Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-15 (of 15 Records) |
Query Trace: Goyal S [original query] |
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Head Impact Exposures Among Youth Tackle and Flag American Football Athletes
Waltzman D , Sarmiento K , Devine O , Zhang X , DePadilla L , Kresnow MJ , Borradaile K , Hurwitz A , Jones D , Goyal R , Breiding MJ . Sports Health 2021 13 (5) 454-462 BACKGROUND: Promoted as a safer alternative to tackle football, there has been an increase in flag football participation in recent years. However, examinations of head impact exposure in flag football as compared with tackle football are currently limited. HYPOTHESIS: Tackle football athletes will have a greater number and magnitude of head impacts compared with flag football athletes. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: Using mouthguard sensors, this observational, prospective cohort study captured data on the number and magnitude of head impacts among 524 male tackle and flag football athletes (6-14 years old) over the course of a single football season. Estimates of interest based on regression models used Bayesian methods to estimate differences between tackle and flag athletes. RESULTS: There were 186,239 head impacts recorded during the study. Tackle football athletes sustained 14.67 (95% CI 9.75-21.95) times more head impacts during an athletic exposure (game or practice) compared with flag football athletes. Magnitude of impact for the 50th and 95th percentile was 18.15g (17.95-18.34) and 52.55g (51.06-54.09) for a tackle football athlete and 16.84g (15.57-18.21) and 33.51g (28.23-39.08) for a flag football athlete, respectively. A tackle football athlete sustained 23.00 (13.59-39.55) times more high-magnitude impacts (≥40g) per athletic exposure compared with a flag football athlete. CONCLUSION: This study demonstrates that youth athletes who play tackle football are more likely to experience a greater number of head impacts and are at a markedly increased risk for high-magnitude impacts compared with flag football athletes. CLINICAL RELEVANCE: These results suggest that flag football has fewer head impact exposures, which potentially minimizes concussion risk, making it a safer alternative for 6- to 14-year-old youth football athletes. |
Contraception claims by medication for opioid use disorder prescription status among insured women with opioid use disorder, United States, 2018
Goyal S , Monsour M , Ko JY , Curtis KM , Whiteman MK , Coy KC , Cox S , Romero L . Contraception 2022 117 67-72 OBJECTIVE(S): To understand how contraception method use differed between women prescribed and not prescribed medications for opioid use disorder (MOUD) among commercially-insured and Medicaid-insured women. STUDY DESIGN: IBM Watson Health MarketScan Commercial Claims and Encounters database and the Multi-State Medicaid database were used to calculate the 1) crude prevalence and 2) adjusted odds ratios (adjusted for demographic characteristics) of using long-acting reversible or short-acting hormonal contraception methods or female sterilization compared with none of these methods (no method) in 2018 by MOUD status among women with OUD, aged 20 to 49 years, with continuous health insurance coverage through commercial insurance or Medicaid for six years. Claims data was used to define contraception use. Fisher exact test or (2) test with a p-value 0.0001, based on the Holm-Bonferroni method, and 95% confidence intervals were used to determine statistically significant differences for prevalence estimates and adjusted odds ratios, respectively. RESULTS: Only 41% of commercially-insured and Medicaid-insured women with OUD were prescribed MOUD. Medicaid-insured women with OUD prescribed MOUD had a significantly lower crude prevalence of using no method (71.1% vs 79.0%) and higher odds of using female sterilization (aOR, 1.33; 95% CI: 1.06 - 1.67 vs no method) than those not prescribed MOUD. Among commercially-insured women there were no differences in contraceptive use by MOUD status and 66% used no method. CONCLUSIONS: Among women with six years of continuous insurance coverage, contraceptive use differed by MOUD status and insurance. Prescribing MOUD for women with OUD can be improved to ensure quality care. IMPLICATIONS: Only two in five women with OUD had evidence of being prescribed MOUD, and majority did not use prescription contraception or female sterilization. Our findings support opportunities to improve prescribing for MOUD and integrate contraception and MOUD services to improve clinical care among women with OUD. |
SARS-CoV-2 Infection Among Pregnant People at Labor and Delivery and Changes in Infection Rates in the General Population: Lessons Learned From Illinois.
