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Wood GE, Iverson-Cabral SL, Gillespie CW, Lowens MS, Manhart LE, Totten PA. Sequence variation and immunogenicity of the Mycoplasma genitalium MgpB and MgpC adherence proteins during persistent infection of men with non-gonococcal urethritis. PLoS One 2020; 15:e0240626. [PMID: 33045031 PMCID: PMC7549776 DOI: 10.1371/journal.pone.0240626] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022] Open
Abstract
Mycoplasma genitalium is a sexually transmitted bacterial pathogen that infects men and women. Antigenic variation of MgpB and MgpC, the immunodominant adherence proteins of M. genitalium, is thought to contribute to immune evasion and chronic infection. We investigated the evolution of mgpB and mgpC sequences in men with non-gonococcal urethritis persistently infected with M. genitalium, including two men with anti-M. genitalium antibodies at enrollment and two that developed antibodies during follow-up. Each of the four patients was persistently infected with a different strain type and each patient produced antibodies targeting MgpB and MgpC. Amino acid sequence evolution in the variable regions of MgpB and MgpC occurred in all four patients with changes observed in single and multiple variable regions over time. Using the available crystal structure of MgpC of the G37 type strain we found that predicted conformational B cell epitopes localize predominantly to the variable region of MgpC, amino acids that changed during patient infection lie in these epitopes, and variant amino acids are in close proximity to the conserved sialic acid binding pocket. These findings support the hypothesis that sequence variation functions to avoid specific antibodies thereby contributing to persistence in the genital tract.
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Affiliation(s)
- Gwendolyn E. Wood
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Stefanie L. Iverson-Cabral
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
| | - Catherine W. Gillespie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - M. Sylvan Lowens
- Public Health - Seattle & King County Sexual Health Clinic, Seattle, Washington, United States of America
| | - Lisa E. Manhart
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Patricia A. Totten
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, Pathobiology Interdisciplinary Program, University of Washington, Seattle, Washington, United States of America
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Gillespie CW, Morin PE, Tucker JM, Purvis L. Medication Adherence, Health Care Utilization, and Spending Among Privately Insured Adults With Chronic Conditions in the United States, 2010-2016. Am J Med 2020; 133:690-704.e19. [PMID: 31987798 DOI: 10.1016/j.amjmed.2019.12.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic conditions are common and costly for older Americans and for the health system. Adherence to daily maintenance medications may improve patient health and lead to lower health care spending. METHODS To identify predictors of adherence and to quantify associations with health care utilization and spending among older adults with chronic conditions, we conducted a longitudinal retrospective analysis using the OptumLabs Data Warehouse. This database of deidentified administrative claims includes medical and eligibility information for more than 200 million commercial and Medicare Advantage enrollees. We identified adults age 50+ years initiating treatment for atrial fibrillation (N = 33,472), chronic obstructive pulmonary disease (COPD; N = 44,130), diabetes (N =76,726), and hyperlipidemia (N= 249,391) between January 2010 and December 2014. We assessed adherence, health care utilization, and spending during the first 2 years of treatment. RESULTS During the first year of treatment, 13%-53% of each condition cohort was adherent (proportion of days covered ≥0.80). White race, Midwest residence, and having fewer comorbidities consistently and independently predicted adherence among enrollees initiating treatment for chronic obstructive pulmonary disease, diabetes, and hyperlipidemia. Male sex and higher net worth were also independently associated with adherence among commercial enrollees with these conditions. Patients in most condition cohorts who were adherent to treatment had significantly lower odds of hospitalization or emergency department use compared to patients who were not adherent. Additional spending on pharmacy claims by patients who were adherent was not consistently offset by lower spending on medical claims over a 2-year horizon. CONCLUSIONS Although many patient factors are strongly associated with medication adherence, the problem of non-adherence is common across all groups and may increase risk of adverse health outcomes.
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Affiliation(s)
- Catherine W Gillespie
- AARP Public Policy Institute, Washington, DC; Visiting Fellow, OptumLabs, Cambridge, Mass.
| | | | | | - Leigh Purvis
- AARP Public Policy Institute, Washington, DC; Visiting Fellow, OptumLabs, Cambridge, Mass
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Ah Mew N, Cnaan A, McCarter R, Choi H, Glass P, Rice K, Scavo L, Gillespie CW, Diaz GA, Berry GT, Wong D, Konczal L, McCandless SE, Coughlin Ii CR, Weisfeld-Adams JD, Ficicioglu C, Yudkoff M, Enns GM, Lichter-Konecki U, Gallagher R, Tuchman M. Conducting an investigator-initiated randomized double-blinded intervention trial in acute decompensation of inborn errors of metabolism: Lessons from the N-Carbamylglutamate Consortium. ACTA ACUST UNITED AC 2018; 3:157-170. [PMID: 30613471 PMCID: PMC6311376 DOI: 10.3233/trd-180031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Organic acidemias and urea cycle disorders are ultra-rare inborn errors of metabolism characterized by episodic acute decompensation, often associated with hyperammonemia, resulting in brain edema and encephalopathy. Retrospective reports and translational studies suggest that N-carbamylglutamate (NCG) may be effective in reducing ammonia levels during acute decompensation in two organic acidemias, propionic and methylmalonic acidemia (PA and MMA), and in two urea cycle disorders, carbamylphosphate synthetase 1 and ornithine transcarbamylase deficiency (CPSD and OTCD). We established the 9-site N-carbamylglutamate Consortium (NCGC) in order to conduct two randomized double-blind, placebo-controlled trials of NCG in acute hyperammonemia of PA, MMA, CPSD and OTCD. Conducting clinical trials is challenging in any disease, but poses unique barriers and risks in the ultra-rare disorders. As the number of clinical trials in orphan diseases increases, evaluating the successes and opportunities for improvement in such trials is essential. We summarize herein the design, methods, experiences, challenges and lessons from the NCGC-conducted trials.
