scholarly journals Pain Persistence Is Associated With Increased Odds of MCI in Late Midlife and Early Older Adulthood

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 115-115
Author(s):  
Tyler Bell ◽  
Jeremy Elman ◽  
Carol Franz ◽  
William Kremen
Keyword(s):  
Pain Intensity ◽  
Persistent Pain ◽  
Time Varying ◽  
Opioid Use ◽  
Older Adulthood ◽  
Clinical Pain ◽  
Time Invariant ◽  
The Impact ◽  
Time Varying Covariates ◽  
Late Midlife

Abstract Twenty percent of older adults will experience persistent pain, the sensation of bodily harm lasting three or more months. Persistent pain doubles the risk of dementia, but we know less about the impact on earlier stages, such as mild cognitive impairment (MCI). As a step for clarification, this study leveraged data from the Vietnam Era Twin Study of Aging (VETSA) to understand how pain persistence relates to MCI in late midlife to early older adulthood. Participants (n=1,465, 100% male) were recruited across three waves at average ages 56, 62, and 68. At each wave, participants completed the SF-36 and were asked to rate their pain intensity from none (1) to very severe (6). Clinical pain was coded as pain intensity rated more than mild (>3/6). As a time-varying predictor, pain persistence was then calculated as a running frequency of the total waves reporting clinical pain. MCI diagnosis was based on Jak-Bondi criteria. Age, depressive symptoms, comorbidities, and opioid use were included as time-varying covariates. Age and education were included as time-invariant covariates. General estimating equations showed that pain persistence over two waves, reported in 35% of the sample, increased MCI odds by 57% (OR=1.57, 95%CI: 1.28 to 1.94). Pain persistence over three waves, reported in 17% of the sample, increased MCI odds by 98% (OR=1.98, 95%CI: 1.44 to 2.70). The findings emphasize the role of pain in earlier stages of dementia and the potential importance of pain management in offsetting cognitive decline.

“I Hope I Get It”: impact of Tony Award nominations and wins on Broadway production longevity

2018 ◽  
Vol 8 (1) ◽  
pp. 30-46 ◽  
Author(s):  
Russell Thomas Warne
Keyword(s):  
Statistical Power ◽  
Open Science ◽  
Production Costs ◽  
Time Varying ◽  
Cumulative Impact ◽  
Content Type ◽  
Theater Production ◽  
Time Invariant ◽  
The Impact ◽  
Time Varying Covariates

PurposeThe purpose of this paper is to ascertain the relative impact of different Tony Award nominations and wins on the financial success of a Broadway theater production, as defined by the length of the production’s run.Design/methodology/approachCox hazard regression was used to identify the impact of Tony Award nominations and wins (time-varying covariates), while controlling for several time-invariant covariates: type of production (play or musical, revival or original Broadway production), production costs (operationalized via the cast size), the month and year of opening, and initial marketing success (defined as the percentage of first full week’s tickets sold).FindingsThe award with the strongest relationship with production longevity was the Tony Award for Best Musical (nomination OR=0.566,p=0.110; win OR=0.323,p=0.020). Several other awards had a relationship with production longevity, but most were not statistically significant.Research limitations/implicationsThe limitations include the low statistical power for many time-varying covariates and the cumulative impact of multiple awards was not investigated. Future researchers interested in the Broadway industry should not combine Tony Awards because of the varying impact on economic outcomes for a production.Originality/valueThis study is the first to investigate all 22 Tony Award nominations and wins and their individual impact on an economic outcome. This paper includes the study’s raw data and SPSS syntax to comply with open science practices. The author encourages readers to replicate the analysis.

scholarly journals Proper Specification of Nonproportional Hazards Corrections in Duration Models

2017 ◽  
Vol 25 (1) ◽  
pp. 138-144 ◽  
Author(s):  
Shuai Jin ◽  
Frederick J. Boehmke
Keyword(s):  
Proportional Hazards ◽  
Model Specification ◽  
Duration Models ◽  
Time Varying ◽  
Nonproportional Hazards ◽  
Incorrect Model ◽  
Proper Estimation ◽  
Time Invariant ◽  
Time Varying Covariates ◽  
Biased Estimates

