Relapses and disease-modifying drug treatment in pregnancy and live birth in US women with MS

ObjectiveTo evaluate relapse rates and disease-modifying drug (DMD) treatment in US women with multiple sclerosis (MS) and a live birth.MethodsThis retrospective administrative claims database study used US commercial health plan data from women with MS and a live birth from January 1, 2006, to June 30, 2015. Relapses and DMD treatment were evaluated 1-year prepregnancy, during pregnancy, during puerperium (6 weeks postpregnancy), and 1-year postpregnancy. Relapse was defined as MS-related hospitalization, emergency room visit, or outpatient visit with corticosteroid prescription within 7 days. Generalized estimating equation models for longitudinal data tested for differences between prepregnancy vs the other time periods.ResultsA total of 2,158 patients were eligible. The odds of relapse declined during pregnancy (odds ratio [OR] 0.623, 95% confidence interval [CI] 0.521–0.744; p < 0.0001), increased during puerperium (OR 1.710, 95% CI 1.358–2.152; p < 0.0001), and ended at a higher level during the last 3 postpartum quarters (OR 1.216, 95% CI 1.052–1.406; p = 0.0081). The proportion of women with DMD treatment was rather low overall: approximately 20% prepregnancy, bottoming to 1.9% during the second trimester, and peaking at 25.5% 9 to 12 months postpartum. DMD treatment declined significantly during pregnancy (OR 0.171, 95% CI 0.144–0.203; p < 0.0001), remained lower during puerperium (OR 0.361, 95% CI 0.312–0.418; p < 0.0001), and ended at a higher level during the last 3 postpartum quarters (OR 1.259, 95% CI 1.156–1.371; p < 0.0001).ConclusionsThe rate of MS relapse decreased during pregnancy, increased 6 months postpartum, and decreased 6 to 12 months postpartum. DMD treatment was uncommon in the year before pregnancy, further decreased immediately prepregnancy and during pregnancy, and increased postpartum.

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Quality improvement teams, super-users, and nurse champions: a recipe for meaningful use?

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocw029 ◽

2016 ◽

Vol 23 (6) ◽

pp. 1195-1198 ◽

Cited By ~ 6

Author(s):

Christopher M Shea ◽

Kristin L Reiter ◽

Mark A Weaver ◽

Jordan Albritton

Keyword(s):

Quality Improvement ◽

Correlation Matrix ◽

Odds Ratio ◽

Meaningful Use ◽

Estimating Equation ◽

Generalized Estimating Equation ◽

Clinical Data Warehouse ◽

Working Correlation ◽

Stage 1 ◽

Super Users

Abstract Objective This study assessed whether having an electronic health record (EHR) super-user, nurse champion for meaningful use (MU), and quality improvement (QI) team leading MU implementation is positively associated with MU Stage 1 demonstration. Methods Data on MU demonstration of 596 providers in 37 ambulatory care clinics came from the clinical data warehouse and administrative systems of UNC Health Care. We surveyed the 37 clinics about champions, super-users, and QI teams. We used generalized estimating equation methods with an independence working correlation matrix to account for clustering within clinics and to weight contributions from each clinic according to clinic size. Results Having a QI team lead MU implementation was significantly associated with MU demonstration (odds ratio, OR = 3.57, 95% CI, 1.83-6.96, P < .001, Table 2 ). Having neither a nurse champion nor an EHR super-user was significant. Conclusion Our findings support the alignment of MU with QI efforts by having the QI team lead MU implementation.

