Pooja Bansil

Maternal and fetal outcomes among women with depression.

OBJECTIVE To compare maternal and fetal outcomes among women with and without diagnosed depression at the time of delivery. METHODS Hospital discharge data from the 1998-2005 Nationwide Inpatient Sample (NIS) were used to examine delivery-related hospitalizations for select maternal and fetal outcomes by depression diagnosis. RESULTS The rate of depression per 1000 deliveries increased significantly from 2.73 in 1998 to 14.1 in 2005 (p < 0.001). Women diagnosed with depression were significantly more likely to have cesarean delivery, preterm labor, anemia, diabetes, and preeclampsia or hypertension compared with women without depression. Fetal outcomes significantly associated with maternal depression were fetal growth restriction, fetal abnormalities, fetal distress, and fetal death. CONCLUSIONS These findings suggest that depression is associated with adverse maternal and fetal outcomes. Our results provide additional impetus to screen for depression among women of reproductive age, especially those who plan to become pregnant.

Hospitalizations of pregnant HIV-infected women in the USA prior to and during the era of HAART, 1994-2003

Background:The literature on whether HIV infection and its complex antiretroviral treatments confer a higher risk for adverse pregnancy outcomes is controversial. Objective:We compared rates of hospitalization for select morbidities among HIV-infected and uninfected pregnant women in the USA. Design and Methods:Using data from the 1994–2003 Nationwide Inpatient Sample, we used descriptive statistics and multivariate logistic regression to examine socio-demographic characteristics, morbidity outcomes and time trends. Results:There were approximately 6000 hospitalizations per year of HIV-infected pregnant women in the USA. HIV-infected women were more likely to be hospitalized in urban hospitals, in the South, have Medicaid as the expected payer, have longer hospitalizations and incur higher charges than uninfected women. Hospitalizations for major puerperal sepsis, genitourinary infections, influenza, bacterial infections, preterm labor/delivery, and liver disorders were more frequent among pregnant HIV-infected women than their uninfected counterparts. However, rates of pre-eclampsia and antepartum hemorrhage were not significantly different. While rates of inpatient mortality and various infectious conditions decreased between 1994 and 2003, the rate of gestational diabetes increased among HIV-infected pregnant women. Conclusions:HIV-infected pregnant women in the USA continue to be at higher risk for morbidity and adverse obstetric outcomes. With the introduction of antiretroviral therapy, rates of most of the conditions examined have either decreased or remained stable, hence current antiretroviral regimens do not seem to be associated with major adverse pregnancy outcomes on a population basis. The increase in gestational diabetes among HIV-infected women may be associated, in part, with antiretroviral therapy and merits further attention.

Trends in hospitalizations of HIV-infected children and adolescents in the United States: analysis of data from the 1994-2003 Nationwide Inpatient Sample.

OBJECTIVE. The objective of this study was to describe trends in hospital use by HIV-infected children and adolescents in the United States in the 10 years from 1994 (before highly active antiretroviral therapy) to 2003 (widespread use of highly active antiretroviral therapy). METHODS. Data from the Nationwide Inpatient Sample database were used. The most frequent diagnoses were evaluated by year, and trends in hospitalizations for selected diagnoses and procedures were examined by multivariate logistic regression. RESULTS. In 2003, there were an estimated 3419 hospitalizations of HIV-infected children who were 18 years or younger, compared with 11785 such hospitalizations in 1994 (a 71% decrease). This decrease was more marked among infants and children who were younger than 5 years (94% for boys and 92% for girls) than among adolescents (decrease of 47% for boys and increase of 23% for girls 15–18 years of age). The inpatient fatality rate among HIV-infected children decreased from 5.0% in 1994 to 1.8% in 2003. The number of hospitalizations among HIV-infected children in the highly active antiretroviral therapy era decreased significantly compared with before highly active antiretroviral therapy (1994–1996) for Pneumocystis jiroveci, bacterial infection, or sepsis; fungal infection; encephalopathy; failure to thrive; and lymphocytic interstitial pneumonia. No significant change in the number of hospitalizations for Pneumococcus or cytomegalovirus was observed. CONCLUSIONS. Dramatic decreases in the number of hospitalizations among HIV-infected children occurred since the advent of highly active antiretroviral therapy in the United States. However, this trend is not seen in hospitalizations of adolescents, particularly girls. Hospitalizations for several HIV-related conditions are less frequent in the highly active antiretroviral therapy era, but for certain other conditions, the hospitalization burden remains high.

