OBJECTIVE: To quantify risk of Parkinson’s Disease (PD) after traumatic brain injury (TBI) sustai... more OBJECTIVE: To quantify risk of Parkinson’s Disease (PD) after traumatic brain injury (TBI) sustained in older-adulthood. BACKGROUND: TBI is a risk factor for PD. Risk of PD after recent TBI in older adults has proven difficult to assess due to possible confounding or reverse-causation if patients with incipient PD are more prone to injury. To mitigate this concern we compared TBI to non-TBI trauma (NTT). DESIGN/METHODS: Using administrative emergency department (ED) and inpatient data from California hospitals, we identified patients age 蠅55 with TBI (n=53,303) or NTT (n=114,269) diagnosed in 2005-2006 who didn’t have baseline PD or dementia and survived to discharge (total n=167,572). TBI was defined according to Centers for Disease Control ICD-9 criteria. NTT was defined as fracture, excluding fractures of head/neck. Using Cox proportional hazards ratios (adjusted for demographics, comorbidities, healthcare use, trauma severity), we estimated risk of PD after TBI or NTT through 12/31/2011, excluding patients with PD diagnoses made 1 TBI) were also assessed. RESULTS: TBI patients were significantly more likely to be diagnosed with PD compared to NTT patients (1.7[percnt] versus 1.1[percnt], p 1 TBI HR 1.85, 95[percnt] CI 1.56-2.18) suggested a dose-response. CONCLUSIONS: Among patients age 蠅55 presenting to an ED/inpatient setting with trauma, TBI is associated with a 45[percnt] increased risk of PD over the subsequent 5-7 years that is likely not entirely due to confounding or reverse-causation. Disclosure: Dr. Gardner has nothing to disclose. Dr. Burke has nothing to disclose. Dr. Nettiksimmons has nothing to disclose. Dr. Kaup has nothing to disclose. Dr. Barnes has received research support from Posit Science. Dr. Goldman has nothing to disclose. Dr. Tanner has received personal compensation for activities with Pfizer Inc. as a consultant. Dr. Yaffe has received personal compensation for activities with Pfizer Inc., Medivation, and Novartis.
Single nucleotide polymorphisms (SNPs) in and near ABCA7, BIN1, CASS4, CD2AP, CD33, CELF1, CLU, c... more Single nucleotide polymorphisms (SNPs) in and near ABCA7, BIN1, CASS4, CD2AP, CD33, CELF1, CLU, complement receptor 1 (CR1), EPHA1, EXOC3L2, FERMT2, HLA cluster (DRB5-DQA), INPP5D, MEF2C, MS4A cluster (MS4A3-MS4A6E), NME8, PICALM, PTK2B, SLC24A4, SORL1, and ZCWPW1 have been associated with Alzheimer's disease (AD) in large meta-analyses. We aimed to determine whether established AD-associated genes are associated with longitudinal cognitive decline by examining aggregate variation across these gene regions. In two single-sex cohorts of older, community-dwelling adults, we examined the association between SNPs in previously implicated gene regions and cognitive decline (age-adjusted person-specific cognitive slopes) using a Sequence Kernel Association Test (SKAT). In regions which showed aggregate significance, we examined the univariate association between individual SNPs in the region and cognitive decline. Only two of the original AD-associated SNPs were significantly associat...
To investigate the association between subjective memory complaints (SMCs) and long-term risk of ... more To investigate the association between subjective memory complaints (SMCs) and long-term risk of cognitive impairment in aging because most previous studies have followed individuals for only a few years. Participants were 1,107 cognitively normal, community-dwelling older women (aged 65 years and older at baseline) in a prospective study of aging. SMCs were assessed shortly after baseline and repeatedly over time with the yes/no question, "Do you feel you have more problems with memory than most?" Cognitive status 18 years later (normal or impaired with mild cognitive impairment or dementia) was determined by an expert panel. Using logistic regression, we investigated the association between SMCs over time and risk of cognitive impairment, adjusting for demographics, baseline cognition, and characteristics that differed between those with and without SMCs. At baseline, 8.0% of participants (n = 89) endorsed SMCs. Baseline SMCs were associated with increased risk of cognit...
