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Artikel ; Online: Mediation Analysis of Maternal Smoking, Gestational Age, and Birth Weight on the Texas-Mexico Border.

Ogbutor, Chinodebem / Mishaw, Stephanie M / Mulla, Zuber D

2023 Band 116, Heft 6, Seite(n) 478–481

Abstract: Objectives: Published data on the indirect effect of maternal smoking on birth weight as mediated by gestational age in Hispanic populations are lacking. Our goal was to conduct such a mediation analysis using data from El Paso County, Texas.: Methods! ...

Abstract	Objectives: Published data on the indirect effect of maternal smoking on birth weight as mediated by gestational age in Hispanic populations are lacking. Our goal was to conduct such a mediation analysis using data from El Paso County, Texas. Methods: El Paso County is located on the US-Mexico border. A simple mediation analysis was conducted using year 2010 El Paso County birth certificate data. The SAS macro PROCESS 3.5.3 was used to estimate the direct and indirect effects of active maternal smoking (by trimester) on birth weight (in grams) in the setting of linear regression. The single mediator was gestational age in weeks. A direct or indirect effect was deemed to be present if the 95% confidence limits (CLs) excluded 0. Analyses were adjusted for multiple variables, including maternal prepregnancy body mass index. The indirect effect was reported along with a 95% bootstrap CL. Results: A total of 16,654 singleton births were included in the cohort. The majority of the mothers were White Hispanic (87.2%). The mean (standard deviation) birth weight was 3198.6 g (517.2). A direct effect of maternal smoking during each trimester on birth weight was detected. An indirect effect of maternal smoking on birth weight was not detected in any of the trimesters. In adjusted analyses for the third trimester, the indirect effect for every 1-U increase in the mean number of cigarettes smoked per day was -4.18 (95% bootstrap CL -10.64 to 1.99). Conclusions: In our large, predominantly Hispanic cohort, it appears that gestational age is not a mediator of the effect of maternal smoking on birth weight. Future studies in our population should explore other possible mediators of this association.
Mesh-Begriff(e)	Pregnancy ; Female ; Humans ; Gestational Age ; Texas/epidemiology ; Mexico ; Mediation Analysis ; Smoking/adverse effects ; Smoking/epidemiology ; Birth Weight
Sprache	Englisch
Erscheinungsdatum	2023-06-01
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	185329-6
ISSN	1541-8243 ; 0038-4348
ISSN (online)	1541-8243
ISSN	0038-4348
DOI	10.14423/SMJ.0000000000001566
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Sleep Apnea and Poor COVID-19 Outcomes: Beware of Causal Intermediates and Colliders.

Mulla, Zuber D / Pathak, Indu S

American journal of respiratory and critical care medicine

2021 Band 203, Heft 10, Seite(n) 1325–1326

Mesh-Begriff(e)	COVID-19 ; Hospitalization ; Humans ; SARS-CoV-2 ; Sleep Apnea Syndromes/complications ; Sleep Apnea, Obstructive/complications
Sprache	Englisch
Erscheinungsdatum	2021-03-08
Erscheinungsland	United States
Dokumenttyp	Letter ; Comment
ZDB-ID	1180953-x
ISSN	1535-4970 ; 0003-0805 ; 1073-449X
ISSN (online)	1535-4970
ISSN	0003-0805 ; 1073-449X
DOI	10.1164/rccm.202101-0088LE
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: The Cost of Hospitalized Ocular Injuries in Texas, 2013-2014.

Nelson, Patricia C / Mulla, Zuber D

Ophthalmic epidemiology

2020 Band 27, Heft 5, Seite(n) 409–416

Abstract: Purpose: Healthcare costs are a continual concern. To improve our cost-efficiency we must identify the direct costs of ocular injuries requiring hospitalization. The purpose of this study was to evaluate the direct costs of hospitalized ocular injuries ... ...

