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Kapp KL, Ji Choi M, Bai K, Du L, Yende S, Kellum JA, Angus DC, Peck-Palmer OM, Robinson RAS. PATHWAYS ASSOCIATED WITH POSITIVE SEPSIS SURVIVAL OUTCOMES IN AFRICAN AMERICAN/BLACK AND NON-HISPANIC WHITE PATIENTS WITH URINARY TRACT INFECTION. Shock 2023; 60:362-372. [PMID: 37493584 PMCID: PMC10527228 DOI: 10.1097/shk.0000000000002176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
ABSTRACT Urinary tract infections (UTIs) are a common cause of sepsis worldwide. Annually, more than 60,000 US deaths can be attributed to sepsis secondary to UTIs, and African American/Black adults have higher incidence and case-fatality rates than non-Hispanic White adults. Molecular-level factors that may help partially explain differences in sepsis survival outcomes between African American/Black and Non-Hispanic White adults are not clear. In this study, patient samples (N = 166) from the Protocolized Care for Early Septic Shock cohort were analyzed using discovery-based plasma proteomics. Patients had sepsis secondary to UTIs and were stratified according to self-identified racial background and sepsis survival outcomes. Proteomics results suggest patient heterogeneity across mechanisms driving survival from sepsis secondary to UTIs. Differentially expressed proteins (n = 122, false discovery rate-adjusted P < 0.05) in Non-Hispanic White sepsis survivors were primarily in immune system pathways, while differentially expressed proteins (n = 47, false discovery rate-adjusted P < 0.05) in African American/Black patients were mostly in metabolic pathways. However, in all patients, regardless of racial background, there were 16 differentially expressed proteins in sepsis survivors involved in translation initiation and shutdown pathways. These pathways are potential targets for prognostic intervention. Overall, this study provides information about molecular factors that may help explain disparities in sepsis survival outcomes among African American/Black and Non-Hispanic White patients with primary UTIs.
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Affiliation(s)
- Kathryn L. Kapp
- Department of Chemistry, Vanderbilt University, Nashville, TN, 37235, USA
- The Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, 32732, USA
| | - Min Ji Choi
- Department of Chemistry, Vanderbilt University, Nashville, TN, 37235, USA
| | - Kun Bai
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
| | - Liping Du
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 37203, USA
- Vanderbilt Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Sachin Yende
- The Clinical Research, Investigation, and Systems Modeling of Acute Illnesses (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Clinical and Translational Science, University of Pittsburgh, PA, 15261, USA
| | - John A. Kellum
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Derek C. Angus
- The Clinical Research, Investigation, and Systems Modeling of Acute Illnesses (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Clinical and Translational Science, University of Pittsburgh, PA, 15261, USA
| | - Octavia M. Peck-Palmer
- The Clinical Research, Investigation, and Systems Modeling of Acute Illnesses (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, 15213, USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
- Department of Clinical and Translational Science, University of Pittsburgh, PA, 15261, USA
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Renã A. S. Robinson
- Department of Chemistry, Vanderbilt University, Nashville, TN, 37235, USA
- The Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, 32732, USA
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Boyd BAJ, Winkelman WD, Mishra K, Vittinghoff E, Jacoby VL. Racial and ethnic differences in reconstructive surgery for apical vaginal prolapse. Am J Obstet Gynecol 2021; 225:405.e1-405.e7. [PMID: 33984303 DOI: 10.1016/j.ajog.2021.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is limited literature identifying racial and ethnic health disparities among surgical modalities and outcomes in the field of urogynecology and specifically pelvic organ prolapse surgery. OBJECTIVE This study aimed to evaluate the differences in surgical approach for apical vaginal prolapse and postoperative complications by race and ethnicity. STUDY DESIGN This is a retrospective cohort study of women undergoing surgical repair for apical vaginal prolapse between 2014 and 2017 using data from the American College of Surgeons National Surgical Quality Improvement Program. Patients were eligible for inclusion if they underwent either vaginal colpopexy or abdominal sacrocolpopexy. Abdominal sacrocolpopexy cases were further divided into those performed by laparotomy and those performed by laparoscopy. Multivariable logistic regression models that controlled for age, comorbidities, American Society of Anesthesiologists physical status classification, and concurrent surgery were used to determine whether race and ethnicity are associated