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Maizel JL, Haller MJ, Maahs DM, Addala A, Lal RA, Filipp SL, Gurka MJ, Westen S, Dixon BN, Figg L, Hechavarria M, Malden KG, Walker AF. COVID-19 impacts and inequities among underserved communities with diabetes. J Clin Transl Endocrinol 2024; 36:100337. [PMID: 38559803 PMCID: PMC10973684 DOI: 10.1016/j.jcte.2024.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/22/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Background People with diabetes have higher COVID-19 morbidity and mortality. These risks are amplified for underserved communities including racial/ethnic minorities and people with lower socioeconomic status. However, limited research has examined COVID-19 outcomes specifically affecting underserved communities with diabetes. Methods From November 2021 to July 2022, adults with insulin-requiring diabetes at federally qualified health centers in Florida and California (n = 450) completed surveys examining COVID-19 outcomes and demographics. Surveys assessed COVID-19 severity, vaccination uptake, mask-wearing habits, income changes, and healthcare access changes. Surveys also included the full Coronavirus Anxiety Scale (CAS-19). Descriptive statistics were computed for all outcomes. Between-group comparisons for state and race/ethnicity were evaluated via Chi-Squared, Fisher's Exact, Cochran-Mantel-Haenszel, One-Way ANOVA, and t-tests. Logistic regression determined factors associated with COVID-19 vaccination uptake. Data were self-reported and analyzed cross-sectionally. Results Overall, 29.7 % reported contracting COVID-19; of those, 45.3 % sought care or were hospitalized. Most (81.3 %) received ≥ 1 vaccine. Hispanics had the highest vaccination rate (91.1 %); Non-Hispanic Blacks (NHBs) had the lowest (73.9 %; p =.0281). Hispanics had 4.63x greater vaccination odds than Non-Hispanic Whites ([NHWs]; 95 % CI = [1.81, 11.89]). NHWs least often wore masks (18.8 %; p <.001). Participants reported pandemic-related healthcare changes (62 %) and higher costs of diabetes medications (41 %). Income loss was more frequent in Florida (76 %; p <.001). NHBs most frequently reported "severe" income loss (26.4 %; p =.0124). Loss of health insurance was more common among NHBs (13.3 %; p =.0416) and in Florida (9.7 %; p =.039). COVID-19 anxiety was highest among NHBs and Hispanics (IQR = [0.0, 3.0]; p =.0232) and in Florida (IQR = [0.0, 2.0]; p =.0435). Conclusions Underserved communities with diabetes had high COVID-19 vaccine uptake but experienced significant COVID-19-related physical, psychosocial, and financial impacts. NHBs and those in Florida had worse outcomes than other racial/ethnic groups and those in California. Further research, interventions, and policy changes are needed to promote health equity for this population.
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Affiliation(s)
- Jennifer L. Maizel
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Department of Public Health, 3300 South University Drive, Fort Lauderdale, FL 33328, USA
- University of Florida College of Public Health and Health Professions, Department of Health Services Research, Management, and Policy, 1225 Center Drive, Gainesville, FL 32611, USA
| | - Michael J. Haller
- University of Florida College of Medicine, Department of Pediatrics, 1600 Southwest Archer Road, Gainesville, FL 32610, USA
| | - David M. Maahs
- Stanford University School of Medicine, Department of Pediatrics and Division of Diabetes and Endocrinology, 291 Campus Drive, Stanford, CA 94305, USA
| | - Ananta Addala
- Stanford University School of Medicine, Department of Pediatrics and Division of Diabetes and Endocrinology, 291 Campus Drive, Stanford, CA 94305, USA
| | - Rayhan A. Lal
- Stanford University School of Medicine, Department of Pediatrics and Division of Diabetes and Endocrinology, 291 Campus Drive, Stanford, CA 94305, USA
- Stanford University School of Medicine, Division of Endocrinology, Gerontology, and Metabolism, 291 Campus Drive, Stanford, CA 94305, USA
| | - Stephanie L. Filipp
- University of Florida College of Medicine, Department of Pediatrics, 1600 Southwest Archer Road, Gainesville, FL 32610, USA
| | - Matthew J. Gurka
- University of Florida College of Medicine, Department of Pediatrics, 1600 Southwest Archer Road, Gainesville, FL 32610, USA
| | - Sarah Westen
- University of Florida College of Public Health and Health Professions, Department of Clinical and Health Psychology, 1225 Center Drive, Gainesville, FL 32611, USA
| | - Brittney N. Dixon
- University of Florida College of Public Health and Health Professions, Department of Health Services Research, Management, and Policy, 1225 Center Drive, Gainesville, FL 32611, USA
| | - Lauren Figg
- Stanford University School of Medicine, Department of Pediatrics and Division of Diabetes and Endocrinology, 291 Campus Drive, Stanford, CA 94305, USA
| | - Melanie Hechavarria
- University of Florida College of Medicine, Department of Pediatrics, 1600 Southwest Archer Road, Gainesville, FL 32610, USA
| | - Keilecia G. Malden
- University of Florida College of Medicine, Department of Pediatrics, 1600 Southwest Archer Road, Gainesville, FL 32610, USA
| | - Ashby F. Walker
- University of Florida College of Public Health and Health Professions, Department of Health Services Research, Management, and Policy, 1225 Center Drive, Gainesville, FL 32611, USA
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Smith KM, Keshwani S, Walsh MG, Winterstein AG, Gurka MJ, Libby A, Hogan WR, Pepine CJ, Cooper-DeHoff RM, Smith SM. Initial Antihypertensive Prescribing in Relation to Blood Pressure Among Florida Medicaid and Medicare Recipients in the OneFlorida+ Research Consortium. Hypertension 2024; 81:e7-e9. [PMID: 38232142 DOI: 10.1161/hypertensionaha.123.21901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
- Kayla M Smith
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (K.M.S., S.K., M.G.W., A.G.W., S.M.S.), University of Florida, Gainesville, FL
| | - Shailina Keshwani
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (K.M.S., S.K., M.G.W., A.G.W., S.M.S.), University of Florida, Gainesville, FL
| | - Marta G Walsh
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (K.M.S., S.K., M.G.W., A.G.W., S.M.S.), University of Florida, Gainesville, FL
- Now with Mayo Clinic, Rochester, MN (M.G.W.)
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (K.M.S., S.K., M.G.W., A.G.W., S.M.S.), University of Florida, Gainesville, FL
| | - Matthew J Gurka
- Department of Pediatrics, College of Medicine (M.J.G.), University of Florida, Gainesville, FL
| | - Anne Libby
- Department of Emergency Medicine, School of Medicine, University of Colorado Denver, Denver, CO (A.L.)
| | - William R Hogan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine (W.R.H.), University of Florida, Gainesville, FL
- Now with Data Science Institute, Medical College of Wisconsin, Milwaukee, WI (W.R.H.)
| | - Carl J Pepine
- Divisio of Cardiovascular Medicine, Department of Medicine, College of Medicine (C.J.P., R.M.C.-D., S.M.S.), University of Florida, Gainesville, FL
| | - Rhonda M Cooper-DeHoff
- Divisio of Cardiovascular Medicine, Department of Medicine, College of Medicine (C.J.P., R.M.C.-D., S.M.S.), University of Florida, Gainesville, FL
- Department of Pharmacotherapy and Translational Research, College of Pharmacy (R.M.C.-D.), University of Florida, Gainesville, FL
| | - Steven M Smith
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy (K.M.S., S.K., M.G.W., A.G.W., S.M.S.), University of Florida, Gainesville, FL
- Divisio of Cardiovascular Medicine, Department of Medicine, College of Medicine (C.J.P., R.M.C.-D., S.M.S.), University of Florida, Gainesville, FL
- Center for Integrative Cardiovascular and Metabolic Disease (S.M.S), University of Florida, Gainesville, FL
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Klarman MB, Chi X, Cajusma Y, Flaherty KE, Capois AC, Dofiné MDV, Exantus L, Friesen J, Beau de Rochars VM, Becker T, Baril C, Gurka MJ, Nelson EJ. Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting. BMJ Paediatr Open 2024; 8:e002164. [PMID: 38191203 PMCID: PMC10806461 DOI: 10.1136/bmjpo-2023-002164] [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: 06/30/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE To develop and evaluate a guideline for a paediatric telemedicine and medication delivery service (TMDS). METHODS A clinical guideline for paediatric telemedicine was derived from the World Health (WHO) Organization Integrated Management of Childhood Illness (IMCI) Handbook. The guideline was deployed at a TMDS in Haiti and evaluated through a prospective cohort study; children ≤10 years were enrolled. For non-severe cases, paired virtual and in-person examinations were conducted at the call centre and household; severe cases were referred to the hospital. The performance of virtual examination components were evaluated by comparison with the paired in-person examination findings (reference). RESULTS A total of 391 cases were enrolled. Among the 320 cases with paired examinations, no general WHO danger signs were identified during in-person examinations; 5 cases (2%) required hospital referral due to problem-specific danger signs or other reasons for escalation. Cohen's kappa for the virtual designation of mild cases was 0.78 (95% CI: 0.69 to 0.87). The sensitivity and specificity of a virtually reported fever were 91% (95% CI: 87% to 96%) and 69% (95% CI: 62% to 76%), respectively; the sensitivity and specificity of virtually reported 'fast breathing' were 47% (95% CI: 21% to 72%) and 89% (95% CI: 85% to 94%), respectively. Kappa for 'no' and 'some' dehydration indicated moderate congruence between virtual and in-person examinations (0.69; 95% CI: 0.41 to 0.98). At 10 days, 273 (95%) of the 287 cases reached by phone were better/recovered. CONCLUSION Critical components of the virtual examination (triage, danger signs and dehydration assessment) performed well despite varied performance among the problem-specific components. The study and associated resources represents formative steps towards an evidence-based paediatric telemedicine guideline built on WHO clinical principles. In-person examinations for select cases were important to address limitations with virtual examinations and identify cases for escalation. TRIAL REGISTRATION NUMBER NCT03943654.
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Affiliation(s)
- Molly B Klarman
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Youseline Cajusma
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Katelyn E Flaherty
- Departments of Emergency Medicine and Environmental and Global Health, University of Florida, Gainesville, Florida, USA
| | - Anne Carine Capois
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | | | - Lerby Exantus
- Faculté de Médecine et de Pharmacie, Université d'État d'Haiti, Port-au-Prince, Haiti
| | | | | | - Torben Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Chantale Baril
- Faculté de Médecine et de Pharmacie, Université d'État d'Haiti, Port-au-Prince, Haiti
| | - Matthew J Gurka
- Departments of Pediatrics and Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Eric J Nelson
- Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, Florida, USA
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Newsome FA, Cardel MI, Chi X, Lee AM, Miller D, Menon S, Janicke DM, Gurka MJ, Butryn ML, Manasse S. Wellness Achieved Through Changing Habits: A Randomized Controlled Trial of an Acceptance-Based Intervention for Adolescent Girls With Overweight or Obesity. Child Obes 2023; 19:525-534. [PMID: 36394498 PMCID: PMC10734897 DOI: 10.1089/chi.2022.0116] [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: 11/18/2022]
Abstract
Background: Obesity prevalence among adolescent girls continues to rise. Acceptance-based therapy (ABT) is effective for weight loss in adults and feasible and acceptable for weight loss among adolescents. This pilot randomized controlled trial (RCT) assessed effectiveness of an adolescent-tailored ABT intervention on decreasing weight-related outcomes and improving psychological outcomes compared with enhanced care. Methods: In this 6-month, two-arm pilot RCT, participants were randomized to the ABT intervention or to enhanced care. The ABT intervention condition attended 15 virtual, 90-minute group sessions. The enhanced care comparison received 15 healthy lifestyle handouts and virtually met twice with a registered dietitian. The primary outcome assessed was change in BMI expressed as a percentage of the 95th percentile (%BMIp95). Results: Participants included 40 girls (ages 14-19) assigned to ABT (n = 20) or enhanced care (n = 20). A decrease in %BMIp95 was observed within the ABT intervention [d = -0.19, 95% confidence interval, CI: (-0.36 to -0.02)], however, not within the enhanced care comparison [d = -0.01, 95% CI: (-0.09 to 0.07)]. The ABT group showed slight changes in psychological flexibility [d = -0.34, 95% CI: (-0.62 to -0.06)] over enhanced care [d = -0.11, 95% CI: (-0.58 to 0.37)]. There was no significant intervention effect noted between groups. Conclusion: In this pilot RCT, the ABT intervention was as effective as enhanced care for weight loss. However, previous ABT studies occurred in person, and this study was conducted virtually due to COVID-19. Thus, future research investigating the potential effectiveness of ABT in-person among adolescents and optimization of virtual interventions is needed.
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Affiliation(s)
- Faith A. Newsome
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
| | - Michelle I. Cardel
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
- WW International, Inc., New York, NY, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, FL, USA
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
| | - Alexandra M. Lee
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
- WW International, Inc., New York, NY, USA
| | - Darci Miller
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
| | - Sarada Menon
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
| | - David M. Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Matthew J. Gurka
- Department of Health Outcomes and Biomedical Informatics and University of Florida, Gainesville, FL, USA
| | - Meghan L. Butryn
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia PA, USA
| | - Stephanie Manasse
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia PA, USA
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Chen G, Donahoo WT, Cardel MI, Holgerson A, Ayzengart A, Johnson-Mann CN, Gurka MJ. Variation by race/ethnicity in the utilization and weight loss following metabolic bariatric surgery. Surg Obes Relat Dis 2023; 19:1391-1404. [PMID: 37666726 DOI: 10.1016/j.soard.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/02/2023] [Accepted: 06/13/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Understanding the disparities in utilization and weight loss outcomes of metabolic and bariatric surgery (MBS) by demographics will inform strategies targeting potential treatment gaps and enhance overall clinical obesity treatment. OBJECTIVE To identify factors associated with utilization and longitudinal weight loss after MBS. SETTING OneFlorida Clinical Research Consortium Database. METHODS We performed a retrospective study using data from the OneFlorida Clinical Research Consortium between 2012 and 2018. We used logistic regression with intersectional effects to identify factors associated with utilization of MBS. Mixed-effect models were used to estimate longitudinal percentage total weight loss among those who underwent MBS with up to 18 months of follow-up. RESULTS Among 429,821 patients eligible for MBS, 8290 (1.9%) underwent MBS between 2012 and 2018. Intersectional analysis revealed that non-Hispanic Black patients experienced an inferior utilization of MBS compared with non-Hispanic White and Hispanic counterparts, defined by the interaction between race/ethnicity and demographic factors, including male sex, older age, and insurance coverage. In the longitudinal weight loss assessment, 4016 patients (48.3% Roux-en-Y gastric bypass, 51.7% sleeve gastrectomy) were included. We found that non-Hispanic Black patients experienced significantly less weight loss than non-Hispanic White and Hispanic counterparts. Other factors associated with less weight loss over time included undergoing sleeve gastectomy, male sex, lower preoperative body mass index, and having type 2 diabetes at the time of surgery. CONCLUSIONS Our findings will help to design new strategies focusing on the intersection of race/ethnicity and sociodemographic factors to improve access and effectiveness of MBS.
