1
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Cozen AE, Carton T, Hamad R, Kornak J, Faulkner Modrow M, Peyser ND, Park S, Orozco JH, Brandner M, O'Brien EC, Djibo DA, McMahill-Walraven CN, Isasi CR, Beatty AL, Olgin JE, Marcus GM, Pletcher MJ. Factors associated with anxiety during the first two years of the COVID-19 pandemic in the United States: An analysis of the COVID-19 Citizen Science study. PLoS One 2024; 19:e0297922. [PMID: 38319951 PMCID: PMC10846720 DOI: 10.1371/journal.pone.0297922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/15/2024] [Indexed: 02/08/2024] Open
Abstract
COVID-19 increased the prevalence of clinically significant anxiety in the United States. To investigate contributing factors we analyzed anxiety, reported online via monthly Generalized Anxiety Disorders-7 (GAD-7) surveys between April 2020 and May 2022, in association with self-reported worry about the health effects of COVID-19, economic difficulty, personal COVID-19 experience, and subjective social status. 333,292 anxiety surveys from 50,172 participants (82% non-Hispanic white; 73% female; median age 55, IQR 42-66) showed high levels of anxiety, especially early in the pandemic. Anxiety scores showed strong independent associations with worry about the health effects of COVID-19 for oneself or family members (GAD-7 score +3.28 for highest vs. lowest category; 95% confidence interval: 3.24, 3.33; p<0.0001 for trend) and with difficulty paying for basic living expenses (+2.06; 1.97, 2.15, p<0.0001) in multivariable regression models after adjusting for demographic characteristics, COVID-19 case rates and death rates, and personal COVID-19 experience. High levels of COVID-19 health worry and economic stress were each more common among participants reporting lower subjective social status, and median anxiety scores for those experiencing both were in the range considered indicative of moderate to severe clinical anxiety disorders. In summary, health worry and economic difficulty both contributed to high rates of anxiety during the first two years of the COVID-19 pandemic in the US, especially in disadvantaged socioeconomic groups. Programs to address both health concerns and economic insecurity in vulnerable populations could help mitigate pandemic impacts on anxiety and mental health.
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Affiliation(s)
- Aaron E Cozen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Thomas Carton
- Louisiana Public Health Institute, New Orleans, LA, United States of America
| | - Rita Hamad
- Dept of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States of America
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Madelaine Faulkner Modrow
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Noah D Peyser
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Soo Park
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Jaime H Orozco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Matthew Brandner
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Department of Family and Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States of America
| | - Emily C O'Brien
- Duke Clinical Research Institute, Durham, NC, United States of America
| | | | | | - Carmen R Isasi
- Department of Epidemiology, Albert Einstein College of Medicine, The Bronx, NY, United States of America
| | - Alexis L Beatty
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Jeffrey E Olgin
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Gregory M Marcus
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
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2
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Webster-Clark M, Toh S, Arnold J, McTigue KM, Carton T, Platt R. External validity in distributed data networks. Pharmacoepidemiol Drug Saf 2023; 32:1360-1367. [PMID: 37463756 DOI: 10.1002/pds.5666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/20/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE While much has been written about how distributed networks address internal validity, external validity is rarely discussed. We aimed to define key terms related to external validity, discuss how they relate to distributed networks, and identify how three networks (the US Food and Drug Administration's Sentinel System, the Canadian Network for Observational Drug Effect Studies [CNODES], and the National Patient Centered Clinical Research Network [PCORnet]) deal with external validity. METHODS We define external validity, target populations, target validity, generalizability, and transportability and describe how each relates to distributed networks. We then describe Sentinel, CNODES, and PCORnet and how each approaches these concepts, including a sample case study. RESULTS Each network approaches external validity differently. As its target population is US citizens and it includes only US data, Sentinel primarily worries about lack of external validity by not including some segments of the population. The fact that CNODES includes Canadian, United States, and United Kingdom data forces them to seriously consider whether the United States and United Kingdom data will be transportable to Canadian citizens when they meta-analyze database-specific estimates. PCORnet, with its focus on study-specific cohorts and pragmatic trials, conducts more case-by-case explorations of external validity for each new analytic data set it generates. CONCLUSIONS There is no one-size-fits-all approach to external validity within distributed networks. With these networks and comparisons between their findings becoming a key part of pharmacoepidemiology, there is a need to adapt tools for improving external validity to the distributed network setting.
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Affiliation(s)
- Michael Webster-Clark
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Gillings Schools of Global Public Health, UNC Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jonathan Arnold
- Department of Medicine, University of Pittsburg, Pittsburgh, Pennsylvania, USA
| | - Kathleen M McTigue
- Department of Medicine, University of Pittsburg, Pittsburgh, Pennsylvania, USA
| | - Thomas Carton
- Division of Health Services Research, Louisiana Public Health Institute, New Orleans, Louisiana, USA
| | - Robert Platt
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
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3
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Nowakowska J, Cameron DR, De Martino A, Kühn J, Le Fresne-Languille S, Leuillet S, Amouzou Y, Wittke F, Carton T, Le Vacon F, Chaves RL, Nicolas-Metral V, Vuagniaux G. Evaluation of the microbiota-sparing properties of the anti-staphylococcal antibiotic afabicin. J Antimicrob Chemother 2023:7192828. [PMID: 37294305 PMCID: PMC10393889 DOI: 10.1093/jac/dkad181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Antibiotic use is associated with collateral damage to the healthy microbiota. Afabicin is a first-in-class prodrug inhibitor of the FabI enzyme that, when converted to the pharmacologically active agent afabicin desphosphono, demonstrates a staphylococcal-specific spectrum of activity. An expected benefit of highly targeted antibiotics such as afabicin is microbiome preservation. OBJECTIVES To compare the effects of oral treatment with afabicin and standard-of-care antibiotics upon the murine gut microbiota, and to assess the effects of oral afabicin treatment on the human gut microbiota. METHODS Gut microbiota effects of a 10 day oral course of afabicin treatment were monitored in mice and compared with clindamycin, linezolid and moxifloxacin at human-equivalent dose levels using 16S rDNA sequencing. Further, the gut microbiota of healthy volunteers was longitudinally assessed across 20 days of oral treatment with afabicin 240 mg twice daily. RESULTS Afabicin treatment did not significantly alter gut microbiota diversity (Shannon H index) or richness (rarefied Chao1) in mice. Only limited changes to taxonomic abundances were observed in afabicin-treated animals. In contrast, clindamycin, linezolid and moxifloxacin each caused extensive dysbiosis in the murine model. In humans, afabicin treatment was not associated with alterations in Shannon H or rarefied Chao1 indices, nor relative taxonomic abundances, supporting the findings from the animal model. CONCLUSIONS Oral treatment with afabicin is associated with preservation of the gut microbiota in mice and healthy subjects.
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Affiliation(s)
- J Nowakowska
- Translational Medicine Department, Debiopharm International SA, Chemin Messidor 5-7, 1006 Lausanne, Switzerland
| | - D R Cameron
- Translational Medicine Department, Debiopharm International SA, Chemin Messidor 5-7, 1006 Lausanne, Switzerland
| | - A De Martino
- Research and Development Department, Biofortis SAS, 3 route de la Chatterie, 44800 Saint-Herblain, France
| | - J Kühn
- Translational Medicine Department, Debiopharm International SA, Chemin Messidor 5-7, 1006 Lausanne, Switzerland
| | - S Le Fresne-Languille
- Research and Development Department, Biofortis SAS, 3 route de la Chatterie, 44800 Saint-Herblain, France
| | - S Leuillet
- Research and Development Department, Biofortis SAS, 3 route de la Chatterie, 44800 Saint-Herblain, France
| | - Y Amouzou
- Research and Development Department, Biofortis SAS, 3 route de la Chatterie, 44800 Saint-Herblain, France
| | - F Wittke
- Clinical Development Department, Debiopharm International SA, Chemin Messidor 5-7, 1006 Lausanne, Switzerland
| | - T Carton
- Research and Development Department, Biofortis SAS, 3 route de la Chatterie, 44800 Saint-Herblain, France
| | - F Le Vacon
- Research and Development Department, Biofortis SAS, 3 route de la Chatterie, 44800 Saint-Herblain, France
| | - R L Chaves
- Clinical Development Department, Debiopharm International SA, Chemin Messidor 5-7, 1006 Lausanne, Switzerland
| | - V Nicolas-Metral
- Translational Medicine Department, Debiopharm International SA, Chemin Messidor 5-7, 1006 Lausanne, Switzerland
| | - G Vuagniaux
- Translational Medicine Department, Debiopharm International SA, Chemin Messidor 5-7, 1006 Lausanne, Switzerland
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4
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Chamberlain AM, Cooper-DeHoff RM, Fontil V, Nilles EK, Shaw KM, Smith M, Lin F, Vittinghoff E, Maeztu C, Todd JV, Carton T, O'Brien EC, Faulkner Modrow M, Wozniak G, Rakotz M, Sanchez E, Smith SM, Polonsky TS, Ahmad FS, Liu M, McClay JC, VanWormer JJ, Taylor BW, Chrischilles EA, Wu S, Viera AJ, Ford DE, Hwang W, Knowlton KU, Pletcher MJ. Disruption in Blood Pressure Control With the COVID-19 Pandemic: The PCORnet Blood Pressure Control Laboratory. Mayo Clin Proc 2023; 98:662-675. [PMID: 37137641 PMCID: PMC9874044 DOI: 10.1016/j.mayocp.2022.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To explore trends in blood pressure (BP) control before and during the COVID-19 pandemic. PATIENTS AND METHODS Health systems participating in the National Patient-Centered Clinical Research Network (PCORnet) Blood Pressure Control Laboratory Surveillance System responded to data queries, producing 9 BP control metrics. Averages of the BP control metrics (weighted by numbers of observations in each health system) were calculated and compared between two 1-year measurement periods (January 1, 2019, through December 31, 2019, and January 1, 2020, through December 31, 2020). RESULTS Among 1,770,547 hypertensive persons in 2019, BP control to <140/<90 mm Hg varied across 24 health systems (range, 46%-74%). Reduced BP control occurred in most health systems with onset of the COVID-19 pandemic; the weighted average BP control was 60.5% in 2019 and 53.3% in 2020. Reductions were also evident for BP control to <130/<80 mm Hg (29.9% in 2019 and 25.4% in 2020) and improvement in BP (reduction of 10 mm Hg in systolic BP or achievement of systolic BP <140 mm Hg; 29.7% in 2019 and 23.8% in 2020). Two BP control process metrics exhibited pandemic-associated disruption: repeat visit in 4 weeks after a visit with uncontrolled hypertension (36.7% in 2019 and 31.7% in 2020) and prescription of fixed-dose combination medications among those with 2 or more drug classes (24.6% in 2019 and 21.5% in 2020). CONCLUSION BP control decreased substantially during the COVID-19 pandemic, with a corresponding reduction in follow-up health care visits among persons with uncontrolled hypertension. It is unclear whether the observed decline in BP control during the pandemic will contribute to future cardiovascular events.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville; Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville
| | - Valy Fontil
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco; UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA
| | | | - Kathryn M Shaw
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville
| | - Myra Smith
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Carlos Maeztu
- Citizen Scientist, Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville
| | | | | | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University, Durham, NC
| | | | | | | | | | - Steven M Smith
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville
| | - Tamar S Polonsky
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mei Liu
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City
| | - James C McClay
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha
| | - Jeffrey J VanWormer
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI
| | | | | | - Shenghui Wu
- Department of Health and Exercise Science, Appalachian State University, Boone, NC
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, Durham, NC
| | - Daniel E Ford
- Johns Hopkins Institute for Clinical and Translational Research, Baltimore, MD
| | - Wenke Hwang
- Penn State University College of Medicine, Hershey, PA
| | - Kirk U Knowlton
- Cardiovascular Department, Intermountain Heart Institute, Salt Lake City, UT
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California San Francisco
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5
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Nilles EK, Champon X, Mulder H, Shaw KM, Smith M, Lampron ZM, Wozniak G, Chamberlain AM, Carton T, Viera AJ, Ahmad FS, Steinberg BA, Chuang CH, Mctigue KM, McClay JC, Polonsky TS, Maeztu C, Sanders M, Warren N, Singh R, Liu M, VanWormer JJ, Park S, Modrow MF, Rakotz M, Cooper-Dehoff RM, Pletcher MJ, O'Brien EC. Seasonal variation in blood pressure control across US health systems. J Hypertens 2023; 41:751-758. [PMID: 36883471 DOI: 10.1097/hjh.0000000000003396] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE We aimed to characterize seasonal variation in US population-based blood pressure (BP) control and BP-related metrics and evaluate the association between outdoor temperature and BP control variation. METHODS We queried electronic health records (EHRs) from 26 health systems, representing 21 states, to summarize BP metrics by quarters of 12-month periods from January 2017 to March 2020. Patients with at least one ambulatory visit during the measurement period and a hypertension diagnosis during the first 6 months or prior to the measurement period were included. Changes in BP control, BP improvement, medication intensification, average SBP reduction after medication intensification across quarters and association with outdoor temperature were analyzed using weighted generalized linear models with repeated measures. RESULTS Among 1 818 041 people with hypertension, the majority were more than 65 years of age (52.2%), female (52.1%), white non-Hispanic (69.8%) and had stage 1/2 hypertension (64.8%). Overall, BP control and process metrics were highest in quarters 2 and 3, and lowest in quarters 1 and 4. Quarter 2 had the highest percentage of improved BP (31.95 ± 0.90%) and average SBP reduction after medication intensification (16 ± 0.23 mmHg). Quarter 3 had the highest percentage of BP controlled (62.25 ± 2.55%) and lowest with medication intensification (9.73 ± 0.60%). Results were largely consistent in adjusted models. Average temperature was associated with BP control metrics in unadjusted models, but associations were attenuated following adjustment. CONCLUSION In this large, national, EHR-based study, BP control and BP-related process metrics improved during spring/summer months, but outdoor temperature was not associated with performance following adjustment for potential confounders.