Abstract	Purpose: Healthcare costs are a continual concern. To improve our cost-efficiency we must identify the direct costs of ocular injuries requiring hospitalization. The purpose of this study was to evaluate the direct costs of hospitalized ocular injuries in Texas. Methods: Retrospective cohort study using the Texas Hospital Inpatient Discharge Public Use Data File, 2013-2014. Persons hospitalized for ocular trauma were identified using ICD-9-CM codes. Injuries were subcategorized as ocular adnexal, open globe, or closed globe based on diagnosis and procedure codes and analyzed across three age groups: 18-44, 45-64, and >65 years. Results: From 2013 to 2014, 1498 patients were hospitalized with ocular adnexal injuries, 644 with open globe injuries, and 2877 with closed globe injuries. Length of stay ranged from 2 to 4 days. The median total charges ranged between $34,576 and $55,409 across all injuries and groups. The largest portion of medical costs were due to radiology in the ocular adnexal and closed globe groups, and operating room charges in the open globe group. Conclusions: Median hospitalization costs for ocular injuries were between $34,576 and $55,409 for a 2-4 day length of stay. Open globe injuries had the shortest median lengths of stay, 2-3 days, and lower median total costs. Only in the open globe group were operative costs higher than radiology costs. Operative charges were lowest in the oldest age group, who also had longer lengths of stay. Our reported costs were lower than other nationally reported ocular injury costs for similar lengths of hospital stay.
Mesh-Begriff(e)	Adolescent ; Adult ; Eye Injuries/economics ; Health Care Costs ; Hospitalization ; Humans ; Retrospective Studies ; Texas ; Young Adult
Sprache	Englisch
Erscheinungsdatum	2020-05-20
Erscheinungsland	England
Dokumenttyp	Journal Article
ZDB-ID	1213070-9
ISSN	1744-5086 ; 0928-6586
ISSN (online)	1744-5086
ISSN	0928-6586
DOI	10.1080/09286586.2020.1766512
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: An Evacuation Simulation in Multiple Neonatal Intensive Care Units Across a Single City: Lessons Learned.

Tullius, Zoe / Helgesen, Wanda / Mulla, Zuber D / Chheda, Sadhana

Disaster medicine and public health preparedness

2022 Band 17, Seite(n) e244

Abstract: Objective: Evacuations of neonatal intensive care units (NICUs) in emergency situations pose specialized challenges given their population of critically-ill neonates. Most of the literature on this topic describes planned evacuations and simulations due ...

Abstract	Objective: Evacuations of neonatal intensive care units (NICUs) in emergency situations pose specialized challenges given their population of critically-ill neonates. Most of the literature on this topic describes planned evacuations and simulations due to natural disasters, usually involving only NICU staff. This study examines a unique emergent NICU evacuation simulation involving multiple responders occurring on a citywide scale. Methods: A simulated evacuation in response to a fire was conducted in 6 different NICUs in El Paso, Texas. The exercise utilized response from NICU staff and first responders. A standardized tool, by independent evaluators, was used to evaluate staff competencies while reactions were assessed using post-exercise surveys. Results: This city-wide multidisciplinary simulation improved NICU personnel skills in evacuation and also introduced first responders to this specialized patient population. Areas of strength across all NICUs included teamwork, knowledge of evacuation equipment, and patient tracking. Areas for improvement included lack of adequate equipment for post-evacuation care, understanding implications of smoke exposure, alternative evacuation routes, incident command structure, and unified communication. Conclusions: This successful, citywide NICU evacuation simulation improved knowledge among participants, introduced first responders to a specialized patient population, and provided valuable lessons on neonate-specific themes that can be incorporated to improve citywide emergency preparedness.
Mesh-Begriff(e)	Infant, Newborn ; Humans ; Intensive Care Units, Neonatal ; Computer Simulation ; Natural Disasters ; Texas
Sprache	Englisch
Erscheinungsdatum	2022-08-03
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2022.158
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: The essentials of a faculty development program in the setting of a new medical school.