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Affiliation(s)
- Guanming Chen
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida
| | - William T Donahoo
- Department of Endocrinology, University of Florida College of Medicine, Gainesville, Florida
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida; WW International, Inc., New York, New York
| | - Allison Holgerson
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | | | | | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida; Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.
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Zeldman J, Varela EG, Gorin AA, Gans KM, Gurka MJ, Bernier AV, Mobley AR. Home Visitation Program Staff Attitudes and Intentions Towards Using Digital Technology to Educate Families About Preventing Early Childhood Obesity: A Qualitative Study. Matern Child Health J 2023; 27:1905-1913. [PMID: 37273139 PMCID: PMC10241118 DOI: 10.1007/s10995-023-03731-3] [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] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Home visitation programs that reach families of young children offer a unique opportunity for large-scale early childhood obesity prevention efforts. The objective of this qualitative research was to determine stakeholder attitudes, subjective norms, perceived ease of use and usefulness, behavioral control, and behavioral intentions towards utilizing technology in a home visitation program targeting early childhood obesity prevention. METHODS Staff from the Florida Maternal, Infant, and Early Childhood Home Visiting Program (n = 27) were interviewed individually by a trained research assistant using a semi-structured script based on constructs from the Technology Acceptance Model and Theory of Planned Behavior. Demographic and technology use information were collected. Interviews were recorded and transcribed verbatim, with data extracted and coded by two trained researchers using a theoretical thematic analysis approach. RESULTS Most of the home visiting staff (78%) were white and non-Hispanic and employed for an average of 5 years with the program. Most staff (85%) indicated they were currently using videoconferencing for home visits. Themes and subthemes emerged, including positive attitudes towards technology as a flexible and time-efficient program alternative for childhood obesity prevention with recommendations to keep content short, at a low literacy level, and available in more than one language for ease of use. Participants recommended developing training tutorials to improve program implementation. Internet access and potential social disconnect were cited as concerns for using technology. DISCUSSION Overall, home visitation staff had positive attitudes and intentions for using technology in home visiting programs with families for early childhood obesity prevention.
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Affiliation(s)
- Jamie Zeldman
- Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, 32611, USA
| | - Elder Garcia Varela
- Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, 32611, USA
| | - Amy A Gorin
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
- Institute for Collaboration On Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
| | - Kim M Gans
- Institute for Collaboration On Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269, USA
- Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT, 06269, USA
| | - Matthew J Gurka
- Department of Pediatrics, College of Medicine, University of Florida, 1699 SW 16th Avenue, Gainesville, FL, 32608, USA
| | - Angelina V Bernier
- Department of Pediatrics, College of Medicine, University of Florida, 1699 SW 16th Avenue, Gainesville, FL, 32608, USA
| | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida, PO Box 118210, Gainesville, FL, 32611, USA.
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Addala A, Hechavarria M, Figg L, Roque X, Filipp SL, Anez-Zabala C, Lal R, Gurka MJ, Haller MJ, Maahs DM, Walker AF. Recruiting historically under-represented individuals into Project ECHO Diabetes: using barrier analysis to understand disparities in clinical research in the USA. BMJ Open 2023; 13:e072546. [PMID: 37648378 PMCID: PMC10471869 DOI: 10.1136/bmjopen-2023-072546] [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: 02/08/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES Individuals under-recruited in diabetes research studies include those not seen at endocrinology centres and those from rural, low socioeconomic and/or under-represented racial/ethnic groups. The purpose of this descriptive analysis is to detail recruitment and retention efforts of Project ECHO Diabetes clinical sites affiliated with Stanford University and University of Florida. DESIGN Prospective collection of participant engagement and qualitative analysis of barriers and facilitators of research engagement within Project ECHO Diabetes, a virtual tele-education programme for healthcare providers in the management of individuals with insulin-requiring diabetes. SETTING Data were collected at the patient level, provider level and clinic level between 1 May 2021 and 31 July 2022. PARTICIPANTS Participants and study personnel were recruited from 33 Project ECHO Diabetes sites in California and Florida. OUTCOMES We report study completion rates for participants recruited into 33 Project ECHO Diabetes sites. Using barrier analysis, a methodology designed for the real-time assessment of interventions and system processes to identify barriers and facilitators, study personnel identified significant barriers to recruitment and retention and mapped them to actionable solutions. RESULTS In total, 872 participants (California n=495, Florida n=377) were recruited with differing recruitment rates by site (California=52.7%, Florida=21.5%). Barrier analysis identified lack of trust, unreliable contact information, communication issues and institutional review board (IRB) requirements as key recruitment barriers. Culturally congruent staff, community health centre (CHC) support, adequate funding and consent process flexibility were solutions to address recruitment challenges. Barriers to retention were inconsistent postal access, haemoglobin A1c kit collection challenges, COVID-19 pandemic and broadband/connectivity issues. Additional funding supporting research staff and analogue communication methods were identified as solutions address barriers to retention. CONCLUSIONS Funded partnerships with CHCs, trusted by their local communities, were key in our recruitment and retention strategies. IRB consent process flexibility reduced barriers to recruitment. Recruiting historically under-represented populations is feasible with funding aimed to address structural barriers to research participation.
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Affiliation(s)
- Ananta Addala
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA
- Department of Pediatrics, Stanford Diabetes Research Center, Stanford, California, USA
| | | | - Lauren Figg
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA
| | - Xanadu Roque
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Stephanie L Filipp
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | | | - Rayhan Lal
- Department of Pediatrics, Stanford Diabetes Research Center, Stanford, California, USA
- Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew J Gurka
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Michael J Haller
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - David M Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA
- Department of Pediatrics, Stanford Diabetes Research Center, Stanford, California, USA
| | - Ashby F Walker
- Health Services Research Management and Policy, University of Florida, Gainesville, Florida, USA
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8
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Figg L, Addala A, Jain I, Anez C, Midney P, DeChirico C, Symanski C, Fitzgerald BC, Colbert K, Raymer T, Stockton-Joreteg C, Murphy E, Collins L, Bernstein C, Hechavarria M, Sheehan EP, Bernier A, Westen SC, Hood KK, Zaharieva DP, Basina M, Cuttriss N, Filipp SL, Gurka MJ, Walker AF, Maahs DM, Haller MJ, Lal RA. The Promising Success of Project Extension for Community Healthcare Outcomes (ECHO) Diabetes: Case Series. JMIR Diabetes 2023; 8:e46050. [PMID: 37535407 PMCID: PMC10436109 DOI: 10.2196/46050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/04/2023] [Accepted: 05/24/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND In the United States, there are over 37 million people with diabetes but only 8000 endocrinologists. Therefore, many people with diabetes receive care exclusively from primary care providers (PCPs). To democratize knowledge regarding insulin-requiring diabetes through tele-education, Stanford University and the University of Florida developed Project Extension for Community Healthcare Outcomes (ECHO) Diabetes. OBJECTIVE ECHO Diabetes uses a Hub and Spoke model connecting specialists (the "Hub") with PCPs (the "Spokes"). One-hour, weekly sessions include Hub diabetes didactic presentations and Spoke deidentified case presentations. Lessons learned during these sessions target provider knowledge and confidence surrounding diabetes management and patient care. METHODS Spokes were asked to provide short descriptions of people with diabetes whose diabetes management improved directly or indirectly from their providers' participation or their involvement with a Diabetes Support Coach (DSC). We provide a case series to describe individuals and outcomes. Because this study was not a randomized controlled trial and was a prospective observation of patients with the intervention delivered to providers, the trial is not registered in a public trials registry. RESULTS A case series of 11 people with diabetes was compiled from 10 PCPs and 1 DSC from California and Florida between 2021 and 2022. The principal impact of ECHO Diabetes is the education amplified from PCPs and DSCs to people with diabetes. In all cases, people with diabetes reported increased engagement and improved diabetes management. Several cases reflected increased access to diabetes technology, improvement in glycemic outcomes, and positive trends in mental health measures. CONCLUSIONS This case series elucidates the potential value of the ECHO Diabetes program to people with diabetes who receive their diabetes care from PCPs. Those matched with a DSC saw clinically significant improvements in hemoglobin A1c and mental health outcomes.
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Affiliation(s)
- Lauren Figg
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Ananta Addala
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Ishaan Jain
- Stanford University, Stanford, CA, United States
| | - Claudia Anez
- Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, United States
- University of Florida Diabetes Institute, Gainesville, FL, United States
| | - Paul Midney
- Healthcare Network of Southwest Florida, Naples, FL, United States
| | - Corin DeChirico
- Healthcare Network of Southwest Florida, Naples, FL, United States
| | - Colleen Symanski
- Treasure Coast Community Health Center, Vero Beach, FL, United States
| | - Brian C Fitzgerald
- University of Florida Health Family Medicine, Old Town, FL, United States
| | - Kristi Colbert
- United Indian Health Services Potawot Health Village, Arcata, CA, United States
| | - Terry Raymer
- United Indian Health Services Potawot Health Village, Arcata, CA, United States
| | | | | | - Leah Collins
- Anderson Valley Health Center, Boonville, CA, United States
| | - Cyd Bernstein
- Anderson Valley Health Center, Boonville, CA, United States
| | - Melanie Hechavarria
- Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, United States
- University of Florida Diabetes Institute, Gainesville, FL, United States
| | - Eleni P Sheehan
- Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, United States
- University of Florida Diabetes Institute, Gainesville, FL, United States
| | - Angelina Bernier
- Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, United States
- University of Florida Diabetes Institute, Gainesville, FL, United States
| | - Sarah C Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Korey K Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Marina Basina
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Nicolas Cuttriss
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States
- Extension for Community Healthcare Outcomes Diabetes Action Network, Chevy Chase, MD, United States
| | - Stephanie L Filipp
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Matthew J Gurka
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Ashby F Walker
- University of Florida Diabetes Institute, Gainesville, FL, United States
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, United States
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael J Haller
- Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, United States
- University of Florida Diabetes Institute, Gainesville, FL, United States
| | - Rayhan A Lal
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, United States
- Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
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9
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O'Donnell HK, Trojanowski PJ, Alonso GT, Majidi S, Snell-Bergeon J, Wadwa RP, Vigers T, Pyle L, Gurka MJ, Shaffer E, Driscoll KA. A randomized controlled clinical trial to improve health outcomes in youth with type 1 diabetes: Study design and baseline characteristics. Contemp Clin Trials 2023; 131:107270. [PMID: 37348599 DOI: 10.1016/j.cct.2023.107270] [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: 12/28/2022] [Revised: 05/31/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
Most adolescents with T1D do not meet glycemic recommendations or consistently perform the required self-management behaviors to prevent acute- and long-term deleterious health outcomes. In addition, most youth with T1D do not have access to behavioral health services to address T1D management barriers. Thus, delivering behavioral interventions during routine medical appointments may hold promise for improving T1D outcomes in adolescents. The overall objective of this study was to examine the effect of behavioral interventions, either a Personalized T1D Self-Management Behaviors Feedback Report or Problem-Solving Skills, delivered by a T1D behavioral health provider and a T1D medical provider during a joint, fully integrated appointment to improve health outcomes in youth with T1D. This paper describes the study rationale, design, and baseline characteristics for the 109 adolescent-caregiver dyads who participated. Primary and secondary outcomes include hemoglobin A1c (A1C), T1D self-management behaviors, and biological indicators of complications.
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Affiliation(s)
- Holly K O'Donnell
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Paige J Trojanowski
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - G Todd Alonso
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Shideh Majidi
- Children's National, Pediatric Endocrinology, 111 Michigan Ave NW, Washington DC, United States of America.
| | - Janet Snell-Bergeon
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - R Paul Wadwa
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Tim Vigers
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Laura Pyle
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Matthew J Gurka
- University of Florida, College of Medicine, Department of Pediatrics, PO Box 100177, Gainesville, FL, United States of America.
| | - Emily Shaffer
- University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Gainesville, FL, United States of America.
| | - Kimberly A Driscoll
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America; University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Gainesville, FL, United States of America; University of Florida Diabetes Institute, United States of America.
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10
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Varma DS, Mualem M, Goodin A, Gurka KK, Wen TST, Gurka MJ, Roussos-Ross K. Acceptability of an mHealth App for Monitoring Perinatal and Postpartum Mental Health: Qualitative Study With Women and Providers. JMIR Form Res 2023; 7:e44500. [PMID: 37285185 DOI: 10.2196/44500] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/14/2023] [Accepted: 04/07/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Up to 15% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. OBJECTIVE This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. METHODS Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. RESULTS Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. CONCLUSIONS The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population.
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Affiliation(s)
- Deepthi S Varma
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Maya Mualem
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Amie Goodin
- Pharmaceutical Outcomes and Policy, Center for Drug Evaluation and Safety Consortium for Medical Marijuana Clinical Outcomes Research, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Kelly K Gurka
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Tony Soo-Tung Wen
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Matthew J Gurka
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, United States
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Kay Roussos-Ross
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, United States
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, United States
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11
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Bteddini DS, LeLaurin JH, Chi X, Hall JM, Theis RP, Gurka MJ, Lee JH, Mobley EM, Khalil GE, Polansky CJ, Kellner AM, Fahnlander AM, Kelder SH, Fiellin LE, Gutter MS, Shenkman EA, Salloum RG. Mixed methods evaluation of vaping and tobacco product use prevention interventions among youth in the Florida 4-H program. Addict Behav 2023; 141:107637. [PMID: 36753933 DOI: 10.1016/j.addbeh.2023.107637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Novel prevention programs are developed to address the increase in e-cigarette use (vaping) among children. However, it remains paramount to test their feasibility in rural settings. This pilot study implemented and evaluated the feasibility and outcomes of two innovative programs, CATCH My Breath and smokeSCREEN, among youth in rural settings in Florida. METHODS We conducted four focus groups with youth aged 11-17 recruited from 4-H rural clubs in Florida. In a subsequent randomized trial, we recruited 82 youth participants and assigned them to one of three arms: CATCH My Breath, smokeSCREEN, or control. CATCH My Breath and smokeSCREEN participants attended online group intervention sessions while the control group received educational material. Pre- and post-surveys were administered to all participants to assess knowledge, susceptibility, perceived positive outcomes and risk perceptions related to tobacco and e-cigarette use. Other feasibility parameters were also assessed. RESULTS Focus group discussions provided insights about feasibility and informed the implementation of both interventions in terms of delivery format, scheduling of sessions and incentives. After the intervention, CATCH My Breath participants significantly improved their general tobacco-related knowledge (post-pre = 16.21-12.92 = 3.3, p <.01) and risk perceptions towards other flavored tobacco products (post-pre = 19.29-17.71 = 1.6, p <.05). smokeSCREEN participants significantly improved their general tobacco knowledge (post-pre = 18.77-13.77 = 5.0, p <.01), knowledge about e-cigarettes (post-pre = 9.08-6.31 = 2.8, p <.01) and risk perception towards e-cigarettes (post-pre = 24.69-21.92 = 2.8, p <.05). CONCLUSIONS This study demonstrated feasibility of delivering the interventions via participant engagement, participants' willingness to be randomized, assessment of outcome measures, and exploration of different recruitment methods. Despite the potential positive influence of CATCH My Breath and smokeSCREEN on youth participants, further evaluation with larger samples is needed.
