Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-9 (of 9 Records) |
Query Trace: Gillen M [original query] |
---|
Multisystem Inflammatory Syndrome in U.S. Children and Adolescents.
Feldstein LR , Rose EB , Horwitz SM , Collins JP , Newhams MM , Son MBF , Newburger JW , Kleinman LC , Heidemann SM , Martin AA , Singh AR , Li S , Tarquinio KM , Jaggi P , Oster ME , Zackai SP , Gillen J , Ratner AJ , Walsh RF , Fitzgerald JC , Keenaghan MA , Alharash H , Doymaz S , Clouser KN , Giuliano JS Jr , Gupta A , Parker RM , Maddux AB , Havalad V , Ramsingh S , Bukulmez H , Bradford TT , Smith LS , Tenforde MW , Carroll CL , Riggs BJ , Gertz SJ , Daube A , Lansell A , Coronado Munoz A , Hobbs CV , Marohn KL , Halasa NB , Patel MM , Randolph AG . N Engl J Med 2020 383 (4) 334-346 BACKGROUND: Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome. METHODS: We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms. RESULTS: We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores >/=2.5) were documented in 15 patients (8%), and Kawasaki's disease-like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%). CONCLUSIONS: Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.). |
Decolonization to reduce postdischarge infection risk among MRSA carriers
Huang SS , Singh R , McKinnell JA , Park S , Gombosev A , Eells SJ , Gillen DL , Kim D , Rashid S , Macias-Gil R , Bolaris MA , Tjoa T , Cao C , Hong SS , Lequieu J , Cui E , Chang J , He J , Evans K , Peterson E , Simpson G , Robinson P , Choi C , Bailey CCJr , Leo JD , Amin A , Goldmann D , Jernigan JA , Platt R , Septimus E , Weinstein RA , Hayden MK , Miller LG . N Engl J Med 2019 380 (7) 638-650 BACKGROUND: Hospitalized patients who are colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at high risk for infection after discharge. METHODS: We conducted a multicenter, randomized, controlled trial of postdischarge hygiene education, as compared with education plus decolonization, in patients colonized with MRSA (carriers). Decolonization involved chlorhexidine mouthwash, baths or showers with chlorhexidine, and nasal mupirocin for 5 days twice per month for 6 months. Participants were followed for 1 year. The primary outcome was MRSA infection as defined according to Centers for Disease Control and Prevention (CDC) criteria. Secondary outcomes included MRSA infection determined on the basis of clinical judgment, infection from any cause, and infection-related hospitalization. All analyses were performed with the use of proportional-hazards models in the per-protocol population (all participants who underwent randomization, met the inclusion criteria, and survived beyond the recruitment hospitalization) and as-treated population (participants stratified according to adherence). RESULTS: In the per-protocol population, MRSA infection occurred in 98 of 1063 participants (9.2%) in the education group and in 67 of 1058 (6.3%) in the decolonization group; 84.8% of the MRSA infections led to hospitalization. Infection from any cause occurred in 23.7% of the participants in the education group and 19.6% of those in the decolonization group; 85.8% of the infections led to hospitalization. The hazard of MRSA infection was significantly lower in the decolonization group than in the education group (hazard ratio, 0.70; 95% confidence interval [CI], 0.52 to 0.96; P=0.03; number needed to treat to prevent one infection, 30; 95% CI, 18 to 230); this lower hazard led to a lower risk of hospitalization due to MRSA infection (hazard ratio, 0.71; 95% CI, 0.51 to 0.99). The decolonization group had lower likelihoods of clinically judged infection from any cause (hazard ratio, 0.83; 95% CI, 0.70 to 0.99) and infection-related hospitalization (hazard ratio, 0.76; 95% CI, 0.62 to 0.93); treatment effects for secondary outcomes should be interpreted with caution owing to a lack of prespecified adjustment for multiple comparisons. In as-treated analyses, participants in the decolonization group who adhered fully to the regimen had 44% fewer MRSA infections than the education group (hazard ratio, 0.56; 95% CI, 0.36 to 0.86) and had 40% fewer infections from any cause (hazard ratio, 0.60; 95% CI, 0.46 to 0.78). Side effects (all mild) occurred in 4.2% of the participants. CONCLUSIONS: Postdischarge MRSA decolonization with chlorhexidine and mupirocin led to a 30% lower risk of MRSA infection than education alone. (Funded by the AHRQ Healthcare-Associated Infections Program and others; ClinicalTrials.gov number, NCT01209234 .). |
Revisiting Pneumatic Nail Gun Trigger Recommendations