with the type of colpopexy (vaginal vs abdominal) or the surgical route of abdominal sacrocolpopexy. Similar models that also controlled for surgical approach were used to assess 30-day complications by race and ethnicity. RESULTS A total of 22,861 eligible surgical cases were identified, of which 12,337 (54%) were vaginal colpopexy and 10,524 (46%) were abdominal sacrocolpopexy. Among patients who had an abdominal sacrocolpopexy, 2262 (21%) were performed via laparotomy and 8262 (79%) via laparoscopy. The study population was 70% White, 9% Latina, 6% African American, 3% Asian, 0.6% Native Hawaiian or Pacific Islander, 0.4% American Indian or Alaska Native, and 11% unknown. In multivariable analysis, Asian and Native Hawaiian or Pacific Islander women were less likely to undergo abdominal sacrocolpopexy compared with White women (odds ratio, 0.82; 95% confidence interval, 0.68-0.99, and odds ratio, 0.56; 95% confidence interval, 0.39-0.82, respectively). Among women who underwent an abdominal sacrocolpopexy, Latina women and Native Hawaiian or Pacific Islander women were less likely to undergo a laparoscopic approach compared with White women (odds ratio, 0.68; 95% confidence interval, 0.58-0.79, and odds ratio, 0.31; 95% confidence interval, 0.1-0.56, respectively). Complication rates also differed by race and ethnicity. After a colpopexy, African American women were more likely to need a blood transfusion (odds ratio, 3.04; 95% confidence interval, 1.95-4.73; P≤.001) and have a deep vein thrombosis or pulmonary embolus (odds ratio, 2.46; 95% confidence interval, 1.10-5.48; P=.028), but less likely to present with postoperative urinary tract infections (odds ratio, 0.68; 95% confidence interval, 0.49-0.96; P=.028) than White women in multivariable regression models. Using the Clavien-Dindo classification system, Latina women had higher odds of developing grade II complications than White women in multivariable models (odds ratio, 1.25; 95% confidence interval, 1.04-1.51; P=.02). CONCLUSION There are racial and ethnic differences in the type and route of surgical repair for apical vaginal prolapse. In particular, Latina and Pacific Islander women were less likely to undergo a laparoscopic approach to abdominal sacrocolpopexy compared with White women. Although complications were uncommon, there were several complications including blood transfusions that were higher among African American and Latina women. Additional studies are needed to better understand and describe associated factors for these differences in care and surgical outcomes.
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Affiliation(s)
- Brittni A J Boyd
- Department of Obstetrics, Gynecology, and Reproductive Science, University of California, San Francisco, CA.
| | - William D Winkelman
- Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Kavita Mishra
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Vanessa L Jacoby
- Department of Obstetrics, Gynecology, and Reproductive Science, University of California, San Francisco, CA
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Hernández-Torres FA, Hernández-Nava N. [Analysis of the epidemiological profile of the indigenous community of Hueyapan, Morelos]. Rev Med Inst Mex Seguro Soc 2019; 57:291-298. [PMID: 32568484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The epidemiological transition is a phenomenon that has had a different impact between urban and rural settings. The WHO points out that the population with the lowest socioeconomic status is the most adversely affected for the unequal distribution of resources, indigenous people are a part of this population. OBJECTIVE To analyze the epidemiological profile of the indigenous people of Hueyapan, Morelos during the months of March to June 2017. METHODS A cross-sectional epidemiological study was carried out in the indigenous community of Hueyapan, belonging to the municipality of Morelos, in 2017. A sample of 338 households was calculated; as inclusion criteria, those dwellings where the age of residence in Hueyapan was equal to or greater than four years were taken; a systematic sampling was carried out every three households, in addition, Mexico's INEGI and Health Department databases were analyzed from 2011 to 2015. RESULTS In relation to morbidity, an upward trend was found in the crude rate, from 119.7 per 1,000 in 2011 to 270.7 per 1000 in 2015, among the most prevalent diseases in those years, infectious diseases were identified as major and the appearance of noncommunicable diseases began to be observed. In relation to mortality, a linear trend was observed in the crude rate of 5.7 per 1000 in 2011 to 6.6 per 1000 in 2015. CONCLUSIONS The epidemiological profile of Hueyapan coincides with a process of epidemiological transition where there is a double burden of disease. This suggests a challenge for the public health area that should be addressed from the creation of health strategies, programs and policies aimed at this population from an intercultural approach.
