1,194 results on '"Weiss, Robert E"'
Search Results
2. Mobile-Enhanced Prevention Support Study for Men Who Have Sex With Men and Transgender Women Leaving Jail: Protocol for a Randomized Controlled Trial
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Edwards, Gabriel G, Reback, Cathy J, Cunningham, William E, Hilliard, Charles L, McWells, Charles, Mukherjee, Sukrit, Weiss, Robert E, and Harawa, Nina T
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Medicine ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
BackgroundMen who have sex with men (MSM) and transgender women, particularly those who have experienced criminal justice involvement, have particularly high HIV burdens, and a majority of those in jail have substance use disorders (SUDs). MSM and transgender women also experience elevated rates of incarceration. Once community re-entry occurs, individuals are in a critical period for addressing potential risks of HIV and sexually transmitted infection (STI) acquisition and negative sequelae of substance use. Further, the impact experienced by one’s social and sexual networks experienced at the time of detention and release have important health implications for MSM and transgender women. ObjectiveThe purpose of this study is to test a new intervention—Mobile-Enhanced Prevention Support (MEPS)—that involves a GPS-based mobile app called GeoPassport (referred to as GeoPass in practice), incentives, and peer support for promoting HIV prevention, substance use treatment, and use of related services. MethodsA two-arm, unblinded, randomized controlled trial will seek to enroll 300 HIV-negative MSM and transgender women, aged 18-49 years, with SUDs, who are either in jail or have recently left jail. Participants will be enrolled by study staff and randomized to the MEPS intervention group or usual care group. The intervention group will receive customized wellness goals in addition to GeoPass, cash incentives, and the support of a trained peer mentor for 6 months. Data collection will consist of a baseline survey and three follow-up surveys at 3, 6, and 9 months postenrollment, either in person or by phone or videoconference when necessary. The primary outcomes include establishing a primary care provider; being prescribed and adhering to pre-exposure prophylaxis (PrEP) for HIV; screening for HIV, STIs, and hepatitis C virus; and engagement in recommended treatment for SUDs. Secondary outcomes include obtaining treatment for any identified infections and avoiding recidivism. ResultsEnrollment began in November 2019 and study completion is expected in 2023. ConclusionsThis study will advance our knowledge base on patient navigation and peer mentor interventions. Peer navigation services have been studied for the treatment of HIV, but less often in the context of HIV and STI prevention among sexual and gender minority populations at the time of re-entry into the community from jail. The MEPS study will examine the acceptability and feasibility of combining peer mentor services with a mobile app to facilitate service utilization and participant–peer mentor communication. MEPS will assess patterns of PrEP uptake and utilization in MSM and transgender women leaving jail. The study will provide heretofore unavailable data from persons leaving jail regarding HIV PrEP, STI screening, substance abuse treatment, and service utilization patterns and experiences, including geocoded data for those in the intervention arm. Trial RegistrationClinicalTrials.gov (NCT04036396); https://www.clinicaltrials.gov/ct2/show/NCT04036396 International Registered Report Identifier (IRRID)PRR1-10.2196/18106
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- 2020
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3. Racial, gender, and psychosocial disparities in viral suppression trends among people receiving coordinated HIV care in Los Angeles County
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Li, Michael J, Chau, Brendon, Garland, Wendy H, Oksuzyan, Sona, Weiss, Robert E, Takada, Sae, Kao, Uyen, Lee, Sung-Jae, and Shoptaw, Steven J
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Behavioral and Social Science ,Women's Health ,Sexually Transmitted Infections ,Minority Health ,Social Determinants of Health ,HIV/AIDS ,Clinical Research ,Infectious Diseases ,Health Disparities ,Infection ,Humans ,Female ,HIV Infections ,Los Angeles ,Bayes Theorem ,Ethnicity ,Racial Groups ,disparities ,gender ,HIV ,psychosocial health ,public health programs ,race ,viral suppression ,Biological Sciences ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Virology ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectiveTo longitudinally evaluate differences in HIV viral suppression (
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- 2023
4. A Bayesian Dirichlet Auto-Regressive Moving Average Model for Forecasting Lead Times
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Katz, Harrison, Brusch, Kai, and Weiss, Robert E.
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Statistics - Methodology ,Statistics - Applications - Abstract
Lead time data is compositional data found frequently in the hospitality industry. Hospitality businesses earn fees each day, however these fees cannot be recognized until later. For business purposes, it is important to understand and forecast the distribution of future fees for the allocation of resources, for business planning, and for staffing. Motivated by 5 years of daily fees data, we propose a new class of Bayesian time series models, a Bayesian Dirichlet Auto-Regressive Moving Average (B-DARMA) model for compositional time series, modeling the proportion of future fees that will be recognized in 11 consecutive 30 day windows and 1 last consecutive 35 day window. Each day's compositional datum is modeled as Dirichlet distributed given the mean and a scale parameter. The mean is modeled with a Vector Autoregressive Moving Average process after transforming with an additive log ratio link function and depends on previous compositional data, previous compositional parameters and daily covariates. The B-DARMA model offers solutions to data analyses of large compositional vectors and short or long time series, offers efficiency gains through choice of priors, provides interpretable parameters for inference, and makes reasonable forecasts.
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- 2023
5. A Spatially Varying Hierarchical Random Effects Model for Longitudinal Macular Structural Data in Glaucoma Patients
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Su, Erica, Weiss, Robert E., Nouri-Mahdavi, Kouros, and Holbrook, Andrew J.
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Statistics - Applications - Abstract
We model longitudinal macular thickness measurements to monitor the course of glaucoma and prevent vision loss due to disease progression. The macular thickness varies over a 6$\times$6 grid of locations on the retina with additional variability arising from the imaging process at each visit. Currently, ophthalmologists estimate slopes using repeated simple linear regression for each subject and location. To estimate slopes more precisely, we develop a novel Bayesian hierarchical model for multiple subjects with spatially varying population-level and subject-level coefficients, borrowing information over subjects and measurement locations. We augment the model with visit effects to account for observed spatially correlated visit-specific errors. We model spatially varying (a) intercepts, (b) slopes, and (c) log residual standard deviations (SD) with multivariate Gaussian process priors with Mat\'ern cross-covariance functions. Each marginal process assumes an exponential kernel with its own SD and spatial correlation matrix. We develop our models for and apply them to data from the Advanced Glaucoma Progression Study. We show that including visit effects in the model reduces error in predicting future thickness measurements and greatly improves model fit.
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- 2023
6. Comparison of Ganglion Cell Layer and Inner Plexiform Layer Rates of Change in Suspected and Established Glaucoma.
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Mohammadi, Massood, Su, Erica, Chew, Leila, Mohammadzadeh, Vahid, Caprioli, Joseph, Weiss, Robert E, and Nouri-Mahdavi, Kouros
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Nerve Fibers ,Retinal Ganglion Cells ,Humans ,Glaucoma ,Tomography ,Optical Coherence ,Bayes Theorem ,Cohort Studies ,Prospective Studies ,Cross-Sectional Studies ,Intraocular Pressure ,Eye Disease and Disorders of Vision ,Neurodegenerative ,Clinical Research ,Clinical Sciences ,Opthalmology and Optometry ,Public Health and Health Services ,Ophthalmology & Optometry - Abstract
PurposeWe compared ganglion cell layer (GCL) and inner plexiform layer (IPL) rates of change (RoC) in patients with glaucoma suspect (GS) and established glaucoma (EG) to test the hypothesis that IPL thickness changes would occur earlier than GCL changes in eyes with early damage.DesignProspective, cohort study.MethodsA total of 64 GS eyes (46 patients) and 112 EG eyes (112 patients) with ≥2 years of follow-up and ≥3 macular optical coherence tomography scans were included. GCL and IPL superpixel thickness measurements were exported. A Bayesian hierarchical model with random intercepts/slopes and random residual variances was fitted to estimate RoC in individual superpixels. Normalized RoC and proportions of superpixels with significantly negative and positive GCL and IPL RoC were compared within the groups.ResultsThe average (SD) follow-up time and number of scans were 3.5 (0.7) years and 4.2 (1.0), respectively, in the GS group and 3.6 (0.4) years and 7.3 (1.1) in the EG group. Mean (SD) normalized RoC was faster for GCL than IPL (-0.69 [0.05] vs -0.33 [0.04]) in the GS group, whereas it was faster for IPL (-0.47 [0.03] vs -0.28 [0.02]) in EG eyes. GCL RoC were significantly negative in 24 of 36 superpixels compared with 8 of 36 for IPL (P < .001) in GS eyes. In the EG group, 23 of 36 superpixels had significant negative IPL RoC compared with 13 of 36 superpixels for GCL (P = .006).ConclusionsGCL thickness is more likely to demonstrate change over time compared with IPL in glaucoma suspects. There is no evidence of preferential IPL thinning in eyes with suspected early glaucoma damage.
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- 2023
7. Utilizing Soccer for Delivery of HIV and Substance Use Prevention for Young South African Men: 6-Month Outcomes of a Cluster Randomized Controlled Trial
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Rabie, Stephan, Tomlinson, Mark, Almirol, Ellen, Stewart, Jackie, Skiti, Zwelibanzi, Weiss, Robert E, Vogel, Lodewyk, and Rotheram-Borus, Mary Jane
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Clinical Trials and Supportive Activities ,Behavioral and Social Science ,Substance Misuse ,Prevention ,Mental Health ,Clinical Research ,Drug Abuse (NIDA only) ,HIV/AIDS ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Prevention of disease and conditions ,and promotion of well-being ,Good Health and Well Being ,Adolescent ,Adult ,Humans ,Male ,Young Adult ,Black People ,HIV Infections ,Soccer ,South Africa ,Substance-Related Disorders ,Health Promotion ,HIV prevention ,Substance use ,At-risk men ,Cluster randomized controlled trial ,Intervention ,Public Health and Health Services ,Social Work ,Public Health - Abstract
Young men in South Africa face the intersecting epidemics of HIV, substance use and endemic poverty. We tested the effectiveness of a behavioral intervention using soccer training to reduce the cluster of risks associated with HIV and substance use. This cluster randomized controlled trial was conducted with men aged 18-29 years old in 27 neighborhoods in the townships of Cape Town, South Africa. Neighborhoods were randomized to receive for 6 months either: (1) Soccer League (SL; n = 18 neighborhoods, n = 778 men) who attended soccer three times weekly (72 sessions; 94% uptake, 45.5% weekly attendance rate), combined with an HIV/substance use, cognitive-behavioral intervention; or (2) a Control Condition (CC; n = 9; 415 men) who received educational materials and referrals at 3 month intervals. The primary outcome was the number of significant changes in a cluster of outcomes including HIV-related risks, substance abuse, employment/income, mental health, violence, and community engagement. There was only one significant difference on the rapid diagnostic tests for mandrax at 6 months, an insufficient number of changes to indicate a successful intervention. A group-based behavioral intervention was ineffective in addressing multiple risk behaviors among at-risk young men, similar to the findings of several recent soccer-related interventions. Early adulthood may be too late to alter well-established patterns of risk behaviors.Clinical Trial Registration This trial was prospectively registered on 24 November 2014 with ClinicalTrials.gov NCT02358226.