Albers J , Lowe BD , Lipscomb H , Hudock SD , Dement J , Evanoff B , Fullen M , Gillen M , Kaskutas V , Nolan J , Patterson D , Platner J , Pompeii L , Schoenfisch A . Prof Saf 2015 60 (3) 30-33 Pneumatic framing nail gun use is ubiquitous throughout the modern homebuilding industry. This tool has a safety device at the end of the gun muzzle that must be depressed before the fastener can be discharged. Generally, these devices have two types of trigger systems that then define how the nail gun fires in response to a trigger press: 1. The sequential actuation trigger requires that each nail can only be discharged when the safety tip is first depressed and, while held depressed, the trigger is squeezed. 2. The contact actuation trigger allows the operator to first squeeze the trigger and, while holding the trigger squeezed, repeatedly bump the safety tip on the workpiece to shoot multiple nails. In the authors' view, however, an unintended consequence of the recommendations published in (Baggs, et al, 1999) and (2001) has been the creation of the appearance of competing risks with nail gun trigger systems. |
Regional variation in colorectal cancer testing and geographic availability of care in a publicly insured population
Wheeler SB , Kuo TM , Goyal RK , Meyer AM , Hassmiller Lich K , Gillen EM , Tyree S , Lewis CL , Crutchfield TM , Martens CE , Tangka F , Richardson LC , Pignone MP . Health Place 2014 29c 114-123 Despite its demonstrated effectiveness, colorectal cancer (CRC) testing is suboptimal, particularly in vulnerable populations such as those who are publicly insured. Prior studies provide an incomplete picture of the importance of the intersection of multilevel factors affecting CRC testing across heterogeneous geographic regions where vulnerable populations live. We examined CRC testing across regions of North Carolina by using population-based Medicare and Medicaid claims data from disabled individuals who turned 50 years of age during 2003-2008. We estimated multilevel models to examine predictors of CRC testing, including distance to the nearest endoscopy facility, county-level endoscopy procedural rates, and demographic and community contextual factors. Less than 50% of eligible individuals had evidence of CRC testing; men, African-Americans, Medicaid beneficiaries, and those living furthest away from endoscopy facilities had significantly lower odds of CRC testing, with significant regional variation. These results can help prioritize intervention strategies to improve CRC testing among publicly insured, disabled populations. |
Obesity paradox in end-stage kidney disease patients
Park J , Ahmadi SF , Streja E , Molnar MZ , Flegal KM , Gillen D , Kovesdy CP , Kalantar-Zadeh K . Prog Cardiovasc Dis 2014 56 (4) 415-425 In the general population, obesity is associated with increased cardiovascular risk and decreased survival. In patients with end-stage renal disease (ESRD), however, an "obesity paradox" or "reverse epidemiology" (to include lipid and hypertension paradoxes) has been consistently reported, i.e. a higher body mass index (BMI) is paradoxically associated with better survival. This survival advantage of large body size is relatively consistent for hemodialysis patients across racial and regional differences, although published results are mixed for peritoneal dialysis patients. Recent data indicate that both higher skeletal muscle mass and increased total body fat are protective, although there are mixed data on visceral (intra-abdominal) fat. The obesity paradox in ESRD is unlikely to be due to residual confounding alone and has biologic plausibility. Possible causes of the obesity paradox include protein-energy wasting and inflammation, time discrepancy among competitive risk factors (undernutrition versus overnutrition), hemodynamic stability, alteration of circulatory cytokines, sequestration of uremic toxin in adipose tissue, and endotoxin-lipoprotein interaction. The obesity paradox may have significant clinical implications in the management of ESRD patients especially if obese dialysis patients are forced to lose weight upon transplant wait-listing. Well-designed studies exploring the causes and consequences of the reverse epidemiology of cardiovascular risk factors, including the obesity paradox, among ESRD patients could provide more information on mechanisms. These could include controlled trials of nutritional and pharmacologic interventions to examine whether gain in lean body mass or even body fat can improve survival and quality of life in these patients. |
Lessons learned from use of social network strategy in HIV testing programs targeting African American men who have sex with men
McCree DH , Millett G , Baytop C , Royal S , Ellen J , Halkitis PN , Kupprat SA , Gillen S . Am J Public Health 2013 103 (10) 1851-6 OBJECTIVES: We report lessons derived from implementation of the Social Network Strategy (SNS) into existing HIV counseling, testing, and referral services targeting 18- to 64-year-old Black gay, bisexual, and other men who have sex with men (MSM). METHODS: The SNS procedures used in this study were adapted from a Centers for Disease Control and Prevention-funded, 2-year demonstration project involving 9 community-based organizations (CBOs) in 7 cities. Under the SNS, HIV-positive and HIV-negative men at high risk for HIV (recruiters) were enlisted to identify and recruit persons from their social, sexual, or drug-using networks (network associates) for HIV testing. Sites maintained records of modified study protocols for ascertaining lessons learned. The