Publications by authors named "Jeanette M Jerrell"

69 Publications

Epidemiology of Pediatric Hypertrophic Cardiomyopathy in a 10-Year Medicaid Cohort.

Pediatr Cardiol 2021 Jan 3;42(1):210-214. Epub 2020 Oct 3.

University of South Carolina School of Medicine, Columbia, SC, USA.

The epidemiologic data for pediatric hypertrophic cardiomyopathy (HCM) needs to be periodically updated as diagnostic techniques and management strategies improve. Herein, the incidence, prevalence, and mortality rates of pediatric HCM in a population-based treatment system are described. Patients aged ≤ 17 years and diagnosed with HCM on service visits over a 10-year period in one state Medicaid database (2007-2016) were analyzed. The cohort included 137 unique patients; 64.2% were male; 40.9% were African American; 42.3% were first diagnosed ≤ 24 months. The accrued 10-year prevalence rate for pediatric HCM was 1.2/1,000,000 and the annual incidence rate (CY 2010) was 1.3/100,000. Cardiac-related mortality was 2.9% in those who died cohort (N = 10); 70.0% of those who died were ≤ 13 months of age. Arrhythmia was diagnosed in 30.7% of the cohort, heart failure in 12.4%, and low birth weight in 8.8%. Inborn errors of metabolism were diagnosed in 8.0% of the cohort; malformation syndromes in 13.1%, and neuromuscular disorders in 2.9%; therefore, 75.9% were classified as idiopathic HCM. Our findings are somewhat higher than extant study estimates but update and augment them in representing a Southeast US statewide service system.
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http://dx.doi.org/10.1007/s00246-020-02472-2DOI Listing
January 2021

Population-based treated prevalence, risk factors, and outcomes of bicuspid aortic valve in a pediatric Medicaid cohort.

Ann Pediatr Cardiol 2018 May-Aug;11(2):119-124

Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, USA.

Background: We investigated the treated prevalence of bicuspid aortic valve in a pediatric population with congenital heart disease and its incident complications.

Materials And Methods: A 15-year retrospective data set was analyzed. Selection criteria included age ≤17 years, enrollees in the South Carolina State Medicaid program and diagnosed as having bicuspid aortic valve on one or more service visits.

Results: The 15-year-treated prevalence of predominantly isolated bicuspid aortic valve was 2% (20/1000) of pediatric congenital heart disease cases, with a non-African American: African-American ratio of 3.5:1, and a male:female ratio of 1.6:1. Aortic stenosis (28.0%), ventricular septal defect (20.6%), and coarctation of the aorta (20.6%) were the most prevalent coexisting congenital heart lesions. Of the 378 bicuspid aortic valve cases examined, 10.3% received aortic valve repair/replacement, which was significantly more likely to be performed in children with diagnosed aortic stenosis (adjusted odds ratio = 12.90; 95% confidence interval = 5.66-29.44). Cohort outcomes over the study period indicated that 9.5% had diagnosed heart failure, but <1% had diagnosed supraventricular tachycardia, infective endocarditis, aneurysm, dissection, or death.

Conclusions: The majority of isolated bicuspid aortic valve cases without aortic stenosis did not require surgical intervention. Outcomes for cases requiring repair/replacement were relatively benign.
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http://dx.doi.org/10.4103/apc.APC_137_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963224PMC
June 2018

Risk Factors for Heart Failure and Its Costs Among Children with Complex Congenital Heart Disease in a Medicaid Cohort.

Pediatr Cardiol 2017 Dec 29;38(8):1672-1679. Epub 2017 Aug 29.

Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, 15 Medical Park, Suite 301, Columbia, SC, 29203, USA.

Little research attention has been paid to the occurrence of heart failure (HF) in children with complex congenital heart diseases (CHDs). Herein, we describe the prevalence, risk factors, and costs associated with HF in complex CHD. Patients aged ≤17 years and diagnosed with a complex CHD on multiple service visits over a 15-year period in the SC Medicaid dataset (1996-2010) were tracked and analyzed. The cohort included 2999 unduplicated patients; 51.0% were male; 34.4% were African American. HF was diagnosed in 7.6%. Single ventricle lesions, genetic syndromes, and ventricular arrhythmia were significantly associated with an increased likelihood of being diagnosed with HF, controlling for development of comorbid pulmonary hypertension. Patients with HF received significantly more subspecialty care, more surgeries, more hospitalizations, more total days of inpatient care, and more emergency department care than those without HF. Patients with significantly higher total care costs paid by Medicaid had HF, more cardiac surgeries, and more specialized mechanical or other support procedures, controlling for diagnosed single ventricle CHD, a genetic syndrome, and number of non-cardiac surgeries. Complex CHD patients with HF incur significantly higher care costs but require multifaceted, intensive supports for management of incident complications and comorbid conditions.
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http://dx.doi.org/10.1007/s00246-017-1712-8DOI Listing
December 2017

The Efficacy of Psychostimulants in Major Depressive Episodes: A Systematic Review and Meta-Analysis.

J Clin Psychopharmacol 2017 Aug;37(4):412-418

From the *Mood Disorder Psychopharmacology Unit, University Health Network; †Brain and Cognition Discovery Foundation, ‡Department of Psychiatry, §Department of Pharmacology, and ∥Institute of Medical Science, University of Toronto, Toronto, ON, Canada; ¶Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada; #Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; and **Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC.

Background: Psychostimulants are frequently prescribed off-label for adults with major depressive disorder or bipolar disorder. The frequent and increasing usage of stimulants in mood disorders warrants a careful appraisal of the efficacy of this class of agents. Herein, we aim to estimate the efficacy of psychostimulants in adults with unipolar or bipolar depression.

Methods: The PubMed/Medline database was searched from inception to January 16, 2016 for randomized, placebo-controlled clinical trials investigating the antidepressant efficacy of psychostimulants in the treatment of adults with unipolar or bipolar depression.

Results: Psychostimulants were associated with statistically significant improvement in depressive symptoms in major depressive disorder (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.13-1.78; P = 0.003) and bipolar disorder (OR, 1.42; 95% CI, 1.13-1.78; P = 0.003). Efficacy outcomes differed across the psychostimulants evaluated as a function of response rates: ar/modafinil (OR, 1.47; 95% CI, 1.20-1.81; P = 0.0002); dextroamphetamine (OR, 7.11; 95% CI, 1.09-46.44; P = 0.04); lisdexamfetamine dimesylate (OR, 1.21; 95% CI, 0.94-1.56; P = ns); methylphenidate (OR, 1.49; 95% CI, 0.88-2.54; P = ns). Efficacy outcomes also differed between agents used as adjunctive therapy (OR, 1.39; 95% CI, 1.19-1.64) or monotherapy (OR, 2.25; 95% CI, 0.67-7.52).

