Faculty Bibliography

Background/UNASSIGNED:Older adults with acute myocardial infarction (AMI) have higher prevalence of functional impairments, including deficits in cognition, strength, and sensory domains, than their younger counterparts. Objective/UNASSIGNED:To develop and evaluate the prognostic utility of a risk model for 6-month post-AMI mortality in older adults that incorporates information about functional impairments. Design/UNASSIGNED:Prospective cohort study. (ClinicalTrials.gov: NCT01755052). Setting/UNASSIGNED:94 hospitals throughout the United States. Participants/UNASSIGNED:3006 persons aged 75 years or older who were hospitalized with AMI and discharged alive. Measurements/UNASSIGNED:Functional impairments were assessed during hospitalization via direct measurement (cognition, mobility, muscle strength) or self-report (vision, hearing). Clinical variables associated with mortality in prior risk models were ascertained by chart review. Seventy-two candidate variables were selected for inclusion, and backward selection and Bayesian model averaging were used to derive (n = 2004 participants) and validate (n = 1002 participants) a model for 6-month mortality. Results/UNASSIGNED:Participants' mean age was 81.5 years, 44.4% were women, and 10.5% were nonwhite. There were 266 deaths (8.8%) within 6 months. The final risk model included 15 variables, 4 of which were not included in prior risk models: hearing impairment, mobility impairment, weight loss, and lower patient-reported health status. The model was well calibrated (Hosmer-Lemeshow P > 0.05) and showed good discrimination (area under the curve for the validation cohort = 0.84). Adding functional impairments significantly improved model performance, as evidenced by category-free net reclassification improvement indices of 0.21 (P = 0.008) for hearing impairment and 0.26 (P < 0.001) for mobility impairment. Limitation/UNASSIGNED:The model was not externally validated. Conclusion/UNASSIGNED:A newly developed model for 6-month post-AMI mortality in older adults was well calibrated and had good discriminatory ability. This model may be useful in decision making at hospital discharge. Primary Funding Source/UNASSIGNED:National Heart, Lung, and Blood Institute of the National Institutes of Health.

OBJECTIVE:The number of novel psychedelic phenethylamines and tryptamines has continued to increase, but little academic research has focused on the effects of these substances. We sought to determine and compare the subjective effects of various substances. METHODS:We conducted in-depth interviews with 39 adults (75.4% male and 87.2% White) who reported experience using psychedelic phenethylamines and/or tryptamines. Participants described the effects of compounds they have used. We examined the subjective drug effects in a qualitative descriptive manner. RESULTS:Participants reported on the use of 36 compounds. The majority (64.1%) reported the use of 2C series drugs, with 2C-B use being most prevalent; 38.5% reported the use of NBOMe, and 25.6% reported the use of DOx. With regard to tryptamines, 46.2% reported use, and 4-AcO-DMT was the most prevalent drug used in this class. 2C-B was often described as being more favorable than other 2C series compounds with the effects described as being comparable with MDMA and LSD. NBOMe effects were generally described in an unfavorable manner, and the effects of DOx were often described as lasting too long (12-36 hr). The effects of 4-AcO-DMT were often described as mimicking psilocybin. CONCLUSION/CONCLUSIONS:Knowing the effects of various compounds can inform education, prevention, and harm reduction efforts regarding the use of these drugs.

Hispanic women have a higher prevalence of weight associated complications in pregnancy. This ethnic disparity is likely related to behavior patterns, social circumstances, environmental exposures, and access to healthcare, rather than biologic differences. The objective was to determine associations between sociodemographic characteristics, health behaviors, and psychosocial stressors and gestational weight gain (GWG) in low-income Hispanic women. During pregnancy, information on sociodemographic characteristics, health behaviors, and psychosocial stressors were collected. Linear regression estimated mean differences in GWG by selected predictors. Multinomial logistic regression estimated odds of inadequate and excessive GWG by selected predictors. Five-hundred and eight women were included, 38% had inadequate and 28% had excessive GWG; 57% with a normal pre-pregnancy BMI had inadequate GWG. Compared to women with normal BMI, women with overweight or obesity were more likely to have excessive GWG (aRRR = 1.88, 95% CI: 1.04, 3.40 and aRRR = 1.98, 95% CI: 1.08, 3.62, respectively). Mean total GWG was higher among women who were nulliparous (ß = 1.34 kg, 95% CI: 0.38, 2.29) and those who engaged in ≥3 h of screen time daily (ß = 0.98 kg, 95% CI: 0.02, 1.94), and lower among women who were physically active during pregnancy (ß = -1.00 kg, 95% CI: -1.99, -0.03). Eating breakfast daily was associated with lower risk of inadequate GWG (aRRR = 0.47, 95% CI: 0.26, 0.83). Depressive symptoms and poor adherence to dietary recommendations were prevalent, but none of the psychosocial or dietary variables were associated with GWG. In this cohort of primarily immigrant, low-income, Hispanic women, there were high rates of poor adherence to diet and physical activity recommendations, and a majority of women did not meet GWG guidelines. Modifiable health behaviors were associated with GWG, and their promotion should be included in prenatal care.