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Affiliation(s)
- Dima S Bteddini
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jaclyn M Hall
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ryan P Theis
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ji-Hyun Lee
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL 32610, USA; Division of Quantitative Sciences, University of Florida Health Cancer Center, University of Florida, Gainesville, FL 32610, USA
| | - Erin M Mobley
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL 32209, USA
| | - George E Khalil
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Caroline J Polansky
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Allie M Kellner
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Alexandra M Fahnlander
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Steven H Kelder
- Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center School of Public Health, Austin, TX 78701, USA
| | - Lynn E Fiellin
- play2PREVENT Lab at Yale, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Michael S Gutter
- Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL 32610, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
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12
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Louis-Jacques AF, Heuberger AJ, Mestre CT, Evans VF, Wilson RE, Gurka MJ, Lewis TR. Improving Racial and Ethnic Equity in Clinical Trials Enrolling Pregnant and Lactating Individuals. J Clin Pharmacol 2023; 63 Suppl 1:S21-S33. [PMID: 37317498 DOI: 10.1002/jcph.2263] [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: 12/01/2022] [Accepted: 04/27/2023] [Indexed: 06/16/2023]
Abstract
Racial and ethnic marginalized populations have historically been poorly represented, underrecruited, and underprioritized across clinical trials enrolling pregnant and lactating individuals. The objectives of this review are to describe the current state of racial and ethnic representation in clinical trials enrolling pregnant and lactating individuals and to propose evidence-based tangible solutions to achieving equity in these clinical trials. Despite efforts from federal and local organizations, only marginal progress has been made toward achieving equity in clinical research. This continued limited inclusion and transparency in pregnancy trials exacerbates health disparities, limits the generalizability of research findings, and may heighten the maternal child health crisis in the United States. Racial and ethnic underrepresented communities are willing to participate in research; however, they face unique barriers to access and participation. Multifaceted approaches are required to facilitate the participation of marginalized individuals in clinical trials including partnering with the local community to understand their priorities, needs, and assets; establishing accessible recruitment strategies; creating flexible protocols; supporting participants for their time; and increasing culturally congruent and/or culturally sensitive research staff. This article also highlights exemplars in pregnancy research.
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Affiliation(s)
| | | | | | - Victoria F Evans
- University of Florida, College of Medicine, Gainesville, FL, USA
| | - Roneé E Wilson
- University of South Florida, College of Public Health, Tampa, FL, USA
| | - Matthew J Gurka
- University of Florida, College of Medicine, Gainesville, FL, USA
| | - Tamorah R Lewis
- Department of Paediatrics, Division of Neonatology, The Hospital for Sick Children (SickKids), Toronto, ON, USA
- Department of Paediatrics Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children (SickKids), Toronto, ON, USA
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13
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Fleiss N, Gurka MJ, Burchfield DJ. Short course antibiotic therapy: When is no difference the same? J Perinatol 2023; 43:683-684. [PMID: 37029166 DOI: 10.1038/s41372-023-01671-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Noa Fleiss
- Department of Pediatrics, Division of Neonatology, Yale School of Medicine, New Haven, CT, USA.
| | - Matthew J Gurka
- Department of Pediatrics, Pediatric Research Hub, University of Florida, Gainesville, FL, USA
| | - David J Burchfield
- Department of Pediatrics, Division of Neonatology, University of Florida, Gainesville, FL, USA
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14
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Rand KH, Bhaduri-McIntosh S, Gurka MJ, Chi X, Harris A. Is Kawasaki Disease Caused by a Respiratory Virus? Pediatr Infect Dis J 2023; 42:468-472. [PMID: 37171979 DOI: 10.1097/inf.0000000000003889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Kawasaki disease is characterized by high fever, rash, cervical lymphadenopathy, conjunctival injection, oral mucous membrane changes and swelling of the extremities followed by skin sloughing. Despite >50 years of study, no bacterial, viral or other infectious agent has been consistently associated with the illness. The lockdown and social distancing for COVID-19 in March 2020 led to a marked decrease in respiratory virus circulation. This provided an "experiment of nature" to determine whether Kawasaki disease would decline in parallel. METHODS Discharge ICD-10 diagnosis codes were obtained from the Vizient Clinical Data Base for Kawasaki disease and respiratory viruses, and analyzed for the age group < 5 years. Weekly respiratory virus positivity data were also obtained from BioFire Diagnostics. RESULTS Common enveloped respiratory viruses declined precipitously from April 2020 through March 2021 to levels at or below historical seasonal minimum levels. Kawasaki Disease declined about 40% compared with 2018-2019, which is distinctly different from the pattern seen for the enveloped respiratory viruses. Strong seasonality was seen for Kawasaki disease as far back as 2010, and correlated most closely with respiratory syncytial virus, human metapneumovirus and less so with influenza virus suggesting there is a baseline level of Kawasaki disease activity that is heightened during yearly respiratory virus activity but that remains at a certain level even in the near total absence of respiratory viruses. CONCLUSIONS The striking decrease in enveloped respiratory viruses after lockdown and social distancing was not paralleled by a comparable decrease in Kawasaki disease incidence, suggesting a different epidemiology.
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Affiliation(s)
- Kenneth H Rand
- From the Departments of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | | | - Matthew J Gurka
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Xiaofei Chi
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Alyssa Harris
- Center for Advanced Analytics & Informatics, Vizient Inc., Irving, Texas
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15
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Lin B, Zheng Y, Roussos-Ross D, Gurka KK, Gurka MJ, Hu H. An external exposome-wide association study of opioid use disorder diagnosed during pregnancy in Florida. Sci Total Environ 2023; 870:161842. [PMID: 36716893 PMCID: PMC9998369 DOI: 10.1016/j.scitotenv.2023.161842] [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] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
The prevalence of opioid use disorder (OUD) during pregnancy has quadrupled in recent years and widely varies geographically in the US. However, few studies have examined which environmental factors are associated with OUD during pregnancy. We conducted an external exposome-wide association study (ExWAS) to investigate the associations between external environmental factors and OUD diagnosed during pregnancy. Data were obtained from a unique, statewide database in Florida comprising linked individual-level birth and electronic health records. A total of 255,228 pregnancies with conception dates between 2012 and 2016 were included. We examined 82 exposome measures characterizing seven aspects of the built and social environment and spatiotemporally linked them to each individual record. A two-phase procedure was utilized for the external ExWAS. In Phase 1, we randomly divided the data into a discovery set (50 %) and a replication set (50 %). Associations between exposome measures (normalized and standardized) and OUD initially diagnosed during pregnancy were examined using logistic regression. A total of 15 variables were significant in both the discovery and replication sets. In Phase 2, multivariable logistic regression was used to fit all variables selected from Phase 1. Measures of walkability (the national walkability index, OR: 1.23, 95 % CI: 1.17, 1.29), vacant land (the percent vacant land for 36 months or longer, OR: 1.06, 95 % CI: 1.00, 1.12) and food access (the percentage of low food access population that are seniors at 1/2 mile, OR: 1.47, 95 % CI: 1.38, 1.57) were each associated with diagnosis of OUD during pregnancy. This is the first external ExWAS of OUD during pregnancy, and the results suggest that low food access, high walkability, and high vacant land in under-resourced neighborhoods are associated with diagnosis of OUD during pregnancy. These findings could help develop complementary tools for universal screening for substance use and provide direction for future studies.
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Affiliation(s)
- Boya Lin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yi Zheng
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Dikea Roussos-Ross
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Kelly K Gurka
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA; Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Hui Hu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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16
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Henry M, Filipp SL, Aydin EY, Chiriboga N, Zelinka K, Smith LE, Gurka MJ, Irazuzta J, Fonseca Y, Winter MC, Pringle C. Multicentric validation of a prognostic tool for predicting brain death following out-of-hospital cardiac arrest in children. Resuscitation 2023; 185:109727. [PMID: 36764571 PMCID: PMC10065949 DOI: 10.1016/j.resuscitation.2023.109727] [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: 11/09/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
AIM Out-of-hospital cardiac arrest (OHCA) in pediatric patients is associated with high rates of mortality and neurologic injury, with no definitive evidence-based method to predict outcomes available. A prognostic scoring tool for adults, The Brain Death After Cardiac Arrest (BDCA) score, was recently developed and validated. We aimed to validate this score in pediatric patients. METHODS Retrospective cohort study of pediatric patients admitted to 5 PICUs after OHCA between 2011 and 2021. We extracted BDCA score elements for those who survived at least 24 hours but died as a result of their OHCA. We assessed score discrimination for the definitive outcome of brain death. Subgroup analysis was performed for infants < 12mo versus children ≥ 12mo, those who likely had brain death but had withdrawal of life sustaining therapy (WLST) prior to declaration, and by etiology and duration of arrest. RESULTS 389 subjects were identified across 5 institutions, with 282 meeting inclusion criteria. 169 (59.9%) were formally declared brain dead; 58 (20.6%) had findings consistent with brain death but had withdrawal of life sustaining therapies prior to completion of formal declaration. Area under the receiver operating characteristic curve for the age ≥ 12mo cohort was 0.82 [95% CI 0.75, 0.90], which mirrored the adult subject AUCs of 0.82 [0.77, 0.86] and 0.81 [0.76, 0.86] in the development and validation cohorts. Scores demonstrated worse discrimination in the infant cohort (AUC = 0.61). CONCLUSIONS The BDCA score shows promise in children ≥ 12mo following OHCA and may be considered in conjunction with existing multimodal prognostication approaches.
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Affiliation(s)
- Matthew Henry
- College of Medicine, Department of Pediatrics, Critical Care Medicine, University of Florida, PO Box 100296, Gainesville, FL 32610, United States.
| | - Stephanie L Filipp
- College of Medicine, Department of Pediatrics, Pediatric Research Hub, University of Florida, United States
| | - Elber Yuksel Aydin
- College of Medicine, Department of Pediatrics, Critical Care Medicine, University of Florida-Jacksonville, United States
| | - Nicolas Chiriboga
- Pediatric Neurocritical Care, Northwestern University Feinberg School of Medicine, United States
| | - Kailea Zelinka
- Department of Pediatrics, Critical Care Medicine, University of Maryland, United States
| | - Lorena Espinosa Smith
- Children's Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, United States
| | - Matthew J Gurka
- College of Medicine, Department of Pediatrics, Pediatric Research Hub, University of Florida, United States
| | - Jose Irazuzta
- College of Medicine, Department of Pediatrics, Critical Care Medicine, University of Florida-Jacksonville, United States
| | - Yudy Fonseca
- Department of Pediatrics, Critical Care Medicine, University of Maryland School of Medicine, United States
| | - Meredith C Winter
- Children's Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, United States; University of Southern California Keck School of Medicine, Department of Pediatrics, United States
| | - Charlene Pringle
- College of Medicine, Department of Pediatrics, Critical Care Medicine, University of Florida, PO Box 100296, Gainesville, FL 32610, United States
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17
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Lewit EM, Figg LE, Addala A, Filipp SL, Lal R, Gurka MJ, Herndon JB, Haller MJ, Maahs DM, Walker AF. Project ECHO Diabetes Cost Modeling to Support the Replication and Expansion of Tele-mentoring Programs in Non-research Settings. Diabetes Ther 2023; 14:509-518. [PMID: 36680682 PMCID: PMC9981830 DOI: 10.1007/s13300-022-01364-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/23/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Project ECHO Diabetes is a tele-education learning model for primary care providers (PCPs) seeking to improve care for patients with diabetes from marginalized communities. Project ECHO Diabetes utilized expert "hub" teams comprising endocrinologists, dieticians, nurses, psychologists, and social workers and "spokes" consisting of PCPs and their patients with diabetes. This Project ECHO Diabetes model provided diabetes support coaches to provide additional support to patients. We sought to estimate the costs of operating a Project ECHO Diabetes hub, inclusive of diabetes support coach costs. METHODS Data from Project ECHO Diabetes from June 2021 to June 2022 and wages from national databases were used to estimate hub and diabetes support coach costs to operate a 6-month, 24-session Project ECHO Diabetes program at hubs (University of Florida and Stanford University) and spokes (PCP clinic sites in Florida and California). RESULTS Hub costs for delivering a 6-month Project ECHO Diabetes program to five spoke clinics were $96,873. Personnel costs were the principal driver. Mean cost was $19,673 per spoke clinic and $11.37 per spoke clinic patient. Diabetes support coach costs were estimated per spoke clinic and considered scalable in that they would increase proportionately with the number of spoke clinics in a Project ECHO Diabetes cohort. Mean diabetes support coach costs were $6,506 per spoke clinic and $3.72 per patient. Total program costs per hub were $129,404. Mean cost per clinic was $25,881. Mean cost per patient was $15.03. CONCLUSION Herein, we document real-world costs to operate a Project ECHO Diabetes hub and diabetes support coaches. Future analysis of Project ECHO Diabetes will include estimates of spoke participation costs and changes in health care costs and savings. As state agencies, insurers, and philanthropies consider the replication of Project ECHO Diabetes, this analysis provides important initial information regarding primary operating costs.
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Affiliation(s)
- Eugene M Lewit
- Department of Health Policy, Stanford University, Stanford, CA, USA.
- , 2448 Emerson Street, Palo Alto, CA, 94301, USA.
| | - Lauren E Figg
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - Ananta Addala
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - Stephanie L Filipp
- Department of Pediatrics, Pediatric Endocrinology, University of Florida, PO Box 100296, Gainesville, FL, 32610, USA
| | - Rayhan Lal
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
- Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - Matthew J Gurka
- Department of Pediatrics, Pediatric Endocrinology, University of Florida, PO Box 100296, Gainesville, FL, 32610, USA
| | | | - Michael J Haller
- Department of Pediatrics, Pediatric Endocrinology, University of Florida, PO Box 100296, Gainesville, FL, 32610, USA.
| | - David M Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - Ashby F Walker
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
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Smith KM, Winterstein AG, Gurka MJ, Walsh M, Keshwani S, Libby A, Hogan W, Pepine CJ, Cooper-Dehoff RM, Smith SM. Abstract P394: Initial Antihypertensive Prescribing in Relation to Blood Pressure Among Medicaid and Medicare Recipients. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Introduction:
Early treatment for hypertension (HTN) portends better outcomes. However, few real-world studies have assessed initial antiHTN regimens and how they differ by baseline blood pressure (BP). We sought to compare initial treatment patterns, stratified by BP, between Medicaid and Medicare recipients.
Methods:
We performed a cross-sectional study of adults with newly-treated HTN in the One Florida+ Consortium(2012-2020) who had linked claims-EHR data from the treatment initiation visit. Eligible patients were Floridians with Medicaid or Medicare aged ≥18 years, with diagnosed HTN, who filled ≥1 first-line antiHTN class with no evidence of anti HTN fills during the year prior (in which continuous insurance enrollment was required). Baseline BP was categorized per current HTN guidelines, and logistic regression was used to estimate age-adjusted odds of combination vs. monotherapy, per 10 mmHg increase in systolic BP (SBP) or diastolic BP (DBP).
