Publications by authors named "Karen Williams"

242 Publications

The Best Science is Inclusive of African Americans.

J Urban Health 2021 Sep 14. Epub 2021 Sep 14.

Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, OH, USA.

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http://dx.doi.org/10.1007/s11524-021-00576-5DOI Listing
September 2021

Racism, Stress, and Health.

Nurs Res 2021 Set/Oct 01;70(5S Suppl 1):S1-S2

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http://dx.doi.org/10.1097/NNR.0000000000000534DOI Listing
August 2021

Marla Sokolowski: and now for someone completely different.

J Neurogenet 2021 Jul 14:1-5. Epub 2021 Jul 14.

Department of Psychological Sciences, University of San Diego, San Diego, CA, USA.

A comprehensive science, technology, engineering, and mathematics (STEM) education has persistent formative effects on individuals, communities, and society. In this regard, Marla Sokolowski's academic legacy will forever reflect her unique contributions to STEM education and mentoring. Furthermore, her creative and multidisciplinary approach to research has resulted in groundbreaking advances in our understanding of behavior genetics. Illustrated here are a few of our life-long learning experiences drawn mainly from earlier parts of Marla's career.
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http://dx.doi.org/10.1080/01677063.2021.1940175DOI Listing
July 2021

The influence of growth and training loads on injury risk in competitive trampoline gymnasts.

J Sports Sci 2021 Jul 3:1-10. Epub 2021 Jul 3.

Department for Health, University of Bath, Bath, UK.

There is currently limited research exploring the relationship between growth, training load and injury in gymnasts. Twenty-one national level, trampoline gymnasts recorded training load and injury for 8-weeks. Percentage of predicted adult height (%PAH) was calculated using the Khamis-Roche method and used to define growth spurt status. Training load was calculated using the session rate of perceived exertion and analysed as differential loads and as a 7-day exponentially weighted moving average (EWMA7day). There was a significant non-linear association between %PAH and the probability of injury when adjusting for either training load metric (differential load, P = 0.015; EWMA7day; P = 0.008), with the highest injury risk estimated at ~90% PAH (circa growth spurt). The probability of injury significantly increased with increases in EWMA7day training load (RR: 1.88 95% CI: 1.21- 2.91, P = 0.005) but not with differential load. No significant interaction between %PAH, training load and the probability of injury were observed. Data suggest that competitive trampoline gymnasts are at an increased risk of injury during the adolescent growth spurt or with higher weekly training loads. Coaches should be educated and encouraged to identify periods of rapid growth and monitor training load, to reduce the risk of injury.
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http://dx.doi.org/10.1080/02640414.2021.1948259DOI Listing
July 2021

Exploring the convergence of knowledge, attitudes, and practice towards mental illness among nurses in South India: A cross-sectional analysis.

Asian J Psychiatr 2021 Aug 14;62:102696. Epub 2021 May 14.

KLE University Kaher Institute for Nursing Sciences, JN Medical College Campus, Nehru Nagar, Belagavi 590010, Karnataka, India.

Mental illness is a leading cause of global morbidity. Over 10% of the Indian population experience a mental health disorder yet deficits in knowledge and negative attitudes towards metal illness limit early identification and treatment. We explored the relationship among knowledge, attitudes and practice among generalist nurses working at a large tertiary care hospital in South India. Participants demonstrated positive attitudes and sufficient knowledge about mental illness, yet these variables did not predict practice when presented with a patient case scenario of postpartum depression-related mental distress in a non-psychiatric inpatient setting. Findings warrant application-based pedagogies to facilitate nurses' enhanced recognition and treatment of patients experiencing mental distress in non-psychiatric settings.
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http://dx.doi.org/10.1016/j.ajp.2021.102696DOI Listing
August 2021

Sleep among Obstetrics and Gynecology Trainees: Results from a Yoga-Based Wellness Initiative.

Am J Perinatol 2021 May 3. Epub 2021 May 3.

Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, Missouri.

Objective:  This study aimed to determine the feasibility of using a wrist-based fitness tracking device to assess sleep among Obstetrics and Gynecology (OBGYN) trainees who engaged in a yoga-based wellness program. We also sought to evaluate the effects of yoga on sleep.

Study Design:  A quality improvement initiative consisting of an 8-week wellness program of weekly yoga classes, nutrition, and physical challenges was implemented for OBGYN residents and Maternal-Fetal Medicine fellows. The Polar A370 fitness tracker device was provided and synced to the Polar Flow for Coach program for inclusion. Data obtained included total and restful sleep from each night the device were worn. Pre- and post-assessment of the Pittsburg Sleep Quality Index (PSQI) were compared. Linear mixed models were used to estimate and test the effect of yoga on sleep while controlling for on-call shifts.

Results:  Of the 15 participants who synced their device, 13 (87%) were included for analysis. Sleep data from 572 nights were analyzed. The mean (SD) total sleep was 434.28 (110.03) minutes over the 8 weeks. A minimum of 7 hours (420 minutes) of total sleep occurred 59.3% of the time. After controlling for Friday or Saturday night on-call, those who attended yoga class had a significantly greater total sleep (yoga: 425.14 minutes [41.89], no yoga: 357.33 [43.04] minutes;  = 0.04). There was no significant change in the mean global PSQI score after the program (pre: 5.0 [1.6], post: 5.1 [2.5],  = 0.35).

