Scholarly Commons @ Baystate Health
Not a member yet
8474 research outputs found
Sort by
Birth Outcomes in Relation to Neighborhood Food Access and Individual Food Insecurity During Pregnancy in the Environmental influences on Child Health Outcomes (ECHO)-Wide Cohort Study
No full textBackground: Limited access to healthy foods, resulting from residence in neighborhoods with low food access or from household food insecurity, is a public health concern. Contributions of these measures during pregnancy to birth outcomes remain understudied.
Objective: We examined associations of neighborhood food access and individual food insecurity during pregnancy with birth outcomes.
Study design: We used data from 53 cohorts participating in the nationwide Environmental influences on Child Health Outcomes (ECHO)-Wide Cohort Study. Participant inclusion required a geocoded residential address or response to a food insecurity question during pregnancy and information on birth outcomes. Exposures include low-income-low-food-access (LILA, where nearest supermarket is \u3e0.5 miles for urban or \u3e10 miles for rural areas) or low-income-low-vehicle-access (LILV, where few households have a vehicle and \u3e0.5 miles from the nearest supermarket) neighborhoods and individual food insecurity. Mixed-effects models estimated associations with birth outcomes, adjusting for socioeconomic and pregnancy characteristics.
Results: Among 22,206 pregnant participants (mean age 30.4 years) with neighborhood food access data, 24.1% resided in LILA neighborhoods and 13.6% in LILV neighborhoods. Of 1,630 pregnant participants with individual-level food insecurity data (mean age 29.7 years), 8.0% experienced food insecurity. Residence in LILA (vs. non-LILA) neighborhoods was associated with lower birth weight (β -44.3 grams; 95% CI -62.9, -25.6), lower birth weight-for-gestational-age z-score (-0.09 SD units; -0.12, -0.05), higher odds of small-for-gestational-age (OR 1.15; 95% CI 1.00, 1.33), and lower odds of large-for-gestational-age (0.85; 95% CI 0.77, 0.94). Similar findings were observed for residence in LILV neighborhoods. No associations of individual food insecurity with birth outcomes were observed.
Conclusion: Residence in LILA or LILV neighborhoods during pregnancy is associated with adverse birth outcomes. These findings highlight the need for future studies examining whether investing in neighborhood resources to improve food access during pregnancy would promote equitable birth outcomes.
Keywords: Birth Weight; Epidemiology; Food Insecurity; Gestational Age; Health Disparities; Neighborhood Food Access
Measuring accuracy of International Classification of Diseases codes in identification of patients with non-cystic fibrosis bronchiectasis
No full textIntroduction: Non-cystic fibrosis bronchiectasis is a disease which is increasing in incidence and prevalence worldwide. The incidence of the disease is frequently estimated using databases that rely on International Classification of Diseases, ninth and tenth revisions, clinical modification (ICD-9-CM/ICD-10-CM) discharge diagnoses. Code accuracy has proved to be a major issue for other diagnoses using ICD codes. This study aims to investigate the accuracy of the ICD codes for the diagnosis of non-cystic fibrosis bronchiectasis.
Methods: This is a retrospective diagnostic accuracy study which compares the radiologist\u27s diagnosis of bronchiectasis with the ICD code reflection of that diagnosis at discharge.
Results: Sensitivities were 34% (same for both ICD-9-CM and ICD-10-CM windows) and specificities ranged from 69% for the ICD-9-CM window to 81% for ICD-10-CM window.
Conclusion: We observed that ICD codes are an insufficient method to identify patients with a radiologist diagnosis of bronchiectasis
Sex differences in response inhibition-related neural predictors of PTSD in recent trauma-exposed civilians
No full textBackground: Females are more likely to develop posttraumatic stress disorder (PTSD) than males. Impaired inhibition has been identified as mechanism for PTSD development, but studies on the potential sex differences of this neurobiological mechanism and how it relates to PTSD severity and progression are sparse. Here we examined sex differences in neural activation during response inhibition and PTSD following recent trauma.
