Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Population Health
Total Results:
12218
The Epidemiologic Data on Falls, 1998-2010: More Older Americans Report Falling
PMID: 25599461
ISSN: 2168-6106
CID: 1439992
Small-area spatiotemporal analysis of pedestrian and bicyclist injuries in New York City
BACKGROUND: This study quantifies the spatiotemporal risk of pedestrian and bicyclist injury in New York City at the census tract level over a recent 10-year period, identifies areas of increased risk, and evaluates the role of socioeconomic and traffic-related variables in injury risk. METHODS: Crash data on 140,835 pedestrian and bicyclist injuries in 1908 census tracts from 2001 to 2010 were obtained from the New York City Department of Transportation. We analyzed injury counts within census tracts with Bayesian hierarchical spatial models using integrated nested Laplace approximations. The model included variables for social fragmentation, median household income, and average vehicle speed and traffic density, as well as a spatially unstructured random effect term, a spatially structured conditional autoregression term, a first-order random walk-correlated time variable, and an interaction term for time and place. Incidence density ratios, credible intervals, and probability exceedances were calculated and mapped. RESULTS: The yearly rate of crashes involving injuries to "pedestrians" (including bicyclists) decreased 16.2% over the study period, from 23.7 per 10,000 population to 16.2 per 10,000. The temporal term in the spatiotemporal model indicated that much of the decrease over the study period occurred during the first 4 years of the study period. Despite an overall decrease, the model identified census tracts that were at persistently high risk of pedestrian injury throughout the study period, as well as areas that experienced sporadic annual increases in risk. Aggregate social, economic, and traffic-related measures were associated with pedestrian injury risk at the ecologic level. Every 1-unit increase in a standardized social fragmentation index was associated with a 19% increase in pedestrian injury risk (incidence density ratio = 1.19 [95% credible interval = 1.16 - 1.23]), and every 1 standardized unit increase in traffic density was associated with a 20% increase in pedestrian injury risk (1.20 [1.15 - 1.26]). Each 10-mile-per-hour increase in average traffic speed in a census tract was associated with a 24% decrease in pedestrian injury risk (0.76 [0.69 - 0.83]). CONCLUSIONS: The risk of a pedestrian or bicyclist being struck by a motor vehicle in New York City decreased from 2001 to 2004 and held fairly steady thereafter. Some census tracts in the city did not benefit from overall reductions or experienced sporadic years of increased risk compared with the city as a whole. Injury risk at the census tract level was associated with social, economic, and traffic-related factors.
PMID: 25643104
ISSN: 1531-5487
CID: 1601472
Dietary Variety Is Inversely Associated with Body Adiposity among US Adults Using a Novel Food Diversity Index
BACKGROUND: Consuming a variety (vs. monotony) of energy-poor, nutrient-dense foods may help individuals adhere to dietary patterns favorably associated with weight control. OBJECTIVE: The objective of this study was to examine whether greater healthful food variety quantified using the US Healthy Food Diversity (HFD) index favorably influenced body adiposity. METHODS: Men and nonpregnant, nonlactating women aged >/=20 y with two 24-h recalls from the cross-sectional NHANES 2003-2006 (n = 7470) were included in this study. Dietary recalls were merged with the MyPyramid Equivalent database to generate the US HFD index, which ranges from 0 to approximately 1, with higher scores indicative of diets with a higher number and proportion of healthful foods. Multiple indicators of adiposity including BMI, waist-to-height ratio, android-to-gynoid fat ratio, fat mass index (FMI), and percentage body fat were assessed across US HFD index quintiles. ORs and 95% CIs were computed with use of multivariable logistic regression (SAS v. 9.3). RESULTS: The US HFD index was inversely associated with most adiposity indicators in both sexes. After multivariable adjustment, the odds of obesity, android-to-gynoid ratio >1, and high FMI were 31-55% lower (P-trend < 0.01) among women in quintile 5 vs. quintile 1 of the US HFD index. Among men, the odds of obesity, waist-to-height ratio >/=0.5, and android-to-gynoid ratio >1 were 40-48% lower (P-trend
PMID: 25733472
ISSN: 0022-3166
CID: 1481392
Validation of the korean lewy body composite risk score for discrimination of dementia with lewy bodies in the Korean elderly [Meeting Abstract]
