RESUMO
Genetic studies of both the human host and Mycobacterium tuberculosis (MTB) demonstrate independent association with tuberculosis (TB) risk. However, neither explains a large portion of disease risk or severity. Based on studies in other infectious diseases and animal models of TB, we hypothesized that the genomes of the two interact to modulate risk of developing active TB or increasing the severity of disease, when present. We examined this hypothesis in our TB household contact study in Kampala, Uganda, in which there were 3 MTB lineages of which L4-Ugandan (L4.6) is the most recent. TB severity, measured using the Bandim TBscore, was modeled as a function of host SNP genotype, MTB lineage, and their interaction, within two independent cohorts of TB cases, N = 113 and 121. No association was found between lineage and severity, but association between multiple polymorphisms in IL12B and TBscore was replicated in two independent cohorts (most significant rs3212227, combined p = 0.0006), supporting previous associations of IL12B with TB susceptibility. We also observed significant interaction between a single nucleotide polymorphism (SNP) in SLC11A1 and the L4-Ugandan lineage in both cohorts (rs17235409, meta p = 0.0002). Interestingly, the presence of the L4-Uganda lineage in the presence of the ancestral human allele associated with more severe disease. These findings demonstrate that IL12B is associated with severity of TB in addition to susceptibility, and that the association between TB severity and human genetics can be due to an interaction between genes in the two species, consistent with host-pathogen coevolution in TB.
Assuntos
Coevolução Biológica , Mycobacterium tuberculosis/genética , Polimorfismo de Nucleotídeo Único , Tuberculose/genética , Adolescente , Adulto , Idoso , Proteínas de Transporte de Cátions/genética , Evolução Molecular , Feminino , Genoma Bacteriano , Interações Hospedeiro-Patógeno , Humanos , Subunidade p40 da Interleucina-12/genética , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/patogenicidade , Tuberculose/microbiologia , Tuberculose/patologiaRESUMO
Immediately after the approval of direct-acting antiviral medications for the treatment of hepatitis C virus (HCV) in 2013, state Medicaid programs limited access to these expensive treatments based on liver disease stage, absence of active alcohol or substance use, and prescriber limitations. New York State fee-for-service (FFS) Medicaid eliminated these requirements in May 2016, but the effect on providers and patients obtaining prior authorization (PA) from Medicaid managed care organizations (MCOs) was unknown. We used a mixed methods approach to assess whether the removal of HCV treatment restrictions was associated with changes in Medicaid MCOs' PA approval processes and length of time to treatment initiation at two large urban New York City provider organizations participating in Project INSPIRE, an HCV care coordination demonstration project. At baseline, the top criteria for clinic care coordinators ranking MCOs as being "most difficult" were liver staging criteria, delayed treatment, and requiring a urine toxicology test. At follow-up, liver staging criteria were replaced by medication formulary limitations. Univariate analysis of the Project INSPIRE participant data suggests a decrease in the percentage of participants with insurance/PA-related treatment delays pre- versus post-policy change (23% versus 15%, p value = 0.02). Interrupted time series analysis found a 2 percentage point decrease (p value = 0.02) in the proportion of PAs each month with insurance-related treatment delays that was attributable to policy change. These results from two urban clinics indicate New York State FFS Medicaid's policy change for HCV treatment may have been associated with some changes in Medicaid MCO PA decisions, but MCO PA denials and treatment delays were still observed "on the ground" by clinic staff.
