Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Population Health
Total Results:
12221
"To speak of death is to invite it": Provider perceptions of palliative care for cardiovascular patients in Western Kenya
CONTEXT/BACKGROUND:Cardiovascular disease (CVD) is the leading cause of death globally and a significant health burden in Kenya. Despite improved outcomes in CVD, palliative care has limited implementation for CVD in low- and middle-income countries. This may be partly due to providers' perceptions of palliative care and end-of-life decision-making for CVD patients. OBJECTIVES/OBJECTIVE:Our goal was to explore providers' perceptions of palliative care for CVD in Western Kenya in order to inform its implementation. METHODS:We conducted eight focus group discussions as well as five key informant interviews. These were conducted by moderators using structured question guides. Qualitative analysis was performed using the constant comparative method. A coding scheme was developed and agreed upon by consensus by two investigators, each of whom then independently coded each transcript. Relationships between codes were formulated and codes were grouped into distinct themes. New codes were iteratively added with successive focus group or interview until thematic saturation was reached. RESULTS:Four major themes emerged to explain the complexities of integrating of palliative care for CVD patients in Kenya: (1) stigma of discussing death and dying, (2) mismatch between patient and clinician perceptions of disease severity, (3) the effects of poverty on care, and (4) challenges in training and practice environments. All clinicians expressed a need for integrating palliative care for patients with CVD. CONCLUSIONS:These results suggest attainable interventions supported by local providers can help improve CVD care and quality of life for patients living with advanced heart disease in low-resource settings worldwide.
PMID: 32437947
ISSN: 1873-6513
CID: 4444602
Joint attention partially mediates the longitudinal relation between attuned caregiving and executive functions for low-income children
Using data from a large longitudinal sample (N = 1,292) of children and their caregivers in predominantly low-income, nonurban communities, we investigated longitudinal relations between attuned caregiving in infancy, joint attention in toddlerhood, and executive functions in early childhood. The results from path analysis demonstrated that attuned caregiving during infancy predicted more joint attention in toddlerhood, which was in turn associated with better executive function performance in early childhood. Joint attention was a stronger predictor of executive functions for lower-income families. Moreover, joint attention mediated the relation between attuned caregiving and executive functions, and this mediation was amplified for lower-income families. These results highlight joint attention as a key mechanism through which attuned caregiving supports the development of executive functions, particularly for low-income families. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
PMID: 32700951
ISSN: 1939-0599
CID: 4533372
Reactions to the National Academies/Royal Society Report on Heritable Human Genome Editing
In September 2020, a detailed report on Heritable Human Genome Editing was published. The report offers a translational pathway for the limited approval of germline editing under limited circumstances and assuming various criteria have been met. In this perspective, some three dozen experts from the fields of genome editing, medicine, bioethics, law, and related fields offer their candid reactions to the National Academies/Royal Society report, highlighting areas of support, omissions, disagreements, and priorities moving forward.
PMID: 33095048
ISSN: 2573-1602
CID: 4679172
Disparities in access to care and research participation in advanced Parkinson's disease: Differences between a home visit study and outpatient clinic population [Meeting Abstract]
Objective: To describe sociodemographic differences between individuals with advanced Parkinson's Disease (PD) still receiving care in an outpatient clinic vs. those enrolled in an interdisciplinary home visit study.
Background(s): Individuals with PD from underrepresented minority backgrounds face disparities in access to expert neurologic care. Such disparities also persist in PD research participation, sometimes attributed to mistrust and stigma. As minority patients become homebound, they are further estranged from care and research representation. We launched an interdisciplinary home visit study to extend continuity of care to homebound individuals with advanced PD. Here, we seek to identify sociodemographic differences between home visit (HV) participants and the outpatient (OP) clinic population from which they were recruited to determine whether disparities in care and research enrollment among minority patients persist with this patient-centered, care-focused intervention. Design/Methods: Cross-sectional study comparing individuals with advanced PD-Hoehn & Yahr stage >3-drawn from a single movement disorders center between 2017- 2019. We conducted a chart review for demographic information and used t-tests or Wilcoxon signed-rank tests as appropriate to assess population differences.
Result(s): The HV population is significantly older (n = 58 HV, 1015 OP; mean age 78.4 (SD 7.5) vs. 75.0 (SD 9.2), respectively, p = 0.002) and includes nearly twice the percentage of minority patients (26.3% non-Caucasian vs. 14.7% non-Caucasian in OP, p = 0.02). As expected, HV had worse PD severity, with 62.1% stage 4 and 17.2% stage 5, vs. 28.6% and 11.0% of OP, respectively (p <0.0001).
