Characterization of CKD illness representation profiles using patient-level factors.

BACKGROUND: Illness perceptions are the unique perspective individuals have on their illness, based on their context and experiences, and are associated with patient outcomes including coping and adherence. The purpose of this study was to explore characteristics that may be driving membership in illness perceptions cluster groups for adults with chronic kidney disease (CKD). METHODS: This study was conducted within the multicenter longitudinal Chronic Renal Insufficiency Cohort (CRIC) Study. Cross-sectional data were collected and combined with CRIC data. Illness perceptions were measured using the Revised Illness Perception Questionnaire. Clustering analysis was conducted in R, and bivariate analysis including linear regression was performed in STATA 16. RESULTS: The sample (n = 197) had a mean age of 68, was 52% women, 53% non-White, and mean estimated glomerular filtration rate (eGFR) 56 ml/min/1.73 m2. Three cluster groups were identified, labeled as "Disengaged" (n = 20), "Well-Resourced" (n = 108), and "Distressed" (n = 69). The "Disengaged" group was characterized by low CKD knowledge, many recent hospitalization days, and the lowest perceived CKD burden. The "Well-Resourced" group was characterized by the highest levels of education, CKD knowledge, optimism, and medication adherence. The "Distressed" group was characterized by the highest levels of depression scores, comorbidity burden, CKD burden, CKD symptoms, and lowest optimism. Group membership significantly predicted the number of hospitalization days in adjusted analyses. CONCLUSIONS: Illness perceptions groups are associated with number of hospitalization days but are independent of many patient characteristics. Illness perceptions data could be used to tailor care for specific patients at risk for poor health outcomes.

Trends in pediatric passenger restraint use by rurality and age in Iowa, 2006-2019.

OBJECTIVE: Pediatric restraint use has increased over time in the United States, but motor vehicle crashes remain a leading cause of death for children under age 18. Age-appropriate use of safety restraints (safety seats, booster seats, seat belt) and statewide child restraint laws can greatly reduce injury or death in the event of a crash. Surveillance of pediatric restraint use and compliance with policy can inform prevention efforts. This study aims to examine time trends in pediatric restraint use and compliance with pediatric passenger laws in Iowa by rurality and age. METHODS: Fourteen years of Iowa observational pediatric restraint use data (2006-2019) are included in this cross-sectional study. Proportions of restrained youth by year, age, and rurality (rural, urban) were calculated. Log-linear models were used to compute the Annual Percent Change (APC) by year to explore trends in restraint use over time by rurality and by age group. RESULTS: A total of 42,007 observed pediatric passengers with complete data from 2006 to 2019 were included in this study. Restraint use increased across all years and all age groups observed, with the largest increases among the older pediatric age groups. However, restraint use was consistently highest among the youngest child passengers. With all study years combined, the odds of being compliantly restrained were 13% lower in rural areas (OR = 0.87, 95% CI = 0.80, 0.95) compared to urban areas. CONCLUSIONS: Restraint use was lower in rural areas and among older pediatric passengers, suggesting targeted efforts to increase restraint use among these groups may have the greatest impact on overall occupant protection.

Association between driver and child passenger restraint: Analysis of community-based observational survey data from 2005 to 2019.

