Abstract: Sleep is a contributing factor to optimal health and vitality. However, to date, no national study has evaluated the simultaneous relationship between sleep disorders, quality, and duration with hypertension. Using data from National Health and Nutrition Examination Survey (NHANES) (2005 to 2008), hypertension was defined by current use of antihypertensive medication or systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Self-reported sleep disorders and duration were categorized from a single household interview question, and sleep quality was determined from several questions on sleeping habits. The prevalence of hypertension was 30.2% and 7.5%, and 33.0% and 52.1% reported having sleep disorders, short sleep, and poor sleep, respectively. After adjustment for demographic characteristics and comorbidities, having sleep disorders only was not significantly associated with hypertension (odds ratio [OR], 1.65; 95% confidence interval [CI], 0.73-3.77). However, this association was modified by sleep duration: significant associations were observed among adults with concurrent sleep disorders and short sleep (OR, 2.30; 95% CI, 1.49-3.56) and with sleep disorders, short sleep, and poor sleep (OR, 1.84; 95% CI, 1.13-2.98). These findings indicate an association between a combination of sleep problems and hypertension, but prospective studies are needed to understand the complex interplay between them.
Abstract: Stroke is an important contributor to maternal morbidity and mortality, but there are no recent data on trends in pregnancy-related hospitalizations that have involved a stroke. This report describes stroke hospitalizations for women in the antenatal, delivery, and postpartum periods from 1994 to 1995 to 2006 to 2007 and analyzes the changes in these hospitalizations over time.
Abstract: Depression and chronic disease have implications for women's overall health and future pregnancies. The objective of this study was to estimate the prevalence and predictors of diabetes and chronic disease risk factors among reproductive-age women with depression.
Abstract: OBJECTIVE: We sought to define the prevalence, trends, and outcomes of primary and secondary chronic hypertension in a population-based sample of deliveries. STUDY DESIGN: An estimated 56,494,634 deliveries were identified from the 1995 through 2008 Nationwide Inpatient Sample. The association of primary and secondary chronic hypertension with adverse fetal and maternal outcomes was evaluated using regression modeling and adjusted population-attributable fractions were calculated. RESULTS: During the study period, the prevalence of primary and secondary hypertension increased from 0.90% in 1995 through 1996 to 1.52% in 2007 through 2008 (P for trend < .001) and from 0.07% to 0.24% (P for trend < .001), respectively. The population-attributable fraction for chronic hypertension was considerable for many maternal adverse outcomes, including acute renal failure (21%), pulmonary edema (14%), preeclampsia (11%), and in-hospital mortality (10%). CONCLUSION: Primary and secondary chronic hypertension were both strongly associated with adverse pregnancy outcomes and accounted for a substantial fraction of maternal morbidity. Prioritizing research efforts in this area is needed.
Abstract: We describe hospitalization trends of invasive pneumococcal disease (IPD) among HIV-infected adolescents and adults since the introduction of highly active antiretroviral therapy (HAART) and the 7-valent pneumococcal conjugate vaccine (PCV7) in the United States, using the nation-wide inpatient sample. We estimated national trends of IPD hospitalizations during 3 periods: 1994-1995 (pre-HAART/pre-PCV7); 1998-1999 (HAART/pre-PCV7); and 2004-2005 (HAART/ early PCV7). The number of IPD hospitalizations among HIV-infected individuals declined 49.2% between 1994/1995 and 2004/2005. Compared with 1994-1995, the adjusted odds ratio for IPD hospitalizations of HIV-infected adolescents and adults in the United States during 2004-2005 was 0.64 (95% confidence interval: 0.54 to 0.77). The decrease was observed after introduction of the PCV7.
Abstract: We describe hospitalization trends of invasive pneumococcal disease (IPD) among human immunodeficiency virus-infected individuals <25 years of age since the introduction of highly active antiretroviral therapy (HAART) and the 7-valent pneumococcal conjugate vaccine (PCV7) in the United States, using the Nationwide Inpatient Sample. We estimated national trends of IPD hospitalizations during 3 periods: 1994 to 1995 (pre-HAART and pre-PCV7 era); 1998 to 1999 (HAART and pre-PCV7 era); and 2004 to 2005 (HAART and early PCV7 era). The number of IPD hospitalizations among human immunodeficiency virus-infected children and youth <25 years in the United States declined by 78.7% between 1994/1995 and 2004/2005 (P = 0.03). This decrease was more pronounced among younger children.
Abstract: To examine trends in the prevalence of diabetes among delivery hospitalizations in the U.S. and to describe the characteristics of these hospitalizations.
Abstract: Psychiatric illnesses commonly co-occur with HIV infection and such illnesses have been linked to women's poorer medication adherence and suicide. Using hospital discharge data from the 1994-2004 Nationwide Inpatient Sample, we conducted this study to describe hospitalizations with psychiatric diagnoses from 1994 through 2004 and evaluate the association of specific psychiatric disorders among hospitalized HIV-infected women in the USA with their lack of adherence to medical treatment and suicide attempt. Multivariable logistic regression analyses were used to examine trends in hospitalizations with psychiatric diagnoses among nonpregnant HIV-infected women and the association between specific disorders and women's lack of adherence to medical treatment and suicide attempt. Between 1994 and 2004, the estimated number of all hospitalizations among nonpregnant HIV-infected women increased by 8%, while the number of hospitalizations with a psychiatric diagnosis in this population increased by 73%. After adjusting for demographic factors and alcohol/substance abuse, we found that HIV-infected women were more likely to be hospitalized for mood (odds ratio (OR): 2.35; 95% confidence interval (CI): 1.93-2.88), anxiety (OR: 2.24, 95%CI: 1.74-2.88), and psychotic (OR: 1.45, 95%CI: 1.10-1.90) disorders in 2004 than in 1994. There was a significant association of alcohol/substance abuse with mood, adjustment, anxiety, personality, and psychotic disorders. Noncompliance with medical treatment was significantly associated with psychotic disorders, whereas suicide attempt/self-inflicted injury was significantly associated with mood, adjustment, anxiety, personality, and psychotic disorders. The number of hospitalizations with a psychiatric diagnosis among HIV-infected women in the USA has increased substantially. As HIV-infected women live longer, these results highlight the need for targeted public health interventions to address mental health issues in this population.