Conclusions: Psychostimulants are insufficiently studied as adjunctive or monotherapy in adults with mood disorders. Most published studies have significant methodological limitations (eg, heterogeneous samples, dependent measures, type/dose of agent). In addition to improvements in methodological factors, a testable hypothesis is that psychostimulants may be more appropriately tested in select domains of psychopathology (eg, cognitive emotional processing), rather than as "broad-spectrum" antidepressants.
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http://dx.doi.org/10.1097/JCP.0000000000000723DOI Listing
August 2017

Diagnostic clusters associated with an early onset schizophrenia diagnosis among children and adolescents.

Hum Psychopharmacol 2017 03;32(2)

Department of Health Management and Informatics, Office of Research Biostatistics Research and Design Unit, University of Missouri School of Medicine, Columbia, Missouri, USA.

Objective: Given the greater severity and chronicity of psychiatric disorders that first declare in individuals under the age of 18, early onset schizophrenia (EOS) and its association with co-occurring psychiatric conditions deserve further investigation.

Methods: Cluster and discriminant analyses were used to examine the heterogeneity of children and adolescents diagnosed with schizophrenia in 1 statewide system of care. A retrospective cohort design was employed, using South Carolina's (USA) Medicaid claims dataset covering outpatient and inpatient medical services between January, 1999 and December, 2013 to identify patients ≤17 years of age.

Results: Among the 613 EOS patients selected, 3 main clusters of ICD-9 psychiatric diagnoses were identified: (1) older children with schizophrenia coaggregated with a spectrum of mood/emotional dysregulation conditions; (2) younger children with coaggregated schizophrenia, mental retardation/intellectual disability or autism spectrum disorders; and (3) older children with schizophrenia and significantly fewer diagnosed co-occurring conditions. Externalizing/disruptive behavior disorders (i.e., attention deficit hyperactivity disorder, conduct disorder, and oppositional defiant disorder) were significantly associated with Clusters 1 and 2.

Conclusion: Symptom patterns plus age of first diagnosis are important differentiators of EOS subgroups in this cohort. Earlier recognition of psychiatric symptom/syndrome patterns that frequently co-occur may enable clinicians to stratify/tailor treatment interventions.
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http://dx.doi.org/10.1002/hup.2589DOI Listing
March 2017

Pharmacotherapy effectiveness for clinical subgroups among children and adolescents with early onset schizophrenia.

Hum Psychopharmacol 2017 03;32(2)

Department of Health Management and Informatics Office of Research Biostatistics Research and Design Unit, University of Missouri School of Medicine, Columbia, Missouri, USA.

Objective: This study aims to determine the effectiveness of pharmacotherapies among children and adolescents diagnosed with early onset schizophrenia subgrouped according to their co-occurring psychiatric disorders.

Methods: A retrospective cohort design was employed, using South Carolina's (USA) Medicaid claims dataset covering outpatient and inpatient medical services, between January, 1999 and December, 2013 to identify patients ≤17 years of age. Random effects regression analyses assessed differential changes in acute psychiatric service utilization over time across the 3 subgroups associated with antipsychotic, mood stabilizer, psychostimulant, or antidepressant pharmacotherapy.

Results: For patients with schizophrenia and comorbid mood disorders or emotional dysregulation (Cluster 1), or schizophrenia and severe cognitive impairments (Cluster 2), those treated with monotherapy second-generation antipsychotics (SGAs) over time demonstrated consistently lower use of acute psychiatric treatment services as did those coprescribed mood stabilizers, primarily lithium, or anticonvulsants. In all clusters, including the relatively homogenous subgroup of patients with early onset schizophrenia and few comorbid disorders, acute psychiatric service utilization was significantly higher and more variable over time for those prescribed multiple SGAs.

Conclusions: Regardless of the specific constellation of symptoms and comorbid disorders targeted, the coprescription of multiple SGAs was not effective over time in stabilizing children and adolescents outside of acute care settings.
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http://dx.doi.org/10.1002/hup.2585DOI Listing
March 2017

Factors Associated With Musculoskeletal Injuries in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.

Prim Care Companion CNS Disord 2016 23;18(3). Epub 2016 Jun 23.

Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia.

Background: Musculoskeletal injuries may be associated with attention-deficit/hyperactivity disorder (ADHD) symptom severity, comorbid psychiatric or medical conditions, and the prescribed psychostimulant.

Methods: A population-based, retrospective cohort design was employed using South Carolina's Medicaid claims data set covering outpatient and inpatient medical services and medication prescriptions over an 11-year period (January 1, 1996, through December 31, 2006) for patients ≤ 17 years of age with ≥ 2 visits for diagnostic codes for ADHD. A cohort of 7,725 cases was identified and analyzed using logistic regression to compare risk factors for those who sustained focal musculoskeletal injuries and those who did not.

Results: The risk of sustaining sprains, arthropathy and connective tissue disorders, or muscle and joint disorders was significantly related to being diagnosed with comorbid hypertension (adjusted odds ratios [aORs] = 1.60, 2.09, and 1.46, respectively) and a substance use disorder (aORs = 1.58, 1.38, and 1.28). Having a substance use disorder was also related to incident fractures and dorso/spinal injuries (aORs = 1.42 and 1.21). Diagnosed hypertension was related to incident concussions (aOR = 2.00), a diagnosed thyroid disorder was related to an increased risk of sprain and concussion (aORs = 1.44 and 2.05), a diagnosed anxiety disorder was related to an increased risk of dorso/spinal disorders (aOR = 1.71), and diagnosed diabetes was related to incident bone and cartilage disorders (aOR = 1.61).

Conclusions: Comorbid hypertension, substance use disorders, and thyroid disorders deserve increased clinical surveillance in children and adolescents with ADHD because they may be associated with an increased risk of more than one musculoskeletal injury.
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http://dx.doi.org/10.4088/PCC.16m01937DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035814PMC
March 2017

Factors Differentiating Childhood-Onset and Adolescent-Onset Schizophrenia:A Claims Database Study.

Prim Care Companion CNS Disord 2016 3;18(2). Epub 2016 Mar 3.

Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada.

Background: The greater severity and burden of illness in individuals with early onset schizophrenia (ie, before age 18 years) deserves further investigation, specifically regarding its prevalence in community-based treatment and its association with other psychiatric or medical conditions.

