Browsing by Author "Wessel, Jennifer"

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    Clinical characteristics and 12-month outcomes of patients with valvular and non-valvular atrial fibrillation in Kenya
    (PLOS, 2017-09-21) Temu, Tecla M.; Lane, Kathleen A.; Shen, Changyu; Ng'ang'a, Loise; Akwanalo, Constantine O.; Chen, Peng-Sheng; Emonyi, Wilfred; Heckbert, Susan R.; Koech, Myra M.; Manji, Imran; Vatta, Matteo; Velazquez, Eric J.; Wessel, Jennifer; Kimaiyo, Sylvester; Inui, Thomas S.; Bloomfield, Gerald S.; Biostatistics, School of Public Health
    Background Atrial fibrillation (AF) is a major contributor to the global cardiovascular disease burden. The clinical profile and outcomes of AF patients with valvular heart diseases in sub-Saharan Africa (SSA) have not been adequately described. We assessed clinical features and 12-month outcomes of patients with valvular AF (vAF) in comparison to AF patients without valvular heart disease (nvAF) in western Kenya. Methods We performed a cohort study with retrospective data gathering to characterize risk factors and prospective data collection to characterize their hospitalization, stroke and mortality rates. Results The AF patients included 77 with vAF and 69 with nvAF. The mean (SD) age of vAF and nvAF patients were 37.9(14.5) and 69.4(12.3) years, respectively. There were significant differences (p<0.001) between vAF and nvAF patients with respect to female sex (78% vs. 55%), rates of hypertension (29% vs. 73%) and heart failure (10% vs. 49%). vAF patients were more likely to be taking anticoagulation therapy compared to those with nvAF (97% vs. 76%; p<0.01). After 12-months of follow-up, the overall mortality, hospitalization and stroke rates for vAF patients were high, at 10%, 34% and 5% respectively, and were similar to the rates in the nvAF patients (15%, 36%, and 5%, respectively). Conclusion Despite younger age and few comorbid conditions, patients with vAF in this developing country setting are at high risk for nonfatal and fatal outcomes, and are in need of interventions to improve short and long-term outcomes.
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    The Continuing Evolution of Precision Health in Type 2 Diabetes: Achievements and Challenges
    (Springer, 2019) Lin, Yuan; Wessel, Jennifer; Epidemiology, School of Public Health
    Purpose of Review The purpose of this review was to summarize recent advances in the genomics of type 2 diabetes (T2D) and to highlight current initiatives to advance precision health. Recent Findings Generation of multi-omic data to measure each of the “biologic layers,” developments in describing genomic function and annotation in T2D relevant tissue, along with the increasing recognition that T2D is a heterogeneous disease, and large-scale collaborations have all contributed to advancing our understanding of the molecular basis of T2D. Summary Substantial advances have been made in understanding the molecular basis of T2D pathogenesis, such that precision health diabetes is increasingly becoming a reality. For precision diabetes to become a routine in clinical and public health, additional large-scale multi-omic initiatives are needed along with better assessment of our environment to delineate an individual’s diabetes subtype for improved detection and management.
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    Epidemiological Analysis of SARS-CoV-2: Three Papers Examining Health Status, Response Bias, and Strategies for Engagment
    (2022-02) Duszynski, Thomas J.; Wessel, Jennifer; Dixon, Brian E.; Li, Xin; Menachemi, Nir
    The emergence of the global SARS-CoV-2 pandemic created tremendous impact on humanity beginning in late 2019. Public health researchers at Indiana University Richard M. Fairbanks School of Public Health responded by conducting research into the etiological profile of the virus, including a large Indiana state-wide population-based prevalence study in early 2020. Methods Data on demographics, tobacco use, health status, and reasons for participating in the population prevalence study were used to conduct three retrospective cross-sectional studies. The first study assessed the association of self-reported health and tobacco behaviors with COVID-19 infection (n=8,241). The second study used successive wave analysis to assess nonresponse bias (n=3,658). Finally, participants demographics were characterized by who responded to text, email, phone calls, or postcards and by the number of prompts needed to elicit participation (n= 3,658). Results The first study found self-identified health status of those reporting “poor, “fair” or good” had a higher risk of past or current infections compared to “very good” or “excellent” health status (P <0.02). Positive smoking status was inversely associated with SARS-CoV-2 infection (p <0.001). When assessing the sample for non-response bias (n=3,658), 40.9% responded in wave 1 of recruitment, 34.1% in wave 2 and 25.0% in wave 3 for an overall participation rate of 23.6%. There were no significant differences in response by waves and demographics, being recently exposed or reasons for participating. In the final study, compared to males, females made up 54.6% of the sample and responded at a higher rate to postcards (8.2% vs. 7.5%) and text/emails (28.1 vs. 24.6%, 2= 7.43, p 0.025); and responded at a higher percentage after 1 contact (21.4 vs. 17.9%, 2 = 7.6, p 0.023). Conclusion This research contributed to the scientific understanding of the etiological picture of SARS-CoV-2. Additionally, the current study used a novel method that public health practitioners can easily implement to detect non-response bias in primary data collection without advanced statistical methods. Finally, the current study allows researchers to focus not only on the modality of inviting participants, but the frequency of invitations needed to secure specific populations, reducing time and resources.