Assuntos
Hepatite C Crônica , Hepatite C , Antivirais/uso terapêutico , Hepacivirus , Hepatite C/tratamento farmacológico , Humanos , Programas de Assistência Gerenciada , Medicaid , Cidade de Nova Iorque , Estados UnidosRESUMO
OBJECTIVE: To estimate the cost of delivering a hepatitis C virus care coordination program at 2 New York City health care provider organizations and describe a potential payment model for these currently nonreimbursed services. DESIGN: An economic evaluation of a hepatitis C care coordination program was conducted using micro-costing methods compared with macro-costing methods. A potential payment model was calculated for 3 phases: enrollment to treatment initiation, treatment initiation to treatment completion, and a bonus payment for laboratory evidence of successful treatment outcome (sustained viral response). SETTING: Two New York City health care provider organizations. PARTICIPANTS: Care coordinators and peer educators delivering care coordination services were interviewed about time spent on service provision. De-identified individual-level data on study participant utilization of services were also used. INTERVENTION: Project INSPIRE is an innovative hepatitis C care coordination program developed by the New York City Department of Health and Mental Hygiene. MAIN OUTCOME MEASURES: Average cost per participant per episode of care for 2 provider organizations and a proposed payment model. RESULTS: The average cost per participant at 1 provider organization was $787 ($522 nonoverhead cost, $264 overhead) per episode of care (5.6 months) and $656 ($429 nonoverhead cost, $227 overhead, 5.7 months) at the other one. The first organization had a lower macro-costing estimate ($561 vs $787) whereas the other one had a higher macro-costing estimate ($775 vs $656). In the 3-phased payment model, phase 1 reimbursement would vary between the provider organizations from approximately $280 to $400, but reimbursement for both organizations would be approximately $220 for phase 2 and approximately $185 for phase 3. CONCLUSIONS: The cost of this 5.6-month care coordination intervention was less than $800 including overhead or less than $95 per month. A 3-phase payment model is proposed and requires further evaluation for implementation feasibility. Project INSPIRE's HCV care coordination program provides good value for a cost of less than $95 per participant per month. The payment model provides an incentive for successful cure of hepatitis C with a bonus payment; using the bonus payment to support HCV tele-mentoring expands HCV treatment capacity and empowers more primary care providers to treat their own patients with HCV.
Assuntos
Hepatite C/terapia , Administração dos Cuidados ao Paciente/economia , Mecanismo de Reembolso , Gerenciamento Clínico , Custos de Cuidados de Saúde/estatística & dados numéricos , Hepacivirus/efeitos dos fármacos , Hepacivirus/patogenicidade , Hepatite C/epidemiologia , Humanos , Cidade de Nova Iorque/epidemiologia , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/tendênciasRESUMO
BACKGROUND: Appraisal delay is the time a patient takes to consider a symptom as not only noticeable, but a sign of illness. The study's objective was to determine the association between appraisal delay in seeking tuberculosis (TB) treatment and geographic distance measured by network travel (driving and pedestrian) time (in minutes) and distance (Euclidean and self-reported) (in kilometers) and to identify other risk factors from selected covariates and how they modify the core association between delay and distance. METHODS: This was part of a longitudinal cohort study known as the Kawempe Community Health Study based in Kampala, Uganda. The study enrolled households from April 2002 to July 2012. Multivariable interval regression with multiplicative heteroscedasticity was used to assess the impact of time and distance on delay. The delay interval outcome was defined using a comprehensive set of 28 possible self-reported symptoms. The main independent variables were network travel time (in minutes) and Euclidean distance (in kilometers). Other covariates were organized according to the Andersen utilization conceptual framework. RESULTS: A total of 838 patients with both distance and delay data were included in the network analysis. Bivariate analyses did not reveal a significant association of any distance metric with the delay outcome. However, adjusting for patient characteristics and cavitary disease status, the multivariable model indicated that each minute of driving time to the clinic significantly (p = 0.02) and positively predicted 0.25 days' delay. At the median distance value of 47 min, this represented an additional delay of about 12 (95% CI: [3, 21]) days to the mean of 40 days (95% CI: [25, 56]). Increasing Euclidean distance significantly predicted (p = 0.02) reduced variance in the delay outcome, thereby increasing precision of the mean delay estimate. At the median Euclidean distance of 2.8 km, the variance in the delay was reduced by more than 25%. CONCLUSION: Of the four geographic distance measures, network travel driving time was a better and more robust predictor of mean delay in this setting. Including network travel driving time with other risk factors may be important in identifying populations especially vulnerable to delay.
Assuntos
Acessibilidade aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Viagem/estatística & dados numéricos , Tuberculose/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Uganda , Adulto JovemRESUMO
Community water fluoridation is considered a significant public health achievement of the 20th century. In this paper, the hypothesis that added water fluoridation has contributed to diabetes incidence and prevalence in the United States was investigated. Panel data from publicly available sources were used with population-averaged models to test the associations of added and natural fluoride on the outcomes at the county level in 22 states for the years 2005 and 2010. The findings suggest that a 1 mg increase in the county mean added fluoride significantly positively predicts a 0.23 per 1,000 person increase in age-adjusted diabetes incidence (P < 0.001), and a 0.17% increase in age-adjusted diabetes prevalence percent (P < 0.001), while natural fluoride concentration is significantly protective. For counties using fluorosilicic acid as the chemical additive, both outcomes were lower: by 0.45 per 1,000 persons (P < 0.001) and 0.33% (P < 0.001), respectively. These findings are adjusted for county-level and time-varying changes in per capita tap water consumption, poverty, year, population density, age-adjusted obesity and physical inactivity, and mean number of years since water fluoridation started. Sensitivity analyses revealed robust effects for both types of fluoride. Community water fluoridation is associated with epidemiological outcomes for diabetes.