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Affiliation(s)
- Francisca Angélica Hernández-Torres
- Instituto Nacional de Salud Pública, Escuela de Salud Pública de México Campus Cuernavaca, Maestría en Salud Pública. Cuernavaca, Morelos, México
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Eguia E, Cobb AN, Kirshenbaum EJ, Afshar M, Kuo PC. Racial and Ethnic Postoperative Outcomes After Surgery: The Hispanic Paradox. J Surg Res 2018; 232:88-93. [PMID: 30463790 DOI: 10.1016/j.jss.2018.05.074] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/03/2018] [Accepted: 05/31/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Hispanic population in the United States have previously been shown to have, in some cases, better health outcomes than non-Hispanic whites (NHWs) despite having lower socioeconomic status and higher frequency of comorbidities. This epidemiologic finding is coined as the Hispanic Paradox (HP). Few studies have evaluated if the HP exists in surgical patients. Our study aimed to examine postoperative complications between Hispanic and NHW patients undergoing low- to high-risk procedures. MATERIALS AND METHODS We conducted a retrospective cohort study analyzing adult patients who underwent high-, intermediate-, and low-risk procedures. The Healthcare Cost and Utilization Project California State Inpatient Database between 2006 and 2011 was used to identify the patient cohort. Candidate variables for the adjusted model were determined a priori and included patient demographics with the ethnic group as the exposure of interest. RESULTS The median age for Hispanics was 52 (SD 19.3) y, and 38.8% were male (n = 87,837). A higher proportion of Hispanics had Medicaid insurance (23.9% versus 3.8%) or were self-pay (14.2% versus 4.5%) compared with NHWs. In adjusted analysis, Hispanics had a higher odds risk for postoperative complications across all risk categories combined (OR 1.06, 95% CI 1.04-1.09). They also had an increased in-hospital (OR 1.38, 95% CI 1.14-1.30) and 30-d mortality in high-risk procedures (OR 1.34, 95% CI 1.19-1.51). CONCLUSIONS Hispanics undergoing low- to high-risk surgery have worse outcomes compared with NHWs. These results do not support the hypothesis of an HP in surgical outcomes.
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Affiliation(s)
- Emanuel Eguia
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; One: MAP Division of Clinical Informatics and Analytics, Department of Surgery, Loyola University Chicago, Maywood, Illinois.
| | - Adrienne N Cobb
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; One: MAP Division of Clinical Informatics and Analytics, Department of Surgery, Loyola University Chicago, Maywood, Illinois
| | - Eric J Kirshenbaum
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Majid Afshar
- Department of Pulmonary and Critical Care, Loyola University Medical Center, Maywood, Illinois
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, Florida
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Elnasasra A, Alnsasra H, Smolyakov R, Riesenberg K, Nesher L. Ethnic Diversity and Increasing Resistance Patterns of Hospitalized Community-Acquired Urinary Tract Infections in Southern Israel: A Prospective Study. Isr Med Assoc J 2017; 19:538-542. [PMID: 28971635] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Little is known about the incidence of urinary tract infections (UTI) in the dispersed Bedouin population. UTIs are routinely treated empirically according to local resistance patterns, which is important when evaluating the risk factors and antibiotic resistance patterns in the Bedouin population. OBJECTIVES To analyze risk factors, pathogens, and antibiotic resistance patterns of UTIs in the Bedouin population compared to the general population in southern Israel. To compare data from this study to that from a previous study conducted at our center. METHODS We prospectively followed all patients hospitalized with community acquired UTIs during a 4 month period at Soroka Medical Center. We also compared results from this study to those from a study conducted in 2000. RESULTS The study comprised 223 patients: 44 Bedouin (19.7%), 179 (80.3) non-Bedouin; 158 female (70.9%), 65 male (29.1). The Bedouin were younger (51.7 vs. 71.1 years of age, P < 0.001) and had a lower Charlson Comorbidity Index (2.25 vs. 4.87, P < 0.001). Enterobacteriaceae were the most common pathogens identified, and Escherichia coli (E. coli) was the most common with 156 (70%) strains identified, followed by Klebsiella spp. with 29 (13%), Proteus spp. with 18 (8%), pseudomonas with 9 (4%), and other bacteria including enterococci with 11 (5%). The prevalence of E. coli increased significantly from 56% in 2000 to 70% in this study. We also noted an increase in community acquired extended spectrum beta lactamase (ESBL) pathogens from 4.5% in 2000 to 25.5% in the present study. No statistically significant difference was observed between the Bedouin and general populations in the causal pathogens, resistance to antibiotics, length of therapy, and readmission rate within 60 days. CONCLUSIONS The Bedouin population hospitalized for UTIs is younger and presents with fewer co-morbidities. Isolated pathogens were similar to those found in the general population as was the presence of drug resistant infections. Overall, a substantial percentage of pathogens were resistant to standard first-line antibiotics, driving the need to change from empiric therapy to aminoglycoside therapy.
