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Friedlander DF, McClintock TR, Haleblian GE. AUTHOR REPLY. Urology 2021; 157:113. [PMID: 34895587 DOI: 10.1016/j.urology.2021.05.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/12/2021] [Indexed: 10/19/2022]
Affiliation(s)
- David F Friedlander
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tyler R McClintock
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - George E Haleblian
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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McClintock TR, Friedlander DF, Feng AY, Shah MA, Pallin DJ, Chang SL, Bader AM, Feeley TW, Kaplan RS, Haleblian GE. Determining variable costs in the acute urolithiasis cycle of care through time-driven activity-based costing. Urology 2021; 157:107-113. [PMID: 34391774 DOI: 10.1016/j.urology.2021.05.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize full cycle of care costs for managing an acute ureteral stone using time-driven activity-based costing. METHODS We defined all phases of care for patients presenting with an acute ureteral stone and built an overarching process map. Maps for sub-processes were constructed through interviews with providers and direct observation of clinical spaces. This facilitated calculation of cost per minute for all aspects of care delivery, which were multiplied by associated process times. These were added to consumable costs to determine cost for each specific step and later aggregated to determine total cost for each sub-process. We compared costs of eight common clinical pathways for acute stone management, defining total cycle of care cost as the sum of all sub-processes that comprised each pathway. RESULTS Cost per sub-process included $920 for emergency department (ED) care, $1665 for operative stent placement, $2368 for percutaneous nephrostomy tube placement, $106 for urology clinic consultation, $238 for preoperative center visit, $4057 for ureteroscopy with laser lithotripsy (URS), $2923 for extracorporeal shock wave lithotripsy, $169 for clinic stent removal, $197 for abdominal x-ray, and $166 for ultrasound. The lowest cost pathway ($1388) was for medical expulsive therapy, whereas the most expensive pathway ($8002) entailed a repeat ED visit prompting temporizing stent placement and interval URS. CONCLUSION We found a high degree of cost variation between care pathways common to management of acute ureteral stone episodes. Reliable cost accounting data and an understanding of variability in clinical pathway costs can inform value-based care redesign as payors move away from pure fee-for-service reimbursement.
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Affiliation(s)
- Tyler R McClintock
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urology, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA; Harvard Business School, Boston, MA.
| | - David F Friedlander
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Aiden Y Feng
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Angela M Bader
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas W Feeley
- Harvard Business School, Boston, MA; The Institute for Cancer Care Innovation and Division of Anesthesiology and Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - George E Haleblian
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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McClintock TR, Gondi S, Wang Y, Friedlander DF, Cole AP, Sun M, Melnitchouk N, Chang SL, Haider AH, Weissman JS, Trinh QD. Association of Affordable Care Act-related Medicaid expansion with variation in utilization of surgical services. Am J Surg 2020; 220:441-447. [DOI: 10.1016/j.amjsurg.2019.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 01/11/2023]
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McClintock TR, Cone EB, Marchese M, Chen X, Nguyen PL, Sun M, Trinh QD. Prostate cancer management costs vary by disease stage at presentation. Prostate Cancer Prostatic Dis 2020; 23:564-566. [PMID: 32409730 DOI: 10.1038/s41391-020-0239-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/09/2020] [Accepted: 05/06/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Tyler R McClintock
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Harvard Business School, Boston, MA, USA
| | - Eugene B Cone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maya Marchese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Xi Chen
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Maxine Sun
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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McClintock TR, Shah MA, Chang SL, Haleblian GE. Time-Driven Activity-Based Costing in Urologic Surgery Cycles of Care. Value Health 2019; 22:768-771. [PMID: 31277822 DOI: 10.1016/j.jval.2019.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/31/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Tyler R McClintock