Conclusion:  Wearable fitness monitors provide insight into sleep patterns displayed during training and can serve as a tool to identify those who are sleep deprived and assist in the evaluation of trainee wellness. Training programs are encouraged to provide access to yoga and mindfulness interventions to improve sleep and possibly clinical performance.

Key Points: · Yoga improves trainee sleep by approximately 60 minutes.. · Total and restful sleep are reduced during night float rotation.. · Trainees obtained 7 hours of sleep approximately 60% of the time..
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http://dx.doi.org/10.1055/s-0041-1728838DOI Listing
May 2021

Two Community-Based Strategies to Recruit Black Women in Research.

J Urban Health 2021 Apr 26. Epub 2021 Apr 26.

College of Nursing, The Ohio State University, 1585 Neil Ave, Columbus, OH, 43210, USA.

To adequately address health disparities, underserved populations must be recruited for biomedical research. Particularly, Black women have been insufficiently included in biomedical research for reasons beyond those of participant preference. Researchers can and should be taking responsibility to ensure rigorous methods are employed to appropriately recruit Black women and enable meaningful implications of their results. The objective of this paper is to identify and describe innovative community-based strategies for successful recruitment of Black women in research. Three studies are referenced to exemplify recruitment methods and demonstrate promising recruitment results in sample size and screening-to-enrollment ratio.
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http://dx.doi.org/10.1007/s11524-021-00541-2DOI Listing
April 2021

Trends in referrals to liaison psychiatry teams from UK emergency departments for patients over 65.

Int J Geriatr Psychiatry 2021 09 29;36(9):1415-1422. Epub 2021 Apr 29.

Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK.

Introduction: The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number and type referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.

Methods: We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. We described trends in the number, rate, age, mental health presentation, and time taken to assessment over a 7 years period.

Results: Referral data from 28 EDs across England and Scotland were analysed (n = 18,828 referrals). There was a general trend towards increasing numbers of people referred to liaison psychiatry year on year. Variability in referral numbers between different departments, ranged from 0.1 to 24.3 per 1000 ED attendances. The most common reasons for referral were mood disorders, self-harm and suicidal ideas. The majority of referrals were assessed within 60 min, however there is variability between departments, some recording waits over 11 h.

Discussion: The data suggests great inter-departmental variability in referral numbers. Is not possible to establish the cause of variability. However, the data highlights the importance of asking further questions about why the differences exist, and the impact that has on patient care.
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http://dx.doi.org/10.1002/gps.5547DOI Listing
September 2021

Ten-year cardiovascular risk among cancer survivors: The National Health and Nutrition Examination Survey.

PLoS One 2021 4;16(3):e0247919. Epub 2021 Mar 4.

Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America.

Background: Cancer survivors have a higher risk of developing and dying from cardiovascular disease (CVD) compared to the general population. We sought to determine whether 10-year risk of atherosclerotic CVD (ASCVD) is elevated among those with vs. without a cancer history in a nationally representative U.S. sample.

Methods: Participants aged 40-79 years with no CVD history were included from the 2007-2016 National Health and Nutrition Examination Survey. Cancer history was self-reported and 10-year risk of ASCVD was estimated using Pooled Cohort Equations. We used logistic regression to estimate associations between cancer history and odds of elevated (≥7.5%) vs. low (<7.5%) 10-year ASCVD risk. An interaction between age and cancer history was examined.

Results: A total of 15,095 participants were included (mean age = 55.2 years) with 12.3% (n = 1,604) reporting a cancer history. Individuals with vs. without a cancer history had increased odds of elevated 10-year ASCVD risk (OR = 3.42, 95% CI: 2.51-4.66). Specifically, those with bladder/kidney, prostate, colorectal, lung, melanoma, or testicular cancer had a 2.72-10.47 higher odds of elevated 10-year ASCVD risk. Additionally, age was an effect modifier: a cancer history was associated with 1.24 (95% CI: 1.19-4.21) times higher odds of elevated 10-year ASCVD risk among those aged 60-69, but not with other age groups.

Conclusions: Adults with a history of self-reported cancer had higher 10-year ASCVD risk. ASCVD risk assessment and clinical surveillance of cardiovascular health following a cancer diagnosis could potentially reduce disease burden and prolong survival, especially for patients with specific cancers and high ASCVD risk.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247919PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932508PMC
March 2021

"Remdesivir-Associated Pancreatitis".

Am J Ther 2021 Feb 10. Epub 2021 Feb 10.

Department of Medicine, Guthrie Robert Packer Hospital, Sayre, PA; Clinical Pharmacy Specialist, PGY1 Pharmacy Residency Program Director, Guthrie Robert Packer Hospital, Sayre, PA; and Hospitalist Department, Guthrie Robert Packer Hospital, Sayre, PA.