The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvemen... more The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvement learning network of seven rural clinics in California. The goal of this network is to improve childhood obesity prevention and management practices at participating clinics. Our objective is to describe clinical practices regarding weight assessment and nutrition and physical activity counselling at participating clinics before implementation of the quality improvement intervention. Participants were 2-11 year old children seen for well-child care in 2010. Telephone surveys of English and Spanish-speaking parents were conducted within three days of their child's well-child visit to determine the content of counselling during the visit regarding nutrition and physical activity. Medical record reviews were conducted to determine clinicians' assessment of weight status. Twenty-seven clinicians conducted 144 well-child visits included in the study. Body mass index (BMI) was documented in 71% of medical records. Fewer than 10% of medical records had documentation of weight category. Sixty-nine percent of parents received counselling on physical activity and 62% reported receiving counselling on fruit and vegetable intake. Parents were counselled less frequently on breakfast intake, sweetened beverages, television and family meals. Parents of overweight/obese children did not receive more counselling than parents of children with a healthy BMI. Clinician-level effects accounted for moderately large amount of variation in counselling, but accounted for smaller variation in documentation of BMI and weight category. There was high between-clinic variation in documentation practices, with 54% of the total variance for documentation attributable to clinic-level effects. Rural clinicians, like those elsewhere, do not uniformly assess BMI percentile or counsel families on behavioural risk factors for paediatric obesity. There exists considerable clinician-level variation in counselling practices and clinic-site level correlation in documentation practices related to BMI percentile and weight category.
Balancing career and family obligations poses challenges to medical school faculty and contribute... more Balancing career and family obligations poses challenges to medical school faculty and contributes to dissatisfaction and attrition from academics. We examined the relationship between family setting and responsibilities, rank, and career and work-life satisfaction for faculty in a large U.S. medical school. Baseline faculty surveys were analyzed from the first year of a 4-year National Institutes of Health-funded study to evaluate awareness, knowledge, attitudes, and use of family friendly policies and career satisfaction. The study focus was on the impact of family responsibilities and characteristics of the faculty position (rank, clinical vs. nonclinical, and academic series) in multivariate comparisons between primary predictors and outcomes of interest. Both clinical and family responsibilities for children under 18 play a major and interacting role in satisfaction with career and work-life balance. Clinical faculty respondents without children at home reported significantly g...
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, Jan 21, 2015
To determine whether a diagnosis of sleep disturbance is associated with dementia in older vetera... more To determine whether a diagnosis of sleep disturbance is associated with dementia in older veterans. For this retrospective cohort study, we obtained medical record data from the Department of Veterans Affairs National Patient Care Database for 200,000 randomly selected veterans aged 55 years and older. Prevalent cases of dementia from the baseline period (2000-2003) were excluded, leaving an analytic sample of 179,738 male veterans. Follow-up took place from 2004 to 2011. The primary outcome was all-cause dementia, ascertained using International Classification of Disease, Ninth Revision codes. Sleep disturbance, the primary predictor, was also ascertained using these codes. After adjusting for potential confounders, those with sleep disturbance had a 27% increased risk of dementia (hazard ratio: 1.27; 95% confidence interval: 1.20-1.34). Sleep disturbance was associated with increased risk of dementia among a large cohort of older, primarily male veterans.
We sought to develop and validate a risk index for prospective cognitive decline in older adults ... more We sought to develop and validate a risk index for prospective cognitive decline in older adults based on blood-derived markers. The index was based on 8 markers that have been previously associated with cognitive aging: APOE genotype, plasma β-amyloid 42/40 ratio, telomere length, cystatin C, glucose, C-reactive protein, interleukin-6, and albumin. The outcome was person-specific cognitive slopes (Modified Mini-Mental State Examination) from 11 years of follow-up. A total of 1,445 older adults comprised the development sample. An index based on dichotomized markers was divided into low-, medium-, and high-risk categories; the risk categories were validated with the remaining sample (n = 739) using linear regression. Amyloid was measured on a subsample (n = 865) and was included only in a secondary index. The risk categories showed significant differences from each other and were predictive of prospective cognitive decline in the validation sample, even after adjustment for age and ...
The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvemen... more The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvement learning network of seven rural clinics in California. The goal of this network is to improve childhood obesity prevention and management practices at participating clinics. Our objective is to describe clinical practices regarding weight assessment and nutrition and physical activity counselling at participating clinics before implementation of the quality improvement intervention. Participants were 2-11 year old children seen for well-child care in 2010. Telephone surveys of English and Spanish-speaking parents were conducted within three days of their child's well-child visit to determine the content of counselling during the visit regarding nutrition and physical activity. Medical record reviews were conducted to determine clinicians' assessment of weight status. Twenty-seven clinicians conducted 144 well-child visits included in the study. Body mass index (BMI) was documen...
