International Journal of Environmental Research and Public Health
The disproportionate burden of cardiovascular diseases (CVD) and associated risk factors continue... more The disproportionate burden of cardiovascular diseases (CVD) and associated risk factors continues to exist in the Central Appalachian Region (CAR) of the United States. Previous studies to gather data about patient-centered care for CVD in the region were conducted through focus group discussions. There have not been any studies that used a collaborative framework where patients, providers, and community stakeholders were engaged as panelists. The objective of this study was to identify patient-centered research priorities for CVD in the CAR. We used a modified Delphi approach to administer questionnaires to forty-two stakeholder experts in six states representing the CAR between the fall of 2018 and the summer of 2019. Their responses were analyzed for rankings and derived priorities by research gaps. Six of the fifteen research priorities identified were patient-centered. These patient-centered priorities included shorter wait times for appointments; educating patients at their l...
Aim: To examine the association of cardiovascular disease risk factors with and their cumulative ... more Aim: To examine the association of cardiovascular disease risk factors with and their cumulative effect on coronary artery calcium in hard-to-reach asymptomatic patients with diabetes. Methods: A total of 2563 community-dwelling asymptomatic subjects from Central Appalachia participated in coronary artery calcium screening at a heart centre. Binary variable was used to indicate that coronary artery calcium was either present or absent. Independent variables consisted of demographic and modifiable risk factors and medical conditions. Descriptive statistics and multinomial logistic regression analyses were conducted. Results: In total, 55.8% and 13.7% of study participants had subclinical atherosclerosis (coronary artery calcium ⩾1) and diabetes, respectively. The presence of coronary artery calcium was higher in subjects with diabetes (68.5%) than those without (53.8%). Compared to subjects without diabetes with coronary artery calcium = 0, obesity, hypertension, hypercholesterolaemi...
To review the landmark studies in predicting obstructive coronary artery disease (CAD) in symptom... more To review the landmark studies in predicting obstructive coronary artery disease (CAD) in symptomatic patients with stable chest pain and identify better prediction tools and propose a simplified algorithm to guide the health care providers in identifying low risk patients to defer further testing. There are a few risk prediction models described for stable chest pain patients including Diamond-Forrester (DF), Duke Clinical Score (DCS), CAD Consortium Basic, Clinical, and Extended models. The CAD Consortium models demonstrated that DF and DCS models overestimate the probability of CAD. All CAD Consortium models performed well in the contemporary population. PROMISE trial secondary data results showed that a clinical tool using readily available ten very low-risk pre-test variables could discriminate low-risk patients to defer further testing safely. In the contemporary population, CAD Consortium Basic or Clinical model could be used with more confidence. Our proposed simple algorith...
International journal of public health, Jan 29, 2016
To estimate prevalence and identify correlates of age of smoking initiation among adolescents in ... more To estimate prevalence and identify correlates of age of smoking initiation among adolescents in Africa. Data (n = 16,519) were obtained from nationally representative Global Youth Tobacco Surveys in nine West African countries. Study outcome was adolescents' age of smoking initiation categorized into six groups: ≤7, 8 or 9, 10 or 11, 12 or 13, 14 or 15 and never-smoker. Explanatory variables included sex, parental or peer smoking behavior, exposure to tobacco industry promotions, and knowledge about smoking harm. Weighted multinomial logit models were conducted to determine correlates associated with adolescents' age of smoking initiation. Age of smoking initiation was as early as ≤7 years; prevalence estimates ranged from 0.7 % in Ghana at 10 or 11 years age to 9.6 % in Cote d'Ivoire at 12 or 13 years age. Males, exposures to parental or peer smoking, and industry promotions were identified as significant correlates. West African policymakers should adopt a preventive ...
