Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Population Health
Total Results:
12221
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
Integration of partners of young women with cancer in oncofertility evidence-based informational resources
Oncofertility has evolved over the years, with a prodigious amount of research documenting the importance of fertility for young patients with cancer, and the potential impact that fertility impairments due to cancer treatments has on their Quality of Life (QoL). Multiple professional bodies and scientific societies have included fertility as an integral part of clinical management. Clinical guidelines advocate that health professionals have the duty to discuss the risk of infertility and fertility preservation options as early as possible and refer to fertility specialists when appropriate. Collectively, fertility decisions are regarded as difficult for both patients and providers. Since providing fertility-related information is vital for better decision making, researchers and policy makers have concentrated their efforts in developing educational tools to aid decisions and guidelines to optimize the delivery of this information, focusing mainly on patients-providers and largely neglecting the role and influence that partners play in this process. Here, we reflect on the importance of partners in fertility decisions, with a focus on the provision of fertility-related information that is also geared towards partner. We highlight the need to involve partners in fertility discussions, and that their needs should be taken into account in both clinical guidelines and in the development of educational tools, for an optimal decision-making process.
PMID: 32864852
ISSN: 2045-7634
CID: 4583832
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
Impact of a Primary Care Provider Tele-Mentoring and Community Health Worker Intervention on Utilization in Medicaid Patients with Diabetes
OBJECTIVE:The Endocrinology ECHO intervention utilized a tele-mentoring model that connects primary care providers (PCPs) and community health workers (CHWs) with specialists for training in diabetes care. We evaluated the impact of the Endo ECHO intervention on healthcare utilization and care for Medicaid patients with diabetes in New Mexico. METHODS:Between January 2015 and April 2017, patients with complex diabetes from 10 health centers in NM were recruited to receive diabetes care from a PCP and CHW upskilled through Endo ECHO. We matched intervention patients in the NM Medicaid claims database to comparison Medicaid beneficiaries using 5:1 propensity matching. We used a difference-in-difference (DID) approach to compare utilization and processes of care between intervention and comparison patients. RESULTS:Of 541 Medicaid patients enrolled in Endo ECHO, 305 met inclusion criteria and were successfully matched. Outpatient visits increased with Endo ECHO for intervention patients as compared to comparison patients (rate ratio, 1.57; 95% confidence interval [CI], 1.43 to 1.72). The intervention was associated with an increase in emergency department (ED) visits (rate ratio, 1.30; 95% CI, 1.04 to 1.63) but no change in hospitalizations (rate ratio, 1.47; 95% CI, 0.95 to 2.23). Among intervention patients, utilization of metformin increased from 57.1% to 60.7%, with a DID between groups of 8.8% (95% CI, 4.0% to 13.6%). We found similar increases in use of statins (DID, 8.5%; 95% CI, 3.2% to 13.8%), angiotensin-converting enzyme inhibitors (DID, 9.5%; 95% CI, 3.5% to 15.4%), or antidepressant therapies (DID, 9.4%; 95% CI, 1.1% to 18.1%). CONCLUSION/CONCLUSIONS:Patient enrollment in Endo ECHO was associated with increased outpatient and ED utilization and increased uptake of prescription-related quality measures. No impact was observed on hospitalization.
PMID: 33471708
ISSN: 1530-891x
CID: 4882082
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
Acceleration of kidney function decline after incident hospitalization with cardiovascular disease: the Stockholm CREAtinine Measurements (SCREAM) project
AIMS:The cardiorenal syndrome refers to a bidirectional relationship between the kidney and the heart. However, epidemiological evidence of cardiovascular disease (CVD) as a risk factor for chronic kidney disease (CKD) progression is actually scarce. METHODS AND RESULTS:). CONCLUSIONS:Incident hospitalization with cardiac diseases (i.e. HF and CHD) was significantly associated with a subsequent acceleration of eGFR decline.
PMID: 32683762
ISSN: 1879-0844
CID: 5585752
Survey of Principal Investigators in Biobanking: Knowledge, Attitudes, and Research Behaviors About Transgender and Gender-Diverse Patients
PURPOSE/UNASSIGNED:Biobanks usually do not collect transgender and gender-diverse (TGD) demographic information, hindering research on cancer risk and biological effects related to gender-affirming interventions. METHODS/UNASSIGNED:In August 2019, 172 scientists involved in biobanking research at a single institution (H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL) were invited to complete a survey measuring knowledge and attitudes about TGD health and research practices. Quantitative and qualitative analyses were performed. RESULTS/UNASSIGNED:< .001). Qualitative analysis of open-ended questions indicated overall support of TGD data inclusion in biobanks along with perceived barriers to inclusion of such data in biobanks. CONCLUSION/UNASSIGNED:To our knowledge, this was the first study of researchers to assess knowledge, attitudes, and research practices regarding TGD patients. Overall, there was limited knowledge about TGD health and cancer needs and low rates of TGD demographic data collection but a high interest in receiving education regarding this community.
