Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Population Health
Total Results:
12207
Implementation Fidelity of a Complex Behavioral Intervention to Prevent Diabetes Mellitus in Two Safety Net Patient-Centered Medical Homes in New York City [Meeting Abstract]
ISI:000695816000049
ISSN: 0017-9124
CID: 5265982
EXPLORING THE INTERSECTION OF CHRONIC DISEASE, FUNCTION, AND SOCIAL CARE IN ADULT DAY CARE CLIENTS WITH DEMENTIA [Meeting Abstract]
ISI:000842009900321
ISSN: 2399-5300
CID: 5388222
Barriers to Vaccination Among People with Parkinson's Disease and Implications for COVID-19
BACKGROUND:Patients with Parkinson's disease (PD) are at higher risk of vaccine-preventable respiratory infections. However, advanced, homebound individuals may have less access to vaccinations. In light of COVID-19, understanding barriers to vaccination in PD may inform strategies to increase vaccine uptake. OBJECTIVE:To identify influenza and pneumococcal vaccination rates, including barriers and facilitators to vaccination, among homebound and ambulatory individuals with PD and related disorders. METHODS:Cross-sectional US-based study among individuals with PD, aged > 65 years, stratified as homebound or ambulatory. Participants completed semi-structured interviews on vaccination rates and barriers, and healthcare utilization. RESULTS:Among 143 participants, 9.8% had missed all influenza vaccinations in the past 5 years, and 32.2% lacked any pneumococcal vaccination, with no between-group differences. Homebound participants (n = 41) reported difficulty traveling to clinic (p < 0.01) as a vaccination barrier, and despite similar outpatient visit frequencies, had more frequent emergency department visits (31.7% vs. 9.8%, p < 0.01) and hospitalizations (14.6% vs. 2.9%, p = 0.03). Vaccine hesitancy was reported in 35% of participants, vaccine refusal in 19%, and 13.3% reported unvaccinated household members, with no between-group differences. Nearly 13% thought providers recommended against vaccines for PD patients, and 31.5% were unsure of vaccine recommendations in PD. CONCLUSION/CONCLUSIONS:Among a sample of homebound and ambulatory people with PD, many lack age-appropriate immunizations despite ample healthcare utilization. Many participants were unsure whether healthcare providers recommend vaccinations for people with PD. In light of COVID-19, neurologist reinforcement that vaccinations are indicated, safe, and recommended may be beneficial.
PMID: 33935103
ISSN: 1877-718x
CID: 4865872
Conservative kidney management practice patterns in The United States: A ckdopps analysis [Meeting Abstract]
Background: Conservative kidney management (CKM) of kidney failure is an important treatment option for many patients. However, its availability in the United States (US) is not well described. We describe CKM resources and provider practice patterns in US Chronic Kidney Disease (CKD) clinics.
Method(s): Cross sectional analysis of provider surveys (n=22) from unique clinics in the US from the CKD Outcomes and Practice Patterns Study (CKDopps) collected between 2014-2017.
Result(s): Only eight (36%) providers reported involving palliative care in planning for and educating patients about kidney failure. A majority (59%) were extremely comfortable discussing CKM and nearly 100% typically discussed CKM as a treatment option. Nearly all (95%) reported their clinics had the ability to routinely deliver CKM, but only one had a CKM protocol or guideline, and none offered a specific CKM clinic. Most providers said their clinics used the word conservative to describe CKM, with 24% choosing palliative or supportive terminology. Regardless of involvement of PC, most providers estimated that 5% of their patients with or approaching kidney failure were managed with CKM. Patient preference, functional status, frailty, and comorbidities were the most important factors influencing provider decisions in contemplating the suitability of CKM for patients. (Figure 1)
Conclusion(s): Most providers report feeling comfortable discussing CKM, yet almost no clinics report resources or dedicated infrastructure for CKM delivery. Despite reported high frequency of discussing CKM, few patients were described as choosing this treatment pathway. Factors that influence consideration of CKM are consistent with elements that generally influence well-informed geriatric and end-of-life care. Efforts to improve assessment of those elements may allow for more informed recommendations of CKM
Method(s): Cross sectional analysis of provider surveys (n=22) from unique clinics in the US from the CKD Outcomes and Practice Patterns Study (CKDopps) collected between 2014-2017.
