Faculty Bibliography

This study evaluates how teacher report measures align with different conceptualizations of children's social-emotional development. Leveraging seven teacher report measures of social competence and behavioral regulation in a predominantly low-income, population-based rural sample of four-year-old children (n = 828), model fit and validity were evaluated in a series of confirmatory factor models, including bifactor models. A bifactor model with behavioral regulation as a general factor and an orthogonal social competence factor emerged as the preferred model. Results indicate that teacher reports of behavioral regulation capture teachers' perceptions of preschoolers' behavioral regulation. However, teacher reports of social competence reflect teachers' perceptions of both social competence and behavioral regulation. Post-hoc analyses were conducted to explore potential explanations for these findings. Implications for interpreting teacher reports of social-emotional development and for future work strengthening the quality of scalable measures of children's social-emotional development are discussed.

BACKGROUND:The diagnosis of posttraumatic stress disorder (PTSD) is usually based on clinical interviews or self-report measures. Both approaches are subject to under- and over-reporting of symptoms. An objective test is lacking. We have developed a classifier of PTSD based on objective speech-marker features that discriminate PTSD cases from controls. METHODS:Speech samples were obtained from warzone-exposed veterans, 52 cases with PTSD and 77 controls, assessed with the Clinician-Administered PTSD Scale. Individuals with major depressive disorder (MDD) were excluded. Audio recordings of clinical interviews were used to obtain 40,526 speech features which were input to a random forest (RF) algorithm. RESULTS:The selected RF used 18 speech features and the receiver operating characteristic curve had an area under the curve (AUC) of 0.954. At a probability of PTSD cut point of 0.423, Youden's index was 0.787, and overall correct classification rate was 89.1%. The probability of PTSD was higher for markers that indicated slower, more monotonous speech, less change in tonality, and less activation. Depression symptoms, alcohol use disorder, and TBI did not meet statistical tests to be considered confounders. CONCLUSIONS:This study demonstrates that a speech-based algorithm can objectively differentiate PTSD cases from controls. The RF classifier had a high AUC. Further validation in an independent sample and appraisal of the classifier to identify those with MDD only compared with those with PTSD comorbid with MDD is required.

Two studies examined inter-rater reliability and content-related validity of an addiction treatment level of care determination tool currently in use in New York, the LOCADTR 3.0. The studies occurred after tool implementation. In study 1, 139 providers used the LOCADTR 3.0 to determine level of care for four case vignettes. Inter-rater reliability coefficients were calculated. In study 2, 387,338 state records from existing data were analyzed to determine how often providers opted to override the LOCADTR 3.0 level of care determination by choosing an alternative level of care. In study 1, an acceptable inter-rater reliability (IRR = .57-.59) was found. Good indication of content-related validity was also found; participants chose the same level of care the study team chose for each vignette 80% of the time. In study 2, the override option was selected only 10% of the time, further establishing the content validity of the tool. These studies provide evidence for acceptable preliminary reliability and validity of the LOCADTR 3.0.

OBJECTIVES/OBJECTIVE:Patient Health Priorities Identification (PHPI) is a values-based process in which trained facilitators assist older adults with multiple chronic conditions identify their health priorities. The purpose of this study was to evaluate patients' perceptions of PHPI. DESIGN/METHODS:Qualitative study using thematic analysis. SETTING/METHODS:In-depth semistructured telephone and in-person interviews. PARTICIPANTS/METHODS:Twenty-two older adults who participated in the PHPI process. MEASUREMENTS/METHODS:Open-ended questions about patient perceptions of the PHPI process, perceived benefits of the process, enablers and barriers to PHPI, and recommendations for process enhancement. RESULTS:Patient interviews ranged from 9 to 63 minutes (median = 20 min; interquartile range = 15-26). The mean age was 80 years (standard deviation = 7.96), 64% were female, and all patients identified themselves as white. Of the sample, 73% reported no caregiver involvement in their healthcare; 36% lived alone. Most patients felt able to complete the PHPI process with ease. Perceived benefits included increased knowledge and insight into disease processes and treatment options, patient activation, and enhanced communication with family and clinicians. Patients identified several factors that were both enablers and barriers to PHPI including facilitator characteristics, patient demographic and clinical characteristics, social support, relationships between the patient and their primary care provider, and the changing health priorities of the patient. Recommendations for process enhancement included more frequent and flexible facilitator contacts, selection of patients for participation based on specific patient characteristics, clarification of process aims and expectations, involvement of family, written reminders of established health priorities, short duration between facilitation and primary care provider follow-up, and the inclusion of health-related tasks in facilitation visits. CONCLUSIONS:Patients found the PHPI process valuable in identifying actionable health priorities and healthcare goals leading to enhanced knowledge, activation, and communication regarding their treatment options and preferences. PHPI may be useful for aligning the healthcare that patients receive with their values-based priorities.

