Faculty Bibliography

INTRODUCTION/BACKGROUND:The opioid epidemic in the U.S. continues to increase in severity, and misuse of prescription opioids is of particular concern since it commonly precedes heroin use. This study examined whether sexual orientation (i.e., sexual identity and sexual attraction) is a risk factor for prescription opioid misuse and use disorder among a nationally representative sample of adults in the U.S. METHODS:This study used data from adult participants (ages ≥18 years) in the 2015 National Survey on Drug Use and Health. Chi-square tests and logistic regression examined how sexual identity and sexual attraction relate to past-year and past-month prescription opioid misuse and past-year prescription opioid use disorder. Multivariable models examined associations controlling for demographic characteristics and other drug use. Gender-stratified analyses were also conducted. Data were analyzed in 2018. RESULTS:In multivariable analyses, compared with those identifying as heterosexual, bisexual individuals were at 1.53 (95% CI=1.20, 1.97) and 1.66 (95% CI=1.14, 2.42) higher odds of reporting past-year and past-month misuse, respectively. In stratified analyses, female bisexuals remained at high risk. Regarding sexual attraction, compared with being attracted to only the opposite sex, being attracted to mostly the opposite sex (AOR=2.15, 95% CI=1.77, 2.63) or being equally attracted to both sexes (AOR=1.78, 95% CI=1.38, 2.30) were associated with higher odds for past-year opioid misuse. In stratified analyses, these associations were limited to females. CONCLUSIONS:Sexual orientation disparities in opioid misuse and use disorder among a nationally representative sample of U.S. adults was found.

Novel synthetic opioids include various analogs of fentanyl and emerging non-fentanyl compounds with different chemical structures, such as AH-7921, MT-45 and U-47700. In recent years, these drugs have rapidly emerged on the drug market, and their abuse has been increasing worldwide. The motivations for use of these new compounds include their legal status, ready availability, low cost, users' curiosity or preference for their particular pharmacological properties and the intention to avoid detection. Furthermore, more common drugs like heroin are now increasingly being replaced or cut with fentanyl or new designer opioids; thus, many drug users are unintentionally or unknowingly using synthetic fentanyl analogs. In this scenario, the detection of new psychoactive substances in hair can provide insight into their current diffusion among the population and social characteristics of these synthetic drug users. In this manuscript, we describe a simple, fast, specific and sensitive UHPLC-MS-MS method able to detect 13 synthetic opioids (including fentanyl analogs) and metabolites in hair samples. Furthermore, the method includes the detection of 4-anilino-N-phenethyl-piperidine (4-ANPP), which is considered both a precursor and a metabolite of several fentanyl analogs. The method was applied to 34 real hair samples collected in New York City from subjects who had reported past-year non-medical opioid and/or heroin use. In total, 17 samples tested positive for at least one target analyte, with oxycodone (nine samples) and tramadol (eight samples) being the most common. Among these, the method was able to quantify furanyl-fentanyl and fentanyl in the pg/mg range in two samples. Simultaneously, also 4-ANPP was detected, giving evidence for the first time that this compound can be selected as a marker of fentanyl analogs use via hair testing. In conclusion, this study confirmed the increasing diffusion of new synthetic opioids and "fentalogs" with high potency among non-medical opioid users.

BACKGROUND:Pediatric professionals promote shared reading to facilitate school readiness yet relatively few studies examine how parents from underserved communities consider this issue in their daily lives. We sought to understand shared reading within the broader context of parenting among Latino parents. METHODS:We conducted in-depth interviews, purposively sampling Spanish-speaking, Latina mothers of children age ≤ 3 years from an urban Federally Qualified Health Center. Interviews were recorded, transcribed, and analyzed iteratively. We allowed themes to emerge from data rather than impose an a priori framework. We sought disconfirming evidence within interviews and collected additional data to ensure no new themes were identified (saturation). RESULTS:We achieved saturation after 12 interviews. The median child age was 1.4 years. We identified 4 major themes: (1) All participants reported engaging in literacy promoting activities such as conversations, storytelling, play, and singing even if they did not read to their children daily. (2) Parents' attitudes regarding early learning and development influenced the extent to which parents engaged in shared reading with their child. (3) Participants described feelings that they ought to read daily with their children but were not and cited a variety of barriers. (4) Parents who engaged in frequent shared reading described it as a joyful and relaxed experience; parents who did not engage in shared reading described reading as instructing children or engaging in drills (e.g. teaching letters). CONCLUSION/CONCLUSIONS:Urban, Latina mothers who did not read regularly with their children nonetheless recognized its importance suggesting that existing programs have raised awareness even among underserved families. Refinement of messaging may be needed to move past raising awareness to facilitating shared reading for some parents.