Kupesic Plavsic, Sanja / Mulla, Zuber D

Journal of investigative medicine : the official publication of the American Federation for Clinical Research

2020 Band 68, Heft 5, Seite(n) 952–955

Mesh-Begriff(e)	Curriculum ; Faculty ; Humans ; Leadership ; Mentoring ; Schools, Medical ; Writing
Sprache	Englisch
Erscheinungsdatum	2020-05-14
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1217870-6
ISSN	1708-8267 ; 0009-9279 ; 1081-5589
ISSN (online)	1708-8267
ISSN	0009-9279 ; 1081-5589
DOI	10.1136/jim-2020-001341
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: An imbalance-aware deep neural network for early prediction of preeclampsia.

Bennett, Rachel / Mulla, Zuber D / Parikh, Pavan / Hauspurg, Alisse / Razzaghi, Talayeh

PloS one

2022 Band 17, Heft 4, Seite(n) e0266042

Abstract: Preeclampsia (PE) is a hypertensive complication affecting 8-10% of US pregnancies annually. While there is no cure for PE, aspirin may reduce complications for those at high risk for PE. Furthermore, PE disproportionately affects racial minorities, with ...

Abstract	Preeclampsia (PE) is a hypertensive complication affecting 8-10% of US pregnancies annually. While there is no cure for PE, aspirin may reduce complications for those at high risk for PE. Furthermore, PE disproportionately affects racial minorities, with a higher burden of morbidity and mortality. Previous studies have shown early prediction of PE would allow for prevention. We approached the prediction of PE using a new method based on a cost-sensitive deep neural network (CSDNN) by considering the severe imbalance and sparse nature of the data, as well as racial disparities. We validated our model using large extant rich data sources that represent a diverse cohort of minority populations in the US. These include Texas Public Use Data Files (PUDF), Oklahoma PUDF, and the Magee Obstetric Medical and Infant (MOMI) databases. We identified the most influential clinical and demographic features (predictor variables) relevant to PE for both general populations and smaller racial groups. We also investigated the effectiveness of multiple network architectures using three hyperparameter optimization algorithms: Bayesian optimization, Hyperband, and random search. Our proposed models equipped with focal loss function yield superior and reliable prediction performance compared with the state-of-the-art techniques with an average area under the curve (AUC) of 66.3% and 63.5% for the Texas and Oklahoma PUDF respectively, while the CSDNN model with weighted cross-entropy loss function outperforms with an AUC of 76.5% for the MOMI data. Furthermore, our CSDNN model equipped with focal loss function leads to an AUC of 66.7% for Texas African American and 57.1% for Native American. The best results are obtained with 62.3% AUC with CSDNN with weighted cross-entropy loss function for Oklahoma African American, 58% AUC with DNN and balanced batch for Oklahoma Native American, and 72.4% AUC using either CSDNN with weighted cross-entropy loss function or CSDNN with focal loss with balanced batch method for MOMI African American dataset. Our results provide the first evidence of the predictive power of clinical databases for PE prediction among minority populations.
Mesh-Begriff(e)	Bayes Theorem ; Female ; Humans ; Infant ; Neural Networks, Computer ; Pre-Eclampsia/diagnosis ; Pre-Eclampsia/prevention & control ; Pregnancy
Sprache	Englisch
Erscheinungsdatum	2022-04-06
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0266042
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Hospitalizations of children and young adults from peanut-induced anaphylaxis in Texas.

Mulla, Zuber D

Southern medical journal

2011 Band 104, Heft 5, Seite(n) 322–324

Abstract: Objective: Population-based studies of peanut anaphylaxis in Texas children and young adults are lacking. The objective of this investigation was to report the clinical and demographic features of children discharged throughout Texas with a diagnosis of ...

