Timothy N. Crawford

Use of azithromycin for the prevention of bronchopulmonary dysplasia in preterm infants: a randomized, double‐blind, placebo controlled trial

Since preventive therapies for bronchopulmonary dysplasia (BPD) are limited we treated preterm infants with azithromycin to decrease the incidence of BPD.

Effect of an In-Clinic IPV Advocate Intervention to Increase Help Seeking, Reduce Violence, and Improve Well-Being

This quasi-experimental study investigated the efficacy of clinic-based advocacy for intimate partner violence (IPV) to increase help seeking, reduce violence, and improve women’s well-being. Eligible and consenting women attending one of six selected clinics in the rural Southern United States were assessed for IPV. Consenting women disclosing IPV were offered either an in-clinic advocate intervention or usual care, depending on the clinic they attended and were followed for up to 24 months. Over follow-up time both IPV scores and depressive symptoms trended toward greater decline among women in the advocate intervention clinics relative to the usual care (business card referral only).

Histoplasmosis in Patients With Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS): Multicenter Study of Outcomes and Factors Associated With Relapse

AbstractAlthough discontinuation of suppressive antifungal therapy for acquired immunodeficiency syndrome (AIDS)-associated histoplasmosis is accepted for patients with immunologic recovery, there have been no published studies of this approach in clinical practice, and minimal characterization of individuals who relapse with this disease. We performed a multicenter retrospective cohort study to determine the outcome in AIDS patients following discontinuation of suppressive antifungal therapy for histoplasmosis.Ninety-seven patients were divided into a physician-discontinued suppressive therapy group (PD) (38 patients) and a physician-continued suppressive therapy group (PC) (59 patients). The 2 groups were not statistically different at baseline, but at discontinuation of therapy and at the most recent follow-up there were significant differences in adherence to therapy, human immunodeficiency virus (HIV) RNA, and urinary Histoplasma antigen concentration. There was no relapse or death attributed to histoplasmosis in the PD group compared with 36% relapse (p < 0.0001) and 5% death (p = 0.28) in the PC group. Relapse occurred in 53% of the nonadherent patients but not in the adherent patients (p < 0.0001). Sixty-seven percent of patients with initial central nervous system (CNS) histoplasmosis relapsed compared to 15% of patients without CNS involvement (p = 0.0004), which may be accounted for by nonadherence. In addition, patients with antigenuria above 2.0 ng/mL at 1-year follow-up were 12.82 times (95% confidence interval, 2.91–55.56) more likely to relapse compared to those with antigenuria below 2.0 ng/mL.Discontinuation of antifungal therapy was safe in adherent patients who completed at least 1 year of antifungal treatment, and had CD4 counts >150 cells/mL, HIV RNA <400 c/mL, Histoplasma antigenuria <2 ng/mL (equivalent to <4.0 units in second-generation method), and no CNS histoplasmosis.

Impact of Poor Retention in HIV Medical Care on Time to Viral Load Suppression

Objective: The purpose of this study was to evaluate how poor retention in HIV care impacts time to viral suppression after initiating highly active antiretroviral therapy. Methods: A retrospective cohort study design, employing a medical chart review, was conducted at an academic infectious disease clinic at the University of Kentucky. Patients seeking care between 2003 and 2011 were included in the study. A log-normal model was employed to determine the factors associated with time to viral suppression. Results: Of the 532 patients in the study, 426 (80.1%) patients were virally suppressed. Controlling for insurance status, race, baseline CD4 counts, and viral loads, the expected time to viral suppression for nonoptimal retainers was longer compared to optimal retainers (100% retained in care; time ratio: 2.04; 95% confidence interval: 1.40-2.90). Conclusion: Researchers should continue to study the impact of retention on clinical outcomes and strategies to improve retention and reengage those lost to follow-up back into care.

Health profile differences for menthol and non-menthol smokers: findings from the national health interview survey

AIMS Although the adverse effects of smoking are well known, limited information exists about the overall health profiles of menthol smokers when compared to their non-menthol smoking counterparts. Using a well-known nationally representative survey, this study examines differences between self-reported health characteristics for menthol and non-menthol smokers. DESIGN Cross-sectional data from the 2005 National Health Interview Survey and its cancer control supplement were used to analyze responses for current and former smokers (n = 12,004) independently. All analyses were conducted using SAS version 9.2 and SAS callable SUDAAN version 9.0.3. Multiple logistic regression analysis was used to model menthol smoking. FINDINGS After controlling for sex, age and race, we found that in current smokers the mean number of cigarettes smoked per day is significantly lower for menthol smokers when compared to non-menthol smokers [odds ratio (OR): 0.99; 95% confidence interval (CI): 0.98, 1.00]. Also, we found that former menthol smokers had higher body mass indices (BMIs) (OR: 1.01; 95% CI: 1.00, 1.02) and were more likely to have visited the emergency room due to asthma (OR: 2.30, 95% CI: 1.04, 5.09). CONCLUSIONS Overall, current menthol and non-menthol smokers have similar health profiles. However, menthol smokers reported smoking fewer cigarettes per day than their non-menthol counterparts. While these findings are supportive of other published data, future studies may need to tease out the health-related significance of smoking fewer menthol cigarettes per day but having similar health outcomes to those who smoke more non-menthol cigarettes per day. Additionally, our findings suggest that there may be some differences between the former menthol and non-menthol smoker.

