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Zachariah J.P.,Boston Childrens Hospital | Zachariah J.P.,Harvard University | Samnaliev M.,Clinical Research Program
Journal of Medical Economics | Year: 2015

Objectives: To project the cost-effectiveness of population-based echo screening to prevent rheumatic heart disease (RHD) consequences. Background: RHD is a leading cause of cardiovascular mortality and morbidity during adolescence and young adulthood in low- and middle-per capita income settings. Echocardiography-based screening approaches can dramatically expand the number of children identified at risk of progressive RHD. Cost-effectiveness analysis can inform public health agencies and payers about the net economic benefit of such large-scale population-based screening. Methods: A Markov model was constructed comparing a no-screen to echo screen approach. The echo screen program was modeled as a 2-staged screen of a cohort of 11-year-old children with initial short screening performed by dedicated technicians and follow-up complete echo by cardiologists. Penicillin RHD prophylaxis was modeled to only reduce rheumatic fever recurrence-related exacerbation. Quality-adjusted life years (QALYs) and societal costs (in 2010 Australian dollars) associated with each approach were estimated. One-way, two-way and probabilistic sensitivity analyses were performed on RHD prevalence and transition probabilities; echocardiography test characteristics; and societal level costs including supplies, transportation, and labor. Results: The incremental costs and QALYs of the screen compared to no screen strategy were -432 (95% CI=-1357 to 575) and 0.007 (95% CI=-0.0101 to 0.0237), respectively. The joint probability that the screen was both less costly and more effective exceeded 80%. Sensitivity analyses suggested screen strategy dominance depends mostly on the probability of transitioning out of sub-clinical RHD. Conclusion: Two-stage echo RHD screening and secondary prophylaxis may achieve modestly improved outcomes at lower cost compared to clinical detection and deserves closer attention from health policy stakeholders. © 2015 All rights reserved: reproduction in whole or part not permitted.

Richmond T.K.,Childrens Hospital Boston | Walls C.E.,Clinical Research Program | Bryn Austin S.,Childrens Hospital Boston
Obesity | Year: 2012

Our objective was to determine if sexual orientation groups differ in accuracy of BMI (kg/m2) calculated from self-reported height and weight and if weight status modifies possible differences. Using gender-stratified multiple linear regression to analyze Wave III of the National Longitudinal Study of Adolescent Health (n = 12,197), we examined the association of sexual orientation with BMI calculated from self-reported height and weight (self-reported BMI), controlling for BMI calculated from objectively measured height and weight (objectively measured BMI) as well as demographic, health, and behavioral variables. We tested for effect modification of the relationship between sexual orientation and self-reported BMI by objectively measured BMI. The population underestimated their BMI (females: Β = 0.87, P 0.001; males = 0.86, P 0.001). Sexual orientation groups differed little in their accuracy of reporting; only gay males had significant underreporting (Β = 0.37, P = 0.038) relative to their heterosexual peers. We found no evidence of effect modification of the relationship of sexual orientation and self-reported BMI by objectively measured BMI. With the exception of gay males, sexual orientation groups are consistent in their underreporting of BMI thus providing confidence in most comparisons of weight status based on self-report. Self-reporting of weight and height by gay males may exaggerate the differences in BMI between gay and heterosexual males. © 2011 The Obesity Society.

Gooding H.C.,Childrens Hospital Boston | Walls C.E.,Clinical Research Program | Richmond T.K.,Childrens Hospital Boston
Obesity | Year: 2012

Food insecurity has been associated with weight status in children and adults although results have been mixed. We aimed to identify whether food insecurity was associated with BMI in young adults and whether this association differed by gender and was modified by food stamp use and the presence of children in the home. Cross-sectional data from wave 4 (2007-2008) of the National Longitudinal Study of Adolescent Health were analyzed. Multiple linear regression was used to investigate the association between food insecurity and BMI in gender stratified models of young adult women (n = 7,116) and men (n = 6,604) controlling for age, race/ethnicity, income, education, physical activity, smoking, alcohol use, the presence of children in the home, and food stamp use in young adulthood and/or adolescence. Food insecurity was more common in young adult women (14%) than young adult men (9%). After controlling for a variety of individual variables, food insecure women had a BMI that was on average 0.9 kg/m 2 units higher than women who were food secure. This difference in BMI persisted after controlling for recent or past food stamp use and was not different among women with or without children in the household. No relationship was found between food insecurity and BMI in young adult men. Providers should inquire about food insecurity, especially when treating obesity, and policy initiatives should address the role of access to healthy food in those facing food insecurity. © 2011 The Obesity Society.

Dal-Re R.,Clinical Research Program | Caplan A.L.,New York University
European Journal of Clinical Pharmacology | Year: 2014

Purpose: Outcome reporting bias is a well-known fact in clinical research. It's critical since readers believe that published articles are reliable and accurate. Methods: The need for investigators to register the trials at the start have made it possible to compare the content of the published article with the registered information. Results: Nearly one-third of clinical trials have changed their primary outcome from the time of registration to publication. Conclusions: Editors should implement measures aimed at preventing outcome reporting bias. To this end, it is proposed that authors, when submitting a manuscript to a journal, should also submit all trial information they have posted on a registry. Authors should comment on the accuracy and completeness of the information provided in the manuscript with respect to that included on the registry. Peer review should only start after the editorial staff has checked the accuracy of the manuscript content with the trial's registered information. This straightforward, although admittedly somewhat demanding exercise for editorial staff, will help ensure the accuracy of published articles and, hence, reduce outcome reporting bias. © 2014 Springer-Verlag.

Routh J.C.,Childrens Hospital Boston | Routh J.C.,Harvard University | Graham D.A.,Clinical Research Program | Nelson C.P.,Childrens Hospital Boston
Journal of Urology | Year: 2010

Purpose: Anecdotal and lay press reports suggest that the incidence of pediatric urolithiasis is increasing but reliable data are lacking. The objective of this study was to examine trends in the epidemiology of urolithiasis at pediatric hospitals nationwide. Materials and Methods: The Pediatric Health Information System database is a national database covering 42 freestanding United States pediatric hospitals that captures inpatient admissions, and emergency department and outpatient surgery visits. We searched the Pediatric Health Information System database to identify children (18 years old or younger) treated for urolithiasis between 1999 and 2008. Patients with urolithiasis were measured as a proportion of the total number of patients seen per hospital annually. Trends were verified by comparing results to 2 other common pediatric diagnosesappendicitis and viral bronchiolitis. Results: We identified 7,921 children diagnosed with urolithiasis during the study period. The total number of children with urolithiasis seen in Pediatric Health Information System hospitals increased from 125 in 1999 to 1,389 in 2008. Mean number of stone cases per hospital per year increased from 13.9 to 32.6. Compared to total hospital patients, the proportion of patients with pediatric urolithiasis increased from 18.4 per 100,000 in 1999 to 57.0 per 100,000 in 2008, an adjusted annual increase of 10.6% (p <0.0001). Urolithiasis also increased compared to appendicitis (p <0.0001) and bronchiolitis (p <0.0001). Conclusions: Even after correcting for increases in total patient volume at Pediatric Health Information System hospitals, there has been a significant increase in the number of children diagnosed with and treated for urolithiasis at these hospitals in the last decade. © 2010 American Urological Association Education and Research, Inc.

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