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Roche M, Nattiv A, Sainani K, Barrack M, Kraus E, Tenforde A, Kussman A, Olson EM, Kim B, Fahy K, Miller E, Diamond E, Meraz S, Singh S, Nattiv A, Fredericson M. Higher Triad Risk Scores Are Associated With Increased Risk for Trabecular-Rich Bone Stress Injuries in Female Runners. Clin J Sport Med 2023; 33:631-637. [PMID: 37655940 DOI: 10.1097/jsm.0000000000001180] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 05/22/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Bone stress injuries (BSIs) in trabecular-rich bone are associated with greater biological risk factors compared with cortical-rich bone. We hypothesized that female runners with high Female Athlete Triad (Triad)-related risk would be at greater risk for trabecular-rich BSIs than runners with low Triad-related risk. DESIGN Prospective cohort study. SETTING Two NCAA institutions. PARTICIPANTS Female runners were followed prospectively for up to 5 years. INTERVENTION The intervention consisted of team nutrition presentations focused on optimizing energy availability plus individualized nutrition sessions. Triad Cumulative Risk Assessment (CRA) categories were assigned yearly based on low-energy availability, menstrual status, age of menarche, low body mass index, low bone mineral density, and prior BSI. MAIN OUTCOME MEASURES The outcome was the annual incidence of trabecular- and cortical-rich BSI. Generalized Estimating Equations (GEE, to account for the correlated nature of the observations) with a Poisson distribution and log link were used for statistical modeling. RESULTS Cortical-rich BSI rates were higher than trabecular-rich BSI rates (0.32 vs 0.13 events per person-year). Female runners with high Triad-related risk had a significantly higher incidence rate ratio of trabecular-rich BSI (RR: 4.40, P = 0.025) and cortical-rich BSI (RR: 2.87, P = 0.025) than women with low Triad-related risk. Each 1-point increase in Triad CRA score was associated with a significant 26% increased risk of trabecular-rich BSI ( P = 0.0007) and a nonsignificant 14% increased risk of cortical-rich BSI ( P = 0.054). CONCLUSIONS Increased Triad CRA scores were strongly associated with increased risk for trabecular-rich BSI. Incorporating Triad CRA scores in clinical care could guide BSI prevention.
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Affiliation(s)
- Megan Roche
- Stanford Department of Epidemiology and Population Health, Stanford, California
| | - Aurelia Nattiv
- Department of Family Medicine and Orthopaedic Surgery, Division of Sports Medicine and Non-Operative Orthopedics, University of California Los Angeles, Los Angeles, California
| | - Kristin Sainani
- Stanford Department of Epidemiology and Population Health, Stanford, California
| | - Michelle Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California
| | - Emily Kraus
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Adam Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | - Andrea Kussman
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Emily Miller Olson
- Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Brian Kim
- Department of Orthopaedic Surgery, University of California Irvine, Irvine, California
| | - Katherine Fahy
- Department of Family Medicine and Orthopaedic Surgery, Division of Sports Medicine and Non-Operative Orthopedics, University of California Los Angeles, Los Angeles, California
| | - Emily Miller
- Department of Family Medicine and Orthopaedic Surgery, Division of Sports Medicine and Non-Operative Orthopedics, University of California Los Angeles, Los Angeles, California
| | - Elyse Diamond
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Sonya Meraz
- Tan Chingfen Graduate School of Nursing, University of Massachusetts, North Worcester, Massachusetts; and
| | - Sonal Singh
- School of Medicine, St. George University, Grenada, West Indies
| | - Aurelia Nattiv
- Department of Family Medicine and Orthopaedic Surgery, Division of Sports Medicine and Non-Operative Orthopedics, University of California Los Angeles, Los Angeles, California
| | - Michael Fredericson
- Department of Family Medicine, University of Washington, Seattle, Washington
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Fredericson M, Roche M, Barrack MT, Tenforde A, Sainani K, Kraus E, Kussman A, Miller Olson E, Kim BY, Fahy K, Miller E, Diamond E, Meraz S, Singh S, Nattiv A. Healthy Runner Project: a 7-year, multisite nutrition education intervention to reduce bone stress injury incidence in collegiate distance runners. BMJ Open Sport Exerc Med 2023; 9:e001545. [PMID: 37180969 PMCID: PMC10174024 DOI: 10.1136/bmjsem-2023-001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Objectives We evaluated the effect of a nutrition education intervention on bone stress injury (BSI) incidence among female distance runners at two NCAA Division I institutions. Methods Historical BSI rates were measured retrospectively (2010-2013); runners were then followed prospectively in pilot (2013-2016) and intervention (2016-2020) phases. The primary aim was to compare BSI rates in the historical and intervention phases. Pilot phase data are included only for descriptive purposes. The intervention comprised team nutrition presentations focused on optimising energy availability plus individualised nutrition sessions for runners with elevated Female Athlete Triad risk. Annual BSI rates were calculated using a generalised estimating equation Poisson regression model adjusted for age and institution. Post hoc analyses were stratified by institution and BSI type (trabecular-rich or cortical-rich). Results The historical phase included 56 runners and 90.2 person-years; the intervention phase included 78 runners and 137.3 person-years. Overall BSI rates were not reduced from the historical (0.52 events per person-year) to the intervention (0.43 events per person-year) phase. Post hoc analyses demonstrated trabecular-rich BSI rates dropped significantly from 0.18 to 0.10 events per person-year from the historical to intervention phase (p=0.047). There was a significant interaction between phase and institution (p=0.009). At Institution 1, the overall BSI rate dropped from 0.63 to 0.27 events per person-year from the historical to intervention phase (p=0.041), whereas no decline was observed at Institution 2. Conclusion Our findings suggest that a nutrition intervention emphasising energy availability may preferentially impact trabecular-rich BSI and depend on team environment, culture and resources.
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Affiliation(s)
- Michael Fredericson
- Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Stanford University, Stanford, California, USA
| | - Megan Roche
- Department of Epidemiology, Stanford Hospital and Clinics, Stanford, California, USA
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, California, USA
| | - Adam Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Kristin Sainani
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Emily Kraus
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, California, USA
| | - Andrea Kussman
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, California, USA
| | | | - Brian Young Kim
- Family Medicine, University of California, Los Angeles, Santa Monica, California, USA
| | - Katherine Fahy
- Department of Family Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Emily Miller
- Family Medicine, University of California, Los Angeles, Santa Monica, California, USA
| | - Ellie Diamond
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Sonya Meraz
- School of Nursing, University of Massachusetts System, Boston, Massachusetts, USA
| | - Sonal Singh
- School of Medicine, St George’s University, St George’s, Grenada
| | - Aurelia Nattiv
- Division of Sports Medicine, Departments of Family Medicine and Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
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Oberle L, Nattiv A, Fredericson M, Sainani K, Roche M, Diamond E, Lewis T, Krause E, McIntyre A, Wang J, Barrack MT. Perceptions Of Weight And Nutrition On Performance Among Division 1 Distance Runners, A Pilot Study. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000879108.14363.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roche M, Sainani K, Walker M, Kelly R, Fredericson M, Kraus E. Evaluating Genetic Predictors Of Bone Health In Ultramarathon Runners: Are Females Overriding Their Genetic Predisposition? Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000881664.21888.c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Høeg TB, Olson EM, Skaggs K, Sainani K, Fredericson M, Roche M, Kraus E. Prevalence of Female and Male Athlete Triad Risk Factors in Ultramarathon Runners. Clin J Sport Med 2022; 32:375-381. [PMID: 34232162 DOI: 10.1097/jsm.0000000000000956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/29/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify the prevalence of male and female athlete triad risk factors in ultramarathon runners and explore associations between sex hormones and bone mineral density (BMD). DESIGN Multiyear cross-sectional study. SETTING One hundred-mile ultramarathon. PARTICIPANTS Competing runners were recruited in 2018 and 2019. ASSESSMENT OF RISK FACTORS Participants completed a survey assessing eating behaviors, menstrual history, and injury history; dual-energy x-ray absorptiometry for BMD; and laboratory evaluation of sex hormones, vitamin D, and ferritin (2019 cohort only). MAIN OUTCOME MEASURE A Triad Cumulative Risk Assessment Score was calculated for each participant. RESULTS One hundred twenty-three runners participated (83 males and 40 females, mean age 46.2 and 41.8 years, respectively). 44.5% of men and 62.5% of women had elevated risk for disordered eating. 37.5% of women reported a history of bone stress injury (BSI) and 16.7% had BMD Z scores <-1.0. 20.5% of men had a history of BSI and 30.1% had Z-scores <-1.0. Low body mass index (BMI) (<18.5 kg/m 2 ) was seen in 15% of women and no men. The Triad Cumulative Risk Assessment classified 61.1% of women and 29.2% of men as moderate risk and 5.6% of both men and women as high risk. CONCLUSIONS Our study is the first to measure BMD in both male and female ultramarathon runners. Our male population had a higher prevalence of low BMD than the general population; females were more likely to report history of BSI. Risk of disordered eating was elevated among our participants but was not associated with either low BMD or low BMI.
