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Using a patient-engaged approach to identify cross-cutting disease factors impacting mental health in youth with rheumatologic disease [Meeting Abstract]

Danguecan, A; Fawole, O; Reed, M; Harris, J; Hersh, A; Rodriquez, M; Onel, K; Lawson, E; Rubinstein, T; Ardalan, K; Morgan, E; Paul, A; Barlin, J; Daly, R P; Dave, M; Malloy, S; Hume, S; Schrandt, S; Marrow, L; Chapson, A; Napoli, D; Napoli, M; Moyer, M; Del, Gaizo V; Von, Scheven E; Knight, A
Background/Purpose: Mental health problems are common and often untreated in youth with rheumatologic disease, yet their relationship with disease features is poorly understood. We engaged patients and parents on the research team to identify cross-cutting disease factors impacting mental health in this population.
Method(s): An anonymous cross-sectional online survey examined mental health experiences of patients with juvenile arthritis, juvenile dermatomyositis, or systemic lupus erythematosus. Youth ages 14-24 years and parents of youth 8-24 years were eligible. The survey was developed with patient and parent advisors, the Childhood Arthritis & Rheumatology Research Alliance (CARRA), and the Patients, Advocates, and Rheumatology Teams Network for Research and Service (PARTNERS). Participants were recruited through the Arthritis Foundation, Lupus Foundation of America, and Cure JM Foundation. Primary outcome was the presence of any clinician or self-diagnosed mental health problem. Exposures of interest included several cross-cutting disease factors: disease duration, active disease status, current steroid medication, history of disease flare following remission, and appearance-altering comorbidities (psoriasis, stretch marks, alopecia, skin ulceration, visible scarring). We used logistic regression models to examine the association between any clinician or self-diagnosed mental health problems and disease factors for the combined youth/parent sample, and for youth and parents separately. Secondarily, we examined results by mental health problem (depression, anxiety, self-harm/ suicidal ideation). Alpha values < .05 were considered significant.
Result(s): See Table 1 for sample characteristics. 447 respondents included 123 youth and 324 parents; they were not required to be dyads. Combining youth and parent responses, 210 had juvenile arthritis, 173 had juvenile dermatomyositis, and 64 had systemic lupus erythematosus. Those with and without mental health problems were comparable on many demographic and disease factors, although patients with appearance altering comorbidities were more likely to report mental health problems. Rates of clinician and self-diagnosed depression, anxiety, suicidal thoughts, and self-harm are shown in Figure 1. Adjusted logistic regression models (Table 2) indicate that having appearance altering comorbidities predicted the presence of a mental health problem in the combined youth/parent sample and in the parent-only sample. In the combined sample, appearance altering comorbidities also predicted depression and anxiety problems, whereas history of flare following remission predicted reported suicidal ideation or self-harm. Within the youth responses, there was a trend for depression to be more likely among those taking steroids (p=.053).
Conclusion(s): Certain cross-cutting rheumatologic disease factors such as appearance-altering comorbidities are predictive of mental health problems such as depression or anxiety. These findings are helpful for identifying targets for mental health screening in youth with rheumatologic disease, and should be addressed in screening recommendations.(Figure Presented)
EMBASE:632792241
ISSN: 2326-5205
CID: 4603032

Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America

Buser, Zorica; Ortega, Brandon; D'Oro, Anthony; Pannell, William; Cohen, Jeremiah R; Wang, Justin; Golish, Ray; Reed, Michael; Wang, Jeffrey C
STUDY DESIGN/METHODS:Retrospective database study. OBJECTIVE:Low back and neck pain are among the top leading causes of disability worldwide. The aim of our study was to report the current trends on spine degenerative disorders and their treatments. METHODS:Patients diagnosed with lumbar or cervical spine conditions within the orthopedic subset of Medicare and Humana databases (PearlDiver). From the initial cohorts we identified subgroups based on the treatment: fusion or nonoperative within 1 year from diagnosis. Poisson regression was used to determine demographic differences in diagnosis and treatment approaches. RESULTS:Within the Medicare database there were 6 206 578 patients diagnosed with lumbar and 3 156 215 patients diagnosed with cervical degenerative conditions between 2006 and 2012, representing a 16.5% (lumbar) decrease and 11% (cervical) increase in the number of diagnosed patients. There was an increase of 18.5% in the incidence of fusion among lumbar patients. For the Humana data sets there were 1 160 495 patients diagnosed with lumbar and 660 721 patients diagnosed with cervical degenerative disorders from 2008 to 2014. There was a 33% (lumbar) and 42% (cervical) increases in the number of diagnosed patients. However, in both lumbar and cervical groups there was a decrease in the number of surgical and nonoperative treatments. CONCLUSIONS:There was an overall increase in both lumbar and cervical conditions, followed by an increase in lumbar fusion procedures within the Medicare database. There is still a burning need to optimize the spine care for the elderly and people in their prime work age to lessen the current national economic burden.
PMCID:5810888
PMID: 29456916
ISSN: 2192-5682
CID: 5186212

Platelet-Rich Plasma for the Treatment of Female Pattern Hair Loss: A Patient Survey

Laird, Mary E; Lo Sicco, Kristen I; Reed, Michael L; Brinster, Nooshin K
PMID: 28375977
ISSN: 1524-4725
CID: 2521442

Platelet-rich plasma for the treatment of androgenetic alopecia: A patient survey [Meeting Abstract]

Laird, Mary; Lo Sicco, Kristen; Reed, Michael; Brinster, Nooshin
ISI:000403369302011
ISSN: 0190-9622
CID: 2615672

Attention-deficit/hyperactivity disorder symptoms in adults with self-reported epilepsy: Results from a national epidemiologic survey of epilepsy

Ettinger, Alan B; Ottman, Ruth; Lipton, Richard B; Cramer, Joyce A; Fanning, Kristina M; Reed, Michael L
OBJECTIVE:To assess symptoms of attention-deficit/hyperactivity disorder (ADHD) and their impact among adults with epilepsy from a large community-based survey. METHODS:Adults who self-reported epilepsy were sent a postal survey including the Adult ADHD Self-Report Scale version 6 (ASRS-6), Physicians Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Assessment 7 (GAD-7), and questions about seizure frequency and number of antiepileptic drugs (AEDs) during the preceding 3 months. Individuals with ASRS-6 scores >14 were classified as ASRS+, and those with lower scores as ASRS-. Outcome measures included the Quality of Life in Epilepsy Inventory 10 (QOLIE-10), Quality of Life and Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and the Sheehan Disability Scale (SDS). The relationship of ADHD symptoms to quality of life outcomes was modeled hierarchically, with linear regression controlling for sociodemographic covariates, comorbid depression and anxiety, seizure frequency, and number of AEDs. RESULTS:Among 1,361 of respondents with active epilepsy, 18.4% (n = 251) were classified as ASRS+ and at risk for ADHD. Compared to ASRS- cases, ASRS+ individuals were more likely to have elevated depression and anxiety scores as well as greater seizure frequency and more AED use (p < 0.05 for all). Modeling results comparing ASRS+ and ASRS- cases, controlling for all covariates, indicated that ASRS+ cases had lower quality of life (Beta [β] = -3.07, 95% confidence interval [CI] -4.19 to -1.96) and worse physical (β = -0.048 95% CI -0.076 to -0.020) and social functioning (β = -0.058, 95% CI -0.081 to -0.035) on the Q-LES-Q, and increases in family (β = 1.57, 95% CI 1.09-2.05), social (β = 1.68, 95% CI 1.20-2.16), and work-related disability (β-1.86, 95% CI 1.27-2.46). SIGNIFICANCE/CONCLUSIONS:ADHD symptoms occur in nearly one of five adults with epilepsy, and are associated with increased psychosocial morbidity and lowered QOL. Future studies should clarify the nature and causes of ADHD symptoms in adults with epilepsy.
PMID: 25594106
ISSN: 1528-1167
CID: 5327442

The effect of the new 2010 World Health Organization criteria for semen analyses on male infertility