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Affiliation(s)
- Aref Elnasasra
- Division of Internal Medicine, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Hilmi Alnsasra
- Division of Internal Medicine, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Rozalia Smolyakov
- Division of Internal Medicine, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Infectious Disease Institute, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Klaris Riesenberg
- Division of Internal Medicine, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Infectious Disease Institute, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Lior Nesher
- Division of Internal Medicine, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Infectious Disease Institute, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Koh GCH, Tai BC, Ang LW, Heng D, Yuan JM, Koh WP. All-cause and cause-specific mortality after hip fracture among Chinese women and men: the Singapore Chinese Health Study. Osteoporos Int 2013; 24:1981-9. [PMID: 23224227 PMCID: PMC9244854 DOI: 10.1007/s00198-012-2183-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED All-cause mortality risk persisted for 5 years after hip fractures in both men and women. There may be gender-specific differences in effect and duration of excess risk for cause-specific mortality after hip fracture. INTRODUCTION To determine all-cause and cause-specific mortality risk in the first 5 years after hip fracture in an Asian Chinese population. METHODS The Singapore Chinese Health Study is a population-based cohort of 63,257 middle-aged and elderly Chinese men and women in Singapore recruited between 1993 and 1998. This cohort was followed up for hip fracture and death via linkage with nationwide hospital discharge database and death registry. As of 31 December 2008, we identified 1,166 hip fracture cases and matched five non-fracture cohort subjects by age and gender for each fracture case. Cox proportional hazards and competing risks regression models with hip fracture as a time-dependent covariate were used to determine all-cause and cause-specific mortality risk, respectively. RESULTS Increase in all-cause mortality risk persisted till 5 years after hip fracture (adjusted hazard ratio, aHR = 1.58 [95 % CI, 1.35-1.86] for females and aHR = 1.64 [95 % CI, 1.30-2.06] for males). Men had higher mortality risk after hip fracture than women for deaths from stroke and cancer up to 1 year post-fracture but women with hip fracture had higher coronary artery mortality risk than men for 5 years post-fracture. Men had higher risk of death from pneumonia while women had increased risk of death from urinary tract infections. There was no difference in mortality risk by types of hip fracture surgery. CONCLUSIONS All-cause mortality risk persisted for 5 years after hip fractures in men and women. There are gender-specific differences in effect size and duration of excess mortality risk from hip fractures between specific causes of death.
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Affiliation(s)
- G C-H Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Block MD3, #03-20, 16 Medical Drive, 117597 Singapore, Singapore.
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Fary Ka E, Seck SM, Niang A, Cisse MM, Diouf B. Patterns of autosomal dominant polycystic kidney diseases in black Africans. Saudi J Kidney Dis Transpl 2010; 21:81-86. [PMID: 20061698] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is not well described in black Africans while some data suggesting the disease is exceptional in this race. A retrospective study of patients with ADPKD followed in nephrology department of a teaching hospital in Dakar (January 1, 1995 to December 31, 2005) was therefore undertaken. Prevalence of ADPKD was one in 250. Mean age was 47 + or - 5 years with a predominance of male (57%). High blood pressure (HBP) was present in 68% of patients. Other renal manifestations were flank pain, hematuria and proteinuria. Majority of patients had impaired renal function at time of diagnosis. Extra-renal cysts were essentially found in liver (45.5%), pancreas and seminal vesicles. Main complications: ESRD (51%) occurred within a 6 year mean period, urinary tract infection (13%) and cerebral haemorrhage (2%). HBP control, in general needed 2 or more antihypertensive drugs. Fourteen patients died, ten patients had been on haemodialysis and four others died from uremic complications. In conclusion, ADPKD in black African adults is not rare and probably underdiagnosed. Early HBP and ESRD are likely more frequent than in other races. Earlier ultrasound detection and strategies to preserve renal function should be offered to at-risk individuals to improve outcomes.