Goyal S , Gerardin J , Cobey S , Son C , McCarthy O , Dror A , Lightner S , Ezike NO , Duffus WA , Bennett AC . Public Health Rep 2022 137 (4) 333549221091826 OBJECTIVES: The Illinois Department of Public Health (IDPH) assessed whether increases in the SARS-CoV-2 test positivity rate among pregnant people at labor and delivery (L&D) could signal increases in SARS-CoV-2 prevalence in the general Illinois population earlier than current state metrics. MATERIALS AND METHODS: Twenty-six birthing hospitals universally testing for SARS-CoV-2 at L&D voluntarily submitted data from June 21, 2020 through January 23, 2021, to IDPH. Hospitals reported the daily number of people who delivered, SARS-CoV-2 tests, and test results as well as symptom status. We compared the test positivity rate at L&D with the test positivity rate of the general population and the number of hospital admissions for COVID-19-like illness by quantifying correlations in trends and identifying a lead time. RESULTS: Of 26 633 reported pregnant people who delivered, 96.8% (n = 25 772) were tested for SARS-CoV-2. The overall test positivity rate was 2.4% (n = 615); 77.7% (n = 478) were asymptomatic. In Chicago, the only region with a sufficient sample size for analysis, the test positivity rate at L&D (peak of 5% on December 7, 2020) was lower and more stable than the test positivity rate of the general population (peak of 14% on November 13, 2020) and lagged hospital admissions for COVID-19-like illness (peak of 118 on November 15, 2020) and the test positivity rate of the general population by about 10 days (Pearson correlation = 0.73 and 0.75, respectively). PRACTICE IMPLICATIONS: Trends in the test positivity rate at L&D did not provide an earlier signal of increases in Illinois's SARS-CoV-2 prevalence than current state metrics did. Nonetheless, the role of universal testing protocols in identifying asymptomatic infection is important for clinical decision making and patient education about infection prevention and control. |
Sensitivity of Pregnancy Field on the COVID-19 Case Report Form Among Pregnancies Completed Through December 31, 2020: Illinois and Tennessee.
Manning SE , Bennett A , Ellington S , Goyal S , Harvey E , Sizemore L , Wingate H . Matern Child Health J 2021 26 (2) 1-7 PURPOSE: The considerable volume of infections from SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), has made it challenging for health departments to collect complete data for national disease reporting. We sought to examine sensitivity of the COVID-19 case report form (CRF) pregnancy field by comparing CRF data to the gold standard of CRF data linked to birth and fetal death certificates. DESCRIPTION: CRFs for women aged 15-44 years with laboratory-confirmed SARS-CoV-2 infection were linked to birth and fetal death certificates for pregnancies completed during January 1-December 31, 2020 in Illinois and Tennessee. Among linked records, pregnancy was considered confirmed for women with a SARS-CoV-2 specimen collection date on or prior to the delivery date. Sensitivity of the COVID-19 CRF pregnancy field was calculated by dividing the number of confirmed pregnant women with SARS-CoV-2 infection with pregnancy indicated on the CRF by the number of confirmed pregnant women with SARS-CoV-2 infection. ASSESSMENT: Among 4276 (Illinois) and 2070 (Tennessee) CRFs that linked with a birth or fetal death certificate, CRF pregnancy field sensitivity was 45.3% and 42.1%, respectively. In both states, sensitivity varied significantly by maternal race/ethnicity, insurance, trimester of prenatal care entry, month of specimen collection, and trimester of specimen collection. Sensitivity also varied by maternal education in Illinois but not in Tennessee. CONCLUSION: Sensitivity of the COVID-19 CRF pregnancy field varied by state and demographic factors. To more accurately assess outcomes for pregnant women, jurisdictions might consider utilizing additional data sources and linkages to obtain pregnancy status. |
Antibiotic Testing and Successful Treatment of Hospitalized Patients with Extensively Drug-Resistant (XDR) Campylobacter jejuni Infections Linked to a Pet Store Puppy Outbreak.
