HIV Infection and Falls: Epidemiology and Risk Assessment

HIV 感染和跌倒：流行病学和风险评估

• 批准号: 8263213
• 负责人: Julie A Womack
• 金额: $ 9.29万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-02-09 至 2015-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8263213
• 关键词: Accident and Emergency department; Address; Adult; Age; Age of Onset; Age-Years; Aging; Alcohol abuse; Area; Attention; Biometry; Blindness; CD4 Lymphocyte Count; Cells; Chronic; Clinic; Clinical; Clinical Research; Code; Cohort Studies; Commit; Computerized Medical Record; Computers; Connecticut; Data; Data Analyses; Data Set; Delirium; Dementia; Depressed mood; Development; Diagnostic; Discipline; Dizziness; Drug usage; Educational workshop; Elderly; Environment; Epidemiology; Evaluation; Faculty; Fall prevention; Foundations; Fracture; Frequencies; Future; General Population; Goals; HIV; HIV Infections; Health; Health Personnel; Health Status; Healthcare; Home environment; Homelessness; Hospitalization; Incidence; Individual; Informatics; Intervention; Intervention Studies; Interview; K-Series Research Career Programs; Life; Logistic Regressions; Medical History; Medical Informatics; Mental Depression; Mentors; Modeling; National Institute of Nursing Research; Orthostasis; Outpatients; Participant; Patients; Persons; Pharmaceutical Preparations; Physical therapy exercises; Polypharmacy; Population; Population Attributable Risks; Premature aging syndrome; Preparation; Prevalence; Prevention; Preventive Intervention; Protease Inhibitor; Qualitative Methods; Radiology Specialty; Recording of previous events; Recruitment Activity; Recurrence; Reporting; Research; Research Personnel; Research Project Grants; Research Training; Resources; Risk; Risk Assessment; Risk Factors; Ritonavir; Sampling; School Nursing; Scientist; Signal Transduction; Soft Tissue Injuries; Structure; Syndrome; Testing; Time; Training; Training Activity; Traumatic Brain Injury; United States; Veterans; Viral Load result; Visit; Work; aged; aging population; antiretroviral therapy; base; career; chronic pain; cohort; efavirenz; experience; fall risk; falls; frailty; health administration; men; muscle strength; non-nucleoside reverse transcriptase inhibitors; polysubstance abuse; primary outcome; professor; programs; skills

DESCRIPTION (provided by applicant): Candidate: As an Assistant Professor at the Yale School of Nursing, I am ideally suited for a K01 Mentored Research Scientist Career Development Award from the National Institute of Nursing Research. My immediate goals/training needs are: 1) to develop my understanding of aging and geriatric syndromes, falls in particular; 2) to develop more advanced skills in information extraction and statistical analysi; 3) to gain experience in qualitative methods; and 4) To develop skills in clinical intervention research. My long-term goals are: 1) to be an independent and productive investigator in the field of geriatric syndromes and HIV, with particular expertise in falls and the use of electronic medical record-based observational cohorts; 2) to develop a falls assessment and prevention intervention tailored to the HIV infected populations; and 3) to use this approach to explore other geriatric syndromes in the context of HIV infection. This project brings together mentors from multiple disciplines who are committed to my development as an independent researcher. The goal-directed training activities address my immediate goals/training needs and include didactics, intensive workshops, ongoing participation in seminars, particularly in aging and biostatistics, work on the research project itself, and preparation of an R03 that will launch the next step in my career. Environment: The facilities and resources provided by Yale and the Veterans Health Administration (VHA) Connecticut are unparalleled. The Yale School of Nursing provides extensive support to faculty conducting clinical research. The Yale Center for Medical Informatics supports resources for training and research in informatics, particularly in the area o information extraction. Much of the work that informs our understanding of falls in the elderly and falls prevention interventions comes from the Yale Program on Aging. This cross- disciplinary program provides extensive educational opportunities as well as access to individuals from a broad range of disciplines who incorporate aging as a focus of their clinical and research work. The VHA Connecticut is the home of the Veterans Aging Cohort Study (VACS) which provides the data for this project and has extensive computer resources that make the exploration of large datasets, such as VACS, feasible. Research: The research will explore serious falls (SF), falls that are serious enough to merit a visit to a health care provide, among HIV infected and uninfected individuals aged > 40 years. There is evidence that falls are a problem among HIV infected individuals. However, the differences that exist between this population and the general elderly population highlight the inappropriateness of simply imposing falls prevention interventions that work in the elderly on HIV infected individuals. Orthostasis and vision loss are common in the elderly, but are not central health concerns for HIV infected individuals. HIV specific factors such as lower CD4 count, higher viral load, efavirenz use, and ritonavir use may also contribute to falls risk. I propose the following specific aims: 1) To determine the incidence, frequency, sequelae, and age of onset of SF; 2) To elucidate traditional and HIV-specific risk factors for SF; 3) In HIV infected individuals who have had a serious fall, to describe the factors that contributed to the fall, as well as their risk for a subsequent fall. In SA1, there are three dependent variables: first serious fall (SF), recurrent SFs, and serious fall sequelae. Serious falls will be identified using falls-related E-codes. In addition, I will use information extraction to identify serious falls in radiology reports and in outpatient progress notes. HIV status is the primary predictor variable. Sequelae of SFs will be identified by diagnostic codes. The independent variable is HIV status. I will use Poisson regression, piecewise logistic regression, and Cox regression models to test the hypotheses. In SA2, serious falls are the primary outcome and will be identified as in SA1. The primary independent variable is HIV status. In the first model that will combine HIV infected and uninfected Veterans, I will explore the contribution of traditional risk factors to the risk of a serious fall. I will test whether polysubstance abuse has a greater association with SF in HIV infected individuals by inclusion of an interaction between polysubstance abuse and HIV status and include traditional RFs. In a separate model restricted to HIV infected individuals, I will tes the contribution of HIV specific risk factors, particularly CD4 count and efavirenz use, in additio to traditional risk factors, to the risk of serious falls. I will use a longitudinal piecewise logitic regression and estimate the longitudinal average attributable fraction of each RF. SA3 will be explored from a sample of locally recruited HIV infected patients with a history of a serious fall. This is a qualitative aim that will use semi-structured, face-to-face interviews. An interpretive descriptive approach will guide data analysis. Data collected from the electronic medical record will provide specific information about the participants' medical history and about the evaluation of the fall in the emergency room or in the clinic. Together, these aims will provide me with the information necessary to develop a falls prevention intervention that is tailored to the specific risks encountered by HIV infected individuals and to begin to build a career in geriatric syndromes in the context of HIV infection. PUBLIC HEALTH RELEVANCE: Falls and their health consequences have never been explored among HIV infected individuals, but there is ample evidence that they are a problem. Falls prevention interventions that work in the elderly will likely not be appropriate for HIV infected populations, given the differences in the two populations and in their major falls risk factors. The information from this study will provide a foundation on which falls interventions can be developed that target the specific risk factors and needs of HIV infected populations.

描述（由申请人提供）：候选人：作为耶鲁大学护理学院的助理教授，我非常适合获得国家护理研究所的K01指导研究科学家职业发展奖。我的直接目标/培训需求是：1）尤其属于我对衰老和老年综合症的理解； 2）在信息提取和统计分析方面发展更先进的技能； 3）获得定性方法的经验； 4）发展临床干预研究的技能。我的长期目标是：1）成为老年综合症和艾滋病毒领域的独立和生产性研究者，在瀑布方面具有特别的专业知识，并使用了基于电子病历的观察人群； 2）开发针对艾滋病毒感染人群量身定制的跌倒评估和预防干预； 3）使用这种方法探索其他 在HIV感染的情况下，老年综合征。该项目汇集了来自多个学科的导师，他们致力于我作为独立研究人员的发展。以目标为导向的培训活动满足了我的直接目标/培训需求，包括教学，密集的研讨会，持续参加研讨会，尤其是在衰老和生物统计学方面，研究研究项目本身以及R03的准备，这些R03将在我的职业生涯中启动下一步。环境：耶鲁大学和退伍军人卫生管理局（VHA）康涅狄格州提供的设施和资源是无与伦比的。耶鲁大学护理学院为进行临床研究的教师提供了广泛的支持。耶鲁大学医学信息学中心支持用于信息学培训和研究的资源，尤其是在该领域o信息提取方面。耶鲁大学衰老计划的大部分内容都可以理解我们对老年人和瀑布预防干预措施的跌倒。该跨学科计划提供了广泛的教育机会，并获得了来自广泛学科的个人的访问，这些学科将衰老纳入其临床和研究工作的重点。 VHA Connecticut是退伍军人老化队列研究（VACS）的所在地，该研究提供了该项目的数据，并具有广泛的计算机资源，可以探索大型数据集，例如VACS，可行。研究：该研究将探索严重的跌倒（SF），在受艾滋病毒感染和未感染> 40岁的艾滋病毒感染的人中，跌倒得足以值得访问医疗保健提供。有证据表明跌倒是艾滋病毒感染者的问题。但是，该人群与一般老年人口之间存在的差异凸显了仅征收跌落的预防干预措施，这些干预措施在老年人中对艾滋病毒感染的个体起作用。正骨和视力丧失在老年人中很常见，但对艾滋病毒感染者而言并不是核心健康问题。 HIV特定因素，例如较低的CD4计数，较高的病毒载量，Efavirenz使用和利托那韦的使用也可能导致跌倒风险。我提出以下特定目的：1）确定SF的发病率，频率，后遗症和年龄； 2）阐明SF的传统和HIV特异性风险因素； 3）在艾滋病毒感染中，他们的跌倒严重，以描述导致跌倒的因素以及随后跌倒的风险。在SA1中，有三个因变量：第一个严重跌倒（SF），复发性SF和严重的秋季后遗症。将使用与秋季相关的电子编码来确定严重的跌倒。此外，我将使用信息提取来确定放射学报告和门诊进度注释中的严重跌幅。 HIV状态是主要预测变量。 SF的后遗症将通过诊断代码识别。自变量是艾滋病毒状况。我将使用泊松回归，分段逻辑回归和COX回归模型来测试假设。在SA2中，严重的跌倒是主要结果，将被确定为SA1中。主要自变量是艾滋病毒状态。在将艾滋病毒感染和未感染的退伍军人结合起来的第一个模型中，我将探讨传统危险因素对严重跌倒风险的贡献。我将测试通过滥用Polysubstance滥用和艾滋病毒状况之间的相互作用，并包括传统的RFS，在艾滋病毒感染的个体中与SF在受艾滋病毒感染的个体中是否具有更大的关联。在仅限于艾滋病毒感染者的单独模型中，我将对艾滋病毒特定的风险因素（尤其是CD4计数和efavirenz使用）的贡献，以对传统风险因素的添加，以实现严重跌倒的风险。我将使用纵向分段的logitic回归，并估计每个RF的纵向归因分数。 SA3将从当地招募的艾滋病毒感染患者样本中探索，患有严重衰落的病史。 这是一个定性的目标，它将使用半结构化的面对面访谈。解释性描述性方法将指导数据分析。从电子病历中收集的数据将提供有关参与者的病史以及评估急诊室或诊所下降的特定信息。这些目标共同为我提供必要的信息，以开发预防瀑布的干预措施，该干预措施是根据艾滋病毒感染者遇到的特定风险量身定制的，并开始在HIV感染的背景下在老年综合症中建立职业。 公共卫生相关性：跌倒及其健康后果从未在艾滋病毒感染者中探索，但是有足够的证据表明它们是一个问题。鉴于两个人群及其主要跌倒危险因素的差异，在老年人中起作用的跌倒预防干预措施可能不适合艾滋病毒感染人群。这项研究的信息将为跌倒干预措施可以提供一个基础 开发针对艾滋病毒感染人群的特定风险因素和需求的开发。