Publications by authors named "Khosrow Heidari"

22 Publications

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High-risk opioid analgesic dispensing to adolescents 12-18 years old in South Carolina: 2010-2017.

Pharmacoepidemiol Drug Saf 2022 03 9;31(3):353-360. Epub 2021 Dec 9.

Department of Medicine, College of Medicine, The Medical University of South Carolina, Charleston, South Carolina, USA.

Purpose: To evaluate "high-risk" opioid dispensing to adolescents, including daily morphine milligram equivalents (MME) above recommended amounts, the percentage of extended-release opioid prescriptions dispensed to opioid-naïve adolescents, and concurrent use of opioids and benzodiazepines, and to evaluate changes in those rates over time.

Methods: Retrospective cohort study of one state's prescription drug monitoring program data (2010-2017), evaluating adolescents 12-18 years old dispensed opioid analgesic prescriptions. Outcomes of interest were the quarterly frequencies of the high-risk measures. We utilized generalized linear regression to determine whether the rate of the outcomes changed over time.

Results: The quarterly percentage of adolescents ages 12-18 years old dispensed an opioid who received ≥90 daily MME declined from 4.1% in the first quarter (Q1) of 2010 to 3.4% in the final quarter (Q4) of 2017 (p < 0.0001). The frequency of adolescents dispensed ≥50 daily MME changed little over time. In 2010, the percentage of adolescents receiving an extended-release opioid who were opioid naïve was 60.7%, declining to 50.6% by Q4 of 2017 (p > 0.10 overall change 2010-2017). The percentage of adolescent opioid days overlapping with benzodiazepine days was 1.6% in Q1 of 2010, declining to 1.1% by Q4 of 2017 (p < 0.001).

Conclusions: Among persons 12-18 years old dispensed an opioid analgesic, receipt of ≥90 daily MME declined during the years 2010-2017, as did the percentage of adolescent opioid days that overlapped with benzodiazepines. More than half of the individuals who received extended-release opioid analgesics were identified as opioid naïve and, counter to guidelines, received products intended for opioid-tolerant individuals.
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http://dx.doi.org/10.1002/pds.5389DOI Listing
March 2022

Trends in Dispensed Opioid Analgesic Prescriptions to Children in South Carolina: 2010-2017.

Pediatrics 2021 03 1;147(3). Epub 2021 Feb 1.

Medicine, College of Medicine, and.

Background And Objectives: Despite published declines in opioid prescribing and dispensing to children in the past decade, in few studies have researchers evaluated all children in 1 state or examined changes in mean daily opioid dispensed. In this study, we evaluated changes in the rate of dispensed opioid analgesics and the mean daily opioid dispensed to persons 0 to 18 years old in 1 state over an 8-year period.

Methods: We identified opioid analgesics dispensed to children 0 to 18 years old between 2010 and 2017 using South Carolina prescription drug monitoring program data. We used generalized linear regression analyses to examine changes over time in the following: (1) rate of dispensed opioid prescriptions and (2) mean daily morphine milligram equivalents (MMEs) per prescription.

Results: From the first quarter of 2010 to the end of the fourth quarter of 2017, the quarterly rate of opioids dispensed decreased from 18.68 prescriptions per 1000 state residents to 12.03 per 1000 residents ( < .0001). The largest declines were among the oldest individuals, such as the 41.2% decline among 18-year-olds. From 2010 through 2017, the mean daily MME dispensed declined by 7.6%, from 40.7 MMEs per day in 2010 to 37.6 MMEs per day in 2017 ( < .0001), but the decrease was limited to children 0 to 9 years old.

Conclusions: The rate of opioid analgesic prescriptions dispensed to children 0 to 18 years old in South Carolina declined by 35.6% over the years 2010-2017; however, the MME dispensed per day declined minimally, suggesting that more can be done to improve opioid prescribing and dispensing.
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http://dx.doi.org/10.1542/peds.2020-0649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924141PMC
March 2021

High-Risk Opioid Prescribing Trends: Prescription Drug Monitoring Program Data From 2010 to 2018.

J Public Health Manag Pract 2021 Jul-Aug 01;27(4):379-384

Division of General Internal Medicine, Department of Medicine (Drs Ball, Moran, and Mauldin, Ms Zhang, and Mr Marsden), Department of Health Administration and Policy, College of Health Professions (Dr Simpson), and Department of Psychiatry and Behavioral Sciences (Dr McCauley), Medical University of South Carolina, Charleston, South Carolina; and Blue Cross Blue Shield of South Carolina, Columbia, South Carolina (Mr Heidari).