Conclusion(s): The proportion of minority patients with advanced PD enrolled in a home-based study is significantly greater than that receiving care in the OP setting from which they originated. This suggests that social determinants of health may contribute to advanced PD patients from underrepresented minorities becoming lost to follow-up earlier than white patients. We are actively comparing our homebound population with matched controls from a longitudinal national registry to determine the generalizability of this finding. Our results suggest that despite their advanced age, disease, and homebound status, this population is amenable to research participation. Ultimately, continued access to care poses a large but surmountable hurdle to research participation for minority patients
Background(s): Individuals with PD from underrepresented minority backgrounds face disparities in access to expert neurologic care. Such disparities also persist in PD research participation, sometimes attributed to mistrust and stigma. As minority patients become homebound, they are further estranged from care and research representation. We launched an interdisciplinary home visit study to extend continuity of care to homebound individuals with advanced PD. Here, we seek to identify sociodemographic differences between home visit (HV) participants and the outpatient (OP) clinic population from which they were recruited to determine whether disparities in care and research enrollment among minority patients persist with this patient-centered, care-focused intervention. Design/Methods: Cross-sectional study comparing individuals with advanced PD-Hoehn & Yahr stage >3-drawn from a single movement disorders center between 2017- 2019. We conducted a chart review for demographic information and used t-tests or Wilcoxon signed-rank tests as appropriate to assess population differences.
Result(s): The HV population is significantly older (n = 58 HV, 1015 OP; mean age 78.4 (SD 7.5) vs. 75.0 (SD 9.2), respectively, p = 0.002) and includes nearly twice the percentage of minority patients (26.3% non-Caucasian vs. 14.7% non-Caucasian in OP, p = 0.02). As expected, HV had worse PD severity, with 62.1% stage 4 and 17.2% stage 5, vs. 28.6% and 11.0% of OP, respectively (p <0.0001).
Conclusion(s): The proportion of minority patients with advanced PD enrolled in a home-based study is significantly greater than that receiving care in the OP setting from which they originated. This suggests that social determinants of health may contribute to advanced PD patients from underrepresented minorities becoming lost to follow-up earlier than white patients. We are actively comparing our homebound population with matched controls from a longitudinal national registry to determine the generalizability of this finding. Our results suggest that despite their advanced age, disease, and homebound status, this population is amenable to research participation. Ultimately, continued access to care poses a large but surmountable hurdle to research participation for minority patients
EMBASE:633963933
ISSN: 1531-8249
CID: 4803492
Serially assessed bisphenol A and phthalate exposure and association with kidney function in children with chronic kidney disease in the US and Canada: A longitudinal cohort study
BACKGROUND:Exposure to environmental chemicals may be a modifiable risk factor for progression of chronic kidney disease (CKD). The purpose of this study was to examine the impact of serially assessed exposure to bisphenol A (BPA) and phthalates on measures of kidney function, tubular injury, and oxidative stress over time in a cohort of children with CKD. METHODS AND FINDINGS/RESULTS:Samples were collected between 2005 and 2015 from 618 children and adolescents enrolled in the Chronic Kidney Disease in Children study, an observational cohort study of pediatric CKD patients from the US and Canada. Most study participants were male (63.8%) and white (58.3%), and participants had a median age of 11.0 years (interquartile range 7.6 to 14.6) at the baseline visit. In urine samples collected serially over an average of 3.0 years (standard deviation [SD] 1.6), concentrations of BPA, phthalic acid (PA), and phthalate metabolites were measured as well as biomarkers of tubular injury (kidney injury molecule-1 [KIM-1] and neutrophil gelatinase-associated lipocalin [NGAL]) and oxidative stress (8-hydroxy-2'-deoxyguanosine [8-OHdG] and F2-isoprostane). Clinical renal function measures included estimated glomerular filtration rate (eGFR), proteinuria, and blood pressure. Linear mixed models were fit to estimate the associations between urinary concentrations of 6 chemical exposure measures (i.e., BPA, PA, and 4 phthalate metabolite groups) and clinical renal outcomes and urinary concentrations of KIM-1, NGAL, 8-OHdG, and F2-isoprostane controlling for sex, age, race/ethnicity, glomerular status, birth weight, premature birth, angiotensin-converting enzyme inhibitor use, angiotensin receptor blocker use, BMI z-score for age and sex, and urinary creatinine. Urinary concentrations of BPA, PA, and phthalate metabolites were positively associated with urinary KIM-1, NGAL, 8-OHdG, and F2-isoprostane levels over time. For example, a 1-SD increase in ∑di-n-octyl phthalate metabolites was associated with increases in NGAL (β = 0.13 [95% CI: 0.05, 0.21], p = 0.001), KIM-1 (β = 0.30 [95% CI: 0.21, 0.40], p < 0.001), 8-OHdG (β = 0.10 [95% CI: 0.06, 0.13], p < 0.001), and F2-isoprostane (β = 0.13 [95% CI: 0.01, 0.25], p = 0.04) over time. BPA and phthalate metabolites were not associated with eGFR, proteinuria, or blood pressure, but PA was associated with lower eGFR over time. For a 1-SD increase in ln-transformed PA, there was an average decrease in eGFR of 0.38 ml/min/1.73 m2 (95% CI: -0.75, -0.01; p = 0.04). Limitations of this study included utilization of spot urine samples for exposure assessment of non-persistent compounds and lack of specific information on potential sources of exposure. CONCLUSIONS:Although BPA and phthalate metabolites were not associated with clinical renal endpoints such as eGFR or proteinuria, there was a consistent pattern of increased tubular injury and oxidative stress over time, which have been shown to affect renal function in the long term. This raises concerns about the potential for clinically significant changes in renal function in relation to exposure to common environmental toxicants at current levels.
