Faculty Bibliography

PURPOSE/OBJECTIVE:Over half of males experience fertility impairment after childhood cancer therapy, which often causes psychosocial distress. Yet, fertility preservation (FP) remains underutilized. The goals of this study were to determine the feasibility and impact of implementing a family-centered FP values clarification tool on sperm banking attempts among adolescent males newly diagnosed with cancer, and identify key determinants of banking attempts. METHODS:A prospective pilot study was conducted among families of males (12-25 years old), prior to cancer therapy. Thirty-nine of 41 families agreed to participate (95%); 98 participants (32 adolescents, 37 mothers, 29 fathers) completed the Family-centered Adolescent Sperm banking values clarification Tool (FAST). Analyses assessed the impact of the FAST on banking attempts and examined associations between demographic/medical characteristics, FAST subscales (perceived threat, benefits, barriers), and banking attempts. RESULTS:=.59, p=.02) were associated with banking attempts. CONCLUSION/CONCLUSIONS:Adolescent sperm banking attempt rates significantly increased after implementation of a family-centered FP values clarification tool prior to cancer treatment. Findings underscore the importance of targeting both adolescents and their parents, particularly fathers, in FP efforts.

Objective and Objective/UNASSIGNED:Obstructive Sleep Apnea (OSA) is a highly prevalent disorder that disparately affects racial/ethnic minorities. OSA functional health literacy can contribute to health disparities. Documenting poor OSA functional health literacy is needed to inform research agendas, policy, and advocacy efforts. The objective of this study is to develop a scale for measuring OSA functional health literacy among diverse audiences and a variety of reading levels and to ascertain its reliability and validity. Methods/UNASSIGNED:Development of the 18-item Survey of OSA Functional Health Literacy (SOFHL) was guided by literature review and input from experts. A convenience sample of persons enrolled in a clinical trial completed the survey (n=194). The psychometric evaluation was conducted using factor analysis to identify the number of dimensions in the SOFHL and their relationship to other domains that are relevant to OSA functional health literacy. Results/UNASSIGNED:Internal consistency reliability (alpha) was estimated for the resulting scale and correlations with educational attainment and income completed. All respondents were Black and 29% reported average household income less than $10,000 USD. Confirmatory factor analysis provided support for two dimensions: OSA general knowledge (alpha=0.81) and self-efficacy for OSA self-management (alpha=0.71). Conclusions/UNASSIGNED:Higher educational attainment and socioeconomic status were associated with better OSA functional health literacy. These results provide preliminary support for the SOFHL, a measure that can be used to assess OSA functional health literacy.

Objectives/UNASSIGNED:To understand how patients and family members experience dehumanizing or humanizing treatment when in the ICU. Design/UNASSIGNED:Qualitative study included web-based focus groups and open-ended surveys posted to ICU patient/family social media boards. Focus groups were audio recorded and transcribed. Social media responses were collected and organized by stakeholder group. Data underwent qualitative analysis. Setting/UNASSIGNED:Remote focus groups and online surveys. Patients/UNASSIGNED:ICU patient survivors, family members, and ICU teams. Interventions/UNASSIGNED:Not available. Measurements and Main Results/UNASSIGNED:Semi-structured questions and open-ended survey responses. We enrolled 40 patients/family members and 31 ICU team members. Focus groups and surveys revealed three primary themes orienting humanizing/dehumanizing ICU experiences: 1) communication, 2) outcomes, and 3) causes of dehumanization. Dehumanization occurred during "communication" exchanges when ICU team members talked "over" patients, made distressing remarks when patients were present, or failed to inform patients about ICU-related care. "Outcomes" of dehumanization were associated with patient loss of trust in the medical team, loss of motivation to participate in ICU recovery, feeling of distress, guilt, depression, and anxiety. Humanizing behaviors were associated with improved recovery, well-being, and trust. "Perceived causes" of dehumanizing behaviors were linked to patient, ICU team, and healthcare system factors. CONCLUSIONS:Behaviors of ICU clinicians may cause patients and families to feel dehumanized when in the ICU. Negative behaviors are noticed by patients and families, possibly contributing to poor outcomes including mental health, recovery, and lack of trust in ICU teams. Supporting ICU clinicians may enable a more empathic environment and in turn more humanizing clinician-patient encounters.