Objective: Deaths due to opioids have continued to increase in South Carolina, with 816 opioid-involved overdose deaths reported in 2018, a 9% increase from the prior year. The objective of the current study is to examine longitudinal trends (quarter [Q] 1 2010 through Q4 2018) of opioid prescribing volume and high-risk opioid prescribing behaviors in South Carolina using comprehensive dispensing data available in the South Carolina Prescription Drug Monitoring Program (SC PDMP).

Design: Retrospective analyses of SC PDMP data were performed using general linear models to assess quarterly time trends and change in rate of each outcome Q1 2010 through Q4 2018.

Participants: Opioid analgesic prescription fills from SC state residents between Q1 2010 and Q4 2018.

Main Outcome Measures: High-risk prescribing behaviors included (1) opioid prescribing rate; (2) percentage of patients receiving opioids dispensed 90 or more average morphine milligram equivalents daily; (3) percentage of opioid prescribed days with overlapping opioid and benzodiazepine prescriptions; (4) rate per 100 000 residents of multiple provider episodes; and (5) percentage of patients prescribed extended release opioids who were opioid naive.

Results: A total of 33 027 461 opioid prescriptions were filled by SC state residents within the time period of Q1 2010 through Q4 2018. A 41% decrease in the quarterly prescribing rate of opioids occurred from Q1 2010 to Q4 2018. The decrease in overall opioid prescribing was mirrored by significant decreases in all 4 high-risk prescribing behaviors.

Conclusion: PDMPs may represent the most complete data regarding the dispensing of opioid prescriptions and as such be valuable tools to inform and monitor the supply of licit opioids. Our results indicate that public health policy, legislative action, and multiple clinical interventions aimed at reducing high rates of opioid prescribing across the health care ecosystem appear to be succeeding in the state of South Carolina.
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http://dx.doi.org/10.1097/PHH.0000000000001203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940459PMC
September 2020

Effect of Payor-Mandated Review of Prescription Drug Monitoring Program on Opioid Prescriber Rates.

South Med J 2020 09;113(9):415-417

From the Departments of Medicine and Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, and the South Carolina Department of Health & Environmental Control, Columbia.

Objective: To evaluate the effect of a 2016 South Carolina payor mandate to query the state prescription drug monitoring program (PDMP) before prescribing controlled substances on the rate of opioid prescribers in South Carolina.

Methods: South Carolina PDMP datasets from 2010-2017 were evaluated using interrupted time series regression to compare changes in the rate of opioid prescribers before and after the 2016 mandate. The rate of opioid prescribers was defined as the number of prescribers who prescribed class II to IV opioids on any one prescription in each quarter divided by the total number of South Carolina prescribers who prescribed any one class II to IV medication. The rate of high-dose opioid prescribers was defined as the number of prescribers who prescribed ≥90-morphine milligram equivalent per day on any one prescription in each quarter divided by all of the prescribers who prescribed an opioid analgesic prescription.

Results: The rates of South Carolina opioid prescribers decreased from 75% in 2010 to 60% in 2017, with no significant change in slope ( = 0.24) after the 2016 payor mandates. The rates of South Carolina high-dose opioid prescribers decreased from 40% in 2010 to 32% in 2017, with a significant decrease in slope ( < 0.001) after the payor mandate.

Conclusions: The slope of the South Carolina high-dose opioid prescriber rate significantly decreased after the 2016 South Carolina payor mandate, while the slope of the South Carolina opioid prescriber rate did not. The long-term outcomes related to the change in opioid prescriber rates are unknown and warrant further study.
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http://dx.doi.org/10.14423/SMJ.0000000000001139DOI Listing
September 2020

Does Emergency Medical Services Transportation Mitigate Post-stroke Discharge Disability? A Prospective Observational Study.

J Gen Intern Med 2020 11 31;35(11):3173-3180. Epub 2020 Aug 31.

Prisma Health Stroke Unit, Dept of Neurology, University of South Carolina School of Medicine, Columbia, SC, USA.

Background: Whether emergency medical services (EMS) transport improves disability outcomes compared with other transport among acute ischemic stroke (AIS) patients is unknown.