Method: A retrospective cohort design was employed using the South Carolina Medicaid claims database covering outpatient and inpatient medical services from January 1, 1999, through December 31, 2013, to identify patients aged ≤ 17 years with a diagnosis of schizophrenia spectrum disorders (ICD-9-CM). Logistic regression was used to examine the factors differentiating childhood- versus adolescent-onset schizophrenia in a community-based system of care.

Results: Early onset schizophrenia was diagnosed in 613 child and adolescent cases during the study epoch or 0.2% of this population-based cohort. The early onset cohort was primarily male (64%) and black (48%). The mean length of time followed in the Medicaid dataset was 12.6 years. Within the early onset cohort, 22.5% were diagnosed at age ≤ 12 years and 77.5% were diagnosed as adolescents. The childhood-onset subgroup was twice as likely to have speech, language, or educational disabilities and an attention-deficit/hyperactivity disorder diagnosis but significantly less likely to have schizophrenia or schizoaffective disorder, an organic brain disorder or mental retardation/intellectual disability, or a substance use disorder (adjusted OR = 2.01, 2.26, 0.38, 0.31, 0.47, and 0.32, respectively) compared to the adolescent-onset subgroup.

Conclusion: Primary care providers should identify and maintain surveillance of cases of pediatric neurodevelopmental disorders, which appear to be highly comorbid and genetically related, and refer them early and promptly for specialized treatment.
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http://dx.doi.org/10.4088/PCC.15m01901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956428PMC
February 2017

Factors associated with musculoskeletal injuries in children and adolescents with sickle cell disease.

Am J Hematol 2016 06 13;91(6):E314-6. Epub 2016 Apr 13.

Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, South Carolina.

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http://dx.doi.org/10.1002/ajh.24365DOI Listing
June 2016

Long-Term Neurodevelopmental Outcomes in Children and Adolescents With Congenital Heart Disease.

Prim Care Companion CNS Disord 2015 22;17(5). Epub 2015 Oct 22.

Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia.

Background: Effective medical and surgical management of pediatric congenital heart disease (CHD) to reduce long-term adverse neurodevelopmental outcomes is an important clinical objective in primary and specialty health care. We identify clinical predictors associated with an increased risk of 6 long-term neurodevelopmental outcomes in children with CHD compared to the general pediatric Medicaid population.

Method: South Carolina's retrospective, 15-year Medicaid data set (January 1, 1996-December 31, 2010) for 19,947 patients aged ≤ 17 years diagnosed with ≥ 1 CHD lesions (on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification codes) were compared to 19,948 patients without CHD matched on age at entry into and duration in Medicaid using logistic and Cox proportional hazards regression.

Results: The CHD cohort was significantly less likely to have incident neurologic or psychiatric disorders, mental retardation, developmental delays, or inattention/hyperactivity (adjusted odds ratios [ORs] = 0.34, 0.56, 0.03, 0.01, 0.004, respectively) but was more likely to have incident seizures (OR = 2.00) compared to controls. Exposure to both cardiac and noncardiac surgical intervention was associated with a significantly increased risk of developing neurologic or psychiatric disorders, mental retardation, developmental delays, or inattention/hyperactivity (cardiac ORs = 1.66, 2.00, 1.67, 1.43, 1.76, respectively) (noncardiac ORs = 2.25, 1.59, 1.48, 1.29, 1.36, 2.46, respectively). Any documented hypoxemia was associated with a significantly increased risk of developing 5 of the neurodevelopmental conditions (neurologic OR = 4.52, psychiatric OR = 1.60, mental retardation OR = 2.90, developmental delay OR = 2.12, seizures OR = 4.23).

Conclusion: Practitioners should maintain vigilant surveillance of all CHD patients, especially those exposed to surgical procedures or experiencing hypoxemia, to identify any neurodevelopmental issues early and address them promptly.
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http://dx.doi.org/10.4088/PCC.15m01842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4732321PMC
February 2016

Anhedonia and cognitive function in adults with MDD: results from the International Mood Disorders Collaborative Project.

CNS Spectr 2016 Oct 30;21(5):362-366. Epub 2015 Dec 30.

1Department of Psychiatry,University of Toronto,Toronto,Ontario,Canada.

Background: Cognitive dysfunction is common in major depressive disorder (MDD) and a critical determinant of health outcome. Anhedonia is a criterion item toward the diagnosis of a major depressive episode (MDE) and a well-characterized domain in MDD. We sought to determine the extent to which variability in self-reported cognitive function correlates with anhedonia.

Method: A post hoc analysis was conducted using data from (N=369) participants with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR)-defined diagnosis of MDD who were enrolled in the International Mood Disorders Collaborative Project (IMDCP) between January 2008 and July 2013. The IMDCP is a collaborative research platform at the Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, Canada, and the Cleveland Clinic, Cleveland, Ohio. Measures of cognitive function, anhedonia, and depression severity were analyzed using linear regression equations.

Results: A total of 369 adults with DSM-IV-TR-defined MDD were included in this analysis. Self-rated cognitive impairment [ie, as measured by the Adult ADHD Self-Report Scale (ASRS)] was significantly correlated with a proxy measure of anhedonia (r=0.131, p=0.012). Moreover, total depression symptom severity, as measured by the total Montgomery-Åsberg Depression Rating Scale (MADRS) score, was also significantly correlated with self-rated measures of cognitive dysfunction (r=0.147, p=0.005). The association between anhedonia and self-rated cognitive dysfunction remained significant after adjusting for illness severity (r=0.162, p=0.007).

Conclusions: These preliminary results provide empirical data for the testable hypothesis that anhedonia and self-reported cognitive function in MDD are correlated yet dissociable domains. The foregoing observation supports the hypothesis of overlapping yet discrete neurobiological substrates for these domains.
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http://dx.doi.org/10.1017/S1092852915000747DOI Listing
October 2016

Incidence of primary hypertension in a population-based cohort of HIV-infected compared with non-HIV-infected persons and the effect of combined antiretroviral therapy.

J Am Soc Hypertens 2015 May 19;9(5):351-7. Epub 2015 Jan 19.

Division of Infectious Diseases, Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA.

