Faculty Bibliography

OBJECTIVES/OBJECTIVE:We explored medications for opioid use disorder treatment (MOUD) utilization in six New York City public hospitals that implemented the "Consultation for Addiction Care and Treatment in Hospitals (CATCH)" program. METHODS:CATCH rolled out between October 2018 and February 2020. Data from the electronic health record were analyzed for the first year post-implementation. Eligible cases included adults with an opioid-related diagnosis admitted to inpatient departments served by CATCH, with a stay of ≥1 night. Patients were classified as receiving an MOUD order if there was at least 1 order of buprenorphine, methadone, or naltrexone. Logistic regression modeled the impact of CATCH consults on MOUD orders, controlling for demographic and clinical characteristics with hospital as a random effect. RESULT/RESULTS:Among 2117 eligible patients, 71.4% were male, with a mean age of 51.2 years, and 27.2% identified as Black, 21.2% as White, and 34.5% as Hispanic. MOUD was ordered in 60.9% of admissions, and 41.5% had a completed CATCH consult. Patients identified as Black had lower odds of receiving a MOUD order than those identified as White (OR: 0.52, 95% CI: 0.38-0.71; P < 0.001). Patients with a CATCH consult had higher odds of receiving a MOUD order (OR: 3.22, 95% CI: 2.54-4.07; P < 0.001). CONCLUSION/CONCLUSIONS:Majority of patients in our sample received a MOUD order, with higher odds among those with a CATCH consult. Further research is needed on the drivers of racial disparities in MOUD, and other contextual, organizational, and population-specific barriers and facilitators contributing to receipt of hospital-based addiction consult services and MOUD.

Lingering effects of the COVID-19 pandemic are still of grave concern to families within the U.S. Latine community, as pre-pandemic disparities in healthcare and economic stability were significantly exacerbated by the global crisis (Martínez et al., 2021). In this mixed-methods study, we interviewed 42 pregnant and postpartum Latine mothers from low-income households living in the New York Metropolitan area to better understand pandemic related challenges and potential sources of support unique to this group of women. First, we identified broad themes related to specific psychosocial stressors impacting Latine mothers and their families. Second, in an effort to investigate coping strategies that may buffer feelings of persistent stress, mothers were divided into sustained-stress and tapered-stress groups based on reported levels of perceived stress during the height of the pandemic (March-April 2020) compared to the time of interview (August-December 2020). These two groups of mothers were significantly different on levels of PTSD symptoms, social support, and perceived discrimination. Notably, mothers in the tapered-stress group who reported lower-levels of stress at the time of interview described experiences of being distracted by daily activities or by family members as a coping mechanism. Together, these findings highlight the need to address structural barriers and improve access to mental health support in order to mitigate continuing sources of pandemic related stressors for Latine families.

BACKGROUND AND AIMS/OBJECTIVE:It is unclear if findings from randomized controlled trials (RCT) of medications for opioid use disorder apply to real-world settings. We estimated the effectiveness of buprenorphine-naloxone (BUP-NX) versus extended-release naltrexone (XR-NTX) on treatment interruption in a RCT and an observational study based on real-world data. DESIGN/METHODS:Target trial emulation to harmonize the protocol and statistical analyses of X:BOT (target trial) and the observational study (observational emulation). Baseline was randomization in the target trial and medically managed opioid withdrawal (MMOW) discharge in the observational emulation. SETTINGS/METHODS:X:BOT trial and Massachusetts Public Health Data Warehouse observational data (United States). PARTICIPANTS/METHODS:The target trial included all X:BOT participants. The observational emulation trial included MMOW discharges from January 2014 to May 2016. MEASUREMENTS/METHODS:Treatment strategies were BUP-NX versus XR-NTX initiation within 28 days of baseline. The outcome was treatment interruption (earliest of treatment discontinuation, incarceration, MMOW readmission, death). We estimated the 24-week risk and risk difference. FINDINGS/RESULTS:In the target trial, 94% (269/287) and 66% (187/283) of participants randomized to BUP-NX or XR-NTX initiated their assigned treatment within 28 days, respectively. In the observational emulation, BUP-NX and XR-NTX were initiated within 28 days in 9% (5209/59 076) and 3% (1813/59 076) of MMOW discharges, respectively. The adjusted 24-week treatment interruption risks (95% confidence interval) for BUP-NX and XR-NTX were 68% (60%,77%) and 72% (60%,83%) in the target trial [risk difference, -4 percentage points (pp; -17 pp,11 pp)] and 82% (81%,83%) and 93% (92%,95%) in the observational emulation [risk difference,-11 pp (-13 pp,-10 pp)]. CONCLUSIONS:Buprenorphine-naloxone might be superior to extended-release naltrexone in real-world settings where the majority of people struggle to remain on medications for opioid use disorder. Buprenorphine-naloxone initiators had a lower risk of treatment interruption than extended-release naltrexone initiators in an observational emulation, but similar risks in a randomized controlled trial, although confidence intervals were wide. Trial participation, study size and residual confounding may explain these differences.