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- 2023
8. Multivariate Longitudinal Modeling of Macular Ganglion Cell Complex: Spatiotemporal Correlations and Patterns of Longitudinal Change
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Mohammadzadeh, Vahid, Su, Erica, Shi, Lynn, Coleman, Anne L, Law, Simon K, Caprioli, Joseph, Weiss, Robert E, and Nouri-Mahdavi, Kouros
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Mathematical Sciences ,Biomedical and Clinical Sciences ,Statistics ,Ophthalmology and Optometry ,Eye Disease and Disorders of Vision ,Neurodegenerative ,Aging ,Clinical Research ,Bayesian Ganglion cell complex Hierarchical Longitudinal Macular OCT ,Bayesian ,GCC ,ganglion cell complex ,Ganglion cell complex ,Hierarchical ,Longitudinal ,Macular OCT ,PC ,principal component ,RNFL ,retinal nerve fiber layer ,SD ,standard deviation ,VF ,visual field - Abstract
PurposeTo investigate spatiotemporal correlations among ganglion cell complex (GCC) superpixel thickness measurements and explore underlying patterns of longitudinal change across the macular region.DesignLongitudinal cohort study.SubjectsOne hundred eleven eyes from 111 subjects from the Advanced Glaucoma Progression Study with ≥ 4 visits and ≥ 2 years of follow-up.MethodsWe further developed our proposed Bayesian hierarchical model for studying longitudinal GCC thickness changes across macular superpixels in a cohort of glaucoma patients. Global priors were introduced for macular superpixel parameters to combine data across superpixels and better estimate population slopes and intercepts.Main outcome measuresBayesian residual analysis to inspect cross-superpixel correlations for subject random effects and residuals. Principal component analysis (PCA) to explore underlying patterns of longitudinal macular change.ResultsAverage (standard deviation [SD]) follow-up and baseline 10-2 visual field mean deviation were 3.6 (0.4) years and -8.9 (5.9) dB, respectively. Superpixel-level random effects and residuals had the greatest correlations with nearest neighbors; correlations were higher in the superior than in the inferior region and strongest among random intercepts, followed by random slopes, residuals, and residual SDs. PCA of random intercepts showed a first large principal component (PC) across superpixels that approximated a global intercept, a second PC that contrasted the superior and inferior macula, and a third PC, contrasting inner and nasal superpixels with temporal and peripheral superpixels. PCs for slopes, residual SDs, and residuals were remarkably similar to those of random intercepts.ConclusionsIntroduction of cross-superpixel random intercepts and slopes is expected to improve estimation of population and subject parameters. Further model enhancement may be possible by including cross-superpixel random effects and correlations to address spatiotemporal relationships in longitudinal data sets.
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- 2022
9. Local and global topics in text modeling of web pages nested in web sites
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Wang, Jason and Weiss, Robert E
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Economics ,Statistics ,Econometrics ,Mathematical Sciences ,Clinical Research ,Health Services ,Hierarchical models ,Text analysis ,Bayesian models ,Public health ,Internet ,Computation Theory and Mathematics ,Statistics & Probability - Published
- 2022
10. Comparison of Retinal Nerve Fiber Layer and Ganglion Cell Complex Rates of Change in Patients With Moderate to Advanced Glaucoma
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MOHAMMADI, MASSOOD, SU, ERICA, MOHAMMADZADEH, VAHID, BESHARATI, SAJAD, MARTINYAN, ARTHUR, COLEMAN, ANNE L., LAW, SIMON K., CAPRIOLI, JOSEPH, WEISS, ROBERT E., and NOURI-MAHDAVI, KOUROS
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- 2024
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11. National Trends in PSA Cancer Screening With Parallel Investigation of Colorectal Cancer Screening: An Analysis of the CDC Behavioral Risk Factor Surveillance System From 2012 to 2022
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Nguyen, Anh, Fastenau, John, Mehta, Juhi, Kovac, Evan, and Weiss, Robert E.
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- 2024
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12. A Bayesian Dirichlet auto-regressive moving average model for forecasting lead times
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Katz, Harrison, Brusch, Kai Thomas, and Weiss, Robert E.
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- 2024
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13. Ganglion Cell Complex: The Optimal Measure for Detection of Structural Progression in the Macula.
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Mohammadzadeh, Vahid, Su, Erica, Rabiolo, Alessandro, Shi, Lynn, Zadeh, Sepideh Heydar, Law, Simon K, Coleman, Anne L, Caprioli, Joseph, Weiss, Robert E, and Nouri-Mahdavi, Kouros
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Retinal Ganglion Cells ,Macula Lutea ,Humans ,Glaucoma ,Tomography ,Optical Coherence ,Bayes Theorem ,Prospective Studies ,Intraocular Pressure ,Eye Disease and Disorders of Vision ,Clinical Research ,Neurodegenerative ,Eye ,Clinical Sciences ,Opthalmology and Optometry ,Public Health and Health Services ,Ophthalmology & Optometry - Abstract
PurposeTo test the hypothesis that macular ganglion cell complex (GCC) thickness from optical coherence tomography (OCT) provides a stronger change signal regardless of glaucoma severity compared with other macular measures.DesignProspective cohort study.MethodsEyes were from 112 patients with moderate to severe glaucoma at baseline from a tertiary glaucoma center. In each 3° × 3° macular superpixel, a hierarchical Bayesian random intercept and slope model with random residual variance was fit to longitudinal full macular thickness (FMT), outer retina layers, GCC, ganglion cell-inner plexiform layer (GCIPL), and ganglion cell layer (GCL) measurements. We estimated population- and individual-level slopes and intercepts. Proportions of substantial worsening and improving superpixel slopes were compared between layers and in superpixels with mild to moderate vs severe damage (total deviation of corresponding visual field location ≥ -8 vs < -8 dB).ResultsMean (SD) follow-up time and baseline 10-2 visual field mean deviation were 3.6 (0.4) years and -8.9 (5.9) dB, respectively. FMT displayed the highest proportion of significant negative slopes (1932/3519 [54.9%]), followed by GCC (1286/3519 [36.5%]), outer retina layers (1254/3519 [35.6%]), (GCIPL) (1075/3518 [30.6%]), and (GCL) (698/3518 [19.8%]). Inner macular measures detected less worsening in the severe glaucoma group; yet GCC (223/985 [22.6%]) identified the highest proportion (GCIPL: 183/985 [18.6%]; GCL: 106/985 [10.8%]). Proportions of positive rates were small and comparable among all measures.ConclusionsGCC is the optimal macular measure for detection of structural change in eyes with moderate to severe glaucoma. Although a higher proportion of worsening superpixels was observed for FMT, a large portion of FMT change could be attributed to changes in outer retina layers.
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- 2022
14. Detecting Fast Progressors: Comparing a Bayesian Longitudinal Model to Linear Regression for Detecting Structural Changes in Glaucoma
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BESHARATI, SAJAD, SU, ERICA, MOHAMMADZADEH, VAHID, MOHAMMADI, MASSOOD, CAPRIOLI, JOSEPH, WEISS, ROBERT E., and NOURI-MAHDAVI, KOUROS
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- 2024
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15. Hierarchical Topic Presence Models
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Wang, Jason and Weiss, Robert E.
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Computer Science - Information Retrieval - Abstract
Topic models analyze text from a set of documents. Documents are modeled as a mixture of topics, with topics defined as probability distributions on words. Inferences of interest include the most probable topics and characterization of a topic by inspecting the topic's highest probability words. Motivated by a data set of web pages (documents) nested in web sites, we extend the Poisson factor analysis topic model to hierarchical topic presence models for analyzing text from documents nested in known groups. We incorporate an unknown binary topic presence parameter for each topic at the web site and/or the web page level to allow web sites and/or web pages to be sparse mixtures of topics and we propose logistic regression modeling of topic presence conditional on web site covariates. We introduce local topics into the Poisson factor analysis framework, where each web site has a local topic not found in other web sites. Two data augmentation methods, the Chinese table distribution and P\'{o}lya-Gamma augmentation, aid in constructing our sampler. We analyze text from web pages nested in United States local public health department web sites to abstract topical information and understand national patterns in topic presence.
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- 2021
16. Local and Global Topics in Text Modeling of Web Pages Nested in Web Sites
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Wang, Jason and Weiss, Robert E.
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Computer Science - Information Retrieval ,Statistics - Methodology - Abstract
Topic models are popular models for analyzing a collection of text documents. The models assert that documents are distributions over latent topics and latent topics are distributions over words. A nested document collection is where documents are nested inside a higher order structure such as stories in a book, articles in a journal, or web pages in a web site. In a single collection of documents, topics are global, or shared across all documents. For web pages nested in web sites, topic frequencies likely vary between web sites. Within a web site, topic frequencies almost certainly vary between web pages. A hierarchical prior for topic frequencies models this hierarchical structure and specifies a global topic distribution. Web site topic distributions vary around the global topic distribution and web page topic distributions vary around the web site topic distribution. In a nested collection of web pages, some topics are likely unique to a single web site. Local topics in a nested collection of web pages are topics unique to one web site. For US local health department web sites, brief inspection of the text shows local geographic and news topics specific to each department that are not present in others. Topic models that ignore the nesting may identify local topics, but do not label topics as local nor do they explicitly identify the web site owner of the local topic. For web pages nested inside web sites, local topic models explicitly label local topics and identifies the owning web site. This identification can be used to adjust inferences about global topics. In the US public health web site data, topic coverage is defined at the web site level after removing local topic words from pages. Hierarchical local topic models can be used to identify local topics, adjust inferences about if web sites cover particular health topics, and study how well health topics are covered.
