Faculty Bibliography

INTRODUCTION:Accumulated vascular damage contributes to the onset and progression of vascular dementia and possibly to Alzheimer's disease. Here we evaluate the feasibility and utility of using retinal imaging of microvascular markers to identify older adults at risk of cognitive disease. METHODS:The "Eye Determinants of Cognition" (EyeDOC) study recruited a biracial, population-based sample of participants from two sites: Jackson, MS, and Washington Co, MD. Optical coherence tomographic angiography (OCTA) was used to capture vessel density (VD) from a 6 × 6 mm scan of the macula in several vascular layers from 2017 to 2019. The foveal avascular zone (FAZ) area was also estimated. Image quality was assessed by trained graders at a reading center. A neurocognitive battery of 10 tests was administered at three time points from 2011 to 2019 and incident mild cognitive impairement (MCI)/dementia cases were ascertained. Linear mixed-effects models were used to evaluate associations of retinal vascular markers with cognitive factor score change over time. RESULTS:Nine-hundred and seventy-six older adults (mean age of 78.7 (± 4.4) years, 44% black) were imaged. Gradable images were obtained in 55% (535/976), with low signal strength (66%) and motion artifact (22%) being the largest contributors to poor quality. Among the 297 participants with both high-quality images and no clinically significant retinal pathology, the average decline in global cognitive function factor score was -0.03 standard deviations per year. In adjusted analyses, no associations of VD or FAZ with longitudinal changes in either global cognitive function or with incident MCI/dementia were found. CONCLUSIONS:In this large biracial community sample of older adults representative of the target population for retinal screening of cognitive risk, we found that obtaining high-quality OCTA scans was infeasible in a nearly half of older adults. Among the select sample of healthier older adults with scans, OCTA markers were not predictive of cognitive impairment.

We propose a randomized controlled trial to evaluate the effectiveness of a community health worker-led decision-coaching program to facilitate shared decision-making for prostate cancer screening decisions by Black men at a primary care federally qualified health center.

BACKGROUND:Nutritional deficiencies are common during pregnancy and a year after childbirth. At the same time, maternal depression affects many women during pregnancy up to 1 year after childbirth. The objectives of this study were to determine the associations between nutrition status, dietary intake, and maternal depression among pregnant women. METHODS:< .05 were considered significant. RESULTS:< .004). CONCLUSION:These findings reveal an association between poor nutrition and maternal depression. These results suggest that nutritional deficiencies could be a contributing factor for maternal depression. Study recommends dietary interventions as cost-effective way to reduce deficiencies and improve mental health problems for pregnant women. Assessment of maternal depression and dietary intake be integrated as fundamental components of antenatal care.

OBJECTIVE: Offering fertility preservation (FP) prior to gonadotoxic therapy is standard of care. Periodically, parents and children disagree about whether to pursue FP for the minor. This study reviews existing literature on parent-child disagreements regarding FP, weighs relevant rights and interests, and offers recommendations for how to navigate these ethically challenging situations. MATERIALS AND METHODS: The scoping review follows the PRISMA-ScR checklist and is registered with the Open Science Framework. A comprehensive literature search was performed in February 2021. Abstracts were screened using Covidence based on predefined criteria. Full-text articles were assessed for: 1) evidence that parentchild discordance about FP exists, 2) data on how parents or children want their views incorporated, 3) examples of how discord has been resolved, or 4) suggestions for how to handle discordance. For the ethical analysis, rights and interests identified in the review were explored and recommendations for resolving disagreement were developed.
RESULT(S): 689 abstracts were screened, 109 were selected for full-text review and 29 papers were included in the final analysis. Studies emphasized that parents and adolescent minors desire information about FP, and there was broad consensus that the views' of minors nearing adulthood should be more heavily weighted.1 However, there was a range in parent comfort with allowing minor participation in FP decision-making.2 Some authors highlighted the default stance that minors must assent to FP, while others argued that older adolescents may be able to fully consent.3 Some posit that if parents decline FP, the physician should persuade them to reconsider,4 while others proposed that parents should be able to decline, especially given the high cost.5 The ethical analysis weighs rights and interests including: minor's autonomy, minor's best interest, right to an open future, and parental autonomy. It concludes that when medically appropriate, FP is generally in a minor's best interest because it promotes future choice. Therefore, both parents and minors should be encouraged to pursue FP. If a younger minor refuses, whether FP is performed should depend on the minor's maturity, reason for refusing, and whether FP is likely to provide significant benefit. Older adolescents should be able to refuse out of respect for their autonomy. Special application of these recommendations is needed for transgender minors because of their unique concerns, including the possibility of FP inducing gender dysphoria.
CONCLUSION(S): This scoping review supports the conclusions that minors should be included in FP discussions and should have increasing decision- making authority as they near adulthood. When parents and minors disagree about FP, who should ultimately decide depends on the minor's age, maturity, whether the minor or parent declines FP, and whether FP is likely to provide significant benefit. IMPACT STATEMENT: This study offers a rigorous scoping review, ethical analysis and recommendations for navigating parent-child disagreement regarding FP in minors

INTRODUCTION/BACKGROUND:Neighborhood walkability has been established as a potentially important determinant of various health outcomes that are distributed inequitably by race/ethnicity and sociodemographic status. The objective of this study is to assess the differences in walkability across major urban centers in the U.S. METHODS:City- and census tract-level differences in walkability were assessed in 2020 using the 2019 Walk Score across 500 large cities in the U.S. RESULTS:At both geographic levels, high-income and majority White geographic units had the lowest walkability overall. Walkability was lower with increasing tertile of median income among majority White, Latinx, and Asian American and Native Hawaiian and Pacific Islander neighborhoods. However, this association was reversed within majority Black neighborhoods, where tracts in lower-income tertiles had the lowest walkability. Associations varied substantially by region, with the strongest differences observed for cities located in the South. CONCLUSIONS:Differences in neighborhood walkability across 500 U.S. cities provide evidence that both geographic unit and region meaningfully influence associations between sociodemographic factors and walkability. Structural interventions to the built environment may improve equity in urban environments, particularly in lower-income majority Black neighborhoods.

