Faculty Bibliography

INTRODUCTION/BACKGROUND:A 2021 federal rule permits opioid treatment programs (OTPs) to provide methadone through mobile medication units (MMUs), creating an opportunity to provide medication for people in residential care facilities. We used simulations to quantify the potential of MMUs to expand methadone access to people residing in residential substance use treatment facilities (RTF), skilled nursing facilities (SNF), and nursing facilities (NF) in New York State under different scenarios. METHODS:For each facility (RTF, SNF, and NF), a need score was created using three items: facility opioid use disorder (OUD) population, driving distance to nearest OTP, and county overdose mortality rate. We then demonstrated potential patient reach following the launch of 50 hypothetical MMUs making one stop per day to the highest need facilities. In refinements, we examined three additional scenarios involving more daily stops and prioritizing rural areas. RESULTS:Our sample included 3214 people with OUD estimated to be housed in 1052 facilities in New York, with the majority in RTFs (51.5%). The demonstrated percentage of OUD population served ranged from 23.5% to 35.8%, and the percentage of facilities served ranged from 23.8% to 37.4%. Each scenario reached a large percentage of rural facilities (73-76%). Prioritizing rural facilities decreased the proportion of OUD population served (10% reduction) but did not substantially increase driving time. Allowing multiple stops increased the proportion of OUD population served (32-36% vs. 24-26%). CONCLUSIONS:Using methods based on location information and spatial relationships, state officials can develop priorities and assess tradeoffs of MMU deployment and distribution strategies.

BACKGROUND:Climate anxiety describes emotional responses such as worry or distress related to climate change. While it is common and linked to mental health in the general population, little is known about its relevance for individuals with pre-existing mental disorders. METHODS:A nationwide cross-sectional online survey was conducted in Germany between March and July 2025 among adults with at least one self-reported mental disorder. Participants provided socio-demographic and clinical information and completed four items assessing dimensions of climate-related distress: general concern, perceived impact on mental well-being, perceived effects of climatic events on psychological symptoms, and interference with everyday functioning. Group differences were examined using non-parametric tests, and associations with age were analyzed using Spearman correlations with Bonferroni correction. RESULTS:The sample included 427 participants (mean age 36.5 years; 73% female). Reported climate-related distress levels were relatively low across all dimensions within this sample, with minimal interference with daily functioning. Gender differences were found only for perceived effects of climatic events on psychological symptoms, with women reporting higher impact. Associations with age were weak and not significant after correction. Exploratory analyses indicated some variation across diagnostic groups, but most differences were small and did not remain significant after correction. DISCUSSION/CONCLUSIONS:Climate-related distress among individuals with mental disorders appears present but generally modest and rarely functionally impairing. Weak and inconsistent associations with sociodemographic and diagnostic factors suggest that climate-related distress is not strongly structured by specific diagnoses, supporting its consideration within broader clinical and psychological contexts.

BACKGROUND:Hospital ownership type may influence acute cardiovascular disease disparities that persist across the U.S. We examined associations between hospital ownership type and in-hospital and readmission outcomes for STEMI hospitalizations. METHODS:We performed a retrospective cohort study of hospitalizations for STEMI using the National Readmissions Database (2016-2022). Hospitals were categorized as nonprofit, for-profit, or public. Outcomes included in-hospital mortality and 90-day readmission for acute coronary syndrome, heart failure, cardiovascular, and all causes. Associations were assessed using multivariable logistic and Cox proportional hazards regression, adjusting for patient, hospitalization, and hospital-level characteristics. RESULTS:Of 610,427 STEMI hospitalizations, 460,451 (75.4%) were at nonprofit, 88,965 (14.6%) at for-profit, and 61,011 (10.0%) at public hospitals. Compared with nonprofit hospitals, for-profit hospitals (aOR 1.09, 95% CI 1.05-1.13) and public hospitals (aOR 1.17, 95% CI 1.12-1.22) were each associated with higher odds of in-hospital mortality. For-profit hospitals were associated with higher risk of 90-day readmission for acute coronary syndrome (aHR 1.15, 95% CI 1.10-1.21), heart failure (aHR 1.08, 95% CI 1.03-1.13), cardiovascular (aHR 1.08, 95% CI 1.05-1.12), and all causes (aHR 1.13, 95% CI 1.10-1.16) relative to nonprofit hospitals. Public hospitals were associated with higher risk of 90-day readmission for heart failure (aHR 1.08, 95% CI 1.02-1.13) relative to nonprofit hospitals. CONCLUSIONS:For-profit and public hospitals were associated with higher in-hospital mortality and 90-day readmission for various causes compared with nonprofit hospitals. These findings suggest that hospital-level factors may contribute to disparities in STEMI outcomes and warrant further investigation.

PURPOSE/OBJECTIVE:(REFLECT), a digital health application designed to provide education and decision support related to fertility, genetic risk, and future family building for AYAs with cancer. This study developed and pilot-tested REFLECT to support informed decision-making. METHODS:REFLECT was developed using evidence-based content and implemented on a web-based platform integrating multimedia education and decision support. Two iterative rounds of user testing were conducted with AYA survivors (ages 18-39) using a Learner Verification framework to assess comprehension, usability, relevance, and acceptability. Participant feedback informed iterative refinements. RESULTS:= 16) reported that REFLECT was engaging, easy to navigate, and relevant to fertility, genetics, and future family-building concerns. Iterative testing identified opportunities to improve navigation, accessibility, and content organization, which were addressed through refinement. Participants reported increased confidence in discussing fertility preservation and genetic risk with providers and emphasized the value of an integrated patient-centered tool, particularly at the time of diagnosis. CONCLUSION/CONCLUSIONS:This pilot demonstrates that REFLECT is feasible, acceptable, and usable among AYAs. By integrating fertility and genetic risk education with decision support in an accessible digital format, REFLECT addresses a critical gap in AYA oncology care. These findings support further evaluation in clinical settings.

