Identifying risk factors for early-onset colorectal cancer (EOCRC) could help reverse its rising incidence through risk factor reduction and/or early screening. We sought to identify EOCRC risk factors that could be used for decisions... more
Identifying risk factors for early-onset colorectal cancer (EOCRC) could help reverse its rising incidence through risk factor reduction and/or early screening. We sought to identify EOCRC risk factors that could be used for decisions about early screening. Using electronic databases and medical record review, we compared male veterans ages 35 to 49 years diagnosed with sporadic EOCRC (2008–2015) matched 1:4 to clinic and colonoscopy controls without colorectal cancer, excluding those with established inflammatory bowel disease, high-risk polyposis, and nonpolyposis syndromes, prior bowel resection, and high-risk family history. We ascertained sociodemographic and lifestyle factors, family and personal medical history, physical measures, vital signs, medications, and laboratory values 6 to 18 months prior to case diagnosis. In the derivation cohort (75% of the total sample), univariate and multivariate logistic regression models were used to derive a full model and a more parsimonio...
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Identifying risk factors for early-onset colorectal cancer (EOCRC) could help reverse its rising incidence through risk factor reduction and/or early screening. We sought to identify EOCRC risk factors that could be used for decisions... more
Identifying risk factors for early-onset colorectal cancer (EOCRC) could help reverse its rising incidence through risk factor reduction and/or early screening. We sought to identify EOCRC risk factors that could be used for decisions about early screening. Using electronic databases and medical record review, we compared male veterans ages 35 to 49 years diagnosed with sporadic EOCRC (2008–2015) matched 1:4 to clinic and colonoscopy controls without colorectal cancer, excluding those with established inflammatory bowel disease, high-risk polyposis, and nonpolyposis syndromes, prior bowel resection, and high-risk family history. We ascertained sociodemographic and lifestyle factors, family and personal medical history, physical measures, vital signs, medications, and laboratory values 6 to 18 months prior to case diagnosis. In the derivation cohort (75% of the total sample), univariate and multivariate logistic regression models were used to derive a full model and a more parsimonio...
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Supplemental Methods 1: Contains details pertaining to data analysis
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Supplemental Table 1: Contains descriptive data for all candidate variables in cases and controls
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Objectives: To understand the impact of the coronavirus disease-2019 pandemic on sleep services within the United States Department of Veterans Affairs using separate surveys from “pre-COVID” and pandemic periods. Methods: Data from a... more
Objectives: To understand the impact of the coronavirus disease-2019 pandemic on sleep services within the United States Department of Veterans Affairs using separate surveys from “pre-COVID” and pandemic periods. Methods: Data from a pre-pandemic survey (September to November 2019) were combined with data from a pandemic-period survey (August to November 2020) to Veterans Affairs sleep medicine providers about their local sleep services within 140 Veterans Affairs facilities). Results: A total of 67 (47.9%) facilities responded to the pandemic online survey. In-lab diagnostic and titration sleep studies were stopped at 91.1% of facilities during the pandemic; 76.5% of facilities resumed diagnostic studies and 60.8% resumed titration studies by the time of the second survey. Half of the facilities suspended home sleep testing; all facilities resumed these services. In-person positive airway pressure clinics were stopped at 76.3% of facilities; 46.7% resumed these clinics. Video tele...
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Objective The objective of this study was to derive profiles of alcohol, tobacco, and recreational drug use during pregnancy for first-time mothers with latent class growth analysis (LCGA) and determine the association of these classes... more
Objective The objective of this study was to derive profiles of alcohol, tobacco, and recreational drug use during pregnancy for first-time mothers with latent class growth analysis (LCGA) and determine the association of these classes with the risk of adverse pregnancy outcomes (APO). Study Design A secondary analysis of a prospective cohort of Nulliparous Outcomes in Pregnancy: Monitoring Mothers-to-Be was conducted in eight medical centers across the United States from September 30, 2010, to September 23, 2013. Self-reported use of any alcohol, tobacco, or recreational drugs in the 1 month prior to the visit was assessed at up to four visits throughout pregnancy, and APOs included a composite of preterm birth, hypertensive disorder of pregnancy (HDP), small for gestational age (SGA) infant, or stillbirth, and each adverse outcome separately. Results Four latent classes were identified from the LCGA for 10,031 nulliparous pregnant women that were on average 26.9 years old (standar...