INTRODUCTION: Crash data suggest an association between driver seatbelt use and child passenger restraint. However, community-based restraint use is largely unknown. We examined the association between driver seatbelt use and child restraint using data from a state-wide observational study. METHODS: Data from Iowa Child Passenger Restraint Survey, a representative state-wide survey of adult seat belt use and child passenger safety, were analyzed. A total of 44,996 child passengers age 0-17 years were observed from 2005 to 2019. Information about driver seatbelt use and child restraint was directly observed by surveyors and driver age was reported. Logistic regression was used to examine the association between driver seatbelt use and child restraint adjusting for vehicle type, community size, child seating position, child passenger age, and year. RESULTS: Over the 15-year study period, 4,114 (9.1%) drivers were unbelted, 3,692 (8.2%) children were completely unrestrained, and another 1,601 (3.6%) children were improperly restrained (analyzed as unrestrained). About half of unbelted drivers had their child passengers unrestrained (51.8%), while nearly all belted drivers had their child passengers properly restrained (92.3%). Compared with belted drivers, unbelted drivers had an 11-fold increased odds of driving an unrestrained child passenger (OR = 11.19, 95%CI = 10.36, 12.09). The association between driver seatbelt use and child restraint was much stronger among teenage drivers. Unbelted teenage drivers were 33-fold more likely (OR = 33.34, 95%CI = 21.11, 52.64) to have an unrestrained child passenger. CONCLUSION: These data suggest that efforts to increase driver seatbelt use may also have the added benefit of increasing child restraint use. Practical applications: Enforcement of child passenger laws and existing education programs for new drivers could be leveraged to increase awareness of the benefits of seatbelt use for both drivers themselves and their occupants. Interventions aimed at rural parents could emphasize the importance of child safety restraints.

Cardiovascular disease and risk of incident diabetes mellitus: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

BACKGROUND: Studies have reported an association between prevalent cardiovascular disease (CVD) and risk of diabetes mellitus (DM). However, factors that may explain the association remain unclear. We examined the association of prevalent CVD with incident DM and assessed whether weight gain and medication use may explain the association. METHODS: Data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Visit 1 (2008-2011) and Visit 2 (2014-2017) were used to compare incidence of DM among individuals with and without self-reported CVD at Visit 1. A total of 1899 individuals with self-reported CVD were matched to controls free of self-reported CVD at Visit 1 using 1:1 propensity score matching. Covariates included in the propensity model were sociodemographic characteristics, lifestyle factors, comorbid conditions, and study site. The effect of self-reported CVD on incident DM was examined using a generalized estimating equation. The mediating effects of weight gain and use of cardiovascular medications were evaluated. RESULTS: Covariate distributions were similar among individuals with and without self-reported CVD. The incidence of DM among persons with self-reported CVD was 15.3% vs 12.7% among those without self-reported CVD. Compared to individuals without self-reported CVD, individuals with self-reported CVD had a 24% increased risk for incident DM (odds ratio = 1.24, 95% confidence interval = 1.01, 1.51). The association between self-reported CVD and DM was mediated by the use of beta-blockers (proportion explained = 25.4%), statins (proportion explained = 18%), and diuretics (proportion explained = 8%). We found that weight gain did not explain the observed association. CONCLUSIONS: Prevalent cardiovascular disease was associated with a significant increased risk of incident diabetes. The observed association was partially explained by some medications used to manage CVD.

Association of elevated serum aminotransferase levels with chronic kidney disease measures: hispanic community health study/study of latinos.

BACKGROUND: Previous studies have shown an association between non-alcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD), but it is unclear whether the association is independent of metabolic syndrome. METHODS: Data from 13,006 participants aged 18 to 74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) without viral hepatitis, excessive alcohol consumption, or high transferrin saturation levels were analyzed. Suspected NAFLD was defined as presence of sex-specific elevations in serum aminotransferase levels (aspartate aminotransferase (AST) > 37 U/L or alanine aminotransferase (ALT) > 40 U/L for men and AST or ALT > 31 U/L for women). Logistic regression was used to examine cross-sectional associations of elevated serum aminotransferase levels with low estimated glomerular filtration rate (eGFR < 60 ml/min/1.73 m2 based on cystatin C), and with high urinary albumin-to-creatinine ratio (UACR) (> 17 mg/g in men and > 25 mg/ g in women) in separate models adjusting for demographic characteristics and metabolic syndrome. RESULTS: Mean (SD) age was 41 (0.27) years, and 45 % were male. Elevated serum aminotransferase levels were noted in 18.8 % of the population and were associated with greater odds of high UACR (OR = 1.31; 95 % CI = 1.10, 1.56) after adjusting for demographic characteristics; this association became non-significant after adjustment for metabolic syndrome (OR = 1.11, 95 % CI = 0.92, 1.33). In contrast, elevated serum aminotransferase levels were not associated with low eGFR (odds ratio (OR) = 0.73; 95 % confidence interval (CI) = 0.45, 1.18) after adjusting for covariates. CONCLUSIONS: In this sample of diverse U.S. Hispanic Latino adults, elevated serum aminotransferase levels were not independently associated with measures of CKD.