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Affiliation(s)
- Ester Kim Nilles
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - XiaoXia Champon
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - Hillary Mulder
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | - Kathryn M Shaw
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Myra Smith
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Zachary M Lampron
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
| | | | - Alanna M Chamberlain
- Department of Quantitative Health Sciences
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Thomas Carton
- Louisiana Public Health Institute, Tulane University, New Orleans, Louisiana
| | - Anthony J Viera
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, North Carolina
| | - Faraz S Ahmad
- Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Kathleen M Mctigue
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Tamar S Polonsky
- Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Carlos Maeztu
- Department of Health Outcomes and Policy, Clinical and Translational Science Institute, University of Florida, Gainesville, Florida
| | - Margaret Sanders
- Louisiana Public Health Institute, Tulane University, New Orleans, Louisiana
| | | | | | - Mei Liu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Jeffrey J VanWormer
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology and Population Health, Marshfield, Wisconsin
| | - Soo Park
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | | | | | - Rhonda M Cooper-Dehoff
- Department of Pharmacotherapy and Translational Research, Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Emily C O'Brien
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
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6
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Zang C, Hou Y, Schenck E, Xu Z, Zhang Y, Xu J, Bian J, Morozyuk D, Khullar D, Nordvig A, Shenkman E, Rothman R, Block J, Lyman K, Zhang Y, Varma J, Weiner M, Carton T, Wang F, Kaushal R. Risk Factors and Predictive Modeling for Post-Acute Sequelae of SARS-CoV-2 Infection: Findings from EHR Cohorts of the RECOVER Initiative. Res Sq 2023:rs.3.rs-2592194. [PMID: 36945608 PMCID: PMC10029117 DOI: 10.21203/rs.3.rs-2592194/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Background Patients who were SARS-CoV-2 infected could suffer from newly incidental conditions in their post-acute infection period. These conditions, denoted as the post-acute sequelae of SARS-CoV-2 infection (PASC), are highly heterogeneous and involve a diverse set of organ systems. Limited studies have investigated the predictability of these conditions and their associated risk factors. Method In this retrospective cohort study, we investigated two large-scale PCORnet clinical research networks, INSIGHT and OneFlorida+, including 11 million patients in the New York City area and 16.8 million patients from Florida, to develop machine learning prediction models for those who are at risk for newly incident PASC and to identify factors associated with newly incident PASC conditions. Adult patients aged 20 with SARS-CoV-2 infection and without recorded infection between March 1st, 2020, and November 30th, 2021, were used for identifying associated factors with incident PASC after removing background associations. The predictive models were developed on infected adults. Results We find several incident PASC, e.g., malnutrition, COPD, dementia, and acute kidney failure, were associated with severe acute SARS-CoV-2 infection, defined by hospitalization and ICU stay. Older age and extremes of weight were also associated with these incident conditions. These conditions were better predicted (C-index >0.8). Moderately predictable conditions included diabetes and thromboembolic disease (C-index 0.7-0.8). These were associated with a wider variety of baseline conditions. Less predictable conditions included fatigue, anxiety, sleep disorders, and depression (C-index around 0.6). Conclusions This observational study suggests that a set of likely risk factors for different PASC conditions were identifiable from EHRs, predictability of different PASC conditions was heterogeneous, and using machine learning-based predictive models might help in identifying patients who were at risk of developing incident PASC.
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7
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Fontil V, Modrow MF, Cooper‐DeHoff RM, Wozniak G, Rakotz M, Todd J, Azar K, Murakami L, Sanders M, Chamberlain AM, O'Brien E, Lee A, Carton T, Pletcher MJ. Improvement in Blood Pressure Control in Safety Net Clinics Receiving 2 Versions of a Scalable Quality Improvement Intervention: BP MAP A Pragmatic Cluster Randomized Trial. J Am Heart Assoc 2023; 12:e024975. [PMID: 36695297 PMCID: PMC9973613 DOI: 10.1161/jaha.121.024975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Uncontrolled blood pressure (BP) remains a leading cause of death in the United States. The American Medical Association developed a quality improvement program to improve BP control, but it is unclear how to efficiently implement this program at scale across multiple health systems. Methods and Results We conducted BP MAP (Blood Pressure Measure Accurately, Act Rapidly, and Partner With Patients), a comparative effectiveness trial with clinic-level randomization to compare 2 scalable versions of the quality improvement program: Full Support (with support from quality improvement expert) and Self-Guided (using only online materials). Outcomes were clinic-level BP control (<140/90 mm Hg) and other BP-related process metrics calculated using electronic health record data. Difference-in-differences were used to compare changes in outcomes from baseline to 6 months, between intervention arms, and to a nonrandomized Usual Care arm composed of 18 health systems. A total of 24 safety-net clinics in 9 different health systems underwent randomization and then simultaneous implementation. BP control increased from 56.7% to 59.1% in the Full Support arm, and 62.0% to 63.1% in the Self-Guided arm, whereas BP control dropped slightly from 61.3% to 60.9% in the Usual Care arm. The between-group differences-in-differences were not statistically significant (Full Support versus Self-Guided=+1.2% [95% CI, -3.2% to 5.6%], P=0.59; Full Support versus Usual Care=+3.2% [-0.5% to 6.9%], P=0.09; Self-Guided versus Usual Care=+2.0% [-0.4% to 4.5%], P=0.10). Conclusions In this randomized trial, 2 methods of implementing a quality improvement intervention in 24 safety net clinics led to modest improvements in BP control that were not statistically significant. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03818659.
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Affiliation(s)
- Valy Fontil
- University of California San FranciscoSan FranciscoCA
| | | | | | | | | | | | - Kristen Azar
- University of California San FranciscoSan FranciscoCA
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8
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Abstract
This cohort study examines time trends in officially reported SARS-CoV-2 case counts and unreported home test positivity.
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Affiliation(s)
- Soo Park
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | | | - Rita Hamad
- Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Family and Community Medicine, University of California, San Francisco
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
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9
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Godefroy E, Barbé L, Le Moullac-Vaidye B, Rocher J, Breiman A, Leuillet S, Mariat D, Chatel JM, Ruvoën-Clouet N, Carton T, Jotereau F, Le Pendu J. Microbiota-induced regulatory T cells associate with FUT2-dependent susceptibility to rotavirus gastroenteritis. Front Microbiol 2023; 14:1123803. [PMID: 36922975 PMCID: PMC10008897 DOI: 10.3389/fmicb.2023.1123803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
The FUT2 α1,2fucosyltransferase contributes to the synthesis of fucosylated glycans used as attachment factors by several pathogens, including noroviruses and rotaviruses, that can induce life-threatening gastroenteritis in young children. FUT2 genetic polymorphisms impairing fucosylation are strongly associated with resistance to dominant strains of both noroviruses and rotaviruses. Interestingly, the wild-type allele associated with viral gastroenteritis susceptibility inversely appears to be protective against several inflammatory or autoimmune diseases for yet unclear reasons, although a FUT2 influence on microbiota composition has been observed. Here, we studied a cohort of young healthy adults and showed that the wild-type FUT2 allele was associated with the presence of anti-RVA antibodies, either neutralizing antibodies or serum IgA, confirming its association with the risk of RVA gastroenteritis. Strikingly, it was also associated with the frequency of gut microbiota-induced regulatory T cells (Tregs), so-called DP8α Tregs, albeit only in individuals who had anti-RVA neutralizing antibodies or high titers of anti-RVA IgAs. DP8α Tregs specifically recognize the human symbiont Faecalibacterium prausnitzii, which strongly supports their induction by this anti-inflammatory bacterium. The proportion of F. prausnitzii in feces was also associated with the FUT2 wild-type allele. These observations link the FUT2 genotype with the risk of RVA gastroenteritis, the microbiota and microbiota-induced DP8α Treg cells, suggesting that the anti-RVA immune response might involve an induction/expansion of these T lymphocytes later providing a balanced immunological state that confers protection against inflammatory diseases.
