porrett
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Deirdre Sawinski
- Division of Renal Electrolyte and Hypertension, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Arthur J. Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN
| |
Collapse
|
11
|
Do TH, Howard MA, Palzer EF, Huling JD, Alvi MA, Cramer SW, Zhu P, Johnson RA, Jean J, Lu J, Jonason AB, Hanson J, Sabal L, Sun KW, McGovern RA, Chen CC. Readmission risk of malignant brain tumor patients undergoing laser interstitial thermal therapy (LITT) and stereotactic needle biopsy (SNB): a covariate balancing weights analysis of the National Readmissions Database (NRD). J Neurooncol 2022; 159:553-561. [DOI: 10.1007/s11060-022-04093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/07/2022] [Indexed: 10/16/2022]
|
12
|
Cramer SW, Do TH, Palzer EF, Naik A, Rice AL, Novy SG, Hanson JT, Piazza AN, Howard MA, Huling JD, Chen CC, McGovern RA. Persistent Racial Disparities in Deep Brain Stimulation for Parkinson's Disease. Ann Neurol 2022; 92:246-254. [PMID: 35439848 PMCID: PMC9546407 DOI: 10.1002/ana.26378] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 01/03/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
We sought to determine whether racial and socioeconomic disparities in the utilization of deep brain stimulation (DBS) for Parkinson's disease (PD) have improved over time. We examined DBS utilization and analyzed factors associated with placement of DBS. The odds of DBS placement increased across the study period, whereas White patients with PD were 5 times more likely than Black patients to undergo DBS. Individuals, regardless of racial background, with 2 or more comorbidities were 14 times less likely to undergo DBS. Privately insured patients were 1.6 times more likely to undergo DBS. Despite increasing DBS utilization, significant disparities persist in access to DBS. ANN NEUROL 2022;92:246–254
Collapse
Affiliation(s)
- Samuel W Cramer
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN
| | - Truong H Do
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN
| | - Elise F Palzer
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL
| | | | | | - Jacob T Hanson
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN
| | | | | | - Jared D Huling
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN.,Division of Neurosurgery, Minneapolis VA Health Care System, Minneapolis, MN
| |
Collapse
|
13
|
Macdonald DM, Palzer EF, Abbasi A, Baldomero AK, Bhatt SP, Casaburi R, Connett JE, Dransfield MT, Gaeckle NT, Mkorombindo T, Rossiter HB, Stringer WW, Tiller NB, Wendt CH, Zhao D, Kunisaki KM. Chronotropic index during 6-minute walk and acute respiratory events in COPDGene. Respir Med 2022; 194:106775. [PMID: 35203009 PMCID: PMC8932051 DOI: 10.1016/j.rmed.2022.106775] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lower heart rate (HR) increases during exercise and slower HR recovery (HRR) after exercise are markers of worse autonomic function that may be associated with risk of acute respiratory events (ARE). METHODS Data from 6-min walk testing (6MWT) in COPDGene were used to calculate the chronotropic index (CI) [(HR immediately post 6MWT - resting HR)/((220 - age) - resting HR)] and HRR at 1 min after 6MWT completion. We used zero-inflated negative binomial regression to test associations of CI and HRR with rates of any ARE (requiring steroids and/or antibiotics) and severe ARE (requiring emergency department visit or hospitalization), among all participants and in spirometry subgroups (normal, chronic obstructive pulmonary disease [COPD], and preserved ratio with impaired spirometry). RESULTS Among 4,484 participants, mean follow-up time was 4.1 years, and 1,966 had COPD. Among all participants, CI-6MWT was not associated with rate of any ARE [adjusted incidence rate ratio (aIRR) 0.98 (0.95-1.01)], but higher CI-6MWT was associated with lower rate of severe ARE [0.95 (0.92-0.99)]. Higher HRR was associated with a lower rate of both any ARE [0.97 (0.95-0.99)] and severe ARE [0.95 (0.92-0.98)]. Results were similar in the COPD spirometry subgroup. CONCLUSION Heart rate measures derived from 6MWT tests may have utility in predicting risk of acute respiratory events and COPD exacerbations.
