Publications by authors named "Mark D Peterson"

216 Publications

Muscle weakness is a prognostic indicator of disability and chronic disease multimorbidity.

Exp Gerontol 2021 Sep 2;152:111462. Epub 2021 Jul 2.

Institute for Social Research, University of Michigan, United States of America.

Background: The objective of this study was to use nationally-representative data on Americans greater than 50 years of age to determine the association between grip strength and inflammation as independent predictors of incident disability, chronic multimorbidity and dementia.

Methods: Middle age and older adults (n = 12,618) from the 2006-2008 waves of the Health and Retirement Study with 8-years of follow-up were included. Longitudinal modeling was performed to examine the association between baseline grip strength (normalized to body mass: NGS) and high sensitivity C-reactive protein (hs-CRP) (≥3.0 mg/L) with incident physical disabilities (i.e., ≥2 limitations to activities of daily living), chronic multimorbidity (≥2 of chronic conditions), and dementia.

Results: The odds of incident disability were 1.25 (95% CI: 1.20-1.30) and 1.31 (95% CI: 1.26-1.36) for men and women respectively, for each 0.05-unit lower NGS. The odds of incident chronic multimorbidity were 1.14 (95% CI: 1.08-1.20) and 1.14 (95% CI: 1.07-1.21) for men and women respectively for each 0.05-unit lower NGS. The odds of incident dementia were 1.10 for men (95% CI: 1.02-1.20) for each 0.05-unit lower NGS, but there was no significant association for women. Elevated hs-CRP was only associated with chronic multimorbidity among men (OR = 1.29; 95% CI: 1.00-1.73) and women (OR = 1.60; 95% CI: 1.26-2.02).

Conclusions: Our findings indicate a robust inverse association between NGS and disability and chronic, multimorbidity in older men and women, and dementia in men. Elevated hs-CRP was only associated with chronic multimorbidity in men and women. Healthcare providers should implement measures of grip strength in routine health assessments and discuss the potential dangers of weakness as well as interventions to improve strength with their patients.
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http://dx.doi.org/10.1016/j.exger.2021.111462DOI Listing
September 2021

Blood pressure in adults with cerebral palsy: a systematic review and meta-analysis of individual participant data.

J Hypertens 2021 Jun 7. Epub 2021 Jun 7.

Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam Rijndam Rehabilitation, Rotterdam, the Netherlands Division of Physical Therapy, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus Center for Gait and Motion Analysis, Children's Hospital Colorado, Aurora, Colorado, USA Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine Shirley Ryan AbilityLab, Chicago, Illinois, USA Department of Pediatrics CanChild Centre for Childhood Disability Research School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands Support and Expert Center for Persons with Intellectual Disability, KTO, Paimio, Finland Department of Pediatrics, Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, Ontario, Canada Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA Department of Rehabilitation Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand Department of Biostatistics Department of Epidemiology Departments of Pharmacy and Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.

Objectives: This systematic review and meta-analysis was designed to determine the overall mean blood pressure and prevalence of hypertension among a representative sample of adults living with cerebral palsy by combining individual participant data. Additional objectives included estimating variations between subgroups and investigating potential risk factors for hypertension.

Methods: Potential datasets were identified by literature searches for studies published between January 2000 and November 2017 and by experts in the field. Samples of adults with cerebral palsy (n ≥ 10, age ≥ 18 years) were included if blood pressure data, cerebral palsy-related factors (e.g. cerebral palsy subtype), and sociodemographic variables (e.g. age, sex) were available. Hypertension was defined as at least 140/90 mmHg and/or use of antihypertensive medication.

Results: We included data from 11 international cohorts representing 444 adults with cerebral palsy [median (IQR) age of the sample was 29.0 (23.0-38.0); 51% men; 89% spastic type; Gross Motor Function Classification System levels I-V]. Overall mean SBP was 124.9 mmHg [95% confidence interval (CI) 121.7-128.1] and overall mean DBP was 79.9 mmHg (95% CI 77.2-82.5). Overall prevalence of hypertension was 28.7% (95% CI 18.8-39.8%). Subgroup analysis indicated higher blood pressure levels or higher prevalence of hypertension in adults with cerebral palsy above 40 years of age, men, those with spastic cerebral palsy or those who lived in Africa. BMI, resting heart rate and alcohol consumption were risk factors that were associated with blood pressure or hypertension.

Conclusion: Our findings underscore the importance of clinical screening for blood pressure in individuals with cerebral palsy beginning in young adulthood.
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http://dx.doi.org/10.1097/HJH.0000000000002912DOI Listing
June 2021

Development of Quality Indicators for the Management of Acute Type A Aortic Dissection.

Can J Cardiol 2021 Jun 3. Epub 2021 Jun 3.

Division of Cardiac Surgery, Department of Surgery, Western University, London, ON.

In an effort to further improve surgical outcomes in patients with acute type A aortic dissection (ATAD), the Canadian Thoracic Aortic Collaborative (CTAC), with the support of the Canadian Society of Cardiac Surgeons (CSCS), endeavored to develop quality indicators (QIs) for the management of patients with ATAD. After two successive consultations with the CTAC membership, 11 QIs were selected and separated into 5 broad categories: pre-operative (time from presentation to diagnosis, time from presentation to the operating room), intra-operative (use of hypothermic circulatory arrest and antegrade cerebral perfusion), 30-day outcomes (30-day rates of all-cause mortality, 30-day rates of new post-operative stroke), 1-year outcomes (1-year rates of follow-up imaging, 1-year rates of all-cause mortality, and 1-year rates of surgical re-intervention), and institutional (institutional surgical volumes, individual surgical volumes and presence of institutional aortic disease teams). The purpose of this manuscript was to describe the process by which QIs for the management of ATAD were developed and the feasibility by which they may be collected using existing clinical and administrative data sources. Furthermore, we demonstrate how they may be used to evaluate success following surgery for repair of ATAD and ultimately improve clinical outcomes.
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http://dx.doi.org/10.1016/j.cjca.2021.05.015DOI Listing
June 2021

Frozen Elephant Trunk for Aortic Arch Reconstruction is Associated with Reduced Mortality as Compared to Conventional Techniques.

Semin Thorac Cardiovasc Surg 2021 Jun 3. Epub 2021 Jun 3.

University of Manitoba, Winnipeg, Manitoba, Canada.