Dance festival attendees are at high risk for consuming adulterated drugs. In recent years, drug checking studies have been conducted at various dance festivals to provide valuable harm reduction information to attendees regarding drug content. We conducted a review of the literature to determine the generalizability of findings to the target population of interest-festival attendees at risk for using adulterated drugs. Six published studies involving drug checking at festivals were reviewed. All relied on self-selected samples and male attendees were overrepresented based on previous research. Test methods, drugs tested, definitions of adulteration, and prevalence of adulteration varied across studies. Prevalence of detection of adulterants ranged from 11% to 55%. While the drug checking services described appear to have been beneficial for participants, results have limited generalizability to the target population. We recommend that researchers expand beyond the self-selection model in future studies and utilize recruitment methods that involve random sampling techniques such as systematic random sampling, stratified random sampling, or time-space sampling within festivals. We also recommend that individuals approached are surveyed for demographic characteristics, planned drug use at the festival, and willingness to test their drugs. These methods would help determine how representative the sample is compared to the target population and allow for more generalizable estimates. In conclusion, as these valuable harm reduction services expand, it may be possible to reach a wider portion of the population at risk and to obtain more generalizable estimates of engagement, adulteration, and reactions to learning one possesses adulterated drugs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVE:People experiencing homelessness (PEH) have high rates of substance use, and homelessness may be an important driver of health disparities in the opioid overdose epidemic. However, few studies focus on homelessness among the opioid use disorder (OUD) treatment population. We examine national-level trends in substance use treatment admissions among PEH with OUD. METHODS:This study used data from first-time treatment admissions in the United States from the Treatment Episode Data Set: Admissions (TEDS-A) to examine characteristics and trends of adults experiencing homelessness who entered state-licensed substance use treatment programs for OUD from 2013 to 2017. We used chi-squared analyses to examine changes in characteristics of this population over time and logistic regression to assess characteristics associated with receipt of medications for opioid use disorder (MOUD) among PEH. RESULTS:Among all adults with OUD entering specialty treatment from 2013 to 2017, 12.5% reported experiencing homelessness. Compared to individuals not experiencing homelessness, PEH were more likely to be male, inject opioids, use cocaine or methamphetamine, and enter into residential detoxification treatment. PEH were less likely to enter outpatient treatment or receive MOUD. From 2013 to 2017, significant increases occurred in the proportion of PEH who had co-occurring psychiatric problems and used methamphetamines. Over time, treatment type shifted significantly from residential detoxification to outpatient treatment. Receipt of MOUD increased among PEH over time (13.7% to 25.2%), but lagged behind increases among individuals not experiencing homelessness. Among PEH, being older was associated with receiving MOUD, while concurrent methamphetamine use [adjusted odds ratio (AOR) 0.63; 95% CI 0.58, 0.69] and living in the southern United States (AOR 0.27; 95% CI 0.25, 0.30) were associated with not receiving MOUD. DISCUSSION/CONCLUSIONS:The proportion of PEH with OUD who receive medications as part of treatment increased over time, but three quarters of PEH entering treatment still do not receive this highest standard in evidence-based care. The sharp increase observed in concomitant methamphetamine use in this population is concerning and has implications for treatment.

INTRODUCTION/BACKGROUND:New York State implemented a Health Homes (HH) care management program to facilitate access to health services for Medicaid enrollees with multiple chronic conditions. This study assessed the impact of HH on health care utilization outcomes among enrollees who have substance use disorder (SUD). METHODS:Using HH enrollment data and Medicaid claims data 1 year before and after enrollment, this study compared HH enrollees who enrolled between 2012 and 2014 to a statistically matched comparison group created with propensity score methods. Analyses used generalized gamma models, logistic regression models, and difference-in-differences analyses to assess the impact of HH on general (all-cause) health care and SUD-related outpatient, emergency department (ED), hospitalization, and detoxification utilization as well as total Medicaid cost. RESULTS:The sample consisted of 41,229 HH enrollees and a comparison group of 39,471 matched patients. HH-enrolled patients who had SUD utilized less SUD-related ED services (average marginal effect (AME) = -1.85; 95% CI = -2.45, -1.24), SUD-related hospitalizations (AME = -1.28; 95% CI: -1.64, -0.93), and detoxification services (AME = -1.30; 95% CI = -1.64, -0.96), relative to the comparison group during the 1 year post-HH enrollment. SUD-related outpatient visits did not change significantly (AME = -0.28; 95% CI = -0.76, 0.19) for enrollees, but general health care outpatient visits increased (AME = 1.63; 95% CI = 1.33, 1.93). CONCLUSION/CONCLUSIONS:These findings provide preliminary evidence that care management programs can decrease ED visits and hospitalizations among people with SUD.