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George E Haleblian
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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McClintock TR, Wang Y, Shah MA, Mossanen M, Chung BI, Chang SL. Hospital Charges for Urologic Surgery Episodes of Care Are Rising Despite Declining Costs. Mayo Clin Proc 2019; 94:995-1002. [PMID: 31079963 DOI: 10.1016/j.mayocp.2019.02.008] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/01/2019] [Accepted: 02/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the temporal relationship of hospital charges relative to recorded costs for surgical episodes of care. PATIENTS AND METHODS This retrospective cohort study selected individuals who underwent any of 8 index urologic surgical procedures at 392 unique institutions from January 1, 2005, through December 31, 2015. For each surgical encounter, cost and charge data reported by hospitals were extracted and adjusted to 2016 US dollars. Trend analysis and multivariable logistic regression modeling were used to assess outcomes. The primary outcome was trend in median charge and cost. Secondary outcomes consisted of hospital characteristics associated with membership in the highest quartile of institutional charge-to-cost ratio. RESULTS Cohort-level median cost per encounter trended down from $6824 in 2005 to $5586 in 2015 (P for trend<.001), and charges increased from $20,210 to $25,773 during the same period (P for trend<.001). Hospitals in the highest quartile of institutional charge-to-cost ratio were more likely to be safety net, nonteaching, urban, lower surgical volume, smaller, and located outside the Midwest (P<.001 for each characteristic). CONCLUSION The pricing trends shown herein could indicate some success in cost-containment for surgical episodes of care, although higher hospital charges may be increasingly used to bolster reimbursement from third-party payers and to compensate for escalating costs in other areas.
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Affiliation(s)
- Tyler R McClintock
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ye Wang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Matthew Mossanen
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Affiliation(s)
- Tyler R. McClintock
- Division of Urology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
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McClintock TR, von Landenberg N, Cole AP, Lipsitz SR, Gild P, Sun M, Fletcher SA, Roghmann F, Menon M, Nguyen PL, Noldus J, Choueiri TK, Kibel AS, Trinh QD. Neoadjuvant Androgen Deprivation Therapy Prior to Radical Prostatectomy: Recent Trends in Utilization and Association with Postoperative Surgical Margin Status. Ann Surg Oncol 2018; 26:297-305. [PMID: 30430324 DOI: 10.1245/s10434-018-7035-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE In this study, we sought to describe the contemporary trends in utilization of neoadjuvant androgen deprivation therapy (ADT). As a secondary endpoint, we assessed the community-level effect of neoadjuvant ADT on positive surgical margins after radical prostatectomy (RP). METHODS Using the National Cancer Database (2004-2014), we identified patients with clinically localized prostate cancer (PCa) [cT1-4N0M0] treated with RP. The estimated annual percentage change (EAPC) mixed linear regression methodology was used for temporal trend analysis of neoadjuvant ADT. Observed differences in baseline characteristics between patients treated with neoadjuvant ADT versus those who were not were then controlled for using an inverse probability of treatment weighting (IPTW) approach. IPTW-adjusted analyses were then performed to examine the odds of positive surgical margins. RESULTS Overall, 8184 (2.12%) and 377,843 (97.88%) individuals with PCa were treated with neoadjuvant ADT prior to RP versus RP only, respectively. There was a consistent trend in decreasing use of neoadjuvant ADT over time, with a nadir observed in 2011 [EAPC - 8.08; 95% confidence interval (CI) - 11.7 to - 4.32; p < 0.05]. In IPTW-adjusted analyses, the odds of positive surgical margins were lower in patients receiving neoadjuvant ADT with low-risk [odds ratio (OR) 0.65; 95% CI 0.51-0.84; p < 0.001] and intermediate-risk [OR 0.76; 95% CI 0.69-0.85; p < 0.001] PCa. CONCLUSIONS After a period of steady decline, there appears to be a modest trend towards increased utilization of neoadjuvant ADT in more recent years. We found an association between neoadjuvant ADT and decreased odds of positive surgical margins among low- and intermediate-risk patients.
