Hongfei Guo

Long-term consequences of kidney donation.

BACKGROUND The long-term renal consequences of kidney donation by a living donor are attracting increased appropriate interest. The overall evidence suggests that living kidney donors have survival similar to that of nondonors and that their risk of end-stage renal disease (ESRD) is not increased. Previous studies have included relatively small numbers of donors and a brief follow-up period. METHODS We ascertained the vital status and lifetime risk of ESRD in 3698 kidney donors who donated kidneys during the period from 1963 through 2007; from 2003 through 2007, we also measured the glomerular filtration rate (GFR) and urinary albumin excretion and assessed the prevalence of hypertension, general health status, and quality of life in 255 donors. RESULTS The survival of kidney donors was similar to that of controls who were matched for age, sex, and race or ethnic group. ESRD developed in 11 donors, a rate of 180 cases per million persons per year, as compared with a rate of 268 per million per year in the general population. At a mean (+/-SD) of 12.2+/-9.2 years after donation, 85.5% of the subgroup of 255 donors had a GFR of 60 ml per minute per 1.73 m(2) of body-surface area or higher, 32.1% had hypertension, and 12.7% had albuminuria. Older age and higher body-mass index, but not a longer time since donation, were associated with both a GFR that was lower than 60 ml per minute per 1.73 m(2) and hypertension. A longer time since donation, however, was independently associated with albuminuria. Most donors had quality-of-life scores that were better than population norms, and the prevalence of coexisting conditions was similar to that among controls from the National Health and Nutrition Examination Survey (NHANES) who were matched for age, sex, race or ethnic group, and body-mass index. CONCLUSIONS Survival and the risk of ESRD in carefully screened kidney donors appear to be similar to those in the general population. Most donors who were studied had a preserved GFR, normal albumin excretion, and an excellent quality of life.

Pregnancy Outcomes After Kidney Donation

The outcome of pregnancy in kidney donors has generally been viewed to be favorable. We determined fetal and maternal outcomes in a large cohort of kidney donors. A total of 2102 women have donated a kidney at our institution; 1589 donors responded to our pregnancy surveys; 1085 reported 3213 pregnancies and 504 reported none. Fetal and maternal outcomes in postdonation pregnancies were comparable to published rates in the general population. Postdonation (vs. predonation) pregnancies were associated with a lower likelihood of full‐term deliveries (73.7% vs. 84.6%, p = 0.0004) and a higher likelihood of fetal loss (19.2% vs. 11.3%, p < 0.0001). Postdonation pregnancies were also associated with a higher risk of gestational diabetes (2.7% vs. 0.7%, p = 0.0001), gestational hypertension (5.7% vs. 0.6%, p < 0.0001), proteinuria (4.3% vs. 1.1%, p < 0.0001) and preeclampsia (5.5% vs. 0.8%, p < 0.0001). Women who had both pre‐ and post‐donation pregnancies were also more likely to have these adverse maternal outcomes in their postdonation pregnancies. In this large survey of previous living donors in a single center, fetal and maternal outcomes and pregnancy outcomes after kidney donation were similar to those reported in the general population, but inferior to predonation pregnancy outcomes.

Psychosocial Distress and Stroke Risk in Older Adults

Background and Purpose— To investigate the association of psychosocial distress with risk of stroke mortality and incident stroke in older adults. Methods— Data were from the Chicago Health and Aging Project, a longitudinal population-based study conducted in 3 contiguous neighborhoods on the south side of Chicago, IL. Participants were community-dwelling black and non-Hispanic white adults, aged 65 years and older (n=4120 for stroke mortality; n=2649 for incident stroke). Psychosocial distress was an analytically derived composite measure of depressive symptoms, perceived stress, neuroticism, and life dissatisfaction. Cox proportional hazards models examined the association of distress with stroke mortality and incident stroke over 6 years of follow-up. Results— Stroke deaths (151) and 452 incident strokes were identified. Adjusting for age, race, and sex, the hazard ratio (HR) for each 1-SD increase in distress was 1.47 (95% confidence interval [CI]=1.28–1.70) for stroke mortality and 1.18 (95% CI=1.07–1.30) for incident stroke. Associations were reduced after adjustment for stroke risk factors and remained significant for stroke mortality (HR=1.29; 95% CI=1.10–1.52) but not for incident stroke (HR=1.09; 95% CI=0.98–1.21). Secondary analyses of stroke subtypes showed that distress was strongly related to incident hemorrhagic strokes (HR=1.70; 95% CI=1.28–2.25) but not ischemic strokes (HR=1.02; 95% CI=0.91–1.15) in fully adjusted models. Conclusions— Increasing levels of psychosocial distress are related to excess risk of both fatal and nonfatal stroke in older black and white adults. Additional research is needed to examine pathways linking psychosocial distress to cerebrovascular disease risk.