PURPOSE/OBJECTIVE:To examine how the choice of neighborhood food environment definition impacts the association with diet. METHODS:) and relative measures (i.e., percentage of all food stores or restaurants); and various buffer distances, including administrative units (census tract) and empirically-derived buffers ("classic" network, "sausage" network) tailored to community type (higher-density urban, lower-density urban, suburban/small town, rural). Using generalized estimating equations, we estimated the association between each geospatial measure and DIS, controlling for individual- and neighborhood-level sociodemographics. RESULTS:The choice of buffer-based measure did not change the direction or magnitude of associations with DIS. Effect estimates derived from administrative units were smaller than those derived from tailored empirically-derived buffer measures. Substantively, a 10% increase in the percentage of fast food restaurants using a "classic" network buffer was associated with a 6.3 (SE=1.17) point higher DIS (p<0.001). The relationship between the percentage of supermarkets and DIS, however, was null. We observed high correlation coefficients between buffer-based density measures of supermarkets and fast food restaurants (r=0.73-0.83), which made it difficult to estimate independent associations by food outlet type. CONCLUSIONS:Researchers should tailor buffer-based measures to community type in future studies, and carefully consider the theoretical and statistical implications for choosing relative (vs. absolute) measures.

BACKGROUND:There is a lack of consensus in optimal management of portal vein thrombosis (PVT) in patients with cirrhosis. The purpose of this study is to compare the safety and thrombosis burden change for cirrhotic patients with non-tumoral PVT managed by transjugular intrahepatic portosystemic shunt (TIPS) only, anticoagulation only, or no treatment. METHODS:This single-center retrospective study evaluated 52 patients with cirrhosis and non-tumoral PVT managed by TIPS only (14), anticoagulation only (11), or no treatment (27). The demographic, clinical, and imaging data for patients were collected. The portomesenteric thrombosis burden and liver function tests at early follow-up (6-9 months) and late follow-up (9-16 months) were compared to the baseline. Adverse events including bleeding and encephalopathy were recorded. RESULTS:= 0.007). No bleeding complications attributable to anticoagulation were observed. CONCLUSION/CONCLUSIONS:TIPS decreased portomesenteric thrombus burden compared to anticoagulation or no treatment for cirrhotic patients with PVT. Both TIPS and anticoagulation were safe therapies.

BACKGROUND:Blood pressure (BP) measurement error may lead to under- or overtreatment of hypertension. One common source of error is terminal digit preference, most often a terminal digit of "0." The objective was to evaluate national trends in terminal digit preference in office BP measurements among adults with treated hypertension. METHODS:Data were from IQVIA's National Disease and Therapeutic Index, a nationally representative, serial cross-sectional survey of office-based physicians. The analysis included office visits from 2015 to 2019 among adults aged ≥18 years receiving antihypertensive treatment. Annual trends were examined in the percent of systolic and diastolic BP measurements ending in zero by patient sex, age, and race/ethnicity, physician specialty, and first or subsequent hypertension treatment visit. RESULTS:From 2015 to 2019, there were ~60 million hypertension treatment visits annually (unweighted N: 5,585-9,085). There was a decrease in the percent of visits with systolic (41.7%-37.7%) or diastolic (42.7%-37.8%) BP recordings ending in zero. Trends were similar by patient characteristics. However, a greater proportion of measurements ended in zero among patients aged ≥80 (vs. 15-59 or 60-79) years, first (vs. subsequent) treatment visits, visits to cardiologists (vs. primary care physicians), and visits with systolic BP ≥140 or diastolic BP ≥90 (vs. <140/90) mm Hg. CONCLUSIONS:Despite modest improvement, terminal digit preference remains a common problem in office BP measurement in the United States. Without bias, 10%-20% of measurements are expected to end in zero. Reducing digit preference is a priority for improving BP measurement accuracy and hypertension management.