Objective: To study severity-adjusted associations of hospital arrival mode (EMS vs. other transport) with in-hospital and discharge disability outcomes.

Design: Prospective observational study.

Participants: AIS patients discharged April 2016 to October 2017 from a safety-net hospital in South Carolina.

Main Measures: National Institutes of Health Stroke Scale (NIHSS) change at discharge (admission NIHSS score minus discharge NIHSS, continuous variable), 24-h NIHSS change (attaining high improvement, admission NIHSS minus 24-h NIHSS being 75th percentile or higher), door to neuroimaging (DTI) time, and IV alteplase receipt. NIHSS change was assessed within stroke severity groups, mild, moderate, and severe (admission NIHSS 0-5, 6-14, and ≥ 15, respectively).

Key Results: Of 1168 patients, 838 were study-eligible (52% male, 52.4% Black, 72.2% EMS arrivals, 56.6% mild strokes). Severe and moderate stroke patients were more likely than mild stroke patients to use EMS (adjusted odds ratios, AOR [95% CI] 11.7 [5.0, 27.4] and 4.0 [2.6, 6.3], respectively). EMS arrival was associated with shorter DTI time (adjusted difference - 88.4 min) and higher likelihood of alteplase administration (AOR 5.3 [2.5, 11.4]), both key mediating variables in disability outcomes. High 24-h NIHSS improvement was more likely for EMS arrivals vs. other arrivals among moderate strokes (AOR 3.4 [1.1, 10.9]) and severe strokes (AOR > 999). EMS arrivals had substantially higher NIHSS improvement at discharge within the severe stroke group (adjusted NIHSS change at discharge, 5.9 points higher, p = 0.01). Alteplase recipients showed higher discharge NIHSS improvement than non-recipients (by 2.8 and 1.9 points among severe and moderate strokes, respectively; p = 0.01, 0.02).

Conclusions: The findings offer evidence for including stroke education as a standard of care in the primary care management of patients with stroke-risk comorbidities/lifestyle in order to minimize post-stroke disability.
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http://dx.doi.org/10.1007/s11606-020-06114-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661625PMC
November 2020

Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey.

BMC Health Serv Res 2019 Dec 3;19(1):929. Epub 2019 Dec 3.

University of South Carolina School of Medicine and Prisma Health Midlands Richland Stroke Unit, Columbia, SC, USA.

Background: Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS.

Methods: During 2016-2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, knowledge of stroke and EMS importance, subjective reactions, role of bystanders and financial factors. Descriptive and multiple regression analyses were performed.

Results: Of 108 inpatients surveyed (out of 1179 AIS admissions), 49% were male, 44% African American, mean age 63.5 years, 59% mild strokes, 75 (69%) arrived by EMS, 33% were unaware of any stroke symptom prior to stroke, and 75% were unaware of the importance of EMS use for good outcome. Significant factors that influenced EMS use decisions (identified by regression analysis adjusting for stroke severity) were: prior familiarity with stroke (self or family/friend with stroke) adjusted odds ratio, 5.0 (95% confidence interval, 1.6, 15.1), perceiving symptoms as relevant for self and indicating possible stroke, 26.3 (7.6, 91.1), and bystander discouragement to call 911, 0.1 (0.01,0.7). Further, all 27 patients who knew the importance of EMS had used EMS. All patients whose physician office advised actions other than calling EMS at symptom onset, did not use EMS.

Conclusion: Systematic stroke education of patients with stroke-relevant comorbidities and life-style risk factors, and public health educational programs may increase EMS use and mitigate post-stroke disability.
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http://dx.doi.org/10.1186/s12913-019-4741-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892139PMC
December 2019

Use of a Cross-Sectional Survey in the Adult Population to Characterize Persons at High-Risk for Chronic Obstructive Pulmonary Disease.

Healthcare (Basel) 2019 Jan 18;7(1). Epub 2019 Jan 18.

Division of Pulmonary, Critical Care and Sleep Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.

Rationale/Objective: The Behavioral Risk Factor Surveillance System (BRFSS) health survey has been used to describe the epidemiology of chronic obstructive pulmonary disease (COPD) in the US. Through addressing respiratory symptoms and tobacco use, it could also be used to characterize COPD risk.