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Background Chronic neck pain (CNP) is prevalent, and it reduces functional status and quality of life and is associated with deleterious psychological outcomes in affected individuals. Despite the desirability of massage and its... more
Background Chronic neck pain (CNP) is prevalent, and it reduces functional status and quality of life and is associated with deleterious psychological outcomes in affected individuals. Despite the desirability of massage and its demonstrated effectiveness in CNP treatment, multiple accessibility barriers exist. Caregiver-applied massage has demonstrated feasibility in various populations but has not been examined in Veterans with CNP or compared in parallel to therapist-delivered massage. Objective This manuscript described the original study design, lessons learned, and resultant design modifications for the Trial Outcomes for Massage: Care Ally–Assisted Versus Therapist-Treated (TOMCATT) study. Methods TOMCATT began as a 3-arm, randomized controlled trial of 2 massage delivery approaches for Veterans with CNP with measures collected at baseline, 1 and 3 months after intervention, and 6 months (follow-up). Arm I, care ally–assisted massage, consisted of an in-person, 3.5-hour train...
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BackgroundConfigurational methods are increasingly being used in health services research.ObjectivesTo use configurational analysis and logistic regression within a single data set to compare results from the two methods.DesignSecondary... more
BackgroundConfigurational methods are increasingly being used in health services research.ObjectivesTo use configurational analysis and logistic regression within a single data set to compare results from the two methods.DesignSecondary analysis of an observational cohort; a split-sample design involved randomly dividing patients into training and validation samples.Participants and settingPatients who had a transient ischaemic attack (TIA) in US Department of Veterans Affairs hospitals.MeasuresThe patient outcome was the combined endpoint of all-cause mortality or recurrent ischaemic stroke within 1 year post-TIA. The quality-of-care outcome was the without-fail rate (proportion of patients who received all processes for which they were eligible, among seven processes).ResultsFor the recurrent stroke or death outcome, configurational analysis yielded a three-pathway model identifying a set of (validation sample) patients where the prevalence was 15.0% (83/552), substantially higher...
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BACKGROUND Chronic neck pain is prevalent and reduces functional status, quality of life, and is associated with deleterious psychological outcomes in affected individuals. Despite desirability for massage and its demonstrated... more
BACKGROUND Chronic neck pain is prevalent and reduces functional status, quality of life, and is associated with deleterious psychological outcomes in affected individuals. Despite desirability for massage and its demonstrated effectiveness for chronic neck pain, multiple accessibility barriers exist. Caregiver applied massage approaches have demonstrated feasibility in various populations but has not been examined in Veterans with chronic neck pain or compared in parallel to therapist-delivered massage. OBJECTIVE This manuscript describes the original study design, lessons learned, and resultant design modification for the Trial Outcomes for Massage: Care Ally-Assisted vs. Therapist Treated (TOMCATT) study. METHODS TOMCATT began as a 3-arm, randomized controlled trial of two massage delivery approaches for Veterans with chronic neck pain with measures collected at baseline, 1-, 3-(post-intervention), and 6months (follow-up). Arm I: Care ally-assisted massage consisted of: i) in-per...
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Background To understand the impact of the COVID-19 pandemic on sleep services within the US Department of Veterans Affairs (VA) using separate surveys from “pre-COVID” and pandemic periods (N=140 VA facilities). Most sleep services were... more
Background To understand the impact of the COVID-19 pandemic on sleep services within the US Department of Veterans Affairs (VA) using separate surveys from “pre-COVID” and pandemic periods (N=140 VA facilities). Most sleep services were interrupted secondary to the COVID-19 pandemic: more than three-quarters of facilities that responded to the survey discontinued in-lab studies, approximately two-thirds suspended in-person positive airway pressure (PAP) clinics, and one-third stopped home sleep testing (HST). As the pandemic progressed, in-lab diagnostic and titration studies resumed at more than half of sites, less than half provided in-person PAP services, whereas all facilities restarted HST. Most expanded or started telehealth services. Infection control precautions were common. Increased stress, anxiety, fear, and burnout related to the pandemic and workflow changes were often reported by respondents. Methods Data from a pre-pandemic survey (September-November 2019) were combi...