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Affiliation(s)
- Tyler R McClintock
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicolas von Landenberg
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Urology, Ruhr-University Bochum, Marien Hospital Herne, Herne, Germany
| | - Alexander P Cole
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philipp Gild
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxine Sun
- Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Sean A Fletcher
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Florian Roghmann
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mani Menon
- Vattikuti Urology Institute, Vattikuti Urology Institute (VUI) Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Paul L Nguyen
- Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Joachim Noldus
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Toni K Choueiri
- Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
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McClintock TR, Wang Y, Cole AP, Chung BI, Kibel AS, Chang SL, Trinh QD. Contemporary trends in the utilisation of radical prostatectomy. BJU Int 2018; 122:726-728. [PMID: 29797448 DOI: 10.1111/bju.14411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Tyler R McClintock
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ye Wang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander P Cole
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Adam S Kibel
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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McClintock TR, Cole AP, Kwon NK, Fletcher SA, Berg S, Nabi J, Menon M, Kibel AS, Trinh QD. MP13-19 TESTOSTERONE REPLACEMENT THERAPY IS ASSOCIATED WITH INCREASED INCIDENCE OF UROLITHIASIS. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McClintock TR, Bjurlin MA, Stifelman MD. Reply: To PMID 24909960. Urology 2014; 84:333. [PMID: 24909963 DOI: 10.1016/j.urology.2014.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Tyler R McClintock
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Marc A Bjurlin
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Michael D Stifelman
- Department of Urology, New York University Langone Medical Center, New York, NY
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McClintock TR, Bjurlin MA, Wysock JS, Borofsky MS, Marien TP, Okoro C, Stifelman MD. Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial nephrectomy? Urology 2014; 84:327-32. [PMID: 24909960 DOI: 10.1016/j.urology.2014.02.044] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/07/2013] [Accepted: 02/06/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare renal functional outcomes in robotic partial nephrectomy (RPN) with selective arterial clamping guided by near-infrared fluorescence (NIRF) imaging to a matched cohort of patients who underwent RPN without selective arterial clamping and NIRF imaging. METHODS From April 2011 to December 2012, NIRF imaging-enhanced RPN with selective clamping was used in 42 cases. Functional outcomes of successful cases were compared with a cohort of patients, matched by tumor size, preoperative estimated glomerular filtration rate (eGFR), functional kidney status, age, sex, body mass index, and American Society of Anesthesiologists score, who underwent RPN without selective clamping and NIRF imaging. RESULTS In matched-pair analysis, selective clamping with NIRF was associated with superior kidney function at discharge, as demonstrated by postoperative eGFR (78.2 vs 68.5 mL/min/1.73 m(2); P = .04), absolute reduction of eGFR (-2.5 vs -14.0 mL/min/1.73 m(2); P <.01), and percent change in eGFR (-1.9% vs -16.8%; P <.01). Similar trends were noted at 3 month follow-up, but these differences became nonsignificant (P[eGFR] = .07; P[absolute reduction of eGFR] = .10; and P[percent change in eGFR] = .07). In the selective clamping group, a total of 4 perioperative complications occurred in 3 patients, all of which were Clavien grade I-III. CONCLUSION Use of NIRF imaging was associated with improved short-term renal functional outcomes when compared with RPN without selective arterial clamping and NIRF imaging. With this effect attenuated at later follow-up, randomized prospective studies and long-term assessment of kidney-specific functional outcomes are needed to further assess the benefits of this technology.
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Affiliation(s)
- Tyler R McClintock
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Marc A Bjurlin
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - James S Wysock
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Michael S Borofsky
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Tracy P Marien
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Chinonyerem Okoro
- Department of Urology, New York University Langone Medical Center, New York, NY
| | - Michael D Stifelman
- Department of Urology, New York University Langone Medical Center, New York, NY.