Methods: Four US states added questions to the 2015 BRFSS regarding productive cough, shortness of breath, dyspnea on exertion, and tobacco duration. We determined COPD risk categories: provider-diagnosed COPD as self-report, high-risk for COPD as ≥10 years tobacco smoking and at least one significant respiratory symptom, and low risk was neither diagnosed COPD nor high risk. Disease burden was defined by respiratory symptoms and health impairments. Data were analyzed using multiple logistic regression models with age as a covariate.

Results: Among 35,722 adults ≥18 years, the overall prevalence of COPD and high-risk for COPD were 6.6% and 5.1%. Differences among COPD risk groups were evident based on gender, race, age, geography, tobacco use, health impairments, and respiratory symptoms. Risk for disease was seen early where 3.75% of 25⁻34 years-old met high-risk criteria. Longer tobacco duration was associated with an increased prevalence of COPD, particularly >20 years. Seventy-nine percent of persons ≥45 years-old with frequent shortness of breath (SOB) reported having or being at risk of COPD, reflecting disease burden.

Conclusion: These data, representing nearly 18% of US adults, indicates those at high risk for COPD share many, but not all of the characteristics of persons diagnosed with the disease and demonstrates the value of the BRFSS as a tool to define lung health at a population level.
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http://dx.doi.org/10.3390/healthcare7010012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473439PMC
January 2019

South Carolina 20 Years of Diabetes--A Public Health Concern.

Am J Med Sci 2016 Apr;351(4):327-32

South Carolina Department of Health and Environmental Control, Columbia, South Carolina; Core for Applied Research & Evaluation, University of South Carolina School of Public Health, Columbia, South Carolina.

Objective: To assess and enumerate the trends in diabetes prevalence, morbidity and mortality rates in South Carolina (SC) within the past 2 decades.

Materials And Methods: We analyzed state-level data from vital records, Behavioral Risk Factor Surveillance System, Children's Health Assessment Survey and Administrative Claim Files.

Results: Over the past 20 years, there has been an average 2.5% annual increase in diabetes prevalence among adults in SC (P < 0.01). Although a typical reduction in mortality rate of 2.2% has been observed during the same period, the increased number of people living with diabetes (from 5.0% in 1995 to 12.0% in 2014) has brought more need for diabetes care, particularly for severe in-hospital cases and cases with crisis at the emergency department, totaling $404 million in annual costs.

Conclusions: SC has experienced an epidemic of diabetes. Coupled with declining trends in mortality and increased hospitalization and emergency department visits, the state is experiencing historical morbidity and complications due to diabetes. The shift in complexity of the disease onset and management has resulted in more individuals living with cardiovascular disease and other comorbidities. The cost of care for all South Carolinians with diabetes is estimated to exceed 2.8 billion dollars in 2014 and projected to be more than 4 billion dollars by 2020. If the diabetes prevalence trend of increasing rates continues over the next 20 years, the number of individuals living with diabetes and its complications would rise to 1.3 million in SC.
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http://dx.doi.org/10.1016/j.amjms.2016.01.006DOI Listing
April 2016

Gender and asthma-chronic obstructive pulmonary disease overlap syndrome.

J Asthma 2016 09 6;53(7):720-31. Epub 2016 Apr 6.

f Division of Pulmonary, Critical Care, Allergy and Sleep Medicine , Medical University of South Carolina , Charleston , SC , USA.

Objective: To assess relationships between obstructive lung diseases, respiratory symptoms, and comorbidities by gender.

Methods: Data from 12 594 adult respondents to the 2012 South Carolina Behavioral Risk Factor Surveillance System telephone survey were used. Five categories of chronic obstructive airway disease (OAD) were defined: former asthma only, current asthma only, chronic obstructive pulmonary disease (COPD) only, asthma-COPD overlap syndrome (ACOS), and none. Associations of these categories with respiratory symptoms (frequent productive cough, shortness of breath, and impaired physical activities due to breathing problems), overall health, and comorbidities were assessed using multivariable logistic regression for men and women.

Results: Overall, 16.2% of men and 18.7% of women reported a physician diagnosis of COPD and/or asthma. Former asthma only was higher among men than women (4.9% vs. 3.2%, t-test p = 0.008). Current asthma only was more prevalent among women than men (7.2% vs. 4.7%, p < 0.001), as was ACOS (4.0% vs. 2.2%, p < 0.001). Having COPD only did not differ between women (4.3%) and men (4.4%). Adults with ACOS were most likely to report the 3 respiratory symptoms. COPD only and ACOS were associated with higher likelihoods of poor health and most comorbidities for men and women. Current asthma only was also associated with these outcomes among women, but not among men.