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Affiliation(s)
| | - Avital Cnaan
- Children's National Health System, Washington, DC, USA
| | | | - Henry Choi
- Children's National Health System, Washington, DC, USA
| | - Penny Glass
- Children's National Health System, Washington, DC, USA
| | - Katie Rice
- Children's National Health System, Washington, DC, USA
| | - Louis Scavo
- Children's National Health System, Washington, DC, USA
| | | | - George A Diaz
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gerard T Berry
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Derek Wong
- UCLA Mattel Children's Hospital, Los Angeles, CA, USA
| | - Laura Konczal
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Shawn E McCandless
- Children's Hospital Colorado and University of Colorado Denver, Aurora, CO, USA
| | | | | | - Can Ficicioglu
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark Yudkoff
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory M Enns
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
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Gillespie CW, Morin PE. Osteoporosis-Related Health Services Utilization Following First Hip Fracture Among a Cohort of Privately-Insured Women in the United States, 2008-2014: An Observational Study. J Bone Miner Res 2018; 33:549. [PMID: 29509334 DOI: 10.1002/jbmr.3366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gillespie CW, Morin PE. Osteoporosis-Related Health Services Utilization Following First Hip Fracture Among a Cohort of Privately-Insured Women in the United States, 2008-2014: An Observational Study. J Bone Miner Res 2017; 32:1052-1061. [PMID: 28229485 DOI: 10.1002/jbmr.3079] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/20/2016] [Accepted: 01/04/2017] [Indexed: 11/09/2022]
Abstract
Timely identification and treatment of osteoporosis following hip fracture is recommended to mitigate future fracture risk, yet prior work has demonstrated a disconnect between evidence-based recommendations and real-world implementation. We sought to describe contemporary patterns of osteoporosis screening and initiation of pharmacotherapy following hip fracture based on medical and pharmacy claims in the OptumLabs™ Data Warehouse. From a national sample, we identified 8349 women aged 50+ years enrolled in private commercial or Medicare Advantage plans with no prior history of osteoporosis diagnosis, osteoporosis pharmacotherapy, or hip fracture who experienced a hip fracture between 2008 and 2013. Just 17.1% and 23.1% of these women had evidence of osteoporosis assessment and/or treatment within 6 or 12 months of their fractures, respectively. Women aged 80+ years were one-third less likely to utilize recommended services within 6 months, compared to those aged 50 to 79 years (13.8% versus 20.8%; p < 0.001). Utilization of bone mass measurement increased significantly among women aged 65+ years over the study period (p < 0.001) while declining among those aged 50 to 64 years (p = 0.2). In contrast, rates of osteoporosis pharmacotherapy remained steady among women aged 50 to 64 years (p = 0.8) yet declined among women aged 65 to 79 years and aged 80+ years (p = 0.07 and p = 0.004, respectively). Accounting for differences in all measured characteristics, receipt of primary care was the strongest and most consistent predictor of osteoporosis assessment or treatment following fracture. © 2017 American Society for Bone and Mineral Research.
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Gingold JA, Briccetti C, Zook K, Gillespie CW, Gubernick RS, Moon RY, Fu LY. Context Matters: Practitioner Perspectives on Immunization Delivery Quality Improvement Efforts. Clin Pediatr (Phila) 2016; 55:825-37. [PMID: 26743455 DOI: 10.1177/0009922815625874] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Uneven adherence to immunization guidelines might leave some communities vulnerable to outbreaks of vaccine-preventable diseases. To examine factors related to implementation of immunization delivery best practices, we analyzed responses to monthly surveys and debriefing interviews from 16 diverse pediatric practices engaged in a year-long virtual learning collaborative. The collaborative provided a toolkit, online learning sessions, performance feedback, and conference calls with a quality improvement coach. Participants used iterative plan-do-study-act cycles to implement self-selected changes in immunization practices. Descriptive statistics were applied to quantitative data; qualitative data were analyzed using a framework approach. Impediments to implementing guidelines included difficulties with electronic record systems, rigid management structures, competing priorities, and parental resistance. Facilitators included linkage with regional immunization registries, positive social interactions, and performance feedback. Findings suggest that improving immunization delivery requires not only awareness of recommendations and training in improvement methods but also efforts to ameliorate contextual factors that impede immunization delivery.
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Affiliation(s)
| | | | - Kathleen Zook
- Children's National Health System, Washington, DC, USA
| | | | - Ruth S Gubernick
- Independent Quality Improvement Consultant, Collingswood, NJ, USA
| | - Rachel Y Moon
- Children's National Health System, Washington, DC, USA
| | - Linda Y Fu
- Children's National Health System, Washington, DC, USA
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Fu LY, Zook K, Gingold JA, Gillespie CW, Briccetti C, Cora-Bramble D, Joseph JG, Haimowitz R, Moon RY. Strategies for Improving Vaccine Delivery: A Cluster-Randomized Trial. Pediatrics 2016; 137:peds.2015-4603. [PMID: 27244859 DOI: 10.1542/peds.2015-4603] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Accepted: 03/11/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE New emphasis on and requirements for demonstrating health care quality have increased the need for evidence-based methods to disseminate practice guidelines. With regard to impact on pediatric immunization coverage, we aimed to compare a financial incentive program (pay-for-performance [P4P]) and a virtual quality improvement technical support (QITS) learning collaborative. METHODS This single-blinded (to outcomes assessor), cluster-randomized trial was conducted among unaffiliated pediatric practices across the United States from June 2013 to June 2014. Practices received either the P4P or QITS intervention. All practices received a Vaccinator Toolkit. P4P practices participated in a tiered financial incentives program for immunization coverage improvement. QITS practices participated in a virtual learning collaborative. Primary outcome was percentage of all needed vaccines received (PANVR). We also assessed immunization up-to-date (UTD) status. RESULTS Data were analyzed from 3,147 patient records from 32 practices. Practices in the study arms reported similar QI activities (∼6 to 7 activities). We found no difference in PANVR between P4P and QITS (mean ± SE, 90.7% ± 1.1% vs 86.1% ± 1.3%, P = 0.46). Likewise, there was no difference in odds of being UTD between study arms (adjusted odds ratio 1.02, 95% confidence interval 0.68 to 1.52, P = .93). In within-group analysis, patients in both arms experienced nonsignificant increases in PANVR. Similarly, the change in adjusted odds of UTD over time was modest and nonsignificant for P4P but reached significance in the QITS arm (adjusted odds ratio 1.28, 95% confidence interval 1.02 to 1.60, P = .03). CONCLUSIONS Participation in either a financial incentives program or a virtual learning collaborative led to self-reported improvements in immunization practices but minimal change in objectively measured immunization coverage.