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Background: Patients vary greatly in their use of care after hospitalization for stroke. We classified stroke patients according to their care trajectories and associated costs in the 12-month period after hospital discharge. Methods: We... more
Background: Patients vary greatly in their use of care after hospitalization for stroke. We classified stroke patients according to their care trajectories and associated costs in the 12-month period after hospital discharge. Methods: We followed a cohort of 3,811 veterans for one year after hospitalization with ischemic stroke in Veterans Health Administration facilities in 2007. Three discharge outcomes -- nursing home care, home care, and mortality -- were modeled jointly with Latent Class Growth Analysis. VA and Medicare costs were obtained for use of institutional care (inpatient acute, rehabilitation facility, and nursing home) and home care (home health, other home care, and outpatient rehabilitation). Covariates included patient age, NIHSS stroke severity and FIM scores measured at hospital discharge. Results: Members of the cohort had one of five care trajectories: 49% had a Rapid Recovery with little or no use of care in the 12 months after discharge, 15% had a Gradual Rec...
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Objective Social support has been linked to more effective pain adaptation. The relationship between social support and other relevant constructs is less well understood. Chief among these is patient activation, which has robust links to... more
Objective Social support has been linked to more effective pain adaptation. The relationship between social support and other relevant constructs is less well understood. Chief among these is patient activation, which has robust links to effective self-management, yet has not been well studied in chronic pain. We sought to better understand these relationships in an effort to inform future intervention strategies for patients with chronic pain. Methods Using baseline data from a clinical trial with patients with chronic pain (N = 213), we analyzed the relationships among perceived social support and patient activation, depression, anxiety, general health perceptions, pain centrality, pain catastrophizing, and pain intensity and interference. Multiple linear regression was used to examine the effect of social support on outcomes. Patient activation was explored as a mediator of the effect of social support on outcomes. Results Social support was significantly associated with all outc...
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OBJECTIVE: To estimate alcohol, tobacco, and recreational drug use during pregnancy among nulliparous women. METHODS: In a cohort of nulliparous women followed through pregnancy from the first-trimester nuMoM2b (Nulliparous Outcomes in... more
OBJECTIVE: To estimate alcohol, tobacco, and recreational drug use during pregnancy among nulliparous women. METHODS: In a cohort of nulliparous women followed through pregnancy from the first-trimester nuMoM2b (Nulliparous Outcomes in Pregnancy: Monitoring Mothers to be) study, self-reported use of alcohol, tobacco, and drugs was chronicled longitudinally at four study visits in this secondary analysis. Rates of use before pregnancy, in each trimester (visit 1, visit 2, visit 3, approximating each trimester), and at the time of delivery (visit 4) were recorded. The amount of alcohol, tobacco, and drug exposure were recorded using validated measures, and trends across pregnancy were analyzed. RESULTS: Of the 10,038 study participants, 10,028 had information regarding alcohol, tobacco, and drug use at visit 1, 9,412 at visit 2, 9,217 at visit 3, and 7,167 at visit 4. The rates of drinking alcohol, which had been 64.6% in the 3 months before pregnancy, were lower in pregnancy (3.9% at...