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Evaluating risk of hospitalization with G-CSF use in real-world oncology practice

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.6626 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 6626-6626

Author(s):

H. Tan ◽

K. Tomic ◽

G. Daniel ◽

D. Hurley ◽

R. Barron

Keyword(s):

Real World ◽

Estimating Equation ◽

Generalized Estimating Equation ◽

Published Data ◽

Administrative Claims ◽

Health Plans ◽

Cycle Basis ◽

Prophylactic Use ◽

Oncology Practice ◽

Stimulating Factor

6626 Background: Limited published data exist on how granulocyte colony-stimulating factor (G-CSF) treatment patterns affect risk of neutropenia-related hospitalizations. This study examines prophylactic vs. delayed use of G-CSF and compares the effectiveness of prophylaxis with filgrastim (FIL) vs. pegfilgrastim (PEG). Methods: A retrospective analysis of administrative claims from U.S. commercial health plans identified adult patients with non-Hodgkin's lymphoma, breast, or lung cancer, treated with chemotherapy between July 2004 and January 2008. For these patients, the first course of chemotherapy and each unique cycle with use of G-CSF (FIL or PEG) was identified and designated ‘prophylaxis’ if used within the first 5 days of each cycle, or ‘delayed', if after day 5. The risk of neutropenia-related hospitalization was then evaluated on a cycle basis. A generalized estimating equation (GEE) was used to adjust for baseline demographics and clinical characteristics. Results: Among 5,571 patient-cycles identified: 87.4% were prophylactic and 12.6% were delayed G-CSF. PEG use was primarily prophylactic (93.6%) in contrast to use of FIL which was delayed in 62.5% of patient-cycles. The rate of neutropenic hospitalization was 1.2% for prophylaxis (n=59) and 3.7% for delayed G-CSF (n=26) (P < 0.001). Among prophylactic patient-cycles, the neutropenic hospitalization rate was lower with PEG than FIL (1.1% (n=51) vs. 3.5% (n=8), p = 0.001). Multivariate analyses using GEE model showed consistent trends (Table). Conclusions: Prophylactic G-CSF use was associated with lower neutropenic hospitalization risk than delayed use. Among prophylactic use in real-world oncology practice, PEG was associated with about a two-thirds lower risk of neutropenic hospitalization compared with FIL. [Table: see text] [Table: see text]

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Unusually High Incidences of Pseudomonas Bacteremias Within Topical Polymyxin–Based Decolonization Studies of Mechanically Ventilated Patients: Benchmarking the Literature

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy256 ◽

2018 ◽

Vol 5 (11) ◽

Cited By ~ 6

Author(s):

James C Hurley

Keyword(s):

Odds Ratio ◽

Observational Studies ◽

Prolonged Mechanical Ventilation ◽

Estimating Equation ◽

Generalized Estimating Equation ◽

Control Groups ◽

Intervention Component ◽

Mechanically Ventilated ◽

The Mean ◽

Summary Odds Ratio

Abstract Background Topical polymyxin (PM)–based regimens to decolonize patients receiving prolonged mechanical ventilation (MV) have been widely studied. However, paradoxical bacteremia incidences remain unexplained. Methods The literature was searched for studies of topical PM–based regimens used to decontaminate MV patients reporting incidences of overall and Pseudomonas bacteremia data. In addition, observational groups without any intervention and trials of various interventions other than topical PM (non-PM studies) served to provide external benchmarks and additional points of reference, respectively. The bacteremia incidences were extracted from the control and intervention (component) groups of these studies and compared with metaregression using generalized estimating equation methods. Results The summary odds ratio derived from studies of topical PM–based interventions against overall bacteremia was 0.60 (95% confidence interval [CI], 0.53–0.69). Benchmark incidences per 100 MV patients for overall (mean, 8.9%; 95% CI, 6.9% to 10.9%) and Pseudomonas (mean, 0.7%; 95% CI, 0.5% to 1.1%) bacteremia were derived from 16 observational studies. By contrast, among 17 studies of topical PM, the mean incidences among control groups for overall (mean, 15.3%; 95% CI, 11.5% to 20.3%) and Pseudomonas (mean, 1.6%; 95% CI, 0.9% to 3.1%) bacteremia were both higher, whereas these incidences in the intervention groups for both topical PM and non-PM studies were in each case more similar to the respective benchmarks. These paradoxical incidences cannot readily be explained in metaregression models. Conclusions Paradoxically, despite an apparent prevention effect of topical PM–based methods against bacteremia overall, the incidences of Pseudomonas bacteremia within the component groups of these studies are unusually high vs literature-derived benchmarks.