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Affiliation(s)
- Linda Y Fu
- Goldberg Center for Community Pediatric Health and Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia;
| | - Kathleen Zook
- Goldberg Center for Community Pediatric Health and SciMetrika, LLC, Silver Spring, Maryland
| | | | - Catherine W Gillespie
- Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia; AARP Public Policy Institute, Washington, District of Columbia
| | - Christine Briccetti
- Goldberg Center for Community Pediatric Health and The George Washington University School of Medicine, Washington, District of Columbia
| | - Denice Cora-Bramble
- Goldberg Center for Community Pediatric Health and Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California; and
| | - Rachel Haimowitz
- The George Washington University School of Medicine, Washington, District of Columbia
| | - Rachel Y Moon
- Goldberg Center for Community Pediatric Health and Center for Translational Science, Children's National Health System, Washington, District of Columbia; The George Washington University School of Medicine, Washington, District of Columbia; Division of General Pediatrics, University of Virginia School of Medicine, Charlottesville, Virgina
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Arya R, Gillespie CW, Cnaan A, Devarajan M, Clark P, Shinnar S, Vinks AA, Mizuno K, Glauser TA. Obesity and overweight as CAE comorbidities and differential drug response modifiers. Neurology 2016; 86:1613-21. [PMID: 27029636 DOI: 10.1212/wnl.0000000000002611] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/14/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study examined whether overweight and obesity are pretreatment comorbidities and predictors of short-term drug response in newly diagnosed untreated childhood absence epilepsy (CAE). We also examined whether dietary intake accounts for observed pretreatment body mass index (BMI) distribution. METHODS Pretreatment height and weight were available for 445 of 446 participants in the NIH-funded CAE comparative effectiveness trial (NCT00088452). Twenty-four-hour dietary recalls were collected. Calculated BMI and dietary intake were standardized for age, sex, and race/ethnicity and compared to age-matched US population from the National Health and Nutrition Examination Survey (NHANES). Logistic regression models tested BMI as a predictor of treatment response. Pharmacokinetic variables were explored as contributors to differential drug response. RESULTS After standardizing for demographic differences, children with CAE were more likely to be overweight (19.3% vs 13.8%; p < 0.001) or obese (14.5% vs 11.5%; p < 0.001) than NHANES controls. The combined prevalence of overweight and obesity was 33.8% in the CAE cohort and 25.3% among controls (p < 0.001). Mean daily energy intake (difference -79.5 kcal/day, p = 0.04) and daily carbohydrate intake (difference -10.7 g/day, p = 0.04) were lower in the CAE group than in NHANES controls. With increasing baseline BMI z score, the efficacy and effectiveness of ethosuximide and valproic acid over lamotrigine became more pronounced, despite no significant differences in drug exposure and trough levels. CONCLUSIONS Overweight and obesity are more prevalent in children with newly diagnosed CAE than in age-matched peers, despite lower caloric and carbohydrate intake. Baseline BMI may also predict differential drug response, which cannot be attributed to pharmacokinetic differences.
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Affiliation(s)
- Ravindra Arya
- From the Comprehensive Epilepsy Center (R.A., M.D., P.C., T.A.G.), Division of Neurology, and Division of Clinical Pharmacology (A.A.V., K.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's National Health System (C.W.G., A.C.), Washington, DC; and Montefiore Medical Center (S.S.), Albert Einstein College of Medicine, Bronx, NY.
| | - Catherine W Gillespie
- From the Comprehensive Epilepsy Center (R.A., M.D., P.C., T.A.G.), Division of Neurology, and Division of Clinical Pharmacology (A.A.V., K.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's National Health System (C.W.G., A.C.), Washington, DC; and Montefiore Medical Center (S.S.), Albert Einstein College of Medicine, Bronx, NY
| | - Avital Cnaan
- From the Comprehensive Epilepsy Center (R.A., M.D., P.C., T.A.G.), Division of Neurology, and Division of Clinical Pharmacology (A.A.V., K.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's National Health System (C.W.G., A.C.), Washington, DC; and Montefiore Medical Center (S.S.), Albert Einstein College of Medicine, Bronx, NY
| | - Mahima Devarajan
- From the Comprehensive Epilepsy Center (R.A., M.D., P.C., T.A.G.), Division of Neurology, and Division of Clinical Pharmacology (A.A.V., K.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's National Health System (C.W.G., A.C.), Washington, DC; and Montefiore Medical Center (S.S.), Albert Einstein College of Medicine, Bronx, NY
| | - Peggy Clark
- From the Comprehensive Epilepsy Center (R.A., M.D., P.C., T.A.G.), Division of Neurology, and Division of Clinical Pharmacology (A.A.V., K.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's National Health System (C.W.G., A.C.), Washington, DC; and Montefiore Medical Center (S.S.), Albert Einstein College of Medicine, Bronx, NY
| | - Shlomo Shinnar
- From the Comprehensive Epilepsy Center (R.A., M.D., P.C., T.A.G.), Division of Neurology, and Division of Clinical Pharmacology (A.A.V., K.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's National Health System (C.W.G., A.C.), Washington, DC; and Montefiore Medical Center (S.S.), Albert Einstein College of Medicine, Bronx, NY
| | - Alexander A Vinks