Results:
We included 2,902 patients (47% Medicaid, 53% Medicare); mean age was 44 (Medicaid) and 67 yrs(Medicare); 60% (64% and 56%, respectively) were women and 42% (57% and 29%, respectively) were Black. Initial antiHTN classes were similar comparing cohorts: ACEI, ARB and thiazide initiation varied little by BP category, in contrast to CCBs and β-blockers (Figure, panels A-B). In age-adjusted analyses, use of initial combination therapy was 40% more likely (OR, 1.40; 95% CI, 1.11, 1.76) among Medicare recipients and inversely related to BP category (panels C-D) among Medicare patients, in which each 10mmHg greater SBP (OR, 0.93; 95% CI, 0.88, 0.97) and DBP (OR 0.82; 95% CI, 0.75, 0.90) had lower odds of combination therapy. Among Medicaid recipients, only SBP associated with combination therapy (OR1.11; 95% CI, 1.03, 1.20).
Conclusions:
We observed similar initial class patterns among Medicaid & Medicare recipients across baseline BP, but differential use of combination therapy was less likely at higher baseline BP in Medicare recipients, which contrasts current guidance.
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Affiliation(s)
- Kayla M Smith
- Dept of Pharmaceutical Outcomes and Policy, College of Pharmacy, Univ of Florida, Gainesville, FL
| | - Almut G Winterstein
- Dept of Pharmaceutical Outcomes and Policy, College of Pharmacy, Univ of Florida, Gainesville, FL
| | - Matthew J Gurka
- Dept of Pediatrics, College of Medicine, Univ of Florida, Gainesville, FL
| | - Marta Walsh
- Dept of Pharmaceutical Outcomes and Policy, College of Pharmacy, Univ of Florida, Gainesville, FL
| | - Shailina Keshwani
- Dept of Pharmaceutical Outcomes and Policy, College of Pharmacy, Univ of Florida, Gainesville, FL
| | - Anne Libby
- Dept of Emergency Medicine, Sch of Medicine, Univ of Colorado Denver, Aurora, CO
| | - William Hogan
- Dept of Health Outcomes and Biomedical Informatics, College of Medicine, Univ of Florida, Gainesville, FL
| | - Carl J Pepine
- Div of Cardiovascular Medicine, Dept of Medicine, College of Medicine, Univ of Florida, Gainesville, FL
| | - Rhonda M Cooper-Dehoff
- Dept of Pharmacotherapy and Translational Rsch, College of Pharmacy, Univ of Florida, Gainesville, FL
| | - Steven M Smith
- Dept of Pharmaceutical Outcomes and Policy, College of Pharmacy, Univ of Florida, Gainesville, FL
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Borgia RE, Gurka MJ, Filipp SL, Elder M, Cardel M, Shiff NJ. Race, ethnicity and patient-reported outcomes in childhood-onset systemic lupus erythematosus. Clin Exp Rheumatol 2023; 41:186-194. [PMID: 36135940 DOI: 10.55563/clinexprheumatol/tn0x4k] [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: 05/10/2022] [Accepted: 07/25/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study assesses the association of race/ethnicity with the Patient-Reported Outcomes Measurement Information System (PROMIS®) in childhood-onset systemic lupus erythematosus (cSLE) patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. METHODS cSLE patients enrolled in the CARRA Registry within two years of cSLE diagnosis who met ACR and/or SLICC classification criteria for lupus were included. Baseline demographics, laboratory, and disease features as well as patient-reported outcomes were obtained. Multivariable linear regression analysis was used to examine the association of race and ethnicity with PROMIS scores at registry enrolment. RESULTS 425 cSLE patients met inclusion criteria: 83.8% were female, 30.6% non-Hispanic White, 29.7% Black, 22.1% Hispanic. The mean age at diagnosis was 13.9 years (SD 2.5). Household income and highest parental education varied by race/ethnic group, as did frequency of rash, leukopenia, and anti-Smith antibodies. The cohort had low-moderate baseline disease activity (SLEDAI mean: 6.0 [SD 6.7]). The overall PROMIS Global Health mean T-score was 38.6 (SD 6.5), more than one standard deviation below the general population mean of 50. There was no association between race/ethnicity and PROMIS scores in multivariable linear regression analysis. CONCLUSIONS In this multiethnic paediatric lupus cohort, PROMIS global health was lower when compared with the general paediatric US population. Moreover, PROMIS global health, pain interference, and physical function mobility did not vary across races/ethnicities.
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Affiliation(s)
- R Ezequiel Borgia
- Division of Pediatric Allergy, Immunology and Rheumatology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, and Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA.
| | - Matthew J Gurka
- Department of Pediatrics, University of Florida, Gainesville, USA
| | | | - Melissa Elder
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Florida, Gainesville, USA
| | - Michelle Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Natalie J Shiff
- University of Saskatchewan, Department of Community Health and Epidemiology, Saskatoon, Canada, and Janssen Scientific Affairs, LLC, Horsham, PA, USA
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20
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Smith SM, Winterstein AG, Gurka MJ, Walsh MG, Keshwani S, Libby AM, Hogan WR, Pepine CJ, Cooper‐DeHoff RM. Initial Antihypertensive Regimens in Newly Treated Patients: Real World Evidence From the OneFlorida+ Clinical Research Network. J Am Heart Assoc 2022; 12:e026652. [PMID: 36565195 PMCID: PMC9973585 DOI: 10.1161/jaha.122.026652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Knowledge of real-world antihypertensive use is limited to prevalent hypertension, limiting our understanding of how treatment evolves and its contribution to persistently poor blood pressure control. We sought to characterize antihypertensive initiation among new users. Methods and Results Using Medicaid and Medicare data from the OneFlorida+ Clinical Research Consortium, we identified new users of ≥1 first-line antihypertensives (angiotensin-converting enzyme inhibitor, calcium channel blocker, angiotensin receptor blocker, thiazide diuretic, or β-blocker) between 2013 and 2021 among adults with diagnosed hypertension, and no antihypertensive fill during the prior 12 months. We evaluated initial antihypertensive regimens by class and drug overall and across study years and examined variation in antihypertensive initiation across demographics (sex, race, and ethnicity) and comorbidity (chronic kidney disease, diabetes, and atherosclerotic cardiovascular disease). We identified 143 054 patients initiating 188 995 antihypertensives (75% monotherapy; 25% combination therapy), with mean age 59 years and 57% of whom were women. The most commonly initiated antihypertensive class overall was angiotensin-converting enzyme inhibitors (39%) followed by β-blockers (31%), calcium channel blockers (24%), thiazides (19%), and angiotensin receptor blockers (11%). With the exception of β-blockers, a single drug accounted for ≥75% of use of each class. β-blocker use decreased (35%-26%), and calcium channel blocker use increased (24%-28%) over the study period, while initiation of most other classes remained relatively stable. We also observed significant differences in antihypertensive selection across demographic and comorbidity strata. Conclusions These findings indicate that substantial variation exists in initial antihypertensive prescribing, and there remain significant gaps between current guideline recommendations and real-world implementation in early hypertension care.
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Affiliation(s)
- Steven M. Smith
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFL,Division of Cardiovascular Medicine, Department of Medicine, College of MedicineUniversity of FloridaGainesvilleFL,Center for Integrative Cardiovascular and Metabolic DiseaseUniversity of FloridaGainesvilleFL
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFL
| | - Matthew J. Gurka
- Department of Health Outcomes and Biomedical Informatics, College of MedicineUniversity of FloridaGainesvilleFL
| | - Marta G. Walsh
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFL
| | - Shailina Keshwani
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFL
| | - Anne M. Libby
- Department of Emergency Medicine, School of MedicineUniversity of Colorado DenverAuroraCO
| | - William R. Hogan
- Department of Pharmaceutical Outcomes and Policy, College of PharmacyUniversity of FloridaGainesvilleFL
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, Department of Medicine, College of MedicineUniversity of FloridaGainesvilleFL
| | - Rhonda M. Cooper‐DeHoff
- Division of Cardiovascular Medicine, Department of Medicine, College of MedicineUniversity of FloridaGainesvilleFL,Center for Integrative Cardiovascular and Metabolic DiseaseUniversity of FloridaGainesvilleFL,Department of Pharmacotherapy and Translational Research, College of PharmacyUniversity of FloridaGainesvilleFL
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21
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Addala A, Filipp SL, Figg LE, Anez-Zabala C, Lal RA, Gurka MJ, Haller MJ, Maahs DM, Walker AF. Tele-education model for primary care providers to advance diabetes equity: Findings from Project ECHO Diabetes. Front Endocrinol (Lausanne) 2022; 13:1066521. [PMID: 36589850 PMCID: PMC9800890 DOI: 10.3389/fendo.2022.1066521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction In the US, many individuals with diabetes do not have consistent access to endocrinologists and therefore rely on primary care providers (PCPs) for their diabetes management. Project ECHO (Extension for Community Healthcare Outcomes) Diabetes, a tele-education model, was developed to empower PCPs to independently manage diabetes, including education on diabetes technology initiation and use, to bridge disparities in diabetes. Methods PCPs (n=116) who participated in Project ECHO Diabetes and completed pre- and post-intervention surveys were included in this analysis. The survey was administered in California and Florida to participating PCPs via REDCap and paper surveys. This survey aimed to evaluate practice demographics, protocols with adult and pediatric T1D management, challenges, resources, and provider knowledge and confidence in diabetes management. Differences and statistical significance in pre- and post-intervention responses were evaluated via McNemar's tests. Results PCPs reported improvement in all domains of diabetes education and management. From baseline, PCPs reported improvement in their confidence to serve as the T1D provider for their community (pre vs post: 43.8% vs 68.8%, p=0.005), manage insulin therapy (pre vs post: 62.8% vs 84.3%, p=0.002), and identify symptoms of diabetes distress (pre vs post: 62.8% vs 84.3%, p=0.002) post-intervention. Compared to pre-intervention, providers reported significant improvement in their confidence in all aspects of diabetes technology including prescribing technology (41.2% vs 68.6%, p=0.001), managing insulin pumps (41.2% vs 68.6%, p=0.001) and hybrid closed loop (10.2% vs 26.5%, p=0.033), and interpreting sensor data (41.2% vs 68.6%, p=0.001) post-intervention. Discussion PCPs who participated in Project ECHO Diabetes reported increased confidence in diabetes management, with notable improvement in their ability to prescribe, manage, and troubleshoot diabetes technology. These data support the use of tele-education of PCPs to increase confidence in diabetes technology management as a feasible strategy to advance equity in diabetes management and outcomes.
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Affiliation(s)
- Ananta Addala
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, United States
| | - Stephanie L Filipp
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Lauren E Figg
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, United States
| | - Claudia Anez-Zabala
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Rayhan A Lal
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, United States
- Department of Medicine, Division of Endocrinology, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew J Gurka
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Michael J Haller
- Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - David M Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, United States
| | - Ashby F Walker
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, United States
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22
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Klarman MB, Flaherty KE, Chi X, Cajusma Y, Capois AC, Vladimir Dofiné MD, Exantus L, Friesen J, Beau de Rochars VM, Baril C, Gurka MJ, Becker TK, Nelson EJ. Implementation of a pediatric telemedicine and medication delivery service in a resource-limited setting: A pilot study for clinical safety and feasibility. J Pediatr 2022:S0022-3476(22)01121-0. [PMID: 36528053 DOI: 10.1016/j.jpeds.2022.12.005] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/25/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Determine the clinical safety and feasibility of implementing a telemedicine and medication delivery service (TMDS) to address gaps in nighttime access to healthcare for children in low-resource settings. STUDY DESIGN We implemented a TMDS called 'MotoMeds' in Haiti as a prospective cohort study. A parent/guardian of a sick child ≤10 years contacted the call center (6pm-5am). A nurse provider used decision support tools to triage cases (mild, moderate, severe). Severe cases were referred to emergency care. For non-severe cases, providers gathered clinical findings to generate an assessment and plan. For cases within the delivery zone, a provider and driver were dispatched and the provider performed a paired in-person exam as a reference standard for the call center assessment. Families received a follow-up call at 10 days. Data were analyzed for clinical safety and feasibility. RESULTS A total of 391 cases were enrolled from September 9, 2019, to January 19, 2021. Most cases were not severe (92%; 361); household visits were completed for 89% (347) of these cases. Among the 30 severe cases, 67% (20) sought referred care. Respiratory problems were most common (63%; 246). At 10-days, 95% (329) of parents reported their child "improved" or "recovered". Overall 99% (344) rated the TMDS as "good" or "great". The median phone consultation time was 20 minutes, time to household arrival was 73 minutes, and total time was 114 minutes/case. CONCLUSION The TMDS was a feasible healthcare delivery model. Although many cases were likely self-limiting, the TMDS was associated with high rates of reported improvement in clinical status at 10 days.
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Affiliation(s)
- Molly B Klarman
- Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, FL.
| | - Katelyn E Flaherty
- Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, FL; Department of Emergency Medicine, University of Florida, Gainesville, FL
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | - Youseline Cajusma
- Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, FL
| | - Anne Carine Capois
- Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, FL
| | | | - Lerby Exantus
- Université d'État d'Haiti- Faculté de Médecine et de Pharmacie, Port-au-Prince, Haiti
| | | | - Valery M Beau de Rochars
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
| | - Chantale Baril
- Université d'État d'Haiti- Faculté de Médecine et de Pharmacie, Port-au-Prince, Haiti
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL
| | - Eric J Nelson
- Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, FL
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Kalavalapalli S, Leiva EG, Lomonaco R, Chi X, Shrestha S, Dillard R, Budd J, Romero JP, Li C, Bril F, Samraj G, Pennington J, Townsend P, Orlando F, Shetty S, Mansour L, Silva-Sombra LR, Bedossa P, Malaty J, Barb D, Gurka MJ, Cusi K. Adipose Tissue Insulin Resistance Predicts the Severity of Liver Fibrosis in Patients with Type 2 Diabetes and NAFLD. J Clin Endocrinol Metab 2022; 108:1192-1201. [PMID: 36378995 DOI: 10.1210/clinem/dgac660] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT While T2D is a risk factor for liver fibrosis in NAFLD, the specific contribution of insulin resistance (IR) relative to other factors is unknown. OBJECTIVE Assess the impact on liver fibrosis in NAFLD of adipose tissue (Adipo-IR) and liver (HOMA-IR) IR in people with T2D and NAFLD. DESIGN Participants were screened by elastography in the outpatient clinics for hepatic steatosis and fibrosis, including routine metabolites, cytokeratin-18 (marker of hepatocyte apoptosis/steatohepatitis), and HOMA-IR/Adipo-IR. SETTING University ambulatory care practice. PARTICIPANTS 483 participants with T2D. INTERVENTION Screening for steatosis and fibrosis with elastography. MAIN OUTCOME MEASURES Liver steatosis (CAP) and fibrosis (LSM) and measurements of IR (Adipo-IR, HOMA-IR) and fibrosis (cytokeratin-18). RESULTS Clinically significant liver fibrosis (stage F ≥ 2= LSM ≥8.0 kPa) was found in 11%, having more features of the metabolic syndrome, lower adiponectin, and higher AST, ALT, liver fat and cytokeratin-18 (p < 0.05-0.01). In multivariable analysis including just clinical variables (model 1), obesity (BMI) had the strongest association with fibrosis (OR: 2.56, CI:1.87-3.50; p < 0.01). When metabolic measurements and cytokeratin-18 were included (model 2), only BMI, AST and liver fat remained significant. When fibrosis stage was adjusted for BMI, AST, and steatosis (model 3), only adipo-IR remained strongly associated with fibrosis (OR: 1.51, CI:1.05-2.16; p = 0.03), but not BMI, hepatic IR or steatosis. CONCLUSIONS These findings pinpoint to the central role of dysfunctional, insulin-resistant adipose tissue to advanced fibrosis in T2D, beyond simply BMI or steatosis. The clinical implication is that targeting adipose tissue should be the priority of treatment in NAFLD.