Conclusions: In this large population-based sample, women were more likely than men to report ACOS and current asthma, but not COPD alone. Gender differences were evident between the OAD groups in sociodemographic characteristics, respiratory symptoms, and comorbidities, as well as overall health.
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http://dx.doi.org/10.3109/02770903.2016.1154072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108520PMC
September 2016

Telestroke Centers as an Option for Addressing Geographical Disparities in Access to Stroke Care in South Carolina, 2013.

Prev Chronic Dis 2015 Dec 24;12:E227. Epub 2015 Dec 24.

South Carolina Department of Health and Environmental Control, Columbia, South Carolina.

Telestroke centers can increase access to proper and timely diagnosis and treatment of stroke, especially for rural populations, thereby reducing disability and death. Census tract information was used to map primary stroke centers geographically and to identify areas that would benefit from additional access to medical care via telestroke centers (health care facilities that provide information on stroke care from a distance). Results indicate that in 2013, approximately half of the South Carolina population did not have access to a primary stroke center within a 30-minute drive of their home, and 30% did not have access within 60 minutes. Increasing access to prompt evaluation, diagnosis, and treatment of stroke and improving long-term quality of life requires the addition of telestroke centers in areas without primary stroke centers and examination of the effects of these centers on stroke incidence and mortality in South Carolina.
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http://dx.doi.org/10.5888/pcd12.150418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4692474PMC
December 2015

Targeting Persons With or At High Risk for Chronic Obstructive Pulmonary Disease by State-based Surveillance.

COPD 2015 14;12(6):680-9. Epub 2015 Sep 14.

i Department of Medicine, University of Arizona College of Medicine , Tucson , Arizona , USA.

Unlabelled: The Behavioral Risk Factor Surveillance System (BRFSS) survey is used to estimate chronic obstructive pulmonary disease (COPD) prevalence and could be expanded to describe respiratory symptoms in the general population and to characterize persons with or at high risk for the disease. Tobacco duration and respiratory symptom questions were added to the 2012 South Carolina BRFSS. Data concerning sociodemographics, chronic illnesses, health behaviors, and respiratory symptoms were collected in 9438 adults ≥ 35 years-old. Respondents were categorized as having COPD, high risk, or low risk for the disease. High risk was defined as no self-reported COPD, ≥ 10 years' tobacco use, and ≥ 1 respiratory symptom (frequent productive cough or shortness of breath (SOB), or breathing problems affecting activities). Prevalence of self-reported and high-risk COPD were 9.1% and 8.0%, respectively. Overall, 17.3%, 10.6%, and 5.2% of all respondents reported activities limited by breathing problems, frequent productive cough, and frequent SOB, respectively. The high-risk group was more likely than the COPD group to report a productive cough and breathing problems limiting activities as well as being current smokers, male, and African-American. Health impairment was more severe in the COPD than the high-risk group, and both were worse than the low-risk group.

Conclusions: Persons at high risk for COPD share many, but not all, of the characteristics of persons diagnosed with the disease. Additional questions addressing smoking duration and respiratory symptoms in the BRFSS identifies groups at high risk for having or developing COPD who may benefit from smoking cessation and case-finding interventions.
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http://dx.doi.org/10.3109/15412555.2015.1043424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674427PMC
September 2016

Smoking duration, respiratory symptoms, and COPD in adults aged ≥45 years with a smoking history.

Int J Chron Obstruct Pulmon Dis 2015 21;10:1409-16. Epub 2015 Jul 21.

Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA.

Background: The purpose of this study was to assess the relationship of smoking duration with respiratory symptoms and history of chronic obstructive pulmonary disease (COPD) in the South Carolina Behavioral Risk Factor Surveillance System survey in 2012.

Methods: Data from 4,135 adults aged ≥45 years with a smoking history were analyzed using multivariable logistic regression that accounted for sex, age, race/ethnicity, education, and current smoking status, as well as the complex sampling design.