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Affiliation(s)
- Emmanuelle Godefroy
- Inserm, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1303/EMR6001, Nantes Université, Nantes, France
| | - Laure Barbé
- Inserm, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1303/EMR6001, Nantes Université, Nantes, France
| | - Béatrice Le Moullac-Vaidye
- Inserm, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1303/EMR6001, Nantes Université, Nantes, France
| | - Jézabel Rocher
- Inserm, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1303/EMR6001, Nantes Université, Nantes, France
| | - Adrien Breiman
- Inserm, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1303/EMR6001, Nantes Université, Nantes, France.,CHU de Nantes, Nantes, France
| | | | - Denis Mariat
- INRAE, AgroParisTech, UMR1319, MICALIS, Université Paris Saclay, Jouy en Josas, France
| | - Jean-Marc Chatel
- INRAE, AgroParisTech, UMR1319, MICALIS, Université Paris Saclay, Jouy en Josas, France
| | - Nathalie Ruvoën-Clouet
- Inserm, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1303/EMR6001, Nantes Université, Nantes, France.,ONIRIS, Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation, Nantes, France
| | | | - Francine Jotereau
- Inserm, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1303/EMR6001, Nantes Université, Nantes, France
| | - Jacques Le Pendu
- Inserm, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1303/EMR6001, Nantes Université, Nantes, France
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10
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Marsolo K, Kiernan D, Toh S, Phua J, Louzao D, Haynes K, Weiner M, Angulo F, Bailey C, Bian J, Fort D, Grannis S, Krishnamurthy AK, Nair V, Rivera P, Silverstein J, Zirkle M, Carton T. Assessing the impact of privacy-preserving record linkage on record overlap and patient demographic and clinical characteristics in PCORnet®, the National Patient-Centered Clinical Research Network. J Am Med Inform Assoc 2022; 30:447-455. [PMID: 36451264 PMCID: PMC9933062 DOI: 10.1093/jamia/ocac229] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/03/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE This article describes the implementation of a privacy-preserving record linkage (PPRL) solution across PCORnet®, the National Patient-Centered Clinical Research Network. MATERIAL AND METHODS Using a PPRL solution from Datavant, we quantified the degree of patient overlap across the network and report a de-duplicated analysis of the demographic and clinical characteristics of the PCORnet population. RESULTS There were ∼170M patient records across the responding Network Partners, with ∼138M (81%) of those corresponding to a unique patient. 82.1% of patients were found in a single partner and 14.7% were in 2. The percentage overlap between Partners ranged between 0% and 80% with a median of 0%. Linking patients' electronic health records with claims increased disease prevalence in every clinical characteristic, ranging between 63% and 173%. DISCUSSION The overlap between Partners was variable and depended on timeframe. However, patient data linkage changed the prevalence profile of the PCORnet patient population. CONCLUSIONS This project was one of the largest linkage efforts of its kind and demonstrates the potential value of record linkage. Linkage between Partners may be most useful in cases where there is geographic proximity between Partners, an expectation that potential linkage Partners will be able to fill gaps in data, or a longer study timeframe.
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Affiliation(s)
- Keith Marsolo
- Corresponding Author: Keith Marsolo, PhD, Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC 27710, USA;
| | - Daniel Kiernan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | | | - Darcy Louzao
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin Haynes
- Scientific Affairs, HealthCore, Inc., Wilmington, Delaware, USA
| | - Mark Weiner
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Francisco Angulo
- Department of Medicine, Cook County Health and Hospital System, Chicago, Illinois, USA
| | - Charles Bailey
- Department of Pediatrics, Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jiang Bian
- Department of Health Outcomes and Bioinformatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Daniel Fort
- Center for Outcomes and Health Services Research, Ochsner Health, New Orleans, Louisiana, USA
| | - Shaun Grannis
- Regenstrief Institute, Indiana University, Indianapolis, Indiana, USA
| | | | | | | | - Jonathan Silverstein
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Thomas Carton
- Louisiana Public Health Institute, New Orleans, Louisiana, USA
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11
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Kiernan D, Carton T, Toh S, Phua J, Zirkle M, Louzao D, Haynes K, Weiner M, Angulo F, Bailey C, Bian J, Fort D, Grannis S, Krishnamurthy AK, Nair V, Rivera P, Silverstein J, Marsolo K. Establishing a framework for privacy-preserving record linkage among electronic health record and administrative claims databases within PCORnet ®, the National Patient-Centered Clinical Research Network. BMC Res Notes 2022; 15:337. [PMID: 36316778 PMCID: PMC9620597 DOI: 10.1186/s13104-022-06243-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 07/04/2022] [Accepted: 10/21/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine whether a secure, privacy-preserving record linkage (PPRL) methodology can be implemented in a scalable manner for use in a large national clinical research network. RESULTS We established the governance and technical capacity to support the use of PPRL across the National Patient-Centered Clinical Research Network (PCORnet®). As a pilot, four sites used the Datavant software to transform patient personally identifiable information (PII) into de-identified tokens. We queried the sites for patients with a clinical encounter in 2018 or 2019 and matched their tokens to determine whether overlap existed. We described patient overlap among the sites and generated a "deduplicated" table of patient demographic characteristics. Overlapping patients were found in 3 of the 6 site-pairs. Following deduplication, the total patient count was 3,108,515 (0.11% reduction), with the largest reduction in count for patients with an "Other/Missing" value for Sex; from 198 to 163 (17.6% reduction). The PPRL solution successfully links patients across data sources using distributed queries without directly accessing patient PII. The overlap queries and analysis performed in this pilot is being replicated across the full network to provide additional insight into patient linkages among a distributed research network.
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Affiliation(s)
- Daniel Kiernan
- grid.38142.3c000000041936754XDepartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215 USA
| | - Thomas Carton
- grid.468191.30000 0004 0626 8374Louisiana Public Health Institute, New Orleans, LA 70112 USA
| | - Sengwee Toh
- grid.38142.3c000000041936754XDepartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215 USA
| | | | - Maryan Zirkle
- grid.507100.30000 0004 6004 8305Cohen Veterans Bioscience, New York, NY 10018 USA
| | - Darcy Louzao
- grid.26009.3d0000 0004 1936 7961Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27710 USA
| | - Kevin Haynes
- grid.467616.40000 0001 0698 1725Scientific Affairs, HealthCore, Inc., Wilmington, DE 19801 USA
| | - Mark Weiner
- grid.5386.8000000041936877XDepartment of Medicine, Weill Cornell Medicine, New York, NY 10021 USA
| | - Francisco Angulo
- grid.428291.4Department of Medicine, Cook County Health and Hospital System, Chicago, IL 60612 USA
| | - Charles Bailey
- grid.239552.a0000 0001 0680 8770Applied Clinical Research Center, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104 USA
| | - Jiang Bian
- grid.15276.370000 0004 1936 8091College of Medicine, University of Florida, Gainesville, FL 32610 USA
| | - Daniel Fort
- grid.416735.20000 0001 0229 4979Center for Outcomes and Health Services Research, Ochsner Health, New Orleans, LA 70121 USA
| | - Shaun Grannis
- grid.257413.60000 0001 2287 3919Regenstrief Institute, Indiana University, Indianapolis, IN 46202 USA
| | | | | | - Pedro Rivera
- grid.429963.30000 0004 0628 3400OCHIN, Inc., Portland, OR 97201 USA
| | - Jonathan Silverstein
- grid.21925.3d0000 0004 1936 9000Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA 15206 USA
| | - Keith Marsolo
- grid.26009.3d0000 0004 1936 7961Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27710 USA ,grid.26009.3d0000 0004 1936 7961Department of Population Health Sciences, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27710 USA
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12
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Pletcher MJ, Fontil V, Modrow MF, Carton T, Chamberlain AM, Todd J, O’Brien EC, Sheer A, Vittinghoff E, Park S, Orozco J, Lin F, Maeztu C, Wozniak G, Rakotz M, Shay CM, Cooper-DeHoff RM. Effectiveness of Standard vs Enhanced Self-measurement of Blood Pressure Paired With a Connected Smartphone Application: A Randomized Clinical Trial. JAMA Intern Med 2022; 182:1025-1034. [PMID: 35969408 PMCID: PMC9379824 DOI: 10.1001/jamainternmed.2022.3355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/19/2022] [Indexed: 01/24/2023]
Abstract
Importance Self-measured blood pressure (SMBP) with commercially available connected smartphone applications may help patients effectively use SMBP measurements. Objective To determine if enhanced SMBP paired with a connected smartphone application was superior to standard SMBP for blood pressure (BP) reduction or patient satisfaction. Design, Setting, and Participants This randomized clinical trial was conducted among 23 health systems participating in PCORnet, the National Patient-Centered Clinical Research Network, and included patients who reported having uncontrolled BP at their last clinic visit, a desire to lower their BP, and a smartphone. Enrollment and randomization occurred from August 3, 2019, to December 31, 2020, which was followed by 6 months of follow-up for each patient. Analysis commenced shortly thereafter. Interventions Eligible participants were randomly assigned to enhanced SMBP using a device that paired with a connected smartphone application (enhanced) or a standard device (standard). Participants received their device in the mail, along with web-based educational materials and phone-based support as needed. No clinician engagement was undertaken, and the study provided no special mechanisms for delivering measurements to clinicians for use in BP management. Main Outcomes and Measures Reduction in systolic BP, defined as the difference between clinic BP at baseline and the most recent clinic BP extracted from electronic health records at 6 months. Results Enrolled participants (1051 enhanced [50.0%] vs 1050 standard [50.0%]; 1191 women [56.7%]) were mostly middle-aged or older (mean [SD] age, 58 [13] years), nearly a third were Black or Hispanic (645 [31%]), and most were relatively comfortable using technology (mean [SD], 4.1 [1.1] of 5). The mean (SD) change in systolic BP from baseline to 6 months was -10.8 (18) mm Hg vs -10.6 (18) mm Hg (enhanced vs standard: adjusted difference, -0.19 mm Hg; 95% CI, -1.83 to 1.44; P = .81). Secondary outcomes were mostly null, except for documented attainment of BP control to lower than 140/<90 mm Hg, which occurred in 32% enhanced vs 29% standard groups (odds ratio, 1.15; 95% CI, 1.01-1.34). Most participants were very likely to recommend their SMBP device to a friend (70% vs 69%). Conclusions and Relevance This randomized clinical trial found that enhanced SMBP paired with a smartphone application is not superior to standard SMBP for BP reduction or patient satisfaction. Trial Registration ClinicalTrials.gov Identifier: NCT03796689.
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Affiliation(s)
- Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Valy Fontil
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | | | | | - Alanna M. Chamberlain
- Departments of Quantitative Health Sciences and Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Emily C. O’Brien
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina
| | - Amy Sheer
- Division of General Internal Medicine, Department of Medicine, University of Florida, College of Medicine, Gainesville
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Soo Park
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jaime Orozco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | | | | | | | - Rhonda M. Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville
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13
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Viall AH, Bekemeier B, Yeager V, Carton T. Dance of Dollars: State Funding Effects on Local Health Department Expenditures. J Public Health Manag Pract 2022; 28:E577-E585. [PMID: 34475369 PMCID: PMC8810718 DOI: 10.1097/phh.0000000000001418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We examined changes in total local health department (LHD) expenditures in the state of Washington following introduction of a new state funding program to support core public health services and infrastructure. METHODS We used a pre/posttest design regression model to evaluate changes in LHD expenditures 1, 2, and 6 years into the new state program. To address potential endogeneity in the model, we repeated all 3 analyses using 2-stage least squares regression. RESULTS In the base case, overall spending among LHDs significantly increased with receipt of the new state funds in the first years of the program (2008 and 2009). However, those increases were not sustained over the longer term (2013). In subpopulation analyses, total LHD spending increased more among larger LHDs. CONCLUSIONS Between 2006 and 2013, new state investments in core public health functions increased Washington State LHD expenditures in the short term, but those increases did not persist over time. For public health financial modernization efforts to translate into public health infrastructure modernization successes, the way new investments are structured may be as important as the amount of funding added.