The American journal of the medical sciences, 2015
Annually, over 150,000 cardiovascular events occur among individuals <65 years old in the Unit... more Annually, over 150,000 cardiovascular events occur among individuals <65 years old in the United States, including asymptomatic ones. Coronary artery calcium (CAC), a subclinical marker of coronary artery disease (CAD), enhances risk stratification among asymptomatic individuals. This study assessed the prevalence of CAC in a rural population and determined relationships between traditional risk factors for CAD and CAC scores. During January 2011 to December 2012, asymptomatic individuals from central Appalachia were screened for CAC in the largest tertiary cardiovascular institute. Based on Agatston scale, participants were grouped into 4 CAC scores: zero (CAC = 0), mild (CAC = 1-99), moderate (CAC = 100-399) and severe (CAC ≥ 400). Multinomial logistic regression was used to examine associations between potential risk factors of CAD and CAC score. Of 1,674 participants, 55.4% had positive CAC score (CAC > 0). Increasing age and being male were positively associated with high...
Background: Tennessee, the third largest tobacco-producing state in the U.S., enacted Non-Smokers... more Background: Tennessee, the third largest tobacco-producing state in the U.S., enacted Non-Smokers Protection Act in 2007, making most enclosed public places 100% smoke-free.We conducted a stakeholder analysis of why and how the diverse interests in the state collaborated to develop the policy and identified areas and opportunities for improvement. Methods: We utilized qualitative research approach by triangulating interviews with archival documents and news reports. We thematically coded archival documents and interviews using Nvivo software to identify strategic relationships, cross-cutting issues, and themes in policy development and implementation process. Additionally, the coded data was analyzed using descriptive characteristics. To date, we have conducted 21 interviews with legislators, government officials, representatives from NGO's, health organizations and businesses. Preliminary results: The interviews revealed that the smoke-free policy idea for Tennessee originated ...
Background: In late 2009, 12 countries including the US, initiated negotiations for the Trans-Pac... more Background: In late 2009, 12 countries including the US, initiated negotiations for the Trans-Pacific Partnership agreement (TPP). This which will create the largest free trade area in the world that will impact public health policy. From 2009 to 2013, the US Trade Representative (USTR) solicited public comments on the TPP. This paper aims to analyze these comments to identify key stakeholders and their arguments to inform ongoing negotiations and trade-health issues in international governance. Methods: Publicly available comments at USTR were imported into NVivo 10. Researchers did line-by-line coding of these comments to identify themes. The themes identified in the individual comments were then merged into larger conceptual themes and we report descriptive statistics involving these themes. Results: Of the 978 comments, 955 were from nongovernmental entities (92% by business groups, 7% by public health and environmental groups, and 1% by individuals). About 91% of comments were ...
Background: In 2003, the WHO Framework Convention on Tobacco Control (FCTC) was adopted to addres... more Background: In 2003, the WHO Framework Convention on Tobacco Control (FCTC) was adopted to address the globalization of tobacco epidemic. This study aims to understand the progression of FCTC implementation across 176 State Parties. Methods: A mixed-methods approach was used to qualitatively code components of >200 FCTC implementation reports with Nvivo to determine the extent of FCTC implementation. Descriptive statistics were reported to determine nature of implementation. Additionally, ANOVA was conducted to identify differences in implementation of FCTC provisions in each State Party, and across State Parties, the 6 WHO regions and by levels of income. Furthermore, cochrane- armitage trend test was conducted to evaluate the progress of FCTC implementation in each State during 2003-2012. Results: There were significant differences in FCTC implementation across State Parties and also by WHO regions, with highest variation for Articles 8, 12 and 13. While all countries have some...
Background: Over 2,800 bilateral investment treaties (BITs) exist worldwide. Unlike other treatie... more Background: Over 2,800 bilateral investment treaties (BITs) exist worldwide. Unlike other treaties, BITs are unique in international trade/investment because they grant investors the right to sue States. Recently, these have become challenging with Philip Morris' lawsuits against Uruguay (February 2010) and Australia (November 2011) that their tobacco control policies violated BITs with Switzerland and Hong Kong. This study investigates how tobacco industry utilized BITs to facilitate globalization of tobacco and undermine health policy. Methods: A standard qualitative research approach was used by triangulating information from tobacco documents' libraries, UN, World Bank, WHO and WTO. Additionally, relevant literature was searched from PubMed, JSTOR and Google Scholar. Hundreds of documents were retrieved and thematically analyzed using Nvivo v9.0 software. Results: Since mid-1960s, investor-State disputes have been settled mostly through World Bank's ICSID and UN Comm...
