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1.
Am J Kidney Dis ; 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31378646

RESUMO

RATIONALE & OBJECTIVE: Studies of patients on maintenance dialysis therapy suggest that standard-dose influenza vaccine (SDV) may not prevent influenza-related outcomes. Little is known about the comparative effectiveness of SDV versus high-dose influenza vaccine (HDV) in this population. STUDY DESIGN: Cohort study using data from the US Renal Data System. SETTING & PARTICIPANTS: 507,552 adults undergoing in-center maintenance hemodialysis between the 2010 to 2011 and 2014 to 2015 influenza seasons. EXPOSURES: SDV and HDV. OUTCOMES: All-cause mortality, hospitalization due to influenza or pneumonia, and influenza-like illness during the influenza season. ANALYTIC APPROACH: Patients were eligible for inclusion in multiple yearly cohorts; thus, our unit of analysis was the influenza patient-season. To examine the relationship between vaccine dose and effectiveness outcomes, we estimated risk differences and risk ratios using propensity score weighting of Kaplan-Meier functions, accounting for a wide range of patient- and facility-level characteristics. For nonmortality outcomes, we used competing-risk methods to account for the high mortality rate in the dialysis population. RESULTS: Within 225,215 influenza patient-seasons among adults 65 years and older, 97.4% received SDV and 2.6% received HDV. We observed similar risk estimates for HDV and SDV recipients for mortality (risk difference, -0.08%; 95% CI, -0.85% to 0.80%), hospitalization due to influenza or pneumonia (risk difference, 0.15%; 95% CI, -0.69% to 0.93%), and influenza-like illness (risk difference, 0.00%; 95% CI, -1.50% to 1.08%). Our findings were similar among adults younger than 65 years, as well as within other subgroups defined by influenza season, age group, dialysis vintage, month of influenza vaccination, and vaccine valence. LIMITATIONS: Residual confounding and outcome misclassification. CONCLUSIONS: The HDV does not appear to provide additional protection beyond the SDV against all-cause mortality or influenza-related outcomes for adults undergoing hemodialysis. The additional cost and side effects associated with HDV should be considered when offering this vaccine. Future studies of HDV and other influenza vaccine strategies are warranted.

2.
Addict Behav ; 2018 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-30415786

RESUMO

Randomized trials are considered the gold standard for assessing the causal effects of a drug or intervention in a study population, and their results are often utilized in the formulation of health policy. However, there is growing concern that results from trials do not necessarily generalize well to their respective target populations, in which policies are enacted, due to substantial demographic differences between study and target populations. In trials related to substance use disorders (SUDs), especially, strict exclusion criteria make it challenging to obtain study samples that are fully "representative" of the populations that policymakers may wish to generalize their results to. In this paper, we provide an overview of post-trial statistical methods for assessing and improving upon the generalizability of a randomized trial to a well-defined target population. We then illustrate the different methods using a randomized trial related to methamphetamine dependence and a target population of substance abuse treatment seekers, and provide software to implement the methods in R using the "generalize" package. We discuss several practical considerations for researchers who wish to utilize these tools, such as the importance of acquiring population-level data to represent the target population of interest, and the challenges of data harmonization.

3.
JAMA Intern Med ; 178(1): 102-109, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29228098

RESUMO

Importance: Increases in prescription opioid use in the United States have been attributed to changing prescribing guidelines and attitudes toward pain relief; however, the spread of opioid use within households through drug diversion may also be a contributing factor. Objective: To investigate whether individuals living in a household with a prescription opioid user are more likely to initiate prescription opioids themselves, compared with individuals in households with a prescription nonsteroidal anti-inflammatory drug (NSAID) user. Design, Setting, and Participants: This was a retrospective cohort study using administrative health care claims data from 2000 to 2014 of commercial insurance beneficiaries sharing a health plan with continuous prescription drug coverage, without opioid or NSAID use in the prior year. Enrollees were followed from the date of the first prescription filled by a household member for an eligible opioid or NSAID until initiation of prescription opioids, disenrollment, or administrative censoring after 1 year or the end of follow-up on December 31, 2014. Risk of opioid initiation was derived from inverse probability-weighted (IPW) Kaplan-Meier estimators that adjusted for potential confounders, prognostic factors, and predictors of censoring. Exposure: Outpatient pharmacy dispensing of a prescription opioid or prescription NSAID. Main Outcomes and Measures: Incident outpatient pharmacy fill for a prescription opioid by a household member. Results: From 2000 to 2014, 12 695 280 individuals were exposed to prescription opioids and 6 359 639 to prescription NSAIDS through an index prescription to a household member. The IPW estimated risk of opioid initiation in the subsequent year was 11.83% (95% CI, 11.81%-11.85%) among individuals exposed to prescription opioids in the household, compared with 11.11% (95% CI, 11.09%-11.14%) among individuals exposed to prescription NSAIDs, resulting in a risk difference of 0.71% (95% CI, 0.68%-0.74%). An unmeasured confounder that is modestly associated with the exposure (eg, prevalence difference = 0.9%) and the outcome (eg, risk difference = 0.9) after adjustment for all measured variables could explain our observed estimate of the overall risk difference (0.71%). Conclusions and Relevance: Living in a household with a prescription opioid user may increase risk of prescription opioid use, which may reflect both increased access to these products as well as shared risk factors, such as prescriber preference and prescription drug monitoring.