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McClintock TR, Parvez F, Wu F, Wang W, Islam T, Ahmed A, Shaheen I, Sarwar G, Demmer RT, Desvarieux M, Ahsan H, Chen Y. Association between betel quid chewing and carotid intima-media thickness in rural Bangladesh. Int J Epidemiol 2014; 43:1174-82. [PMID: 24550247 DOI: 10.1093/ije/dyu009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Areca nut, more commonly known as betel nut, is the fourth most commonly used addictive substance in the world. Though recent evidence suggests it may play a role in the development of cardiovascular disease, no studies have investigated whether betel nut use is related to subclinical atherosclerosis. METHODS We evaluated the association between betel nut use and subclinical atherosclerosis in 1206 participants randomly sampled from the Health Effects of Arsenic Longitudinal Study (HEALS). Frequency and duration of betel nut use were assessed at baseline, and carotid IMT was measured on average 6.65 years after baseline. RESULTS A positive association was observed between duration and cumulative exposure (function of duration and frequency) of betel nut use and IMT, with above-median use for duration (7 or more years) and cumulative exposure (30 or more quid-years) corresponding to a 19.1 μm [95% confidence interval (CI): 5.3-32.8; P ≤ 0.01] and 16.8 μm (95% CI: 2.9-30.8; P < 0.05) higher IMT in an adjusted model, respectively. This association was more pronounced in men [32.8 μm (95% CI: 10.0-55.7) and 30.9 μm (95% CI: 7.4-54.2)]. There was a synergy between cigarette smoking and above-median betel use such that the joint exposure was associated with a 42.4 μm (95% CI: 21.6-63.2; P ≤ 0.01) difference in IMT. CONCLUSION Betel nut use at long duration or high cumulative exposure levels is associated with subclinical atherosclerosis as manifested through carotid IMT. This effect is especially pronounced among men and cigarette smokers.
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Affiliation(s)
- Tyler R McClintock
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Faruque Parvez
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Fen Wu
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Weijia Wang
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Tariqul Islam
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Alauddin Ahmed
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Ishrat Shaheen
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Golam Sarwar
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Ryan T Demmer
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Moise Desvarieux
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USADepartments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USADepartments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, Unive
| | - Habibul Ahsan
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Yu Chen
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY, USA, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA, U-Chicago Research Bangladesh, Dhaka, Bangladesh, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, INSERM, UMR-S 707, Université Pierre et Marie Curie-Paris 6, Paris, France, École des Hautes Études en Santé Publique, Paris and Rennes, France and Departments of Health Studies, Medicine and Human Genetics and Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
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14
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McClintock TR, Chen Y, Parvez F, Makarov DV, Ge W, Islam T, Ahmed A, Rakibuz-Zaman M, Hasan R, Sarwar G, Slavkovich V, Bjurlin MA, Graziano JH, Ahsan H. Association between arsenic exposure from drinking water and hematuria: results from the Health Effects of Arsenic Longitudinal Study. Toxicol Appl Pharmacol 2014; 276:21-7. [PMID: 24486435 DOI: 10.1016/j.taap.2014.01.015] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/18/2014] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
Abstract
Arsenic (As) exposure has been associated with both urologic malignancy and renal dysfunction; however, its association with hematuria is unknown. We evaluated the association between drinking water As exposure and hematuria in 7843 men enrolled in the Health Effects of Arsenic Longitudinal Study (HEALS). Cross-sectional analysis of baseline data was conducted with As exposure assessed in both well water and urinary As measurements, while hematuria was measured using urine dipstick. Prospective analyses with Cox proportional regression models were based on urinary As and dipstick measurements obtained biannually since baseline up to six years. At baseline, urinary As was significantly related to prevalence of hematuria (P-trend<0.01), with increasing quintiles of exposure corresponding with respective prevalence odds ratios of 1.00 (reference), 1.29 (95% CI: 1.04-1.59), 1.41 (95% CI: 1.15-1.74), 1.46 (95% CI: 1.19-1.79), and 1.56 (95% CI: 1.27-1.91). Compared to those with relatively little absolute urinary As change during follow-up (-10.40 to 41.17 μg/l), hazard ratios for hematuria were 0.99 (95% CI: 0.80-1.22) and 0.80 (95% CI: 0.65-0.99) for those whose urinary As decreased by >47.49 μg/l and 10.87 to 47.49 μg/l since last visit, respectively, and 1.17 (95% CI: 0.94-1.45) and 1.36 (95% CI: 1.10-1.66) for those with between-visit increases of 10.40 to 41.17 μg/l and >41.17 μg/l, respectively. These data indicate a positive association of As exposure with both prevalence and incidence of dipstick hematuria. This exposure effect appears modifiable by relatively short-term changes in drinking water As.