BACKGROUND:Blood eosinophils are used to determine eligibility for agents targeting IL-5 in patients with uncontrolled asthma. However, little is known about the variability of blood eosinophil measures in these patients before treatment initiation. OBJECTIVE:To characterize variability and patterns of variability of blood eosinophil levels in a real-world clinic for severe asthmatics. METHODS:Retrospective review of blood eosinophils measured over a 5-year period in patients enrolled in an urban clinic. Repeated measures of blood eosinophil levels in individuals were evaluated and cluster analysis was performed to characterize patients by eosinophil patterns. Clinical characteristics associated with eosinophil levels and patterns of variability were analyzed. RESULTS:Patients treated in the Bellevue Hospital Asthma Clinic within a 3-month period were identified (n = 219). Blood eosinophil measures were obtained over the previous 5 years. Only 6% (n= 13) of patients had levels that were consistently above 300 cells/μL. Nearly 50% (n = 104) had eosinophil levels that traversed the threshold of 300 cells/μL. In contrast, 102 (46%) had levels that never reached the threshold of 300 cells/μL. Cluster analyses revealed three clusters with differing patterns of levels and variability. There was a suggestion of decreased clinical control and increased atopy in the cluster with the greatest variability in blood eosinophil measures. CONCLUSION/CONCLUSIONS:In an urban clinic for patients referred for uncontrolled asthma, blood measures of eosinophils were variable and showed differing patterns of variability. These data reinforce the need to perform repeated eosinophil blood measures for appropriate designation for therapeutic intervention.

Context/UNASSIGNED:Early prediction of dysglycaemia is crucial to prevent progression to type 2 diabetes. The one-hour post-load plasma glucose (1-h PG) has been reported a better predictor of dysglycaemia than fasting plasma glucose (FPG), 2-h PG, or glycated haemoglobin (HbA1c). Objective/UNASSIGNED:To evaluate the predictive performance of clinical markers, metabolites, HbA1c, and plasma glucose (PG) and serum insulin (INS) levels during a 75-gram oral glucose tolerance test (OGTT). Design and Setting/UNASSIGNED:We measured PG and INS levels at 0, 30, 60, and 120 minutes during an OGTT in 543 individuals in the Botnia Prospective Study, 146 of whom progressed to type 2 diabetes within a 10-year follow-up period. Using combinations of variables, we evaluated 1527 predictive models for progression to type 2 diabetes. Results/UNASSIGNED:The 1-h PG outperformed every individual marker except 30-min PG or mannose, whose predictive performances were lower but not significantly worse. HbA1c performed inferior to 1-h PG according to DeLong test p-value but not false discovery rate. Combining the metabolic markers with PG measurements and HbA1c significantly improved the predictive models, and mannose was found to be a robust metabolic marker. Conclusions/UNASSIGNED:The 1-h PG, alone or in combination with metabolic markers, is a robust predictor for determining the future risk of type 2 diabetes outperforms the 2-h PG, and is cheaper to measure than metabolites. Metabolites add to the predictive value of PG and HbA1c measurements. Shortening the standard 75-gram OGTT to one hour improves its predictive value as well as clinical usability.

Air pollution poses a great environmental risk to health. Outdoor fine particulate matter (PM_2.5) exposure is the fifth leading risk factor for death in the world, accounting for 4.2 million deaths and more than a hundred million disability-adjusted-life-years lost according to the Global Burden of Disease Report. The World Health Organization attributes 3.8 million additional deaths to Indoor air pollution. Air pollution can harm acutely, usually manifested by respiratory or cardiac symptoms, as well as chronically, potentially affecting every organ in the body. It can cause, complicate, or exacerbate many adverse health conditions. Tissue damage may result directly from pollutant toxicity, because fine and ultrafine particles can gain access to organs, or indirectly through systemic inflammatory processes. Susceptibility is partly under genetic and epigenetic regulation. Although air pollution affects people of all regions, ages, and social groups, it is likely to cause greater illness in those with heavy exposure and greater susceptibility. Persons are more vulnerable to air pollution if they have other illnesses or less social support. Harmful effects occur on a continuum of dosage and even at levels below air quality standards previously considered to be safe.

Relatively little research has addressed whether conceptual frameworks of early learning generalize across different national contexts. This article reports on a cross-country measurement invariance analysis of the International Development and Early Learning Assessment (IDELA). The IDELA is a direct assessment tool for 3- to 6-year-old children, intended to measure Early Literacy, Early Numeracy, Motor, and Social-Emotional development. Its generalizability is evaluated using samples from 5 countries: Afghanistan (N = 2,629); Bolivia (N = 480); Ethiopia (N = 682); Uganda (N = 504); and Vietnam (N = 675). The 4-domain model of the IDELA was supported in each country, although the domains were highly correlated. Measurement invariance analysis revealed that most IDELA items do not provide a basis for comparing children's development over the 5 countries. This research supports the use of the IDELA for program evaluation and within-country monitoring purposes, but cautions against its use for international comparisons. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

In this study, we examined the nonkin support networks of orphaned adolescents participating in a family-based economic-strengthening intervention in HIV-impacted communities in Uganda. We analyzed data from a cluster randomized experimental study for orphaned adolescents aged 11-17 years. Participants were randomly assigned to either the control condition, which received bolstered standard of care (BSOC) services, or the treatment condition, which received BSOC services plus an economic-strengthening intervention. We conducted binary logistic regression analyses to examine the effect of the intervention on participants' nonkin support networks. Results indicated that the existing social support networks for orphaned adolescents are small, limited, and usually comprised individuals with similar socioeconomic situations and challenges. Because orphaned adolescents are socially isolated and the threshold for nonkin supportive services is very low, the BSOC services provided to the control condition appeared to be instrumental in their survival and well-being. Availability of personal savings was associated with higher odds of identifying at least one supportive nonkin tie. The extended family system is still the primary and major source of social support to orphaned children in HIV-affected communities. In the absence of public safety nets, building social assets, over and above offering economic opportunities to extended families supporting orphaned children, is critical.

BACKGROUND:Breast reconstruction can help restore the shape and appearance of breasts after surgery. Studies have shown that minority and uninsured patients are less likely to receive breast reconstruction after mastectomy. OBJECTIVE:We sought to determine if post-mastectomy reconstruction varied by patient ethnicity and insurance status in a medically underserved population. METHODS:This was a retrospective study of mastectomy patients seen at Bellevue Hospital Center, a safety-net hospital in New York City, between January 2010 and December 2015. The Chi square test was used to compare patient characteristics versus type of reconstruction chosen and likelihood of reconstruction. Logistic regression was used to examine likelihood of reconstruction, controlling for patient insurance status, race, age, stage at presentation, and contralateral prophylactic mastectomy. RESULTS:Of the 750 patients included in the database, 220 underwent mastectomy. Overall, 73.6% of our patient population received breast reconstruction. Patients with Medicare insurance were less likely to get reconstruction compared with patients with other types of insurance (37.5%, p = 0.04). Hispanic patients were most likely to receive reconstruction (89.1%), followed by Black patients (80%) and Asian patients (66.7%) [p = 0.03]. There were no significant associations between patient race or stage at presentation and type of reconstruction. In a multivariate logistic regression, advancing age was associated with a decreased likelihood of reconstruction (adjusted odds ratio 0.91, p < 0.001). CONCLUSIONS:In our underserved patient population, patients received breast reconstruction at rates higher than the national average. Institutional availability of patient navigators and preoperative counseling may contribute to more equal access to breast reconstruction.