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Affiliation(s)
- Elhadj Fary Ka
- Nephrology and Dialysis Department, Teaching Hospital Aristide, Le Dantec-Dakar BP, Dakar, Senegal
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Abstract
BACKGROUND Participants enrolled in the North American Research Committee on Multiple Sclerosis (NARCOMS) registry report disability status using Performance Scales (PS), a self-report measure. The bladder/bowel subscale (PSB) of PS has not been validated. It is also unknown whether ethnic or socioeconomic disparities exist in bladder care. OBJECTIVE We aimed to validate the bladder/bowel subscale used by the NARCOMS registry and to describe urologic symptoms, investigations, and treatments received by registry participants. METHODS In the Fall 2005 update questionnaire, we collected the Bowel Control Scale (BWCS) and Urogenital Distress Inventory-6 (UDI-6) as criterion measures and urologic investigations and treatments. We measured associations between investigations, treatments, and symptoms with clinical and sociodemographic variables using chi(2) tests for categorical variables and Kruskal-Wallis tests for continuous variables, followed by multivariable logistic regression. RESULTS Nine thousand six hundred eighty-eight participants completed the survey. For the UDI-6, the median (interquartile range) score was 33.3 (16.7 to 50.0), for the BWCS 3 (1 to 6), and for the PSB 1 (1 to 3). The correlation between the PSB and the UDI-6 was r = 0.67 and between the PSB and the BWCS r = 0.53 (both p < 0.0001). Participants had increased odds of receiving medication for bladder symptoms if they had health insurance (odds ratio [OR] 1.90; 1.07 to 3.35). Participants who were white (OR 1.5; 1.16 to 1.94) and had health insurance (OR 2.0; 1.3 to 3.07) had increased odds of undergoing urologic investigations. CONCLUSION The Performance Scales bladder question has adequate criterion and construct validity in multiple sclerosis (MS). There are ethnic and socioeconomic disparities in bladder management in MS.
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Affiliation(s)
- R A Marrie
- Department of Neurology, Cleveland Clinic Foundation, OH 44195, USA.
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Daniels NA, Link CL, Barry MJ, McKinlay JB. Association between past urinary tract infections and current symptoms suggestive of chronic prostatitis/chronic pelvic pain syndrome. J Natl Med Assoc 2007; 99:509-16. [PMID: 17534008 PMCID: PMC2576075] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a major cause of illness, and its association with history of past urinary tract infections is unclear. We surveyed a racially, ethnically and socioeconomically diverse, community-based sample of adults aged 30-79 years in Boston, MA. This report gives estimates from the 2,301 men in the BACH survey: 700 black, 766 Hispanic and 835 white. Symptoms of chronic prostatitis--any perineal and/or ejaculatory pain and a pain score of > or =4--were derived from the NIH Chronic Prostatitis Symptom Index and were used to identify men with symptoms suggesting CP/CPPS. The overall prevalence of symptoms suggestive of CP/CPPS is 6.3%. The number of urinary tract infections, particularly >3, was associated with symptoms suggestive of CP/CPPS (P < 0.01). There is a strong association between current symptoms of CP/CPPS and a history of urinary tract infections, particularly of multiple infections. The causality between chronic UTIs and CP/CPPS needs to be clarified by further study.
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Affiliation(s)
- Nicholas A Daniels
- University of California, San Francisco, Department of Medicine, Division of General Internal Medicine, San Francisco, CA 94115, USA.