Abstract	Objective: Population-based studies of peanut anaphylaxis in Texas children and young adults are lacking. The objective of this investigation was to report the clinical and demographic features of children discharged throughout Texas with a diagnosis of anaphylaxis triggered by peanut consumption and calculate the peanut anaphylaxis hospitalization rate by age group. Methods: Public-use statewide Texas hospital discharge data for the years 2004 through 2007 were analyzed. Patients under the age of 25 years who were Texas residents were included in the study if their principal or secondary diagnosis was anaphylactic shock due to peanut, ICD-9-CM code 995.61. Clinical and demographic features were summarized. Peanut anaphylaxis hospitalization rates were calculated by dividing the number of hospitalizations in a particular age group by the appropriate Texas resident population estimate. Results: Thirty-four patients were identified, 23 of whom (67.7%) were male. The majority (91%) of the patients were emergency or urgent admissions. After controlling for patient sex and whether or the not patient was self-pay, asthmatics were more likely than non-asthmatics to have received mechanical ventilation (adjusted exact odds ratio = 15.98, P = 0.01). The highest risk of peanut anaphylaxis hospitalization was in the youngest age group, children under five years 1.9/1 million. Conclusion: Epidemiologic analysis of a statewide hospital discharge database revealed that the highest risk of peanut anaphylaxis hospitalization in Texas children and young adults was in children under five years. Asthmatics were significantly more likely than non-asthmatics to receive mechanical ventilation during their hospitalization.
Mesh-Begriff(e)	Adolescent ; Age Factors ; Anaphylaxis/epidemiology ; Anaphylaxis/etiology ; Child ; Child, Preschool ; Female ; Hospitalization/statistics & numerical data ; Humans ; Infant ; Length of Stay ; Male ; Peanut Hypersensitivity/epidemiology ; Respiration, Artificial/statistics & numerical data ; Texas/epidemiology ; Young Adult
Sprache	Englisch
Erscheinungsdatum	2011-05
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	185329-6
ISSN	1541-8243 ; 0038-4348
ISSN (online)	1541-8243
ISSN	0038-4348
DOI	10.1097/SMJ.0b013e318219583f
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Predictors of timely diagnostic follow-up after an abnormal Pap test among Hispanic women seeking care in El Paso, Texas.

Carrillo, Thelma / Montealegre, Jane R / Bracamontes, Christina G / Scheurer, Michael E / Follen, Michele / Mulla, Zuber D

BMC women's health

2021 Band 21, Heft 1, Seite(n) 11

Abstract: Background: Diagnostic follow-up of women with an abnormal Pap test is necessary to resolve the risk developing cervical cancer. The purpose of this study is to describe patient characteristics associated with timely receipt of a diagnostic colposcopy ... ...

Abstract	Background: Diagnostic follow-up of women with an abnormal Pap test is necessary to resolve the risk developing cervical cancer. The purpose of this study is to describe patient characteristics associated with timely receipt of a diagnostic colposcopy after an abnormal Pap test among Hispanic women in El Paso, a Texas-Mexico border city. Methods: We conducted a retrospective chart review of Hispanic patients seen at an academic colposcopy clinic following an abnormal Pap test. An optimal diagnostic interval to colposcopy was based on a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) quality indicator and was defined as receipt of colposcopy within 90 days or less from the date of an abnormal Pap test. Risk ratios (RR) were calculated by building a generalized linear model fit using a Poisson distribution, log link, and robust variance. Results: Overall, 177 of the 270 women (65.6%) received follow-up within an optimal diagnostic interval. After adjusting for other variables in the model, women who were 30 years of age or older were 32% more likely to have an optimal interval than younger women (adjusted RR = 1.32, P < 0.01). High school graduates were less likely than more educated women to have an optimal interval (adjusted RR = 0.68, P < 0.01). Participation in the NBCCEDP was not associated with receipt of follow-up within an optimal diagnostic interval. Conclusions: Compared with women with greater educational attainment, high school graduates were less likely to receive follow-up within an optimal diagnostic interval, as were younger (≤ 30 years) women compared with older women. Participation in the NBCCEDP was not associated with receipt of care within an optimal diagnostic interval.
Mesh-Begriff(e)	Aged ; Colposcopy ; Female ; Follow-Up Studies ; Hispanic Americans ; Humans ; Mexico ; Papanicolaou Test ; Pregnancy ; Retrospective Studies ; Texas ; Uterine Cervical Neoplasms/diagnosis ; Vaginal Smears
Sprache	Englisch
Erscheinungsdatum	2021-01-06
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, N.I.H., Extramural
ISSN	1472-6874
ISSN (online)	1472-6874
DOI	10.1186/s12905-020-01161-9
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Correction to: Predictors of timely diagnostic follow-up after an abnormal Pap test among Hispanic women seeking care in El Paso, Texas.