To examine the perioperative outcomes following aortic arch repair using frozen elephant trunk (FET) vs conventional elephant trunk (ET) techniques. Between 2002 and 2018, 390 patients underwent aortic repair with elephant trunk reconstruction at 9 centers: 172 patients received a FET (mean age: 65+/-13 years, 30% female, 37% aortic dissection) and 218 patients received an ET (mean age: 63+/-13 years, 37% female, 43% aortic dissection). Outcomes of interest included in-hospital mortality; stroke; and spinal cord injury (SCI). In-hospital mortality rate was 11% (n = 43) overall, 9% (n = 15) for FET and 13% (n = 28) for ET. Post-operative stroke occurred in 13% (n = 49) overall, 13% (n = 22) for FET and 12% (n = 27) for ET. The rate of post-operative SCI was 3% (n = 13) overall, 5.0% (n = 9) for FET and 2.0% (n = 4) for ET. When compared to ET, the propensity score analysis confirmed FET to be associated with lower mortality (adjusted risk difference -7.0% (95% CI -13.0 to -1.0), P = 0.02). There was no significant difference in the propensity score-adjusted risk difference for stroke between FET and ET (-0.7%, 95% CI -7.4% to 6.1%, P = 0.85), nor for SCI (3.3%, 95% CI -0.4% to 7.0%, P = 0.085) On multivariable analysis, FET was associated with lower odds of mortality (OR 0.44, 95% CI 0.21-0.95, P = 0.04), and had similar odds of stroke (OR 0.83, 95% CI 0.41-1.70, P = 0.62) and SCI (OR 2.83, 95% CI 0.83-9.60, P = 0.1). FET repair is associated with lower in-hospital mortality as compared to conventional ET, and results in similar risk of stroke and spinal cord injury. Further investigation is warranted.
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http://dx.doi.org/10.1053/j.semtcvs.2021.03.049DOI Listing
June 2021

Cardiovascular and metabolic morbidity following spinal cord injury.

Spine J 2021 May 21. Epub 2021 May 21.

Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.

Background Context: Individuals living with a spinal cord injury (SCI) are at heightened risk for a number of chronic health conditions such as secondary comorbidities that may develop or be influenced by the injury, the presence of impairment, and/or the process of aging.

Purpose: The objective of this study was to compare the incidence of and adjusted hazards for cardiovascular and metabolic (cardiometabolic) morbidities among adults following SCI compared to adults without SCIs.

Study Design/setting: Longitudinal cohort from a nationwide insurance claims database.

Patient Sample: Privately-insured beneficiaries were included if they had an ICD-9-CM diagnostic code for traumatic SCI (n=9,081). Adults without SCI were also included (n=1,474,232).

Outcome Measures And Methods: Incidence estimates of common cardiometabolic morbidities were compared at 4-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident cardiometabolic morbidities.

Results: Adults living with traumatic SCIs had a higher 5-year incidence of any cardiometabolic morbidities (56.2% vs. 36.4%) as compared to adults without SCI, and differences were to a clinically meaningful extent. Survival models demonstrated that adults with SCI had a greater hazard for any cardiometabolic morbidity (Hazard Ratio [HR]: 1.67; 95%CI: 1.58, 1.76) and all cardiometabolic disorders; this ranged from HR: 1.45 (1.32, 1.59) for non-alcoholic fatty liver disease to HR: 3.55 (3.36, 3.76) for heart failure.

Conclusions: Adults with SCIs have a significantly higher incidence of and risk for common cardiometabolic morbidities, as compared to adults without SCIs. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of cardiometabolic disease onset/progression in this vulnerable population.
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http://dx.doi.org/10.1016/j.spinee.2021.05.014DOI Listing
May 2021

Psychological, cardiometabolic, musculoskeletal morbidity and multimorbidity among adults with cerebral palsy and spina bifida: a retrospective cross-sectional study.

Am J Phys Med Rehabil 2021 May 17. Epub 2021 May 17.

Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan Department of Emergency Medicine, Michigan Medicine, University of Michigan Department of Surgery, Michigan Medicine, University of Michigan Department of Family Medicine, Michigan Medicine, University of Michigan.

Background: Individuals living with cerebral palsy (CP) or spina bifida (SB) are at heightened risk for a number of chronic health conditions such as secondary comorbidities, that may develop or be influenced by the disability, the presence of impairment, and/or the process of aging. However, very little is known about the prevalence and/or risk of developing secondary-comorbidities among individuals living with CP or SB throughout adulthood. The objective of this study was to compare the prevalence of psychological, cardiometabolic, musculoskeletal morbidity, and multimorbidity among adults with and without CP or SB.

Methods: Privately-insured beneficiaries were included if they had an ICD-9-CM diagnostic code for CP or SB (n = 29,841). Adults without CP or SB were also included (n = 5,384,849). Prevalence estimates of common psychological, cardiometabolic, and musculoskeletal morbidity and multimorbidity (≥2 conditions) were compared.

Results: Adults living with CP or SB had a higher prevalence of all psychological disorders and psychological multimorbidity (14.6% vs 5.4%), all cardiometabolic disorders and cardiometabolic multimorbidity (22.4% vs. 15.0%), and all musculoskeletal disorders and musculoskeletal multimorbidity (12.2% vs. 5.4%), as compared to adults without CP or SB, and differences were to a clinically meaningful extent.

Conclusions: Adults with CP or SB have a significantly higher prevalence of common psychological, cardiometabolic, and musculoskeletal morbidity and multimorbidity, as compared to adults without CP or SB. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of disease onset/progression in these higher risk populations.
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http://dx.doi.org/10.1097/PHM.0000000000001787DOI Listing
May 2021

Commentary: Timely repair of acute aortic dissection: Every minute counts.

J Thorac Cardiovasc Surg 2021 Apr 17. Epub 2021 Apr 17.

Western University, London, Ontario, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.04.026DOI Listing
April 2021

Musculoskeletal diagnoses, comorbidities, and physical and occupational therapy use among older adults with and without cerebral palsy.

Disabil Health J 2021 Apr 15:101109. Epub 2021 Apr 15.

Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address:

Background: Musculoskeletal (MSK) disorder in adults with cerebral palsy (CP) is higher than in the general population. Evidence lacks about physical therapy (PT) and occupational therapy (OT) service utilization among older adults (65> years) living with CP.

Objective: We compared the presence of comorbidities and patterns of PT and OT use among older adults with and without CP seeking care for MSK disorders.

