1
|
Simmonds KP, Atem FD, Welch BG, Ifejika NL. Racial and Ethnic Disparities in the Medical Management of Poststroke Complications Among Patients With Acute Stroke. J Am Heart Assoc 2024; 13:e030537. [PMID: 38390802 PMCID: PMC10944023 DOI: 10.1161/jaha.123.030537] [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: 04/14/2023] [Accepted: 01/04/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND To inform clinical practice, we sought to identify racial and ethnic differences in the medical management of common poststroke complications. METHODS AND RESULTS A cohort of acutely hospitalized, first-time non-Hispanic White (NHW), non-Hispanic Black, and Hispanic patients with stroke was identified from electronic medical records of 51 large health care organizations (January 1, 2003 to December 5, 2022). Matched propensity scores were used to account for baseline differences. Primary outcomes included receipt of medication(s) associated with the management of the following poststroke complications: arousal/fatigue, spasticity, mood, sleep, neurogenic bladder, neurogenic bowel, and seizure. Differences were measured at 14, 90, and 365 days. Subgroup analyses included differences restricted to patients with ischemic stroke, younger age (<65 years), and stratified by decade (2003-2012 and 2013-2022). Before matching, the final cohort consisted of 348 286 patients with first-time stroke. Matching resulted in 63 722 non-Hispanic Black-NHW pairs and 24 009 Hispanic-NHW pairs. Non-Hispanic Black (versus NHW) patients were significantly less likely to be treated for all poststroke complications, with differences largest for arousal/fatigue (relative risk (RR), 0.58 [95% CI, 0.54-0.62]), spasticity (RR, 0.64 [95% CI, 0.0.62-0.67]), and mood disorders (RR, 0.72 [95% CI, 0.70-0.74]) at 14 days. Hispanic-NHW differences were similar, albeit with smaller magnitudes, with the largest differences present for spasticity (RR, 0.67 [95% CI, 0.63-0.72]), arousal/fatigue (RR, 0.77 [95% CI, 0.70-0.85]), and mood disorders (RR, 0.79 [95% CI, 0.77-0.82]). Subgroup analyses revealed similar patterns for ischemic stroke and patients aged <65 years. Disparities for the current decade remained significant but with smaller magnitudes compared with the prior decade. CONCLUSIONS There are significant racial and ethnic disparities in the treatment of poststroke complications. The differences were greatest at 14 days, outlining the importance of early identification and management.
Collapse
Affiliation(s)
- Kent P Simmonds
- Department of Physical Medicine and Rehabilitation UT Southwestern Medical Center Dallas TX USA
| | - Folefac D Atem
- Department of Physical Medicine and Rehabilitation UT Southwestern Medical Center Dallas TX USA
- Department of Biostatistics University of Texas Health Science Center at Houston School of Public Health Houston TX USA
| | - Babu G Welch
- Department of Neurological Surgery UT Southwestern Medical Center Dallas TX USA
| | - Nneka L Ifejika
- Department of Physical Medicine and Rehabilitation UT Southwestern Medical Center Dallas TX USA
- Department of Neurology UT Southwestern Medical Center Dallas TX USA
| |
Collapse
|
2
|
Yudkin JS, Allicock MA, Atem FD, Galeener CA, Messiah SE, Barlow SE. Efficacy of a Primary Care eHealth Obesity Treatment Pilot Intervention Developed for Vulnerable Pediatric Patients. Child Obes 2024; 20:75-86. [PMID: 36893214 DOI: 10.1089/chi.2022.0185] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Background: Challenges to treat excess weight in primary care settings include time constraints during encounters and barriers to multiple visits for patient families, especially those from vulnerable backgrounds. Dynamo Kids! (DK), a bilingual (English/Spanish) e-health intervention, was created to address these system-level challenges. This pilot study assessed the effect of DK use on parent-reported healthy habits and child BMI. Methods: In this 3-month, quasi-experimental cohort design, DK was offered to parents with children aged 6-12 years with BMI ≥85th percentile in three public primary care sites in Dallas, Texas. DK included three educational modules, one tracking tool, recipes, and links to internet resources. Parents completed an online survey before and after 3 months. Pre-post changes in family nutrition and physical activity (FNPA) scores, clinic-measured child %BMIp95, and self-reported parent BMI were assessed using mixed-effects linear regression modeling. Results: A total of 73 families (mean child age = 9.3 years; 87% Hispanic, 12% non-Hispanic Black, and 77% Spanish-speaking families) completed the baseline survey (participants) and 46 (63%) used the DK site (users). Among users, pre-post changes (mean [standard deviation]) showed an increase in FNPA scores (3.0 [6.3], p = 0.01); decrease in child %BMIp95 (-1.03% [5.79], p = 0.22); and decrease in parent BMI (-0.69 [1.76], p = 0.04). Adjusted models showed -0.02% [95% confidence interval: -0.03 to -0.01] change in child %BMIp95 for each minute spent on the DK website. Conclusions: DK demonstrated a significant increase in parent FNPA scores and decrease in self-reported parent BMI. e-Health interventions may overcome barriers and require a lower dosage than in-person interventions.
Collapse
Affiliation(s)
- Joshua S Yudkin
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Marlyn A Allicock
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Folefac D Atem
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Carol A Galeener
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Sarah E Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Sarah E Barlow
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children's Health, Dallas, TX, USA
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
3
|
Iwatate E, Atem FD, Jones EC, Hughes JL, Yokoo T, Messiah SE. Trends in the relationship between suicide behaviors and obesity among adolescents in the United States from 1999 to 2019. Eur Child Adolesc Psychiatry 2024; 33:725-737. [PMID: 36933151 DOI: 10.1007/s00787-023-02191-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
Previous studies indicate that obesity is a risk factor of suicide behaviors among adolescents. Whether this association has remained consistent during the ongoing obesity epidemic remains unknown. The time trends of the obesity-suicide association were examined using the 1999-2019 biannual Youth Risk Behavior Survey data (n = 161,606). Prevalence odds ratio of suicide behaviors among adolescents with obesity (vs. adolescents with no obesity) for each survey year and time trends using National Cancer Institute Joinpoint regression analysis was calculated. For each year post-baseline, there was a significant increase of prevalence odds ratio of 1.4 (1.2-1.6)-1.6 (1.3-2.0) for suicide ideation, 1.3 (1.1-1.7) -1.7 (1.4-2.0) for plan, and 1.3 (1.0-1.7) -1.9 (1.5-2.4) for an attempt, except for the 2013 survey for attempt (1.19 [0.9-1.6]). Significant positive trends were found from1999 to 2019 for ideation and plan, with biannual %-changes of + 0.92 and + 1.22%, respectively. Adolescents with obesity have consistently higher odds of engaging in suicide behaviors than their peers without obesity since the beginning of the United States obesity epidemic, and this association grew stronger as the obesity epidemic continued.
Collapse
Affiliation(s)
- Eriko Iwatate
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Regional Campus, Trinity Towers, 2777 N Stemmons Fwy, Dallas, TX, 75207, USA.