Methods: Participants (N= 205, 138 female sex assigned at birth) were recruited from emergency departments within 72 hours of a traumatic event. PTSD symptoms were assessed 2-weeks and 6-months post-trauma. A Go/NoGo task was performed 2-weeks post-trauma in a 3T MRI scanner to measure neural activity during response inhibition in the ventromedial prefrontal cortex (vmPFC), right inferior frontal gyrus (rIFG), and the bilateral hippocampus. General Linear models were used to examine the interaction effect of sex on the relationship between our regions of interest (ROIs) and the whole brain, and PTSD symptoms at 6-months, and symptom progression between 2-weeks and 6-months.
Results: Lower response-inhibition-related vmPFC activation 2-weeks post-trauma predicted more PTSD symptoms at 6-months in females but not in males, while greater response-inhibition-related rIFG activation predicted lower PTSD symptom progression in males but not females. Whole brain interaction effects were observed in the medial temporal gyrus and left precentral gyrus.
Conclusions: There are sex differences in the relationship between inhibition-related brain activation and PTSD symptom severity and progression. These findings suggest that sex differences should be assessed in future PTSD studies and reveal potential targets for sex-specific interventions.
Keywords: Posttraumatic stress disorder (PTSD); functional Magnetic Resonance Imaging (fMRI); response inhibition; right inferior frontal gyrus (rIFG); sex differences; ventromedial prefrontal cortex (vmPFC)
It Can\u27t Hurt! : Why Many Patients With Limited Life Expectancy Decide to Accept Lung Cancer Screening
No full textPurpose: Lung cancer screening (LCS) has less benefit and greater potential for iatrogenic harm among people with multiple comorbidities and limited life expectancy. Yet, such individuals are more likely to undergo screening than healthier LCS-eligible people. We sought to understand how patients with marginal LCS benefit conceptualize their health and make decisions regarding LCS.
Methods: We interviewed 40 people with multimorbidity and limited life expectancy, as determined by high Care Assessment Need scores, which predict 1-year risk of hospitalization or death. Patients were recruited from 6 Veterans Health Administration facilities after discussing LCS with their clinician. We conducted a thematic analysis using constant comparison to explore factors that influence LCS decision making.
Results: Patients commonly held positive beliefs about screening and perceived LCS to be noninvasive. When posed with hypothetical scenarios of limited benefit, patients emphasized the nonlongevity benefits of LCS (eg, peace of mind, planning for the future) and generally did not consider their health status or life expectancy when making decisions regarding LCS. Most patients were unaware of possible additional evaluations or treatment of screen-detected findings, but when probed further, many expressed concerns about the potential need for multiple evaluations, referrals, or invasive procedures.
Conclusions: Patients in this study with multimorbidity and limited life expectancy were unaware of their greater risk of potential harm when accepting LCS. Given patient trust in clinician recommendations, it is important that clinicians engage patients with marginal LCS benefit in shared decision making, ensuring that their values of desiring more information about their health are weighed against potential harms from further evaluations.
Keywords: cancer: screening; chronic care: comorbidity/multimorbidity; lung cancer; lung cancer screening; primary care issues: patient-centered care; qualitative methods: key informant/depth interviewing
SARS-CoV-2 Symptoms during the Omicron Surge Differ between Boosted and Vaccinated Non-Boosted Persons
No full textPurpose: To determine the impact of booster COVID-19 vaccination on SARS-CoV-2 symptoms. Background: The Omicron surge of infections provided an opportunity to evaluate symptoms in relation to booster receipt. Methods: At a US medical college, the number, type, and duration of symptoms were evaluated for 476 students or employees, factoring in days between last vaccination and SARS-CoV-2 diagnosis. Results: Compared with vaccinated non-boosted individuals, boosted individuals reported a significantly higher frequency of nasal congestion (57.9% vs. 44.4%, p = 0.018) and nasal congestion and/or sore throat (77.2% vs. 62.0%, p = 0.003); in contrast, the frequency of body/muscle aches was significantly less among boosted individuals (22.1% vs. 32.4%, p = 0.038). With each one week increase in time since booster receipt, the probability of fever increased significantly by 4.4% (OR 1.044, 95% CI 1.01, 1.07, p = 0.001), and the probability of cough increased significantly by 4.8% (OR 1.048, 95% CI 1.01, 10.8, p= 0.010). Conclusions: Within a medical college population, during the first 7 months of the Omicron surge of infections, compared with vaccinated non-boosted individuals, boosted individuals significantly more often reported the following: nasal congestion as well as nasal congestion and/or sore throat. In contrast, body/muscle aches were reported significantly less often. The rates of fever and cough each significantly increased as time since booster dose receipt increased. These data suggest that having had a booster vaccination, as well the timing of receiving it, impacts the clinical manifestations of breakthrough SARS-CoV-2 infections. Additional studies are needed to precisely define SARS-CoV-2 symptoms in relation to booster vaccinations.