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Affiliation(s)
- Tyler R McClintock
- Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Urology, New York University School of Medicine, New York, NY, USA
| | - Yu Chen
- Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA.
| | - Faruque Parvez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Danil V Makarov
- Department of Urology, New York University School of Medicine, New York, NY, USA; Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA; United States Department of Veterans Affairs Harbor Healthcare System, New York, NY, USA; New York University Cancer Institute, New York, NY, USA
| | - Wenzhen Ge
- Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Tariqul Islam
- U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh
| | | | | | - Rabiul Hasan
- U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh
| | - Golam Sarwar
- U-Chicago Research Bangladesh, Ltd., Dhaka, Bangladesh
| | - Vesna Slavkovich
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marc A Bjurlin
- Department of Urology, New York University School of Medicine, New York, NY, USA
| | - Joseph H Graziano
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Habibul Ahsan
- Department of Health Studies, The University of Chicago, Chicago, IL, USA; Department of Medicine, The University of Chicago, Chicago, IL, USA; Department of Human Genetics, The University of Chicago, Chicago, IL, USA; Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA.
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15
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Bjurlin MA, Gan M, McClintock TR, Volpe A, Borofsky MS, Mottrie A, Stifelman MD. Near-infrared fluorescence imaging: emerging applications in robotic upper urinary tract surgery. Eur Urol 2013; 65:793-801. [PMID: 24099660 DOI: 10.1016/j.eururo.2013.09.023] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 09/11/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Near-infrared fluorescence (NIRF) imaging is a technology with emerging applications in urologic surgery. OBJECTIVE To describe surgical techniques and provide clinical outcomes for robotic partial nephrectomy (RPN) with selective clamping and robotic upper urinary tract reconstruction featuring novel applications of NIRF imaging. DESIGN, SETTING, AND PARTICIPANTS Data from 90 patients who underwent successful RPN with selective clamping or upper urinary tract reconstruction utilizing NIRF imaging between April 2011 and October 2012 were reviewed. SURGICAL PROCEDURE We performed RPN utilizing NIRF imaging to aid with selective clamping and upper tract reconstruction with NIRF imaging, the details of which are outlined in this paper and the accompanying video. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patient characteristics, perioperative outcomes, and complications were analyzed. RESULTS AND LIMITATIONS Of the 48 RPN patients for whom selective clamping was attempted successfully, median estimated blood loss was 200.0 ml, warm ischemia time was 17.0 min, and median change in estimated glomerular filtration rate was -6.3%. There was a 12.5% complication rate, and all complications were Clavien grade 1-3 (14.3%). The upper urinary tract reconstruction utilizing NIRF imaging was performed in 42 patients and included pyelopasty (n=20), ureteral reimplant (n=13), ureterolysis (n=7), and ureteroureterostomy (n=2). Radiographic and symptomatic improvement was observed in 100% of the pyeloplasty, ureteral reimplant, and ureteroureterostomy patients and 71.4% of ureterolysis patients, for an overall success rate of 95.2%. This study is limited by the small sample size, the short follow-up period, and the lack of a comparative cohort. CONCLUSIONS Our technique of RPN with selective arterial clamping and robotic upper urinary tract reconstruction utilizing NIRF imaging is presented. This technology provides real-time intraoperative angiogram to confirm selective ischemia and may be an adjunct technology to confirm well-perfused tissue within a reconstruction anastomosis. Further investigation is needed to evaluate long-term outcomes of NIRF imaging in robotic upper urinary tract surgery and to delineate its indications.