| | - Folefac D Atem
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth, Dallas Regional Campus, Dallas, TX, USA
- Center for Pediatric Population Health, Children's Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
| | - Eric C Jones
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, El Paso Regional Campus, El Paso, TX, USA
| | - Jennifer L Hughes
- Department of Psychiatry and Behavioral Health, College of Medicine and Division of Health Behavior and Health Promotion, College of Public Health, Big Lots Behavioral Health Services, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern, Dallas, TX, USA
| | - Sarah E Messiah
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Regional Campus, Trinity Towers, 2777 N Stemmons Fwy, Dallas, TX, 75207, USA
| |
Collapse
|
4
|
Nguyen B, Marshall JL, Rana C, Atem FD, Stutzman SE, Olson DM, Aiyagari V, Ray B. Prospective study examining the impact of cerebral angiography on quantitative pupillometer values in the interventional radiology suite. BMJ Open 2024; 14:e080779. [PMID: 38423768 PMCID: PMC10910682 DOI: 10.1136/bmjopen-2023-080779] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES The purpose of this pilot study was to obtain baseline quantitative pupillometry (QP) measurements before and after catheter-directed cerebral angiography (DCA) to explore the hypothesis that cerebral angiography is an independent predictor of change in pupillary light reflex (PLR) metrics. DESIGN This was a prospective, observational pilot study of PLR assessments obtained using QP 30 min before and after DCA. All patients had QP measurements performed with the NPi-300 (Neuroptics) pupillometer. SETTING Recruitment was done at a single-centre, tertiary-care academic hospital and comprehensive stroke centre in Dallas, Texas. PARTICIPANTS Fifty participants were recruited undergoing elective or emergent angiography. Inclusion criteria were a physician-ordered interventional neuroradiological procedure, at least 18 years of age, no contraindications to PLR assessment with QP, and nursing transport to and from DCA. Patients with a history of eye surgery were excluded. MAIN OUTCOME MEASURES Difference in PLR metric obtained from QP 30 min before and after DCA. RESULTS Statistically significant difference was noted in the pre and post left eye readings for the minimum pupil size (a.k.a., pupil diameter on maximum constriction). The mean maximum constriction diameter prior to angiogram of 3.2 (1.1) mm was statistically larger than after angiogram (2.9 (1.0) mm; p<0.05); however, this was not considered clinically significant. Comparisons for all other PLR metrics pre and post angiogram demonstrated no significant difference. Using change in NPi pre and post angiogram (Δpre=0.05 (0.77) vs Δpost=0.08 (0.67); p=0.62), we calculated the effect size as 0.042. Hence, detecting a statistically significant difference in NPi, if a difference exists, would require a sample size of ~6000 patients. CONCLUSIONS Our study provides supportive data that in an uncomplicated angiogram, even with intervention, there is no effect on the PLR.
Collapse
Affiliation(s)
- Brian Nguyen
- Neurology - Division of Neurocritical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jade L Marshall
- Neurology - Division of Neurocritical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chahat Rana
- Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Folefac D Atem
- Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sonja E Stutzman
- Neurology - Division of Neurocritical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - DaiWai M Olson
- Neurology - Division of Neurocritical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Venkatesh Aiyagari
- Neurology - Division of Neurocritical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Bappaditya Ray
- Neurology - Division of Neurocritical Care, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
5
|
Atem FD, Bluestein MA, Chen B, Harrell MB, Messiah SE, Kuk AE, Pérez A. Application of inverse weighting analysis to assess the association of youth perceptions with the age of initiation of tobacco products. Front Public Health 2024; 12:1203631. [PMID: 38450147 PMCID: PMC10915753 DOI: 10.3389/fpubh.2024.1203631] [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] [Received: 04/11/2023] [Accepted: 01/15/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction To examine if perceptions of harmfulness and addictiveness of hookah and cigarettes impact the age of initiation of hookah and cigarettes, respectively, among US youth. Youth (12-17 years old) users and never users of hookah and cigarettes during their first wave of PATH participation were analyzed by each tobacco product (TP) independently. The effect of perceptions of (i) harmfulness and (ii) addictiveness at the first wave of PATH participation on the age of initiation of ever use of hookah was estimated using interval-censoring Cox proportional hazards models. Methods Users and never users of hookah at their first wave of PATH participation were balanced by multiplying the sampling weight and the 100 balance repeated replicate weights with the inverse probability weight (IPW). The IPW was based on the probability of being a user in their first wave of PATH participation. A Fay's factor of 0.3 was included for variance estimation. Crude hazard ratios (HR) and 95% confidence intervals (CIs) are reported. A similar process was repeated for cigarettes. Results Compared to youth who perceived each TP as "a lot of harm", youth who reported perceived "some harm" had younger ages of initiation of these tobacco products, HR: 2.53 (95% CI: 2.87-4.34) for hookah and HR: 2.35 (95% CI: 2.10-2.62) for cigarettes. Similarly, youth who perceived each TP as "no/little harm" had an earlier age of initiation of these TPs compared to those who perceived them as "a lot of harm", with an HR: 2.23 (95% CI: 1.82, 2.71) for hookah and an HR: 1.85 (95% CI: 1.72, 1.98) for cigarettes. Compared to youth who reported each TP as "somewhat/very likely" as their perception of addictiveness, youth who reported "neither likely nor unlikely" and "very/somewhat unlikely" as their perception of addictiveness of hookah had an older age of initiation, with an HR: 0.75 (95% CI: 0.67-0.83) and an HR: 0.55 (95% CI: 0.47, 0.63) respectively. Discussion Perceptions of the harmfulness and addictiveness of these tobacco products (TPs) should be addressed in education campaigns for youth to prevent early ages of initiation of cigarettes and hookah.
Collapse
Affiliation(s)
- Folefac D. Atem
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Center for Pediatric Population Health, School of Public Health in Dallas, UT Health Science Center School of Public Health, Dallas, TX, United States
| | - Meagan A. Bluestein
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Melissa B. Harrell
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
- Consultant with Litigation Involving the Vaping Industry, Austin, TX, United States
| | - Sarah E. Messiah
- Center for Pediatric Population Health, School of Public Health in Dallas, UT Health Science Center School of Public Health, Dallas, TX, United States
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Arnold E. Kuk
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Adriana Pérez
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, United States
- Michael & Susan Dell Center for Healthy Living, School of Public Health, Austin Campus, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| |
Collapse
|
6
|
Yudkin JS, Koym K, Hamad Y, Malthaner LQ, Burgess RM, Ortiz LN, Dhurjati N, Mitha S, Calvi G, Hill K, Brownell M, Wei E, Swartz K, Atem FD, Galeener CA, Messiah SE, Barlow SE, Allicock MA. Family-based pediatric weight management interventions in US primary care settings targeting children ages 6-12 years old: A systematic review guided by the RE-AIM framework. Transl Behav Med 2024; 14:34-44. [PMID: 37632769 DOI: 10.1093/tbm/ibad051] [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] [Indexed: 08/28/2023] Open
Abstract
Obesity is a pandemic that disproportionately affects children from vulnerable populations in the USA. Current treatment approaches in primary care settings in the USA have been reported to be insufficient at managing pediatric obesity, primarily due to implementation challenges for healthcare systems and barriers for families. While the literature has examined the efficacy of pediatric obesity interventions focused on internal validity, it lacks sufficient reporting and analysis of external validity necessary for successful translation to primary care settings. We conducted a systematic review of the primary-care-setting literature from January 2007 to March 2020 on family-based pediatric weight management interventions in both English and/or Spanish for children ages 6-12 years in the USA using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. A literature search, using PRISMA guidelines, was conducted in January 2022 using the following electronic databases: Medline Ovid, Embase, and Cochrane Library. 22 270 records were screened, and 376 articles were reviewed in full. 184 studies were included. The most commonly reported dimensions of the RE-AIM framework were Reach (65%), Efficacy/Effectiveness (64%), and Adoption (64%), while Implementation (47%) and Maintenance (42%) were less often reported. The prevalence of reporting RE-AIM construct indicators ranged greatly, from 1% to 100%. This systematic review underscores the need for more focus on external validity to guide the development, implementation, and dissemination of future pediatric obesity interventions based in primary care settings. It also suggests conducting additional research on sustainable financing for pediatric obesity interventions.
