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Bromley MI, Gain EP, Ajoku M, Ray MA, Mzayek F, Kedia SK, Yu X. Burden of Chronic and Heavy Opioid Use Among Elderly Community Dwellers in the U.S. AJPM Focus 2024; 3:100175. [PMID: 38298247 PMCID: PMC10828592 DOI: 10.1016/j.focus.2023.100175] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Introduction Opioid overprescribing may fuel the opioid epidemic and increase the risk of complications of opioid misuse. This study examined trends and determinants of chronic and heavy opioid use among elderly community dwellers in the U.S. Methods Medicare Current Beneficiary Surveys data from 2006 to 2019 were used. Common opioid medications were identified in the prescription medication files (n=47,264). Patients with Chronic users were defined as those receiving 6 or more opioid prescriptions within a year or on medication for 3 or more months, and heavy users were those having an average daily dose of 90 or more morphine milligram equivalents or 3,780 morphine milligram equivalents or more per continuous treatment episode. Results One in 6 elderly community dwellers ever used opioids during the study period. Chronic users were more likely to be women than men (68.9% vs 31.1%, p<0.001). Of all survey participants, 4.3% were chronic users, and 2.8% were heavy users. Among ever users, 27.7% were chronic users, and 18.1% were heavy users. The rate of opioid use rose from 12.1% in 2006, peaked at 22.8% in 2013, and decreased to 11.7% in 2019. Chronic use was 5.1%, 10.7%, and 7.6%, respectively. Heavy use was 5.5%, 10.7%, and 7.6%, respectively. However, for chronic and heavy users, there was no significant difference in the median opioid dosage and opioid duration between males and females. Conclusions Among elderly Medicare beneficiaries, opioid prescriptions have been decreasing since 2013. However, a substantial number of elderly people were chronic and heavy users, calling for better opioid management among them.
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Affiliation(s)
- Morgan I. Bromley
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Easter P. Gain
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Mark'Quest Ajoku
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Meredith A. Ray
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Fawaz Mzayek
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Satish K. Kedia
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Xinhua Yu
- Epidemiology, Biostatistics, and Environmental Health Division, School of Public Health, The University of Memphis, Memphis, Tennessee
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Ahuja NA, Kedia SK, Regmi S, Dillon PJ. Disparities in E-Cigarette Harm and Addiction Perceptions Among Adolescents in the United States: a Systematic Review of the Literature. J Racial Ethn Health Disparities 2024; 11:696-709. [PMID: 36877379 DOI: 10.1007/s40615-023-01553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Health disparities associated with e-cigarette use are increasingly apparent among US adolescents. Perceptions of e-cigarette harm and addiction play an important role in understanding adolescents' e-cigarette use behavior. The objective of this systematic review is to examine racial/ethnic and socio-economic disparities in e-cigarette harm and addiction perceptions among US adolescents. METHODS We searched five databases to identify cross-sectional or longitudinal studies that focused on adolescents (≤ 18 years of age) who were ever, current, or never e-cigarettes users; we then examined how race/ethnicity and/or socio-economic status (SES) impacted e-cigarette harm and/or addiction perceptions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias. RESULTS Adhering to PRISMA guidelines, eight of 226 identified studies met the inclusion criteria. These eight studies examined either perceptions regarding absolute e-cigarette harm and/or addiction (i.e., assessing perception of only e-cigarette) or relative e-cigarette harm and/or addiction (i.e., comparative perceptions to traditional cigarettes) by race and ethnicity. Two of the eight studies assessed absolute harm and/or addiction perceptions of e-cigarettes by SES. Our results indicate that, compared to all other racial/ethnic groups, relative e-cigarette harm and addiction perceptions were lower among Non-Hispanic White adolescents; however, absolute e-cigarette harm perception was higher among these groups. No clear patterns of racial/ethnic differences in absolute e-cigarette addiction perceptions and SES differences in absolute e-cigarette harm perceptions were reported. CONCLUSION More research is needed to explicitly assess perceptions of e-cigarette harm and addiction among US adolescents by race/ethnicity and SES to develop subgroup appropriate public health messaging.
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Affiliation(s)
- Nikhil A Ahuja
- Department of Public Health, College of Health Professions, Slippery Rock University of Pennsylvania, Slippery Rock, PA, USA.
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Sanjaya Regmi
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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Yu X, Gain EP, Kedia SK. Bidirectional associations between alcohol drinking and depressive symptom scores among US older adults. J Affect Disord 2024; 349:48-53. [PMID: 38190853 DOI: 10.1016/j.jad.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/22/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND This study examines the bidirectional associations between alcohol drinking and depression in which low to moderate alcohol drinking may reduce the risk of depression, while the occurrence of depression may increase the amount of alcohol drinking as a coping strategy. METHOD Data for the community-dwelling older adults from the Medicare Current Beneficiary Survey (MCBS) 2016 to 2019 were analyzed using random intercept cross-lagged panel models to explore the within-individual causal associations for males and females separately. Socioeconomic status (SES), smoking and comorbidities were adjusted in the models. RESULTS Among 3388 older adults with three measures for the number of alcohol drinks and Patient Health Questionnaire (PHQ) depression scores, a prior increase in the number of drinks was related to a moderate non-significant decrease in PHQ scores in the follow-up, but a previous increase in the PHQ scores was significantly associated with a decrease in the number of drinks at the follow-up visit in the adjusted models (regression coefficient = -0.144, p = 0.017 for males; and coefficient = -0.11, p < 0.001 for females). CONCLUSION Prior depression may lead to reduced drinking in the follow up visits, but no bidirectional association was found among US older adults.
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Affiliation(s)
- Xinhua Yu
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, United States of America.
| | - Easter P Gain
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, United States of America
| | - Satish K Kedia
- Division of Social Behavioral Sciences, School of Public Health, University of Memphis, United States of America
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Regmi S, Kedia SK, Ahuja NA, Lee G, Entwistle C, Dillon PJ. Association Between Adverse Childhood Experiences and Opioid Use-Related Behaviors: A Systematic Review. Trauma Violence Abuse 2023:15248380231205821. [PMID: 37920999 DOI: 10.1177/15248380231205821] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
As opioid use-related behaviors continue at epidemic proportions, identifying the root causes of these behaviors is critical. Adverse childhood experiences (ACEs) are shown to be an important predictor of opioid initiation, opioid dependence, and lifetime opioid overdose. The purpose of this systematic review is to examine the association between ACEs and opioid use-related behaviors later in life and to discuss implications for policy, practice, and research regarding ACEs and opioids. Five databases (PubMed, PsycINFO, CINAHL, Medline, and Scopus) were used to identify studies investigating the association between ACEs and opioid use-related behaviors. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 20 studies out of the initial 428 met the inclusion criteria for this review. Among the included 20 studies, 15 focused on the relationship between ACEs and lifetime opioid use-related behaviors, and five focused on current opioid use-related behaviors. All studies found statistical associations between ACEs and lifetime or current opioid use-related behaviors. Five studies found a significant gradient effect; that is, as the number of ACEs increased, the risk of opioid use-related behaviors also increased. A significant dose-response relationship exists between ACEs and opioid use-related behaviors. Hence, it is essential for clinicians to screen for ACEs before prescribing opioid medications, for opioid treatment to incorporate trauma-informed methods, and for messaging around opioid use interventions to include information about ACEs. The current review points to a critical need to implement standardized ACE screening instruments in clinical and research settings.
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Kedia SK, Entwistle C, Lee G, Magaña L, Burke EM, Joshi A. Expectations of employers in the United States for entry-level public health job skills with a bachelor's degree: an analysis of the positions advertised in an online job portal. Front Public Health 2023; 11:1218509. [PMID: 37869185 PMCID: PMC10585022 DOI: 10.3389/fpubh.2023.1218509] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives To analyze the current public health labor market for bachelor's-level graduates. Methods Public health-related job postings (N = 365) from across the United States were collected from an online job portal, Indeed.com, from November 7-14, 2022. Job titles, organization type, degree requirements, work experience, job location, and preferred skills for bachelor's-level public health positions were analyzed. Results Thirty-one job titles were identified. Approximately one-third (32.33%) of postings were from the Northeastern US; 23.56% were from the Southeastern region. Thirty-five job skill categories were identified. Most jobs (92.33%) required oral and written communication skills, and 85.21% specified educational skills for public health promotion. Cultural competency, project management, and case management abilities were also highly sought. Conclusion This study revealed the needs of the public health workforce and bolstered the case that public health degree-seekers should be equipped with a set of strategic skills applicable to a range of multisectoral and multidisciplinary public health jobs. Policy implications Given the rapid changes in the field of public health, ongoing analysis of the labor market benefits educators, employers, and policymakers alike.
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Affiliation(s)
- Satish K. Kedia
- School of Public Health, University of Memphis, Memphis, TN, United States
| | - Coree Entwistle
- School of Public Health, University of Memphis, Memphis, TN, United States
| | - Guijin Lee
- School of Public Health, University of Memphis, Memphis, TN, United States
| | - Laura Magaña
- Association of Schools and Programs of Public Health (ASPPH), Washington, DC, United States
| | - Emily M. Burke
- Association of Schools and Programs of Public Health (ASPPH), Washington, DC, United States
| | - Ashish Joshi
- School of Public Health, University of Memphis, Memphis, TN, United States
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Regmi S, Kedia SK, Schmidt M, Mahmood A, Lugemwa T, Dillon PJ. Methamphetamine-Induced Wakefulness and Sleep Management: A Qualitative Analysis of Online Narratives. J Psychoactive Drugs 2023:1-8. [PMID: 37598359 DOI: 10.1080/02791072.2023.2246458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023]
Abstract
While much attention has been given to methamphetamine's wake-promoting properties and the concept of using methamphetamine to increase energy, little is known about the ways people who use methamphetamine manage their use to pursue their functional goals or the challenges they encounter doing so. This qualitative study explores the experiences of people who used methamphetamine to manage wakefulness and reduce sleep as a means to achieve functional goals. We conducted a grounded theory analysis of 202 anonymous letters submitted to an online forum. Five themes emerged from this process: (1) Using methamphetamine to extend wakefulness and reduce the need for sleep; (2) Losing control over wakefulness and the need for sleep; (3) Managing wakefulness and the need for sleep while on methamphetamine; (4) Getting caught in a cycle of wakefulness and sleep; and (5) Sleep disruptions even after ceasing methamphetamine use. Participants believed methamphetamine was critical to meeting their functional goals, and they went to great lengths to try to manage the substance's ill effects. Thus, clients in treatment for methamphetamine use disorder may benefit from interventions addressing their underlying motivations and perceived associations between methamphetamine and meeting functional goals.