OBJECTIVES/OBJECTIVE:Guidelines recommend that smokers participate in four or more counseling sessions when trying to quit, but smokers rarely engage in multiple sessions. The "decoy effect" is a cognitive bias that can cause consumer preferences for a "target" product to change when presented with a similar but inferior product (a "decoy"). This study tested the use of a decoy to guide smokers' selection of a target number of counseling sessions. During an online survey, adult tobacco users (N = 93) were randomized to one of two groups that determined the answer choices they saw in response to a question assessing their interest in multi-session cessation counseling. Group A choose between two sessions or a "target" of five sessions. Group B was given a third "decoy" option of seven sessions. Binary logistic regression was used to compare groups on the proportion of participants selecting the "target." RESULTS:Among 90 participants with complete data, a decoy effect was not found. There was no significant difference between groups in the proportion of participants selecting the target of five sessions (47% in Group B vs. 53% in Group A; aOR = 0.76, 95%CI 0.48-1.19). Trial Registration This study was retrospectively registered at clinicaltrials.gov on December 13, 2019 (NCT04200157).

Little is understood about how an unconditional cash transfer might operate and affect behavior among low-income parents of infants in the United States. We investigate these questions using data from a random-assignment pilot study (N = 30) in which unconditional cash transfers were distributed monthly on debit cards to two groups of low-income parents in New York City during the first 12 months of their newborns"™ lives. Mothers were randomized to receive either $100 per month or $20 per month. Mothers distinguished spending the cash transfer on essentials vs. extras, such as going out to dinner with family. The monthly cash transfer "tided them over," even at the lower amount of $20, especially when income from other sources ran short at the end of the month. Some mothers reported saving money for unexpected expenses.

Satisfaction greatly impacts decisions about where and how to access healthcare. This cross-sectional study uses data gathered from young adult gay men in New York City. Findings indicate that participants who experienced discrimination in a healthcare setting were less likely to prefer coordinated healthcare. Participants who disclosed their sexual orientation and were comfortable discussing sexual activity with their provider were more likely to agree that their healthcare needs were adequately addressed. The healthcare system does not fully address the healthcare needs of gay men. Preferences for coordination of care, nondisclosure of sexual orientation, and low levels of satisfaction with services further discourage healthcare usage among this population.

Spanking is a divisive discipline practice in the USA and is considered an inappropriate and harmful discipline tactic by some scholars and practitioners. However, increased diversity in the USA has contributed to varying cultural beliefs regarding discipline, which in turn influences child development. While prior literature has examined correlates of spanking, few studies have examined its impact on Latinx children over time. We examined the use of spanking by Mexican-American (n = 185) and Dominican-American mothers (n = 141) across three time points. The main objective was to investigate whether maternal spanking predicted externalizing problems in young Latinx youth overtime. Families were recruited from public urban schools. Data were collected when children were 4-, 5- and 6-years old. A three-wave cross-lagged multi-group path analysis examined the potential reciprocal relationships between maternal spanking and child externalizing behaviors. According to cross-sectional linear regression models, spanking was concurrently associated with behavior problems at all three time points. However, the results of the cross-lagged multi-group path analyses showed that spanking did not predict subsequent behavior problems, nor did behavior problems predict subsequent spanking. The impact of spanking on child behavior may not be long-lasting in all Latinx families. Spanking and youth externalizing problems are concurrently and positively related; however, maternal use of spanking as a means of discipline did not result in negative and long term effects on child externalizing problems. Implications for practice with Latinx families are explored.

Prediabetes is a highly prevalent metabolic disorder. Screening is mandatory, since this condition is associated, in the absence of treatment, with an increased risk of developing diabetes and related complications, in particular cardiovascular. Diagnosis of prediabetes is currently based on glycemic criteria (fasting plasma glucose and/or glycemia at 120 min of a 75-gram oral glucose tolerance tests [OGTT] and/or the glycated hemoglobin [HbA1c]). Substantial recently published data suggests that diagnosis of prediabetes based on current criteria is already "delayed" in the natural evolution of dysglycemia. In contrast, a glucose level greater than 155 mg/dL (8.6 mmol/L) at 60 minute of the OGTT could be an earlier marker for risk of hyperglycemia than the 120 minute value, in individuals with normal glucose tolerance, before "prediabetes" is detected as conventionally defined. This parameter is also associated with better performance in terms of prediction of diabetes, macroangiopathy and mortality, when compared with conventional tests. The 1-hour postload OGTT could therefore replace current criteria for diagnosis of early metabolic abnormalities, in particular in the presence of discordant results from traditional first line tests (fasting glucose and HbA1c), leading to a more rapid therapeutic intervention.