Collapse
Affiliation(s)
- Joshua S Yudkin
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Kelsey Koym
- Texas Medical Center Library, Houston, TX, USA
| | - Yasmin Hamad
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Lauren Q Malthaner
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Rebecca Meredith Burgess
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | | | - Nalini Dhurjati
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sharmin Mitha
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Gabriela Calvi
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Kristina Hill
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Children's Health, Children's Medical Center Dallas, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | | | - Elena Wei
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Kyle Swartz
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Folefac D Atem
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Carol A Galeener
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sarah E Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sarah E Barlow
- Children's Health, Children's Medical Center Dallas, Dallas, TX, USA
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marlyn A Allicock
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| |
Collapse
|
7
|
Venkatachalam AM, Hossain SR, Manchi MR, Chavez AA, Abraham AM, Stone S, Truong V, Cobos CU, Khuong T, Atem FD, Welch BG, Ifejika NL. Variability in the Transition of Care to Poststroke Rehabilitation During the First Wave of COVID-19. Am J Phys Med Rehabil 2023; 102:1085-1090. [PMID: 37205606 DOI: 10.1097/phm.0000000000002287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate transitions of acute stroke and inpatient rehabilitation facility care during the first wave of COVID-19. DESIGN This is a retrospective observational study (3 comprehensive stroke centers with hospital-based inpatient rehabilitation facilities) between January 1, 2019, and May 31, 2019 (acute stroke = 584, inpatient rehabilitation facility = 210) and January 1, 2020, and May 31, 2020 (acute stroke = 534, inpatient rehabilitation facility = 186). Acute stroke characteristics included stroke type, demographics, and medical comorbidities. The proportion of patients admitted for acute stroke and inpatient rehabilitation facility care was analyzed graphically and using t test assuming unequal variances. RESULTS The proportion of intracerebral hemorrhage patients (28.5% vs. 20.5%, P = 0.035) and those with history of transient ischemic attack (29% vs. 23.9%; P = 0.049) increased during the COVID-19 first wave in 2020. Uninsured acute stroke admissions decreased (7.3% vs. 16.6%) while commercially insured increased (42.7% vs. 33.4%, P < 0.001).Acute stroke admissions decreased from 116.5 per month in 2019 to 98.8 per month in 2020 ( P = 0.008) with no significant difference in inpatient rehabilitation facility admissions (39 per month in 2019, 34.5 per month in 2020; P = 0.66).In 2019, monthly changes in acute stroke admissions coincided with inpatient rehabilitation facility admissions.In 2020, acute stroke admissions decreased 80.6% from January to February, while inpatient rehabilitation facility admissions remained stable. Acute stroke admissions increased 12.8% in March 2020 and remained stable in April, while inpatient rehabilitation facility admissions decreased by 92%. CONCLUSIONS Acute stroke hospitalizations significantly decreased per month during the first wave of COVID-19, with a delayed effect on the transition from acute stroke to inpatient rehabilitation facility care.
Collapse
Affiliation(s)
- Aardhra M Venkatachalam
- From the Ross University School of Medicine, Miramar, Florida (AMV); University of Texas Health Science Center at Houston School of Public Health, Dallas, Texas (SRH, FDA); Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas (MRM, AAC, AMA, NLI); UT Southwestern Medical Center, Dallas, Texas (SS); Department of Neurology, Loma Linda University Medical Center, Loma Linda, California (VT, CUC, TK); Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas (BGW); and Department of Neurology, UT Southwestern Medical Center, Dallas, Texas (NLI)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Yudkin JS, Allicock MA, Atem FD, Galeener CA, Messiah SE, Barlow SE. The Use of Electronic Health Record Data to Identify Variation in Referral, Consent, and Engagement in a Pediatric Intervention for Overweight and Obesity: A Cross-Sectional Study. Popul Health Manag 2023; 26:365-377. [PMID: 37792388 DOI: 10.1089/pop.2023.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Clinical weight management programs face low participation. The authors assessed whether using electronic health record (EHR) data can identify variation in referral, consent, and engagement in a pediatric overweight and obesity (OW/OB) intervention. Using Epic EHR data collected between August 2020 and April 2021, sociodemographic and clinical diagnostic data (ie, International Classification of Disease [ICD] codes from visit and problem list [PL]) were analyzed to determine their association with referral, consent, and engagement in an OW/OB intervention. Bivariate analyses and multivariable logistic regression modeling were performed, with Bayesian inclusion criterion score used for model selection. Compared with the 581 eligible patients, referred patients were more likely to be boys (60% vs. 54%, respectively; P = 0.04) and have a higher %BMIp95 (119% vs. 112%, respectively; P < 0.01); consented patients were more likely to have a higher %BMIp95 (120% vs. 112%, respectively; P < 0.01) and speak Spanish (71% vs. 59%, respectively; P = 0.02); and engaged patients were more likely to have a higher %BMIp95 (117% vs. 112%, respectively; P = 0.03) and speak Spanish (78% vs. 59%, respectively; P < 0.01). The regression model without either ICD codes or PL diagnoses was the best fit across all outcomes, which were associated with baseline %BMIp95 and health clinic location. Neither visit nor PL diagnoses helped to identify variation in referral, consent, and engagement in a pediatric OW/OB intervention, and their role in understanding participation in such interventions remains unclear. However, additional efforts are needed to refer and engage younger girls with less extreme cases of OW/OB, and to support non-Hispanic families to consent.
Collapse
Affiliation(s)
- Joshua S Yudkin
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
| | - Marlyn A Allicock
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
| | - Folefac D Atem
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
| | - Carol A Galeener
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
| | - Sarah E Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas, USA
- Department of Pediatrics, McGovern Medical School, Houston, Texas, USA
| | - Sarah E Barlow
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Children's Health, Children's Medical Center Dallas, Dallas, Texas, USA
| |
Collapse
|
9
|
Roberts MM, Marino M, Wells R, Atem FD, Balasubramanian BA. Differences in Use of Clinical Decision Support Tools and Implementation of Aspirin, Blood Pressure Control, Cholesterol Management, and Smoking Cessation Quality Metrics in Small Practices by Race and Sex. JAMA Netw Open 2023; 6:e2326905. [PMID: 37531106 PMCID: PMC10398408 DOI: 10.1001/jamanetworkopen.2023.26905] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/22/2023] [Indexed: 08/03/2023] Open
Abstract
Importance Practice-level evidence is needed to clarify the value of population-based clinical decision support (CDS) tools in reducing racial and sex disparities in cardiovascular care. Objective To evaluate the association between CDS tools and racial and sex disparities in the aspirin use, blood pressure control, cholesterol management, and smoking cessation (ABCS) care quality metrics among smaller primary care practices. Design, Setting, and Participants This cross-sectional study used practice-level data from the Agency for Healthcare Research and Quality-funded EvidenceNOW initiative. The national initiative from May 1, 2015, to April 30, 2021, spanned 12 US states and focused on improving cardiovascular preventive care by providing quality improvement support to smaller primary care practices. A total of 576 primary care practices in EvidenceNOW submitted both survey data and electronic health record (EHR)-derived ABCS data stratified by race and sex. Main Outcomes and Measures Practice-level estimates of disparities between Black and White patients and between male and female patients were calculated as the difference in proportions of eligible patients within each practice meeting ABCS care quality metrics. The association between CDS tools (EHR prompts, standing orders, and clinical registries) and disparities was evaluated by multiply imputed multivariable models for each CDS tool, adjusted for practice rurality, ownership, and size. Results Across the 576 practices included in the analysis, 219 (38.0%) had patient panels that were more than half White and 327 (56.8%) had panels that were more than half women. The proportion of White compared with Black patients meeting metrics for blood pressure (difference, 5.16% [95% CI, 4.29%-6.02%]; P < .001) and cholesterol management (difference, 1.49% [95% CI, 0.04%-2.93%] P = .04) was higher; the proportion of men meeting metrics for aspirin use (difference, 4.36% [95% CI, 3.34%-5.38%]; P < .001) and cholesterol management (difference, 3.88% [95% CI, 3.14%-4.63%]; P < .001) was higher compared with women. Conversely, the proportion of women meeting practice blood pressure control (difference, -1.80% [95% CI, -2.32% to -1.28%]; P < .001) and smoking cessation counseling (difference, -1.67% [95% CI, -2.38% to -0.95%]; P < .001) metrics was higher compared with men. Use of CDS tools was not associated with differences in race or sex disparities except for the smoking metric. Practices using CDS tools showed a higher proportion of men meeting the smoking counseling metric than women (coefficient, 3.82 [95% CI, 0.95-6.68]; P = .009). Conclusions and Relevance The findings of this cross-sectional study suggest that practices using CDS tools had small disparities that were not statistically significant, but CDS tools were not associated with reductions in disparities. More research is needed on effective practice-level interventions to mitigate disparities.
