Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Champaloux SW[original query] |
---|
Reply
Tepper NK , Curtis KM , Champaloux SW . Am J Obstet Gynecol 2018 218 (3) 364-365 We thank Drs Driul and Londero for their interest in our study.1 We agree that thrombogenic mutations may be a contributing factor in migraine-related stroke. We did not adjust for known thrombogenic mutations; however, because combined hormonal contraceptives (CHCs) are not recommended for use by women with known thrombogenic mutations because of safety concerns,2 we expect that there would be only a small number of women with those disorders who use CHCs. Our analysis adjusted for the important confounders mentioned by Drs Driul and Londero, namely age, hypertension, smoking, and obesity as well as others that included diabetes mellitus, ischemic heart disease, and valvular heart disease, while noting the potential for misclassification from the use of healthcare claims data. Because of the use of healthcare claims data, we could not assess migraine or aura frequency. Although there is some evidence that migraine frequency impacts stroke risk,3 it is not clear whether aura frequency is related to stroke risk; these associations warrant further study. | | We agree that the mechanism of ischemic stroke related to migraine with aura is not well understood and probably involves multiple mechanisms.3 The pathways may include cerebral hypoperfusion related to the aura, arterial dissections, patent foramen ovale, or the presence of vascular risk factors.3 Although these complex mechanisms need to be further clarified, migraine with aura is associated independently with an increased risk of ischemic stroke.3 Given that CHCs are also associated with an elevated risk of ischemic stroke, even at lower doses of ethinyl estradiol (including 20 μg),4 and that stroke is a devastating event, concerns remain about the use of CHCs in women who experience migraine with aura. Based on current understanding of mechanisms, it is not clear that there are subgroups of women with migraine with aura (eg, women without a thrombogenic mutation) for whom CHCs would not further elevate the risk of stroke to an unacceptable level.2 In addition, the prevalence of thrombogenic mutations is low, and the cost of screening is high; therefore, screening is not recommended before considering whether to use CHCs.2 | | Future studies are needed on the pathophysiology and magnitude of risk of stroke related to migraine, hormonal contraceptives, and other stroke risk factors. Such research would contribute to better understanding the safety of hormonal contraceptive use among women with migraine. Healthcare providers should counsel women about risks, benefits, and alternatives so that women can make informed decisions about contraceptive method choice. |
Sensitivity and specificity of suspected case definition used during West Africa Ebola epidemic
Hsu CH , Champaloux SW , Keita S , Martel L , Bilivogui P , Knust B , McCollum AM . Emerg Infect Dis 2018 24 (1) 9-14 Rapid early detection and control of Ebola virus disease (EVD) is contingent on accurate case definitions. Using an epidemic surveillance dataset from Guinea, we analyzed an EVD case definition developed by the World Health Organization (WHO) and used in Guinea. We used the surveillance dataset (March-October 2014; n = 2,847 persons) to identify patients who satisfied or did not satisfy case definition criteria. Laboratory confirmation determined cases from noncases, and we calculated sensitivity, specificity and predictive values. The sensitivity of the defintion was 68.9%, and the specificity of the definition was 49.6%. The presence of epidemiologic risk factors (i.e., recent contact with a known or suspected EVD case-patient) had the highest sensitivity (74.7%), and unexplained deaths had the highest specificity (92.8%). Results for case definition analyses were statistically significant (p<0.05 by chi(2) test). Multiple components of the EVD case definition used in Guinea contributed to improved overall sensitivity and specificity. |
Use of combined hormonal contraceptives among women with migraines and risk of ischemic stroke
Champaloux SW , Tepper NK , Monsour M , Curtis KM , Whiteman MK , Marchbanks PA , Jamieson DJ . Am J Obstet Gynecol 2016 216 (5) 489 e1-489 e7 BACKGROUND: Migraine with aura and combined hormonal contraceptives are independently associated with an increased risk of ischemic stroke. However, little is known about whether there are any joint effects of migraine and hormonal contraceptives on risk of stroke. OBJECTIVE: To estimate the incidence of stroke in women of reproductive age and examine the association between combined hormonal contraceptive use, migraine type (with or without aura), and ischemic stroke. STUDY DESIGN: This study used a nationwide health care claims database and employed a nested case control study design. Women ages 15-49 years with first-ever stroke during 2006-2012 were identified using the International Classification of Diseases-9th Revision-Clinical Modifications inpatient services diagnosis codes. Four controls were matched to each case based on age. Migraine headache with and without aura was identified using inpatient or outpatient diagnosis codes. Current combined hormonal contraceptive use was identified using the National Drug Code from the pharmacy database. Conditional logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals of ischemic