Browsing by Subject "epidemiology"
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Item Open Access Acquisition, Analysis, and Sharing of Data in 2015 and Beyond: A Survey of the Landscape: A Conference Report From the American Heart Association Data Summit 2015.(J Am Heart Assoc, 2015-11-05) Antman, Elliott M; Benjamin, Emelia J; Harrington, Robert A; Houser, Steven R; Peterson, Eric D; Bauman, Mary Ann; Brown, Nancy; Bufalino, Vincent; Califf, Robert M; Creager, Mark A; Daugherty, Alan; Demets, David L; Dennis, Bernard P; Ebadollahi, Shahram; Jessup, Mariell; Lauer, Michael S; Lo, Bernard; MacRae, Calum A; McConnell, Michael V; McCray, Alexa T; Mello, Michelle M; Mueller, Eric; Newburger, Jane W; Okun, Sally; Packer, Milton; Philippakis, Anthony; Ping, Peipei; Prasoon, Prad; Roger, Véronique L; Singer, Steve; Temple, Robert; Turner, Melanie B; Vigilante, Kevin; Warner, John; Wayte, Patrick; American Heart Association Data Sharing Summit AttendeesBACKGROUND: A 1.5-day interactive forum was convened to discuss critical issues in the acquisition, analysis, and sharing of data in the field of cardiovascular and stroke science. The discussion will serve as the foundation for the American Heart Association's (AHA's) near-term and future strategies in the Big Data area. The concepts evolving from this forum may also inform other fields of medicine and science. METHODS AND RESULTS: A total of 47 participants representing stakeholders from 7 domains (patients, basic scientists, clinical investigators, population researchers, clinicians and healthcare system administrators, industry, and regulatory authorities) participated in the conference. Presentation topics included updates on data as viewed from conventional medical and nonmedical sources, building and using Big Data repositories, articulation of the goals of data sharing, and principles of responsible data sharing. Facilitated breakout sessions were conducted to examine what each of the 7 stakeholder domains wants from Big Data under ideal circumstances and the possible roles that the AHA might play in meeting their needs. Important areas that are high priorities for further study regarding Big Data include a description of the methodology of how to acquire and analyze findings, validation of the veracity of discoveries from such research, and integration into investigative and clinical care aspects of future cardiovascular and stroke medicine. Potential roles that the AHA might consider include facilitating a standards discussion (eg, tools, methodology, and appropriate data use), providing education (eg, healthcare providers, patients, investigators), and helping build an interoperable digital ecosystem in cardiovascular and stroke science. CONCLUSION: There was a consensus across stakeholder domains that Big Data holds great promise for revolutionizing the way cardiovascular and stroke research is conducted and clinical care is delivered; however, there is a clear need for the creation of a vision of how to use it to achieve the desired goals. Potential roles for the AHA center around facilitating a discussion of standards, providing education, and helping establish a cardiovascular digital ecosystem. This ecosystem should be interoperable and needs to interface with the rapidly growing digital object environment of the modern-day healthcare system.Item Open Access Acute Kidney Injury after Lung Transplantation: A Systematic Review and Meta-Analysis.(Journal of clinical medicine, 2019-10) Lertjitbanjong, Ploypin; Thongprayoon, Charat; Cheungpasitporn, Wisit; O'Corragain, Oisín A; Srivali, Narat; Bathini, Tarun; Watthanasuntorn, Kanramon; Aeddula, Narothama Reddy; Salim, Sohail Abdul; Ungprasert, Patompong; Gillaspie, Erin A; Wijarnpreecha, Karn; Mao, Michael A; Kaewput, WisitLung transplantation has been increasingly performed worldwide and is considered an effective therapy for patients with various causes of end-stage lung diseases. We performed a systematic review to assess the incidence and impact of acute kidney injury (AKI) and severe AKI requiring renal replacement therapy (RRT) in patients after lung transplantation. A literature search was conducted utilizing Ovid MEDLINE, EMBASE, and Cochrane Database from inception through June 2019. We included studies that evaluated the incidence of AKI, severe AKI requiring RRT, and mortality risk of AKI among patients after lung transplantation. Pooled incidence and odds ratios (ORs) with 95% confidence interval (CI) were obtained using random-effects meta-analysis. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019134095). A total of 26 cohort studies with a total of 40,592 patients after lung transplantation were enrolled. Overall, the pooled estimated incidence rates of AKI (by standard AKI definitions) and severe AKI requiring RRT following lung transplantation were 52.5% (95% CI: 45.8-59.1%) and 9.3% (95% CI: 7.6-11.4%). Meta-regression analysis demonstrated that the year of study did not significantly affect the incidence of AKI (p = 0.22) and severe AKI requiring RRT (p = 0.68). The pooled ORs of in-hospital mortality in patients after lung transplantation with AKI and severe AKI requiring RRT were 2.75 (95% CI, 1.18-6.41) and 10.89 (95% CI, 5.03-23.58). At five years, the pooled ORs of mortality among patients after lung transplantation with AKI and severe AKI requiring RRT were 1.47 (95% CI, 1.11-1.94) and 4.79 (95% CI, 3.58-6.40), respectively. The overall estimated incidence rates of AKI and severe AKI requiring RRT in patients after lung transplantation are 52.5% and 9.3%, respectively. Despite advances in therapy, the incidence of AKI in patients after lung transplantation does not seem to have decreased. In addition, AKI after lung transplantation is significantly associated with reduced short-term and long-term survival.Item Open Access Addressing the Menace of Enterococcal Endocarditis.(Journal of the American College of Cardiology, 2020-02) Bashore, Thomas M; Turner, Nicholas AItem Open Access Association of Biomarkers with Individual and Multiple Body Sites of Pain: The Johnston County Osteoarthritis Project.(Journal of pain research, 2022-01) Norman, Katherine S; Goode, Adam P; Alvarez, Carolina; Hu, David; George, Steven Z; Schwartz, Todd A; Danyluk, Stephanie T; Fillipo, Rebecca; Kraus, Virginia B; Huebner, Janet L; Cleveland, Rebecca J; Jordan, Joanne M; Nelson, Amanda E; Golightly, Yvonne MIntroduction
Biochemical biomarkers may provide insight into musculoskeletal pain reported at individual or multiple body sites. The purpose of this study was to determine if biomarkers or pressure-pain threshold (PPT) were associated with individual or multiple sites of pain.Methods
This cross-sectional analysis included 689 community-based participants. Self-reported symptoms (ie, pain, aching, or stiffness) were ascertained about the neck, upper back/thoracic, low back, shoulders, elbows, wrist, hands, hips, knees, ankles, and feet. Measured analytes included CXCL-6, RANTES, HA, IL-6, BDNF, OPG and NPY. A standard dolorimeter measured PPT. Logistic regression was used determine the association between biomarkers and PPT with individual and summed sites of pain.Results
Increased IL-6 and HA were associated with knee pain (OR=1.30, 95% CI 1.03, 1.64) and (OR=1.32, 95% CI 1.01, 1.73) respectively; HA was also associated with elbow/wrist/hand pain (OR=1.60, 95% CI 1.22, 2.09). Those with increased NPY levels were less likely to have shoulder pain (OR=0.56, 95% CI 0.33, 0.93). Biomarkers HA (OR=1.50, 95% CI 1.07, 2.10), OPG (OR=1.74, 95% CI 1.00, 3.03), CXCL-6 (OR=1.75, 95% CI 1.02, 3.01) and decreased PPT (OR=3.97, 95% CI 2.22, 7.12) were associated with multiple compared to no sites of pain. Biomarker HA (OR=1.57, 95% CI 1.06, 2.32) and decreased PPT (OR=3.53, 95% CI 1.81, 6.88) were associated with multiple compared to a single site of pain.Conclusion
Biomarkers of inflammation (HA, OPG, IL-6 and CXCL-6), pain (NPY) and PPT may help to understand the etiology of single and multiple pain sites.Item Open Access Bioaerosol Sampling in Clinical Settings: A Promising, Noninvasive Approach for Detecting Respiratory Viruses.(Open Forum Infect Dis, 2017) Nguyen, Tham T; Poh, Mee K; Low, Jenny; Kalimuddin, Shirin; Thoon, Koh C; Ng, Wai C; Anderson, Benjamin D; Gray, Gregory CBACKGROUND: Seeking a noninvasive method to conduct surveillance for respiratory pathogens, we sought to examine the usefulness of 2 types of off-the-shelf aerosol samplers to detect respiratory viruses in Singapore. METHODS: In this pilot study, we ran the aerosol samplers several times each week with patients present in the patient waiting areas at 3 primary health clinics during the months of April and May 2016. We used a SKC BioSampler with a BioLite Air Sampling Pump (run for 60 min at 8 L/min) and SKC AirChek TOUCH personal air samplers with polytetrafluoroethylene Teflon filter cassettes (run for 180 min at 5 L/min). The aerosol specimens and controls were studied with molecular assays for influenza A virus, influenza B virus, adenoviruses, and coronaviruses. RESULTS: Overall, 16 (33.3%) of the 48 specimens indicated evidence of at least 1 respiratory pathogen, with 1 (2%) positive for influenza A virus, 3 (6%) positive for influenza B virus, and 12 (25%) positive for adenovirus. CONCLUSIONS: Although we were not able to correlate molecular detection with individual patient illness, patients with common acute respiratory illnesses were present during the samplings. Combined with molecular assays, it would suggest that aerosol sampling has potential as a noninvasive method for novel respiratory virus detection in clinical settings.Item Open Access Childhood bullying involvement predicts low-grade systemic inflammation into adulthood.