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  1. Article ; Online: Historic Redlining and Impact of Structural Racism on Diabetes Prevalence in a Nationally Representative Sample of U.S. Adults.

    Egede, Leonard E / Walker, Rebekah J / Campbell, Jennifer A / Linde, Sebastian

    Diabetes care

    2024  

    Abstract: ... prevalence of diabetes in a U.S. national sample.: Research design and methods: Using a previously ... with historically HOLC-graded areas. The final analytic sample consisted of 11,375 U.S. census tracts. Structural ...

    Abstract Objective: We investigated direct and indirect relationships between historic redlining and prevalence of diabetes in a U.S. national sample.
    Research design and methods: Using a previously validated conceptual model, we hypothesized pathways between structural racism and prevalence of diabetes via discrimination, incarceration, poverty, substance use, housing, education, unemployment, and food access. We combined census tract-level data, including diabetes prevalence from the Centers for Disease Control and Prevention PLACES 2019 database, redlining using historic Home Owners' Loan Corporation (HOLC) maps from the Mapping Inequality project, and census data from the Opportunity Insights database. HOLC grade (a score between 1 [best] and 4 [redlined]) for each census tract was based on overlap with historically HOLC-graded areas. The final analytic sample consisted of 11,375 U.S. census tracts. Structural equation modeling was used to investigate direct and indirect relationships adjusting for the 2010 population.
    Results: Redlining was directly associated with higher crude prevalence of diabetes within a census tract (r = 0.01; P = 0.008) after adjusting for the 2010 population (χ2(54) = 69,900.95; P < 0.001; root mean square error of approximation = 0; comparative fit index = 1). Redlining was indirectly associated with diabetes prevalence via incarceration (r = 0.06; P < 0.001), poverty (r = -0.10; P < 0.001), discrimination (r = 0.14; P < 0.001); substance use (measured by binge drinking: r = -0.65, P < 0.001; and smoking: r = 0.35, P < 0.001), housing (r = 0.06; P < 0.001), education (r = -0.17; P < 0.001), unemployment (r = -0.17; P < 0.001), and food access (r = 0.14; P < 0.001) after adjusting for the 2010 population.
    Conclusions: Redlining has significant direct and indirect relationships with diabetes prevalence. Incarceration, poverty, discrimination, substance use, housing, education, unemployment, and food access may be possible targets for interventions aiming to mitigate the impact of structural racism on diabetes.
    Language English
    Publishing date 2024-02-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 441231-x
    ISSN 1935-5548 ; 0149-5992
    ISSN (online) 1935-5548
    ISSN 0149-5992
    DOI 10.2337/dc23-2184
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  2. Article ; Online: Psychological Distress and Cannabis Vaping Among U.S. Adolescents.

    Mattingly, Delvon T / Agbonlahor, Osayande / Hart, Joy L / McLeish, Alison C / Walker, Kandi L

    American journal of preventive medicine

    2023  Volume 66, Issue 3, Page(s) 534–539

    Abstract: ... the relationship between psychological distress and cannabis vaping among a nationally representative sample of U.S ... Severe psychological distress was associated with past 30-day cannabis vaping among U.S. adolescents ...

    Abstract Introduction: Cannabis vaping has become increasingly popular among adolescents in recent years. However, research examining mental health determinants of cannabis vaping is scant. This study investigated the relationship between psychological distress and cannabis vaping among a nationally representative sample of U.S. adolescents.
    Methods: Data are from the cross-sectional 2022 National Youth Tobacco Survey, restricted to adolescents ages 11-18 (n=22,202). Psychological distress was categorized as normal, mild, moderate, and severe according to the Patient Health Questionnaire for Depression and Anxiety-4. Cannabis vaping was defined as any use in the past 30 days. To estimate the association between psychological distress and cannabis vaping, logistic regression was performed adjusted for age, biological sex, race/ethnicity, sexual orientation, school grades, family smoking/vaping, nicotine vaping, other tobacco use, and blunt use. Analyses were conducted in 2023.
    Results: Nearly 8% of adolescents vaped cannabis in the past 30 days, and 25.6% reported moderate or severe psychological distress. Mild, moderate, and severe psychological distress were associated with cannabis vaping in the unadjusted model. In the adjusted model, the odds of cannabis vaping were higher among adolescents who had severe psychological distress (OR: 1.46, 95% CI: 1.09-1.96), compared to adolescents with no distress. Older age, poor grades, family smoking/vaping, nicotine vaping, other tobacco use, and blunt use were also associated with cannabis vaping.
    Conclusions: Severe psychological distress was associated with past 30-day cannabis vaping among U.S. adolescents. Adolescents experiencing psychological distress need to be screened for cannabis vaping to help prevent and reduce use and promote mental health.
    MeSH term(s) Humans ; Male ; Adolescent ; Female ; Cannabis ; Vaping/epidemiology ; Cross-Sectional Studies ; Tobacco Use ; Psychological Distress ; Electronic Nicotine Delivery Systems
    Language English
    Publishing date 2023-10-21
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 632646-8
    ISSN 1873-2607 ; 0749-3797
    ISSN (online) 1873-2607
    ISSN 0749-3797
    DOI 10.1016/j.amepre.2023.10.013
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  3. Article ; Online: Comparison of Racial and Ethnic Mortality Disparities among Post-9/11 Veterans with and without Traumatic Brain Injury to the Total U.S. Adult Population.

    Howard, Jeffrey T / Stewart, Ian J / Walker, Lauren E / Amuan, Megan / Rayha, Kara / Janak, Jud C / Pugh, Mary Jo

    Journal of racial and ethnic health disparities

    2024  

    Abstract: Introduction: The extent of racial/ethnic disparities and whether they are attenuated in the Veteran population compared to the total US population is not well understood. We aimed to assess racial/ethnic mortality disparities from all-cause, ... ...

    Abstract Introduction: The extent of racial/ethnic disparities and whether they are attenuated in the Veteran population compared to the total US population is not well understood. We aimed to assess racial/ethnic mortality disparities from all-cause, cardiovascular (CVD) and cancer among post-9/11 military Veterans with and without exposure to TBI, compared to the total US population.
    Methods: This cohort study included 2,502,101 US military Veterans (18,932,083 person-years) who served after 09/11/2001 with 3 or more years of care in the Military Health System (MHS); or had 3 or more years of care in the MHS and 2 or more years of care in the Veterans Health Administration. Mortality follow-up occurred from 01/01/2002 to 12/31/2020. Mortality rate ratios (MRR) from negative binomial regression models were reported for racial/ethnic groups compared to White non-Hispanic Veterans for all-cause, CVD and cancer mortality. Veteran MRR were compared to the total US population.
    Results: Mortality rates for Black Non-Hispanic Veterans were higher for all-cause (MRR = 1.21;95%CI: 1.13-1.29; p < 0.001), CVD (MRR = 1.78;95%CI: 1.62-1.96; p < 0.001) and cancer (MRR = 1.17;95%CI: 1.10-1.25; p < 0.001) than in White Non-Hispanic Veterans. Among Veterans with TBI, only Black Non-Hispanics had higher mortality than White Non-Hispanics and only for CVD (MRR = 1.32;95%CI: 1.12-1.54; p < 0.001), while CVD mortality was higher among Veterans without TBI (MRR = 1.77;95%CI: 1.63-1.93;p < 0.001). MRR for Black Non-Hispanics in the total US population, were consistently higher than those in the Veteran population for all-cause (MRR = 1.52;95%CI: 1.46-1.58; p < 0.001), CVD (MRR = 2.03;95%CI: 1.95-2.13; p < 0.001) and cancer (MRR = 1.26;95%CI: 1.22-1.30; p < 0.001).
    Conclusion: This Veteran cohort experienced less racial/ethnic disparity in mortality than the total US population, especially among Veterans with TBI.
    Language English
    Publishing date 2024-04-15
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2760524-3
    ISSN 2196-8837 ; 2197-3792
    ISSN (online) 2196-8837
    ISSN 2197-3792
    DOI 10.1007/s40615-024-02004-1
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  4. Article ; Online: An Ensemble of U-Net Models for Kidney Tumor Segmentation With CT Images.

    Causey, Jason / Stubblefield, Jonathan / Qualls, Jake / Fowler, Jennifer / Cai, Lingrui / Walker, Karl / Guan, Yuanfang / Huang, Xiuzhen

    IEEE/ACM transactions on computational biology and bioinformatics

    2022  Volume 19, Issue 3, Page(s) 1387–1392

    Abstract: ... of U-Net models developed after testing many model variations. Our model has consistent performance ...

    Abstract We present here the Arkansas AI-Campus solution method for the 2019 Kidney Tumor Segmentation Challenge (KiTS19). Our Arkansas AI-Campus team participated the KiTS19 Challenge for four months, from March to July of 2019. This paper provides a summary of our methods, training, testing and validation results for this grand challenge in biomedical imaging analysis. Our deep learning model is an ensemble of U-Net models developed after testing many model variations. Our model has consistent performance on the local test dataset and the final competition independent test dataset. The model achieved local test Dice scores of 0.949 for kidney and tumor segmentation, and 0.601 for tumor segmentation, and the final competition test earned Dice scores 0.9470 and 0.6099 respectively. The Arkansas AI-Campus team solution with a composite DICE score of 0.7784 has achieved a final ranking of top fifty worldwide, and top five among the United States teams in the KiTS19 Competition.
    MeSH term(s) Humans ; Image Processing, Computer-Assisted ; Kidney Neoplasms/diagnostic imaging ; Tomography, X-Ray Computed
    Language English
    Publishing date 2022-06-03
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ISSN 1557-9964
    ISSN (online) 1557-9964
    DOI 10.1109/TCBB.2021.3085608
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  5. Article ; Online: Assessing Clinician Utilization of Next-Generation Antibiotics Against Resistant Gram-Negative Infections in U.S. Hospitals : A Retrospective Cohort Study.

    Strich, Jeffrey R / Mishuk, Ahmed / Diao, Guoqing / Lawandi, Alexander / Li, Willy / Demirkale, Cumhur Y / Babiker, Ahmed / Mancera, Alex / Swihart, Bruce J / Walker, Morgan / Yek, Christina / Neupane, Maniraj / De Jonge, Nathaniel / Warner, Sarah / Kadri, Sameer S

    Annals of internal medicine

    2024  

    Abstract: Background: The U.S. antibiotic market failure has threatened future innovation and supply ... To determine use patterns of recently U.S. Food and Drug Administration (FDA)-approved gram-negative ... Retrospective cohort.: Setting: 619 U.S. hospitals.: Participants: Adult inpatients.: Measurements ...

    Abstract Background: The U.S. antibiotic market failure has threatened future innovation and supply. Understanding when and why clinicians underutilize recently approved gram-negative antibiotics might help prioritize the patient in future antibiotic development and potential market entry rewards.
    Objective: To determine use patterns of recently U.S. Food and Drug Administration (FDA)-approved gram-negative antibiotics (ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam, plazomicin, eravacycline, imipenem-relebactam-cilastatin, and cefiderocol) and identify factors associated with their preferential use (over traditional generic agents) in patients with gram-negative infections due to pathogens displaying difficult-to-treat resistance (DTR; that is, resistance to all first-line antibiotics).
    Design: Retrospective cohort.
    Setting: 619 U.S. hospitals.
    Participants: Adult inpatients.
    Measurements: Quarterly percentage change in antibiotic use was calculated using weighted linear regression. Machine learning selected candidate variables, and mixed models identified factors associated with new (vs. traditional) antibiotic use in DTR infections.
    Results: Between quarter 1 of 2016 and quarter 2 of 2021, ceftolozane-tazobactam (approved 2014) and ceftazidime-avibactam (2015) predominated new antibiotic usage whereas subsequently approved gram-negative antibiotics saw relatively sluggish uptake. Among gram-negative infection hospitalizations, 0.7% (2551 [2631 episodes] of 362 142) displayed DTR pathogens. Patients were treated exclusively using traditional agents in 1091 of 2631 DTR episodes (41.5%), including "reserve" antibiotics such as polymyxins, aminoglycosides, and tigecycline in 865 of 1091 episodes (79.3%). Patients with bacteremia and chronic diseases had greater adjusted probabilities and those with do-not-resuscitate status, acute liver failure, and
    Limitation: Residual confounding.
    Conclusion: Despite FDA approval of 7 next-generation gram-negative antibiotics between 2014 and 2019, clinicians still frequently treat resistant gram-negative infections with older, generic antibiotics with suboptimal safety-efficacy profiles. Future antibiotics with innovative mechanisms targeting untapped pathogen niches, widely available susceptibility testing, and evidence demonstrating improved outcomes in resistant infections might enhance utilization.
    Primary funding source: U.S. Food and Drug Administration; NIH Intramural Research Program.
    Language English
    Publishing date 2024-04-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/M23-2309
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  6. Article ; Online: Associations Between State and Local Government Spending and Pregnancy-Related Mortality in the U.S.

    Vilda, Dovile / Walker, Brigham C / Hardeman, Rachel R / Wallace, Maeve E

    American journal of preventive medicine

    2023  Volume 64, Issue 4, Page(s) 459–467

    Abstract: ... spending and population-level characteristics were obtained from U.S. Census Bureau surveys. Generalized ...

    Abstract Introduction: There is limited evidence on how government spending is associated with maternal death. This study investigates the associations between state and local government spending on social and healthcare services and pregnancy-related mortality among the total, non-Hispanic Black, Hispanic, and non-Hispanic White populations.
    Methods: State-specific total population and race/ethnicity-specific 5-year (2015-2019) pregnancy-related mortality ratios were estimated from annual natality and mortality files provided by the National Center for Health Statistics. Data on state and local government spending and population-level characteristics were obtained from U.S. Census Bureau surveys. Generalized linear Poisson regression models with robust SEs were fitted to estimate adjusted rate ratios and 95% CIs associated with proportions of total spending allocated to social services and healthcare domains, adjusting for state-level covariates. All analyses were completed in 2021-2022.
    Results: State and local government spending on transportation was associated with 11% lower overall pregnancy-related mortality (adjusted rate ratio=0.89, 95% CI=0.83, 0.96) and 9%-12% lower pregnancy-related mortality among the racial/ethnic groups. Among spending subdomains, expenditures on higher education, highways and roads, and parks and recreation were associated with lower pregnancy-related mortality rates in the total population (adjusted rate ratio=0.90, 95% CI=0.86, 0.94; adjusted rate ratio=0.87, 95% CI=0.81, 0.94; and adjusted rate ratio=0.68, 95% CI=0.49, 0.95, respectively). These results were consistent among the racial/ethnic groups, but patterns of associations with pregnancy-related mortality and other spending subdomains differed notably between racial/ethnic groups.
    Conclusions: Investing more in local- and state-targeted spending in social services may decrease the risk for pregnancy-related mortality, particularly among Black women.
    MeSH term(s) Female ; Humans ; Pregnancy ; Ethnicity ; Hispanic or Latino ; Local Government ; Racial Groups ; United States/epidemiology ; Maternal Mortality/ethnology ; Black or African American ; White ; Financing, Government ; State Government
    Language English
    Publishing date 2023-01-17
    Publishing country Netherlands
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 632646-8
    ISSN 1873-2607 ; 0749-3797
    ISSN (online) 1873-2607
    ISSN 0749-3797
    DOI 10.1016/j.amepre.2022.10.022
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  7. Article ; Online: Notes from the Field: Legionnaires Disease in a U.S. Traveler After Staying in a Private Vacation Rental House in the U.S. Virgin Islands - United States, February 2022.

    Mac, Valerie V / Labgold, Katie / Moline, Heidi L / Smith, Jessica C / Carroll, Jamaal / Clemmons, Nakia / Edens, Chris / Ellis, Brett / Harrison, Cosme / Henderson, Kelley C / Ishaq, Maliha K / Kozak-Muiznieks, Natalia A / Kunz, Jasen / Lawrence, Marlon / Lucas, Claressa E / Walker, Heather L / Willby, Melisa J / Ellis, Esther M

    MMWR. Morbidity and mortality weekly report

    2023  Volume 72, Issue 20, Page(s) 564–565

    MeSH term(s) Humans ; United States/epidemiology ; United States Virgin Islands/epidemiology ; Legionnaires' Disease/diagnosis ; Legionnaires' Disease/epidemiology ; Recreation
    Language English
    Publishing date 2023-05-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 412775-4
    ISSN 1545-861X ; 0149-2195
    ISSN (online) 1545-861X
    ISSN 0149-2195
    DOI 10.15585/mmwr.mm7220a5
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    Zs.B 1827: Show issues Location:
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  8. Article ; Online: Understanding the Impact of Insufficient Sleep in Children with Behavior Problems on Caregiver Stress: Results from a U.S. National Study.

    Gissandaner, Tre D / Stearns, Melanie A / Sarver, Dustin E / Walker, Benjamin / Ford, Hannah

    Clinical child psychology and psychiatry

    2023  Volume 28, Issue 4, Page(s) 1550–1564

    Abstract: ... representative survey of parents or caregivers conducted across the United States (U.S.). The current study used data ... for children 6-17 years old with a final analytic sample size of 41,541, representing a total of 47,357,862 U.S ...

    Abstract Research indicates strong connections between child ADHD, child ODD/CD, and sleep. Children experiencing these concerns also have caregivers who report feeling more stress. However, no studies have examined how child ADHD and ODD/CD interact together and with insufficient sleep to potentially exacerbate caregiver stress. Data were acquired from the 2018/2019 National Survey of Children's Health, a nationally representative survey of parents or caregivers conducted across the United States (U.S.). The current study used data for children 6-17 years old with a final analytic sample size of 41,541, representing a total of 47,357,862 U.S. youth. Overall child ADHD and ODD/CD were each uniquely associated with increased caregiver stress, while adequate child sleep duration was related to decreased caregiver stress. However, these findings were qualified by a significant two-way interaction that revealed that caregiver stress among children with comorbid ADHD and ODD/CD was not significantly greater than that of children with ODD/CD alone. Significant interactions between sleep and ODD/CD on caregiver stress were generally not observed, except potentially in females with ADHD. Our findings underscore the importance of considering strategies to reduce both youth symptoms and caregiver stress simultaneously. Additionally, ensuring adequate sleep for all children is recommended.
    MeSH term(s) Female ; Adolescent ; Humans ; Child ; Attention Deficit Disorder with Hyperactivity/epidemiology ; Caregivers ; Sleep Deprivation/complications ; Parents ; Problem Behavior ; Comorbidity ; Attention Deficit and Disruptive Behavior Disorders
    Language English
    Publishing date 2023-02-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 1324235-0
    ISSN 1461-7021 ; 1359-1045
    ISSN (online) 1461-7021
    ISSN 1359-1045
    DOI 10.1177/13591045231156342
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  9. Article ; Online: Phthalate exposure among U.S. college-aged women

    Barbara A Beckingham / Kerry Wischusen / Joanna P Walker

    PLoS ONE, Vol 17, Iss 2, p e

    Biomonitoring in an undergraduate student cohort (2016-2017) and trends from the National Health and Examination Survey (NHANES, 2005-2016).

    2022  Volume 0263578

    Abstract: ... to the U.S. female population in the most recent NHANES cycle (2015-2016) except for MEP and mono-isobutyl ... in the general U.S. population, the sociocultural character of this cohort, and the time of day of spot sampling ...

