Faculty Bibliography

BACKGROUND AND OBJECTIVE: Effective communication with primary care physicians is important yet incompletely understood for Spanish-speaking parents. We predicted lower satisfaction among Spanish-speaking compared to English-speaking Latino and non-Latino parents. METHODS: Cross-sectional analysis at 2-month well visits within the Greenlight study at 4 pediatric resident clinics. Parents reported satisfaction with 14 physician communication items using the validated Communication Assessment Tool (CAT). High satisfaction was defined as "excellent" on each CAT item. Mean estimations compared satisfaction for communication items among Spanish- and English-speaking Latinos and non-Latinos. We used generalized linear regression modeling, adjusted for parent age, education, income, and clinic site. Among Spanish-speaking parents, we compared visits conducted in Spanish with and without an interpreter, and in English. RESULTS: Compared to English-speaking Latino (n = 127) and non-Latino parents (n = 432), fewer Spanish-speaking parents (n = 303) reported satisfaction with 14 communication items. No significant differences were found between English-speaking Latinos and non-Latinos. Greatest differences were found in the use of a greeting that made the parent comfortable (59.4% of Spanish-speaking Latinos endorsing "excellent" vs 77.5% English-speaking Latinos, P < .01) and discussing follow-up (62.5% of Spanish-speaking Latinos vs 79.8% English-speaking Latinos, P < .01). After adjusting for parent age, education, income, and study site, Spanish-speaking Latinos were still less likely to report high satisfaction with these communication items. Satisfaction was not different among Spanish-speaking parents when the physician spoke Spanish versus used an interpreter. CONCLUSIONS: Satisfaction with physician communication was associated with language but not ethnicity. Spanish-speaking parents less frequently report satisfaction with communication, and innovative solutions to enhance communication quality are needed.

BACKGROUND: There is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST. METHODS: Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses. RESULTS: The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications. CONCLUSIONS: The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months.

Background: Asian Americans are one of the fastest growing minority populations in the United States. With increases in the older adult population too, there needs to be research dedicated to their health. Past studies have shown that social isolation and loneliness predict greater physical, mental, and cognitive decline. This literature review was conducted to address this emerging need to understand the scope of research focused on social isolation and Asian American older adults. Methods: The PRISMA guidelines were used to guide this review. Four interdisciplinary databases searched were: PubMed, CINAHL, PsychINFO, and AgeLine. Search terms included variations on the words social isolation, loneliness, Asian Americans, and older adults. The date of the last search was July 6th, 2016. Articles were reviewed based on 5 eligibility criteria: (1) topic relevance, (2) study participants > 60 years of age, (3) Asian immigrants as main participants, (4) conducted in a Western country, and (5) published in the English language. The remaining studies were assessed on eight categories: ethnic group, health topic, geographic location, subject population, recruitment site, study design, outcomes accessed, and outcomes measures. Results: The search yielded 203 articles from the four databases. 49 articles were removed as duplicates. The 154 remaining studies were reviewed based on their abstract and 34 met the eligibility criteria and underwent full text review. Existing research has focused primarily on immigrant Chinese and Korean older adult populations located in major gateway cities (ex: Los Angeles, New York City). Studies were largely observational studies that were conducted using small community-based samples which makes generalizability difficult. There were zero interventional studies. Conclusions: There are critical gaps in the literature on social isolation in Asian immigrant populations. Future studies should prioritize health promotion intervention research and focus on diverse understudied Asian subgroups (e.g. South Asians, Cambodians, Filipinos). Potential pitfalls of this literature review include: accessing only four major databases, limiting searches to after 1995, and studies were conducted throughout countries with different healthcare systems

The number of new HIV infections continues to be on the rise in many high-income countries, most notably among men who have sex with men (MSM). Despite recent attention to the use of antiretroviral medications as pre-exposure prophylaxis (PrEP) among MSM, considerably less research has been devoted to examining the awareness and use of post-exposure prophylaxis (PEP). Based on a convenience sample of 179 self-reported HIV-uninfected MSM using a geosocial-networking smartphone application, this study is among the first to examine the awareness and use of PEP and their demographic and behavioral correlates among MSM in London. Most respondents (88.3%) had heard of PEP, where 27.4% reported having used it. In multivariable models, the disclosure of one's sexual orientation to their general practitioner (Prevalence ratio [PR]: 3.49; 95% confidence interval (CI): 1.14, 10.70; p = .029) and reporting one's HIV status as negative (rather than unknown) (PR: 11.49; 95% CI: 1.68, 76.92; p = .013) were associated with having heard of PEP; while the recent use of club drugs (PR: 3.02; 95% CI: 1.42, 6.43; p = .004) was associated with having ever used PEP. High awareness and use in this sample suggest that PEP is a valuable risk-reduction strategy that should be capitalized on, be it in addition to or in the absence of PrEP.