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Affiliation(s)
- Sanjaya Regmi
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Michael Schmidt
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Asos Mahmood
- Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tony Lugemwa
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
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Schmidt M, Kedia SK, Dillon PJ, Howell KH. Challenges to Help-Seeking Among Women of Color Exposed to Intimate Partner Violence. J Interpers Violence 2023; 38:8088-8113. [PMID: 36799512 DOI: 10.1177/08862605231153880] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Women exposed to intimate partner violence (IPV) often rely on support from their informal support networks to obtain resources that may mitigate IPV. This study explored the challenges women of color encounter in seeking advice and information from their informal support networks (i.e., family, friends, neighbors, community members) regarding IPV support services. In-depth interviews were conducted with 29 IPV survivors who self-identified as Black or Hispanic. Data were analyzed using grounded theory methodology. Results showed that participants lacked informational support, both in their communities and in their interpersonal relationships with family and friends. Communities treated IPV as normal and propagated the belief that women's responsibilities were to men and family. Family and friends discouraged IPV information seeking and advised that IPV should be kept private to avoid community shaming. The community environments also lacked information about resources for women experiencing IPV. The lack of information from their informal support networks appeared to delay participants' help-seeking. As the frequency and severity of violence escalated, some participants engaged in independent information searching, using social media and online information sources as well as conventional media like radio and newspapers. Others received information from first responders in the wake of a violent emergency. Participants described the information they received online or from first responders as empowering, encouraging them to engage in support services. Similarly, they felt empowered by the information they received from social workers, counselors, and victims' advocates, and they wished to use what they learned to help other women in similar circumstances. Women experiencing IPV and their communities need more information regarding IPV support services. Successful interventions for IPV survivors and their support networks may necessitate community-level education and altering biased perceptions of gender-appropriate behaviors.
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Ahuja N, Kedia SK, Jiang Y, Xie L, Ward KD, Pichon LC, Dillon PJ, Yu X. Factors Associated With E-Cigarette Quitting Behavior Among Adolescents in the United States: A Prospective Observational Study. J Adolesc Health 2022; 71:729-736. [PMID: 36088234 DOI: 10.1016/j.jadohealth.2022.07.001] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE This prospective observational study examined the association of socioecological factors with quitting behavior among US adolescents who exclusively use electronic cigarettes (e-cigarettes). METHODS We used data from past 30-day adolescent exclusive e-cigarette users (n = 243) participating in Wave 3 of the Population Assessment of Tobacco and Health study, who were then followed-up with approximately 12 months later for Wave 4. Weighted unadjusted and adjusted multivariate logistic regression models and structural equation modeling were performed to analyze the data. RESULTS Adolescents were significantly less likely to quit e-cigarettes if they perceived that nicotine in e-cigarettes was "slightly/somewhat harmful" to health (adjusted odds ratio [aOR] = 0.38; 95% confidence interval [CI]: 0.16-0.90, p = .02). Similarly, adolescents who reported that someone else in their home owned an e-cigarette (aOR = 0.43 [95% CI: 0.19-0.94], p = .03) or important people in their life used e-cigarettes (aOR = 0.45 [95% CI: 0.21-0.95], p = .03) were significantly less likely to quit e-cigarettes. The structural equation modeling showed a direct significant relationship of individual-level (b = 0.206, p = .02) and interpersonal-level factors (b = 0.170, p = .04) with e-cigarette quitting behavior. DISCUSSION Our findings suggest that individual-level (harm perception) and interpersonal-level (e-cigarette use at home and by important people) factors may play a significant role in e-cigarette quitting behavior among US adolescents.
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Affiliation(s)
- Nikhil Ahuja
- Department of Public Health and Social Work, Slippery Rock University of Pennsylvania, Slippery Rock, Pennsylvania.
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, University of Memphis, School of Public Health, Memphis, Tennessee
| | - Yu Jiang
- Division of Epidemiology and Biostatistics, University of Memphis, School of Public Health, Memphis, Tennessee
| | - Lu Xie
- Division of Epidemiology and Biostatistics, University of Memphis, School of Public Health, Memphis, Tennessee
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, University of Memphis, School of Public Health, Memphis, Tennessee
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, University of Memphis, School of Public Health, Memphis, Tennessee
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, Ohio
| | - Xinhua Yu
- Division of Epidemiology and Biostatistics, University of Memphis, School of Public Health, Memphis, Tennessee
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Ahuja NA, Kedia SK, Ward KD, Pichon LC, Chen W, Dillon PJ, Navaparia H. Effectiveness of Interventions to Improve Oral Cancer Knowledge: a Systematic Review. J Cancer Educ 2022; 37:479-498. [PMID: 33506408 DOI: 10.1007/s13187-021-01963-x] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
Oral cancer is prone to late-stage diagnosis, and subsequent low five-year survival rates. A small number of interventions or campaigns designed to enhance knowledge of risk factors and symptoms associated with oral cancer have been attempted in the UK, US, and some other countries. The purpose of this systematic review is to assess the effectiveness of interventions designed to improve oral cancer knowledge. We searched five databases to identify randomized controlled trials (RCTs) and non-randomized/quasi-experimental (NR/QE) studies targeting the general population or high-risk groups (tobacco users or alcohol consumers), aged ≥15 years, and reporting the outcomes of individual and/or community level interventions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias. Adhering to PRISMA guidelines, 27 (eight RCTs and 19 NR/QE studies) of the 551 studies identified from the five databases met the inclusion criteria. All RCTs and nine NR/QE studies used either printed materials, health education sessions, multimedia aids, or some combinations of these tools. The other ten NR/QE studies were community-based and used mass media campaigns to increase oral cancer awareness. Overall, the majority of studies significantly improved oral cancer knowledge; however, heterogeneity in study design and variation in measurement tools made it difficult to compare outcomes. Findings suggest that individual and/or community level interventions are generally effective in increasing knowledge of oral cancer risk factors, signs and symptoms, and/or its early diagnosis and prevention strategies among the general population or high-risk groups. However, the long-term benefits of these interventions are understudied.
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Affiliation(s)
- Nikhil A Ahuja
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA.
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Weiyu Chen
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 3825 Desoto Avenue, Memphis, TN, 38152, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Hitesh Navaparia
- Department of Oral and Maxillofacial Surgery, Vaidik Dental College and Research Center, Daman, India
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Kedia SK, Ahuja N, Dillon PJ, Jones A, Kumar S, Satapathy S. Efficacy of Extended-Release Injectable Naltrexone on Alcohol Use Disorder Treatment: A Systematic Review. J Psychoactive Drugs 2022; 55:233-245. [PMID: 35635191 DOI: 10.1080/02791072.2022.2073300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Alcohol use disorder (AUD) is a serious public health problem. Over 3.3 million people worldwide die each year due to alcohol-related causes, which is almost 5.3% of all deaths. This systematic review examines the effectiveness of injectable naltrexone treatment for people with AUD based on randomized clinical trial studies conducted between January 2004 and December 2019. Following PRISMA-P, this review searched PubMed, PsycINFO, CINAHL, Cochrane Library, and Web of Science for relevant studies. The inclusion criteria were AUD treatment, injectable naltrexone, and randomized clinical trials. Only articles written in English, involving human participants, and published in peer-reviewed journals were considered for this review. A total of 11 studies met the inclusion criteria. Ten out of the 11 studies assessed the impact of injectable naltrexone in a 3- to 6-month follow-up period, with one study having a year follow-up. This systematic review indicates that overall, injectable naltrexone therapy produced positive AUD treatment outcomes, including reduced mean time to first drinking day and/or heavy drinking day, decreased number of drinking and/or heavy drinking days, and increased abstinence, frequently at a statistically significant level in the larger studies. However, in all studies, less than half of the participants were completely abstinent after receiving injectable naltrexone. Injectable naltrexone treatment along with psychosocial therapy holds promise for addressing AUD.
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Affiliation(s)
- Satish K. Kedia
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Nikhil Ahuja
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Patrick J. Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Andrew Jones
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Santosh Kumar
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sanjaya Satapathy
- Sandra Atlas Bass Center for Liver Diseases & Transplantation, Department of Medicine, North Shore University Hospital/Northwell Health, Manhasset, NY, USA
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Ahuja NA, Kedia SK, Jiang Y, Ward KD, Pichon LC, Dillon PJ, Yu X, Xie L. Factors Associated with E-Cigarette Quit Intention Among Adolescents in the United States. Subst Use Misuse 2022; 57:2074-2084. [PMID: 36205511 DOI: 10.1080/10826084.2022.2130000] [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] [Indexed: 10/10/2022]
Abstract
Background: Given increasing use of e-cigarettes among adolescents in the United States and its potential for nicotine addiction, encouraging adolescents to quit using these products has become a public health priority. This study examined factors at various socio-ecological levels associated with e-cigarette quit intention (pre-contemplation, contemplation, or preparation) using the Stages of Change of the Trans-theoretical Model among the U.S. adolescents. Methods: We used cross-sectional data from the past 30-day adolescent exclusive e-cigarette users participating in Wave 4 of the Population Assessment of Tobacco and Health study (n = 349). Weighted adjusted multinomial logistic regression models were used to analyze the data. Results: Compared to pre-contemplators and contemplators, preparators were more likely to believe that nicotine in e-cigarettes was "very/extremely harmful" (vs. "not at all harmful") to health (p < 0.001) and people cause a "lot of harm" (vs. "no harm") to themselves when they use e-cigarettes (p < 0.001). In comparison to pre-contemplators, contemplators and preparators were more likely to report that their parents/guardians talked with them about not using e-cigarettes than those whose parents/guardians did not talk with them (p < 0.001). Additionally, contemplators and preparators were also more likely to report that they "often/very often" (vs. never) noticed health warnings on e-cigarette packages (p < 0.001). Conclusion: Our findings suggest that harm perception, influence of family, and e-cigarette health warnings are some of the important factors associated with the stages of change for intention to quit among adolescent e-cigarette users. This study will help public health practitioners and researchers design multi-level e-cigarette cessation interventions for adolescents.
