Searched for: school:SOM
Department/Unit:Population Health
Patient-Reported Outcomes from a Pilot Plant-Based Lifestyle Medicine Program in a Safety-Net Setting
Massar, Rachel E; McMacken, Michelle; Kwok, Lorraine; Joshi, Shivam; Shah, Sapana; Boas, Rebecca; Ortiz, Robin; Correa, Lilian; Polito-Moller, Krisann; Albert, Stephanie L
Lifestyle medicine interventions that emphasize healthy behavior changes are growing in popularity in U.S. health systems. Safety-net healthcare settings that serve low-income and uninsured populations most at risk for lifestyle-related disease are ideal venues for lifestyle medicine interventions. Patient-reported outcomes are important indicators of the efficacy of lifestyle medicine interventions. Past research on patient-reported outcomes of lifestyle medicine interventions has occurred outside of traditional healthcare care settings. In this study, we aimed to assess patient-reported outcomes on nutrition knowledge, barriers to adopting a plant-based diet, food and beverage consumption, lifestyle behaviors, self-rated health, and quality-of-life of participants in a pilot plant-based lifestyle medicine program in an urban safety-net healthcare system. We surveyed participants at three time points (baseline, 3 months, 6 months) to measure change over time. After 6 months of participation in the program, nutrition knowledge increased by 7.2 percentage points, participants reported an average of 2.4 fewer barriers to adopting a plant-based diet, the score on a modified healthful plant-based diet index increased by 5.3 points, physical activity increased by 0.7 days per week while hours of media consumption declined by 0.7 h per day, and the percentage of participants who reported that their quality of sleep was "good" or "very good" increased by 12.2 percentage points. Our findings demonstrate that a lifestyle medicine intervention in a safety-net healthcare setting can achieve significant improvements in patient-reported outcomes. Key lessons for other lifestyle medicine interventions include using a multidisciplinary team; addressing all pillars of lifestyle medicine; and the ability for patients to improve knowledge, barriers, skills, and behaviors with adequate support.
PMCID:10343841
PMID: 37447186
ISSN: 2072-6643
CID: 5535302
Learning to PERSEVERE: A pilot study of peer mentor support and caregiver education in Lewy body dementia
Fleisher, Jori E; Suresh, Madhuvanthi; Levin, Melissa E; Hess, Serena P; Akram, Faizan; Dodson, Danielle; Tosin, Michelle; Stebbins, Glenn T; Woo, Katheryn; Ouyang, Bichun; Chodosh, Joshua
BACKGROUND:Lewy Body Disease (LBD) is the second most common neurodegenerative disorder. Despite high family caregiver strain and adverse patient and caregiver outcomes, few interventions exist for LBD family caregivers. Based on a successful peer mentoring pilot study in advanced Parkinson's Disease, we revised the curriculum of this peer-led educational intervention incorporating LBD caregiver input. OBJECTIVE:We assessed feasibility of a peer mentor-led educational intervention and its impact on LBD family caregivers' knowledge, dementia attitudes, and mastery. METHODS:Using community-based participatory research, we refined a 16-week peer mentoring intervention and recruited caregivers online through national foundations. Experienced LBD caregiver mentors were trained and matched with newer caregiver mentees with whom they spoke weekly for 16 weeks, supported by the intervention curriculum. We measured intervention fidelity biweekly, program satisfaction, and change in LBD knowledge, dementia attitudes, and caregiving mastery before and after the 16-week intervention. RESULTS:Thirty mentor-mentee pairs completed a median of 15 calls (range: 8-19; 424 total calls; median 45 min each). As satisfaction indicators, participants rated 95.3% of calls as useful, and at week 16, all participants indicated they would recommend the intervention to other caregivers. Mentees' knowledge and dementia attitudes improved by 13% (p < 0.05) and 7% (p < 0.001), respectively. Training improved mentors' LBD knowledge by 32% (p < 0.0001) and dementia attitudes by 2.5% (p < 0.001). Neither mentor nor mentee mastery changed significantly (p = 0.36, respectively). CONCLUSIONS:This LBD caregiver-designed and -led intervention was feasible, well-received, and effective in improving knowledge and dementia attitudes in both seasoned and newer caregivers. TRIAL REGISTRATION/BACKGROUND:https://clinicaltrials.gov/ct2/show/NCT04649164ClinicalTrials.gov Identifier: NCT04649164; December 2, 2020.