Background: The WHO Framework Convention on Tobacco Control (FCTC) was adopted in 2003 to address... more Background: The WHO Framework Convention on Tobacco Control (FCTC) was adopted in 2003 to address global tobacco epidemic. Of 41 (out of 47) countries in the WHO African region that have ratified the FCTC, 28 have enacted legislation to implement various provisions. This study aims to evaluate progression of FCTC implementation in the WHO African region and investigate activities of the tobacco industry in the process. Methods: Using a mixed-methods approach, three FCTC Parties in three phases of implementation: No legislation, no implementation (Zambia); Legislation, but no implementation (Tanzania); and Legislation plus implementation (Ghana) were selected. NVivo 10 was used to compare the FCTC implementation reports and delineate the levels of implementation of the FCTC Articles. Additionally, triangulation of interviews with key informants and archival documents was used to identify key characteristics that led to differences in implementation processes. Results: The FCTC has pu...
Background: Coronary artery calcium (CAC), detected by computed tomography (CT), is a sub-clinica... more Background: Coronary artery calcium (CAC), detected by computed tomography (CT), is a sub-clinical marker for coronary artery disease (CAD), the commonest form of cardiovascular disease (CVD), that predicts risk of future coronary events among asymptomatic individuals with high prognostic significance. This study aims to investigate the prevalence of CAC and its association with traditional and psychosocial risk factors of CAD in Central Appalachian. Methods: During 2011 to 2012, CAC was assessed by CT among asymptomatic individuals (n=1724) from Eastern Tennessee, Southwest Virginia, South Kentucky and Southwest North Carolina at a tertiary heart institute. Participants were self- or physician-referred and males aged 45-75 years and females aged 55-75 years were included in this study. Using standardized method, CAC scores were stratified as no (CAC = 0), mild (CAC = 0-99), moderate (CAC = 100-399), and high (CAC ≥ 400). Data on demographics (age, gender, race/ethnicity), lifestyle...
Journal of the American College of Cardiology, 2015
Background: Traditionally, hemodynamic significance of an intermediate lesion of a native coronar... more Background: Traditionally, hemodynamic significance of an intermediate lesion of a native coronary artery is determined by invasive angiographic assessment using fractional flow reserve (FFR). Non-invasive FFR assessment with computed tomography (CT-FFR) is a novel method for determining hemodynamic significance of a coronary artery lesion. The objective of our meta-analysis is to determine the diagnostic performance of CT-FFR in assessment of hemodynamically significant coronary artery stenosis. methods: PubMed and the Cochrane Center Register of Controlled Trials were searched through September 2014. Six original studies were found comparing CT-FFR to invasive FFR in evaluation of hemodynamic significance of coronary lesions (n=1247). Hemodynamically significant lesion was defined by an invasive FFR or CT-FFR of 0.80 or less. Sensitivity, specificity, positive predictive value, negative predictive value and positive and negative likelihood ratios (LR+ and LR-respectively) were calculated using hierarchical summary receiver operating curves and compared with bivariate random-effects model to accommodate for heterogeneity due to study design, population and diagnostic test accuracy. results: Total of 395 (32%) lesions were hemodynamically significant. The sensitivity, specificity, positive predictive value and negative predictive value of CT-FFR were 83%, 79%, 64% and 91% respectively. The LR+ was 3.9 and LR-was 0.2. conclusion: The results of our meta-analysis assessing diagnostic value of CT-FFR in 1247 native coronary artery lesions suggest that CT-FFR is a feasible non-invasive method in assessing hemodynamic significance of coronary artery lesions in patients with stable coronary artery disease. However, the LR assessment suggests the LR-may be used to defer an invasive study unless clinical indications indicate otherwise.