Result(s): Only eight (36%) providers reported involving palliative care in planning for and educating patients about kidney failure. A majority (59%) were extremely comfortable discussing CKM and nearly 100% typically discussed CKM as a treatment option. Nearly all (95%) reported their clinics had the ability to routinely deliver CKM, but only one had a CKM protocol or guideline, and none offered a specific CKM clinic. Most providers said their clinics used the word conservative to describe CKM, with 24% choosing palliative or supportive terminology. Regardless of involvement of PC, most providers estimated that 5% of their patients with or approaching kidney failure were managed with CKM. Patient preference, functional status, frailty, and comorbidities were the most important factors influencing provider decisions in contemplating the suitability of CKM for patients. (Figure 1)
Conclusion(s): Most providers report feeling comfortable discussing CKM, yet almost no clinics report resources or dedicated infrastructure for CKM delivery. Despite reported high frequency of discussing CKM, few patients were described as choosing this treatment pathway. Factors that influence consideration of CKM are consistent with elements that generally influence well-informed geriatric and end-of-life care. Efforts to improve assessment of those elements may allow for more informed recommendations of CKM
EMBASE:636328616
ISSN: 1533-3450
CID: 5179742
Current trends in the application of causal inference methods to pooled longitudinal observational infectious disease studies-A protocol for a methodological systematic review
INTRODUCTION:Pooling (or combining) and analysing observational, longitudinal data at the individual level facilitates inference through increased sample sizes, allowing for joint estimation of study- and individual-level exposure variables, and better enabling the assessment of rare exposures and diseases. Empirical studies leveraging such methods when randomization is unethical or impractical have grown in the health sciences in recent years. The adoption of so-called "causal" methods to account for both/either measured and/or unmeasured confounders is an important addition to the methodological toolkit for understanding the distribution, progression, and consequences of infectious diseases (IDs) and interventions on IDs. In the face of the Covid-19 pandemic and in the absence of systematic randomization of exposures or interventions, the value of these methods is even more apparent. Yet to our knowledge, no studies have assessed how causal methods involving pooling individual-level, observational, longitudinal data are being applied in ID-related research. In this systematic review, we assess how these methods are used and reported in ID-related research over the last 10 years. Findings will facilitate evaluation of trends of causal methods for ID research and lead to concrete recommendations for how to apply these methods where gaps in methodological rigor are identified. METHODS AND ANALYSIS:We will apply MeSH and text terms to identify relevant studies from EBSCO (Academic Search Complete, Business Source Premier, CINAHL, EconLit with Full Text, PsychINFO), EMBASE, PubMed, and Web of Science. Eligible studies are those that apply causal methods to account for confounding when assessing the effects of an intervention or exposure on an ID-related outcome using pooled, individual-level data from 2 or more longitudinal, observational studies. Titles, abstracts, and full-text articles, will be independently screened by two reviewers using Covidence software. Discrepancies will be resolved by a third reviewer. This systematic review protocol has been registered with PROSPERO (CRD42020204104).