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Affiliation(s)
- Marc A Bjurlin
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
| | - Melanie Gan
- O.L.V. Vattikuti Robotic Surgery Institute, Aalst, Belgium
| | - Tyler R McClintock
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
| | - Alessandro Volpe
- O.L.V. Vattikuti Robotic Surgery Institute, Aalst, Belgium; Department of Urology, University of Eastern Piedmont, Novara, Italy
| | - Michael S Borofsky
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA
| | - Alexandre Mottrie
- O.L.V. Vattikuti Robotic Surgery Institute, Aalst, Belgium; Department of Urology, O.L.V. Hospital Aalst, Aalst, Belgium
| | - Michael D Stifelman
- Department of Urology, New York University, Langone Medical Center, New York, NY, USA.
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16
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Chen Y, Wu F, Parvez F, Ahmed A, Eunus M, McClintock TR, Patwary TI, Islam T, Ghosal AK, Islam S, Hasan R, Levy D, Sarwar G, Slavkovich V, van Geen A, Graziano JH, Ahsan H. Arsenic exposure from drinking water and QT-interval prolongation: results from the Health Effects of Arsenic Longitudinal Study. Environ Health Perspect 2013; 121:427-32. [PMID: 23384555 PMCID: PMC3620737 DOI: 10.1289/ehp.1205197] [Citation(s) in RCA: 39] [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] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 01/31/2013] [Indexed: 05/21/2023]
Abstract
BACKGROUND Arsenic exposure from drinking water has been associated with heart disease; however, underlying mechanisms are uncertain. OBJECTIVE We evaluated the association between a history of arsenic exposure from drinking water and the prolongation of heart rate-corrected QT (QTc), PR, and QRS intervals. METHOD We conducted a study of 1,715 participants enrolled at baseline from the Health Effects of Arsenic Longitudinal Study. We assessed the relationship of arsenic exposure in well water and urine samples at baseline with parameters of electrocardiogram (ECG) performed during 2005-2010, 5.9 years on average since baseline. RESULTS The adjusted odds ratio (OR) for QTc prolongation, defined as a QTc ≥ 450 msec in men and ≥ 460 msec in women, was 1.17 (95% CI: 1.01, 1.35) for a 1-SD increase in well-water arsenic (108.7 µg/L). The positive association appeared to be limited to women, with adjusted ORs of 1.24 (95% CI: 1.05, 1.47) and 1.24 (95% CI: 1.01, 1.53) for a 1-SD increase in baseline well-water and urinary arsenic, respectively, compared with 0.99 (95% CI: 0.73, 1.33) and 0.86 (95% CI: 0.49, 1.51) in men. There were no apparent associations of baseline well-water arsenic or urinary arsenic with PR or QRS prolongation in women or men. CONCLUSIONS Long-term arsenic exposure from drinking water (average 95 µg/L; range, 0.1-790 µg/L) was associated with subsequent QT-interval prolongation in women. Future longitudinal studies with repeated ECG measurements would be valuable in assessing the influence of changes in exposure.
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Affiliation(s)
- Yu Chen
- Department of Population Health, New York University School of Medicine, New York University, New York, New York 10016 USA.
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17
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Prabhu V, Lee T, McClintock TR, Lepor H. Short-, Intermediate-, and Long-term Quality of Life Outcomes Following Radical Prostatectomy for Clinically Localized Prostate Cancer. Rev Urol 2013; 15:161-177. [PMID: 24659913 PMCID: PMC3922321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Many clinically localized prostate cancers that are diagnosed today are low risk, and prevention of disease-specific mortality may only be realized decades after treatment. Radical prostatectomy (RP) may adversely impact health-related quality of life (HRQOL) by causing both transient or permanent urinary incontinence and erectile dysfunction. In contrast, RP may also improve HRQOL via relief of lower urinary tract symptoms in men suffering from these symptoms prior to surgery. Because the average man treated for prostate cancer has a life expectancy of approximately 14 years, it is imperative to consider the long-term impact of RP on both survival and HRQOL in treatment decision making. This comprehensive literature review examines short-, intermediate-, and long-term HRQOL following RP. In addition, the long-term results of RP are compared with other treatment modalities for treating clinically localized prostate cancer.
