Faculty Bibliography

OBJECTIVE:To determine if World Trade Center (WTC) exposure is associated with hearing loss. METHODS:Logistic regression to evaluate the immediate impact of WTC exposure and parametric survival analysis to assess longitudinal outcomes. RESULTS:Those arriving on the morning of 9/11/2001 had elevated odds of low-frequency (odds ratio [OR]: 1.24;95%CI:1.04-1.47) and high-frequency (OR:1.16;95%CI:1.02-1.31) hearing loss at their first post-9/11/2001 exam. Longitudinally, participants arriving before 9/13/2001 and spending ≥6 months at the WTC-site had greater risk of hearing loss in the low frequencies (risk ratio [RR]:1.31;95%CI:1.05-1.60) and high frequencies (RR:1.37;95%CI:1.22-1.54). By 2016, 3,194 (37%) had abnormal hearing sensitivity in either ear and 1,751 (20%) in both ears. CONCLUSIONS:More heavily WTC-exposed workers were at increased risk of hearing loss, and group differences persisted for at least 15 years. Those with abnormal hearing sensitivity may benefit from interventions such as hearing aids and other rehabilitation.

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Background: Our study aims to demonstrate through implementation of telepsychiatry for child psychiatry patients evaluated in the pediatric emergency room (PedsER); we can reduce length of stay (LOS) and reduce factors contributing to physician burnout through reduction of on-call travel burden.Introduction: Telepsychiatry has increased access to health care using real-time interactive videoconferencing, allowing clinicians and patients in separate locations to have a meaningful clinical encounter. Use has increased over the past several years given cost reduction and need for psychiatric specialty services in under-resourced systems.Materials and Methods: We evaluated data regarding child psychiatry fellow use of telepsychiatry through a prospective real-time questionnaire filled out by the on-call clinician from July 1, 2017 to December 23, 2017 (study period). LOS was measured from the patient's registration time through time of discharge.Results: Telepsychiatry significantly reduced the total monthly LOS for nonhospitalized patients in the PedsER during the study period compared to all prior months (285-193 h; p = 0.032) and compared to a similar prior seasonal time frame (329-193 h; p = 0.017). Telepsychiatry use reduced travel for face-to-face evaluations by 75% and saved 2.22 h per call day.Discussion: Unique in this study is enhancing on-site psychiatric consultation in the emergency room, rather than solving a systems issue of referring out for psychiatric consultation. Moreover, this study uniquely demonstrated a noted improvement in on-call physician travel burden by reducing travel time with telepsychiatry. Physician burnout is notably high during residency training. Factors such as telepsychiatry can improve work efficiency and lend time to activities outside of work, mitigating the onset of this challenging issue.Conclusions: Telepsychiatry was shown to be effective in reducing dwell time and improving on-call burden. This study also showed promise in our system for improving access to other forms of specialized care consultation in PedsER settings.

A critical task in psychotherapy research is identifying the conditions within which treatment benefits can be replicated and outside of which those benefits are reduced. We tested the robustness of beneficial effects found in two previous trials of the modular Child STEPs treatment program for youth anxiety, depression, trauma, and conduct problems. We conducted a randomized trial, with two significant methodological changes from previous trials: (a) shifting from cluster- to person-level randomization, and (b) shifting from individual to more clinically feasible group-based consultation with STEPs therapists. Fifty community clinicians from multiple outpatient clinics were randomly assigned to receive training and consultation in STEPs (n = 25) or to provide usual care (UC; n = 25). There were 156 referred youths-ages 6-16 (M = 10.52, SD = 2.53); 48.1% male; 79.5% Caucasian, 12.8% multiracial, 4.5% Black, 1.9% Latino, 1.3% Other-who were randomized to STEPs (n = 77) or UC (n = 79). Following previous STEPs trials, outcome measures included parent- and youth-reported internalizing, externalizing, total, and idiographic top problems, with repeated measures collected weekly during treatment and longer term over 2 years. Participants in both groups showed statistically significant improvement on all measures, leading to clinically meaningful problem reductions. However, in contrast to previous trials, STEPs was not superior to UC on any measure. As with virtually all treatments, the benefits of STEPs may depend on the conditions-for example, of study design and implementation support-in which it is tested. Identifying those conditions may help guide appropriate use of STEPs, and other treatments, in the future.