Collapse
Affiliation(s)
- David M Macdonald
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA.
| | - Elise F Palzer
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Asghar Abbasi
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Arianne K Baldomero
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | - Surya P Bhatt
- Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard Casaburi
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - John E Connett
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Mark T Dransfield
- Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nathaniel T Gaeckle
- Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | | | - Harry B Rossiter
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - William W Stringer
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nicholas B Tiller
- Division of Respiratory & Critical Care, Physiology & Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Chris H Wendt
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| | - Dongxing Zhao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, China
| | - Ken M Kunisaki
- Pulmonary Section, Minneapolis VA, Minneapolis, MN, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
14
|
Ingraham NE, Vakayil V, Pendleton KM, Robbins AJ, Freese RL, Palzer EF, Charles A, Dudley RA, Tignanelli CJ. Recent Trends in Admission Diagnosis and Related Mortality in the Medically Critically Ill. J Intensive Care Med 2022; 37:185-194. [PMID: 33353475 DOI: 10.1177/0885066620982905] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE With decades of declining ICU mortality, we hypothesized that the outcomes and distribution of diseases cared for in the ICU have changed and we aimed to further characterize them. STUDY DESIGN AND METHODS A retrospective cohort analysis of 287,154 nonsurgical-critically ill adults, from 237 U.S. ICUs, using the manually abstracted Cerner APACHE Outcomes database from 2008 to 2016 was performed. Surgical patients, rare admission diagnoses (<100 occurrences), and low volume hospitals (<100 total admissions) were excluded. Diagnoses were distributed into mutually exclusive organ system/disease-based categories based on admission diagnosis. Multi-level mixed-effects negative binomial regression was used to assess temporal trends in admission, in-hospital mortality, and length of stay (LOS). RESULTS The number of ICU admissions remained unchanged (IRR 0.99, 0.98-1.003) while certain organ system/disease groups increased (toxicology [25%], hematologic/oncologic [55%] while others decreased (gastrointestinal [31%], pulmonary [24%]). Overall risk-adjusted in-hospital mortality was unchanged (IRR 0.98, 0.96-1.0004). Risk-adjusted ICU LOS (Estimate -0.06 days/year, -0.07 to -0.04) decreased. Risk-adjusted mortality varied significantly by disease. CONCLUSION Risk-adjusted ICU mortality rate did not change over the study period, but there was evidence of shifting disease burden across the critical care population. Our data provides useful information regarding future ICU personnel and resource needs.
Collapse
Affiliation(s)
- Nicholas E Ingraham
- Department of Medicine, 311816University of Minnesota Medical School, Minneapolis, MN, USA
- School of Public Health, 311816University of Minnesota, Minneapolis, MN, USA
| | - Victor Vakayil
- School of Public Health, 311816University of Minnesota, Minneapolis, MN, USA
- Department of Surgery, 311816University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kathryn M Pendleton
- Department of Medicine, 311816University of Minnesota Medical School, Minneapolis, MN, USA
| | - Alexandria J Robbins
- Department of Surgery, 311816University of Minnesota Medical School, Minneapolis, MN, USA
| | - Rebecca L Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, 311816University of Minnesota, Minneapolis, MN, USA
| | - Elise F Palzer
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, 311816University of Minnesota, Minneapolis, MN, USA
| | - Anthony Charles
- Department of Surgery, 2331University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Gillings School of Global Public Health, 2331University of North Carolina, Chapel Hill, NC, USA
| | - R Adams Dudley
- Department of Medicine, 311816University of Minnesota Medical School, Minneapolis, MN, USA
- School of Public Health, 311816University of Minnesota, Minneapolis, MN, USA
- Institute for Health Informatics, 311816University of Minnesota Academic Health Center, Minneapolis, MN, USA
| | - Christopher J Tignanelli
- Department of Surgery, 311816University of Minnesota Medical School, Minneapolis, MN, USA
- Institute for Health Informatics, 311816University of Minnesota Academic Health Center, Minneapolis, MN, USA
- Department of Surgery, North Memorial Health Hospital, Robbinsdale, MN, USA
| |
Collapse
|
15
|