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- 2021
17. Characteristics and Longitudinal Patterns of Erectile Dysfunction Drug Use Among Men Who Have Sex with Men in the U.S.
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Park, Jee Won, Dobs, Adrian S, Ho, Ken S, Palella, Frank J, Seaberg, Eric C, Weiss, Robert E, and Detels, Roger
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HIV ,Multivariate analysis ,Phosphodiesterase 5 inhibitors ,Recreational drugs ,Sexual behavior ,Sexual orientation ,Cohort Studies ,Erectile Dysfunction ,Homosexuality ,Male ,Humans ,Male ,Pharmaceutical Preparations ,Sexual Behavior ,Sexual and Gender Minorities ,Substance-Related Disorders ,Clinical Research ,HIV/AIDS ,Prevention ,Substance Abuse ,Behavioral and Social Science ,Infectious Diseases ,Drug Abuse (NIDA Only) ,Sexually Transmitted Infections ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Clinical Psychology ,Public Health and Health Services ,Other Studies in Human Society ,Psychology - Abstract
We investigated the longitudinal relationship between erectile dysfunction (ED) drug use with behavioral factors, including substance use and sexual activities in men who have sex with men from the Multicenter AIDS Cohort Study during 1998-2016 (n = 1636). We used a bivariate random-intercept model to evaluate ED drug use along with other behavioral factors to assess relationships between the two outcomes over time on a population level and also at the individual level. Average ED drug use among men who have sex with men (MSM) with HIV was positively correlated with average use of marijuana (r = .19), poppers (r = .27), and stimulants (r = .25). In this group, testosterone use (r = .32), multiple partners (r = .41), insertive anal intercourse with condom (r = .40), and insertive anal intercourse without condom (r = .43) all showed moderate correlations over time with average ED use (p
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- 2021
18. Explaining the Decline of Child Mortality in 44 Developing Countries: A Bayesian Extension of Oaxaca Decomposition Methods
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Ramos, Antonio P., Flores, Martin J., Gao, Leiwen, Heuveline, Patrick, and Weiss, Robert E.
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Statistics - Applications ,Statistics - Methodology - Abstract
We investigate the decline of infant mortality in 42 low and middle income countries (LMIC) using detailed micro data from 84 Demographic and Health Surveys. We estimate infant mortality risk for each infant in our data and develop a novel extension of Oaxaca decomposition to understand the sources of these changes. We find that the decline in infant mortality is due to a declining propensity for parents with given characteristics to experience the death of an infant rather than due to changes in the distributions of these characteristics over time. Our results suggest that technical progress and policy health interventions in the form of public goods are the main drivers of the the recent decline in infant mortality in LMIC.
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- 2020
19. A general semiparametric Bayesian discrete-time recurrent events model
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King, Adam J and Weiss, Robert E
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Bioengineering ,Drug Abuse (NIDA only) ,Patient Safety ,Rare Diseases ,Substance Misuse ,Good Health and Well Being ,Bayes Theorem ,Humans ,Markov Chains ,Monte Carlo Method ,Proportional Hazards Models ,Software ,Competing risks ,Cox model ,Discrete time ,Generalized additive models ,Recurrent events ,Semiparametric models ,Substance abuse ,Statistics ,Genetics ,Statistics & Probability - Abstract
Event time variables are often recorded in a discrete fashion, especially in the case of patient-reported outcomes. This work is motivated by a study of illicit drug users, in which time to drug use cessation has been recorded as a number of whole months. Existing approaches for handling such discrete data include treating the survival times as continuous (with adjustments for inevitable tied outcomes), or using discrete models that omit important features like random effects. We provide a general Bayesian discrete-time proportional hazards model, incorporating a number of features popular in continuous-time models such as competing risks and frailties. Our model also provides flexible baseline hazards for time effects, as well as generalized additive models style semiparametric incorporation of other time-varying covariates. Our specific modeling choices enable efficient Markov chain Monte Carlo inference algorithms, which we provide to the user in the form of a freely available R package called $\texttt{brea}$. We demonstrate that our model performs better on our motivating substance abuse application than existing approaches. We also present a reproducible application of the $\texttt{brea}$ software to a freely available data set from a clinical trial of anesthesia administration methods.
- Published
- 2021
20. Estimating Ganglion Cell Complex Rates of Change With Bayesian Hierarchical Models.
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Mohammadzadeh, Vahid, Su, Erica, Heydar Zadeh, Sepideh, Law, Simon K, Coleman, Anne L, Caprioli, Joseph, Weiss, Robert E, and Nouri-Mahdavi, Kouros
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Retinal Ganglion Cells ,Humans ,Glaucoma ,Tomography ,Optical Coherence ,Bayes Theorem ,Intraocular Pressure ,Visual Fields ,Eye Disease and Disorders of Vision ,Aging ,Neurodegenerative ,optical coherence tomography ,OCT ,macula ,progression ,ganglion cell complex ,GCC ,longitudinal ,bayesian ,superpixels ,Biomedical Engineering ,Opthalmology and Optometry - Abstract
PurposeDevelop a hierarchical longitudinal regression model for estimating local rates of change of macular ganglion cell complex (GCC) measurements with optical coherence tomography (OCT).MethodsWe enrolled 112 eyes with four or more macular OCT images and ≥2 years of follow-up. GCC thickness measurements within central 6 × 6 superpixels were extracted from macular volume scans. We fit data from each superpixel separately with several hierarchical Bayesian random-effects models. Models were compared with the Watanabe-Akaike information criterion. For our preferred model, we estimated population and individual slopes and intercepts (baseline thickness) and their correlation.ResultsMean (SD) follow-up time and median (interquartile range) baseline 24-2 visual field mean deviation were 3.6 (0.4) years and -6.8 (-12.2 to -4.3) dB, respectively. The random intercepts and slopes model with random residual variance was the preferred model. While more individual and population negative slopes were observed in the paracentral and papillomacular superpixels, superpixels in the superotemporal and inferior regions displayed the highest correlation between baseline thickness and rates of change (r = -0.43 to -0.50 for the top five correlations).ConclusionsA Bayesian linear hierarchical model with random intercepts/slopes and random variances is an optimal initial model for estimating GCC slopes at population and individual levels. This novel model is an efficient method for estimating macular rates of change and probability of glaucoma progression locally.Translational relevanceThe proposed Bayesian hierarchical model can be applied to various macular outcomes from different OCT devices and to superpixels of variable sizes to estimate local rates of change and progression probability.
- Published
- 2021
21. Detection of Glaucoma Deterioration in the Macular Region with Optical Coherence Tomography: Challenges and Solutions
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Nouri-Mahdavi, Kouros and Weiss, Robert E
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Biomedical and Clinical Sciences ,Ophthalmology and Optometry ,Biomedical Imaging ,Neurosciences ,Eye Disease and Disorders of Vision ,Neurodegenerative ,Clinical Research ,Aging ,Macular Degeneration ,Bioengineering ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,Eye ,Artificial Intelligence ,Glaucoma ,Humans ,Intraocular Pressure ,Macula Lutea ,Nerve Fibers ,Tomography ,Optical Coherence ,Visual Fields ,Clinical Sciences ,Opthalmology and Optometry ,Public Health and Health Services ,Ophthalmology & Optometry ,Ophthalmology and optometry - Abstract
PurposeMacular imaging with optical coherence tomography (OCT) measures the most critical retinal ganglion cells (RGCs) in the human eye. The goal of this perspective is to review the challenges to detection of glaucoma progression with macular OCT imaging and propose ways to enhance its performance.DesignPerspective with review of relevant literature.MethodsReview of challenges and issues related to detection of change on macular OCT images in glaucoma eyes. The primary outcome measures were confounding factors affecting the detection of change on macular OCT images.ResultsThe main challenges to detection of structural progression in the macula consist of the magnitude of and the variable amount of test-retest variability among patients, the confounding effect of aging, lack of a reliable and easy-to-measure functional outcome or external standard, the confounding effects of concurrent macular conditions including myopia, and the measurement floor of macular structural outcomes. Potential solutions to these challenges include controlling head tilt or torsion during imaging, estimating within-eye variability for individual patients, improved data visualization, the use of artificial intelligence methods, and the implementation of statistical approaches suitable for multidimensional longitudinal data.ConclusionsMacular OCT imaging is a crucial structural imaging modality for assessing central RGCs. Addressing the current shortcomings in acquisition and analysis of macular volume scans can enhance its utility for measuring the health of central RGCs and therefore assist clinicians with timely institution of appropriate treatment.