Assuntos
Diabetes Mellitus/epidemiologia , Fluoretação , Fluoretos/administração & dosagem , Ácido Silícico/administração & dosagem , Diabetes Mellitus/induzido quimicamente , Relação Dose-Resposta a Droga , Fluoretação/estatística & dados numéricos , Humanos , Incidência , Prevalência , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: Individual adherence to a 9-month regimen of isoniazid (9INH) for treatment of latent tuberculosis infection (LTBI) was hypothesized to reflect a prevalent elastic health behavior pattern, or prevention behavior correlated with relevant disease burden. METHOD: Log-rank tests were used to compare survival functions among raw prevalence tertiles for diseases including TB, diabetes, and obesity. Own and cross-prevalence elasticities were calculated and spatially characterized behavioral response to diseases that may impact TB re-infection and/or re-activation. Discrete choice models were used to assess the significance of the spatial elasticities among an ethnically diverse clinic population of 552 patients in an urban American county in 2010. RESULTS: Log-rank results revealed a statistical association between dropout and chronic disease prevalence (p < .01), but not TB prevalence (p = .13). Discrete choice models incorporating spatial elasticities and controlling for patient- and treatment-level characteristics demonstrated significant associations with adherence (p < .01), an effect robust to various alternative treatment definitions. CONCLUSION: Individual LTBI adherence tracks a prevalence elastic pattern that may represent a potential risk for re-infection and re-activation.
Assuntos
Antituberculosos/uso terapêutico , Isoniazida/uso terapêutico , Tuberculose Latente/tratamento farmacológico , Adesão à Medicação/psicologia , Adulto , Idoso , Feminino , Humanos , Tuberculose Latente/epidemiologia , Tuberculose Latente/psicologia , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Análise Espacial , Adulto JovemAssuntos
Antituberculosos , Tuberculose Latente , Humanos , Mycobacterium tuberculosis , TuberculoseRESUMO
This study assessed the impact of individual social risk factor variables and social determinants of health (SDOH) measures on hospital readmission rates and penalties used in the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP). Using 2012-16 hospital discharge data from New York City, we projected HRRP penalties by augmenting CMS's readmission model for heart attack, heart failure, and pneumonia with SDOH scores constructed at each of four geographic levels and a measure of individual-level social risk. Including additional SDOH scores in the model, especially those constructed with the most granular geographic data, along with social risk factor variables substantially affects projected penalties for hospitals treating the highest proportion of patients with high SDOH scores. Improved performance occurred even after we included peer-group stratification in the HRRP model pursuant to the 21st Century Cures Act. Small improvements in model accuracy were associated with substantial shifts in projected performance. Our results suggest that CMS's continued omission of relevant patient and geographic data from the HRRP readmission model misallocates penalties attributable to SDOH and social risk factor effects to hospitals with the largest share of high-risk patients.
Assuntos
Readmissão do Paciente , Determinantes Sociais da Saúde , Idoso , Humanos , Medicare , Cidade de Nova Iorque , Políticas , Estados UnidosRESUMO
The New York City Department of Health and Mental Hygiene (DOHMH) implemented Project INSPIRE, an integrated model of hepatitis C care coordination and telementoring services, from 2014 to 2017. We evaluated the use of chronic care management (CCM) codes to sustain the intervention. DOHMH data were collected as part of a Healthcare Innovation Award from the Centers for Medicare & Medicaid Services (CMS). A retrospective cohort medical billing study was conducted by assigning INSPIRE activities to procedure codes in both facility and nonfacility settings. Rates for procedures were extracted from the CMS's 2018 fee schedules and added across the eligibility periods for Medicare enrollees. Reimbursement was adjusted on the basis of expected patient attrition and compared to costs. The minimum number needed to treat (NNT) to break even was calculated in each setting. Facility reimbursement was higher than costs, whereas nonfacility reimbursement was lower (both P < .01). The NNT was 23 patients in facilities and 33 patients in nonfacilities; 24 patients per care coordinator were treated annually in INSPIRE. CCM fees alone were insufficient to fully reimburse the costs in either setting. Implementation of an appropriate risk financing strategy is necessary to mitigate financial shortfalls when providing CCM services in facility settings.
