Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-8 (of 8 Records) |
Query Trace: Kleinbaum DG[original query] |
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Surgical site infection risk following cesarean deliveries covered by Medicaid or private insurance
Yi SH , Perkins KM , Kazakova SV , Hatfield KM , Kleinbaum DG , Baggs J , Slayton RB , Jernigan JA . Infect Control Hosp Epidemiol 2019 40 (6) 1-10 OBJECTIVE: To compare risk of surgical site infection (SSI) following cesarean delivery between women covered by Medicaid and private health insurance. STUDY DESIGN: Retrospective cohort. STUDY POPULATION: Cesarean deliveries covered by Medicaid or private insurance and reported to the National Healthcare Safety Network (NHSN) and state inpatient discharge databases by hospitals in California (2011-2013). METHODS: Deliveries reported to NHSN and state inpatient discharge databases were linked to identify SSIs in the 30 days following cesarean delivery, primary payer, and patient and procedure characteristics. Additional hospital-level characteristics were obtained from public databases. Relative risk of SSI by primary payer primary payer was assessed using multivariable logistic regression adjusting for patient, procedure, and hospital characteristics, accounting for facility-level clustering. RESULTS: Of 291,757 cesarean deliveries included, 48% were covered by Medicaid. SSIs were detected following 1,055 deliveries covered by Medicaid (0.75%) and 955 deliveries covered by private insurance (0.63%) (unadjusted odds ratio, 1.2; 95% confidence interval [CI], 1.1-1.3; P < .0001). The adjusted odds of SSI following cesarean deliveries covered by Medicaid was 1.4 (95% CI, 1.2-1.6; P < .0001) times the odds of those covered by private insurance. CONCLUSIONS: In this, the largest and only multicenter study to investigate SSI risk following cesarean delivery by primary payer, Medicaid-insured women had a higher risk of infection than privately insured women. These findings suggest the need to evaluate and better characterize the quality of maternal healthcare for and needs of women covered by Medicaid to inform targeted infection prevention and policy. |
The effect of a regimen of antifungal cream use on episodes of acute adenolymphangitis (ADL) among lymphedema patients: An application using marginal structural models
Mues KE , Klein M , Kleinbaum DG , Flanders WD , Fox LM . J Epidemiol Glob Health 2017 8 176-182 Episodes of adenolymphangitis (ADL) are a recurrent clinical aspect of lymphatic filariasis (LF) and a risk factor for progression of lymphedema. Inter-digital entry lesions, often found on the web spaces between the toes of those suffering from lymphedema, have been shown to contribute to the occurrence of ADL episodes. Use of antifungal cream on lesions is often promoted as a critical component of lymphedema management.Our objective was to estimate the observed effect of antifungal cream use on ADL episodes according to treatment regimen among a cohort of lymphedema patients enrolled in a morbidity management program. We estimated this effect using marginal structural models for time varying confounding.In this longitudinal study, we estimate that for every one-unit increase in the number of times one was compliant to cream use through 12 months, there was a 23% (RR = 0.77 (0.62, 0.96)) decrease in the number of ADL episodes at 18 months, however the RR's were not statistically significant at other study time points. Traditionally adjusted models produced a non-significant RR closer to the null at all time points.This is the first study to estimate the effect of a regimen of antifungal cream on the frequency of ADL episodes. This study also highlights the importance of the consideration and proper handling of time-varying confounders in longitudinal observational studies. |
Sustained infection reduction in outpatient hemodialysis centers participating in a collaborative bloodstream infection prevention effort
Yi SH , Kallen AJ , Hess S , Bren VR , Lincoln ME , Downham G , Kelley K , Booth SL , Weirich H , Shugart A , Lines C , Melville A , Jernigan JA , Kleinbaum DG , Patel PR . Infect Control Hosp Epidemiol 2016 37 (7) 1-4 Among dialysis facilities participating in a bloodstream infection (BSI) prevention collaborative, access-related BSI incidence rate improvements observed immediately following implementation of a bundle of BSI prevention interventions were sustained for up to 4 years. Overall, BSI incidence remained unchanged from baseline in the current analysis. |
Changes in antibody levels during and following an episode of acute adenolymphangitis (ADL) among lymphedema patients in Leogane, Haiti
Mues KE , Lammie PJ , Klein M , Kleinbaum DG , Addiss D , Fox LM . PLoS One 2015 10 (10) e0141047 INTRODUCTION: Episodes of acute adenolymphangitis (ADL) are often the first clinical sign of lymphatic filariasis (LF). They are often accompanied by swelling of the affected limb, inflammation, fever, and general malaise and lead to the progression of lymphedema. Although ADL episodes have been studied for a century or more, questions still remain as to their etiology. We quantified antibody levels to pathogens that potentially contribute to ADL episodes during and after an episode among lymphedema patients in Leogane, Haiti. We estimated the proportion of ADL episodes hypothesized to be attributed to specific pathogens. METHODS: We measured antibody levels to specific pathogens during and following an ADL episode among 41 lymphedema patients enrolled in a cohort study in Leogane, Haiti. We calculated the absolute and relative changes in antibody levels between the ADL and convalescent time points. We calculated the proportion of episodes that demonstrated a two-fold increase in antibody level for several bacterial, fungal, and filarial pathogens. RESULTS: Our results showed the greatest proportion of two-fold changes in antibody levels for the carbohydrate antigen Streptococcus group A, followed by IgG2 responses to a soluble filarial antigen (BpG2), Streptococcal Pyrogenic Exotoxin B, and an antigen for the fungal pathogen Candida. When comparing the median antibody level during the ADL episode to the median antibody level at the convalescent time point, only the antigens for Pseudomonas species (P-value = 0.0351) and Streptolysin O (P-value = 0.0074) showed a significant result. CONCLUSION: Although our results are limited by the lack of a control group and few antibody responses, they provide some evidence for infection with Streptococcus A as a potential contributing factor to ADL episodes. Our results add to the current evidence and illustrate the importance of determining the causal role of bacterial and fungal pathogens and immunological antifilarial response in ADL episodes. |
Impact of a community-based lymphedema management program on episodes of adenolymphangitis (ADLA) and lymphedema progression - Odisha State, India
Mues KE , Deming M , Kleinbaum DG , Budge PJ , Klein M , Leon JS , Prakash A , Rout J , Fox LM . PLoS Negl Trop Dis 2014 8 (9) e3140 BACKGROUND: Lymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression. METHODOLOGY/PRINCIPAL FINDINGS: A lymphedema management program was implemented in Odisha State, India from 2007-2010 by the non-governmental organization, Church's Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value = 0.0004), while those whose lymphedema regressed increased over time (P-value<0.0001). Overall compliance to lymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions. CONCLUSIONS/SIGNIFICANCE: These results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and rate of ADLA episodes. |
Do differences in risk factors, medical care seeking, or medical practices explain the geographic variation in campylobacteriosis in Foodborne Diseases Active Surveillance Network (FoodNet) sites?