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Affiliation(s)
- Srilaxmi Kalavalapalli
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - Eddison Godinez Leiva
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - Romina Lomonaco
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - Xiaofei Chi
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Sulav Shrestha
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - Rachel Dillard
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - Jeffery Budd
- Division of General Internal Medicine, University of Florida, Gainesville, FL, USA
| | | | - Christina Li
- Division of General Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Fernando Bril
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - George Samraj
- Department of Family Medicine, University of Florida, Gainesville, FL, USA
| | - John Pennington
- Department of Family Medicine, University of Florida, Gainesville, FL, USA
| | - Petra Townsend
- Department of Family Medicine, University of Florida, Gainesville, FL, USA
| | - Frank Orlando
- Department of Family Medicine, University of Florida, Gainesville, FL, USA
| | - Shwetha Shetty
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - Lydia Mansour
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | | | - Pierre Bedossa
- Publique-Hôpitaux de Paris, Beaujon Hospital, Pathology Department and University Paris-Diderot, Paris, France
| | - John Malaty
- Department of Family Medicine, University of Florida, Gainesville, FL, USA
| | - Diana Barb
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
| | - Matthew J Gurka
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA
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Fedele DA, Hollenbach J, Sinisterra M, LeFave E, Fishe J, Salloum RG, Bian J, Gurka MJ. Implementation of a pediatric asthma management program in rural primary care clinics. J Asthma 2022; 60:1080-1087. [PMID: 36194428 PMCID: PMC10115910 DOI: 10.1080/02770903.2022.2132954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Rural communities experience a significant asthma burden. We pilot tested the implementation of Easy Breathing, a decision support program for improving primary care provider adherence to asthma guidelines in a rural community, and characterized asthma risk factors for enrollees. METHODS We implemented Easy Breathing in two rural primary care practices for two years. Patient demographics, exposure histories, asthma severity, asthma medications, and treatment plans were collected. Providers' adherence to guidelines included the frequency of children with persistent asthma who were prescribed guidelines-based therapy and the frequency of children with a written asthma treatment plan on file. Clinicians provided feedback on the feasibility and acceptability of Easy Breathing using a validated survey tool and through semi-structured interviews. RESULTS Two providers implemented the program. Enrollment included 518 children, of whom 135 (26%) had physician-confirmed asthma. After enrollment into Easy Breathing, 75% of children with asthma received a written asthma treatment plan All children with persistent asthma were prescribed an anti-inflammatory drug as part of their treatment plan. Providers (n = 2) rated Easy breathing as highly acceptable (M = 4.5), feasible (M = 4.5), and appropriate (M = 4.5). Qualitative feedback was positive, with suggestions to integrate the paper-based program into the electronic health record system for broader uptake. Enrollees with asthma were more likely to have a family history of asthma and endorse exposure to tobacco smoke and cockroaches. CONCLUSIONS Easy Breathing shows promise as a decision support system that can be implemented in rural, medically underserved communities via primary care.
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Affiliation(s)
- David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Jessica Hollenbach
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Manuela Sinisterra
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Elizabeth LeFave
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Jennifer Fishe
- Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
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Salloum RG, Bilello L, Bian J, Diiulio J, Paz LG, Gurka MJ, Gutierrez M, Hurley RW, Jones RE, Martinez-Wittinghan F, Marcial L, Masri G, McDonnell C, Militello LG, Modave F, Nguyen K, Rhodes B, Siler K, Willis D, Harle CA. Study protocol for a type III hybrid effectiveness-implementation trial to evaluate scaling interoperable clinical decision support for patient-centered chronic pain management in primary care. Implement Sci 2022; 17:44. [PMID: 35841043 PMCID: PMC9287973 DOI: 10.1186/s13012-022-01217-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background The US continues to face public health crises related to both chronic pain and opioid overdoses. Thirty percent of Americans suffer from chronic noncancer pain at an estimated yearly cost of over $600 billion. Most patients with chronic pain turn to primary care clinicians who must choose from myriad treatment options based on relative risks and benefits, patient history, available resources, symptoms, and goals. Recently, with attention to opioid-related risks, prescribing has declined. However, clinical experts have countered with concerns that some patients for whom opioid-related benefits outweigh risks may be inappropriately discontinued from opioids. Unfortunately, primary care clinicians lack usable tools to help them partner with their patients in choosing pain treatment options that best balance risks and benefits in the context of patient history, resources, symptoms, and goals. Thus, primary care clinicians and patients would benefit from patient-centered clinical decision support (CDS) for this shared decision-making process. Methods The objective of this 3-year project is to study the adaptation and implementation of an existing interoperable CDS tool for pain treatment shared decision making, with tailored implementation support, in new clinical settings in the OneFlorida Clinical Research Consortium. Our central hypothesis is that tailored implementation support will increase CDS adoption and shared decision making. We further hypothesize that increases in shared decision making will lead to improved patient outcomes, specifically pain and physical function. The CDS implementation will be guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. The evaluation will be organized by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. We will adapt and tailor PainManager, an open source interoperable CDS tool, for implementation in primary care clinics affiliated with the OneFlorida Clinical Research Consortium. We will evaluate the effect of tailored implementation support on PainManager’s adoption for pain treatment shared decision making. This evaluation will establish the feasibility and obtain preliminary data in preparation for a multi-site pragmatic trial targeting the effectiveness of PainManager and tailored implementation support on shared decision making and patient-reported pain and physical function. Discussion This research will generate evidence on strategies for implementing interoperable CDS in new clinical settings across different types of electronic health records (EHRs). The study will also inform tailored implementation strategies to be further tested in a subsequent hybrid effectiveness-implementation trial. Together, these efforts will lead to important new technology and evidence that patients, clinicians, and health systems can use to improve care for millions of Americans who suffer from pain and other chronic conditions. Trial registration ClinicalTrials.gov, NCT05256394, Registered 25 February 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01217-4.
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Affiliation(s)
- Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Lori Bilello
- Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | | | - Laura Gonzalez Paz
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Maria Gutierrez
- Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Robert W Hurley
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ross E Jones
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Francisco Martinez-Wittinghan
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | | | - Ghania Masri
- Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Cara McDonnell
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | | | - François Modave
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Khoa Nguyen
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | | | - Kendra Siler
- CommunityHealth IT, Kennedy Space Center, Merritt Island, FL, USA
| | - David Willis
- CommunityHealth IT, Kennedy Space Center, Merritt Island, FL, USA
| | - Christopher A Harle
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL, 32610, USA.
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Mobley EM, Smotherman C, Fishe JN, Anton S, Braithwaite D, Gurka MJ, Gutter MS, Parker AS. An Analysis of Factors Related to Care Engagement along the Cancer Survivorship Care Continuum for Cancer Survivors in Florida. Cancer Epidemiol Biomarkers Prev 2022; 31:1508. [PMID: 35775216 DOI: 10.1158/1055-9965.epi-22-0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study identifies factors associated with care engagement along the cancer survivorship care continuum for Floridians. METHODS We identified patients from the OneFlorida Data Trust with a cancer diagnosis at any age and encounters from 2012-2020. Multivariable logistic regression models produced odds ratios (OR) predicting 1) any outpatient non-acute care visit, 2) cancer-related visit with any provider, 3) cancer-related visit with a cancer provider, and 4) survivorship visit with a cancer provider. Encounter-based independent variables were insurance, Social Deprivation Index quartile, and Rural Urban Continuum Area (adjusted for age, sex, race, ethnicity, and treatment). RESULTS 662,489 survivors were included in the sample. Those with Medicaid and dual eligible status (Medicare and Medicaid) were more likely to have an outpatient visit (Medicaid OR 2.02, 95%CI 1.93-2.12; dual eligible 3.06, 2.91-3.22) or a cancer-related visit with a cancer provider (Medicaid 1.82, 1.77-1.86; dual eligible 1.32, 1.28-1.35), and less likely to have a survivorship visit (Medicaid 0.27, 0.26-0.28; dual eligible 0.20, 0.19-0.21). Uninsured survivors were less likely to have all visit types, while those with Medicare were more likely. Those from the most socially deprived areas were more likely to have an outpatient visit (1.09, 1.03-1.14) and less likely to have a cancer-related visit with any provider (0.90, 0.88-0.92) or a cancer provider (0.93, 0.91-0.95). Survivors from non-metropolitan areas were more likely to have an outpatient visit (1.38, 1.22-1.56), cancer-related visit (1.22, 1.16-1.28), cancer-related visit with a cancer provider (1.45, 1.39-1.52), and a survivorship visit (1.34, 1.22-1.48). CONCLUSIONS Survivors who have public insurance are more likely to have outpatient visits, and those with Medicaid or dual eligible status are less likely to have survivorship visits. Uninsured status is consistently associated with lack of engagement across the care continuum. Those from areas with higher social deprivation are more likely to have outpatient visits, but less likely to have a cancer-related visit with or without a cancer provider. Survivors from non-metropolitan areas are more likely to engage in all visit types along the care continuum.
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Cardenas J, Pringle C, Filipp SL, Gurka MJ, Ryan KA, Avery KL. Changes in Critical Bronchiolitis After COVID-19 Lockdown. Cureus 2022; 14:e25064. [PMID: 35719813 PMCID: PMC9203253 DOI: 10.7759/cureus.25064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/05/2022] Open
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Lee AM, Huo T, Miller D, Gurka MJ, Thompson LA, Modave FP, Hong YR, Pavela G, Cardel MI. The effects of experimentally manipulated social status and subjective social status on physical activity among Hispanic adolescents: An RCT. Pediatr Obes 2022; 17:e12877. [PMID: 34859604 PMCID: PMC9010353 DOI: 10.1111/ijpo.12877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/20/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low objective socioeconomic status (SES) and subjective social status (SSS), one's perceived social rank, are associated with obesity. This association may be due, in part, to social status-related differences in energy expenditure. Experimental studies are needed to assess the extent to which SES and SSS relate to energy expenditure. OBJECTIVE Assess the effects of experimentally manipulated social status and SSS on moderate-to-vigorous physical activity (MVPA) and sedentary behaviour. METHODS One hundred thirty-three Hispanic adolescents aged 15-21 were randomized to a high or low social status position, facilitated through a rigged game of Monopoly™. SSS was assessed with MacArthur Scales. Post-manipulation 24-h MVPA and sedentary behaviour were assessed via accelerometry. Analyses were conducted with general linear regression models. RESULTS Experimentally manipulated social status did not significantly affect the total time spent in MVPA or sedentary behaviour; however, identifying as low SSS was significantly associated with less MVPA (p = 0.0060; 18.76 min less). CONCLUSIONS Tewnty-four-hour MVPA and sedentary behaviour are not affected by an acute experimental manipulation of social status. However, low SSS, independent of SES, was associated with clinically significant differences in MVPA. SSS may be a better predictor of MVPA than SES among Hispanic adolescents, potentially influencing obesity, and other health-related outcomes.
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Affiliation(s)
- Alexandra M. Lee
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
| | - Tianyao Huo
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
| | - Darci Miller
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
| | - Matthew J. Gurka
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
| | - Lindsay A. Thompson
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida,Department of Pediatrics, UF Health
| | - François P. Modave
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida
| | - Young-Rock Hong
- Dept. of Health Services Research, Management, and Policy, University of Florida
| | - Gregory Pavela
- Dept. of Health Behavior, University of Alabama at Birmingham
| | - Michelle I. Cardel
- Dept. of Health Outcomes and Biomedical Informatics, University of Florida,WW International, Inc
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Wu Y, Yang X, Morris HL, Gurka MJ, Shenkman EA, Cusi K, Bril F, Donahoo WT. Non-invasive Diagnosis of Nonalcoholic Steatohepatitis and Advanced Liver Fibrosis: using Machine Learning Methods (Preprint). JMIR Med Inform 2022; 10:e36997. [PMID: 35666557 PMCID: PMC9210198 DOI: 10.2196/36997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yonghui Wu
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Xi Yang
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | | | - Matthew J Gurka
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Elizabeth A Shenkman
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Kenneth Cusi
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Fernando Bril
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William T Donahoo
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
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Bruggeman BS, Campbell-Thompson M, Filipp SL, Gurka MJ, Atkinson MA, Schatz DA, Jacobsen LM. Substance Use Affects Type 1 Diabetes Pancreas Pathology: Implications for Future Studies. Front Endocrinol (Lausanne) 2021; 12:778912. [PMID: 34912300 PMCID: PMC8667172 DOI: 10.3389/fendo.2021.778912] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Access to human pancreas samples from organ donors has greatly advanced our understanding of type 1 diabetes pathogenesis; however, previous studies have shown that donors have a high rate of substance use, and its impact on pancreatic histopathology in this disease is not well described. One-hundred-thirty-one type 1 diabetes and 111 control organ donor pancreata from persons 12-89 years of age (mean 29.8 ± 15.5 years) within the Network for Pancreatic Organ donors with Diabetes (nPOD) were examined for insulin positivity, insulitis, amyloid staining, acute and chronic pancreatitis, and chronic exocrine changes (acinar atrophy, fibrosis, fatty infiltration, or periductal fibrosis); findings were compared by history of substance use. A secondary analysis compared exocrine pancreatic histopathologic findings in type 1 diabetes versus control organ donors regardless of substance use history. We observed a high but congruent rate of substance use in type 1 diabetes and control organ donors (66.4% and 64% respectively). Among donors with type 1 diabetes (but not controls), islet amyloid (OR 9.96 [1.22, 81.29]) and acute pancreatitis (OR 3.2 [1.06, 9.63]) were more common in alcohol users while chronic exocrine changes (OR 8.86 [1.13, 69.31]) were more common in cocaine users. Substance use impacted the pancreata of donors with type 1 diabetes more than controls. Overall, despite similar rates of substance use, acute pancreatitis (15.3% versus 4.5%, p=0.0061), chronic pancreatitis (29.8% versus 9.9%, p=0.0001), and chronic exocrine changes (73.3% versus 36.9%, p<0.0001) were more common in type 1 diabetes donors than controls. Alcohol and/or cocaine use in type 1 diabetes organ donors increases exocrine pancreas pathology and islet amyloid deposition but does not affect insulitis or insulin positivity. Exocrine pathology in type 1 diabetes donors is common, and further study of the pathophysiology of these changes is needed.