- From the Comprehensive Epilepsy Center (R.A., M.D., P.C., T.A.G.), Division of Neurology, and Division of Clinical Pharmacology (A.A.V., K.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's National Health System (C.W.G., A.C.), Washington, DC; and Montefiore Medical Center (S.S.), Albert Einstein College of Medicine, Bronx, NY
| | - Kana Mizuno
- From the Comprehensive Epilepsy Center (R.A., M.D., P.C., T.A.G.), Division of Neurology, and Division of Clinical Pharmacology (A.A.V., K.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's National Health System (C.W.G., A.C.), Washington, DC; and Montefiore Medical Center (S.S.), Albert Einstein College of Medicine, Bronx, NY
| | - Tracy A Glauser
- From the Comprehensive Epilepsy Center (R.A., M.D., P.C., T.A.G.), Division of Neurology, and Division of Clinical Pharmacology (A.A.V., K.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Children's National Health System (C.W.G., A.C.), Washington, DC; and Montefiore Medical Center (S.S.), Albert Einstein College of Medicine, Bronx, NY
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Lim SS, Carnahan E, Nelson EC, Gillespie CW, Mokdad AH, Murray CJL, Fisher ES. Validation of a new predictive risk model: measuring the impact of the major modifiable risks of death for patients and populations. Popul Health Metr 2015; 13:27. [PMID: 26435702 PMCID: PMC4591717 DOI: 10.1186/s12963-015-0059-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 05/22/2014] [Accepted: 09/14/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Modifiable risks account for a large fraction of disease and death, but clinicians and patients lack tools to identify high risk populations or compare the possible benefit of different interventions. METHODS We used data on the distribution of exposure to 12 major behavioral and biometric risk factors inthe US population, mortality rates by cause, and estimates of the proportional hazards of risk factor exposure from published systematic reviews to develop a risk prediction model that estimates an adult's 10 year mortality risk compared to a population with optimum risk factors. We compared predicted risk to observed mortality in 8,241 respondents in NHANES 1988-1994 and NHANES 1999-2004 with linked mortality data up to the end of 2006. RESULTS Predicted risk showed good discrimination with an area under the receiver operating characteristic (ROC) curve of 0.84 (standard error 0.01) for women and 0.84 (SE 0.01) for men. Across deciles of predicted risk, mortality was accurately predicted in men ((Χ (2) statistic = 12.3 for men, p=0.196) but slightly overpredicted in the highest decile among women (Χ (2) statistic = 22.8, p=0.002). Mortality risk was highly concentrated; for example, among those age 30-44 years, 5.1 % (95 % CI 4.1 % - 6.0 %) of the male and 5.9 % (95 % CI 4.8 % - 6.9 %) of the female population accounted for 25 % of the risk of death. CONCLUSION The risk model accurately predicted mortality in a representative sample of the US population and could be used to help inform patient and provider decision-making, identify high risk groups, and monitor the impact of efforts to improve population health.
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Affiliation(s)
- Stephen S. Lim
- />Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121 USA
| | - Emily Carnahan
- />Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121 USA
| | - Eugene C. Nelson
- />The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH USA
| | - Catherine W. Gillespie
- />Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121 USA
| | - Ali H. Mokdad
- />Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121 USA
| | - Christopher J. L. Murray
- />Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave., Suite 600, Seattle, WA 98121 USA
| | - Elliott S. Fisher
- />The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH USA
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Abstract
BACKGROUND This study compares a Pediatric Early Warning Score (PEWS) to physician opinion in identifying patients at risk for deterioration. METHODS Maximum PEWS recorded during each admission was retrospectively ascertained from electronic medical record data. Physician opinion regarding risk of subsequent deterioration was determined by assignment to an institutional "senior sign-out" (SSO) list that highlights patients whom senior pediatric residents have identified as at risk. Deterioration events were defined as intubation, initiation of high flow nasal cannula, inotropes, noninvasive mechanical ventilation, or aggressive fluid resuscitation within 12 hours of transfer to the PICU. We assessed the relationships of sociodemographic variables, PEWS, and SSO assignment with subsequent deterioration events using multivariate regression analysis to control for a number of covariates. RESULTS There were 97 patients with nonelective transfers to the PICU who were eligible for placement on the SSO lists before transfer, 51 of whom experienced qualifying deterioration events. Maximum recorded PEWS was significantly higher for patients with a subsequent deterioration event during the first 12 hours after transfer, compared with those who were transferred but did not experience a deterioration event in the first 12 hours (mean [SD]: 3.9 [2.0] vs 2.9 [2.0]; P = .01). This association persisted even after multivariate adjustment. SSO assignment was only marginally associated with risk of deterioration among this patient population, with or without adjustment for covariates. CONCLUSIONS The PEWS was significantly associated with ICU deterioration, whereas physician opinion was not. Used alone or in conjunction with physician assessment, PEWS is a valuable tool for identifying patients vulnerable to acute deterioration.