Association of Diet Quality Indices with Longitudinal Changes in Kidney Function in U.S. Hispanics/Latinos: Findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Background: Recent studies suggest an association between diet quality and incident CKD. However, Hispanics/Latinos were under-represented in these studies. We examined the relationship of diet quality with change in kidney function in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: Individuals who participated in HCHS/SOL visits 1 (2008-2011) and 2 (2014-2017) were analyzed (n=9921). We used Alternate Healthy Eating Index 2010 (AHEI-2010), Dietary Approaches to Stop Hypertension (DASH), and Mediterranean Diet (MeDS) scores as measures of dietary quality. Scores were calculated from two 24-hour dietary recalls administered at visit 1 and categorized into quartiles of each dietary score (higher quartiles correspond to a healthier diet). Kidney function was assessed at both visits using eGFR and urine albumin-creatinine ratio (UACR). Annualized change was computed as the difference in eGFR or UACR between visits divided by follow-up time in years. Weighted linear-regression models were used to examine the association between quartiles of each dietary quality index and annualized change in eGFR and UACR, adjusted for potential confounders. Results: At visit 1, the mean (SD) age of participants was 41 (0.28) years, and 56% were female. The baseline mean eGFR was 107.1 ml/min per 1.73 m2, and baseline median UACR was 6.1 mg/g. On average, eGFR declined by 0.65 ml/min per 1.73 m2 per year, and UACR increased by 0.79 mg/g per year over a 6-year period. Lower AHEI-2010 quartiles were associated with eGFR decline in a dose-response manner (P trend=0.02). Higher AHEI-2010 quartiles showed a trend toward lower annualized change in UACR, but the result did not reach significance. Neither MeDS nor DASH scores were associated with eGFR decline or change in UACR. Conclusions: Unhealthy diet, assessed at baseline by AHEI-2010, was associated with kidney-function decline over 6 years. Improving the quality of foods and nutrients according to the AHEI-2010 may help maintain kidney function in the Hispanic/Latino community.

Characteristics of agricultural and occupational injuries by workers' compensation and other payer sources.

BACKGROUND: Workers' compensation claims data are routinely used to identify and describe work-related injury for public health surveillance and research, yet the proportion of work-related injuries covered by workers' compensation, especially in the agricultural industry, is unknown. METHODS: Using data from the Iowa Trauma Registry, we determined the sensitivity and specificity of the use of workers' compensation as a payer source to ascertain work-related injuries requiring acute care comparing agriculture with other rural industries. RESULTS: The sensitivity of workers' compensation as a payer source to identify work-related agricultural injuries was 18.5%, suggesting that the large majority of occupational agricultural injuries would not be accurately identified through workers' compensation records. For rural nonagricultural, rural occupational injuries, the sensitivity was higher (64.2%). Work-related agricultural injuries were most frequently covered by private insurance (39.6%) and public insurance (21.4%), while rural nonagricultural injuries were most frequently covered by workers' compensation (65.2%). CONCLUSIONS: Workers' compensation claims data will not include the majority of work-related agricultural injuries.

Classifying and predicting risky driving among novice drivers: A group-based trajectory approach.