Collapse
Affiliation(s)
- Madeline M. Roberts
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Dallas
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland
- School of Public Health, Oregon Health & Science University, Portland
| | - Rebecca Wells
- Department of Management, Policy, & Community Health, UTHealth Houston School of Public Health, Houston
| | - Folefac D. Atem
- Department of Biostatistics and Data Science, UTHealth Houston School of Public Health, Dallas
| | - Bijal A. Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston (UTHealth Houston) School of Public Health, Dallas
| |
Collapse
|
10
|
Manchi MR, Venkatachalam AM, Atem FD, Stone S, Mathews AA, Abraham AM, Chavez AA, Welch BG, Ifejika NL. Effect of inpatient rehabilitation facility care on ninety day modified Rankin score in ischemic stroke patients. J Stroke Cerebrovasc Dis 2023; 32:107109. [PMID: 37031503 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107109] [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: 01/28/2023] [Revised: 03/25/2023] [Accepted: 03/28/2023] [Indexed: 04/11/2023] Open
Abstract
OBJECTIVE To determine Inpatient Rehabilitation Facility (IRF) treatment effect on modified Rankin Scale (mRS) scores at 90 days in acute ischemic stroke (AIS) patients. MATERIALS AND METHODS This prospective cross-sectional study included 738 AIS patients admitted 1/1/2018-12/31/2020 to a Comprehensive Stroke Center with a Stroke Rehabilitation program. We compared outcomes for patients who went directly home versus went to IRF at hospital discharge: (1) acute care length of stay (LOS), (2) National Institutes of Health Stroke Scale (NIHSS) score, (3) mRS score at hospital discharge and 90 days, (4) the proportion of mRS scores ≤ 2 from hospital discharge to 90 days. RESULTS Among 738 patients, 499 went home, and 239 went to IRF. IRF patients were more likely to have increased acute LOS (10.7 vs 3.9 days; t-test, P<0.0001), increased mean NIHSS score (7.8 vs 4.8; t-test, P<0.0001) and higher median mRS score (3 vs 1, t-test, P<0.0001) compared to patients who went home. At 90 days, ischemic stroke patients who received IRF care were more likely to progress to a mRS ≤ 2 (18.7% increase) compared to patients discharged home from acute care (16.3% decrease). Home patients experienced a one-point decrease in mRS at 90 days compared to those who received IRF treatment (median mRS of 3 vs. 2, t-test, P<0.05). CONCLUSIONS In ischemic stroke patients, IRF treatment increased the likelihood of achieving mRS ≤ 2 at 90 days indicating the ability to live independently, and decreased the likelihood of mRS decrease, compared with patients discharged directly home after acute stroke care.
Collapse
Affiliation(s)
- Maunica R Manchi
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Stop 9055, Dallas, TX 75390, United States
| | | | - Folefac D Atem
- University of Texas Health Science Center at Houston School of Public Health, Dallas, TX, United States
| | - Suzanne Stone
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Amy A Mathews
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Stop 9055, Dallas, TX 75390, United States
| | - Annie M Abraham
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Stop 9055, Dallas, TX 75390, United States
| | - Audrie A Chavez
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Stop 9055, Dallas, TX 75390, United States
| | - Babu G Welch
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Nneka L Ifejika
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Stop 9055, Dallas, TX 75390, United States; Department of Neurology, University of Texas Southwestern Medical Center, DALLAS, TX, United States.
| |
Collapse
|
11
|
Iwatate E, Atem FD, Jones EC, Hughes JL, Yokoo T, Messiah SE. Association of Obesity, Suicide Behaviors, and Psychosocial Wellness Among Adolescents in the United States. J Adolesc Health 2023; 72:526-534. [PMID: 36646564 DOI: 10.1016/j.jadohealth.2022.11.240] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Adolescents with obesity are more likely to exhibit suicide behaviors, but this association may be confounded by psychosocial stigma related to obesity. We examined whether the obesity is independently associated with suicide behaviors among United States adolescents, after adjusting for the psychosocial factors. METHODS We analyzed data from 2019 Youth Risk Behavior Survey data (N = 13,871 United States adolescents) on recent (past year) suicide behavior (attempt, ideation, and plan); demographics (age, sex, and race/ethnicity); and psychosocial factors (feeling sad/hopeless, alcohol and illegal drug use, being bullied, and sexually abused). Participants were classified as having obesity (Y/N) per standardized percentiles. Logistic regression was employed to examine the association between obesity and suicide attempt, ideation, and plan, while adjusting for psychosocial covariates. RESULTS The prevalence of suicide attempt, ideation, and plan was 8.90%, 18.75%, and 15.71%, respectively. Obesity prevalence was 15.5%. The odds of suicide attempt, ideation, and plan were 1.65 (1.30-2.11), 1.31 (0.89-1.61), and 1.27 (1.02-1.57), respectively, among those with obesity versus without obesity. DISCUSSION Obesity is significantly associated with a suicide attempt, ideation, and plan among United States adolescents, even after adjusting for confounding psychosocial factors. Further research on the temporality and causality of this association is needed.
Collapse
Affiliation(s)
- Eriko Iwatate
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas.
| | - Folefac D Atem
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas; Center for Pediatric Population Health, Children's Health System of Texas and UTHealth School of Public Health, Dallas, Texas
| | - Eric C Jones
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas
| | - Jennifer L Hughes
- Department of Psychiatry and Behavioral Health, Big Lots Behavioral Health Services, College of Medicine, Nationwide Children's Hospital, Columbus, Ohio; Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Sarah E Messiah
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, Texas; Center for Pediatric Population Health, Children's Health System of Texas and UTHealth School of Public Health, Dallas, Texas
| |
Collapse
|
12
|
Xie L, Gelfand A, Mathew MS, Atem FD, Delclos GL, Messiah SE. Association of corticosteroid use and attention deficit/hyperactivity disorder in asthmatic children varies by age. J Asthma 2023; 60:698-707. [PMID: 35696551 DOI: 10.1080/02770903.2022.2089995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We aim to examine the impact of corticosteroids use on ADHD among children with asthma by administration routes. METHODS A population-based, cross-sectional analysis included pediatric patients ages 5-20 years old from the 2016 and 2019 Kids Inpatient Database (unweighted N = 111,702). ICD-10-CM codes were used to identify corticosteroids use, asthma, and ADHD cases. Survey logistic regression models with purposeful variable selection algorithms were built to examine the association between corticosteroids use, and ADHD by asthma severity and age. An inverse probability weighting (IPW) approach was used to help further control residual confounding. RESULTS Among children aged 5-11 years old, the odds of ADHD were significantly higher in children with moderate to severe asthma who used inhaled corticosteroids than nonusers (moderate asthma: adjusted odds ratios [aOR] 1.46, 95% confidence interval [CI] 1.14-2.44; severe asthma: aOR 1.61, 95% CI 1.18-2.21). Although oral corticosteroid use was not independently associated with ADHD in young children, combined use of inhaled and oral corticosteroid had almost 5 times higher odds of use among ADHD in children with severe asthma vs. nonusers (aOR 4.85, 95% CI 2.07 - 11.35). No associations were found between any corticosteroid use and ADHD among asthmatic children aged 12-20 years. CONCLUSIONS In this retrospective analysis, we found inhaled corticosteroids were positively associated with ADHD in younger children with moderate to severe asthma, but not in older children.
Collapse
Affiliation(s)
- Luyu Xie
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| | - Andrew Gelfand
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Sunil Mathew
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| | - Folefac D Atem
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| | - George L Delclos
- School of Public Health, University of Texas Health Science Center, Houston Campus, Houston, TX, USA
| | - Sarah E Messiah
- School of Public Health, University of Texas Health Science Center, Dallas Campus, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| |
Collapse
|
13
|
Draganic K, Denke L, Atem FD, Kershaw C, Williams K, England V. Longitudinal depression screening of frontline critical care nurses during the COVID-19 pandemic: A mixed-methods study. Nursing 2023; 53:54-61. [PMID: 36946641 DOI: 10.1097/01.nurse.0000920444.46279.2c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE To evaluate the severity and longitudinal trends of depression in critical care nurses caring for patients with COVID-19 in the US during a global pandemic. METHODS The study employed longitudinal mixed methods. Using the Patient Health Questionnaire (PHQ-9), nurses were sent electronic surveys at baseline, 1 month, and between 3 and 6 months to measure the severity and trends of depression during the prevaccination stage of the COVID-19 pandemic. One-on-one interviews were conducted with critical care nurses to evaluate their depressive symptoms. RESULTS Forty-eight nurses completed the questionnaire at baseline, 40 completed 1-month surveys, and 20 completed the 3 to 6 month surveys. The mean PHQ-9 score was 5.85, 6.20, and 8.30 at baseline, at 1 month, and at 3 to 6 months, respectively. PHQ-9 scores increased significantly over time (estimate = 1.120, P = .037). The probability of participants being moderately to severely depressed was 0.980 (P = .049) at baseline, 0.990 (P = .013) at 1 month, and 1.0 (P = .002) at 3 to 6 months. Fourteen nurses were included in a single, one-on-one interview. Eight major themes were found in qualitative analyses. For example, nurses expressed fear of spreading COVID-19 to their loved one and community. Common themes identified within the interviews included uncertainty, limited human interaction, fluctuations in mood, life is in my hands, a threat to others, positive and negative coping, nurses as scapegoats, and emerging vulnerability to COVID-19 exposure. All 14 nurses who were interviewed denied accessing any mental health services. CONCLUSIONS More research is needed to evaluate critical care nurses who care for patients with COVID-19 and their levels of depression to improve practice at the bedside further and develop policies to promote their well-being.