(Proc Natl Acad Sci U S A, 2014-05-27) Copeland, WE; Wolke, D; Lereya, ST; Shanahan, L; Worthman, C; Costello, EJBullying is a common childhood experience that involves repeated mistreatment to improve or maintain one's status. Victims display long-term social, psychological, and health consequences, whereas bullies display minimal ill effects. The aim of this study is to test how this adverse social experience is biologically embedded to affect short- or long-term levels of C-reactive protein (CRP), a marker of low-grade systemic inflammation. The prospective population-based Great Smoky Mountains Study (n = 1,420), with up to nine waves of data per subject, was used, covering childhood/adolescence (ages 9-16) and young adulthood (ages 19 and 21). Structured interviews were used to assess bullying involvement and relevant covariates at all childhood/adolescent observations. Blood spots were collected at each observation and assayed for CRP levels. During childhood and adolescence, the number of waves at which the child was bullied predicted increasing levels of CRP. Although CRP levels rose for all participants from childhood into adulthood, being bullied predicted greater increases in CRP levels, whereas bullying others predicted lower increases in CRP compared with those uninvolved in bullying. This pattern was robust, controlling for body mass index, substance use, physical and mental health status, and exposures to other childhood psychosocial adversities. A child's role in bullying may serve as either a risk or a protective factor for adult low-grade inflammation, independent of other factors. Inflammation is a physiological response that mediates the effects of both social adversity and dominance on decreases in health.Item Open Access Congenital Heart Disease Epidemiology in the United States: Blindly Feeling for the Charging Elephant.(Circulation, 2016-07-12) Krasuski, Richard A; Bashore, Thomas MItem Open Access Defining the Need for Causal Inference to Understand the Impact of Social Determinants of Health: A Primer on Behalf of the Consortium for the Holistic Assessment of Risk in Transplantation (CHART).(Annals of surgery open : perspectives of surgical history, education, and clinical approaches, 2023-12) Bhavsar, Nrupen A; Patzer, Rachel E; Taber, David J; Ross-Driscoll, Katie; Deierhoi Reed, Rhiannon; Caicedo-Ramirez, Juan C; Gordon, Elisa J; Matsouaka, Roland A; Rogers, Ursula; Webster, Wendy; Adams, Andrew; Kirk, Allan D; McElroy, Lisa MObjective
This study aims to introduce key concepts and methods that inform the design of studies that seek to quantify the causal effect of social determinants of health (SDOH) on access to and outcomes following organ transplant.Background
The causal pathways between SDOH and transplant outcomes are poorly understood. This is partially due to the unstandardized and incomplete capture of the complex interactions between patients, their neighborhood environments, the tertiary care system, and structural factors that impact access and outcomes. Designing studies to quantify the causal impact of these factors on transplant access and outcomes requires an understanding of the fundamental concepts of causal inference.Methods
We present an overview of fundamental concepts in causal inference, including the potential outcomes framework and direct acyclic graphs. We discuss how to conceptualize SDOH in a causal framework and provide applied examples to illustrate how bias is introduced.Results
There is a need for direct measures of SDOH, increased measurement of latent and mediating variables, and multi-level frameworks for research that examine health inequities across multiple health systems to generalize results. We illustrate that biases can arise due to socioeconomic status, race/ethnicity, and incongruencies in language between the patient and clinician.Conclusions