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- 2021
22. Associations between caregiver mental health and young children’s behaviour in a rural Kenyan sample
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Laurenzi, Christina A, Hunt, Xanthe, Skeen, Sarah, Sundin, Phillip, Weiss, Robert E, Kosi, Victor, Rotheram-Borus, Mary Jane, and Tomlinson, Mark
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Health Services and Systems ,Health Sciences ,Depression ,Behavioral and Social Science ,Mental Health ,Clinical Research ,Mental health ,Good Health and Well Being ,Adult ,Anxiety ,Caregivers ,Child ,Child ,Preschool ,Cross-Sectional Studies ,Humans ,Kenya ,Child behaviour ,caregiver depression ,caregiver anxiety ,parenting stress ,Sub-Saharan Africa ,Public Health and Health Services ,Epidemiology ,Public health - Abstract
Background: Research shows that caregiver mental health problems have direct, significant effects on child behaviour. While these risks are amplified in low-resource settings, limited evidence exists from these places, especially sub-Saharan Africa. Objective: We measured associations between caregiver mental health and child behaviour in a rural Kenyan sample, hypothesizing that higher rates of caregiver mental health would be associated with increased child behavioural problems. We also sought to provide an overview of caregiver mental health symptoms in our sample. Method: Cross-sectional data were collected from caregivers of children ages 4-5 years old enrolled in a community-based early child development programme in western Kenya. 465 caregivers were recruited and assessed at baseline, and answered questions about child behaviour, mental health symptoms (depression, anxiety, stress), and help-seeking. A multivariate linear regression model was used to assess significance of each mental health factor. Results: Caregiver anxiety (p = 0.01) and parenting stress (p
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- 2021
23. Family disability, poverty and parenting stress: Analysis of a cross-sectional study in Kenya
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Hunt, Xanthe, Laurenzi, Christina, Skeen, Sarah, Swartz, Leslie, Sundin, Phillip, Weiss, Robert E, and Tomlinson, Mark
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Health Services and Systems ,Public Health ,Health Sciences ,Behavioral and Social Science ,Pediatric ,Mental Health ,No Poverty ,poverty ,parent child relationship ,parenting stress ,disabled children ,child development ,child rearing ,Health services and systems ,Public health - Abstract
BackgroundHouseholds with a disabled member, be they a caregiver or a child, are poorer than households not affected by disability. Poverty, caregiving as a person with a disability and being the caregiver of a child with a disability can lead to increased parenting stress.ObjectivesThe objective of this study was to examine whether parenting stress experienced by caregivers in a household with a disabled member is greater when the disabled member is the caregiver, or the child, and how much of these respective relationships is explained by poverty.MethodWe collected cross-sectional data using a demographic survey, the Washington Group Questions on adult disability, the 10 Questions on child disability and the Parenting Stress Index-Short Form, from 465 caregivers enrolled in a non-governmental child development programme in Kenya.ResultsHouseholds with a disabled member were poorer than households without a disabled member. Parenting stress of disabled caregivers was higher than parenting stress of non-disabled caregivers; however, this relationship disappeared when socio-economic status was controlled for. Caregivers of disabled children were more stressed than caregivers of non-disabled children, and this effect was not explained by differences in socio-economic status.ConclusionOur findings highlight the importance of developing a comprehensive understanding of the stressors facing households with a disabled member, particularly if that member is a child, so that supportive interventions can adequately cater to the needs of caregivers, and their children, in the context of poverty.
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- 2021
24. Comparing Rates of Change in Moderate to Advanced Glaucoma: Retinal Nerve Fiber Layer Versus Bruch Membrane Opening-Minimum Rim Width
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SHI, LYNN, MOHAMMADI, MASSOOD, MOHAMMADZADEH, VAHID, SU, ERICA, WEISS, ROBERT E., CAPRIOLI, JOSEPH, and NOURI-MAHDAVI, KOUROS
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- 2023
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25. Recommendations for patients with prostate cancer who wish to undergo a kidney transplant
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Whang, Matthew, Sheng, John, Chang, Chrystal, Weiss, Robert E., Bhalla, Rahuldev, Geffner, Stuart, and Weng, Francis
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- 2023
- Full Text
- View/download PDF
26. Using Machine Learning to Identify Predictors of Sexually Transmitted Infections Over Time Among Young People Living With or at Risk for HIV Who Participated in ATN Protocols 147, 148, and 149
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Comulada, W. Scott, Rotheram-Borus, Mary Jane, Arnold, Elizabeth Mayfield, Norwood, Peter, Lee, Sung-Jae, Ocasio, Manuel A., Flynn, Risa, Nielsen-Saines, Karin, Bolan, Robert, Klausner, Jeffrey D., Swendeman, Dallas, Abdalian, Sue Ellen, Bryson, Yvonne, Cortado, Ruth, Fernandez, M. Isabel, Kerin, Tara, Lightfoot, Marguerita, Milburn, Norweeta, Ramos, Wilson, Reback, Cathy, Tang, Wenze, Rezvan, Panteha Hayati, and Weiss, Robert E.
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- 2023
- Full Text
- View/download PDF
27. Association of work-family experience with mid- and late-life memory decline in US women.
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Mayeda, Elizabeth Rose, Mobley, Taylor M, Weiss, Robert E, Murchland, Audrey R, Berkman, Lisa F, and Sabbath, Erika L
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Animals ,Humans ,Memory Disorders ,Health Surveys ,Longitudinal Studies ,Marital Status ,Mothers ,Aging ,Aged ,Middle Aged ,Women ,Working ,Employment ,United States ,Female ,Cognitive Dysfunction ,Basic Behavioral and Social Science ,Behavioral and Social Science ,Clinical Research ,2.3 Psychological ,social and economic factors ,Aetiology ,1.2 Psychological and socioeconomic processes ,Underpinning research ,Decent Work and Economic Growth ,Clinical Sciences ,Neurosciences ,Cognitive Sciences ,Neurology & Neurosurgery - Abstract
ObjectiveTo test the hypothesis that life course patterns of employment, marriage, and childrearing influence later-life rate of memory decline among women, we examined the relationship of work-family experiences between ages 16 and 50 years and memory decline after age 55 years among US women.MethodsParticipants were women ages ≥55 years in the Health and Retirement Study. Participants reported employment, marital, and parenthood statuses between ages 16 and 50 years. Sequence analysis was used to group women with similar work-family life histories; we identified 5 profiles characterized by similar timing and transitions of combined work, marital, and parenthood statuses. Memory performance was assessed biennially from 1995 to 2016. We estimated associations between work-family profiles and later-life memory decline with linear mixed-effects models adjusted for practice effects, baseline age, race/ethnicity, birth region, childhood socioeconomic status, and educational attainment.ResultsThere were 6,189 study participants (n = 488 working nonmothers, n = 4,326 working married mothers, n = 530 working single mothers, n = 319 nonworking single mothers, n = 526 nonworking married mothers). Mean baseline age was 57.2 years; average follow-up was 12.3 years. Between ages 55 and 60, memory scores were similar across work-family profiles. After age 60, average rate of memory decline was more than 50% greater among women whose work-family profiles did not include working for pay after childbearing, compared with those who were working mothers.ConclusionsWomen who worked for pay in early adulthood and midlife experienced slower rates of later-life memory decline, regardless of marital and parenthood status, suggesting participation in the paid labor force may protect against later-life memory decline.
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- 2020
28. Trajectories of Viral Suppression in People Living With HIV Receiving Coordinated Care: Differences by Comorbidities.
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Li, Michael J, Su, Erica, Garland, Wendy H, Oksuzyan, Sona, Lee, Sung-Jae, Kao, Uyen H, Weiss, Robert E, and Shoptaw, Steven J
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Substance Misuse ,Infectious Diseases ,Mental Health ,HIV/AIDS ,Drug Abuse (NIDA only) ,Infection ,Good Health and Well Being ,Adult ,Ambulatory Care Facilities ,Comorbidity ,Female ,HIV Infections ,Ill-Housed Persons ,Humans ,Longitudinal Studies ,Los Angeles ,Male ,Program Evaluation ,Sexual and Gender Minorities ,Socioeconomic Factors ,Treatment Outcome ,stimulant use ,substance use ,homelessness ,depression ,HIV ,viral suppression ,HIV care ,case management ,Clinical Sciences ,Public Health and Health Services ,Virology - Abstract
BackgroundIn March of 2013, the Los Angeles County (LAC) Division of HIV and STD Programs implemented a clinic-based Medical Care Coordination (MCC) Program to increase viral suppression (VS) (
- Published
- 2020
29. The Accuracy of Interqual Criteria in Determining the Observation versus Inpatient Status in Older Adults with Syncope
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Chang, Anna Marie, Hollander, Judd E, Su, Erica, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Aging ,Aged ,Aged ,80 and over ,Cohort Studies ,Female ,Humans ,Inpatients ,Length of Stay ,Male ,Middle Aged ,Syncope ,case management ,geriatrics ,InterQual ,syncope ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
BackgroundMcKesson's InterQual criteria are widely used in hospitals to determine if patients should be classified as observation or inpatient status, but the accuracy of the criteria is unknown.ObjectiveWe sought to determine whether InterQual criteria accurately predicted length of stay (LOS) in older patients with syncope.MethodsWe conducted a secondary analysis of a cohort study of adults ≥60 years of age who had syncope. We calculated InterQual criteria and classified the patient as observation or inpatient status. Outcomes were whether LOS were less than or greater than 2 midnights.ResultsWe analyzed 2361 patients; 1227 (52.0%) patients were male and 1945 (82.8%) were white, with a mean age of 73.2 ± 9.0 years. The median LOS was 32.6 h (interquartile range 24.2-71.8). The sensitivity of InterQual criteria for LOS was 60.8% (95% confidence interval 57.9-63.6%) and the specificity was 47.8% (95% confidence interval 45.0-50.5%).ConclusionsIn older adults with syncope, those who met InterQual criteria for inpatient status had longer LOS compared with those who did not; however, the accuracy of the criteria to predict length of stay over 2 days is poor, with a sensitivity of 60% and a specificity of 48%. Future research should identify criteria to improve LOS prediction.
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- 2020
30. Small Randomized Controlled Trial of the New Passport to Wellness HIV Prevention Intervention for Black Men Who Have Sex With Men (BMSM).
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Harawa, Nina T, Schrode, Katrina M, McWells, Charles, Weiss, Robert E, Hilliard, Charles L, and Bluthenthal, Ricky N
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Health Services and Systems ,Public Health ,Health Sciences ,Prevention ,Clinical Research ,Sexual and Gender Minorities (SGM/LGBT*) ,Behavioral and Social Science ,HIV/AIDS ,Pediatric AIDS ,Pediatric ,Mental Health ,Infectious Diseases ,Clinical Trials and Supportive Activities ,Prevention of disease and conditions ,and promotion of well-being ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Good Health and Well Being ,Adult ,Black or African American ,Anti-HIV Agents ,HIV Infections ,Health Knowledge ,Attitudes ,Practice ,Homosexuality ,Male ,Humans ,Los Angeles ,Male ,Outcome and Process Assessment ,Health Care ,Peer Group ,Post-Exposure Prophylaxis ,Pre-Exposure Prophylaxis ,Sexually Transmitted Diseases ,Surveys and Questionnaires ,Unsafe Sex ,HIV prevention ,HIV testing ,pre-exposure prophylaxis ,Black/African American MSM ,post-exposure prophylaxis ,Public Health and Health Services ,Social Work ,Public health - Abstract
We developed and tested Passport to Wellness (PtW), a client-centered intervention to improve engagement in HIV/STI prevention and services to improve social determinants of health among Black men who have sex with men (BMSM) using incentives and peer support. We assessed PtW's impact on HIV/STI screening and pre/post-exposure prophylaxis (PrEP/PEP) knowledge/uptake using a randomized trial that compared the full intervention to one lacking peer support. We compared changes within groups surveyed at baseline and 6 months. We enrolled 80 eligible BMSM, among 399 screened. Among retained participants (34 peer-supported; 27 comparison), overall increases were observed in HIV (30% to 87%; p < .001) and STI (28% to 80%; p < .001) testing within the prior 6 months, as well as in PrEP and PEP awareness, and PrEP use. Statistically significant between group differences were not observed. Tailored prevention planning, incentives, and addressing social determinants may help move Black MSM along the HIV prevention continuum.
