Faculty Bibliography

OBJECTIVE:To obtain perspectives about existing compensation structures in gynecologic oncology, including common challenges and successful strategies within diverse systems. METHODS:Electronic mail was used to recruit OB/GYN department chairs and directors of cancer centers who were gynecologic oncologists and responsible for administering compensation structures at their institution. Using a semi-structured guide, three interviewers conducted 30-min qualitative interviews, which were recorded and transcribed. Two coders used the constant comparative method to summarize key themes. RESULTS:Response rate was 65 %, resulting in 17 interviewees. Participants were a third women and in their current position for a median of 7 years. The most prominent theme was the tension of balancing reimbursement for revenue-generating clinical activities with non-clinical work in research and education. Chair discretionary funds were useful to offset unfunded responsibilities. Broad clinical productivity measures were used: from more traditional work Relative Value Units (wRVUs) to measures that captured downstream impact, such as number of new patients or surgeries. Even in institutions with centralized funds flow systems, disparities were frequently noted for the monetary value assigned per wRVU. Academic scorecards were described as a method to ascribe value for academic work, often for bonus incentives. Another common stressor unique to gynecologic oncology was low reimbursement for chemotherapy-related services compared to surgery. Provision of regular productivity reports was common, but full transparency was controversial. CONCLUSIONS:Our inquiry demonstrates that our academic leaders are unable to use compensation to fully support areas they deem important.

Environmental exposure-associated diseases, particularly in the context of rising air pollution and inhalant use, are an active area of research. Our group is dedicated to the study of exposure-related inflammation and its downstream adverse health effects. While many studies have focused on the impact of environmental exposures on respiratory sequelae, there is growing evidence of the involvement of other systems including gastrointestinal. This systematic review provides updates on the associations between inhalation exposures and the risk of upper gastrointestinal disease. Primary search identified N = 764 PubMed and N = 1,036 Web of Science studies, of which N = 111 met eligibility criteria. Our systematic review and meta-analysis showed significant associations between inhalational exposures (cigarette smoking, waterpipe smoking, and particulate matter) and upper gastrointestinal diseases. The pooled estimate of esophagitis was 1.32 (95% confidence interval [CI], 1.06-1.65; I²:86%), gastroesophageal reflux disease was 1.71 (1.14-2.55; I²:94%), peptic ulcer disease was 1.21 (1.03-1.43; I²:93%), esophageal cancer was 1.83 (1.54-2.18; I²:73%), and gastric cancer was 1.71 (1.39-2.10; I²:73%). However, the pooled estimate for Barrett's esophagus was 0.93 (0.65-1.34; I²:76%), indicating no significant association. Sensitivity analyses confirmed these findings. Risk of bias assessment showed most studies were of good quality. Our findings emphasize the impact of inhalational exposures on gastrointestinal disease risk, highlighting the need for further research to better understand this interaction and targeted public health interventions.

BACKGROUND:Maternal thyroid dysfunction and maternal depression during pregnancy may increase the risk of child behavioral and emotional problems. We sought to investigate the independent and interactive associations of these two risk factors with child behavior problems. METHODS:We combined data from four cohorts in the Environmental influences on Child Health Outcomes (ECHO) program (N = 949). Maternal thyroid function (thyroid-stimulating hormone [TSH], free thyroxine [fT4], thyroid peroxidase autoantibodies [TPO-Ab], fT4/TSH ratio) was measured predominantly during the first half of pregnancy. We harmonized maternal depression into a continuous measure of antepartum depressive symptomatology and a dichotomous measure reflecting (history of) clinical depression. Child internalizing and externalizing problems were harmonized to the T-score metric of the Child Behavior Checklist. We used multiple linear regression and random effects meta-analysis to assess the average relationship between each predictor and outcome, and the variability in these relationships across cohorts. RESULTS:Across cohorts, antepartum depressive symptomatology was positively associated with both internalizing (meta B = 2.879, 95 % CI 1.87-3.89, p < .001) and externalizing problems (meta B = 1.683, 95 % CI 0.67-2.69, p = .001). None of the indicators of maternal thyroid function was associated with child behavior problems across cohorts. TPO-Ab concentrations were positively associated with child externalizing problems only in offspring of depressed mothers (meta B = 3.063, 95 % CI 0.73-5.40, p = .010). CONCLUSIONS:This study supports the importance of maternal antepartum mental health for child behavior across diverse populations. However, we found little empirical evidence for an association between maternal thyroid function within the normal range during pregnancy and child behavioral problems.