The Lewy Body Composite Risk Score (LBCRS) was developed as an useful tool to enhance the accuracy of the cognitive diagnosis for patients affected by Lewy Bodies' pathological conditions. This study aimed to assess the diagnostic accuracy of the Korean version of the LBCRS (K-LBCRS) among Korean population with Alzheimer's dementia (AD) and Dementia with Lewy bodies (DLB). The 49 subjects who participated in this study have (32 with AD, 17 with DLB) visited the neurology outpatient clinic of KUMC. The subjects' demographic data and administered K-MMSE, Clinical Dementia Rating sum of boxes (CDR-SB), K-LBCRS, NPI, Mayo Fluctuation Scale (MFS), Mayo Sleep Questionnaire (MSQ), Epworth Sleepiness Scale (ESS), and mini Physical Performance Test (PPT) were collected. The K-LBCRS was created through translation and back-translation of the LBCRS. The sensitivity, the specificity, and the area under the curve were evaluated by receiver operator characteristics (ROC) analysis. An ROC curve was used to determine the optimal cut-off values for discrimination of DLB against AD. The ROC analysis showed that the optimal cut-off point of the K-LBCRS for identification of DLB was 2/3, which gave the balance between sensitivity (94%) and specificity (75%). The K-LBCRS was significantly correlated with CDR-SB (r=0.40), MFQ (r=0.75) in AD group, whereas ESS (r=0.71), MFQ (r=0.82) was significant in DLB group. The K-LBCRS has important clinical characteristics of DLB that may differentiate it from AD, and as a result may enable the K-LBCRS as a clinically useful screening tool to discriminate the two groups
EMBASE:71854865
ISSN: 1660-2854
CID: 1561852
What happens to patients with COPD with long-term oxygen treatment who receive mechanical ventilation for COPD exacerbation? A 1-year retrospective follow-up study
We performed a retrospective cohort study of patients with chronic obstructive lung disease (COPD) on long-term oxygen treatment (LTOT) who received invasive mechanical ventilation for COPD exacerbation. Of the 4791 patients, 23% died in the hospital, and 45% died in the subsequent 12 months. 67% of patients were readmitted at least once in the subsequent 12 months, and 26.8% were discharged to a nursing home or skilled nursing facility within 30 days. We conclude that these patients have high mortality rates, both in-hospital and in the 12 months postdischarge. If patients survive, many will be readmitted to the hospital and discharged to nursing home. These potential outcomes may support informed critical care decision making and more preference congruent care.
PMCID:4345793
PMID: 24826845
ISSN: 1468-3296
CID: 995012
Extended-release naltrexone to prevent relapse among opioid dependent, criminal justice system involved adults: Rationale and design of a randomized controlled effectiveness trial
BACKGROUND: Extended-release naltrexone (XR-NTX, Vivitrol(R); Alkermes Inc.) is an injectable monthly sustained-release mu opioid receptor antagonist. XR-NTX is a potentially effective intervention for opioid use disorders and as relapse prevention among criminal justice system (CJS) populations. METHODS: This 5-site open-label randomized controlled effectiveness trial examines whether XR-NTX reduces opioid relapse compared with treatment as usual (TAU) among community dwelling, non-incarcerated volunteers with current or recent CJS involvement. The XR-NTX arm receives 6 monthly XR-NTX injections at Medical Management visits; the TAU group receives referrals to available community treatment options. Assessments occur every 2weeks during a 24-week treatment phase and at 12- and 18-month follow-ups. The primary outcome is a relapse event, defined as either self-report or urine toxicology evidence of >/=10days of opioid use in a 28-day (4week) period, with a positive or missing urine test counted as 5days of opioid use. RESULTS: We describe the rationale, specific aims, and design of the study. Alternative design considerations and extensive secondary aims and outcomes are discussed. CONCLUSIONS: XR-NTX is a potentially important treatment and relapse prevention option among persons with opioid dependence and CJS involvement. ClinicalTrials.gov: NCT00781898.
PMCID:4380547
PMID: 25602580
ISSN: 1559-2030
CID: 1520542
Conjoint trajectories of depressive symptoms and delinquent behavior predicting substance use disorders
AIMS: This study examines the conjoint trajectories of depressive symptoms and delinquent behavior from adolescence (age 14) into young adulthood (age 24) as predictors of substance use disorders (SUDs) in adulthood (age 32). METHODS: Of the 816 participants, 52% were African Americans, and 48% were Puerto Ricans. After we obtained the conjoint trajectory groups using Mplus, we performed logistic regression analyses using SAS to compare the Bayesian Posterior Probability (BPP) of each of the conjoint trajectory groups with the BPP of the reference conjoint trajectory group to predict SUDs. RESULTS: Four conjoint trajectory groups were obtained. The higher BPPs of both the high depressive symptoms and low delinquent behavior trajectory group (AOR=3.54, p<.05) and the medium depressive symptoms and high delinquent behavior trajectory group (AOR=10.28, p<.001), as compared with the BPP of the low depressive symptoms and low delinquent behavior trajectory group, were associated with an increased likelihood of SUDs in adulthood. These associations were maintained with control on gender, ethnicity, the use of alcohol, cigarettes, and marijuana, socioeconomic status (SES) at age 14, and income and educational level at age 36. CONCLUSIONS: Prevention and treatment of delinquent individuals reporting SUDs might be more effective if their depressive symptoms were also addressed. Similarly, prevention and treatment of depressed individuals reporting SUDs might be more effective if their delinquent behavior was also addressed.
