Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Population Health
Total Results:
12818
Twitter Response to the 2018 United States Preventive Services Task Force Guidelines on Prostate Cancer Screening [Letter]
Prostate cancer screening reduces advanced disease and prostate cancer death but is controversial due to downstream harms including unnecessary biopsies and overtreatment. In 2012 the United States Preventive Services Task Force (USPSTF) recommended against screening men for prostate cancer, a practice common since the early 1990's. This dramatic policy change was opposed by many physicians and patient groups. Our group reported on the Twitter response within 24 hours of these guidelines, showing a missed opportunity for greater advocacy since the majority of tweets did not express an opinion.
PMID: 30811805
ISSN: 1464-410x
CID: 3703732
Development of an Outpatient Palliative Care Protocol to Monitor Fidelity in the Emergency Medicine Palliative Care Access Trial
PMID: 31486726
ISSN: 1557-7740
CID: 4067522
THEOVERALLHEALTHSTATUS OF INFERTILEMEN IN THE UNITED STATES IS SIMILAR TO THAT OF FERTILE MEN [Meeting Abstract]
OBJECTIVE: Epidemiologic studies have found that a greater degree of comorbidity is associated with worse fertility potential. However, these findings are largely based on retrospective studies of men interacting with the health care system. Our objective was to evaluate the association of fertility and health status in men in the United States using a nationally representative survey. DESIGN: We compared the demographics, healthcare utilization, and overall health status of fertile and infertile men in the National Survey for Family Growth (NSFG). MATERIALS AND METHODS: We performed an analysis of the male 2011-2017 cycles of the NSFG, a nationally representative survey of family planning. Infertile men were defined as men who had ever used infertility services or men who self-reported as non-surgically sterile. Men who reported completed pregnancies were considered fertile.
RESULT(S): Of the 13,861 men surveyed, 1,071 men were infertile, and 5,661 men were known to be fertile. Projecting to the national population, this translates to 5,205,771 infertile men and a 26,577,702 fertile men. Of the total population of sexually active men aged 15-49, roughly 8.5% (95%CI: 7.8-9.3) of men were infertile. Compared to known fertile men, infertile men had significant demographic and healthcare utilization differences (Table). Infertile men were wealthier, better educated, more likely to be white, more likely to be married, and more likely to have private insurance. Importantly, infertile men and fertile men had similar overall health status. On multivariate analysis, differences in income, marital status, and usual healthcare place remained significant.
CONCLUSION(S): While infertile men do have significant demographic and healthcare utilization differences compared to fertile men, the overall health status of both infertile and fertile men appear similar
RESULT(S): Of the 13,861 men surveyed, 1,071 men were infertile, and 5,661 men were known to be fertile. Projecting to the national population, this translates to 5,205,771 infertile men and a 26,577,702 fertile men. Of the total population of sexually active men aged 15-49, roughly 8.5% (95%CI: 7.8-9.3) of men were infertile. Compared to known fertile men, infertile men had significant demographic and healthcare utilization differences (Table). Infertile men were wealthier, better educated, more likely to be white, more likely to be married, and more likely to have private insurance. Importantly, infertile men and fertile men had similar overall health status. On multivariate analysis, differences in income, marital status, and usual healthcare place remained significant.
