Faculty Bibliography

PURPOSE OF REVIEW/OBJECTIVE:Diabetes care is characterized by the widespread use of plastics. With plastic-associated endocrine-disrupting chemicals (EDCs) implicated in diabetes pathogenesis, this review examines how medical plastics relate to diabetes and related disorders and proposes interventions to improve the situation. RECENT FINDINGS/RESULTS:Plastic-associated EDCs and micro-/nanoplastics (MNPs) are linked to metabolic dysfunction. Medical care exposes patients to these agents; however, the precise contribution of diabetes care to these exposures and their associated adverse health effects remains poorly defined. Diabetes care is an increasingly important contributor to plastic pollution and climate change, yet inadequate systems exist to mitigate its environmental impact. Plastic-associated EDCs and MNPs remain an underappreciated metabolic health threat. Mitigating the deleterious impacts of plastics on human and planetary health requires concerted actions from manufacturers, scientists, policymakers, professional organizations, healthcare providers, and patients. Doing so has the potential to improve metabolic health and promote health equity.

BACKGROUND/UNASSIGNED:Skilled nursing facilities (SNFs) play a critical role in postacute recovery for older adults with heart failure (HF), yet the transition from SNF to home remains a vulnerable and understudied phase of care. Although discharge guidelines emphasize clear communication, HF-specific self-care education, medication management, and follow-up coordination, little is known about how these practices are implemented during SNF-to-home transitions. METHODS/UNASSIGNED:We conducted a convergent mixed-methods study across 4 nonprofit SNFs, integrating data from postdischarge patient and caregiver surveys, structured medical record abstraction of discharge instructions, and semi-structured staff interviews. Eligible patients were Medicare beneficiaries aged ≥65 years discharged from SNF to home following HF hospitalization, with SNF stays ≤60 days. Quantitative data were analyzed using descriptive statistics, while qualitative data underwent thematic and directed content analysis. Findings were triangulated across data sources to identify key challenges and actionable strategies. RESULTS/UNASSIGNED:Among 150 respondents, 59% reported receiving written discharge instructions; however, HF-specific self-care elements (eg, daily weight monitoring, low salt diet) were documented in only 15% to 41% of instructions. Although 87% reported receiving a medication list, only 53% had it reflected in the discharge instructions, and adherence support was infrequently addressed (24%). Follow-up coordination was similarly discordant: 37% of respondents reported a scheduled primary care appointment, compared with 13% documented in discharge instructions. Staff interviews revealed nonstandardized discharge workflows, workforce constraints, and reliance on verbal education, contributing to variability in patient preparation and communication across care settings. CONCLUSIONS/UNASSIGNED:SNF-to-home transitions after HF hospitalization are marked by discordance between patient-reported education and written documentation, as well as inconsistent medication and follow-up coordination. These gaps represent modifiable vulnerabilities during a high-risk recovery period. Standardized HF-focused discharge workflows and strengthened cross-setting communication may improve transitional care, while long-term solutions must address structural and workforce constraints.

BACKGROUND:There are limited studies on telehealth use patterns among patients with prostate cancer. OBJECTIVE:We assessed the patterns of delivery of care for prostate cancer management in the Veterans Health Administration (VHA). DESIGN/METHODS:A retrospective observational cohort study from January 2016 to February 2023. PARTICIPANTS/METHODS:Data were from the VHA's Corporate Data Warehouse (CDW). Veterans with a new diagnosis of prostate cancer were included in the study. Those who died within 1 year of diagnosis, had missing staging information, or had no prostate-specific antigen (PSA), biopsy, or treatment recorded within 2 years of initial diagnosis were excluded. MAIN MEASURES/METHODS:Veterans were categorized into watchful waiting, active surveillance, and active treatment management groups based on subsequent care received and categorized into National Comprehensive Cancer Network (NCCN) risk categories. We categorized outpatient urology or oncology visits as telephone-based, video-based, or in-person using administrative stop codes. We used logistic regression models to evaluate the characteristics associated with at least one video/virtual visit. KEY RESULTS/RESULTS:In total, 60,381 Veterans were included in the study (20.3% low risk, 49.8% intermediate risk, and 29.8% high risk). Even during the COVID-19 pandemic, less than 6% and 9% of Veterans had at least one urology or oncology video visit, respectively, in the first year after diagnosis across all management groups. In the regression model, Veterans aged 60 and older were less likely to have video visits for both urology and oncology. In contrast, living in urban areas, being diagnosed during the COVID-19 pandemic, and being in the intermediate NCCN risk group were associated with higher odds of having at least one video visit in both specialties. CONCLUSIONS:Despite improvements in telehealth use among Veterans with prostate cancer, telehealth utilization, particularly video visits, remains low, warranting attention from leadership and policymakers.