Methods: A 20% national sample of Medicare claims data (2011-2014) identified community-living older adults with (n = 8796) and without CP (n = 5,613,384) with one or more ambulatory claims for MSK diagnoses. The sample matched one CP case to two non-CP cases per year on MSK diagnoses, age, sex, race, dual eligibility, and census region. Exposure variable was the presence/absence of a CP diagnosis. Outcomes were use of PT and OT services identified via CPT and revenue center codes, and the presence/absence of Elixhauser comorbidities.

Results: In older adults with MSK diagnoses, less than a third regularly utilized PT and/or OT services, and adults with CP utilized significantly less PT than adults without CP, and for some MSK diagnoses had fewer visits than their matched peers. Older adults with CP were at greater risk for secondary conditions that influence morbidity, mortality, and quality of life compared to their age-matched peers without CP.

Conclusions: Older adults with CP and MSK diagnoses had a greater prevalence of numerous comorbidities and lower use of PT services relative to their non-CP peers.
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http://dx.doi.org/10.1016/j.dhjo.2021.101109DOI Listing
April 2021

Commentary: The Ross procedure in a polyethylene terephthalate graft: Is everything OK in there?

J Thorac Cardiovasc Surg 2021 Feb 27. Epub 2021 Feb 27.

Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2021.02.078DOI Listing
February 2021

Does adding an aortic root replacement or sinus repair during arch repair increase postoperative mortality? Evidence from the Canadian Thoracic Aortic Collaborative.

Eur J Cardiothorac Surg 2021 Mar 26. Epub 2021 Mar 26.

Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada.

Objectives: The aim of this study was to examine the effect of the addition of an aortic root replacement or sinus repair on mortality and morbidity during aortic arch repair.

Methods: A total of 2472 patients underwent proximal or total aortic arch repair with hypothermic circulatory arrest between 2002 and 2018 at 12 centres. Multivariable logistic regressions (MV) and propensity score (PS) with inverse probability of treatment weighting (IPTW) analyses were performed.

Results: A total of 1099 (44.5%) patients had additional aortic root replacement (n = 934) or sinus repair (n = 165). Those with aortic root interventions were younger (61 ± 13 vs 64 ± 13 years, P < 0.001) and had less females (23% vs 35%, P < 0.001), less dissection (31% vs 36%, P = 0.004), less urgent cases (35% vs 39%, P = 0.047), more connective tissue disease (7% vs 3%, P < 0.001) and less total arch replacements (14% vs 22%, P < 0.001). On adjusted analyses, the addition of aortic root procedure was associated with increased mortality [MV: odds ratio (OR) 1.41, 95% confidence interval (CI) 1.03-1.92; PS-IPTW: risk increased by 3.7%, 95% CI 1.2-6.3%, P = 0.004]. Reoperation for bleeding was also increased with the addition of aortic root intervention (MV: OR 1.48, 95% 1.10-1.99; PS-IPTW: risk increased by 3.2%, 95% CI 0.8-5.6%, P = 0.009). The risks of stroke and dialysis-dependent renal failure were similar. When looking only at non-elective cases, the increased risk of mortality was more pronounced (MV: OR 1.60, 95% CI 1.11-2.32, P = 0.013; PS-IPTW: risk increased by 6.8%, 95 CI 1.7-11.8%, P = 0.008, and a number need to harm of 15 patients to cause 1 additional death).

Conclusions: The addition of aortic root replacement or sinus repair during proximal or total aortic arch repair seems to increase postoperative mortality only in non-elective cases.
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http://dx.doi.org/10.1093/ejcts/ezab125DOI Listing
March 2021

Letter to the Editor: Traumatic Spinal Cord Injury and Risk of Early and Late Onset Alzheimer's Disease and related Dementia: Large Longitudinal Study.

Arch Phys Med Rehabil 2021 Jul 18;102(7):1431-1432. Epub 2021 Mar 18.

Institute for Healthcare Policy and Innovation, and, Departments of Physical Medicine and Rehabilitation, Obstetrics and Gynecology, Emergency Medicine, Surgery, and Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, MI.

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http://dx.doi.org/10.1016/j.apmr.2021.03.003DOI Listing
July 2021

Timecourse of Morbidity Onset Among Adults Living With Cerebral Palsy.

Am J Prev Med 2021 07 13;61(1):37-43. Epub 2021 Mar 13.

Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan.

Introduction: Despite the greater risk of an array of morbidities, little is known about when morbidities occur for adults with cerebral palsy. The objective of this study is to determine the timecourse of morbidity risk/development for adults with cerebral palsy and the effect by patient-level factors.

Methods: Cross-sectional data from 2016 were used from a random 20% sample from the fee-for-service Medicare database. Diagnosis codes identified adults aged ≥18 years with cerebral palsy and 16 clinically relevant morbidities. Qualitative and quantitative approaches identified the age where each morbidity became exceedingly prevalent. The effect of the timecourse by sex, race, and co-occurring intellectual disabilities and epilepsy was examined. Data were sequestered and analyzed in 2020.

Results: Among 16,818 adults with cerebral palsy, the prevalence of most morbidities was already high among those aged 18-30 years, and all morbidities increased with age except liver disease and anxiety. Hypertension and diabetes exhibited a positive linear trend with age. Of the morbidities that did not exhibit a linear trend, the qualitative and quantitative approaches were consistent considering that the cardiorespiratory diseases, osteoarthritis, renal disease, and dementia became exceedingly more prevalent at age >50 years, whereas the threshold was >60 years for depression, cancer, and metastatic cancer. There were interactions with sex, race, and co-occurring intellectual disabilities and epilepsy for some of the morbidities.

Conclusions: Morbidity prevalence is already elevated early in adulthood among individuals living with cerebral palsy, with an abrupt increase by age 50 years. Preventive efforts should be adopted early in the lifespan and not later than age 50 years for adults with cerebral palsy.
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http://dx.doi.org/10.1016/j.amepre.2021.01.020DOI Listing
July 2021

Transfemoral Transcatheter Tricuspid Valve Replacement With the EVOQUE System: A Multicenter, Observational, First-in-Human Experience.

JACC Cardiovasc Interv 2021 Mar 10;14(5):501-511. Epub 2021 Feb 10.

St. Paul's Hospital, Centre for Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada.

Objectives: The purpose of this observational first-in-human experience was to investigate the feasibility and safety of the EVOQUE tricuspid valve replacement system and its impact on short-term clinical outcomes.

Background: Transcatheter tricuspid intervention is a promising option for selected patients with severe tricuspid regurgitation (TR). Although transcatheter leaflet repair is an option for some, transcatheter tricuspid valve replacement (TTVR) may be applicable to a broader population.