Serodiscussion-the mutual discussion of HIV statuses between sexual partners-can be viewed as an essential prerequisite for risk-reduction behaviors among men who have sex with men (MSM). The current study aimed to assess the prevalence of serodiscussion with one's most recent sexual partner and its association with sexual behaviors with these partners. Broadcast advertisements were placed on a geosocial-networking smartphone application, encouraging users to complete an online survey. A total of 200 MSM completed the survey. Serodiscussion occurred in 43.5% of dyads, and it was most common in dyads where both partners were reported to be HIV positive, chi2(5) = 60.3, P < .001. Serodiscussion was associated with engagement in both condomless insertive, chi2(1) = 3.847, P = .046, and receptive anal intercourse, chi2(1) = 6.5, P = .011. However, there were no significant differences in how recently a respondent was tested for HIV, representing potentially high-risk scenarios.

In a longitudinal population-based study of 2,905 children, we investigated if infants' neuromotor development was associated with autistic traits in childhood. Overall motor development and muscle tone were examined by trained research assistants with an adapted version of Touwen's Neurodevelopmental Examination between ages 2 and 5 months. Tone was assessed in several positions and items were scored as normal, low, or high tone. Parents rated their children's autistic traits with the Social Responsiveness Scale (SRS) and the Pervasive Developmental Problems (PDP) subscale of the Child Behavior Checklist at 6 years. We defined clinical PDP if scores were >98th percentile of the norm population. Diagnosis of autism spectrum disorder (ASD) was clinically confirmed in 30 children. We observed a modest association between overall neuromotor development in infants and autistic traits. Low muscle tone in infancy predicted autistic traits measured by SRS (adjusted beta = 0.05, 95% CI for B: 0.00-0.02, P = 0.01), and PDP (adjusted beta = 0.08, 95% CI for B: 0.04-0.10, P < 0.001). Similar results emerged for the association of low muscle tone and clinical PDP (adjusted OR = 1.36, 95% CI: 1.08-1.72, P = 0.01) at age 6 years. Results remained unchanged if adjusted for child intelligence. There was no association between high muscle tone and SRS or PDP. Exclusion of children with ASD diagnosis did not change the association. This large study showed a prospective association of infant muscle tone with autistic traits in childhood. Our findings suggest that early detection of low muscle tone might be a gateway to improve early diagnosis of ASD. Autism Res 2017. (c) 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Background: The National Committee for Quality Assurance (NCQA) developed the Healthcare Effectiveness Data and Information Set (HEDIS) performance measures to evaluate health plan performance against benchmarks or other plans. The Center for Medicare and Medicaid Services (CMS) requires insurance plans to submit HEDIS data to qualify as a Medicare Advantage Plan (MAP) or a MAP that includes Medicare Part D (MAPD). Our MAPD selected and tested HEDIS and other 5-Star measures comparing the quality of care for MAPD members who did and did not use a Geriatric Assessment Center (GAC) serving MAPD members within a markedly impoverished region in the western US. Members visit the GAC typically once per year. Methods: We selected eight measures reflecting preventive care, chronic disease management, and continuity of care (See Table). Within one Medical Group, we compared the performance of these measures for Plan Members having attended the GAC in 2014 with Plan members who did not but had at least one primary care provider (PCP) visit. We used exact match procedures to identify a comparison group based on age, gender, Low-Income Subsidy Level, Risk Adjustment Factor and Special Needs Plan. Results: We identified 258 members who used the GAC in 2014 and 258 as the matched control group (See Table). Preventive care but not chronic disease management performance measures were significantly better for members who used the GAC. GAC users had better care continuity performance (measured by readmission rates) but this was not statistically significant. Conclusions: The GAC is well suited to achieving high quality preventive care due to the ease of completion in one visit. Chronic disease management care continuity is likely better suited to a repeated visit care structure. (Table Presented)