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Affiliation(s)
- Abigail H. Viall
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Betty Bekemeier
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Valerie Yeager
- Department of Health Management and Policy, Richard M. Fairbanks School of Public Health, Indiana University, Bloomington, IN, USA
| | - Thomas Carton
- Louisiana Public Health Institute, New Orleans, LA, USA
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14
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Cooper-DeHoff RM, Fontil V, Carton T, Chamberlain AM, Todd J, O'Brien EC, Shaw KM, Smith M, Choi S, Nilles EK, Ford D, Tecson KM, Dennar PE, Ahmad F, Wu S, McClay JC, Azar K, Singh R, Faulkner Modrow M, Shay CM, Rakotz M, Wozniak G, Pletcher MJ. Tracking Blood Pressure Control Performance and Process Metrics in 25 US Health Systems: The PCORnet Blood Pressure Control Laboratory. J Am Heart Assoc 2021; 10:e022224. [PMID: 34612048 PMCID: PMC8751828 DOI: 10.1161/jaha.121.022224] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The National Patient-Centered Clinical Research Network Blood Pressure Control Laboratory Surveillance System was established to identify opportunities for blood pressure (BP) control improvement and to provide a mechanism for tracking improvement longitudinally. Methods and Results We conducted a serial cross-sectional study with queries against standardized electronic health record data in the National Patient-Centered Clinical Research Network (PCORnet) common data model returned by 25 participating US health systems. Queries produced BP control metrics for adults with well-documented hypertension and a recent encounter at the health system for a series of 1-year measurement periods for each quarter of available data from January 2017 to March 2020. Aggregate weighted results are presented overall and by race and ethnicity. The most recent measurement period includes data from 1 737 995 patients, and 11 956 509 patient-years were included in the trend analysis. Overall, 15% were Black, 52% women, and 28% had diabetes. BP control (<140/90 mm Hg) was observed in 62% (range, 44%-74%) but varied by race and ethnicity, with the lowest BP control among Black patients at 57% (odds ratio, 0.79; 95% CI, 0.66-0.94). A new class of antihypertensive medication (medication intensification) was prescribed in just 12% (range, 0.6%-25%) of patient visits where BP was uncontrolled. However, when medication intensification occurred, there was a large decrease in systolic BP (≈15 mm Hg; range, 5-18 mm Hg). Conclusions Major opportunities exist for improving BP control and reducing disparities, especially through consistent medication intensification when BP is uncontrolled. These data demonstrate substantial room for improvement and opportunities to close health equity gaps.
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Affiliation(s)
| | - Valy Fontil
- University of California San Francisco San Francisco CA
| | - Thomas Carton
- Louisiana Public Health InstituteTulane University New Orleans LA
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15
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Bobin-Dubigeon C, Luu HT, Leuillet S, Lavergne SN, Carton T, Le Vacon F, Michel C, Nazih H, Bard JM. Faecal Microbiota Composition Varies between Patients with Breast Cancer and Healthy Women: A Comparative Case-Control Study. Nutrients 2021; 13:nu13082705. [PMID: 34444865 PMCID: PMC8399700 DOI: 10.3390/nu13082705] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 01/04/2023] Open
Abstract
The intestinal microbiota plays an essential role in many diseases, such as obesity, irritable bowel disease (IBD), and cancer. This study aimed to characterize the faecal microbiota from early-stage breast cancer (BC) patients and healthy controls. Faeces from newly diagnosed breast cancer patients, mainly for an invasive carcinoma of no specific type (HR+ and HER2−), before any therapeutic treatment and healthy controls were collected for metabarcoding analyses. We show that the Shannon index, used as an index of diversity, was statistically lower in the BC group compared to that of controls. This work highlights a reduction of microbial diversity, a relative enrichment in Firmicutes, as well as a depletion in Bacteroidetes in patients diagnosed with early BC compared to those of healthy women. A tendency towards a decreased relative abundance of Odoribacter sp., Butyricimonas sp., and Coprococcus sp. was observed. This preliminary study suggests that breast cancer patients may differ from healthy subjects in their intestinal bacterial composition.
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Affiliation(s)
- Christine Bobin-Dubigeon
- Institut de Cancérologie de l’Ouest, 44805 Saint-Herblain, France;
- EA 2160—IUML FR3473 CNRS, Nantes University, 44035 Nantes, France; (H.T.L.); (H.N.)
- Research Center of Human Nutrition CRNH Ouest, 44093 Nantes, France;
- Correspondence:
| | - Huyen Trang Luu
- EA 2160—IUML FR3473 CNRS, Nantes University, 44035 Nantes, France; (H.T.L.); (H.N.)
- Research Center of Human Nutrition CRNH Ouest, 44093 Nantes, France;
| | - Sébastien Leuillet
- Biofortis Mérieux NutriSciences, 3 Route de la Chatterie, 44800 Saint-Herblain, France; (S.L.); (S.N.L.); (T.C.); (F.L.V.)
| | - Sidonie N. Lavergne
- Biofortis Mérieux NutriSciences, 3 Route de la Chatterie, 44800 Saint-Herblain, France; (S.L.); (S.N.L.); (T.C.); (F.L.V.)
| | - Thomas Carton
- Biofortis Mérieux NutriSciences, 3 Route de la Chatterie, 44800 Saint-Herblain, France; (S.L.); (S.N.L.); (T.C.); (F.L.V.)
| | - Françoise Le Vacon
- Biofortis Mérieux NutriSciences, 3 Route de la Chatterie, 44800 Saint-Herblain, France; (S.L.); (S.N.L.); (T.C.); (F.L.V.)
| | - Catherine Michel
- Research Center of Human Nutrition CRNH Ouest, 44093 Nantes, France;
- UMR 1280, 44035 Nantes, France
| | - Hassane Nazih
- EA 2160—IUML FR3473 CNRS, Nantes University, 44035 Nantes, France; (H.T.L.); (H.N.)
- Research Center of Human Nutrition CRNH Ouest, 44093 Nantes, France;
| | - Jean-Marie Bard
- Institut de Cancérologie de l’Ouest, 44805 Saint-Herblain, France;
- EA 2160—IUML FR3473 CNRS, Nantes University, 44035 Nantes, France; (H.T.L.); (H.N.)
- Research Center of Human Nutrition CRNH Ouest, 44093 Nantes, France;
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16
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Pletcher MJ, Olgin JE, Peyser ND, Modrow MF, Lin F, Martin J, Carton T, Beatty AL, Vittinghoff E, Marcus GM. Factors Associated With Access to and Timing of Coronavirus Testing Among US Adults After Onset of Febrile Illness. JAMA Netw Open 2021; 4:e218500. [PMID: 33938937 PMCID: PMC8094007 DOI: 10.1001/jamanetworkopen.2021.8500] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/11/2021] [Indexed: 12/23/2022] Open
Abstract
Importance Active SARS-CoV-2 (coronavirus) transmission continues in the US. It is unclear whether better access to coronavirus testing and more consistent use of testing could substantially reduce transmission. Objective To describe coronavirus testing in persons with new onset of febrile illness and analyze whether there are changes over time and differences by race and ethnicity. Design, Setting, and Participants This cohort study used data from the COVID-19 Citizen Science Study, launched in March 2020, which recruited participants via press release, word-of-mouth, and partner organizations. Participants completed daily surveys about COVID-19 symptoms and weekly surveys about coronavirus testing. All adults (aged at least 18 years) with a smartphone were eligible to join. For this analysis, US participants with new onset of febrile illness from April 2020 to October 2020 were included. Data analysis was performed from November 2020 to March 2021. Main Outcomes and Measures Receipt of a coronavirus test result within 7 days of febrile illness onset. Results Of the 2679 participants included in this analysis, the mean (SD) age was 46.3 (13.4) years, 1983 were female (74%), 2017 were college educated (75%), and a total of 3865 distinct new febrile illness episodes were reported (300 episodes [7.8%] from Hispanic participants, 71 episodes [1.8%] from Black participants, and 3494 episodes [90.4%] from not Black, not Hispanic participants) between April 2 and October 23, 2020. In weekly surveys delivered during the 14 days after fever onset, 12% overall (753 participants) indicated receipt of a test result. Using serial survey responses and parametric time-to-event modeling, it was estimated that by 7 days after onset of febrile illness, a total of 20.5% (95% CI, 19.1%-22.0%) had received a test result. This proportion increased from 9.8% (95% CI, 7.5%-12.0%) early in the epidemic to 24.1% (95% CI, 21.5%-26.7%) at the end of July, but testing rates did not substantially improve since then, increasing to 25.9% (95% CI; 21.6%-30.3%) in late October at the start of the winter surge. Black participants reported receiving a test result about half as often as others (7% [7 of 103] of survey responses vs 12% [53 of 461] for Hispanic vs 13% [693 of 5516] for not Black, not Hispanic; P = .03). This association was not statistically significant in adjusted time-to-event models (hazard ratio = 0.59 vs not Black, not Hispanic participants; 95% CI, 0.26-1.34). Conclusions and Relevance Systematic underuse of coronavirus testing was observed in this cohort study through late October 2020, at the beginning of the winter COVID-19 surge, which may have contributed to preventable coronavirus transmission.
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Affiliation(s)
- Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco
| | - Jeffrey E. Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Noah D. Peyser
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Madelaine Faulkner Modrow
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | | | - Alexis L. Beatty
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Gregory M. Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco
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17
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Pensec C, Gillaizeau F, Guenot D, Bessard A, Carton T, Leuillet S, Campone M, Neunlist M, Blottière HM, Le Vacon F. Impact of pemetrexed chemotherapy on the gut microbiota and intestinal inflammation of patient-lung-derived tumor xenograft (PDX) mouse models. Sci Rep 2020; 10:9094. [PMID: 32499509 PMCID: PMC7272463 DOI: 10.1038/s41598-020-65792-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
Chemotherapy remains the gold standard for advanced cancer. Pemetrexed, a chemotherapeutic agent used in non-small cell lung cancer, can induce significant side effects in patients. Although microbiota’s role in the efficacy and/or toxicity of chemotherapy agents has been demonstrated, the impacts of pemetrexed on the gut microbiota and on gastrointestinal inflammation remain unknown. The objective of this study was to evaluate the impact of pemetrexed and the tumor graft on the gut microbiota composition in immunodeficient mice. The faecal microbiota composition was studied with metabarcoding before, 24-h and one week after treatment. The colon epithelial barrier integrity was evaluated by histological examination, intestinal permeability measurement, and selected cytokines quantification. The tumor graft induced some variations in the microbiota composition. Pemetrexed further increased the relative abundance of Enterobacteriaceae and 3 families from the Firmicutes phylum: Enterococcaceae, Lactobacillaceae and Streptococcaceae. Pemetrexed also significantly altered the epithelial barrier integrity, which was associated with early inflammation. This pilot study shows that the association of a lung tumor graft with pemetrexed causes an alteration in the microbiota composition. Such information increases our knowledge about the impact of chemotherapy on the microbiota, which could help to minimize side effects and improve therapeutic effectiveness in the future.
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Affiliation(s)
- Cindy Pensec
- Biofortis Mérieux NutriSciences, 44800, Saint Herblain, France.,IMODI Consortium:
| | | | - Dominique Guenot
- IMODI Consortium:.,Université de Strasbourg (Unistra), EA 3430, U1113 IRFAC, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67200, Strasbourg, France
| | - Anne Bessard
- TENS, INSERM U1235, Institut des Maladies de l'Appareil Digestif du CHU de Nantes, Université de Nantes, 44035 Nantes, France
| | - Thomas Carton
- Biofortis Mérieux NutriSciences, 44800, Saint Herblain, France.,IMODI Consortium:
| | - Sébastien Leuillet
- Biofortis Mérieux NutriSciences, 44800, Saint Herblain, France.,IMODI Consortium:
| | | | - Michel Neunlist
- TENS, INSERM U1235, Institut des Maladies de l'Appareil Digestif du CHU de Nantes, Université de Nantes, 44035 Nantes, France
| | - Hervé M Blottière
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 78350, Jouy-en-Josas, France.,MetaGenoPolis, INRA, Université Paris-Saclay, 78350, Jouy-en-Josas, France
| | - Françoise Le Vacon
- Biofortis Mérieux NutriSciences, 44800, Saint Herblain, France. .,IMODI Consortium:, .