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Affiliation(s)
- Nikhil A Ahuja
- Department of Public Health and Social Work, Slippery Rock University of Pennsylvania, Slippery Rock, Pennsylvania, USA
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Yu Jiang
- Division of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, Ohio, USA
| | - Xinhua Yu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Lu Xie
- Division of Epidemiology and Biostatistics, School of Public Health, University of Memphis, Memphis, Tennessee, USA
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Kedia SK, Ali B, Jiang Y, Arshad H, Satapathy SK, Gonzalez HC. Post-liver transplant outcomes in patients with major psychiatric diagnosis in the United States. Ann Hepatol 2021; 22:100311. [PMID: 33482365 DOI: 10.1016/j.aohep.2021.100311] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/01/2020] [Accepted: 12/11/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES Higher rates of psychiatric disorders are reported among cirrhotic patients. This study examines the demographic and clinical outcomes post-liver transplant (LT) among cirrhotic patients with a major psychiatric diagnosis (cases) compared to those without psychiatric diagnosis (controls). MATERIALS AND METHODS Retrospective case control design was used among 189 cirrhotic patients who had undergone LT at Methodist University Hospital Transplant Institute, Memphis, TN between January 2006 and December 2014. Multivariable regression and Cox proportional hazard regression were conducted to compare allograft loss and all-cause mortality. RESULTS The study sample consisted of a matched cohort of 95 cases and 94 controls with LT. Females and those with Hepatic Encephalopathy (HE) were more likely to have psychiatric diagnosis. Patients with hepatocellular carcinoma (HCC) were twice as likely to have allograft loss. Psychiatric patients with HCC had two and a half times (HR 2.54; 95% CI: 1.20-5.37; p = 0.015) likelihood of all-cause mortality. Data censored at 1-year post-LT revealed that patients with psychiatric diagnosis have a three to four times higher hazard for allograft loss and all-cause mortality compared to controls after adjusting for covariates, whereas when the data is censored at 5 year, allograft loss and all-cause mortality have two times higher hazard ratio. CONCLUSIONS The Cox proportional hazard regression analysis of censored data at 1 and 5 year indicate higher allograft loss and all-cause mortality among LT patients with psychiatric diagnosis. Patients with well-controlled psychiatric disorders who undergo LT need close monitoring and medication adherence.
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Affiliation(s)
- Satish K Kedia
- School of Public Health, University of Memphis, Memphis, TN, United States.
| | - Bilal Ali
- James D Eason Transplant Institute, Methodist University Hospital, University of Tennessee Health Science Center, Memphis, TN, United States.
| | - Yu Jiang
- School of Public Health, University of Memphis, Memphis, TN, United States.
| | - Hassan Arshad
- School of Public Health, University of Memphis, Memphis, TN, United States.
| | - Sanjaya K Satapathy
- Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases & Transplantation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, NY, United States.
| | - Humberto C Gonzalez
- Department of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, MI, United States; Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, United States.
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Ahuja N, Kedia SK, Dillon PJ, Jiang Y, Yu X. Perception and intention of using less harmful and less addictive hypothetical modified risk tobacco products among never tobacco users in the united states. Addict Behav 2021; 122:107016. [PMID: 34147711 DOI: 10.1016/j.addbeh.2021.107016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 01/03/2023]
Abstract
AIMS There is limited research focusing on how never tobacco users respond to claims associated with modified risk tobacco products (MRTPs). The purpose of the present study is twofold: (1) to identify how never tobacco users perceive hypothetical modified risk tobacco product (MRTP) claims; and (2) to assess whether these perceptions impact their intentions of using MRTPs described as "less harmful" and "less addictive." METHOD The present study draws upon a nationally representative dataset of US adults aged ≥ 18 years (n = 850) from a cross-sectional survey (HINTS-FDA, Cycle 2, 2017). Weighted unadjusted and adjusted logistic regression analyses were performed to analyze the data. RESULTS Participants who perceived tobacco products labeled as having "no additives" to be less harmful were close to three times more likely to report intentions of using "less harmful" (Adjusted OR = 2.93 [95% CI: 1.12-7.65]) and "less addictive" (Adjusted OR = 2.72 [95% CI: 1.03-7.21]) tobacco products than those who perceived them to be more/equally harmful. Participants who believed that tobacco products could be manufactured without some chemicals were over five and six times more likely to report intentions of using "less harmful" (Adjusted OR = 5.53 [95% CI: 1.59-19.25]) and "less addictive" (Adjusted OR = 6.60 [95% CI: 2.65-16.46]) tobacco products than those who were unlikely to believe it. CONCLUSIONS Our findings have implications for FDA's regulation of MRTPs and provides insights regarding how the marketing of authorized MRTPs could impact population health in the future.
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Affiliation(s)
- Nikhil Ahuja
- Division of Social and Behavioral Sciences, University of Memphis, School of Public Health, Memphis, TN, USA.
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, University of Memphis, School of Public Health, Memphis, TN, USA.
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA.
| | - Yu Jiang
- Division of Epidemiology and Biostatistics, University of Memphis, School of Public Health, Memphis, TN, USA.
| | - Xinhua Yu
- Division of Epidemiology and Biostatistics, University of Memphis, School of Public Health, Memphis, TN, USA.
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14
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Kedia SK, Ahuja NA, Carswell A, Vander Weg MW, Scarinci IC, Ward KD. Smoking Cessation among Pregnant and Postpartum Women from Low-Income Groups in the United States. J Midwifery Womens Health 2021; 66:486-493. [PMID: 34260136 DOI: 10.1111/jmwh.13242] [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: 08/24/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pregnancy creates a unique window of opportunity for smoking cessation. However, pregnant women from underserved groups can face personal, social, and environmental challenges that impede quitting. This study draws upon the socioecological framework to explore perspectives on smoking cessation among pregnant and postpartum women from low-income groups in the mid-South of the United States. METHODS Semistructured interviews were conducted with 60 women who were pregnant or postpartum. Data were analyzed in Dedoose qualitative software using the directed content analysis approach. RESULTS Findings reveal that at the individual level, motivations for smoking cessation included the fact of being pregnant, risks associated with the infant's health, and desire to breastfeed. However, some pregnant women perceived that slowing down on smoking during pregnancy was adequate to prevent harm to their fetuses. Individual-level factors that made smoking cessation difficult included nicotine addiction and habit, boredom, stressful life circumstances, fear of weight gain, and perceived lack of willpower. At the interpersonal level, living in a smoke-free environment where loved ones do not smoke and emotional and practical support from social network members including partners and family members were thought to facilitate smoking cessation. At the organizational level, access to nicotine replacement therapies and counseling aided in their abilities to quit smoking. At the policy level, pregnant women viewed increase in cigarette prices, warning labels on the cigarette pack, and the potential for a ban on cigarette sales as having some effect in helping them quit smoking. DISCUSSION This study offers theoretical insights into factors that function as barriers or facilitators of smoking cessation among pregnant and postpartum women from low-income groups in the United States. Designing multilevel smoking cessation interventions while considering the interplay of individual, interpersonal, organizational, and policy level factors may lead to better cessation outcomes.
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Affiliation(s)
- Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Nikhil A Ahuja
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
| | | | - Mark W Vander Weg
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa.,Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
| | - Isabel C Scarinci
- Division of Preventive Medicine, Department of Medicine, University of Alabama, Birmingham, Alabama
| | - Kenneth D Ward
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
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Kedia SK, Dillon PJ, Jiang Y, James W, Collins AC, Bhuyan SS. The Association Between Substance Use and Violence: Results from a Nationally Representative Sample of High School Students in the United States. Community Ment Health J 2021; 57:294-306. [PMID: 32500451 DOI: 10.1007/s10597-020-00648-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/25/2020] [Indexed: 11/26/2022]
Abstract
With over 52% of high school students reporting that they have tried alcohol or illicit drugs, 16% carrying a weapon, and 23% engaging in a physical fight, substance use and youth violence remain critical public health challenges in the United States. Using data from the 2017 Youth Risk Behavior Survey, study results revealed that youth who reported heavy use of either alcohol, marijuana, or illicit drugs were three to ten times more likely to report carrying a weapon or engaging in a physical fight. Similarly, youth with heavy substance use were one and half times to 14 times more likely to be a victim of violence or sexual or dating violence. The SEM analysis indicated that substance use had a significant effect on all aspects of violence. School-based behavioral health specialists and community-based pediatricians may need to develop targeted messages to address the potential for violence among youth who use alcohol and/or illicit drugs.
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Affiliation(s)
- Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 205 Robison Hall, Memphis, TN, 38152, USA.
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, USA
| | - Yu Jiang
- Division of Epidemiology, Biostatistics, and Environmental Health Sciences, School of Public Health, University of Memphis, Memphis, USA
| | - Wesley James
- Department of Sociology, University of Memphis, Memphis, USA
| | - Andy C Collins
- Division of Social and Behavioral Sciences, School of Public Health, The University of Memphis, 205 Robison Hall, Memphis, TN, 38152, USA
| | - Soumitra S Bhuyan
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, USA
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Kedia SK, Dillon PJ, Basu A. A Qualitative Exploration of "Mother First" Identity and Antiretroviral Adherence among African American Women Living with HIV in the Mid-South Region of the United States. Health Commun 2020; 35:1190-1199. [PMID: 31167571 DOI: 10.1080/10410236.2019.1623641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The majority of African American women living with HIV are of child-bearing age and large numbers of these women express a desire to have children. Extant research suggests that motherhood provides HIV-positive women with a sense of hope and normalcy and, in some cases, is associated with positive HIV-related health behaviors. Guided by the tenets of the culture-centered approach (CCA), this qualitative study sought to understand the relationship between motherhood identity and ART adherence among a sample of 50 African American women living with HIV in the Mid-South region of the United States. Our theoretically-informed thematic analysis of in-depth interviews with all 50 women produced three primary themes: (1) experiencing HIV through the lens of motherhood, (2) the physical and social realities of the "mother first" orientation while living with HIV, and (3) the impact of the "mother first" orientation on ART adherence and self-care. These findings identify how participants' "mother first" identity orientation interacts with their sociocultural environment to enable and constrain their attempts at ART adherence. The findings also provide empirical evidence to support the CCA's theorizing regarding the ways in which the materiality of structures interact with symbolic cultural meanings to (re)produce health inequalities.