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- 2020
31. Mobile-Enhanced Prevention Support Study for Men Who Have Sex With Men and Transgender Women Leaving Jail: Protocol for a Randomized Controlled Trial (Preprint)
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Edwards, Gabriel G, Reback, Cathy J, Cunningham, William E, Hilliard, Charles L, McWells, Charles, Mukherjee, Sukrit, Weiss, Robert E, and Harawa, Nina T
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Sexual and Gender Minorities (SGM/LGBT*) ,Substance Misuse ,Drug Abuse (NIDA only) ,Clinical Research ,Health Services ,Infectious Diseases ,Sexually Transmitted Infections ,HIV/AIDS ,Behavioral and Social Science ,Clinical Trials and Supportive Activities ,Prevention ,Mental Health ,Prevention of disease and conditions ,and promotion of well-being ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Infection ,Good Health and Well Being - Abstract
BACKGROUND Men who have sex with men (MSM) and transgender women, particularly those who have experienced criminal justice involvement, have particularly high HIV burdens, and a majority of those in jail have substance use disorders (SUDs). MSM and transgender women also experience elevated rates of incarceration. Once community re-entry occurs, individuals are in a critical period for addressing potential risks of HIV and sexually transmitted infection (STI) acquisition and negative sequelae of substance use. Further, the impact experienced by one’s social and sexual networks experienced at the time of detention and release have important health implications for MSM and transgender women. OBJECTIVE The purpose of this study is to test a new intervention—Mobile-Enhanced Prevention Support (MEPS)—that involves a GPS-based mobile app called GeoPassport (referred to as GeoPass in practice), incentives, and peer support for promoting HIV prevention, substance use treatment, and use of related services. METHODS A two-arm, unblinded, randomized controlled trial will seek to enroll 300 HIV-negative MSM and transgender women, aged 18-49 years, with SUDs, who are either in jail or have recently left jail. Participants will be enrolled by study staff and randomized to the MEPS intervention group or usual care group. The intervention group will receive customized wellness goals in addition to GeoPass, cash incentives, and the support of a trained peer mentor for 6 months. Data collection will consist of a baseline survey and three follow-up surveys at 3, 6, and 9 months postenrollment, either in person or by phone or videoconference when necessary. The primary outcomes include establishing a primary care provider; being prescribed and adhering to pre-exposure prophylaxis (PrEP) for HIV; screening for HIV, STIs, and hepatitis C virus; and engagement in recommended treatment for SUDs. Secondary outcomes include obtaining treatment for any identified infections and avoiding recidivism. RESULTS Enrollment began in November 2019 and study completion is expected in 2023. CONCLUSIONS This study will advance our knowledge base on patient navigation and peer mentor interventions. Peer navigation services have been studied for the treatment of HIV, but less often in the context of HIV and STI prevention among sexual and gender minority populations at the time of re-entry into the community from jail. The MEPS study will examine the acceptability and feasibility of combining peer mentor services with a mobile app to facilitate service utilization and participant–peer mentor communication. MEPS will assess patterns of PrEP uptake and utilization in MSM and transgender women leaving jail. The study will provide heretofore unavailable data from persons leaving jail regarding HIV PrEP, STI screening, substance abuse treatment, and service utilization patterns and experiences, including geocoded data for those in the intervention arm. CLINICALTRIAL ClinicalTrials.gov (NCT04036396); https://www.clinicaltrials.gov/ct2/show/NCT04036396 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/18106
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- 2020
32. Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score
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Probst, Marc A, Gibson, Thomas, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Aging ,Cardiovascular ,Neurosciences ,Heart Disease ,Clinical Research ,Emergency Care ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Good Health and Well Being ,Aged ,Area Under Curve ,Cardiovascular Diseases ,Emergency Service ,Hospital ,Female ,Health Status Indicators ,Humans ,Male ,Practice Guidelines as Topic ,Prospective Studies ,Risk Assessment ,Syncope ,United States ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
Study objectiveOlder adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes.MethodsWe performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome.ResultsWe enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670).ConclusionAmong older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.
- Published
- 2020
33. Associations between young children’s exposure to household violence and behavioural problems: Evidence from a rural Kenyan sample
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Laurenzi, Christina A, Skeen, Sarah, Sundin, Phillip, Hunt, Xanthe, Weiss, Robert E, Rotheram-Borus, Mary Jane, and Tomlinson, Mark
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Development Studies ,Human Society ,Violence Research ,Mental Health ,Youth Violence ,Behavioral and Social Science ,Pediatric ,Violence Against Women ,Aetiology ,2.3 Psychological ,social and economic factors ,Mental health ,Peace ,Justice and Strong Institutions ,Gender Equality ,Caregivers ,Child ,Child Development ,Child Rearing ,Child ,Preschool ,Cross-Sectional Studies ,Female ,Humans ,Intimate Partner Violence ,Kenya ,Male ,Parenting ,Psychology ,Child ,Rural Population ,Violence ,Household violence ,child discipline ,psychological discipline ,child behavioural outcomes ,early child development ,Public Health and Health Services ,Public Health ,Epidemiology ,Public health ,Policy and administration - Abstract
Little is known about how young children in low- and middle-income countries (LMICs) experience violence in their homes, and how different types of household violence may affect child development. This study reports on levels of exposure to household violence and associations with child behavioural outcomes in preschool-aged children in western Kenya. A sample of 465 caregivers, whose children (n = 497) attended early learning centres supported by an international NGO, were enrolled in the study. Caregivers reported on exposure to intimate partner violence (IPV), household discipline practices, attitudes about gender roles, and child behavioural outcomes. Multivariable analysis showed significant predictive effects of IPV (regression coefficient = 1.35, SE = 0.54, p = 0.01) and harsh psychological child discipline (regression coefficient = 0.74, SE = 0.22, p = 0.001), but not physical discipline (regression coefficient = 0.42, SE = 0.24, p = 0.08), on worse child behavioural problems. These findings indicate that child exposure to violence in different forms is highly prevalent, and associated with poorer outcomes in young children. Community-based programmes focused on parenting and early child development are well-positioned to address household violence in LMIC settings, but must be supported to provide a broader understanding of violence and its immediate and long-term consequences.
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- 2020
34. Leave no child behind: Using data from 1.7 million children from 67 developing countries to measure inequality within and between groups of births and to identify left behind populations
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Ramos, Antonio P, Flores, Martin J, and Weiss, Robert E
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Epidemiology ,Public Health ,Health Sciences ,Human Society ,Basic Behavioral and Social Science ,Behavioral and Social Science ,Prevention ,Pediatric ,Aetiology ,2.4 Surveillance and distribution ,Generic health relevance ,Good Health and Well Being ,Reduced Inequalities ,Child Mortality ,Child ,Preschool ,Developing Countries ,Female ,Global Health ,Humans ,Infant ,Infant Mortality ,Infant ,Newborn ,Male ,Parturition ,Poverty ,Pregnancy ,Risk Factors ,Socioeconomic Factors ,Surveys and Questionnaires ,Sustainable Development ,General Science & Technology - Abstract
BackgroundGoal 3.2 from the Sustainable Development Goals (SDG) calls for reductions in national averages of Under-5 Mortality. However, it is well known that within countries these reductions can coexist with left behind populations that have mortality rates higher than national averages. To measure inequality in under-5 mortality and to identify left behind populations, mortality rates are often disaggregated by socioeconomic status within countries. While socioeconomic disparities are important, this approach does not quantify within group variability since births from the same socioeconomic group may have different mortality risks. This is the case because mortality risk depends on several risk factors and their interactions and births from the same socioeconomic group may have different risk factor combinations. Therefore mortality risk can be highly variable within socioeconomic groups. We develop a comprehensive approach using information from multiple risk factors simultaneously to measure inequality in mortality and to identify left behind populations.MethodsWe use Demographic and Health Surveys (DHS) data on 1,691,039 births from 182 different surveys from 67 low and middle income countries, 51 of which had at least two surveys. We estimate mortality risk for each child in the data using a Bayesian hierarchical logistic regression model. We include commonly used risk factors for monitoring inequality in early life mortality for the SDG as well as their interactions. We quantify variability in mortality risk within and between socioeconomic groups and describe the highest risk sub-populations.FindingsFor all countries there is more variability in mortality within socioeconomic groups than between them. Within countries, socioeconomic membership usually explains less than 20% of the total variation in mortality risk. In contrast, country of birth explains 19% of the total variance in mortality risk. Targeting the 20% highest risk children based on our model better identifies under-5 deaths than targeting the 20% poorest. For all surveys, we report efficiency gains from 26% in Mali to 578% in Guyana. High risk births tend to be births from mothers who are in the lowest socioeconomic group, live in rural areas and/or have already experienced a prior death of a child.InterpretationWhile important, differences in under-5 mortality across socioeconomic groups do not explain most of overall inequality in mortality risk because births from the same socioeconomic groups have different mortality risks. Similarly, policy makers can reach the highest risk children by targeting births based on several risk factors (socioeconomic status, residing in rural areas, having a previous death of a child and more) instead of using a single risk factor such as socioeconomic status. We suggest that researchers and policy makers monitor inequality in under-5 mortality using multiple risk factors simultaneously, quantifying inequality as a function of several risk factors to identify left behind populations in need of policy interventions and to help monitor progress toward the SDG.