Methods: Twenty-five patients with severe TR underwent EVOQUE TTVR in a compassionate-use experience. The primary outcome was technical success, with NYHA (NYHA) functional class, TR grade, and major adverse cardiac and cerebrovascular events assessed at 30-day follow-up.

Results: All patients (mean age 76 ± 3 years, 88% women) were at high surgical risk (mean Society of Thoracic Surgeons risk score 9.1 ± 2.3%), with 96% in NYHA functional class III or IV. TR etiology was predominantly functional, with mean tricuspid annular diameter of 44.8 ± 7.8 mm and mean tricuspid annular plane systolic excursion of 16 ± 2 mm. Technical success was 92%, with no intraprocedural mortality or conversion to surgery. At 30-day follow-up, mortality was 0%, 76% of patients were in NYHA functional class I or II, and TR grade was ≤2+ in 96%. Major bleeding occurred in 3 patients (12%), 2 patients (8%) required pacemaker implantation, and 1 patient (4%) required dialysis.

Conclusions: This first-in-human experience evaluating EVOQUE TTVR demonstrated high technical success, acceptable safety, and significant clinical improvement. Larger prospective studies are needed to confirm durability and safety and the impact on long-term clinical outcomes.
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http://dx.doi.org/10.1016/j.jcin.2020.11.045DOI Listing
March 2021

Traumatic Spinal Cord Injury and Risk of Early and Late Onset Alzheimer's Disease and Related Dementia: Large Longitudinal Study.

Arch Phys Med Rehabil 2021 Jun 27;102(6):1147-1154. Epub 2021 Jan 27.

Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Neurosurgery, Michigan Medicine, University of Michigan, Ann Arbor, MI.

Objective: Traumatic spinal cord injury (TSCI) is a life altering event most often causing permanent physical disability. Little is known about the risk of developing Alzheimer disease and related dementia (ADRD) among middle-aged and older adults living with TSCI. Time to diagnosis of and adjusted hazard for ADRD was assessed.

Design: Cohort study.

Setting: Using 2007-2017 claims data from the Optum Clinformatics Data Mart, we identified adults (45+) with diagnosis of TSCI (n=7019). Adults without TSCI diagnosis were included as comparators (n=916,516). Using age, sex, race/ethnicity, cardiometabolic, psychological, and musculoskeletal chronic conditions, US Census division, and socioeconomic variables, we propensity score matched persons with and without TSCI (n=6083). Incidence estimates of ADRD were compared at 4 years of enrollment. Survival models were used to quantify unadjusted, fully adjusted, and propensity-matched unadjusted and adjusted hazard ratios (HRs) for incident ADRD.

Participants: Adults with and without TSCI (N=6083).

Intervention: Not applicable.

Main Outcomes Measures: Diagnosis of ADRD.

Results: Both middle-aged and older adults with TSCI had higher incident ADRD compared to those without TSCI (0.5% vs 0.2% and 11.7% vs 3.3% among 45-64 and 65+ y old unmatched cohorts, respectively) (0.5% vs 0.3% and 10.6% vs 6.2% among 45-64 and 65+ y old matched cohorts, respectively). Fully adjusted survival models indicated that adults with TSCI had a greater hazard for ADRD (among 45-64y old: unmatched HR: 3.19 [95% confidence interval, 95% CI, 2.30-4.44], matched HR: 1.93 [95% CI, 1.06-3.51]; among 65+ years old: unmatched HR: 1.90 [95% CI, 1.77-2.04], matched HR: 1.77 [1.55-2.02]).

Conclusions: Adults with TSCI are at a heightened risk for ADRD. Improved clinical screening and early interventions aiming to preserve cognitive function are of paramount importance for this patient cohort.
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http://dx.doi.org/10.1016/j.apmr.2020.12.019DOI Listing
June 2021

Risk of dementia in adults with cerebral palsy: a matched cohort study using general practice data.

BMJ Open 2021 01 25;11(1):e042652. Epub 2021 Jan 25.

Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland.

Objectives: Determine the risk of incident dementia in adults with cerebral palsy (CP) compared with age, sex and general practice (GP) matched controls.

Design: Retrospective cohort study.

Setting: UK GPs linked into the Clinical Practice Research Datalink (CPRD).

Participants: CPRD data were used to identify adults aged 18 or older with a diagnosis of CP. Each adult with CP was matched to three controls who were matched for age, sex and GP. In total, 1703 adults with CP and 5109 matched controls were included in the analysis. The mean baseline age of participants was 33.30 years (SD: 15.48 years) and 46.8% of the sample were female.

Primary Outcome: New diagnosis of dementia during the follow-up period (earliest date of 1987 to latest date of 2015).

Results: During the follow-up, 72 people were identified with a new diagnosis of dementia. The overall proportion of people with and without CP who developed dementia was similar (CP: n=19, 1.1%; matched controls n=54, 10.0%). The unadjusted HR suggested that people with CP had an increased hazard of being diagnosed with dementia when compared with matched controls (HR 2.69, 95% CI 1.44 to 5.00). This association was attenuated when CP comorbidities (sensory impairment, intellectual disability and epilepsy) were accounted for (HR 1.92, 95% CI 0.92 to 4.02).

Conclusions: There was no difference in the proportion of people with CP and matched controls who were diagnosed with dementia during the follow-up. Furthermore, while there was evidence for an increased hazard of dementia among people with CP, the fact that this association was attenuated after controlling for comorbidities indicates that this association may be explained by comorbidities rather than being a direct result of CP. Findings should be interpreted with caution due to the low number of incident cases of dementia.
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http://dx.doi.org/10.1136/bmjopen-2020-042652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839844PMC
January 2021

Commentary: The Ross procedure: One surgeon's journey toward mastery.

J Thorac Cardiovasc Surg 2021 03 20;161(3):918-919. Epub 2021 Jan 20.

Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2020.12.056DOI Listing
March 2021

Cerebral Palsy Grows Up.

Mayo Clin Proc 2021 06 12;96(6):1404-1406. Epub 2021 Jan 12.

Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI.

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http://dx.doi.org/10.1016/j.mayocp.2020.10.006DOI Listing
June 2021

A randomized trial comparing axillary versus innominate artery cannulation for aortic arch surgery.

J Thorac Cardiovasc Surg 2020 Dec 1. Epub 2020 Dec 1.

Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.

Background: Cerebral protection remains the cornerstone of successful aortic surgery; however, there is no consensus as to the optimal strategy.

Objective: To compare the safety and efficacy of innominate to axillary artery cannulation for delivering antegrade cerebral protection during proximal aortic arch surgery.