BACKGROUND/UNASSIGNED:High 1-hour plasma glucose (1-h PG) level has been proposed by the International Diabetes Federation to identify high-risk individuals and diagnose type 2 diabetes mellitus (T2DM). In a longitudinal cohort, we examined T2DM risk, β-cell function, and the genetic and lifestyle effects associated with the high 1-h PG. METHODS/UNASSIGNED:We analyzed 6,588 participants without baseline T2DM from a community-based prospective cohort in Korea. Participants underwent biennial 2-hour 75-g oral glucose tolerance tests over 14 years. We assessed incident T2DM risk across 1-h PG groups: <155, 155-208, and ≥209 mg/dL. T2DM polygenic risk scores (PRS) were stratified into low (1st quintile), intermediate (2nd-4th quintiles), and high (5th quintile). Lifestyle was evaluated using Life's Essential 8. RESULTS/UNASSIGNED:Compared to the <155 mg/dL group, hazard ratios for T2DM were 3.34 (95% confidence interval [CI], 2.99 to 3.74; P<0.001) for 155-208 mg/dL, and 6.81 (95% CI, 5.81 to 7.98; P<0.001) for ≥209 mg/dL. Both groups had lower baseline disposition index compared to the <155 mg/dL group (57.3% and 72.7%, respectively; both P<0.001). Higher T2DM PRS was associated with elevated baseline 1-h PG (low: 131 mg/dL, intermediate: 141 mg/dL, high: 151 mg/dL) and faster increase in 1-h PG (1.36 vs. 1.85 vs. 2.21 mg/dL/year; all P<0.001). Importantly, healthy lifestyle attenuated the increase in rate across all PRS groups. CONCLUSION/UNASSIGNED:High 1-h PG predicts T2DM risk and is associated with β-cell dysfunction. The 1-h PG level is influenced by genetic risk and can be modified with a healthy lifestyle.

OBJECTIVE:Little is known about patterns of anxiety and depressive symptoms (ADS) beginning in infancy, particularly in the U.S. It is also unclear how early harsh discipline predicts these symptoms over time. We aimed to describe longitudinal patterns of ADS from 18 months through 6 years of age and examine whether those patterns are associated with harsh discipline at 18 months. METHODS:We performed a secondary analysis of parent-child dyads in a study focused on early relational health and school readiness in low-income families in the U.S. We used group-based trajectory modeling to identify distinct patterns of ADS between 18 months and 6 years. Multinomial logistic regression was used to examine the relationship between harsh discipline (total, physical, and verbal) and trajectory group membership. RESULTS:We identified three ADS trajectories: low (29%), moderate (61%), and high (10%). Children who experienced more total harsh discipline were at greater risk of belonging to the moderate (relative risk ratio (RRR), 1.98; 95% CI, 1.19-3.32) and high groups (RRR, 2.76; 95% CI, 1.32-5.77) than the low group. After disaggregating harsh discipline into physical and verbal components and controlling for each other, harsh verbal discipline alone significantly predicted membership in the moderate group only (RRR, 1.62; 95% CI, 1.10-2.38). CONCLUSIONS:Approximately 10% of the sample developed persistent ADS starting in infancy with harsh discipline as a risk factor. Findings underscore the importance of addressing harsh discipline in early anticipatory guidance.

OBJECTIVE:To evaluate the relationship between the Global Budget Revenue (GBR) model and surgical outcomes. SUMMARY BACKGROUND DATA/BACKGROUND:Medicare tested GBR in Maryland, wherein hospitals received a fixed annual revenue to cover healthcare delivery for their population. The relationship between GBR implementation and outcomes after cancer surgery is unclear. METHODS:Observational difference-in-differences analysis using 100% national Medicare data to compare changes in outcomes between GBR hospitals and matched control hospitals before (2011-2013) and after (2014-2018) policy implementation in Traditional Medicare beneficiaries undergoing cystectomy, prostatectomy, or nephrectomy for cancer. The primary outcome was achievement of a textbook outcome, defined as the absence of in-hospital and 30-day mortality, postoperative complications, a prolonged length of stay (i.e., above the 75th percentile by procedure and year) and readmission within 30 days of discharge. The secondary outcome was Medicare inpatient spending. RESULTS:This study included 23 Maryland hospitals with 4,910 beneficiaries and 371 control hospitals with 57,456 beneficiaries. Textbook outcomes increased from 72.8% to 76.1% in GBR hospitals and from 70.2% to 70.5% in matched controls, a differential increase of 2.9 percentage points (95% CI, 0.5 to 5.3; P=0.02). The greater improvement at GBR hospitals was a result of reducing complications (-1.5 percentage points; 95% CI, -2.9 to -0.1) and limiting prolonged lengths of stay (-1.8 percentage points; 95% CI, -2.9 to -0.7). Medicare inpatient spending declined by $771 (95% CI, -$1,275 to -$267) more at GBR hospitals. CONCLUSIONS:The GBR was associated with improved surgical outcomes and lower Medicare inpatient spending.