BACKGROUND: The statistical association between increased exposure to air pollution and increased risk of morbidity and mortality is well established. However, documentation of the health benefits of lowering air pollution levels, which would support the biological plausibility of those past statistical associations, are not as well developed. A better understanding of the aftereffects of interventions to reduce air pollution is needed in order to: 1) better document the benefits of lowered air pollution; and, 2) identify the types of reductions that most effectively provide health benefits. METHODS: This study analyzes daily health and pollution data from three major cities in Israel that have undergone pollution control interventions to reduce sulfur emissions from combustion sources. In this work, the hypothesis tested is that transitions to cleaner fuels are accompanied by a decreased risk of daily cardiovascular and respiratory mortalities. Interrupted time series regression models are applied in order to test whether the cleaner air interventions are associated with a statistically significant reduction in mortality. RESULTS: In the multi-city meta-analysis we found statistically significant reductions of 13.3% [CI -21.9%, -3.8%] in cardiovascular mortality, and a borderline significant (p=0.06) reduction of 19.0% [CI -35.1%, 1.1%] in total mortality. CONCLUSIONS: Overall, new experiential evidence is provided consistent with human health benefits being associated with interventions to reduce air pollution. The methods employed also provide an approach that may be applied elsewhere in the future to better document and optimize the health benefits of clean air interventions.

RATIONALE: Development of cervical squamous carcinoma (CXCA) is accompanied by changes in estrogen receptors (ERs, ERalpha and ERbeta) and ezrin expression; however, reports have been conflicting. Using histologically documented staging of cervical biopsies, we determined ezrin and ER relationships during CXCA development. METHODS: Immunoreactive (ir) ezrin, ir-ERalpha, and ir-ERbeta were studied in normal epithelium, carcinoma in situ/cervical intraepithelial neoplasia (CIN) 1 to 3, and local invasion or metastatic CXCA. Results were compared using H scoring. Cultures of Caski metastatic CXCA cells were treated with estradiol and/or tamoxifen and studied for ER-driven ir-ezrin and the morphologic response. RESULTS: Koilocytosis was present and indicated viral presence. The ezrin H score increased from CIN1 to CIN3, reaching significant differences from normal by CIN3 (P = .004) and 2x normal in metastatic CXCA. Estrogen receptor alpha and ERbeta H scores fell, reaching significance by CIN3 (ERalpha, P = .0001; ERbeta, P = .024). During estradiol treatment, ezrin in Caski cells increased and localized to the periphery, in ruffles and processes. The selective ER modulator tamoxifen blocked the estradiol-induced changes. CONCLUSIONS: During cervical carcinogenesis, the usual relationship between estrogen and ezrin induction is abridged. This is consistent with the effects of human papilloma virus viral proteins such as E6 and E7 that upregulate SIX1, a protein that induces ezrin. Cervical carcinogenesis is progressive but arrests at the preinvasive stage for varying lengths of time. These studies suggest that changes in ezrin may be associated with the development of the invasive phenotype and penetration of the basement membrane. They also raise the possibility that inhibiting ezrin expression could be a target for the prevention of invasive CXCA.

BACKGROUND: In 2012 The Joint Commission implemented new Tobacco Treatment (TOB) performance measures for hospitals. A study evaluated the impact of a hospital-based electronic health record (EHR) intervention on adherence to the revised TOB measures. METHODS: The study was conducted in two acute care hospitals in New York City. Data abstracted from the EHR were analyzed retrospectively from 4,871 smokers discharged between December 2012 and March 2015 to evaluate the impact of two interventions: an order set to prompt clinicians to prescribe pharmacotherapy and a nurse-delivered counseling module that automatically populated the nursing care plan for all smokers. The study estimated the relative odds of a patient being prescribed medication and/or receiving smoking cessation counseling in the intervention period compared to the baseline time period. RESULTS: There was a modest increase in medication orders (odds ratio [OR], 1.35). In contrast, rates of counseling increased 10-fold (OR, 10.54). Patients admitted through surgery were less likely to receive both counseling and medication compared with the medicine service. CONCLUSION: Hospitalization presents an important opportunity to engage smokers in treatment for primary and secondary prevention of tobacco-related illnesses. EHRs can be leveraged to facilitate integration of TOB measure requirements into routine inpatient care; however, the smaller effect on prescribing patterns suggests limitations in this approach alone in changing clinician behavior to meet this measure. The success of the nurse-focused EHR-driven intervention suggests an effective tool for integrating the cessation counseling component of the new measures and the importance of nursing's role in achieving the Joint Commission measure targets.