Progress towards an equitable transplant system requires establishing causal pathways between psychosocial risk factors, access, and outcomes. This is predicated on accurate and precise quantification of social risk, best facilitated by improved organization of health system data and multicenter efforts to collect and learn from it in ways relevant to specialties and service lines.Item Open Access Disseminated Adenovirus Infection After Combined Liver-Kidney Transplantation(FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY, 2018-11-20) Hemmersbach-Miller, Marion; Bailey, Emily S; Kappus, Matthew; Prasad, Vinod K; Gray, Gregory C; Alspaugh, J AndrewItem Embargo Epidemiology and Outcomes of Pediatric Surgical Patients at a Tertiary Hospital in Northern Tanzania(2024) Espinoza Gonzalez, PamelaBackground: Over 1.7 billion children and adolescents around the world lack access to safe and affordable surgical care, mostly in low- and middle-income countries (LMICs), where children and adolescents can account for up to half of a country’s population. Yet, the burden of surgical needs for children in Tanzania is still poorly defined. The aim of this study is to assess the epidemiology and outcomes of pediatric surgical procedures performed over one year at the Kilimanjaro Christian Medical Centre, Moshi, Tanzania.Methods: We reviewed the medical and surgical records of all children (< 16 years of age) who underwent surgery between January 1st, 2022 and December 31st, 2022 at the Kilimanjaro Christian Medical Centre. Descriptive statistics were used to assess demographic and clinical characteristics. Geospatial mapping tools were used to visualize the distribution of the patient’s district of origin. Results: We collected data on 2031 children, 59.8% (n = 1215) of whom were male, and more than half were between 1 and 5 years old (58.6%, [n = 1191]). In terms of procedure type, half of the procedures were tonsillectomies/adenoidectomies (51.1%), followed by laparotomies (3.4%), and ventriculoperitoneal shunts (3.2%). We identified 33 deaths prior to discharge. Children from uninsured families and those under one year old were more likely to have traveled longer, visited another health facility, and required an emergency procedure compared to children from insured families and other age groups. Conclusion: Being a child who is under one year old and from an uninsured family is associated with more urgent procedures and poorer outcomes, highlighting disparities in access to surgery for children in Northern Tanzania. Resource mobilization to provide financial protection for families who seek surgical care and health system strengthening at lower-level hospitals are crucial to addressing inequitable and unaffordable access to surgical care and improving health outcomes for children across Tanzania.
Item Open Access Geographic and Racial Disparities in Infant Hearing Loss.(Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2018-10-09) Lantos, Paul M; Maradiaga-Panayotti, Gabriela; Barber, Xavier; Raynor, Eileen; Tucci, Debara; Hoffman, Kate; Permar, Sallie R; Jackson, Pearce; Hughes, Brenna L; Kind, Amy; Swamy, Geeta KObjective Approximately 1 to 2 of every 1000 American newborns has hearing loss identified by newborn screening. This study was designed to determine if infant hearing loss is more common in socioeconomically disadvantaged communities. Study Design In this retrospective study, we analyzed electronic medical record data using geostatistical models. Setting Infants were residents of Durham County, North Carolina, born in 2 hospitals of the Duke University Health System. This county includes the city of Durham and surrounding suburban and rural communities. Subjects and Methods Subjects were hearing-screened newborns, born between 2005 and 2016, whose residential address was in Durham County, North Carolina. This was a retrospective study using medical record data. We used Bayesian regression models with smoothing of coordinate date to identify both spatial and nonspatial predictors of infant hearing loss. Results We identified 19,348 infants from Durham County, of whom 675 had failed initial hearing screening and 191 had hearing loss confirmed on follow-up. Hearing loss was significantly associated with minority race (odds ratio [OR], 2.45; 95% confidence interval, 1.97-3.06), as well as lower gestational age and maternal sexually transmitted infections. We identified significant geographic heterogeneity, with a higher probability of hearing loss in poorer urban neighborhoods (local OR range, 0.59-1.39). Neighborhood disadvantage was a significant predictor of hearing loss, as was high local seroprevalence of cytomegalovirus (CMV) among pregnant women. Conclusions Urban, low-income neighborhoods have a high prevalence of infant hearing loss compared with more affluent surrounding communities, particularly among minorities. This distribution may be attributable to congenital CMV infection.Item Open Access Geographic Expansion of Lyme Disease in the Southeastern United States, 2000-2014.