Association of Intimate Partner Violence and Childhood Sexual Abuse with Cancer-Related Well-Being in Women

BACKGROUND Limited evidence suggests that intimate partner violence (IPV) may be associated with poorer cancer outcomes. We hypothesized that timing and type of IPV as well as childhood sexual abuse (CSA) may negatively affect depression, perceived stress, and cancer-related well-being. METHODS This was a cross-sectional study of women diagnosed with either breast, cervical, or colorectal cancer in the prior 12 months included in the Kentucky Cancer Registry. Consenting women were interviewed by phone (n=553). Multivariate analysis of covariance (MANCOVA) was used to determine the association between IPV (37% lifetime prevalence) and type, timing, and the range of correlated cancer-related well-being indicators, adjusting for confounding factors. RESULTS IPV (p=0.002) and CSA (p=0.03) were associated with the six correlated well-being indicators. Specifically, lifetime and current IPV were associated with lower Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) (p=0.006) and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-SP) (p=0.03) scores, higher perceived stress at diagnosis (p=0.006), and depressive symptom scores at diagnosis (p<0.0001), whereas CSA was associated with lower FACT-B (p=0.02), increased number of comorbid conditions (p=0.03), and higher current stress levels (p=0.04). Current and past IPV, as well as psychologic abuse, were associated with poorer well-being among women with a recent cancer diagnosis. CONCLUSIONS Our results provide evidence that both IPV and CSA negatively influence cancer-related well-being indicators. These data suggest that identification of lifetime IPV and other stressors may provide information that healthcare providers can use to best support and potentially improve the well-being of female cancer patients.

Predictors of well-being among college students

ABSTRACT Objectives: Identification of health-related risk behaviors associated with well-being in college students is essential to guide the development of health promotion strategies for this population. The purposes were to evaluate well-being among undergraduate students and to identify health-related risk behaviors that predict well-being in this population. Methods: A cross-sectional Web-based survey of undergraduate students was conducted at a metropolitan university in the Southeast United States. A total of 568 students responded (response rate 14.2%). Data were collected on health-related risk behaviors using the National College Health Assessment II. Results: Controlling demographic characteristics, the best predictive model included physical activity, current tobacco user, depression, ever received mental health services, and sleep quality, which was the strongest predictor (β = .45, p < .001). This model explained 35% of the variance in well-being. Conclusions: Interventions that promote sleep quality among college students may be most beneficial in improving well-being.

Poor retention in care one-year after viral suppression: a significant predictor of viral rebound

Optimal retention in care should be continuously monitored even after suppression to prevent the risk of viral rebound. The purpose of this study is to assess the association between retention in care and viral rebound 12 months after viral suppression. A retrospective medical chart review study was conducted at an academic clinic in Lexington, KY, to determine an association between retention in care and viral rebound. A total of 658 patients, who were virally suppressed at any time between 2003 and 2009, were followed for 12 months after viral suppression. Retention in care was defined as having at least one clinic visit every three months (visit constancy) and viral rebound was defined as a viral load >400 copies/ml. Of the 658 patients included in the study, 43% were less than optimally retained in care and 26% had a viral rebound 12 months after suppression. In the multivariable logistic regression model, the odds of a viral rebound were much greater for suboptimal (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.44–3.63) and poor (OR: 15.1; 95% CI: 6.82–33.41) retainers compared to optimal retainers. The results of the study suggest that retention in HIV care plays a central role in maintaining optimal outcomes such as viral suppression. Interventions that target improvement in retention in care among those who are poorly retained must be set in place in order to reduce the risk of a viral rebound.

Autonomic Nervous System Function Following Prenatal Opiate Exposure

In utero exposure to opiates may affect autonomic functioning of the fetus and newborn. We investigated heart rate variability (HRV) as a measure of autonomic stability in prenatal opiate-exposed neonates (n = 14) and in control term infants (n = 10). Electrocardiographic data during both non-nutritive and nutritive sucking were evaluated for RR intervals, heart rate (HR), standard deviation of the consecutive RR intervals (SDRR), standard deviation of the differences of consecutive RR intervals (SDDRR), and the power spectral densities in low and high frequency bands. In controls, mean HR increased significantly, 143–161 per min (p = 0.002), with a trend toward a decrease in RR intervals from non-nutritive to nutritive sucking; these measures did not change significantly among exposed infants. Compared to controls, exposed infants demonstrated significantly greater HRV or greater mean SDRR and SDDRR during non-nutritive period (p < 0.01), greater mean SDDRR during nutritive sucking (p = 0.02), and higher powers in the low and high frequency bands during nutritive feedings. Our findings suggest that prenatal opiate exposure may be associated with changes in autonomic nervous system (ANS) functioning involving both sympathetic and parasympathetic branches. Future studies are needed to examine the effects of prenatal opiate exposure on ANS function.

Beyond social support: Self-care confidence is key for adherence in patients with heart failure:

Background: Adherence to treatment is crucial to improve outcomes in patients with heart failure. Good social support is associated with better adherence, but the mechanism for this association has not been well-explored. Aims: The aim of this secondary analysis was to examine whether self-care confidence mediates the relationship between social support and treatment adherence in heart failure patients hospitalized with acute exacerbation. Methods: A total of 157 inpatients with heart failure (63.5±13 years, 73% New York Heart Association class III/IV) were recruited from two hospitals located in urban areas in the USA. Participants completed the Self-Care of Heart Failure Index, the Multidimensional Perceived Social Support Scale, and the Medical Outcomes Study Specific Adherence Scale. A series of regression models were used to determine the mediation relationship. Results: Controlling for marital status and hospital site, social support was associated with adherence (p=0.03). When self-confidence was included in the model, the effect of social support became non-significant, indicating full mediation of the relationship between social support and adherence by self-care confidence. The indirect effect (0.04) of social support on adherence through self-confidence was significant (95% confidence interval: 0.01–0.09). Conclusion: Heart failure self-care confidence mediated the relationship between social support and treatment adherence. Thus interventions targeting patients’ self-care confidence is essential to maximize patients’ treatment adherence.