BACKGROUND:Little is known about disparities in pain treatment associated with weight status despite prior research on weight-based discrepancies in other realms of healthcare and stigma among clinicians. OBJECTIVE:To investigate the association between weight status and the receipt of prescription analgesics in a nationally representative sample of adults with back pain, adjusting for the burden of pain. DESIGN/METHODS:Cross-sectional analyses using the Medical Expenditure Panel Survey (2010-2017). PARTICIPANTS/METHODS:Five thousand seven hundred ninety-one civilian adults age ≥ 18 with back pain. MAIN MEASURES/METHODS:We examine the odds of receiving prescription analgesics for back pain by weight status using logistic regression. We study the odds of receiving (1) any pain prescription, (2) three pain prescription categories (opioid only, non-opioid only, the combination of both), and (3) opioids conditional on having a pain prescription. KEY RESULTS/RESULTS:The odds of receiving pain prescriptions increase monotonically across weight categories, when going from normal weight to obesity II/III, despite adjustments for the burden of pain. Relative to normal weight, higher odds of receiving any pain prescription is associated with obesity I (OR = 1.30 [95% CI = 1.04-1.63]) and obesity II/III (OR = 1.72 [95% CI = 1.36-2.18]). Obesity II/III is also associated with higher odds of receiving opioids only (OR = 1.53 [95% CI = 1.16-2.02]), non-opioids only (OR = 1.77 [95% CI = 1.21-2.60]), and a combination of both (OR = 2.48 [95% CI = 1.44-4.29]). Obesity I is associated with increased receipt of non-opioids only (OR = 1.55 [95% CI = 1.07-2.23]). Conditional on having a pain prescription, the odds of receiving opioids are comparable across weight categories. CONCLUSIONS:This study suggests that, relative to those with normal weight, adults with obesity are more likely to receive prescription analgesics for back pain, despite adjustments of the burden of pain. Hence, the possibility of weight-based undertreatment is not supported. These findings are reassuring because individuals with obesity generally experience a higher prevalence of back pain. The possibility of over-treatment associated with obesity, however, may warrant further investigation.

BACKGROUND:Proteomic profiling may allow identification of plasma proteins that associate with subsequent changesin kidney function, elucidating biologic processes underlying the development and progression of CKD. METHODS:We quantified the association between 4877 plasma proteins and a composite outcome of ESKD or decline in eGFR by ≥50% among 9406 participants in the Atherosclerosis Risk in Communities (ARIC) Study (visit 3; mean age, 60 years) who were followed for a median of 14.4 years. We performed separate analyses for these proteins in a subset of 4378 participants (visit 5), who were followed at a later time point, for a median of 4.4 years. For validation, we evaluated proteins with significant associations (false discovery rate <5%) in both time periods in 3249 participants in the Chronic Renal Insufficiency Cohort (CRIC) and 703 participants in the African American Study of Kidney Disease and Hypertension (AASK). We also compared the genetic determinants of protein levels with those from a meta-analysis genome-wide association study of eGFR. RESULTS:-trace protein. Of these proteins, 12 were also significantly associated in CRIC, and nine were significantly associated in AASK. Higher levels of each protein associated with higher risk of 50% eGFR decline or ESKD. We found genetic evidence for a causal role for one protein, lectin mannose-binding 2 protein (LMAN2). CONCLUSIONS:Large-scale proteomic analysis identified both known and novel proteomic risk factors for eGFR decline.

OBJECTIVES/OBJECTIVE:The role of overcrowded and multigenerational households as a risk factor for COVID-19 remains unmeasured. The objective of this study is to examine and quantify the association between overcrowded and multigenerational households and COVID-19 in New York City (NYC). STUDY DESIGN/METHODS:Cohort study. METHODS:We conducted a Bayesian ecological time series analysis at the ZIP Code Tabulation Area (ZCTA) level in NYC to assess whether ZCTAs with higher proportions of overcrowded (defined as the proportion of the estimated number of housing units with more than one occupant per room) and multigenerational households (defined as the estimated percentage of residences occupied by a grandparent and a grandchild less than 18 years of age) were independently associated with higher suspected COVID-19 case rates (from NYC Department of Health Syndromic Surveillance data for March 1 to 30, 2020). Our main measure was an adjusted incidence rate ratio (IRR) of suspected COVID-19 cases per 10,000 population. Our final model controlled for ZCTA-level sociodemographic factors (median income, poverty status, White race, essential workers), the prevalence of clinical conditions related to COVID-19 severity (obesity, hypertension, coronary heart disease, diabetes, asthma, smoking status, and chronic obstructive pulmonary disease), and spatial clustering. RESULTS: = 0.99, 95% CI: 0.99-1.00). CONCLUSIONS:Overcrowdedness and multigenerational housing are independent risk factors for suspected COVID-19. In the early phase of the surge in COVID cases, social distancing measures that increase house-bound populations may inadvertently but temporarily increase SARS-CoV-2 transmission risk and COVID-19 disease in these populations.