Abstract: We report a case of acute pancreatitis that developed after four days of remdesivir therapy in a patient being treated for COVID-19. Despite improvement in patient's respiratory status, abdominal pain worsened and clinical signs and symptoms progressed to a diagnosis of acute pancreatitis 4 days after initiation of remdesivir therapy. Withdrawal of remdesivir paired with medical management of acute pancreatitis led to the resolution of pancreatitis within three days. To our knowledge, this is the first case report depicting remdesivir as a possible cause of acute pancreatitis.
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http://dx.doi.org/10.1097/MJT.0000000000001266DOI Listing
February 2021

Differences in cervical cancer screening and follow-up for black and white women in the United States.

Gynecol Oncol 2021 02 13;160(2):369-374. Epub 2020 Dec 13.

Obstetrics, Gynecology & Reproductive Biology, College of Human Medicine, Michigan State University, Spectrum Health Medical Group, Grand Rapids, MI 49503, United States of America. Electronic address:

Objective: To study differences in screening adherence and follow-up after an abnormal Pap test in Non-Hispanic Black (Black) and Non-Hispanic White (White) women.

Methods: An observational cohort study using 2010 National Health Interview Survey cancer module to examine HPV knowledge, screening behavior, and follow-up to abnormal Pap test in Black and White women 18 years of age or older without a hysterectomy. We fit logistic regression models to examine associations between race and primary outcome variables including: HPV awareness, Pap test in the last three years, provider recommended Pap test, received Pap test results, had an abnormal Pap test, recommended follow-up, and adhered to the recommendation for follow-up.

Results: Analyzing data for 7509 women, Black women had lower odds ratios [OR] for: 1) HPV awareness (71% vs 83%; OR = 0.42; 95% CI = 0.36-0.49); 2) reporting Pap screening was recommended (59% vs 64%; OR = 0.76; 95% CI = 0.66-0.88), and 3) acknowledging receipt of Pap results (92% vs 94%; OR = 0.64; 95% CI = 0.49-0.83). Group differences persisted after covariates adjustment. In adjusted models, Black women had higher odds of reporting recent Pap screening (84% vs 77%; OR = 1.7; 95% CI = 1.42-2.03), but reported lower odds of receiving a follow-up recommendation subsequent to abnormal test (78% vs 87%; OR = 0.54; 95% CI = 0.31-0.95).

Conclusion: Black women reported higher cervical cancer screening adherence but lower rates of being informed of an abnormal Pap test and contacted for follow-up treatment. We recommend a multilevel approach to deliver culturally appropriate education and communication for patients, physicians, clinicians in training, and clinic level ancillary staff.
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http://dx.doi.org/10.1016/j.ygyno.2020.11.027DOI Listing
February 2021

Crop wild relatives of the United States require urgent conservation action.

Proc Natl Acad Sci U S A 2020 12 14;117(52):33351-33357. Epub 2020 Dec 14.

NatureServe, Arlington, VA 22202.

The contributions of crop wild relatives (CWR) to food security depend on their conservation and accessibility for use. The United States contains a diverse native flora of CWR, including those of important cereal, fruit, nut, oil, pulse, root and tuber, and vegetable crops, which may be threatened in their natural habitats and underrepresented in plant conservation repositories. To determine conservation priorities for these plants, we developed a national inventory, compiled occurrence information, modeled potential distributions, and conducted threat assessments and conservation gap analyses for 600 native taxa. We found that 7.1% of the taxa may be critically endangered in their natural habitats, 50% may be endangered, and 28% may be vulnerable. We categorized 58.8% of the taxa as of urgent priority for further action, 37% as high priority, and 4.2% as medium priority. Major ex situ conservation gaps were identified for 93.3% of the wild relatives (categorized as urgent or high priority), with 83 taxa absent from conservation repositories, while 93.1% of the plants were equivalently prioritized for further habitat protection. Various taxonomic richness hotspots across the US represent focal regions for further conservation action. Related needs include facilitating greater access to and characterization of these cultural-genetic-natural resources and raising public awareness of their existence, value, and plight.
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http://dx.doi.org/10.1073/pnas.2007029117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776777PMC
December 2020

Headache management in a Veteran population: First considerations.

Authors:
Karen A Williams

J Am Assoc Nurse Pract 2020 Nov;32(11):758-763

Headache Center of Excellence, Central Virginia VA Health Care System, Richmond, Virginia.

It is estimated that almost half the general population has a headache disorder. The majority of these are considered tension-type headaches. Migraines and chronic daily headache (CDH) are not as common but are much more debilitating. Although CDH/chronic migraine (CM) occurs in about 3% of the population, it has been found to be 20% or higher in the post 9/11 combat Veteran population. Data from the Veterans Health Administration show that more than 380,000 Veterans, younger than 50 years, received care for a headache in 2017. Approximately 75% of the headache care was from a primary care provider. The purpose of the article is to review physical examination for the veteran with a history of a headache disorder, discuss contributing factors and comorbid conditions, as well as give an overview of current treatment options, with a focus on the post-9/11 combat Veteran who has CDH/CM.
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http://dx.doi.org/10.1097/JXX.0000000000000539DOI Listing
November 2020

The Genetic Diversity of Cranberry Crop Wild Relatives, Aiton and L., in the US, with Special Emphasis on National Forests.