CONCLUSION(S): While infertile men do have significant demographic and healthcare utilization differences compared to fertile men, the overall health status of both infertile and fertile men appear similar
EMBASE:638063846
ISSN: 1556-5653
CID: 5251702
Prenatal exposure to phenols and lung function, wheeze, and asthma in school-age children from 8 European birth cohorts [Meeting Abstract]
Prenatal exposure to phenolic compounds, widely used in many consumer products, can alter lung development and increase the risk of respiratory disorders in the offspring. However, evidence is scarce and mostly focused on bisphenol-A (BPA), although there are other substitutes that could also interfere with the developing respiratory system. We aim to estimate the association between exposure to 5 phenols during pregnancy (BPA, BPAF, BPB, BPF, and BPS) and lung function, wheeze, and asthma in school-age children. We included 2685 mother-child pairs from 8 European birth cohorts. Phenols concentrations were determined in urinary maternal samples collected during pregnancy (1999-2010). Between 6 and 10 years of age, spirometry was performed, and wheeze and asthma were assessed from questionnaires. Adjusted multivariable linear regression and logistic regression models were used to assess the associations. We performed meta-analyses of cohort-specific estimates. We observed widespread prenatal BPA exposure with 79% of the samples above detectable limits; the other phenols were detected in fewer samples. Median BPA concentrations ranged from 1.04 to 9.54 ng/g of creatinine. Increasing BPA concentrations during pregnancy tended to be associated with lower FVC and FEV1 and were associated with increased odds of wheezing between ages 6 and 10 years (adjusted odds ratio=1.09; 95% CI=0.96, 1.24), but notwith asthma. Final results including associations of the other phenols with respiratory outcomes including wheezing patterns from birth will be presented. Preliminary results showed that prenatal exposure to BPA might increase the odds of wheezing in school-age children
EMBASE:630916626
ISSN: 1399-3003
CID: 4330642
Global social welfare : research, policy & practice. 2019:6(3):177-188.DOI: 10.1007/s40609-018-0126-8
Building Mental Health Research Capacity in Kenya: A South - North Collaboration
This paper describes a mental health capacity-building partnership between the University of Nairobi (UON) and the University of Washington (UW) that was built upon a foundational 30-year HIV/AIDS research training collaboration between the two institutions. With funding from the US National Institute of Mental Health Medical Education Program Initiative (MEPI), UW and UON faculty collaborated to develop and offer a series of workshops in research methods, grant writing, and manuscript publication for UON faculty and post-graduate students committed to mental health research. UON and UW scientists provided ongoing mentorship to UON trainees through Skype and email. Three active thematic research groups emerged that focused on maternal and child mental health, gender-based violence, and HIV-related substance abuse. Challenges to conducting mental health research in Kenya included limited resources to support research activities, heavy teaching responsibilities, clinical duties, and administrative demands on senior faculty, and stigmatization of mental health conditions, treatment, and research within Kenyan society. The partnership yielded a number of accomplishments: a body of published papers and presentations at national and international meetings on Kenyan mental health topics, the institution of systematic mental health data collection in rural clinics, funded research proposals, and a mental health research resource centre. We highlight lessons learned for future mental health research capacity-building initiatives.
PMCID:6688501
PMID: 31403024
ISSN: 2196-8799
CID: 5831862
Commentary on Ondersma et al. (2019): Will better self-report screening instruments be enough to detect drug use during pregnancy?
PMID: 31301078
ISSN: 1360-0443
CID: 3976992
Patient Characteristics Associated with More Bother from Lower Urinary Tract Symptoms
PURPOSE:Some patients continue to have bothersome lower urinary tract symptoms despite treatment. We examined characteristics associated with bother from lower urinary tract symptoms in a prospective cohort. MATERIALS AND METHODS:In this 1-year prospective, observational cohort study we obtained data on patients with lower urinary tract symptoms who were seeking care at a total of 6 tertiary care centers in the United States. Participants answered the AUA-SI (American Urological Association Symptom Index) global urinary bother question at study entry and 12 months later. Multilevel logistic and linear regression was used to identify factors associated with worsening bother and bother at 12 months, respectively. RESULTS:Of the 756 participants 121 (16%) had worsened lower urinary tract symptom bother during the study period. When adjusted for other variables, worsened lower urinary tract symptom bother was more likely among men who were nonwhite (OR 1.79, 95% CI 0.94-3.40) or who had diabetes (OR 1.68, 95% CI 0.86-3.27) and among women with diabetes (OR 1.77, 95% CI 0.85-3.67), prior treatment of lower urinary tract symptoms (OR 2.58, 95% CI 1.22-5.46) or a higher depression level (OR 1.29, 95% CI 1.10-1.52). Baseline factors associated with more severe bother at 12 months in men included more severe bother at baseline, nonwhite race, worse urinary frequency and incontinence, and higher levels of stress (p <0.05). Among women more severe bother at baseline, urinary urgency and frequency, and worse physical function were associated with more severe bother at 12 months. CONCLUSIONS:Urinary symptom severity at baseline, race, depression and psychological stress were associated with the bother of lower urinary tract symptoms in a prospective cohort of men and women treated at tertiary care facilities. These findings may inform the clinical care of patients with bothersome lower urinary tract symptoms and direct providers to better prognosticate for patients with challenging lower urinary tract symptoms cases.