PMCID:7556524
PMID: 33052911
ISSN: 1549-1676
CID: 4641512
Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. 2020:26(Supp 1):i12-i26.DOI: 10.1136/injuryprev-2019-043296
Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017
BACKGROUND:The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. METHODS:Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. RESULTS:For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. CONCLUSIONS:The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.
PMID: 31915273
ISSN: 1475-5785
CID: 5831932
High-Sensitivity Cardiac Troponin I and T for Cardiovascular Risk Stratification in Adults With Diabetes [Letter]
PMCID:7510022
PMID: 32788284
ISSN: 1935-5548
CID: 5585782
Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. 2020:26(Supp 1):i96-i114.DOI: 10.1136/injuryprev-2019-043494
Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017
BACKGROUND:Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. METHODS:We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). FINDINGS:In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). INTERPRETATION:Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
PMID: 32332142
ISSN: 1475-5785
CID: 5831962
Reproductive sciences (Thousand Oaks, Calif.). 2020:27(10):1839-1847.DOI: 10.1007/s43032-020-00201-x
Hypothalamic-Pituitary-Adrenal Axis Responses in Women with Endometriosis-Related Chronic Pelvic Pain
Some chronic pain conditions and comorbidities suppress the hypothalamic-pituitary-adrenal (HPA) axis and response to dynamic testing. We measured HPA axis responses to corticotropin-releasing hormone (CRH) administration in relation to chronic pelvic pain and endometriosis. In a cross-sectional study of women (n = 54) with endometriosis-associated chronic pelvic pain (n = 22), chronic pelvic pain alone (n = 12), or healthy volunteers (n = 20), adrenocorticotropic-releasing hormone (ACTH) and cortisol levels were measured at 0, 15, 30, and 45 min after intravenous ovine CRH administration. ACTH and cortisol delta (peak-baseline) and area under the curve (AUC) were compared by study group and assessed for association with race and menstrual and non-menstrual pain severity. HPA axis responses did not differ among the racially diverse groups or in those with pain compared with healthy volunteers. However, when stratified by race, ACTH delta (129.9 ± 130.7 vs. 52.5 ± 66.0 pg/mL; p = 0.003), ACTH AUC (4813 ± 4707 vs. 2290 ± 2900 min*pg/mL; p = 0.013), and cortisol delta (26.3 ± 21.5 vs. 13.2 ± 9.7 μg/mL; p = 0.005) were significantly higher in black (n = 10) than predominately white (non-black) subjects (n = 44; 39/44 white). In analyses among primarily white (non-black) women, greater menstrual pain severity was associated with blunted ACTH delta (p = 0.015) and cortisol delta (p = 0.023), and greater non-menstrual pain severity with blunted cortisol delta (p = 0.017). Neuroendocrine abnormalities in women with chronic pelvic pain may differ by pain manifestations and may vary by race. The higher HPA axis response in black women merits investigation in pelvic pain studies stratified by race. In white (non-black) women experiencing pain, a blunted response was related to pain severity suggesting pain affects women independently of endometriosis lesions.
PMID: 32572832
ISSN: 1933-7205
CID: 5069732
Joint Commission journal on quality & patient safety. 2020:46(10):591-595.DOI: 10.1016/j.jcjq.2020.07.001
Assessing and Supporting Late Career Practitioners: Four Key Questions
PMID: 32859507
ISSN: 1938-131x
CID: 4582592