Methods: This randomized controlled trial (The Aortic Surgery Cerebral Protection Evaluation CardioLink-3 Trial, ClinicalTrials.gov Identifier: NCT02554032), conducted across 6 Canadian centers between January 2015 and June 2018, allocated 111 individuals to innominate or axillary artery cannulation. The primary safety outcome was neuroprotection per the appearance of new severe ischemic lesions on the postoperative diffusion-weighted-magnetic resonance imaging. The primary efficacy outcome was the difference in total operative time. Secondary outcomes included 30-day all-cause mortality and postoperative stroke.

Results: One hundred two individuals (mean age, 63 ± 11 years) were in the primary safety per-protocol analysis. Baseline characteristics between the groups were similar. New severe ischemic lesions occurred in 19 participants (38.8%) in the axillary versus 18 (34%) in the innominate group (P for noninferiority = .0009). Total operative times were comparable (median, 293 minutes; interquartile range, 222-411 minutes) for axillary versus (298 minutes; interquartile range, 231-368 minutes) for innominate (P for superiority = .47). Stroke/transient ischemic attack occurred in 4 (7.1%) participants in the axillary versus 2 (3.6%) in the innominate group (P = .43). Thirty-day mortality, seizures, delirium, and duration of mechanical ventilation were similar in both groups.

Conclusions: diffusion-weighted magnetic resonance imaging assessments indicate that antegrade cerebral protection with innominate cannulation is safe and affords similar neuroprotection to axillary cannulation during aortic surgery, although the burden of new neurological lesions is high in both groups.
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http://dx.doi.org/10.1016/j.jtcvs.2020.10.152DOI Listing
December 2020

Vitamin D supplementation associated with 12-weeks multimodal training in older women with low bone mineral density: A randomized double-blind placebo-controlled trial.

Exp Gerontol 2021 04 6;146:111211. Epub 2021 Jan 6.

Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Graduate Program in Aging Sciences from the University Sao Judas Tadeu (USJT), São Paulo, SP, Brazil.

Objective: To evaluate the influence of vitamin D supplementation with a multimodal exercise program on postural balance and muscle strength in older women with low bone mineral density (BMD) and vitamin D insufficiency.

Methods: 12-week, randomized, double-blind, placebo-controlled clinical trial. Total of 422 subjects were screened for participation, and 46 met the inclusion criteria. Those were randomized into an experimental group (EG; n = 23) and control group (CG; n = 23). At the time of enrollment, all subjects had low BMD, vitamin D insufficiency, and were not practicing resistance exercise. Muscle strength assessments were performed by the 30-s sit to stand test; 15-steps climbing test; handgrip dynamometer and knee muscle strength using an isokinetic dynamometer at 60°/sec. Postural balance was clinically evaluated by the MiniBESTest and by a force platform. Dynamic balance was assessed by standing up from a chair and walk over a step, using also a force platform.

Results: In the EG, vitamin D levels increased in the post-treatment period (P < 0.001) whereas in CG levels remained unchanged (P = 0.86). Both groups improved muscular strength in the dynamometry isokinetic test: flexors PT/BW - right (P < 0.02) and left side (P < 0.04). In the dynamic postural balance during the task to step up over: the Lift Up Left was better in the CG (P = 0.01); the Moment Time left was better in the CG (P = 0.01); the Impact index left was better in the EG (P = 0.01). The Mini-BESTest - both groups improved the postural balance test (P < 0.001).

Conclusion: Vitamin D supplementation associated with multimodal exercise program did not augment muscle strength adaptation or postural balance in older women with low bone mineral density and vitamin D insufficiency.
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http://dx.doi.org/10.1016/j.exger.2020.111211DOI Listing
April 2021

The respiratory disease burden of non-traumatic fractures for adults with cerebral palsy.

Bone Rep 2020 Dec 27;13:100730. Epub 2020 Oct 27.

Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.

Background: Individuals with cerebral palsy (CP) are vulnerable to non-trauma fracture (NTFx) and premature mortality due to respiratory disease (RD); however, very little is known about the contribution of NTFx to RD risk among adults with CP. The purpose of this study was to determine if NTFx is a risk factor for incident RD and if NTFx exacerbates RD risk in the adult CP population.

Methods: Data from 2011 to 2016 Optum Clinformatics® Data Mart and a random 20% sample Medicare fee-for-service were used for this retrospective cohort study. Diagnosis codes were used to identify adults (18+ years) with and without CP, NTFx, incident RD at 3-, 6-, 12-, and 24-month time points (pneumonia, chronic obstructive pulmonary disease, interstitial/pleura disease), and comorbidities. Crude incidence rates per 100 person years of RD were estimated. Cox regression estimated hazard ratios (HR and 95% confidence interval [CI]) for RD measures, comparing: (1) CP and NTFx (CP + NTFx); (2) CP without NTFx (CP w/o NTFx); (3) without CP and with NTFx (w/o CP + NTFx); and (4) without CP and without NTFx (w/o CP w/o NTFx) after adjusting for demographics and comorbidities.

Results: The crude incidence rate was elevated for CP + NTFx vs. CP w/o NTFx and w/o CP + NTFx for each RD measure. After adjustments, the HR was elevated for CP + NTFx vs. CP w/o NTFx for pneumonia and interstitial/pleura disease at all time points (all  < 0.05), but not chronic obstructive pulmonary disease (e.g., 24-month HR = 1.07; 95%CI = 0.88-1.31). The adjusted HR was elevated for CP + NTFx vs. w/o CP + NTFx for pneumonia at all time points, interstitial/pleura disease at 12- and 24-month time points, and chronic obstructive pulmonary disease at 24-months (all  < 0.05). There is evidence of a time-dependent effect of NTFx on pneumonia and interstitial/pleura disease for CP + NTFx as compared to CP w/o NTFx.

Conclusions: Study findings suggest that NTFx is a risk factor for incident RD, including pneumonia and interstitial/pleura disease, among adults with CP and that NTFx exacerbates RD risk for adults with vs. without CP.
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http://dx.doi.org/10.1016/j.bonr.2020.100730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645631PMC
December 2020

Commentary: Coronavirus disease 2019 and acute aortic dissection: So many questions, so few answers.

JTCVS Tech 2020 Dec 29;4:55-56. Epub 2020 Oct 29.

Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

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http://dx.doi.org/10.1016/j.xjtc.2020.10.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598354PMC
December 2020

Test-Retest Reliability and Correlates of Vertebral Bone Marrow Lipid Composition by Lipidomics Among Children With Varying Degrees of Bone Fragility.

