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1. Postpartum Emergency Department Visits and Inpatient Readmissions in a Medicaid Population of Mothers

Author

Cynthia Denemark, David A. Paul, Katie Gelinas, Abiy Agiro, Michael F. Pollack, Matthew K. Hoffman, Anthony J. Brazen, and Deborah B. Ehrenthal

Subjects
Adult, medicine.medical_specialty, Population, Mothers, Logistic regression, Patient Readmission, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, medicine, Humans, Obstetrical delivery, 030212 general & internal medicine, education, Retrospective Studies, Inpatients, education.field_of_study, 030219 obstetrics & reproductive medicine, Medicaid, business.industry, Postpartum Period, Postpartum care, Retrospective cohort study, General Medicine, Emergency department, Delivery, Obstetric, United States, Logistic Models, Emergency medicine, Female, Emergency Service, Hospital, business, Postpartum period
Abstract

Little comprehensive literature exists to broadly examine risk factors for emergency department (ED) utilization or inpatient admission after obstetrical delivery.We conducted a retrospective cohort study of Medicaid-insured women from 2009 to 2012 who delivered at a regional perinatal center in the Mid-Atlantic. Women were included if Medicaid was the primary payer of record for the delivery and there was continuous 9-month predelivery Medicaid eligibility. Electronic obstetrical data were linked to Medicaid claims for 9-month prenatal and 6-month postpartum care following delivery. Negative binomial regression was used to examine factors associated with an ED visit; multivariable logistic regression was used to examine factors associated with hospital admission.Following 4484 births, 1564 (34.9%) mothers had an ED visit, and 298 (6.6%) a hospital admission, within 6 months of delivery. Mother's race was significantly associated with both ED visits and inpatient admissions, whereas age and marital status were associated with ED use. Medical comorbidities, tobacco and substance use, cesarean delivery, and severe obstetrical morbidity were associated with both ED visits and hospital admission. In addition, both prenatal opioid use and bipolar disorder increased the odds of ED use and hospital admission.Medical, social, and behavioral characteristics of women, as well as cesarean delivery, were associated with increased medical utilization in the postpartum.

Published
2017
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2. Iron Deficiency in Patients With Nonalcoholic Fatty Liver Disease Is Associated With Obesity, Female Gender, and Low Serum Hepcidin