Parametric and nonparametric duration models assume proportional hazards: The effect of a covariate on the hazard rate stays constant over time. Researchers have developed techniques to test and correct nonproportional hazards, including interacting the covariates with some function of time. Including this interaction term means that the specification now involves time-varying covariates, and the model specification should reflect this feature. However, in situations with no time-varying covariates initially, researchers often continue to model the duration with only time-invariant covariates. This error results in biased estimates, particularly for the covariates interacted with time. We investigate this issue in over forty political science articles and find that of those studies that begin with time-invariant covariates and correct for nonproportional hazards the majority suffer from incorrect model specification. Proper estimation usually produces substantively or statistically different results.

scholarly journals Measuring effects of medication adherence on time-varying health outcomes using Bayesian dynamic linear models

Biostatistics ◽  
2019 ◽  
Author(s):  
Luis F Campos ◽  
Mark E Glickman ◽  
Kristen B Hunter
Keyword(s):  
Medication Adherence ◽  
Linear Models ◽  
Time Varying ◽  
Dynamic Parameters ◽  
Posterior Density ◽  
Modeling Framework ◽  
Dynamic Linear Models ◽  
Health Measures ◽  
The Impact ◽  
Time Varying Covariates

Summary One of the most significant barriers to medication treatment is patients’ non-adherence to a prescribed medication regimen. The extent of the impact of poor adherence on resulting health measures is often unknown, and typical analyses ignore the time-varying nature of adherence. This article develops a modeling framework for longitudinally recorded health measures modeled as a function of time-varying medication adherence. Our framework, which relies on normal Bayesian dynamic linear models (DLMs), accounts for time-varying covariates such as adherence and non-dynamic covariates such as baseline health characteristics. Standard inferential procedures for DLMs are inefficient when faced with infrequent and irregularly recorded response data. We develop an approach that relies on factoring the posterior density into a product of two terms: a marginal posterior density for the non-dynamic parameters, and a multivariate normal posterior density of the dynamic parameters conditional on the non-dynamic ones. This factorization leads to a two-stage process for inference in which the non-dynamic parameters can be inferred separately from the time-varying parameters. We demonstrate the application of this model to the time-varying effect of antihypertensive medication on blood pressure levels for a cohort of patients diagnosed with hypertension. Our model results are compared to ones in which adherence is incorporated through non-dynamic summaries.

Navigating the Intersection Between Persistent Pain and the Opioid Crisis: Population Health Perspectives for Physical Therapy

2020 ◽  
Vol 100 (6) ◽  
pp. 995-1007
Author(s):  
Todd E Davenport ◽  
Andra C DeVoght ◽  
Holly Sisneros ◽  
Stephen Bezruchka
Keyword(s):  
Physical Therapy ◽  
Population Health ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Opioid Use Disorder ◽  
Persistent Pain ◽  
Opioid Use ◽  
Individual Level ◽  
American Physical ◽  
The Impact

Abstract The physical therapy profession has recently begun to address its role in preventing and managing opioid use disorder (OUD). This topic calls for discussion of the scope of physical therapist practice, and the profession’s role, in the prevention and treatment of complex chronic illnesses, such as OUD. OUD is not just an individual-level problem. Abundant scientific literature indicates OUD is a problem that warrants interventions at the societal level. This upstream orientation is supported in the American Physical Therapy Association’s vision statement compelling societal transformation and its mission of building communities. Applying a population health framework to these efforts could provide physical therapists with a useful viewpoint that can inform clinical practice and research, as well as develop new cross-disciplinary partnerships. This Perspective discusses the intersection of OUD and persistent pain using the disease prevention model. Primordial, primary, secondary, and tertiary preventive strategies are defined and discussed. This Perspective then explains the potential contributions of this model to current practices in physical therapy, as well as providing actionable suggestions for physical therapists to help develop and implement upstream interventions that could reduce the impact of OUD in their communities.