INTRODUCTION: Classifying risky driving among new teenage drivers is important for efficiently targeting driving interventions. We thoroughly investigated whether novice drivers can be clustered by their driving outcome profiles over time. METHODS: A sample of 51 newly licensed teen drivers was recruited and followed over a period of 20 weeks. An in-vehicle video recording system was used to gather data on dangerous driving events referred to as DDEs (elevated g-force, near-crash, and crash events), risky driving behaviors referred to as RDBs (e.g., running stop signs, cell phone use while driving), and miles traveled. The DDE and RDB weekly rates rate were determined by dividing the number of DDEs and RDBs in a week by the number of miles traveled in that week, respectively. Group-based trajectory modeling was used to map the clustering of DDE rate and RDB rate patterns over time and their associated covariates. RESULTS: Two distinct DDE rate patterns were found. The first group (69.1% of the study population) had a lower DDE rate which was consistent over time. The second had a higher DDE rate pattern (30.9%) and characterized by a rising trend in DDE rate followed by a steady decrease (inverted U-shaped pattern). Two RDB rate patterns were also identified: a lower RDB rate pattern (83.4% of the study population) and a higher RDB rate pattern (16.6%). RDB and DDE rate patterns were positively related, and therefore, co-occurred. The results also showed that males were more likely than females to be in the higher DDE and RDB rate patterns. CONCLUSION: The groups identified by trajectory models may be useful for targeting driving interventions to teens that would mostly benefit as the different trajectories may represent different crash risk levels. Practical applications: Parents using feedback devices to monitor the driving performance of their teens can use the initial weeks of independent driving to classify their teens as low or high-risk drivers. Teens making a very few DDEs during their early weeks of independent driving are likely to remain in the lower risk group over time and can be spared from monitoring and interventions. However, teens making many DDEs during their initial weeks of unsupervised driving are likely to continue to make even more DDEs and would require careful monitoring and targeted interventions.

Teen driver system modeling: a tool for policy analysis.

BACKGROUND: Motor vehicle crashes remain the leading cause of teen deaths in spite of preventive efforts. Prevention strategies could be advanced through new analytic approaches that allow us to better conceptualize the complex processes underlying teen crash risk. This may help policymakers design appropriate interventions and evaluate their impacts. METHODS: System Dynamics methodology was used as a new way of representing factors involved in the underlying process of teen crash risk. Systems dynamics modeling is relatively new to public health analytics and is a promising tool to examine relative influence of multiple interacting factors in predicting a health outcome. Dynamics models use explicit statements about the process being studied and depict how the elements within the system interact; this usually leads to discussion and improved insight. A Teen Driver System Model was developed by following an iterative process where causal hypotheses were translated into systems of differential equations. These equations were then simulated to test whether they can reproduce historical teen driving data. The Teen Driver System Model that we developed was calibrated on 47 newly-licensed teen drivers. These teens were recruited and followed over a period of 5-months. A video recording system was used to gather data on their driving events (elevated g-force, near-crash, and crash events) and miles traveled. RESULTS: The analysis suggests that natural risky driving improvement curve follows a course of a slow improvement, then a faster improvement, and finally a plateau: that is, an S-shaped decline in driving events. Individual risky driving behavior depends on initial risk and driving exposure. Our analysis also suggests that teen risky driving improvement curve is created endogenously by several feedback mechanisms. A feedback mechanism is a chain of variables interacting with each other in such a way they form a closed path of cause and effect relationships. CONCLUSIONS: Teen risky driving improvement process is created endogenously by several feedback mechanisms. The model proposed in the present article to reflect this improvement process can spark discussion, which may pinpoint to additional processes that can benefit from further empirical research and result in improved insight.

Does crash risk increase when emergency vehicles are driving with lights and sirens?

