Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Population Health
Total Results:
12207
Parent-Child Communication and Reproductive Considerations in Families with Genetic Cancer Predisposition Syndromes: A Systematic Review
PMCID:7899160
PMID: 32898455
ISSN: 2156-535x
CID: 4798352
Adiposity Measures and Morning Serum Cortisol in African Americans: Jackson Heart Study
OBJECTIVE:Altered hormonal regulation, including cortisol, is a proposed mechanism linking adiposity to obesity-related disorders. We examined the association of anthropometric, adipokine, and body fat distribution measures of adiposity with morning serum cortisol in an African American (AA) cohort. METHODS:We investigated the cross-sectional associations of adiposity measures (BMI, waist circumference, leptin, adiponectin, leptin:adiponectin ratio, subcutaneous and visceral adipose tissue) and liver attenuation with cortisol in the Jackson Heart Study. Linear regression models were used to analyze the association between exposures and cortisol. Models were adjusted for multiple covariates. RESULTS:Among 4,211 participants, a 1-SD higher BMI and waist circumference were associated with a 3.92% and 3.05% lower cortisol, respectively. A 1-SD higher leptin and leptin:adiponectin ratio were associated with a 6.48% and 4.97% lower morning serum cortisol, respectively. A 1-SD higher subcutaneous adipose tissue was associated with a 4.97% lower cortisol (all P < 0.001). There were no associations of liver attenuation or visceral adipose tissue with cortisol. CONCLUSIONS:Several measures of adiposity are associated with lower morning serum cortisol among AAs, with leptin having the greatest magnitude. Future studies examining the role of morning serum cortisol in the pathway from adiposity to cardiometabolic disease in AAs are warranted.
PMID: 33491313
ISSN: 1930-739x
CID: 5069722
Subgroup Variation and Neighborhood Social Gradients-an Analysis of Hypertension and Diabetes Among Asian Patients (New York City, 2014-2017)
Diabetes and hypertension are socially patterned by individual race/ethnicity and by neighborhood economic context, but distributions among Asian subgroups are undercharacterized. We examined variation in prevalence for both conditions, comparing between US Asian subgroups, including within South Asian nationalities, and comparing within subgroups by neighborhood economic context. We obtained data on a non-probability sample of 633,664 patients ages 18-64 in New York City, NY, USA (2014-2017); 30,138 belonged to one of seven Asian subgroups (Asian Indian, Bangladeshi, Pakistani, Chinese, Korean, Japanese, and Filipino). We used electronic health records to classify disease status. We characterized census tract economic context using the Index of Concentration at the Extremes and estimated prevalence differences using multilevel models. Among Asian men, hypertension prevalence was highest for Filipinos. Among Asian women, hypertension prevalence was highest for Filipinas and Bangladeshis. Diabetes prevalence was highest among Pakistanis and Bangladeshis of both genders, exceeding all other Asian and non-Asian groups. There was consistent evidence of an economic gradient for both conditions, whereby persons residing in the most privileged neighborhood tertile had the lowest disease prevalence. The economic gradient was particularly strong for diabetes among Pakistanis, whose prevalence in the most deprived tertile exceeded that of the most privileged by 9 percentage points (95% CI 3, 14). Only Koreans departed from the trend, experiencing the highest diabetes prevalence in the most privileged tertile. US Asian subgroups largely demonstrate similar neighborhood economic gradients as other groups. Disaggregating Asian subgroups, including within South Asian nationalities, reveals important heterogeneity in prevalence.
PMID: 32488823
ISSN: 2196-8837
CID: 4514682
Development and Assessment of a Pictographic Pediatric Constipation Action Plan
OBJECTIVE:To assess the Uniformed Services Constipation Action Plan (USCAP) as an evidence-based, personalized, clinical action tool with pictograms to aid clinicians and families in the management of functional constipation. STUDY DESIGN/METHODS:The USCAP facilitates the management functional constipation by using a health literacy-informed approach to provide instructions for pharmacotherapies and lifestyle modifications. This study included part 1 (pictogram validation) and part 2 (assessment). For part 1, pictogram transparency, translucency, and recall were assessed by parent survey (transparency ≥85%, mean translucency score ≥5, recall ≥85% required for validation). For part 2, the USCAP was assessed by parents, clinical librarians, and clinicians. Parental perceptions (n = 65) were assessed using the Consumer Information Rating Form (17 questions) to gauge comprehensibility, design quality and usefulness. Readability was assessed by 5 formulas and a Readability Composite Score was calculated. Clinical librarians (n = 3) used the Patient Education Materials Assessment Tool to measure understandability (19 questions) and actionability (7 questions) (>80% rating was acceptable). Suitability was assessed by clinicians (n = 34) using Doak's Suitability Assessment of Materials (superior ≥70% rating). RESULTS:All 12 pictograms demonstrated appropriate transparency, translucency, and recall. Parental perceptions reflected appropriate comprehensibility, design quality, and usefulness. The Readability Composite Score was consistent with a fifth-grade level. Clinical librarians reported acceptable understandability and actionability. Clinicians reported superior suitability. CONCLUSIONS:The USCAP met all criteria for clinical implementation and future study of USCAP implementation for treating children with chronic functional constipation.