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Bard JM, Bobin-Dubigeon C, Luu HT, Vacon FL, Carton T, Nazih H. Viability of MCF7 Cells Exposed to Basolateral Secretion from CaCo2 Cells Pretreated with Fecal Waters from Breast Cancer Patients and Controls. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa044_007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
There is increasing evidence suggesting that microbiota may play a role in breast cancer disease and influence the disease severity. Several mechanisms may be involved in this relationship. Our hypothesis is that the role of microbiota in the disease may be at least partly related to its influence in gut lipid and lipoprotein metabolisms. This hypothesis was tested in an in vitro model combining MCF7 and Caco2 cells.
Methods
32 women newly diagnosed for breast cancer, before any treatment and 28 apparently healthy women provided their stools from which bacterial DNA was extracted and amplified by qPCR, targeting 16S rRNA sequences specific to bacterial groups. Fecal waters (FW) were also obtained from these stools. Intestinal Caco-2 cells grown on filter inserts were incubated apically with 10% FW for 24 h. Then, MCF-7 cells were incubated with the whole basolateral medium for 24 h. The viability of these cells was estimated by MTT test. In parallel, LXR, apolipoproteins AIV and E gene expression was estimated by RT QPCR in CaCo2 cells and short chain fatty acids (SCFA) were quantified in FW. A logistic regression model was used to establish the Odds ratios (OR) for the disease of MCF7 viability and CaCo2 gene expression. The relationship between % bacterial groups, CaCo2 gene expression, SCFA and viability was established by regression models.
Results
Patients and controls differed by the MCF7 viability (1.05 [1.01–1.10], p = 0.04) and a tendency towards a difference was observed for apo AIV gene expression (0.63 [0.39–1.01], p = 0.055), (OR [5th-95th]). Viability was positively correlated with % Bifidobacterium sp. (21.18 ± 7.66, p = 0.008) and negatively correlated with valerate (−2.849 ± 1.048, p = 0.009), (ß±s.d.). These correlations were maintained in a multiple regression model.
Conclusions
Microbiota may interact with intestine cell lipid metabolism and therefore influence cancer disease through gut cell secretion or permeability.
Funding Sources
Ligue Contre le cancer and private funds from Integrated Center for Oncology.
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Pletcher MJ, Fontil V, Carton T, Shaw KM, Smith M, Choi S, Todd J, Chamberlain AM, O’Brien EC, Faulkner M, Maeztu C, Wozniak G, Rakotz M, Shay CM, Cooper RM. The PCORnet Blood Pressure Control Laboratory: A Platform for Surveillance and Efficient Trials. Circ Cardiovasc Qual Outcomes 2020; 13:e006115. [PMID: 32142371 PMCID: PMC10681810 DOI: 10.1161/circoutcomes.119.006115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Uncontrolled blood pressure (BP) is a leading preventable cause of death that remains common in the US population despite the availability of effective medications. New technology and program innovation has high potential to improve BP but may be expensive and burdensome for patients, clinicians, health systems, and payers and may not produce desired results or reduce existing disparities in BP control. METHODS AND RESULTS The PCORnet Blood Pressure Control Laboratory is a platform designed to enable national surveillance and facilitate quality improvement and comparative effectiveness research. The platform uses PCORnet, the National Patient-Centered Clinical Research Network, for engagement of health systems and collection of electronic health record data, and the Eureka Research Platform for eConsent and collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. Three demonstration projects are underway: BP track will conduct national surveillance of BP control and related clinical processes by measuring theory-derived pragmatic BP control metrics using electronic health record data, with a focus on tracking disparities over time; BP MAP will conduct a cluster-randomized trial comparing effectiveness of 2 versions of a BP control quality improvement program; BP Home will conduct an individual patient-level randomized trial comparing effectiveness of smartphone-linked versus standard home BP monitoring. Thus far, BP Track has collected electronic health record data from over 826 000 eligible patients with hypertension who completed ≈3.1 million ambulatory visits. Preliminary results demonstrate substantial room for improvement in BP control (<140/90 mm Hg), which was 58% overall, and in the clinical processes relevant for BP control. For example, only 12% of patients with hypertension with a high BP measurement during an ambulatory visit received an order for a new antihypertensive medication. CONCLUSIONS The PCORnet Blood Pressure Control Laboratory is designed to be a reusable platform for efficient surveillance and comparative effectiveness research; results from demonstration projects are forthcoming.
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Affiliation(s)
- Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Valy Fontil
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Thomas Carton
- University of Florida, College of Medicine, Gainesville, FL
| | | | - Myra Smith
- University of Florida, College of Medicine, Gainesville, FL
| | - Sujung Choi
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, NC
| | | | | | - Emily C. O’Brien
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, NC
| | - Madelaine Faulkner
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | | | | | - Christina M. Shay
- Center for Health Metrics and Evaluation, American Heart Association
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Pletcher MJ, Fontil V, Carton T, Shaw K, Smith M, Todd J, Chamberlain AM, Obrien E, Faulkner M, Maeztu C, Wozniak G, Rakotz M, Shay C, Cooper DeHoff RM. Abstract P2050: The Pcornet Blood Pressure Control Laboratory. Hypertension 2019. [DOI: 10.1161/hyp.74.suppl_1.p2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
New technology and healthcare delivery approaches may help improve blood pressure (BP) control. Randomized controlled trials (RCTs) can demonstrate effectiveness of these emerging approaches, both overall and especially within underserved populations, but RCTs are expensive. Our objective is to establish a national platform to support BP control surveillance and efficient RCTs.
Methods:
The PCORnet BP Control Laboratory, designed and launched in partnership with the American Heart Association (AHA) and the American Medical Association (AMA), leverages electronic health record (EHR) systems throughout the US, the National Patient-Centered Outcomes Research Network (PCORnet), and the NIH-funded Eureka Research Platform, which enables direct-to-participant research including collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. We will use these resources to 1) Conduct national surveillance through quarterly EHR data queries to calculate and track institution- and clinic-level BP control metrics across 23 PCORnet institutions, overall and within key subgroups, and support participation in the AHA/AMA’s Target:BP recognition program (BP Track); 2) Compare effectiveness of a Full Support versus Self-Guided version of the AMA’s Measure Accurately, Act Rapidly, and Partner with Patients (MAP) program at improving BP control in a cluster randomized trial of 24 safety net clinics (BP MAP); and 3) Compare effectiveness of Smartphone-linked versus standard home BP monitoring at reducing systolic BP in an individual-level, direct-to-participant RCT of 2000 patients with uncontrolled BP (BP Home).
Results:
Preliminary BP Track queries demonstrate an overall BP control rate of 56%, lower control in Black patients (51%), substantial heterogeneity in clinic-level metrics (e.g., 33% vs. 64% BP control), and low rates of medication intensification (9% prescribed a new medication class when BP was high). BP Track will launch PCORnet-wide queries in June; BP MAP in May; and BP Home in August 2019.
Conclusions:
Feasibility testing is underway to determine if the PCORnet BP Control Laboratory will be useful for investigators interested in conducting efficient RCTs of BP control interventions.
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21
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Pensec C, Guenot D, Calvet L, Mignard C, Duchamp O, Carton T, Leuillet S, Blottière HM, Vacon FL. Abstract 662: Impact of chemotherapy on the intestinal microbiome and epithelial barrier in PDX models of lung cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction In the field of lung cancer treatments, significant progresses have been realized during last decade, such as targeted therapies and immunotherapies. Nevertheless, chemotherapy remains the gold standard for cancer. Pemetrexed is a chemotherapeutic agent commonly used in advanced lung cancer. This drug has a broad-spectrum effect that can induce significant side effects in patients. However, the impact of pemetrexed on gut microbiota and gastrointestinal inflammation in PDX mice remains unknown, although the role of the microbiota in carcinogenesis and modulation of efficacy or toxicity of chemotherapy agents has been demonstrated. The aim of this new study was to explore the impact of pemetrexed on the gut microbiota and the integrity of intestinal epithelial barrier and inflammation markers of PDX models following treatment.
Methods Upon establishment of the PDX model, mice were treated with pemetrexed for 2 weeks. Stool specimens were collected at 3 time-points: before, after and one week after treatment. Gut microbiota composition was studied by 16S rRNA gene sequencing. The colon integrity of the epithelial barrier was evaluated by a histological examination, a permeability measurement and a selected cytokines expression. In parallel, body weight was recorded and tissues were sampled for assessment of toxicity and inflammation.
Results Pemetrexed induced a significant body weight loss after each treatment cycle reflecting toxicity as known in clinical results. We have found that pemetrexed and tumor induced several modifications on microbiota composition, and the more important perturbation was the significant increase of the relative abundance of Enterobacteriaceae. A significant alteration of epithelial barrier integrity associated with early inflammation and infiltration of leukocytes into mucosal tissues was observed following treatment. Moreover, we have shown that pemetrexed effect on the microbiota was reproducible on several models of lung PDX models of lung carcinoma, and that dysbiosis seem proportional to the effectiveness of chemotherapy.
Conclusion This work is a preliminary approach, that confirms the relationship between microbiota and chemotherapy. A better understanding of gut microbiota alterations induced by chemotherapy could help reduce side effects. It is essential to expand our knowledge about the chemotherapy impact on microbiota in order to minimize the side effects, avoid infection complications, and improve therapy efficiency.
Citation Format: Cindy Pensec, Dominique Guenot, Loreley Calvet, Caroline Mignard, Olivier Duchamp, Thomas Carton, Sébastien Leuillet, Hervé M. Blottière, Françoise Le Vacon. Impact of chemotherapy on the intestinal microbiome and epithelial barrier in PDX models of lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 662.
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Affiliation(s)
- Cindy Pensec
- 1Biofortis Mérieux NutriSciences, Saint Herblain, France
| | - Dominique Guenot
- 2Université de Strasbourg (Unistra), EA 3430 U1123, Progression tumorale et microenvironnement, Strasbourg, France
| | | | | | | | - Thomas Carton
- 1Biofortis Mérieux NutriSciences, Saint Herblain, France
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22
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Barbé L, Le Moullac-Vaidye B, Echasserieau K, Bernardeau K, Carton T, Bovin N, Nordgren J, Svensson L, Ruvoën-Clouet N, Le Pendu J. Histo-blood group antigen-binding specificities of human rotaviruses are associated with gastroenteritis but not with in vitro infection. Sci Rep 2018; 8:12961. [PMID: 30154494 PMCID: PMC6113245 DOI: 10.1038/s41598-018-31005-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/10/2018] [Indexed: 12/30/2022] Open
Abstract
Human strains of rotavirus A (RVAs) recognize fucosylated glycans belonging to histo-blood group antigens (HBGAs) through their spike protein VP8*. Lack of these ligands due to genetic polymorphisms is associated with resistance to gastroenteritis caused by P[8] genotype RVAs. With the aim to delineate the contribution of HBGAs in the process, we analyzed the glycan specificity of VP8* proteins from various P genotypes. Binding to saliva of VP8* from P[8] and P[4] genotypes required expression of both FUT2 and FUT3 enzymes, whilst binding of VP8* from the P[14] genotype required FUT2 and A enzymes. We further defined a glycan motif, GlcNAcβ3Galβ4GlcNAc, recognized by P[6] clinical strains. Conversion into Lewis antigens by the FUT3 enzyme impaired recognition, explaining their lower binding to saliva of Lewis positive phenotype. In addition, the presence of neutralizing antibodies was associated with the presence of the FUT2 wild type allele in sera from young healthy adults. Nonetheless, in vitro infection of transformed cell lines was independent of HBGAs expression, indicating that HBGAs are not human RV receptors. The match between results from saliva-based binding assays and the epidemiological data indicates that the polymorphism of human HBGAs controls susceptibility to RVAs, although the exact mechanism remains unclear.
