Faculty Bibliography

OBJECTIVE:Physical activity can reduce cardiovascular disease and depression risk and improve quality of life in patients with systemic lupus erythematosus (SLE). To facilitate physical activity and achieve health benefits in patients with SLE, it is critical to understand potential barriers to physical activity, including socioeconomic, social, demographic, quality-of-life, or clinical factors. METHODS:We conducted cross-sectional analyses of data from a large, diverse cohort of patients with SLE. All completed the International Physical Activity Questionnaire, recalling the past seven days of vigorous physical activity, moderate activity, or walking. Data included financial insecurity, Everyday Discrimination Scale, education, demographics, lupus-specific disease activity, immunosuppressive medication, Census Block Area Deprivation Index, and patient-reported pain, fatigue, and cognitive function. Multivariable models included logistic regression for dichotomous outcome of "any" moderate/vigorous physical activity and quasi-Poisson model for total combined days of moderate and vigorous activity. RESULTS:Of the 271 participants, 170 (63%) reported any moderate or vigorous activity in the past 7 days (mean = 2.6 days of moderate/vigorous activity). Only 4% reported zero days of physical activity. Logistic regression analysis indicated that active disease was associated with 47% lower odds of engaging in any moderate/vigorous physical activity (P = 0.04) and with a 35% reduction in the mean number of days of moderate to vigorous physical activity (P = 0.04). In contrast, individual- and area-level socioeconomic factors and patient-reported outcomes were not associated with physical activity. CONCLUSION/CONCLUSIONS:Moderate/vigorous physical activity was negatively associated only with disease activity. The current study reinforces the need primarily to control SLE disease activity to promote patients' ability to be physically active, which may improve symptoms.

OBJECTIVE:Epidemiologic estimates for age of systemic lupus erythematosus (SLE) diagnosis are limited, particularly for men and racial and ethnic subpopulations in the United States. Leveraging the Centers for Disease Control and Prevention (CDC) National Lupus Registry network of population-based SLE registries, meta-analyses were performed estimating age-specific incidence of SLE by sex, race, and ethnicity. METHODS:The CDC network of SLE registries includes five state-based registries, plus a sixth Indian Health Service registry. Incidence periods spanned calendar years 2002-2018. Registries provided age-specific incidence of SLE, fulfilling the American College of Rheumatology (ACR) SLE classification criteria, per 100,000 person-years, stratified by sex, race, and ethnicity for the meta-analyses. RESULTS:Incidence rates among women were highest for those aged 30-39 (12.7, 95%CI: 9.5-16.8), while rates among men were highest for those aged 60-69 (2.1, 95%CI: 1.3-3.4). Black women aged 20-39 had the highest SLE incidence rates (23.6, 95%CI: 20.7-26.8). Among women diagnosed with SLE before age 20, incidence was highest among Asian (6.5, 95%CI: 2.8-15.2) individuals. Among women diagnosed with SLE after age 60, incidence was highest among American Indian/Alaska Native (9.4, 95%CI: 3.4-15.4) individuals. Weighted percentages show 10.0% of those with SLE were diagnosed before age 20, while 15.1% were diagnosed after age 60. The largest proportion of individuals with SLE, 22.1%, were diagnosed between 30-39 years. CONCLUSIONS:This study provides comprehensive sex- and race-specific estimates of age at SLE diagnosis. The substantial later in life SLE incidence among men and disease burden in pediatric and older populations should raise awareness in considering SLE in the differential diagnosis in previously underrecognized groups.

