Searched for: school:SOM
Department/Unit:Population Health
Sexualised drug use among sexual minority young adults in the United States: The P18 cohort study
Ristuccia, Annie; LoSchiavo, Caleb; Halkitis, Perry N; Kapadia, Farzana
BACKGROUND:Substance use and condomless sexual behaviours are both well studied in sexual minority men, but few researchers have used event-level data collection to examine sexualised drug use in sexual and gender minority young adults. The aim of this study is to describe the co-occurrence of sex under the influence of substances and condomless sexual behaviours, using nuanced event-level data, in a racially/ethnically and socioeconomically diverse sample in New York City. METHODS:Data from one wave of a cohort of sexual and gender minority young adults who were assigned male at birth (n = 500) were used to characterise co-occurrence of sex under the influence of drugs and condomless sexual behaviours (oral receptive, anal insertive, and anal receptive sex), in the last 30 days. Logistic regression models were constructed to assess associations between sex while high and condomless sexual behaviours, controlling for sociodemographic factors. RESULTS:Preliminary analyses indicated significant associations between engaging in sex while high and condomless sexual behaviours. In unadjusted regression models, sexualised and non-sexualised drug use were both significantly associated with increased odds of condomless sexual behaviours. In adjusted models, sexualised drug use remained significantly associated with condomless anal insertive sex (AOR = 3.57) and condomless anal receptive sex (AOR = 4.98). Having multiple sexual partners was also significantly associated with greater odds of condomless sexual activity in all three adjusted models. CONCLUSION/CONCLUSIONS:Multivariable analyses indicated that engaging in sex while high on any drug was associated with increased condomless sexual behaviour, but that sexualised drug use was associated with particularly elevated condomless anal sex. These findings provide insight for understanding the co-occurrence of substance use and condomless sex, and suggest a need for HIV/STI risk reduction strategies that address the role of sexualised drug use.
PMCID:5970984
PMID: 29610012
ISSN: 1873-4758
CID: 3136022
Assessing Gaps in the HIV Care Continuum in Young Men Who Have Sex With Men: The P18 Cohort Study
Greene, Richard E; Luong, Albert; Barton, Staci C; Kapadia, Farzana; Halkitis, Perry N
PMCID:5911404
PMID: 29336955
ISSN: 1552-6917
CID: 3055402
Recruitment Techniques and Strategies in a Community-Based Colorectal Cancer Screening Study of Men and Women of African Ancestry
Davis, Stacy N; Govindaraju, Swapamthi; Jackson, Brittany; Williams, Kimberly R; Christy, Shannon M; Vadaparampil, Susan T; Quinn, Gwendolyn P; Shibata, David; Roetzheim, Richard; Meade, Cathy D; Gwede, Clement K
BACKGROUND:Recruiting ethnically diverse Black participants to an innovative, community-based research study to reduce colorectal cancer screening disparities requires multipronged recruitment techniques. OBJECTIVES/OBJECTIVE:This article describes active, passive, and snowball recruitment techniques, and challenges and lessons learned in recruiting a diverse sample of Black participants. METHODS:For each of the three recruitment techniques, data were collected on strategies, enrollment efficiency (participants enrolled/participants evaluated), and reasons for ineligibility. RESULTS:Five hundred sixty individuals were evaluated, and 330 individuals were enrolled. Active recruitment yielded the highest number of enrolled participants, followed by passive and snowball. Snowball recruitment was the most efficient technique, with enrollment efficiency of 72.4%, followed by passive (58.1%) and active (55.7%) techniques. There were significant differences in gender, education, country of origin, health insurance, and having a regular physician by recruitment technique (p < .05). DISCUSSION/CONCLUSIONS:Multipronged recruitment techniques should be employed to increase reach, diversity, and study participation rates among Blacks. Although each recruitment technique had a variable enrollment efficiency, the use of multipronged recruitment techniques can lead to successful enrollment of diverse Blacks into cancer prevention and control interventions.