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Abstract
OBJECTIVE To characterize the racial and ethnic differences in rates of urinary tract infections among febrile infants who present to an urban pediatric emergency department. METHODS A retrospective chart review was conducted using the medical records of an urban pediatric emergency department from the period between 5/2002 and 1/2003. Data were collected from infants aged 1 to 24 months from whom urine cultures were obtained as part of their fever workup. Demographic data were recorded as provided by the parents or caregivers of the patients. Urine culture results were also recorded. RESULTS Four hundred and sixty five children had urine cultures performed during the study period and fulfilled the inclusion criteria. Parents characterized the children as white (45%), Hispanic (27%), African American (20%), Asian (3.9%), or others (4.3%). Clinical parameters including the height of fever, age of the patient, and proportion of men were similar between the subjects in each racial and ethnic group. Sixty-four children were diagnosed as having UTI. The overall prevalence of UTI was 14% (95% confidence interval [CI] 11%-17%). Rates of UTI (SD) were as follows: Asian 22% (10%), white 16% (2.4%), Hispanic 16% (3.1%), African American 4.0% (1.9%), and Others 11 % (6.2%). African American infants had a lower rate of UTI (p = 0.007) compared with the general population. The odds ratio (OR) of UTI in white versus African American children and Hispanic versus African American children were 4.4 (95% CI, 1.5 to 12.6) and 4.6 (95% CI, 1.5 to 13.9), respectively. These results were consistent after adjustment for sex. CONCLUSIONS Urinary tract infections were common in our study population of racially and ethnically diverse children. Given similar clinical parameters, white and Hispanic children were much more likely to be diagnosed with UTI than African-American children.
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Affiliation(s)
- Lei Chen
- Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT 06504, USA.
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Abstract
PURPOSE We determine if the incidence and grade of vesicoureteral reflux (VUR) differs in children based on age, race and gender, and if the incidence and severity of VUR are related to race in girls younger than 7 years presenting for evaluation after urinary tract infection (UTI). MATERIALS AND METHODS The records of all children who underwent a voiding cystourethrogram or radionuclide cystogram between 1993 and 2001 were retrospectively reviewed. Age, gender, race, clinical indication and highest grade of VUR were recorded for the first voiding cystourethrogram or radionuclide cystogram. Frequency tables and logistic regression were conducted to correlate demographics to incidence and severity of VUR. RESULTS A total of 15,504 patients were included in the analysis. Overall, black children were a third as likely as white children (p <0.0001) and females were twice as likely as males (p <0.0001) to have VUR. Compared to children 0 to 2 years old, the occurrence of reflux was 0.5 times as likely in those 3 to 6 years old (p <0.0001), 0.3 times as likely in those 7 to 11 years old (p <0.0001) and 0.15 times as likely in those 12 to 21 years old (p <0.0001). When analyzing children with UTI, results were similar. Of the patients with VUR 65% were younger than 7 years. The incidence of VUR in black girls younger than 7 years with a diagnosis of UTI was less than 10% compared to white girls, and no black girl had high grade reflux. In young children referred for UTI the incidence and severity of VUR in black patients were significantly lower than those of white girls. CONCLUSIONS This study validates previous observations regarding the low incidence of VUR in black children.
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Affiliation(s)
- Deepa H Chand
- Section of Pediatric Nephrology and Hypertension, The Children's Hospital at the Cleveland Clinic Foundation, Ohio 44195, USA.
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Siala E, Aoun K, Zallagua N, Maatoug R, Bouratbine A. [Value of screening for intestinal and urinary parasites in non-resident permanent students in Tunisia]. Arch Inst Pasteur Tunis 2003; 80:29-33. [PMID: 15941065] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In order to fight digestive and urinary parasitoses, a national program of surveillance has been founded. The screening of these parasitoses among the non permanent resident students in Tunisia (ENRPTS) is one of the main actions of this program. Among 2560 ENRPTS tested in the laboratory of Parasitologie of Institut Pasteur of Tunis, between 1998 and 2002, 674 were infected by parasites, which represents a global prévalence of 26.3%. The intestinal protozoa constitute the majority of parasites identified (87.4%). Entamoeba histolytica has been isolated in 89 cases, essentially from students from tropical African countries. Urinary bilharziosis has been diagnosed in 25 cases. These results confirm the utility of the control of the ENRPTS. The precocious tracking permits to avoid the introduction and the dissemination of parasites already absent or rare in our country.