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- 2020
35. Orthostatic vital signs do not predict 30 day serious outcomes in older emergency department patients with syncope: A multicenter observational study
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White, Jennifer L, Hollander, Judd E, Chang, Anna Marie, Nishijima, Daniel K, Lin, Amber L, Su, Erica, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Nicks, Bret A, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Clinical Research ,Cardiovascular ,Heart Disease ,Emergency Care ,Aged ,Aged ,80 and over ,Case-Control Studies ,Electrocardiography ,Emergency Service ,Hospital ,Female ,Heart Diseases ,Humans ,Male ,Middle Aged ,Physical Examination ,Prospective Studies ,Syncope ,Vital Signs ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
BackgroundSyncope is a common chief complaint among older adults in the Emergency Department (ED), and orthostatic vital signs are often a part of their evaluation. We assessed whether abnormal orthostatic vital signs in the ED are associated with composite 30-day serious outcomes in older adults presenting with syncope.MethodsWe performed a secondary analysis of a prospective, observational study at 11 EDs in adults ≥ 60 years who presented with syncope or near syncope. We excluded patients lost to follow up. We used the standard definition of abnormal orthostatic vital signs or subjective symptoms of lightheadedness upon standing to define orthostasis. We determined the rate of composite 30-day serious outcomes, including those during the index ED visit, such as cardiac arrhythmias, myocardial infarction, cardiac intervention, new diagnosis of structural heart disease, stroke, pulmonary embolism, aortic dissection, subarachnoid hemorrhage, cardiopulmonary resuscitation, hemorrhage/anemia requiring transfusion, with major traumatic injury from fall, recurrent syncope, and death) between the groups with normal and abnormal orthostatic vital signs.ResultsThe study cohort included 1974 patients, of whom 51.2% were male and 725 patients (37.7%) had abnormal orthostatic vital signs. Comparing those with abnormal to those with normal orthostatic vital signs, we did not find a difference in composite 30-serious outcomes (111/725 (15.3%) vs 184/1249 (14.7%); unadjusted odds ratio, 1.05 [95%CI, 0.81-1.35], p = 0.73). After adjustment for gender, coronary artery disease, congestive heart failure (CHF), history of arrhythmia, dyspnea, hypotension, any abnormal ECG, physician risk assessment, medication classes and disposition, there was no association with composite 30-serious outcomes (adjusted odds ratio, 0.82 [95%CI, 0.62-1.09], p = 0.18).ConclusionsIn a cohort of older adult patients presenting with syncope who were able to have orthostatic vital signs evaluated, abnormal orthostatic vital signs did not independently predict composite 30-day serious outcomes.
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- 2019
36. Long term surgical outcomes for infective endocarditis in people who inject drugs: a systematic review and meta-analysis
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Goodman-Meza, David, Weiss, Robert E, Gamboa, Sebastián, Gallegos, Abel, Bui, Alex AT, Goetz, Matthew B, Shoptaw, Steven, and Landovitz, Raphael J
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Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiovascular ,Emerging Infectious Diseases ,Infectious Diseases ,Heart Disease ,Good Health and Well Being ,Cardiac Surgical Procedures ,Endocarditis ,Humans ,Kaplan-Meier Estimate ,Proportional Hazards Models ,Staphylococcal Infections ,Substance Abuse ,Intravenous ,Treatment Outcome ,People who inject drugs ,Surgery ,Meta-analysis ,Microbiology ,Medical Microbiology ,Clinical sciences ,Medical microbiology ,Public health - Abstract
BackgroundIn recent years, the number of infective endocarditis (IE) cases associated with injection drug use has increased. Clinical guidelines suggest deferring surgery for IE in people who inject drugs (PWID) due to a concern for worse outcomes in comparison to non-injectors (non-PWID). We performed a systematic review and meta-analysis of long-term outcomes in PWID who underwent cardiac surgery and compared these outcomes to non-PWID.MethodsWe systematically searched for studies reported between 1965 and 2018. We used an algorithm to estimate individual patient data (eIPD) from Kaplan-Meier (KM) curves and combined it with published individual patient data (IPD) to analyze long-term outcomes after cardiac surgery for IE in PWID. Our primary outcome was survival. Secondary outcomes were reoperation and mortality at 30-days, one-, five-, and 10-years. Random effects Cox regression was used for estimating survival.ResultsWe included 27 studies in the systematic review and 19 provided data (KM or IPD) for the meta-analysis. PWID were younger and more likely to have S. aureus than non-PWID. Survival at 30-days, one-, five-, and 10-years was 94.3, 81.0, 62.1, and 56.6% in PWID, respectively; and 96.4, 85.0, 70.3, and 63.4% in non-PWID. PWID had 47% greater hazard of death (HR 1.47, 95% CI, 1.05-2.05) and more than twice the hazard of reoperation (HR 2.37, 95% CI, 1.25-4.50) than non-PWID.ConclusionPWID had shorter survival that non-PWID. Implementing evidence-based interventions and testing new modalities are urgently needed to improve outcomes in PWID after cardiac surgery.
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- 2019
37. MP70-07 THE INCIDENCE AND MORTALITY OF BLADDER CANCER IN TWO UNDERSERVED CITIES IN NEW JERSEY
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Williams, Samantha, primary, Nguyen, Anh, additional, Fernandez, Gabriel, additional, Berg, Courtney, additional, Anderson, Rebecca, additional, Gillan, Ernest, additional, Kovac, Evan, additional, Alwaal, Amjad, additional, and Weiss, Robert E., additional
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- 2024
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38. Measuring Within and Between Group Inequality in Early-Life Mortality Over Time: A Bayesian Approach with Application to India
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Ramos, Antonio P. and Weiss, Robert E.
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Statistics - Applications - Abstract
Most studies on inequality in infant and child mortality compare average mortality rates between large groups of births, for example, comparing births from different countries, income groups, ethnicities, or different times. These studies do not measure within-group disparities. The few studies that have measured within-group variability in infant and child mortality have used tools from the income inequality literature, such as Gini indices. We show that the latter are inappropriate for infant and child mortality. We develop novel tools that are appropriate for analyzing infant and child mortality inequality, including inequality measures, covariate adjustments, and ANOVA methods. We illustrate how to handle uncertainty about complex inference targets, including ensembles of probabilities and kernel density estimates. We illustrate our methodology using a large data set from India, where we estimate infant and child mortality risk for over 400,000 births using a Bayesian hierarchical model. We show that most of the variance in mortality risk exists within groups of births, not between them, and thus that within-group mortality needs to be taken into account when assessing inequality in infant and child mortality. Our approach has broad applicability to many health indicators.
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- 2018
39. Depression, anxiety, and psychological distress among caregivers of young children in rural Lesotho: Associations with food insecurity, household death and parenting stress
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Marlow, Marguerite, Skeen, Sarah, Hunt, Xanthe, Sundin, Phillip, Weiss, Robert E., Mofokeng, Shoeshoe, Makhetha, Moroesi, Cluver, Lucie, Sherr, Lorraine, and Tomlinson, Mark
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- 2022
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40. Performance of the American Heart Association/American College of Cardiology/Heart Rhythm Society versus European Society of Cardiology guideline criteria for hospital admission of patients with syncope
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Widmer, Velina, Leu, Kathrin, Reichlin, Tobias, Shrestha, Samyut, Freese, Michael, Krisai, Philipp, Belkin, Maria, Kawecki, Damian, Morawiec, Beata, Muzyk, Piotr, Nowalany-Kozielska, Ewa, Geigy, Nicolas, Martinez-Nadal, Gemma, Fuenzalida Inostroza, Carolina Isabel, Mandrión, José Bustamante, Poepping, Imke, Greenslade, Jaimi, Hawkins, Tracey, Rentsch, Katharina, Mitrovic, Sandra, von Eckardstein, Arnold, Buser, Andreas, Osswald, Stefan, Walter, Joan, Adler, David H., Bastani, Aveh, Baugh, Christopher W., Caterino, Jeffrey M., Diercks, Deborah B., Hollander, Judd E., Nicks, Bret A., Nishijima, Daniel K., Shah, Manish N., Stiffler, Kirk A., Wilber, Scott T., Storrow, Alan B., du Fay de Lavallaz, Jeanne, Zimmermann, Tobias, Badertscher, Patrick, Lopez-Ayala, Pedro, Nestelberger, Thomas, Miró, Òscar, Salgado, Emilio, Zaytseva, Xenia, Gafner, Michele Sara, Christ, Michael, Cullen, Louise, Than, Martin, Martin-Sanchez, F. Javier, Di Somma, Salvatore, Peacock, W. Frank, Keller, Dagmar I., Costabel, Juan Pablo, Sigal, Alan, Puelacher, Christian, Wussler, Desiree, Koechlin, Luca, Strebel, Ivo, Schuler, Sereina, Manka, Robert, Bilici, Murat, Lohrmann, Jens, Kühne, Michael, Breidthardt, Tobias, Clark, Carol L., Probst, Marc, Gibson, Thomas A., Weiss, Robert E., Sun, Benjamin C., and Mueller, Christian
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- 2022
- Full Text
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41. Methamphetamine use drives decreases in viral suppression for people living with HIV released from a large municipal jail: Results of the LINK LA clinical trial
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Goodman-Meza, David, Shoptaw, Steve, Weiss, Robert E, Nakazono, Terry, Harawa, Nina T, Takada, Sae, Garland, Wendy H, and Cunningham, William E
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Pharmacology and Pharmaceutical Sciences ,Biomedical and Clinical Sciences ,Sexually Transmitted Infections ,Clinical Trials and Supportive Activities ,Opioids ,Health Disparities ,Women's Health ,Social Determinants of Health ,Brain Disorders ,Opioid Misuse and Addiction ,Infectious Diseases ,Methamphetamine ,Behavioral and Social Science ,Substance Misuse ,Prevention ,HIV/AIDS ,Clinical Research ,Drug Abuse (NIDA only) ,Health Services ,Good Health and Well Being ,Adult ,Analgesics ,Opioid ,Anti-HIV Agents ,Cocaine ,Continuity of Patient Care ,Female ,HIV Infections ,Humans ,Linear Models ,Los Angeles ,Male ,Middle Aged ,Patient Acceptance of Health Care ,Prisoners ,Prisons ,Substance-Related Disorders ,Substance use ,Stimulant ,HIV viral suppression ,Jail ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Substance Abuse ,Biochemistry and cell biology ,Pharmacology and pharmaceutical sciences ,Epidemiology - Abstract
BackgroundPeople living with HIV (PLWH) often experience decreases in HIV viral suppression (VS) after release from jail. The Linking Inmates to Care in LA (LINK LA) peer navigation intervention helped maintain VS 12 months after release from jail compared to standard of care. In this study, we analyzed correlates of substance use and tested whether substance use was an independent correlate of decreased VS in LINK LA participants.MethodsWe analyzed LINK LA data collected at baseline, 3, and 12 months. We defined high-risk drug use as any reported methamphetamine, cocaine, or opioid use in the 30 days prior to a study visit (or jail entry at baseline). We used generalized linear mixed models to test associations of sociodemographic variables with type of substance used, and we tested correlates of VS while controlling for time, the intervention, and their interaction.ResultsAt baseline (n = 356), 71% of participants reported high-risk drug use: 58%, methamphetamine; 17%, cocaine; 7%, heroin; and 4%, prescription opioids. Non-Hispanic Whites and those younger than 35 were most likely to use methamphetamine; Blacks were most likely to use cocaine; people who inject drugs were most likely to use opioids. Participants who used high-risk drugs had 53% lower adjusted odds than non-users of maintaining VS (AOR 0.47, 95% CI 0.31-0.70, p
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- 2019
42. Clinical Benefit of Hospitalization for Older Adults With Unexplained Syncope: A Propensity-Matched Analysis
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Probst, Marc A, Su, Erica, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Aging ,Clinical Research ,Aged ,Aged ,80 and over ,Emergency Service ,Hospital ,Female ,Hospitalization ,Humans ,Incidence ,Male ,Medically Unexplained Symptoms ,Middle Aged ,Patient Discharge ,Propensity Score ,Prospective Studies ,Risk Assessment ,Syncope ,United States ,Clinical Sciences ,Emergency & Critical Care Medicine - Abstract
Study objectiveMany adults with syncope are hospitalized solely for observation and testing. We seek to determine whether hospitalization versus outpatient management for older adults with unexplained syncope is associated with a reduction in postdisposition serious adverse events at 30 days.MethodsWe performed a propensity score analysis using data from a prospective, observational study of older adults with unexplained syncope or near syncope who presented to 11 emergency departments (EDs) in the United States. We enrolled adults (≥60 years) who presented with syncope or near syncope. We excluded patients with a serious diagnosis identified in the ED. Clinical and laboratory data were collected on all patients. The primary outcome was rate of post-ED serious adverse events at 30 days.ResultsWe enrolled 2,492 older adults with syncope and no serious ED diagnosis from April 2013 to September 2016. Mean age was 73 years (SD 8.9 years), and 51% were women. The incidence of serious adverse events within 30 days after the index visit was 7.4% for hospitalized patients and 3.19% for discharged patients, representing an unadjusted difference of 4.2% (95% confidence interval 2.38% to 6.02%). After propensity score matching on risk of hospitalization, there was no statistically significant difference in serious adverse events at 30 days between the hospitalized group (4.89%) and the discharged group (2.82%) (risk difference 2.07%; 95% confidence interval -0.24% to 4.38%).ConclusionIn our propensity-matched sample of older adults with unexplained syncope, for those with clinical characteristics similar to that of the discharged cohort, hospitalization was not associated with improvement in 30-day serious adverse event rates.