PMCID:4272888
PMID: 25462648
ISSN: 0306-4603
CID: 1422952
Prostate cancer: Predicting prostate biopsy results-PCA3 versus phi
PMID: 25644161
ISSN: 1759-4812
CID: 1495642
Institutional characteristics associated with receipt of emergency care for obstructive pyelonephritis at community hospitals
PURPOSE: Delivering the recommended care is an important quality measure that has been insufficiently studied in urology. Obstructive pyelonephritis is a suitable case study for this focus because many patients do not receive such care, although guidelines advocate decompression. We determined the influence of hospital factors, particularly familiarity with urolithiasis, on the likelihood of decompression in such patients. MATERIALS AND METHODS: We used the NIS from 2002 to 2011 to retrospectively identify patients admitted to community hospitals with severe infection and ureteral calculi. Hospital familiarity with nephrolithiasis was estimated by calculating hospital stone volume (divided into quartiles) and hospital treatment intensity (the decompression rate in patients with ureteral calculi and no infection). After calculating national estimates we performed logistic regression to determine the association between the receipt of decompression and hospital stone volume, controlling for treatment intensity and other covariates thought to be associated with receiving recommended care. RESULTS: Of an estimated 107,848 patients with obstructive pyelonephritis 27.4% failed to undergo decompression. Discrepancies were greatest between hospitals with the highest and lowest stone volumes (76% vs 25%, OR 2.77, 95% CI 1.94-3.96, p <0.01) as well as high and low treatment intensity (78% vs 37%, p <0.01). CONCLUSIONS: High hospital stone volume and treatment intensity were associated with an increased likelihood of receiving decompression. Such findings might be useful to identify hospitals and regions where access to quality urological care should be augmented.
PMID: 25234299
ISSN: 0022-5347
CID: 1506662
Association of chronic pelvic pain and endometriosis with signs of sensitization and myofascial pain
OBJECTIVE:To evaluate sensitization, myofascial trigger points, and quality of life in women with chronic pelvic pain with and without endometriosis. METHODS:A cross-sectional prospective study of women aged 18-50 years with pain suggestive of endometriosis and healthy, pain-free volunteers without a history of endometriosis. Patients underwent a physiatric neuromusculoskeletal assessment of clinical signs of sensitization and myofascial trigger points in the abdominopelvic region. Pain symptoms, psychosocial, and quality-of-life measures were also assessed. All participants with pain underwent laparoscopic excision of suspicious lesions to confirm endometriosis diagnosis by histologic evaluation. RESULTS:Patients included 18 with current, biopsy-proven endometriosis, 11 with pain only, and 20 healthy volunteers. The prevalence of sensitization as measured by regional allodynia and hyperalgesia was similar in both pain groups (83 and 82%) but much lower among healthy volunteers (15%, P<.001). Nearly all women with pain had myofascial trigger points (94 and 91%). Adjusting for study group, those with high anxiety (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.004-1.099, P=.031) and depression (OR 1.06, 95% CI 1.005-1.113, P=.032) scores were more likely to have sensitization. Pain patients with any history of endometriosis had the highest proportion of sensitization compared with the others (87% compared with 67% compared with 15%; P<.001). Adjusting for any history of endometriosis, those with myofascial trigger points were most likely sensitized (OR 9.41, 95% CI 1.77-50.08, P=.009). CONCLUSION/CONCLUSIONS:Sensitization and myofascial trigger points were common in women with pain regardless of whether they had endometriosis at surgery. Those with any history of endometriosis were most likely to have sensitization. Traditional methods of classifying endometriosis-associated pain based on disease, duration, and anatomy are inadequate and should be replaced by a mechanism-based evaluation, as our study illustrates. CLINICAL TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov, www.clinicaltrials.gov, NCT00073801. LEVEL OF EVIDENCE/METHODS:II.
PMCID:4347996
PMID: 25730237
ISSN: 1873-233x
CID: 5069772