BACKGROUND AND OBJECTIVES/OBJECTIVE:GLP-1-based medications have rapidly reshaped the landscape of obesity treatment. Semaglutide was approved for obesity treatment in 2021 in the US and 2022 in Europe, sparking global interest, and the GLP-1/GIP dual-agonist tirzepatide has demonstrated even greater efficacy. However, survey-based data on who uses or considers these medications-particularly across socioeconomic groups, BMI categories, and weight management experiences-remain limited. SUBJECTS/METHODS/METHODS:A nationally representative online survey of Finnish adults (n = 1729, of which 1693 were included) was conducted in June 2025 via a market research company using quota sampling. Use and awareness of GLP-1 medications for obesity were measured with a single item listing widely known brands-Ozempic, Wegovy, Zepbound, and Mounjaro-to aid recognition. In regression analyses, current, past, and potential users (n = 322) were combined. RESULTS:In total, 3.5% reported current and 2.0% past use, and 13.5% expressed interest in future use. Notably, ~40% of individuals with obesity reported no interest. Bivariate analysis showed that current use was more common among women, those aged 50-69, those with household income exceeding €70,000, individuals with higher BMI, frequent weight loss attempts, experiences of weight-based discrimination, and self-blame. Multivariable analysis showed that current, past, and potential use had strongest associations with BMI ≥30.0 kg/m², repeated or persistent weight loss attempts, experiences of discriminatory treatment due to weight, self-blaming thoughts and hopeful perceptions of GLP-1 medications. Concern about serious health risks was associated with lower likelihood of use or interest. CONCLUSIONS:GLP-1-based medications are gaining recognition, but uptake remains heterogeneous and many individuals with obesity remain uninterested. Concerns about potential health risks persist. Attitudes toward these medications are shaped not only by weight status but also by prior weight management experiences and perceptions. Clinical communication should be sensitive to these factors.

BACKGROUND:The Starting Early Program (StEP) promotes healthy nutrition during early life and leads to healthier child weight, but whether dietary patterns contribute to weight or mediate StEP weight outcomes has not been studied. OBJECTIVES/OBJECTIVE:This secondary analysis identified infant dietary patterns in StEP, determined associations between dietary patterns and child weight outcomes, and examined whether dietary patterns mediated the relationship between StEP and child weight. METHODS:-score (WFAz) and likelihood of being classified as overweight (WFA ≥85th percentile) were assessed using linear and logistic multivariable regression models. Mediation was used to assess intervention effects on WFAz via impacts on infant dietary patterns. RESULTS:Four classes of infant dietary patterns were identified: Breastfed-High variety, Formula fed-High variety, Formula fed-Low variety, and Mixed fed-Low variety. Compared to the Breastfed-High variety class, infants in the Formula fed-Low variety class had higher WFAz and were more likely to be classified as overweight at 24 and 36 months. Participation in StEP increased membership in Breastfed-High variety, which mediated the association between StEP and lower WFAz at 24 months. CONCLUSIONS:Infant dietary patterns were identified, and some were associated with child overweight. StEP was associated with a dietary pattern most consistent with guidelines, which mediated intervention effects on child weight.

INTRODUCTION/BACKGROUND:Identifying individuals who undergo cognitive decline is vital to the success of prevention trials that aim to slow cognitive decline. Yet, the benefits of using blood-based biomarkers of neurodegeneration, as well as amyloid and tau, to enrich population-based prevention trials have not been quantified. METHODS: = 552). RESULTS:Elevated plasma biomarker levels identified dementia-free older adults with faster cognitive decline. By selecting participants with Quanterix SiMoA measurements of neurofilament light > 30.65 pg/mL, the sample size needed to detect a 33% reduction in cognitive decline in a clinical trial decreased by 57%. DISCUSSION/CONCLUSIONS:Clinical trials can use plasma biomarkers as a screening tool to increase statistical power.