Plants (Basel) 2020 Oct 26;9(11). Epub 2020 Oct 26.

Department of Horticulture, University of Wisconsin, Madison, WI 53706, USA.

Knowledge of the genetic diversity in populations of crop wild relatives (CWR) can inform effective strategies for their conservation and facilitate utilization to solve agricultural challenges. Two crop wild relatives of the cultivated cranberry are widely distributed in the US. We studied 21 populations of Aiton and 24 populations of L. across much of their native ranges in the US using 32 simple sequence repeat (SSR) markers. We observed high levels of heterozygosity for both species across populations with private alleles ranging from 0 to 26. For , we found a total of 613 alleles and high levels of heterozygosity (H = 0.99, H = 0.75). We also observed high numbers of alleles (881) and levels of heterozygosity (H = 0.71, H = 0.80) in (4x). Our genetic analyses confirmed the field identification of a native population of on the Okanogan-Wenatchee National Forest in the state of Washington, far outside the previously reported range for the species. Our results will help to inform efforts of the United States Department of Agriculture Agricultural Research Service (USDA-ARS) and the United States Forest Service (USFS) to conserve the most diverse and unique wild cranberry populations through ex situ preservation of germplasm and in situ conservation in designated sites on National Forests.
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http://dx.doi.org/10.3390/plants9111446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716231PMC
October 2020

Adherence to Mammography and Pap Screening Guidelines Among Medically Underserved Women: the Role of Family Structures and Network-Level Behaviors.

J Cancer Educ 2020 Oct 27. Epub 2020 Oct 27.

College of Nursing, The Ohio State University, Columbus, OH, USA.

Poor adherence to screening recommendations is an important contributing factor to disparities in breast and cervical cancer outcomes among women in the USA. Screening behaviors are multifactorial, but there has been limited focus on how family network beliefs and behaviors influence individual's likelihood to complete screening. This research aims to fill this gap by evaluating the role of family network composition and screening behaviors on women's likelihood to adhere to mammogram and pap screening recommendations. We used an ego network approach to analyze data from 137 families and their networks. Primary outcomes were whether an individual had received a mammogram in the past year and whether she had received a pap screening in the past 3 years. Network-level predictors included network composition (size of network, average age of network members, satisfaction with family communication) and network screening behaviors. We conducted multivariable logistic regressions to assess the influence of network-level variables on both mammogram and pap smears, adjusting for potential individual-level confounders. Each network had an average age of 47.9 years, and an average size of 3.05 women, with the majority of members being sisters (57.7%). We found differences in network screening behaviors by race, with Arab networks being less likely to have completed self-breast exams (OR = 0.21, 95%CI = 0.05-0.76, p = 0.02), ever a gotten pap screen (OR = 0.11, 95%CI = 0.01-0.85, p = 0.04), and gotten pap screening in the last 3 years (OR = 0.31, 95%CI = 0.10-0.99, p = 0.04) compared with African American networks. Network screening behaviors also strongly influenced the likelihood of an individual completing a similar screening behavior. This analysis sheds light on family network characteristics that influence screening behaviors among medically underserved women. These findings support the development and dissemination of screening interventions among female's family networks.
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http://dx.doi.org/10.1007/s13187-020-01879-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076331PMC
October 2020

The Experiences of Persistent Pain Among Women With a History of Intimate Partner Violence: A Systematic Review.

Trauma Violence Abuse 2020 Sep 18:1524838020957989. Epub 2020 Sep 18.

School of Population Health, 7800University of New South Wales, Sydney, New South Wales, Australia.

Women experience persistent pain at higher rates than men; however, women are less likely to be provided with adequate or appropriate care and more likely to have their pain experiences dismissed. The purpose of this review is to consider the complex interaction of the biopsychosocial factors in the experience of persistent pain in order to inform improved models of care. Given persistent pain is among the most frequently reported health consequences of intimate partner violence (IPV), this review focused on studies exploring the association between persistent pain and IPV. Three reviewers independently and systematically searched seven databases. Qualitative and quantitative studies describing the association between IPV and persistent pain published between January 2000 and June 2018 were included. Twelve studies met the inclusion criteria. The included studies demonstrated that a history of IPV places an additional burden on women who experience persistent pain that cannot be explained by an underlying psychological condition. Health care practitioners should be aware of this phenomena to ensure diagnosis, assessment, and treatment plans are targeted accordingly. Future policy directives and research should account for and seek to elucidate this additional burden.
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http://dx.doi.org/10.1177/1524838020957989DOI Listing
September 2020

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

JAMA 2020 10;324(13):1317-1329

School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited.

Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19.

Design, Setting, And Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020.

Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108).

Main Outcomes And Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%).

Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively.

Conclusions And Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions.

Trial Registration: ClinicalTrials.gov Identifier: NCT02735707.
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http://dx.doi.org/10.1001/jama.2020.17022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489418PMC
October 2020

The ties that bind: Cancer history, communication, and screening intention associations among diverse families.