Collapse
Affiliation(s)
- Keri Draganic
- At the University of Texas, Southwestern Medical Center in Dallas, Tex., Keri Draganic is an acute care nurse practitioner, Linda Denke is a nurse scientist, Corey Kershaw is the medical director of the Medical ICU, Kandace Williams is an adult gerontology acute care nurse practitioner, and Folefac D. Atem is the lead statistician. Victoria England is a retired associate CNO
| | | | | | | | | | | |
Collapse
|
14
|
Atem FD, Bluestein MA, Harrell MB, Chen B, Messiah SE, Kuk AE, Sterling KL, Spells CE, Pérez A. Precise Estimation for the Age of Initiation of Tobacco Use Among U.S. Youth: Finding from the Population Assessment of Tobacco and Health (PATH) Study, 2013-2017. Biostat Biom Open Access J 2022; 11:555801. [PMID: 36777448 PMCID: PMC9912413 DOI: 10.19080/bboaj.2022.11.555801] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Context Youth tobacco use remains a prominent United States public health issue with a high economic and health burden. Method We pooled never and ever users at youth's first wave of PATH participation (waves 1-3) to estimate age of initiation for hookah, e-cigarettes, cigarettes, traditional cigars, cigarillos, and smokeless tobacco prospectively (waves 2-4). Age of initiation of each tobacco product was estimated using weighted interval-censored survival analyses. Weighted interval censoring Cox-proportional hazards regression models were used to assess the association of ever use of the TP at the first wave of PATH participation, sex, and race/ethnicity on the age of initiation of ever use of each tobacco product. Sensitivity analyses were performed to understand the impact of the recalled age of initiation for the left-censored participants by replacing the recalled age of initiation with a uniform "6" years lower bound. Results The proportion of those who ever used each tobacco product at the first wave of PATH participation ranged from 1.8% for traditional cigars to 10.4% for cigarettes. There was a significant increase in ever use of each tobacco product after the age of 14, with e-cigarettes and cigarettes showing the highest cumulative incidence of initiation by age 21, while smokeless and cigarillos recorded the lowest cumulative incidence by age 21. The adjusted Cox models showed boys initiated at earlier ages for all of these tobacco products except for hookah, which showed no difference. Similarly, apart from ever use of hookah, non-Hispanic White youth were more likely to initiate each tobacco product at earlier ages compared to Hispanic, non-Hispanic Black, and non-Hispanic Other youth. Conclusion The increased sample size and the inclusion of ever users yielded greater precision for age of initiation of each tobacco product than analyses limited to never users at the first wave of PATH participation. These analyses can help elucidate population selection criteria for estimating the age of initiation of tobacco products.
Collapse
Affiliation(s)
- Folefac D. Atem
- The University of Texas Health Science Center at Houston, School of Public Health,Center for Pediatric Population Health, Children's Health System of Texas and UT Health Science Center School of Public Health, School of Public Health in Dallas, 2777 N Stemmons Fwy, Dallas, TX
| | - Meagan A. Bluestein
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Melissa B. Harrell
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701,Consultant with litigation involving the vaping industry, Austin TX
| | - Baojiang Chen
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Sarah E. Messiah
- The University of Texas Health Science Center at Houston, School of Public Health,Center for Pediatric Population Health, Children's Health System of Texas and UT Health Science Center School of Public Health, School of Public Health in Dallas, 2777 N Stemmons Fwy, Dallas, TX
| | - Arnold E. Kuk
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Kymberle L. Sterling
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Charles E. Spells
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Adriana Pérez
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| |
Collapse
|
15
|
Romito JW, Atem FD, Manjunath A, Yang A, Romito BT, Stutzman SE, McDonagh DL, Venkatachalam AM, Premachandra L, Aiyagari V. Comparison of Bispectral Index Monitor Data Between Standard Frontal-Temporal Position and Alternative Nasal Dorsum Position in the Intensive Care Unit: A Pilot Study. J Neurosci Nurs 2022; 54:30-34. [PMID: 35007261 DOI: 10.1097/jnn.0000000000000635] [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: 11/27/2022]
Abstract
ABSTRACT BACKGROUND: The Bispectral (BIS) monitor is a validated, noninvasive monitor placed over the forehead to titrate sedation in patients under general anesthesia in the operating room. In the neurocritical care unit, there is limited room on the forehead because of incisions, injuries, and other monitoring devices. This is a pilot study to determine whether a BIS nasal montage correlates to the standard frontal-temporal data in this patient population. METHODS: This prospective nonandomized pilot study enrolled 10 critically ill, intubated, and sedated adult patients admitted to the neurocritical care unit. Each patient had a BIS monitor placed over the standard frontal-temporal location and over the alternative nasal dorsum with simultaneous data collected for 24 hours. RESULTS: In the frontal-temporal location, the mean (SD) BIS score was 50.9 (15.0), average minimum BIS score was 47.0 (15.0), and average maximum BIS score was 58.4 (16.7). In the nasal dorsum location, the mean BIS score was 54.8 (21.6), average minimum BIS score was 52.8 (20.9), and average maximum BIS score was 58.0 (22.2). Baseline nonparametric tests showed nonsignificant P values for all variables except for Signal Quality Index. Generalized linear model analysis demonstrated significant differences between the 2 monitor locations (P < .0001). CONCLUSION: The results of this pilot study do not support using a BIS nasal montage as an alternative for patients in the neurocritical care unit.
Collapse
|
16
|
Venkatachalam AM, Manchi MR, Atem FD, Stone S, Abraham AM, Chavez AA, Welch BG, Ifejika NL. Abstract WP63: The Effect Of Inpatient Rehabilitation Facility Treatment On 90 Day Outcomes: A Shift Analysis Of Modified Rankin Scale Score In Ischemic Stroke Patients. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Several AHA Guidelines recommend inpatient rehabilitation facility (IRF) care to enhance post-stroke recovery. We evaluated the IRF treatment effect on modified Rankin scale (mRS) score change at 90 days in ischemic stroke (IS) patients.
Methods:
Using prospectively collected data from Get With the Guidelines-Stroke, the Uniformed Data System for Medical Rehabilitation registry and the electronic medical record, we identified IS patients with discharge disposition of home or IRF between 1/1/2018-12/31/2020. Sociodemographics, clinical variables and IS treatment rates were summarized. IRF outcomes, including length of stay (LOS), improvement in mobility and self-care scores and discharge disposition were compared in thrombectomy vs no thrombectomy groups. mRS at IRF discharge was calculated with a Cronbach interrater score of 0.88; shift analyses of mRS at hospital discharge and 90 days were completed for IS patients in the Home and IRF care groups.
Results:
Among 738 patients, 499 went home, 239 went to IRF. IRF patients were more likely to have Medicare insurance (49.2 vs 28.9%), undergo thrombectomy (16.3 vs 4.6%) have increased LOS (12.7 vs 4.8 days) and stroke severity (mean NIHSS 7.8 vs 4.8; mean mRS 3.1 vs 1.7) compared to Home (Table 1). At IRF, 39 patients previously underwent thrombectomy, 200 did not. Both groups had a IRF LOS >14 days and considerable recovery in the self-care and mobility domains (Table 2). Shift analysis of mRS at hospital discharge compared to 90 days yielded significant improvements in mRS of 0-2 and lower mortality in the IRF group compared to home group (Figure).