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Affiliation(s)
- Vinay Prabhu
- Department of Urology, New York University School of Medicine, New York, NY
| | - Ted Lee
- Department of Urology, New York University School of Medicine, New York, NY
| | - Tyler R McClintock
- Department of Urology, New York University School of Medicine, New York, NY
| | - Herbert Lepor
- Department of Urology, New York University School of Medicine, New York, NY
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18
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McClintock TR, Chen Y, Bundschuh J, Oliver JT, Navoni J, Olmos V, Lepori EV, Ahsan H, Parvez F. Arsenic exposure in Latin America: biomarkers, risk assessments and related health effects. Sci Total Environ 2012; 429:76-91. [PMID: 22119448 PMCID: PMC3977337 DOI: 10.1016/j.scitotenv.2011.08.051] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 08/08/2011] [Accepted: 08/10/2011] [Indexed: 05/19/2023]
Abstract
In Latin America, several regions have a long history of widespread arsenic (As) contamination from both natural and anthropological sources. Yet, relatively little is known about the extent of As exposure from drinking water and its related health consequences in these countries. It has been estimated that at least 4.5 million people in Latin America are chronically exposed to high levels of As (>50 μg/L), some to as high as 2000 μg/L--200 times higher than the World Health Organization (WHO) provisional standard for drinking water. We conducted a systematic review of 82 peer reviewed papers and reports to fully explore the current understanding of As exposure and its health effects, as well as the influence of genetic factors that modulate those effects in the populations of Latin America. Despite some methodological limitations, these studies suggested important links between the high levels of chronic As exposure and elevated risks of numerous adverse health outcomes in Latin America--including internal and external cancers, reproductive outcomes, and childhood cognitive function. Several studies demonstrated genetic polymorphisms that influence susceptibility to these and other disease states through their modulation of As metabolism, with As methyltransferase (AS3MT), glutathione S-transferase (GST), and genes of one-carbon metabolism being specifically implicated. While the full extent and nature of the health burden are yet to be known in Latin America, these studies have significantly enriched knowledge of As toxicity and led to subsequent research. Targeted future studies will not only yield a better understanding of the public health impact of As in Latin America populations, but also allow for effective and timely mitigation efforts.
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Affiliation(s)
- Tyler R. McClintock
- New York University School of Medicine, New York University, New York, NY, USA
| | - Yu Chen
- Department of Environmental Medicine, New York University, New York, NY, USA
| | - Jochen Bundschuh
- Institute of Applied Research, Karlsruhe University of Applied Sciences, Moltkestrasse 30, 76133 Karlsruhe, Germany
- Department of Earth Sciences, National Cheng Kung University, University Road, Tainan City 701, Taiwan
| | - John T. Oliver
- Columbia University Medical Center, Hammer Health Sciences Center, New York, NY, USA
| | - Julio Navoni
- Cátedra de Toxicología y Química Legal- Facultad de Farmacia y Bioquímica. Universidad de Buenos Aires. Junín 956- piso 7, 1113 Buenos Aires, Argentina
| | - Valentina Olmos
- Cátedra de Toxicología y Química Legal- Facultad de Farmacia y Bioquímica. Universidad de Buenos Aires. Junín 956- piso 7, 1113 Buenos Aires, Argentina
| | - Edda Villaamil Lepori
- Cátedra de Toxicología y Química Legal- Facultad de Farmacia y Bioquímica. Universidad de Buenos Aires. Junín 956- piso 7, 1113 Buenos Aires, Argentina
| | - Habibul Ahsan
- Departments of Medicine and Human Genetics and Cancer Research Center, The University of Chicago, Chicago, IL, USA
- Department of Health Studies, The University of Chicago, Chicago, IL, USA
| | - Faruque Parvez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- Address for correspondence and reprints: Faruque Parvez, Department of Environmental Health Sciences, 60 Haven Ave, B-1, New York, NY 10032. Phone / Fax: 212-305-4101/ 212-305-3857,
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19