Carrillo, Thelma / Montealegre, Jane R / Bracamontes, Christina G / Scheurer, Michael E / Follen, Michele / Mulla, Zuber D

BMC women's health

2021 Band 21, Heft 1, Seite(n) 38

Sprache	Englisch
Erscheinungsdatum	2021-01-27
Erscheinungsland	England
Dokumenttyp	Published Erratum
ISSN	1472-6874
ISSN (online)	1472-6874
DOI	10.1186/s12905-021-01186-8
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Outcomes of Women Delivering at Very Advanced Maternal Age.

Arya, Sushila / Mulla, Zuber D / Plavsic, Sanja Kupesic

Journal of women's health (2002)

2018 Band 27, Heft 11, Seite(n) 1378–1384

Abstract: Background: The purpose of this study was to evaluate the maternal outcome in women with very advanced maternal age (VAMA) at childbirth (>45 years) compared to advanced maternal age (35-39 and 40-44 years).: Methods: Retrospective cohort study using ...

Abstract	Background: The purpose of this study was to evaluate the maternal outcome in women with very advanced maternal age (VAMA) at childbirth (>45 years) compared to advanced maternal age (35-39 and 40-44 years). Methods: Retrospective cohort study using the Texas Public Use Data File, years 2013-2014. Maternal age was a three-level variable: 35-39 (referent), 40-44, and 45-59 years (VAMA). Adjusted risk ratios (aRRs) for the two older age groups for various obstetrical and nonobstetrical complications were calculated from log-binomial regression models. Results: The sample consisted of 96,879 deliveries. In univariate analyses, a higher frequency (p < 0.05) of gestational diabetes, pregestational diabetes, chronic hypertension, pregnancy related hypertensive disorders, multiple gestation, oligohydramnios, polyhydramnios, placenta previa, postpartum hemorrhage, small for gestational age, intrauterine fetal death, and length of stay were noted in the two older maternal age groups compared to the youngest maternal age group. Multiple gestations were noted to be more frequent in the two older groups: the VAMA group had a 336% increase in their risk (aRR = 4.36, 95% CI: 3.68-5.17), while women 40-44 years of age experienced a 17% increase in their risk (aRR = 1.17, 95% CI: 1.07-1.29) compared to women in the 35-39 year group. The risk of the following outcomes was approximately doubled in VAMA women compared to the referent (all statistically significant): small for gestational age (aRR = 1.92), stillbirth (aRR = 2.12), and intrauterine fetal death (aRR = 1.96). Conclusions: This population-based study detected a dose-response association between maternal age and the risk of multiple maternal and fetal complications.
Mesh-Begriff(e)	Adult ; Cesarean Section/statistics & numerical data ; Delivery, Obstetric/methods ; Delivery, Obstetric/statistics & numerical data ; Female ; Humans ; Infant, Newborn ; Infant, Small for Gestational Age ; Maternal Age ; Middle Aged ; Pregnancy ; Pregnancy Complications/classification ; Pregnancy Complications/epidemiology ; Pregnancy Outcome/epidemiology ; Pregnancy, Multiple/statistics & numerical data ; Premature Birth/epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stillbirth/epidemiology ; Texas/epidemiology
Sprache	Englisch
Erscheinungsdatum	2018-07-17
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	1139774-3
ISSN	1931-843X ; 1059-7115 ; 1540-9996
ISSN (online)	1931-843X
ISSN	1059-7115 ; 1540-9996
DOI	10.1089/jwh.2018.7027
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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