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- 2019
43. Recurrent syncope is not an independent risk predictor for future syncopal events or adverse outcomes
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Chang, Anna Marie, Hollander, Judd E, Su, Erica, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiovascular ,Clinical Research ,Aging ,Heart Disease ,Aged ,Aged ,80 and over ,Cardiovascular Diseases ,Case-Control Studies ,Emergency Service ,Hospital ,Female ,Humans ,Male ,Middle Aged ,Prospective Studies ,Recurrence ,Risk Assessment ,Risk Factors ,Syncope ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode.MethodsThis study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60 years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of 30-day serious outcome. The secondary outcome was 30-day serious cardiac arrhythmia. In multivariate analysis, we assessed whether prior syncope was an independent predictor of 30-day serious events.ResultsThe study cohort included 3580 patients: 1281 (35.8%) had prior syncope and 2299 (64.2%) were presenting with first episode of syncope. 498 (13.9%) patients had 1 prior episode while 771 (21.5%) had >1 prior episode. Those with recurrent syncope were more likely to have congestive heart failure, coronary artery disease, previous diagnosis of arrhythmia, and an abnormal ECG. Overall, 657 (18.4%) of the cohort had a serious outcome by 30 days after index ED visit. In multivariate analysis, we found no significant difference in risk of events (adjusted odds ratio 1.09; 95% confidence interval 0.90-1.31; p = 0.387).ConclusionIn older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events.
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- 2019
44. Do High‐sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?
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Clark, Carol L, Gibson, Thomas A, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Diercks, Deborah B, Hollander, Judd E, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Cardiovascular ,Emergency Care ,Heart Disease ,Prevention ,Clinical Research ,Adult ,Aged ,Biomarkers ,Case-Control Studies ,Emergency Service ,Hospital ,Female ,Humans ,Male ,Middle Aged ,Natriuretic Peptide ,Brain ,Peptide Fragments ,Prospective Studies ,Syncope ,Troponin T ,Clinical Sciences ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
OBJECTIVES:An estimated 1.2 million annual emergency department (ED) visits for syncope/near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high-sensitivity troponin (hscTnT) and natriuretic peptide (NT-proBNP) are unclear. The objective of this study was to determine if hscTnT and NT-proBNP drawn in the ED are independently associated with 30-day death/serious cardiac outcomes in adult patients presenting with syncope. METHODS:A prespecified secondary analysis of a prospective, observational trial enrolling participants ≥ age 60 presenting with syncope, at 11 United States hospitals, was conducted between April 2013 and September 2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow-up. Within 3 hours of consent, hscTnT and NT-proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT and 2010 Cobas, respectively. Primary outcome was combined 30-day all-cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistic regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods. RESULTS:The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT-proBNP levels. HscTnT levels ≤ 5 ng/L were associated with a 4% (95% confidence interval [CI] = 3%-5%) outcome risk, and hscTnT > 50 ng/L, a 29% (95% CI = 26%-33%) risk. NT-proBNP levels ≤ 125 ng/L were associated with a 4% (95% CI = 4%-5%) risk, and NT-proBNP > 2,000 ng/L a 29% (95% CI = 25%-32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings. CONCLUSIONS:hscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope.
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- 2019
45. Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope
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Bastani, Aveh, Su, Erica, Adler, David H, Baugh, Christopher, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Malveau, Susan E, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, Yagapen, Annick N, Weiss, Robert E, and Sun, Benjamin C
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Cardiovascular ,Lung ,Aging ,Clinical Research ,Heart Disease ,Emergency Care ,Aged ,Aged ,80 and over ,Case-Control Studies ,Emergency Service ,Hospital ,Female ,Humans ,Male ,Middle Aged ,Prospective Studies ,Risk Assessment ,Syncope ,Clinical Sciences ,Emergency & Critical Care Medicine - Abstract
Study objectiveControversy remains in regard to the risk of adverse events for patients presenting with syncope compared with near-syncope. The purpose of our study is to describe the difference in outcomes between these groups in a large multicenter cohort of older emergency department (ED) patients.MethodsFrom April 28, 2013, to September 21, 2016, we conducted a prospective, observational study across 11 EDs in adults (≥60 years) with syncope or near-syncope. A standardized data extraction tool was used to collect information during their index visit and at 30-day follow-up. Our primary outcome was the incidence of 30-day death or serious clinical events. Data were analyzed with descriptive statistics and multivariate logistic regression analysis adjusting for relevant demographic or historical variables.ResultsA total of 3,581 patients (mean age 72.8 years; 51.6% men) were enrolled in the study. There were 1,380 patients (39%) presenting with near-syncope and 2,201 (61%) presenting with syncope. Baseline characteristics revealed a greater incidence of congestive heart failure, coronary artery disease, previous arrhythmia, nonwhite race, and presenting dyspnea in the near-syncope compared with syncope cohort. There were no differences in the primary outcome between the groups (near-syncope 18.7% versus syncope 18.2%). A multivariate logistic regression analysis identified no difference in 30-day serious outcomes for patients with near-syncope (odds ratio 0.94; 95% confidence interval 0.78 to 1.14) compared with syncope.ConclusionNear-syncope confers risk to patients similar to that of syncope for the composite outcome of 30-day death or serious clinical event.
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- 2019
46. Predictors of Clinically Significant Echocardiography Findings in Older Adults with Syncope: A Secondary Analysis
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Probst, Marc A, Gibson, Thomas A, Weiss, Robert E, Yagapen, Annick N, Malveau, Susan E, Adler, David H, Bastani, Aveh, Baugh, Christopher W, Caterino, Jeffrey M, Clark, Carol L, Diercks, Deborah B, Hollander, Judd E, Nicks, Bret A, Nishijima, Daniel K, Shah, Manish N, Stiffler, Kirk A, Storrow, Alan B, Wilber, Scott T, and Sun, Benjamin C
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Cardiovascular ,Clinical Research ,Aging ,Heart Disease ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Aged ,Echocardiography ,Emergency Service ,Hospital ,Female ,Humans ,Male ,Middle Aged ,Predictive Value of Tests ,Prospective Studies ,Risk Assessment ,Sensitivity and Specificity ,Syncope ,Clinical Sciences ,General & Internal Medicine - Abstract
BackgroundSyncope is a common reason for visiting the emergency department (ED) and is associated with significant healthcare resource utilization.ObjectiveTo develop a risk-stratification tool for clinically significant findings on echocardiography among older adults presenting to the ED with syncope or nearsyncope.DesignProspective, observational cohort study from April 2013 to September 2016.SettingEleven EDs in the United States.PatientsWe enrolled adults (=60 years) who presented to the ED with syncope or near-syncope who underwent transthoracic echocardiography (TTE).MeasurementsThe primary outcome was a clinically significant finding on TTE. Clinical, electrocardiogram, and laboratory variables were also collected. Multivariable logistic regression analysis was used to identify predictors of significant findings on echocardiography.ResultsA total of 3,686 patients were enrolled. Of these, 995 (27%) received echocardiography, and 215 (22%) had a significant finding on echocardiography. Regression analysis identified five predictors of significant finding: (1) history of congestive heart failure, (2) history of coronary artery disease, (3) abnormal electrocardiogram, (4) high-sensitivity troponin-T >14 pg/mL, and 5) N-terminal pro B-type natriuretic peptide >125 pg/mL. These five variables make up the ROMEO (Risk Of Major Echocardiography findings in Older adults with syncope) criteria. The sensitivity of a ROMEO score of zero for excluding significant findings on echocardiography was 99.5% (95% CI: 97.4%-99.9%) with a specificity of 15.4% (95% CI: 13.0%-18.1%).ConclusionsIf validated, this risk-stratification tool could help clinicians determine which syncope patients are at very low risk of having clinically significant findings on echocardiography.RegistrationClinicalTrials.gov Identifier NCT01802398.