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OBJECTIVE Although yoga shows promise as a treatment for posttraumatic stress disorder (PTSD), there are few randomized controlled trials that demonstrate significant benefits for individuals with PTSD. The present study addresses this... more
OBJECTIVE Although yoga shows promise as a treatment for posttraumatic stress disorder (PTSD), there are few randomized controlled trials that demonstrate significant benefits for individuals with PTSD. The present study addresses this need by comparing the effects of a holistic yoga program (HYP) to that of a wellness lifestyle program (WLP) on PTSD symptom severity with a randomized clinical trial. METHOD The sample consisted of 209 participants (91.4% veterans; 66% male; 61.7% White) who met diagnostic criteria for PTSD at baseline. Participants were randomly assigned to attend one of the 2 weekly interventions for 16 weeks. The HYP consisted of yoga instruction, while the WLP consisted of didactics, discussions, and walking. PTSD severity was measured using the Clinician Administered PTSD Scale (CAPS-5) and the PTSD Checklist (PCL-5). RESULTS Analyses revealed that the HYP reduced PTSD severity measured by the CAPS-5 significantly more than the WLP at treatment end (mean difference = -5.4, effect size = 0.46, p < .001), but not at 7-month follow up (mean difference = -0.9, p = .603). Similarly, the HYP reduced PTSD severity measured by the PCL-5 significantly more than the WLP at treatment end (difference = -6.0, p = .001), but not at 7-month follow up (mean difference = -1.0, p = .682). CONCLUSION Yoga may be an effective intervention for PTSD in addition to standard treatments. Future yoga trials should consider adding a social component to interventions or booster classes to maintain effects long term. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Background: Rapid repeat pregnancy (RRP) is common among adolescents and is associated with adverse maternal and infant outcomes. Despite evidence that use of long-acting forms of contraception before hospital discharge can help minimize... more
Background: Rapid repeat pregnancy (RRP) is common among adolescents and is associated with adverse maternal and infant outcomes. Despite evidence that use of long-acting forms of contraception before hospital discharge can help minimize RRP rates, barriers to placement existed within the state of Indiana. We sought to determine state-specific RRP and induced abortion rates for adolescents based on chosen postpartum contraception to inform policy change. Methods: We examined a retrospective cohort of 227 adolescents (ages 12-18 years) who gave birth in Indiana between 2010 and 2012. Demographics, postpartum contraception, and subsequent pregnancies or abortions after the sentinel delivery were obtained. Rates of RRP based on type of immediate postpartum contraception, etonogestrel (ENG) contraceptive implant, depo-medroxyprogesterone acetate (DMPA) injection, and short-acting methods were compared. Bivariate and logistic regression analyses were conducted. Results: RRP rates were 3.7% for those with ENG contraceptive implant, 22.6% for those with DMPA, and 39.1% for those who choose short-acting methods (p = 0.01). Adolescents who did not choose an ENG contraceptive implant were significantly more likely to have an RRP (adjusted odds ratio [aOR] = 11.8, 95% confidence interval: 2.74-110.3), compared with other contraceptive methods, even after adjusting for covariates such as age, prior pregnancies, and postpartum visit attendance. Conclusions: Immediate postpartum receipt of ENG implant was significantly associated with a lower likelihood of RRP in adolescents in Indiana. These data facilitated state policy change regarding insurance reimbursement to improve statewide access for all women, regardless of age, showing how local data can inform policy change.
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INTRODUCTION: This study assessed the attitudes, knowledge and experiences caring for lesbian, bisexual, and transgender (LBT) patients among members of a national group of obstetrician-gynecologists. METHODS: Members of the American... more
INTRODUCTION: This study assessed the attitudes, knowledge and experiences caring for lesbian, bisexual, and transgender (LBT) patients among members of a national group of obstetrician-gynecologists. METHODS: Members of the American College of Obstetricians and Gynecologists (the College) who attended College meetings in Denver and Indiana completed a survey assessing care practices, knowledge and attitudes toward LBT patients. RESULTS: 196 out of 425 (46.1%) physicians completed the survey. Most physicians often or sometimes ask about sexual orientation, but they rarely ask about gender identity. Over 98% feel comfortable treating lesbian and bisexual patients, but 30% believe a provider should be allowed to decline to treat LBT patients if it conflicts with the provider’s religious beliefs. Over 84% agree that their workplace is a safe place for LGBT patients, but most do not have or know if they have office measures that would create a welcoming space, such as posted nondiscrimi...
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INTRODUCTION: To assess the rate of and reasons for unfulfilled sterilization requests, specifically regarding issues with the Medicaid Consent for sterilization, and to determine the proportion of patients who subsequenstly receive... more
INTRODUCTION: To assess the rate of and reasons for unfulfilled sterilization requests, specifically regarding issues with the Medicaid Consent for sterilization, and to determine the proportion of patients who subsequenstly receive interval sterilization by 3 months postpartum. METHODS: Prospective observational cohort study of women delivering over an 8 month period and requesting immediate postpartum sterilization. Records of women with unfulfilled requests were reviewed up to 3 months postpartum to determine rates of postpartum follow up and interval sterilization. Primary analysis examined unfulfilled sterilization requests associated with the Medicaid Consent form and secondarily all other reasons for unfulfilled requests and alternative contraceptive methods chosen. Bivariate analyses were performed to evaluate the relationship between unfulfilled sterilization and sociodemographic characteristics. RESULTS: 334 women delivered and requested immediate postpartum sterilization....