Adolescent relationship abuse (ARA) is a significant public health problem. Coaching Boys Into Me... more Adolescent relationship abuse (ARA) is a significant public health problem. Coaching Boys Into Men (CBIM) is an evidence-based ARA prevention program that trains coaches to deliver violence prevention messages to male athletes. Assessing acceptability and impact of CBIM on coaches may inform prevention efforts that involve these important adults in health promotion among youth. As part of a two-armed cluster-randomized controlled trial of CBIM in 16 high schools in Northern California, coaches completed baseline and postseason surveys (n = 176) to assess their attitudes and confidence delivering the program. Coaches in the intervention arm also participated in interviews (n = 36) that explored program acceptability, feasibility, and impact. Relative to controls, intervention coaches showed increases in confidence intervening when witnessing abusive behaviors among their athletes, greater bystander intervention, and greater frequency of violence-related discussions with athletes and ...
Objective: Traumatic brain injury (TBI) is thought to be a risk factor for Parkinson's diseas... more Objective: Traumatic brain injury (TBI) is thought to be a risk factor for Parkinson's disease (PD) but results are conflicting. Many studies do not account for confounding or reverse-causation. We sought to address these concerns by quantifying risk of PD after TBI compared to non-TBI trauma (NTT, defined as fractures). Methods: Using inpatient/emergency department (ED) ICD-9 code data for California hospitals from 2005-2006, we identified patients age ≥55 with TBI (n=52,393) or NTT (n=113,406) and without baseline PD or dementia who survived hospitalization. Using Kaplan-Meier estimates and Cox proportional hazards models (adjusted for age, sex, race/ethnicity, income, comorbidities, healthcare use, trauma severity), we estimated risk of PD after TBI during follow-up ending in 2011. We also assessed interaction with mechanism of injury (fall vs. non-fall) and effect of TBI-severity (mild vs. moderate/severe) and TBI-frequency (1 TBI vs. >1 TBI). Results: TBI patients were s...
OBJECTIVE: To quantify risk of Parkinson’s Disease (PD) after traumatic brain injury (TBI) sustai... more OBJECTIVE: To quantify risk of Parkinson’s Disease (PD) after traumatic brain injury (TBI) sustained in older-adulthood. BACKGROUND: TBI is a risk factor for PD. Risk of PD after recent TBI in older adults has proven difficult to assess due to possible confounding or reverse-causation if patients with incipient PD are more prone to injury. To mitigate this concern we compared TBI to non-TBI trauma (NTT). DESIGN/METHODS: Using administrative emergency department (ED) and inpatient data from California hospitals, we identified patients age 蠅55 with TBI (n=53,303) or NTT (n=114,269) diagnosed in 2005-2006 who didn’t have baseline PD or dementia and survived to discharge (total n=167,572). TBI was defined according to Centers for Disease Control ICD-9 criteria. NTT was defined as fracture, excluding fractures of head/neck. Using Cox proportional hazards ratios (adjusted for demographics, comorbidities, healthcare use, trauma severity), we estimated risk of PD after TBI or NTT through 12/31/2011, excluding patients with PD diagnoses made 1 TBI) were also assessed. RESULTS: TBI patients were significantly more likely to be diagnosed with PD compared to NTT patients (1.7[percnt] versus 1.1[percnt], p 1 TBI HR 1.85, 95[percnt] CI 1.56-2.18) suggested a dose-response. CONCLUSIONS: Among patients age 蠅55 presenting to an ED/inpatient setting with trauma, TBI is associated with a 45[percnt] increased risk of PD over the subsequent 5-7 years that is likely not entirely due to confounding or reverse-causation. Disclosure: Dr. Gardner has nothing to disclose. Dr. Burke has nothing to disclose. Dr. Nettiksimmons has nothing to disclose. Dr. Kaup has nothing to disclose. Dr. Barnes has received research support from Posit Science. Dr. Goldman has nothing to disclose. Dr. Tanner has received personal compensation for activities with Pfizer Inc. as a consultant. Dr. Yaffe has received personal compensation for activities with Pfizer Inc., Medivation, and Novartis.