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Affiliation(s)
- Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis
| | | | - Ambar Basu
- Department of Communication, University of South Florida
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Dillon PJ, Kedia SK, Isehunwa OO, Sharma M. Motivations for Treatment Engagement in a Residential Substance Use Disorder Treatment Program: A Qualitative Study. Subst Abuse 2020; 14:1178221820940682. [PMID: 32922019 PMCID: PMC7457698 DOI: 10.1177/1178221820940682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
AIMS The aim of this study was to explore perspectives on motivations for treatment engagement from substance use disorder (SUD) clients in a long-term residential rehabilitation program. DESIGN AND METHODS A convenience sample of 30 clients who were enrolled in a year-long SUD treatment program at a residential rehabilitation facility took part in in-depth interviews. Interview transcripts were analyzed using the directed content analysis approach. RESULTS Participant accounts indicated that their treatment engagement was motivated by factors that aligned with the six primary constructs of the Health Belief Model: (i) perceived susceptibility (eg, believing that their substance use required intervention and that they were prone to relapse), (ii) perceived severity (eg, substance use negatively impacted their health and harmed their close relationships), (iii) perceived benefits (eg, opportunities for a better life, reconnecting with family members and close friends, & avoiding legal consequences), (iv) perceived barriers (eg, the length of the treatment program), (v) cues to actions (eg, decisive moments, elements of the treatment program, & faith and spirituality), and (vi) self-efficacy in remaining abstinent (eg, treatment program provided them with skills and experiences to maintain long-term sobriety). DISCUSSION Our analysis indicates that participants' treatment engagement was linked to their beliefs regarding the severity of their substance use disorder, their treatment program's ability to help them avoid future relapse, and their own capability to act upon the strategies and resources provided by the treatment program. A theoretical understanding of these aspects can contribute to the future planning of precision interventions.
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Affiliation(s)
- Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH, USA
| | - Satish K Kedia
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Oluwaseyi O Isehunwa
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA, USA
| | - Manoj Sharma
- School of Public Health, University of Nevada, Las Vegas, NV, USA
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18
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Satapathy SK, Thornburgh C, Heda R, Jiang Y, Kedia SK, Nair SP, Eason JD, Maluf D. Predicting harmful alcohol relapse after liver transplant: The HALT score. Clin Transplant 2020; 34:e14003. [PMID: 32506677 DOI: 10.1111/ctr.14003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/11/2019] [Revised: 05/18/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alcohol-associated liver disease (AALD) is a rapidly growing indication for liver transplantation (LT). We aimed to examine various clinical, demographic, and behavioral factors to predict post-LT alcohol relapse and graft survival. METHODS Retrospective analysis was performed on 241 LT recipients with AALD as either a primary or secondary indication for LT (2006-2015). RESULTS Patients with <6 months of alcohol abstinence had significantly increased cumulative incidence for alcohol relapse compared to those with >6 months of abstinence (P = .0041, Log-Rank). We identified four variables to predict harmful alcohol relapse post-LT: age at LT, non-alcohol-related criminal history, pre-LT abstinence period (Ref >6 months of alcohol abstinence), and drinks per day (Ref <10 drinks/day). Area under the curve (AUC) for the final model was 0.79 (95% CI: 0.68-0.91). Our multivariable model was evaluated with internal cross-validation; random sampling of the study subjects 100 times yielded a median C statistic of 75 (±SD 0.097) and accuracy of 91 (±SD 0.026). The four-variable model served to form the harmful alcohol use post-LT (HALT) score. Graft survival remained significantly lower in patients with <6 months of pre-LT alcohol abstinence and those with blue-collar jobs. CONCLUSION The HALT score identifies LT candidates with AALD at significant risk for alcohol relapse, potentially guiding transplant centers for pre- and post-LT interventions for improved patient outcomes.
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Affiliation(s)
- Sanjaya K Satapathy
- Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases & Transplantation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, United States, USA
| | - Cody Thornburgh
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rajiv Heda
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yu Jiang
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Satish K Kedia
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Satheesh P Nair
- James D Eason Transplant Institute, Methodist University Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James D Eason
- James D Eason Transplant Institute, Methodist University Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Daniel Maluf
- James D Eason Transplant Institute, Methodist University Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
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Satapathy SK, Gonzalez HC, Vanatta J, Dyer A, Angel W, Nouer SS, Kocak M, Kedia SK, Jiang Y, Clark I, Yadak N, Nezakagtoo N, Helmick R, Horton P, Campos L, Agbim U, Maliakkal B, Maluf D, Nair S, Halford HH, Eason JD. A pilot study of ex-vivo MRI-PDFF of donor livers for assessment of steatosis and predicting early graft dysfunction. PLoS One 2020; 15:e0232006. [PMID: 32407331 PMCID: PMC7224456 DOI: 10.1371/journal.pone.0232006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/06/2020] [Indexed: 01/13/2023] Open
Abstract
Background The utility of ex vivo Magnetic resonance imaging proton density fat fraction (MRI-PDFF) in donor liver fat quantification is unknown. Purpose To evaluate the diagnostic accuracy and utility in predicting early allograft dysfunction (EAD) of ex vivo MRI-PDFF measurement of fat in deceased donor livers using histology as the gold standard. Methods We performed Ex vivo, 1.5 Tesla MRI-PDFF on 33 human deceased donor livers before implantation, enroute to the operating room. After the exclusion of 4 images (technical errors), 29 MRI images were evaluable. Histology was evaluable in 27 of 29 patients. EAD was defined as a peak value of aminotransferase >2000 IU/mL during the first week or an INR of ≥1.6 or bilirubin ≥10 mg/dL at day 7. Results MRI-PDFF values showed a strong positive correlation (Pearson’s correlation coefficient) when histology (macro-steatosis) was included (r = 0.78, 95% confidence interval 0.57‐0.89, p<0.0001). The correlation appeared much stronger when macro plus micro-steatosis were included (r = 0.87, 95% confidence interval 0.72‐0.94, p<0.0001). EAD was noted in 7(25%) subjects. AUC (Area Under the Curve) for macro steatosis (histology) predicted EAD in 73% (95% CI: 48–99), micro plus macro steatosis in 76% (95% CI: 49–100). AUC for PDFF values predicted EAD in 67(35–98). Comparison of the ROC curves in a multivariate model revealed, adding MRI PDFF values to macro steatosis increased the ability of the model in predicting EAD (AUC: 79%, 95% CI: 59–99), and addition of macro plus micro steatosis based on histology predicted EAD even better (AUC: 90%: 79–100, P = 0.054). Conclusion In this pilot study, MRI-PDFF imaging showed potential utility in quantifying hepatic steatosis ex-vivo donor liver evaluation and the ability to predict EAD related to severe allograft steatosis in the recipient.
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Affiliation(s)
- Sanjaya K. Satapathy
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
- Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases, Northwell Health/ North Shore University Hospital, Manhasset, New York, United States of America
- * E-mail:
| | - Humberto C. Gonzalez
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
- Wayne State University School of Medicine/Henry Ford Health System, Detroit, MI, United States of America
| | - Jason Vanatta
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
- Center for Abdominal Transplantation, Cleveland Clinic Florida, Weston, FL, United States of America
| | - Andrew Dyer
- Department of Radiology, Methodist University Hospital, Memphis, TN, United States of America
| | - Wesley Angel
- Department of Radiology, Methodist University Hospital, Memphis, TN, United States of America
| | - Simonne S. Nouer
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Knoxville, Tennessee, United States of America
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Knoxville, Tennessee, United States of America
| | - Satish K. Kedia
- School of Public Health, University of Memphis, Memphis, TN, United States of America
| | - Yu Jiang
- School of Public Health, University of Memphis, Memphis, TN, United States of America
| | - Ian Clark
- Department of Pathology, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Nour Yadak
- Department of Pathology, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Nosratollah Nezakagtoo
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Ryan Helmick
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Peter Horton
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Luis Campos
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Uchenna Agbim
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Benedict Maliakkal
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Daniel Maluf
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Satheesh Nair
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Hollis H. Halford
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - James D. Eason
- Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, TN, United States of America
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States of America
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Ali B, Jiang Y, Agbim U, Kedia SK, Satapathy SK, Barnes M, Maliakkal B, Nair SP, Eason JD, Gonzalez HC. Effect of opioid treatment on clinical outcomes among cirrhotic patients in the United States. Clin Transplant 2020; 34:e13845. [DOI: 10.1111/ctr.13845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/30/2020] [Accepted: 02/22/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Bilal Ali
- Division of Gastroenterology Department of Medicine University of Tennessee Health Science Center Memphis TN USA
| | - Yu Jiang
- School of Public Health University of Memphis Memphis TN USA
| | - Uchenna Agbim
- Division of Gastroenterology Department of Medicine University of Tennessee Health Science Center Memphis TN USA
| | - Satish K. Kedia
- School of Public Health University of Memphis Memphis TN USA
| | - Sanjaya K. Satapathy
- Division of Hepatology at Sandra Atlas Bass Center for Liver Disease and Transplantation Donald and Barbara Zucker School of Medicine Northwell Health Long Island NY USA
| | - Matthew Barnes
- Division of Gastroenterology Department of Medicine University of Tennessee Health Science Center Memphis TN USA
| | - Benedict Maliakkal
- Division of Transplant Surgery Department of Surgery Methodist University Hospital University of Tennessee Health Science Center Memphis TN USA
| | - Satheesh P. Nair
- Division of Transplant Surgery Department of Surgery Methodist University Hospital University of Tennessee Health Science Center Memphis TN USA
| | - James D. Eason
- Division of Transplant Surgery Department of Surgery Methodist University Hospital University of Tennessee Health Science Center Memphis TN USA
| | - Humberto C. Gonzalez
- Department of Gastroenterology and Hepatology Henry Ford Health System Detroit MI USA
- Department of Internal Medicine Wayne State University School of Medicine Detroit MI USA
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Satapathy SK, Jiang Y, Agbim U, Wu C, Bernstein DE, Teperman LW, Kedia SK, Aithal GP, Bhamidimarri KR, Duseja A, Maiwall R, Maliakkal B, Jalal P, Patel K, Puri P, Ravinuthala R, Wong VWS, Abdelmalek MF, Ahmed A, Thuluvath PJ, Singal AK. Posttransplant Outcome of Lean Compared With Obese Nonalcoholic Steatohepatitis in the United States: The Obesity Paradox. Liver Transpl 2020; 26:68-79. [PMID: 31665561 DOI: 10.1002/lt.25672] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Received: 06/06/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
Morbid obesity is considered a relative contraindication for liver transplantation (LT). We investigated if body mass index (BMI; lean versus obese) is a risk factor for post-LT graft and overall survival in nonalcoholic steatohepatitis (NASH) and non-NASH patients. Using the United Network for Organ Sharing (UNOS) database, LT recipients from January 2002 to June 2013 (age ≥18 years) with follow-up until 2017 were included. The association of BMI categories calculated at LT with graft and overall survival after LT were examined. After adjusting for confounders, all obesity cohorts (overweight and class 1, class 2, and class 3 obesity) among LT recipients for NASH had significantly reduced risk of graft and patient loss at 10 years of follow-up compared with the lean BMI cohort. In contrast, the non-NASH group of LT recipients had no increased risk for graft and patient loss for overweight, class 1, and class 2 obesity groups but had significantly increased risk for graft (P < 0.001) and patient loss (P = 0.005) in the class 3 obesity group. In this retrospective analysis of the UNOS database, adult recipients selected for first LT and NASH patients with the lowest BMI have the worse longterm graft and patient survival as opposed to non-NASH patients where the survival was worse with higher BMI.