Goyal D , Watkins LKF , Montgomery MP , Jones SMB , Caidi H , Friedman CR . J Glob Antimicrob Resist 2021 26 84-90 OBJECTIVES: Most patients with Campylobacter infections do not require antibiotics; however, they are indicated in severe cases. Clinical breakpoints for many antibiotics have not yet been established by the Clinical and Laboratory Standards Institute, making antibiotic selection for resistant infections challenging. During an outbreak of pet store puppy-associated extensively drug resistant (XDR) Campylobacter jejuni infections resistant to seven classes of antibiotics, several patients required antibiotics. The aims of this study were to describe the minimal inhibitory concentrations (MICs) of the outbreak strain for various antibiotics and the successful treatment of two patients using imipenem-cilastatin, a drug not traditionally used to treat Campylobacter infections. METHODS: We used whole genome multi-locus sequence typing (wgMLST) to determine the genetic relatedness of Campylobacter isolates collected from two human patients' stool samples with the outbreak strain. We performed extended antimicrobial susceptibility testing on 14 outbreak isolates and 6 control strains to determine MICs for 30 antibiotics from 14 classes. RESULTS: Isolates from both patients were found to be highly related to the outbreak strain by wgMLST. MICs indicated resistance of outbreak strain to most antibiotic classes; exceptions included phenicols, glycylcyclines, and carbapenems. Due to potential side effects of phenicols and safety issues precluding use of glycylcyclines like tigecycline when alternatives agents are available, we used carbapenems to treat patients who got severely ill from the outbreak strain infections. CONCLUSIONS: Stewardship and clinical vigilance are warranted when deciding whether and how to treat patients with suspected C. jejuni diarrhea with antibiotics. Clinicians should maintain a high index of suspicion for XDR Campylobacter when patients fail to improve and consider use of carbapenems in such settings. |
Differences in Head Impact Exposures Between Youth Tackle and Flag Football Games and Practices: Potential Implications for Prevention Strategies
Sarmiento K , Waltzman D , Devine O , Zhang X , DePadilla L , Kresnow MJ , Borradaile K , Hurwitz A , Jones D , Goyal R , Breiding MJ . Am J Sports Med 2021 49 (8) 3635465211011754 BACKGROUND: Interventions designed to reduce the risk for head impacts and concussion in youth football have increased over the past decade; however, understanding of the role of regular game play on head impact exposure among youth tackle and flag football athletes is currently limited. PURPOSE: To explore head impact exposure among youth tackle and flag football athletes (age range, 6-14 years) during both practices and games. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Using the Vector MouthGuard sensor, the authors collected head impact data from 524 tackle and flag youth football athletes over the course of a football season. Quantities of interest were estimated from regression models using Bayesian methods. RESULTS: For impacts ≥10g, a tackle football athlete had an estimated 17.55 (95% CI, 10.78-28.96) times more head impacts per practice compared with a flag football athlete (6.85 [95% CI, 6.05-7.76] and 0.39 [95% CI, 0.24-0.62] head impacts, respectively). Additionally, a tackle football athlete had an estimated 19.48 (95% CI, 12.74-29.98) times more head impacts per game compared with a flag football athlete (13.59 [95% CI, 11.97-15.41] and 0.70 [95% CI, 0.46-1.05] head impacts, respectively). Among tackle football athletes, the estimated average impact rate was 6.51 (95% CI, 5.75-7.37) head impacts during a practice and 12.97 (95% CI, 11.36-14.73) impacts during a game, resulting in 2.00 (95% CI, 1.74-2.29) times more ≥10g head impacts in games versus practices. Tackle football athletes had 2.06 (95% CI, 1.80-2.34) times more high-magnitude head impacts (≥40g) during a game than during a practice. On average, flag football athletes experienced an estimated 0.37 (95% CI, 0.20-0.60) head impacts during a practice and 0.77 (95% CI, 0.53-1.06) impacts during a game, resulting in 2.06 (95% CI, 