J Med Screen 2021 06 11;28(2):108-113. Epub 2020 May 11.

Martha S. Pitzer Center for Women, Children & Youth, College of Nursing, The 2647Ohio State University, Columbus, OH, USA.

Objective: Breast and cervical cancers are screen-detectable; yet, challenges exist with ensuring uptake of mammography and Pap smear. Family, a central factor in developing knowledge to carry out health promotion behaviors, may be an asset to improving intention to screen among non-adherent women from underrepresented minority groups. We explored familial cancer; communication; and breast and cervical screening intention among non-adherent Black, Latina, and Arab women in the United States who participated in a randomized controlled trial of the Kin Keeper Cancer Prevention Intervention study. The intervention was a culturally-targeted breast and cervical cancer literacy tool for Black, Latina, and Arab women, consisting of two family-focused education sessions on the cancers, their screening guidelines, and risk-reducing health-related behaviors.

Methods: For this secondary analysis, we assessed family cancer history, family communication, and screening intention for breast and cervical cancer in age-eligible, non-adherent participants. Descriptive statistics examined sample characteristics of the intervention and control groups. Odds ratios were estimated from logistic regression modeling to assess the intervention and sample characteristic effects on screening intention.

Results: Of the 516 participants, 123 and 98 were non-adherent to breast and cervical cancer screening, respectively. The intervention (OR = 1.95 for mammography; OR = 1.62 for Pap smear) and highly communicative (OR = 2.57 for mammography; OR = 3.68 for Pap smear) families reported greater screening intention. Family history of cancer only increased screening intention for mammography (OR = 2.25).

Conclusion: Family-focused approaches supporting communication may increase breast and cervical cancer screening intention among non-adherent, underrepresented minority groups.
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http://dx.doi.org/10.1177/0969141320920900DOI Listing
June 2021

Rural Healthcare Center Preparation and Readiness Response to Threat of COVID-19.

J Am Coll Surg 2020 06 10;230(6):1105-1110. Epub 2020 Apr 10.

Guthrie Clinic/Robert Packer Hospital, Sayre, PA. Electronic address:

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http://dx.doi.org/10.1016/j.jamcollsurg.2020.04.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146674PMC
June 2020

A Multicenter Evaluation of Vancomycin-Associated Acute Kidney Injury in Hospitalized Patients with Acute Bacterial Skin and Skin Structure Infections.

Infect Dis Ther 2020 Mar 25;9(1):89-106. Epub 2020 Jan 25.

Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA.

Background: We sought to determine the real-world incidence of and risk factors for vancomycin-associated acute kidney injury (V-AKI) in hospitalized adults with acute bacterial skin and skin structure infections (ABSSSI).

Methods: Retrospective, observational, cohort study at ten U.S. medical centers between 2015 and 2019. Hospitalized patients treated with vancomycin (≥ 72 h) for ABSSSI and ≥ one baseline AKI risk factor were eligible. Patients with end-stage kidney disease, on renal replacement therapy or AKI at baseline, were excluded. The primary outcome was V-AKI by the vancomycin guidelines criteria.

Results: In total, 415 patients were included. V-AKI occurred in 39 (9.4%) patients. Independent risk factors for V-AKI were: chronic alcohol abuse (aOR 4.710, 95% CI 1.929-11.499), no medical insurance (aOR 3.451, 95% CI 1.310-9.090), ICU residence (aOR 4.398, 95% CI 1.676-11.541), Gram-negative coverage (aOR 2.926, 95% CI 1.158-7.392) and vancomycin duration (aOR 1.143, 95% CI 1.037-1.260). Based on infection severity and comorbidities, 34.7% of patients were candidates for oral antibiotics at baseline and 39.3% had non-purulent cellulitis which could have been more appropriately treated with a beta-lactam. Patients with V-AKI had significantly longer hospital lengths of stay (9 vs. 6 days, p = 0.001), higher 30-day readmission rates (30.8 vs. 9.0%, p < 0.001) and increased all-cause 30-day mortality (5.1 vs. 0.3%, p = 0.024) CONCLUSIONS: V-AKI occurred in approximately one in ten ABSSSI patients and may be largely prevented by preferential use of oral antibiotics whenever possible, using beta-lactams for non-purulent cellulitis and limiting durations of vancomycin therapy.
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http://dx.doi.org/10.1007/s40121-019-00278-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054514PMC
March 2020

Case report: Albendazole associated psychosis.

Ment Health Clin 2019 Nov 27;9(6):397-400. Epub 2019 Nov 27.

Introduction: The association of psychosis with albendazole monotherapy has not been established in current literature.

Case Report: We present the first reported case of acute psychosis associated with albendazole. Upon cessation of the agent and the introduction of aripiprazole, the patient's psychosis remitted, and the patient did not present for acute treatment in the months to follow.