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Affiliation(s)
- J B Fenix
- Children's National Health System, Washington, District of Columbia; and
| | - Catherine W Gillespie
- Children's National Health System, Washington, District of Columbia; and George Washington School of Medicine, Washington, District of Columbia
| | - Amanda Levin
- Children's National Health System, Washington, District of Columbia; and George Washington School of Medicine, Washington, District of Columbia
| | - Nathan Dean
- Children's National Health System, Washington, District of Columbia; and George Washington School of Medicine, Washington, District of Columbia
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Mokdad AH, Gagnier MC, Colson KE, Zúñiga-Brenes P, Ríos-Zertuche D, Haakenstad A, Palmisano EB, Anderson BW, Desai SS, Gillespie CW, Murphy T, Naghavi P, Nelson J, Ranganathan D, Schaefer A, Usmanova G, Wilson S, Hernandez B, Lozano R, Iriarte E. Health and wealth in Mesoamerica: findings from Salud Mesomérica 2015. BMC Med 2015; 13:164. [PMID: 26170012 PMCID: PMC4501100 DOI: 10.1186/s12916-015-0393-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 06/04/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Individual income and poverty are associated with poor health outcomes. The poor face unique challenges related to access, education, financial capacity, environmental effects, and other factors that threaten their health outcomes. METHODS We examined the variation in the health outcomes and health behaviors among the poorest quintile in eight countries of Mesoamerica using data from the Salud Mesomérica 2015 baseline household surveys. We used multivariable logistic regression to measure the association between delivering a child in a health facility and select household and maternal characteristics, including education and measures of wealth. RESULTS Health indicators varied greatly between geographic segments. Controlling for other demographic characteristics, women with at least secondary education were more likely to have an in-facility delivery compared to women who had not attended school (OR: 3.20, 95 % confidence interval [CI]: 2.56-3.99, respectively). Similarly, women from households with the highest expenditure were more likely to deliver in a health facility compared to those from the lowest expenditure households (OR 3.06, 95 % CI: 2.43-3.85). Household assets did not impact these associations. Moreover, we found that commonly-used definitions of poverty do not align with the disparities in health outcomes observed in these communities. CONCLUSIONS Although poverty measured by expenditure or wealth is associated with health disparities or health outcomes, a composite indicator of health poverty based on coverage is more likely to focus attention on health problems and solutions. Our findings call for the public health community to define poverty by health coverage measures rather than income or wealth. Such a health-poverty metric is more likely to generate attention and mobilize targeted action by the health communities than our current definition of poverty.
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Affiliation(s)
- Ali H Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Marielle C Gagnier
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - K Ellicott Colson
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California.
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá.
| | - Diego Ríos-Zertuche
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá.
| | - Annie Haakenstad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Brent W Anderson
- Pardee RAND Graduate School, 1776 Main Street, Santa Monica, California, 90401, USA.
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | | | - Tasha Murphy
- University of Washington School of Social Work, 4101 15th Avenue N, Seattle, WA, USA.
| | - Paria Naghavi
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Jennifer Nelson
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá.
| | - Dharani Ranganathan
- George Washington University, 950 New Hampshire Ave, NW, Washington, DC, USA.
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Gulnoza Usmanova
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Shelley Wilson
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Emma Iriarte
- Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá.
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Fu LY, Zook K, Gingold J, Gillespie CW, Briccetti C, Cora-Bramble D, Joseph JG, Moon RY. Frequent vaccination missed opportunities at primary care encounters contribute to underimmunization. J Pediatr 2015; 166:412-7. [PMID: 25465848 DOI: 10.1016/j.jpeds.2014.10.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 06/17/2014] [Revised: 09/10/2014] [Accepted: 10/24/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine missed opportunities to administer an eligible vaccination (MOs) and their contribution to underimmunization in contemporary pediatric practices. STUDY DESIGN This study was a retrospective analysis from 42 diverse pediatric practices located throughout the US. Medical records of 50 randomly selected children 3-18 months of age per practice were reviewed in Spring 2013. Immunization status for age and MOs were assessed as of each encounter and as of March 1, 2013. RESULTS Of 2076 eligible patients, 72.7% (95% CI 67.6-77.9) were up-to-date with receipt of standard vaccines. Most children (82.4%; 95% CI 78.3-85.9) had at least 1 MO, and 37.8% (95% CI 30.0-46.2) had at least one MO to administer an overdue vaccination. After adjustment, risk of underimmunization was 3.5 times greater for patients who had ever experienced an MO for an overdue vaccination compared with those who had not (adjusted relative risk = 3.5; 95% CI 2.8-4.3). If all age-appropriate vaccinations had been administered at the last recorded encounter, 45.5% (95% CI 36.8-54.5) of the underimmunized patients would have been up to date at the time of assessment. CONCLUSION MOs were common and contributed substantially to underimmunization in this contemporary sample of diverse primary care practice settings.
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Affiliation(s)
- Linda Y Fu
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC; Center for Translational Science, Children's National Health System, Washington, DC.
| | - Kathleen Zook
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC
| | - Janet Gingold
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC
| | | | - Christine Briccetti
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC
| | - Denice Cora-Bramble
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC; Center for Translational Science, Children's National Health System, Washington, DC
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA
| | - Rachel Y Moon
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC; Center for Translational Science, Children's National Health System, Washington, DC
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13
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Khosropour CM, Manhart LE, Gillespie CW, Lowens MS, Golden MR, Jensen NL, Kenny GE, Totten PA. Efficacy of standard therapies against Ureaplasma species and persistence among men with non-gonococcal urethritis enrolled in a randomised controlled trial. Sex Transm Infect 2015; 91:308-13. [PMID: 25616607 DOI: 10.1136/sextrans-2014-051859] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/29/2014] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Ureaplasma urealyticum biovar 2 (UU-2), but not Ureaplasma parvum (UP), has been associated with non-gonococcal urethritis (NGU), but little is known about species-specific responses to standard therapies. We examined species-specific treatment outcomes and followed men with treatment failure for 9 weeks. METHODS From May 2007 to July 2011, men aged ≥16 attending a sexually transmitted disease (STD) clinic in Seattle, Washington, with NGU (urethral discharge or urethral symptoms plus ≥5 polymorphonuclear leucocytes /high-powered field) enrolled in a double-blind, randomised trial. Participants received active azithromycin (1 g) + placebo doxycycline or active doxycycline (100 mg twice a day ×7 days) + placebo azithromycin. Ureaplasma were detected in culture followed by species-specific PCR. Outcomes were assessed at 3, 6 and 9 weeks. At 3 weeks, men with persistent Ureaplasma detection received 'reverse therapy' (e.g., active doxycycline if they first received active azithromycin). At 6 weeks, persistently positive men received moxifloxacin (400 mg×7 days). RESULTS Of 490 men, 107 (22%) and 60 (12%) were infected with UU-2 and UP, respectively, and returned at 3 weeks. Persistent detection was similar for UU-2-infected men initially treated with azithromycin or doxycycline (25% vs. 31%; p=0.53), but differed somewhat for men with UP (45% vs. 24%; p=0.11). At 6 weeks, 57% of UU-2-infected and 63% of UP-infected men who received both drugs had persistent detection. Failure after moxifloxacin occurred in 30% and 36%, respectively. Persistent detection of UU-2 or UP was not associated with signs/symptoms of NGU. CONCLUSIONS Persistent detection after treatment with doxycycline, azithromycin and moxifloxacin was common for UU and UP, but not associated with persistent urethritis. TRIAL REGISTRATION NUMBER NCT00358462.