Literature remains scarce on the impact of antiretroviral medications on hypertension in the HIV population. We used the South Carolina Medicaid database linked with the enhanced HIV/AIDS system surveillance database for 1994-2011 to evaluate incident hypertension and the impact of combination antiretroviral therapy (cART) in HIV/AIDS population compared with a propensity- matched non-HIV control group. Multivariable, time-dependent survival analysis suggested no significant difference in incidence of hypertension between the HIV group and the non-HIV control group. However, subgroup analysis suggested that among the HIV-infected group, months of exposure to both non-nucleoside reverse transcriptase inhibitors (adjusted hazard ratio, 1.52; 95% confidence interval, 1.3-1.75) and protease inhibitors (adjusted hazard ratio, 1.26; 95% confidence interval, 1.11-1.44) were associated with an increased risk of incident hypertension after adjusting for traditional demographic and metabolic risk factors. In people with HIV/AIDS, prolonged exposure to both protease inhibitor-based and non-nucleoside reverse transcriptase inhibitor-based cART may increase the risk of incident hypertension.
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http://dx.doi.org/10.1016/j.jash.2015.01.007DOI Listing
May 2015

Correlates of incident bipolar disorder in children and adolescents diagnosed with attention-deficit/hyperactivity disorder.

J Clin Psychiatry 2014 Nov;75(11):e1278-83

Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, 15 Medical Park, Ste 301, Columbia, SC 29203

Background: The greater severity and chronicity of illness in youths with co-occurring attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder deserve further investigation as to the risk imparted by comorbid conditions and the pharmacotherapies employed.

Method: A retrospective cohort design was employed, using South Carolina's Medicaid claims dataset covering outpatient and inpatient medical and psychiatric service claims with International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses and medication prescriptions between January 1996 and December 2006 for patients ≤ 17 years of age.

Results: The cohort included 22,797 cases diagnosed with ADHD at a mean age of 7.8 years; 1,604 (7.0%) were diagnosed with bipolar disorder at a mean age of 12.2 years. The bipolar disorder group developed conduct disorder (CD)/oppositional defiant disorder (ODD), anxiety disorder, and a substance use disorder later than the ADHD-only group. The odds of a child with ADHD developing bipolar disorder were significantly and positively associated with a comorbid diagnosis of CD/ODD (adjusted odds ratio [aOR] = 4.01), anxiety disorder (aOR = 2.39), or substance use disorder (aOR = 1.88); longer treatment with methylphenidate, mixed amphetamine salts, or atomoxetine (aOR = 1.01); not being African American (aOR = 1.61); and being treated with certain antidepressant medications, most notably fluoxetine (aOR = 2.00), sertraline (aOR = 2.29), bupropion (aOR = 2.22), trazodone (aOR = 2.15), or venlafaxine (aOR = 2.37) prior to the first diagnosis of mania.

Conclusions: Controlling for pharmacotherapy differences, incident bipolar disorder was more likely in individuals clustering specific patterns of comorbid psychiatric disorders, suggesting that there are different pathways to bipolarity and providing a clinical impetus for prioritizing prevention and preemptive strategies to reduce their hazardous influence.
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http://dx.doi.org/10.4088/JCP.14m09046DOI Listing
November 2014

The impact of cognitive impairment on perceived workforce performance: results from the International Mood Disorders Collaborative Project.

Compr Psychiatry 2015 Jan 23;56:279-82. Epub 2014 Aug 23.

Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.

Background: Cognitive dysfunction and depression severity are key mediators of workplace adjustment in adults with major depressive disorder (MDD). Herein, we sought to determine the extent to which measures of depression severity and cognitive dysfunction were associated with perceived global disability, workplace performance and quality of life.

Method: A post hoc analysis was conducted using data from 260 participants with a diagnosis of DSM-IV-TR-defined MDD who were enrolled in the International Mood Disorders Collaborative Project (IMDCP) between January 2008 and July 2013. Measures of workplace function, global disability, depression severity, cognitive function, and quality of life were employed. These data were analyzed using a multiple variable linear regression equations.

Results: Perceived global disability was significantly predicted by clinical ratings of depression severity (β=0.54), and perceived inattention (β=0.24), accounting for 37% of the variance. In addition, perceived inattention (β=0.58) and clinical ratings of depression severity (β=0.18), were also significant predictors of perceived workplace productivity/performance, accounting for 38% of the variance. Finally, both clinical ratings of depression severity (β=-0.54), and perceived inattention (β=-0.18) were significant inverse predictors of perceived quality of life, accounting for 34% of the variance.

Conclusion: The overarching finding in the analysis herein is that workplace performance variability is explained by subjective measures of cognitive dysfunction to a greater extent than total depression symptom severity. Conversely, total depression symptom severity accounts for a greater degree of variability in global measures of disability relative to cognitive measures. Treatment strategies for adults with major depressive disorder should address issues of cognitive dysfunction to improve workforce participation and performance.
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http://dx.doi.org/10.1016/j.comppsych.2014.08.051DOI Listing
January 2015

Letter to editor: Incident depression increases medical utilization in Medicaid patients with hypertension.

Expert Rev Cardiovasc Ther 2015 Jan 15;13(1):15-6. Epub 2014 Nov 15.

Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine , 3555 Harden Street Ext, Columbia, SC 29203 , USA.

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http://dx.doi.org/10.1586/14779072.2014.986099DOI Listing
January 2015

Impact of clinical and therapeutic factors on incident cardiovascular and cerebrovascular events in a population-based cohort of HIV-infected and non-HIV-infected adults.

Clin Cardiol 2014 Sep;37(9):517-22

Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi.

Background: Cardiovascular and cerebrovascular (CVD) events/diseases are a common cause of non-acquired immunodeficiency syndrome (AIDS)-related mortality in the aging human immunodeficiency virus (HIV)-infected population. The incidence rate and clinical correlates of CVD in people living with HIV/AIDS compared to the general population warrants further investigation.

Hypothesis: HIV/AIDS is associated with increased risk CVD compared to general population.

Methods: CVD events in a matched cohort of HIV-infected and non-HIV-infected adults, ≥18 years old, served through the South Carolina Medicaid program during 1994 to 2011 were examined using time-dependent proportional hazards regression and marginal structural modeling.

Results: A retrospective cohort of 13,632 adults was followed longitudinally for an average of 51 months. The adjusted hazard ratio (aHR) of incident CVD events was higher among HIV-infected individuals exposed to combination antiretroviral therapy (cART) (aHR = 1.15) compared to the non-HIV-infected group, but did not differ from the subgroup of cART-naïve HIV-infected adults. A higher aHR of incident CVD was associated with comorbid hypertension (aHR = 2.18), diabetes (aHR = 1.38), obesity (aHR = 1.30), tobacco use (aHR = 1.47), and hepatitis C coinfection (aHR = 1.32), and older age (aHR = 1.26), but with a lower risk among females (aHR = 0.86). A higher risk of incident CVD events was also apparent in HIV-infected individuals with exposure to both protease inhibitors (adjusted risk ratio [aRR] = 1.99) and non-nucleoside reverse transcriptase inhibitors (aRR = 2.19) compared to those with no exposure. Sustained viral load suppression was associated with a lower risk of incident CVD events (aRR = 0.74).