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Chen Y, McClintock TR, Segers S, Parvez F, Islam T, Ahmed A, Rakibuz-Zaman M, Hasan R, Sarwar G, Ahsan H. Prospective investigation of major dietary patterns and risk of cardiovascular mortality in Bangladesh. Int J Cardiol 2012; 167:1495-501. [PMID: 22560940 DOI: 10.1016/j.ijcard.2012.04.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 04/09/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Dietary pattern analysis is emerging as a practical, effective tool for relating comprehensive dietary intake to risk of cardiovascular disease mortality. However, no studies have applied this technique to a population outside of the developed world. METHODS We conducted prospective cohort analyses in 11,116 participants enrolled in the Health Effects of Arsenic Study in Araihazar, Bangladesh, measuring deaths attributable to disease of circulatory system, heart disease, and cerebrovascular disease. Participants were enrolled in 2000 and followed up for an average of 6.6 years. Dietary information was obtained through a previously validated food-frequency questionnaire at baseline. RESULTS Principal component analysis based on our comprehensive, 39 item FFQ yielded 3 dietary patterns: (i) a "balanced" pattern, comprised of steamed rice, red meat, fish, fruit and vegetables; (ii) an "animal protein" diet, which was more heavily weighted towards eggs, milk, red meat, poultry, bread, and vegetables; and (iii) a "gourd and root vegetable" diet that heavily relied on a variety of gourds, radishes, pumpkin, sweet potato, and spinach. We observed a positive association between increasing adherence to the animal protein diet and risk of death from both disease of the circulatory system and heart disease; the hazard ratios were 1.13 (95% CI, 1.00-1.28, p=0.05) and 1.17 (95% CI, 0.99-1.38, p=0.07), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern, after controlling for age, sex, body mass index, smoking status, and energy intake. The positive association was more significant among ever smokers; the hazard ratios (95% CI) for deaths from disease of the circulatory system and heart disease were 1.17 (1.02-1.34) and 1.20 (1.00-1.45), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern. CONCLUSIONS An animal protein-rich diet in rural Bangladesh may increase risk of heart disease mortality, especially among smokers. This emphasizes the need to further explore and address the impact of dietary patterns on cardiovascular disease in populations undergoing epidemiologic transition.
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Affiliation(s)
- Yu Chen
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA.
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20
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Gitlin JN, Narayan AK, Mitchell CA, Akmal AM, Eisner DJ, Peterson LM, Nie D, McClintock TR. A comparative study of conventional mammography film interpretations with soft copy readings of the same examinations. J Digit Imaging 2007; 20:42-52. [PMID: 17191103 PMCID: PMC3043891 DOI: 10.1007/s10278-006-1046-1] [Citation(s) in RCA: 7] [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: 10/23/2022] Open
Abstract
An acceptable mammography film digitizer must provide high-quality images at a level of diagnostic accuracy comparable to reading conventional film examinations. The purpose of this study was to determine if there are significant differences between the interpretations of conventional film-screen mammography examinations and soft copy readings of the images produced by a mammography film digitizer. Eight radiologists interpreted 120 mammography examinations, half as original films and the other half as digital images on a soft copy work station. No radiologist read the same examination twice. The interpretations were recorded in accordance with the Breast Imaging Reporting and Data System and included other variables such as perceived image quality and diagnostic difficulty and confidence. The results provide support for the hypothesis that there are no significant differences between the interpretations of conventional film-screen mammography examinations and soft copy examinations produced by a mammography film digitizer.
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Affiliation(s)
- Joseph N Gitlin
- The John Hopkins Medical Institutions in Baltimore, The John Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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