Assuntos
Cuidados Críticos/economia , Cuidados Críticos/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Hepatite C/economia , Hepatite C/terapia , Medicare/economia , Medicare/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Centers for Medicare and Medicaid Services, U.S./estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Masculino , Cidade de Nova Iorque , Estudos Retrospectivos , Estados UnidosRESUMO
INTRODUCTION: Epidemiological and genetic studies have reported a link between antecedent ADHD and dementia. The underpinning mechanisms of these associations are not known and have generated considerable speculation. METHODS: We have extracted hospitalization discharge data on dementia and ADHD (representing a severe phenotype) from the Healthcare Cost and Utilization Project (HCUPnet) and utilized a Poisson regression with two-ways fixed effects to investigate this association. RESULTS: An unadjusted ten-year lagged measure of a severe ADHD phenotype increases hospitalization risk for an all-listed Lewy Body Dementia (LBD) diagnosis (IRR: 1.21, 95% C.I. 1.08-1.35) and Alzheimer's disease (AD) discharge diagnosis (IRR: 1.15, 95% C.I.: 1.05-1.27). However, these relationships may be dependent upon the extent of metabolic dysregulation in a subtype-specific manner, as controlling for diabetes removes the significant association between antecedent ADHD and risk of AD but not LBD. DISCUSSION: These results indicate that the association between antecedent ADHD and dementia risk may be uniquely influenced by metabolic dysregulation, building upon prior discussion in this journal of a purported link between AD and diabetes. We tie the current findings to environmental risk factors that we have previously implicated in the etiology of ADHD to generate testable hypotheses on the underlying brain neurochemistry that may facilitate the link between metabolic dysregulation and dementia subtype risk.
Assuntos
Doença de Alzheimer/metabolismo , Transtorno do Deficit de Atenção com Hiperatividade/metabolismo , Doença por Corpos de Lewy/metabolismo , Doenças Metabólicas/metabolismo , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/patologia , Animais , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/patologia , Encéfalo/metabolismo , Encéfalo/patologia , Estudos de Coortes , Humanos , Doença por Corpos de Lewy/epidemiologia , Doença por Corpos de Lewy/patologia , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/patologia , Estados Unidos/epidemiologiaRESUMO
Yorbik et al. reported novel findings regarding a hypothesized relationship between childhood attention-deficit hyperactivity disorder (ADHD) and later risk for coronary heart disease in adulthood. The authors found that mean platelet volume (MPV), a marker of platelet reactivity and a presumable biomarker in patients with cardiovascular disease, was significantly elevated in children with ADHD compared to healthy controls. The mechanistic importance of this novel discovery remains unknown and warrants clarification. We have made the novel proposition that environmental exposure to the agricultural and combustion air pollutant, nitrous oxide (N2O), may be an etiological contributor to neurodevelopmental disorders. Clinical studies suggest that N2O may enhance platelet hyperaggregation, possibly via its biphasic role as an MAO inhibitor especially at trace levels of exposure or via the generation of oxidative stress. Therefore, this correspondence briefly details the hypothesis that altered biochemical profiles in neurodevelopmental disorders, derived from chronic environmental exposure to the agricultural and combustion air pollutant, N2O, may promote coronary artery disease in adulthood.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/complicações , Doença da Artéria Coronariana/etiologia , Adulto , Poluentes Atmosféricos/efeitos adversos , Apelina/sangue , Transtorno do Deficit de Atenção com Hiperatividade/sangue , Criança , Doença da Artéria Coronariana/sangue , Exposição Ambiental/efeitos adversos , Humanos , Volume Plaquetário Médio , Modelos Biológicos , Óxido Nitroso/efeitos adversos , Agregação Plaquetária/efeitos dos fármacos , Fatores de RiscoRESUMO
The incorporation of genetics into health services research has largely floundered, despite the rapidly accelerating availability of, and access to, such data. This is expected given the ethical questions involved. However, using these new resources robustly to examine population choices when it comes to health insurer selection, coverage therein and especially the subsequent use of health services is a necessary step forward, especially given the increasing prevalence of multimorbidity. Such a novel advancement in health services research may eventually propel public and private insurers to redesign their infrastructure to more accurately reflect the behavioural inclinations of their beneficiary populations. Using this resource will likely provide equally important insight for countries with extensive mixed insurer systems (like the United States) or nations with a greater emphasis on single-payer systems (such as various European models).