scholarly journals FRI0066 SUBCLINICAL CORONARY CALCIFICATION ASSOCIATED WITH LONG-TERM CARDIOVASCULAR OUTCOMES IN RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 609.1-610
Author(s):  
G. Karpouzas ◽  
S. Ormseth ◽  
E. Hernandez ◽  
M. Budoff
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Disease ◽  
Cardiovascular Event ◽  
Cardiovascular Events ◽  
Regression Models ◽  
Time Varying ◽  
Event Risk ◽  
The Impact ◽  
Time Varying Covariates

Background:Large, multicenter studies established the strong prognostic value of coronary artery calcium (CAC) scoring in asymptomatic individuals. Increasing CAC score is an independent predictor of worsening cardiovascular disease event risk in general patients. The prognostic significance of higher CAC score strata in the long-term cardiovascular risk in rheumatoid arthritis (RA) is unknown.Objectives:To evaluate the long-term cardiovascular event risk across CAC strata in a prospective, single center cohort of established RA patients without symptoms or prior diagnosis of cardiovascular disease.Methods:One hundred-fifty patients underwent computed tomography angiography for coronary atherosclerosis evaluation. CAC score was measured according to Agatston. CVD events were prospectively recorded, including cardiac death, myocardial infarction, unstable angina, revascularization, stroke, claudication, and heart failure hospitalization over 6.0±2.4 years of follow-up. Unadjusted, robust Cox proportional hazards regression models evaluated CVD event risk across higher CAC strata (CAC=1-99, CAC=100-399 and CAC≥400) compared to CAC=0. Additional multivariable robust Cox regression models with time-varying covariates evaluated the impact of log transformed CAC or different CAC thresholds (CAC>0 vs. CAC=0, CAC≥100 vs. CAC<100 and CAC≥400 vs. CAC<400) on future CVD events. Models were controlled for Framingham-D’Agostino clinical risk score, time-varying current bDMARD use and time-varying CRP.Results:Sixteen patients incurred 19 events, for a total of 2.1 (95% CI 1.3-3.3) events/100 patient-years. Increasing HR for cardiovascular events was observed for ascending CAC strata; 3.87 (1.03-14.48), 6.31 (1.38-28.91) and 16.98 (4.50-64.10) for CAC=1-99, CAC=100-399 and CAC≥400 respectively compared to CAC=0 (figure 1). In fully adjusted models, CAC score associated with future event risk independently of Framingham D’Agostino score, time-varying bDMARD use and time-varying CRP (HR=1.31 [95%CI 1.04-1.66]). CAC thresholds ≥100 (vs. <100) and CAC≥400 (vs. <400) in fully adjusted models similarly constituted independent predictors of long-term cardiovascular events (Figure 2).Figure 1.Increasing CAC scores associated with higher cardiovascular event risk in RAFigure 2.Impact of different CAC thresholds on cardiovascular event risk in RAConclusion:Increasing CAC scores are strong, independent predictors of long-term cardiovascular events in RA patients without symptoms or prior diagnosis of cardiovascular disease.Disclosure of Interests:George Karpouzas Grant/research support from: Pfizer, Consultant of: Sanofi-Genzyme-Regeneron, Janssen, Speakers bureau: Sanofi-Genzyme-Regeneron, BMS, Sarah Ormseth: None declared, Elizabeth Hernandez: None declared, Matthew Budoff: None declared

The impact of an innovative pharmacist-led inpatient opioid de-escalation intervention in post-operative orthopedic patients

2020 ◽  
Vol 16 (3) ◽  
pp. 167-176
Author(s):  
Thuy Bui, BPharm ◽  
Richard Grygiel, MPharm ◽  
Alex Konstantatos, MB BS (Hons), FANZCA, Dip Obs, MRCA ◽  
Nick Christelis ◽  
Susan Liew, MB BS (Hons), FRACS ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Intervention Group ◽  
Public Health Problem ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Post Intervention ◽  
Before And After ◽  
Orthopedic Patients ◽  
The Impact ◽  
Post Intervention Group