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Affiliation(s)
- E Siala
- Laboratoire de Parasitologie Clinique, Institut Pasteur de Tunis, BP 74, 1002 Tunis Belvédère, Tunisie
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14
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Abstract
BACKGROUND Urinary tract infections (UTIs) are a common source of bacterial infection among young febrile children. Clinical variables affecting the sensitivity of the urinalysis (UA) as a screen for UTI have not been previously investigated. The limited sensitivity of the UA for detecting a UTI requires that a urine culture be obtained in some children regardless of the UA result; however, a proper urine culture requires an invasive procedure, so the criteria for its use should be optimized. OBJECTIVES To determine how the sensitivity of the standard UA as a screening test for UTI varies with age, and to determine the clinical situation that necessitates the collection of a urine culture regardless of the UA result. METHODS Retrospective medical record review of patients younger than 2 years with fever (>/=38 degrees C) seen in the emergency department during a period of 65 months. All urine cultures were reviewed for the collection method, isolates, and colony counts. A UA result was considered positive if the presence of 1 of the following was detected: leukocyte esterase, nitrite, or pyuria (>/=5 white blood cells per high power field). Patients who had a paired UA and urine culture were used to calculate the sensitivity, specificity, and likelihood ratios of the UA. The prevalence of UTIs was also subcategorized by age, race, sex, and fever. RESULTS Medical records of 37 450 febrile children younger than 2 years were reviewed. Forty-four percent were girls. Median age and temperature were 10.6 months and 38.8 degrees C. A total of 11 089 patients (30%) had urine cultures obtained. The sensitivity of the UA was 82% (95% confidence interval [CI], 79%-84%) and did not vary by age subgroups. The specificity of UA was 92% (95% CI, 91%-92%). The likelihood ratios for a positive UA and negative UA were 10.6 (95% CI, 10.0-11.2) and 0.19 (95% CI, 0.18-0.20), respectively. Prevalence of UTI was 2.1% overall (2.9% for girls and 1.5% for boys, respectively). Among girls, the prevalence of UTI was 5.0% in white patients, 2.1% in Hispanic patients, and 1.0% in black patients. Among boys, the prevalence was 2.2% in Hispanic patients, 1.4% in white patients, and 0.8% in black patients. Higher prevalence was also seen among patients with a temperature at or above 39 degrees C compared with those whose temperature was between 38.0 degrees C and 38.9 degrees C. The greatest prevalence of UTI (13%) was found among white girls younger than 6 months with a temperature at or greater than 39 degrees C. The posttest probability of a UTI in the presence of a negative UA can be calculated using the negative likelihood ratio and the patient-specific prevalence of UTI. When the prevalence of UTI is 2%, 1 UA among 250 will produce a false-negative test result. CONCLUSIONS The sensitivity of the standard UA is 82% (95% CI, 79%-84%) and does not vary with age in febrile children younger than 2 years. The prevalence of UTI varies by age, race, sex, and temperature. A negative likelihood ratio and estimates of prevalence can be used to calculate the risk of missing a UTI due to a false-negative UA result.
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Affiliation(s)
- R Bachur
- Division of Emergency Medicine, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
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15
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Hood HM, Allman RM, Burgess PA, Farmer R, Xu W. Effects of timely antibiotic administration and culture acquisition on the treatment of urinary tract infection. Am J Med Qual 1998; 13:195-202. [PMID: 9833332 DOI: 10.1177/106286069801300405] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to assess the timeliness of initial antibiotic administration and culture acquisition for Medicare patients discharged with a principal diagnosis of urinary tract infection. The main outcome measurement was reduced length of stay. Data were collected retrospectively from 24,389 randomly selected discharged Medicare patients from September 1, 1994, to August 31, 1995. Only 61% of the cases as urinary tract infection had adequate criteria to confirm the diagnosis. Of these cases, antibiotics were administered within 4 hr after presentation in 40.9% patients. Urine cultures within 24 hr of presentation were noted more frequently (94%)than blood cultures (66%). Urine cultures obtained before antibiotic administration were noted more frequently (82%) than were blood cultures (58%). Timely antibiotic administration and the acquisition of urine cultures in the first 24 hr of hospitalization were independently associated with shorter length of stay.
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Affiliation(s)
- H M Hood
- Alabama Quality Assurance Foundation, Birmingham 35243-2327, USA
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16
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Abstract
Records from patients admitted to the surgical or medical department or examined in the respective outpatient departments in a Kuwaiti district hospital were reviewed retrospectively to discern the demographic characteristics of patients with complicated urinary tract infections (UTI), underlying conditions, pathogens and their antimicrobial susceptibility patterns. Kuwaiti nationals constituted the largest group, followed by Egyptians, which in the population of 225 patients studied comprised 41% and 27%, respectively; 65 of these 225 patients (29%) had urinary stones; 33 of the 92 Kuwaiti patients (36%) had diabetes mellitus; 38 of the 60 Egyptian patients (63%) had urinary stones and 18 had bilharziasis (30%). Pathogens were isolated 353 times from 225 patients. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and several other organisms in those patients with bilharziasis, urinary stones, and especially diabetes mellitus, displayed lower susceptibility frequencies to antimicrobials in comparison with other surgical and medical UTI isolates. Surgical and medical UTI organisms showed an overall higher antimicrobial resistance frequency than did UTI organisms from the maternity department or regional clinics. More than half of the population of Kuwaiti consists of expatriates from different countries. Such a population structure can exhibit peculiarities when health is considered. All this should be taken into consideration while dealing with disease management.