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Affiliation(s)
- Laure Barbé
- CRCINA, Inserm, Université d'Angers, Université de Nantes, Nantes, France
| | | | - Klara Echasserieau
- CRCINA, Inserm, Université d'Angers, Université de Nantes, Nantes, France
- Plateforme P2R « Production de protéines recombinantes », SFR Sante F. Bonamy-IRS-UN, Université de Nantes, INSERM, CNRS, CHU Nantes, Nantes, France
| | - Karine Bernardeau
- CRCINA, Inserm, Université d'Angers, Université de Nantes, Nantes, France
- Plateforme P2R « Production de protéines recombinantes », SFR Sante F. Bonamy-IRS-UN, Université de Nantes, INSERM, CNRS, CHU Nantes, Nantes, France
| | | | - Nicolai Bovin
- Institute of Bioorganic Chemistry RAS, Moscow, Russia
| | - Johan Nordgren
- Division of Molecular Virology, Medical Faculty, University of Linköping, Linköping, Sweden
| | - Lennart Svensson
- Division of Molecular Virology, Medical Faculty, University of Linköping, Linköping, Sweden
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Nathalie Ruvoën-Clouet
- CRCINA, Inserm, Université d'Angers, Université de Nantes, Nantes, France
- Oniris, Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation, Nantes, France
| | - Jacques Le Pendu
- CRCINA, Inserm, Université d'Angers, Université de Nantes, Nantes, France.
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Celestin MD, Ferguson T, Ledford EC, Tseng TS, Carton T, Moody-Thomas S. Differences in Treating Tobacco Use Across National, State, and Public Hospital System Surveys. Prev Chronic Dis 2018; 15:E103. [PMID: 30124428 PMCID: PMC6110402 DOI: 10.5888/pcd15.170575] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Louisiana Tobacco Control Initiative (TCI), a multidisciplinary program specializing in helping tobacco users quit, assisted health care providers in Louisiana’s public hospitals with integrating evidence-based treatment of tobacco use into clinical practice. Our study compared smoking behavior, provider adherence to the 5 A’s tobacco cessation intervention (ask, advise, assess, assist, and arrange), cessation assistance awareness, quit attempts, and treatment preference among respondents to a TCI survey with a sample of respondents from the National Adult Tobacco Survey (NATS) and a sample from the Louisiana Adult Tobacco Survey (LATS). In 2010, more TCI respondents were asked if they smoked, advised to quit, helped to set a quit date, counseled, and arranged to be contacted for follow-up than respondents to NATS or LATS. Fewer TCI respondents received self-help material or were prescribed medication to assist in quitting than NATS and LATS respondents. In 2010 and 2013, TCI participants reported more quit attempts when 4 or more of the 5 A’s were received. Thus, public health systems can promote treatment of tobacco use.
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Affiliation(s)
- Michael D Celestin
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health - New Orleans, New Orleans, Louisiana.,2020 Gravier St, 3rd Floor, New Orleans, LA 70112.
| | - Tekeda Ferguson
- Department of Epidemiology, School of Public Health, Louisiana State University Health - New Orleans, New Orleans, Louisiana
| | | | - Tung-Sung Tseng
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health - New Orleans, New Orleans, Louisiana
| | - Thomas Carton
- Louisiana Public Health Institute, New Orleans, Louisiana
| | - Sarah Moody-Thomas
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health - New Orleans, New Orleans, Louisiana
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24
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Costea PI, Zeller G, Sunagawa S, Pelletier E, Alberti A, Levenez F, Tramontano M, Driessen M, Hercog R, Jung FE, Kultima JR, Hayward MR, Coelho LP, Allen-Vercoe E, Bertrand L, Blaut M, Brown JRM, Carton T, Cools-Portier S, Daigneault M, Derrien M, Druesne A, de Vos WM, Finlay BB, Flint HJ, Guarner F, Hattori M, Heilig H, Luna RA, van Hylckama Vlieg J, Junick J, Klymiuk I, Langella P, Le Chatelier E, Mai V, Manichanh C, Martin JC, Mery C, Morita H, O'Toole PW, Orvain C, Patil KR, Penders J, Persson S, Pons N, Popova M, Salonen A, Saulnier D, Scott KP, Singh B, Slezak K, Veiga P, Versalovic J, Zhao L, Zoetendal EG, Ehrlich SD, Dore J, Bork P. Towards standards for human fecal sample processing in metagenomic studies. Nat Biotechnol 2017; 35:1069-1076. [PMID: 28967887 DOI: 10.1038/nbt.3960] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/11/2017] [Indexed: 12/30/2022]
Abstract
Technical variation in metagenomic analysis must be minimized to confidently assess the contributions of microbiota to human health. Here we tested 21 representative DNA extraction protocols on the same fecal samples and quantified differences in observed microbial community composition. We compared them with differences due to library preparation and sample storage, which we contrasted with observed biological variation within the same specimen or within an individual over time. We found that DNA extraction had the largest effect on the outcome of metagenomic analysis. To rank DNA extraction protocols, we considered resulting DNA quantity and quality, and we ascertained biases in estimates of community diversity and the ratio between Gram-positive and Gram-negative bacteria. We recommend a standardized DNA extraction method for human fecal samples, for which transferability across labs was established and which was further benchmarked using a mock community of known composition. Its adoption will improve comparability of human gut microbiome studies and facilitate meta-analyses.
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Affiliation(s)
- Paul I Costea
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Georg Zeller
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Shinichi Sunagawa
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany.,Department of Biology, Institute of Microbiology, ETH Zurich, Zurich, Switzerland
| | - Eric Pelletier
- CEA - Institut François Jacob - Genoscope, Evry, France.,CNRS UMR-8030, Evry, France.,Université Evry Val d'Essonne, Evry, France
| | | | - Florence Levenez
- Metagenopolis, Institut National de la Recherche Agronomique, Jouy en Josas, France
| | - Melanie Tramontano
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Marja Driessen
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Rajna Hercog
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Ferris-Elias Jung
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Jens Roat Kultima
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Matthew R Hayward
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Luis Pedro Coelho
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Emma Allen-Vercoe
- Department of Molecular and Cellular Biology, The University of Guelph, Guelph, Ontario, Canada
| | | | - Michael Blaut
- Department of Gastrointestinal Microbiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Jillian R M Brown
- School of Microbiology & APC Microbiome Institute, University College Cork, Cork, Ireland
| | | | | | - Michelle Daigneault
- Metagenopolis, Institut National de la Recherche Agronomique, Jouy en Josas, France
| | | | | | - Willem M de Vos
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, the Netherlands.,Immunobiology Research Program, Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - B Brett Finlay
- Michael Smith Laboratories, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harry J Flint
- Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, UK
| | - Francisco Guarner
- Digestive System Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Masahira Hattori
- Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan.,Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan
| | - Hans Heilig
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, the Netherlands
| | - Ruth Ann Luna
- Texas Children's Hospital, Feigin Center, Houston, Texas, USA
| | | | - Jana Junick
- Department of Gastrointestinal Microbiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Ingeborg Klymiuk
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Philippe Langella
- Metagenopolis, Institut National de la Recherche Agronomique, Jouy en Josas, France
| | | | - Volker Mai
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Chaysavanh Manichanh
- Digestive System Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jennifer C Martin
- Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, UK
| | | | - Hidetoshi Morita
- Graduate School of Environmental and Life Science, Okayama University, Okayama, Japan
| | - Paul W O'Toole
- School of Microbiology & APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Céline Orvain
- CEA - Institut François Jacob - Genoscope, Evry, France
| | - Kiran Raosaheb Patil
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany
| | - John Penders
- School of Nutrition and Translational Research in Metabolism (NUTRIM) and Care and Public Health Research Institute (Caphri), Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Søren Persson
- Unit of Foodborne Infections, Department of Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Nicolas Pons
- Metagenopolis, Institut National de la Recherche Agronomique, Jouy en Josas, France
| | | | - Anne Salonen
- Immunobiology Research Program, Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
| | - Delphine Saulnier
- Department of Gastrointestinal Microbiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Karen P Scott
- Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen, UK
| | - Bhagirath Singh
- Centre for Human Immunology, Department of Microbiology & Immunology and Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Kathleen Slezak
- Department of Gastrointestinal Microbiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | | | | | - Liping Zhao
- Ministry of Education Key Laboratory for Systems Biomedicine, Shanghai Centre for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Erwin G Zoetendal
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, the Netherlands
| | - S Dusko Ehrlich
- Metagenopolis, Institut National de la Recherche Agronomique, Jouy en Josas, France.,King's College London, Centre for Host-Microbiome Interactions, Dental Institute Central Office, Guy's Hospital, London, UK
| | - Joel Dore
- Metagenopolis, Institut National de la Recherche Agronomique, Jouy en Josas, France
| | - Peer Bork
- Structural and Computational Biology, European Molecular Biology Laboratory, Heidelberg, Germany.,Department of Bioinformatics, Biocenter, University of Würzburg, Würzburg, Germany.,Molecular Medicine Partnership Unit, Heidelberg, Germany.,Max-Delbrück-Centre for Molecular Medicine, Berlin, Germany
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Pensec C, Martino AD, Serres LA, Amouzou Y, Leuillet S, campone M, Carton T, VACON FLE. Abstract LB-172: Chemotherapy impact on the gut microbiota: clinical trial on patients. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-lb-172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The French Consortium IMODI (Innovative MODels Initiative) aims to develop predictive preclinical mouse models for new chemotherapeutic treatment discovery, to progress toward personalized medicine. In this consortium, Biofortis Merieux NutriSciences issue is to better understand the relation between gut microbiota and cancer, particularly during chemotherapeutic treatment. Because chemotherapy can lead to disruption in microbiota composition and several side effects, our purpose is to identify and track the impact of chemotherapy treatment on the gut microbiota.
To this aim, we coordinate a clinical study to recruit patients with four types of cancer (breast, ovary, liver and prostate) from 7 clinical centers. Gut microbiota composition is assessed by targeted metagenomic, from patient stool samples, collected before, during and after chemotherapy. The 16S rDNA sequences will be analyzed using an in-house bioinformatic pipeline based on mothur software.
Interestingly, preliminary results from preclinical studies showed that some chemotherapeutic treatments could have an effect on gut microbiota composition associated with weight loss. These results support that microbiota is an important additional parameter for evaluating the efficacy and the toxicity of pharmacological treatments. The clinical study is ongoing to better understand the effect of chemotherapy on the gut microbiota. This approach may lead to beneficial intervention for cancer patients, particularly to minimize side effects and infectious complications.