Conclusions: After adjusting for traditional risk factors and sociodemographic differences, there is higher risk of incident cardiovascular events among HIV-infected individuals exposed to combined antiretroviral medications compared to the general population.
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http://dx.doi.org/10.1002/clc.22311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6649542PMC
September 2014

Risk factors for incident major depressive disorder in children and adolescents with attention-deficit/hyperactivity disorder.

Eur Child Adolesc Psychiatry 2015 Jan 5;24(1):65-73. Epub 2014 Apr 5.

Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, 15 Medical Park, Suite 301, Columbia, SC, 29203, USA,

The greater burden of illness in youth with co-occurring attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD) deserves further investigation, specifically regarding the influence of other psychiatric or medical conditions and the pharmacotherapies prescribed. A retrospective cohort design was employed, using South Carolina's (USA) Medicaid claims' dataset covering outpatient and inpatient medical services, and medication prescriptions between January, 1996 and December, 2006 for patients ≤17 years of age. The cohort included 22,452 cases diagnosed with ADHD at a mean age 7.8 years; 1,259 (5.6 %) cases were diagnosed with MDD at a mean age of 12.1 years. The probability of a child with ADHD developing MDD was significantly associated with a comorbid anxiety disorder (aOR = 3.53), CD/ODD (aOR = 3.45), or a substance use disorder (aOR = 2.31); being female (aOR = 1.77); being treated with pemoline (aOR = 1.69), atomoxetine (aOR = 1.31), or mixed amphetamine salts (aOR = 1.28); a comorbid obesity diagnosis (aOR = 1.29); not being African American (aOR = 1.23), and being older at ADHD diagnosis (aOR = 1.09). Those developing MDD also developed several comorbid disorders later than the ADHD-only cohort, i.e., conduct disorder/oppositional-defiant disorder (CD/ODD), at mean age of 10.8 years, obesity at 11.6 years, generalized anxiety disorder at 12.2 years, and a substance use disorder at 15.7 years of age. Incident MDD was more likely in individuals clustering several demographic, clinical, and treatment factors. The phenotypic progression suggested herein underscores the need for coordinated early detection and intervention to prevent or delay syndromal MDD, or to minimize its severity and associated impairment over time.
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http://dx.doi.org/10.1007/s00787-014-0541-zDOI Listing
January 2015

Utility of Two PANSS 5-Factor Models for Assessing Psychosocial Outcomes in Clinical Programs for Persons with Schizophrenia.

Schizophr Res Treatment 2013 5;2013:705631. Epub 2013 Dec 5.

Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, 3555 Harden Street Extension, 15 MP, Suite 301, Columbia, SC 29203, USA.

Using symptom factors derived from two models of the Positive and Negative Syndrome Scale (PANSS) as covariates, change over time in consumer psychosocial functioning, medication adherence/compliance, and treatment satisfaction outcomes are compared based on a randomized, controlled trial assessing the effectiveness of antipsychotic medications for 108 individuals diagnosed with schizophrenia. Random effects regression analysis was used to determine the relative performance of these two 5-factor models as covariates in estimating change over time and the goodness of fit of the regression equations for each outcome. Self-reported psychosocial functioning was significantly associated with the relief of positive and negative syndromes, whereas patient satisfaction was more closely and significantly associated with control of excited/activation symptoms. Interviewer-rated psychosocial functioning was significantly associated with relief of positive and negative symptoms, as well as excited/activation and disoriented/autistic preoccupation symptoms. The VDG 5-factor model of the PANSS represents the best "goodness of fit" model for assessing symptom-related change associated with improved psychosocial outcomes and functional recovery. Five-factor models of the syndromes of schizophrenia, as assessed using the PANSS, are differentially valuable in determining the predictors of psychosocial and satisfaction changes over time, but not of improved medication adherence/compliance.
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http://dx.doi.org/10.1155/2013/705631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871510PMC
January 2014

Advancing biomarker research: utilizing 'Big Data' approaches for the characterization and prevention of bipolar disorder.

Bipolar Disord 2014 Aug 16;16(5):531-47. Epub 2013 Dec 16.

Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.

Objective: To provide a strategic framework for the prevention of bipolar disorder (BD) that incorporates a 'Big Data' approach to risk assessment for BD.

Methods: Computerized databases (e.g., Pubmed, PsychInfo, and MedlinePlus) were used to access English-language articles published between 1966 and 2012 with the search terms bipolar disorder, prodrome, 'Big Data', and biomarkers cross-referenced with genomics/genetics, transcriptomics, proteomics, metabolomics, inflammation, oxidative stress, neurotrophic factors, cytokines, cognition, neurocognition, and neuroimaging. Papers were selected from the initial search if the primary outcome(s) of interest was (were) categorized in any of the following domains: (i) 'omics' (e.g., genomics), (ii) molecular, (iii) neuroimaging, and (iv) neurocognitive.

Results: The current strategic approach to identifying individuals at risk for BD, with an emphasis on phenotypic information and family history, has insufficient predictive validity and is clinically inadequate. The heterogeneous clinical presentation of BD, as well as its pathoetiological complexity, suggests that it is unlikely that a single biomarker (or an exclusive biomarker approach) will sufficiently augment currently inadequate phenotypic-centric prediction models. We propose a 'Big Data'- bioinformatics approach that integrates vast and complex phenotypic, anamnestic, behavioral, family, and personal 'omics' profiling. Bioinformatic processing approaches, utilizing cloud- and grid-enabled computing, are now capable of analyzing data on the order of tera-, peta-, and exabytes, providing hitherto unheard of opportunities to fundamentally revolutionize how psychiatric disorders are predicted, prevented, and treated. High-throughput networks dedicated to research on, and the treatment of, BD, integrating both adult and younger populations, will be essential to sufficiently enroll adequate samples of individuals across the neurodevelopmental trajectory in studies to enable the characterization and prevention of this heterogeneous disorder.

Conclusions: Advances in bioinformatics using a 'Big Data' approach provide an opportunity for novel insights regarding the pathoetiology of BD. The coordinated integration of research centers, inclusive of mixed-age populations, is a promising strategic direction for advancing this line of neuropsychiatric research.
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http://dx.doi.org/10.1111/bdi.12162DOI Listing
August 2014

Factors associated with the occurrence and treatment of supraventricular tachycardia in a pediatric congenital heart disease cohort.

Pediatr Cardiol 2014 Feb 1;35(2):368-73. Epub 2013 Sep 1.