Results: The distribution of smoking duration ranged from 19.2% (1-9 years) to 36.2% (≥30 years). Among 1,454 respondents who had smoked for ≥30 years, 58.3% were current smokers, 25.0% had frequent productive cough, 11.2% had frequent shortness of breath, 16.7% strongly agreed that shortness of breath affected physical activity, and 25.6% had been diagnosed with COPD. Prevalence of COPD and each respiratory symptom was lower among former smokers who quit ≥10 years earlier compared with current smokers. Smoking duration had a linear relationship with COPD (P<0.001) and all three respiratory symptoms (P<0.001) after adjusting for smoking status and other covariates. While COPD prevalence increased with prolonged smoking duration in both men and women, women had a higher age-adjusted prevalence of COPD in the 1-9 years, 20-29 years, and ≥30 years duration periods.

Conclusion: These state population data confirm that prolonged tobacco use is associated with respiratory symptoms and COPD after controlling for current smoking behavior.
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http://dx.doi.org/10.2147/COPD.S82259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516194PMC
April 2016

Body mass index, respiratory conditions, asthma, and chronic obstructive pulmonary disease.

Respir Med 2015 Jul 16;109(7):851-9. Epub 2015 May 16.

Department of Medicine, University of Arizona, Phoenix, AZ, USA.

Background: This study aims to assess the relationship of body mass index (BMI) status with respiratory conditions, asthma, and chronic obstructive pulmonary disease (COPD) in a state population.

Methods: Self-reported data from 11,868 adults aged ≥18 years in the 2012 South Carolina Behavioral Risk Factor Surveillance System telephone survey were analyzed using multivariable logistic regression that accounted for the complex sampling design and adjusted for sex, age, race/ethnicity, education, smoking status, physical inactivity, and cancer history.

Results: The distribution of BMI (kg/m(2)) was 1.5% for underweight (<18.5), 32.3% for normal weight (18.5-24.9), 34.6% for overweight (25.0-29.9), 26.5% for obese (30.0-39.9), and 5.1% for morbidly obese (≥40.0). Among respondents, 10.0% had frequent productive cough, 4.3% had frequent shortness of breath (SOB), 7.3% strongly agreed that SOB affected physical activity, 8.4% had current asthma, and 7.4% had COPD. Adults at extremes of body weight were more likely to report having asthma or COPD, and to report respiratory conditions. Age-adjusted U-shaped relationships of BMI categories with current asthma and strongly agreeing that SOB affected physical activity, but not U-shaped relationship with COPD, persisted after controlling for the covariates (p < 0.001). Morbidly obese but not underweight or obese respondents were significantly more likely to have frequent productive cough and frequent SOB than normal weight adults after adjustment.

Conclusion: Our data confirm that both underweight and obesity are associated with current asthma and obesity with COPD. Increased emphasis on exercise and nutrition may improve respiratory conditions.
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http://dx.doi.org/10.1016/j.rmed.2015.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4487766PMC
July 2015

Evaluation of the Effectiveness of the H.A.N.D.S.SM Program: A School Nurse Diabetes Management Education Program.

J Sch Nurs 2015 Dec 5;31(6):402-10. Epub 2015 Feb 5.

Department of Exercise Sciences, University of South Carolina, School of Public Health, Columbia, SC, USA

The purpose of this project was to determine the effectiveness of the Helping Administer to the Needs of the Student with Diabetes in Schools (H.A.N.D.S.(sm)) continuing education program in improving the level of experience and competence in performing services associated with diabetes care. This program is a live course for school nurses providing clinical information about diabetes management and their professional role in the care of students with diabetes. Pre- and post-surveys were administered via e-mail to assess their level of experience and competence in diabetes care. A total of 105 nurses completed both surveys and were included in the analysis. The changes between pre- and post-survey questions were assessed. The H.A.N.D.S. participants' levels of experience and competence for each of the four categories of diabetes care improved significantly, and a greater number of nurses reported being able to perform the services independently and having the ability to teach others.
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http://dx.doi.org/10.1177/1059840514568895DOI Listing
December 2015

Indicators for chronic disease surveillance - United States, 2013.