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Affiliation(s)
| | - Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, WA, USA Department of Global Health, University of Washington, Seattle, WA, USA
| | - Catherine W Gillespie
- Department of Epidemiology, University of Washington, Seattle, WA, USA Children's National Health System, Washington, DC, USA
| | - M Sylvan Lowens
- Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - Matthew R Golden
- Department of Epidemiology, University of Washington, Seattle, WA, USA Public Health - Seattle and King County HIV/STD Program, Seattle, WA, USA Department of Medicine, University of Washington, Seattle, WA, USA
| | - Nicole L Jensen
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - George E Kenny
- Department of Medicine, University of Washington, Seattle, WA, USA
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14
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Dean PN, Gillespie CW, Greene EA, Pearson GD, Robb AS, Berul CI, Kaltman JR. Sports Participation and Quality of Life in Adolescents and Young Adults with Congenital Heart Disease. CONGENIT HEART DIS 2014; 10:169-79. [DOI: 10.1111/chd.12221] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Peter N. Dean
- Division of Cardiology; Children's National Health System; Washington DC USA
| | | | | | - Gail D. Pearson
- Division of Cardiology; Children's National Health System; Washington DC USA
| | - Adelaide S. Robb
- Division of Psychiatry; Children's National Health System; Washington DC USA
| | - Charles I. Berul
- Division of Cardiology; Children's National Health System; Washington DC USA
| | - Jonathan R. Kaltman
- Division of Cardiology; Children's National Health System; Washington DC USA
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15
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Horn IB, Mitchell SJ, Gillespie CW, Burke KM, Godoy L, Teach SJ. Randomized trial of a health communication intervention for parents of children with asthma. J Asthma 2014; 51:989-95. [PMID: 24945884 DOI: 10.3109/02770903.2014.930881] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine if a health communication intervention targeting parents of high-risk, urban, minority children with asthma could (i) improve parental perceptions of connectedness to and communication with their child's primary care providers (PCP) and (ii) decrease reliance on emergency departments (EDs) and other urgent care services for their child's asthma-related care. METHODS The design was a single blind, parallel groups, randomized controlled trial. Parents were recruited from an ED-based asthma clinic serving primarily low-income, minority children in Washington, DC. The intervention involved face-to-face education on effective communication followed by a single booster call. Standardized instruments were administered to assess primary care connectedness and healthcare utilization at baseline and 2- and 6-months post-enrollment. RESULTS A total of 150 parents of children 1-12 years old were randomized (77 intervention and 73 usual care), and 137 (91%) were successfully followed for six months. Only at the two-month follow-up time-point, parents in the intervention group were significantly more likely to identify a PCP as the main source of their child's asthma care (adjusted odds ratio: 12.6, 95% confidence interval: 1.1-142.1) and to report a significant reduction in ED visits for asthma care (adjusted incidence rate ratio: 0.3, 95% confidence interval: 0.1-0.8). There was no significant effect on parent communication self-efficacy or number of PCP visits. CONCLUSIONS A brief, in-person health communication intervention for parents of high-risk children with asthma resulted in improved identification of PCPs as the usual source of asthma care and reduced reliance on EDs for asthma care, albeit only for two months post-intervention.
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Affiliation(s)
- Ivor B Horn
- Center for Translational Science, Children's National Medical Center , Washington, DC , USA
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16
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Dean PN, Gillespie CW, Greene E, Pearson G, Robb AS, Berul C, Kaltman J. SPORTS PARTICIPATION AND QUALITY OF LIFE IN ADOLESCENTS AND YOUNG ADULTS WITH CONGENITAL HEART DISEASE (SQUAD STUDY). J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60574-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Roth GA, Gillespie CW, Mokdad AA, Shen DD, Fleming DW, Stergachis A, Murray CJL, Mokdad AH. Aspirin use and knowledge in the community: a population- and health facility based survey for measuring local health system performance. BMC Cardiovasc Disord 2014; 14:16. [PMID: 24507089 PMCID: PMC3922250 DOI: 10.1186/1471-2261-14-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 09/04/2013] [Accepted: 01/29/2014] [Indexed: 02/06/2023] Open
Abstract
Background Little is known about the relationship between cardiovascular risk, disease and actual use of aspirin in the community. Methods The Measuring Disparities in Chronic Conditions (MDCC) study is a community and health facility-based survey designed to track disparities in the delivery of health interventions for common chronic diseases. MDCC includes a survey instrument designed to collect detailed information about aspirin use. In King County, WA between 2011 and 2012, we surveyed 4633 white, African American, or Hispanic adults (45% home address-based sample, 55% health facility sample). We examined self-reported counseling on, frequency of use and risks of aspirin for all respondents. For a subgroup free of CAD or cerebral infarction that underwent physical examination, we measured 10-year coronary heart disease risk and blood salicylate concentration. Results Two in five respondents reported using aspirin routinely while one in five with a history of CAD or cerebral infarction and without contraindication did not report routine use of aspirin. Women with these conditions used less aspirin than men (65.0% vs. 76.5%) and reported more health problems that would make aspirin unsafe (29.4% vs. 21.2%). In a subgroup undergoing phlebotomy a third of respondents with low cardiovascular risk used aspirin routinely and only 4.6% of all aspirin users had no detectable salicylate in their blood. Conclusions In this large urban county where health care delivery should be of high quality, there is insufficient aspirin use among those with high cardiovascular risk or disease and routine aspirin use by many at low risk. Further efforts are needed to promote shared-decision making between patients and clinicians as well as inform the public about appropriate use of routine aspirin to reduce the burden of atherosclerotic vascular disease.