1.29-3.58) times more ≥10g head impacts in games versus practices. Because of model instability caused by a large number of zero impacts for flag football athletes, a comparison of high-magnitude head impacts is not reported for practices or games. CONCLUSION: This study provides a characterization of the head impact exposure of practices and games among a large population of youth tackle and flag football athletes aged 6 to 14 years. These findings suggest that a greater focus on game-based interventions, such as fair play interventions and strict officiating, may be beneficial to reduce head impact exposures for youth football athletes. |
Evaluation of vaccine safety after the first public sector introduction of typhoid conjugate vaccine - Navi Mumbai, India, 2018
Longley AT , Date K , Luby SP , Bhatnagar P , Bentsi-Enchill AD , Goyal V , Shimpi R , Katkar A , Yewale V , Jayaprasad N , Horng L , Kunwar A , Harvey P , Haldar P , Dutta S , Gidudu J . Clin Infect Dis 2021 73 (4) e927-e933 BACKGROUND: In December 2017, the World Health Organization (WHO) prequalified the first typhoid conjugate vaccine (TCV) (Typbar-TCV). While no safety concerns were identified in pre- and post-licensure studies, WHO's Global Advisory Committee on Vaccine Safety recommended robust safety evaluation with large-scale TCV introductions. During July-August 2018, the Navi Mumbai Municipal Corporation (NMMC) launched the world's first public sector TCV introduction. Per administrative reports, 113,420 children 9 months-14 years old received TCV. METHODS: We evaluated adverse events following immunization (AEFI) using passive and active surveillance via 1) reports from the passive NMMC AEFI surveillance system, 2) telephone interviews with 5% of caregivers of vaccine recipients 48 hours and 7 days post-vaccination, and 3) chart abstraction for adverse events of special interest (AESI) among patients admitted to 5 hospitals using the Brighton Collaboration criteria followed by ascertainment of vaccination status. RESULTS: We identified 222/113,420 (0.2%) AEFI through the NMMC AEFI surveillance system: 211 (0.19%) minor, 2 (0.002%) severe, and 9 (0.008%) serious. At 48 hours post-vaccination, 1,852/5,605 (33%) caregivers reported one or more AEFI, including injection site pain (n=1,452, 26%), swelling (n=419, 7.5%), and fever (n=416, 7.4%). Of the 4,728 interviews completed at 7 days post-vaccination, the most reported AEFI included fever (n=200, 4%), pain (n=52, 1%), and headache (n=42, 1%). Among 525 hospitalized children diagnosed with an AESI, 60 were vaccinated; no AESI were causally associated with TCV. CONCLUSIONS: No unexpected safety signals were identified with TCV introduction. This provides further reassurance for the large-scale use of Typbar-TCV among children 9 months-14 years old. |
Prevalence of home births and associated risk profile and maternal characteristics, 2016-2018
Goyal S , Kortsmit K , Cox S , DʼAngelo DV , Romero L , Henderson ZT , Barfield WD . Obstet Gynecol 2020 136 (6) 1195-1203 OBJECTIVE: To estimate the prevalence of pregnancies that meet the low-risk criteria for planned home births and describe geographic and maternal characteristics of home births compared with hospital births. METHODS: Data from the 2016-2018 Pregnancy Risk Assessment Monitoring System (PRAMS), a survey among women with recent live births, and linked birth certificate variables were used to calculate the prevalence of home births that were considered low-risk. We defined low-risk pregnancy as a term (between 37 and 42 weeks of gestation), singleton gestation with a birth weight within the 10th-90th percentile mean for gestational age (as a proxy for estimated fetal size appropriate for gestational age), without prepregnancy or gestational diabetes or hypertension, and no vaginal birth after cesarean (VBAC). We also calculated the prevalence of home and hospital births by site and maternal characteristics. Weighted prevalence estimates are presented with 95% CIs to identify differences. RESULTS: The prevalence of home births was 1.1% (unweighted n=1,034), ranging from 0.1% (Alabama) to 2.6% (Montana); 64.9% of the pregnancies were low-risk. Among the 35.1% high-risk home births, 39.5% of