PMID: 37385161
ISSN: 1873-5126
CID: 5540482
Trends in Characteristics of Prescription Opioid-related Poisonings among Older Adults in the United States, 2015-2021
Han, Benjamin H; Jewell, Jennifer S; Ding, Belicia K; Wu, Nicholas C; Cottler, Linda B; Palamar, Joseph J
OBJECTIVES/OBJECTIVE:Few studies have considered how trends in opioid poisonings have changed among older adults. The objective of this study was to examine trends in fatal and nonfatal opioid-related poisonings ("exposures") among older adults. METHODS:National poison center data were used to examine trends in characteristics of reported exposures to commonly prescribed opioids between 2015 and 2021 among adults 60 years or older. We estimated the proportion of opioid exposures by demographic characteristics, the specific opioid(s) involved, exposure type, route of administration, other substances co-used, and medical outcomes for each calendar year. We estimated whether there were linear changes in prevalence by year using logistic regression. RESULTS:Although there was a decrease in the number of opioid exposures within the study population from 7706 in 2015 to 7337 in 2021 (a 4.8% decrease, P = 0.04), exposures increased for adults aged 70 to 79 years (a 14.0% increase, P < 0.001). The proportion classified as "abuse" increased by 63.3% (P < 0.001). There were significant decreases in the proportion involving hydromorphone (a 23.3% decrease, P < 0.001) and morphine (a 22.0% decrease, P < 0.001), with an increase involving buprenorphine (a 216.0% increase, P < 0.001). The proportion increased for co-use of cocaine (a 488.9% increase, P < 0.001) and methamphetamine (a 220.0% increase, P = 0.02), with a decrease in co-use of benzodiazepines (a 25.5% decrease, P < 0.001). The proportion of major medical outcomes increased by 93.9% (P < 0.001). CONCLUSIONS:National patterns of opioid-related poisonings are shifting among older adults, including the types of opioids involved and co-use of other drugs. These results can inform prevention and harm reduction efforts aimed at older adults.
PMID: 37347543
ISSN: 1935-3227
CID: 5542882
Training primary healthcare workers on a task-strengthening strategy for integrating hypertension management into HIV care in Nigeria: implementation strategies, knowledge uptake, and lessons learned
Oladele, David Ayoola; Odusola, Aina Olufemi; Odubela, Oluwatosin; Nwaozuru, Ucheoma; Calvin, Colvin; Musa, Zaidat; Idigbe, Ifeoma; Nwakwo, Chioma; Odejobi, Yemi; Aifah, Angela; Kanneh, Nafesa; Mishra, Shivani; Onakomaiya, Deborah; Iwelunmor, Juliet; Ogedegbe, Olugbenga; Ezechi, Oliver
BACKGROUND:With improved access to anti-retroviral drugs, persons living with HIV/AIDS (PLWHA) are living longer but with attendant increased risks of non-communicable diseases (NCDs). The increasing burden of NCDs, especially hypertension, could reverse gains attributed to HIV care. Nurses and Community Health Officers (CHO) in Nigeria are cardinal in delivering primary health care. A task-strengthening strategy could enable them to manage hypertension in HIV care settings. This study aimed to assess their knowledge and practice of hypertension management among Healthcare workers (HCWs) and to explore the challenges involved in conducting onsite training during pandemics. METHODS:Nurses and CHOs in the employment of the Lagos State Primary Health Care Board (LSPHCB), Lagos State, Nigeria, were recruited. They were trained through hybrid (virtual and onsite) modules before study implementation and a series of refresher trainings. A pre-and post-training test survey was administered, followed by qualitative interviews to assess skills and knowledge uptake, the potential barriers and facilitators of task-sharing in hypertension management in HIV clinics, and the lessons learned. RESULTS:Sixty HCWs participated in the two-day training at baseline. There was a significant improvement in the trainees' knowledge of hypertension management and control. The average score during the pre-test and post-test was 59% and 67.6%, respectively. While about 75% of the participants had a good knowledge of hypertension, its cause, symptoms, and management, 20% had moderate knowledge, and 5% had poor knowledge at baseline. There was also an increase in the mean score between the pre-test and post-test of the refresher training using paired t-tests (P < 0.05). Role-playing and multimedia video use improved the participants' uptake of the training. The primary barrier and facilitator of task sharing strategy in hypertension management reported were poor delineation of duties among HCWs and the existing task shifting at the Primary Healthcare Centres (PHC) level, respectively. CONCLUSIONS:The task strengthening strategy is relevant in managing hypertension in HIV clinics in Nigeria. The capacity development training for the nurses and CHOs involved in the Integration of Hypertension Management into HIV Care in Nigeria: A Task Strengthening Strategy (TASSH-Nigeria) study yielded the requisite improvement in knowledge uptake, which is a reassurance of the delivery of the project outcomes at the PHCs.