PMCID:7557278
PMID: 33068567
ISSN: 1097-6833
CID: 4724952
Concentration and Composition in Subway Systems in the Northeastern United States
OBJECTIVES/OBJECTIVE:The goals of this study were to assess the air quality in subway systems in the northeastern United States and estimate the health risks for transit workers and commuters. METHODS: RESULTS: DISCUSSION/CONCLUSIONS:
PMCID:7874921
PMID: 33565894
ISSN: 1552-9924
CID: 4835492
Don't Ask, Don't Tell: Cannabis Use in Adolescent and Young Adult Cancer Patients
PMID: 32614266
ISSN: 2156-535x
CID: 4798302
Journal of the American College of Radiology : JACR. 2021:18(2):231-232.DOI: 10.1016/j.jacr.2020.10.013
When Less is Not More: Population-level Perspective on Adnexal Cyst Surveillance for Post-Menopausal Women
PMID: 33541553
ISSN: 1558-349x
CID: 4807462
Effectiveness and Reach of the Primary Palliative Care for Emergency Medicine (PRIM-ER) Pilot Study: a Qualitative Analysis
BACKGROUND:Palliative care interventions in the ED capture high-risk patients at a time of crisis and can dramatically improve patient-centered outcomes. OBJECTIVE:To understand the facilitators that contributed to the success of the Primary Palliative Care for Emergency Medicine (PRIM-ER) quality improvement pilot intervention. DESIGN/METHODS:Effectiveness was evaluated through semi-structured interviews. Reach outcomes were measured by percent of all full-time emergency providers (physicians, physician assistants, nurses) who completed the intervention education components and baseline survey assessing attitudes and knowledge on end-of-life care. PARTICIPANTS/METHODS:Emergency medicine providers affiliated with two medical centers (N = 197). Interviews conducted with six key informants at both institutions. APPROACH/METHODS:Interviews were recorded, transcribed, and analyzed using deductive and inductive approaches. Descriptive statistics include reach outcomes and baseline survey results. KEY RESULTS/RESULTS:Both sites successfully implemented all components of the intervention and achieved a high level (> 75%) of intervention reach. Two themes emerged as facilitators to successful effectiveness facilitators of PRIM-ER: (1) institutional leadership support and (2) leveraging established quality improvement (QI) processes. Institutional support included leveraging leadership with authority to (a) mandate trainings; (b) substitute PRIM-ER education for normally scheduled education; and (c) provide protected time to implement intervention components. Effectiveness was also enhanced by capitalizing on existing QI processes which included (a) leveraging interdisciplinary partnerships and communication plans and (b) monitoring performance improvement data. CONCLUSIONS:Capitalizing on strong institutional leadership support and established QI processes enhanced the reach and effectiveness of the PRIM-ER pilot. These findings will guide the PRIM-ER researchers in scaling up the intervention in the remaining 33 sites, as well as enhance the planning of other complex quality improvement interventions in clinical settings. REGISTRATION DETAILS/UNASSIGNED:ClinicalTrials.gov Identifier: NCT03424109; Grant Number: AT009844-01.
PMID: 33111240
ISSN: 1525-1497
CID: 4663602
Urine Metabolites Associated with the Dietary Approaches to Stop Hypertension (DASH) Diet: Results from the DASH-Sodium Trial
SCOPE:Serum metabolomic markers of the Dietary Approaches to Stop Hypertension (DASH) diet are previously reported. In an independent study, the similarity of urine metabolomic markers are investigated. METHODS AND RESULTS:In the DASH-Sodium trial, participants are randomly assigned to the DASH diet or control diet, and received three sodium interventions (high, intermediate, low) within each randomized diet group in random order for 30 days each. Urine samples are collected at the end of each intervention period and analyzed for 938 metabolites. Two comparisons are conducted: 1) DASH-high sodium (n = 199) versus control-high sodium (n = 193), and 2) DASH-low sodium (n = 196) versus control-high sodium. Significant metabolites identified using multivariable linear regression are compared and the top 10 influential metabolites identified using partial least-squares discriminant analysis to the results from the DASH trial. Nine out of 10 predictive metabolites of the DASH-high sodium and DASH-low sodium diets are identical. Most candidate biomarkers from the DASH trial replicated. N-methylproline, chiro-inositol, stachydrine, and theobromine replicated as influential metabolites of DASH diets. CONCLUSIONS:Candidate biomarkers of the DASH diet identified in serum replicated in urine. Replicated influential metabolites are likely to be objective biomarkers of the DASH diet.
PMCID:7967699
PMID: 33300290
ISSN: 1613-4133
CID: 5585972
The Effects of Four Doses of Vitamin D Supplements on Falls in Older Adults : A Response-Adaptive, Randomized Clinical Trial
BACKGROUND:Vitamin D supplementation may prevent falls in older persons, but evidence is inconsistent, possibly because of dosage differences. OBJECTIVE:supplements on falls. DESIGN:2-stage Bayesian, response-adaptive, randomized trial. (ClinicalTrials.gov: NCT02166333). SETTING:2 community-based research units. PARTICIPANTS:688 participants, aged 70 years and older, with elevated fall risk and a serum 25-hydroxyvitamin D [25-(OH)D] level of 25 to 72.5 nmol/L. INTERVENTION:doses, and the best noncontrol dose for preventing falls was determined. After dose finding, participants previously assigned to receive noncontrol doses received the best dose, and new enrollees were randomly assigned to receive 200 IU/d or the best dose. MEASUREMENTS:Time to first fall or death over 2 years (primary outcome). RESULTS: = 0.54). Analysis of falls with adverse outcomes suggested greater risk in the experience-with-best-dose group versus the 200-IU/d group (serious fall: HR, 1.87 [CI, 1.03 to 3.41]; fall with hospitalization: HR, 2.48 [CI, 1.13 to 5.46]). LIMITATIONS:per day, not a placebo. Dose finding ended before the prespecified thresholds for dose suspension and dose selection were reached. CONCLUSION:doses of 1000 IU/d or higher. PRIMARY FUNDING SOURCE:National Institute on Aging.
PMID: 33284677
ISSN: 1539-3704
CID: 5585962