Ailes E , Scallan E , Berkelman RL , Kleinbaum DG , Tauxe RV , Moe CL . Clin Infect Dis 2012 54 Suppl 5 S464-71 BACKGROUND: In the United States, considerable geographic variation in the rates of culture-confirmed Campylobacter infection has been consistently observed among sites participating in the Foodborne Diseases Active Surveillance Network (FoodNet). METHODS: We used data from the FoodNet Population Surveys and a FoodNet case-control study of sporadic infection to examine whether differences in medical care seeking, medical practices, or risk factors contributed to geographic variation in incidence. RESULTS: We found differences across the FoodNet sites in the proportion of persons seeking medical care for an acute campylobacteriosis-like illness (range, 24.9%-43.5%) and in the proportion of ill persons who submitted a stool sample (range, 18.6%-40.7%), but these differences were not statistically significant. We found no evidence of geographic effect modification of previously identified risk factors for campylobacteriosis in the case-control study analysis. The prevalence of some exposures varied among control subjects in the FoodNet sites, including the proportion of controls reporting eating chicken at a commercial eating establishment (18.2%-46.1%); contact with animal stool (8.9%-30.9%); drinking water from a lake, river, or stream (0%-5.1%); and contact with a farm animal (2.1%-12.7%). However, these differences do not fully explain the geographic variation in campylobacteriosis. CONCLUSIONS: Future studies that quantify Campylobacter contamination in poultry or variation in host immunity may be useful in identifying sources of this geographic variation in incidence. |
Validity of expanded program on immunization contact method health behavior estimates in Mali
Wei SC , Vanden Eng JL , Patterson AE , Doumbia S , Kleinbaum DG , Ryman TK , Toure MB , McMorrow ML . J Infect Dis 2012 205 Suppl 1 S112-9 BACKGROUND: In the developing world, household surveys provide high-quality health behavior data integral to public health program management. The Expanded Program on Immunization Contact Method (EPI-CM) is a proposed, less resource-intensive method in which health center staff incorporate health behavior questions into routine vaccination activities. No systematic evaluation of EPI-CM validity has yet been conducted. METHODS: We used concurrent household survey and EPI-CM to collect data on 4 infant health behaviors in Mali at 2 time points (8 total comparisons). Studied health behaviors were bednet use, obtaining care for fever, obtaining care for a respiratory complaint, and using oral rehydration solution for diarrhea. Household survey and EPI-CM estimates were considered equivalent if a 95% confidence interval about the difference in estimated proportions fell within the interval (-.10, .10). RESULTS: EPI-CM estimates were higher than household survey estimates for 7 of 8 unadjusted paired estimates; estimates of bednet use in 2009 met a priori equivalence criteria in a setting of high bednet use (90.5%). When we restricted household survey data to infants up-to-date on vaccinations, estimates for behaviors other than bednet use remained substantially different. CONCLUSIONS: We were unable to demonstrate that EPI-CM, as implemented, consistently produces data comparable with household survey data. |
Effect of the expanded program on immunization contact method of data collection on health behaviors in Mali
Wei SC , Vanden Eng JL , Patterson AE , Doumbia S , Kleinbaum DG , Ryman TK , Toure MB , McMorrow ML . J Infect Dis 2012 205 Suppl 1 S103-11 BACKGROUND: The Expanded Program on Immunization Contact Method (EPI-CM) is a proposed monitoring and program management tool for developing countries. The method involves health workers tallying responses to questions about health behaviors during routine immunizations and providing targeted counseling. We evaluated whether asking caretakers about health behaviors during EPI visits led to changes in those behaviors. METHODS: We worked in 2 districts in Mali: an intervention district where during immunization visits workers asked about 4 health behaviors related to bed net use, fever, respiratory disease, and diarrhea, and a control district where workers conducted routine immunization activities without health behavior questions. To evaluate the effect of EPI-CM, we conducted a cross-sectional household survey at baseline and 1 year postintervention. We used multivariate logistic regression to compare between districts the change over 1 year in 4 health behaviors: use of insecticide-treated nets, appropriate fever treatment, care-seeking for respiratory complaints, and appropriate diarrhea treatment. RESULTS: There were no significant differences between the 2 districts in the change in the 4 health behaviors when controlling for age, sex, maternal education and occupation, immunization history, and wealth. CONCLUSIONS: We found no evidence that EPI-CM increases healthy behaviors. Further evaluation of other potential benefits and costs of EPI-CM is warranted. |
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