    Abstract Importance Phthalates are ubiquitous and many are known or suspected human reproductive and endocrine-disrupting toxicants. A data gap exists in reporting on biomonitoring of phthalate biomarkers in college-aged adults. Objective To analyze phthalate exposure in a cross-sectional sample of female college students using urinary phthalate metabolite concentrations and compare to reference populations including college-aged women sampled in the National Health and Nutrition Examination Survey (NHANES). Methods Nine monoester phthalate metabolites were analyzed in spot urine collected from 215 female undergraduates (age 18-22, 2016-2017) at a public university in Charleston, SC USA and a subset of participants completed a questionnaire detailing demographics and behaviors including personal care and cosmetic product use (e.g. in the past 6 or 24 hrs). Urine specific gravity was used to assess effect of urine dilution. Phthalate metabolite concentrations were compared to reference populations and the temporal trends of the same age-group in the National Health and Nutrition Examination Survey (NHANES) were analyzed. Results Total urinary phthalate metabolite concentrations in individuals ranged three orders of magnitude (geometric mean 56.6 ng/mL, IQR 26.6-114 ng/mL). A third of urine samples had relatively high urine specific gravity levels indicating potential dehydration status. All geometric mean concentrations were similar to the U.S. female population in the most recent NHANES cycle (2015-2016) except for MEP and mono-isobutyl phthalate (MiBP). Relatively low MEP and MiBP may be explained by a time trend of declining MEP in the general U.S. population, the sociocultural character of this cohort, and the time of day of spot sampling in evening. NHANES data indicate a significant effect of sample timing on phthalate metabolite concentrations and decline in most, but not all, phthalate metabolites sampled in women aged 18-22 years over the decade (2005-2016). Significance This study reports phthalate metabolites ...
    Keywords Medicine ; R ; Science ; Q
    Subject code 333
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  10. Article: Sociodemographic factors associated with major depressive episodes and suicidal ideation among emerging adults with diabetes in the U.S.

    Yadav, Sandhya / Hong, Young-Rock / Westen, Sarah / Marlow, Nicole M / Haller, Michael J / Walker, Ashby F

    Frontiers in endocrinology

    2023  Volume 14, Page(s) 1276336

    Abstract: Background: Research focused on disparities related to mental health comorbidities, especially among emerging adults with diabetes, is limited. Identifying associated factors of disparities could inform policy decisions to make diabetes-related ... ...

    Abstract Background: Research focused on disparities related to mental health comorbidities, especially among emerging adults with diabetes, is limited. Identifying associated factors of disparities could inform policy decisions to make diabetes-related interdisciplinary care more accessible for vulnerable groups.
    Method: Using data from the National Survey on Drug Use and Health (2015-2019), we examined disparities in presence of major depressive episode (MDE) and suicidal ideation among emerging adults with diabetes. Survey design-adjusted bivariate and multivariable logistic regression models were used for statistical analyses.
    Results: The study included 1,125 emerging adults (18-25 years old), with a history of type 1 diabetes (T1D) or type 2 diabetes (T2D). After controlling for sociodemographic and health-related characteristics, we found lower odds of having past-year major MDE for non-Hispanic Black (AOR, 0.42, p=0.032) compared to their non-Hispanic White counterparts. Females were 3.02 times more likely to have past-year MDE than males (AOR, 3.02, p=0.004). The odds of having past-year MDE were 1.96 times higher among individuals who identified as LGB (lesbian, gay, bisexual) (AOR, 1.96, P=0.038). There were no statistically significant disparities in suicidal ideation related to race/ethnicity, sex, education, and family income. However, individuals who identified as LGB had significantly higher likelihood of suicidal ideation than their heterosexual counterparts (AOR, 2.47, P=0.004).
    Conclusion: Significant disparities related to MDE and suicidal ideation exist based on race/ethnicity, gender, and sexual orientation. Integration of a mental health professional into the multidisciplinary diabetes care team is critical for effective management of comorbid mental health conditions in younger patients with diabetes.
    MeSH term(s) Adult ; Humans ; Male ; Female ; Adolescent ; Young Adult ; Suicidal Ideation ; Diabetes Mellitus, Type 2/epidemiology ; Depressive Disorder, Major/epidemiology ; Sociodemographic Factors ; Sexual and Gender Minorities
    Language English
    Publishing date 2023-12-07
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2592084-4
    ISSN 1664-2392
    ISSN 1664-2392
    DOI 10.3389/fendo.2023.1276336
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