Discussion/conclusion: The temporal relationship and laboratory data support albendazole's role in leading to the aforementioned toxicity. Such reactions, although rare, can drastically impact patient care and may warrant increased provider consideration when choosing to prescribe albendazole.
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http://dx.doi.org/10.9740/mhc.2019.11.397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881107PMC
November 2019

Allostatic load in the association of depressive symptoms with incident coronary heart disease: The Jackson Heart Study.

Psychoneuroendocrinology 2019 11 4;109:104369. Epub 2019 Jul 4.

Division of Endocrinology, Diabetes & Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH, United States.

African Americans are at heightened risk for coronary heart disease (CHD), with biologic pathways poorly understood. We examined the role of allostatic load (AL) in the association of depressive symptoms with incident CHD among 2,670 African American men and women in the prospective Jackson Heart Study. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression Scale (CES-D). Incident CHD was ascertained by self-report, death certificate survey, and adjudicated medical record surveillance. Baseline AL was quantified using biologic parameters of metabolic, cardiovascular, immune, and neuroendocrine subsystems and as a combined meta-factor. Sequential models adjusted for demographic, socioeconomic, and behavioral covariates, stratified to examine differences by sex. Greater depressive symptomatology was associated with greater metabolic, cardiovascular, and immune AL (p-values≤0.036) and AL meta-factor z-scores (p = 0.007), with findings driven by observations among females. Each 1-point increase in baseline depressive symptomatology, and 1-SD increase in metabolic AL, neuroendocrine AL, and AL meta-factor z-scores was associated with 3.3%, 88%, 39%, and 130% increases in CHD risk, respectively (p-values <0.001). Neuroendocrine AL and AL meta-factor scores predicted incident CHD among males but not females in stratified analyses. Metabolic AL partially mediated the association of depressive symptoms with incident CHD (5.79% mediation, p = 0.044), a finding present among females (p = 0.016) but not males (p = 0.840). Among African American adults, we present novel findings of an association between depressive symptomatology and incident CHD, partially mediated by metabolic AL. These findings appear to be unique to females, an important consideration in the design of targeted interventions for CHD prevention.
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http://dx.doi.org/10.1016/j.psyneuen.2019.06.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232849PMC
November 2019

Addressing Obstetrics and Gynecology Trainee Burnout Using a Yoga-Based Wellness Initiative During Dedicated Education Time.

Obstet Gynecol 2019 05;133(5):994-1001

Department of Obstetrics, Gynecology and Women's Health, Saint Louis University, St. Louis, and the Department of Bioinformatics, University of Missouri Kansas City, Kansas City, Missouri.

Objective: To estimate the feasibility of implementing a yoga-based wellness program during training and its influence on burnout, depression, anxiety, stress, and mindfulness among obstetrics and gynecology trainees.

Methods: We conducted a departmental quality improvement initiative consisting of weekly 1-hour yoga classes conducted during protected education time and nutrition and physical challenges for 24 obstetrics and gynecology residents and five maternal-fetal medicine fellows. Participants received a free wrist-worn fitness tracker device to record their activity. Preprogram and postprogram data collection included results from validated scales on burnout, mindfulness, depression and anxiety, blood pressure, heart rate, and weight. Wilcoxon signed rank tests were used for analysis. A P-value <.05 was considered significant.

Results: Over an 8-week period, 90% (n=26) of participants attended at least one yoga class and 68% attended at least 50% of the classes. No participant completed all sessions. Eighty percent (n=20) engaged in at least one nutrition challenge and 60% (n=15) in at least one physical challenge. After the program, a significant reduction in the depersonalization component of burnout (P=.04), anxiety (P=.02), and systolic (preprogram: 122, postprogram: 116 mm Hg; P=.01) and diastolic blood pressure (preprogram: 82, postprogram: 76 mm Hg; P=.01) occurred. Those participants who attended more than 50% of yoga classes demonstrated a significant reduction in systolic and diastolic blood pressure compared with less-frequent attendees (P=.02 and .04, respectively). A postprogram survey revealed feelings of increased camaraderie, appreciation, motivation, and overall training experience.

Discussion: Implementing a wellness program consisting of weekly yoga classes is feasible and may be beneficial. A wellness initiative that emphasizes active participation during education time with the autonomy to implement daily wellness activities may reduce burnout and improve well-being.
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http://dx.doi.org/10.1097/AOG.0000000000003229DOI Listing
May 2019

Stress, Resilience, and Cardiovascular Disease Risk Among Black Women.

Circ Cardiovasc Qual Outcomes 2019 04;12(4):e005284

College of Public Health, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus (A.L.).

Background: Empirical data on the link between stress and cardiovascular disease (CVD) risk among black women is limited. We examined associations of stressful life events and social strain with incident CVD among black women and tested for effect modification by resilience.