PMCID:5925754
PMID: 29698327
ISSN: 1538-9847
CID: 3052822
Patients with active cancer in the emergency department: A multicenter study from the comprehensive oncologic emergencies research network [Meeting Abstract]
Caterino, J; Klotz, A; Venkat, A; Bastani, A; Baugh, C W; Coyne, C J; Reyes-Gibby, C; Grudzen, C; Henning, D J; Adler, D H; Wilson, J; Rico, J; Shapiro, N I; Pallin, D; Swor, R A; Yeung, S -C; Madsen, T; Ryan, R; Kyriacou, D; Bernstein, S L
Background: Increasing numbers of patients with cancer present to emergency departments (EDs), but there is little information on their ED care. Our objective was to describe the epidemiology of patients with active cancer presenting to US EDs. Methods: Prospective observational study using a convenience sample of ED patients >=18 years of age with active cancer presenting to 18 sites of the Comprehensive ONcologic Emergencies Research Network (CONCERN). ED patient surveys and 30-day chart reviews were completed. Descriptive statistics are reported. Results: We enrolled 1,075 patients (n per ED range 18-71). Mean age was 62 years with 52% female, 12% African American, 3.1% Asian, and 7.2% Hispanic. Common cancer types were gastrointestinal (20%); leukemia, myeloma and lymphoma (18%); lung (13%); and breast (11%). Seventy-two percent (n=773) had received cancer therapy within the prior 30 days including 495 (46%) chemotherapy,108 (10%) radiation, and 85 (7.9%) surgery. Emergency severity index scores included 0.9% Level 1, 40% Level 2, and 51% Level 3. Symptoms at presentation included nausea (32%), shortness of breath (35%), chest pain (16%), and abdominal pain (32%). ED nausea medicine was administered to 260 (25%), including half of those complaining of (160/326, 49%). Fifteen percent (n=152) had fever a%o38.0AdegreeC in the ED or within the prior 24 hours and 27% received ED antibiotics (n=285). Pain was present in 56% (n=604) and was moderate in 17% (n=186) and severe in 31% (n=338). Forty-eight percent (n=519) had pain medications in the ED including 35% with opioids (n=381). Only 35% (n=66) of those with moderate and 69% (n=232) of those with severe pain received opioids in the ED. Twenty five percent of all patients (n=274) had a final ED pain score in the moderate or severe range. Fifty-seven percent (n=615) were admitted (including 10% to stepdown or intensive care units), 6.6% (n=70) were placed in an ED observation unit, 1.9% (n=20) died in the ED, and 32% (n=342) were discharged. Thirty-day mortality was 5.8% (n=62) and 30- day ED revisit rate was 27% (n=286). Conclusion: ED patients with active cancer present with a substantial symptom burden and are frequently undertreated in the ED. This is a high acuity population with high rates of admission, revisit, and mortality. Further study to improve processes of care for this population is warranted
EMBASE:622358490
ISSN: 1553-2712
CID: 3152382
Sacubitril/valsartan initiation among renin-angiotensin aldosterone system inhibitor-naive heart failure patients with reduced ejection fraction [Meeting Abstract]
Mohanty, A F; Levitan, E B; Dodson, J A; He, T; Russo, P A; Bress, A P
Background/Introduction: The 2016 ESC Guideline on the Diagnosis and Treatment of Acute and Chronic Heart Failure endorsed sacubitril/valsartan (S/V) as class I-B treatment for heart failure with reduced ejection fraction(HFrEF) based on the PARADIGM-HF trial. Data on characteristics of S/V initiators and S/V adherence among renin-angiotensin aldosterone system inhibitor (RAASi)-nai ve patients treated in the community are limited. Purpose: Determine associated baseline patient and healthcare facility characteristics and medication adherence of S/V vs angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) in