PMCID:10286327
PMID: 37344869
ISSN: 1472-6963
CID: 5538462
A Community-Based Survey of Colorectal Cancer Screening Behaviors in Chinese Immigrants Residing in a Major Metropolitan Area
Vang, Suzanne; Wang, Christina P; Cheung, Aaron J; Lin, Jenny J; Jandorf, Lina H
ORIGINAL:0017011
ISSN: 2577-2228
CID: 5556762
Proteomic cardiovascular risk assessment in chronic kidney disease
Deo, Rajat; Dubin, Ruth F; Ren, Yue; Murthy, Ashwin C; Wang, Jianqiao; Zheng, Haotian; Zheng, Zihe; Feldman, Harold; Shou, Haochang; Coresh, Josef; Grams, Morgan; Surapaneni, Aditya L; Bhat, Zeenat; Cohen, Jordana B; Rahman, Mahboob; He, Jiang; Saraf, Santosh L; Go, Alan S; Kimmel, Paul L; Vasan, Ramachandran S; Segal, Mark R; Li, Hongzhe; Ganz, Peter
AIMS:Chronic kidney disease (CKD) is widely prevalent and independently increases cardiovascular risk. Cardiovascular risk prediction tools derived in the general population perform poorly in CKD. Through large-scale proteomics discovery, this study aimed to create more accurate cardiovascular risk models. METHODS AND RESULTS:Elastic net regression was used to derive a proteomic risk model for incident cardiovascular risk in 2182 participants from the Chronic Renal Insufficiency Cohort. The model was then validated in 485 participants from the Atherosclerosis Risk in Communities cohort. All participants had CKD and no history of cardiovascular disease at study baseline when ∼5000 proteins were measured. The proteomic risk model, which consisted of 32 proteins, was superior to both the 2013 ACC/AHA Pooled Cohort Equation and a modified Pooled Cohort Equation that included estimated glomerular filtrate rate. The Chronic Renal Insufficiency Cohort internal validation set demonstrated annualized receiver operating characteristic area under the curve values from 1 to 10 years ranging between 0.84 and 0.89 for the protein and 0.70 and 0.73 for the clinical models. Similar findings were observed in the Atherosclerosis Risk in Communities validation cohort. For nearly half of the individual proteins independently associated with cardiovascular risk, Mendelian randomization suggested a causal link to cardiovascular events or risk factors. Pathway analyses revealed enrichment of proteins involved in immunologic function, vascular and neuronal development, and hepatic fibrosis. CONCLUSION:In two sizeable populations with CKD, a proteomic risk model for incident cardiovascular disease surpassed clinical risk models recommended in clinical practice, even after including estimated glomerular filtration rate. New biological insights may prioritize the development of therapeutic strategies for cardiovascular risk reduction in the CKD population.
PMID: 37014015
ISSN: 1522-9645
CID: 5587122
Longitudinal stability of inter-eye differences in optical coherence tomography measures for identifying unilateral optic nerve lesions in multiple sclerosis
Patil, Sachi A; Joseph, Binu; Tagliani, Paula; Sastre-Garriga, Jaume; Montalban, Xavier; Vidal-Jordana, Angela; Galetta, Steven L; Balcer, Laura J; Kenney, Rachel C
INTRODUCTION:Optical coherence tomography (OCT)-derived peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell+inner plexiform layer (GCIPL) thickness inter-eye differences (IEDs) are robust measurements for identifying clinical history acute ON in people with MS (PwMS). This study investigated the utility and durability of these measures as longitudinal markers to identify optic nerve lesions. METHODS:Prospective, multi-center international study of PwMS (with/without clinical history of ON) and healthy controls. Data from two sites in the International MS Visual System Consortium (IMSVISUAL) were analyzed. Mixed-effects models were used to compare inter-eye differences based on MS and acute ON history. RESULTS:Average age of those with MS (n = 210) was 39.1 ± 10.8 and 190 (91%) were relapsing-remitting. Fifty-nine (28.1%) had a history of acute unilateral ON, while 9/210 (4.3%) had >1 IB episode. Median follow-up between OCT scans was 9 months. By mixed-effects modeling, IEDs were stable between first and last visits within groups for GCIPL for controls (p = 0.18), all PwMS (p = 0.74), PwMs without ON (p = 0.22), and PwMS with ON (p = 0.48). For pRNFL, IEDs were within controls (p = 0.10), all PwMS (p = 0.53), PwMS without ON history (p = 0.98), and PwMS with history of ON (p = 0.81). CONCLUSION:We demonstrated longitudinal stability of pRNFL and GCIPL IEDs as markers for optic nerve lesions in PwMS, thus reinforcing the role for OCT in demonstrating optic nerve lesions.