Methods And Results: Our analysis included 10 785 black women enrolled in the Women's Health Initiative Observational Study and Clinical Trials cohort. Participants were followed for CVD for up to 23 years (mean, 12.5). Multivariable Cox regression was used to estimate hazard ratios and 95% CIs for associations between stress-related exposures and incident CVD. We included interactions between follow-up time (age) and stressful life events because of evidence of nonproportional hazards. Effect modification by resilience was examined in the sub-cohort of 2765 women with resilience and stressful life events measures. Higher stressful life events were associated with incident CVD at ages 55 (hazard ratio for highest versus lowest quartile=1.80; 95% CI, 1.27-2.54) and 65 (hazard ratio for highest versus lowest quartile=1.40; 95% CI, 1.16-1.68), but not at older ages. Adjustment for CVD risk factors attenuated these associations. Similar associations were observed for social strain. In the sub-cohort of women with updated stressful life events and resilience measures, higher stressful life events were associated with incident CVD in multivariable-adjusted models (hazard ratio=1.61; 95% CI, 1.04-2.51). Resilience did not modify this association nor was resilience independently associated with incident CVD.

Conclusions: In this cohort of older black women, recent reports of stressful life events were related to incident CVD. Resilience was unrelated to incident CVD.

Clinical Trials Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00000611.
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http://dx.doi.org/10.1161/CIRCOUTCOMES.118.005284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6508630PMC
April 2019

Application of the Public Health Exposome Framework to Estimate Phenotypes of Resilience in a Model Ohio African-American Women's Cohort.

J Urban Health 2019 03;96(Suppl 1):57-71

Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA.

We report integration of the United States Environmental Protection Agency's (USEPA) United States Environmental Justice Screen (EJSCREEN) database with our Public Health Exposome dataset to interrogate 9232 census blocks to model the complexity of relationships among environmental and socio-demographic variables toward estimating adverse pregnancy outcomes [low birth weight (LBW) and pre-term birth (PTB)] in all Ohio counties. Using a hill-climbing algorithm in R software, we derived a Bayesian network that mapped all controlled associations among all variables available by applying a mapping algorithm. The results revealed 17 environmental and socio-demographic variables that were represented by nodes containing 69 links accounting for a network with 32.85% density and average degree of 9.2 showing the most connected nodes in the center of the model. The model predicts that the socio-economic variables low income, minority, and under age five populations are correlated and associated with the environmental variables; particulate matter (PM) level in air, proximity to risk management facilities, and proximity to direct discharges in water are linked to PTB and LBW in 88 Ohio counties. The methodology used to derive significant associations of chemical and non-chemical stressors linked to PTB and LBW from indices of geo-coded environmental neighborhood deprivation serves as a proxy for design of an African-American women's cohort to be recruited in Ohio counties from federally qualified community health centers within the 9232 census blocks. The results have implications for the development of severity scores for endo-phenotypes of resilience based on associations and linkages for different chemical and non-chemical stressors that have been shown to moderate cardio-metabolic disease within a population health context.
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http://dx.doi.org/10.1007/s11524-018-00338-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430281PMC
March 2019

Management of Chronic Migraine and Occipital Neuralgia in Post 9/11 Combat Veterans.

Mil Med 2019 07;184(7-8):e207-e211

Central Texas Veterans Health Care System, Research Service, Biostatistician,1901 Veterans Memorial Drive, Temple, TX.

Introduction: The rate of chronic migraine (CM) has been shown to be 20% or greater in the post 9/11 combat veteran population with a history of traumatic brain injury, while the rate is much lower at 3-5% in the general population. Studies have shown that medications such as oral topiramate or intramuscular injections of onabotulinum toxin A (Botox) have been used for CM prevention, and occipital blocks have been shown to be helpful in treating occipital neuralgia and short-term relief of CM. However, there are no known studies that have specifically evaluated the use of Botox and occipital blocks for reducing headache frequency in the US veteran population. The purpose of this study was to evaluate the effectiveness of using occipital blocks and Botox as dual therapy for reducing headache frequency in post 9/11 combat veterans with CM, occipital neuralgia, and a history of TBI or neck trauma.

Materials And Methods: Following Institutional Review Board approval, a retrospective chart review was completed on post 9/11 combat veterans treated in a headache clinic located at the Central Texas Veteran Health Care System. The electronic medical record was used to retrieve the charts of post 9/11 combat veterans who (1) had a confirmed deployment-related history of TBI or neck trauma; (2) were diagnosed with CM and occipital neuralgia; and (3) were treated in the headache clinic between January 1, 2014 and December 31, 2015 with the administration of occipital blocks and Botox within the first six months. Of 282 charts that were reviewed, a total of 30 (N = 30) veterans fit the criteria. The mean number of self-reported headache days per month (28 days) for the month prior to starting treatment was compared to the number of headache days per month (28 days) 6 months after initiation of therapy.

Results: Results revealed that the mean number of headache days in the month prior to treatment was 24.1 (22.0, 25.7). The mean number of headache days in the month post-treatment (6 months after the initiation of dual therapy with occipital blocks and Botox) was 12.9 (9.7, 16.4). The mean difference in the number of headache days from pre- to post-treatment (pre-treatment minus post-treatment) was 11.2 (8.2, 14.2).