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Research Interests: Prostate Cancer, Medicine, Clinical Pathology, Prospective studies, Humans, and 15 moreClinical, Male, Clinical Sciences, Aged, Middle Aged, Neoplasm Invasiveness, Prognosis, Prostate Specific Antigen, Logistic Models, Adenocarcinoma, Neoplasm staging, Prostatic neoplasms, Prostatectomy, surgical margin, and Perineural invasion
BackgroundFibromyalgia is a common pain condition that often leads to significant disability. Unfortunately, the effectiveness of most medications for fibromyalgia is limited, and there is a need for alternative, non-pharmacological... more
BackgroundFibromyalgia is a common pain condition that often leads to significant disability. Unfortunately, the effectiveness of most medications for fibromyalgia is limited, and there is a need for alternative, non-pharmacological therapies. Yoga and aerobic exercise are both evidence-based non-pharmacological treatments for fibromyalgia. However, no prior studies have directly compared the effectiveness of yoga vs. exercise.ObjectiveThis article describes the study design and recruitment outcomes of the Pain Outcomes comparing Yoga vs. Structured Exercise (POYSE) Trial, a two-arm randomized comparative effectiveness trial.MethodsVeterans with fibromyalgia, defined by the 2010 American College of Rheumatology diagnostic criteria, who also experienced at least moderate pain severity were enrolled. The participants were randomized to a 12-week yoga-based or a structured exercise program (SEP) and will undergo comprehensive outcome assessments at baseline, 1, 3, 6, and 9 months by in...
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Research Interests: Medicine, Colorectal cancer, Humans, Internal Medicine, Female, and 15 moreMale, Massachusetts, Colonoscopy, African Americans, Aged, Middle Aged, Odds ratio, European Continental Ancestry Group, Asymptomatic, Adenoma, Cross Sectional Studies, Participants, Colorectal Neoplasms, mass Screening, and Medical and Health Sciences
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Although video-based teleconferencing is becoming more widespread in the medical profession, especially for scheduled consultations, applications for rapid assessment of acute medical problems are rare. After regular business hours in the... more
Although video-based teleconferencing is becoming more widespread in the medical profession, especially for scheduled consultations, applications for rapid assessment of acute medical problems are rare. After regular business hours in the nursing home, physicians are often not immediately available at the bedside to evaluate patients with acute medical problems. Spontaneous videoconferencing between residents (patients) and off-site, on-call physicians offers additional opportunities for physicians to gather additional information directly from residents. We have designed, assembled, tested, and implemented a portable, wireless conferencing system that uses public Internet channels for secure, live videoconferencing. The system includes a rolling cart with videoconferencing hardware and software, a remotely controllable digital camera, lamps, wireless network, and battery. A semi-automated paging system informs physicians of residents’ study status and indications for conferencing. ...
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Tumor volume is one of the most powerful predictors of patient outcome in prostatic adenocarcinoma. It is uncertain as to which preoperative variables are most predictive of final tumor volume at radical prostatectomy, especially among... more
Tumor volume is one of the most powerful predictors of patient outcome in prostatic adenocarcinoma. It is uncertain as to which preoperative variables are most predictive of final tumor volume at radical prostatectomy, especially among patients who have had positive biopsies at multiple biopsy sites. The current study attempted to identify the biopsy variables that are most predictive of final tumor volume. The authors examined prostate biopsy specimens from 151 consecutive patients with at least 2 positive biopsy sites. The following data were collected: highest percentage of adenocarcinoma at any biopsy site, percentage of adenocarcinoma at the biopsy site with the highest Gleason score, highest percentage of cores positive for adenocarcinoma at any biopsy site, percentage of positive cores with carcinoma at the site with the highest Gleason score, number of positive sites, tumor bilaterality, and percentage of biopsy sites positive for disease. All patients underwent radical prostatectomy. The prostatectomy specimens were entirely embedded and whole mounted. Tumor volume was measured using the grid method. Logarithmic transformation was applied to tumor volumes for the purposes of the analysis. Highest percentage of adenocarcinoma at any biopsy site (P = 0.012), percentage of adenocarcinoma at the biopsy site with the highest Gleason score (P = 0.021), number of positive biopsy sites (P = 0.026), tumor bilaterality (P = 0.008), and percentage of biopsy sites positive for disease (P = 0.0001) all were significant predictors of tumor volume on linear regression analysis. Highest percentage of cores positive for adenocarcinoma (P = 0.081) and percentage of positive cores with carcinoma at the site with the highest Gleason score (P = 0.240) were not significant predictors of tumor volume. Based on the model F statistic, percentage of biopsy sites positive for tumor, tumor bilaterality, and highest percentage of adenocarcinoma at any biopsy site were the variables that were most predictive of tumor volume. Highest percentage of adenocarcinoma at any biopsy site, percentage of adenocarcinoma at the biopsy site with the highest Gleason score, number of positive biopsy sites, tumor bilaterality, and percentage of biopsy sites positive for disease all are useful preoperative predictors of tumor volume in radical prostatectomy specimens. Although these preoperative biopsy parameters were significant in linear regression models, none was sufficient as a single predictor of tumor volume.