Assuntos
Genética Comportamental/métodos , Comportamentos Relacionados com a Saúde , Pesquisa sobre Serviços de Saúde/métodos , Variação Genética , Humanos , Participação do Paciente/psicologiaRESUMO
This short communication identifies a significant flaw in research investigating the neurodevelopmental consequences of general anesthesia exposure. We have identified that chronic environmental exposure to pervasive air pollutants that are also widely used as anesthetic agents, specifically nitrous oxide (N2O), may contribute to the rising prevalence of neurodevelopmental disorders. Consistent with the emerging link between microbes and psychiatric illness risk, this epidemiological analysis extends our prior conclusions by proposing that such exposures may alter host immunity so as to enhance vulnerability to certain pathogenic microbes that have been implicated in neurodevelopmental disorders, including Pseudomonas aeruginosa and Clostridium difficile.
Assuntos
Anestésicos Inalatórios/efeitos adversos , Infecções por Clostridium/complicações , Transtornos do Neurodesenvolvimento/induzido quimicamente , Transtornos do Neurodesenvolvimento/complicações , Infecções por Pseudomonas/complicações , Adolescente , Adulto , Anestésicos Gerais/efeitos adversos , Criança , Pré-Escolar , Clostridioides difficile , Infecções por Clostridium/microbiologia , Humanos , Lactente , Pessoa de Meia-Idade , Infecções por Pseudomonas/etiologia , Pseudomonas aeruginosa , Adulto JovemRESUMO
Min and Min (2017) conducted an epidemiological investigation that revealed further support of a link between exposure to air pollution and risk for attention-deficit hyperactivity disorder (ADHD) in childhood. We have previously reported that exposure to the agricultural and combustion pollutant, nitrous oxide (N2O), may be a primary environmental trigger in the onset of neurodevelopmental disorders, like ADHD and autism spectrum disorders. In order to validate our prior work pointing to an association between farm use of nitrogen fertilizers and a severe ADHD phenotype, we have utilized a different statistical approach (i.e., Poisson regression methodology) including two-way fixed effects. The results reported in this correspondence indicate that for a one-log unit increase in the farm use of nitrogen fertilizers, hospitalization risk for ADHD and conduct disorders increases by a factor of 1.16 (p<0.017), which was a statistically significant increase in risk after multiple pollutant comparison correction. Exposure to PM10 and NOx in this analysis was not associated with an increased risk of hospitalization for ADHD and conduct disorder. We are able to validate our prior conclusions and, therefore, suggest that future analyses dedicated to improving the literature on the association between air pollution and risk of ADHD take into account environmental emissions of N2O.
Assuntos
Poluentes Atmosféricos/análise , Dióxido de Nitrogênio/análise , Poluição do Ar/análise , Transtorno do Deficit de Atenção com Hiperatividade , Humanos , Material Particulado/análise , RiscoRESUMO
The link between various air pollutants and hospitalization for epilepsy has come under scrutiny. We have proposed that exposure to air pollution and specifically the pervasive agricultural air pollutant and greenhouse gas, nitrous oxide (N2O), may provoke susceptibility to neurodevelopmental disorders. Evidence supports a role of N2O exposure in reducing epileptiform seizure activity, while withdrawal from the drug has been shown to induce seizure-like activity. Therefore, we show here that the statewide use of anthropogenic nitrogen fertilizers (the most recognized causal contributor to environmental N2O burden) is significantly negatively associated with hospitalization for epilepsy in all three pre-specified hospitalization categories, even after multiple pollutant comparison correction (p<.007), while the other identified pollutants were not consistently statistically significantly associated with hospitalization for epilepsy. We discuss potential neurological mechanisms underpinning this association between air pollutants associated with farm use of anthropogenic nitrogen fertilizers and hospitalization for epilepsy.
