Hector Lemus

Self-Reported Age of Onset and Telescoping for Cigarettes, Alcohol, and Marijuana: Across Eight Years of the National Longitudinal Survey of Youth.

Smoking, drinking, and illicit drug use are leading causes of morbidity and mortality, both during adolescence as well as later in life. The determination of how well national and local policy and intervention efforts address teen substance use depends largely on the collection of valid and accurate data. Assessments of substance use rely heavily on retrospective self-report measures, but the reliability and validity, however, may be limited by various sources of measurement error. This study utilizes four waves of data from the National Longitudinal Survey of Youth spanning eight years. Results from multiple linear regression analyses showed that the single most consistent variable associated with telescoping was the number of years since the substance was first reported. Time since first report was the single consistent variable and was strongly associated with telescoping in each wave-to-wave comparison for all three substances under study. Implications for policy and research are discussed.

Disease Severity and Pregnancy Outcomes in Women with Rheumatoid Arthritis: Results from the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project

Objective. To determine the effect of rheumatoid arthritis (RA) disease severity on pregnancy outcomes in pregnant women with and without autoimmune diseases. Methods. A prospective cohort study was conducted using the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project. Pregnant women with RA enrolled between 2005 and 2013 were selected if they (1) delivered a live-born singleton infant; and (2) completed 3 telephone-based measures of RA disease severity prior to 20 weeks’ gestation, including the Health Assessment Questionnaire Disability Index (HAQ-DI), pain score, and patient’s global scale. Associations between RA disease severity and preterm delivery, small for gestational age (SGA), or cesarean delivery were tested in unadjusted and multivariate analyses using modified Poisson regression models. Results. The sample consisted of 440 women with RA. Several unadjusted comparisons yielded significant associations. After adjustment for covariates, increasing disease severity was associated with risk for preterm delivery and SGA. For each unit increase in HAQ-DI (0–1), the adjusted relative risk (aRR) for preterm delivery increased by 58% (aRR 1.58, 95% CI 1.17–2.15). Among those with HAQ-DI > 0.5, the aRR for SGA was 1.81 (95% CI 1.01–3.33). Conclusion. RA disease severity in early pregnancy, as measured in this study, was predictive of preterm delivery and SGA. These findings suggest that the risk of preterm delivery and SGA in women with RA might be lowered if RA is well controlled early in pregnancy.

Determination of clinical and demographic predictors of laboratory-confirmed influenza with subtype analysis.

BackgroundRapid influenza diagnosis is important for early identification of outbreaks, effective management of high-risk contacts, appropriate antiviral use, decreased inappropriate antibiotic use and avoidance of unnecessary laboratory testing. Given the inconsistent performance of many rapid influenza tests, clinical diagnosis remains integral for optimizing influenza management. However, reliable clinical diagnostic methods are not well-established. This study assesses predictors of influenza, and its various subtypes, in a broad population at the point of care, across age groups, then evaluates the performance of clinical case definitions composed of identified predictors.MethodsRespiratory specimens and demographic and clinical data were obtained from 3- to 80-year-old US military family members presenting for care with influenza-like illness (ILI) from November 2007 to April 2008. Molecular and virus isolation techniques were used to detect and subtype influenza viruses. Associations between influenza diagnosis and demographic/clinical parameters were assessed by logistic regression, including influenza type and subtype analyses. The predictive values of multiple combinations of identified clinical predictors (case definitions), and the Centers for Disease Control and Prevention (CDC) ILI case definition, were estimated.ResultsOf 789 subjects, 220 (28%) had laboratory-confirmed influenza (51 A(H1), 46 A(H3), 19 A(unsubtypeable), 67 B, 1 AB coinfection), with the proportion of influenza A to B cases highest among 6- to 17-year-olds (p = 0.019). Independent predictors of influenza included fever, cough, acute onset, body aches, and vaccination status among 6- to 49-year-olds, only vaccination among 3- to 5-year-olds, and only fever among 50- to 80-year-olds. Among 6- to 49-year-olds, some clinical case definitions were highly sensitive (100.0%) or specific (98.6%), but none had both parameters over 60%, though many performed better than the CDC ILI case definition (sensitivity 37.7%, 95% confidence interval 33.6–41.9% in total study population).ConclusionsPatterns of influenza predictors differed across age groups, with most predictors identified among 6- to 49-year-olds. No combination of clinical and demographic predictors served as a reliable diagnostic case definition in the population and influenza season studied. A standardized clinical case definition combined with a point-of-care laboratory test may be the optimal rapid diagnostic strategy available.