Conclusion:
In ischemic stroke patients with higher disease severity, IRF treatment is a catalyst for improved functional recovery.
Collapse
Affiliation(s)
| | - Maunica R Manchi
- Physical Medicine and Rehabilitation, UT Southwestern Med Cntr, Dallas, TX
| | - Folefac D Atem
- UNIV OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON SCHOOL OF PUBLIC HEALTH, Dallas, TX
| | | | - Annie M Abraham
- Physical Medicine and Rehabilitation, UT Southwestern Med Cntr, Dallas, TX
| | | | | | | |
Collapse
|
17
|
Nyancho D, Atem FD, Venkatachalam AM, Barnes A, Hill M, Traylor JI, Stutzman SE, Bedros N, Aiyagari V, Aoun SG. Anisocoria Correlates With Injury Severity and Outcomes After Blunt Traumatic Brain Injury. J Neurosci Nurs 2021; 53:251-255. [PMID: 34620803 DOI: 10.1097/jnn.0000000000000613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
ABSTRACT BACKGROUND: Automated infrared pupillometry (AIP) has been shown to be helpful in the setting of aneurysmal subarachnoid hemorrhage and stroke as an indicator of imminent irreversible brain injury. We postulated that the early detection of pupillary dysfunction after light stimulation using AIP may be useful in patients with traumatic brain injury (TBI). METHODS: We performed a retrospective review of the Establishing Normative Data for Pupillometer Assessment in Neuroscience Intensive Care database, a prospectively populated multicenter registry of patients who had AIP measurements taken during their intensive care unit admission. The primary eligibility criterion was a diagnosis of blunt TBI. Ordinal logistic modeling was used to explore the association between anisocoria and daily Glasgow Coma Scale scores and discharge modified Rankin Scale scores from the intensive care unit and from the hospital. RESULTS: Among 118 subjects in the who met inclusion, there were 6187 pupillometer readings. Of these, anisocoria in ambient light was present in 12.8%, and that after light stimulation was present in 9.8%. Anisocoria after light stimulation was associated with worse injury severity (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.14-0.46]), lower discharge Glasgow Coma Scale scores (OR, 0.28 [95% CI, 0.17-0.45]), and lower discharge modified Rankin Scale scores (OR, 0.28 [95% CI, 0.17-0.47]). Anisocoria in ambient light showed a similar but weaker association. CONCLUSION: Anisocoria correlates with injury severity and with patient outcomes after blunt TBI. Anisocoria after light stimulation seems to be a stronger predictor than does anisocoria in ambient light. These findings represent continued efforts to understand pupillary changes in the setting of TBI.
Collapse
|
18
|
Li A, Atem FD, Venkatachalam AM, Barnes A, Stutzman SE, Olson DM. Admission Glasgow Coma Scale Score as a Predictor of Outcome in Patients Without Traumatic Brain Injury. Am J Crit Care 2021; 30:350-355. [PMID: 34467380 DOI: 10.4037/ajcc2021163] [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: 11/01/2022]
Abstract
BACKGROUND The Glasgow Coma Scale was developed in 1974 as an injury severity score to assess and predict outcome after traumatic brain injury. The tool is now used to score depth of impaired consciousness in patients with and without traumatic brain injury. However, evidence supporting the use of the Glasgow Coma Scale in the latter group is limited. OBJECTIVE To assess Glasgow Coma Scale score on hospital admission as a predictor of outcome in patients without traumatic brain injury. METHODS This was a secondary analysis of prospectively collected data from 3507 patients admitted to 4 hospitals between October 2015 and October 2019. Patients with a primary diagnosis of traumatic brain injury were excluded from this study. RESULTS The mean age of the 3507 participants in the study was 57 years. Participants were primarily female (52%), White (77%), and non-Hispanic (89%). On admission, 90% of patients had a modified Rankin Scale score of 0 to 3 and 72% had a Glasgow Coma Scale score of 13 to 15 (mild injury). Generalized estimating equation modeling indicated that admission Glasgow Coma Scale score did not predict modified Rankin Scale score at discharge in patients not diagnosed with traumatic brain injury (Glasgow Coma Scale score <8: z = -7.89, P < .001; Glasgow Coma Scale score 8-12: z = -4.17, P < .001). CONCLUSIONS The Glasgow Coma Scale is not recommended for use in patients without traumatic brain injury; clinicians should use a more appropriate and validated clinical assessment instrument for this patient population.
Collapse
Affiliation(s)
- Amy Li
- Amy Li is a master of public health graduate from the School of Public Health, University of Texas Health Science Center in Houston
| | - Folefac D. Atem
- Folefac D. Atem is an associate professor of biostatistics and data science, School of Public Health, University of Texas Health Science Center in Houston
| | - Aardhra M. Venkatachalam
- Aardhra M. Venkatachalam is a clinical data specialist, University of Texas Southwestern Medical Center, Dallas
| | - Arianna Barnes
- Arianna Barnes is a clinical nurse, Providence Mission Hospital, Mission Viejo, California
| | - Sonja E. Stutzman
- Sonja E. Stutzman is a clinical research manager, University of Texas Southwestern Medical Center, Dallas
| | - DaiWai M. Olson
- DaiWai M. Olson is a a professor of neurology and a critical care nurse, University of Texas Southwestern Medical Center
| |
Collapse
|
19
|
Singh P, Stutzman SE, Venkatachalam A, Olson DM, Barnes A, Atem FD. Identification of abnormal pupil dilation velocity as a biomarker of cerebral injury in neurocritically ill patients. Rev Bras Ter Intensiva 2021; 33:412-421. [PMID: 35107552 PMCID: PMC8555398 DOI: 10.5935/0103-507x.20210065] [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] [Received: 12/01/2020] [Accepted: 02/02/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To calculate mean dilation velocities for Glasgow coma scale-derived injury severity classifications stratified by multiple confounding variables. METHODS In this study, we examined 68,813 pupil readings from 3,595 patients to determine normal dilation velocity with brain injury categorized based upon a Glasgow coma scale as mild (13 - 15), moderate (9 - 12), or severe (3 - 8). The variables age, sex, race, pupil size, intensive care unit length of stay, intracranial pressure, use of narcotics, Glasgow coma scale, and diagnosis were considered as confounding and controlled for in statistical analysis. Machine learning classification algorithm-based logistic regression was employed to identify dilation velocity cutoffs for Glasgow coma scale categories. RESULTS The odds ratios and confidence intervals of these factors were shown to be statistically significant in their influence on dilation velocity. Classification based on the area under the curve showed that for the mild Glasgow coma scale, the dilation velocity threshold value was 1.2mm/s, with false probability rates of 0.1602 and 0.1902 and areas under the curve of 0.8380 and 0.8080 in the left and right eyes, respectively. For the moderate Glasgow coma scale, the dilation velocity was 1.1mm/s, with false probability rates of 0.1880 and 0.1940 and areas under the curve of 0.8120 and 0.8060 in the left and right eyes, respectively. Furthermore, for the severe Glasgow coma scale, the dilation velocity was 0.9mm/s, with false probability rates of 0.1980 and 0.2060 and areas under the curve of 0.8020 and 0.7940 in the left and right eyes, respectively. These values were different from the previous method of subjective description and from previously estimated normal dilation velocities. CONCLUSION Slower dilation velocities were observed in patients with lower Glasgow coma scores, indicating that decreasing velocities may indicate a higher degree of neuronal injury.