PMCID:8084147
PMID: 33914795
ISSN: 1932-6203
CID: 5031522
Barriers to treatment for opioid use disorder in Colombia
ISI:000608550400001
ISSN: 1465-9891
CID: 4774042
Impact of being an adolescent mother on subsequent maternal health, parenting, and child development in Kenyan low-income and high adversity informal settlement context
BACKGROUND:Women who have experienced adolescent pregnancy and early motherhood are disproportionately affected in terms of their health and parenting capabilities, as well as their offspring's health. Guided by Stress Process and Social Determinants of Health (SDH) Frameworks, which posit that multiple sources of stressors and structural determinants of adolescent pregnancy influence adolescent mothers' subsequent health and quality of parenting (Xavier et al 2018, McLoyd 1998, Conger et al 2010, Gipson et al 2008). These dynamics then further impact offspring's outcomes. Using an Integrated Stress-SDH Process for Health Disparities model and we test on whether early motherhood is associated with and subsequent maternal and child health from two informal settlements in Nairobi. METHODS:A cross-sectional design with 394 mothers of 2-16 years old children who sought maternal and child health services at Kariobangi and Kangemi public health centers between October 2015 to April 2016 were recruited. Participating mothers were asked questions related to their adolescent pregnancy history, their current health, wellbeing, and parenting practices, and their child's health. Structural equation modeling (SEM) was utilized to examine hypothesized mediational pathways that adolescent pregnancy history has negative influences on women's health and parenting during adulthood, which also influence their child's health and development. RESULTS:Our study supports that women with a history of adolescent motherhood have poor physical and mental health outcomes as adults after adjusting for demographic confounders. SEM results partially support the Stress-SDH Process model that history of adolescent pregnancy had negative consequences on women's adulthood health, which also negatively impacted offspring's physical and mental health. CONCLUSION/CONCLUSIONS:Consistent with the Stress Process and SDH literature, we found consistent cross-cultural literature that adolescent pregnancy set the stage for, subsequent poor maternal health and child outcomes. Although history of adolescent pregnancy and motherhood was not necessarily associated with negative parenting, consistent with parenting literature, negative parenting was associated with poor child mental health. Findings suggest importance of providing integrated care that address health and parenting needs to optimize offspring's development in instances of early motherhood.
PMCID:8016237
PMID: 33793592
ISSN: 1932-6203
CID: 4862342
Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems
ISI:000608170600001
ISSN: 1741-7015
CID: 5071382
Exploring Associative Pathways and Gender Effects of Racial and Weight Discrimination with Sleep Quality, Physical Activity, and Dietary Behavior in Adults with Higher Body Mass Index and Elevated Cardiovascular Disease Risk [Meeting Abstract]
ISI:000752020004089
ISSN: 0009-7322
CID: 5477632
Global decrease in brain sodium concentration after mild traumatic brain injury
The pathological cascade of tissue damage in mild traumatic brain injury is set forth by a perturbation in ionic homeostasis. However, whether this class of injury can be detected in vivo and serve as a surrogate marker of clinical outcome is unknown. We employ sodium MRI to test the hypotheses that regional and global total sodium concentrations: (i) are higher in patients than in controls and (ii) correlate with clinical presentation and neuropsychological function. Given the novelty of sodium imaging in traumatic brain injury, effect sizes from (i), and correlation types and strength from (ii), were compared to those obtained using standard diffusion imaging metrics. Twenty-seven patients (20 female, age 35.9 ± 12.2 years) within 2 months after injury and 19 controls were scanned with proton and sodium MRI at 3 Tesla. Total sodium concentration, fractional anisotropy and apparent diffusion coefficient were obtained with voxel averaging across 12 grey and white matter regions. Linear regression was used to obtain global grey and white matter total sodium concentrations. Patient outcome was assessed with global functioning, symptom profiles and neuropsychological function assessments. In the regional analysis, there were no statistically significant differences between patients and controls in apparent diffusion coefficient, while differences in sodium concentration and fractional anisotropy were found only in single regions. However, for each of the 12 regions, sodium concentration effect sizes were uni-directional, due to lower mean sodium concentration in patients compared to controls. Consequently, linear regression analysis found statistically significant lower global grey and white matter sodium concentrations in patients compared to controls. The strongest correlation with outcome was between global grey matter sodium concentration and the composite z-score from the neuropsychological testing. In conclusion, both sodium concentration and diffusion showed poor utility in differentiating patients from controls, and weak correlations with clinical presentation, when using a region-based approach. In contrast, sodium linear regression, capitalizing on partial volume correction and high sensitivity to global changes, revealed high effect sizes and associations with patient outcome. This suggests that well-recognized sodium imbalances in traumatic brain injury are (i) detectable non-invasively; (ii) non-focal; (iii) occur even when the antecedent injury is clinically mild. Finally, in contrast to our principle hypothesis, patients' sodium concentrations were lower than controls, indicating that the biological effect of traumatic brain injury on the sodium homeostasis may differ from that in other neurological disorders. Note: This figure has been annotated.
PMCID:8066885
PMID: 33928248
ISSN: 2632-1297
CID: 4852212