Bomberg EM, Palzer EF, Rudser KD, Kelly AS, Bramante CT, Seligman HK, Noni F, Fox CK. Anti-obesity medication prescriptions by race/ethnicity and use of an interpreter in a pediatric weight management clinic. Ther Adv Endocrinol Metab 2022; 13:20420188221090009. [PMID: 35432917 PMCID: PMC9005816 DOI: 10.1177/20420188221090009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Race/ethnicity and low English proficiency healthcare disparities are well established in the United States. We sought to determine if there are race/ethnicity differences in anti-obesity medication (AOM) prescription rates among youth with severe obesity treated in a pediatric weight management clinic and if, among youth from non-primary English speaking families, there are differences in prescriptions between those using interpreters during visits versus not. METHODS We reviewed electronic health records of 2- to 18-year-olds with severe obesity seen from 2012 to 2021. Race/ethnicity was self-report, and AOMs included topiramate, stimulants (e.g. phentermine, lisdexamfetamine), naltrexone (±bupropion), glucagon-like peptide-1 agonists, and orlistat. We used general linear regression models with log-link to compare incidence rate ratios (IRRs) within the first 1 and 3 years of being followed, controlling for age, percent of the 95th BMI percentile (%BMIp95), number of obesity-related comorbidities (e.g. insulin resistance, hypertension), median household income, and interpreter use. We repeated similar analyses among youth from non-primary English speaking families, comparing those using interpreters versus not. RESULTS 1,725 youth (mean age 11.5 years; %BMIp95 142%; 53% non-Hispanic White, 20% Hispanic/Latino, 16% non-Hispanic black; 6% used interpreters) were seen, of which 15% were prescribed AOMs within 1 year. The IRR for prescriptions was lower among Hispanic/Latino compared to non-Hispanic White youth at one (IRR 0.70; CI: 0.49-1.00; p = 0.047) but not 3 years. No other statistically significant differences by race/ethnicity were found. Among non-primary English speaking families, the IRR for prescriptions was higher at 1 year (IRR 2.49; CI: 1.32-4.70; p = 0.005) in those using interpreters versus not. CONCLUSIONS Among youth seen in a pediatric weight management clinic, AOM prescription incidence rates were lower in Hispanics/Latinos compared to non-Hispanic Whites. Interpreter use was associated with higher prescription incidence rates among non-primary English speakers. Interventions to achieve equity in AOM prescriptions may help mitigate disparities in pediatric obesity.
Collapse
Affiliation(s)
| | - Elise F. Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kyle D. Rudser
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Carolyn T. Bramante
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Hilary K. Seligman
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Favour Noni
- University of Minnesota, Minneapolis, MN, USA
| | - Claudia K. Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
16
|
Hamade YJ, Palzer EF, Helgeson ES, Hanson JT, Walczak TS, McGovern RA. Persistent racial and ethnic disparities as a potential source of epilepsy surgery underutilization: Analysis of large national datasets from 2006-2016. Epilepsy Res 2021; 176:106725. [PMID: 34304018 DOI: 10.1016/j.eplepsyres.2021.106725] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/10/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE High volume surgical epilepsy centers have reported a decrease in surgical resections and an increase in intracranial monitoring. Despite this increase in complexity, epilepsy surgery remains significantly underutilized. The goal of this study is to examine the utilization of and access to epilepsy surgery in the United States from 2006 to 2016. METHODS We used administrative datasets from the National Inpatient Sample (NIS) and Center for Medicare and Medicaid Services (CMS) to report national estimates of epilepsy surgery and changes in surgery types. We also examined disparities and barriers in access to epilepsy surgery. RESULTS Inpatient epilepsy admissions increased from 2.41 to 5.78 per 100,000 between 2006 and 2016, while surgical epilepsy admissions plateaued after 2011. Open resections comprised 75 % of all surgical cases from 2006 to 2011 then decreased each year to 50 % in 2016 with both temporal and extratemporal resections decreasing proportionally. Intracranial monitoring increased in the last two years of the study due to an increase in SEEG/depth electrode cases. The multivariate analysis showed that patients with Medicaid (OR 0.75, 95 % CI 0.67-0.83) and Medicare (OR 0.62, 95 % CI 0.54-0.70) were significantly less likely to undergo epilepsy surgery compared to those with private insurance. Black patients were less likely to undergo epilepsy surgery than White or Hispanic patients (OR 0.57, 95 % CI 0.49-0.67). No significant difference was found in epilepsy surgery rates after implementation of the Affordable Care Act (ACA) in 2014. CONCLUSION This study identifies recent trends in epilepsy surgical approaches and suggests that improving access to care does not necessarily address disparities present in the treatment of epilepsy patients who need surgical care.