neonates were large for gestational age, 20.5% of neonates were small for gestational age, 17.1% of the women had diabetes, 16.9% of the women had hypertension, 10.6% of the deliveries were VBACs, and 10.1% of the deliveries were preterm. A significantly higher percentage of women with home births than hospital births were non-Hispanic White (83.9% vs 56.5%), aged 35 years or older (24.0% vs 18.1%), with less than a high school-level of education (24.6% vs 12.2%), and reported no health insurance (27.0% vs 1.9%). A significantly lower percentage of women with home births than hospital births initiated prenatal visits in the first trimester (66.9% vs 87.1%), attended a postpartum visit (80.1% vs 90.0%), and most often laid their infants on their backs for sleep (59.3% vs 79.5%). CONCLUSIONS: Understanding the risk profile, geographic distribution, and characteristics of women with home births can guide efforts around safe birthing practices. |
Intussusception after rotavirus vaccine introduction in India
Reddy SN , Nair NP , Tate JE , Thiyagarajan V , Giri S , Praharaj I , Mohan VR , Babji S , Gupte MD , Arora R , Bidari S , Senthamizh S , Mekala S , Goru KB , Reddy B , Pamu P , Gorthi RP , Badur M , Mohan V , Sathpathy S , Mohanty H , Dash M , Mohakud NK , Ray RK , Mohanty P , Gathwala G , Chawla S , Gupta M , Gupta R , Goyal S , Sharma P , Mathew MA , Jacob TJK , Sundaram B , Purushothaman GKC , Dorairaj P , Jagannatham M , Murugiah K , Boopathy H , Maniam R , Gurusamy R , Kumaravel S , Shenoy A , Jain H , Goswami JK , Wakhlu A , Gupta V , Vinayagamurthy G , Parashar UD , Kang G . N Engl J Med 2020 383 (20) 1932-1940 BACKGROUND: A three-dose, oral rotavirus vaccine (Rotavac) was introduced in the universal immunization program in India in 2016. A prelicensure trial involving 6799 infants was not large enough to detect a small increased risk of intussusception. Postmarketing surveillance data would be useful in assessing whether the risk of intussusception would be similar to the risk seen with different rotavirus vaccines used in other countries. METHODS: We conducted a multicenter, hospital-based, active surveillance study at 27 hospitals in India. Infants meeting the Brighton level 1 criteria of radiologic or surgical confirmation of intussusception were enrolled, and rotavirus vaccination was ascertained by means of vaccination records. The relative incidence (incidence during the risk window vs. all other times) of intussusception among infants 28 to 365 days of age within risk windows of 1 to 7 days, 8 to 21 days, and 1 to 21 days after vaccination was evaluated by means of a self-controlled case-series analysis. For a subgroup of patients, a matched case-control analysis was performed, with matching for age, sex, and location. RESULTS: From April 2016 through June 2019, a total of 970 infants with intussusception were enrolled, and 589 infants who were 28 to 365 days of age were included in the self-controlled case-series analysis. The relative incidence of intussusception after the first dose was 0.83 (95% confidence interval [CI], 0.00 to 3.00) in the 1-to-7-day risk window and 0.35 (95% CI, 0.00 to 1.09) in the 8-to-21-day risk window. Similar results were observed after the second dose (relative incidence, 0.86 [95% CI, 0.20 to 2.15] and 1.23 [95% CI, 0.60 to 2.10] in the respective risk windows) and after the third dose (relative incidence, 1.65 [95% CI, 0.82 to 2.64] and 1.08 [95% CI, 0.69 to 1.73], respectively). No increase in intussusception risk was found in the case-control analysis. CONCLUSIONS: The rotavirus vaccine produced in India that we evaluated was not associated with intussusception in Indian infants. (Funded by the Bill and Melinda Gates Foundation and others.). |
Identification of substance-exposed newborns and neonatal abstinence syndrome using ICD-10-CM - 15 hospitals, Massachusetts, 2017