OBJECTIVES/OBJECTIVE:There is increased recognition of the importance of hearing ability in social connectedness and healthy aging. Hearing loss is common among Veterans, and hearing rehabilitation is prioritized within the Veterans Administration (VA). Despite the attention to hearing care in the VA, limited data on cochlear implant (CI) utilization raises concern about whether this transformative and accessible treatment is reaching Veterans who could be helped with communication to improve their quality of life. The overall hypothesis is that Veterans with severe hearing loss, despite having unique rehabilitative needs, are not consistently treated as a distinct population. In this article, we identify patterns associated with specific management strategies for Veterans with severe hearing loss and describe the utilization of CIs in the VA as an evidence-based strategy when hearing aids provide limited benefit. DESIGN/METHODS:We investigated rehabilitation strategies used for Veterans with severe hearing loss. We defined a population-based cohort of 213,285 United States Veterans with newly diagnosed bilateral severe or worse hearing loss from January 1, 2006, to December 31, 2023. Severe hearing loss was defined as having a 4-frequency pure tone average (0.5, 1, 2, and 4 kHz) ≥70 dB HL in both ears. Speech perception abilities were also collected. We related hearing rehabilitation treatment of Veterans to factors hypothesized to impact care, including audiologic results, sociodemographic characteristics, comorbidities, and geography. Main outcomes included the receipt of CI and the cumulative incidence of CI. We used a competing risks framework to determine the factors associated with CI receipt. RESULTS:Of the 213,285 Veterans with bilateral severe or poorer hearing loss (mean age [SD], 80.3 [9.7]), 202,949 (95.2%) were fit with hearing aids, 5335 (2.5%) had a CI procedure, and 5001 (2.3%) had no evidence of receiving hearing rehabilitation. The 5- and 10-yr cumulative incidence (95% confidence interval) of receipt of CI was 1.9% (1.8 to 2.0%) and 2.9% (2.8 to 3.0%), respectively (death treated as a competing risk). In competing risks regression, age, race and ethnicity, VA priority group, word recognition score (WRS), hearing loss severity, the year hearing loss was first identified, and a greater number of comorbidities were all significantly associated with the receipt of CI. Patient age, word recognition score, and hearing loss severity were found to be the most important predictors of CI receipt based on concordance loss. CONCLUSIONS:Most Veterans with severe hearing loss and poor speech understanding, who are likely to be audiologic candidates for CIs, are treated with hearing aids, whereas relatively few receive CIs. The treatment approach may be driven by several different factors specific to the Veteran, site of care, and VA policies. A multifaceted strategy and care delivery may be required to improve evidence-based care for those with severe hearing loss.

BACKGROUND/UNASSIGNED:Racial and ethnic disparities are a concern in lung cancer screening. OBJECTIVE/UNASSIGNED:To investigate the performance of risk prediction models to define screening eligibility across 4 U.S. racial and ethnic groups. DESIGN/UNASSIGNED:Cohort study. SETTING/UNASSIGNED:United States, Lung Cancer Cohort Consortium. PARTICIPANTS/UNASSIGNED:641 830 participants aged 50 to 80 years with a smoking history from 12 U.S. cohorts, including 6390 Asian, 9781 Hispanic, 39 872 non-Hispanic Black, and 585 787 non-Hispanic White participants. MEASUREMENTS/UNASSIGNED:Calibration and discrimination were quantified for 16 lung cancer prediction models. Then, screening-related metrics were calculated after applying model thresholds to select the same number of eligible participants as the 2021 criteria from the U.S. Preventive Services Task Force (USPSTF-2021). These included eligibility, sensitivity, and efficiency measured as estimated number needed to screen (NNS; the ratio between participants and lung cancer cases) for each strategy or prediction model in each racial and ethnic group. RESULTS/UNASSIGNED:General patterns across the 16 models included substantial underestimation of lung cancer risk in non-Hispanic Black participants (expected-observed ratio < 0.75 for 11 of 16 models), lower discrimination in Asian participants than all other groups (13 of 16 models), and lower discrimination in non-Hispanic Black than non-Hispanic White participants (15 of 16 models). When a same-sized screening-eligible population as USPSTF-2021 (38.0%) was enforced, all risk-based strategies achieved better average estimated screening efficiency and reduced racial and ethnic differences in efficiency compared with USPSTF-2021. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Model 2012 (PLCOm2012) and Life Years gained From Screening-Computed Tomography model (LYFS-CT) performed best (mean estimated NNS, 36.5 [SD, 8.8] and 40.1 [SD, 8.2], respectively). However, no strategy could simultaneously optimize eligibility, sensitivity, and efficiency while also reducing racial and ethnic differences. LIMITATION/UNASSIGNED:Smaller sample for Asian and Hispanic participants. CONCLUSION/UNASSIGNED:To optimize efficiency and minimize its variation across racial and ethnic groups, risk-based strategies were superior to USPSTF criteria. Further optimization of prediction models for the diverse U.S. population is needed. PRIMARY FUNDING SOURCE/UNASSIGNED:U.S. National Cancer Institute, Lung Cancer Research Foundation, and Cancer Research UK.