Breast Milk CD4+ T Cells Express High Levels of C Chemokine Receptor 5 and CXC Chemokine Receptor 4 and Are Preserved in HIV-Infected Mothers Receiving Highly Active Antiretroviral Therapy

BACKGROUND Transmission of human immunodeficiency virus (HIV) to the infant through breast-feeding is a major problem worldwide; however, the biological circumstances of such transmission remain unclear. Little characterization of breast milk CD4(+) T lymphocytes has been done so far. METHODS We performed a detailed immunophenotypic analysis of T lymphocytes in the breast milk, compared with the blood, of HIV-uninfected (n=9) and HIV-infected (n=10) women receiving highly active antiretroviral therapy, by use of multiparameter flow cytometry. Descriptive statistics and nonparametric comparisons were performed using SAS software (version 9.1; SAS Institute). RESULTS In uninfected women, 44%-78% of breast milk CD4(+) T cells expressed the C chemokine receptor 5 (CCR5), whereas 26%-73% of cells coexpressed CCR5 and CXC chemokine receptor 4 (CXCR4). In contrast, only 7%-20% of peripheral blood CD4(+) T cells expressed CCR5 and 1%-20% coexpressed CCR5 and CXCR4. The level of CCR5 expression in CD4(+) T cells in breast milk was higher than in blood. In HIV-infected women, the high frequency of CD4(+)CCR5(+) T cells in breast milk was preserved. CONCLUSIONS A majority of CD4(+) T cells in breast milk express high levels of CCR5 and CXCR4. Unlike other mucosal immune sites, in which CD4(+)CCR5(+) T cells are rapidly eliminated by HIV, these cells are preserved in breast milk during HIV infection.

Eating disorders among delivery hospitalizations: prevalence and outcomes.

OBJECTIVE The purpose of this study was to describe trends in the prevalence of eating disorders among delivery hospitalizations in the United States from 1994 to 2004 and to compare hospital, demographic, and obstetrical outcomes among women with and without eating disorders. METHODS Hospital discharge data for 1994 to 2004 from the Nationwide Inpatient Sample (NIS) were used to assess the relationship between eating disorders (anorexia nervosa and bulimia nervosa) and obstetrical complications. Analyses were limited to delivery-related hospitalizations. RESULTS There were an estimated 1,668 delivery hospitalizations with an eating disorder diagnosis in the United States in the 11-year period, resulting in an overall rate of 0.39 per 10,000 deliveries. After adjustment for hospital and demographic characteristics, delivery hospitalizations with an eating disorder were significantly more likely than those without an eating disorder to have fetal growth restriction (odds ratio [OR] 9.08, 95% confidence interval [CI] 6.45-12.77), preterm labor (OR 2.78, 95% CI 2.10-3.69), anemia (OR 1.73, 95% CI 1.25-2.38), genitourinary tract infections (OR 1.66, 95% CI 1.03-2.68), and labor induction (OR 1.32, 95% CI 1.01-1.73). CONCLUSIONS Although the prevalence of eating disorders among delivery hospitalizations is lower than in the general population, the fact that women with eating disorders are at increased risk of adverse pregnancy outcomes highlights the importance of screening for and appropriate clinical care of eating disorders in pregnancy.

Hospitalizations for invasive pneumococcal disease among HIV-1-infected adolescents and adults in the United States in the era of highly active antiretroviral therapy and the conjugate pneumococcal vaccine.