JBMR Plus 2020 Oct 8;4(10):e10400. Epub 2020 Sep 8.

Department of Orthopaedic Surgery University of Michigan Ann Arbor MI USA.

The reliability of lipidomics, an approach to identify the presence and interactions of lipids, to analyze the bone marrow lipid composition among pediatric populations with bone fragility is unknown. The objective of this study was to assess the test-retest reliability, standard error of measurement (SEM), and the minimal detectable change (MDC) of vertebral bone marrow lipid composition determined by targeted lipidomics among children with varying degrees of bone fragility undergoing routine orthopedic surgery. Children aged 10 to 19 years, with a confirmed diagnosis of adolescent idiopathic scoliosis ( = 13) or neuromuscular scoliosis and cerebral palsy ( = 3), undergoing posterior spinal fusion surgery at our institution were included in this study. Transpedicular vertebral body bone marrow samples were taken from thoracic vertebrae (T11, 12) or lumbar vertebrae (L1 to L4). Lipid composition was assessed via targeted lipidomics and all samples were analyzed in the same batch. Lipid composition measures were examined as the saturated, monounsaturated, and polyunsaturated index and as individual fatty acids. Relative and absolute test-retest reliability was assessed using the intraclass correlation coefficient (ICC), SEM, and MDC. Associations between demographics and index measures were explored. The ICC, SEM, and MDC were 0.81 (95% CI, 0.55-0.93), 1.6%, and 4.3%, respectively, for the saturated index, 0.66 (95% CI, 0.25-0.87), 3.5%, and 9.7%, respectively, for the monounsaturated index, and 0.60 (95% CI, 0.17-0.84), 3.6%, and 9.9%, respectively, for the polyunsaturated index. For the individual fatty acids, the ICC showed a considerable range from 0.04 (22:2n-6) to 0.97 (18:3n-3). Age was positively correlated with the saturated index ( = 0.36; = 0.014) and negatively correlated with the polyunsaturated index ( = 0.26; = 0.043); there was no difference in index measures by sex ( > 0.58). The test-retest reliability was moderate-to-good for index measures and poor to excellent for individual fatty acids; this information can be used to power research studies and identify measures for clinical or research monitoring. © 2020 The Authors. published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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http://dx.doi.org/10.1002/jbm4.10400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574707PMC
October 2020

Musculoskeletal morbidity following spinal cord injury: A longitudinal cohort study of privately-insured beneficiaries.

Bone 2021 01 20;142:115700. Epub 2020 Oct 20.

Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA. Electronic address:

Background: People living with spinal cord injuries (SCIs) experience motor, sensory and autonomic impairments that cause musculoskeletal disorders following the injury and that progress throughout lifetime. The range and severity of issues are largely dependent on level and completeness of the injury and preserved function.

Objective: High risk of developing musculoskeletal morbidities among individuals after sustaining a traumatic SCI is well known in the clinical setting, however, there is a severe lack of evidence in literature. The objective of this study was to compare the incidence of and adjusted hazards for musculoskeletal morbidities among adults with and without SCIs.

Methods: Privately-insured beneficiaries were included if they had an ICD-9-CM diagnostic code for SCI (n = 9081). Adults without SCI were also included (n = 1,474,232). Incidence estimates of common musculoskeletal morbidities (e.g., osteoporosis, sarcopenia, osteoarthritis, fractures, etc.) were compared at 5-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident musculoskeletal morbidities.

Results: Adults living with traumatic SCIs had a higher incidence of any musculoskeletal morbidities (82.4% vs. 47.5%) as compared to adults without SCI, and differences were to a clinically meaningful extent. Survival models demonstrated that adults with SCI had a greater fully-adjusted hazard for any musculoskeletal morbidity (Hazard Ratio [HR]: 2.41; 95%CI: 2.30, 2.52), and all musculoskeletal disorders, and ranged from HR: 1.26 (1.14, 1.39) for rheumatoid arthritis to HR: 7.02 (6.58, 7.49) for pathologic fracture.

Conclusions: Adults with SCIs have a significantly higher incidence of and risk for common musculoskeletal morbidities, as compared to adults without SCIs. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of musculoskeletal disease onset/progression in this higher risk population.
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http://dx.doi.org/10.1016/j.bone.2020.115700DOI Listing
January 2021

The mortality burden of non-trauma fracture for adults with cerebral palsy.

Bone Rep 2020 Dec 7;13:100725. Epub 2020 Oct 7.

Department of Orthopaedic Surgery, University of Michigan, 1540 E Hospital Dr., Ann Arbor, MI 48109, United States of America.

Background: Individuals with cerebral palsy (CP) manifest skeletal fragility problems early in life, are vulnerable to non-trauma fracture (NTFx), and have a high burden of premature mortality. No studies have examined the contribution of NTFx to mortality among adults with CP. The purpose of this study was to determine if NTFx is a risk factor for mortality among adults with CP and if NTFx exacerbates mortality risk compared to adults without CP.

Methods: Data from 2011 to 2016 Optum Clinformatics® Data Mart and a random 20% sample Medicare fee-for-service were used for this retrospective cohort study. Diagnosis codes were used to identify adults (18+ years) with and without CP, NTFx, and pre-NTFx comorbidities. Crude mortality rates per 100 person years were estimated. Cox regression estimated hazard ratios (HR and 95% confidence interval [CI]) for mortality, comparing: (1) CP and NTFx (CP + NTFx;  = 1777); (2) CP without NTFx (CP w/o NTFx;  = 12,933); (3) without CP and with NTFx (w/o CP + NTFx;  = 433,560); and (4) without CP and without NTFx (w/o CP w/o NTFx;  = 6.8 M) after adjusting for demographics and pre-NTFx comorbidities.

Results: The 3-, 6-, and 12-month crude mortality rates were highest among CP + NTFx (12-month mortality rate = 6.80), followed by w/o CP + NTFx (12-month mortality rate = 4.91), CP w/o NTFx (12-month mortality rate = 2.15), and w/o CP w/o NTFx (12-month mortality rate = 0.49). After adjustments, the mortality rate was elevated for CP + NTFx for all time points compared to CP w/o NTFx (e.g., 12-month HR = 1.61; 95%CI = 1.29-2.01), w/o CP + NTFx (e.g., 12-month HR = 1.49; 95%CI = 1.24-1.80), and w/o CP w/o NTFx (e.g., 12-month HR = 5.33; 95%CI = 4.42-6.44). There were site-specific effects (vertebral column, lower extremities) on 12-month mortality.