Department Medicine, University of Mississippi School of Medicine, 2500 N State St, Jackson, MS, 39216, USA.

In patients with congenital heart disease (CHD), the association between supraventricular tachycardia (SVT), type of pathophysiology, and therapeutic interventions in a population-based cohort warrants further examination. A retrospective, longitudinal 15-year data set (1996-2010) was analyzed. Inclusion criteria included age ≤17 years, enrolled in South Carolina State Medicaid, and diagnosed as having one or more CHDs as well as SVT. SVT was diagnosed in 6.5 % of CHD patients (N = 1,169) during the 15-year epoch investigated. SVT was less likely to occur in African-American (hazard ratio [HR] = 0.76) or male patients (HR = 0.88), but it was significantly more likely to occur in patients age ≤12 months or in adolescents ≥13 years in those undergoing multiple surgeries/medical interventions for their CHD (HR = 1.14), those receiving antiarrhythmic/diuretic/preload-/afterload-reducing medications (HR = 5.46), and those with severe/cyanotic CHDs (HR = 1.52) or chromosomal abnormalities (HR = 1.64). Children who had an atrial septal defect secundum (adjusted odds ratio [aOR] = 3.03) and those treated with diuretic or antiarrhythmic medication (aOR = 1.80) were significantly more likely to undergo SVT ablation, whereas those with late-onset pulmonary hypertension (ages 6-12 years old) were significantly less likely to undergo SVT ablation. SVT recurred in only 14 of 166 patients who underwent SVT ablation. Multiple medical interventions at an early age may increase the risk of SVT occurrence in young CHD patients regardless of the severity/complexity of the CHD.
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http://dx.doi.org/10.1007/s00246-013-0784-3DOI Listing
February 2014

Association of clinical and therapeutic factors with incident dyslipidemia in a cohort of human immunodeficiency virus-infected and non-infected adults: 1994-2011.

Metab Syndr Relat Disord 2013 Dec 2;11(6):417-26. Epub 2013 Aug 2.

1 Division of Internal Medicine, Department of Medicine, University of Mississippi School of Medicine , Jackson, Mississippi.

Objective: The aim of this study was to determine the incidence rate of dyslipidemia in a retrospective cohort of human immunodeficiency virus (HIV)-infected and non-HIV-infected adults and to evaluate the association of incident dyslipidemia with exposure to combination antiretroviral therapy (cART).

Methods: The study cohort included HIV-infected individuals and a matched group of non-HIV-infected individuals served through the South Carolina Medicaid database in 1994-2011. Linkage with the HIV/AIDS surveillance database provided time-varying viro-immunological status. Time-dependent proportional hazards analysis and marginal structural models were used to assess the demographic, therapeutic, and clinical factors associated with incident dyslipidemia.

Results: Among 13,632 adults with a median age of 39 years, the overall incidence rate per 1000 person years of dyslipidemia was higher in cART-treated compared to cART-naïve and matched non-HIV groups (24.55 vs. 14.32 vs. 23.23, respectively). Multivariable results suggested a significantly higher risk of dyslipidemia in the cART-treated HIV-infected group [adjusted hazard ratio (aHR)=1.18; 95% confidence interval (CI)=1.07-1.30] and a significantly lower risk in the cART naïve HIV-infected group (aHR=0.66; CI=0.53-0.82) compared to the control non-HIV-infected group. Marginal structural modeling suggested a significant association between incident dyslipidemia and exposure to both protease inhibitor- [adjusted rate ratio (aRR)=1.27; CI=1.08-1.49] and non-nucleoside reverse transcriptase inhibitor- (aRR=1.78; CI=1.19-2.66) based cART regimens. Pre-existing hypertension, obesity, and diabetes increased the risk of dyslipidemia, whereas hepatitis C virus, lower CD4(+) T cell count, and higher HIV viral load had a protective effect.

Conclusions: Incident dyslipidemia is lower in the early stages of HIV infection, but may significantly increase with cumulative exposure to cART. Viro-immunological status and underlying comorbidities have a strong association with the onset of dyslipidemia.
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http://dx.doi.org/10.1089/met.2013.0017DOI Listing
December 2013

Obesity and mental illness: implications for cognitive functioning.

Adv Ther 2013 Jun 3;30(6):577-88. Epub 2013 Jul 3.

Department of Psychiatry, University of Toronto, Toronto, ON, Canada.

A priority research and clinical agenda is to identify determinants of cognitive impairment in individuals with neuropsychiatric disorders (NPD). The bidirectional association between NPD and cognitive performance has been reported to be mediated and/or moderated by obesity in a subset of individuals. Obesity can be conceptualized as a neurotoxic phenotype among individuals with NPD as evidenced by alterations in the structure and function of neural circuits and disseminated networks, diminished cognitive performance, and adverse effects on illness trajectory. The neurotoxic effect of obesity provides a rationale for screening, treating, and preventing obesity in neuropsychiatric populations. Research endeavors that aim to refine mediators and moderators of this association as well as novel strategies to reverse the injurious process of obesity on cognition are warranted.
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http://dx.doi.org/10.1007/s12325-013-0040-5DOI Listing
June 2013

Individual risk factors and complexity associated with congenital heart disease in a pediatric medicaid cohort.

South Med J 2013 Jul;106(7):385-90

University of South Carolina School of Medicine, Columbia, SC, USA.

Objectives: To determine the sex and race differences associated with specific congenital heart diseases (CHDs) and the patterns of concomitant conditions associated with eight severe, complex lesions.

Methods: A 15-year Medicaid dataset (1996-2010) from one state was analyzed for 14,496 patients aged 17 years and younger and diagnosed as having a CHD on one or more service visits to a pediatrician or pediatric cardiologist.

Results: Controlling for all other diagnosed CHDs, boys were more likely to be diagnosed as having transposition of the great arteries, hypoplastic left heart syndrome, aortic stenosis, and coarctation of the aorta, whereas African Americans were more likely to be diagnosed as having tricuspid regurgitation, atrial septal defect sinus venosus, coronary artery anomaly, and pulmonary stenosis. Ventricular septal defects, atrial septal defects secundum, patent ductus arteriosus, and pulmonary stenosis were the most prevalent isolated CHDs, whereas tetralogy of Fallot, atrioventricular canal/endocardial cushion defect, common/single ventricle, double outlet right ventricle, and transposition of the great arteries were the most prevalent severe, complex lesions. The complexity of some severe cardiac anomalies appears to be increasing over time.