MMWR Recomm Rep 2015 Jan;64(RR-01):1-246

Chronic diseases are an important public health problem, which can result in morbidity, mortality, disability, and decreased quality of life. Chronic diseases represented seven of the top 10 causes of death in the United States in 2010 (Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. Natl Vital Stat Rep 2013;6. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf Adobe PDF file). Chronic diseases and risk factors vary by geographic area such as state and county, where essential public health interventions are implemented. The chronic disease indicators (CDIs) were established in the late 1990s through collaboration among CDC, the Council of State and Territorial Epidemiologists, and the Association of State and Territorial Chronic Disease Program Directors (now the National Association of Chronic Disease Directors) to enable public health professionals and policymakers to retrieve data for chronic diseases and risk factors that have a substantial impact on public health. This report describes the latest revisions to the CDIs, which were developed on the basis of a comprehensive review during 2011-2013. The number of indicators is increasing from 97 to 124, with major additions in systems and environmental indicators and additional emphasis on high-impact diseases and conditions as well as emerging topics.
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January 2015

Association between prevalence of chronic obstructive pulmonary disease and health-related quality of life, South Carolina, 2011.

Prev Chronic Dis 2013 Dec 26;10:E215. Epub 2013 Dec 26.

Bureau of Community Health and Chronic Disease Prevention, South Carolina Department of Health & Environmental Control, Columbia, South Carolina.

Introduction: We investigated the prevalence of chronic obstructive pulmonary disease (COPD) in various population subgroups in South Carolina and examined associations between COPD and 4 core measures of health-related quality of life (HRQOL).

Methods: Data from 12,851 participants of the 2011 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. COPD prevalence rates were age-adjusted to the 2000 standard US population. Logistic regression models were used to estimate adjusted odds ratios (AOR's) and 95% confidence intervals (CIs).

Results: The overall age-adjusted prevalence of self-reported diagnosis of COPD among community-dwelling adults in South Carolina in 2011 was 7.1% (standard error [SE] ±0.3). Prevalence of self-reported diagnosis of COPD was highest among women (8.9%; SE, ±0.5), those aged 65 years or older (12.9%; SE, ±0.5), current smokers (15.9%; SE, ±0.7), and those with low levels of education and income. Compared with community-dwelling adults without COPD, those with COPD were more likely to report fair or poor general health status (AOR, 3.97; 95% CI, 3.13-5.03), 14 or more physically unhealthy days (AOR, 2.10, 95% CI, 1.57-2.81), 14 or more mentally unhealthy days (AOR, 1.72; 95% CI, 1.21-2.43), and 14 or more days of activity limitation (AOR, 2.22; 95% CI, 1.53-3.22) within the previous 30 days.

Conclusion: COPD is a highly prevalent disease in South Carolina, especially among older people and smokers, and it is associated with poor HRQOL. Future work aimed at reducing risk factors may decrease the disease prevalence, and increasing early detection and improving access to appropriate medical treatments can improve HRQOL for those living with COPD.
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http://dx.doi.org/10.5888/pcd10.130192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873217PMC
December 2013

Brief update on the burden of diabetes in South Carolina.

Am J Med Sci 2013 Apr;345(4):302-306

Chronic Disease Epidemiology and Evaluation Division, Bureau of Community Health and Chronic Disease Prevention, South Carolina Department of Health and Environmental Control, Columbia, South Carolina.

Diabetes is a serious disease, which is often accompanied by complications, such as blindness, kidney failure, heart attacks, strokes and amputations. High blood pressure and abnormal cholesterol levels are frequent comorbidities. Diabetes has an immense impact on public health and medical care. In South Carolina (SC), medical costs rise with increased duration of the disease, and lifespan is shortened by 5 to 10 years in most patients. To describe the burden of diabetes in SC, we examined the public health surveillance systems available to estimate the prevalence, mortality and hospitalization rates and some disability statistics and hospital charges. Diabetes is the 7 leading cause of death in SC, directly or indirectly claiming more than 3,000 lives annually, and the 5 leading cause of death in blacks, claiming about 1,200 black lives each year. Minorities, predominantly blacks, experienced a substantially higher death rate and more years of potential life lost than whites. The racial disparity in mortality has widened over the past 10 years. People with diabetes are at increased risk for blindness, lower extremity amputation, kidney failure, nerve disease, hypertension, ischemic heart disease and stroke. Approximately 450,000 South Carolinians are affected by diabetes, many of whom were still undiagnosed in 2010. One of every 5 patients in a SC hospital has diabetes, and 1 in every 10 visits to a SC emergency room is diabetes related. The total charges for diabetes and diabetes-related hospitalizations and emergency room visits were more than $4.2 billion in 2010.
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http://dx.doi.org/10.1097/MAJ.0b013e31828bf2f0DOI Listing
April 2013

HIV testing in women: missed opportunities.