PMID: 37167654
ISSN: 1878-5883
CID: 5503382
Partial convergence of the human vaginal and rectal maternal microbiota in late gestation and early post-partum
Shin, Hakdong; Martinez, Keith A; Henderson, Nora; Jay, Melanie; Schweizer, William; Bogaert, Debby; Park, Gwoncheol; Bokulich, Nicholas A; Blaser, Martin J; Dominguez-Bello, Maria Gloria
The human vaginal and fecal microbiota change during pregnancy. Because of the proximity of these perineal sites and the evolutionarily conserved maternal-to-neonatal transmission of the microbiota, we hypothesized that the microbiota of these two sites (rectal and vaginal) converge during the last gestational trimester as part of the preparation for parturition. To test this hypothesis, we analyzed 16S rRNA sequences from vaginal introitus and rectal samples in 41 women at gestational ages 6 and 8 months, and at 2 months post-partum. The results show that the human vaginal and rectal bacterial microbiota converged during the last gestational trimester and into the 2nd month after birth, with a significant decrease in Lactobacillus species in both sites, as alpha diversity progressively increased in the vagina and decreased in the rectum. The microbiota convergence of the maternal vaginal-anal sites perinatally might hold significance for the inter-generational transmission of the maternal microbiota.
PMCID:10264455
PMID: 37311781
ISSN: 2055-5008
CID: 5541392
Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection
Thaweethai, Tanayott; Jolley, Sarah E; Karlson, Elizabeth W; Levitan, Emily B; Levy, Bruce; McComsey, Grace A; McCorkell, Lisa; Nadkarni, Girish N; Parthasarathy, Sairam; Singh, Upinder; Walker, Tiffany A; Selvaggi, Caitlin A; Shinnick, Daniel J; Schulte, Carolin C M; Atchley-Challenner, Rachel; Alba, George A; Alicic, Radica; Altman, Natasha; Anglin, Khamal; Argueta, Urania; Ashktorab, Hassan; Baslet, Gaston; Bassett, Ingrid V; Bateman, Lucinda; Bedi, Brahmchetna; Bhattacharyya, Shamik; Bind, Marie-Abele; Blomkalns, Andra L; Bonilla, Hector; Bush, Patricia A; Castro, Mario; Chan, James; Charney, Alexander W; Chen, Peter; Chibnik, Lori B; Chu, Helen Y; Clifton, Rebecca G; Costantine, Maged M; Cribbs, Sushma K; Davila Nieves, Sylvia I; Deeks, Steven G; Duven, Alexandria; Emery, Ivette F; Erdmann, Nathan; Erlandson, Kristine M; Ernst, Kacey C; Farah-Abraham, Rachael; Farner, Cheryl E; Feuerriegel, Elen M; Fleurimont, Judes; Fonseca, Vivian; Franko, Nicholas; Gainer, Vivian; Gander, Jennifer C; Gardner, Edward M; Geng, Linda N; Gibson, Kelly S; Go, Minjoung; Goldman, Jason D; Grebe, Halle; Greenway, Frank L; Habli, Mounira; Hafner, John; Han, Jenny E; Hanson, Keith A; Heath, James; Hernandez, Carla; Hess, Rachel; Hodder, Sally L; Hoffman, Matthew K; Hoover, Susan E; Huang, Beatrice; Hughes, Brenna L; Jagannathan, Prasanna; John, Janice; Jordan, Michael R; Katz, Stuart D; Kaufman, Elizabeth S; Kelly, John D; Kelly, Sara W; Kemp, Megan M; Kirwan, John P; Klein, Jonathan D; Knox, Kenneth S; Krishnan, Jerry A; Kumar, Andre; Laiyemo, Adeyinka O; Lambert, Allison A; Lanca, Margaret; Lee-Iannotti, Joyce K; Logarbo, Brian P; Longo, Michele T; Luciano, Carlos A; Lutrick, Karen; Maley, Jason H; Marathe, Jai G; Marconi, Vincent; Marshall, Gailen D; Martin, Christopher F; Matusov, Yuri; Mehari, Alem; Mendez-Figueroa, Hector; Mermelstein, Robin; Metz, Torri D; Morse, Richard; Mosier, Jarrod; Mouchati, Christian; Mullington, Janet; Murphy, Shawn N; Neuman, Robert B; Nikolich, Janko Z; Ofotokun, Ighovwerha; Ojemakinde, Elizabeth; Palatnik, Anna; Palomares, Kristy; Parimon, Tanyalak; Parry, Samuel; Patterson, Jan