Faculty Bibliography

The objective of this systematic review was to identify the evidence of testicular cancer risk for people with intersex conditions. This assessment is hoped to help refine risk stratification tools for assessing gonadal malignancy risk and guide the development of more robust evidence-based management strategies. The literature was searched in Ovid MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health using a search string developed by a multidisciplinary team. The protocol was registered at Prospective Register of Systematic Reviews as CRD42021231313. A total of 3608 articles were found. After selection, 301 publications were included (1215 individuals). The results identified significant evidence that pre-pubertal gonadectomy may be linked to lower rates of malignant gonadal changes for patients with partial gonadal dysgenesis, Turner's syndrome with Y-chromosome material, complete androgen insensitivity, partial androgen insensitivity, and patients with ovotestis/es. The evidence was not significant for patients with complete gonadal dysgenesis, Klinefelter syndrome, nor WT1-related syndromes. Specific cancer outcomes were unable to be assessed due to small sample sizes and thus it is unknown if clinically significant cancer outcomes are meaningfully altered by pre-pubertal gonadectomy. Importantly, the quality of data on the topic of gonadal malignancy in intersex patients with testicular tissue was determined to be poor overall. The quality was relatively more robust regarding the conditions of Complete Androgen Insensitivity, Klinefelter syndrome, and patients with ovotestis/es. More high-quality research is needed to draw specific conclusions on the risks and benefits of performing pre-pubertal gonadectomy for intersex patients. When counseling these patients, clinicians should be transparent regarding the paucity of data supporting pre-pubertal gonadectomy.

BACKGROUND:Self-reported smoking may not fully capture individualized risk of smoking-related cancer. Circulating proteins may reflect biological consequences of smoking. Thus, we developed a score from smoking-related proteins and evaluated its association with smoking-related cancer. METHODS:This prospective cohort study included 10,563 participants aged 47-70 years in the Atherosclerosis Risk in Communities study. Plasma proteins were measured by SomaScan. The score was constructed from proteins associated with current smoking, packyears, and/or recent quitting identified by linear regression and elastic net regression. Cox regression was used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). We confirmed the association in a case-cohort study in the European Prospective Investigation into Cancer and Nutrition (EPIC). RESULTS:aHRs comparing score quartiles Q4 to Q1 for total incidence and mortality of 13 smoking-related cancers were 3.89 (95% CI 3.06-4.96) and 5.73 (95% CI 4.08-8.06) before, and 2.28 (95% CI 1.65-3.15) and 2.07 (95% CI 1.74-4.10) after adjusting for self-reported smoking. aHRs for lung cancer were 12.1 (95% CI 7.11-20.6) and 14.2 (95% CI 7.58-26.8) before, 3.04 (95% CI 1.59-5.81) and 4.12 (95% CI 1.99-8.53) after adjusting. In EPIC, aHRs for lung cancer were 9.47 (95% CI 6.82-13.15) before and 2.23 (95% CI 1.48-3.35) after adjusting. CONCLUSION/CONCLUSIONS:The smoking-related protein score provided relative risk information for smoking-associated cancers beyond self-reported smoking, which was confirmed in an independent cohort. Such a score may be considered for use in risk stratification for prevention and cancer screening in settings in which detailed smoking history cannot be obtained.

INTRODUCTION/BACKGROUND:Elevated concentrations of air pollutants in residential neighborhoods are associated with poorer survival, cognitive, and cardiovascular health among older adults. Older kidney transplant (KT) recipients may be more vulnerable due to chronic immunosuppression and age-related co-morbidities. Therefore, we quantified the associations between pollutant concentrations and post-KT outcomes among older recipients. METHODS:]) were obtained from the Center for Air, Climate and Energy Solutions, and matched by ZIP code and year of KT. We used shared frailty models (cluster = state) to estimate the adjusted hazard ratios (aHR) of mortality and death-censored graft failure (DCGF) and competing risk models with cluster-robust standard errors to estimate the adjusted subhazard ratios (aSHR) of dementia and stroke by pollutant concentrations. RESULTS:concentrations were associated with a 3% (aSHR = 1.03, 95% CI: 1.00-1.07) and 4% higher risk of stroke (aSHR = 1.04, 95% CI: 1.02-1.07), respectively. CONCLUSION/CONCLUSIONS:Residence in neighborhoods with high concentrations of ambient air pollutants can worsen patient and graft survival, as well as increase the risk of stroke among older KT recipients. Early screening and interventions targeting older recipients living in such neighborhoods may be crucial for preserving cognitive and cerebrovascular health, as well as improving longitudinal quality of life.