Single nucleotide polymorphisms (SNPs) in and near ABCA7, BIN1, CASS4, CD2AP, CD33, CELF1, CLU, c... more Single nucleotide polymorphisms (SNPs) in and near ABCA7, BIN1, CASS4, CD2AP, CD33, CELF1, CLU, complement receptor 1 (CR1), EPHA1, EXOC3L2, FERMT2, HLA cluster (DRB5-DQA), INPP5D, MEF2C, MS4A cluster (MS4A3-MS4A6E), NME8, PICALM, PTK2B, SLC24A4, SORL1, and ZCWPW1 have been associated with Alzheimer's disease (AD) in large meta-analyses. We aimed to determine whether established AD-associated genes are associated with longitudinal cognitive decline by examining aggregate variation across these gene regions. In two single-sex cohorts of older, community-dwelling adults, we examined the association between SNPs in previously implicated gene regions and cognitive decline (age-adjusted person-specific cognitive slopes) using a Sequence Kernel Association Test (SKAT). In regions which showed aggregate significance, we examined the univariate association between individual SNPs in the region and cognitive decline. Only two of the original AD-associated SNPs were significantly associat...
To investigate the association between subjective memory complaints (SMCs) and long-term risk of ... more To investigate the association between subjective memory complaints (SMCs) and long-term risk of cognitive impairment in aging because most previous studies have followed individuals for only a few years. Participants were 1,107 cognitively normal, community-dwelling older women (aged 65 years and older at baseline) in a prospective study of aging. SMCs were assessed shortly after baseline and repeatedly over time with the yes/no question, "Do you feel you have more problems with memory than most?" Cognitive status 18 years later (normal or impaired with mild cognitive impairment or dementia) was determined by an expert panel. Using logistic regression, we investigated the association between SMCs over time and risk of cognitive impairment, adjusting for demographics, baseline cognition, and characteristics that differed between those with and without SMCs. At baseline, 8.0% of participants (n = 89) endorsed SMCs. Baseline SMCs were associated with increased risk of cognit...
The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvemen... more The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvement learning network of seven rural clinics in California. The goal of this network is to improve childhood obesity prevention and management practices at participating clinics. Our objective is to describe clinical practices regarding weight assessment and nutrition and physical activity counselling at participating clinics before implementation of the quality improvement intervention. Participants were 2-11 year old children seen for well-child care in 2010. Telephone surveys of English and Spanish-speaking parents were conducted within three days of their child's well-child visit to determine the content of counselling during the visit regarding nutrition and physical activity. Medical record reviews were conducted to determine clinicians' assessment of weight status. Twenty-seven clinicians conducted 144 well-child visits included in the study. Body mass index (BMI) was documented in 71% of medical records. Fewer than 10% of medical records had documentation of weight category. Sixty-nine percent of parents received counselling on physical activity and 62% reported receiving counselling on fruit and vegetable intake. Parents were counselled less frequently on breakfast intake, sweetened beverages, television and family meals. Parents of overweight/obese children did not receive more counselling than parents of children with a healthy BMI. Clinician-level effects accounted for moderately large amount of variation in counselling, but accounted for smaller variation in documentation of BMI and weight category. There was high between-clinic variation in documentation practices, with 54% of the total variance for documentation attributable to clinic-level effects. Rural clinicians, like those elsewhere, do not uniformly assess BMI percentile or counsel families on behavioural risk factors for paediatric obesity. There exists considerable clinician-level variation in counselling practices and clinic-site level correlation in documentation practices related to BMI percentile and weight category.
Balancing career and family obligations poses challenges to medical school faculty and contribute... more Balancing career and family obligations poses challenges to medical school faculty and contributes to dissatisfaction and attrition from academics. We examined the relationship between family setting and responsibilities, rank, and career and work-life satisfaction for faculty in a large U.S. medical school. Baseline faculty surveys were analyzed from the first year of a 4-year National Institutes of Health-funded study to evaluate awareness, knowledge, attitudes, and use of family friendly policies and career satisfaction. The study focus was on the impact of family responsibilities and characteristics of the faculty position (rank, clinical vs. nonclinical, and academic series) in multivariate comparisons between primary predictors and outcomes of interest. Both clinical and family responsibilities for children under 18 play a major and interacting role in satisfaction with career and work-life balance. Clinical faculty respondents without children at home reported significantly g...