IMPORTANCE/UNASSIGNED:Hypertension is often underrecognized, leading to preventable morbidity and mortality. Tailored data systems combined with care augmented by trained nonphysicians have the potential to improve cardiovascular care. OBJECTIVE/UNASSIGNED:To determine whether previously collected cardiovascular imaging data could be harnessed to improve the detection and treatment of hypertension through a system-level intervention. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:The NOTIFY-LVH trial was a 2-arm, pragmatic randomized clinical trial conducted from March 2023 through June 2024 within the Mass General Brigham health care system, a multi-institutional network serving the greater Boston, Massachusetts, area. The study included individuals with a Mass General Brigham primary care affiliation who had left ventricular hypertrophy (LVH) on a prior echocardiogram, had no established cardiomyopathy diagnosis, and were not being treated with antihypertensive medications. Patients were followed for 12 months postintervention. INTERVENTION/UNASSIGNED:Population health coordinators contacted clinicians of patients randomized to the intervention, notifying them of LVH and offering assistance with follow-up care. A clinical support pathway-including 24-hour ambulatory blood pressure monitoring or cardiology referrals-was provided to aid LVH evaluation. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was the initiation of an antihypertensive medication. Secondary outcomes included new hypertension and cardiomyopathy diagnoses. RESULTS/UNASSIGNED:A total of 648 patients were randomized-326 to the intervention and 322 to the control. Mean (SD) patient age was 59.4 (10.8) years and 248 patients (38.3%) were female. A total of 102 patients (15.7%) had a baseline diagnosis of hypertension and 109 patients (20.1%) had a mean outpatient blood pressure of 130/80 mm Hg or higher. Over 12 months, 53 patients (16.3%) in the intervention arm were prescribed an antihypertensive medication vs 16 patients (5.0%) in the control arm (adjusted odds ratio [OR], 3.76; 95% CI, 2.09-6.75; P < .001). Individuals in the intervention group were also more likely to be diagnosed with hypertension (adjusted OR, 4.43; 95% CI, 2.36-8.33; P < .001). Cardiomyopathy diagnoses did not significantly differ between groups. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In the NOTIFY-LVH randomized clinical trial, a centralized population health coordinator-led notification and clinical support pathway for individuals with LVH on prior echocardiograms increased the initial treatment of hypertension. This work highlights the potential benefit of leveraging preexisting but potentially underutilized cardiovascular data to improve health care delivery through mechanisms augmenting the traditional ambulatory care system. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT05713916.

BACKGROUND:Lack of sexual orientation and gender identity (SOGI) collection hinders the ability to identify cancer disparities, create opportunities for improvement, and reveal the burden of cancer among sexual and gender minority (SGM) populations. Our institution is one of the first NCI-Designated Comprehensive Cancer Centers to collect SOGI as standard-of-care demographics. METHODS:This analysis includes 118 320 patients who came to the H. Lee Moffitt Cancer Center & Research Institute ("Moffitt") between January 1, 2016 and December 31, 2023 and completed the institutional standard-of-care electronic patient questionnaire. Descriptive analyses were conducted to assessed overall and age-specific differences between SGM and non-SGM patients (ie, cisgender-heterosexual) for demographics, SOGI disclosure, clinical covariates, and psychosocial and quality-of-life needs. RESULTS:Compared with non-SGM patients, SGM patients were statistically significant younger, single, self-identified as racial and ethnic minorities, reported higher psychosocial and quality-of-life needs, and had higher-than-expected rates for several specific cancer sites. CONCLUSIONS:Revealing these real-world cancer disparities among SGM patients based on only 7 years of SOGI data collection highlights the fundamental importance of systematic collection of this demographic information for identifying and eventually mitigating health disparities.