Note: This abstract was not presented at the meeting.
Citation Format: Cindy Pensec, Alessandra De Martino, Laure-Anne Serres, IMODI consortium, Yao Amouzou, Sebastien Leuillet, Mario campone, Thomas Carton, Françoise LE VACON. Chemotherapy impact on the gut microbiota: clinical trial on patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-172. doi:10.1158/1538-7445.AM2017-LB-172
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Affiliation(s)
- Cindy Pensec
- 1Biofortis Mérieux NutriSciences, Saint Herblain, France
| | | | | | - Yao Amouzou
- 1Biofortis Mérieux NutriSciences, Saint Herblain, France
| | | | - Mario campone
- 2Institut Cancérologie Ouest, Saint Herblain, France
| | - Thomas Carton
- 1Biofortis Mérieux NutriSciences, Saint Herblain, France
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Futrell Dunaway L, Carton T, Ma P, Mundorf AR, Keel K, Theall KP. Beyond Food Access: The Impact of Parent-, Home-, and Neighborhood-Level Factors on Children's Diets. Int J Environ Res Public Health 2017. [PMID: 28632162 PMCID: PMC5486348 DOI: 10.3390/ijerph14060662] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Despite the growth in empirical research on neighborhood environmental characteristics and their influence on children’s diets, physical activity, and obesity, much remains to be learned, as few have examined the relationship between neighborhood food availability on dietary behavior in children, specifically. This analysis utilized data from a community-based, cross-sectional sample of children (n = 199) that was collected in New Orleans, Louisiana, in 2010. This dataset was linked to food environment data to assess the impact of neighborhood food access as well as household and parent factors on children’s diets. We observed a negligible impact of the neighborhood food environment on children’s diets, except with respect to fast food, with children who had access to fast food within 500 m around their home significantly less likely (OR = 0.35, 95% CI: 0.1, 0.8) to consume vegetables. Key parental and household factors did play a role in diet, including receipt of public assistance and cooking meals at home. Children receiving public assistance were 2.5 times (95% CI: 1.1, 5.4) more likely to consume fruit more than twice per day compared with children not receiving public assistance. Children whose family cooked dinner at home more than 5 times per week had significantly more consumption of fruit (64% vs. 58%) and vegetables (55% vs. 39%), but less soda (27% vs. 43%). Findings highlight the need for future research that focuses on the dynamic and complex relationships between built and social factors in the communities and homes of children that impact their diet in order to develop multilevel prevention approaches that address childhood obesity.
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Affiliation(s)
- Lauren Futrell Dunaway
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
- Mary Amelia Douglas Whited Community Women's Health Education Center and Prevention Research Center (PRC), Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
| | - Thomas Carton
- Louisiana Public Health Institute, New Orleans, LA 70112, USA.
| | - Ping Ma
- Children's HealthSM, Children's Medical Center, Dallas, TX 75235, USA.
| | | | - Kelsey Keel
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
- Mary Amelia Douglas Whited Community Women's Health Education Center and Prevention Research Center (PRC), Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
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Culbertson A, Goel S, Madden MB, Safaeinili N, Jackson KL, Carton T, Waitman R, Liu M, Krishnamurthy A, Hall L, Cappella N, Visweswaran S, Becich MJ, Applegate R, Bernstam E, Rothman R, Matheny M, Lipori G, Bian J, Hogan W, Bell D, Martin A, Grannis S, Klann J, Sutphen R, O'Hara AB, Kho A. The Building Blocks of Interoperability. A Multisite Analysis of Patient Demographic Attributes Available for Matching. Appl Clin Inform 2017; 8:322-336. [PMID: 28378025 PMCID: PMC6241737 DOI: 10.4338/aci-2016-11-ra-0196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/21/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient matching is a key barrier to achieving interoperability. Patient demographic elements must be consistently collected over time and region to be valuable elements for patient matching. OBJECTIVES We sought to determine what patient demographic attributes are collected at multiple institutions in the United States and see how their availability changes over time and across clinical sites. METHODS We compiled a list of 36 demographic elements that stakeholders previously identified as essential patient demographic attributes that should be collected for the purpose of linking patient records. We studied a convenience sample of 9 health care systems from geographically distinct sites around the country. We identified changes in the availability of individual patient demographic attributes over time and across clinical sites. RESULTS Several attributes were consistently available over the study period (2005-2014) including last name (99.96%), first name (99.95%), date of birth (98.82%), gender/sex (99.73%), postal code (94.71%), and full street address (94.65%). Other attributes changed significantly from 2005-2014: Social security number (SSN) availability declined from 83.3% to 50.44% (p<0.0001). Email address availability increased from 8.94% up to 54% availability (p<0.0001). Work phone number increased from 20.61% to 52.33% (p<0.0001). CONCLUSIONS Overall, first name, last name, date of birth, gender/sex and address were widely collected across institutional sites and over time. Availability of emerging attributes such as email and phone numbers are increasing while SSN use is declining. Understanding the relative availability of patient attributes can inform strategies for optimal matching in healthcare.
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Affiliation(s)
- Adam Culbertson
- Adam Culbertson, 4300 Wilson Blvd., Suite 250, Arlington, VA 22203,
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Kuehn J, Wittke F, Barbier M, Fresne SL, Carton T, Leuillet S, Vacon FL, Vuagniaux G. The Staphylococcal-Specific Antibiotic Debio 1450 Minimizes Disturbance to the Gut Microbiota in Mice. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Le Huërou-Luron I, Bouzerzour K, Ferret-Bernard S, Ménard O, Le Normand L, Perrier C, Le Bourgot C, Jardin J, Bourlieu C, Carton T, Le Ruyet P, Cuinet I, Bonhomme C, Dupont D. A mixture of milk and vegetable lipids in infant formula changes gut digestion, mucosal immunity and microbiota composition in neonatal piglets. Eur J Nutr 2016; 57:463-476. [PMID: 27744547 DOI: 10.1007/s00394-016-1329-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/11/2016] [Indexed: 01/29/2023]
Abstract
PURPOSE Although composition of infant formula has been significantly improved during the last decade, major differences with the composition and structure of breast milk still remain and might affect nutrient digestion and gut biology. We hypothesized that the incorporation of dairy fat in infant formulas could modify their physiological impacts by making their composition closer to that of human milk. The effect of milk fat and milk fat globule membrane (MFGM) fragments in infant formulas on gut digestion, mucosal immunity and microbiota composition was evaluated. METHODS Three formulas containing either (1) vegetable lipids stabilized only by proteins (V-P), (2) vegetable lipids stabilized by a mixture of proteins and MFGM fragments (V-M) and (3) a mixture of milk and vegetable lipids stabilized by a mixture of proteins and MFGM fragments (M-M) were automatically distributed to 42 newborn piglets until slaughter at postnatal day (PND) 7 or 28, and compared to a fourth group of sow's suckling piglets (SM) used as a breast-fed reference. RESULTS At both PND, casein and β-lactoglobulin digestion was reduced in M-M proximal jejunum and ileum contents compared to V-P and V-M ones leading to more numerous β-Cn peptides in M-M contents. The IFNγ cytokine secretion of ConA-stimulated MLN cells from M-M piglets tended to be higher than in V-P ones at PND 7 and PND 28 and was closer to that of SM piglets. No dietary treatment effect was observed on IL-10 MLN cell secretion. Changes in faecal microbiota in M-M piglets resulted in an increase in Proteobacteria and Bacteroidetes and a decrease in Firmicutes phyla compared to V-P ones. M-M piglets showed higher abundances of Parabacteroides, Escherichia/Shigella and Klebsiella genus. CONCLUSIONS The incorporation of both milk fat and MFGM fragments in infant formula modifies protein digestion, the dynamic of the immune system maturation and the faecal microbiota composition.
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Affiliation(s)
- Isabelle Le Huërou-Luron
- UR1341 ADNC, INRA, Domaine de la Prise, 35590, Saint-Gilles, France. .,UR1341 ADNC, INRA, Domaine de la Prise, 35590, Saint-Gilles, France.
| | - Karima Bouzerzour
- UMR1253 STLO, INRA, 35000, Rennes, France.,UMR1253 STLO, Agrocampus Ouest, 35000, Rennes, France
| | | | - Olivia Ménard
- UMR1253 STLO, INRA, 35000, Rennes, France.,UMR1253 STLO, Agrocampus Ouest, 35000, Rennes, France
| | | | - Cécile Perrier
- UR1341 ADNC, INRA, Domaine de la Prise, 35590, Saint-Gilles, France
| | - Cindy Le Bourgot
- UR1341 ADNC, INRA, Domaine de la Prise, 35590, Saint-Gilles, France
| | - Julien Jardin
- UMR1253 STLO, INRA, 35000, Rennes, France.,UMR1253 STLO, Agrocampus Ouest, 35000, Rennes, France
| | - Claire Bourlieu
- UMR1253 STLO, INRA, 35000, Rennes, France.,UMR1253 STLO, Agrocampus Ouest, 35000, Rennes, France
| | | | | | | | | | - Didier Dupont
- UMR1253 STLO, INRA, 35000, Rennes, France.,UMR1253 STLO, Agrocampus Ouest, 35000, Rennes, France
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Levy D, Fergus C, Rudov L, McCormick-Ricket I, Carton T. Tobacco Policies in Louisiana: Recommendations for Future Tobacco Control Investment from SimSmoke, a Policy Simulation Model. Prev Sci 2015; 17:199-207. [PMID: 26314867 DOI: 10.1007/s11121-015-0587-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the presence of tobacco control policies, Louisiana continues to experience a high smoking burden and elevated smoking-attributable deaths. The SimSmoke model provides projections of these health outcomes in the face of existing and expanded (simulated) tobacco control polices. The SimSmoke model utilizes population data, smoking rates, and various tobacco control policy measures from Louisiana to predict smoking prevalence and smoking-attributable deaths. The model begins in 1993 and estimates are projected through 2054. The model is validated against existing Louisiana smoking prevalence data. The most powerful individual policy measure for reducing smoking prevalence is cigarette excise tax. However, a comprehensive cessation treatment policy is predicted to save the most lives. A combination of tobacco control policies provides the greatest reduction in smoking prevalence and smoking-attributable deaths. The existing Louisiana excise tax ranks as one of the lowest in the country and the legislature is against further increases. Alternative policy measures aimed at lowering prevalence and attributable deaths are: cessation treatments, comprehensive smoke-free policies, and limiting youth access. These three policies have a substantial effect on smoking prevalence and attributable deaths and are likely to encounter more favor in the Louisiana legislature than increasing the state excise tax.