OBJECTIVE:This study examined racial and ethnic differences in percent total weight loss (%TWL) and glycemic improvement following sleeve gastrectomy (SG) and explored the role of socioeconomic and psychosocial factors in postsurgical outcomes. METHODS:This longitudinal study included patients who underwent SG between 2017 and 2020, with follow-up visits over 24 months. RESULTS:Non-Hispanic Black (NHB) participants had lower %TWL at 3, 12, and 24 months compared with Hispanic (H) and non-Hispanic White (NHW) participants. Fat mass index was initially lower in NHB, with smaller reductions over time and significant group differences persisting at 24 months. NHB participants had higher baseline fat-free mass index values; by 24 months, fat-free mass index values were lower in H participants. Hemoglobin A1c decreased across all groups but remained consistently higher in NHB and H compared with NHW at 24 months. NHB participants reported higher perceived discrimination, sleep disturbance, and perceived stress than H and NHW participants at all time points. Employment status predicted %TWL at 12 months. There was a significant interaction between race and ethnicity and employment status observed at 12 and 24 months, suggesting that employment-related disparities could impact surgical outcomes. CONCLUSIONS:NHB participants experienced less favorable outcomes following SG, emphasizing the need for tailored interventions addressing socioeconomic and psychosocial disparities.

Despite a global reduction in neonatal deaths in the last few decades, high neonatal mortality rates persist in low- to middle-income countries. Mobile health interventions offer a promising solution to promote early newborn care (ENC) practices and improve neonatal health. The Mobile WACh NEO randomized controlled trial evaluated the effect of a text messaging communication intervention on neonatal health outcomes in Kenya from 2020 to 2023. Perinatal participants received automated messages from enrollment at 28-36 weeks gestation until six weeks postpartum and could message with a study nurse. This secondary analysis aimed to characterize participant text engagement and examine associations between engagement and maternal-neonatal health outcomes. Among 2,470 intervention participants retained through follow-up, median time in the intervention was 14 weeks. Participants received a median of 58 automated messages (average 0.58 per day), sent a median of 24 messages (average 0.25 per day), and received a median of 14 nurse responses (average 0.14 per day). Younger, more educated, unmarried, unemployed, and first-time mothers sent more messages, while those who had a lower social support score at baseline messaged less. Increased participant messaging was associated with greater increase in neonatal danger sign knowledge from baseline to six-week follow-up (Adj Est: 0.39; 95% CI: 0.09-0.68) and lower odds of early initiation of breastfeeding (aOR: 0.62; 95% CI: 0.45-0.86). Our findings contribute to the understanding of who can benefit from mobile health programs and how these interventions might impact behaviors and outcomes.

BACKGROUND:Investigation of circulating plasma proteins may reveal insights into molecular pathways that contribute to the development of heart failure (HF) among people with chronic kidney disease. OBJECTIVES/OBJECTIVE:The authors aimed to identify circulating kidney function-related plasma proteins that are associated with the risk of incident HF. METHODS:The authors studied participants of the ongoing longitudinal ARIC (Atherosclerosis Risk In Communities) study. Relative plasma concentrations of 4,697 unique proteins were measured with the use of an aptamer assay (Somalogic). Each protein was tested for associations with estimated glomerular filtration rate (eGFR), log-transformed urine albumin-to-creatinine ratio (UACR), and incident HF by means of multivariable linear and Cox regression models. Protein-HF associations were validated externally in the CRIC (Chronic Renal Insufficiency Cohort) study. Two-sample mendelian randomization was used to test for potential causal associations. RESULTS:In fully adjusted models, 44 plasma proteins were associated with either eGFR or UACR and incident HF at 2 separate ARIC study visits, of which 29 were validated externally in CRIC. Most plasma proteins were associated with HF with preserved ejection fraction, but not reduced ejection fraction. A cluster within these 44 plasma proteins were associated with larger left ventricular end-diastolic volume index and left ventricular diastolic dysfunction. Mendelian randomization suggests that Golgi membrane protein 1 is causally associated with HF and eGFR. CONCLUSIONS:This study identified 44 eGFR- and UACR-related plasma proteins that are associated with incident HF independently from demographics, risk factors, and kidney function. These results may inform future therapeutic and biomarker development for the prevention and treatment of incident HF.