Tennessee medicine : journal of the Tennessee Medical Association, 2013
Tobacco use in Tennessee is higher than the national average and the decline in usage rate has st... more Tobacco use in Tennessee is higher than the national average and the decline in usage rate has stalled. The smokefree policy enacted to address this health issues contains several exemptions and does not repeal preemption that was introduced in 1994. In March 2013, the Governor unveiled Health and Wellness Initiatives, including reduction in the use of "tobacco products." To achieve this goal, two approaches should be considered and integrated into the initiative to facilitate the decline in tobacco use - policy and population. On the policy approach, the Governor should consider working for the repeal of state preemption of local tobacco control policymaking by the 1994 Prevention of Youth Access to Tobacco Act, and for removing exemption for certain venues from the Non-Smoker Protection Act. On the population approach, the Governor should consider focusing on young adults as an integral part of the target group and tobacco-free campuses as a strategy for addressing tobac...
Objective: To perform systematic review of the effects of screening for coronary artery calcium (... more Objective: To perform systematic review of the effects of screening for coronary artery calcium (CAC), a subclinical marker of coronary artery disease (CAD), on behavioral or lifestyle modification, risk perception, and medication adherence. Methods: We searched through CINAHL, PsychInfo, Web of Science, Cochrane Central Register of Control Trials, and PubMed (Medline) for studies on the effects of CAC screening in asymptomatic individuals across three major domains: behavioral modification, risk perception for CAD, and medication adherence. We extracted data from the retrieved studies, assessed and synthesized the information. Results: Of the 15 retrieved studies, three were randomized control trials and 12 were observational studies. CAC score was ascertained either as total score, quartiles, or standardized Agatston's ordinal scale. While all the 15 studies involved issues related to behavioral and medication adherence, four involved risk perception of CAD. Although no standardized approach was used in these studies, CAC screening enhanced medication adherence in 13 of the 15 studies, while the others were mixed. Conclusion: CAC screening improved medication adherence and could likely motivated individuals for beneficial behavioral or lifestyle changes to improve CAD. The mixed results suggest the need for further research because screening for subclinical atherosclerosis has significant implications for early detection and prevention of future cardiovascular events by aggressive risk factors modification.
International Journal of Environmental Research and Public Health
The disproportionate burden of cardiovascular diseases (CVD) and associated risk factors continue... more The disproportionate burden of cardiovascular diseases (CVD) and associated risk factors continues to exist in the Central Appalachian Region (CAR) of the United States. Previous studies to gather data about patient-centered care for CVD in the region were conducted through focus group discussions. There have not been any studies that used a collaborative framework where patients, providers, and community stakeholders were engaged as panelists. The objective of this study was to identify patient-centered research priorities for CVD in the CAR. We used a modified Delphi approach to administer questionnaires to forty-two stakeholder experts in six states representing the CAR between the fall of 2018 and the summer of 2019. Their responses were analyzed for rankings and derived priorities by research gaps. Six of the fifteen research priorities identified were patient-centered. These patient-centered priorities included shorter wait times for appointments; educating patients at their l...
Aim: To examine the association of cardiovascular disease risk factors with and their cumulative ... more Aim: To examine the association of cardiovascular disease risk factors with and their cumulative effect on coronary artery calcium in hard-to-reach asymptomatic patients with diabetes. Methods: A total of 2563 community-dwelling asymptomatic subjects from Central Appalachia participated in coronary artery calcium screening at a heart centre. Binary variable was used to indicate that coronary artery calcium was either present or absent. Independent variables consisted of demographic and modifiable risk factors and medical conditions. Descriptive statistics and multinomial logistic regression analyses were conducted. Results: In total, 55.8% and 13.7% of study participants had subclinical atherosclerosis (coronary artery calcium ⩾1) and diabetes, respectively. The presence of coronary artery calcium was higher in subjects with diabetes (68.5%) than those without (53.8%). Compared to subjects without diabetes with coronary artery calcium = 0, obesity, hypertension, hypercholesterolaemi...