Goyal S , Saunders KC , Moore CS , Fillo KT , Ko JY , Manning SE , Shapiro-Mendoza C , Gupta M , Romero L , Coy KC , McDow KB , Keaton AA , Sinatra J , Jones K , Alpren C , Barfield WD , Diop H . MMWR Morb Mortal Wkly Rep 2020 69 (29) 951-955 Opioid use disorder and neonatal abstinence syndrome (NAS) increased in Massachusetts from 1999 to 2013 (1,2). In response, in 2016, the state passed a law requiring birth hospitals to report the number of newborns who were exposed to controlled substances to the Massachusetts Department of Public Health (MDPH)* by mandating monthly reporting of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes related to maternal dependence on opioids (F11.20) or benzodiazepines (F13.20) and to newborns affected by maternal use of drugs of addiction (P04.49) or experiencing withdrawal symptoms from maternal drugs of addiction (P96.1) separately.(†) MDPH uses these same codes for monthly, real-time crude estimates of NAS and uses P96.1 alone for official NAS state reporting.(§) MDPH requested CDC's assistance in evaluating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of either maternal or newborn codes to identify substance-exposed newborns, and of newborn exposure codes (both exposure [P04.49] or withdrawal [P96.1]) and the newborn code for withdrawal alone (P96.1) to identify infants with NAS cases related to three exposure scenarios: 1) opioids, 2) opioids or benzodiazepines, and 3) any controlled substance. Confirmed diagnoses of substance exposure and NAS abstracted from linked clinical records for 1,123 infants born in 2017 and their birth mothers were considered the diagnostic standard and were compared against hospital-reported ICD-10-CM codes. For identifying substance-exposed newborns across the three exposure scenarios, the newborn exposure codes had higher sensitivity (range = 31%-61%) than did maternal drug dependence codes (range = 16%-41%), but both sets of codes had high PPV (≥74%). For identifying NAS, for all exposure scenarios, the sensitivity for either newborn code (P04.49 or P96.1) was ≥92% and the PPV was ≥64%; for P96.1 alone the sensitivity was ≥79% and the PPV was ≥92% for all scenarios. Whereas ICD-10-CM codes are effective for NAS surveillance in Massachusetts, they should be applied cautiously for substance-exposed newborn surveillance. Surveillance for substance-exposed newborns using ICD-10-CM codes might be improved by increasing the use of validated substance-use screening tools and standardized facility protocols and improving communication between patients and maternal health and infant health care providers. |
Potentially serious drug interactions resulting from the pretravel health encounter
Sbaih N , Buss B , Goyal D , Rao SR , Benefield R , Walker AT , Esposito DH , Ryan ET , LaRocque RC , Leung DT . Open Forum Infect Dis 2018 5 (11) ofy266 Travelers seen for pretravel health encounters are frequently prescribed new travel-related medications, which may interact with their previously prescribed medications. In a cohort of 76 324 travelers seen at 23 US clinics, we found that 2650 (3.5%) travelers were prescribed travel-related medications with potential for serious drug interactions. |
The acceptability and validity of self-collected nasal swabs for detection of influenza virus infection among older adults in Thailand
Goyal S , Prasert K , Praphasiri P , Chittaganpitch M , Waicharoen S , Ditsungnoen D , Jaichuang S , Lindblade KA . Influenza Other Respir Viruses 2017 11 (5) 412-417 BACKGROUND: Self-collection of nasal swabs could improve the timeliness of influenza virus detection in older adults. OBJECTIVES: Measure the acceptability, adequacy, timeliness and validity of self-collected nasal swabs among adults ≥65 years in Thailand. METHODS: Our evaluation consisted of two parts: a one-month study among randomly-selected, community-dwelling older adults to simulate community-based surveillance for acute respiratory infections (ARI); and a clinic study of older adults with ARI to evaluate the sensitivity and specificity of self-collected nasal swabs for influenza virus infection compared with healthcare worker (HCW)-collected nasal and nasopharyngeal swabs. RESULTS: In the community study, 24% of participants experienced an ARI during the observation period. All (100%) participants with an ARI self-collected nasal swabs within 72 hours of symptom onset of which 92% were considered adequate samples. In the clinic study, 45% of patients with ARI presented within 72 hours of symptom onset. The sensitivity of self-collected nasal