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Article ; Online: Estimation of non-monotonic transition rates in a semi-Markov process with covariates adjustments and application to caregivers' stress data.

Ngan, Esther / Chan, Wenyaw / Leon-Novelo, Luis / Pavlik, Valory

2023 Volume 42, Issue 30, Page(s) 5646–5656

Abstract: With the large ongoing number of aged people and Alzheimer's disease (AD) patients worldwide, unpaid caregivers have become the primary sources of their daily caregiving. Alzheimer's family caregivers often suffer from physical and mental morbidities ... ...

Abstract	With the large ongoing number of aged people and Alzheimer's disease (AD) patients worldwide, unpaid caregivers have become the primary sources of their daily caregiving. Alzheimer's family caregivers often suffer from physical and mental morbidities owing to various reasons. The aims of this paper were to develop alternate methods to understand the transition properties, the dynamic change, and the long-run behavior of AD caregivers' stress levels, by assuming their transition to the next level only depends on the duration of the current stress level. In this paper, we modeled the transition rates in the semi-Markov Process with log-logistic hazard functions. We assumed the transition rates were non-monotonic over time and the scale of transition rates depended on covariates. We also extended the uniform accelerated expansion to calculate the long-run probability distribution of stress levels while adjusting for multiple covariates. The proposed methods were evaluated through an empirical study. The application results showed that all the transition rates of caregivers' stress levels were right skewed. Care recipients' baseline age was significantly associated with the transitions. The long-run probability of severe state was slightly higher, implying a prolonged recovery time for severe stress patients.
MeSH term(s)	Humans ; Aged ; Caregivers ; Markov Chains ; Alzheimer Disease ; Anxiety
Language	English
Publishing date	2023-10-08
Publishing country	England
Document type	Journal Article
ZDB-ID	843037-8
ISSN	1097-0258 ; 0277-6715
ISSN (online)	1097-0258
ISSN	0277-6715
DOI	10.1002/sim.9930
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Article ; Online: Non-homogeneous continuous-time Markov chain with covariates: Applications to ambulatory hypertension monitoring.

Chang, Joonha / Chan, Hei Kit / Lin, Jeffrey / Chan, Wenyaw

Statistics in medicine

2023 Volume 42, Issue 12, Page(s) 1965–1980

Abstract: Hypertension significantly increases the risk for many health conditions including heart disease and stroke. Hypertensive patients often have continuous measurements of their blood pressure to better understand how it fluctuates over the day. The ... ...

Abstract	Hypertension significantly increases the risk for many health conditions including heart disease and stroke. Hypertensive patients often have continuous measurements of their blood pressure to better understand how it fluctuates over the day. The continuous-time Markov chain (CTMC) is commonly used to study repeated measurements with categorical outcomes. However, the standard CTMC may be restrictive, because the rates of transitions between states are assumed to be constant through time, while the transition rates for describing the dynamics of hypertension are likely to be changing over time. In addition, the applications of CTMC rarely account for the effects of other covariates on state transitions. In this article, we considered a non-homogeneous continuous-time Markov chain with two states to analyze changes in hypertension while accounting for multiple covariates. The explicit formulas for the transition probability matrix as well as the corresponding likelihood function were derived. In addition, we proposed a maximum likelihood estimation algorithm for estimating the parameters in the time-dependent rate function. Lastly, the model performance was demonstrated through both a simulation study and application to ambulatory blood pressure data.
MeSH term(s)	Humans ; Markov Chains ; Blood Pressure Monitoring, Ambulatory ; Likelihood Functions ; Computer Simulation ; Hypertension
Language	English
Publishing date	2023-03-10
Publishing country	England
Document type	Journal Article
ZDB-ID	843037-8
ISSN	1097-0258 ; 0277-6715
ISSN (online)	1097-0258
ISSN	0277-6715
DOI	10.1002/sim.9707
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Article ; Online: A Dynamic Risk Model for Multitype Recurrent Events.