Conclusions: Changes over time in pediatric CHD caseload mix may affect care management and result in prognosis or outcome differences. These changes present important opportunities for pediatricians and pediatric cardiologists to collaborate, especially in the care of the most severe anomalies.
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http://dx.doi.org/10.1097/SMJ.0b013e31829bd0bcDOI Listing
July 2013

Changes in cognitive function associated with syndrome changes on two five-factor models of the Positive and Negative Syndrome Scale.

Hum Psychopharmacol 2012 Nov;27(6):566-76

Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC, USA.

Objective: This study aims to examine the association between neuropsychological function and symptom changes over time on two five-factor models, pentagonal (PM) and Van der Gaag (VDG), of the Positive and Negative Syndrome Scale (PANSS) and to determine the added value of these syndrome models for interpreting neuropsychological changes.

Methods: Data were collected in a randomized controlled trial comparing second-generation and conventional antipsychotic medications for 108 adult patients diagnosed with schizophrenia and monitored prospectively for 12 months using standard neuropsychological instruments and the PANSS. Random-effects regression was used to estimate the change over time in neuropsychological function and the association of PANSS covariates.

Results: Improvements in positive, negative, and cognitive syndromes were significant predictors of change on nine neuropsychological measures. The neuropsychological function was worsening on five of these measures. The PM model represented the best set of predictors examining positive and negative syndrome covariates, whereas the VDG model consistently represented the best predictors examining cognitive syndrome covariates.

Conclusions: The PM positive and negative syndrome factors and the VDG disorganized thoughts syndrome factor are differentially associated with changes in neuropsychological function over time. Clinical investigators may want to target their use of these factors from the PANSS according to the outcome variables being measured.
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http://dx.doi.org/10.1002/hup.2266DOI Listing
November 2012

Prevalence and management of patent ductus arteriosus in a pediatric medicaid cohort.

Clin Cardiol 2013 Sep 29;36(9):502-6. Epub 2013 May 29.

Department Medicine, University of Mississippi School of Medicine, Jackson, Mississippi.

Background: Widespread use of echocardiography has made earlier diagnosis of patent ductus arteriosus (PDA) possible, but pharmacological or surgical intervention is highly variable. Herein, we investigate the prevalence of PDA and its management in a routine care system.

Methods: A 15-year retrospective dataset (1996-2010) was analyzed. Selection criteria included age ≤17 years, enrollees in South Carolina State Medicaid, and diagnosed as having PDA on 1 or more service visits to a pediatrician or pediatric cardiologist.

Results: The 15-year treated prevalence rate of PDA was 0.25/1000 pediatric cases of congenital heart disease (CHD). PDA was more prevalent in non-African American patients (adjusted odds ratio [aOR]: 1.12), but not in females after controlling for all other CHDs diagnosed in the cohort. Associated CHDs were present in 57.6% of the cases, primarily atrial or ventricular septal defects, and fewer patients (5.5%) developed pulmonary hypertension. Of 3627 PDA cases examined, 70.0% received no medications or PDA repair. Therapeutic ibuprofen was used for closure in 24.4% of the cases, and a PDA repair was performed in 7.8%. Younger children (aOR: 0.82), those who received an atrial septal defect closure (aOR: 5.18), and those who were treated with digoxin (aOR: 1.86) or with diuretics or preload/afterload reducing agents (ie, calcium channel blockers or angiotensin-converting enzyme inhibitors) (aOR: 5.72) were significantly more likely to have a PDA repair procedure.

Conclusions: The majority of diagnosed PDA cases did not require pharmacological or surgical intervention. Those receiving pharmacological or surgical intervention were treated conservatively in relation to the presence of distress symptoms or concomitant CHDs requiring intervention.
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http://dx.doi.org/10.1002/clc.22150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6649434PMC
September 2013

Prevalence of treatment, risk factors, and management of atrial septal defects in a pediatric Medicaid cohort.

Pediatr Cardiol 2013 Oct 26;34(7):1723-8. Epub 2013 Apr 26.

Department of Pediatrics, University of South Carolina School of Medicine, 9 Medical Park, Suite 110, Columbia, SC, 29203, USA.

Atrial septal defects (ASDs) vary greatly depending on their size, age at closure, and clinical management. This report characterizes the prevalence, complexity, and clinical management of these lesions in a statewide pediatric cohort and examines predictors for receiving closures. A 15-year Medicaid data set (1996-2010) from one state was analyzed. The selection criteria specified patients 17 years of age or younger with a diagnosis of ASD primum, secundum, or sinus venosus on one or more service visits to a pediatrician or pediatric cardiologist. During the 15-year period, ASDs represented a prevalence rate for treatment of 0.47/1000 CHDs identified, with 61 % presenting as complex lesions. Concomitant cardiac anomalies that might have a negative impact on prognosis were present including patent ductus arteriosus (26.1 %), pulmonary hypertension (3.8 %), and supraventricular tachycardia (2.4 %). Pharmacologic treatments, predominantly diuretics, were prescribed for 21 % of the cohort. Both surgical closures (6.3 %) and transcatheter closures (1.4 %) were used for ASD secundum cases, whereas surgical closures predominated for ASD primum (25.6 %) and sinus venosus (13.5 %) lesions. The postoperative follow-up period was two to three times longer for children with ASD primum or sinus venosus than for those with ASD secundum (average, ~1 year). Factors predicting the likelihood of having ASD closure were older age, having a concomitant patent ductus arteriosus (PDA) repair, treatment with ibuprofen, having two or more concomitant CHDs, and receiving diuretics or preload/afterload-reducing agents. Care of ASDs in routine practice settings involves more complications and appears to be more conservative than portrayed in previous investigations of isolated ASDs.
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http://dx.doi.org/10.1007/s00246-013-0705-5DOI Listing
October 2013

A comparison of the PANSS pentagonal and Van Der Gaag 5-factor models for assessing change over time.

Psychiatry Res 2013 May 11;207(1-2):134-9. Epub 2013 Jan 11.

University of South Carolina School of Medicine, Department of Neuropsychiatry, 3555 Harden Street, Suite 301, Columbia, SC 29203, USA.

