Faculty Bibliography

The purpose of this research was to examine whether the local food environment, specifically the distance to the nearest sugar sweetened beverage (SSB) vendor, a measure of SSB availability and accessibility, was correlated with the likelihood of self-reported SSB consumption among a sample of fast food consumers. As part of a broader SSB behavior study in 2013-2014, respondents were surveyed outside of major chain fast food restaurants in New York City (NYC). Respondents were asked for the intersection closest to their home and how frequently they consume SSBs. Comprehensive, administrative food outlet databases were used to geo-locate the SSB vendor closest to the respondents' home intersections. We then used a logistic regression model to estimate the association between the distance to the nearest SSB vendor (overall and by type) and the likelihood of daily SSB consumption. Our results show that proximity to the nearest SSB vendor was not statistically significantly associated with the likelihood of daily SSB consumption, regardless of type of vendor. Our results are robust to alternative model specifications, including replacing the linear minimum distance measure with count of the total number of SSB vendors or presence of a SSB vendor within a buffer around respondents' home intersections. We conclude that there is not a strong relationship between proximity to nearest SSB vendor, or proximity to a specific type of SSB vendor, and frequency of self-reported SSB consumption among fast food consumers in NYC. This suggests that policymakers focus on alternative strategies to curtail SSB consumption, such as improving the within-store food environment or taxing SSBs.

OBJECTIVE:To examine predictors for understanding reason for hospitalization. METHODS:This was a retrospective analysis of a prospective, observational cohort study of patients 65 years or older admitted for acute coronary syndrome, heart failure, or pneumonia and discharged home. Primary outcome was complete understanding of diagnosis, based on post-discharge patient interview. Predictors assessed were the following: jargon on discharge instructions, type of medical team, whether outpatient provider knew if the patient was admitted, and whether the patient reported more than one day notice before discharge. RESULTS:Among 377 patients, 59.8% of patients completely understood their diagnosis. Bivariate analyses demonstrated that outpatient provider being aware of admission and having more than a day notice prior to discharge were not associated with patient understanding diagnosis. Presence of jargon was not associated with increased likelihood of understanding in a multivariable analysis. Patients on housestaff and cardiology teams were more likely to understand diagnosis compared to non-teaching teams (OR 2.45, 95% CI 1.30-4.61, p<0.01 and OR 3.83, 95% CI 1.92-7.63, p<0.01, respectively). CONCLUSIONS:Non-teaching team patients were less likely to understand their diagnosis. Further investigation of how provider-patient interaction differs among teams may aid in development of tools to improve hospital to community transitions.

BACKGROUND:Clinical performance measures, such as for cholesterol control targets, have played an integral role in assessing the value of care and translating evidence into clinical practice. New guidelines often require development of corresponding performance metrics and systems changes that can be especially challenging in safety-net health care institutions. Understanding how public health care institutions respond to changing practice guidelines may be critical to informing how we adopt evolving evidence in clinical settings that care for the most vulnerable populations. METHODS:We conducted six focus groups with representatives of California's 21 public hospital systems to examine their reactions to the recent 2013 cholesterol treatment guideline. RESULTS:Participants reported a sense of confusion and lack of direction in implementing the new guideline. They cited organizational and data infrastructural inadequacies that made implementation of the new guidelines impractical in their clinical settings. CONCLUSION/CONCLUSIONS:Adopting new performance measures to align with evolving cholesterol guidelines is a complex process that may work at odds with existing quality improvement priorities. Current efforts to translate evidence into practice may rely too much on performance measures and not enough on building capacity or support for innovative efforts to meet the goals of guidelines.

Introduction Supporting patients' decision making about clinical trials may enhance trial participation. To date, few theory-based interventions have been tested to address this issue. Objectives In this study, we aimed to evaluate the effect of a multimedia psychoeducation (MP) intervention, relative to print education (PE), on patients' decision support needs and attitudes about clinical trials. Methods Patients with cancer who were eligible for participation in an National Cancer Institute (NCI) therapeutic cancer clinical trial were recruited through the nationwide University of Rochester Cancer Center (URCC) NCI Community Oncology Research Program (NCORP) from 2014- 2016 and randomized to the MP or PE intervention. Assessments at baseline (before intervention), post-intervention, and at a two-month follow- up included patients' decision support needs, attitudes regarding clinical trials, and clinical trial participation. Results We recruited 418 cancer patients (ages 26-89, various cancer types). Relative to the PE condition, the MP condition did not significantly affect decision support needs. However, patients in the MP condition reported significantly more positive attitudes about clinical trials and were more likely to participate in a clinical trial than those in the PE condition (69% vs. 62%, p=0.01). Furthermore, improvement in attitudes about clinical trials significantly mediated the effect of the intervention on participation in clinical trials. Conclusions The MP intervention was able to improve patient attitudes toward clinical trials when compared with PE, and this improvement led to increased rates of participation in trials. The MP intervention could be disseminated to improve attitudes about clinical trials among cancer patients