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Affiliation(s)
- Tracy Beth Høeg
- Department of Physical Medicine & Rehabilitation School of Medicine, University of California-Davis, Sacramento, California.,Northern California Orthopaedic Associates, Grass Valley, California
| | - Emily Miller Olson
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
| | - Kira Skaggs
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
| | - Kristin Sainani
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Michael Fredericson
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
| | - Megan Roche
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Emily Kraus
- Stanford Department of Orthopaedic Surgery, Stanford University, Palo Alto, California; and
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Roche M, Sainani K, Noordsy D, Fredericson M. The Impacts of COVID-19 on Mental Health and Training in US Professional Endurance Athletes. Clin J Sport Med 2022; 32:290-296. [PMID: 34711711 DOI: 10.1097/jsm.0000000000000983] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We examined how professional athletes are affected by COVID-19. Our primary aim was to assess changes in mental health that occurred after COVID-19 restrictions, and our secondary aim was to assess changes in exercise volume and intensity. DESIGN Cross-sectional study. SETTING United States. PARTICIPANTS Strava professional endurance athletes. ASSESSMENT OF RISK FACTORS Participants completed a survey, and a subset of participants consented to have their activity data analyzed. The survey included questions on COVID-19 symptoms, exercise, and mental health, as measured by a modified Patient Health Questionnaire. MAIN OUTCOME MEASURES Participants were asked about 2 periods in 2020: before COVID-19 (January 1-March 14) and during COVID-19 (March 15-August 25), and activity data from both periods were downloaded. Activity data consisted of Global Positioning System and self-reported uploads. RESULTS One hundred thirty-one male and female Strava athletes were enrolled, and a subset of athletes (n = 114) consented to have their activity data analyzed. During COVID-19 restrictions, 22.2% of participants reported feeling down or depressed and 27.4% of participants reported feeling nervous or anxious at least half the days in a week compared with 3.8% and 4.6% before COVID-19 restrictions, respectively (P < 0.0001). Activity data revealed a significant increase (P < 0.0001) in exercise minutes per day during COVID-19 (mean = 103.00, SD = 42.1) compared with before COVID-19 restrictions (mean = 92.4, SD = 41.3), with no significant changes in intensity. CONCLUSIONS Athletes reported significant increases in feeling down or depressed and nervous or anxious despite an increase in exercise duration during COVID-19. Future research should assess how to support athletes with mental health resources.
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Affiliation(s)
- Megan Roche
- Departments of Epidemiology and Population Health; and
| | | | - Douglas Noordsy
- Psychiatry and Behavioral Science, Stanford University, Stanford, California; and
| | - Michael Fredericson
- Division of Physical Medicine & Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Stanford, California
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T. Tchakoute C, Rhee SY, Hare CB, Shafer RW, Sainani K. Adherence to contemporary antiretroviral treatment regimens and impact on immunological and virologic outcomes in a US healthcare system. PLoS One 2022; 17:e0263742. [PMID: 35157724 PMCID: PMC8843209 DOI: 10.1371/journal.pone.0263742] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Only a few recent reports have examined longitudinal adherence patterns in US clinics and its impact on immunological and virological outcomes among large cohorts initiating contemporary antiretroviral therapy (ART) in US clinics. Methods We followed all persons with HIV (PLWH) in a California clinic population initiating ART between 2010 and 2017. We estimated longitudinal adherence for each PLWH by calculating the medication possession ratio within multiple 6-month intervals using pharmacy refill records. Results During the study, 2315 PWLH were followed for a median time of 210.8 weeks and only 179 (7.7%) were lost-to-follow-up. The mean adherence was 84.9%. Age (Hazard Ratio (HR): (95% confidence interval): 1.25 (1.20–1.31) per 10-year increase) and Black race (HR: 0.62 (0.53–0.73) vs. White) were associated with adherence in the cohort. A 10% percent increase in adherence increased the odds of being virally suppressed by 37% (OR and 95% CI: 1.37 [1.33–1.41]) and was associated with an increase in mean CD4 count by 8.54 cells/ul in the next 6-month interval (p-value <0.0001). Conclusions Our study shows that despite large improvements in retention in care, demographic disparities in adherence to ART persist. Adherence was lower among younger patients and black patients. Our study confirmed the strong association between adherence to ART and viral suppression but could only establish a weak association between adherence and CD4 count. These findings reaffirm the importance of adherence and retention in care and further highlight the need for tailored patient-centered HIV Care Models as a strategy to improve PLWH’s outcomes.