Author

Kathryn J. Fowler, Nicholas Raviele, Linda D. Ferrell, Maximillian Lee, Debra King, Melissa Paiz, Puneet Puri, Michael Fuchs, Michael S. Middleton, Tarek Hassanein, Edward Doo, Danielle Brandman, Katie Gelinas, Kim M. Cecil, Ryan M. Gill, Katie Amsden, Sherry Boyett, Archana Bhatt, Melissa Young, Mangesh R. Pagadala, Carol Sargeant, Jean P. Molleston, Mark Fishbein, Averell H. Sherker, Deana Rich, Muhammad Y. Sheikh, Kumar Sandrasegaran, Jaividhya Dasarathy, Sarah E. Barlow, Cheryl Shaw, Laura R. Carucci, Randolph K. Otto, Kimberly Pfeifer, James Tonascia, Ann O. Scheimann, Kimberlee Bernstein, Karen F. Murray, Laura A. Wilson, Amy Jones, Carol Hawkins, Evelyn K. Hsu, Laura Miriel, Miriam B. Vos, Joan Siegner, Gerald Behr, Brandon Ang, Stavra A. Xanthakos, Adina Alazraki, Elizabeth M. Brunt, Michael Torbenson, Cynthia Behling, Alexander Ko, Daniel J. Podberesky, Milana Isaacson, Peter F. Whitington, Elizabeth Kirwan, Girish Subbarao, Emily R. Perito, Saeed Mohammad, Ryan Himes, Pat Osmack, Jolene Schlosser, Patrika Tsai, Kenneth A. Kraft, Patricia Ugalde-Nicalo, Ronen Arnon, Melissa J. Contos, Bimalijit Sandhu, Mariel Boyd, Cynthia D. Guy, ünalp-Arida Aynur ünalp-Arida, Elena Reynoso, Pradeep R. Atla, Ajay Jain, Oscar W. Cummings, Shetal N. Shah, Shannon Cooney, Rajesh Krisnamurthy, Srinivasan Dasarathy, Sonia Garcia, Matthew M. Yeh, Rohit Loomba, Rohit Kohli, Ruth Sargent, Patricia Belt, Patricia R. Robuck, Ivana A. Vaughn, Mandeep Singh, Marwan Ghabril, Mohhamad S. Siddiqui, Kimberly Noble, Kara Cooper, Kimberly P. Newton, Kevin P. May, Brent A. Neuschwander-Tetri, Joel E. Lavine, Rish K. Pai, Chia Wang, Stephanie H. Abrams, Velimir A. Luketic, Kris V. Kowdley, Christopher J. N. Kigongo, Arthur J. McCullough, David E. Kleiner, Jay H. Hoofnagle, Katherine P. Yates, Sandra Arroyo, Jeanne M. Clark, Erin Corless, Melanie B. White, Dawn Piercy, Yi Ping Pan, Iliana Doycheva, Camille Langlois, Philip J. Rosenthal, Ann Quinn, James E. Nelson, Ali A. Mencin, Cynthia K. Rigsby, Stephanie Buie, Nadia Ovchinsky, Tracey Pierce, Jose Derdoy, Kathleen Lake, Cynthia Fleming, Mark L. Van Natta, Asma Siddique, Arun J. Sanyal, Janis Durelle, Phirum Nguyen, Anna Mae Diehl, Crystal Slaughter, Mazen Noureddin, Leanel Maldonado, Rebekah Garcia, Nathan M. Bass, Linda Ragozzino, Jody Mooney, Smitha Marri, Claudia Ortiz Zein, Beverly Morris, Bilal Hameed, Claude B. Sirlin, Alice L. Sternberg, Jeffrey B. Schwimmer, Melissa Wagner, David L. Coy, Michele Donithan, Naga Chalasani, Heather Patton, Susan Stewart, Dana Romo, Stephanie DeVore, Manal F. Abdelmalek, Shannon Fleck, Gilman D. Grave, Saul J. Karpen, Aliya Qayyum, Ann Klipsch, Bradley E. Aouizerat, Simon Horslen, Mustafa R. Bashir, Norah A. Terrault, Lacey Siekas, Elizabeth Byam, Sarah Ackermann, Jennifer Collins, Patricia Brandt, Ben Wolford, Raj Vuppalanchi, Rebecca Cleeton, and Cathy Hurtado

Subjects
Adult, Male, Serum, medicine.medical_specialty, Interleukin-1beta, Ferroportin, Article, Body Mass Index, Young Adult, Sex Factors, Hepcidins, Non-alcoholic Fatty Liver Disease, Risk Factors, Hepcidin, Internal medicine, Diabetes mellitus, Nonalcoholic fatty liver disease, medicine, Humans, Obesity, Aged, Aged, 80 and over, Hepatology, biology, Interleukin-6, Transferrin saturation, business.industry, Racial Groups, Gastroenterology, Iron Deficiencies, Iron deficiency, Middle Aged, medicine.disease, Endocrinology, biology.protein, Female, Metabolic syndrome, business, Body mass index, Alaska
Abstract

Iron deficiency is often observed in obese individuals. The iron regulatory hormone hepcidin is regulated by iron and cytokines interleukin (IL) 6 and IL1β. We examine the relationship between obesity, circulating levels of hepcidin, and IL6 and IL1β, and other risk factors in patients with nonalcoholic fatty liver disease (NAFLD) with iron deficiency.We collected data on 675 adult subjects (18 years old) enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network. Subjects with transferrin saturation20% were categorized as iron deficient, whereas those with transferrin saturation ≥20% were classified as iron normal. We assessed clinical, demographic, anthropometric, laboratory, dietary, and histologic data from patients, and serum levels of hepcidin and cytokines IL6 and IL1β. Univariate and multivariate analysis were used to identify risk factors for iron deficiency.One-third of patients (231 of 675; 34%) were iron deficient. Obesity, diabetes, and metabolic syndrome were more common in subjects with iron deficiency (P.01), compared with those that were iron normal. Serum levels of hepcidin were significantly lower in subjects with iron deficiency (61 ± 45 vs 81 ± 51 ng/mL; P.0001). Iron deficiency was significantly associated with female gender, obesity, increased body mass index and waist circumference, presence of diabetes, lower alcohol consumption, black or American Indian/Alaska Native race (P ≤ .018), and increased levels of IL6 and IL1β (6.6 vs 4.8 for iron normal, P ≤ .0001; and 0.45 vs 0.32 for iron normal, P ≤ .005).Iron deficiency is prevalent in patients with NAFLD and associated with female gender, increased body mass index, and nonwhite race. Serum levels of hepcidin were lower in iron-deficient subjects, reflecting an appropriate physiologic response to decreased circulating levels of iron, rather than a primary cause of iron deficiency in the setting of obesity and NAFLD.