(Open Forum Infect Dis, 2015-12) Lantos, Paul M; Nigrovic, Lise E; Auwaerter, Paul G; Fowler, Vance G; Ruffin, Felicia; Brinkerhoff, R Jory; Reber, Jodi; Williams, Carl; Broyhill, James; Pan, William K; Gaines, David NBackground. The majority of Lyme disease cases in the United States are acquired on the east coast between northern Virginia and New England. In recent years the geographic extent of Lyme disease has been expanding, raising the prospect of Lyme disease becoming endemic in the southeast. Methods. We collected confirmed and probable cases of Lyme disease from 2000 through 2014 from the Virginia Department of Health and North Carolina Department of Public Health and entered them in a geographic information system. We performed spatial and spatiotemporal cluster analyses to characterize Lyme disease expansion. Results. There was a marked increase in Lyme disease cases in Virginia, particularly from 2007 onwards. Northern Virginia experienced intensification and geographic expansion of Lyme disease cases. The most notable area of expansion was to the southwest along the Appalachian Mountains with development of a new disease cluster in the southern Virginia mountain region. Conclusions. The geographic distribution of Lyme disease cases significantly expanded in Virginia between 2000 and 2014, particularly southward in the Virginia mountain ranges. If these trends continue, North Carolina can expect autochthonous Lyme disease transmission in its mountain region in the coming years.Item Open Access Global distribution of Leptospira serovar isolations and detections from animal host species: a systematic review and online database.(medRxiv, 2023-10-03) Hagedoorn, Nienke N; Maze, Michael J; Carugati, Manuela; Cash-Goldwasser, Shama; Allan, Kathryn J; Chen, Kevin; Cossic, Brieuc; Demeter, Elena; Gallagher, Sarah; German, Richard; Galloway, Renee L; Habuš, Josipa; Rubach, Matthew P; Shiokawa, Kanae; Sulikhan, Nadezhda; Crump, John AOBJECTIVES: Leptospira, the spirochaete causing leptospirosis, can be classified into >250 antigenically distinct serovars. Although knowledge of the animal host species and geographic distribution of Leptospira serovars is critical to understand the human and animal epidemiology of leptospirosis, currently data are fragmented. We aimed to systematically review the literature on animal host species and geographic distribution of Leptospira serovars to examine associations between serovars with animal host species and regions, and to identify geographic regions in need of study. METHODS: Nine library databases were searched from inception through 9 March 2023 using keywords including Leptospira, animal, and a list of serovars. We sought reports of detection of Leptospira, from any animal, characterized by cross agglutinin absorption test, monoclonal antibody typing, serum factor analysis, or pulsed-field gel electrophoresis to identify the serovar. RESULTS: We included 409 reports, published from 1927 through 2022, yielding data on 154 Leptospira serovars. The reports included data from 66 (26.5%) of 249 countries. Detections were from 144 animal host species including 135 (93.8%) from the class Mammalia, 5 (3.5%) from Amphibia, 3 (2.1%) from Reptilia, and 1 (0.7%) from Arachnida. Across the animal host species, Leptospira serovars that were detected in the largest number of animal species included Grippotyphosa (n=39), Icterohaemorrhagiae (n=29), Pomona (n=28), Australis (n=25), and Ballum (n=25). Of serovars, 76 were detected in a single animal host species. We created an online database to identify animal host species for each serovar by country. CONCLUSIONS: We found that many countries have few or no Leptospira serovars detected from animal host species and that many serovars were detected from a single animal species. Our study highlights the importance of efforts to identify animal host species of leptospirosis, especially in places with a high incidence of human leptospirosis. We provide an updated resource for leptospirosis researchers.Item Open Access GWAS Identifies New Loci for Painful Temporomandibular Disorder.