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A Longitudinal Study of Changes in Cognition Among Older Thais: Studying From the Kanchanaburi Demographic Surveillance System

Gerontology and Geriatric Medicine ◽

10.1177/2333721419862885 ◽

2019 ◽

Vol 5 ◽

pp. 233372141986288

Author(s):

Natchaphon Auampradit ◽

Patama Vapattanawong ◽

Sureeporn Punpuing ◽

Malee Sunpuwan ◽

Tawanchai Jirapramukpitak

Keyword(s):

Cognitive Impairment ◽

Odds Ratio ◽

Surveillance System ◽

Wealth Index ◽

Estimating Equation ◽

Demographic Surveillance System ◽

Generalized Estimating Equation ◽

Delayed Recall ◽

Longitudinal Effects ◽

Working Status

Objectives: To examine the impacts of changes in social determinants of health (SDH) toward changes in cognition. Methods: Longitudinal data came from the Kanchanaburi Demographic Surveillance System (KDSS) collected in 2007 and 2011. Cognitive impairment was measured by category fluency and delayed recall. Generalized estimating equation (GEE) was used to investigate changes in cognition by taking SDH and other variables including age, gender, marital status, education, and depression into the model. Results: GEE revealed longitudinal effects of wealth index and working status against cognition. Older Thais living with richest wealth index (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.31-0.94) and still being employed (OR = 0.65; 95% CI = 0.47-0.89) were less likely to have cognitive impairment. Discussion: Poorer wealth index and being unemployed were served as a risk factor for cognitive impairment over time. Increasing age was still the major risk for cognitive impairment.

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Contemporary Trends in the Treatment of Mild Ischemic Stroke with Intravenous Thrombolysis: Paul Coverdell National Acute Stroke Program

Cerebrovascular Diseases ◽

10.1159/000517969 ◽

2021 ◽

pp. 1-7

Author(s):

Ganesh Asaithambi ◽

Xin Tong ◽

Sallyann M. Coleman King ◽

Mary G. George

Keyword(s):

Ischemic Stroke ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Intravenous Thrombolysis ◽

Estimating Equation ◽

National Institutes Of Health ◽

Generalized Estimating Equation ◽

Mild Stroke ◽

The Impact ◽

Program Data

Background: Presentation with mild symptoms is a common reason for intravenous thrombolysis (IVT) nonuse among acute ischemic stroke (AIS) patients. We examined the impact of IVT on the outcomes of mild AIS over time. Methods: Using the Paul Coverdell National Stroke Program data, we examined trends in IVT utilization from 2010 to 2019 among AIS patients presenting with National Institutes of Health Stroke Scale (NIHSS) scores ≤5. Outcomes adjudicated included rates of discharge to home and ability to ambulate independently at discharge. We used generalized estimating equation models to examine the effect of IVT on outcomes of AIS patients presenting with mild symptoms and calculated adjusted odds ratio (AOR) with 95% confidence intervals (CI). Results: During the study period, 346,762 patients presented with mild AIS symptoms. Approximately 6.2% were treated with IVT. IVT utilization trends increased from 3.7% in 2010 to 7.7% in 2019 (p < 0.001). Patients treated with IVT had higher median NIHSS scores upon presentation (IVT 3 [2, 4] vs. no IVT 2 [0, 3]). Rates of discharge to home (AOR 2.06, 95% CI: 1.99–2.13) and ability to ambulate at time of discharge (AOR 1.82, 95% CI: 1.76–1.89) were higher among those treated with IVT. Conclusion: There was an increased trend in IVT utilization among AIS patients presenting with mild symptoms. Utilization of IVT increased the odds of being discharged to home and the ability to ambulate at discharge independently in patients with mild stroke.