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Background: Telestroke consultation is increasingly used to provide stroke care. Much like in-person stroke consults, stroke mimics are common. This study sought to identify patient and hospital characteristics more likely to be... more
Background: Telestroke consultation is increasingly used to provide stroke care. Much like in-person stroke consults, stroke mimics are common. This study sought to identify patient and hospital characteristics more likely to be associated with a Telestroke diagnosis of stroke mimic. Methods: We analyzed 2 years of video consults by the VA National Telestroke Program (NTSP). Stroke mimic was defined as a Telestroke consult coded as a diagnosis of “other.” Text responses for “other” diagnoses were grouped into clinical categories. We used Chi-squared and t-tests analysis to compare characteristics of patients with a stroke mimic diagnosis and those without. Co-variates studied included age, gender, co-morbid conditions (history of dementia, cancer, or alcohol abuse), NIHSS, time of consult (night/weekend vs day), location of consult (emergency department vs inpatient), hospital rurality; hospital consult volume, and duration of institutional participation in NTSP at time of consult. ...
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Background and ObjectivesTelestroke networks are associated with improved outcomes from acute ischemic stroke (AIS) and facilitate greater access to care, particularly in underserved regions. These networks also have the potential to... more
Background and ObjectivesTelestroke networks are associated with improved outcomes from acute ischemic stroke (AIS) and facilitate greater access to care, particularly in underserved regions. These networks also have the potential to influence patient disposition through avoiding unnecessary interhospital transfers. This study examines the effect of implementation of the VA National Telestroke Program (NTSP) on interhospital transfer among Veterans.MethodsWe analyzed patients with AIS presenting to the emergency departments of 21 VA hospitals before and after telestroke implementation. Transfer rates were determined through review of administrative data and chart review and patient and facility-level characteristics were collected to identify predictors of transfer. Comparisons were made using t test, Wilcoxon rank sum, and χ2 analysis. Multivariable logistic regression with sensitivity analysis was conducted to assess the influence of telestroke implementation on transfer rates.Res...
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Background: Post-stroke depression (PSD) is a common occurrence after stroke, with multiple associated co-morbidities, and is often undermanaged. Perceived social support has been shown to be related to the presence of PSD; however,... more
Background: Post-stroke depression (PSD) is a common occurrence after stroke, with multiple associated co-morbidities, and is often undermanaged. Perceived social support has been shown to be related to the presence of PSD; however, little is known about the relationship of social support and its specific dimensions to baseline PSD severity and depression improvement. Methods: We conducted a secondary analysis of data collected as part of a PSD cohort study in which depressed and non-depressed patients were matched 1:1 and enrolled at approximately one month post-stroke. PSD presence was assessed by a structured clinical interview, and PSD severity by the total PHQ-9 score. PSD improvement was measured at 12 weeks, and was defined as a PHQ-9 score < 5 or a decrease by at least 50% from baseline. We constructed multivariable regression models to assess the relationships between social support, as measured by the Medical Outcomes Study Social Support Survey (MOS-SSS) and its subsca...