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Affiliation(s)
- David Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St., NW, Suite 4100, Washington, DC, 20007, USA
| | - Cristin Fergus
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - Lindsey Rudov
- Division of Evaluation and Research, Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, 70112, USA
| | - Iben McCormick-Ricket
- Division of Evaluation and Research, Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, 70112, USA.
| | - Thomas Carton
- Division of Evaluation and Research, Louisiana Public Health Institute, 1515 Poydras Street, Suite 1200, New Orleans, LA, 70112, USA
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31
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Sullivan KE, Boyle M, Nauman E, Carton T. Health care utilization by patients with common variable immune deficiency defined by International Classification of Diseases, Ninth Revision code 279.06. Ann Allergy Asthma Immunol 2015; 115:248-50. [PMID: 26162568 DOI: 10.1016/j.anai.2015.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/27/2015] [Accepted: 06/17/2015] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | - Thomas Carton
- Louisiana Public Health Institute, New Orleans, Louisiana
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32
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Montassier E, Batard E, Massart S, Gastinne T, Carton T, Caillon J, Le Fresne S, Caroff N, Hardouin JB, Moreau P, Potel G, Le Vacon F, de La Cochetière MF. 16S rRNA gene pyrosequencing reveals shift in patient faecal microbiota during high-dose chemotherapy as conditioning regimen for bone marrow transplantation. Microb Ecol 2014; 67:690-9. [PMID: 24402367 DOI: 10.1007/s00248-013-0355-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 12/16/2013] [Indexed: 05/11/2023]
Abstract
Gastrointestinal disturbances are a side-effect frequently associated with haematological malignancies due to the intensive cytotoxic treatment given in connection with bone marrow transplantation (BMT). However, intestinal microbiota changes during chemotherapy remain poorly described, probably due to the use of culture-based and low-resolution molecular methods in previous studies. The objective of our study was to apply a next generation DNA sequencing technology to analyse chemotherapy-induced changes in faecal microbiota. We included eight patients with non-Hodgkin's lymphoma undergoing one course of BMT conditioning chemotherapy. We collected a prechemotherapy faecal sample, the day before chemotherapy was initiated, and a postchemotherapy sample, collected 1 week after the initiation of chemotherapy. Total DNA was extracted from faecal samples, denaturing high-performance liquid chromatography based on amplification of the V6 to V8 region of the 16S ribosomal RNA (rRNA) gene, and 454-pyrosequencing of the 16 S rRNA gene, using PCR primers targeting the V5 and V6 hypervariable 16S rRNA gene regions were performed. Raw sequence data were screened, trimmed, and filtered using the QIIME pipeline. We observed a steep reduction in alpha diversity and significant differences in the composition of the intestinal microbiota in response to chemotherapy. Chemotherapy was associated with a drastic drop in Faecalibacterium and accompanied by an increase of Escherichia. The chemotherapy-induced shift in the intestinal microbiota could induce severe side effects in immunocompromised cancer patients. Our study is a first step in identifying patients at risk for gastrointestinal disturbances and to promote strategies to prevent this drastic shift in intestinal microbiota.
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Affiliation(s)
- Emmanuel Montassier
- EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine, Université de Nantes, 1 Rue G Veil, 44000, Nantes, France,
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33
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Parke C, Cook J, Carton T, Rao S. The louisiana clinical data research network: leveraging regional and national resources to improve clinical research efficiency. Ochsner J 2014; 14:718-723. [PMID: 25598739 PMCID: PMC4295751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Mapping of the human genome and technological advancements allowing storage and rapid retrieval of healthcare data have heralded a new phase in clinical medicine and have served as a catalyst for the advent of personalized medicine. The use of health information databases provides a unique opportunity to investigate questions of great complexity and real-world application in a way that is most useful in providing high quality, safe, and cost-effective clinical care to patients. METHODS The Louisiana Clinical Data Research Network (LACDRN) aims to streamline the workflow of multiinstitutional clinical studies and to dramatically expand the clinical research resources available to local investigators. The LACDRN contains health information for more than 1 million patients in Southeast Louisiana and is a rich resource for researchers to conduct retrospective or observational trials and to recruit patients for prospective studies. RESULTS The LACDRN is part of a large-scale initiative by the Patient-Centered Outcomes Research Institute to create a national electronic health record network that enables the timely initiation and completion of comparative effectiveness research in a coordinated effort. For the first time, network research will be guided in part by input from patients and caregivers, increasing their engagement in the research process. CONCLUSION The establishment of the LACDRN is a unique opportunity for clinicians to take part in an innovative national initiative designed to offer new clinical research options for patients and to carry out cutting-edge translational, clinical, and health services research.
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Affiliation(s)
- Courtney Parke
- Institute of Clinical Research, Ochsner Health System, New Orleans, LA
| | - Julia Cook
- Institute of Clinical Research, Ochsner Health System, New Orleans, LA
| | | | - Sohail Rao
- Institute of Clinical Research, Ochsner Health System, New Orleans, LA
- Academic Division-Research, Ochsner Health System and The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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Popova M, Molimard P, Courau S, Crociani J, Dufour C, Le Vacon F, Carton T. Beneficial effects of probiotics in upper respiratory tract infections and their mechanical actions to antagonize pathogens. J Appl Microbiol 2012; 113:1305-18. [PMID: 22788970 PMCID: PMC7166318 DOI: 10.1111/j.1365-2672.2012.05394.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 06/22/2012] [Accepted: 07/05/2012] [Indexed: 12/16/2022]
Abstract
Probiotics are live micro‐organisms with beneficial effects on human health, which have the ability to counteract infections at different locations of the body. Clinical trials have shown that probiotics can be used as preventive and therapeutic agents in upper respiratory tract infections (URTIs) and otitis. Their mechanical properties allow them to aggregate and to compete with pathogens for nutrients, space and attachment to host cells. Consequently, they can directly antagonize pathogens and thus exert beneficial effects without directly affecting the metabolism of the host. An overview of the probiotics with such traits, tested up to date in clinical trials for the prevention or treatment of URTIs and otitis, is presented in this review. Their mechanical properties in the respiratory tract as well as at other locations are also cited. Species with interesting in vitro properties towards pharyngeal cells or against common respiratory pathogens have also been included. The potential safety risks of the cited species are then discussed. This review could be of help in the screening of probiotic strains with specific mechanical properties susceptible to have positive effects in clinical trials against URTIs.
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Affiliation(s)
- M Popova
- Biofortis, Saint Herblain, France
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35
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Le Fresne S, Popova M, Le Vacon F, Carton T. Application of denaturing high-performance liquid chromatography (DHPLC) for the identification of fish: a new way to determine the composition of processed food containing multiple species. J Agric Food Chem 2011; 59:12302-12308. [PMID: 22023225 DOI: 10.1021/jf2030242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The identification of fish species in transformed food products is difficult because the existing methods are not adapted to heat-processed products containing more than one species. Using a common to all vertebrates region of the cytochrome b gene, we have developed a denaturing high-performance liquid chromatography (DHPLC) fingerprinting method, which allowed us to identify most of the species in commercial crab sticks. Whole fish and fillets were used for the creation of a library of referent DHPLC profiles. Crab sticks generated complex DHPLC profiles in which the number of contained fish species can be estimated by the number of major fluorescence peaks. The identity of some of the species was predicted by comparison of the peaks with the referent profiles, and others were identified after collection of the peak fractions, reamplification, and sequencing. DHPLC appears to be a quick and efficient method to analyze the species composition of complex heat-processed fish products.
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Affiliation(s)
- Sophie Le Fresne
- Biofortis SAS , 21 rue de La Noue Bras de Fer, 44200 Nantes, France
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Caillaux G, de La Cochetière MF, Carton T, Le Vacon F, Rozé JC, Potel G, Caillon J, Gras-Le Guen C. Application of denaturing high-performance liquid chromatography for intestinal microbiota analysis of newborns. J Perinat Med 2010; 38:339-41. [PMID: 20121491 DOI: 10.1515/jpm.2010.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Neonatal microbiota development seems to play a key role in the early origins of health and disease. However, the analysis of this complex ecosystem is still difficult. The aim of this work was to investigate the feasibility of a new technique, denaturing high-performance liquid chromatography (dHPLC), to analyze newborn intestinal microbiota using genomic approaches. METHODS AND RESULTS Eleven neonates were recruited among patients admitted for intestinal surgery to the neonatal intensive care unit. Preoperative samplings were obtained in each case. Three methodologies were compared for each sample: (i) dHPLC, (ii) temporal temperature gradient gel electrophoresis (TTGE), and (iii) conventional culture techniques. RESULTS All samples were poorly colonized. In three samples, the microbiota was detected only with the dHPLC technique. Results obtained with culture and TTGE could be found with dHPLC. CONCLUSION The results suggest that neonatal applications of the dHPLC technique, especially for gut microbiota analysis, appear to be a sensitive and promising analytical technique.
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Affiliation(s)
- Gaëlle Caillaux
- Université de Nantes, Nantes Atlantique Universités, Thérapeutiques Cliniques et Expérimentales des Infections, EA 3826, UFR Médecine, 1 rue G. Veil, F-44000 Nantes, France
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de La Cochetière MF, Montassier E, Hardouin JB, Carton T, Le Vacon F, Durand T, Lalande V, Petit JC, Potel G, Beaugerie L. Human intestinal microbiota gene risk factors for antibiotic-associated diarrhea: perspectives for prevention. Risk factors for antibiotic-associated diarrhea. Microb Ecol 2010; 59:830-837. [PMID: 20186408 PMCID: PMC3348119 DOI: 10.1007/s00248-010-9637-2] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 01/23/2010] [Indexed: 05/28/2023]
Abstract
Antibiotic-associated diarrhea (AAD) is associated with altered intestinal microflora and other symptoms that may lead to possibly death. In critically ill patients, diarrhea increases rates of morbimortality. Assessing diarrhea risks is thus important for clinicians. For this reason, we conducted a hypothesis-generating study focused on AAD to provide insight into methods of prevention. We evaluated the hypothesis of predisposing factors within the resident intestinal microbiota in a cohort of outpatients receiving antibiotherapy. Among the pool of tested variables, only those related to bacterial 16S rRNA genes were found to be relevant. Complex statistical analyses provided further information: amid the bacteria 16S rRNA genes, eight were determined to be essential for diarrhea predisposition and characterized from the most important to the least. Using these markers, AAD risk could be estimated with an error of 2%. This molecular analysis offers new perspectives for clinical applications at the level of prevention.
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Affiliation(s)
- Marie-France de La Cochetière
- Thérapeutiques Cliniques et Expérimentales des Infections, EA3826, Université de Nantes - INSERM, UFR Médecine, 1 rue Gaston Veil, Nantes, 44000, France.
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Carton T, Tan XD, Hartemann P, Joyeux M. Use of genotypic selection to detect P53 codon 273 CGT>CTT transversion: application to an occupationally exposed population. Int J Hyg Environ Health 2006; 210:69-77. [PMID: 16949342 DOI: 10.1016/j.ijheh.2006.07.001] [Citation(s) in RCA: 2] [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] [Received: 09/02/2005] [Revised: 06/21/2006] [Accepted: 07/01/2006] [Indexed: 11/27/2022]
Abstract
CGT>CTT transversion in codon 273 of the P53 tumor-suppressor gene is one of the major mutations detected in human tumors. Within an epidemiological framework, we investigated the use of a genotypic selection method to measure this point mutation. The allele-specific polymerase chain reaction (AS-PCR) that was developed was able to detect 10 mutant copies of the gene among a total of 5 x 10(5) wild-type copies. We used this assay to detect CGT>CTT transversions in buccal cell DNA of production workers (n=76) from a viscose factory exposed to carbon disulfide (amongst other pollutants) and in the DNA of non-exposed office workers (n=67). The mutation appeared more frequently in the exposed than in the non-exposed worker who were smokers. The results of the study indicate that occupational exposure results in a significant increase in P53 CGT>CTT transversions and more especially identified occupational exposure in combination with smoking as a significant risk factor for the mutation. We conclude that AS-PCR of the P53 273rd codon transversions is a suitable technique for studying the effects of occupational exposure.
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Affiliation(s)
- T Carton
- Département Environnement Santé Publique, Faculté de Médecine, Nancy, BP 184, 54505 Vandoeuvre, France.
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