stroke by migraine type and combined hormonal contraceptive use. RESULTS: Between 2006-2012, there were 25,887 ischemic strokes among women ages 15-49, for a cumulative incidence of 11 strokes per 100,000 women. Compared to women with neither migraine nor combined hormonal contraceptive use, the odds ratio of ischemic stroke was highest among women with migraine with aura using combined hormonal contraceptives (odds ratio 6.1, 95% confidence interval 3.1-12.1); odds ratios were also elevated for migraine with aura without combined hormonal contraceptive use (odds ratio 2.7, 95% confidence interval 1.9-3.7), migraine without aura and combined hormonal contraceptive use (odds ratio 1.8, 95% confidence interval 1.1-2.9), and migraine without aura without combined hormonal contraceptive use (odds ratio 2.2, 95% confidence interval 1.9-2.7). CONCLUSION: The joint effect of combined hormonal contraceptives and migraine with aura was associated with a 6-fold increased risk of ischemic stroke compared with neither risk factor. Use of combined hormonal contraceptives did not substantially further increase risk of ischemic stroke among women with migraine without aura. Determining migraine type is critical in assessing safety of combined hormonal contraceptives among women with migraine. |
Contraceptive use among women with medical conditions in a nationwide privately insured population
Champaloux SW , Tepper NK , Curtis KM , Zapata LB , Whiteman MK , Marchbanks PA , Jamieson DJ . Obstet Gynecol 2015 126 (6) 1151-1159 OBJECTIVE: To examine contraceptive use among women with selected medical conditions. METHODS: We used a nationwide health care claims database to identify women aged 15-44 years continuously enrolled in private insurance during 2004-2011 with and without selected medical conditions. We assessed current permanent and reversible prescription contraceptive use during October 1, 2010, to September 30, 2011, with diagnosis, procedure, and pharmacy codes and calculated prevalence by age and condition. We used polytomous logistic regression to calculate odds of female sterilization or reversible prescription methods compared with neither. Among users of reversible methods, we used logistic regression to calculate odds of using long-acting reversible contraceptives compared with shorter acting methods. RESULTS: A low proportion of women with medical conditions were using sterilization or reversible prescription methods (45% and 30% of women aged 15-34 and 35-44 years, respectively), and this proportion was consistently lower among the older age group across all medical conditions. Across both age groups, sterilization and long-acting reversible contraceptives were used less frequently than shorter acting methods (injectable, pill, patch, or ring). The odds of sterilization were higher among women with any compared with no condition for women aged 15-34 years (odds ratio [OR] 4.9, 95% confidence interval [CI], 4.5-5.3) and 35-44 years (OR 1.2, 95% CI, 1.1-1.2). Among women using reversible prescription methods, the odds of using long-acting reversible contraceptives were increased among those with any compared with no condition for women aged 15-34 years (OR 2.2, 95% CI, 2.1-2.5) and 35-44 years (OR 1.1, 95% CI, 1.1-1.2). CONCLUSION: Despite the potential for serious maternal and fetal pregnancy-associated risks, contraceptive use was not optimal among women with medical conditions. LEVEL OF EVIDENCE: III. |
Childhood chronic health conditions and educational attainment: a social ecological approach
Champaloux SW , Young DR . J Adolesc Health 2015 56 (1) 98-105 PURPOSE: This study examined the association between types of chronic health conditions reported during childhood and adolescence and their impact on educational attainment. School and neighborhood environments and potential mediating factors from academic and psychosocial variables were investigated. METHODS: Using the National Longitudinal Survey of Youth-Cohort 1997, multivariate logistic regression models were fit to estimate the association between chronic health conditions and educational attainment, adjusting for confounders. Chronic health conditions were defined as a parental (1997) or participant (2002) report of a chronic health condition and classified into (1) asthma; (2) cancer, diabetes, and epilepsy; (3) heart conditions; and (4) other. Educational attainment was defined as receiving a high school diploma or Graduate Equivalency Degree by age 21, determined from self-report. RESULTS: Youth who reported having a chronic health condition had higher odds of low educational attainment compared with youth who did not report a condition (n = 6,795; odds ratio [OR], 1.47; 95% confidence interval [CI], 1.22-1.76). Specifically, youth with asthma (OR, 1.63; 95% CI, 1.31-2.02) and those with cancer, diabetes, or epilepsy (OR, 1.96; 95% CI, 1.13-3.37) had higher odds of low attainment. For youth who reported cancer, diabetes, or epilepsy, the variables "school absences," "repeated a grade," and "depressive symptoms" attenuated the association and were considered mediators. CONCLUSIONS: Youth with chronic health conditions had lower educational attainment. Students with cancer, diabetes, or epilepsy who had a high number of absences, had repeated a grade, or had a high-depressive symptoms score were particularly impacted. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 13, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure