Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Population Health
Total Results:
12150
Twitter Activity Associated with US News and World Report Reputation Scores for Urology Departments
OBJECTIVE: To analyze the association between US urology department Twitter presence and U.S. News and World Report (USNWR) reputation scores, to examine the content, informational value, and intended audience of these platforms, and to identify objectives for Twitter use. METHODS: We identified Twitter accounts for the top 50 ranked hospitals for urology in the 2016-2017 USNWR. Correlation coefficients were calculated between Twitter metrics (number of followers, following, tweets, and Klout influence scores) with USNWR reputation scores. We also performed a detailed content analysis of urology department tweets during a 6 month period to characterize the content. Finally, we distributed a survey to the urology department accounts via Twitter inquiring who administers the content and their objectives for Twitter use. RESULTS: Among 42 scored urology departments with Twitter accounts, the median number of followers, following, and tweets were 337, 193 and 115, respectively. All of these Twitter metrics had a statistically significant positive correlation with reputation scores (p<0.05). Content analyses revealed that most tweets were about conferences, education, and publications, targeting the general public or urological community. Survey results revealed that the primary reason for twitter use among urology departments was visibility/reputation, and urologists are considered the most important target audience. CONCLUSIONS: There is statistically significant correlation between Twitter activity and USNWR reputation scores for urology departments. Our results suggest that Twitter provides a novel mechanism for urology departments to communicate about academic and educational topics, and social media engagement can enhance reputation.
PMID: 28669746
ISSN: 1527-9995
CID: 2657532
Kidney Disease Measures and Left Ventricular Structure and Function: The Atherosclerosis Risk in Communities Study
BACKGROUND:Heart failure is one of the most important complications of chronic kidney disease (CKD). However, few studies comprehensively investigated left ventricular (LV) structure and function in relation to 2 key CKD measures, estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR). METHODS AND RESULTS/RESULTS:=0.010]). Dichotomizing echo parameters with clinical thresholds, the stronger relationships of ACR over eGFR were further evident. CONCLUSIONS:LV mass was related to both CKD measures, whereas LV size and function were robustly associated with albuminuria. These results have implications for pathophysiological processes behind cardiorenal syndrome and targeted cardiac assessment in patients with CKD.
PMCID:5634280
PMID: 28939714
ISSN: 2047-9980
CID: 5584692
Could EBT Machines Increase Fruit and Vegetable Purchases at New York City Green Carts?
INTRODUCTION: Residents of some low-income neighborhoods have limited access to fresh fruits and vegetables. In 2008, New York City issued new mobile fruit and vegetable cart licenses for neighborhoods with inadequate availability of fresh produce. Some of these carts were equipped with electronic benefit transfer (EBT) machines, allowing them to accept Supplemental Nutrition Assistance Program (SNAP) benefits. This article examines the association between type and quantities of fruits and vegetables purchased from mobile fruit and vegetable vendors and consumer characteristics, including payment method. METHODS: Customers at 4 produce carts in the Bronx, New York, were surveyed during 3 periods in 2013 and 2014. Survey data, including purchased fruit and vegetable quantities, were analyzed using multivariable negative binomial regressions, with payment method (cash only vs EBT or EBT and cash) as the primary independent variable. Covariates included availability of EBT, vendor, and customer sociodemographic characteristics. RESULTS: A total of 779 adults participated in this study. Shoppers who used SNAP benefits purchased an average of 5.4 more cup equivalents of fruits and vegetables than did shoppers who paid with cash. Approximately 80% of this difference was due to higher quantities of purchased fruits. CONCLUSION: Expanding access to EBT machines at mobile produce carts may increase purchases of fruits and vegetables from these vendors.
PMCID:5609498
PMID: 28934080
ISSN: 1545-1151
CID: 2707932
Clinical Reasoning: A 50-year-old woman with SLE and a tumefactive lesion
PMID: 28923891
ISSN: 1526-632x
CID: 2708112
Smoking Behaviors Among Adolescents in Foster Care: A Gender-Based Analysis
BACKGROUND AND OBJECTIVES: Adolescents in foster care are at high risk for cigarette smoking. However, it is not clear how their smoking behaviors vary by gender. The present study examined lifetime and current smoking among males and females, and explored gender-specific risk factors for engagement in smoking behaviors. METHOD: Data from the Multi Site Evaluation of Foster Youth Programs was used to evaluate patterns of smoking among adolescents aged 12-18 years (N = 1121; 489 males, 632 females). RESULTS: Males and females did not differ significantly in rates of lifetime and current smoking, or in the age of smoking initiation and number of cigarettes smoked on a typical day. Gender-based analyses revealed that older age and placement in group homes or residential treatment facilities were associated with heightened risk of smoking among males. In contrast, sexual minority status (i.e., nonheterosexual orientation) and increased childhood victimization were associated with heightened risk of smoking among females. A history of running away was linked to smoking in both genders. CONCLUSION: Gender should be considered when designing intervention programs to address cigarette smoking among foster youth, as the stressors associated with smoking may differ for males and females.
PMCID:6109448
PMID: 28467231
ISSN: 1532-2491
CID: 2546552
International journal of behavioral nutrition & physical activity. 2017:14(1).DOI: 10.1186/s12966-017-0585-9
Financial incentives and purchase restrictions in a food benefit program affect the types of foods and beverages purchased: results from a randomized trial
BACKGROUND:This research evaluated the effects of financial incentives and purchase restrictions on food purchasing in a food benefit program for low income people. METHODS:Participants (n=279) were randomized to groups: 1) Incentive- 30% financial incentive for fruits and vegetables purchased with food benefits; 2) Restriction- no purchase of sugar-sweetened beverages, sweet baked goods, or candies with food benefits; 3) Incentive plus Restriction; or 4) Control- no incentive or restrictions. Participants received a study-specific debit card where funds were added monthly for 12-weeks. Food purchase receipts were collected over 16 weeks. Total dollars spent on grocery purchases and by targeted food categories were computed from receipts. Group differences were examined using general linear models. RESULTS:Weekly purchases of fruit significantly increased in the Incentive plus Restriction ($4.8) compared to the Restriction ($1.7) and Control ($2.1) groups (p <.01). Sugar-sweetened beverage purchases significantly decreased in the Incentive plus Restriction (-$0.8 per week) and Restriction ($-1.4 per week) groups compared to the Control group (+$1.5; p< .0001). Sweet baked goods purchases significantly decreased in the Restriction (-$0.70 per week) compared to the Control group (+$0.82 per week; p < .01). CONCLUSIONS:Paired financial incentives and restrictions on foods and beverages purchased with food program funds may support more healthful food purchases compared to no incentives or restrictions. CLINICAL TRIAL REGISTRATION:Clinicaltrials.gov Identifier: NCT02643576 .
PMCID:5602848
PMID: 28915844
ISSN: 1479-5868
CID: 3830302
Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings The highest globally observed HALE at birth for both women and men was in Singapore, at 75.2 years (95% uncertainty interval 71.9-78.6) for females and 72.0 years (68.8-75.1) for males. The lowest for females was in the Central African Republic (45.6 years [42.0-49.5]) and for males was in Lesotho (41.5 years [39.0-44.0]). From 1990 to 2016, global HALE increased by an average of 6.24 years (5.97-6.48) for both sexes combined. Global HALE increased by 6.04 years (5.74-6.27) for males and 6.49 years (6.08-6.77) for females, whereas HALE at age 65 years increased by 1.78 years (1.61-1.93) for males and 1.96 years (1.69-2.13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2.3% [-5.9 to 0.9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16.1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. This is an Open Access article under the CC BY 4.0 license.
ISI:000410630000005
ISSN: 1474-547x
CID: 2719102
Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
BACKGROUND:The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. METHODS:We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. FINDINGS/RESULTS:Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. INTERPRETATION/CONCLUSIONS:Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. FUNDING/BACKGROUND:The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
PMID: 28919119
ISSN: 1474-547x
CID: 5642122
Trends in the Relationship of Obesity and Disability, 1988-2012
Rising obesity rates coupled with population aging have elicited serious concern over the impact of obesity on disability in later life. Prior work showed a significant increase in the association between obesity and disability from 1988-2004, calling attention to disability as the cost of longer lifetime exposures to obesity. It is not known whether this trend has continued. We examined functional impairment and activities of daily living (ADL) impairment (defined as severe and moderate to severe) for adults aged 60 and older (n = 16,770) over 3 periods in the National Health and Nutrition Examination Surveys. The relative odds of impairment for obese vs. normal weight individuals significantly increased from period 1 (1988-1994) to period 2 (1999-2004) for all outcomes. In period 3 (2005-2012), this association remained stable for functional and severe ADL impairment, and decreased for moderate to severe ADL impairment. The fraction of population disability attributable to obesity followed a similar trend. The trend of an increasing association between obesity and disability has leveled off in more recent years, and is even improving for some measures. These findings suggest that public health and policy concerns that obesity would continue to get more disabling over time have not been borne out.
PMID: 28486588
ISSN: 1476-6256
CID: 2612322
Scientific Challenges in the Risk Assessment of Food Contact Materials
BACKGROUND: Food contact articles (FCAs) are manufactured from food contact materials (FCMs) that include plastics, paper, metal, glass, and printing inks. Chemicals can migrate from FCAs into food during storage, processing, and transportation. Food contact materials' safety is evaluated using chemical risk assessment (RA). Several challenges to the RA of FCAs exist. OBJECTIVES: We review regulatory requirements for RA of FCMs in the United States and Europe, identify gaps in RA, and highlight opportunities for improving the protection of public health. We intend to initiate a discussion in the wider scientific community to enhance the safety of food contact articles. DISCUSSION: Based on our evaluation of the evidence, we conclude that current regulations are insufficient for addressing chemical exposures from FCAs. RA currently focuses on monomers and additives used in the manufacture of products, but it does not cover all substances formed in the production processes. Several factors hamper effective RA for many FCMs, including a lack of information on chemical identity, inadequate assessment of hazardous properties, and missing exposure data. Companies make decisions about the safety of some food contact chemicals (FCCs) without review by public authorities. Some chemical migration limits cannot be enforced because analytical standards are unavailable. CONCLUSION: We think that exposures to hazardous substances migrating from FCAs require more attention. We recommend a) limiting the number and types of chemicals authorized for manufacture and b) developing novel approaches for assessing the safety of chemicals in FCAs, including unidentified chemicals that form during or after production. https://doi.org/10.1289/EHP644.
PMCID:5915200
PMID: 28893723
ISSN: 1552-9924
CID: 2701562