(J Dent Res, 2017-01-01) Sanders, AE; Jain, D; Sofer, T; Kerr, KF; Laurie, CC; Shaffer, JR; Marazita, ML; Kaste, LM; Slade, GD; Fillingim, RB; Ohrbach, R; Maixner, W; Kocher, T; Bernhardt, O; Teumer, A; Schwahn, C; Sipilä, K; Lähdesmäki, R; Männikkö, M; Pesonen, P; Järvelin, M; Rizzatti-Barbosa, CM; Meloto, CB; Ribeiro-Dasilva, M; Diatchenko, L; Serrano, P; Smith, SBTemporomandibular disorder (TMD) is a musculoskeletal condition characterized by pain and reduced function in the temporomandibular joint and/or associated masticatory musculature. Prevalence in the United States is 5% and twice as high among women as men. We conducted a discovery genome-wide association study (GWAS) of TMD in 10,153 participants (769 cases, 9,384 controls) of the US Hispanic Community Health Study/Study of Latinos (HCHS/SOL). The most promising single-nucleotide polymorphisms (SNPs) were tested in meta-analysis of 4 independent cohorts. One replication cohort was from the United States, and the others were from Germany, Finland, and Brazil, totaling 1,911 TMD cases and 6,903 controls. A locus near the sarcoglycan alpha ( SGCA), rs4794106, was suggestive in the discovery analysis ( P = 2.6 × 10(6)) and replicated (i.e., 1-tailed P = 0.016) in the Brazilian cohort. In the discovery cohort, sex-stratified analysis identified 2 additional genome-wide significant loci in females. One lying upstream of the relaxin/insulin-like family peptide receptor 2 ( RXP2) (chromosome 13, rs60249166, odds ratio [OR] = 0.65, P = 3.6 × 10(-8)) was replicated among females in the meta-analysis (1-tailed P = 0.052). The other (chromosome 17, rs1531554, OR = 0.68, P = 2.9 × 10(-8)) was replicated among females (1-tailed P = 0.002), as well as replicated in meta-analysis of both sexes (1-tailed P = 0.021). A novel locus at genome-wide level of significance (rs73460075, OR = 0.56, P = 3.8 × 10(-8)) in the intron of the dystrophin gene DMD (X chromosome), and a suggestive locus on chromosome 7 (rs73271865, P = 2.9 × 10(-7)) upstream of the Sp4 Transcription Factor ( SP4) gene were identified in the discovery cohort, but neither of these was replicated. The SGCA gene encodes SGCA, which is involved in the cellular structure of muscle fibers and, along with DMD, forms part of the dystrophin-glycoprotein complex. Functional annotation suggested that several of these variants reside in loci that regulate processes relevant to TMD pathobiologic processes.Item Open Access High Prevalence of Cervical Myelopathy among Hip Fracture Patients(Operative Techniques in Orthopaedics, 2023-12-01) Zhang, H; Buell, T; Baldwin, E; Dalton, T; Crutcher, C; Abd-El-Barr, MM; Foster, N; Goodwin, CR; Erickson, MHip fractures are devastating injuries for the elderly and an increasing burden to the healthcare system. Cervical spondylotic myelopathy (CSM), as a common cause of disability, instability, and falls in the elderly population, places patients at risk for hip fracture, and myelopathic patients are associated with increased complications after hip surgery. Myelopathy's relationship with hip fractures and impact, however, is not well understood. This study sought to 1) determine the prevalence of CSM among hip fracture patients and 2) hypothesized that hip fractures in CSM patients were associated with greater complexity and costs. In this institutional review board-exempt study, Medicare 1) hip fracture and 2) CSM patients between 2004 and 2014 were identified using the PearlDiver Patient Records Database (PearlDiver Technologies, Inc., CO) with International Classification of Diseases, Ninth Revision, (ICD-9) and Common Procedural Terminology codes. The prevalence of CSM within hip fracture patients was calculated, as was the incidence of hip fractures within CSM patients during this period. Hip fracture patients with CSM were compared with non-CSM hip fracture patients by age, medical comorbidities, average charges/payments, and average lengths of stay (LOS). Hip fracture patients with CSM who underwent cervical surgery were also compared with those who did not undergo cervical surgery, both before and after hip fracture. Statistical analysis with t-test and chi-squared test was performed, with statistical significance set at P < 0.05. Total 22,884 of 2,309,972 hip fracture patients (1.0%) from 2004 to 2014 also had CSM, representing approximately 9900 cases per million persons, higher than previous estimates of the CSM incidence in the general population. These 22,884 hip fracture patients were 4.6% of 496,939 patients with CSM diagnosed during this period, representing a hip fracture incidence of 419 cases per 100,000 persons/year, also higher than previous estimates of hip fracture incidence in the overall population. Hip fracture patients with CSM were significantly younger (P < 0.001) but had significantly greater