Public health can be immediately and substantially improved by policies that also mitigate climate change over the longer term. However, implementation of these policies has been slowed at least in part by doubts and lack of awareness of these health co-benefits. To address this barrier to progress, we demonstrate how an illustrative set of interventions led to environmental, health, and economic benefits, in addition to mitigating climate change. These case studies include the closure of a coal coking plant near Pittsburgh, PA, USA, which was followed by substantial immediate and longer-term reductions in respiratory and cardiovascular health conditions in the affected local community; the health and economic benefits associated with the Barcelona, Spain Superblock program and, the air quality, health, and economic benefits from air pollution initiatives implemented in China. While improvements in air pollution are among the most obvious examples of the co-benefits achievable through climate-friendly interventions, others that reduce greenhouse gas emissions, such as the sustainable food systems in Sweden, forest conservation in Tanzania, and a plant-based food program in New York City, further illustrate how such initiatives can align with better nutrition, economic gains, and improved health. We conclude that more assessments of such interventions are needed internationally to more widely document their health and climate benefits and thereby motivate greater implementation of these interventions. Now is the time to showcase how we can improve the public's health and well-being, while also protecting our planet, the only home future generations will have.

BACKGROUND:In the United States (U.S.), the prevalence of anxiety and depression is increasing, yet significant barriers to mental health treatment remain. U.S. military veterans are disproportionately affected by anxiety and depression. Many veterans receive medical care within the Veterans Health Administration (VHA), an integrated healthcare system that has enacted clinical initiatives to reduce barriers to mental health treatment. OBJECTIVE:We examined associations between VHA healthcare use and receipt of mental health counseling or prescription medication for anxiety or depression. DESIGN/METHODS:Cross-sectional nationally representative study. PARTICIPANTS/METHODS:U.S. veterans aged ≥ 18 years with past 12-month healthcare use and anxiety or depression (N = 1,161). MAIN MEASURES/METHODS:In the 2019 National Health Interview Survey, veterans were assessed for their use of the VHA (vs. non-VHA healthcare use) and receipt of past 12-month mental health counseling, prescription medication for anxiety, or prescription medication for depression. KEY RESULTS/RESULTS:Among all veterans with anxiety or depression, only 23% received mental health counseling, while 26% and 23% received prescription medication for anxiety or depression, respectively. Compared to non-VHA veterans, VHA patients were more likely to receive counseling (adjusted odds ratio [aOR] = 6.28, 95% CI: 5.33, 7.40), and prescription medication for anxiety (aOR = 2.03, 95% CI: 1.72, 2.40), or depression (aOR = 2.54, 95% CI: 2.17, 2.97). CONCLUSIONS:Among veterans with anxiety or depression, VHA patients were more likely to receive mental health treatment than non-VHA veterans. Findings suggest that veteran use of counseling and psychiatric interventions remains limited, though the integrated healthcare system of the VHA may facilitate access to mental health treatment and provides a framework for non-VHA medical centers to expand access to and improve delivery of mental health services.

As the opioid crisis continues, now driven by use of fentanyl, naloxone is an increasingly important intervention to reverse overdoses. More research is needed on the willingness of populations at risk for unintentional fentanyl exposure (through adulterated drugs) to accept naloxone to reverse potential overdoses. Adults (n = 991) entering randomly selected nightclubs in New York City (NYC) were surveyed at the point-of-recruitment in 2024 and were asked about their willingness to accept a free naloxone kit. We examined the prevalence of reported willingness to accept naloxone and reasons for refusal, and we examined prevalence and correlates of participants accepting naloxone. During the survey, 65.2% of participants reported being familiar with naloxone, 62.1% agreed to accept naloxone, and 49.6% were recorded as accepting a kit. Those residing in NYC, compared to visitors, had a higher prevalence of recorded acceptance (aPR = 1.41, 95% CI: 1.11-1.79), as did those reporting familiarity with naloxone (aPR = 1.27, 95% CI: 1.02-1.58), and those with an average higher readiness to intervene in an opioid overdose (aPR = 1.18, 95% CI: 1.04-1.33). The majority who refused (56.1%) reported not being interested; 10.1% reported that they were not worried about overdoses, and 8.2% reported that they already had naloxone. Although 83.4% agreed that naloxone is used to reverse opioid overdoses, 35.4% reportedly thought that naloxone is used to reverse the effects of cocaine or any drug. While at least half of attendees were willing to accept a naloxone kit, lack of interest and lack of knowledge about naloxone were potential barriers to carrying naloxone.