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Affiliation(s)
- Christophe T. Tchakoute
- Division of Epidemiology and Population Health, Department of Medicine, Stanford University, Stanford, CA, United States of America
| | - Soo-Yon Rhee
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, United States of America
| | - C. Bradley Hare
- Department of Infectious Diseases, Kaiser Permanente Northern California, San Francisco, CA, United States of America
| | - Robert W. Shafer
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, United States of America
- * E-mail: (RWS); (KS)
| | - Kristin Sainani
- Division of Epidemiology and Population Health, Department of Medicine, Stanford University, Stanford, CA, United States of America
- * E-mail: (RWS); (KS)
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Chen YT, Miller Olson EK, Lee SH, Sainani K, Fredericson M. Assessing Diagnostic and Severity Grading Accuracy of Ultrasound Measurements for Carpal Tunnel Syndrome Compared to Electrodiagnostics. PM R 2020; 13:852-861. [PMID: 33306874 DOI: 10.1002/pmrj.12533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The combined sensory index (CSI) is the most sensitive electrodiagnostic criteria for carpal tunnel syndrome (CTS), and the CSI and Bland criteria have been shown to predict surgical treatment outcomes. The proposed ultrasound measurements have not been assessed against the CSI for diagnostic accuracy and grading of CTS severity. OBJECTIVE To investigate the use of ultrasound evaluations for both diagnosis and assessment of severity grading of CTS in comparison to electrodiagnostic assessment. DESIGN All patients underwent an electrodiagnostic evaluation using the CSI and Bland severity grading. Each patient underwent an ultrasound evaluation including cross-sectional area (CSA), the change in CSA from the forearm to the tunnel (∆CSA), and the wrist-forearm ratio (WFR). These measurements were assessed for diagnostic and severity grading accuracy using the CSI as the gold standard. SETTING Tertiary academic center. PARTICIPANTS All patients referred for electrodiagnostic evaluation for CTS were eligible for the study. Only those with idiopathic CTS were included and those with prior CTS treatment were also excluded. Ninety-five patients were included in the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary study outcome measure was concordance between CSI diagnosis and severity categories and the ultrasound measurements. Both outcomes were also assessed using Bland criteria. RESULTS Optimal cut-points for diagnosis of CTS were found to be CSA ≥12 mm2 , ∆CSA ≥4 mm2 , WFR ≥1.4. Using these cut-points, C-statistics comparing diagnosis of CTS using ultrasound measurements versus using the CSI ranged from 0.893-0.966. When looking at CSI severity grading compared to ∆CSA, however, the C-statistics were 0.640-0.661 with substantial overlap between severity groups. CONCLUSIONS Although ultrasound measurements had high diagnostic accuracy for CTS based on the CSI criteria, ultrasound measurements were unable to adequately distinguish between CSI severity groups among patients with CTS.