Keywords: COVID-19 vaccination; Omicron; SARS-CoV-2; boosters; symptoms
SFRP1 decreases WNT-Mediated M2 macrophage marker expression in breast tissue
No full textThe Wnt family of secreted proteins are involved in mammary gland development and tumorigenesis. It has recently been shown that Wnt ligands promote M2 macrophage polarization and so we sought to determine the effects of a Wnt signaling antagonist, Secreted Frizzled Related Protein 1 (SFRP1), on M2 marker expression. We measured a murine M2 marker (Arg1) in mice with a targeted deletion of Sfrp1 during different stages of mammary gland development including puberty, pregnancy, and lactation, as well as in response to obesity. Next, to determine whether Wnt signaling/antagonism affects human M2 markers (CD209 and CCL18), we treated a human patient derived explant (PDE) breast tissue sample with exogenous Wnt3a in the presence and absence of rSFRP1. Finally, we expanded our PDE study to 13 patients and performed bulk RNAseq analysis following the treatment described above. We found that in loss of Sfrp1 in the murine mammary gland increased Arg1 expression. Moreover, we showed that Wnt3a increases CD209 and CCL18 mRNA and protein expression in breast PDEs and that their expression is decreased in response to rSFRP1. Our RNAseq analysis unveiled novel genes that were affected by Wnt3a treatment and subsequently reversed when rSFRP1 was added. Validation of these data exhibited that chemokines involved in promoting macrophage polarization and cancer metastasis, including CCL11 and CCL26, were stimulated by Wnt3a signaling and their expression was abrogated by treatment with rSFRP1. Our data suggest that SFRP1 may be an important mediator that tempers Wnt signaling in the tumor microenvironment
Achromobacter cluster related to COVID-19 supply chain issues
No full textIsolation of an unusual organism, Achromobacter xylosoxidans, from 2 cardiac surgical patients on the same day prompted an investigation to search for cases and cause. An extensive review demonstrated a pseudo-outbreak related to practices to conserve laboratory saline due to short supply resulting from supply chain shortage from the coronavirus disease 2019 pandemic
Enhanced Recovery After Surgery Cardiac Society turnkey order set for prevention and management of postoperative atrial fibrillation after cardiac surgery: Proceedings from the American Association for Thoracic Surgery ERAS Conclave 2023
No full textBackground: Postoperative atrial fibrillation (POAF) is a prevalent complication following cardiac surgery that is associated with increased adverse events. Several guidelines and expert consensus documents have been published addressing the prevention and management of POAF. We aimed to develop an order set to facilitate widespread implementation and adoption of evidence-based practices for POAF following cardiac surgery.
Methods: Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set (TKO) for POAF. Orders derived from consistent class I or IIA or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the TKO in bold type. Selected orders that were inconsistently class I or IIA, class IIB, or supported by published evidence appear in italic type.
Results: Preoperatively, the recommendation is to screen patients for paroxysmal or chronic atrial fibrillation and initiate appropriate treatment based on individual risk stratification for the development of POAF. This may include the administration of beta-blockers or amiodarone, tailored to the patient\u27s specific risk profile. Intraoperatively, surgical interventions such as posterior pericardiotomy should be considered in selected patients. Postoperatively, it is crucial to focus on electrolyte normalization, implementation strategies for rate or rhythm control, and anticoagulation management. These comprehensive measures aim to optimize patient outcomes and reduce the occurrence of POAF following cardiac surgery.
Conclusions: Despite the well-established benefits of implementing a multidisciplinary care pathway for POAF in cardiac surgery, its adoption and implementation remain inconsistent. We have developed a readily applicable order set that incorporates recommendations from existing guidelines.
Keywords: enhanced recovery; perioperative care; postoperative atrial fibrillation