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Models for Longitudinal Data: A Generalized Estimating Equation Approach

Biometrics ◽

10.2307/2531734 ◽

1988 ◽

Vol 44 (4) ◽

pp. 1049 ◽

Cited By ~ 2602

Author(s):

Scott L. Zeger ◽

Kung-Yee Liang ◽

Paul S. Albert

Keyword(s):

Longitudinal Data ◽

Estimating Equation ◽

Generalized Estimating Equation ◽

Equation Approach ◽

Generalized Estimating

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Remittances and the Financing of Terrorism In Sub-Saharan Africa: 1974 - 2006

Peace Economics Peace Science and Public Policy ◽

10.1515/1554-8597.1257 ◽

2012 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Juliet U. Elu ◽

Gregory N. Price

Keyword(s):

Economic Growth ◽

Count Data ◽

Important Determinant ◽

Estimating Equation ◽

Sub Saharan Africa ◽

Generalized Estimating Equation ◽

Parameter Estimates ◽

Consumption Expenditures ◽

Sub Saharan ◽

Financing Of Terrorism

AbstractRemittances have been recognized as an important determinant of economic growth for Sub-Saharan African economies as they can finance other determinants that constitute drivers of growth. To the extent that remittances finance terrorism, they can also inhibit economic growth as terrorism can constrain important drivers of growth such as investment and consumption expenditures. In this paper, we appeal to a theory of rational terrorism and consider whether remittances to Sub-Saharan Africa finance terrorism. We estimate the parameters of a static and dynamic terrorism incident supply function with maximum likelihood and Generalized Estimating Equation count data estimators for Sub-Saharan Africa between 1974 and 2006. Our parameter estimates suggest that for Sub-Saharan Africa, remittances are a source of finance for terrorism. We find that approximately one terrorism incident is financed in Sub-Saharan Africa for remittance inflows that range between approximately one quarter of a million dollars and one million dollars.

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Hip and Trunk Muscle Activity and Mechanics During Walking With and Without Unilateral Weight

Journal of Applied Biomechanics ◽

10.1123/jab.2020-0273 ◽

2021 ◽

pp. 1-8

Author(s):

Kerri A. Graber ◽

Kari L. Loverro ◽

Mark Baldwin ◽

Erika Nelson-Wong ◽

Joshua Tanor ◽

...

Keyword(s):

Muscle Activity ◽

Therapeutic Option ◽

Frontal Plane ◽

Estimating Equation ◽

Trunk Muscle ◽

Lower Extremity Injury ◽

Generalized Estimating Equation ◽

Functional Activities ◽

Strengthening Exercises ◽

Hip Abductor

Pelvic drop is caused by decreased hip abductor muscle activity and is associated with lower-extremity injury. Hip abductor strengthening exercises are well established; however, no standard method exists to increase hip abductor activity during functional activities. The purpose of this research was to study the effects of walking with a unilateral weight. A total of 26 healthy adults walked on an instrumented treadmill with and without handheld weight (15%–20% body weight). Muscle activity, kinematic, and kinetic data were collected using surface electromyography, motion capture, and force plates, respectively. Average hip and trunk muscle activity, hip, pelvic, and trunk angles, and peak internal hip moments during stance were compared for each side (contralateral/ipsilateral to the weight) between conditions (unweighted/weighted) using a generalized linear model with generalized estimating equation correction. Interactions between condition and side were observed for muscle activity, frontal plane pelvic and trunk angles, and frontal plane hip moments (P ≤ .003). Compared with the unweighted condition, the weighted condition had higher hip abductor activity contralateral to the weight (P < .001), while no change was found ipsilateral to the weight (P ≥ .790). Similar changes were found for kinematic and kinetic variables. Walking with a unilateral weight may be a therapeutic option to increase functional hip abductor activity.