Collapse
Affiliation(s)
- Youssef J Hamade
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN, 55455, United States.
| | - Elise F Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, United States
| | - Erika S Helgeson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, 55455, United States
| | - Jacob T Hanson
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN, 55455, United States
| | - Thaddeus S Walczak
- Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, 55455, United States
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN, 55455, United States
| |
Collapse
|
17
|
Bomberg EM, Palzer EF, Rudser KD, Kelly AS, Bramante CT, Seligman HK, Noni F, Fox CK. Anti-Obesity Medication Prescriptions by Race/Ethnicity and Use of an Interpreter in a Pediatric Weight Management Clinic. J Endocr Soc 2021. [PMCID: PMC8265710 DOI: 10.1210/jendso/bvab048.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Healthcare disparities associated with race/ethnicity and low English proficiency are well established in the US. We sought to determine if there are race/ethnic differences in anti-obesity medication prescription rates among youth with severe obesity (body mass index (BMI) ≥1.2 times the 95th percentile and/or BMI ≥35 kg/m2) treated in a pediatric weight management clinic (PWMC). We secondarily sought to determine if, among youth from families in whom English was not the primary language, there are differences in prescription rates between those using an interpreter during visits and those not. Methods: We reviewed electronic health records of youth 2–18 years old with severe obesity seen at a PWMC from 2012–2020. Race/ethnicity was self-reported and categorized as Non-Hispanic White (NHW), Hispanic/Latino, Non-Hispanic Black (NHB), Asian, American Indian/Alaska Native and Mixed. Anti-obesity medicines included stimulants (i.e. phentermine, lisdexamfetamine), topiramate, naltrexone (± bupropion), and glucagon-like peptide-1 agonists. We used Poisson regression models with robust standard errors to compare incidence rates of medicine prescription (incidence rate ratio (IRR), accounting for visit frequency) within the first 1 and 3 years of being followed in a PWMC. We controlled for age, baseline degree of obesity (percent of the 95th BMI percentile (%BMIp95)), number of obesity-related comorbidities (i.e. insulin resistance, hypertension, fatty liver), area-level socioeconomic status (median household income based on ZIP code), and interpreter use. We repeated similar analyses among families in whom English was not the primary language, comparing those using an interpreter with those not. Results: From 2012–2020, 1258 youth (mean age 11.8 years; %BMIp95 143%) were seen in our PWMC (57% NHW, 19% Hispanic/Latino, 16% NHB) of which 26% were prescribed anti-obesity medication. 86% primarily spoke English and 5.2% used an interpreter. There were no statistically significant differences in the IRR of prescriptions by race/ethnicity at 1 and 3 years; however, although not statistically significant point estimates suggest Hispanic/Latino youth being prescribed medication less often at 1 (IRR 0.71; p=0.08) and 3 (IRR 0.75; p=0.13) years compared to NHW. Among non-primary English speakers, rates of prescriptions were higher at 1 (IRR 5.7; p<0.01) and 3 (IRR 3.5; p<0.01) years in those using an interpreter versus those not. Conclusions: We found no significant race/ethnic differences in anti-obesity medication prescriptions; however, Hispanic/Latino youth received fewer prescriptions, albeit not statistically significant. Among non-primary English speakers, use of an interpreter was associated with increased prescriptions. Our results suggest that addressing healthcare disparities and language barriers may improve care delivery for youth with obesity.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Favour Noni
- University of Minnesota, Minneapolis, MN, USA
| | | |
Collapse
|
18
|
Tran H, Sagi V, Jarrett S, Palzer EF, Badgaiyan RD, Gupta K. Diet and companionship modulate pain via a serotonergic mechanism. Sci Rep 2021; 11:2330. [PMID: 33526805 PMCID: PMC7851147 DOI: 10.1038/s41598-021-81654-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/08/2021] [Indexed: 01/30/2023] Open
Abstract