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- 2018
47. Gender-specific HIV and substance abuse prevention strategies for South African men: study protocol for a randomized controlled trial
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Rotheram-Borus, Mary Jane, Tomlinson, Mark, Mayekiso, Andile, Bantjes, Jason, Harris, Danielle M, Stewart, Jacqueline, and Weiss, Robert E
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Public Health ,Health Sciences ,Substance Misuse ,Prevention ,Mental Health ,Pediatric AIDS ,Behavioral and Social Science ,HIV/AIDS ,Substance Abuse Prevention ,Drug Abuse (NIDA only) ,Pediatric ,Clinical Research ,Clinical Trials and Supportive Activities ,Management of diseases and conditions ,7.1 Individual care needs ,Infection ,Good Health and Well Being ,Adolescent ,Adult ,Black People ,Crime ,HIV Infections ,Health Behavior ,Health Knowledge ,Attitudes ,Practice ,Humans ,Male ,Peer Influence ,Randomized Controlled Trials as Topic ,Sex Factors ,Sexual Behavior ,Soccer ,Social Determinants of Health ,South Africa ,Substance-Related Disorders ,Time Factors ,Vocational Education ,Young Adult ,Men's HIV risk ,Drug abuse ,Alcohol abuse ,Gender-specific interventions ,HIV prevention for men ,HIV testing ,HIV prevention strategies ,Social determinants of HIV ,Men’s HIV risk ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Cardiovascular System & Hematology ,General & Internal Medicine ,Clinical sciences ,Epidemiology ,Health services and systems - Abstract
BackgroundYoung men in South Africa face concurrent epidemics of HIV, drug and alcohol abuse, and unemployment. Standard HIV prevention programs, located in healthcare settings and/or using counseling models, fail to engage men. Soccer and vocational training are examined as contexts to deliver male-specific, HIV prevention programs.MethodsYoung men (n = 1200) are randomly assigned by neighborhood to one of three conditions: 1) soccer league (n = 400; eight neighborhoods); 2) soccer league plus vocational training (n = 400; eight neighborhoods); or 3) a control condition (n = 400; eight neighborhoods). Soccer practices and games occur three times per week and vocational training is delivered by Silulo Ulutho Technologies and Zenzele Training and Development. At baseline, 6 months, 12 months, and 24 months, the relative efficacy of these strategies to increase the number of significant outcomes (NSO) among 15 outcomes which occur (1) or not (0) are summed and compared using binomial logistic regressions. The summary primary outcome reflects recent HIV testing, substance abuse, employment, sexual risk, violence, arrests, and mental health status.DiscussionThe failure of men to utilize HIV prevention programs highlights the need for gender-specific intervention strategies. However, men in groups can provoke and encourage greater risk-taking among themselves. The current protocol evaluates a male-specific strategy to influence men's risk for HIV, as well as to improve their ability to contribute to family income and daily routines. Both interventions are expected to significantly benefit men compared with the control condition.Trial registrationClinicalTrials.gov registration, NCT02358226 . Registered 24 November 2014.
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- 2018
48. Improving program targeting to combat early-life mortality by identifying high-risk births: an application to India
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Ramos, Antonio P, Weiss, Robert E, and Heymann, Jody S
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Public Health ,Health Sciences ,Prevention ,Clinical Research ,Infant Mortality ,Rare Diseases ,Pediatric ,2.4 Surveillance and distribution ,Aetiology ,Good Health and Well Being ,Adolescent ,Adult ,Bayes Theorem ,Cause of Death ,Demography ,Developing Countries ,Female ,Humans ,Income ,India ,Infant ,Infant Death ,Infant ,Newborn ,Population Health ,Poverty ,Pregnancy ,Pregnancy Complications ,Pregnancy ,High-Risk ,Risk ,Risk Assessment ,Risk Factors ,Young Adult ,Early-life mortality ,Program targeting ,Risk factors ,Bayesian hierarchical model ,Public Health and Health Services ,General & Internal Medicine ,Epidemiology - Abstract
BACKGROUND:It is widely recognized that there are multiple risk factors for early-life mortality. In practice most interventions to curb early-life mortality target births based on a single risk factor, such as poverty. However, most premature deaths are not from the targeted group. Thus interventions target many births that are at not at high risk and miss many births at high risk. METHODS:Using data from the second wave of Demographic and Health Surveys from India and a hierarchical Bayesian model, we estimate infant mortality risk for 73.320 infants in India as a function of 4 risk factors. We show how this information can be used to improve program targeting. We compare our novel approach against common programs that target groups based on a single risk factor. RESULTS:A conventional approach that targets mothers in the lowest quintile of income correctly identifies only 30% of infant deaths. By contrast, using four risk factors simultaneously we identify a group of births of the same size that includes 57% of all deaths. Using the 2012 census to translate these percentages into numbers, there were 25.642.200 births in 2012 and 4.4% died before the age of one. Our approach correctly identifies 643.106 of 1.128.257 infant deaths while poverty only identifies 338.477 infant deaths. CONCLUSION:Our approach considerably improves program targeting by identifying more infant deaths than the usual approach that targets births based on a single risk factor. This leads to more efficient program targeting. This is particularly useful in developing countries, where resources are lacking and needs are high.
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- 2018
49. Markers of Immune Activation and Inflammation, and Non-Hodgkin Lymphoma: A Meta-Analysis of Prospective Studies.
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Makgoeng, Solomon B, Bolanos, Rachel S, Jeon, Christie Y, Weiss, Robert E, Arah, Onyebuchi A, Breen, Elizabeth C, Martínez-Maza, Otoniel, and Hussain, Shehnaz K
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HIV/AIDS ,Hematology ,Lymphoma ,Rare Diseases ,Cancer - Abstract
BackgroundChronic inflammation and immune activation are reported to play a key role in the etiology of non-Hodgkin lymphoma (NHL). We conducted a meta-analysis on the associations between prediagnosis circulating levels of immune stimulatory markers, interleukin 6 (IL-6), IL-10, tumor necrosis factor α (TNF-α), CXCL13, soluble CD23 (sCD23), sCD27, sCD30, and the risk of NHL.MethodsRelevant studies were identified from PubMed, EMBASE, and Web of Science up to January 1, 2017. We calculated summary odds ratio (OR) estimates for the association between one natural log increase in concentration of each biomarker and NHL using random-effects models for NHL as a composite outcome and for several histological subtypes of NHL.ResultsSeventeen nested case control studies were included. Elevated levels of several biomarkers were more strongly associated with increased odds of NHL: TNF-α, OR = 1.18 (95% confidence interval [CI] = 1.04 to 1.34); CXCL13, OR = 1.47 (95% CI = 1.03 to 2.08); sCD23, OR = 1.57 (95% CI = 1.21 to 2.05); sCD27, OR = 2.18 (95% CI = 1.20 to 3.98); sCD30, OR = 1.65 (95% CI = 1.22 to 2.22). In stratified analyses, IL-6, TNF-α, sCD27, and sCD30 were more strongly associated with NHL in HIV-infected individuals compared to HIV-uninfected individuals. Between-study heterogeneity was observed across multiple biomarkers for overall NHL and by subtypes.ConclusionThis meta-analysis provides evidence that elevated circulating levels of TNF-α, CXCL13, sCD23, sCD27, and sCD30 are consistently associated with an increased risk of NHL, suggesting the potential utility of these biomarkers in population risk stratification and prediction.
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- 2018
50. 1082. Meta-Analysis of Survival Outcomes in People Who Inject Drugs After Cardiac Surgery for Infective Endocarditis
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Goodman-Meza, David, Weiss, Robert E, Gamboa, Sebastián, Gallegos, Abel, Landovitz, Raphael J, Bui, Alex AT, Goetz, Matthew B, and Shoptaw, Steven
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Prevention ,Heart Disease ,Infectious Diseases ,Cardiovascular ,Drug Abuse (NIDA only) ,Substance Misuse ,Good Health and Well Being - Abstract
Abstract: Background: The United States’ opioid epidemic has led to an increase in people who inject drugs (PWID) and opioid-associated infections, including infectious endocarditis (IE). Cardiac surgery is often indicated in IE to improve outcomes but is controversial in PWID due to the concerns about continued injection drug use leading to risk for reinfection and decreased survival. In response, we assessed the long-term survival after cardiac valve surgery in PWID compared with people who do not inject drugs (non-PWID) in the published literature. Methods: We performed a systematic review and meta-analysis (MA) of studies that reported survival data after surgery for IE in PWID. We searched PUBMED up to April 2018. We extracted Kaplan–Meier (KM) curves from included studies. From the KM curves, we used an algorithm to estimate individual participant data (eIPD). In a one-step approach, we ran a Cox proportional hazards (CPH) model analysis of the eIPD with study random effects. In a two-step approach, we fitted CPH models by individual study; then, we ran a mixed-effects MA model of the log hazard ratios (HR) and standard errors. Results: We identified 11 retrospective studies. Of these, six reported comparisons of PWID vs. non-PWID, and five reported results for PWID only. Based on eIPD, we included 407 PWID and 1,877 non-PWID. Mean age for PWID was 36.7 years (95% CI 34.4–39.1) and for non-PWID was 52.0 years (95% CI 45.3–59.4). There were 144 deaths (35.3%) in PWID and 559 (29.8%) deaths in non-PWID. We present by study and by group KM curves of eIPD (Figures 1 and 2). In one-step MA (included all 11 studies), the HR for PWID was 1.13 (95% CI 0.92–1.39). In two-step MA (included six comparison studies), heterogeneity was high (I2 = 72%); and there was no significant between-group difference (HR 1.29, 95% CI 0.80–2.07) (Figure 3). Conclusion: Survival time post-surgery of PWID was similar to that of non-PWID. These estimates are concerning, as PWID on average are much younger than non-PWID with IE. Future studies should explore interventions to improve outcomes in PWID after surgery, including treatment of addiction during and after the index hospitalization and provision of naloxone at the time of discharge. Disclosures: All authors: No reported disclosures.
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- 2018
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