RATIONALE & OBJECTIVE:Pneumococcal vaccine is recommended for adults 65 years and older and those younger than 65 years with clinical indications (eg, diabetes, lung/heart disease, kidney failure, and nephrotic syndrome). Its cost-effectiveness in less severe chronic kidney disease (CKD) is uncharacterized. STUDY DESIGN:Cost-effectiveness analysis. SETTING & POPULATION:) or nephrotic-range albuminuria (urinary albumin-creatinine ratio≥2,000mg/g). Data sources were the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004, Centers for Disease Control and Prevention, and the Atherosclerosis Risk in Communities (ARIC) Study. INTERVENTION(S):Vaccination compared to no vaccination. OUTCOMES:Incremental cost-effectiveness ratios based on US dollars per quality-adjusted life-year (QALY). MODEL, PERSPECTIVE, & TIMEFRAME:Markov model, US health sector perspective, and lifetime horizon. RESULTS:The prevalence of pneumococcal vaccination in NHANES 1999 to 2004 was 56.6% (aged 65-79 years), 28.5% (aged 50-64 years with an indication), and 9.7% (aged 50-64 years without an indication), with similar prevalences across CKD risk status. Pneumococcal vaccination was overall cost-effective (<US $100,000/QALY) for adults aged 65 to 79 years (US $15,000/QALY) and 50 to 64 years (US $38,000/QALY). Among those aged 50 to 64 years, incremental cost-effectiveness ratios were lowest for kidney failure or nephrotic-range albuminuria (US $1,000/QALY), followed by CKD with high risk (US $17,000/QALY), CKD with moderate risk (US $25,000/QALY), and no CKD (US $43,000/QALY). Pneumococcal vaccination was cost-effective among adults aged 50 to 64 years with CKD even when assuming the lowest vaccine efficacy or 50% higher vaccine costs. LIMITATIONS:Some model parameters were based on data from the general population. Analysis did not consider costs associated with kidney disease progression. CONCLUSIONS:Uptake of pneumococcal vaccination should be improved in general. Our results also suggest the cost-effectiveness of expanding its indication to younger adults with CKD less severe than kidney failure or nephrotic syndrome.

BACKGROUND:) are linked to poor fetal outcomes but their relationship with childhood development is unclear. OBJECTIVES/OBJECTIVE:increase the risk of early developmental delays. STUDY DESIGN/METHODS:Prospective cohort. SETTINGS/METHODS:New York State excluding New York City. PARTICIPANTS/METHODS:4089 singletons and 1016 twins born between 2008 and 2010. EXPOSURES/UNASSIGNED:estimated by the Environmental Protection Agency Downscaler models were spatiotemporally linked to each child's prenatal and early-life addresses incorporating residential history, and locations of maternal work and day-care. OUTCOMES/RESULTS:, and for those living <1000 m away from a major roadway compared to those living further. Models adjusted for potential confounders. RESULTS:exposures. CONCLUSIONS:were associated with developmental delays. While awaiting larger studies with personal air pollution assessment, efforts to minimize air pollution exposures during critical developmental windows may be warranted.

Low perception of HIV risk is a challenge to PrEP implementation. We analyzed associations between perceptions of PrEP candidacy, behavioral indications for PrEP, and sexual behaviors. We recruited a sample of 580 MSM from a geosocial-networking smartphone application in Paris, France. A modified Poisson regression model was conducted to examine associations between perceived candidacy for PrEP and behavioral indications for PrEP, and relationships among engagement in group sex, transactional sex, HIV test history, and indications for PrEP. Adjusted risk ratios (aRR) and 95% confidence intervals (CIs) were calculated. For the outcome of perceived candidacy for PrEP, a multinomial logistic regression was performed, and adjusted relative risk ratios (aRRR) were calculated. Multivariate analyses were adjusted for socio-demographics. Respondents who considered themselves PrEP candidates were more likely to meet PrEP eligibility criteria compared to those who did not consider themselves candidates (aRR 1.65; 95% CI 1.34-2.03). Those who had engaged in group or transactional sex were more likely to have behavioral indications for PrEP (aRR 1.27; 95% CI 1.07-1.50, aRR 1.32; 95% CI 1.13-1.56, respectively), whereas HIV test history was not significantly associated with behavioral indications for PrEP. Respondents who had engaged in group sex or transactional sex were more likely to perceive themselves as candidates for PrEP (aRRR 2.24; 95% CI 1.21-4.16, aRRR 2.58; 95% CI 1.09-6.13, respectively), although those never tested for HIV were less likely to perceive themselves as candidates for PrEP (aRRR 0.18; 95% CI 0.03-0.91). The elucidation of candidacy perceptions and risk behaviors is key to furthering the effective implementation of PrEP engagement interventions.

Background Transgender and gender non-binary people have unique sexual health needs and rates of HIV and other sexually transmissible infections that outstrip the general population. Very little is known, however, about their experiences of sexual health care, including how those experiences might affect sexual health screening practices. Methods Using data collected via a national survey of transgender and non-binary people in Australia (n=1,636), responses to four items on sexual health care experiences were summed to create a scale from 0 (gender-sensitive) to 4 (gender-insensitive). Bivariate and multivariate analyses compared scale scores and assessed associations with sexual health screening. Results In total, 50% of trans and non-binary participants were uncomfortable disclosing their gender during sexual health care, 68% reported that intake paperwork did not allow accurate gender descriptions, 74% felt staff made assumptions about their bodies or sex lives, and 40% did not receive sexual health care that was sensitive to their needs. On average, non-binary participants experienced the greatest degree of gender-insensitivity (M=2.3) compared with transgender men (M=1.8) and women (M=1.6, p<0.001). Gender insensitivity was most common in hospitals (M=2.9) followed by general practice clinics (M=2.1) and least common in sexual health clinics (M=1.6) and community-lead sexual health services (M=1.3, p<0.001). Among sexually active participants, 51% had received a sexual health screen in the previous year. After controlling for confounders (age, education, income, monogamy, condom use), transgender and non-binary people with more gender-insensitive experiences of sexual health care were less likely to report a recent sexual health screen (adjusted odds ratio=1.3, 95% confidence interval:1.1- 1.5, p<0.001). Conclusion Transgender and, in particular, non-binary people experience gender insensitivity when receiving sexual health care, most notably in hospital settings. This insensitivity is associated with delaying sexual health screens among the sexually active. Educating health providers on gender sensitive sexual health care could improve screening uptake