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    Exploring the Coronary Calcium Scores in Indiana Firefighters from Risk Factors to AI Predictions
    (2024-05) Li, Mingyue; Han, Jiali; Monahan, Patrick O.; Wessel, Jennifer; Nan, Hongmei
    Firefighters, facing toxic exposure and mandatory personal protective equipment use, are at increased risk for cardiovascular strain. Coronary artery disease (CAD) can lead to sudden heart attacks, making early detection and risk assessment critical. Coronary calcium score (CCS), obtained via computed tomography, serve as precise indicators of pre-clinical CAD, and are linked to increased cardiovascular events and mortality. However, specific risk factors affecting CCS in firefighters remain underexplored. In my study, I utilized existing health data from Indiana firefighters aged 35-68, gathered during their health screenings at Ascension Public Safety Medical. Focusing on those with complete evaluations—including physicals, lab tests, fitness assessments, and CT scans for CCS — I first examined the clinical risk factors influencing CCS. Then, I explored the association between maximal oxygen uptake MaxVO2, an essential measure of aerobic capacity and cardiovascular fitness, and CCS among different age groups (< 45, and >= 45 years). Subsequently, I developed machine learning models using these risk factors to predict CCS. I observed significant positive associations between age, monocyte percentage, and CCS. Also, I identified significant positive associations between alkaline phosphatase and CCS. Higher MaxVO2 levels were associated with lower CCS, especially in firefighters over 45. Finally, utilizing these findings, I developed machine learning models to predict CCS and selected the most precise one. In conclusion, this research provides a novel perspective on the cardiovascular risks faced by firefighters. The associations and predictive models I've established not only contribute to the understanding of CCS in this population but pave the way for targeted interventions. These findings emphasize the importance of age, monocyte percentage, alkaline phosphatase, and regular cardiovascular fitness assessments and may influence future guidelines for firefighter health monitoring, ultimately aiming to reduce CAD incidence and enhance occupational safety.
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    Factors Motivating Individuals to Consider Genetic Testing for Type 2 Diabetes Risk Prediction
    (PloS One, 2016) Wessel, Jennifer; Gupta, Jyoti; de Groot, Mary; Department of Medicine, IU School of Medicine
    The purpose of this study was to identify attitudes and perceptions of willingness to participate in genetic testing for type 2 diabetes (T2D) risk prediction in the general population. Adults (n = 598) were surveyed on attitudes about utilizing genetic testing to predict future risk of T2D. Participants were recruited from public libraries (53%), online registry (37%) and a safety net hospital emergency department (10%). Respondents were 37 ± 11 years old, primarily White (54%), female (69%), college educated (46%), with an annual income ≥$25,000 (56%). Half of participants were interested in genetic testing for T2D (52%) and 81% agreed/strongly agreed genetic testing should be available to the public. Only 57% of individuals knew T2D is preventable. A multivariate model to predict interest in genetic testing was adjusted for age, gender, recruitment location and BMI; significant predictors were motivation (high perceived personal risk of T2D [OR = 4.38 (1.76, 10.9)]; family history [OR = 2.56 (1.46, 4.48)]; desire to know risk prior to disease onset [OR = 3.25 (1.94, 5.42)]; and knowing T2D is preventable [OR = 2.11 (1.24, 3.60)], intention (if the cost is free [OR = 10.2 (4.27, 24.6)]; and learning T2D is preventable [OR = 5.18 (1.95, 13.7)]) and trust of genetic testing results [OR = 0.03 (0.003, 0.30)]. Individuals are interested in genetic testing for T2D risk which offers unique information that is personalized. Financial accessibility, validity of the test and availability of diabetes prevention programs were identified as predictors of interest in T2D testing.