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Background: Due to difficulties estimating the risk of preterm labor, many women diagnosed with threatened preterm delivery and given antenatal corticosteroids to improve neonatal outcomes do not deliver until term. Our objective was to... more
Background: Due to difficulties estimating the risk of preterm labor, many women diagnosed with threatened preterm delivery and given antenatal corticosteroids to improve neonatal outcomes do not deliver until term. Our objective was to compare the short-term outcomes of infants born at term to women who received betamethasone (BMZ) for threatened preterm labor to infants who were not exposed to BMZ in utero. Methods: We performed a retrospective cohort study of infants born at or after 37 weeks’ gestational age (GA) to mothers diagnosed with threatened preterm labor during pregnancy. Controlling for covariates, the primary neonatal outcomes of interest, including transient tachypnea of the newborn (TTN), neonatal intensive care unit (NICU) admission, and birthweight, were evaluated for their association with BMZ exposure. Results: Of 5330 women, 1459 (27.5%) women received BMZ at a mean GA of 32.2±3.3 weeks. The mean age of women was 27±5.9 years-old and the mean GA at deli...
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BACKGROUND In the 1970s, numerous medical reports, media coverage, and litigation around the Dalkon Shield intrauterine device (IUD) led to a perception that all intrauterine devices cause upper genital tract infection and infertility.... more
BACKGROUND In the 1970s, numerous medical reports, media coverage, and litigation around the Dalkon Shield intrauterine device (IUD) led to a perception that all intrauterine devices cause upper genital tract infection and infertility. OBJECTIVE To assess the association between intrauterine device use and time to conception. STUDY DESIGN The Fertility After Contraceptive Termination Study is a multicenter, prospective cohort study of women stopping their contraceptive method to attempt conception. We recruited participants between 2011 and 2017. Participants were a convenience sample of women recruited from academic centers in Philadelphia, PA, Los Angeles, CA, St. Louis, MO, Indianapolis, IN, Aurora, Colorado, and Salt Lake City, Utah. Women were eligible if they stopped their contraceptive method within the past 120 days prior to enrollment, were between 18 and 35 years of age, had no history of infertility or sterilization, and had at least 6 months of follow-up. Baseline data included demographic and reproductive characteristics, past contraceptive use, nucleic acid amplification testing for sexually transmitted infections, and serology for past infection with Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. The primary exposure was intrauterine device use (ever); the primary outcome was time to conception. All participants were followed longitudinally for 24 months. We used piecewise exponential proportional hazards models with multiple imputation to provide hazard ratios (HR) and their respective 95% confidence intervals (CI). RESULTS Of the 461 participants, mean age was 28.2 years, 38.7% were Black, 34.1% were considered low socioeconomic status, and 59.7% had a history of intrauterine device use. Without adjusting for any covariates, the median time to conception was shorter for participants who had a history of intrauterine device use (5.1 months) compared to participants who never used an IUD (7.5 months). After controlling for potential confounders, the association of past IUD use with time to conception was not statistically significant (HRadj=1.25, 95% CI 0.99, 1.58). In our multivariable model, age, nulligravidity, Black race, low socioeconomic status, and past Mycoplasma genitalium infection (HR = 0.76, 95% CI = [0.58, 0.99]) were associated with longer times to conception. Conception by 12 months was lower in participants with past Mycoplasma genitalium infection (68% versus 80% without past infection; p = 0.019). CONCLUSIONS We found no impairment of fertility with ever use of an IUD. Serologic evidence of past M. genitalium infection was associated with longer times to conception and higher rates of infertility. M. genitalium infection is a potential modifiable cause of infertility.
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Objectives: To compare the effect of behaviorally-tailored mailed messages on patient activation to reduce stroke risk. Methods: We used EHR data to construct Framingham Stroke Risk Scores (FSRS) in primary care patients in one VA and one... more
Objectives: To compare the effect of behaviorally-tailored mailed messages on patient activation to reduce stroke risk. Methods: We used EHR data to construct Framingham Stroke Risk Scores (FSRS) in primary care patients in one VA and one non-VA urban healthcare system. Patients in the highest risk quintile were eligible. We recruited 15 subjects to develop four stroke risk messages: standard, incentive ($5 gift card), salience, and incentive plus salience. Patients were randomly assigned to receive one of the messages. All letters asked the patient to call a stroke prevention coordinator. Response to the messages (calling the prevention coordinator) was modeled separately in the two healthcare system cohorts using logistic regression. Results: From 6,695 eligibles, 1,759 Veterans (mean age 75.6, 99% male, 61% White, mean FSRS 18.6) and 2,084 non-Veterans (mean age 65.6, 36% male, 68% Black, mean FSRS 13.1) received a letter. Overall call response rate was 23% among Veterans and 13%...