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, Jan 21, 2015
To determine whether a diagnosis of sleep disturbance is associated with dementia in older vetera... more To determine whether a diagnosis of sleep disturbance is associated with dementia in older veterans. For this retrospective cohort study, we obtained medical record data from the Department of Veterans Affairs National Patient Care Database for 200,000 randomly selected veterans aged 55 years and older. Prevalent cases of dementia from the baseline period (2000-2003) were excluded, leaving an analytic sample of 179,738 male veterans. Follow-up took place from 2004 to 2011. The primary outcome was all-cause dementia, ascertained using International Classification of Disease, Ninth Revision codes. Sleep disturbance, the primary predictor, was also ascertained using these codes. After adjusting for potential confounders, those with sleep disturbance had a 27% increased risk of dementia (hazard ratio: 1.27; 95% confidence interval: 1.20-1.34). Sleep disturbance was associated with increased risk of dementia among a large cohort of older, primarily male veterans.
We sought to develop and validate a risk index for prospective cognitive decline in older adults ... more We sought to develop and validate a risk index for prospective cognitive decline in older adults based on blood-derived markers. The index was based on 8 markers that have been previously associated with cognitive aging: APOE genotype, plasma β-amyloid 42/40 ratio, telomere length, cystatin C, glucose, C-reactive protein, interleukin-6, and albumin. The outcome was person-specific cognitive slopes (Modified Mini-Mental State Examination) from 11 years of follow-up. A total of 1,445 older adults comprised the development sample. An index based on dichotomized markers was divided into low-, medium-, and high-risk categories; the risk categories were validated with the remaining sample (n = 739) using linear regression. Amyloid was measured on a subsample (n = 865) and was included only in a secondary index. The risk categories showed significant differences from each other and were predictive of prospective cognitive decline in the validation sample, even after adjustment for age and ...
The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvemen... more The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvement learning network of seven rural clinics in California. The goal of this network is to improve childhood obesity prevention and management practices at participating clinics. Our objective is to describe clinical practices regarding weight assessment and nutrition and physical activity counselling at participating clinics before implementation of the quality improvement intervention. Participants were 2-11 year old children seen for well-child care in 2010. Telephone surveys of English and Spanish-speaking parents were conducted within three days of their child's well-child visit to determine the content of counselling during the visit regarding nutrition and physical activity. Medical record reviews were conducted to determine clinicians' assessment of weight status. Twenty-seven clinicians conducted 144 well-child visits included in the study. Body mass index (BMI) was documen...
Adolescent relationship abuse (ARA) is a significant public health problem. Coaching Boys Into Me... more Adolescent relationship abuse (ARA) is a significant public health problem. Coaching Boys Into Men (CBIM) is an evidence-based ARA prevention program that trains coaches to deliver violence prevention messages to male athletes. Assessing acceptability and impact of CBIM on coaches may inform prevention efforts that involve these important adults in health promotion among youth. As part of a two-armed cluster-randomized controlled trial of CBIM in 16 high schools in Northern California, coaches completed baseline and postseason surveys (n = 176) to assess their attitudes and confidence delivering the program. Coaches in the intervention arm also participated in interviews (n = 36) that explored program acceptability, feasibility, and impact. Relative to controls, intervention coaches showed increases in confidence intervening when witnessing abusive behaviors among their athletes, greater bystander intervention, and greater frequency of violence-related discussions with athletes and ...
Objective: Traumatic brain injury (TBI) is thought to be a risk factor for Parkinson's diseas... more Objective: Traumatic brain injury (TBI) is thought to be a risk factor for Parkinson's disease (PD) but results are conflicting. Many studies do not account for confounding or reverse-causation. We sought to address these concerns by quantifying risk of PD after TBI compared to non-TBI trauma (NTT, defined as fractures). Methods: Using inpatient/emergency department (ED) ICD-9 code data for California hospitals from 2005-2006, we identified patients age ≥55 with TBI (n=52,393) or NTT (n=113,406) and without baseline PD or dementia who survived hospitalization. Using Kaplan-Meier estimates and Cox proportional hazards models (adjusted for age, sex, race/ethnicity, income, comorbidities, healthcare use, trauma severity), we estimated risk of PD after TBI during follow-up ending in 2011. We also assessed interaction with mechanism of injury (fall vs. non-fall) and effect of TBI-severity (mild vs. moderate/severe) and TBI-frequency (1 TBI vs. >1 TBI). Results: TBI patients were s...
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Papers by Jasmine Nettiksimmons