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    Genetic mutations in African patients with atrial fibrillation: Rationale and design of the Study of Genetics of Atrial Fibrillation in an African Population (SIGNAL)
    (Elsevier, 2015-09) Bloomfield, Gerald S.; Temu, Tecla; Akwanalo, Constantine O.; Chen, Peng-Sheng; Emonyi, Wilfred; Heckbert, Susan R.; Koech, Myra M.; Manji, Imran; Shen, Changyu; Vatta, Matteo; Velazquez, Eric J.; Wessel, Jennifer; Kimaiyo, Sylvester; Inui, Thomas S.; Department of Medicine, IU School of Medicine
    BACKGROUND: There is an urgent need to understand genetic associations with atrial fibrillation in ethnically diverse populations. There are no such data from sub-Saharan Africa, despite the fact that atrial fibrillation is one of the fastest growing diseases. Moreover, patients with valvular heart disease are underrepresented in studies of the genetics of atrial fibrillation. METHODS: We designed a case-control study of patients with and without a history of atrial fibrillation in Kenya. Cases with atrial fibrillation included those with and without valvular heart disease. Patients underwent clinical phenotyping and will have laboratory analysis and genetic testing of >240 candidate genes associated with cardiovascular diseases. A 12-month follow-up assessment will determine the groups' morbidity and mortality. The primary analyses will describe genetic and phenotypic associations with atrial fibrillation. RESULTS: We recruited 298 participants: 72 (24%) with nonvalvular atrial fibrillation, 78 (26%) with valvular atrial fibrillation, and 148 (50%) controls without atrial fibrillation. The mean age of cases and controls were 53 and 48 years, respectively. Most (69%) participants were female. Controls more often had hypertension (45%) than did those with valvular atrial fibrillation (27%). Diabetes and current tobacco smoking were uncommon. A history of stroke was present in 25% of cases and in 5% of controls. CONCLUSION: This is the first study determining genetic associations in valvular and nonvalvular atrial fibrillation in sub-Saharan Africa with a control population. The results advance knowledge about atrial fibrillation and will enhance international efforts to decrease atrial fibrillation-related morbidity.
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    Genetic risk for primordial prevention of cardiometabolic disease
    (2019-06) Wessel, Jennifer; Smith, Mitchell
    The prevalence of obesity and type 2 diabetes (T2D) in children has risen dramatically. We hypothesized that providing child’s genetic risk information, to families at high T2D risk, would serve as a motivator to improve behaviors related to the development of risk factors for T2D. We conducted a pilot intervention study of parents (n=51) and their children (n=44) aged 2-8. Family’s physical activity, children’s eating behaviors related to obesity (CEBQ); and parent’s attitudes and motivations for lifestyle change were collected at baseline and 3-month follow-up (3MFU). At baseline, saliva samples were collected from children for genotyping of obesity and T2D risk variants identified in genome-wide association studies. Parents were on average 35±6 years old, BMI 31±7 kg/m2, 60% mothers, 31% black and 7% Latino. Children were 4±2 years with a BMI of 72±26 percentiles. At the risk disclosure session, anxiety (STAI-S) and depressive symptoms (POMS) of parents were measured immediately before and after disclosure of child’s risk; and a significant increase in tension (X =2.58, p=0.03) and anxiety (X =-2.98, p=0.002) was observed. Parents then received a quasi-motivational interviewing and behavioral education intervention. After receiving the intervention parents reported a significant increase in their confidence to change their family’s behaviors (X =-0.31, p=0.002) compared to pre-disclosure. This led to 100% of parents committing to a personalized diet or activity change. At 3MFU, children demonstrated a reduction in their desire to drink (X =1.52, p=0.002) and responsiveness to food (X =1.86, p=0.005). In parents, no elevation in depressiveness or anxiety remained. No change in BMI or physical activity was observed in either group. Our data suggest returning genetic risk results can motivate commitment to behavior change. Future work will test whether combining genetic risk with an established lifestyle intervention may facilitate lowering T2D risk.
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    Genetic Testing and Type 2 Diabetes Risk Awareness
    (2014-03) de Groot, Mary; Wessel, Jennifer
    Purpose The purpose of this study was to examine the motivational, attitudinal, and behavioral predictors of interest in genetic testing (GT) in those with and without awareness of their risk for type 2 diabetes (T2DM). Methods A convenience sample of adults visiting emergency departments, libraries, or an online research registry was surveyed. Responses from adults without diabetes who reported 1 or more risk factors for T2DM (eg, family history, body mass index > 25) were included in the analyses (n = 265). Results Participants were 37 ± 11 years old, white (54%), and female (69%), with some college education (53%) and an annual income below $25 000 (44%). Approximately half (52%) expressed interest in GT for T2DM. Individuals were stratified by perceived risk for T2DM (risk aware or risk unaware). Among the risk aware, younger age (P < .04) predicted greater interest in GT. Among the risk unaware, family history of T2DM (P < .008) and preference to know genetic risk (P < .0002) predicted interest in GT. Both groups identified the need for low-cost GT. Conclusions GT is an increasingly available and accurate tool to predict T2DM risk for patients. In this sample, GT was a salient tool for those with and without awareness of their T2DM risk. Financial accessibility is critical to use of this tool for both groups.
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    Health of Indiana Firefighters
    (2020-12) Muegge, Carolyn Marie; Song, Yiqing; Zollinger, Terrell W.; Wessel, Jennifer; Monahan, Patrick O.
    Background: Firefighters are exposed to carcinogens, toxic agents, and other risks for cancer and cardiovascular disease. Research shows that aero-digestive and genitourinary cancers are in excess among firefighters compared to the general population. Studies examining excess cardiovascular mortality are inconsistent. Limited data exist on chronic disease mortality, risk factor profiles, and barriers to a healthy lifestyle among firefighters at the local level. Purpose: This project examines the relationship between firefighting and chronic disease mortality, determines trajectories of cardiovascular risk factors in a cohort of new firefighters, and studies the relationship between barriers to weight management and firefighter health characteristics. Methods: This study used death certificate data from the Indiana State Department of Health and clinical data from a large occupational medical practice serving firefighters. Regression techniques were used to examine excess mortality among firefighters compared to non-firefighters, evaluate changes in cardiovascular disease risk factors among new firefighters over time, and explore correlates of risk factors and barriers to weight management among overweight and obese firefighters. Results: The odds of death due to malignant cancers were significantly higher among firefighters than non-firefighters (OR, 1.19; 95% CI, 1.08-1.30). Body mass index, total cholesterol, LDL cholesterol, and triglyceride levels increased significantly (p<0.001) while HDL cholesterol levels decreased (p<0.001) from baseline during the first 10 years of the firefighter’s career. Overweight firefighters who were “ready to begin a weight management program” were more likely to identify ‘‘lack of knowledge about weight management,’’ ‘‘lack of access to exercise opportunities,’’ and ‘‘eating helps me cope with stress’’ as barriers, and report a greater number of barriers to weight management. Older firefighters were less likely to identify or report one or more barriers to weight management. Conclusion: These studies suggest the importance of early-career and targeted cardiometabolic health and cancer prevention strategies to reduce chronic disease morbidity and mortality among firefighters.
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    Hearing Loss and Use of Medications for Anxiety and/or Depression in Testicular Cancer Survivors Treated with Cisplatin-Based Chemotherapy
    (2020-05) Ardeshirrouhanifard, Shirin; Song, Yiqing; Travis, Lois; Monahan, Patrick; Wessel, Jennifer
    Testicular cancer is the most common solid tumor among young men. Although testicular cancer survivors (TCS) are expected to live for over 40 years after cancer diagnosis, they are at risk for chemotherapy adverse effects such as hearing loss (HL), tinnitus, and psychosocial effects. The aim of this study was to investigate factors associated with discrepancies between subjective and objective HL, factors associated with HL, and factors associated with the use of medications for anxiety/depression. TCS were enrolled in the Platinum Study. Sociodemographic characteristics, health behaviors, morbidities, and prescription medications were assessed though self-reporting using validated questionnaires. Bilateral pure-tone air conduction thresholds were collected at frequencies 0.25-12 kHz. To assess HL severity, hearing thresholds were classified according to American Speech-Language-Hearing Association criteria. Multivariable multinomial, ordinal, and binomial logistic regressions were used to test factors for association with discrepancy between subjective and objective HL, cisplatin-induced HL, and use of medications for anxiety/depression, respectively. Patients with HL at only extended high frequencies (10-12 kHz) could perceive hearing deficits; thus, it would be preferable for these frequencies to be included in audiometric assessments of cisplatin-treated adult-onset cancer survivors. Age, no noise exposure, and mixed/conductive HL were significantly associated with more underestimation of HL severity. Hearing aid use and education were significantly associated with less underestimation of HL severity. Having tinnitus was associated with more overestimation of HL severity. Age, cumulative cisplatin dose, and hypertension showed significant association with greater HL severity, whereas post-graduate education was associated with less HL severity. Factors associated with more use of medications for anxiety/depression were tinnitus, and peripheral sensory neuropathy, while being employed and engaging in physical activity were significantly associated with less use of anxiety/depression medications. The sole use of patient-reported measures of HL might not be well-suited to evaluate HL in cancer survivors; thus, the use of audiometry may complement patient-reported HL. In terms of modifiable risk factors of cisplatin-induced HL, healthcare providers should monitor patients’ blood pressure and manage hypertension appropriately. In addition, healthcare providers need to effectively manage tinnitus and peripheral neuropathy to improve treatment outcomes of anxiety and depression.