Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Population Health
Total Results:
12818
Measured and estimated glomerular filtration rate: current status and future directions
Evaluation of glomerular filtration rate (GFR) is central to the assessment of kidney function in medical practice, research and public health. Measured GFR (mGFR) remains the reference standard, but the past 20 years have seen major advances in estimated GFR (eGFR). Both eGFR and mGFR are associated with error compared with true GFR. eGFR is now recommended by clinical practice guidelines, regulatory agencies and public health agencies for the initial evaluation of GFR, with measured GFR (mGFR) typically considered an important confirmatory test, depending on how accurate the assessment of GFR needs to be for application to the clinical, research or public health setting. Our approach is to use initial and confirmatory tests as needed to develop a final assessment of true GFR. We suggest that GFR evaluation might be improved by more complete implementation of current recommendations and by further research to improve the accuracy of mGFR and eGFR.
PMID: 31527790
ISSN: 1759-507x
CID: 5585502
Further Utilization of Emergency Department and Inpatient Psychiatric Services Among Young Adults Admitted at the Emergency Department With Clinical Alcohol Intoxication
OBJECTIVES/OBJECTIVE:To assess in a cohort of young adults admitted with alcohol intoxication (AI) to the Emergency Department (ED): how many patients are readmitted to the ED or to a Psychiatric Department (PD) inpatient unit; and which characteristics are associated with further ED and PD inpatient admissions. METHODS:In 630 patients aged 18 to 30 years admitted for AI in 2006 to 2007 to the ED of a Swiss tertiary hospital, further ED and PD inpatient admissions through 2013 were assessed. Patient characteristics at the index (initial) ED visit were assessed using administrative and medical records. MEASUREMENTS/METHODS:Proportion of subjects with at least 1 further ED admission, 1 further ED admission with AI, and any PD admission over the study period.Associations between patients' characteristics at index visit and readmissions were assessed using backward selection multivariate regression analyses. RESULTS:Mean age was 24, 66% were male, 60% had any ED/PD admissions during the study period, 17.9% a PD admission, and 13.8% were re-admitted to ED with AI. Disruptive behavior at the index visit was associated with further ED (odds ratio [OR] 1.69 [1.13; 2.54]) and PD admissions (OR 2.41 [1.44; 4.05]). Psychiatric diagnosis was associated with any further ED admission (OR 2.07 [1.41; 3.05]), with further ED admission with AI (OR 4.56 [2.36; 8.81]) and with PD admission (OR 3.92 [2.40; 6.41]). Female sex predicted any further ED admission (OR 1.65 [1.14; 2.39]). CONCLUSIONS:Young adults presenting with alcohol intoxication have high rates of subsequent inpatient emergency and psychiatric admissions. Being female, presenting with disruptive behavior, and having a psychiatric diagnosis at the ED visit were predictors of further admissions.
PMID: 32012139
ISSN: 1935-3227
CID: 4301222
Impact of Changes in the Food, Built, and Socioeconomic Environment on BMI in US Counties, BRFSS 2003-2012
OBJECTIVE:Researchers have linked geographic disparities in obesity to community-level characteristics, yet many prior observational studies have ignored temporality and potential for bias. METHODS:Repeated cross-sectional data were used from the Behavioral Risk Factor Surveillance System (BRFSS) (2003-2012) to examine the influence of county-level characteristics (active commuting, unemployment, percentage of limited-service restaurants and convenience stores) on BMI. Each exposure was calculated using mean values over the 5-year period prior to BMI measurement; values were standardized; and then variables were decomposed into (1) county means from 2003 to 2012 and (2) county-mean-centered values for each year. Cross-sectional (between-county) and longitudinal (within-county) associations were estimated using a random-effects within-between model, adjusting for individual characteristics, survey method, and year, with nested random intercepts for county-years within counties within states. RESULTS:(95% CI: -0.72 to -0.31) decrease in BMI over time. CONCLUSIONS:These results suggest that community-level characteristics play an important role in shaping geographic disparities in BMI between and within communities over time.
PMID: 31858733
ISSN: 1930-739x
CID: 4243122
Childhood Obesity and the Food Environment: A Population-Based Sample of Public School Children in New York City
OBJECTIVE:This study aimed to examine the relationship between proximity to healthy and unhealthy food outlets around children's homes and their weight outcomes. METHODS:A total of 3,507,542 student-year observations of height and weight data from the 2009-2013 annual FitnessGram assessment of New York City public school students were used. BMI z scores were calculated, student obesity or obesity/overweight was determined using Centers for Disease Control and Prevention growth charts, and these data were combined with the locations of four food outlet types (fast-food restaurants, wait-service restaurants, corner stores, and supermarkets) to calculate distance to the nearest outlet. Associations between weight status outcomes and distance to these food outlet types were examined using neighborhood (census tract) fixed effects. RESULTS:Living farther than 0.025 mile (about half of a city block) from the nearest fast-food restaurant was associated with lower obesity and obesity/overweight risk and lower BMI z scores. Results ranged from 2.5% to 4.4% decreased obesity. Beyond this distance, there were generally no impacts of the food environment and little to no impact of other food outlet types. CONCLUSIONS:Proximity to fast-food restaurants was inversely related to childhood obesity, but no relationships beyond that were seen. These findings can help better inform policies focused on food access, which could, in turn, reduce childhood obesity.