INTRODUCTION: Emergency vehicles, such as police, ambulances, and fire vehicles, need to arrive at the scene of emergencies as quickly as possible, and thus they often travel in emergency mode - using their lights and sirens and often bypassing traffic signals. We examined whether travelling in emergency mode increased crash risk among police, ambulance and fire vehicles. METHODS: We conducted a quasi-induced exposure analysis using data from the Iowa Crash Database for the period of 2005 through 2013. The data are maintained by the Iowa Department of Transportation (IADOT), Office of Driver Services (ODS) and includes all investigating police officer's reports of motor vehicle crashes. The quasi-induced exposure method is an approach to calculate crash risk in the absence of exposure data using vehicles without a contributing cause (did not contribute to the crash) as a proxy for the baseline driving population. RESULTS: From 2005 - 2013, police vehicles were involved in 2406 crashes and ambulances and fire vehicles were involved in 528 crashes. Police vehicles were 1.8 times more likely to crash while driving in emergency mode than usual mode; this was a statistically significant increase. Ambulance and fire vehicles were not more likely to crash in emergency mode compared with usual mode. For police, other factors that contributed to crash risk included gender, age, icy/snowy roads, unpaved roads, and intersections. For ambulances and fire vehicles, other factors that contributed to crash risk included gender, age, weekends, icy/snowy roads and urban locations. CONCLUSION: Crash risk increased when police vehicles drove with lights and sirens but did not increase for ambulance and fire vehicles. Further research is necessary to develop and evaluate strategies to mitigate crash risk among police vehicles. Cultural approaches which prioritize transportation safety in conjunction with reaching the scene as quickly as possible may be warranted.

Midlife Occupational Physical Activity and Risk of Disability Later in Life: National Health and Aging Trends Study.

OBJECTIVES: To determine whether midlife occupational physical activity (PA) is associated with disability in older adults and to test disease as a mediating variable. DESIGN: Cross-sectional study. SETTING: National Health and Aging Trends Study. PARTICIPANTS: Individuals aged 65 and older (N = 7,307). MEASUREMENTS: Participants were classified as to occupational PA levels by linking information from the Occupational Information Network database using standard occupation codes. Disability outcomes and covariates were obtained through in-person interviews. Logistic regression models were used to examine the association between occupational PA and disability. Structural equation modeling (SEM) was fitted to examine the mediating effect of disease. RESULTS: Occupations with high physically demands were associated with greater decline in functional capacity later in life. Individuals with occupations with high and very high PA were less likely to be able to perform activities of daily living than those with occupations with low PA. SEM showed that occupational PA has a very strong direct effect on disability (P < .001) and has an indirect effect on disability through disease (P = .003). The population attributable fraction for high occupational PA was 11%. CONCLUSION: Higher midlife occupational PA levels were significantly associated with poorer ability to perform activities of daily living in older age. Performing the optimal level of occupational PA may be instrumental in reducing disability later in life.

Trends in non-fatal agricultural injuries requiring trauma care.

BACKGROUND: Efforts to control agricultural injuries have been underway for years. Yet, very little is known about their trends over time. We examined trends in non-fatal agricultural injuries through analyzing injuries reported in a state trauma registry. METHODS: Using Iowa Trauma Registry data collected by the Iowa Department of Public Health, we examined trends in non-fatal agricultural injuries reported by acute care hospitals accredited as Level I, II, and III Trauma Care Facilities from 2005 to 2013. Rate ratios and corresponding 95 % confidence intervals were used to examine the burden of non-fatal agricultural injuries across this period. Negative binomial regression was used to calculate the average annual change in agricultural injury rates over time. Joinpoint regression analysis was used to examine the average annual change in the number of injuries over time. RESULTS: Between 2005 and 2013, a total of 1238 agricultural injuries were reported to the trauma registry by Level I, II and III trauma facilities. From 2005 to 2013, the rate of agricultural injuries per 100,000 hired workers, ranchers, and farm operators increased by 11 % for every unit increase in year and had nearly tripled over this time period. From 2005 to 2008 there was a significant annual increase of 31.74 % in the number of agricultural injuries whereas from 2008 to 2013 there was a non-significant annual increase of 3.70 %. The number of moderate and severe/critical injuries increased steadily and significantly over the study period, with annual percent increases of 13 and 20 %, respectively. CONCLUSION: Non-fatal agricultural injuries are rising, although the documented increases could be influenced in some part by treatment patterns in the trauma system, reporting bias or increases in farm work exposure. However, these issues do not likely account for all of the increase found, and this calls for an increase in priority of agricultural safety programs. Since the majority of research involves fatal injuries, information about non-fatal injuries may help inform new intervention approaches.