Factors associated with pathways toward concurrent sex work and injection drug use among female sex workers who inject drugs in northern Mexico

AIMS To identify factors associated with time to initiation of (i) sex work prior to injecting drugs initiation; (ii) injection drug use prior to sex work initiation; and (iii) concurrent sex work and injection drug use (i.e. initiated at the same age) among female sex workers who currently inject drugs (FSW-IDU). DESIGN Parametric survival analysis of baseline data for time to initiation event. SETTING Tijuana and Ciudad Juarez situated on the Mexico-US border. PARTICIPANTS A total of 557 FSW-IDUs aged ≥18 years. MEASUREMENTS Interview-administered surveys assessing context of sex work and injection drug use initiation. FINDINGS Nearly half (n = 258) initiated sex work prior to beginning to inject, a third (n = 163) initiated injection first and a quarter (n = 136) initiated both sex work and injection drug use concurrently. Low education and living in Ciudad Juarez accelerated time to sex work initiation. Being from a southern Mexican state and initiating drug use with inhalants delayed the time to first injection drug use. Having an intimate partner encourage entry into sex work and first injecting drugs to deal with depression accelerated time to initiating sex work and injection concurrently. Early physical abuse accelerated time to initiating sex work and injection, and substantially accelerated time to initiation of both behaviors concurrently. CONCLUSIONS Among female sex workers who currently inject drugs in two Mexican-US border cities, nearly half appear to initiate sex work prior to beginning to inject, nearly one-third initiate injection drug use before beginning sex work and one-quarter initiate both behaviors concurrently. Predictors of these three trajectories differ, and this provides possible modifiable targets for prevention.

A Longitudinal Comparison of Posttraumatic Stress Disorder and Depression Among Military Service Components

The purpose of this study was to longitudinally investigate PTSD and depression between Reserve, National Guard, and active duty continuously and dichotomously. The study consisted of Millennium Cohort Study participants and used self-reported symptoms. Repeated measures modeling assessed PTSD and depression continuously and dichotomously over time. A subanalysis among only recently deployed personnel was conducted. Of the 52,653 participants for the PTSD analysis, the adjusted PCL-C means were 34.6 for Reservists, 34.4 for National Guardsmen, and 34.7 for active duty members, respectively. Of the 53,073 participants for depression analysis, the adjusted PHQ-9 means were 6.8, 6.7, and 7.2, respectively. In dichotomous models, Reservists and National Guardsmen did not have a higher risk of PTSD or depression compared with active duty members. Among deployers, Reservists and National Guardsmen had higher odds (odds ratio = 1.16, 95% confidence limit [CL] [1.01, 1.34] and OR = 1.19, 95% CL [1.04, 1.36], respectively) of screening positive for PTSD, but not depression. Although Reserve and National Guard deployers had modestly increased odds of PTSD compared with active duty members, overall there were minimal differences in the risk and symptom scores of PTSD and depression between service components.

Spirometry Reference Equations from the HCHS/SOL (Hispanic Community Health Study/Study of Latinos)

Rationale: Accurate reference values for spirometry are important because the results are used for diagnosing common chronic lung diseases such as asthma and chronic obstructive pulmonary disease, estimating physiologic impairment, and predicting all‐cause mortality. Reference equations have been established for Mexican Americans but not for others with Hispanic/Latino backgrounds. Objectives: To develop spirometry reference equations for adult Hispanic/Latino background groups in the United States. Methods: The HCHS/SOL (Hispanic Community Health Study/Study of Latinos) recruited a population‐based probability sample of 16,415 Hispanics/Latinos aged 18‐74 years living in the Bronx, Chicago, Miami, and San Diego. Participants self‐identified as being of Puerto Rican, Cuban, Dominican, Mexican, or Central or South American background. Spirometry was performed using standardized methods with central quality control monitoring. Spirometric measures from a subset of 6,425 never‐smoking participants without respiratory symptoms or disease were modeled as a function of sex, age, height, and Hispanic/Latino background to produce background‐specific reference equations for the predicted value and lower limit of normal. Measurements and Main Results: Dominican and Puerto Rican Americans had substantially lower predicted and lower limit of normal values for FVC and FEV1 than those in other Hispanic/Latino background groups and also than Mexican American values from NHANES III (Third National Health and Nutrition Examination Survey). Conclusions: For patients of Dominican and Puerto Rican background who present with pulmonary symptoms in clinical practice, use of background‐specific spirometry reference equations may provide more appropriate predicted and lower limit of normal values, enabling more accurate diagnoses of abnormality and physiologic impairment.

Retrospective analysis of demographic and clinical factors associated with etiology of febrile respiratory illness among US military basic trainees