IMPORTANCE/UNASSIGNED:Pediatric dental-related emergency department visits have drastically increased in recent years. School-based caries prevention programs (SCPPs) aim to address unmet dental needs, yet it is unclear whether they effectively reach high-risk populations. OBJECTIVE/UNASSIGNED:To determine whether children with prior dental care utilization are more likely than children without prior utilization to participate in SCPPs. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study, conducted between June 2023 and October 2025, linked 2019 SCPP clinical trial data and 2016 to 2019 Medicaid claims data to examine disparities in sociodemographic characteristics and dental and dental-related medical care utilization prior to SCPP implementation between participants and nonparticipants. SCPPs were implemented in 47 primary schools in New York, New York, primarily in the Bronx, which was deemed to have the highest risk of tooth decay in the city. Participants included children aged 5 to 13 years in 2019 residing in the Bronx and continuously enrolled in Medicaid between 2018 and 2019. EXPOSURES/UNASSIGNED:Dental and dental-related medical care utilization in 2018, the year prior to SCPP implementation, demographic factors, individual-level clinical dental needs, and health system factors. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was SCPP participation in 2019. Adjusted logistic regression was used to assess whether prior dental care use was independently associated with participation. RESULTS/UNASSIGNED:The study included 63 217 children in total (62 187 nonparticipants and 1030 participants), with a mean age of 7.7 years (95% CI, 7.6-7.7 years). There were 30 590 female children (48.4%), 1852 Asian children (2.9%), 13 926 Black children (22.0%), 31 620 Hispanic children (50.0%), and 1988 White children (3.2%). In multivariable analysis, compared with any dental visits, having no dental visits prior to SCPP implementation was associated with 17% lower odds of participating (adjusted odds ratio, 0.83; 95% CI, 0.71-0.96). Compared with having any dental emergencies, having no dental emergencies was associated with 32% increased odds of participating (adjusted odds ratio, 1.32; 95% CI, 1.08-1.62). Mitigating selection from a statewide SCPP rollout was estimated to save up to $2.4 million in nontraumatic dental-related emergency department visits. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this cross-sectional study of NY Medicaid claims data linked to SCPP participation data, there was evidence that children at high risk of tooth decay who are most in need of dental preventive services have a lower likelihood of participating in school-based prevention programs. More evidence is needed to identify successful strategies for recruitment of high-need children.

ObjectivePatients with systemic lupus erythematosus (SLE) often have concomitant fibromyalgia (FM) or similar symptoms including chronic pain, fatigue, or depression. This study explored whether Patient-Reported Outcomes Measurement Information System (PROMIS) measures provide richer information than 2016 American College of Rheumatology (ACR) FM criteria survey.MethodsPatients with SLE in our convenience cohort were categorized into groups: (1) concurrent FM chronic pain, (2) concurrent non-FM chronic pain, and (3) no chronic pain using 2016 ACR FM Survey. Based on PROs in the FM Survey, we captured comparable PROMIS measures (e.g., depression, fatigue). Associations by pain group were tested using Kruskal-Wallis rank sum test, Shapiro-Wilk normality test, chi-squared test, or Fisher's exact test. Violin plots explored differences across groups.ResultsThe cohort (n = 181) included 31 patients with FM pain, 23 with non-FM chronic pain, and 127 with no chronic pain. Median PROMIS symptom scores (fatigue, sleep disturbance, pain intensity and interference, depression) were highest and cognitive function lowest in the FM group, despite 13% being in remission. There were significant differences on 4 PROMIS measures (cognitive function, fatigue, pain intensity, pain interference) between FM pain and non-FM pain groups (p < .02), the former being worse. There were no significant differences in SLE Disease Activity Index (SLEDAI) score.ConclusionSLE patients with non-FM chronic pain have similar symptoms to FM compared with SLE patients without chronic pain; however, symptoms are not as severe as those meeting FM criteria. PROMIS measures may be used to classify severity more precisely for disease categorization and management.

BACKGROUND:Clinical approaches for pediatric patients requiring endodontic treatment have been associated with specialty type. AIM/OBJECTIVE:The purpose of this study was to elucidate the nuanced clinical decision-making process for endodontic treatment of pediatric patients' permanent teeth. DESIGN/METHODS:A qualitative design was used to explore the experiences and decision-making of general dentists, pediatric dentists, and endodontists. Clinicians practicing in the United States were recruited to interview using purposive sampling methods. A framework, thematic analytic approach was used to evaluate the data. RESULTS:In total, 26 dentists participated in the study: 7 general dentists, 11 pediatric dentists, 6 endodontists, and 2 dual-trained specialists. Overall, clinicians reported that caries on permanent first molars were the most common reason that pediatric patients required endodontic treatment. Access to care was influenced by practitioner clinical training and knowledge; patient behavior; and financial considerations. Treatment planning was influenced by parents, referrals, and clinical philosophy. CONCLUSIONS:The findings explain how clinician decision-making and system-level factors influence access to care for pediatric patients in need of endodontic treatment and propagate oral health disparities. Barriers to accessing care were most limiting for children and adolescents from low-income households and were likely to result in premature tooth loss.