J Womens Health (Larchmt) 2012 Feb 27;21(2):170-8. Epub 2011 Sep 27.

Bureau of Disease Control, STD/HIV Division, South Carolina Department of Health and Environmental Control, Columbia, SC 29201, USA.

Objective: To investigate opportunities for early human immunodeficiency virus (HIV) testing of women.

Methods: A retrospective cohort study design linked case reports from HIV surveillance to several statewide health-care databases. Medical encounters occurring before the first positive HIV test (missed opportunities) were categorized by diagnosis/procedure codes to distinguish visits that were likely to have prompted an HIV test. Women were categorized as late testers (AIDS diagnosis <12 months from first HIV test date), non-late testers (no AIDS diagnosis during study period or diagnosis of AIDS >12 months of HIV diagnosis), of reproductive age (13-44 years old), and not of reproductive age (>44 years old). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to estimate risk and its statistical significance.

Results: Of 3303 HIV-infected women diagnosed during the study period, 2408 (73%) had missed opportunity visits. Late testers (39%) were more likely to be black than white (aOR 1.48, 95% CI 1.12-1.95), be older (>44 years old; aOR 7.85, 95% CI 4.49-13.7), and have >10 missed opportunity visits (aOR 2.17, 95% CI 1.62-2.91). Fifty-four percent of women >44 years old were also late testers. Women >44 years old had lower median initial CD4 counts (p<0.001). The top two procedures were the same for all groups of women but mammography was ranked fourth for women >44 years old and Papanicolau smear was ranked fourth for late testers.

Conclusions: Feasibility and acceptability of routine HIV testing in nontraditional health-care settings, such as mammography and Papanicolau screenings, should be explored to identify late testers and older (not of reproductive age) HIV-infected women.
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http://dx.doi.org/10.1089/jwh.2010.2655DOI Listing
February 2012

Geographic and sociodemographic disparities in drive times to Joint Commission-certified primary stroke centers in North Carolina, South Carolina, and Georgia.

Prev Chronic Dis 2011 Jul 15;8(4):A79. Epub 2011 Jun 15.

University of Illinois at Chicago School of Public Health, Chicago, IL, USA.

Introduction: Timely access to facilities that provide acute stroke care is necessary to reduce disabilities and death from stroke. We examined geographic and sociodemographic disparities in drive times to Joint Commission-certified primary stroke centers (JCPSCs) and other hospitals with stroke care quality improvement initiatives in North Carolina, South Carolina, and Georgia.

Methods: We defined boundaries for 30- and 60-minute drive-time areas to JCPSCs and other hospitals  by  using geographic information systems (GIS) mapping technology and calculated the proportions of the population living in these drive-time areas by sociodemographic characteristics. Age-adjusted county-level stroke death rates were overlaid onto the drive-time areas.

Results: Approximately 55% of the population lived within a 30-minute drive time to a JCPSC; 77% lived within a 60-minute drive time. Disparities in percentage of the population within 30-minute drive times were found by race/ethnicity, education, income, and urban/rural status; the disparity was largest between urban areas (70% lived within 30-minute drive time) and rural areas (26%). The rural coastal plains had the largest concentration of counties with high stroke death rates and the fewest JCPSCs.

Conclusion: Many areas in this tri-state region lack timely access to JCPSCs. Alternative strategies are needed to expand provision of quality acute stroke care in this region. GIS modeling is valuable for examining and strategically planning the distribution of hospitals providing acute stroke care.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136973PMC
July 2011

Efforts to decrease diabetes-related amputations in African Americans by the Racial and Ethnic Approaches to Community Health Charleston and Georgetown Diabetes Coalition.

Fam Community Health 2011 Jan-Mar;34 Suppl 1:S63-78

College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas, Charleston, SC 29425, USA.

Diabetes is the leading cause of amputation of the lower limbs. Yet, half of these amputations might be prevented through simple but effective foot care practices. This article describes the progress made in the reduction of lower extremity amputations in people with diabetes by the Racial and Ethnic Approaches to Community Health (REACH) Charleston and Georgetown Diabetes Coalition. The coalition's community action plan and interventions were based on an expanded Chronic Care Model that spawned changes in policies, health and education systems, and other community systems for people with diabetes and their support systems.
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http://dx.doi.org/10.1097/FCH.0b013e318202bc0bDOI Listing
February 2013
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