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Affiliation(s)
- Gregory A Roth
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA.
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18
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Khosropour CM, Manhart LE, Colombara DV, Gillespie CW, Lowens MS, Totten PA, Golden MR, Simoni J. Suboptimal adherence to doxycycline and treatment outcomes among men with non-gonococcal urethritis: a prospective cohort study. Sex Transm Infect 2013; 90:3-7. [PMID: 24106340 DOI: 10.1136/sextrans-2013-051174] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Doxycycline, one of two recommended therapies for non-gonococcal urethritis (NGU), consists of a 7-day course of therapy (100 mg BID). Since suboptimal adherence may contribute to poor treatment outcomes, we examined the association between self-reported imperfect adherence to doxycycline and clinical and microbiologic failure among men with NGU. METHODS Men aged ≥16 years with NGU attending a Seattle, WA, sexually transmitted diseases clinic were enrolled in a double-blind, parallel-group superiority trial from January 2007 to July 2011. Men were randomised to active doxycycline/placebo azithromycin or placebo doxycycline/active azithromycin. Imperfect adherence was defined as missing ≥1 dose in 7 days. Urine was tested for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Ureaplasma urealyticum-biovar 2 (UU-2) using nucleic acid amplification tests. Clinical failure (symptoms and ≥5 PMNs/HPF or discharge) and microbiologic failure (positive tests for CT, MG, and/or UU-2) were determined after 3 weeks. RESULTS 184 men with NGU were randomised to active doxycycline and provided data on adherence. Baseline prevalence of CT, MG and UU-2 was 26%, 13% and 27%, respectively. 28% of men reported imperfect adherence, and this was associated with microbiologic failure among men with CT (aRR=9.33; 95% CI 1.00 to 89.2) and UU-2 (aRR=3.08; 95% CI 1.31 to 7.26) but not MG. Imperfect adherence was not significantly associated with clinical failure overall or for any specific pathogens, but it was more common among imperfectly adherent men with CT (aRR=2.63; 0.93-7.41, p=0.07). CONCLUSIONS Adherence may be important for microbiologic cure of select pathogens. Factors other than adherence should be considered for CT-negative men with persistent NGU.
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Totten PA, Jensen NL, Khosopour CM, Gillespie CW, Jensen JS, Kenny GK, Golden MR, Manhart LE. O19.1 Azithromycin and Doxycycline Resistance Profiles ofMycoplasma Genitaliumand Association with Treatment Outcomes. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Manhart LE, Khosropour CM, Gillespie CW, Lowens MS, Golden MR, Totten PA. O02.3 Treatment Outcomes For Persistent Mycoplasma Genitalium-Associated NGU: Evidence of Moxifloxacin Treatment Failures. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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21
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Manhart LE, Khosropour CM, Liu C, Gillespie CW, Depner K, Fiedler T, Marrazzo JM, Fredricks DN. O14.1 Bacterial Vaginosis-Associated Bacteria (BVAB) and Non-Gonococcal Urethritis (NGU). Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Khosropour CM, Manhart LE, Gillespie CW, Lowens M, Golden MR, Totten PA. P2.103 Differential Effect of Standard Therapies For Non-Gonococcal Urethritis Against Ureaplasma Species. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Roth GA, Bolliger IW, Gillespie CW, Mokdad AH. Abstract 152: Daily Dietary Sodium Intake and Advice on Dietary Sodium among Heart Failure Patients in the Community. Circ Cardiovasc Qual Outcomes 2013. [DOI: 10.1161/circoutcomes.6.suppl_1.a152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Little is known about the sodium intake of heart failure (HF) patients in the community. We used data from the Measuring Disparities in Chronic Conditions Study to examine the receipt of advice on dietary sodium and its relationship with sodium intake among adults in a large urban county.
Method:
We recruited adults in King County, WA using a home-address based sample as well as sampling from health facilities using medical record billing codes for key cardiovascular conditions. Survey questions addressed past medical history as well as receipt of advice and behavior related to dietary sodium. Diet history was assessed using the National Cancer Institute Diet History Questionnaire II (DHQ) for intake in the past year. We also compared responses and estimated sodium intake for those who did and did not report a diagnosis of HF. As a sensitivity analysis, we repeated our analysis using the subset of individuals who had a medical record with an ICD9 code for HF in the previous two years.
Result:
Our results are based on 3357 respondents from the address-based sample and 3477 from the medical record-based sample. The DHQ was completed by 940 and 1291 of these respondents, respectively. HF was reported by 290 respondents (median age 66 years, 57% male, 6.6% black race, 85% from medical record sample, 43% with a DHQ). Among those reporting a diagnosis of HF, 61% (112 of 183) reported being advised to decrease dietary sodium and 37% (67 of 183) reported being told to buy food items labeled as low salt. These rates were 30% (755 of 2515) and 13% (337 of 2515) respectively among individuals without reported HF. Estimated daily dietary sodium intake over the prior year was lower among those with HF completing a DHQ if they reported receiving counseling (mean 2.5 vs 2.8 gm if advised to cut down on salt and 2.3 vs 2.8 gm if advised to buy low salt labeled products). However, these differences were not statistically significant. Only 65% of respondents with HF (183 of 282) said they buy low salt labeled foods and 26% (61 of 290) reported eating processed, fast, or canned food at least 5 times in the prior month. Overall mean estimated daily dietary sodium intake over the prior year was 2.7 gm for respondents both with and without HF. Results were similar for those with an ICD9 code for HF.
Conclusion:
Our findings revealed that a large percentage of HF patients report no receipt of medical advice to reduce dietary sodium or purchase foods labeled as low salt. Moreover, the dietary intake of salt was similar for HF patients and the general population. These results point to a need for dietary interventions in HF that are both widely adopted and can actually change behavior.