Murray, Katie S; James, Andrew; McGeady, James B; Reed, Michael L; Kuang, Wayne W; Nangia, Ajay K
OBJECTIVE:To quantify the effect of the new 2010 World Health Organization (WHO) semen analysis reference values on reclassifying previous semen analysis parameters and definition of patients with male factor infertility. DESIGN/METHODS:A multi-institutional retrospective chart review. SETTING/METHODS:University and private male infertility clinics. PATIENT(S)/METHODS:Men referred for infertility evaluation. INTERVENTION(S)/METHODS:Comparison of semen analysis values based on 2010 versus 1999 reference criteria. MAIN OUTCOME MEASURE(S)/METHODS:Quantification of the change based on individual sperm parameters and as a whole. RESULT(S)/RESULTS:A total of 184 men had at least two semen analyses; 13 (7%), 17 (9.2%), 34 (18.4%), and 29 (15.7%) patients changed classification to being at or above the reference values by the 2010 criteria for semen volume, sperm concentration, motility, and morphology, respectively. A total of 501 men had one semen analysis on file; 40 (7.9%), 31 (6.2%), 50 (9.9%), and 74 (19.3%) would change classification for volume, concentration, motility, and morphology, respectively. Overall, 103 patients (15.1%) who had one or more parameter below the reference value on the original analysis were converted to having all parameters at or above the 2010 reference values. CONCLUSION(S)/CONCLUSIONS:The 2010 reference values result in some infertile men being reclassified as fertile if status is based on semen analysis alone. This may lead to fewer men being referred for proper infertility evaluation or treatment.
PMID: 22921910
ISSN: 1556-5653
CID: 5355022

Depression and risk of transformation of episodic to chronic migraine

Ashina, Sait; Serrano, Daniel; Lipton, Richard B; Maizels, Morris; Manack, Aubrey N; Turkel, Catherine C; Reed, Michael L; Buse, Dawn C
The aim of this study was to assess the role of depression as a predictor of new onset of chronic migraine (CM) among persons with episodic migraine (EM). The American Migraine Prevalence and Prevention (AMPP) study followed 24,000 persons with severe headache identified in 2004. Using random-effects logistic regression, we modeled the probability that persons with EM in 2005 or 2006 would develop CM in the subsequent year. Depression was assessed in two ways, using a validated questionnaire (PHQ-9 score >/=15) and based on self-reported medical diagnosis. Analyses were adjusted for multiple covariates including sociodemographics, body mass index, headache pain intensity, headache frequency, migraine symptom severity, cutaneous allodynia, acute medication overuse, anti-depressant use and anxiety. Of 6,657 participants with EM in 2005, 160 (2.4 %) developed CM in 2006. Of 6,852 participants with EM in 2006, 144 (2.2 %) developed CM in 2007. In fully adjusted models, PHQ-9 defined depression was a significant predictor of CM onset [odds ratio (OR) = 1.65, 95 % CI 1.12-2.45]. There was a depression-dose effect; relative to participants with no depression or mild depression, those with moderate (OR = 1.77, 95 % CI 1.25-2.52), moderately severe (OR = 2.35, 95 % CI 1.53-3.62), and severe depression (OR = 2.53, 95 % CI 1.52-4.21) were at increased risk for the onset of CM. Among persons with EM, depression was associated with an increased risk of CM after adjusting for sociodemographic variables and headache characteristics. Depression preceded the onset of CM and risk increased with depression severity suggesting a potentially causal role though reverse causality cannot be excluded.
PMCID:3484253
PMID: 23007859
ISSN: 1129-2377
CID: 1790322