Assuntos
Doenças dos Trabalhadores Agrícolas/induzido quimicamente , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Epilepsia/induzido quimicamente , Fertilizantes/toxicidade , Hospitalização/estatística & dados numéricos , Óxido Nitroso/toxicidade , Doenças dos Trabalhadores Agrícolas/epidemiologia , Poluentes Atmosféricos/classificação , Poluição do Ar/estatística & dados numéricos , Epilepsia/epidemiologia , Humanos , Distribuição de PoissonRESUMO
It has previously been demonstrated that emissions of the agricultural pollutant, nitrous oxide (N2O), may be a confounder to the relationship between herbicide use and psychiatric impairments, including ADHD. This report attempts to extend this hypothesis by testing whether annual use of anthropogenic nitrogen-based fertilizers in U.S. agriculture (thought to be the most reliable indicator of environmental N2O emissions) is associated with per capita ethanol consumption patterns, a behavior often comorbid with ADHD. State estimates of anthropogenic nitrogen fertilizers from the United States Geological Survey (USGS) were obtained for the years between 1987 and 2006. Our dependent variable was annual per capita ethanol consumption. Ethanol consumption was categorized as beer, wine, spirits, and all alcoholic beverages. Least squares dummy variable method using two-ways fixed effects was utilized. Among states above the 50th percentile in farm use of anthropogenic nitrogen for all years (i.e., agricultural states), a one log-unit increase in farm use of anthropogenic nitrogen fertilizers is associated with a 0.13 gallon increase in total per capita ethanol consumption (p<0.0125). No statistically significant association between farm use of anthropogenic nitrogen and per capita ethanol consumption was found in states below the 50th percentile in farm use of anthropogenic nitrogen. The new findings are in agreement with both behavioral human studies demonstrating a link between N2O preference and alcohol and drug use history as well as molecular studies elucidating shared mechanisms between trace N2O antinociception and alcohol-seeking related behaviors.
Assuntos
Agricultura/métodos , Consumo de Bebidas Alcoólicas , Fertilizantes/efeitos adversos , Óxido Nitroso/efeitos adversos , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Exposição Ambiental , Poluentes Ambientais/efeitos adversos , Poluentes Ambientais/análise , Fertilizantes/análise , Humanos , Modelos Biológicos , Nitrogênio/análise , Óxido Nitroso/análise , Estados UnidosRESUMO
OBJECTIVE: I sought to determine how medical comorbidities co-exist with incident psychiatric condition. METHOD: I used data from all 11 available waves (1992-2012) of the Health and Retirement Study (HRS). I identified 4,358 index participants with self-reported incident psychiatric condition. I collected comorbidity data from participants preceding, including, and succeeding that incident wave. Comorbidities assessed included high blood pressure (HBP), diabetes mellitus, cancer, lung disease, heart disease, stroke, and arthritis. Modified Poisson regression combined with log-linked binomial regression was used to estimate relative risks (RRs) of reporting a comorbidity preceding and following the incident wave. Multiple comparison testing dictated significance of RRs with p < .007. RESULTS: For the waves preceding the index wave, the RRs of reporting all comorbidities except HBP and cancer were significantly (p < .007) increased. For the waves following incident psychiatric condition, the risks of reporting heart disease, diabetes, and lung disease were significantly (p < .007) increased. These results were adjusted for participant age, race, gender, other comorbidities listed, and the wave in which a comorbidity was reported. CONCLUSION: The bidirectional association between a psychiatric condition and medical illnesses could only be statistically confirmed for lung disease, diabetes, and heart disease. It is of interest to determine how reporting a psychiatric condition may affect the sequelae of health care use and treatment outcomes for patients with either of these comorbidities or a combination of them.
RESUMO
Both prenatal organophosphate (OP) and pyrethroid (PYRE) insecticide exposures have been inconsistently linked with poorer neurodevelopmental outcomes. However, given that neither exposure occurs in isolation, and both classes are neurotoxic, it is important to consider both classes when evaluating these outcomes. Employing biomarkers of pesticide exposure, this research describes the effects of prenatal urinary metabolite levels of PYRE and OP insecticides, measured in both the second and third trimesters of pregnancy and postnatal urinary metabolite levels measured at 2 months of age, on child neurodevelopment at three months of age. Neurodevelopmental data were obtained by administration of the Bayley Scales of Infant Development-II (BSID-II). Generalized linear models using maximum likelihood estimation were used to evaluate the relationship between the indicators of motor and mental neurobehavioral development obtained for 118 infants and prenatal insecticide exposure, accounting for the concurrent infant insecticide exposure. Urinary measures of the PYRE metabolites 3-phenoxybenzoic acid (3PBA) and trans-3-(2,2-dichlorovinyl)-2,2 dimethylcyclopropane-1-carboxylic acid (trans-DCCA) in the third trimester of pregnancy had significant, albeit opposite, effects on mental functioning at three months of age. We observed no significant (p < 0.05) effects on motor development. These results were robust to second month infant urine measures of 3,5,6-trichloro-2-pyridinol (metabolite of OP chlorpyrifos), which independently had a significant and negative influence on mental functioning. Prenatal PYRE exposures exert heterogeneous effects by class on mental, but not motor, functioning at three months of age.