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Affiliation(s)
- Brittany S. Bruggeman
- Department of Pediatrics, Division of Endocrinology, University of Florida, Gainesville, FL, United States
- Diabetes Institute, University of Florida, Gainesville, FL, United States
| | - Martha Campbell-Thompson
- Diabetes Institute, University of Florida, Gainesville, FL, United States
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, United States
| | - Stephanie L. Filipp
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Matthew J. Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Mark A. Atkinson
- Department of Pediatrics, Division of Endocrinology, University of Florida, Gainesville, FL, United States
- Diabetes Institute, University of Florida, Gainesville, FL, United States
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, United States
| | - Desmond A. Schatz
- Department of Pediatrics, Division of Endocrinology, University of Florida, Gainesville, FL, United States
- Diabetes Institute, University of Florida, Gainesville, FL, United States
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, United States
| | - Laura M. Jacobsen
- Department of Pediatrics, Division of Endocrinology, University of Florida, Gainesville, FL, United States
- Diabetes Institute, University of Florida, Gainesville, FL, United States
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Affiliation(s)
- Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, Institute for Child Health Policy, University of Florida, Gainesville, FL.
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Thompson LA, Filipp SL, Mercado RE, Gurka MJ. Streamlining primary care screening for adverse childhood experiences. Pediatr Res 2021; 90:499-501. [PMID: 33446922 DOI: 10.1038/s41390-020-01341-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Lindsay A Thompson
- Department of Pediatrics, University of Florida, Gainesville, FL, USA. .,Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA.
| | - Stephanie L Filipp
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | | | - Matthew J Gurka
- Department of Pediatrics, University of Florida, Gainesville, FL, USA.,Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
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LeLaurin JH, Gurka MJ, Chi X, Lee JH, Hall J, Warren GW, Salloum RG. Concordance Between Electronic Health Record and Tumor Registry Documentation of Smoking Status Among Patients With Cancer. JCO Clin Cancer Inform 2021; 5:518-526. [PMID: 33974447 DOI: 10.1200/cci.20.00187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with cancer who use tobacco experience reduced treatment effectiveness, increased risk of recurrence and mortality, and diminished quality of life. Accurate tobacco use documentation for patients with cancer is necessary for appropriate clinical decision making and cancer outcomes research. Our aim was to assess agreement between electronic health record (EHR) smoking status data and cancer registry data. MATERIALS AND METHODS We identified all patients with cancer seen at University of Florida Health from 2015 to 2018. Structured EHR smoking status was compared with the tumor registry smoking status for each patient. Sensitivity, specificity, positive predictive values, negative predictive values, and Kappa statistics were calculated. We used logistic regression to determine if patient characteristics were associated with odds of agreement in smoking status between EHR and registry data. RESULTS We analyzed 11,110 patient records. EHR smoking status was documented for nearly all (98%) patients. Overall kappa (0.78; 95% CI, 0.77 to 0.79) indicated moderate agreement between the registry and EHR. The sensitivity was 0.82 (95% CI, 0.81 to 0.84), and the specificity was 0.97 (95% CI, 0.96 to 0.97). The logistic regression results indicated that agreement was more likely among patients who were older and female and if the EHR documentation occurred closer to the date of cancer diagnosis. CONCLUSION Although documentation of smoking status for patients with cancer is standard practice, we only found moderate agreement between EHR and tumor registry data. Interventions and research using EHR data should prioritize ensuring the validity of smoking status data. Multilevel strategies are needed to achieve consistent and accurate documentation of smoking status in cancer care.
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Affiliation(s)
- Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Ji-Hyun Lee
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, FL.,Department of Biostatistics, University of Florida, Gainesville, FL
| | - Jaclyn Hall
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC.,Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
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Thompson LA, Gurka MJ, Filipp SL, Schatz DA, Mercado RE, Ostrov DA, Atkinson MA, Rasmussen SA. The influence of selection bias on identifying an association between allergy medication use and SARS-CoV-2 infection. EClinicalMedicine 2021; 37:100936. [PMID: 34104879 PMCID: PMC8175126 DOI: 10.1016/j.eclinm.2021.100936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Medications to prevent and treat SARS-CoV-2 infection are needed to complement emerging vaccinations. Recent in vitro and electronic health record (EHR) studies suggested that certain allergy medications could prevent SARS-CoV-2 infection. We sought to carefully examine the potential selection bias associated with utilizing EHRs in these settings. METHODS We analyzed associations of three allergy medications (cetirizine, diphenhydramine or hydroxyzine) with testing negative for SARS-CoV-2, measuring the potential effect of selection bias on these associations. We used a retrospective cohort of EHR data from 230,376 patients (18 years+) who visited outpatient clinicians in a single, large academic center at least once but were never hospitalized (10/1/2019-6/1/2020). Main exposures included EHR documentation of three allergy medications and allergy, with an intermediate outcome of receipt of a SARS-CoV-2 test, and the primary outcome as testing negative. FINDINGS SARS-CoV-2 testing rates varied by sex, age, race/ethnicity and insurance. Increasing age and public insurance were associated with a higher adjusted odds of test negativity, while being Black or Hispanic was significantly associated with test positivity. Allergy diagnosis and use of any of three allergy medications were each associated with a higher likelihood of receiving a test (e.g. diphenhydramine - Odds Ratio (OR) 2.99, 95% Confidence Interval (CI) 2.73, 3.28; cetirizine 1.75 (95% CI 1.60, 1.92)). Among those tested, only use of diphenhydramine was associated with a negative SARS-CoV-2 test (adjusted OR = 2.23, 95% CI 1.10, 4.55). However, analyses revealed that selection bias may be responsible for the apparent protective effect of diphenhydramine. INTERPRETATION Diphenhydramine use was associated with more SARS-CoV-2 testing and subsequent higher odds for negative tests. While EHR-based observational studies can inform a need for interventional trials, this study revealed limitations of EHR data. The finding that diphenhydramine documentation conferred a higher odds of testing negative for SARS-CoV-2 must be interpreted with caution due to probable selection bias.Abbreviations: SARS-CoV-2, ACE2, COVID-19, EHR.
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Affiliation(s)
- Lindsay A. Thompson
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida USA
| | - Matthew J. Gurka
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida USA
| | - Stephanie L. Filipp
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida USA
| | - Desmond A. Schatz
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL USA
| | - Rebeccah E. Mercado
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL USA
| | - David A. Ostrov
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida USA
| | - Mark A. Atkinson
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL USA
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida USA
| | - Sonja A. Rasmussen
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL USA
- Department of Epidemiology, University of Florida College of Public Health and Health Professions and College of Medicine, Gainesville, Florida USA
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida USA
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Walker AF, Cuttriss N, Haller MJ, Hood KK, Gurka MJ, Filipp SL, Anez-Zabala C, Yabut K, Roque X, Wong JJ, Baer L, Figg L, Bernier A, Westen S, Lewit E, Sheehan E, Basina M, Lal R, Maizel J, Maahs DM. Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D. BMJ Open Diabetes Res Care 2021; 9:9/1/e002262. [PMID: 34244218 PMCID: PMC8268922 DOI: 10.1136/bmjdrc-2021-002262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/05/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Project ECHO (Extension for Community Healthcare Outcomes) is a tele-education outreach model that seeks to democratize specialty knowledge to reduce disparities and improve health outcomes. Limited utilization of endocrinologists forces many primary care providers (PCPs) to care for patients with type 1 diabetes (T1D) without specialty support. Accordingly, an ECHO T1D program was developed and piloted in Florida and California. Our goal was to demonstrate the feasibility of an ECHO program focused on T1D and improve PCPs' abilities to manage patients with T1D. RESEARCH DESIGN AND METHODS Health centers (ie, spokes) were recruited into the ECHO T1D pilot through an innovative approach, focusing on Federally Qualified Health Centers and through identification of high-need catchment areas using the Neighborhood Deprivation Index and provider geocoding. Participating spokes received weekly tele-education provided by the University of Florida and Stanford University hub specialty team through virtual ECHO clinics, real-time support with complex T1D medical decision-making, access to a diabetes support coach, and access to an online repository of diabetes care resources. Participating PCPs completed pre/post-tests assessing diabetes knowledge and confidence and an exit survey gleaning feedback about overall ECHO T1D program experiences. RESULTS In Florida, 12 spoke sites enrolled with 67 clinics serving >1000 patients with T1D. In California, 11 spoke sites enrolled with 37 clinics serving >900 patients with T1D. During the 6-month intervention, 27 tele-education clinics were offered and n=70 PCPs (22 from Florida, 48 from California) from participating spoke sites completed pre/post-test surveys assessing diabetes care knowledge and confidence in diabetes care. There was statistically significant improvement in diabetes knowledge (p≤0.01) as well as in diabetes confidence (p≤0.01). CONCLUSIONS The ECHO T1D pilot demonstrated proof of concept for a T1D-specific ECHO program and represents a viable model to reach medically underserved communities which do not use specialists.
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Affiliation(s)
- Ashby F Walker
- University of Florida Diabetes Institute, Gainesville, FL, USA
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Nicolas Cuttriss
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Michael J Haller
- University of Florida Diabetes Institute, Gainesville, FL, USA
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Korey K Hood
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Stephanie L Filipp
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | | | - Katarina Yabut
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Xanadu Roque
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Jessie J Wong
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Linda Baer
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Lauren Figg
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Angelina Bernier
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Sarah Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Eugene Lewit
- Department of Health Research and Policy, Stanford, Palo Alto, California, USA
| | - Eleni Sheehan
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Marina Basina
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Medicine, Division of Endocrinology, Gerontology & Metabolism, Stanford University, Palo Alto, California, USA
| | - Rayhan Lal
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Medicine, Division of Endocrinology, Gerontology & Metabolism, Stanford University, Palo Alto, California, USA
| | - Jennifer Maizel
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - David M Maahs
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
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Walker AF, Hood KK, Gurka MJ, Filipp SL, Anez-Zabala C, Cuttriss N, Haller MJ, Roque X, Naranjo D, Aulisio G, Addala A, Konopack J, Westen S, Yabut K, Mercado E, Look S, Fitzgerald B, Maizel J, Maahs DM. Barriers to Technology Use and Endocrinology Care for Underserved Communities With Type 1 Diabetes. Diabetes Care 2021; 44:1480-1490. [PMID: 34001535 PMCID: PMC8323174 DOI: 10.2337/dc20-2753] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/31/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Disparities in type 1 diabetes related to use of technologies like continuous glucose monitors (CGMs) and utilization of diabetes care are pronounced based on socioeconomic status (SES), race, and ethnicity. However, systematic reports of perspectives from patients in vulnerable communities regarding barriers are limited. RESEARCH DESIGN AND METHODS To better understand barriers, focus groups were conducted in Florida and California with adults ≥18 years old with type 1 diabetes with selection criteria including hospitalization for diabetic ketoacidosis, HbA1c >9%, and/or receiving care at a Federally Qualified Health Center. Sixteen focus groups were conducted in English or Spanish with 86 adults (mean age 42 ± 16.2 years). Transcript themes and pre-focus group demographic survey data were analyzed. In order of frequency, barriers to diabetes technology and endocrinology care included 1) provider level (negative provider encounters), 2) system level (financial coverage), and 3) individual level (preferences). RESULTS Over 50% of participants had not seen an endocrinologist in the past year or were only seen once including during hospital visits. In Florida, there was less technology use overall (38% used CGMs in FL and 63% in CA; 43% used pumps in FL and 69% in CA) and significant differences in pump use by SES (P = 0.02 in FL; P = 0.08 in CA) and race/ethnicity (P = 0.01 in FL; P = 0.80 in CA). In California, there were significant differences in CGM use by race/ethnicity (P = 0.05 in CA; P = 0.56 in FL) and education level (P = 0.02 in CA; P = 0.90 in FL). CONCLUSIONS These findings provide novel insights into the experiences of vulnerable communities and demonstrate the need for multilevel interventions aimed at offsetting disparities in diabetes.
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Affiliation(s)
- Ashby F Walker
- University of Florida Diabetes Institute, Gainesville, FL .,Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, Stanford, CA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | - Stephanie L Filipp
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | | | - Nicolas Cuttriss
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, Stanford, CA
| | - Michael J Haller
- University of Florida Diabetes Institute, Gainesville, FL.,Department of Pediatrics, University of Florida, Gainesville, FL
| | - Xanadu Roque
- Department of Pediatrics, University of Florida, Gainesville, FL
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, Stanford, CA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Gina Aulisio
- University of Florida Diabetes Institute, Gainesville, FL
| | - Ananta Addala
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, Stanford, CA
| | - Jason Konopack
- Department of Family Medicine, University of Florida, Gainesville, FL
| | - Sarah Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Katarina Yabut
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, Stanford, CA
| | - Elvira Mercado
- Department of Family Medicine, University of Florida, Gainesville, FL
| | - Sydney Look
- College of Medicine, University of Florida, Gainesville, FL
| | - Brian Fitzgerald
- Department of Family Medicine, University of Florida, Gainesville, FL
| | - Jennifer Maizel
- College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - David M Maahs
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, Stanford, CA
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37
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Cardel MI, Lee AM, Chi X, Newsome F, Miller DR, Bernier A, Thompson L, Gurka MJ, Janicke DM, Butryn ML. Feasibility/acceptability of an acceptance-based therapy intervention for diverse adolescent girls with overweight/obesity. Obes Sci Pract 2021; 7:291-301. [PMID: 34123396 PMCID: PMC8170570 DOI: 10.1002/osp4.483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/18/2020] [Accepted: 01/17/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Behavioral obesity interventions using an acceptance-based therapy (ABT) approach have demonstrated efficacy for adults, yet feasibility and acceptability of tailoring an ABT intervention for adolescents remains unknown. OBJECTIVE This study assessed the feasibility and acceptability of an ABT healthy lifestyle intervention among diverse adolescent cisgender girls with overweight/obesity (OW/OB). METHODS Adolescent cisgender girls aged 14-19 with a BMI of ≥85th percentile-for-sex-and-age were recruited for participation in a single-arm feasibility study. The primary outcomes were recruitment and retention while the secondary outcome was change in BMI Z-score over the 6-month intervention. Exploratory outcomes included obesity-related factors, health-related behaviors, and psychological factors. RESULTS Recruitment goals were achieved; 13 adolescents (>60% racial/ethnic minorities) participated in the intervention, and 11 completed the intervention (85% retention). In completers (n = 11), a mean decrease in BMI Z-score of -0.15 (SD = 0.34, Cohen's d = -0.44) was observed. Improvements were also noted for change in percentage of 95th percentile (d = -0.35), percent body fat (d = -0.35), quality of life (d = 0.71), psychological flexibility (d = -0.86), and depression (d = -0.86). CONCLUSIONS These preliminary findings suggest an ABT healthy lifestyle intervention tailored for adolescent cisgender girls with OW/OB may be an acceptable treatment that could lead to improvements in BMI Z-score, obesity-related measures, and psychological outcomes.
