Browsing by Author "Rojas, Leoncio Flavio"

Now showing 1 - 2 of 2
  • Thumbnail Image
    ItemOpen Access
    Identification of novel risk factors for community-acquired Clostridium difficile infection using spatial statistics and geographic information system analyses.
    (PLoS One, 2017) Anderson, Deverick J; Rojas, Leoncio Flavio; Watson, Shera; Knelson, Lauren P; Pruitt, Sohayla; Lewis, Sarah S; Moehring, Rebekah W; Sickbert Bennett, Emily E; Weber, David J; Chen, Luke F; Sexton, Daniel J; CDC Prevention Epicenters Program
    BACKGROUND: The rate of community-acquired Clostridium difficile infection (CA-CDI) is increasing. While receipt of antibiotics remains an important risk factor for CDI, studies related to acquisition of C. difficile outside of hospitals are lacking. As a result, risk factors for exposure to C. difficile in community settings have been inadequately studied. MAIN OBJECTIVE: To identify novel environmental risk factors for CA-CDI. METHODS: We performed a population-based retrospective cohort study of patients with CA-CDI from 1/1/2007 through 12/31/2014 in a 10-county area in central North Carolina. 360 Census Tracts in these 10 counties were used as the demographic Geographic Information System (GIS) base-map. Longitude and latitude (X, Y) coordinates were generated from patient home addresses and overlaid to Census Tracts polygons using ArcGIS; ArcView was used to assess "hot-spots" or clusters of CA-CDI. We then constructed a mixed hierarchical model to identify environmental variables independently associated with increased rates of CA-CDI. RESULTS: A total of 1,895 unique patients met our criteria for CA-CDI. The mean patient age was 54.5 years; 62% were female and 70% were Caucasian. 402 (21%) patient addresses were located in "hot spots" or clusters of CA-CDI (p<0.001). "Hot spot" census tracts were scattered throughout the 10 counties. After adjusting for clustering and population density, age ≥ 60 years (p = 0.03), race (<0.001), proximity to a livestock farm (0.01), proximity to farming raw materials services (0.02), and proximity to a nursing home (0.04) were independently associated with increased rates of CA-CDI. CONCLUSIONS: Our study is the first to use spatial statistics and mixed models to identify important environmental risk factors for acquisition of C. difficile and adds to the growing evidence that farm practices may put patients at risk for important drug-resistant infections.
  • Thumbnail Image
    ItemOpen Access
    Substance use and mental diagnoses among adults with and without type 2 diabetes: Results from electronic health records data.
    (Drug and alcohol dependence, 2015-11) Wu, Li-Tzy; Ghitza, Udi E; Batch, Bryan C; Pencina, Michael J; Rojas, Leoncio Flavio; Goldstein, Benjamin A; Schibler, Tony; Dunham, Ashley A; Rusincovitch, Shelley; Brady, Kathleen T
    BACKGROUND:Comorbid diabetes and substance use diagnoses (SUD) represent a hazardous combination, both in terms of healthcare cost and morbidity. To date, there is limited information about the association of SUD and related mental disorders with type 2 diabetes mellitus (T2DM). METHODS:We examined the associations between T2DM and multiple psychiatric diagnosis categories, with a focus on SUD and related psychiatric comorbidities among adults with T2DM. We analyzed electronic health record (EHR) data on 170,853 unique adults aged ≥18 years from the EHR warehouse of a large academic healthcare system. Logistic regression analyses were conducted to estimate the strength of an association for comorbidities. RESULTS:Overall, 9% of adults (n=16,243) had T2DM. Blacks, Hispanics, Asians, and Native Americans had greater odds of having T2DM than whites. All 10 psychiatric diagnosis categories were more prevalent among adults with T2DM than among those without T2DM. Prevalent diagnoses among adults with T2MD were mood (21.22%), SUD (17.02%: tobacco 13.25%, alcohol 4.00%, drugs 4.22%), and anxiety diagnoses (13.98%). Among adults with T2DM, SUD was positively associated with mood, anxiety, personality, somatic, and schizophrenia diagnoses. CONCLUSIONS:We examined a large diverse sample of individuals and found clinical evidence of SUD and psychiatric comorbidities among adults with T2DM. These results highlight the need to identify feasible collaborative care models for adults with T2DM and SUD related psychiatric comorbidities, particularly in primary care settings, that will improve behavioral health and reduce health risk.