RAASi-naive HFrEF patients. Methods: Retrospective cohort study of U.S. Veterans Affairs (VA) data including HFrEF ( = 1 record of left ventricular ejection fraction (LVEF) = 40%) patients with = 1 in/outpatient visit for HF within 1-year pre-index (baseline period) treated with S/V, ACEI, or ARB from July 2015-June 2017. The index date was first S/V pharmacy fill and if none, first ACEI or ARB fill. RAASi-naive defined as no S/V, ACEI, or ARB fills during the baseline period. Poisson regression models with robust errors were used to compare baseline characteristics and 4-month medication adherence (i.e. follow-up fills, proportion of days covered [PDC], and discontinuation) for S/V vs ACEI or ARB. Medication adherence comparisons were adjusted for baseline characteristics using matching weights. Results: Among RAASi-naive HFrEF Veterans (N = 10,743),most (97.5%)weremale and 371 (3.5%) had an S/V pharmacy fill and 10,372 (96.5%) had an ACEI or ARB fill on the index date. Mean (standard deviation) baseline age, estimated glomerular filtration rate, and LVEF in S/V vs ACEI or ARB initiators were 73.6 (10.7) vs 70.3 (11.4) years, 61.3 (19.1) vs 66.4 (25.2) mL/min/1.73 m2, and 27.9% (8.3%) vs 34.4% (12.0%), respectively. History of ischemic cardiomyopathy was associated with S/V vs ACEI or ARB initiation. Veterans with lower systolic blood pressure, history of stroke, hypertension, myocardial infarction, or a visit with a Cardiologist on the index date were less likely to initiate S/V. In Veterans with a 30 day-supply index fill (N = 251 S/V and N = 3,101 ACEI or ARB) the adjusted risk ratio for 4-month PDC >80% was 0.78, 95% (confidence interval: 0.66-0.93) for S/V vs ACEI or ARB. Follow-up fills and discontinuation were similar for S/V vs ACEI or ARB. Adherence was similar for S/V vs ACEI or ARB among Veterans with a 90 day-supply. Conclusions: In a large, integrated healthcare system, 3.5% RAASi-naive HFrEF patients initiated S/V during the first 2-years post U.S. FDA approval. Overall, our findings suggest that S/V adherence is similar to ACEI or ARB in community-treated RAASi-naive HFrEF patients. The low numbers of S/V initiation may reflect a lag in formulary availability; S/V was added to the VA Formulary in October 2016. The reasons for lack of guideline-directed S/V initiation needs further elucidation
EMBASE:622650625
ISSN: 1879-0844
CID: 3179852
Child Health: Is It Really Assisted Reproductive Technology that We Need to Be Concerned About?
Yeung, Edwina H; Kim, Keewan; Purdue-Smithe, Alexandra; Bell, Griffith; Zolton, Jessica; Ghassabian, Akhgar; Vafai, Yassaman; Robinson, Sonia L; Mumford, Sunni L
Concerns remain about the health of children conceived by infertility treatment. Studies to date have predominantly not identified substantial long-term health effects after accounting for plurality, which is reassuring given the increasing numbers of children conceived by infertility treatment worldwide. However, as technological advances in treatment arise, ongoing studies remain critical for monitoring health effects. To study whether the techniques used in infertility treatment cause health differences, however, remains challenging due to identification of an appropriate comparison group, heterogeneous treatment, and confounding by the underlying causes of infertility. In fact, the factors that are associated with underlying infertility, including parental obesity and other specific male and female factors, may be important independent factors to consider. This review will summarize key methodological considerations in studying children conceived by infertility treatment including the evidence of associations between underlying infertility factors and child health.