Collapse
Affiliation(s)
- Prachi Singh
- University of Texas at Southwestern Medical Center - Dallas, Texas, Estados Unidos
| | - Sonia E Stutzman
- University of Texas at Southwestern Medical Center - Dallas, Texas, Estados Unidos
| | | | - DaiWai M Olson
- University of Texas at Southwestern Medical Center - Dallas, Texas, Estados Unidos
| | - Arianna Barnes
- University of Texas at Southwestern Medical Center - Dallas, Texas, Estados Unidos
| | - Folefac D Atem
- University of Texas at Southwestern Medical Center - Dallas, Texas, Estados Unidos
| |
Collapse
|
20
|
Butt AA, Atem FD, Stutzman SE, Aiyagari V, Venkatachalam AM, Olson DM, Yokobori S. Contribution of pupillary light reflex assessment to Glasgow Coma Scale for prognostication in patients with traumatic brain injury. J Neurocrit Care 2021. [DOI: 10.18700/jnc.210001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
21
|
Mazhar K, Olson DM, Atem FD, Stutzman SE, Moreno J, Venkatachalam A, Aiyagari V. Supratentorial intracerebral hemorrhage volume and other CT variables predict the neurological pupil index. Clin Neurol Neurosurg 2020; 200:106410. [PMID: 33341651 DOI: 10.1016/j.clineuro.2020.106410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/12/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES There is growing interest in the ability of automated infrared pupillometry to assess severity of neurological illness. We studied the correlation between computed tomography (CT) indicators of intracerebral hemorrhage (ICH) severity with objective measures of the pupillary light reflex (PLR), and hypothesized that hemorrhage volume would predict the Neurological Pupil index™ (NPi™), an indicator of pupillary reactivity. METHODS This study examined data from patients with supratentorial ICH who underwent serial pupillometer evaluations. CT images were examined to determine the location and laterality of the hemorrhage, along with hematoma volume (using the simplified ABC/2 method), midline shift, hydrocephalus score, and modified Graeb score (indicating interventricular hemorrhage). Demographics were examined with standard measures of central tendency, hypotheses with logistic regression, categorical data with Fisher's Exact X2, and multivariate modeling with constructed MAX-R models. RESULTS Data were gathered from 44 subjects. ICH volume exhibited the strongest correlation with NPi (ipsilateral [r2 = 0.48, p < 0.0001, contralateral [(r2 = 0.39, p < 0.0001]). Horizontal midline shift of the septum pellucidum also correlated with NPi (ipsilateral [r2 = 0.25, p = 0.0006], contralateral [r2 = 0.15, p = 0.0106]), as did shift of the pineal gland (ipsilateral [r2 = 0.21, p = 0.0017], contralateral[r2 = 0.11, p = 0.0328]). ICH volume was the most predictive of abnormal NPi (AUC = 0.85 for ipsilateral and 0.88 for contralateral NPi), and multivariate modeling identified additional independent predictors of NPi. CONCLUSION ICH volume and shift of midline structures correlate with NPi, and abnormalities in NPi can be predicted by hematoma volume and other CT indicators of ICH severity. Future studies should explore the role of NPi in detecting early hematoma expansion and worsening midline shift.
Collapse
Affiliation(s)
- Khadijah Mazhar
- UT Southwestern Medical School, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - DaiWai M Olson
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States; Department of Neurological Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - Folefac D Atem
- Department of Biostatistics & Data Sciences, University of Texas Health Science Center, 5161 Harry Hines Blvd. CS5.106 Dallas, TX, 75390, United States
| | - Sonja E Stutzman
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - James Moreno
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - Aardhra Venkatachalam
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States
| | - Venkatesh Aiyagari
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States; Department of Neurological Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, United States.
| |
Collapse
|
22
|
Matsouaka RA, Atem FD. Regression with a right-censored predictor using inverse probability weighting methods. Stat Med 2020; 39:4001-4015. [PMID: 32779274 DOI: 10.1002/sim.8704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 12/23/2022]
Abstract
In a longitudinal study, measures of key variables might be incomplete or partially recorded due to drop-out, loss to follow-up, or early termination of the study occurring before the advent of the event of interest. In this paper, we focus primarily on the implementation of a regression model with a randomly censored predictor. We examine, particularly, the use of inverse probability weighting methods in a generalized linear model (GLM), when the predictor of interest is right-censored, to adjust for censoring. To improve the performance of the complete-case analysis and prevent selection bias, we consider three different weighting schemes: inverse censoring probability weights, Kaplan-Meier weights, and Cox proportional hazards weights. We use Monte Carlo simulation studies to evaluate and compare the empirical properties of different weighting estimation methods. Finally, we apply these methods to the Framingham Heart Study data as an illustrative example to estimate the relationship between age of onset of a clinically diagnosed cardiovascular event and low-density lipoprotein among cigarette smokers.
Collapse
Affiliation(s)
- Roland A Matsouaka
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA.,Program for Comparative Effectiveness Methodology, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Folefac D Atem
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston Houston, Houston, Texas, USA
| |
Collapse
|
23
|
Abstract
IMPORTANCE The prevalence of asthma in US children with various developmental disabilities and delays is unclear, including how estimates vary by ethnic group. OBJECTIVE To report asthma prevalence estimates by various disability categories and developmental delays in a diverse sample of the US pediatric population. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study encompassed a total of 71 811 families with children or adolescents aged 0 to 17 years (hereinafter referred to as children) who participated in the 2016 and 2017 National Survey of Children's Health. Data were collected from June 10, 2016, to February 10, 2017, for the 2016 survey and from August 10, 2017, to February 10, 2018, for the 2017 survey. Data were analyzed from September 20, 2019, to April 5, 2020. EXPOSURES Developmental disability, including attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, seizure, intellectual and/or learning disability, and vision, hearing, and/or speech delay. Delay was defined as not meeting growth milestones with unknown cause. MAIN OUTCOMES AND MEASURES Weighted asthma prevalence estimates and 95% CIs were generated for children with and without disabilities. RESULTS A total of 71 811 participants (mean [SE] age, 8.6 [0.1] years; 36 800 boys [51.1%; 95% CI, 50.2%-52.0%]; 50 219 non-Hispanic white [51.4%; 95% CI, 50.6%-52.3%]) were included in our final analytical sample, of whom 5687 (7.9%; 95% CI, 7.5%-8.4%) had asthma and 11 426 (15.3%; 95% CI, 14.7%-16.0%) had at least 1 disability. Overall asthma prevalence estimates were 10 percentage points higher in children with a disability (16.1%; 95% CI, 14.3%-17.8%) vs children without a disability (6.5%; 95% CI, 6.0%-6.9%). The odds of asthma were significantly higher in children with a disability (odds ratio [OR], 2.77; 95% CI, 2.39-3.21) or delay (OR, 2.22; 95% CI, 1.78-2.77) vs typically growing children. Adjusted models remained significant for all disability categories (overall adjusted OR, 2.21; 95% CI, 1.87-2.62). Subgroup analyses showed ethnic minorities had a higher prevalence of concurrent asthma and developmental disabilities vs non-Hispanic whites (19.8% [95% CI, 16.6%-23.0%] vs 12.6% [95% CI, 11.1%-14.0%]; P < .001). CONCLUSIONS AND RELEVANCE These results suggest that US children with various developmental disabilities or delay may have higher odds for developing asthma vs their typically developing peers. These findings support asthma screening in pediatric health care settings among patients with developmental disabilities and delays, particularly among those from ethnic minority backgrounds. In addition, very young children with asthma should be screened for disabilities and delays, because temporality cannot be determined by the current data source and analytical approach.
Collapse
Affiliation(s)
- Luyu Xie
- School of Public Health, University of Texas Health Science Center at Houston, Dallas Campus, Dallas
- Center for Pediatric Population Health, Children’s Health System of Texas, Dallas
| | - Andrew Gelfand
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - George L. Delclos
- School of Public Health, University of Texas Health Science Center at Houston, Houston campus, Houston
| | - Folefac D. Atem
- School of Public Health, University of Texas Health Science Center at Houston, Dallas Campus, Dallas
- Center for Pediatric Population Health, Children’s Health System of Texas, Dallas
| | - Harold W. Kohl
- School of Public Health, University of Texas Health Science Center at Houston, Austin campus, Austin
| | - Sarah E. Messiah
- School of Public Health, University of Texas Health Science Center at Houston, Dallas Campus, Dallas
- Center for Pediatric Population Health, Children’s Health System of Texas, Dallas
| |
Collapse
|
24
|
Weerakoon SM, Stutzman SE, Atem FD, Kuchenbecker KS, Olson DM, Aiyagari V. Investigation of Pupillary Changes After Carotid Endarterectomy and Carotid Stent Placement Using Automated Pupillometry. J Stroke Cerebrovasc Dis 2020; 29:104693. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/25/2022] Open
|
25
|
Atem FD, Matsouaka RA, Zimmern VE. Cox regression model with randomly censored covariates. Biom J 2019; 61:1020-1032. [PMID: 30908720 DOI: 10.1002/bimj.201800275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/11/2022]
Abstract
This paper deals with a Cox proportional hazards regression model, where some covariates of interest are randomly right-censored. While methods for censored outcomes have become ubiquitous in the literature, methods for censored covariates have thus far received little attention and, for the most part, dealt with the issue of limit-of-detection. For randomly censored covariates, an often-used method is the inefficient complete-case analysis (CCA) which consists in deleting censored observations in the data analysis. When censoring is not completely independent, the CCA leads to biased and spurious results. Methods for missing covariate data, including type I and type II covariate censoring as well as limit-of-detection do not readily apply due to the fundamentally different nature of randomly censored covariates. We develop a novel method for censored covariates using a conditional mean imputation based on either Kaplan-Meier estimates or a Cox proportional hazards model to estimate the effects of these covariates on a time-to-event outcome. We evaluate the performance of the proposed method through simulation studies and show that it provides good bias reduction and statistical efficiency. Finally, we illustrate the method using data from the Framingham Heart Study to assess the relationship between offspring and parental age of onset of cardiovascular events.