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Affiliation(s)
- Sanjaya K Satapathy
- Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases, Northshore University Hospital, Northwell Health, Manhasset, NY.,Department of Medicine, Division of Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY
| | - Yu Jiang
- School of Public Health, University of Memphis, Memphis, TN
| | - Uchenna Agbim
- Division of Surgery, Methodist University Hospital Transplant Institute, Memphis, TN
| | - Cen Wu
- Department of Statistics, Kansas State University, Manhattan, KS
| | - David E Bernstein
- Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases, Northshore University Hospital, Northwell Health, Manhasset, NY.,Department of Medicine, Division of Hepatology, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell Health, Manhasset, NY
| | - Lewis W Teperman
- Division of Transplant, Northwell Health System Transplant Center, Northshore University Hospital, Northwell Health, Manhasset, NY
| | - Satish K Kedia
- School of Public Health, University of Memphis, Memphis, TN
| | - Guruprasad P Aithal
- Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, United Kingdom
| | | | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakhi Maiwall
- Institute of Liver & Biliary Sciences, New Delhi, India
| | - Benedict Maliakkal
- Division of Surgery, Methodist University Hospital Transplant Institute, Memphis, TN
| | - Prasun Jalal
- St. Luke's Medical Center, Baylor College of Medicine, Houston, TX
| | - Keyur Patel
- Division of Gastroenterology, University of Toronto, Toronto, ON, Canada
| | - Puneet Puri
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA
| | | | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Manal F Abdelmalek
- Division of Gastroenterology and Hepatology, Duke University, Durham, NC
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA
| | - Paul J Thuluvath
- Institute of Digestive Health & Liver Disease, University of Maryland School of Medicine, Baltimore, MD
| | - Ashwani K Singal
- Division of Gastroenterology and Hepatology, University of South Dakota, Avera McKenna University Health Center and Transplant Institute, Sioux Falls, SD
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Kedia SK, Collins A, Dillon PJ, Akkus C, Ward KD, Jackson BM. Psychosocial interventions for informal caregivers of lung cancer patients: A systematic review. Psychooncology 2019; 29:251-262. [DOI: 10.1002/pon.5271] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/19/2019] [Accepted: 10/20/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Satish K. Kedia
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Andy Collins
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Patrick J. Dillon
- School of Communication Studies Kent State University at Stark North Canton Ohio
| | - Cem Akkus
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Kenneth D. Ward
- Division of Social and Behavioral Sciences, School of Public Health University of Memphis Memphis Tennessee
| | - Bianca M. Jackson
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis Tennessee
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Chavan PP, Kedia SK, Yu X. Impact of Physical and Functional Limitations on Health Care Utilization in Older Cancer Survivors: A Medicare Current Beneficiary Survey. J Aging Health 2019; 32:987-997. [PMID: 31526110 DOI: 10.1177/0898264319872309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study examines effects of physical and functional limitations on health care utilization among older cancer survivors, compared with those without cancer and without physical and functional limitations. Method: Medicare Current Beneficiary Survey data from 2008 to 2011 were used. Physical limitations (PL), activities of daily living (ADL), and instrumental activities of daily living (IADL) were measured on a 5-point scale. Propensity score weighting was developed using logistic regressions. Results: Older cancer survivors with physical and functional limitations had higher rate of emergency department visits than those without limitations (PL: 21.8% vs.17%, adjusted odds ratio [aOR]:1.72, 95% confidence interval [CI]: [1.26, 2.35], p < .05; ADL: 25.8% vs.17.4%, aOR: 2.68, 95% CI: [1.86, 3.86], p < .001), and higher cost of hospitalization (IADL: M = US$24,916, SD: 3,877.1). Conclusion: Older cancer survivors with physical and functional limitations had higher health care utilization compared with those without cancer. Addressing complex and unique health care needs in this population will help reduce excess burden on the health care system.
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Affiliation(s)
- Prachi P Chavan
- Division of Epidemiology, Biostatistics, & Environmental Health, School of Public Health, University of Memphis, TN, USA
| | - Satish K Kedia
- Division of Social & Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Xinhua Yu
- Division of Epidemiology, Biostatistics, & Environmental Health, School of Public Health, University of Memphis, TN, USA
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Agbim U, Jiang Y, Kedia SK, Singal AK, Ahmed A, Bhamidimarri KR, Bernstein DE, Harrison SA, Younossi ZM, Satapathy SK. Impact of Nonmalignant Portal Vein Thrombosis in Transplant Recipients With Nonalcoholic Steatohepatitis. Liver Transpl 2019; 25:68-78. [PMID: 30091296 DOI: 10.1002/lt.25322] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Abstract
Nonalcoholic fatty liver disease is an increasingly prevalent condition, and its more severe progressive state, nonalcoholic steatohepatitis (NASH), is currently the second most common indication for wait-listed adults in the United States. The association of portal vein thrombosis (PVT) prior to or at transplant and poor graft and patient outcomes is not well established, particularly among NASH patients who inherently have an increased hypercoagulable profile. Using the United Network for Organ Sharing data set, we analyzed graft and patient outcomes of patients transplanted for the indication of NASH with and without PVT. Of 3689 NASH transplant recipients, the prevalence of PVT was 12% (450 with PVT and 3239 without PVT). NASH transplant recipients with PVT had inferior graft and patient survival compared with NASH transplant recipients without PVT, even after adjusting for recipient and donor demographic characteristics, body mass index, synthetic dysfunction, and presence of diabetes. In a multivariate Cox regression model, NASH transplant recipients with PVT had a 37% increased risk of graft failure (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.15-1.63; P < 0.001) and 31% increased risk of overall death (HR, 1.31; 95% CI, 1.09-1.58; P < 0.001) compared with NASH transplant recipients without PVT at transplant. This difference in graft and patient survival was most pronounced in the early posttransplant period. These results demonstrate that NASH patients with PVT have decreased graft and patient survival independent of recipient and donor factors.
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Affiliation(s)
- Uchenna Agbim
- Division of Transplant Surgery, Department of Surgery, Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, TN
| | - Yu Jiang
- School of Public Health, University of Memphis, Memphis, TN
| | - Satish K Kedia
- School of Public Health, University of Memphis, Memphis, TN
| | - Ashwani K Singal
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA
| | | | - David E Bernstein
- Division of Hepatology and Sandra Atlas Bass Center for Liver Diseases, Northwell Health, Manhasset, NY
| | - Stephen A Harrison
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Zobair M Younossi
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA
| | - Sanjaya K Satapathy
- Division of Transplant Surgery, Department of Surgery, Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, TN
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25
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Schmidt M, Dillon PJ, Jackson BM, Pirkey P, Kedia SK. "Gave me a line of ice and I got hooked": Exploring narratives of initiating methamphetamine use. Public Health Nurs 2018; 36:18-27. [PMID: 30565331 DOI: 10.1111/phn.12568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explores factors associated with methamphetamine initiation based on the narratives from an online support group for methamphetamine users. METHODS We conducted a qualitative study of 202 first-person narratives submitted to an anonymous, online support group for methamphetamine users. The narratives were analyzed in the Dedoose qualitative software using Charmaz's adaptations to Glaserian grounded theory methodology. RESULTS Ten factors for initiating methamphetamine use emerged from our analysis and corresponded to three constructs from the Theory of Planned Behavior: attitude (needing energy to work, wishing to escape pain, wanting to have fun, and desiring a thinner body), subjective norms (ubiquity of methamphetamine use, yearning for closer relationships, and wanting to fit in), and perceived behavioral control (believing addiction is inevitable, feeling forced to fit in, and having no real control). Many participants described initiating methamphetamine use because they believed it would help them meet personal goals or needs. Other participants began using it out of curiosity, to develop relationships, and/or because of the drug's ubiquity in their social environments. Some users described how their perceived lack of control left them with limited ability to resist trying the drug. CONCLUSIONS Results from this study may aid public health researchers and interventionists seeking theoretically informed methamphetamine prevention programs.