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Affiliation(s)
- Michelle I. Cardel
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
- Center for Integrative Cardiovascular and Metabolic DiseasesUniversity of FloridaGainesvilleFloridaUSA
- Department of PediatricsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Alexandra M. Lee
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Xiaofei Chi
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Faith Newsome
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Darci R. Miller
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Angelina Bernier
- Department of PediatricsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Lindsay Thompson
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
- Department of PediatricsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Matthew J. Gurka
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFloridaUSA
- Department of PediatricsUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - David M. Janicke
- Department of Clinical and Health PsychologyUniversity of Florida College of Public Health and Health ProfessionsGainesvilleFloridaUSA
| | - Meghan L. Butryn
- Department of Psychology and Center for WeightEating and Lifestyle ScienceDrexel University College of Arts and SciencesPhiladelphiaPennsylvaniaUSA
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Lin A, Mack JA, Bruggeman B, Jacobsen LM, Posgai AL, Wasserfall CH, Brusko TM, Atkinson MA, Gitelman SE, Gottlieb PA, Gurka MJ, Mathews CE, Schatz DA, Haller MJ. Low-Dose ATG/GCSF in Established Type 1 Diabetes: A Five-Year Follow-up Report. Diabetes 2021; 70:1123-1129. [PMID: 33632742 PMCID: PMC8173803 DOI: 10.2337/db20-1103] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/30/2020] [Accepted: 02/23/2021] [Indexed: 12/17/2022]
Abstract
Previously, we demonstrated low-dose antithymocyte globulin (ATG) and granulocyte colony-stimulating factor (GCSF) immunotherapy preserved C-peptide for 2 years in a pilot study of patients with established type 1 diabetes (n = 25). Here, we evaluated the long-term outcomes of ATG/GCSF in study participants with 5 years of available follow-up data (n = 15). The primary end point was area under the curve (AUC) C-peptide during a 2-h mixed-meal tolerance test. After 5 years, there were no statistically significant differences in AUC C-peptide when comparing those who received ATG/GCSF versus placebo (P = 0.41). A modeling framework based on mean trajectories in C-peptide AUC over 5 years, accounting for differing trends between groups, was applied to recategorize responders (n = 9) and nonresponders (n = 7). ATG/GCSF reponders demonstrated nearly unchanged HbA1c over 5 years (mean [95% CI] adjusted change 0.29% [-0.69%, 1.27%]), but the study was not powered for comparisons against nonresponders 1.75% (-0.57%, 4.06%) or placebo recipients 1.44% (0.21%, 2.66%). These data underscore the importance of long-term follow-up in previous and ongoing phase 2 trials of low-dose ATG in recent-onset type 1 diabetes.
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Affiliation(s)
- Andrea Lin
- Department of Pathology, Immunology, and Laboratory Medicine, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Jasmine A Mack
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | - Brittany Bruggeman
- Department of Pediatrics, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Laura M Jacobsen
- Department of Pediatrics, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Amanda L Posgai
- Department of Pathology, Immunology, and Laboratory Medicine, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Clive H Wasserfall
- Department of Pathology, Immunology, and Laboratory Medicine, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Todd M Brusko
- Department of Pathology, Immunology, and Laboratory Medicine, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
- Department of Pediatrics, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Mark A Atkinson
- Department of Pathology, Immunology, and Laboratory Medicine, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
- Department of Pediatrics, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Stephen E Gitelman
- Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Peter A Gottlieb
- Division of Endocrinology, Department of Pediatrics and Medicine, University of Colorado, Denver, CO
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL
| | - Clayton E Mathews
- Department of Pathology, Immunology, and Laboratory Medicine, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Desmond A Schatz
- Department of Pediatrics, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
| | - Michael J Haller
- Department of Pediatrics, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL
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Bruggeman B, Zimmerman C, LaPorte A, Stalvey M, Filipp SL, Gurka MJ, Silverstein JH, Jacobsen LM. Barriers to retinopathy screening in youth and young adults with type 1 diabetes. Pediatr Diabetes 2021; 22:469-473. [PMID: 34415074 DOI: 10.1111/pedi.13171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/16/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022] Open
Abstract
Early detection of diabetic retinopathy (DR) is imperative; however, adherence to screening guidelines is poor. We hypothesized that youth and young adults with type 1 diabetes (T1D) who met American Diabetes Association criteria for recommended DR screening at the time of the study (10 years old or greater with diabetes duration of 5 years or more) would report multiple barriers to screening and that targeted barriers and subpopulations could be identified to improve access to care. 271 youth aged 10 to 26 years with T1D of at least 5 years duration were recruited from clinic, diabetes camp, and a diabetes conference and completed a patient-reported questionnaire. 113 (41.7%) reported at least one barrier to DR screening, with missed school and work being the most common (20.7%). Older participants (P = 0.007) and those with a longer diabetes duration (P = 0.018) were more likely to report barriers to screening. Recruitment location, sex, race and ethnicity, HbA1c, insulin regimen, and clinic visit frequency were not associated with reporting at least one barrier. Slightly less than two-thirds (62.1%) of participants who responded (n = 235 out of 271) adhered to recommended screening guidelines of the time and reported having an eye exam within the past year, 24.7% 12-23 months ago, 9.8% 2 years ago or more, and 3.4% had never had a DR exam. As older patients and those with longer duration of diabetes are more likely to have DR, targeted interventions to address barriers to care, such as, missed school and work should be implemented in these groups.
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Affiliation(s)
- Brittany Bruggeman
- Division of Pediatric Endocrinology, University of Florida, Gainesville, Florida, USA
| | - Chelsea Zimmerman
- Division of Pediatric Endocrinology, University of Florida, Gainesville, Florida, USA
| | - Amanda LaPorte
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Michael Stalvey
- Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stephanie L Filipp
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Janet H Silverstein
- Division of Pediatric Endocrinology, University of Florida, Gainesville, Florida, USA
| | - Laura M Jacobsen
- Division of Pediatric Endocrinology, University of Florida, Gainesville, Florida, USA
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40
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Gurka MJ, Siddiqi SU, Filipp SL, Mercado R, Thompson LA, Janicke DM, Shenkman EA. Attention deficit hyperactivity disorder medications and BMI trajectories: The role of medication type, sex and age. Pediatr Obes 2021; 16:e12738. [PMID: 33064373 PMCID: PMC8276278 DOI: 10.1111/ijpo.12738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/17/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) and the medications used to treat it are associated with obesity. Stimulants lead to weight loss, while antipsychotics and antidepressants lead to weight gain. Little is known, however, how alpha-2-agonists impact weight, or the independent effect on BMI of these four classes of medications, which are often prescribed concurrently. We aimed to estimate the proximal change in BMI associated with start of medication and to assess whether medication-specific departures in BMI varied by age and sex. STUDY DESIGN We analysed longitudinal electronic health records from children (4-19 years) with an ADHD diagnosis seen at one healthcare system (2011-2018). Their BMI z-scores were fit as a cubic function of age via a mixed model, separately by sex and adjusting for race/ethnicity. From this model, we estimated annual changes in BMI-z after medication, allowing changes to vary by age and sex. RESULTS Among the 22 714 children with ADHD (mean initial age = 10.0), 4335 (19.1%) were never prescribed ADHD medication. The others (80.9%) experienced departures in BMI-z after start of all four medication classes, which varied across age and sex (interaction P-values < .01). All medications had larger impacts at younger ages. As expected, decreased BMI-z was observed with stimulants, while antidepressants and antipsychotics led to BMI-z increases; alpha-agonists also were associated with BMI-z increases. CONCLUSIONS This longitudinal study revealed that ADHD medications are independently associated with proximal changes in BMI-z after initiation, significantly varying by sex and age. Future research should study further the interactions of these medications on long-term impacts on obesity.
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Affiliation(s)
- Matthew J. Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,Institute for Child Health Policy, University of Florida, Gainesville, Florida,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Siraj U. Siddiqi
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Stephanie L. Filipp
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Rebeccah Mercado
- Institute for Child Health Policy, University of Florida, Gainesville, Florida,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - Lindsay A. Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,Institute for Child Health Policy, University of Florida, Gainesville, Florida,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, Florida
| | - David M. Janicke
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida,Institute for Child Health Policy, University of Florida, Gainesville, Florida
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DeBoer MD, Lin B, Filipp SL, Cusi K, Gurka MJ. Severity of metabolic syndrome is greater among nonalcoholic adults with elevated ALT and advanced fibrosis. Nutr Res 2021; 88:34-43. [PMID: 33743323 DOI: 10.1016/j.nutres.2020.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/11/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
The obesity epidemic has increased risk for nonalcoholic fatty-liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), advanced fibrosis and cirrhosis. We hypothesized that metabolic syndrome (MetS) severity would correlate with markers of NAFLD and NASH fibrosis. We evaluated cross-sectional data from 5463 participants of the National Health and Nutrition Examination Survey 1999-2012, age 20 to 64 years with and without diabetes, excluding those with heavy drinking and infectious liver serologies. We used linear and logistic regression to evaluate links between MetS-severity (using a race/ethnicity-specific MetS-severity-Z-score, MetS-Z) and apparent NALFD sequelae, using elevated alanine aminotransferase (ALT) to determine presence of NAFLD and elevated NAFLD Fibrosis Score to identify advanced fibrosis (NASH Clinical Research Network scoring stage 3-4). The prevalence of unexplained ALT elevations and advanced fibrosis were 11.4% and 1.37%, respectively. MetS-Z-scores were higher among those with elevated ALT (0.7, 95% confidence interval [CI]: 0.6, 0.8) and advanced fibrosis (1.7, CI: 1.5,1.9), compared to those without liver abnormalities (0.2, CI:0.2, 0.3). For every 1-standard-deviation unit increase in MetS-Z, there were higher odds of elevated ALT (OR = 1.58, CI: 1.44, 1.72) and advanced fibrosis (OR = 1.96, CI: 1.77, 2.18), with some attenuation after adjustment for age, sex, race/ethnicity, and diabetes status. Significant differences were noted by race/ethnicity, with stronger links among whites versus blacks. The degree of MetS-severity was associated with progressive increase in apparent NAFLD and advanced fibrosis; as MetS-severity has also been linked to future cardiovascular disease, diabetes, and chronic kidney disease, this provides support for use of a MetS-severity score to screen for general health, with high levels triggering further assessment for liver abnormalities.
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Affiliation(s)
- Mark D DeBoer
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908 USA.
| | - Boya Lin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, 32608 USA
| | - Stephanie L Filipp
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, 32608 USA
| | - Kenneth Cusi
- Division of Endocrinology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, 32608 USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, 32608 USA
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42
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Ruoss JL, Bazacliu C, Russell JT, de la Cruz D, Li N, Gurka MJ, Filipp SL, Polin RA, Triplett EW, Neu J. Routine Early Antibiotic Use in SymptOmatic Preterm Neonates: A Pilot Randomized Controlled Trial. J Pediatr 2021; 229:294-298.e3. [PMID: 32979383 PMCID: PMC8958904 DOI: 10.1016/j.jpeds.2020.09.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 02/04/2023]
Abstract
We enrolled 98 infants (gestational age <33 weeks) in a pilot randomized trial of antibiotics vs no antibiotics; 55 were randomized (lower maternal infectious risk; symptoms expected for gestation). Adverse events did not differ significantly between the randomization arms. This trial establishes a framework for a larger multicentered trial.
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Affiliation(s)
- J. Lauren Ruoss
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Catalina Bazacliu
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Jordan T. Russell
- Department of Microbiology and Cell Science, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, USA
| | - Diomel de la Cruz
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Nan Li
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Matthew J. Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephanie L. Filipp
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Richard A. Polin
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Eric W. Triplett
- Department of Microbiology and Cell Science, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, USA
| | - Josef Neu
- Division of Neonatology, Department of Pediatrics, University of Florida, Gainesville, FL, USA
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Loso JM, Filipp SL, Gurka MJ, Davis MK. Using Queue Theory and Load-Leveling Principles to Identify a Simple Metric for Resource Planning in a Pediatric Emergency Department. Glob Pediatr Health 2021; 8:2333794X20944665. [PMID: 33614834 PMCID: PMC7841236 DOI: 10.1177/2333794x20944665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/15/2020] [Accepted: 06/30/2020] [Indexed: 11/20/2022] Open
Abstract
Increased waiting time in pediatric emergency departments is a well-recognized
and complex problem in a resource-limited US health care system. Efforts to
reduce emergency department wait times include modeling arrival rates, acuity,
process flow, and human resource requirements. The aim of this study was to
investigate queue theory and load-leveling principles to model arrival rates and
to identify a simple metric for assisting with determination of optimal physical
space and human resource requirements. We discovered that pediatric emergency
department arrival rates vary based on time of day, day of the week, and month
of the year in a predictable pattern and that the hourly change in pediatric
emergency department waiting room census may be useful as a simple metric to
identify target times for shifting resources to better match supply and demand
at no additional cost.
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Khan AI, Mack JA, Salimuzzaman M, Zion MI, Sujon H, Ball RL, Maples S, Rashid MM, Chisti MJ, Sarker SA, Biswas D, Hossin R, Bardosh KL, Begum YA, Ahmed A, Pieri D, Haque F, Rahman M, Levine AC, Qadri F, Flora MS, Gurka MJ, Nelson EJ. Electronic decision support and diarrhoeal disease guideline adherence (mHDM): a cluster randomised controlled trial. Lancet Digit Health 2021; 2:e250-e258. [PMID: 33328057 DOI: 10.1016/s2589-7500(20)30062-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/20/2020] [Accepted: 03/03/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Acute diarrhoeal disease management often requires rehydration alone without antibiotics. However, non-indicated antibiotics are frequently ordered and this is an important driver of antimicrobial resistance. The mHealth Diarrhoea Management (mHDM) trial aimed to establish whether electronic decision support improves rehydration and antibiotic guideline adherence in resource-limited settings. METHODS A cluster randomised controlled trial was done at ten district hospitals in Bangladesh. Inclusion criteria were patients aged 2 months or older with uncomplicated acute diarrhoea. Admission orders were observed without intervention in the pre-intervention period, followed by randomisation to electronic (rehydration calculator) or paper formatted WHO guidelines for the intervention period. The primary outcome was rate of intravenous fluid ordered as a binary variable. Generalised linear mixed-effect models, accounting for hospital clustering, served as the analytical framework; the analysis was intention to treat. The trial is registered with ClinicalTrials.gov (NCT03154229) and is completed. FINDINGS From March 11 to Sept 10, 2018, 4975 patients (75·6%) of 6577 screened patients were enrolled. The intervention effect for the primary outcome showed no significant differences in rates of intravenous fluids ordered as a function of decision-support type. Intravenous fluid orders decreased by 0·9 percentage points for paper electronic decision support and 4·2 percentage points for electronic decision support, with a 4·2-point difference between decision-support types in the intervention period (paper 98·7% [95% CI 91·8-99·8] vs electronic 94·5% [72·2-99·1]; pinteraction=0·31). Adverse events such as complications and mortality events were uncommon and could not be statistically estimated. INTERPRETATION Although intravenous fluid orders did not change, electronic decision support was associated with increases in the volume of intravenous fluid ordered and decreases in antibiotics ordered, which are consistent with WHO guidelines. FUNDING US National Institutes of Health.