E; Patterson, Thomas F; Patzer, Rachel E; Peluso, Michael J; Pemu, Priscilla; Pettker, Christian M; Plunkett, Beth A; Pogreba-Brown, Kristen; Poppas, Athena; Quigley, John G; Reddy, Uma; Reece, Rebecca; Reeder, Harrison; Reeves, W B; Reiman, Eric M; Rischard, Franz; Rosand, Jonathan; Rouse, Dwight J; Ruff, Adam; Saade, George; Sandoval, Grecio J; Schlater, Shannon M; Shepherd, Fitzgerald; Sherif, Zaki A; Simhan, Hyagriv; Singer, Nora G; Skupski, Daniel W; Sowles, Amber; Sparks, Jeffrey A; Sukhera, Fatima I; Taylor, Barbara S; Teunis, Larissa; Thomas, Robert J; Thorp, John M; Thuluvath, Paul; Ticotsky, Amberly; Tita, Alan T; Tuttle, Katherine R; Urdaneta, Alfredo E; Valdivieso, Daisy; VanWagoner, Timothy M; Vasey, Andrew; Verduzco-Gutierrez, Monica; Wallace, Zachary S; Ward, Honorine D; Warren, David E; Weiner, Steven J; Welch, Shelley; Whiteheart, Sidney W; Wiley, Zanthia; Wisnivesky, Juan P; Yee, Lynn M; Zisis, Sokratis; Horwitz, Leora I; Foulkes, Andrea S
IMPORTANCE:SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. OBJECTIVE:To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. DESIGN, SETTING, AND PARTICIPANTS:Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. EXPOSURE:SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES:PASC and 44 participant-reported symptoms (with severity thresholds). RESULTS:A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months. CONCLUSIONS AND RELEVANCE:A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.
PMID: 37278994
ISSN: 1538-3598
CID: 5536662
LIMBARE: an Advanced Linear Mixed-effects Breakpoint Analysis with Robust Estimation Method with Applications to Longitudinal Ophthalmic Studies
Lee, TingFang; Schuman, Joel S; Ramos Cadena, Maria de Los Angeles; Zhang, Yan; Wollstein, Gadi; Hu, Jiyuan
PURPOSE/UNASSIGNED:stimation, especially designed for longitudinal ophthalmic studies. LIMBARE accommodates repeated measurements from both eyes and overtime, and effectively address the presence of outliers. METHODS/UNASSIGNED:The model setup of LIMBARE and computing algorithm for point and confidence interval estimates of the breakpoint was introduced. The performance of LIMBARE and other competing methods was assessed via comprehensive simulation studies and application to a longitudinal ophthalmic study with 216 eyes (145 subjects) followed for an average of 3.7±1.3 years to examine the longitudinal association between structural and functional measurements. RESULTS/UNASSIGNED:In simulation studies, LIMBARE showed the smallest bias and mean squared error (MSE) for estimating the breakpoint, with empirical coverage probability of corresponding CI estimate closest to the nominal level for scenarios with and without outlier data points. In the application to the longitudinal ophthalmic study, LIMBARE detected two breakpoints between visual field mean deviation (MD) and retinal nerve fiber layer thickness (RNFL) and one breakpoint between MD and cup to disc ratio (CDR), while the cross-sectional analysis approach only detected one and none, respectively. CONCLUSIONS/UNASSIGNED:LIMBARE enhances breakpoint estimation accuracy in longitudinal ophthalmic studies, while cross-sectional analysis approach is not recommended for future studies. TRANSLATIONAL RELEVANCE/UNASSIGNED:Our proposed method and companion software R package provides a valuable computational tool for advancing longitudinal ophthalmology research and exploring the association relationships between ophthalmic variables.
PMID: 36747697
ISSN: 2692-8205
CID: 5771922