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Affiliation(s)
- Michael Schmidt
- Department of Art, Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Patrick J Dillon
- School of Communication Studies, Kent State University at Stark, North Canton, OH
| | - Bianca M Jackson
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee
| | - Paige Pirkey
- Department of Counseling, Educational Psychology, & Research, University of Memphis, Memphis, Tennessee
| | - Satish K Kedia
- Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
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Ullmann G, Kedia SK, Homayouni R, Akkus C, Schmidt M, Klesges LM, Ward KD. Memphis FitKids: implementing a mobile-friendly web-based application to enhance parents' participation in improving child health. BMC Public Health 2018; 18:1068. [PMID: 30157819 PMCID: PMC6114180 DOI: 10.1186/s12889-018-5968-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Child obesity is a major public health challenge, increasing the risk of chronic medical conditions such as type 2 diabetes, metabolic syndrome, and hypertension. Among U.S. states, Tennessee has one of the highest rates of child obesity. Emerging communication technologies can help to deliver highly disseminable population-level interventions to improve health behavior. The aim of this paper is to report the implementation and the evaluation of the reach of Memphis FitKids, a web-based application, intended to promote healthy behaviors for families and children. Methods A community-level demonstration project, Memphis FitKids, was developed and implemented in Tennessee’s Greater Memphis Area. This application (www.memphisfitkids.org) was designed for parents to assess their children’s obesity risk through determinants such as weight, diet, physical activity, screen time, and sleep adequacy. A built-in “FitCheck” tool used this collected information to create a report with tailored recommendations on how to make healthy changes. A Geographic Information Systems component was implemented to suggest low-cost neighborhood resources that support a healthy lifestyle. A social marketing framework was used to develop and implement FitKids, and a Community Advisory Board with representatives from community partners (e.g., the YMCA of Memphis, the Pink Palace Family of Museums, and the Memphis Public Library) supported the implementation of the project. Five kiosks distributed in the community served as public access points to provide a broad reach across socioeconomic strata. Presentations at community events and the use of Facebook facilitated the promotion of FitKids. Website traffic and Facebook usage were evaluated with Google Analytics and Facebook Insights, respectively. Results In Tennessee, 33,505 users completed 38,429 FitCheck sessions between July 2014 and December 2016. Among these, 6763 sessions were completed at the five kiosks in the community. FitKids was presented at 112 community events and the social media posts reached 23,767 unique Facebook users. Conclusions The Memphis FitKids demonstration project showed that web-based health tools may be a viable strategy to increase access to information about healthy weight and lifestyle options for families. Mobile-friendly web-based applications like Memphis FitKids may also serve health professionals in their efforts to support their clients in adopting healthy behaviors. Electronic supplementary material The online version of this article (10.1186/s12889-018-5968-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gerhild Ullmann
- Social and Behavioral Sciences, School of Public Health, University of Memphis, 3825 Desoto Ave, Memphis, TN, 38152, USA.
| | - Satish K Kedia
- Social and Behavioral Sciences, School of Public Health, University of Memphis, 3825 Desoto Ave, Memphis, TN, 38152, USA
| | - Ramin Homayouni
- Bioinformatics, Biological Sciences, College of Arts and Sciences, University of Memphis, Memphis, TN, USA
| | - Cem Akkus
- Social and Behavioral Sciences, School of Public Health, University of Memphis, 3825 Desoto Ave, Memphis, TN, 38152, USA
| | - Michael Schmidt
- Art, College of Communication and Fine Arts, University of Memphis, Memphis, TN, USA
| | - Lisa M Klesges
- Epidemiology, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Kenneth D Ward
- Social and Behavioral Sciences, School of Public Health, University of Memphis, 3825 Desoto Ave, Memphis, TN, 38152, USA
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27
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Alexander AC, Obong’o CO, Chavan PP, Dillon PJ, Kedia SK. Addicted to the ‘life of methamphetamine’: Perceived barriers to sustained methamphetamine recovery. Drugs: Education, Prevention and Policy 2018. [DOI: 10.1080/09687637.2017.1282423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Adam C. Alexander
- School of Public Health, University of Memphis, Memphis, TN, USA and
| | | | - Prachi P. Chavan
- School of Public Health, University of Memphis, Memphis, TN, USA and
| | - Patrick J. Dillon
- School of Communication Studies, Kent State University, North Canton, OH, USA
| | - Satish K. Kedia
- School of Public Health, University of Memphis, Memphis, TN, USA and
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28
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Smeltzer MP, Rugless FE, Jackson BM, Berryman CL, Faris NR, Ray MA, Meadows M, Patel AA, Roark KS, Kedia SK, DeBon MM, Crossley FJ, Oliver G, McHugh LM, Hastings W, Osborne O, Osborne J, Ill T, Ill M, Jones W, Lee HK, Signore RS, Fox RC, Li J, Robbins ET, Ward KD, Klesges LM, Osarogiagbon RU. Pragmatic trial of a multidisciplinary lung cancer care model in a community healthcare setting: study design, implementation evaluation, and baseline clinical results. Transl Lung Cancer Res 2018. [PMID: 29535915 DOI: 10.21037/tlcr.2018.01.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Responsible for 25% of all US cancer deaths, lung cancer presents complex care-delivery challenges. Adoption of the highly recommended multidisciplinary care model suffers from a dearth of good quality evidence. Leading up to a prospective comparative-effectiveness study of multidisciplinary vs. serial care, we studied the implementation of a rigorously benchmarked multidisciplinary lung cancer clinic. Methods We used a mixed-methods approach to conduct a patient-centered, combined implementation and effectiveness study of a multidisciplinary model of lung cancer care. We established a co-located multidisciplinary clinic to study the implementation of this care-delivery model. We identified and engaged key stakeholders from the onset, used their input to develop the program structure, processes, performance benchmarks, and study endpoints (outcome-related process measures, patient- and caregiver-reported outcomes, survival). In this report, we describe the study design, process of implementation, comparative populations, and how they contrast with patients within the local and regional healthcare system. Trial Registration: ClinicalTrials.gov Identifier: NCT02123797. Results Implementation: the multidisciplinary clinic obtained an overall treatment concordance rate of 90% (target >85%). Satisfaction scores were high, with >95% of patients and caregivers rating themselves as being "very satisfied" with all aspects of care from the multidisciplinary team (patient/caregiver response rate >90%). The Reach of the multidisciplinary clinic included a higher proportion of minority patients, more women, and younger patients than the regional population. Comparative effectiveness: The comparative effectiveness trial conducted in the last phase of the study met the planned enrollment per statistical design, with 178 patients in the multidisciplinary arm and 348 in the serial care arm. The multidisciplinary cohort had older age and a higher percentage of racial minorities, with a higher proportion of stage IV patients in the serial care arm. Conclusions This study demonstrates a comprehensive implementation of a multidisciplinary model of lung cancer care, which will advance the science behind implementing this much-advocated clinical care model.
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Affiliation(s)
- Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Fedoria E Rugless
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Bianca M Jackson
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Courtney L Berryman
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Meredith A Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Meghan Meadows
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Anita A Patel
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Kristina S Roark
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Satish K Kedia
- Division of Social & Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Margaret M DeBon
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Fayre J Crossley
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Georgia Oliver
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Laura M McHugh
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Willeen Hastings
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Orion Osborne
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Jackie Osborne
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Toni Ill
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Mark Ill
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Wynett Jones
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Hyo K Lee
- Deptartment of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Raymond S Signore
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Roy C Fox
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Jingshan Li
- Deptartment of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Edward T Robbins
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Kenneth D Ward
- Division of Social & Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Lisa M Klesges
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
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Satapathy SK, Jiang Y, Eason JD, Kedia SK, Wong E, Singal AK, Tolley EA, Hathaway D, Nair S, Vanatta JM. Cardiovascular mortality among liver transplant recipients with nonalcoholic steatohepatitis in the United States-a retrospective study. Transpl Int 2017. [DOI: 10.1111/tri.13001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sanjaya K. Satapathy
- Department of Surgery; Methodist University Hospital Transplant Institute; University of Tennessee Health Sciences Center; Memphis TN USA
| | - Yu Jiang
- Division of Epidemiology, Biostatistics, & Environmental Health; School of Public Health; University of Memphis; Memphis TN USA
| | - James D. Eason
- Department of Surgery; Methodist University Hospital Transplant Institute; University of Tennessee Health Sciences Center; Memphis TN USA
| | - Satish K. Kedia
- Division of Social and Behavioral Sciences; School of Public Health; University of Memphis; Memphis TN USA
| | - Emily Wong
- Department of Surgery; Methodist University Hospital Transplant Institute; University of Tennessee Health Sciences Center; Memphis TN USA
| | - Ashwani K. Singal
- Division of Gastroenterology and Hepatology; Department of Medicine; University of Alabama at Birmingham; Birmingham AL USA
| | - Elizabeth A. Tolley
- Department of Biostatistics and Epidemiology; University of Tennessee Health Sciences Center; Memphis TN USA
| | - Donna Hathaway
- Department of Advanced Practice and Doctoral Studies; University of Tennessee Health Sciences Center; Memphis TN USA
| | - Satheesh Nair
- Department of Surgery; Methodist University Hospital Transplant Institute; University of Tennessee Health Sciences Center; Memphis TN USA
| | - Jason M. Vanatta
- Department of Surgery; Methodist University Hospital Transplant Institute; University of Tennessee Health Sciences Center; Memphis TN USA
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Karuri AR, Kashyap VK, Yallapu MM, Zafar N, Kedia SK, Jaggi M, Chauhan SC. Disparity in rates of HPV infection and cervical cancer in underserved US populations. Front Biosci (Schol Ed) 2017; 9:254-269. [PMID: 28410118 DOI: 10.2741/s486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
There is a higher rate of HPV infection and cervical cancer incidence and mortality in underserved US population who reside in Appalachian mountain region compared to Northern Plains. Social and behavioral factors such as smoking and alcohol consumption are for such a high incidence. However, by and large, the reasons for these discrepancies lie in the reluctance of the underserved population to adopt preventive measures such as prophylactic Human papilloma virus (HPV) vaccines and Pap smear screening that have significantly reduced the incidence and mortality rate of cervical cancer in Caucasian women. Thus, it is clear that drastic change in social behavior and implementation of preventive measures is required to effectively reduce the incidence and mortality from cervical cancer in this underserved population.