BackgroundBasic trainees in the US military have historically been vulnerable to respiratory infections. Adenovirus and influenza are the most common etiological agents responsible for febrile respiratory illness (FRI) among trainees and present with similar clinical signs and symptoms. Identifying demographic and clinical factors associated with the primary viral pathogens causing FRI epidemics among trainees will help improve differential diagnosis and allow for appropriate distribution of antiviral medications. The objective of this study was to determine what demographic and clinical factors are associated with influenza and adenovirus among military trainees.MethodsSpecimens were systematically collected from military trainees meeting FRI case definition (fever ≥38.0°C with either cough or sore throat; or provider-diagnosed pneumonia) at eight basic training centers in the USA. PCR and/or cell culture testing for respiratory pathogens were performed on specimens. Interviewer-administered questionnaires collected information on patient demographic and clinical factors. Polychotomous logistic regression was employed to assess the association between these factors and FRI outcome categories: laboratory-confirmed adenovirus, influenza, or other FRI. Sensitivity, specificity, positive and negative predictive value were calculated for individual predictors and clinical combinations of predictors.ResultsAmong 21,570 FRI cases sampled between 2004 and 2009, 63.6% were laboratory-confirmed adenovirus cases and 6.6% were laboratory-confirmed influenza cases. Subjects were predominantly young men (86.8% men; mean age 20.8 ± 3.8 years) from Fort Jackson (18.8%), Great Lakes (17.1%), Fort Leonard Wood (16.3%), Marine Corps Recruit Depot (MCRD) San Diego (19.0%), Fort Benning (13.3%), Lackland (7.5%), MCRD Parris Island (8.7%), and Cape May (3.2%). The best multivariate predictors of adenovirus were the combination of sore throat (odds ratio [OR], 2.94; 95% confidence interval [CI], 2.66-3.25), cough (OR, 2.33; 95% CI, 2.11-2.57), and fever (OR, 2.07; 95% CI, 1.90-2.26) with a PPV of 77% (p ≤.05). A combination of cough, fever, training week 0-2 and acute onset were most predictive of influenza (PPV =38%; p ≤ .05).ConclusionsSpecific demographic and clinical factors were associated with laboratory-confirmed influenza and adenovirus among military trainees. Findings from this study can guide clinicians in the diagnosis and treatment of military trainees presenting with FRI.

Relationship between depressive symptoms and cardiovascular risk factors among selected Latino patients at a community clinic.

The objective of this study was to explore the relationship between severity of depression and cardiovascular disease (CVD) risk factors among selected Latino patients within a primary care setting. We conducted a cross-sectional analysis of 164 low-income Latino patients at San Ysidro Health Center (SYHC) who had been recruited into a mental health program between January 2007 and March 2008. Patients were between the ages of 18 and 83 years, 54 were males and 109 females. Patients were screened using the 9-item patient health questionnaire (PHQ-9), a standardized instrument used to measure depression severity. We used regression models to analyze the relationship between severity of depression and CVD risk factors. Seventy-eight percent of the patients had at least mild depression based on PHQ-9 score categories. Significant age-adjusted pairwise associations were found with CVD risk factors; body mass index (BMI), diabetes status, serum cholesterol level, and serum triglyceride level were all associated with depression severity score. Regression models indicated that diabetic patients on anti-depressive medication with higher BMI scores and triglyceride levels had significantly higher depression severity scores. Clinicians should be made aware that depressive symptoms may impede efforts to modify BMI, serum triglycerides, anti-depression medication, and diabetes among Latino patients. They should, therefore, screen and treat depression among Latinos at risk to CVD.

Unfair Treatment and Periodontitis Among Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

This study investigates how perceived unfair treatment, towards self and observed towards others due to ethnicity, is associated with periodontitis among diverse Hispanic/Latino adults, accounting for sociodemographic, health behavior, and acculturation factors. Baseline (2008–2011) dental and survey data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter epidemiologic study, were analyzed (N = 12,750). Crude and adjusted prevalence ratios and confidence limits were estimated. Half (49%) reported never being treated unfairly, while 41% reported they were sometimes, and 10% reported it often/always. One third (32%) never saw others treated unfairly, while 42% reported it sometimes, and 26% reported it often/always. In the final fully adjusted model, the prevalence of periodontitis was higher among adults who were as follows: non-Dominican, older, male, had a past year dental visit, current and former smokers, and among those who observed unfair treatment towards others. Lower prevalence was associated with higher income, higher educational attainment, less than full-time employment, reporting experiencing unfair treatment, higher acculturation scores, and having health insurance. Perceived unfair treatment towards self was negatively associated with periodontitis prevalence, while observed unfair treatment towards others was positively associated with the outcome among diverse Hispanics/Latinos. The associations between unfair treatment and periodontitis warrant further exploration.

A potential impact of nursing characteristics prior to in-hospital cardiac arrest: a self-reported study.

In-hospital cardiac arrest (I-HCA) is a significant public health problem accounting for approximately 200,000 treated cardiac arrests annually in the USA (Morrison et al. 2013). The incidence of I-HCA has been reported to be in the range of 1–5 per 1000 admissions in western countries (Sandroni et al. 2007). The incidence of overall survival to hospital discharge after I-HCA remains less than 30% (Morrison et al. 2013). One way to increase the number of patients who can survive to hospital discharge would be to improve resuscitation training for nurses; the creation of successful training programs that would improve a nurse’s resuscitation knowledge/skills demand a more thorough exploration of nurses’ characteristics. A recent study (Panesar et al. 2014) reported 30 patient safety incidents involving management of cardiac arrests that resulted in death. Poor application of knowledge/skills was among the most common identified weakness in resuscitation management (37%), matched only by equipment deficits. According to a consensus statement by the American Heart Association (AHA) (Morrison et al. 2013), all aspects of I-HCA (e.g. patient safety, training) must be considered a priority to address gaps in science, policy and institutional application and accountability for the care of these patients. Nevertheless, no systematic research has been conducted among nurses to evaluate their current training status (e.g. frequency of training sessions) nor is it known how often nurses encounter I-HCA in different settings. What is known is that rapid deterioration of resuscitative skills has been reported as early as three to six months after training (Smith et al. 2008).