Treatment of severe chronic and acute pain in sickle cell disease (SCD) remains challenging due to the interdependence of pain and psychosocial modulation. We examined whether modulation of the descending pain pathway through an enriched diet and companionship could alleviate pain in transgenic sickle mice. Mechanical and thermal hyperalgesia were reduced significantly with enriched diet and/or companionship. Upon withdrawal of both conditions, analgesic effects observed prior to withdrawal were diminished. Serotonin (5-hydroxytryptamine, 5-HT) was found to be increased in the spinal cords of mice provided both treatments. Additionally, 5-HT production improved at the rostral ventromedial medulla and 5-HT accumulated at the dorsal horn of the spinal cord of sickle mice, suggesting the involvement of the descending pain pathway in the analgesic response. Modulation of 5-HT and its effect on hyperalgesia was also investigated through pharmaceutical approaches. Duloxetine, a serotonin-norepinephrine reuptake inhibitor, showed a similar anti-nociceptive effect as the combination of diet and companionship. Depletion of 5-HT through p-chlorophenylalanine attenuated the anti-hyperalgesic effect of enriched diet and companionship. More significantly, improved diet and companionship enhanced the efficacy of a sub-optimal dose of morphine for analgesia in sickle mice. These findings offer the potential to reduce opioid use without pharmacological interventions to develop effective pain management strategies.
Collapse
Affiliation(s)
- Huy Tran
- grid.17635.360000000419368657 Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN USA
| | - Varun Sagi
- grid.17635.360000000419368657 Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN USA
| | - Sarita Jarrett
- grid.16753.360000 0001 2299 3507Northwestern University, Evanston, IL USA
| | - Elise F. Palzer
- grid.17635.360000000419368657Biostatistical Design and Analysis Center, Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN USA
| | - Rajendra D. Badgaiyan
- grid.267309.90000 0001 0629 5880Department of Psychiatry, Long School of Medicine, University of Texas Health Science Center, San Antonio, Texas USA
| | - Kalpna Gupta
- grid.17635.360000000419368657 Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN USA ,Hematology/Oncology, Department of Medicine, University of California, Irvine and Southern California Institute for Research and Education, VA Medical Center, 5901 East 7th St, Long Beach, CA 90822 USA
| |
Collapse
|
19
|
Soltero EG, Solovey AN, Hebbel RP, Palzer EF, Ryder JR, Shaibi GQ, Olson M, Fox CK, Rudser KD, Dengel DR, Evanoff NG, Kelly AS. Relationship of Circulating Endothelial Cells With Obesity and Cardiometabolic Risk Factors in Children and Adolescents. J Am Heart Assoc 2020; 10:e018092. [PMID: 33372524 PMCID: PMC7955458 DOI: 10.1161/jaha.120.018092] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Circulating endothelial cells (CECs) reflect early changes in endothelial health; however, the degree to which CEC number and activation is related to adiposity and cardiovascular risk factors in youth is not well described. Methods and Results Youth in this study (N=271; aged 8-20 years) were classified into normal weight (body mass index [BMI] percentage <85th; n=114), obesity (BMI percentage ≥95th to <120% of the 95th; n=63), and severe obesity (BMI percentage ≥120% of the 95th; n=94) catagories. CEC enumeration was determined using immunohistochemical examination of buffy coat smears and activated CEC (percentage of vascular cell adhesion molecule-1 expression) was assessed using immunofluorescent staining. Cardiovascular risk factors included measures of body composition, blood pressure, glucose, insulin, lipid profile, C-reactive protein, leptin, adiponectin, oxidized low-density lipoprotein cholesterol, carotid artery intima-media thickness, and pulse wave velocity. Linear regression models examined associations between CEC number and activation with BMI and cardiovascular risk factors. CEC number did not differ among BMI classes (P>0.05). Youth with severe obesity had a higher degree of CEC activation compared with normal weight youth (8.3%; 95% CI, 1.1-15.6 [P=0.024]). Higher CEC number was associated with greater body fat percentage (0.02 per percentage; 95% CI, 0.00-0.03 [P=0.020]) and systolic blood pressure percentile (0.01 per percentage; 95% CI, 0.00-0.01 [P=0.035]). Higher degree of CEC activation was associated with greater visceral adipose tissue (5.7% per kg; 95% CI, 0.4-10.9 [P=0.034]) and non-high-density lipoprotein cholesterol (0.11% per mg/dL; 95% CI, 0.01-0.21 [P=0.039]). Conclusions Methods of CEC quantification are associated with adiposity and cardiometabolic risk factors and may potentially reflect accelerated atherosclerosis as early as childhood.