4.
Ann Epidemiol ; 25(6): 420-5, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25887701

RESUMO

PURPOSE: To investigate whether the gender gap in obesity prevalence is greater among U.S. blacks than whites in a study designed to account for racial differences in socioeconomic and environmental conditions. METHODS: We estimated age-adjusted, race-stratified gender gaps in obesity (% female obese - % male obese, defined as body mass index ≥30 kg/m(2)) in the National Health Interview Survey 2003 and the Exploring Health Disparities in Integrated Communities-Southwest Baltimore 2003 study (EHDIC-SWB). EHDIC-SWB is a population-based survey of 1381 adults living in two urban, low-income, racially integrated census tracts with no race difference in income. RESULTS: In the National Health Interview Survey, the obesity gender gap was larger in blacks than whites as follows: 7.7 percentage points (ppts; 95% confidence interval (CI): 3.4-11.9) in blacks versus -1.5 ppts (95% CI: -2.8 to -0.2) in whites. In EHDIC-SWB, the gender gap was similarly large for blacks and whites as follows: 15.3 ppts (95% CI: 8.6-22.0) in blacks versus 14.0 ppts (95% CI: 7.1-20.9) in whites. CONCLUSIONS: In a racially integrated, low-income urban community, gender gaps in obesity prevalence were similar for blacks and whites.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Obesidade/etnologia , Adulto , Baltimore/epidemiologia , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade
5.
Obesity (Silver Spring) ; 23(1): 213-9, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25294582

RESUMO

OBJECTIVES: Since the 1980s, older, low-educated White women experienced an unprecedented decrease in life expectancy. We investigated whether a similar phenomenon was evident among younger women for obesity. METHODS: Using the National Health and Nutrition Examination Survey, age-adjusted changes were estimated in the prevalence of overall and abdominal obesity (BMI ≥ 30 kg/m(2) , waist circumference > 88 cm) between 1988-1994 and 2003-2010 among non-Hispanic White women aged 25-44 years, stratified by educational attainment (

Assuntos
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Obesidade/epidemiologia , Populações Vulneráveis , Adulto , Afro-Americanos/estatística & dados numéricos , Escolaridade , Feminino , Humanos , Inquéritos Nutricionais , Obesidade/etnologia , Obesidade Abdominal , Pobreza/etnologia , Pobreza/estatística & dados numéricos , Prevalência , Risco , Populações Vulneráveis/etnologia , Populações Vulneráveis/estatística & dados numéricos , Circunferência da Cintura
6.
Eat Behav ; 14(4): 508-12, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24183146

RESUMO

INTRODUCTION: Evidence is growing that an addictive process may play a role in problematic eating behavior. The majority of research on this topic has examined the concept of "food addiction" solely in adult samples. If certain foods have addictive potential, children may be impacted as much as (or more) than adults due to psychological and neurobiological vulnerabilities at younger developmental stages. In the current study, we developed a measure of food addiction in children that reflects the diagnostic indicators of addiction. MATERIALS AND METHODS: The content and reading level of the Yale Food Addiction Scale (YFAS) was altered to be appropriate for children (YFAS-C). The YFAS-C and other eating-related measures were administered to study participants to examine the validity and reliability of the YFAS-C. PARTICIPANTS: 75 children were recruited from the community ranging from lean to obese. RESULTS: The validation of the YFAC-C provides preliminary support for its convergent validity with like constructs and incremental validity in predicting body mass index. Internal consistency was adequate given the small number of items on the scale. DISCUSSION: The YFAS-C appears to be a helpful tool for identifying addictive-like eating in children.


Assuntos
Comportamento Aditivo/diagnóstico , Comportamento Infantil/psicologia , Comportamento Alimentar/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Inquéritos e Questionários , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Masculino , Obesidade/psicologia , Reprodutibilidade dos Testes
7.
Prev Chronic Dis ; 9: E149, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22995103

RESUMO

INTRODUCTION: Governments throughout the world are using or considering various front-of-package (FOP) food labeling systems to provide nutrition information to consumers. Our web-based study tested consumer understanding of different FOP labeling systems. METHODS: Adult participants (N = 480) were randomized to 1 of 5 groups to evaluate FOP labels: 1) no label; 2) multiple traffic light (MTL); 3) MTL plus daily caloric requirement icon (MTL+caloric intake); 4) traffic light with specific nutrients to limit based on food category (TL+SNL); or 5) the Choices logo. Total percentage correct quiz scores were created reflecting participants' ability to select the healthier of 2 foods and estimate amounts of saturated fat, sugar, and sodium in foods. Participants also rated products on taste, healthfulness, and how likely they were to purchase the product. Quiz scores and product perceptions were compared with 1-way analysis of variance followed by post-hoc Tukey tests. RESULTS: The MTL+caloric intake group (mean [standard deviation], 73.3% [6.9%]) and Choices group (72.5% [13.2%]) significantly outperformed the no label group (67.8% [10.3%]) and the TL+SNL group (65.8% [7.3%]) in selecting the more healthful product on the healthier product quiz. The MTL and MTL+caloric intake groups achieved average scores of more than 90% on the saturated fat, sugar, and sodium quizzes, which were significantly better than the no label and Choices group average scores, which were between 34% and 47%. CONCLUSION: An MTL+caloric intake label and the Choices symbol hold promise as FOP labeling systems and require further testing in different environments and population subgroups.