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Affiliation(s)
- Ashraful I Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jasmine A Mack
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - M Salimuzzaman
- Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh
| | - Mazharul I Zion
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Hasnat Sujon
- Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh
| | - Robyn L Ball
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Stace Maples
- Geospatial Center, Stanford University Libraries, Stanford, CA, USA
| | - Md Mahbubur Rashid
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammod J Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shafiqul A Sarker
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Debashish Biswas
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Raduan Hossin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kevin L Bardosh
- Department of Anthropology, University of Florida, Gainesville, FL, USA; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Yasmin A Begum
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Azimuddin Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Dane Pieri
- Independent Technology Developer, San Francisco, CA, USA
| | - Farhana Haque
- Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh; Institute for Global Health, University College London, London, UK
| | - Mahmudur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh
| | - Adam C Levine
- Department of Emergency Medicine, Brown University, Providence, RI, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Meerjady S Flora
- Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Eric J Nelson
- Department of Pediatrics, University of Florida, Gainesville, FL, USA; Department of Environmental and Global Health, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.
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Staras SAS, Richardson E, Merlo LJ, Bian J, Thompson LA, Krieger JL, Gurka MJ, Sanders AH, Shenkman EA. A feasibility trial of parent HPV vaccine reminders and phone-based motivational interviewing. BMC Public Health 2021; 21:109. [PMID: 33422047 PMCID: PMC7797089 DOI: 10.1186/s12889-020-10132-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/25/2020] [Indexed: 11/28/2022] Open
Abstract
Background We assessed the feasibility and acceptability of a sequential approach of parent-targeted HPV vaccine reminders and phone-based Motivation Interviewing (MI). Methods In 2016, we selected all 11- to 12-year-old boys and girls seen in one clinic whose vaccine records did not include the HPV vaccine (n=286). By gender, we individually randomized parents of adolescents to an interactive text message (74 girls and 45 boys), postcard reminder (46 boys and no girls because of previously demonstrated efficacy), or standard care group (75 girls and 46 boys). Reminders were sent with medical director permission and a HIPAA waiver. Two months after reminders, among the adolescents whose vaccine records still did not include the HPV vaccine, we selected a gender-stratified random sample of 20 parents for phone-based MI. We assessed the percentage of deliverable messages, the percentage of parents’ responding to the interactive text message, parent acceptability of receiving a text message, and MI parent responsiveness and interviewer competence (MI Treatment Integrity Coding system). Results Nearly all messages were deliverable (98% of postcards and 74% of text messages). Six of the 88 parents (7%) receiving text messages scheduled an appointment through our interactive system. The acceptability survey response rate was 37% (38/102). Respondents were favorable toward vaccine reminders for all parents (82%). Among 20 sampled parents, 17 were reached by phone of whom 7 completed MI, 4 had or were getting the HPV vaccine for their child, and 5 expressed disinterest. Across the 7 MI calls, the interviewer was rated 100% MI adherent and scored an average 4.19 rating for Global Spirit. Conclusion Without providing explicit consent to receive vaccine-related messages, parents nonetheless found postcards and interactive text messages acceptable. Centralizing MI to phone calls with trained staff was acceptable to parents and resulted in highly MI-adherent interviews. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10132-6.
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Affiliation(s)
- Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA. .,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Eric Richardson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lisa J Merlo
- The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Janice L Krieger
- Department of Advertising, College of Journalism and Communication, University of Florida, Gainesville, FL, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ashley H Sanders
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
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Zimmerman C, Bruggeman B, LaPorte A, Kaushal S, Stalvey M, Beauchamp G, Dayton K, Hiers P, Filipp SL, Gurka MJ, Silverstein JH, Jacobsen LM. Real-World Screening for Retinopathy in Youth With Type 1 Diabetes Using a Nonmydriatic Fundus Camera. Diabetes Spectr 2021; 34:27-33. [PMID: 33627991 PMCID: PMC7887527 DOI: 10.2337/ds20-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the use of a portable retinal camera in diabetic retinopathy (DR) screening in multiple settings and the presence of associated risk factors among children, adolescents, and young adults with type 1 diabetes. DESIGN AND METHODS Five hundred youth with type 1 diabetes of at least 1 year's duration were recruited from clinics, diabetes camp, and a diabetes conference and underwent retinal imaging using a nonmydriatic fundus camera. Retinal characterization was performed remotely by a licensed ophthalmologist. Risk factors for DR development were evaluated by a patient-reported questionnaire and medical chart review. RESULTS Of the 500 recruited subjects aged 9-26 years (mean 14.9, SD 3.8), 10 cases of DR were identified (nine mild and one moderate nonproliferative DR) with 100% of images of gradable quality. The prevalence of DR was 2.04% (95% CI 0.78-3.29), at an average age of 20.2 years, with the youngest affected subject being 17.1 years of age. The rate of DR was higher, at 6.5%, with diabetes duration >10 years (95% CI 0.86-12.12, P = 0.0002). In subjects with DR, the average duration of diabetes was 12.1 years (SD 4.6, range 6.2-20.0), and in a subgroup of clinic-only subjects (n = 114), elevated blood pressure in the year before screening was associated with DR (P = 0.0068). CONCLUSION This study in a large cohort of subjects with type 1 diabetes demonstrates that older adolescents and young adults (>17 years) with longer disease duration (>6 years) are at risk for DR development, and screening using a portable retinal camera is feasible in clinics and other locations. Recent elevated blood pressure was a risk factor in an analyzed subgroup.
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Affiliation(s)
- Chelsea Zimmerman
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
| | - Brittany Bruggeman
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
| | - Amanda LaPorte
- University of Florida College of Medicine, Gainesville, FL
| | | | - Michael Stalvey
- Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, AL
| | - Giovanna Beauchamp
- Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, AL
| | - Kristin Dayton
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
| | - Paul Hiers
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
| | - Stephanie L. Filipp
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL
| | - Matthew J. Gurka
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL
| | | | - Laura M. Jacobsen
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
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Shenkman E, Thompson L, Bussing R, Forrest CB, Woodard J, Sun Y, Mack J, Mistry KB, Gurka MJ. Provider Specialty and Receipt of Metabolic Monitoring for Children Taking Antipsychotics. Pediatrics 2021; 147:e20200658. [PMID: 33262265 PMCID: PMC7780961 DOI: 10.1542/peds.2020-0658] [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] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Metabolic monitoring is important for children taking antipsychotic medication, given the risk for increased BMI, impaired glucose metabolism, and hyperlipidemia. The purpose was to examine the influence of provider specialty on the receipt of metabolic monitoring. Specifically, differences in the receipt of recommended care when a child receives outpatient care from a primary care provider (PCP), a mental health provider with prescribing privileges, or both was examined. METHODS Medicaid enrollment and health care and pharmacy claims data from 2 states were used in the analyses. Providers were assigned to specialties by using a crosswalk of the National Provider Identifier numbers to specialty type. A total of 41 078 children were included. RESULTS For both states, 61% of children saw ≥1 provider type and had adjusted odds ratios for receiving metabolic monitoring that were significantly higher than those of children seeing PCPs only. For example, children seeing a PCP and a mental health provider with prescribing privileges during the year had adjusted odds of receiving metabolic monitoring that were 42% higher than those seeing a PCP alone (P < .001). CONCLUSIONS Shared care arrangements significantly increased the chances that metabolic monitoring would be done. For states, health plans, and clinicians to develop meaningful quality improvement strategies, identifying the multiple providers caring for the children and potentially responsible for ordering tests consistent with evidence-based care is essential. Provider attribution in the context of shared care arrangements plays a critical role in driving quality improvement efforts.
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Affiliation(s)
| | | | - Regina Bussing
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Yijun Sun
- Departments of Health Outcomes and Biomedical Informatics and
| | - Jasmine Mack
- Departments of Health Outcomes and Biomedical Informatics and
| | - Kamila B Mistry
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Matthew J Gurka
- Departments of Health Outcomes and Biomedical Informatics and
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48
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Gurka MJ, Mack JA, Chi X, DeBoer MD. Use of metabolic syndrome severity to assess treatment with vitamin E and pioglitazone for non-alcoholic steatohepatitis. J Gastroenterol Hepatol 2021; 36:249-256. [PMID: 32506513 PMCID: PMC7719569 DOI: 10.1111/jgh.15131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/13/2020] [Accepted: 05/31/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Non-alcoholic steatohepatitis (NASH), which can lead to liver failure, requires liver biopsies to follow and is difficult to treat. Our goal was to assess metabolic syndrome (MetS) severity as a predictor of treatment success and a marker of response. METHODS We assessed data from the Pioglitazone, Vitamin E, or Placebo for NASH Study, in which individuals with biopsy-confirmed NASH were randomized to receive pioglitazone, vitamin E, or placebo for 96 weeks. We assessed associations of a sex-specific and race/ethnicity-specific MetS severity Z-score (MetS-Z) at baseline and 48 weeks with biopsy-determined endpoint of NASH resolution at 96 weeks. RESULTS Baseline MetS-Z was inversely associated with odds of NASH resolution (odds ratio [OR] per 1 SD of MetS-Z: 0.47, 95% confidence interval [CI] 0.28, 0.79). Decrease in MetS-Z during initial 48-week intervention was greatest for pioglitazone treatment (effect size: -0.31, 95% CI -0.15, -0.48) and for vitamin E tended toward being greater for those with versus without NASH resolution (-0.18 vs -0.05). Overall, 48-week change in MetS-Z was associated with NASH resolution (OR per 1-SD change: 0.53, 95% CI 0.33, 0.85), although this was attenuated in models that included transaminases, which remained linked to treatment success (OR by change-in-aspartate aminotransferase Z-score: 0.38, 95% CI 0.19, 0.76). CONCLUSIONS Individuals with more severe metabolic derangement at baseline were less likely to exhibit NASH resolution, suggesting that individuals may have a threshold of MetS severity beyond which successful treatment is unlikely. As an integrated marker of metabolic abnormalities, MetS-Z was correlated with successful treatment, although transaminases were a more consistent marker of NASH resolution.
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Affiliation(s)
- Matthew J. Gurka
- Professor, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States, 32608
| | - Jasmine A. Mack
- Data Management Analyst, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States, 32608
| | - Xiaofei Chi
- Data Management Analyst, Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States, 32608
| | - Mark D. DeBoer
- Professor, Department of Pediatrics, Division of Pediatric Endocrinology, PO Box 800386, University of Virginia, Charlottesville, Virginia, United States, 22908;,Address correspondence to: Mark D. DeBoer, MD, MSc., MCR, 409 Lane Rd., Room 2017, P.O. Box 800386, Charlottesville, VA 22908, Phone: 434-924-5956, Fax: 434-924-9181,
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Cardel MI, DeBoer MD, Gurka MJ. The Relationship between Objective and Subjective Measures of Socioeconomic Status on Metabolic Syndrome Severity Among African American Adults. Psychoneuroendocrinology 2020; 122:104832. [PMID: 32847737 PMCID: PMC8086550 DOI: 10.1016/j.psyneuen.2020.104832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida, PO Box 100177, Gainesville, Florida, 32610-0177, USA.
| | - Mark D DeBoer
- Department of Pediatrics, PO Box 800386, University of Virginia Health System, Charlottesville, Virginia, 22908-0386, USA.
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, PO Box 100177, Gainesville, Florida, 32610-0177, USA.
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Cardel MI, Pavela G, Janicke D, Huo T, Miller D, Lee AM, Gurka MJ, Dhurandhar E, Peters JC, Caldwell AE, Krause E, Fernandez A, Allison DB. Experimentally Manipulated Low Social Status and Food Insecurity Alter Eating Behavior Among Adolescents: A Randomized Controlled Trial. Obesity (Silver Spring) 2020; 28:2010-2019. [PMID: 33150744 PMCID: PMC7653825 DOI: 10.1002/oby.23002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/05/2020] [Accepted: 05/27/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This randomized trial experimentally manipulated social status to assess effects on acute eating behavior and 24-hour energy balance. METHODS Participants (n = 133 Hispanics; age 15-21 years; 60.2% females) were randomized to low social status ("LOW") or high social status ("HIGH") conditions in a rigged game of Monopoly (Hasbro, Inc.). Acute energy intake in a lunchtime meal was measured by food scales. Twenty-four-hour energy balance was assessed via summation of resting metabolic rate (metabolic cart), physical activity energy expenditure (accelerometer), thermic effect of food, and subtraction of twenty-four-hour energy intake (food diary). RESULTS In the total sample, no significant differences were observed by study condition at lunchtime. LOW females consumed a greater percent of lunchtime daily energy needs (37.5%) relative to HIGH females (34.3%); however, this difference was not statistically significant (P = 0.291). In males, however, LOW consumed significantly less (36.5%) of their daily energy needs relative to HIGH males (45.8%; P = 0.001). For 24-hour energy balance, sex differences were nearly significant (P = 0.057; LOW females: surplus +200 kcal; HIGH males: surplus +445 kcal). Food-insecure individuals consumed a nearly significant greater lunchtime percent daily energy than those with food security (40.7% vs. 36.3%; P = 0.0797). CONCLUSIONS The data demonstrate differential acute and 24-hour eating behavior responses between Hispanic male and female adolescents in experimentally manipulated conditions of low social status.
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Affiliation(s)
- Michelle I. Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2004 Mowry Road, PO Box 100177, Gainesville, FL, 32610
| | - Greg Pavela
- Department of Health Behavior, University of Alabama at Birmingham, 227K Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35294
| | - David Janicke
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL, 32610
| | - Tianyao Huo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2004 Mowry Road, PO Box 100177, Gainesville, FL, 32610
| | - Darci Miller
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2004 Mowry Road, PO Box 100177, Gainesville, FL, 32610
| | - Alexandra M. Lee
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2004 Mowry Road, PO Box 100177, Gainesville, FL, 32610
| | - Matthew J. Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, 2004 Mowry Road, PO Box 100177, Gainesville, FL, 32610
| | - Emily Dhurandhar
- Department of Kinesiology and Sport Management, Texas Tech University, Box 43011, 2500 Broadway, Lubbock, TX, 79409
| | - John C. Peters
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Denver, Anschutz Health and Wellness Center, PO Box 6511-MS 8106, 12801 East 17 Ave, RC1 South RM 7103, Aurora, CO, 80045
| | - Ann E. Caldwell
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Denver, Anschutz Health and Wellness Center, PO Box 6511-MS 8106, 12801 East 17 Ave, RC1 South RM 7103, Aurora, CO, 80045
| | - Eric Krause
- Department of Pharmacodynamics, University of Florida, PO Box 100487, Gainesville, FL, 32610
| | - Alicia Fernandez
- Department of Medicine, University of California San Francisco, 1001 Potrero Ave, Rm. 1307, UCSF Box 1364, San Francisco, CA, 94110
| | - David B. Allison
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University-Bloomington, 1025 East 7 Street, Suite 111, Bloomington, IN, 47405
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