Ghosh, Alokananda / Chan, Wenyaw / Younes, Naji / Davis, Barry R

American journal of epidemiology

2022 Volume 192, Issue 4, Page(s) 621–631

Abstract: Recurrent events can occur more than once in the same individual; such events may be of different types, known as multitype recurrent events. They are very common in longitudinal studies. Often there is a terminating event, after which no further events ... ...

Abstract	Recurrent events can occur more than once in the same individual; such events may be of different types, known as multitype recurrent events. They are very common in longitudinal studies. Often there is a terminating event, after which no further events can occur. The risk of any event, including terminating events such as death or cure, is typically affected by prior events. We propose a flexible joint multitype recurrent-events model that explicitly provides estimates of the change in risk for each event due to subject characteristics, including number and type of prior events and the absolute risk for every event type (terminating and nonterminating), and predicts event-free survival probability over a desired time period. The model is fully parametric, and therefore a standard likelihood function and robust standard errors can be constructed. We illustrate the model with applications to the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (1994-2002) and provide discussion of the results and model features.
MeSH term(s)	Humans ; Models, Statistical ; Likelihood Functions ; Myocardial Infarction ; Longitudinal Studies
Language	English
Publishing date	2022-12-22
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwac213
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Article ; Online: Utilization and Predictors of Adjuvant Metformin for Children and Adolescents on Mixed Receptor Antagonists (Second-Generation Antipsychotics).

Chen, Hua / Lyu, Ning / Chan, Wenyaw / De La Cruz, Austin / Calarge, Chadi

Journal of the American Academy of Child and Adolescent Psychiatry

2023 Volume 62, Issue 11, Page(s) 1245–1255

Abstract: Objective: To examine utilization and predictors of adjuvant metformin among pediatric recipients of second-generation antipsychotics (SGAs) (mixed receptor antagonist).: Method: This study used 2016-2021 data of a national electronic medical record ... ...

Abstract	Objective: To examine utilization and predictors of adjuvant metformin among pediatric recipients of second-generation antipsychotics (SGAs) (mixed receptor antagonist). Method: This study used 2016-2021 data of a national electronic medical record database. Eligible participants were children aged 6 to 17 with a new SGA prescription for at least 90 days. Predictors of prescribing adjuvant metformin in general and to nonobese pediatric SGA recipients in particular were assessed using conditional logistic regression and logistic regression analyses, respectively. Results: Of 30,009 pediatric SGA recipients identified, 2.3% (n = 785) received adjuvant metformin. Among 597 participants with a body mass index z score documented during the 6-month period before metformin initiation, 83% were obese, and 34% had either hyperglycemia or diabetes. Significant predictors for metformin prescribing were high baseline body mass index z score (odds ratio [OR] 3.5, 95% CI 2.8-4.5, p < .0001), having hyperglycemia or diabetes (OR 5.3, 95% CI 3.4-8.3, p < .0001), and undergoing a switch from a higher metabolic risk SGA to a lower risk one (OR 9.9, 95% CI 3.5-27.5, p = .0025) or a switch in the opposite direction (OR 4.1, 95% CI 2.1-7.9, p = .0051) compared with no switch. Nonobese metformin users were more likely to have a positive body mass index z score velocity before metformin initiation than their obese counterparts. Receiving the index SGA prescribed by a mental health specialist was associated with higher likelihood of receiving adjuvant metformin and receiving metformin before the development of obesity. Conclusion: Utilization of adjuvant metformin among pediatric SGA recipients is uncommon, and early introduction of the medication among nonobese children is rare.
MeSH term(s)	Humans ; Child ; Adolescent ; Antipsychotic Agents/adverse effects ; Metformin/pharmacology ; Metformin/therapeutic use ; Obesity/drug therapy ; Diabetes Mellitus/drug therapy ; Hyperglycemia/drug therapy
Chemical Substances	Antipsychotic Agents ; Metformin (9100L32L2N)
Language	English
Publishing date	2023-05-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	392535-3
ISSN	1527-5418 ; 0890-8567
ISSN (online)	1527-5418
ISSN	0890-8567
DOI	10.1016/j.jaac.2023.02.017
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Article ; Online: Dimension reduction of 911 Good Samaritan Laws: Drawing inferences from policy surveillance.