Conclusions: NTFx is associated with an increase of 12-month mortality risk among adults with CP and compared to adults without CP. Findings suggest that NTFx may be a robust risk factor for mortality among adults with CP.
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http://dx.doi.org/10.1016/j.bonr.2020.100725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7560646PMC
December 2020

Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD.

J Card Surg 2020 Dec 16;35(12):3467-3473. Epub 2020 Sep 16.

Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Background: Type A acute aortic dissection (TAAAD) represents a surgical emergency requiring intervention regardless of time of day. Whether such a "evening effect" exists regarding outcomes for TAAAD has not been previously studied using a large registry data.

Methods: Patients with TAAAD were identified from the International Registry of Acute Aortic Dissections (1996-2019). Outcomes were compared between patients undergoing operative repair during the daytime (D), defined as 8 am-5 pm, versus the evening (N), defined as 5 pm-8 am.

Results: Four thousand one-hundrd and ninety-seven surgically treated patients with TAAAD were identified, with 1824 patients undergoing daytime surgery (43.5%) and 2373 patients undergoing evening surgery (56.5%). Daytime patients were more likely to have undergone prior cardiac surgery (13.2% vs. 9.5%; p < .001) and have had a prior aortic dissection (4.8% vs. 3.4%; p = .04). Evening patients were more likely to have been transferred from a referring hospital (70.8% vs. 75.0%; p = .003). Daytime patients were more likely to undergo aortic valve sparing root procedures (23.3% vs. 19.2%; p = .035); however, total arch replacement was performed with equal frequency (19.4% vs. 18.8%; p = .751). In-hospital mortality (D: 17.3% vs. N. 16.2%; p = .325) was similar between both groups. Subgroup analysis examining the effect of weekend presentation revealed no significant mortality difference.

Conclusions: A majority of TAAAD patients underwent surgical repair at night. There were higher rates of postoperative tamponade in evening patients; however, mortality was similar. The expertise of cardiac-dedicated operative and critical care teams regardless of time of day as well as training paradigms may explain similar mortality outcomes in this high risk population.
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http://dx.doi.org/10.1111/jocs.15017DOI Listing
December 2020

Polypharmacy Among Privately Insured Adults with Cerebral Palsy: A Retrospective Cohort Study.

J Manag Care Spec Pharm 2020 Sep;26(9):1153-1161

Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.

Background: Adults with cerebral palsy (CP) have increased risk for developing various secondary chronic diseases, especially when they have other neurodevelopmental disabilities (NDDs). Multiple medications are likely prescribed to manage the greater morbidity-related burden for adults with CP; however, because health care delivery and care coordination is suboptimal for this population, adults with CP may have an increased risk for polypharmacy. To date, very little is known about the prescribing practices and extent of polypharmacy for adults with CP.

Objective: To determine the prevalence and adjusted odds of polypharmacy among adults with CP only and those with CP+NDDs, compared with adults without CP.

Methods: Data from 2017 Optum Clinformatics Data Mart, a U.S. private administrative database, was used for this retrospective cohort study. Diagnosis codes were used to identify adults (aged ≥ 18 years) with CP, NDDs (e.g., intellectual disabilities, epilepsy, and autism spectrum disorders), and 24 relevant morbidities. Polypharmacy was examined as 0-4 versus ≥ 5, 0-9 versus ≥ 10, and 0-14 versus ≥ 15 medications. Logistic regression estimated the OR and 95% CI of polypharmacy before and after adjusting for age, sex, region of residence, and multimorbidity (as 0, 1, 2, 3, 4-5, and ≥ 6 morbidities). Exploratory analyses were conducted to compare polypharmacy among young (18-40 years) and middle-aged (41-64 years) adults with CP only and CP + NDDs with elderly (≥ 65 years) adults without CP.

Results: Adults with CP only (n = 5,603) and CP + NDDs (n = 2,474) had higher unadjusted prevalence and adjusted OR for each polypharmacy definition compared with adults without CP (n = 9.0 million; e.g., ≥ 5 medications: adjusted OR for CP only = 1.38, 95% CI = 1.30-1.47; CP + NDDs: OR = 2.42, 95% CI = 2.20-2.67). Adults with CP+NDDs had higher unadjusted prevalence and adjusted OR of each polypharmacy definition compared with CP only. Compared with elderly without CP, the unadjusted prevalence of polypharmacy was lower for young adults with CP only (e.g., ≥ 5 medications: 60.2%, 43.8%), similar for young adults with CP+NDDs (e.g., ≥ 15 medications: 10.9%, 12.5%), and elevated for middle-aged CP only and CP + NDDs (e.g., ≥ 10 medications: 28.7%, 34.3%, 41.7%).

Conclusions: Privately insured adults with CP only and CP + NDDs have an elevated prevalence of polypharmacy compared with adults without CP, even after accounting for multimorbidity. Importantly, adults aged 18-40 years with CP have a similar (CP + NDDs) prevalence of polypharmacy compared with the general geriatric population, with the prevalence increasing further for CP by middle age.

Disclosures: Whitney was supported by the University of Michigan Office of Health Equity and Inclusion Diversity Fund and the American Academy of Cerebral Palsy and Developmental Medicine. These funding sources had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The other authors have no conflicts of interest to disclose.
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http://dx.doi.org/10.18553/jmcp.2020.26.9.1153DOI Listing
September 2020

The Formula for Health and Well-Being in Individuals With Cerebral Palsy: Cross-Sectional Data on Physical Activity, Sleep, and Nutrition.

Ann Rehabil Med 2020 Aug 28;44(4):301-310. Epub 2020 Jul 28.

Department of Pediatrics, McMaster University, Hamilton, ON, Canada.

Objective: To determine physical activity, sleep, and nutrition patterns in individuals with cerebral palsy (CP) and investigate the association of Gross Motor Function Classification System (GMFCS) and age with these health behaviors.

Methods: A cross-sectional study was conducted in an outpatient setting. Participants included adolescents and adults with CP (n=28; GMFCS level I-V; mean age 35.1±14.4 years). An Exercise Questionnaire or Leisure Time Physical Activity Questionnaire was used to measure physical activity in adolescents and adults, respectively. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). An adapted version of the PrimeScreen questionnaire was used to assess nutrition. Linear regression analyses were performed to investigate the association between GMFCS and age with physical activity, sleep, and nutrition.