To review the landmark studies in predicting obstructive coronary artery disease (CAD) in symptom... more To review the landmark studies in predicting obstructive coronary artery disease (CAD) in symptomatic patients with stable chest pain and identify better prediction tools and propose a simplified algorithm to guide the health care providers in identifying low risk patients to defer further testing. There are a few risk prediction models described for stable chest pain patients including Diamond-Forrester (DF), Duke Clinical Score (DCS), CAD Consortium Basic, Clinical, and Extended models. The CAD Consortium models demonstrated that DF and DCS models overestimate the probability of CAD. All CAD Consortium models performed well in the contemporary population. PROMISE trial secondary data results showed that a clinical tool using readily available ten very low-risk pre-test variables could discriminate low-risk patients to defer further testing safely. In the contemporary population, CAD Consortium Basic or Clinical model could be used with more confidence. Our proposed simple algorith...
International journal of public health, Jan 29, 2016
To estimate prevalence and identify correlates of age of smoking initiation among adolescents in ... more To estimate prevalence and identify correlates of age of smoking initiation among adolescents in Africa. Data (n = 16,519) were obtained from nationally representative Global Youth Tobacco Surveys in nine West African countries. Study outcome was adolescents' age of smoking initiation categorized into six groups: ≤7, 8 or 9, 10 or 11, 12 or 13, 14 or 15 and never-smoker. Explanatory variables included sex, parental or peer smoking behavior, exposure to tobacco industry promotions, and knowledge about smoking harm. Weighted multinomial logit models were conducted to determine correlates associated with adolescents' age of smoking initiation. Age of smoking initiation was as early as ≤7 years; prevalence estimates ranged from 0.7 % in Ghana at 10 or 11 years age to 9.6 % in Cote d'Ivoire at 12 or 13 years age. Males, exposures to parental or peer smoking, and industry promotions were identified as significant correlates. West African policymakers should adopt a preventive ...
The American journal of the medical sciences, 2015
Annually, over 150,000 cardiovascular events occur among individuals <65 years old in the Unit... more Annually, over 150,000 cardiovascular events occur among individuals <65 years old in the United States, including asymptomatic ones. Coronary artery calcium (CAC), a subclinical marker of coronary artery disease (CAD), enhances risk stratification among asymptomatic individuals. This study assessed the prevalence of CAC in a rural population and determined relationships between traditional risk factors for CAD and CAC scores. During January 2011 to December 2012, asymptomatic individuals from central Appalachia were screened for CAC in the largest tertiary cardiovascular institute. Based on Agatston scale, participants were grouped into 4 CAC scores: zero (CAC = 0), mild (CAC = 1-99), moderate (CAC = 100-399) and severe (CAC ≥ 400). Multinomial logistic regression was used to examine associations between potential risk factors of CAD and CAC score. Of 1,674 participants, 55.4% had positive CAC score (CAC > 0). Increasing age and being male were positively associated with high...
Background: Tennessee, the third largest tobacco-producing state in the U.S., enacted Non-Smokers... more Background: Tennessee, the third largest tobacco-producing state in the U.S., enacted Non-Smokers Protection Act in 2007, making most enclosed public places 100% smoke-free.We conducted a stakeholder analysis of why and how the diverse interests in the state collaborated to develop the policy and identified areas and opportunities for improvement. Methods: We utilized qualitative research approach by triangulating interviews with archival documents and news reports. We thematically coded archival documents and interviews using Nvivo software to identify strategic relationships, cross-cutting issues, and themes in policy development and implementation process. Additionally, the coded data was analyzed using descriptive characteristics. To date, we have conducted 21 interviews with legislators, government officials, representatives from NGO's, health organizations and businesses. Preliminary results: The interviews revealed that the smoke-free policy idea for Tennessee originated ...
Background: In late 2009, 12 countries including the US, initiated negotiations for the Trans-Pac... more Background: In late 2009, 12 countries including the US, initiated negotiations for the Trans-Pacific Partnership agreement (TPP). This which will create the largest free trade area in the world that will impact public health policy. From 2009 to 2013, the US Trade Representative (USTR) solicited public comments on the TPP. This paper aims to analyze these comments to identify key stakeholders and their arguments to inform ongoing negotiations and trade-health issues in international governance. Methods: Publicly available comments at USTR were imported into NVivo 10. Researchers did line-by-line coding of these comments to identify themes. The themes identified in the individual comments were then merged into larger conceptual themes and we report descriptive statistics involving these themes. Results: Of the 978 comments, 955 were from nongovernmental entities (92% by business groups, 7% by public health and environmental groups, and 1% by individuals). About 91% of comments were ...