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Affiliation(s)
- A M Dobardzic
- Community Medicine and Behavioral Sciences Department, Faculty of Medicine, Kuwait.
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17
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DeBaun M, Rowley D, Province M, Stockbauer JW, Cole FS. Selected antepartum medical complications and very-low-birthweight infants among black and white women. Am J Public Health 1994; 84:1495-7. [PMID: 8092380 PMCID: PMC1615154 DOI: 10.2105/ajph.84.9.1495] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study estimated the risk of very-low-birthweight delivery among Black and White women with selected treatable antepartum medical conditions. A logistic regression model was applied to a retrospective, population-based data set identified by computerized, linked birth certificate and maternal hospital discharge records. For Black mothers, the adjusted odds ratio for very-low-birthweight delivery was statistically significant for essential hypertension and urinary tract infection. For White mothers, the adjusted odds ratio was statistically significant for essential hypertension, urinary tract infection, pregnancy-induced hypertension, and diabetes mellitus. Public policy designed to reduce the risk of very-low-birthweight delivery must include strategies for attenuating the impact of treatable antepartum medical conditions.
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Affiliation(s)
- M DeBaun
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, Mo. 63110
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18
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Schultz R, Read AW, Straton JA, Stanley FJ, Morich P. Genitourinary tract infections in pregnancy and low birth weight: case-control study in Australian aboriginal women. BMJ 1991; 303:1369-73. [PMID: 1760603 PMCID: PMC1671608 DOI: 10.1136/bmj.303.6814.1369] [Citation(s) in RCA: 33] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the association between genital and urinary tract infections in pregnant Aboriginal women and low birth weight. DESIGN Retrospective case-control study controlling for potential confounding variables. SETTING Western Australia from 1985 to 1987. SUBJECTS All Aboriginal women (n = 269) who had given birth to singleton infants weighing 2250 g or less (cases), and 269 randomly selected Aboriginal women who had given birth to singleton infants weighing 3000 g or more (controls). MAIN OUTCOME MEASURES Proportions of women in case and control groups who had had genital and urinary tract infections; odds ratios for low birth weight when genitourinary tract infection was present; population attributable fraction of low birth weight to genitourinary tract infection. RESULTS At the time of delivery 51% of women in the case group (109/215) had genitourinary tract infections compared with 13% of controls (35/266). After controlling for potential confounding variables the odds ratio for giving birth to infants weighing 2250 g or less when genitourinary tract infection was present was 4.0 (95% confidence interval 2.3 to 7.0). The proportion of infants with low birth weight attributable to genitourinary tract infection in the whole population of Aboriginal women was 32% (95% confidence interval 17% to 49%). CONCLUSIONS There was a strong association between low birth weight and the presence of genitourinary tract infections in Aboriginal women both during pregnancy and at the time of delivery. A community intervention trial of screening and treatment of genitourinary infections in this population is recommended.
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Affiliation(s)
- R Schultz
- Department of Public Health, University of Western Australia, Nedlands
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19
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Abstract
Four hundred and ninety-three patients were admitted to the Royal Darwin Hospital in 1980 with urinary tract disease. Aboriginals had an increased incidence (p less than 0.005) of urinary tract infection and glomerulonephritis (p less than 0.001) compared with non Aboriginals. Aboriginals with post-streptococcal glomerulonephritis tended to grow Group A Beta hemolytic streptococci from their skins, non Aboriginals tended to grow it from their throats. Aboriginals had a lower incidence of urolithiasis (p less than 0.001). There was no difference in the incidence of benign prostatic hypertrophy between the two populations.
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Affiliation(s)
- C Assumpcao
- Royal Darwin Hospital, NT, Casuarina, Australia
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