Knowledge, Attitude, and Practices Regarding Vector-borne Diseases in Western Jamaica.

BACKGROUND: Outbreaks of vector-borne diseases (VBDs) such as dengue and malaria can overwhelm health systems in resource-poor countries. Environmental management strategies that reduce or eliminate vector breeding sites combined with improved personal prevention strategies can help to significantly reduce transmission of these infections. OBJECTIVE: The aim of this study was to assess the knowledge, attitudes, and practices (KAPs) of residents in western Jamaica regarding control of mosquito vectors and protection from mosquito bites. METHODS: A cross-sectional study was conducted between May and August 2010 among patients or family members of patients waiting to be seen at hospitals in western Jamaica. Participants completed an interviewer-administered questionnaire on sociodemographic factors and KAPs regarding VBDs. KAP scores were calculated and categorized as high or low based on the number of correct or positive responses. Logistic regression analyses were conducted to identify predictors of KAP and linear regression analysis conducted to determine if knowledge and attitude scores predicted practice scores. FINDINGS: In all, 361 (85 men and 276 women) people participated in the study. Most participants (87%) scored low on knowledge and practice items (78%). Conversely, 78% scored high on attitude items. By multivariate logistic regression, housewives were 82% less likely than laborers to have high attitude scores; homeowners were 65% less likely than renters to have high attitude scores. Participants from households with 1 to 2 children were 3.4 times more likely to have high attitude scores compared with those from households with no children. Participants from households with at least 5 people were 65% less likely than those from households with fewer than 5 people to have high practice scores. By multivariable linear regression knowledge and attitude scores were significant predictors of practice score. CONCLUSION: The study revealed poor knowledge of VBDs and poor prevention practices among participants. It identified specific groups that can be targeted with vector control and personal protection interventions to decrease transmission of the infections.

High prevalence of falls, fear of falling, and impaired balance in older adults with pain in the United States: findings from the 2011 National Health and Aging Trends Study.

OBJECTIVES: To determine the prevalence of clinically relevant falls-related outcomes according to pain status in older adults in the United States. DESIGN: Cross-sectional analysis of the 2011 National Health and Aging Trends Study, a sample of Medicare enrollees aged 65 and older (response rate 71.0%). SETTING: In-person assessments were conducted in the home or residential care facility of the sampled study participant. PARTICIPANTS: Individuals aged 65 and older (n = 7,601, representing 35.3 million Medicare beneficiaries). MEASUREMENTS: Participants were asked whether they had been "bothered by pain" and the location of pain, as well as questions about balance and coordination, fear of falling, and falls. RESULTS: Fifty-three percent of the participants reported bothersome pain. The prevalence of recurrent falls in the past year (≥ 2 falls) was 19.5% in participants with pain and 7.4% in those without (age- and sex-adjusted prevalence ratio (PR) = 2.63, 95% confidence interval (CI) = 2.28-3.05). The prevalence of fear of falling that limits activity was 18.0% in those with pain and 4.4% in those without (adjusted PR = 3.98, 95% CI = 3.24-4.87). Prevalence of balance and falls outcomes increased with number of pain sites. For example, prevalence of problems with balance and coordination that limited activity was 6.6% in participants with no pain, 11.6% in those with one site of pain, 17.7% in those with two sites, 25.0% in those with three sites, and 41.4% in those with four or more sites (P < .001 for trend). Associations were robust to adjustment for several potential confounders, including cognitive and physical performance. CONCLUSION: Falls-related outcomes were substantially more common in older adults with pain than in those without. Accordingly, pain management strategies should be developed and evaluated for falls prevention.