BACKGROUND:Inappropriate imaging to stage low-risk prostate cancer is considered low-value care. Determining the effectiveness of a theory-based intervention, Prostate Cancer Imaging Stewardship (PCIS), to promote guideline-concordant imaging. METHODS:A stepped-wedge, cluster-randomized trial, PCIS, was conducted between March 2018 and March 2021 at ten Veterans Health Administration medical centers (VAMC) initially selected for prostate cancer volume, geographic diversity, and willingness to participate. Intervention initiation at sites were randomized in 3-month intervals. We enrolled 61 urology providers who treat prostate cancer at participating sites. Outcomes were assessed among 2,302 patients with incident prostate cancer aged 18-85 years. PCIS combines three evidence-based provider-focused behavior change strategies: 1) Clinical Reminder Order Check triggered when a provider attempted to order imaging for a patient with PSA < 20ng/mL; 2) VAMC-level academic detailing at initiation and every three months thereafter; 3) Audit and Feedback for providers to improve their imaging performance. The main outcome was guideline-discordant nuclear medicine bone scan (NMBS) imaging for low-risk prostate cancer patients. RESULTS:NMBS imaging would be consistent with National Comprehensive Cancer Network guidelines in 878 patients (38%) and inconsistent in 1424 patients (62%). Among patients not requiring NMBS, 141/690 (20.4%) received guideline-discordant imaging (ie, NMBS ordered) during Control compared to 109/734 (14.9%) during Intervention (OR = 0.54, p = .04). Among patients requiring a NMBS, 29/425 (6.8%) did not receive one (ie, guideline-discordant imaging) during Control compared to 25/453 (5.5%) during the Intervention (OR = 1.36, p = .36). CONCLUSION/CONCLUSIONS:PCIS significantly reduced low-value, guideline-discordant NMBS imaging among low-risk prostate cancer patients without negatively affecting necessary imaging for high-risk patients. CLINICAL TRIALS REGISTRATION/BACKGROUND:NCT03445559.

BACKGROUND:We conducted a cost analysis of implementing a randomized controlled trial that proved the effectiveness of a community health worker (CHW) facilitated weight loss intervention among South Asian patients with prediabetes receiving care at primary care practices in New York City. South Asians have a high prevalence of diabetes, but no study to date has evaluated the cost of implementing an evidence-based lifestyle intervention in this population. Cost estimates are necessary for an intervention's adoption and scale-up. METHODS:The first wave of the intervention was implemented in-person, followed by two waves implemented remotely during the COVID-19 pandemic. We estimated the implementation, intervention, and adaptation costs and the costs by each wave of implementation, by applying the Gold et al.'s economic framework and ERIC discrete implementation strategy compilation Costs were calculated from the perspective of a health care payer, public health agency, or health care system. The CHW intervention included group education sessions over six months. For each wave, we separately estimated the total cost, cost per practice, and cost when implemented at only one practice. Using the Bureau of Labor Statistics salary estimates, we calculated the national average (mean salary) and lower (25th percentile salary) and upper (75th percentile salary) bounds. RESULTS:The average total 6-month implementation costs over 3 waves, each targeting seven practices was $215,420 (range: $158,620-$257,020). Program staff salaries comprised > 93% of total costs. Adaptation cost was nearly 1/3 of start-up costs. On average, implementation at one practice would cost twice as much as the per-practice costs when implemented simultaneously at seven practices in a wave, due to spread of start-up costs across multiple sites. CONCLUSIONS:Staff salaries comprise most of the budget to implement such an intervention. It is most efficient for an agency to implement this intervention across several practices simultaneously. Decision-makers will need to evaluate relative costs and effectiveness of other options to achieve weight loss in a minority community with constrained resources. CLINICALTRIALS:GOV: This study was registered on June 15, 2017 at  https://www. CLINICALTRIALS:gov as NCT03188094. https://clinicaltrials.gov/ct2/show/NCT03188094 .

OBJECTIVES/UNASSIGNED:All traditional dental clinics were closed from March to May 2020 due to the COVID-19 shutdown, potentially causing additional strain on hospital emergency departments (EDs) to care for patients with dental conditions. We evaluated the impact of pandemic-associated dental office closures on the share of dental conditions managed in EDs among children on Medicaid. METHODS/UNASSIGNED:We quantified the change in the dental-related ED burden among publicly insured children before, during, and after pandemic dental office closures across NY using 2018-2020 New York State (NY) Medicaid claims data among children under age 19 using a difference-in-differences approach. RESULTS/UNASSIGNED: < .01). The increases in the dental-related ED burden during dental office closures were due to the increased use of EDs for dental conditions. CONCLUSION/UNASSIGNED:Lack of access to dental care during a time of significant health care system strain was associated with an increased burden on EDs from dental conditions among publicly insured children. Health care systems should consider alternatives to referral programs to dental offices to ensure publicly insured children do not fall through the dental safety net, such as by providing limited dental services on-site or incorporating urgent dental care clinics within hospitals.

BACKGROUND:Evidence suggests that pediatric patients requiring endodontic treatment in the permanent dentition are often a "missed population". AIM/OBJECTIVE:This study surveyed pediatric dentists and endodontists about the frequency with which they encounter pediatric patients requiring endodontic treatment, their training, practice patterns, and decision-making considerations for the treatment of immature permanent teeth. DESIGN/METHODS:analysis. The level of significance was set at 0.05. RESULTS:The response rate was 13.1% (n = 840). The frequency of clinicians encountering pediatric patients requiring endodontic treatment for permanent teeth did not differ significantly by specialty. Pediatric dentists and endodontists reported statistically significant differences in their practice patterns related to the performance of vital pulp therapy (p < 0.001) and procedures for necrotic immature permanent teeth (p < 0.001). Among specialists, apexification was more frequently performed than regenerative endodontic procedures (REPs) (p < 0.001). When asked to consider clinical and patient factors related to the treatment of necrotic immature permanent teeth, pediatric dentists most frequently responded that they were "unsure" of their preferred treatment. CONCLUSION/CONCLUSIONS:Standardized clinical knowledge and management of immature permanent teeth between specialties may improve interdisciplinary care for pediatric patients.

OBJECTIVES/OBJECTIVE:Glucagon-like peptide-1 receptor agonists (GLP1-RA) are an emerging class of medications with demonstrated promise in improving cardiometabolic outcomes. Whether these drugs may be useful in mitigating the cardiac risk associated with SLE remains unknown, and a recent case of drug induced lupus secondary to GLP1-RA use calls the safety of GLP1-RAs in SLE patients into question. Accordingly, this retrospective analysis was initiated to evaluate outcomes of GLP1-RAs in SLE. METHODS:All patients in the NYU Lupus Cohort who had used a GLP1-RA were eligible for inclusion. Patient characteristics were assessed at baseline (most recent rheumatology visit prior to starting GLP1-RA), 1-4 months, and 6-10 months after GLP1-RA initiation. RESULTS:Of the 1211 patients in the cohort, only 24 had received a GLP1-RA. Six were excluded due to insufficient documentation regarding duration of medication use. Of the remaining 18 (median age 50), 17 (94%) were female and 9 (50%) were white. There was one mild-to-moderate flare at 6-10 months, but no patients accumulated new SLE criteria during the follow up period. Compared with baseline, median BMI was reduced by 3% at 1-4 months (p= 0.002) and 13% at 6-10 months (p= 0.001). Nine (50%) patients were initially denied insurance coverage for a GLP1-RA. CONCLUSION/CONCLUSIONS:While limited by a small sample size, this descriptive study showed that GLP1-RAs did not trigger flares above expected background rates and were associated with significantly decreased BMI. Future studies exploring the potential benefits of GLP1-RAs in patients with SLE are warranted.