Objective: Many patients are discharged from hospital after surgery with excessive doses of opioid, and prescription opioid addiction has become a serious public health problem. Inpatient opioid de-escalation performed by clinical pharmacists may assist in reducing opioids before discharge. We aimed to evaluate whether clinical pharmacist-led opioid de-escalation for inpatients after orthopedic surgery led to significant reductions in opioid use at discharge, without resulting in greater pain intensity and side effects.Design: This retrospective pre-/post-intervention study evaluated patients before and after implementation of a pharmacist-led opioid de-escalation service.Setting: A major tertiary institution.Participants: Ninety eight participants underwent de-escalation, and 98 controls received standard care following orthopedic surgery.Intervention: Pharmacist-led opioid de-escalation was initiated after discharge from the institution's Acute Pain Service.Main outcome measure: Primary outcome was total morphine oral equivalence (MOE) required in the 24-hours before discharge between the two groups. Secondary outcomes included pain intensity scores and opioid-related side effects. Results: The post-intervention group used significantly less opioids in the 24 hours preceding discharge compared with the precohort (total MOE 30 vs 45 mg; p = 0.025).There were no differences in pain intensity at rest (p = 0.19) or with movement (p = 0.19). Cases experienced significantly less constipation (29 vs 49 percent; p = 0.004); no differences were observed for other side effects.Discussion: We observed statistically similar pain intensity ratings, in the setting of significantly lowered opioid doses among the post-intervention group prior to discharge.Conclusion: Pharmacist-led inpatient opioid de-escalation is effective, does not increase pain intensity, and reduces constipation. Hospitals should explore the viability of extending pharmacist-led opioid de-escalation to other surgical patients and following hospital discharge, aiming for opioid cessation.

Survival Analysis of Time to Opioid Use and the Role of PTSD-Linked Stress Sensitivity for Predicting Onset Risk for Juvenile Offenders Following Adjudication

2021 ◽  
pp. 003288552110693
Author(s):  
Thomas W. Wojciechowski
Keyword(s):  
Survival Analysis ◽  
Juvenile Offenders ◽  
Stress Sensitivity ◽  
Hazard Models ◽  
Time Varying ◽  
Opioid Use ◽  
Time Varying Covariates ◽  
Moderating Role

This study sought to understand how PTSD predicts opioid use onset rates and how subsequent exposures to violence also influence this risk following adjudication. Survival analysis was used to examine the moderating role that baseline PTSD status plays for predicting rates of opioid use onset risk following adjudication. Hazard models used to examine the role of time-varying covariates for predicting opioid onset risk following adjudication. PTSD was found to predict significantly greater odds of opioid use initiation. Hazard of introducing opioid use was greater during observation periods in which participants witnessed violence. This effect was greater for PTSD sufferers.

scholarly journals BMI Change After Parent’s Death in Adulthood: Examining Age and Race Differences With Time-Varying Effects Modeling

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 869-869
Author(s):  
Hye Won Chai ◽  
Hyungmin Cha ◽  
Debra Umberson
Keyword(s):  
Ethnic Differences ◽  
Late Life ◽  
Race Differences ◽  
Time Varying ◽  
Black Adults ◽  
Race Ethnicity ◽  
The Impact ◽  
Racial Ethnic ◽  
Early Late ◽  
Late Midlife

Abstract Parental bereavement in adulthood is a stressful event that can have adverse health consequences for middle and older adults, including weight gain. Considering that the impact of bereavement is found to vary depending on the timing of death as well as across race/ethnicity, changes in weight after a parent’s passing may also be contingent on the timing of parent’s death and the bereaved individual’s race/ethnicity. Using Time-Varying Effects Modeling (TVEM), this study examined whether changes in BMI following a parent’s death differed across respondent’s age when their parent passed away. We also tested whether these age differences varied by race. Data came the Health and Retirement Study (HRS) Waves 1 – 13 and we selected respondents who experienced passing of either parent while participating in HRS. Analyses were run separately for mother’s death (n = 6,191) and father’s death (n = 3,301). Results showed significant racial/ethnic differences in BMI change following a mother’s death, particularly during late midlife to early late life. Specifically, non-Hispanic White and Black adults showed a greater increase in BMI compared to Hispanic adults. These race differences were consistent for father’s death as well, but to a lesser extent compared to mother’s death. Results suggest that White and Black adults who lost their parents between late midlife and early late life gained more weight compared to their Hispanic counterparts. This may be attributed to the racial/ethnic differences in health behaviors in response to parent’s death.

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