The positive and negative syndrome scale (PANSS) pentagonal (PM) and Van der Gaag (VDG) 5-factor models were compared on a range of change-over-time statistical indicators. PANSS data from a randomized, controlled trial for 108 adults diagnosed with schizophrenia were re-analyzed to calculate five factor scores for each model. Random effects regression was used to determine their relative performance in modeling change-over-time, determining covariance structure, and achieving goodness of fit. Performance of the 10 factors in estimating change-over-time was similar, as were significant covariates for the factor dyads: age, gender, chronicity/acuity, and anticholinergic medication. The PM model factors demonstrated the best "goodness of model fit" to the data on all five of the factor dyads. Correlation analyses indicated significantly high, positive correlations between the five factor dyads: Positive and Negative factors for the PM and VDG models, the PM Activation and VDG Excited factors, the PM Dysphoric Mood and the VDG emotional distress factors, and the PM Autistic Preoccupation and the VDG Disorganized factors, although the PANSS items on each factor differed somewhat. These results extend previous findings and indicate several important performance differences between the PM and VDG models in their parsimonious representation of the syndromes of schizophrenia and estimating change-over-time.
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http://dx.doi.org/10.1016/j.psychres.2012.12.010DOI Listing
May 2013

Prevalence and impact of initial misclassification of pediatric type 1 diabetes mellitus.

South Med J 2012 Oct;105(10):513-7

Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC 29203, USA.

Purpose: To characterize rates of initial misclassification of type 1 diabetes mellitus as type 2/unspecified diabetes mellitus in a cohort of children/adolescents and to examine the impact of misclassification on the risk of diabetes-related complications.

Methods: An 11-year dataset (1996-2006) was analyzed. Inclusion criteria included age 17 years and younger, enrollees in South Carolina State Medicaid, and diagnosis of type 2/unspecified or type 1 diabetes mellitus for at least two visits, 15 days apart. Survival analysis was used to assess the association of "misclassification" with the incidence of diabetic ketoacidosis (DKA), and the cumulative incidence of neuropathy, nephropathy, and cardiovascular complications, after controlling for individual risk factors and comorbid conditions.

Results: A total of 1130 individuals meeting the inclusion criteria were studied for a median of 7 years. Of the 1130 individuals, 669 (59.2%) maintained a diagnosis of type 2/unspecified diabetes mellitus, 205 (18.1%) were consistently diagnosed as type 1 diabetes mellitus, and the remaining 256 individuals (22.7%) were misclassified. Insulin treatment was used in 100% of the type 1 diabetes mellitus group and 73% of the misclassified group. Compared with the type 2 diabetes mellitus group, being misclassified was associated with earlier development of DKA (adjusted hazard ratio [aHR] 5.08, 95% confidence interval [CI] 3.09-8.37), neuropathy (aHR 1.94, CI 1.31-2.88), and nephropathy (aHR 1.72, CI 1.19-2.50), whereas being consistently classified with type 1 diabetes mellitus was associated only with earlier development of DKA (aHR 4.96, CI 2.56-9.61).

Conclusions: Proper categorization of pediatric diabetes can be challenging, especially with comorbid obesity. Failure to ascertain type 1 diabetes mellitus in a timely manner in a pediatric population may increase the risk of substandard care and diabetes-related complications.
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http://dx.doi.org/10.1097/SMJ.0b013e318268ca60DOI Listing
October 2012

Population-based treated prevalence of congenital heart disease in a pediatric cohort.

Pediatr Cardiol 2013 Mar 14;34(3):606-11. Epub 2012 Sep 14.

Department of Pediatrics, University of South Carolina School of Medicine, 9 Medical Park, Suite 110, Columbia, SC 29203, USA.

Extant epidemiologic results for pediatric congenital heart disease (CHD) are dated. Given the degree of variability in previous prevalence estimates and the rapid changes in pediatric cardiology diagnostic and treatment procedures, a reexamination of these rates represents a potentially important update in this area of inquiry. This report characterizes the prevalence rates of children with CHD in one state's treated pediatric population by type of lesion and in comparison with published rates from previous studies. Two 15-year data sets (1996-2010) are analyzed. The inclusion criteria for the study required the participants to be 17 years or younger, enrollees in the South Carolina State Medicaid or State Health Plan, and recipients of a CHD diagnosis on one or more service visits to a pediatrician or pediatric cardiologist. A 15-year accrued prevalence rate for pediatric CHD of 16.7 per 1,000 was found among 1,145,364 unduplicated children served. The annual incidence rates varied from 6.3 to 8.6 per 1,000, with an initial downward trend from 1996 to 2002 followed by an upward trend from 2003 to 2008. A higher prevalence of atrioventricular canal/endocardial cushion defects, common/single ventricle, double-outlet right ventricle, tetralogy of Fallot, and truncus arteriosus and a lower prevalence of dextro-transposition of the great arteries were diagnosed in South Carolina than in other states and countries according to published results. The study results underscore the need for periodic updating of prevalence data for pediatric CHD, both in total and for specific lesions, to anticipate and provide more specialized care to young patients with CHD, especially in the more rare and complex cases.
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http://dx.doi.org/10.1007/s00246-012-0505-3DOI Listing
March 2013

The risk of developing type 2 diabetes mellitus associated with psychotropic drug use in children and adolescents: a retrospective cohort analysis.

Prim Care Companion CNS Disord 2012 12;14(1). Epub 2012 Jan 12.

Departments of Neuropsychiatry, University of South Carolina School of Medicine, Columbia, South Carolina, USA.

Objective: Type 2 diabetes mellitus in children and adolescents has become an important public health concern, in parallel with the "epidemic" of overweight/obesity in this age group and a sharp increase in children being prescribed antidepressant or antipsychotic medications. In children and adolescents, the prevalence of being prescribed antidepressant or antipsychotic medications was examined as well as the association of these medications with developing type 2 diabetes mellitus.

Method: A retrospective cohort design evaluating South Carolina Medicaid medical and pharmacy claims between January 1, 1996, and December 31, 2006, was employed to identify 4,070 children and adolescents diagnosed initially with type 2 diabetes mellitus, 39% of whom were later reclassified as type 1 (using ICD-9 criteria). The added risk of developing type 2 diabetes mellitus posed by the use of antidepressants or antipsychotics was investigated in this cohort, controlling for individual risk factors and comorbid cardiometabolic conditions.

Results: Use of antidepressants or antipsychotics alone, or the 2 in combination, conferred an increased risk (1.3 to 2 times greater) of having diagnosed type 2 diabetes mellitus and several comorbid cardiometabolic conditions (obesity, dyslipidemia, and hypertension). However, psychiatric illnesses generally developed and were treated after the initial development of diabetes.

Conclusions: Depression was diagnosed and treated in 10% to 20% of this cohort. While antidepressants and antipsychotics, alone or in combination, are associated with a diagnosis of type 2 diabetes mellitus and its cardiometabolic comorbidities by adolescence, they do not appear to be an explanatory factor in the early onset of type 2 diabetes mellitus in this age group and do not appear to cloud the initial, overlapping clinical picture between type 1 and type 2 diabetes mellitus.
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http://dx.doi.org/10.4088/PCC.11m01185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357575PMC
June 2013