incidence of hypertension, coronary artery disease, stroke, obesity, tobacco use, diabetes, and osteoporosis (P < 0.001) than non-CSM counterparts, as well as significantly greater average hip fracture-related LOS, per-patient charges, and per-patient payments (P < 0.001). Within this group of hip fractures with CSM, 441 patients (441/22,884; 1.9%) underwent cervical surgery prior to hip fracture, and 245 patients (245/22,884; 1.1%) underwent cervical surgery after hip fracture. These surgically treated patients with CSM were significantly younger but had higher incidence of medical comorbidities (P < 0.001) relative to hip fracture patients with CSM who did not receive cervical surgery at any point. Surgically treated CSM patients also had significantly lower per-patient charges and costs related to their hip fracture care relative to CSM patients with hip fracture who did not receive cervical surgery (P = 0.43, 0.84). This study describes for the first time a high prevalence of CSM in hip fracture patients on a populational level. The 1) prevalence of CSM among hip fracture patients and 2) incidence of hip fractures among CSM patients in this study far exceeded previous epidemiologic estimates. Hip fracture patients with CSM were seen to be significantly younger than hip fracture patients without CSM yet also were seen to have significantly more medical complexity. Hip fracture patients with CSM were also seen to have significantly greater per-patient costs and hip fracture related LOS, findings that are belied by low rates of surgical myelopathy treatment following hip fracture. This study describes for the first time a high prevalence of cervical myelopathy among hip fracture patients on a population level, with implications for both hip fracture prevention and cervical myelopathy diagnosis and treatment.Item Open Access High prevalence of Wuchereria bancrofti infection as detected by immunochromatographic card testing in five districts of Orissa, India, previously considered to be non-endemic(2011-02) Foo, Patricia K; Tarozzi, Alessandro; Mahajan, Aprajit; Yoong, Joanne; Krishnan, Lakshmi; Kopf, Daniel; Blackburn, Brian GIndia accounts for over one-third of the world's burden of lymphatic filariasis (LF). Although most coastal districts of Orissa state (eastern India) are LF-endemic, the western districts of Orissa are considered non-endemic. During a large-scale insecticide-treated bed net/microfinance trial, we tested one randomly selected adult (age 15-60 years) for LF from a random sample of microfinance-member households in five districts of western Orissa, using immunochromatographic card testing (ICT). Overall, 354 (adjusted prevalence 21%, 95%CI 17-25%) of 1563 persons were ICT positive, with district-wide prevalence rates ranging from 15-32%. This finding was not explained by immigration, as only 3% of subjects had ever lived in previously known LF-endemic districts. These results therefore suggest ongoing autochthonous transmission in districts where LF control programs are not operational. Our results highlight the importance of broad, systematic surveillance for LF in India and call for the implementation of LF control programs in our study districts.Item Open Access Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis.(Journal of clinical medicine, 2019-07) Thongprayoon, Charat; Cheungpasitporn, Wisit; Lertjitbanjong, Ploypin; Aeddula, Narothama Reddy; Bathini, Tarun; Watthanasuntorn, Kanramon; Srivali, Narat; Mao, Michael A; Kashani, KianoushAlthough acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%-72.4%) and 44.9% (95%CI: 40.8%-49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87-4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21-4.99). There was no publication bias as evaluated by the funnel plot and Egger's regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.Item Open Access Inpatient Burden and Mortality of Goodpasture's Syndrome in the United States: Nationwide Inpatient Sample 2003-2014.