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Affiliation(s)
- Asok Ranjan Karuri
- Department of Pharmaceutical Sciences and Cancer Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163
| | - Vivek Kumar Kashyap
- Department of Pharmaceutical Sciences and Cancer Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163
| | - Murali Mohan Yallapu
- Department of Pharmaceutical Sciences and Cancer Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163
| | - Nadeem Zafar
- Department of Pathology, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163
| | - Satish K Kedia
- Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, TN, 38152
| | - Meena Jaggi
- Department of Pharmaceutical Sciences and Cancer Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163
| | - Subhash C Chauhan
- Department of Pharmaceutical Sciences and Cancer Research Center, University of Tennessee Health Science Center, Memphis, Tennessee, USA, 38163,
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31
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Kedia SK, Chavan PP, Boop SE, Yu X. Health Care Utilization Among Elderly Medicare Beneficiaries With Coexisting Dementia and Cancer. Gerontol Geriatr Med 2017; 3:2333721416689042. [PMID: 31508440 PMCID: PMC5308432 DOI: 10.1177/2333721416689042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 03/13/2016] [Revised: 05/03/2016] [Accepted: 12/13/2016] [Indexed: 11/16/2022] Open
Abstract
Objective: The goal of this research is to delineate health care utilization among elderly Medicare beneficiaries with coexisting dementia and cancer compared with those with dementia alone, cancer alone, or neither condition. Method: The study cohort included 96,124 elderly patients aged 65 years and older who resided in the Mid-South region of the United States and were enrolled in Medicare during 2009. Multivariate regression analyses were used to examine health care utilizations while adjusting for sociodemographic characteristics. Results: Those with coexisting dementia and cancer diagnoses had higher rates of hospitalizations, hospital readmissions within 30 days, intensive care unit use, and emergency department visits compared with those with dementia only, cancer only, and those with neither condition. Patients with coexisting dementia and cancer also had a higher number of primary care visits and specialist visits. Conclusion: There is a greater need for developing tailored care plans for elderly with these two degenerative health conditions to address their unique health care needs and to reduce financial burden on the patients and the health care system.
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Obong'o CO, Alexander AC, Chavan PP, Dillon PJ, Kedia SK. Choosing to Live or Die: Online Narratives of Recovering from Methamphetamine Abuse. J Psychoactive Drugs 2016; 49:52-58. [PMID: 27938305 DOI: 10.1080/02791072.2016.1262085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The goal of this study is to explore motivating factors for recovering from methamphetamine abuse. The source of data was 202 anonymous letters and stories submitted to an online support platform for methamphetamine users. Qualitative data were analyzed in Dedoose software using grounded theory methodology. Ten primary motivating factors for recovering from methamphetamine abuse were identified and mapped onto four constructs from the Health Belief Model: (1) perceived susceptibility (learning from others and learning from self); (2) perceived severity (fear of death and declining health); (3) perceived benefits (reconnecting with family, reconnecting with society, and recovering self-esteem); and (4) cues to action (hitting rock bottom, finding God, and becoming pregnant). By using data from an online support group and categorizing emerging themes within a theoretical framework, findings from this study provide a comprehensive understanding of factors involved in recovery from methamphetamine abuse and offer further insights in developing theoretically informed interventions for methamphetamine users. This study suggests the utility of online platforms for obtaining anonymous but unique experiences about drug abuse and recovery. Findings may benefit healthcare professionals, counselors, and researchers by helping to develop theoretically informed interventions for methamphetamine abuse.
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Affiliation(s)
- Christopher O Obong'o
- a Graduate Assistant, Division of Social and Behavioral Sciences, School of Public Health , University of Memphis , Memphis , TN , USA
| | - Adam C Alexander
- a Graduate Assistant, Division of Social and Behavioral Sciences, School of Public Health , University of Memphis , Memphis , TN , USA
| | - Prachi P Chavan
- b Graduate Assistant, Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health , University of Memphis , Memphis , TN , USA
| | - Patrick J Dillon
- c Assistant Professor, School of Communication Studies , Kent State University , North Canton , OH , USA
| | - Satish K Kedia
- d Professor, Division of Social and Behavioral Sciences, School of Public Health , University of Memphis , Memphis , TN , USA
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Osarogiagbon RU, Rodriguez HP, Hicks D, Signore RS, Roark K, Kedia SK, Ward KD, Lathan C, Santarella S, Gould MK, Krasna MJ. Deploying Team Science Principles to Optimize Interdisciplinary Lung Cancer Care Delivery: Avoiding the Long and Winding Road to Optimal Care. J Oncol Pract 2016; 12:983-991. [DOI: 10.1200/jop.2016.013813] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The complexity of lung cancer care mandates interaction between clinicians with different skill sets and practice cultures in the routine delivery of care. Using team science principles and a case-based approach, we exemplify the need for the development of real care teams for patients with lung cancer to foster coordination among the multiple specialists and staff engaged in routine care delivery. Achieving coordinated lung cancer care is a high-priority public health challenge because of the volume of patients, lethality of disease, and well-described disparities in quality and outcomes of care. Coordinating mechanisms need to be cultivated among different types of specialist physicians and care teams, with differing technical expertise and practice cultures, who have traditionally functioned more as coactively working groups than as real teams. Coordinating mechanisms, including shared mental models, high-quality communication, mutual trust, and mutual performance monitoring, highlight the challenge of achieving well-coordinated care and illustrate how team science principles can be used to improve quality and outcomes of lung cancer care. To develop the evidence base to support coordinated lung cancer care, research comparing the effectiveness of a diverse range of multidisciplinary care team approaches and interorganizational coordinating mechanisms should be promoted.
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Affiliation(s)
- Raymond U. Osarogiagbon
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center; School of Public Health, University of Memphis, Memphis, TN; School of Public Health, University of California, Berkeley, Berkeley; Bonnie J. Addario Lung Cancer Foundation, San Carlos; Kaiser Permanente Southern California, Pasadena, CA; Dana-Farber Cancer Institute, Boston, MA; and Meridian Cancer Care and Rutgers Medical School, Neptune, NJ
| | - Hector P. Rodriguez
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center; School of Public Health, University of Memphis, Memphis, TN; School of Public Health, University of California, Berkeley, Berkeley; Bonnie J. Addario Lung Cancer Foundation, San Carlos; Kaiser Permanente Southern California, Pasadena, CA; Dana-Farber Cancer Institute, Boston, MA; and Meridian Cancer Care and Rutgers Medical School, Neptune, NJ
| | - Danielle Hicks
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center; School of Public Health, University of Memphis, Memphis, TN; School of Public Health, University of California, Berkeley, Berkeley; Bonnie J. Addario Lung Cancer Foundation, San Carlos; Kaiser Permanente Southern California, Pasadena, CA; Dana-Farber Cancer Institute, Boston, MA; and Meridian Cancer Care and Rutgers Medical School, Neptune, NJ
| | - Raymond S. Signore
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center; School of Public Health, University of Memphis, Memphis, TN; School of Public Health, University of California, Berkeley, Berkeley; Bonnie J. Addario Lung Cancer Foundation, San Carlos; Kaiser Permanente Southern California, Pasadena, CA; Dana-Farber Cancer Institute, Boston, MA; and Meridian Cancer Care and Rutgers Medical School, Neptune, NJ
| | - Kristi Roark
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center; School of Public Health, University of Memphis, Memphis, TN; School of Public Health, University of California, Berkeley, Berkeley; Bonnie J. Addario Lung Cancer Foundation, San Carlos; Kaiser Permanente Southern California, Pasadena, CA; Dana-Farber Cancer Institute, Boston, MA; and Meridian Cancer Care and Rutgers Medical School, Neptune, NJ
| | - Satish K. Kedia
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center; School of Public Health, University of Memphis, Memphis, TN; School of Public Health, University of California, Berkeley, Berkeley; Bonnie J. Addario Lung Cancer Foundation, San Carlos; Kaiser Permanente Southern California, Pasadena, CA; Dana-Farber Cancer Institute, Boston, MA; and Meridian Cancer Care and Rutgers Medical School, Neptune, NJ
| | - Kenneth D. Ward
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center; School of Public Health, University of Memphis, Memphis, TN; School of Public Health, University of California, Berkeley, Berkeley; Bonnie J. Addario Lung Cancer Foundation, San Carlos; Kaiser Permanente Southern California, Pasadena, CA; Dana-Farber Cancer Institute, Boston, MA; and Meridian Cancer Care and Rutgers Medical School, Neptune, NJ
| | - Christopher Lathan
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center; School of Public Health, University of Memphis, Memphis, TN; School of Public Health, University of California, Berkeley, Berkeley; Bonnie J. Addario Lung Cancer Foundation, San Carlos; Kaiser Permanente Southern California, Pasadena, CA; Dana-Farber Cancer Institute, Boston, MA; and Meridian Cancer Care and Rutgers Medical School, Neptune, NJ
| | - Scott Santarella
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center; School of Public Health, University of Memphis, Memphis, TN; School of Public Health, University of California, Berkeley, Berkeley; Bonnie J. Addario Lung Cancer Foundation, San Carlos; Kaiser Permanente Southern California, Pasadena, CA; Dana-Farber Cancer Institute, Boston, MA; and Meridian Cancer Care and Rutgers Medical School, Neptune, NJ
| | - Michael K. Gould
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center; School of Public Health, University of Memphis, Memphis, TN; School of Public Health, University of California, Berkeley, Berkeley; Bonnie J. Addario Lung Cancer Foundation, San Carlos; Kaiser Permanente Southern California, Pasadena, CA; Dana-Farber Cancer Institute, Boston, MA; and Meridian Cancer Care and Rutgers Medical School, Neptune, NJ
| | - Mark J. Krasna
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center; School of Public Health, University of Memphis, Memphis, TN; School of Public Health, University of California, Berkeley, Berkeley; Bonnie J. Addario Lung Cancer Foundation, San Carlos; Kaiser Permanente Southern California, Pasadena, CA; Dana-Farber Cancer Institute, Boston, MA; and Meridian Cancer Care and Rutgers Medical School, Neptune, NJ
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Kedia SK, Ward KD, Digney SA, Jackson BM, Nellum AL, McHugh L, Roark KS, Osborne OT, Crossley FJ, Faris N, Osarogiagbon RU. 'One-stop shop': lung cancer patients' and caregivers' perceptions of multidisciplinary care in a community healthcare setting. Transl Lung Cancer Res 2015; 4:456-64. [PMID: 26380187 DOI: 10.3978/j.issn.2218-6751.2015.07.10] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 07/14/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Multidisciplinary care is rarely practiced in community healthcare settings where the majority of patients receive lung cancer care in the US. We sought direct input from patients and their informal caregivers on their experience of lung cancer care delivery. METHODS We conducted focus groups of patient and caregiver dyads. Patients had received care for lung cancer in or out of a multidisciplinary thoracic oncology clinic coordinated by a nurse navigator. Focus groups were audiotaped, transcribed, and analyzed using Creswell's 7-step process. Recurring overlapping themes were developed using constant comparative methods within the Grounded Theory framework. RESULTS A total of 46 participants were interviewed in focus groups of 5 patient-caregiver dyads. Overlapping themes were a perception that multidisciplinary care improved physician collaboration, patient-physician communication, and patient convenience, while reducing redundancy in testing. Improved coordination decreased confusion, stress, and anxiety. Negative experience of serial care included poor communication among physicians, insensitive communication about illness, delays in diagnosis and treatment, misdiagnosis, and mistreatment. Physician-to-physician communication and patient education were suggested areas for improvement in the multidisciplinary model. CONCLUSIONS Multidisciplinary care was perceived as more patient-centered, effective, safe, and efficient than standard serial care. It was also believed to improve the timeliness of care and equitable access to high quality care. Additional studies to compare these perspectives to those of other key stakeholders, including clinicians, hospital administrators and representatives of third party payers, will facilitate better understanding of the role of multidisciplinary care programs in lung cancer care delivery.