Reader, Shane W / Breckenridge, Ellen D / Chan, Wenyaw / Walton, Gretchen H / Linder, Stephen H

Drug and alcohol dependence

2023 Volume 249, Page(s) 109934

Abstract: Background: 911 Good Samaritan Laws (GSLs) extend legal protection to people reporting drug overdoses who may otherwise be in violation of controlled substance laws. Mixed evidence suggests GSLs decrease overdose mortality, but these studies overlook ... ...

Abstract	Background: 911 Good Samaritan Laws (GSLs) extend legal protection to people reporting drug overdoses who may otherwise be in violation of controlled substance laws. Mixed evidence suggests GSLs decrease overdose mortality, but these studies overlook substantial heterogeneity across states. The GSL Inventory exhaustively catalogs features of these laws into four categories: breadth, burden, strength, and exemption. The present study reduces this dataset to reveal patterns in implementation, facilitate future evaluations, and to produce a roadmap for the dimension reduction of further policy surveillance datasets. Methods: We produced multidimensional scaling plots visualizing the frequency of co-occurring GSL features from the GSL Inventory as well as similarity among state laws. We clustered laws into meaningful groups by shared features; produced a decision tree identifying salient features predicting group membership; scored their relative breadth, burden, strength, and exemption of immunity; and associated groups with state sociopolitical and sociodemographic variables. Results: In the feature plot, breadth and strength features segregate from burdens and exemptions. Regions in the state plot differentiate quantity of substances immunized, burden of reporting requirements, and immunity for probationers. State laws may be clustered into five groups distinguished by proximity, salient features, and sociopolitical variables. Discussion: This study reveals competing attitudes toward harm reduction that underly GSLs across states. These analyses provide a roadmap for the application of dimension reduction methods to policy surveillance datasets, accommodating their binary structure and longitudinal observations. These methods preserve higher-dimensional variance in a form amenable to statistical evaluation.
MeSH term(s)	Humans ; United States ; Legal Epidemiology ; Drug Overdose ; Harm Reduction
Language	English
Publishing date	2023-05-19
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2023.109934
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Article ; Online: The Effectiveness of Metformin in Managing Second Generation Antipsychotic-Induced Weight Gain in Children and Adolescents.

Chen, Hua / Lyu, Ning / Calarge, Chadi / De La Cruz, Austin / Chan, Wenyaw

The Journal of clinical psychiatry

2023 Volume 85, Issue 1

Abstract: Objective:: Methods:: Results:: Conclusions: ...

Abstract	Objective: Methods: Results: Conclusions:
MeSH term(s)	Child ; Humans ; Adolescent ; Antipsychotic Agents/adverse effects ; Weight Gain ; Obesity/chemically induced ; Obesity/drug therapy ; Body Mass Index ; Metformin/therapeutic use
Chemical Substances	Antipsychotic Agents ; Metformin (9100L32L2N)
Language	English
Publishing date	2023-12-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	716287-x
ISSN	1555-2101 ; 0160-6689
ISSN (online)	1555-2101
ISSN	0160-6689
DOI	10.4088/JCP.23m14894
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Zs.B 108: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Association of Nightly Fasting, Meal Frequency, and Skipping Meals with Metabolic Syndrome among Kuwaiti Adults.

Alkhulaifi, Fatema / Al-Hooti, Suad / Al-Zenki, Sameer / Alomirah, Husam / Xiao, Qian / Chan, Wenyaw / Wu, Fuqing / Darkoh, Charles

Nutrients

2024 Volume 16, Issue 7

Abstract: Mounting evidence suggests that meal timing and frequency are associated with cardiometabolic health by influencing circadian rhythms. However, the evidence is inconsistent and limited, especially in non-Western cultures. This cross-sectional study aims ... ...

