by
Douglas Roblin;
Joshua Barzilay;
Dennis Tolsma;
Brandi Robinson;
Laura Schild;
Lee Cromwell;
Hayley Braun;
Rebecca Nash;
Joseph Gerth;
Enid Hunkeler;
Virginia P. Quinn;
Vin Tangpricha;
Michael Goodman
Purpose: We describe a novel algorithm for identifying transgender people and determining their male-to-female (MTF) or female-to-male (FTM) identity in electronic medical records of an integrated health system. Methods: A computer program scanned Kaiser Permanente Georgia electronic medical records from January 2006 through December 2014 for relevant diagnostic codes, and presence of specific keywords (e.g., "transgender" or "transsexual") in clinical notes. Eligibility was verified by review of de-identified text strings containing targeted keywords, and if needed, by an additional in-depth review of records. Once transgender status was confirmed, FTM or MTF identity was assessed using a second program and another round of text string reviews. Results: Of 813,737 members, 271 were identified as possibly transgender: 137 through keywords only, 25 through diagnostic codes only, and 109 through both codes and keywords. Of these individuals, 185 (68%, 95% confidence interval [CI]: 62%-74%) were confirmed as definitely transgender. The proportions (95% CIs) of definite transgender status among persons identified via keywords, diagnostic codes, and both were 45% (37%-54%), 56% (35%-75%), and 100% (96%-100%). Of the 185 definitely transgender people, 99 (54%, 95% CI: 46%-61%) were MTF, 84 (45%, 95% CI: 38%-53%) were FTM. For two persons, gender identity remained unknown. Prevalence of transgender people (per 100,000 members) was 4.4 (95% CI: 2.6-7.4) in 2006 and 38.7 (95% CI: 32.4-46.2) in 2014. Conclusions: The proposed method of identifying candidates for transgender health studies is low cost and relatively efficient. It can be applied in other similar health care systems.
by
Efrain Reisin;
John W. Graves;
Jose-Miguel Yamal;
Joshua Barzilay;
Sara L. Pressel;
Paula T. Einhorn;
Richard A. Dart;
Tamrat M. Retta;
Mohammad G. Saklayen;
Barry R. Davis
OBJECTIVE: Salsalate is a nonacetylated salicylate that lowers glucose levels in people with type 2 diabetes (T2D). Here we examined whether salsalate also lowered serum-protein-bound levels of early and advanced glycation end products (AGEs) that have been implicated in diabetic vascular complications. RESEARCH DESIGN AND METHODS: Participants were from the Targeting Inflammation Using Salsalate for Type 2 Diabetes (TINSAL-T2D) study, which examined the impact of salsalate treatment on hemoglobin A 1c (HbA 1c ) and a wide variety of other parameters. One hundred eighteen participants received salsalate, 3.5 g/day for 48 weeks, and 109 received placebo. Early glycation product levels (HbA1c and fructoselysine [measured as furosine]) and AGE levels (glyoxal and methylglyoxal hydroimidazolones [G- 1 H, MG- 1 H], carboxymethyllysine [CML] , carboxyethyllysine [CEL], pentosidine) were measured in patient serum samples. RESULTS: Forty-eight weeks of salsalate treatment lowered levels of HbA 1c and serum furosine ( P < 0.001) and CML compared with placebo. The AGEs CEL and G- 1 H and MG- 1 H levels were unchanged, whereas pentosidine levels increased more than twofold ( P < 0.001). Among salsalate users, increases in adiponectin levels were associated with lower HbA 1c levels during follow-up (P < 0.001). Changes in renal and in flammation factor levels were not associated with changes in levels of early or late glycation factors. Pentosidine level changes were unrelated to changes in levels of renal function, inflammation, or cytokines. CONCLUSIONS: Salsalate therapy was associated with a reduction in early but not late glycation end products. There was a paradoxical increase in serum pentosidine levels suggestive of an increase in oxidative stress or decreased clearance of pentosidine precursor.
by
Rachel E. Elam;
Petra Bůžková;
Joshua Barzilay;
Zeneng Wang;
Ina Nemet;
Matthew J. Budoff;
Jane A. Cauley;
Howard A. Fink;
Yujin Lee;
John A. Robbins;
Meng Wang;
Stanley L. Hazen;
Dariush Mozaffarian;
Laura D. Carbone
Context:
Gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) may adversely affect bone by inducing oxidative stress. Whether this translates into increased fracture risk in older adults is uncertain.
Objective:
Determine the associations of plasma TMAO with hip fracture and bone mineral density (BMD) in older adults
Design and Setting:
Cox hazard models and linear regression stratified by sex examined the associations of TMAO with hip fracture and BMD in the longitudinal cohort of the Cardiovascular Health Study
Participants:
5019 U.S. adults aged ≥65 years
Exposure:
Plasma TMAO
Main Outcome Measures:
Incident hip fractures; total hip BMD dual x-ray absorptiometry in a subset (n=1400)
Results:
Six hundred sixty-six incident hip fractures occurred during up to 26 years of follow-up (67,574 person-years). After multivariable adjustment, TMAO was not significantly associated with hip fracture (women: hazard ratio (HR) [95% confidence interval (CI)] of 1.00[0.92,1.09] per TMAO doubling; men: 1.12[0.95,1.33]). TMAO was also not associated with total hip BMD (women: BMD difference [95% CI] of 0.42 g/cm2*100 [−0.34,1.17] per TMAO doubling; men: 0.19[−1.04,1.42]). In exploratory analyses, we found an interaction between body mass index (BMI) and the association of TMAO with hip fracture (P<0.01). Higher TMAO was significantly associated with risk of hip fracture in adults with overweight or obesity (BMI≥25) (HR [95% CI]:1.17[1.05,1.31]), but not normal or underweight.
Conclusions:
Among older US men and women, TMAO was not significantly associated with risk of hip fracture or BMD overall. Exploratory analyses suggested a significant association between higher TMAO and hip fracture when BMI was elevated, which merits further study.