Background: In 2003, the WHO Framework Convention on Tobacco Control (FCTC) was adopted to addres... more Background: In 2003, the WHO Framework Convention on Tobacco Control (FCTC) was adopted to address the globalization of tobacco epidemic. This study aims to understand the progression of FCTC implementation across 176 State Parties. Methods: A mixed-methods approach was used to qualitatively code components of >200 FCTC implementation reports with Nvivo to determine the extent of FCTC implementation. Descriptive statistics were reported to determine nature of implementation. Additionally, ANOVA was conducted to identify differences in implementation of FCTC provisions in each State Party, and across State Parties, the 6 WHO regions and by levels of income. Furthermore, cochrane- armitage trend test was conducted to evaluate the progress of FCTC implementation in each State during 2003-2012. Results: There were significant differences in FCTC implementation across State Parties and also by WHO regions, with highest variation for Articles 8, 12 and 13. While all countries have some...
Background: Over 2,800 bilateral investment treaties (BITs) exist worldwide. Unlike other treatie... more Background: Over 2,800 bilateral investment treaties (BITs) exist worldwide. Unlike other treaties, BITs are unique in international trade/investment because they grant investors the right to sue States. Recently, these have become challenging with Philip Morris' lawsuits against Uruguay (February 2010) and Australia (November 2011) that their tobacco control policies violated BITs with Switzerland and Hong Kong. This study investigates how tobacco industry utilized BITs to facilitate globalization of tobacco and undermine health policy. Methods: A standard qualitative research approach was used by triangulating information from tobacco documents' libraries, UN, World Bank, WHO and WTO. Additionally, relevant literature was searched from PubMed, JSTOR and Google Scholar. Hundreds of documents were retrieved and thematically analyzed using Nvivo v9.0 software. Results: Since mid-1960s, investor-State disputes have been settled mostly through World Bank's ICSID and UN Comm...
Background: The WHO Framework Convention on Tobacco Control (FCTC) was adopted in 2003 to address... more Background: The WHO Framework Convention on Tobacco Control (FCTC) was adopted in 2003 to address global tobacco epidemic. Of 41 (out of 47) countries in the WHO African region that have ratified the FCTC, 28 have enacted legislation to implement various provisions. This study aims to evaluate progression of FCTC implementation in the WHO African region and investigate activities of the tobacco industry in the process. Methods: Using a mixed-methods approach, three FCTC Parties in three phases of implementation: No legislation, no implementation (Zambia); Legislation, but no implementation (Tanzania); and Legislation plus implementation (Ghana) were selected. NVivo 10 was used to compare the FCTC implementation reports and delineate the levels of implementation of the FCTC Articles. Additionally, triangulation of interviews with key informants and archival documents was used to identify key characteristics that led to differences in implementation processes. Results: The FCTC has pu...
Background: Coronary artery calcium (CAC), detected by computed tomography (CT), is a sub-clinica... more Background: Coronary artery calcium (CAC), detected by computed tomography (CT), is a sub-clinical marker for coronary artery disease (CAD), the commonest form of cardiovascular disease (CVD), that predicts risk of future coronary events among asymptomatic individuals with high prognostic significance. This study aims to investigate the prevalence of CAC and its association with traditional and psychosocial risk factors of CAD in Central Appalachian. Methods: During 2011 to 2012, CAC was assessed by CT among asymptomatic individuals (n=1724) from Eastern Tennessee, Southwest Virginia, South Kentucky and Southwest North Carolina at a tertiary heart institute. Participants were self- or physician-referred and males aged 45-75 years and females aged 55-75 years were included in this study. Using standardized method, CAC scores were stratified as no (CAC = 0), mild (CAC = 0-99), moderate (CAC = 100-399), and high (CAC ≥ 400). Data on demographics (age, gender, race/ethnicity), lifestyle...