Published
2014
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3. Patient Sex, Reproductive Status, and Synthetic Hormone Use Associate With Histologic Severity of Nonalcoholic Steatohepatitis

Author

Ju Dong Yang, Manal F. Abdelmalek, Cynthia D. Guy, Ryan M. Gill, Joel E. Lavine, Katherine Yates, Jagpal Klair, Norah A. Terrault, Jeanne M. Clark, Aynur Unalp-Arida, Anna Mae Diehl, Ayako Suzuki, Srinivasan Dasarathy, Jaividhya Dasarathy, Carol Hawkins, Arthur J. McCullough, Mangesh Pagadala, Rish Pai, Ruth Sargent, Mustafa Bashir, Stephanie Buie, Cynthia Guy, Christopher Kigongo, Yi-Ping Pan, Dawn Piercy, Naga Chalasani, Oscar W. Cummings, Samer Gawrieh, Marwan Ghabril, Smitha Marri, Linda Ragozzino, Kumar Sandrasegaran, Raj Vuppalanchi, Debra King, Pat Osmack, Joan Siegner, Susan Stewart, Brent A. Neuschwander-Tetri, Susan Torretta, Brandon Ang, Cynthia Behling, Archana Bhatt, Rohit Loomba, Michael Middleton, Heather Patton, Claude Sirlin, Bradley Aouizerat, Nathan M. Bass, Danielle Brandman, Linda D. Ferrell, Ryan Gill, Bilal Hameed, Claudia Ramos, Norah Terrault, Ashley Ungermann, Pradeep Atla, Brandon Croft, Rebekah Garcia, Sonia Garcia, Muhammad Sheikh, Mandeep Singh, Sherry Boyett, Laura Carucci, Melissa J. Contos, Kenneth Kraft, Velimir A.C. Luketic, Puneet Puri, Arun J. Sanyal, Jolene Schlosser, Mohhamad S. Siddiqui, Ben Wolford, Sarah Ackermann, Shannon Cooney, David Coy, Katie Gelinas, Kris V. Kowdley, Maximillian Lee, Tracey Pierce, Jody Mooney, James E. Nelson, Cheryl Shaw, Asma Siddique, Chia Wang, Elizabeth M. Brunt, Kathryn Fowler, David E. Kleiner, Gilman D. Grave, Edward C. Doo, Jay H. Hoofnagle, Patricia R. Robuck, Averell Sherker, Patricia Belt, Michele Donithan, Erin Hallinan, Milana Isaacson, Kevin P. May, Laura Miriel, Alice Sternberg, James Tonascia, Aynur Ünalp-Arida, Mark Van Natta, Ivana Vaughn, and Laura Wilson

Subjects
medicine.medical_specialty, Hepatology, Cross-sectional study, business.industry, Gastroenterology, Physiology, medicine.disease, Article, Menopause, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Transgender hormone therapy, Fibrosis, 030220 oncology & carcinogenesis, Internal medicine, Nonalcoholic fatty liver disease, medicine, 030211 gastroenterology & hepatology, Young adult, business, Body mass index, Hormone
Abstract

Sex and sex hormones can affect responses of patients with nonalcoholic fatty liver disease (NAFLD) to metabolic stress and development of hepatocyte injury and inflammation. We collected data from 3 large US studies of patients with NAFLD (between October 2004 and June 2013) to assess the association between histologic severity and sex, menopause status, synthetic hormone use, and menstrual abnormalities in 1112 patients with a histologic diagnosis of NAFLD. We performed logistic or ordinal logistic regression models, adjusting for covariates relevant to an increase of hepatic metabolic stress. We found that pre-menopausal women were at an increased risk of lobular inflammation, hepatocyte ballooning, and Mallory-Denk bodies than men and also at an increased risk of lobular inflammation and Mallory-Denk bodies than post-menopausal women (P

Published
2017
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