(Journal of clinical medicine, 2020-02) Kaewput, Wisit; Thongprayoon, Charat; Boonpheng, Boonphiphop; Ungprasert, Patompong; Bathini, Tarun; Chewcharat, Api; Srivali, Narat; Vallabhajosyula, Saraschandra; Cheungpasitporn, WisitBackground: Goodpasture's syndrome is a rare, life-threatening, small vessel vasculitis. Given its rarity, data on its inpatient burden and resource utilization are lacking. We conducted this study aiming to assess inpatient prevalence, mortality, and resource utilization of Goodpasture's syndrome in the United States. Methods: The 2003-2014 National Inpatient Sample was used to identify patients with a principal diagnosis of Goodpasture's syndrome. The inpatient prevalence, clinical characteristics, in-hospital treatment, end-organ failure, mortality, length of hospital stay, and hospitalization cost were studied. Multivariable logistic regression was performed to identify independent factors associated with in-hospital mortality. Results: A total of 964 patients were admitted in hospital with Goodpasture's syndrome as the principal diagnosis, accounting for an overall inpatient prevalence of Goodpasture's syndrome among hospitalized patients in the United States of 10.3 cases per 1,000,000 admissions. The mean age of patients was 54 ± 21 years, and 47% were female; 52% required renal replacement therapy, whereas 39% received plasmapheresis during hospitalization. Furthermore, 78% had end-organ failure, with renal failure and respiratory failure being the two most common end-organ failures. The in-hospital mortality rate was 7.7 per 100 admissions. The factors associated with increased in-hospital mortality were age older than 70 years, sepsis, the development of respiratory failure, circulatory failure, renal failure, and liver failure, whereas the factors associated with decreased in-hospital mortality were more recent year of hospitalization and the use of therapeutic plasmapheresis. The median length of hospital stay was 10 days. The median hospitalization cost was $75,831. Conclusion: The inpatient prevalence of Goodpasture's syndrome in the United States is 10.3 cases per 1,000,000 admissions. Hospitalization of patients with Goodpasture's syndrome was associated with high hospital inpatient utilization and costs.Item Open Access Quantification of the pace of biological aging in humans through a blood test, the DunedinPoAm DNA methylation algorithm.(eLife, 2020-05-05) Belsky, Daniel W; Caspi, Avshalom; Arseneault, Louise; Baccarelli, Andrea; Corcoran, David L; Gao, Xu; Hannon, Eiliss; Harrington, Hona Lee; Rasmussen, Line Jh; Houts, Renate; Huffman, Kim; Kraus, William E; Kwon, Dayoon; Mill, Jonathan; Pieper, Carl F; Prinz, Joseph A; Poulton, Richie; Schwartz, Joel; Sugden, Karen; Vokonas, Pantel; Williams, Benjamin S; Moffitt, Terrie EBiological aging is the gradual, progressive decline in system integrity that occurs with advancing chronological age, causing morbidity and disability. Measurements of the pace of aging are needed as surrogate endpoints in trials of therapies designed to prevent disease by slowing biological aging. We report a blood-DNA-methylation measure that is sensitive to variation in pace of biological aging among individuals born the same year. We first modeled change-over-time in 18 biomarkers tracking organ-system integrity across 12 years of follow-up in n = 954 members of the Dunedin Study born in 1972-1973. Rates of change in each biomarker over ages 26-38 years were composited to form a measure of aging-related decline, termed Pace-of-Aging. Elastic-net regression was used to develop a DNA-methylation predictor of Pace-of-Aging, called DunedinPoAm for Dunedin(P)ace(o)f(A)ging(m)ethylation. Validation analysis in cohort studies and the CALERIE trial provide proof-of-principle for DunedinPoAm as a single-time-point measure of a person's pace of biological aging.Item Open Access Risk of coronary artery disease in patients with ankylosing spondylitis: a systematic review and meta-analysis.(Annals of translational medicine, 2015-03) Ungprasert, Patompong; Srivali, Narat; Kittanamongkolchai, WonngarmObjective
To investigate the association between coronary artery disease (CAD) and ankylosing spondylitis (AS).Methods
We conducted a systematic review and meta-analysis of observational studies that reported relative risks, hazard ratios, standardized prevalence ratio or standardized incidence ratios with 95% confidence comparing CAD risk in patients with AS versus non-AS controls. Pooled risk ratios and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance of DerSimonian and Laird.Results
Out of 229 potentially relevant articles, ten studies (five retrospective cohort studies and five cross-sectional studies) were identified and included in our data analysis. The overall pooled risk ratio of CAD in patients with AS was 1.41 (95% CI: 1.29-1.54). The pooled risk ratios for cross-sectional and cohort studies were 2.08 (95% CI: 1.28-3.40) and 1.36 (95% CI: 1.31-1.41), respectively. The statistical heterogeneity of this meta-analysis was moderate with an I(2) of 56%.Conclusions
Our study demonstrated a statistically significant increased CAD risk among patients with AS with 41% excess risk.