IMPORTANCE/UNASSIGNED:Promoting social connection among older adults is a public health priority. Addressing hearing loss may reduce social isolation and loneliness among older adults. OBJECTIVE/UNASSIGNED:To describe the effect of a best-practice hearing intervention vs health education control on social isolation and loneliness over a 3-year period in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This secondary analysis of a multicenter randomized controlled trial with 3-year follow-up was completed in 2022 and conducted at 4 field sites in the US (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland). Data were analyzed in 2024. Participants included 977 adults (aged 70-84 years who had untreated hearing loss without substantial cognitive impairment) recruited from the Atherosclerosis Risk in Communities study (238 [24.4%]) and newly recruited (de novo; 739 [75.6%]). Participants were randomized (1:1) to hearing intervention or health education control and followed up every 6 months. INTERVENTIONS/UNASSIGNED:Hearing intervention (4 sessions with certified study audiologist, hearing aids, counseling, and education) and health education control (4 sessions with a certified health educator on chronic disease, disability prevention). MAIN OUTCOMES AND MEASURES/UNASSIGNED:Social isolation (Cohen Social Network Index score) and loneliness (UCLA Loneliness Scale score) were exploratory outcomes measured at baseline and at 6 months and 1, 2, and 3 years postintervention. The intervention effect was estimated using a 2-level linear mixed-effects model under the intention-to-treat principle. RESULTS/UNASSIGNED:Among the 977 participants, the mean (SD) age was 76.3 (4.0) years; 523 (53.5%) were female, 112 (11.5%) were Black, 858 (87.8%) were White, and 521 (53.4%) had a Bachelor's degree or higher. The mean (SD) better-ear pure-tone average was 39.4 dB (6.9). Over 3 years, mean (SD) social network size reduced from 22.6 (11.1) to 21.3 (11.0) and 22.3 (10.2) to 19.8 (10.2) people over 2 weeks in the hearing intervention and health education control arms, respectively. In fully adjusted models, hearing intervention (vs health education control) reduced social isolation (social network size [difference, 1.05; 95% CI, 0.01-2.09], diversity [difference, 0.19; 95% CI, 0.02-0.36], embeddedness [difference, 0.27; 95% CI, 0.09-0.44], and reduced loneliness [difference, -0.94; 95% CI, -1.78 to -0.11]) over 3 years. Results were substantively unchanged in sensitivity analyses that incorporated models that were stratified by recruitment source, analyzed per protocol and complier average causal effect, or that varied covariate adjustment. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This secondary analysis of a randomized clinical trial indicated that older adults with hearing loss retained 1 additional person in their social network relative to a health education control over 3 years. While statistically significant, it is unknown whether observed changes in social network are clinically meaningful, and loneliness measure changes do not represent clinically meaningful changes. Hearing intervention is a low-risk strategy that may help promote social connection among older adults. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT03243422.

OBJECTIVES/OBJECTIVE:To study the impact of an educational intervention on obstetrician-gynecologist clinicians' knowledge of racial and ethnic disparities in the menopause experience. METHODS:Twenty-five obstetrician-gynecologist physicians (residents, fellows, and attendings) at an academic medical center in New York, NY, completed the Achieving Menopausal Health Equity Network course, a brief web-based intervention consisting of four modules delivered through narrated didactic videos and interactive tools, a 10-item pretest and posttest, and a course evaluation survey. The primary outcome was a change in knowledge scores after the completion of the educational intervention. Item analysis was also performed to assess item discrimination, item difficulty, and response frequency. Feedback on modules was obtained, and thematic analysis was performed. RESULTS:In this study, 25 participants completed the educational intervention. There was a statistically significant increase in mean test scores after participation (pretest mean score=7.1/10 vs. posttest mean score=8.1/10, P =0.0021). The following themes emerged in thematic analysis: knowledge building with potential for practical application for clinicians and non-clinicians, clarity and relevance, and opportunities for growth for future iterations of the modules. CONCLUSIONS:This brief, online educational curriculum focused on racial and ethnic disparities in menopause significantly improved the knowledge of obstetrician-gynecologist clinicians at various levels of training and provides a useful model for introducing more formal training on menopause medicine for obstetrician-gynecologist clinicians.

OBJECTIVES/OBJECTIVE:We examined trends in the socioeconomic distribution of work schedules from 1990s to 2010s and how early adulthood disadvantages are associated work schedules over working age. METHODS:In a representative sample of U.S. workers(N = 3,328), we calculated recycled predictions of day, evening, night, and long shift prevalence associated with time-period. Logistic regression was used to analyze the association of non-day shifts with age and its variations by early adulthood disadvantage in U.S. baby boomers(N = 10,293). RESULTS:Between 1990s-2010s, evening shifts increased in adults without college education and night shifts increased in the lowest income quartile. Day shifts decreased in both groups. Being Black, not attending college, and poverty were associated with non-day shiftwork throughout working age. CONCLUSIONS:Evening and night shifts may have replaced day shifts in disadvantaged populations between 1990s-2010s. Early disadvantages may have sustained effects on work schedules.