We describe hospitalization trends of invasive pneumococcal disease (IPD) among HIV-infected adolescents and adults since the introduction of highly active antiretroviral therapy (HAART) and the 7-valent pneumococcal conjugate vaccine (PCV7) in the United States, using the nation-wide inpatient sample. We estimated national trends of IPD hospitalizations during 3 periods: 1994-1995 (pre-HAART/pre-PCV7); 1998-1999 (HAART/pre-PCV7); and 2004-2005 (HAART/ early PCV7). The number of IPD hospitalizations among HIV-infected individuals declined 49.2% between 1994/1995 and 2004/2005. Compared with 1994-1995, the adjusted odds ratio for IPD hospitalizations of HIV-infected adolescents and adults in the United States during 2004-2005 was 0.64 (95% confidence interval: 0.54 to 0.77). The decrease was observed after introduction of the PCV7.

Children with sickle cell disease and human immunodeficiency virus-1 infection : Use of inpatient care services in the United States

Background: The purpose of this study was to describe hospital use patterns of children with sickle cell disease (SCD) and human immunodeficiency virus type-1 (HIV) infection in the United States. Methods: Hospital discharges of children with 1 or both of the 2 conditions (SCD and HIV infection) were analyzed using nationally weighted data from the 1994 to 2003 Nationwide Inpatient Databases of the Healthcare Cost and Utilization Project. Demographic and hospital characteristics, length of stay, charges and the most frequent diagnoses and procedures performed during the hospitalization were compared. Multivariate logistic regression was used to analyze the effects of age, sex and HIV infection on number of hospitalizations for selected conditions. Results: There were an estimated 686 hospitalizations of children with SCD and HIV infection in the United States in the 10-year period 1994–2003; these hospitalizations aggregated in the South (78.2%) and their expected payer was mostly Medicaid/Medicare (82.0%). Their average length of stay was longer than that of children with SCD alone (8.0 days vs. 4.3 days, respectively), and the mean charges associated with the hospitalization were also higher (

Hospitalizations for invasive pneumococcal disease among human immunodeficiency virus-1 infected children, adolescents and young adults in the United States in the era of highly active antiretroviral therapy and the conjugate pneumococcal vaccine.

18,291 vs.

Diabetes Trends in Hospitalized HIV-Infected Persons in the United States, 1994-2004

9584). Compared with patients with SCD without HIV, HIV infection conferred a higher risk for hospitalizations for bacterial infections and sepsis (odds ratio 2.75; 95% CI, 1.66–4.6), but less of a risk for vaso-occlusive crises (odds ratio 0.32; 95% CI, 0.22–0.48). Inpatient case-fatality rate of children with SCD and HIV was no different from that of children with SCD alone, but lower than that of the rest of children with HIV infection. Conclusions: Hospitalized children with SCD and HIV infection have higher odds of infection than those with SCD alone. Their inpatient case-fatality rate is lower than that of children with HIV infection alone. These findings should be considered in designing appropriate interventions for this population.

Impact of Health Insurance Type on Trends in Newborn Circumcision, United States, 2000 to 2010.

We describe hospitalization trends of invasive pneumococcal disease (IPD) among human immunodeficiency virus-infected individuals <25 years of age since the introduction of highly active antiretroviral therapy (HAART) and the 7-valent pneumococcal conjugate vaccine (PCV7) in the United States, using the Nationwide Inpatient Sample. We estimated national trends of IPD hospitalizations during 3 periods: 1994 to 1995 (pre-HAART and pre-PCV7 era); 1998 to 1999 (HAART and pre-PCV7 era); and 2004 to 2005 (HAART and early PCV7 era). The number of IPD hospitalizations among human immunodeficiency virus-infected children and youth <25 years in the United States declined by 78.7% between 1994/1995 and 2004/2005 (P = 0.03). This decrease was more pronounced among younger children.