Assuntos
Comportamento de Escolha , Participação da Comunidade/psicologia , Rotulagem de Alimentos/métodos , Preferências Alimentares/psicologia , Política Nutricional , Adulto , Participação da Comunidade/estatística & dados numéricos , Connecticut , Ingestão de Energia , Feminino , Alimentos/classificação , Alimentos Orgânicos , Comportamentos Relacionados com a Saúde , Educação em Saúde/métodos , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Valor Nutritivo , Avaliação de Programas e Projetos de Saúde
8.
Am J Prev Med ; 43(2): 134-41, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22813677

RESUMO

BACKGROUND: The U.S. food and beverage industry recently released a new front-of-package nutrition labeling system called Facts Up Front that will be used on thousands of food products. PURPOSE: To test consumer understanding of the Facts Up Front system (Facts Up Front) compared to the Multiple Traffic Light system (Traffic Light). Facts Up Front displays grams/milligrams and percentage daily value information for various nutrients; Traffic Light uses an interpretive color-coded scheme to alert consumers to low, medium, and high levels of certain nutrients. DESIGN: Participants in an Internet-based study were randomized to one of five front-of-package label conditions: (1) no label; (2) Traffic Light; (3) Traffic Light plus information about protein and fiber (Traffic Light+); (4) Facts Up Front; or (5) Facts Up Front plus information about "nutrients to encourage" (Facts Up Front+). SETTING/PARTICIPANTS: A total of 703 adults recruited through an online database in May 2011 participated in this study, and data were analyzed in June 2011. MAIN OUTCOME MEASURES: Total percentage correct quiz scores were generated reflecting participants' ability to compare two foods on nutrient levels, based on their labels, and to estimate amounts of saturated fat, sugar, sodium, fiber and protein in the foods. RESULTS: The front-of-package label groups outperformed the control group on nearly all of the nutrient quizzes (p<0.05). The control group did not differ from the Facts Up Front group on the saturated fat quiz, or from the Facts Up Front+ group on the sugars quiz. Those in the Traffic Light+ group had the best overall performance (>80% on all quizzes). CONCLUSIONS: Overall, those in the Traffic Light+ condition performed better than those in the Facts Up Front conditions on measures of nutrition knowledge and label perceptions. TRIAL REGISTRATION: This study is registered at clinicaltrials.gov NCT01626729.


Assuntos
Compreensão , Rotulagem de Alimentos/normas , Embalagem de Alimentos/normas , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Coleta de Dados , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Estados Unidos
9.
Public Health Nutr ; 15(2): 262-7, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21729490

RESUMO

OBJECTIVE: The 'Smart Choices' programme was an industry-driven, front-of-package (FOP) nutritional labelling system introduced in the USA in August 2009, ostensibly to help consumers select healthier options during food shopping. Its nutritional criteria were developed by members of the food industry in collaboration with nutrition and public health experts and government officials. The aim of the present study was to test the extent to which products labelled as 'Smart Choices' could be classified as healthy choices on the basis of the Nutrient Profile Model (NPM), a non-industry-developed, validated nutritional standard. DESIGN: A total of 100 packaged products that qualified for a 'Smart Choices' designation were sampled from eight food and beverage categories. All products were evaluated using the NPM method. RESULTS: In all, 64 % of the products deemed 'Smart Choices' did not meet the NPM standard for a healthy product. Within each 'Smart Choices' category, 0 % of condiments, 8·70 % of fats and oils, 15·63 % of cereals and 31·58 % of snacks and sweets met NPM thresholds. All sampled soups, beverages, desserts and grains deemed 'Smart Choices' were considered healthy according to the NPM standard. CONCLUSIONS: The 'Smart Choices' programme is an example of industries' attempts at self-regulation. More than 60 % of foods that received the 'Smart Choices' label did not meet standard nutritional criteria for a 'healthy' food choice, suggesting that industries' involvement in designing labelling systems should be scrutinized. The NPM system may be a good option as the basis for establishing FOP labelling criteria, although more comparisons with other systems are needed.


Assuntos
Informação de Saúde ao Consumidor/legislação & jurisprudência , Rotulagem de Alimentos , Alimentos Orgânicos/normas , Educação em Saúde/métodos , Legislação sobre Alimentos , Indústria Alimentícia , Promoção da Saúde , Humanos , Valor Nutritivo , Estados Unidos
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