Sialoendoscopy for the treatment of pediatric salivary gland disorders

Hackett, Alyssa M; Baranano, Christopher F; Reed, Michael; Duvvuri, Umamaheswar; Smith, Richard J; Mehta, Deepak
OBJECTIVE:To show that sialoendoscopy is both a safe and effective alternative to traditional treatments for juvenile recurrent parotitis and sialolithiasis. DESIGN/METHODS:Retrospective medical chart review. SETTING/METHODS:Two major pediatric tertiary care centers. PATIENTS/METHODS:Eighteen pediatric patients. INTERVENTIONS/METHODS:A total of 33 sialendoscopic procedures on 27 glands. MAIN OUTCOME MEASURES/METHODS:Indications for surgery, age at onset of symptoms, age at procedure, sex, intraoperative findings, complications, recurrences, need for additional procedures, and follow-up interval. RESULTS:Juvenile recurrent parotitis was the most common indication for sialendoscopy (12 of 18) followed by sialolithiasis (4 of 18). Ten of 12 patients with juvenile recurrent parotitis were asymptomatic after 1 or 2 sialendoscopies (8 patients and 2 patients, respectively). There were 6 minor complications. Three patients ultimately required gland excision for disease management. CONCLUSION/CONCLUSIONS:Sialoendscopy is safe and effective as a treatment for pediatric salivary gland disorders.
PMID: 23069821
ISSN: 1538-361x
CID: 5481092

Do mood instability symptoms in epilepsy represent formal bipolar disorder?

Lau, Connie; Ettinger, Alan B; Hamberger, Sandra; Fanning, Kristina; Reed, Michael L
We aimed to assess rates of bipolar symptoms versus bipolar disorder in epilepsy, and the effect of bipolar symptoms on quality of life (QOL) in epilepsy. Bipolar, disability, and QOL instruments were administered to 99 tertiary epilepsy center patients. Patients who scored positive on the Mood Disorder Questionnaire (MDQ) also completed depression scales and a structured psychiatric interview. Results indicated MDQ+ patients (10.1%) had worse QOL and more work, social, and family life disruptions. Most MDQ+ patients did not have bipolar disorder. There was close overlap between depressive and bipolar symptomatology. Based on results of this study, bipolar symptom is not synonymous with bipolar disorder. Symptoms picked up by the MDQ may be epilepsy-related depressive symptoms. Bipolar symptoms are associated with more disability, worse QOL, and may have treatment implications.
PMID: 22220741
ISSN: 1528-1167
CID: 5327372

Comorbidities of epilepsy: results from the Epilepsy Comorbidities and Health (EPIC) survey

Ottman, Ruth; Lipton, Richard B; Ettinger, Alan B; Cramer, Joyce A; Reed, Michael L; Morrison, Alan; Wan, George J
PURPOSE/OBJECTIVE:To estimate the prevalence of neuropsychiatric and pain disorders in adults with epilepsy in the United States. METHODS:In 2008, an 11-item survey including validated questions to screen for a lifetime history of epilepsy was mailed to 340,000 households from two national panels selected to be generally representative of the noninstitutionalized U.S. population. Information on epilepsy and other disorders was collected from 172,959 respondents aged 18 or older. Propensity scoring was used to match respondents with and without epilepsy on baseline characteristics and risk factors for epilepsy. Prevalence ratios (PRs) of comorbidities in respondents with epilepsy were calculated using log-binomial generalized linear models. Comorbidities were categorized as neuropsychiatric (anxiety, depression, bipolar disorder, attention-deficit/hyperactivity disorder, sleep disorder/apnea, and movement disorder/tremor), pain (migraine headache, chronic pain, fibromyalgia, neuropathic pain), and other (asthma, diabetes, and high blood pressure). KEY FINDINGS/RESULTS:Two percent (3,488) of respondents reported ever having been told they had epilepsy or a seizure disorder. Respondents with self-reported epilepsy were more likely (p < 0.001) than those without epilepsy to report all six neuropsychiatric disorders (PR from 1.27-2.39), all four pain disorders (PR 1.36-1.96), and asthma (PR 1.25). SIGNIFICANCE/CONCLUSIONS:Neuropsychiatric conditions and pain disorder comorbidities were reported more often in individuals with self-reported epilepsy than in those without epilepsy. Identification of these conditions is an important consideration in the clinical management of epilepsy.
PMID: 21269285
ISSN: 1528-1167
CID: 5327312