PMID: 31675159
ISSN: 1930-739x
CID: 4169022
A multiple casualty incident clinical tracking form for civilian hospitals
BACKGROUND:While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally accepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospi-tal received multiple injured patients within minutes; lessons learned included the need for a formalized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. METHODS:After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for hmultiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. RESULTS:In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in organizing diagnostic and therapeutic triage. CONCLUSIONS:During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.
PMID: 32804385
ISSN: 1932-149x
CID: 4566582
Disparities in hospital smoking cessation treatment by immigrant status
Despite the efficacy of nicotine replacement therapy (NRT) in promoting smoking cessation, no studies have been done to evaluate NRT prescribing rates among immigrants, a vulnerable minority population in the United States. The aim of this study is to explore for differences in NRT prescribing behavior by immigrant status. Participants were enrolled in a smoking cessation trial for hospitalized patients between July 2011 and April 2014 at two NYC hospitals. For this analysis, we used baseline data from patient surveys and electronic medical-record reviews to examine associations between immigrant status and prescription of NRT in-hospital and on discharge, as well as acceptance of NRT in-hospital. We included age, gender, education, health literacy, race, ethnicity, English language ability, inpatient service, and site insurance in the models as potential confounders. Our study population included 1,608 participants, of whom 21% were not born in the United States. Bivariate analysis found that nonimmigrants were more likely than immigrants to be prescribed NRT in the hospital (46.1% vs. 35.7%, p = .0006) and similarly on discharge (19.4% vs. 15.3%, p = .09). Both groups were equally likely to accept NRT in-hospital when prescribed. On multivariable analysis, being an immigrant (OR 0.65), Black race (OR 0.52), and Hispanic ethnicity (OR 0.63) were associated with lower likelihood of being prescribed NRT in-hospital. Multivariable analysis for provision of NRT prescription at discharge showed no significant difference between immigrants and nonimmigrants. These findings show differences in in-hospital smoking cessation treatment between immigrants and nonimmigrants.
PMID: 29727588
ISSN: 1533-2659
CID: 3100922
163 Sexual Concerns of Female Partners of Prostate Cancer Patients: Novel Data from an Online Health Community [Meeting Abstract]
Introduction: Despite substantial evidence on the impact of prostate cancer treatment on sexual function and sexual quality of life for men, there is limited research on the effect that this has on the sexual quality of life of partners. A better understanding of partners' sexual concerns will enable support of mutuality in couples' sexual relationships in PCa survivorship.
Objective(s): To perform a content analysis of posts by female partners to an online prostate cancer community.
Method(s): Inspire is a web-based social platform containing numerous communities about different health topics, which patients and caregivers can use to share information and support. The Inspire UsTOO Prostate Cancer Online Support & Discussion Community is one of the many disease-specific communities, which currently has more than 20,000 members. Through a data use agreement, we obtained anonymized text from postings to the community by female caregivers. Posts were manually reviewed to identify content related to sexual health, and qualitative analysis was performed to identify key themes.
Result(s): There were many posts by women to the online prostate cancer community about sexual issues related to their partner's diagnosis and treatment. Table 1 shows key themes and sample quotes. Partners expressed that intimacy was more important than receptive intercourse, particularly during a stressful time dealing with a cancer diagnosis. Without intimacy, women expressed feelings of grief and isolation. Sexual health was also tied into women's evolving role as a caregiver, requiring time spent to plan ahead for sexual activity as well as research into management options to improve sexual function for their partner.
Conclusion(s): Data from online health communities provide a unique window into the lived experience of patients and their families. Sexual issues resulting from prostate cancer treatment have a significant impact on female partners. Lack of intimacy and changes in the sexual relationship can result in significant feelings of isolation and grief for female partners. [Formula presented] Disclosure: Work supported by industry: no.
Copyright
Objective(s): To perform a content analysis of posts by female partners to an online prostate cancer community.
Method(s): Inspire is a web-based social platform containing numerous communities about different health topics, which patients and caregivers can use to share information and support. The Inspire UsTOO Prostate Cancer Online Support & Discussion Community is one of the many disease-specific communities, which currently has more than 20,000 members. Through a data use agreement, we obtained anonymized text from postings to the community by female caregivers. Posts were manually reviewed to identify content related to sexual health, and qualitative analysis was performed to identify key themes.
Result(s): There were many posts by women to the online prostate cancer community about sexual issues related to their partner's diagnosis and treatment. Table 1 shows key themes and sample quotes. Partners expressed that intimacy was more important than receptive intercourse, particularly during a stressful time dealing with a cancer diagnosis. Without intimacy, women expressed feelings of grief and isolation. Sexual health was also tied into women's evolving role as a caregiver, requiring time spent to plan ahead for sexual activity as well as research into management options to improve sexual function for their partner.
Conclusion(s): Data from online health communities provide a unique window into the lived experience of patients and their families. Sexual issues resulting from prostate cancer treatment have a significant impact on female partners. Lack of intimacy and changes in the sexual relationship can result in significant feelings of isolation and grief for female partners. [Formula presented] Disclosure: Work supported by industry: no.
Copyright
EMBASE:2004351882
ISSN: 1743-6095
CID: 4254502
Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
ISI:000579154000009
ISSN: 0140-6736
CID: 4677352
Mental Contrasting Spurs Energy by Changing Implicit Evaluations of Obstacles
ISI:000648753100003
ISSN: 2333-8113
CID: 5477622
"Patient attitudes toward substance use screening and discussion in primary care" (SW16) [Meeting Abstract]
ISI:000603567100104
ISSN: 1940-0640
CID: 4764182