Conclusion: This study evaluated the effectiveness of using occipital blocks and Botox as dual therapy for reducing headache frequency for post 9/11 combat veterans with CM, occipital neuralgia, and a history of TBI or neck trauma. Results revealed a statistically significant reduction in the number of headache days per month after the dual therapy. There were multiple limitations to the study to include a small sample size, lack of a control group, self-reported headaches for only 1 month pre-and post-treatment, and no control for other interventions or events which may have influenced the outcome. There is a strong need for randomized, double blinded, placebo- controlled studies involving dual therapy in this population. This study, though small, may be helpful in stimulating additional studies and treatments in this veteran population.
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http://dx.doi.org/10.1093/milmed/usy405DOI Listing
July 2019

Understanding African American Women's Resilience in the Face of Allostatic Load.

J Urban Health 2019 03;96(Suppl 1):1-2

Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, 362 Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210, USA.

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http://dx.doi.org/10.1007/s11524-019-00348-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430285PMC
March 2019

Neighborhood Environment and DNA Methylation: Implications for Cardiovascular Disease Risk.

J Urban Health 2019 03;96(Suppl 1):23-34

College of Nursing, The Ohio State University, Columbus, OH, USA.

Exposure to chronic stress such as living in disadvantaged neighborhoods has been related to cardiovascular disease (CVD). Chronic stress may increase the risk for CVD by increasing levels of systemic inflammation (e.g., higher levels of pro-inflammatory cytokines). Differential DNA methylation of inflammation-related candidate genes is also related to higher risk for CVD. Thus, the purpose of this review was to examine the association of neighborhood disadvantage with DNA methylation. A search of literature was conducted using Scopus, CINAHL, PubMed, Medline, and Embase databases. The keywords neighborhood, neighborhood disorder, neighborhood crime, neighborhood violence, neighborhood safety, built environment, and housing vacancy were combined with the keywords DNA methylation and epigenetics. Five studies were included in this review (n = 3 adult blood samples and n = 2 fetal blood samples). Four of the five studies reported an association of neighborhood socioeconomic status, social environment, and crime with either global or gene-specific DNA methylation. Only two studies examined the association of neighborhood disadvantage with inflammation-related candidate genes. One of these studies found a significant association of neighborhood socioeconomic disadvantage and social environment with DNA methylation in inflammation-related candidate genes. Thus, data are limited on the association between neighborhood disadvantage and DNA methylation of inflammation-related candidate genes, as well as genes in other potential mechanistic pathways including psychosocial stress, toxin response, and adiposity. Future studies should examine these associations and the potential epigenetic mechanisms by which neighborhood disadvantage increases the risk for CVD.
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http://dx.doi.org/10.1007/s11524-018-00341-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430282PMC
March 2019

Social Integration and Quality of Social Relationships as Protective Factors for Inflammation in a Nationally Representative Sample of Black Women.

J Urban Health 2019 03;96(Suppl 1):35-43

Martha S. Pitzer Center for Women, Children, and Youth, Ohio State University, College of Nursing, Columbus, OH, USA.

Social integration and supportive relationships protect against cardiovascular disease (CVD). However, prior studies have examined heterogeneous samples which may obscure unique relationships within groups. We investigate the association between social relationships and inflammation-a known CVD risk factor-in Black women, a population with higher rates of CVD and CVD mortality. Secondary data from wave 4 of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed. The sample was comprised of 1829 Black women aged 24-34 years. Social integration was a z-score standardized measure of four items (marital/cohabitation status, church attendance, volunteerism, close friendships). Data on the quality of three relationship types was available: perceived happiness with a romantic relationship and perceived closeness to mother and father figure. Inflammation was measured via high-sensitivity C-reactive protein (hs-CRP) in which levels were categorized based on clinical cut-points for risk of CVD (< 1 mg/L = low risk-reference, 1-3 mg/L = moderate risk, > 3-10 mg/L = high risk, > 10 mg/L = very high risk). Multivariable logistic regression was conducted accounting for the complex survey design and wave 4 control measures (e.g., body mass index, smoking, medications, acute illness, overall health, sociodemographic factors). No significant associations were found between level of social integration and hs-CRP levels. With respect to relationship quality, women who reported they were very happy with their romantic relationship were less likely than those who were only fairly happy or unhappy to have hs-CRP levels in the moderate- (AOR = 0.36, 95% CI = 0.17, 0.75), high (AOR = 0.20, 95% CI = 0.08, 0.49), or very high CVD-risk category (AOR = 0.36, 95% CI = 0.16, 0.80). Women who reported they were somewhat/quite/very close to their mother figure (AOR = 0.48, 95% CI = 0.25, 0.92) and those who reported having no mother figure (AOR = 0.25, 95% CI = 0.08, 0.77) were less likely than women reporting being not very close/not close at all with their mother figure to have hs-CRP levels in the moderate- vs. low-risk category. No statistically significant associations were found between father-figure relationship and hs-CRP CVD risk category. In summary, social integration and the quality of specific social relationships were significantly associated with inflammation in young adult Black women. Thus, interventions designed to enhance social connectedness and positive social relationships among Black women may have the potential to be protective for CVD risk. Further researches with the longitudinal social relationship and inflammatory measures are needed to better understand how changes in social relationships may influence CVD risk over the life course.
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http://dx.doi.org/10.1007/s11524-018-00337-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430279PMC
March 2019
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