Population-Based Analysis of Morbidity and Mortality Following Surgery for Intractable Temporal Lobe Epilepsy in the United States

OBJECTIVE To assess the morbidity of temporal lobe epilepsy (TLE) surgery on a nationwide level in order to address reservations regarding the morbidity of anterior temporal lobectomy (ATL) for TLE despite class I evidence demonstrating the superiority of ATL over continued medical therapy. DESIGN Retrospective cohort study. SETTING The Nationwide Inpatient Sample from 1988 to 2003 was used for analysis. PATIENTS Only patients who were admitted for ATL for TLE (International Classification of Diseases, Ninth Revision, Clinical Modification codes 345.41 and 345.51; primary procedure code, 01.53) were included. MAIN OUTCOME MEASURES Morbidity and mortality. Analysis was adjusted for several variables including patient age, race, sex, admission type, primary payer for care, income in zip code of residence, and hospital volume of care. RESULTS Multivariate analyses revealed that the overall morbidity (postoperative morbidity and/or adverse discharge disposition) following ATL for TLE was 10.8%, with no mortality. Private insurance decreased postoperative morbidity (odds ratio [OR] = 0.52; 95% confidence interval [CI] = 0.28-0.98; P = .04) and adverse discharge disposition (OR = 0.31; 95% CI = 0.12-0.81; P = .02). Increased patient age increased postoperative morbidity (OR = 1.04; 95% CI = 1.01-1.07; P = .03) and adverse discharge disposition (OR = 1.08; 95% CI = 1.02-1.13; P = .004). Neither sex, income, race, nor hospital volume was predictive of postoperative morbidity. The degree of medical comorbidity directly correlated with the incidence of postoperative morbidity. CONCLUSIONS Morbidity following ATL for TLE is low throughout the United States regardless of sex, race, insurance status, or income. Younger age and private insurance status are independently predictive of reduced postoperative morbidity. In patients with low medical comorbidity, ATL for TLE is safe, with low morbidity and no mortality.

Failure to report attempts to quit smoking

INTRODUCTION Accurately assessing quit attempt history is important to develop population estimates of cessation and to increase our understanding of smoking trajectories. Thus, the current study investigated failure to report quit attempts as a function of length of quit attempt by time since quit attempt over the past year. METHODS The present study used data from the Smoking Toolkit Study, a series of population-based surveys of smokers and recent ex-smokers in England aged 16 years and older. Among the 11,772 smokers identified at baseline (24.4% of the total sample), this study focused on the 4234 participants (36.0% of current smokers) who reported between one and three quit attempts in the past year. RESULTS There was a strong trend for quit attempts that lasted for shorter periods of time to fail to be reported. After three months, 90.1% of those lasting less than one day, 63.7% of those lasting between a day a one week, and 38.9% of those lasting between one week and one month failed to be reported. CONCLUSION A large proportion of unsuccessful quit attempts fail to be reported, particularly if they only last a short time or occurred longer ago. Therefore, population estimates of quit attempts based on retrospective data may be considerable underestimates and estimates of the success of quit attempts may be overestimates. Future research is needed to establish whether there is differential reporting of quit attempts as a function of features of attempts such as use of cessation aids.

Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: A randomized controlled trial

AIMS To assess the effects of adding motivational interviewing (MI) counseling to nicotine patch for smoking cessation among homeless smokers. DESIGN Two-group randomized controlled trial with 26-week follow-up. PARTICIPANTS AND SETTING A total of 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/St Paul, Minnesota, USA. INTERVENTION AND MEASUREMENTS All participants received 8-week treatment of 21-mg nicotine patch. In addition, participants in the intervention group received six individual sessions of MI counseling which aimed to increase adherence to nicotine patches and to motivate cessation. Participants in the standard care control group received one session of brief advice to quit smoking. Primary outcome was 7-day abstinence from cigarette smoking at 26 weeks, as validated by exhaled carbon monoxide and salivary cotinine. FINDINGS Using intention-to-treat analysis, verified 7-day abstinence rate at week 26 for the intervention group was non-significantly higher than for the control group (9.3% versus 5.6%, P = 0.15). Among participants who did not quit smoking, reduction in number of cigarettes from baseline to week 26 was equally high in both study groups (-13.7 ± 11.9 for MI versus -13.5 ± 16.2 for standard care). CONCLUSIONS Adding motivational interviewing counseling to nicotine patch did not increase smoking rate significantly at 26-week follow-up for homeless smokers.