BACKGROUND:Globally adolescents continue to have an upward trend in HIV incidence and AIDS-related mortality. The interplay between the rapid physical growth, sexual maturation, and enormous albeit slow-evolving cognitive and psychological changes in adolescence may partly explain this trend. Our main purpose was to highlight key psychosocial characteristics of HIV-infected adolescents and explore if these characteristics are associated with depression symptoms. METHODS:From August to December 2016 after obtaining informed consent, adolescents living with HIV at Kenyatta National Hospital were interviewed using the Home environment, Education and Employment, Activity, Sexuality, Suicide and depression traits (HEADSS) tool combined with the Patient Health Questionnaire (PHQ-9) to elucidate which key symptoms of depression and link with psychosocial characteristics mapped on HEADSS. In order to determine which psychosocial characteristics were linked with risk of depression, the traits of adolescents who were symptomatic were compared to those who were not using univariate and multivariate regression analysis. RESULTS: = 0.06]. CONCLUSION/CONCLUSIONS:One in two of the adolescents interviewed had depression symptoms which were significantly associated with lack of school fees, missing meals, non-adherence to medication, and substance abuse.

Task-shifting to non-physician health workers (NPHWs) has been an effective model for managing infectious diseases and improving maternal and child health. There is inadequate evidence to show the effectiveness of NPHWs to manage cardiovascular diseases (CVDs). In 2012, the Global Alliance for Chronic Diseases funded eight studies which focused on task-shifting to NPHWs for the management of hypertension. We report the lessons learnt from the field. From each of the studies, we obtained information on the types of tasks shifted, the professional level from which the task was shifted, the training provided and the challenges faced. Additionally, we collected more granular data on 'lessons learnt ' throughout the implementation process and 'design to implementation' changes that emerged in each project. The tasks shifted to NPHWs included screening of individuals, referral to physicians for diagnosis and management, patient education for lifestyle improvement, follow-up and reminders for medication adherence and appointments. In four studies, tasks were shifted from physicians to NPHWs and in four studies tasks were shared between two different levels of NPHWs. Training programmes ranged between 3 and 7 days with regular refresher training. Two studies used clinical decision support tools and mobile health components. Challenges faced included system level barriers such as inability to prescribe medicines, varying skill sets of NPHWs, high workload and staff turnover. With the acute shortage of the health workforce in low-income and middle-income countries (LMICs), achieving better health outcomes for the prevention and control of CVD is a major challenge. Task-shifting or sharing provides a practical model for the management of CVD in LMICs.

In this study, factor analysis and mass regression were used to identify four fine particulate matter sources and estimate their contributions to the ambient air pollution in Beijing. The identified sources were traffic re-suspended soil, mixed industrial sources, oil combustion, and secondary sulfate. The estimated source contributions were then introduced into two models as exposure variables to explore the relationships between cardiovascular responses in mice and PM exposures. We observed that PM2.5 has a small negative acute effect on heart rate, but the individual source factors showed much more significant effects. Traffic re-suspended soil had the most significant effect on heart rate, with a positive contribution on the day of exposure and a negative one on day lag 1. Acute heart rate variability outcomes were better explained by the total PM2.5 than by the source components. Chronic effects were observed as a decreased heart rate but an increased number of heart rate variability outcomes

Thyroid hormones are crucial in normal brain development. Transient and mild thyroid hormone insufficiency in pregnancy is also associated with impaired neurodevelopment in the offspring (e.g., 3-4 IQ score loss in association with maternal free thyroxine in the lowest fifth percentile). While inadequate iodine intake remains the most common underlying cause of mild thyroid hormone insufficiency in vulnerable populations including pregnant women, other factors such as exposure to environmental contaminants have recently attracted increasing attention, in particular in interaction with iodine deficiency. Endocrine-disrupting chemicals (EDCs) are natural and synthetic substances with ubiquitous exposure in children and adults including pregnant women. EDCs interfere, temporarily or permanently, with hormonal signaling pathways in the endocrine system by binding to hormone receptors and modifying gene expression. Other mechanisms involve alterations in production, metabolism, and transfer of hormones. Experimental studies have shown that exposures to EDCs affect various brain processes such as neurogenesis, neural differentiation and migration, as well as neural connectivity. Neuroimaging studies confirm brain morphological abnormalities (e.g., cortical thinning) consistent with neurodevelopmental impairments as a result of EDC exposures at standard use levels. In this review, we provide an overview of present findings from toxicological and human studies on the anti-thyroid effect of EDCs with a specific attention to fetal and early childhood exposure. This brief overview highlights the need for additional multidisciplinary studies with a focus on thyroid disruption as an underlying mechanism for developmental neurotoxicity of EDC, which can provide insight into modifiable risk factors of developmental delays in children.