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Affiliation(s)
- Yin-Ting Chen
- Interdisciplinary Pain Management Center, Brooke Army Medical Center, San Antonio, TX, USA
| | - Emily K Miller Olson
- Division of Physical Medicine & Rehabilitation, Department of Orthopaedics, Stanford University, Stanford, CA, USA
| | - Sung-Hoon Lee
- Department of Physical Medicine & Rehabilitation, Kwangju Christian Hospital, Gwangju, South Korea
| | - Kristin Sainani
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Michael Fredericson
- Division of Physical Medicine & Rehabilitation, Department of Orthopaedics, Stanford University, Stanford, CA, USA
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Rhee SY, Clutter D, Hare CB, Tchakoute CT, Sainani K, Fessel WJ, Hurley L, Slome S, Pinsky BA, Silverberg MJ, Shafer RW. Virological Failure and Acquired Genotypic Resistance Associated With Contemporary Antiretroviral Treatment Regimens. Open Forum Infect Dis 2020; 7:ofaa316. [PMID: 32904894 PMCID: PMC7462367 DOI: 10.1093/ofid/ofaa316] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background There are few descriptions of virologic failure (VF) and acquired drug resistance (HIVDR) in large cohorts initiating contemporary antiretroviral therapy (ART). Methods We studied all persons with HIV (PWH) in a California clinic population initiating ART between 2010 and 2017. VF was defined as not attaining virologic suppression, discontinuing ART, or virologic rebound prompting change in ART. Results During the study, 2315 PWH began ART. Six companion drugs were used in 93.3% of regimens: efavirenz, elvitegravir/c, dolutegravir, darunavir/r, rilpivirine, and raltegravir. During a median follow-up of 36 months, 214 (9.2%) PWH experienced VF (2.8 per 100 person-years) and 62 (2.7%) experienced HIVDR (0.8 per 100 person-years). In multivariable analyses, younger age, lower CD4 count, higher virus load, and atazanavir/r were associated with increased VF risk; lower CD4 count, higher virus load, and nevirapine were associated with increased HIVDR risk. Compared with efavirenz, dolutegravir, raltegravir, and darunavir were associated with reduced HIVDR risk. Risks of VF and HIVDR were not significantly associated with ART initiation year. Of the 62 PWH with HIVDR, 42 received an non-nucleoside RT inhibitor (NNRTI), 15 an integrase-strand transfer inhibitor (INSTI), and 5 a protease inhibitor (PI). Among those with HIVDR on an NNRTI or first-generation INSTI, 59% acquired dual class resistance and 29% developed tenofovir resistance; those receiving a PI or dolutegravir developed just M184V. Conclusions Despite the frequent use of contemporary ART regimens, VF and HIVDR continue to occur. Further efforts are required to improve long-term ART virological responses to prevent the consequences of ongoing HIV-1 replication including virus transmission and HIVDR.
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Affiliation(s)
- Soo-Yon Rhee
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, California, USA
| | - Dana Clutter
- Department of Infectious Diseases, Kaiser Permanente Northern California, South San Francisco, California, USA
| | - C Bradley Hare
- Department of Infectious Diseases, Kaiser Permanente Northern California, San Francisco, California, USA
| | - Christophe T Tchakoute
- Division of Epidemiology and Population Health, Department of Medicine, Stanford University, Stanford, California, USA
| | - Kristin Sainani
- Division of Epidemiology and Population Health, Department of Medicine, Stanford University, Stanford, California, USA
| | - W Jeffrey Fessel
- Department of Infectious Diseases, Kaiser Permanente Northern California, San Francisco, California, USA
| | - Leo Hurley
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sally Slome
- Department of Infectious Diseases, Kaiser Permanente Northern California, Oakland, California, USA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Robert W Shafer
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, California, USA
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Skaggs KF, Fredericson M, Miller EK, Roche M, Hoeg TB, Sainani K, Kraus E. Identifying Triad Risk Factors In Ultramarathon Runners. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000670768.43965.fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Miller EK, Fredericson M, Roche M, Skaggs K, Hoeg TB, Sainani K, Kraus E. Genetic Predictions Of Bone Mineral Density In Ultramarathon Runners: For Men, But Not For Women. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000683760.60169.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Frankovich J, Leibold CM, Farmer C, Sainani K, Kamalani G, Farhadian B, Willett T, Park JM, Sidell D, Ahmed S, Thienemann M. The Burden of Caring for a Child or Adolescent With Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): An Observational Longitudinal Study. J Clin Psychiatry 2018; 80. [PMID: 30549499 DOI: 10.4088/jcp.17m12091] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/25/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the longitudinal association between disease severity, time established in clinical treatment, and caregiver burden in a community-based patient population diagnosed with pediatric acute-onset neuropsychiatric syndrome (PANS). METHODS The study included an observational longitudinal cohort design, with Caregiver Burden Inventories (CBIs) collected between April 2013 and November 2016 at the Stanford PANS multidisciplinary clinic. Inclusion criteria for this study were as follows: pediatric patients meeting strict PANS/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) diagnostic criteria (n = 187), having a caregiver fill out at least 1 complete CBI during a disease flare (n = 114); and having family who lives locally (n = 97). For longitudinal analyses, only patients whose caregiver had filled out 2 or more CBIs (n = 94 with 892 CBIs) were included. In the study sample, most primary caregivers were mothers (69 [71.1%] of 97), the majority of PANS patients were male (58 [59.8%] of 97), and mean age at PANS onset was 8.8 years. RESULTS In a patient's first flare tracked by the clinic, 50% of caregivers exceeded the caregiver burden score threshold used to determine respite need in care receiver adult populations. Longitudinally, flares, compared with quiescence, predicted increases in mean CBI score (6.6 points; 95% CI, 5.1 to 8.0). Each year established in clinic predicted decreased CBI score (-3.5 points per year; 95% CI, -2.3 to -4.6). Also, shorter time between PANS onset and entry into the multidisciplinary clinic predicted greater improvement in mean CBI score over time (0.7 points per year squared; 95% CI, 0.1 to 1.3). Time between PANS onset and treatment with antibiotics or immunomodulation did not moderate the relationship between CBI score and time in clinic. CONCLUSIONS PANS caregivers suffer high caregiver burden. Neuropsychiatric disease severity predicts increased caregiver burden. Caregiver burden tends to decrease over time in a group of patients undergoing clinical treatment at a specialty PANS clinic. This decrease could be independent of clinical treatment.