PMID: 30866005
ISSN: 1526-4564
CID: 3733252
ACR Appropriateness Criteria® Staging and Follow-Up of Ovarian Cancer
Kang, Stella K; Reinhold, Caroline; Atri, Mostafa; Benson, Carol B; Bhosale, Priyadarshani R; Jhingran, Anuja; Lakhman, Yulia; Maturen, Katherine E; Nicola, Refky; Pandharipande, Pari V; Salazar, Gloria M; Shipp, Thomas D; Simpson, Lynn; Small, William; Sussman, Betsy L; Uyeda, Jennifer W; Wall, Darci J; Whitcomb, Bradford P; Zelop, Carolyn M; Glanc, Phyllis
In the management of epithelial ovarian cancers, imaging is used for cancer detection and staging, both before and after initial treatment. The decision of whether to pursue initial cytoreductive surgery for ovarian cancer depends in part on accurate staging. Contrast-enhanced CT of the abdomen and pelvis (and chest where indicated) is the current imaging modality of choice for the initial staging evaluation of ovarian cancer. Fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT and MRI may be appropriate for problem-solving purposes, particularly when lesions are present on CT but considered indeterminate. In patients who achieve remission, clinical suspicion for relapse after treatment prompts imaging evaluation for recurrence. Contrast-enhanced CT is the modality of choice to assess the extent of recurrent disease, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT is also usually appropriate, as small metastatic foci may be identified. If imaging or clinical examination confirms a recurrence, the extent of disease and timing of disease recurrence then determines the choice of treatments, including surgery, chemotherapy, and radiation therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
PMID: 29724422
ISSN: 1558-349x
CID: 3061712
Older adults with active cancer in the emergency department: A multicenter study of the comprehensive ONCologic emergencies research network [Meeting Abstract]
Caterino, J; Klotz, A; Venkat, A; Bastani, A; Baugh, C W; Coyne, C J; Reyes-Gibby, C; Grudzen, C; Henning, D J; Adler, D H; Wilson, J; Rico, J; Shapiro, N I; Pallin, D; Swor, R A; Bernstein, S L; Madsen, T; Ryan, R
Background: Older adults are increasingly presenting to US emergency departments but frequently have different patterns of presentation, ED care, and disposition than younger adults. Older adults have been understudied in the cancer population. Our objective was to identify differences in presentation and ED care in older adults with cancer. Methods: Prospective observational study in 18 EDs of the Comprehensive ONCologic Emergencies Research Network. We enrolled a convenience sample of ED patients with active cancer. Descriptive statistics including confidence intervals (CIs) and chi-square tests were calculated comparing older adults >=65 years of age with younger adults aged 18-64. Results: Of 1,075 enrolled patients, 503 (47%) were older adults including 313 (29%) aged 65-74 years, 152 (14%) 75-84 years, and 38 (3.5%) >=85 years. Older adults had similar ESI score distribution to younger adults (p=0.519). Older adults were more likely to be admitted with a 62% (95% CI 57-66) rate versus 54% younger adults (95% CI 50-58%)(p=0.010). There were similar ED observation unit placement rates, 6.8% in older and 6.4% in younger adults. Older adults were less likely to report moderate-to-severe pain, 42% (95% CI 38-47%) versus 55% (95% CI 51-59%)(p<0.001). They were less likely to receive narcotics in the ED (29%, 95% CI 25-33) versus 42% (95% CI 38-46%)(p<0.001). However, older adults with moderate to severe pain received narcotics at similar rates as young adults, 52% (95% CI 45-59%) versus 60% (95% CI 54-66%). Older adults were less likely to complain of nausea, but were treated at equal rates. Twentyeight percent of older adults complained of nausea and 57% of those were treated, whereas 34% of younger patients had nausea of whom 64% were treated. Rates of fever were equal between older and younger adults, 14% and 16%. Conclusion: Older adults with cancer have similar triage severity scores but are admitted at greater rates from the Ed than younger adults. They are less likely to complain of pain and nausea, but unlike in other ED populations, when these symptoms are present they receive treatment at similar rates as younger adults. Further work should explore distinct patterns of presentation and risk stratification for this subpopulation
EMBASE:622358464
ISSN: 1553-2712
CID: 3152392
Estimated Excess Morbidity and Mortality Associated with Air Pollution above ATS-Recommended Standards, 2013-2015. American Thoracic Society and Marron Institute Report
Cromar, Kevin R; Gladson, Laura A; Ghazipura, Marya; Ewart, Gary
PMID: 29425050
ISSN: 2325-6621
CID: 2948342
Response to Comment on Chan et al. FGF23 Concentration and APOL1 Genotype Are Novel Predictors of Mortality in African Americans With Type 2 Diabetes. Diabetes Care 2018;41:178-186 [Comment]
Divers, Jasmin; Freedman, Barry I
PMID: 29678870
ISSN: 1935-5548
CID: 4318722