OBJECTIVE:To evaluate the healthfulness of the food/beverage products featured by TikTok influencers whose audiences include millions of adolescents. DESIGN/METHODS:In a cross-sectional study, we collected the maximum available up to 100 videos from the top 100 TikTok influencers in the US-based on views, likes, comments, and shares-in July 2022. For each video, we identified the most prominent food/beverage product featured. We used the Nutrient Profile Index (NPI) to classify food products as healthy/unhealthy. We grouped beverages by category. SETTING/METHODS:TikTok. PARTICIPANTS/METHODS:n/a. RESULTS:Our sample included 8,871 videos, 1,360 (15.3%) of which featured at least one food (n=755, 55.5%), beverage (n=580, 42.6%), or dietary supplement (n=25, 1.8%). Mean NPI score for foods was 54.73 (SD 19.95). Most foods (58%) were considered unhealthy, with a 20-percentage-point difference between branded (70.8%) and unbranded (50.8%) foods. Alcoholic (n=154, 26.6%) and energy (n=149, 25.7%) drinks were the most featured overall. Among branded beverages, energy drinks were the largest category (n=148, 38.9%). Among unbranded beverages, alcoholic drinks were the largest category (n=73, 36.5%). CONCLUSIONS:More than half of the foods promoted by TikTok influencers were considered unhealthy and most beverages featured were alcoholic and energy drinks. Many foods and a large share of alcoholic beverages were unbranded, either reflecting genuine influencer preferences or potentially masking the true extent of commercial marketing. Given the reach of influencers, including millions of adolescents, stronger regulations are needed for social media platforms, influencers, and brands to protect consumers from undue harm from food/beverage marketing.

Despite well-studied benefits of preventive parenting programs for early child development, various real-world barriers may impede families from engaging in those programs. The current study aims to provide new insights into family engagement by examining enrollment, retention, and involvement and their predictors in an evidence-based universal pediatric primary care parenting program for families with young children. Data (n = 204) were from an ongoing longitudinal randomized controlled trial of PlayReadVIP in Flint, MI. Families (66% Black, 35% White, low socioeconomic status) had high enrollment and retention in the program. As exploratory analyses, random forest models, a machine learning method, identified a multitude of sociodemographic, psychosocial, and contextual predictors of retention and involvement in PlayReadVIP across the first 9 months. As confirmatory analyses, multiple regressions showed that COVID-19 significantly hindered retention (odds ratio = .04; b =  - .30) and involvement (b =  - .31) and that higher parenting self-efficacy was associated with lower retention (odds ratio = .76). Furthermore, the association between COVID-19 and family engagement was moderated by household income, suggesting that families with the highest economic risks were less likely to attend and be actively involved in sessions during the pandemic. This study addresses important research gaps by focusing on multiple aspects of family engagement in a pediatric program during infancy, assessing whether experiencing contextual adversity hinders or motivates engagement, and employing a machine learning method. These findings have crucial implications for designing and implementing early childhood prevention parenting programs to more effectively engage families with higher needs.

BACKGROUND:Midkine is a heparin-binding growth factor that is overexpressed in most human malignancies, including breast cancer. While elevated midkine levels have been associated with tumor progression and aging, its role as a predictive biomarker for breast cancer risk in healthy individuals remains unclear. We previously showed that higher midkine expression in estrogen receptor-positive (ER +) breast cancer in younger (< 55) women is associated with shorter disease-free survival. We investigated whether serum midkine levels in premenopausal women are associated with subsequent risk of ER + breast cancer. METHODS:We conducted a prospective, nested case-control study within the New York University Women's Health Study (NYUWHS). Serum midkine levels were measured in baseline blood samples from 249 premenopausal women who developed ER + breast cancer more than 10 years after blood collection and 249 matched controls. Conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) across quartiles and continuous midkine levels, adjusting for key breast cancer risk factors. RESULTS:Higher circulating midkine levels were associated with a marginally statistically significant lower risk of ER + breast cancer. Compared to the lowest quartile, women in the highest quartile had an OR of 0.55 (95% CI: 0.30-0.99; P for trend = 0.10). A doubling in midkine was associated with a 34% reduction in risk (OR = 0.66; 95% CI: 0.42-1.02). The inverse association was generally consistent across subgroups. CONCLUSION/CONCLUSIONS:These findings suggest that higher baseline serum midkine levels in premenopausal women are associated with a reduced long-term risk of ER + breast cancer. This challenges prior assumptions about midkine's uniformly pro-tumorigenic role and suggests it may be a context-dependent biomarker in breast cancer development.

Medical mistrust as a construct often places the onus of blame for adverse health outcomes on individuals rather than on social structures. In this study, we aimed to determine if medical mistreatment and access to transgender care were potential determinants of medical mistrust. We used longitudinal survey data from 193 transgender women of colour living in New York City. We measured medical mistrust using the Group-Based Medical Mistrust (GBMM) scale. Additionally, we analysed and coded open-ended survey data from participants regarding their trust towards medical institutions to identify potential determinants of medical mistrust. From the quantitative analysis, we found that individuals who experienced mistreatment in healthcare and those who reported poor access to transgender care had higher GBMM scores. Qualitative findings suggested that negative experiences within the healthcare system and historical trauma were key factors contributing to mistrust in medical institutions. Addressing medical mistrust should not occur at the individual level, but rather at the structural level. Potential interventions include improving access to gender affirming care and training health professionals.

IMPORTANCE/UNASSIGNED:Millions of children worldwide are experiencing prolonged symptoms after SARS-CoV-2 infection, yet social risk factors for developing long COVID are largely unknown. As child health is influenced by the environment in which they live and interact, adverse social determinants of health (SDOH) may contribute to the development of pediatric long COVID. OBJECTIVE/UNASSIGNED:To identify whether adverse SDOH are associated with increased odds of long COVID in school-aged children and adolescents in the US. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional analysis of a multicenter, longitudinal, meta-cohort study encompassed 52 sites (health care and community settings) across the US. School-aged children (6-11 years; n = 903) and adolescents (12-17 years; n = 3681) with SARS-CoV-2 infection history were included. Those with an unknown date of first infection, history of multisystem inflammatory syndrome in children, or symptom surveys with less than 50% of questions completed were excluded. Participants were recruited via health care systems, long COVID clinics, fliers, websites, social media campaigns, radio, health fairs, community-based organizations, community health workers, and existing research cohorts from March 2022 to August 2024, and surveys were completed by caregivers between March 2022 and August 2024. EXPOSURE/UNASSIGNED:Twenty-four individual social determinant of health factors were grouped into 5 Healthy People 2030 domains: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality. Latent classes were created within each domain and used in regression models. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Presence of long COVID using caregiver-reported, symptom-based, age-specific research indices. RESULTS/UNASSIGNED:The mean (SD) age among 4584 individuals included in this study was 14 (3) years, and 2330 (51%) of participants were male. The number of latent classes varied by domain; the reference group was the class with the least adversity. In unadjusted analyses, most classes in each domain were associated with higher odds of long COVID. After adjusting for many factors, including age group, sex, timing of infection, referral source, and other social determinant of health domains, economic instability characterized by difficulty covering expenses, poverty, receipt of government assistance, and food insecurity were associated with an increased risk of having long COVID (class 2 adjusted odds ratio [aOR], 1.57; 95% CI, 1.18-2.09; class 4 aOR, 2.39; 95% CI, 1.73-3.30); economic instability without food insecurity (class 3) was not (aOR, 0.93; 95% CI, 0.70-1.23). Poorer social and community context (eg, high levels of discrimination and low social support) was also associated with long COVID (aOR, 2.17; 95% CI, 1.77-2.66). Sensitivity analyses stratified by age group and adjusted for race and ethnicity did not alter or attenuate these results. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this study, economic instability that included food insecurity and poor social and community context were associated with greater odds of pediatric long COVID. Those with food security, despite experiencing other economic challenges, did not have greater odds of long COVID. Further study is needed to determine if addressing SDOH factors can decrease the rate of pediatric long COVID.

BACKGROUND:Latino individuals represent one of the fastest-growing demographic groups in the United States, and the impact of dementia is rising within this population. Despite this growth, most research on healthcare utilization has predominantly focused on non-Hispanic White populations. The limited body of literature that does include Latino populations often treats them as a monolithic racial/ethnic category, which overlooks intra-group heterogeneity. As a result, little is known about how healthcare utilization patterns relate to cognitive impairment status across specific Latino ethnic groups. METHODS:Using data collected from the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA), we examined the odds of overall healthcare utilization and avoidable healthcare utilization according to cognitive impairment and whether these associations vary by Latino ethnicity. Weighted logistic regressions and two-way interactions were conducted. RESULTS:This study included 4,825 (unweighted) Latino participants (1,664 Mexican, 917 Cuban, 859 Puerto Rican, 437 Dominican, 481 Central American, 345 South American, and 142 More than One/Other). Overall, participants reported high rates of overall healthcare utilization (88%) and avoidable healthcare utilization (42%). Individuals with cognitive impairment had higher odds of both overall (OR = 1.94, p = 0.013) and avoidable healthcare utilization (OR = 1.51, p = 0.004) compared to those without cognitive impairment. Puerto Rican participants were the only ethnic group found to have significant differences in avoidable healthcare utilization and cognitive impairment (OR = 2.61, p = 0.014). DISCUSSION/CONCLUSIONS:Disaggregation of Latino data revealed significant healthcare utilization across Latino ethnic groups. Targeted interventions and resources are needed to promote preventive care that may decrease avoidable healthcare utilization and associated expenditures.