Results: The average total physical activity was 29.2±30.0 min/day. Seventy-five percent of the participants had poor sleep quality (PSQI score >5). Seventy-one percent reported "fair" eating behaviors; none reported "excellent" eating behaviors. Neither GMFCS nor age were significantly associated with PSQI score, PrimeScreen score, or total physical activity. A negative correlation existed between sleep quantity (hr/night) and PSQI score (r=-0.66, p=0.01).

Conclusion: The triad of health components, consisting of physical activity, sleep, and nutrition, was not associated with GMFCS or age in our sample of 28 individuals with CP, suggesting that these three health behaviors should be assessed during clinical encounters of CP in adolescents and adults at all levels of the GMFCS.
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http://dx.doi.org/10.5535/arm.19156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463117PMC
August 2020

Psychological morbidity among adults with cerebral palsy and spina bifida.

Psychol Med 2021 03 27;51(4):694-701. Epub 2020 Jul 27.

Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.

Background: Very little is known about the risk of developing psychological morbidities among adults living with cerebral palsy (CP) or spina bifida (SB). The objective of this study was to compare the incidence of and adjusted hazards for psychological morbidities among adults with and without CP or SB.

Methods: Privately insured beneficiaries were included if they had an International Classification of Diseases, Ninth revision, Clinical Modification diagnostic code for CP or SB (n = 15 302). Adults without CP or SB were also included (n = 1 935 480). Incidence estimates of common psychological morbidities were compared at 4-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities.

Results: Adults living with CP or SB had a higher 4-year incidence of any psychological morbidity (38.8% v. 24.2%) as compared to adults without CP or SB, and differences were to a clinically meaningful extent. Fully adjusted survival models demonstrated that adults with CP or SB had a greater hazard for any psychological morbidity [hazard ratio (HR): 1.60; 95% CI 1.55-1.65], and all but one psychological disorder (alcohol-related disorders), and ranged from HR: 1.32 (1.23, 1.42) for substance disorders, to HR: 4.12 (3.24, 5.25) for impulse control disorders.

Conclusions: Adults with CP or SB have a significantly higher incidence of and risk for common psychological morbidities, as compared to adults without CP or SB. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce the risk of disease onset/progression in these higher-risk populations.
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http://dx.doi.org/10.1017/S0033291720001981DOI Listing
March 2021

Cardiometabolic Morbidity in Adults With Cerebral Palsy and Spina Bifida.

Am J Med 2020 12 17;133(12):e695-e705. Epub 2020 Jul 17.

Department of Physical Medicine and Rehabilitation.

Purpose: The purpose of this study was to compare the incidence of, and adjusted hazards for, cardiometabolic morbidities among adults with and without cerebral palsy or spina bifida.

Methods: Privately insured beneficiaries were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code for cerebral palsy or spina bifida (n = 15,302). Adults without cerebral palsy or spina bifida were also included (n = 1,935,480). Incidence estimates of common cardiometabolic morbidities were compared at 4 years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios (HRs) for incident cardiometabolic morbidities.

Results: Adults living with cerebral palsy or spina bifida had a higher 4-year incidence of any cardiometabolic morbidity (41.5% vs 30.6%) as compared to adults without cerebral palsy or spina bifida, and differences were to a clinically meaningful extent. Fully adjusted survival models demonstrated that adults with cerebral palsy or spina bifida had a greater hazard for any cardiometabolic morbidity (HR: 1.52; 95% confidence interval [CI]: 1.47, 1.57), and all but 1 cardiometabolic disorder (nonalcoholic fatty liver disease) and ranged from HR: 1.20 (1.15, 1.25) for hypercholesterolemia to HR: 1.86 (1.74, 1.98) for heart failure.

Conclusions: Adults with cerebral palsy or spina bifida have a significantly higher incidence of, and risk for, common cardiometabolic morbidities, as compared to adults without cerebral palsy or spina bifida. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of cardiometabolic disease onset and progression in these higher-risk populations.
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http://dx.doi.org/10.1016/j.amjmed.2020.05.032DOI Listing
December 2020

Clinical factors associated with mood affective disorders among adults with cerebral palsy.

Neurol Clin Pract 2020 Jun;10(3):206-213

Department of Physical Medicine and Rehabilitation (DGW, SAW, DW, AK, SLM, EAH, MDP), University of Michigan; University of Michigan (DGW, MDP), Institute for Healthcare Policy and Innovation; University of Michigan (DGW), University of Michigan Depression Center, Ann Arbor, MI; and Epidemiology Group (DW), University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Scotland, UK.

Objective: To determine individual and aggregated associations of cerebral palsy (CP)-related symptoms and the effect of comorbid neurodevelopmental conditions on mood (affective) disorders among adults with CP.

Methods: Cross-sectional data from 2016 were extracted from a random 20% sample of the Medicare fee-for-service database. diagnosis codes were used to identify 18- to -64-year-old beneficiaries with CP, as well as mood (affective) disorders, pain, sleep disorders, fatigue, and comorbid neurodevelopmental conditions (intellectual disabilities [ID], autism spectrum disorders [ASD], and epilepsy).

Results: Four thousand eight hundred twenty-three of the 17,212 adults with CP had mood (affective) disorders (28.0%). After adjusting for age, sex, and race, pain (odds ratio [OR] = 2.15; 99.5% confidence interval [CI] = 1.94-2.39), sleep disorders (OR = 2.43; 99.5% CI = 2.13-2.77), fatigue (OR = 1.38; 99.5% CI = 1.18-1.60), ID (OR = 1.47; 99.5% CI = 1.31-1.63), ASD (OR = 1.44; 99.5% CI = 1.16-1.80), and epilepsy (OR = 0.81; 99.5% CI = 0.73-0.91) were each associated with mood (affective) disorders. When pain, sleep disorders, and fatigue were presented as a count variable, the adjusted odds of mood (affective) disorders increased with the number of factors: 1 factor (OR = 1.99; 99.5% CI = 1.79-2.22), 2 factors (OR = 4.18; 99.5% CI = 3.58-4.89), and all 3 factors (OR = 7.38; 99.5% CI = 5.17-10.53).

Conclusions: Among young and middle-aged adults with CP, mood (affective) disorders were associated with pain, sleep disorders, and fatigue, and increasing co-occurrence of these factors further increased the likelihood of mood (affective) disorders. Further, comorbid neurodevelopmental conditions were also associated with mood (affective) disorders among adults with CP. Study findings could be used to improve screening strategies for mood (affective) disorders among adults with CP in the clinical setting.
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http://dx.doi.org/10.1212/CPJ.0000000000000721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292558PMC
June 2020