swabs for detection of influenza virus infection was 78% (95% CI 40-97) compared to nasopharyngeal and 88% (95% CI 47-100) compared to nasal swabs collected by HCW. Specificity was 100% (95% CI 97-100) compared to both methods. Self-collection of nasal swabs was found acceptable by 99% of participants in both studies. CONCLUSIONS: Self-collection of nasal swabs was acceptable to older adults in Thailand who were able to take adequate samples. Self-collection of nasal swabs may improve the timeliness of sample collection but lower sensitivity will need to be considered. This article is protected by copyright. All rights reserved. |
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. |
Life's Simple 7 and risk of incident stroke: the Reasons for Geographic And Racial Differences in Stroke study
Kulshreshtha A , Vaccarino V , Judd SE , Howard VJ , McClellan WM , Muntner P , Hong Y , Safford MM , Goyal A , Cushman M . Stroke 2013 44 (7) 1909-14 BACKGROUND AND PURPOSE: The American Heart Association developed Life's Simple 7 (LS7) as a metric defining cardiovascular health. We investigated the association between LS7 and incident stroke in black and white Americans. METHODS: The Reasons for Geographic And Racial Differences in Stroke (REGARDS) is a national population-based cohort of 30,239 blacks and whites, aged ≥45 years, sampled from the US population from 2003 to 2007. Data were collected by telephone, self-administered questionnaires, and an in-home examination. Incident strokes were identified through biannual participant contact followed by adjudication of medical records. Levels of the LS7 components (blood pressure, cholesterol, glucose, body mass index, smoking, physical activity, and diet) were each coded as poor (0 point), intermediate (1 point), or ideal (2 points) health. An overall LS7 score was categorized as inadequate (0-4), average (5-9), or optimum (10-14) cardiovascular health. RESULTS: Among 22,914 subjects with LS7 data and no previous cardiovascular disease, there were 432 incident strokes over 4.9 years of follow-up. After adjusting for demographics, socioeconomic status, and region of residence, each better health category of the LS7 score was associated with a 25% lower risk of stroke (hazard ratios, 0.75; 95% confidence interval, 0.63-0.90). The association was similar for blacks and whites (interaction P value=0.55). A 1-point higher LS7 score was associated with an 8% lower risk of stroke (hazard ratios, 0.92; 95% confidence interval, 0.88-0.95). CONCLUSIONS: In both blacks and whites, better cardiovascular health, on the basis of the LS7 score, is associated with lower risk of stroke, and a small difference in scores was an important stroke determinant. |
Stroke in South Asia: a systematic review of epidemiologic literature from 1980 to 2010
Kulshreshtha A , Anderson LM , Goyal A , Keenan NL . Neuroepidemiology 2012 38 (3) 123-9 BACKGROUND: Globally 15 million people have an acute stroke every year and one third of them die secondary to stroke events. Most research on stroke prevention and treatment is done in developed countries, yet more than 85% of strokes occur in developing countries. In particular, stroke remains an underrecognized cause of death and disability in South Asia. METHODS: We conducted a systematic review to identify reliable and comparable epidemiological evidence on stroke in South Asia from 1980 to 2010. Publications were screened for eligibility to identify only population-based stroke studies. RESULTS: Of the 71 studies retrieved, only 6 studies from South Asia gave us acceptable estimates of the burden of stroke. Population-based studies from South Asia have stroke prevalence in the range of 45-471 per 100,000. The age-adjusted incidence rate varied from approximately 145 per 100,000 to 262 per 100,000. Rural parts of South Asia have a lower stroke prevalence compared with urban areas. CONCLUSIONS: Our review highlights the paucity of research data in South Asia. This must be addressed in order to accurately determine the burden of stroke in South Asia, so that specific policy recommendations can be formulated to combat the stroke epidemic in this region. |
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