PMID: 32525751
ISSN: 2688-1535
CID: 4631412
Generalized mean residual life models for case-cohort and nested case-control studies
Mean residual life (MRL) is the remaining life expectancy of a subject who has survived to a certain time point and can be used as an alternative to hazard function for characterizing the distribution of a time-to-event variable. Inference and application of MRL models have primarily focused on full-cohort studies. In practice, case-cohort and nested case-control designs have been commonly used within large cohorts that have long follow-up and study rare diseases, particularly when studying costly molecular biomarkers. They enable prospective inference as the full-cohort design with significant cost-saving benefits. In this paper, we study the modeling and inference of a family of generalized MRL models under case-cohort and nested case-control designs. Built upon the idea of inverse selection probability, the weighted estimating equations are constructed to estimate regression parameters and baseline MRL function. Asymptotic properties of the proposed estimators are established and finite-sample performance is evaluated by extensive numerical simulations. An application to the New York University Women's Health Study is presented to illustrate the proposed models and demonstrate a model diagnostic method to guide practical implementation.
PMID: 32529421
ISSN: 1572-9249
CID: 4478632
Knowledge and practice regarding prostate cancer germline testing among urologists: Gaps to address for optimal implementation✰,✰✰
BACKGROUND:Germline testing is recommended for all men with metastatic prostate cancer (PCa), and for some with localized PCa meeting specific histologic or family history criteria. Germline genetic evaluation has important implications for PCa prognosis and management, as well as implications for family members and cancer screening. Despite the importance of germline evaluation, its utilization in urologic practice is unknown. MATERIALS AND METHODS/METHODS:We conducted a 32-item survey of U.S. urologists to examine knowledge of germline testing guidelines and practice patterns. It was shared through email to 6 American Urological Association sections, the Veterans Affairs Urology Mailgroup, and social media. RESULTS:Among 132 total respondents from diverse practice settings across the U.S., 12% perform germline testing, 44% refer to a genetic counselor, 11% do both, and 33% do not test/refer. Only 4% had formal education in genetics. While 98% ask about PCa family history, only 76% and 52% ask about breast and ovarian cancer. When presented with hypothetical case scenarios where germline testing is indicated, many respondents indicated they would not offer genetic counseling or testing. Younger age (p = 0,03), academic practice (p = 0.04), and specializing in PCa/oncology (p = 0.007) were significantly associated with performing or referring for germline testing. Specializing in PCa/oncology was significantly associated with recommending germline testing for all case scenarios involving metastatic PCa (p = 0.0009) CONCLUSION: Our results suggest significant gaps in knowledge of germline testing and alignment of practice with national guidelines among urologists. Germline testing education and facilitation of genetic evaluation in urologic practice is warranted.
PMID: 33091732
ISSN: 2468-2942
CID: 4660982
Role for OCT in detecting hemi-macular ganglion cell layer thinning in patients with multiple sclerosis and related demyelinating diseases
OBJECTIVE:Investigations have found associations of homonymous thinning of the macular ganglion cell/ inner-plexiform layer (GCIPL) with demyelinating lesions in the post-chiasmal visual pathway among patients with multiple sclerosis (MS). Retinal thinning may also occur through retrograde trans-synaptic degeneration, a process by which lesions in post-geniculate visual pathway structures lead to thinning of the GCIPL across thalamic synapses. The purpose of our study was to determine the frequency of homonymous hemimacular thinning that occurs in association with post-chiasmal visual pathway demyelinating lesions in patients with MS and other demyelinating diseases. METHODS:Adult patients with demyelinating diseases (MS, neuromyelitis optica spectrum disorder [NMOSD], myelin oligodendrocyte glycoprotein antibody disease (anti-MOG)) who were participants in an ongoing observational study of visual pathway structure and function were analyzed for the presence of hemimacular GCIPL thinning on OCT scans. Brain MRI scans were examined for the presence of post-geniculate visual pathway demyelinating lesions. RESULTS:Among 135 participants in the visual pathway study, 5 patients (3.7%) had homonymous hemimacular GCIPL thinning. Eleven patients (8.1%) had a whole+half pattern of GCIPL thinning, characterized by hemimacular thinning in one eye and circumferential macular thinning in the contralateral eye. All but one patient with homonymous hemimacular thinning had demyelinating lesions in the post-geniculate visual pathway; however, these lesions were located in both cerebral hemispheres. CONCLUSION/CONCLUSIONS:Homonymous hemimacular thinning in the GCIPL by OCT is associated with post-chiasmal visual pathway demyelinating lesions but it appears to be a relatively uncommon contributor to GCIPL loss. Patients with this pattern of GCIPL often fail to complain of hemifield visual loss. Future studies with prospective and detailed MR imaging may be able to more closely associate demyelinating lesions in anatomically appropriate regions of the post-chiasmal visual pathways with homonymous hemimacular thinning.
PMID: 33035869
ISSN: 1878-5883
CID: 4627332
