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Severe delayed QT prolongation: A novel risk factor for adverse cardiovascular events from acute drug overdose [Meeting Abstract]

Roberts, E; Richardson, L; Vedanthan, R; Manini, A
Background: In ED patients who present with acute drug overdose, severe QTc prolongation (>500 ms) has been shown to be a predictor of adverse cardiovascular events (ACVE). However, it is unclear what clinical factors are associated with delayed severe QTc prolongation (dsQTp), and it is unknown whether dsQTp can predict ACVE. This study aims to: (1) Define clinical factors associated with dsQTp, and (2) test whether dsQTp is an independent predictor for ACVE.
Method(s): This was a prospective cohort study at 2 urban tertiary care EDs. Data was collected by trained research assistants, and included demographics, drug exposure, medication administration, initial and repeat ECG data, lab data, and outcome measures. dsQTp was defined as presence of initial QTc 499. The primary study outcome was the composite of ACVE defined as in-hospital occurrence of any of the following: MI, shock, ventricular dysrhythmia, and cardiac arrest. Univariate statistics and multivariable logistic regression calculations were made using SPSS version 24. With a fixed sample size of 1670, we calculated that we would have 99% power to show a 3-fold increase in risk with 0.05 alpha.
Result(s): Out of 2311 patients screened, 641 were excluded (age 500) leaving 1670 patients for analysis. The dsQTp group (N = 27) was found to be older than the control group (N = 1643)(40.1 vs 51.6, P
Conclusion(s): This cohort study reveals a subset of ED patients who are at greater risk of overdose-related ACVE but not immediately apparent by the initial ECG. Further study is needed to identify which patients are at risk for dsQTp, as they may require prolonged observation and repeated ECGs. Limitations include missing repeat QTc measurements, and inability to control for overdose severity as a surrogate for repeat ECGs. Future study is warranted to further characterize patients at risk for dsQTp to evaluate other exposure-related factors as yet undiscovered
EMBASE:628976683
ISSN: 1556-9519
CID: 4053532

Prevalence of Parkinson's disease across North America

Marras, C; Beck, J C; Bower, J H; Roberts, E; Ritz, B; Ross, G W; Abbott, R D; Savica, R; Van Den Eeden, S K; Willis, A W; Tanner, C M
Estimates of the prevalence of Parkinson's disease in North America have varied widely and many estimates are based on small numbers of cases and from small regional subpopulations. We sought to estimate the prevalence of Parkinson's disease in North America by combining data from a multi-study sampling strategy in diverse geographic regions and/or data sources. Five separate cohort studies in California (2), Minnesota (1), Hawaii USA (1), and Ontario, Canada (1) estimated the prevalence of PD from health-care records (3), active ascertainment through facilities, large group, and neurology practices (1), and longitudinal follow-up of a population cohort (1). US Medicare program data provided complementary estimates for the corresponding regions. Using our age- and sex-specific meta-estimates from California, Minnesota, and Ontario and the US population structure from 2010, we estimate the overall prevalence of PD among those aged ≥45 years to be 572 per 100,000 (95% confidence interval 537-614) that there were 680,000 individuals in the US aged ≥45 years with PD in 2010 and that that number will rise to approximately 930,000 in 2020 and 1,238,000 in 2030 based on the US Census Bureau population projections. Regional variations in prevalence were also observed in both the project results and the Medicare-based calculations with which they were compared. The estimates generated by the Hawaiian study were lower across age categories. These estimates can guide health-care planning but should be considered minimum estimates. Some heterogeneity exists that remains to be understood.
PMCID:6039505
PMID: 30003140
ISSN: 2373-8057
CID: 3191892

FAMILY/CAREGIVER MEMBER OPPORTUNITY FOR INTERVENTION [Meeting Abstract]

Boden-Albala, B; Roberts, E; Parikh, N; Goldmann, E; Southwick, L; Carman, H
ISI:000386912100663
ISSN: 1747-4949
CID: 2740522

Screening for trauma exposure, and posttraumatic stress disorder and depression symptoms among mothers receiving child welfare preventive services

Chemtob, Claude M; Griffing, Sascha; Tullberg, Erika; Roberts, Elizabeth; Ellis, Peggy
The role of parental trauma exposure and related mental health symptoms as risk factors for child maltreatment for parents involved with the child welfare (CW) system has received limited attention. In particular, little is known about the extent to which mothers receiving CW services to prevent maltreatment have experienced trauma and suffered trauma-related psychopathology. This study examined screening data collected from 127 mothers receiving CW preventive services. There were high levels of trauma exposure among screened mothers and their young children. Among mothers, 91.6% experienced at least one traumatic event (M = 2.60) and 92.2% reported their children had been exposed to one or more traumas (M = 4.85). Mothers reported high levels of trauma-related symptoms: 54.3% met probable criteria for posttraumatic stress disorder (PTSD) or depression (61.7%). Nearly half (48.8%) met criteria for co-morbid PTSD and depression. The large majority of the clients with trauma-related disorders were not receiving mental health services. Latina women had significantly more severe PTSD symptoms than African American women. Case planners reported that the screening process was useful and feasible. These findings underscore the feasibility and importance of trauma screening among parents receiving CW preventive services.
PMID: 22533045
ISSN: 0009-4021
CID: 165634

Obsessional and atypical tic symptoms in an adolescent with complex Tourette's disorder and atypical pervasive developmental disorder not otherwise specified [Case Report]

Roberts, Elizabeth; Rostain, Anthony L; Samar, Stephanie; Coffey, Barbara J
PMID: 20578936
ISSN: 1557-8992
CID: 110666

Replacement of dominant temporal lobe by arteriovenous malformation with minimal neuropsychological impairment: Report of a case

Koffler, Sandra P; Roberts, Elizabeth V; Mancall, Elliott L
Describes the case of a 26-yr-old woman with a large arteriovenous malformation in the left temporal lobe and a normal neurologic examination. The S was evaluated with the Luria-Nebraska Neuropsychological Battery, the Halstead-Reitan Neuropsychological Test Battery, and supplementary neuropsychological tests. Results demonstrating striking preservation of cognitive abilities provide evidence of the plasticity of the developing brain with a congenital lesion that grows slowly. Such findings are consistent with similar observations in children with congenital or early acquired lesions. Mild loss of abilities associated with the locus of the lesion indicates, however, that functional transfer is incomplete. Testing demonstrates evidence of deficits referable to the opposite 'normal' cerebral hemisphere.
PSYCH:1991-27866-001
ISSN: 0894-4105
CID: 110804