Abstract	Mounting evidence suggests that meal timing and frequency are associated with cardiometabolic health by influencing circadian rhythms. However, the evidence is inconsistent and limited, especially in non-Western cultures. This cross-sectional study aims to investigate the association between temporal habits of dietary intake, such as nightly fasting duration and meal frequency, and metabolic syndrome among Kuwaiti adults. A 24-hour recall was used to assess temporal habits of dietary intake. Meal frequency was defined as the number of daily eating episodes. The study included a total of 757 adults aged 20 years and older. The participants' mean age was 37.8 ± 12.3 years. After adjusting for all confounders, higher meal frequency was found to be associated with a lower prevalence of metabolic syndrome in adults (OR, 0.43; 95%CI, 0.19-0.96) and a lower prevalence of elevated triglycerides in men only (OR, 0.23; 95%CI, 0.09-0.60). No association was found between nightly fasting and metabolic syndrome, but a longer fasting duration was associated with a lower prevalence of elevated triglycerides (OR, 0.19; 95%CI, 0.06-0.63). The findings suggest that having frequent meals and longer durations of nightly fasting may help decrease the risk of metabolic syndrome and elevated triglycerides.
MeSH term(s)	Adult ; Male ; Humans ; Middle Aged ; Metabolic Syndrome/epidemiology ; Cross-Sectional Studies ; Kuwait/epidemiology ; Fasting ; Hypertriglyceridemia ; Meals ; Triglycerides
Chemical Substances	Triglycerides
Language	English
Publishing date	2024-03-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu16070984
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Article ; Online: Different Cognitive Profiles Are Associated with Progression Rate and Age at Death in Probable Alzheimer's Disease.

Sood, Ajay / Pavlik, Valory / Darby, Eveleen / Chan, Wenyaw / Doody, Rachelle

Journal of Alzheimer's disease : JAD

2021 Volume 80, Issue 2, Page(s) 735–747

Abstract: Background: Cognitive profiles characterized by primarily language or visuospatial deficits have been documented in individuals meeting diagnostic criteria for probable Alzheimer's disease (AD), but their association with progression rate or overall ... ...

Abstract	Background: Cognitive profiles characterized by primarily language or visuospatial deficits have been documented in individuals meeting diagnostic criteria for probable Alzheimer's disease (AD), but their association with progression rate or overall survival is not well described. Objective: To compare time from diagnosis to severe disease stage and death in probable AD patients classified into three groups based on neuropsychological test performance: marked verbal impairment (Verb-PI) with relatively preserved visuospatial function, marked visuospatial impairment with preserved verbal function (Vis-PI), and balanced verbal and visuospatial impairments (Bal-PI). Methods: This prospective cohort study included 540 probable AD patients attending an academic memory clinic who were enrolled from 1995-2013 and followed annually. Eligible individuals had a Mini-Mental State Exam (MMSE) score ≥10 at baseline, and at least one annual follow up visit. We used Cox proportional hazards modeling to analyze the association of cognitive profiles with time to decline in MMSE and CDR Global Score. Results: Sixty-one (11.3%) individuals had a Verb-PI profile, 86 (16%) had a Vis-PI profile, and 393 (72.8%) a Bal-PI profile. MMSE decline to <10 was faster in Verb-PI than Vis-PI (HR 2.004, 95%CI, 1.062-3.780; p = 0.032). Progression to CDR-GS = 3 was faster in Verb-PI individuals compared to Bal-PI (HR 1.604, 95%CI, 1.022-2.515; p = 0.040) or Vis-PI (HR 2.388, 95%CI, 1.330-4.288; p = 0.004) individuals. Baseline cognitive profile did not affect mortality. Conclusion: A recognition of different AD profiles may help to personalize care by providing a better understanding of pathogenesis and expected progression.
MeSH term(s)	Aged ; Aged, 80 and over ; Alzheimer Disease/mortality ; Alzheimer Disease/physiopathology ; Cognition/physiology ; Cognitive Dysfunction/mortality ; Cognitive Dysfunction/physiopathology ; Disease Progression ; Humans ; Male ; Neuropsychological Tests ; Prospective Studies
Language	English
Publishing date	2021-02-12
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1440127-7
ISSN	1875-8908 ; 1387-2877
ISSN (online)	1875-8908
ISSN	1387-2877
DOI	10.3233/JAD-201124
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Article: Evaluation of the kitchen microbiome and food safety behaviors of predominantly low-income families.