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Affiliation(s)
- Jennifer Frankovich
- Stanford University School of Medicine, Division of Pediatrics, Department of Pediatric Rheumatology, 700 Welch Rd, Ste 301, MC: 5896, Palo Alto, CA 94304. .,Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA.,Stanford PANS Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Collin McCloskey Leibold
- Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA.,Stanford PANS Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Cristan Farmer
- Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Kristin Sainani
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
| | - Gabbi Kamalani
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Bahare Farhadian
- Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA.,Stanford PANS Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Theresa Willett
- Pediatric Divisions of Allergy, Immunology, & Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA.,Stanford PANS Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jennifer M Park
- Pediatric Divisions of Child & Adolescent Psychiatry, Stanford University School of Medicine, Palo Alto, California, USA
| | - Douglas Sidell
- Pediatric Otolaryngology/Head and Neck Surgery at Lucille Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sana Ahmed
- Stanford PANS Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Margo Thienemann
- Pediatric Divisions of Child & Adolescent Psychiatry, Stanford University School of Medicine, Palo Alto, California, USA
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Miller E, Fredericson M, Kussman A, Krauss E, Singh S, Deakins-Roche M, Kim B, Tenforde A, Sainani K, Nattiv A. Youth Multi-sport Participation Is Associated With Higher Bone Mineral Density In Female Collegiate Distance Runners. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536695.58667.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wedekind L, Sainani K, Pershing S. Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments. JAMA Ophthalmol 2016; 134:537-543. [DOI: 10.1001/jamaophthalmol.2016.0316] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lauren Wedekind
- Department of Ophthalmology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California2Department of Human Biology, Stanford University, Stanford, California
| | - Kristin Sainani
- Department of Health Research and Policy, Stanford University, Stanford, California
| | - Suzann Pershing
- Department of Ophthalmology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California4Byers Eye Institute at Stanford University, Palo Alto, California
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Tenforde AS, Sainani K, Sayres L, Fredericson M. Poster 184 Female Athlete Triad Risk Factors Are Associated with Impaired Bone Health in Adolescent Runners. PM R 2014. [DOI: 10.1016/j.pmrj.2014.08.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Effinger K, Leisenring W, Oeffinger K, Hudson M, Ness K, Marina N, Castellino S, Stovall M, Armstrong G, Robison L, Sainani K, Whittemore A. Longitudinal Evaluation of Health Status in Aging Pediatric Hodgkin Lymphoma Survivors: Report from the Childhood Cancer Survivor Study. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fu T, Keiser E, Linos E, Rotatori RM, Sainani K, Lingala B, Lane AT, Schneider L, Tang JY. Eczema and sensitization to common allergens in the United States: a multiethnic, population-based study. Pediatr Dermatol 2014; 31:21-6. [PMID: 24283549 DOI: 10.1111/pde.12237] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The relationship between food and environmental allergens in contributing to eczema risk is unclear on a multiethnic population level. Our purpose was to determine whether sensitization to specific dietary and environmental allergens as measured according to higher specific immunoglobulin E (IgE) levels is associated with eczema risk in children. National Health and Nutrition Examination Survey participants ages 1 to 17 years were asked whether they had ever received a diagnosis of eczema from a physician (n = 538). Total and specific serum IgE levels for four dietary allergens (egg, cow's milk, peanut, and shrimp) and five environmental allergens (dust mite, cat, dog, Aspergillus, and Alternaria) were measured. Logistic regression was used to examine the association between eczema and IgE levels. In the United States, 10.4 million children (15.6%) have a history of eczema. Eczema was more common in black children (p < 0.001) and in children from families with higher income and education (p = 0.01). The median total IgE levels were higher in children with a history of eczema than in those without (66.4 vs 50.6 kU/L, p = 0.004). In multivariate analysis adjusted for age, race, sex, family income, household education, and physician-diagnosed asthma, eczema was significantly associated with sensitization to cat dander (odds ratio [OR] = 1.2, 95% confidence interval [CI] 1.05, 1.4, p = 0.009) and dog dander (OR = 1.5, 95% CI, 1.2, 1.7, p < 0.001). After correction for multiple comparisons, only sensitization to dog dander remained significant. U.S. children with eczema are most likely to be sensitized to dog dander. Future prospective studies should further explore this relationship.