study was conducted between April 2008 and May 2010 at CBOs in Washington, DC, and New York, New York, and at a health department in Baltimore, Maryland. RESULTS:. Several common lessons regarding development of the plan, staffing, training, and use of incentives were identified across the sites. Collectively, these lessons indicate use of SNS is resource-intensive, requiring a detailed plan, dedicated staff, and continual input from clients and staff for successful implementation. CONCLUSION: SNS may provide a strategy for identifying and targeting clusters of high-risk Black MSM for HIV testing. Given the resources needed to implement the strategy, additional studies using an experimental design are needed to determine the cost-effectiveness of SNS compared with other testing strategies. |
Sexual risk taking in relation to sexual identification, age, and education in a diverse sample of African American men who have sex with men (MSM) in New York City
Hampton M , Halkitis P , Storholm E , Kupprat S , Siconolfi D , Jones D , Steen J , Gillen S , McCree D . AIDS Behav 2013 17 (3) 931-938 HIV disproportionately affects African American men who have sex with men (MSM) in the United States. To inform this epidemiological pattern, we examined cross-sectional sexual behavior data in 509 African American MSM. Bivariate logistic regression analyses were conducted to examine the extent to which age, education,and sexual identity explain the likelihood of engaging in sex with a partner of a specific gender and the likelihood of engaging in unprotected sexual behaviors based on partner gender. Across all partner gender types,unprotected sexual behaviors were more likely to be reported by men with lower education. Younger, non-gay identified men were more likely to engage in unprotected sexual behaviors with transgender partners, while older, non-gay identified men were more likely to engage in unprotected sexual behaviors with women. African American MSM do not represent a monolithic group in their sexual behaviors, highlighting the need to target HIV prevention efforts to different subsets of African American MSM communities as appropriate. |
Path forward: emerging issues and challenges
Gillen M , Gittleman JL . J Safety Res 2010 41 (3) 301-6 The NIOSH Construction Program worked with industry stakeholders to develop a National Occupational Safety and Health Construction Agenda to target future research and activities. The Program and its partners are also cognizant that new developments can emerge over time and that research can play an important role in helping to understand and address these emerging issues. Examples of emerging issues relevant to construction safety and health are described. These include: (a) climate change and energy considerations; (b) green construction developments and opportunities; (c) new materials; (d) changes in industry structure and practice; (e) workforce developments and disparities; (f) injury underreporting and cost and risk shifting; and (g) increased interest in addressing root causes. Responding to emerging issues while maintaining a focus on fundamental longstanding issues represents an ongoing challenge for researchers and industry organizations. Additional research to understand the diffusion and adoption of research by the industry is also needed. Research accomplished to date provides a strong foundation for addressing future industry needs and trends. |
The NIOSH Construction Program: research to practice, impact, and developing a National Construction Agenda
Gillen M . J Safety Res 2010 41 (3) 289-299 The U.S. National Institute for Occupational Safety and Health (NIOSH) conducts research to improve and protect the health and safety of workers. This paper describes the experience of the NIOSH Construction Program with two recent program planning initiatives intended to improve the program: (a) an independent external review of work over the past decade and (b) the development of strategic goals organized into a "National Construction Agenda" to guide a decade of future work. These goals, developed with input from construction industry stakeholders and researchers, are a part of the NIOSH National Occupational Research Agenda (NORA) initiative. The NORA goals are intended to provide an ambitious set of goals for all construction stakeholders to work together on. Both efforts relate to ensuring the relevance and impact of research, reflecting an emerging policy perspective that research programs should be judged not just by the quality and quantity of science produced, but by the industry impact and tangible benefit resulting from the research. This paper describes how views on research planning have evolved to incorporate lessons learned about how research leads to improved safety and health for workers. It also describes the process used to develop the goals and the resulting strategic and intermediate goals that comprise the National Construction Agenda. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Sep 16, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure