Faculty Bibliography

INTRODUCTION/BACKGROUND:Law enforcement seizure data can indicate potential shifts in drug availability. We examined trends in the size of illicit fentanyl seizures in the United States from 2018 through 2023. METHODS:Using national High Intensity Drug Trafficking Areas data, we examined trends in the weight of fentanyl powder and number of fentanyl-containing pills per seizure with a focus on federal and other common state-level weight cutoffs that indicate various levels of trafficking (e.g., 1-4 g, 40-399 g, ≥400 g). RESULTS:Between 2018 and 2023, the plurality of fentanyl powder seizures weighed 40-399 g (27.7%), followed by seizures weighing 4-39 g (25.8%), 1-4 g (18.6%), ≥400 g (17.4%), and <1 g (10.4%). During this period, there was a decrease in the percentage weighing ≥400 g (annual percentage change [APC] = -5.3, 95% confidence interval [CI] -9.4, -1.0) and an increase in the percentage weighing 1-4 g (APC = 5.6, 95% CI 3.2, 8.1). With respect to fentanyl pill seizures, the plurality contained 40-399 pills (10 = 1 g; 25.4%), followed by 400-3999 (21.8%), <10 pills (20.4%), 10-39 pills (18.6%) and ≥4000 pills (13.8%). During this period, there was a decrease in seizures of <10 pills (APC = -12.6, 95% CI -23.2, -0.7) and increases in seizures containing 400-3999 (APC = 14.0, 95% CI 5.3, 23.1) and ≥4000 pills (APC = 12.6, 95% CI 7.4, 17.8). DISCUSSION AND CONCLUSIONS/CONCLUSIONS:The size of fentanyl seizures varies greatly, with a sizeable portion legally classified as drug trafficking. While the weight of fentanyl powder seizures is decreasing, the size of pill seizures is increasing. The increasing availability of fentanyl pills in particular needs to be monitored to inform prevention and harm reduction efforts.

BACKGROUND/UNASSIGNED:Digital health technologies have been proposed as a potential solution to improving maternal cardiovascular (CV) health in the postpartum (PP) period. In this context we performed a systematic scoping review of digital health interventions designed to improve PP CV health. METHODS/UNASSIGNED:We conducted a systematic review of PubMed/MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library. We included studies of PP women, with an intervention involving digital or mobile health (wearable devices, telemedicine, or remote monitoring). We included studies that measured an outcome related to CV health. RESULTS/UNASSIGNED:= 27 studies) showed no significant benefit in terms of lowered caloric intake and/or weight loss up to 1 year PP. 6 studies examined improvements in cardiometabolic markers such as lipids and glucose levels, of which the majority showed no benefit. CONCLUSION/UNASSIGNED:The majority of studies we reviewed found that digital health interventions such as mobile health, telemonitoring and wearable devices were feasible and had mixed effectiveness in improving postpartum CV health in the postpartum period.

BACKGROUND AND OBJECTIVE/OBJECTIVE:As most Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions on MRI harbor Gleason grade (GG) group ≥2 disease on biopsy, optimal management of patients with imaging-biopsy discordance remains unclear. To estimate grade misclassification, we evaluated the incidence of Gleason upgrading among patients with GG1 disease in the setting of a PI-RADS 5 lesion. METHODS:We conducted a single-institution retrospective analysis to identify patients with GG1 prostate cancer on fusion biopsy with MRI demonstrating ≥1 PI-RADS 5 lesion. Primary study outcome was identification of ≥GG2 disease on subsequent active surveillance (AS) biopsy or radical prostatectomy (RP). We used multivariable models to examine factors associated with reclassification. RESULTS:We identified 110 patients with GG1 disease on initial biopsy and ≥1 PI-RADS 5 lesion. There were 104 patients (94.6%) initially managed with AS and 6 (5.5%) received treatment. Sixty-one patients (58.7%) on AS underwent additional biopsies. Of these, 43 (70.5%) patients had tumor upgrading, with 32 (74.4%) upgraded on first surveillance biopsy. Forty-four (40%) patients ultimately received treatment, including prostatectomy in 15 (13.6%) and radiation in 25 (22.7%). Two patients (1.8%) developed metastases. In multivariable models, genomic classifier score was associated with upgrading. Limitations include a lack of multi-institutional data and long-term outcomes data. CONCLUSIONS:Most patients diagnosed with GG1 prostate cancer on MRI-Ultrasound fusion biopsy in the setting of a PI-RADS 5 lesion were found to have ≥GG2 disease on subsequent tissue sampling, suggesting substantial initial misclassification and reinforcing the need for confirmatory testing.

INTRODUCTION/BACKGROUND:Many U.S. states expanded the generosity of Medicaid insurance coverage of tobacco dependence treatment over the last fifteen years, but little is known about how coverage impacts cigarette smoking, especially for individuals with substance use disorder. METHODS:Data are from the 2009 to 2018 National Survey on Drug Use and Health and include Medicaid beneficiaries 18-64 years old with past year substance use disorder who smoked at least 100 cigarettes in their lifetime. Outcomes were smoking cessation, nicotine dependence, and number of cigarettes smoked per month. Difference-in-differences models were estimated for smoking behavior by state and year of comprehensive tobacco dependence treatment coverage, estimating multivariable linear probability models, adjusted for sociodemographic characteristics, co-occurring mental illness, and area-level provider supply. All data were analyzed in 2023 and 2024. RESULTS:Rates of nicotine dependence among individuals with past-year SUD increased slightly between 2009 and 2018 among individuals living in states with comprehensive tobacco dependence treatment coverage (55.6% to 58.6%) and changed little among individuals living in states with no or partial TDT coverage (60.0% to 59.5%). Quit rates increased for individuals with substance use disorder during this time, with no differences by comprehensive tobacco dependence treatment coverage. In adjusted models, no significant association between comprehensive Medicaid tobacco dependence treatment coverage and smoking behaviors was identified (e.g., cessation: β= -0.02, CI=-0.08, 0.04). One-year lagged outcomes and sensitivity analyses accounting for the differential time of initiation of state policies demonstrated similar results. CONCLUSIONS:Comprehensive tobacco dependence treatment coverage had no differential effect on smoking cessation among ever smokers with or without substance use disorder, and its expansion was not associated with changes in smoking behaviors for Medicaid beneficiaries with substance use disorder. Other multilevel interventions may be needed to impact smoking cessation rates, such as awareness and education campaigns of expanded tobacco dependence treatment coverage benefits, and interventions that reduce social and structural barriers to treatment.

When evaluating reproductive care for lesbian, gay, bisexual, transgender, and queer+ patients, there are multiple factors that must be addressed from a clinician, clinic, and social standpoint. Clinicians should be trained in culturally humble and trauma-informed care; clinics should have intake forms that identify sexual orientation, gender identity, and pronouns. The clinic environment should be inclusive, with all gender or single-stall bathrooms, and patient-facing educational materials that are representative of individuals with diverse partnerships, races, and ethnicities. In order to provide genuine culturally humble care, clinicians must be adequately trained and clinics must be appropriately prepared.

OBJECTIVE:This cross-sectional study investigated the associations of neighborhood-level factors with immune activation, systemic inflammation, and leukocyte telomere length in 110 sexual minority men with human immunodeficiency virus. METHOD/METHODS:From 2013 to 2017, sexual minority men with human immunodeficiency virus who used stimulants were recruited in San Francisco, California and provided blood samples to measure the markers of immune activation, systemic inflammation, and leukocyte telomere length. To measure neighborhood-level indices, the home address for each participant was geocoded and linked to data from the Centers for Disease Control and Prevention. Hierarchical linear modeling was employed to investigate the associations of neighborhood-level factors with systemic inflammation and leukocyte telomere length. RESULTS:After adjusting for age, stimulant use, self-reported income, level of education, and race and ethnicity, residing in neighborhoods with greater percentages of poverty (β = .33, p < .001) and a higher proportion of racial/ethnic minority residents (β = .26, p < .05) were independently associated with higher levels of interleukin-6. Additionally, residing in neighborhoods with higher percentage of uninsured individuals was independently associated with higher tumor necrosis factor-alpha (β = .24, p < .05). Indices of neighborhood-level adversity were additionally associated with providing a urine sample that was reactive for stimulants (OR = 1.31, p = .002), which was, in turn, associated with shorter leukocyte telomere length (β = -.31, p < .05). CONCLUSIONS:Future longitudinal research should examine the biobehavioral pathways linking neighborhood-level factors and stimulant use with systemic inflammation and cellular aging. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Prenatal exposure to phthalates might influence the development of childhood obesity. Most previous studies used body mass index (BMI) at a specific age instead of BMI development, which might be a better indicator of later health. We aimed to assess the association of prenatal phthalate exposure with longitudinal BMI development from infancy to adolescence. Among 1,379 mother-child pairs from a population-based cohort study, phthalate concentrations were measured in maternal spot urine samples, collected during first, second and third trimester. We estimated age- and sex-adjusted BMI standard deviation scores (SDS) at 6 months and 1, 2, 3, 4, 6, 10 and 13 years. We examined the associations of maternal phthalate urine concentrations during pregnancy with repeated measures of BMI using linear mixed effects models. An interquartile range higher natural log-transformed maternal first trimester high-molecular weight phthalate and di-2-ethylhexylphthalate (DEHP) urine concentrations were associated with a -0.10 (95% confidence interval (CI) -0.15 to -0.04), and -0.09 (95% CI -0.15 to -0.04) lower age- and sex-adjusted BMI at 6 months. An interquartile range higher natural log-transformed maternal first trimester phthalic acid and low-molecular weight phthalate urine concentrations were associated with a 0.11 (95% CI 0.03 to 0.18) and 0.13 (95% CI 0.04 to 0.21) higher age- and sex-adjusted BMI at 13 years old. No significant associations were observed for maternal second and third trimester phthalate urine concentrations with BMI. Thus, higher maternal phthalate metabolites urine concentrations appear to be related to lower BMI at early ages but with higher BMI at later ages.

OBJECTIVE:We assess diabetes risk in adulthood among adolescents with isolated glucosuria. RESEARCH DESIGN AND METHODS/METHODS:Included were adolescents (16-19 years) examined before military service between 1993 and 2015. Data were linked with the Israeli National Diabetes Registry. Glucosuria was confirmed following normal renal function and glucose tolerance tests. Cox models were applied. RESULTS:The study included 1,611,467 adolescents, of whom 755 (0.05%) had glucosuria. The latter group had a higher proportion of males (75% vs. 57%) and a lower proportion of BMI ≥ 85th percentile (10.4% vs. 16.3%) compared with nonglucosuric (all P < 0.001). During follow-up, 10,328 diabetes cases were recorded with an incidence rate of 87.5 and 43.3 per 100,000 person-years for those with versus without glucosuria, respectively. Individuals with glucosuria had an adjusted hazard ratio of 2.17 (95% CI, 1.17-4.04) for diabetes. CONCLUSIONS:Glucosuria in adolescents is associated with an increased risk of early-onset diabetes.