Collapse
Affiliation(s)
- Erica G Soltero
- Department of Pediatrics Children's Nutrition Research CenterBaylor College of Medicine Houston TX
| | - Anna N Solovey
- Vascular Biology Center Division of Hematology Oncology & Transplantation University of Minnesota Medical School Minneapolis MN
| | - Robert P Hebbel
- Vascular Biology Center Division of Hematology Oncology & Transplantation University of Minnesota Medical School Minneapolis MN.,Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Elise F Palzer
- Division of Biostatistics School of Public Health University of Minnesota Minneapolis MN
| | - Justin R Ryder
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN.,Department of Pediatrics University of Minnesota Medical School Minneapolis MN
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention Arizona State University Phoenix AZ.,Department of Pediatric Endocrinology and Diabetes Phoenix Children's Hospital Phoenix AZ
| | - Micah Olson
- Center for Health Promotion and Disease Prevention Arizona State University Phoenix AZ.,Department of Pediatric Endocrinology and Diabetes Phoenix Children's Hospital Phoenix AZ
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN.,Department of Pediatrics University of Minnesota Medical School Minneapolis MN
| | - Kyle D Rudser
- Division of Biostatistics School of Public Health University of Minnesota Minneapolis MN.,Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN
| | - Donald R Dengel
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN.,Department of Pediatrics University of Minnesota Medical School Minneapolis MN.,School of Kinesiology University of Minnesota Minneapolis MN
| | - Nicholas G Evanoff
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN.,School of Kinesiology University of Minnesota Minneapolis MN
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine University of Minnesota Medical School Minneapolis MN.,Department of Pediatrics University of Minnesota Medical School Minneapolis MN
| |
Collapse
|
20
|
Wojcicki AV, George PE, Palzer EF, Brearley AM, Gustafson KL, Eckerle JK. Vitamin D Deficiency in a Minnesota-Based Foster Care Population: A Cross Sectional Study. Child Youth Serv Rev 2020; 119:105611. [PMID: 33162630 PMCID: PMC7643840 DOI: 10.1016/j.childyouth.2020.105611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Children in foster care have complex health concerns that often interplay with their childhood experiences, environment and access to care. Studies suggest that foster care youth are at an increased risk for mental health disorders and physical disabilities. Although traditionally associated with insufficient bone development, the implications of vitamin D deficiency are broadening to encompass behavioral, neurodevelopmental, and psychological phenomena. Due to its association with diet, prenatal factors, and the prevalence of nutrition related deficiencies in foster care patients, we hypothesize that foster care patients exhibit lower levels of total 25-hydroxy vitamin D [25(OH)D] than the general pediatric population. A retrospective cross-sectional chart review of foster care patients and similar-aged non-fostered controls screened for vitamin D deficiency was conducted between January 2013 and May 2018 (n=407). Twenty-five (OH)D levels were comparable between foster care children and controls (p=0.771). A univariate analysis of risk factors within the foster care group found that higher BMI, older age, ADHD, and number of transitions was associated with decreased levels of 25(OH)D. Recognition and treatment of low 25(OH)D in foster care patients with specific risk factors may serve as an adjunct for meeting their medical and psychosocial needs.
Collapse
Affiliation(s)
- Anna V Wojcicki
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Priya E George
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Elise F Palzer
- Division of Biostatistics, School of Public Health and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Ann M Brearley
- Division of Biostatistics, School of Public Health and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Kimara L Gustafson
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Judith K Eckerle
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| |
Collapse
|
21
|
Affiliation(s)
- Elise F Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Shruti Vempati
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Erika S Helgeson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|