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Affiliation(s)
- Gregory A Roth
- Institute for Health Metrics and Evaluation, Univ of Washington, Seattle, WA
| | - Ian W Bolliger
- Institute for Health Metrics and Evaluation, Seattle, WA
| | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, Seattle, WA
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24
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Manhart LE, Gillespie CW, Lowens MS, Khosropour CM, Colombara DV, Golden MR, Hakhu NR, Thomas KK, Hughes JP, Jensen NL, Totten PA. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis 2012; 56:934-42. [PMID: 23223595 DOI: 10.1093/cid/cis1022] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Azithromycin or doxycycline is recommended for nongonococcal urethritis (NGU); recent evidence suggests their efficacy has declined. We compared azithromycin and doxycycline in men with NGU, hypothesizing that azithromycin was more effective than doxycycline. METHODS From January 2007 to July 2011, English-speaking males ≥16 years, attending a sexually transmitted diseases clinic in Seattle, Washington, with NGU (visible urethral discharge or ≥5 polymorphonuclear leukocytes per high-power field [PMNs/HPF]) were eligible for this double-blind, parallel-group superiority trial. Participants received active azithromycin (1 g) + placebo doxycycline or active doxycycline (100 mg twice daily for 7 days) + placebo azithromycin. Urine was tested for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Ureaplasma urealyticum biovar 2 (UU-2), and Trichomonas vaginalis (TV) using nucleic acid amplification tests. Clinical cure (<5 PMNs/HPF with or without urethral symptoms and absence of discharge) and microbiologic cure (negative tests for CT, MG, and/or UU-2) were determined after 3 weeks. RESULTS Of 606 men, 304 were randomized to azithromycin and 302 to doxycycline; CT, MG, TV, and UU-2 were detected in 24%, 13%, 2%, and 23%, respectively. In modified intent-to-treat analyses, 172 of 216 (80%; 95% confidence interval [CI], 74%-85%) receiving azithromycin and 157 of 206 (76%; 95% CI, 70%-82%) receiving doxycycline experienced clinical cure (P = .40). In pathogen-specific analyses, clinical cure did not differ by arm, nor did microbiologic cure differ for CT (86% vs 90%, P = .56), MG (40% vs 30%, P = .41), or UU-2 (75% vs 70%, P = .50). No unexpected adverse events occurred. CONCLUSIONS Clinical and microbiologic cure rates for NGU were somewhat low and there was no significant difference between azithromycin and doxycycline. Mycoplasma genitalium treatment failure was extremely common. Clinical Trials Registration.NCT00358462.
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Affiliation(s)
- Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
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Abstract
Deaf children's patterns of emergent literacy can parallel those of hearing children, but their acquisition of conventional reading skills in elementary school is often delayed. Group storybook reading in the residences of a state-sponsored school for the Deaf was investigated as a means of fostering literacy development outside the classroom. Eighteen children, ages 4-11 years, participated. The nine children in the experimental group cottages participated in group storybook reading twice each week for 5 months. Both the experimental and the control-group cottages were provided with a variety of books that were rotated biweekly. Children were highly engaged during the storybook-reading sessions, particularly when the readers used an interactive/expressive reading style. Children in the experimental group performed more independently on an emergent reading task, and their counselors judged them to be more interested in books than children in the control group.
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Affiliation(s)
- C W Gillespie
- Department of Teaching and Learning, School of Education, Drake University, Des Moines, IA, USA
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Abstract
The purpose of this study was to add to the sparse knowledge about literacy environments and practices in children's residences at schools for the deaf by conducting a nationwide survey. Twenty-six residential schools for the deaf throughout the country responded by mail. Results revealed that all of the responding schools made reading and writing materials available to children in their residences. Counselors read to children individually and supervised homework, and children wrote letters and read independently. However in half of the residences, materials were not regularly rotated and in most residences time was not set aside for group storybook reading. Implications for practice include focusing on providing interesting and stimulating literacy materials for children, rotating materials regularly, and planning group literacy-related events such as storybook reading or storytelling.
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Madden RH, Hough B, Gillespie CW. Occurrence of Salmonella in Porcine Liver in Northern Ireland. J Food Prot 1986; 49:893-894. [PMID: 30965495 DOI: 10.4315/0362-028x-49.11.893] [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: 11/11/2022]
Abstract
Pork livers from four pork processing plants in Northern Ireland were studied to assess their contamination by salmonellae. Additionally, aerobic plate counts (APC) and counts of Enterobacteriaceae were made. One hundred twenty livers were sampled immediately after evisceration and 110 sampled after being chilled overnight in the commercial premises. No salmonellae were detected. Geometric mean values for the APC were 1.6 × 104 and 3.1 × 105 CFU/g for fresh and chilled livers, respectively. Homologous geometric mean values for Enterobacteriaceae were 7.9 × 102 and 6.0 × 102 CFU/g, respectively.
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Affiliation(s)
- R H Madden
- Agricultural and Food Bacteriology Research Division, Department of Agriculture for Northern Ireland, Newforge Lane, Belfast BT9 5PX, Northern Ireland and Department of Agricultural and Food Bacteriology, The Queen's University of Belfast, Newforge Lane, Belfast BT9 5PX, Northern Ireland
| | - B Hough
- Agricultural and Food Bacteriology Research Division, Department of Agriculture for Northern Ireland, Newforge Lane, Belfast BT9 5PX, Northern Ireland and Department of Agricultural and Food Bacteriology, The Queen's University of Belfast, Newforge Lane, Belfast BT9 5PX, Northern Ireland
| | - C W Gillespie
- Agricultural and Food Bacteriology Research Division, Department of Agriculture for Northern Ireland, Newforge Lane, Belfast BT9 5PX, Northern Ireland and Department of Agricultural and Food Bacteriology, The Queen's University of Belfast, Newforge Lane, Belfast BT9 5PX, Northern Ireland
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