Abstract: The prevalence of diabetes in the United States is rising. As HIV-infected people live longer, they become more susceptible to chronic diseases such as diabetes. Additionally, some antiretroviral agents have been linked to impaired glucose tolerance and increased diabetes risk. To estimate the burden and trends of diabetes among hospitalized HIV-infected persons in the United States, we used data from the 1994-2004 Nationwide Inpatient Sample, a nationally representative survey of inpatient hospitalizations. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for demographic and hospital characteristics using logistic regression. Between 1994 and 2004, the rate of hospitalizations with a diabetes code per 100 hospitalizations increased from 3.9 to 8.4 (2.2 fold) among HIV-infected persons. Among HIV-uninfected people, the corresponding rate increased from 12.8 to 17.7 (1.4 fold). Since 1998, the mean age of HIV-infected hospitalized people with a diabetes diagnosis rose from 45 to 66 years and became similar to that of HIV-uninfected people. Compared to 1994-1996, in 2002-2004 the probability of hospitalizations with diabetes increased among both HIV-infected and HIV-uninfected persons (OR, 1.92, 95% CI, 1.79-2.05 and OR, 1.38, 95% CI, 1.36-1.40, respectively). Given the increasing prevalence of diabetes in hospitalized HIV-infected persons, it will be important to monitor the trends closely in addition to the effects of different types of antiretroviral regimens, in order to optimize comprehensive long-term care of HIV-infected persons.
Abstract: The purpose of this study was to describe trends in the prevalence of eating disorders among delivery hospitalizations in the United States from 1994 to 2004 and to compare hospital, demographic, and obstetrical outcomes among women with and without eating disorders.
Abstract: The objective of this study was to describe trends in hospital use by HIV-infected children and adolescents in the United States in the 10 years from 1994 (before highly active antiretroviral therapy) to 2003 (widespread use of highly active antiretroviral therapy).
Abstract: Transmission of human immunodeficiency virus (HIV) to the infant through breast-feeding is a major problem worldwide; however, the biological circumstances of such transmission remain unclear. Little characterization of breast milk CD4(+) T lymphocytes has been done so far.
Abstract: The purpose of this study was to describe hospital use patterns of children with sickle cell disease (SCD) and human immunodeficiency virus type-1 (HIV) infection in the United States.
Abstract: Highly active antiretroviral therapy (HAART) has improved the outlook of HIV-infected patients, but it has several side effects, particularly when it is used during pregnancy. Prior to the advent of HAART, HIV-infected women were at increased risk for adverse pregnancy outcomes. This report describes hospital use among pregnant HIV-infected women in the United States in the HAART era and compares hospitalizations for select morbidities in pregnant HIV-infected vs. uninfected women. In 2003, the majority of HIV-infected pregnant women were hospitalized in urban hospitals in the South and had Medicare or Medicaid as the expected payer. HIV-infected pregnant women had longer hospitalizations and incurred higher hospitalization charges than uninfected women. In addition, HIV-infected pregnant women were more likely to be hospitalized for major puerperal sepsis, sexually transmitted infections, urinary tract infections, bacterial infections, liver disorders, and preterm labor/delivery than uninfected women, even after adjusting for sociodemographic factors and comorbid conditions. No significant differences were observed in the rates of preeclampsia and antepartum hemorrhage in the two groups. HIV-infected pregnant women in the United States in the era of HAART remain at higher risk for several morbidities and adverse obstetrical outcomes than uninfected women.
Abstract: The literature on whether HIV infection and its complex antiretroviral treatments confer a higher risk for adverse pregnancy outcomes is controversial.
Abstract: The World Wide Web is being used increasingly as a resource for accessing health-related information. In our study, we identified types of health-related Web sites visited most often, determined how often patients shared Web-accessed health information with their doctors, and examined factors that encouraged Internet use for locating health-related information. We also compared health-related Internet use among people who did not have any type of chronic disease with people who reported having one or more chronic diseases.
Abstract: High blood pressure awareness, advice received from health care providers, and adoption of heart-healthy behaviors were assessed using the Healthstyles 2002 survey. About 20% of respondents reported that they had high blood pressure, and 53% of these were currently taking medications to lower blood pressure. Black men had the highest adjusted prevalence of high blood pressure (32%). Medication use among persons with high blood pressure was lower among Hispanics (45%) than among blacks (54%) and whites (54%). Persons reporting having high blood pressure were five times more likely to report having received advice from a health care professional to go on a diet or change eating habits (p<0.05) and reduce salt or sodium in their diet (p<0.05), but five times less likely to have received advice to exercise (p<0.05) than those reporting not having high blood pressure, after adjustment for differences in sex, race/ethnicity, and age. Persons with self-reported high blood pressure were also more likely to be making these modifications (p<0.05). Among people with high blood pressure, current medication use was associated with both receiving and following advice for diet change and salt reduction (p<0.05). Future initiatives are needed to improve the proportion of Hispanics and blacks taking prescribed medications to improve high blood pressure control and reduce risk for serious sequelae such as heart disease and stroke.