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The relationship between remission and health-related quality of life in a cohort of SLE patients

Rheumatology ◽

10.1093/rheumatology/key349 ◽

2018 ◽

Vol 58 (4) ◽

pp. 628-635 ◽

Cited By ~ 8

Author(s):

Michel W P Tsang-A-Sjoe ◽

Irene E M Bultink ◽

Maaike Heslinga ◽

Lilian H van Tuyl ◽

Ronald F van Vollenhoven ◽

...

Keyword(s):

Quality Of Life ◽

Global Assessment ◽

Short Form ◽

Estimating Equation ◽

Generalized Estimating Equation ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

The Relationship

Abstract Objective To investigate the relationship between remission and health-related quality of life (HRQoL) in patients with SLE in a longitudinal observational cohort. Methods HRQoL was measured at cohort visits using the physical and mental component score (PCS and MCS, respectively) of the Short Form 36 questionnaire. Definitions of Remission in SLE remission categories (no remission/remission on therapy/remission off therapy) were applied. Determinants of PCS and MCS were identified with simple linear regression analyses. Association between remission and HRQoL was assessed using generalized estimating equation models. Results Data from 154 patients with 2 years of follow-up were analysed. At baseline 60/154 (39.0%) patients were in either form of remission. Patients in remission had higher Short Form 36 scores in all subdomains compared with patients not in remission. PCS was positively associated with remission and employment, and negatively associated with SLICC damage index, ESR, medication, patient global assessment and BMI. MCS was positively associated with Caucasian ethnicity and negatively associated with patient global assessment. In generalized estimating equation analysis, a gradual and significant increase of PCS was observed from patients not in remission (mean PCS 36.0) to remission on therapy (41.8) to remission off therapy (44.8). No significant difference in MCS was found between remission states. Conclusion we show a strong and persistent association between remission and PCS, but not MCS. These results support the relevance (construct validity) of the Definition of Remission in SLE remission definitions and the further development of a treat-to-target approach in SLE.

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Foreign Direct Investment, Economic Freedom and Economic Growth: Evidence from Developing Countries

International Journal of Economics and Finance ◽

10.5539/ijef.v8n11p200 ◽

2016 ◽

Vol 8 (11) ◽

pp. 200 ◽

Cited By ~ 5

Author(s):

Md. Shakib Hossain

Keyword(s):

Economic Growth ◽

Developing Countries ◽

Foreign Direct Investment ◽

Standard Deviation ◽

Poisson Regression ◽

Direct Investment ◽

Economic Freedom ◽

Random Effect ◽

Estimating Equation ◽

Generalized Estimating Equation

This paper has explores the interplay between economic freedom, foreign direct investment and economic growth using panel data analysis for a sample of 79 developing countries from 1998 to 2014 by considering the level of economic freedom, as provided by the “Heritage Foundation”. Panel unit root, pedroni residual co-integration test, generalized least square (GLS), feasible GLS (FGLS), pooled OLS, random effect, fixed effect, poisson regression, prais-winsten, generalized method of movement (GMM) and generalized estimating equation (GEE) methods have used to estimates the relationship. According to the OLS and generalized method of movement the coefficient implies that a one standard deviation improvement in business freedom, trade freedom, size, investment freedom, property rights, freedom from corruption, labor freedom, financial freedom, fiscal freedom, monetary freedom increases FDI by 21.4%, 15.6%, 21.6%, 17.5%, 11.55, 9.1%, 6.9%, 8.5%, 7.4%, 10.3% and 56.1%, 45.3%, 58.3%, 51.6%, 33.7%, 39.2%, 47.4%, 41.6%, 32.5%, 38.5% points respectively and for the economic variable ,the coefficient implies that a one standard deviation improvement in GDPG and GDPPC increases FDI by 24.1%, 17.4% and 30.2%, 33.4% points respectively. By using the other method like random effect, fixed effect, poisson regression, prais-winsten and generalized estimating equation (GEE) method explores that economic freedom in the host country is a positive determinants of FDI inflows in developing countries and also the result suggests that foreign direct investment is positively correlated with the economic growth in the host countries.

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