Carstens, Christina K / Salazar, Joelle K / Sharma, Shreela V / Chan, Wenyaw / Darkoh, Charles

Frontiers in microbiology

2022 Volume 13, Page(s) 987925

Abstract: Bacterial pathogens in the domestic environment present a risk to residents, particularly among susceptible populations. However, the impact of consumer demographic characteristics and food handling methods on kitchen microbiomes is not fully understood. ...

Abstract	Bacterial pathogens in the domestic environment present a risk to residents, particularly among susceptible populations. However, the impact of consumer demographic characteristics and food handling methods on kitchen microbiomes is not fully understood. The domestic kitchen bacterial communities of ten predominantly low-income families in Houston, TX, were assessed in conjunction with a cross-sectional food safety survey to evaluate differences in household and surface-specific microbiomes and bacterial foodborne pathogen presence. Three kitchen surfaces within each household, including the sink drain, the refrigerator handle, and the counter, were environmentally sampled and metataxonomically evaluated via targeted 16S rRNA sequencing. Disposable dish sponges were also acquired and examined. Results indicated that alpha diversity did not vary by the households, sampling locations, or demographic characteristics evaluated. Significant differences in beta diversity were observed among the bacterial communities of five pairs of households and between refrigerator handle and disposable dish sponge microbiomes. A total of 89 unique bacterial foodborne pathogens were identified across surface types. Each household contained at least one contaminated surface, and the most common bacterial foodborne pathogens identified were
Language	English
Publishing date	2022-09-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2587354-4
ISSN	1664-302X
ISSN	1664-302X
DOI	10.3389/fmicb.2022.987925
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Article ; Online: Does hospital location matter? Association of neighborhood socioeconomic disadvantage with hospital quality in US metropolitan settings.

Nwana, Nwabunie / Chan, Wenyaw / Langabeer, James / Kash, Bita / Krause, Trudy Millard

Health & place

2022 Volume 78, Page(s) 102911

Abstract: An aspect of a hospital's location, such as its degree of socioeconomic disadvantage, could potentially affect quality ratings of the hospital; yet, few studies have granularly explored this relationship in United States (US) metropolitan areas ... ...

Abstract	An aspect of a hospital's location, such as its degree of socioeconomic disadvantage, could potentially affect quality ratings of the hospital; yet, few studies have granularly explored this relationship in United States (US) metropolitan areas characterized by a wide breadth of socioeconomic disparities across neighborhoods. An understanding of the effect of neighborhood socioeconomic disadvantage on hospital quality of care is informative for targeting resources in poor neighborhoods. We assessed the association of neighborhood socioeconomic disadvantage with hospital quality of care across several areas of quality (including mortality, readmission, safety, patient experience, effectiveness of care, summary and overall star rating) in US metropolitan areas. Hospitals in the most disadvantaged neighborhoods, compared to hospitals in the least disadvantaged neighborhoods, had worse mortality scores, readmission scores, safety of care scores, patient experience of care scores, effectiveness of care scores, summary scores and overall star rating. Timeliness of care and efficient use of imaging scores were not strongly associated with neighborhood socioeconomic disadvantage; although, future studies are needed to validate this finding. Policymakers could target innovative strategies for improving neighborhood socioeconomic conditions in more disadvantaged areas, as this may improve hospital quality.
MeSH term(s)	United States ; Humans ; Residence Characteristics ; Hospitals ; Vulnerable Populations ; Socioeconomic Factors
Language	English
Publishing date	2022-11-12
Publishing country	England
Document type	Journal Article
ZDB-ID	1262540-1
ISSN	1873-2054 ; 1353-8292
ISSN (online)	1873-2054
ISSN	1353-8292
DOI	10.1016/j.healthplace.2022.102911
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