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Affiliation(s)
- Teresa Fu
- Department of Dermatology, School of Medicine, Stanford University, Redwood City, California
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Sayres L, Arroyo J, Collado H, Cutti P, Fredericson M, Sainani K, Tenforde AS. Poster 135 Dietary Intake as a Predictor of Low Bone Density in Young Female Runners. PM R 2011. [DOI: 10.1016/j.pmrj.2011.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
| | - Julia Arroyo
- Stanford University, Stanford, CA, United States
| | | | - Phil Cutti
- Stanford University, Stanford, CA, United States
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Lin AY, Chua MS, Choi YL, Yeh W, Kim YH, Azzi R, Adams GA, Sainani K, van de Rijn M, So SK, Pollack JR. Comparative profiling of primary colorectal carcinomas and liver metastases identifies LEF1 as a prognostic biomarker. PLoS One 2011; 6:e16636. [PMID: 21383983 PMCID: PMC3044708 DOI: 10.1371/journal.pone.0016636] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 01/03/2011] [Indexed: 12/19/2022] Open
Abstract
Purpose We sought to identify genes of clinical significance to predict survival and the risk for colorectal liver metastasis (CLM), the most common site of metastasis from colorectal cancer (CRC). Patients and Methods We profiled gene expression in 31 specimens from primary CRC and 32 unmatched specimens of CLM, and performed Significance Analysis of Microarrays (SAM) to identify genes differentially expressed between these two groups. To characterize the clinical relevance of two highly-ranked differentially-expressed genes, we analyzed the expression of secreted phosphoprotein 1 (SPP1 or osteopontin) and lymphoid enhancer factor-1 (LEF1) by immunohistochemistry using a tissue microarray (TMA) representing an independent set of 154 patients with primary CRC. Results Supervised analysis using SAM identified 963 genes with significantly higher expression in CLM compared to primary CRC, with a false discovery rate of <0.5%. TMA analysis showed SPP1 and LEF1 protein overexpression in 60% and 44% of CRC cases, respectively. Subsequent occurrence of CLM was significantly correlated with the overexpression of LEF1 (chi-square p = 0.042), but not SPP1 (p = 0.14). Kaplan Meier analysis revealed significantly worse survival in patients with overexpression of LEF1 (p<0.01), but not SPP1 (p = 0.11). Both univariate and multivariate analyses identified stage (p<0.0001) and LEF1 overexpression (p<0.05) as important prognostic markers, but not tumor grade or SPP1. Conclusion Among genes differentially expressed between CLM and primary CRC, we demonstrate overexpression of LEF1 in primary CRC to be a prognostic factor for poor survival and increased risk for liver metastasis.
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Affiliation(s)
- Albert Y Lin
- Department of Medicine, Santa Clara Valley Medical Center, San Jose, California, United States of America.
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Tenforde AS, Fredericson M, Sainani K, Smith KE. Poster 135: Prevalence of the Female Athlete Triad in Female Distance Runners. PM R 2010. [DOI: 10.1016/j.pmrj.2010.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Kristin Sainani
- Department of Health Research and Policy, Stanford University, Stanford, CA 94305, USA.
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Tenforde AS, Collado H, Fredericson M, McCurdy ML, McDonald S, Sainani K, Sayres L. Poster 158: Risk Factors for Developing Stress Fractures in Female Distance Runners. PM R 2009. [DOI: 10.1016/j.pmrj.2009.08.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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