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Affiliation(s)
- Satish K Kedia
- 1 School of Public Health, University of Memphis, Memphis, TN, USA ; 2 Focus Group Task Force, Thoracic Oncology Research Group; 3 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 4 Alliance for Nonprofit Excellence, Memphis, TN, USA
| | - Kenneth D Ward
- 1 School of Public Health, University of Memphis, Memphis, TN, USA ; 2 Focus Group Task Force, Thoracic Oncology Research Group; 3 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 4 Alliance for Nonprofit Excellence, Memphis, TN, USA
| | - Siri A Digney
- 1 School of Public Health, University of Memphis, Memphis, TN, USA ; 2 Focus Group Task Force, Thoracic Oncology Research Group; 3 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 4 Alliance for Nonprofit Excellence, Memphis, TN, USA
| | - Bianca M Jackson
- 1 School of Public Health, University of Memphis, Memphis, TN, USA ; 2 Focus Group Task Force, Thoracic Oncology Research Group; 3 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 4 Alliance for Nonprofit Excellence, Memphis, TN, USA
| | - April L Nellum
- 1 School of Public Health, University of Memphis, Memphis, TN, USA ; 2 Focus Group Task Force, Thoracic Oncology Research Group; 3 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 4 Alliance for Nonprofit Excellence, Memphis, TN, USA
| | - Laura McHugh
- 1 School of Public Health, University of Memphis, Memphis, TN, USA ; 2 Focus Group Task Force, Thoracic Oncology Research Group; 3 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 4 Alliance for Nonprofit Excellence, Memphis, TN, USA
| | - Kristina S Roark
- 1 School of Public Health, University of Memphis, Memphis, TN, USA ; 2 Focus Group Task Force, Thoracic Oncology Research Group; 3 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 4 Alliance for Nonprofit Excellence, Memphis, TN, USA
| | - Orion T Osborne
- 1 School of Public Health, University of Memphis, Memphis, TN, USA ; 2 Focus Group Task Force, Thoracic Oncology Research Group; 3 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 4 Alliance for Nonprofit Excellence, Memphis, TN, USA
| | - Fayre J Crossley
- 1 School of Public Health, University of Memphis, Memphis, TN, USA ; 2 Focus Group Task Force, Thoracic Oncology Research Group; 3 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 4 Alliance for Nonprofit Excellence, Memphis, TN, USA
| | - Nicholas Faris
- 1 School of Public Health, University of Memphis, Memphis, TN, USA ; 2 Focus Group Task Force, Thoracic Oncology Research Group; 3 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 4 Alliance for Nonprofit Excellence, Memphis, TN, USA
| | - Raymond U Osarogiagbon
- 1 School of Public Health, University of Memphis, Memphis, TN, USA ; 2 Focus Group Task Force, Thoracic Oncology Research Group; 3 Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA ; 4 Alliance for Nonprofit Excellence, Memphis, TN, USA
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Abstract
BACKGROUND Leprosy is a chronic, infectious disease caused by Mycobacterium leprae. It is classified into five groups based on clinical, histological, microbiological and immunological criteria (Ridley and Jopling Classification) . However, a great variation has been observed in the interpretation of histopathological examination ok skin biopsies and clinical presentation of the disease. OBJECTIVE To correlate clinical diagnosis with histopathological diagnosis of leprosy patients in Nepal. METHODS A retrospective hospital-based study was conducted among patients with all clinical types of leprosy, classified as per the Ridley-Jopling classification. Skin biopsies were taken from active lesions in all patients and were stained with Hematoxylin and Eosin stain and modified Fite-Ferraco stain for identification of Mycobacterium leprae. The histopathological findings were compared with clinical diagnoses. RESULTS A total 156 patients were studied, out of which 84 (53.8%) males and 72 (46.1%) females between 8 and 86 years of age. The majority of patients 33 (23.57%) were in the age group of 21-30 years and least affected was children below 10 years 1(0.007%).Overall coincidence of clinical and histopathological diagnoses of classification was seen in 115 cases (80.4%). The maximum correlation (95.2%) was noted in LL patients (p value 0.000049) followed by BT(89.74%), TT (73.2%),BL(72.4%), BB(64.7%). CONCLUSION Leprosy still continues to be one of the common infectious disease in Nepal and skin biopsy is a useful tool in confirming the clinical diagnosis of leprosy as well as for the therapeutic guide.
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Affiliation(s)
- M C Mathur
- Department of Dermatology, College of Medical Sciences, Bharatpur, Chitwan, Nepal
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Mathur M, Kedia SK. Multiple familial trichoepithelioma: A case report. J Coll Med Sci-Nepal 2012. [DOI: 10.3126/jcmsn.v6i4.6731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Trichoepithelioma are benign epidermal appendageal tumour with follicular differentiation. Tumor has been categorized into solitary, multiple and desmoplastic types. The multiple familial trichoepithelioma is autosomal dominant inheritance and rarely seen. Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 64-68 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6731
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Mathur M, Kedia SK, Chimire RBK. An intravenous biological therapy for psoriasis: Infliximab. J Coll Med Sci-Nepal 2012. [DOI: 10.3126/jcmsn.v7i1.5977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Psoriasis is a common, chronic inflammatory skin disease which typically follows a relapsing and remitting course and is associated with joint disease. The significant reduction in quality of life and the psychosocial disability suffered by patients underline the need for prompt, effective treatment and long-term disease control. Patients with moderate to severe disease often require systemic treatment with effective & new modalities such as biological-Infliximab. Review will highlight fundamental aspects of infliximab and its use in Psoriasis as well as provide specific comments regarding this monoclonal antibody and its position in of psoriasis in the future treatment. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5977 JCMSN 2011; 7(1): 69-72
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Mathur M, Kedia SK, Ghimire RB. "Epizoonosis of dermatophytosis": a clinico- mycological study of dermatophytic infections in central Nepal. Kathmandu Univ Med J (KUMJ) 2012; 10:30-33. [PMID: 22971858 DOI: 10.3126/kumj.v10i1.6910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Identification of dermatophytic species in clinical settings are important not only for epidemiological but also for the treatment. OBJECTIVES Present study was carried out to find out the clinical variants of Dermatophytosis and species of fungus responsible for the disease. METHODS The prospective observational analysis of 200 clinically suspected cases of dermatophytic infection attending Dermatology department of College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan, Nepal. Skin scraping, hair and nail samples were collected and processed according to standard protocol. RESULTS Maximum number of patients enrolled in study were reported for treatment 5-8 weeks after the onset of disease. Overall male predominance was observed and ages between 26-30 years. Tinea corporis was the most common clinical type of tinea with female dominance in our study. 10 % of cases were having extensive Tinea. 71.5% of samples were positive on direct microscopy and 62 % positive on culture. Samples from T capitis were highest positive by direct microscopy (80%) and over all dominant species of fungus isolated in our study was Trichophyton verrucosum (30.6%). CONCLUSIONS The study highlighted Tinea corporis as the most common clinical type with female predominance. Overall predominant causative fungal species isolated was Trichophyton verrucosum.
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Affiliation(s)
- M Mathur
- Department of Dermatology, College of Medical Sciences, Bharatpur, Chitwan, Nepal.
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Kedia SK, Mathur M. Tinea incognito: Report of two cases. J Coll Med Sci-Nepal 1970. [DOI: 10.3126/jcmsn.v6i3.4076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Tinea incognito remains diagnostic challenge even to expert specialist because of modified clinical presentation caused by of inappropriate use of topical steroid. Topical steroid are being prescribed frequently for vary many dermatosis including fungal infection of skin and being used by patient as "over the counter drug" leading to varied clinical presentation of common dermatosis. This case report is of iatrogenic dermatosis that was invariably misdiagnosed by general physicians. Key words: Tinea incognito; dermatosis; fungal infection. DOI: 10.3126/jcmsn.v6i3.4076Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.46-49
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