Racial Disparities in the Surgical Management of Intractable Temporal Lobe Epilepsy in the United States: A Population-Based Analysis

OBJECTIVE To determine whether, over a long time span, race and/or other predictive factors for patients with intractable temporal lobe epilepsy (TLE) who receive anterior temporal lobectomy (ATL) exist on a national level. DESIGN Retrospective cohort study. PATIENTS Adult patients with TLE admitted for ATL (International Classification of Diseases, Ninth Revision, Clinical Modification, 345.41, 345.51; primary procedure code, 01.53). INTERVENTIONS A population-based analysis was performed using the Nationwide Inpatient Sample from 1988 through 2003. Variables besides race that were examined included patient age, sex, and insurance status. RESULTS Of the 5779 adults admitted with TLE from 1988 through 2003, 562 (9.7%) received ATL. Multivariate analyses revealed that African American race (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.38-0.84; P = .005) and increased age (OR, 0.98; 95% CI, 0.97-0.99; P < .001 per 1-year increase in age) independently predicted decreased likelihood of receiving ATL for TLE, while private insurance increased the odds of ATL receipt (OR, 1.85; 95% CI, 1.39-2.46; P < .001). These findings remained stable over time. CONCLUSIONS Fewer than 10% of the TLE patient population receives ATL. Younger age and private insurance are independent predictors of receiving ATL, and African American race independently predicts decreased likelihood of receiving ATL. Despite recent attempts to bridge racial health disparities, the gap between African American and other races in optimal TLE management has remained relatively unchanged on a nationwide level.

Neighborhood Cohesion Is Associated With Reduced Risk of Stroke Mortality

Background and Purpose— Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence. Methods— Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence. Results— Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5). Conclusions— Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.

Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers

AIMS To assess the effects of adding motivational interviewing (MI) counseling to nicotine patch for smoking cessation among homeless smokers. DESIGN Two-group randomized controlled trial with 26-week follow-up. PARTICIPANTS AND SETTING A total of 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/St Paul, Minnesota, USA. INTERVENTION AND MEASUREMENTS All participants received 8-week treatment of 21-mg nicotine patch. In addition, participants in the intervention group received six individual sessions of MI counseling which aimed to increase adherence to nicotine patches and to motivate cessation. Participants in the standard care control group received one session of brief advice to quit smoking. Primary outcome was 7-day abstinence from cigarette smoking at 26 weeks, as validated by exhaled carbon monoxide and salivary cotinine. FINDINGS Using intention-to-treat analysis, verified 7-day abstinence rate at week 26 for the intervention group was non-significantly higher than for the control group (9.3% versus 5.6%, P = 0.15). Among participants who did not quit smoking, reduction in number of cigarettes from baseline to week 26 was equally high in both study groups (-13.7 ± 11.9 for MI versus -13.5 ± 16.2 for standard care). CONCLUSIONS Adding motivational interviewing counseling to nicotine patch did not increase smoking rate significantly at 26-week follow-up for homeless smokers.

Metabolites of a tobacco-specific lung carcinogen in children exposed to secondhand or thirdhand tobacco smoke in their homes

Background: People exposed to secondhand tobacco smoke (SHS) inhale the lung carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) which is metabolized to NNAL and its glucuroniders. These urinary metabolites, termed total NNAL, can be quantified. A related compound, iso-NNAL, has been proposed as a biomarker for exposure to smoke constituent residues on surfaces (thirdhand tobacco smoke). There is limited information in the literature on levels of total NNAL in children exposed to SHS. Methods: We recruited 79 parent–child dyads from homes where the enrolled parent was a cigarette smoker and visited their homes. Parents were asked questions, home ambient air quality was evaluated, and children provided urine samples. Urine was analyzed for total NNAL, total cotinine, total nicotine, and iso-NNAL. Results: Ninety percent of the children had detectable total NNAL in urine; total nicotine and total cotinine were also detected in most samples. There were significant positive relationships between biomarker levels and exposure of children in the home. Levels were highest in homes with no smoking restrictions. African American children had significantly higher levels than other children. iso-NNAL was not detected in any urine sample. Conclusions: There was nearly universal exposure of children to the lung carcinogen NNK, due mainly to exposure to SHS from adult smokers in their homes. Impact: Homes with adult smokers should adopt restrictions to protect their children from exposure to a potent lung carcinogen. Cancer Epidemiol Biomarkers Prev; 20(6); 1213–21. ©2011 AACR.