PMCID:6697227
PMID: 31063049
ISSN: 1527-3792
CID: 4554742
Conducting reproductive research during a new childhood cancer diagnosis: ethical considerations and impact on participants
PURPOSE/OBJECTIVE:Research among adults shows benefits and low perceived burden of engaging in behavioral research. However, questions remain regarding the ethics of conducting behavioral research in pediatric populations during sensitive situations, including during a new life-threatening diagnosis or at end-of-life. We examined reactions to participating in a behavioral reproductive research study among male adolescents newly diagnosed with cancer and their parents, as a step towards optimizing fertility preservation utilization in a population where future infertility is common. METHODS:Pediatric literature regarding the ethics of behavioral research was reviewed. In our pilot, forty-four participants (19 mothers, 11 fathers, 14 male adolescents newly diagnosed with cancer) from 20 families completed demographic questionnaires and a fertility preservation decision tool developed by the study team. Qualitative interviews exploring the impact of study participation were subsequently conducted. Verbatim transcripts were coded for thematic content using the constant comparison method. RESULTS:Literature review showed positive reactions to research participation among youth/caregivers. In our pilot study, 89% (n = 17) of mothers, 64% (n = 7) of fathers, and 71% (n = 10) of adolescents reported at least one benefit of participating. Eleven percent (n = 2) of mothers, 36% (n = 4) of fathers, and 29% (n = 4) of adolescents said they were not affected; none of the participants reported a negative effect. CONCLUSION/CONCLUSIONS:Consistent with prior literature, our study suggests behavioral reproductive research prior to cancer treatment can offer direct benefits to participants and society, without increasing burden. These findings will inform future interventions to improve long-term psychosocial and reproductive outcomes for youth with cancer.
PMID: 31372871
ISSN: 1573-7330
CID: 4015462
Validation of Predictive Metabolic Syndrome Biomarkers of World Trade Center Lung Injury: a 16-Year Longitudinal Study
BACKGROUND:Metabolic Syndrome (MetSyn) predicted future development of World Trade Center lung injury(WTC-LI) in a subgroup of never smoking, male firefighters. An intra-cohort validation of MetSyn as predictors of WTC-LI is examined in the WTC-exposed cohort that has been longitudinally followed for 16 years. METHODS:<LLN. RESULTS:Cases were more likely to smoke, be highly exposed, and have MetSyn. There was a significant exposure dose response; the most highly-exposed individuals had 30.1%-increased risk of developing WTC-LI; having MetSyn increased risk of WTC-LI by 55.7%; smoking increased risk by 15.2%. There was significant interaction between smoking and exposure. CONCLUSIONS:We validated the utility of MetSyn to predict future WTC-LI in a larger population of exposed individuals. MetSyn defined by dyslipidemia, insulin resistance, and cardiovascular disease suggests that systemic inflammation can contribute to future lung function loss.
PMID: 30836056
ISSN: 1931-3543
CID: 3722962
Engagement and partnership with peer mentors in the development of the "Positive and Healthy Living Program": a process paper
Partnership and engagement are mediators of change in the efficient uptake of evidence-based patient-centered health interventions. We reflect on our process of engagement and preparation of peer mentors in the development of peer-led psychotherapy intervention for HIV infected adolescents in active care at the Comprehensive Care Centre (CCC) at Kenyatta National Hospital. The program was implemented in two phases, using a Consultation, Involve, Collaboration and Empowerment approach as stepping stones to guide our partnership and engagement process with stakeholders and ten peer mentors embedded in the CCC. Our partnership process promoted equity, power-and-resource sharing including making the peer mentors in-charge of the process and being led by them in manual development. This process of partnership and engagement demonstrated that engaging key stakeholders in projects lead to successful development, implementation, dissemination and sustainment of evidence-based interventions. Feedback and insights bridged the academic and clinical worlds of our research by helping us understand clinical, family, and real-life experiences of persons living with HIV that are often not visible in a research process. Our findings can be used to understand and design mentorship programs targeting lay health workers and peer mentors at community health care levels.
PMCID:6625933
PMID: 30704270
ISSN: 1360-0451
CID: 5831102