Journal of the American College of Cardiology, 2015
Background: Traditionally, hemodynamic significance of an intermediate lesion of a native coronar... more Background: Traditionally, hemodynamic significance of an intermediate lesion of a native coronary artery is determined by invasive angiographic assessment using fractional flow reserve (FFR). Non-invasive FFR assessment with computed tomography (CT-FFR) is a novel method for determining hemodynamic significance of a coronary artery lesion. The objective of our meta-analysis is to determine the diagnostic performance of CT-FFR in assessment of hemodynamically significant coronary artery stenosis. methods: PubMed and the Cochrane Center Register of Controlled Trials were searched through September 2014. Six original studies were found comparing CT-FFR to invasive FFR in evaluation of hemodynamic significance of coronary lesions (n=1247). Hemodynamically significant lesion was defined by an invasive FFR or CT-FFR of 0.80 or less. Sensitivity, specificity, positive predictive value, negative predictive value and positive and negative likelihood ratios (LR+ and LR-respectively) were calculated using hierarchical summary receiver operating curves and compared with bivariate random-effects model to accommodate for heterogeneity due to study design, population and diagnostic test accuracy. results: Total of 395 (32%) lesions were hemodynamically significant. The sensitivity, specificity, positive predictive value and negative predictive value of CT-FFR were 83%, 79%, 64% and 91% respectively. The LR+ was 3.9 and LR-was 0.2. conclusion: The results of our meta-analysis assessing diagnostic value of CT-FFR in 1247 native coronary artery lesions suggest that CT-FFR is a feasible non-invasive method in assessing hemodynamic significance of coronary artery lesions in patients with stable coronary artery disease. However, the LR assessment suggests the LR-may be used to defer an invasive study unless clinical indications indicate otherwise.
Tennessee medicine : journal of the Tennessee Medical Association, 2013
Tobacco use in Tennessee is higher than the national average and the decline in usage rate has st... more Tobacco use in Tennessee is higher than the national average and the decline in usage rate has stalled. The smokefree policy enacted to address this health issues contains several exemptions and does not repeal preemption that was introduced in 1994. In March 2013, the Governor unveiled Health and Wellness Initiatives, including reduction in the use of "tobacco products." To achieve this goal, two approaches should be considered and integrated into the initiative to facilitate the decline in tobacco use - policy and population. On the policy approach, the Governor should consider working for the repeal of state preemption of local tobacco control policymaking by the 1994 Prevention of Youth Access to Tobacco Act, and for removing exemption for certain venues from the Non-Smoker Protection Act. On the population approach, the Governor should consider focusing on young adults as an integral part of the target group and tobacco-free campuses as a strategy for addressing tobac...
Objective: To perform systematic review of the effects of screening for coronary artery calcium (... more Objective: To perform systematic review of the effects of screening for coronary artery calcium (CAC), a subclinical marker of coronary artery disease (CAD), on behavioral or lifestyle modification, risk perception, and medication adherence. Methods: We searched through CINAHL, PsychInfo, Web of Science, Cochrane Central Register of Control Trials, and PubMed (Medline) for studies on the effects of CAC screening in asymptomatic individuals across three major domains: behavioral modification, risk perception for CAD, and medication adherence. We extracted data from the retrieved studies, assessed and synthesized the information. Results: Of the 15 retrieved studies, three were randomized control trials and 12 were observational studies. CAC score was ascertained either as total score, quartiles, or standardized Agatston's ordinal scale. While all the 15 studies involved issues related to behavioral and medication adherence, four involved risk perception of CAD. Although no standardized approach was used in these studies, CAC screening enhanced medication adherence in 13 of the 15 studies, while the others were mixed. Conclusion: CAC screening improved medication adherence and could likely motivated individuals for beneficial behavioral or lifestyle changes to improve CAD. The mixed results suggest the need for further research because screening for subclinical atherosclerosis has significant implications for early detection and prevention of future cardiovascular events by aggressive risk factors modification.
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Papers by Hadii Mamudu