Collapse
Affiliation(s)
- Folefac D Atem
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Roland A Matsouaka
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.,Program for Comparative Effectiveness Methodology, Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Vincent E Zimmern
- Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA.,Department of Pediatrics, Children Hospital Dallas, Dallas, TX, USA
| |
Collapse
|
26
|
Abstract
This article describes a nonparametric conditional imputation analytic method for randomly censored covariates in linear regression. While some existing methods make assumptions about the distribution of covariates or underestimate standard error due to lack of imputation error, the proposed approach is distribution-free and utilizes resampling to correct for variance underestimation. The performance of the novel method is assessed using simulations, and results are contrasted with methods currently used for a limit of detection censored design, including the complete case approach and other nonparametric approaches. Theoretical justifications for the proposed method are provided, and its application is demonstrated through a study of association between lipoprotein cholesterol in offspring and parental history of cardiovascular disease.
Collapse
|
27
|
Allport SA, Kikah N, Abu Saif N, Ekokobe F, Atem FD. Parental Age of Onset of Cardiovascular Disease as a Predictor for Offspring Age of Onset of Cardiovascular Disease. PLoS One 2016; 11:e0163334. [PMID: 28002456 PMCID: PMC5176186 DOI: 10.1371/journal.pone.0163334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The risk for cardiovascular disease (CVD) is higher for individuals with a first-degree relative who developed premature CVD (with a threshold at age 55 years for a male or 65 years for a female). However, little is known about the effect that each unit increase or decrease of maternal or paternal age of onset of CVD has on offspring age of onset of CVD. We hypothesized that there is an association between maternal and paternal age of onset of CVD and offspring age of onset of CVD. METHODS We used the Framingham Heart Study database and performed conditional imputation for CVD-censored parental age (i.e. parents that didn't experience onset of CVD) and Cox proportional regression analysis, with offspring's age of onset of CVD as the dependent variable and parental age of onset of CVD as the primary predictor. Modifiable risk factors in offspring, such as cigarette smoking, body mass index (BMI), diabetes mellitus, systolic blood pressure (SBP), high-density lipoprotein (HDL) level, and low-density lipoprotein (LDL) level, were controlled for. Separate analyses were performed for the association between maternal age of onset of CVD and offspring age of onset of CVD and the association between paternal age of onset of CVD and offspring age of onset of CVD. RESULTS Parental age of onset of CVD was predictive of offspring age of onset of CVD for maternal age of onset of CVD (P < .0001; N = 1401) and for paternal age of onset of CVD (P = 0.0134; N = 1221). A negative estimate of the coefficient of interest signifies that late onset of cardiovascular events in parents is protective of onset of CVD in offspring. Cigarette smoking and HDL level were important associated confounders. CONCLUSIONS Offspring age of onset of cardiovascular disease is significantly associated with both maternal and paternal age of onset CVD. The incorporation of the parameters, maternal or paternal age of onset of CVD, into risk estimate calculators may improve accuracy of identification of high-risk patients in clinical settings.
Collapse
Affiliation(s)
- Shannon Anjelica Allport
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- The University of Texas Health Science Center School of Public Health, Dallas, Texas, United States of America
| | - Ngum Kikah
- The University of Texas Health Science Center School of Public Health, Dallas, Texas, United States of America
| | - Nessim Abu Saif
- The University of Texas Health Science Center School of Public Health, Dallas, Texas, United States of America
- Trinity School of Medicine, Kingstown, St. Vincent and the Grenadines
| | - Fonkem Ekokobe
- Texas A &M Health Science Center School of Medicine, Dallas, Texas, United States of America
| | - Folefac D. Atem
- The University of Texas Health Science Center School of Public Health, Dallas, Texas, United States of America
| |
Collapse
|
28
|
Atem FD, Qian J, Maye JE, Johnson KA, Betensky RA. Linear Regression with a Randomly Censored Covariate: Application to an Alzheimer's Study. J R Stat Soc Ser C Appl Stat 2016; 66:313-328. [PMID: 28239197 DOI: 10.1111/rssc.12164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The association between maternal age of onset of dementia and amyloid deposition (measured by in vivo positron emission tomography (PET) imaging) in cognitively normal older offspring is of interest. In a regression model for amyloid, special methods are required due to the random right censoring of the covariate of maternal age of onset of dementia. Prior literature has proposed methods to address the problem of censoring due to assay limit of detection, but not random censoring. We propose imputation methods and a survival regression method that do not require parametric assumptions about the distribution of the censored covariate. Existing imputation methods address missing covariates, but not right censored covariates. In simulation studies, we compare these methods to the simple, but inefficient complete case analysis, and to thresholding approaches. We apply the methods to the Alzheimer's study.
Collapse
Affiliation(s)
| | - Jing Qian
- University of Massachusetts, Amherst, USA
| | | | | | | |
Collapse
|
29
|
Atem FD, Qian J, Maye JE, Johnson KA, Betensky RA. Multiple Imputation of a Randomly Censored Covariate Improves Logistic Regression Analysis. J Appl Stat 2016; 43:2886-2896. [PMID: 27713593 PMCID: PMC5047523 DOI: 10.1080/02664763.2016.1155110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/13/2016] [Indexed: 10/22/2022]
Abstract
Randomly censored covariates arise frequently in epidemiologic studies. The most commonly used methods, including complete case and single imputation or substitution, suffer from inefficiency and bias. They make strong parametric assumptions or they consider limit of detection censoring only. We employ multiple imputation, in conjunction with semi-parametric modeling of the censored covariate, to overcome these shortcomings and to facilitate robust estimation. We develop a multiple imputation approach for randomly censored covariates within the framework of a logistic regression model. We use the non-parametric estimate of the covariate distribution or the semiparametric Cox model estimate in the presence of additional covariates in the model. We evaluate this procedure in simulations, and compare its operating characteristics to those from the complete case analysis and a survival regression approach. We apply the procedures to an Alzheimer's study of the association between amyloid positivity and maternal age of onset of dementia. Multiple imputation achieves lower standard errors and higher power than the complete case approach under heavy and moderate censoring and is comparable under light censoring. The survival regression approach achieves the highest power among all procedures, but does not produce interpretable estimates of association. Multiple imputation offers a favorable alternative to complete case analysis and ad hoc substitution methods in the presence of randomly censored covariates within the framework of logistic regression.
Collapse
Affiliation(s)
- Folefac D Atem
- Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jing Qian
- Public Health, University of Massachusetts, Amherst, MA, USA
| | - Jacqueline E Maye
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | | | - Rebecca A Betensky
- Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
30
|
Atem FD, Sharma RK, Anderson SJ. Fitting bivariate multilevel models to assess long-term changes in body mass index and cigarette smoking. J Appl Stat 2011. [DOI: 10.1080/02664763.2010.529880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
31
|
Costa R, Abdulhaq H, Haq B, Shadduck RK, Latsko J, Zenati M, Atem FD, Rossetti JM, Sahovic EA, Lister J. Activity of azacitidine in chronic myelomonocytic leukemia. Cancer 2010; 117:2690-6. [DOI: 10.1002/cncr.25759] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 09/10/2010] [Accepted: 10/04/2010] [Indexed: 12/17/2022]
|