Faculty Bibliography

The current study examines the longitudinal patterns of both cigarette smoking and depressive symptoms as predictors of generalized anxiety disorder (GAD) using data from the Harlem Longitudinal Development Study. There were 674 African American (53%) and Puerto Rican (47%) participants. Among the 674 participants, 60% were females. In the logistic regression analyses, the indicator variables of membership in each of the joint trajectories of cigarette smoking and depressive symptoms from the mid 20s to the mid 30s were used as the independent variables, and the diagnosis of GAD in the mid 30s was used as the dependent variable. The high cigarette smoking with high depressive symptoms group and the low cigarette smoking with high depressive symptoms group were associated with an increased likelihood of having GAD as compared to the no cigarette smoking with low depressive symptoms group. The findings shed light on the prevention and treatment of GAD.

Objective: With the growing use of robotic surgery, there is an increased occurrence of port-site hernias requiring operative intervention. Currently there is limited literature, and prior studies have failed to find surgical or patient-related risk factors. We sought to identify patient and surgical risk factors, evaluate clinical presentation, and report management of this postoperative complication at a high-volume multispecialty robotic surgical center. Method: All robotic surgeries performed at a single institution from September 1, 2010, to September 1, 2015, were included. Univariate analysis was used to compare patient demographics and medical conditions for those who did and did not develop port-site hernias. Results: A total of 4,858 robotic surgeries were completed during the study period. A total of 37 (0.7%) port-site hernias requiring operative intervention were identified following urologic (23/1,888, 1.2%), gynecologic (13/2,661, 0.5%), and general surgery (1/309, 0.3%) procedures. Hernias occurred at the umbilical (n = 23) and 8-mm lateral port sites (n = 14). Only umbilical ports were closed under direct visualization. Median time from surgery to hernia diagnosis was 201 days (range 2-975). Presentation included bulge symptoms (n = 29) and nausea/vomiting (n = 6). The herniated contents included bowel/omentum (n =19), fat (n =14), or empty sac (n = 4). All cases were managed surgically, 21 with laparoscopy and 16 with laparotomy, with presentation within 30 days necessitating urgent surgery (n = 6). A total of 7/37 patients had complications from reoperation (bowel resection, n = 3; abscess formation, n=2; blood transfusion, n = 1). There was no difference between patients who did and did not develop a port-site hernia with regards to age, gender, BMI, smoking status, hypertension, diabetes, rheumatologic disease, HIV, prior hernia, or cancer diagnosis. (See Table 1.) Conclusion: Port-site hernias necessitating operative intervention following robotic surgery are rare, occurring in 0.7% of patients in our cohort. We found no patient or surgical variable to be predictive of this complication. Hernias occurred at both the umbilical and lateral ports. Despite needing a second surgery, all patients recovered and did not suffer significant long-term morbidity

BACKGROUND: Technology-delivered interventions are useful tools for addressing unhealthy alcohol use. Smartphones in particular offer opportunities to deliver interventions at the user's convenience. We developed a smartphone application with 5 modules (personal feedback, self-monitoring of drinking, designated driver tool, blood alcohol content calculator, information). We assessed its acceptability and associations between use and drinking outcomes. METHODS: 130 adults with unhealthy alcohol use (>14 (men)/ >7 (women) drinks/week or > = 1 episode/month with 6 or more drinks) recruited in Switzerland (n = 70) and Canada (n = 60) were offered to use the application. Follow-up occurred after 3 months. We assessed appreciation, usefulness and self-reported frequency of use of the modules, and drinking outcomes (drinks/week, binge drinking). Associations between application use and drinking at 3 months were evaluated with negative binomial and logistic regression models, adjusted for baseline values and gender. RESULTS: 48% of participants were women, mean (SD) age: 32.8(10.0). Follow-up rate: 86.2%. There were changes from baseline (BL) to follow-up (FU) in number of drinks/week, BL: 15.0(16.5); FU: 10.9(10.5), p = 0.01, and binge drinking, BL: 95.4%; FU: 64.3%, p<0.0001. All modules had median ratings between 6 and 8 (scale of 1-10). 77% of participants used the application; 76% used the personal feedback module, 41% the self-monitoring of drinking, 22% the designated driver tool, 53% the BAC calculator, and 31% the information module. Participants using the application more than once reported significantly fewer drinks/week at follow up: IRR (number of drinks per week) 0.70 (0.51; 0.96). CONCLUSIONS: A smartphone application for unhealthy alcohol use appears acceptable and useful (although there is room for improvement). Without prompting, its use is infrequent. Those who used the application more than once reported less weekly drinking than those who did not. Efficacy of the application should be tested in a randomized trial with strategies to increase frequency of its use.

PURPOSE: Transgender youth are at high risk for mental health morbidities. Based on treatment guidelines, puberty blockers and gender-affirming hormone therapy should be considered to alleviate distress due to discordance between an individual's assigned sex and gender identity. The goals of this study were to examine the: (1) prevalence of mental health diagnoses, self-injurious behaviors, and school victimization and (2) rates of insurance coverage for hormone therapy, among a cohort of transgender adolescents at a large pediatric gender program, to understand access to recommended therapy. METHODS: An IRB-approved retrospective medical record review (2014-2016) was conducted of patients with ICD 9/10 codes for gender dysphoria referred to pediatric endocrinology within a large multidisciplinary gender program. Researchers extracted the following details: demographics, age, assigned sex, identified gender, insurance provider/coverage, mental health diagnoses, self-injurious behavior, and school victimization. RESULTS: Seventy-nine records (51 transgender males, 28 transgender females) met inclusion criteria (median age: 15 years, range: 9-18). Seventy-three subjects (92.4%) were diagnosed with one or more of the following conditions: depression, anxiety, post-traumatic stress disorder, eating disorders, autism spectrum disorder, and bipolar disorder. Fifty-nine (74.7%) reported suicidal ideation, 44 (55.7%) exhibited self-harm, and 24 (30.4%) had one or more suicide attempts. Forty-six (58.2%) subjects reported school victimization. Of the 27 patients prescribed gonadotropin-releasing hormone analogues, only 8 (29.6%) received insurance coverage. CONCLUSION: Transgender youth face significant barriers in accessing appropriate hormone therapy. Given the high rates of mental health concerns, self-injurious behavior, and school victimization among this vulnerable population, healthcare professionals must work alongside policy makers toward insurance coverage reform.

BACKGROUND: Excess body weight has been reported to be associated with excessive school absenteeism (ESA), but less is known about the association with perceived body weight. The study objective was to weigh the relative influence of perceived and measured weight status on school attendance. METHODS: We used the data from 3113 adolescents age 12-19 years who were interviewed as a part of the National Health and Nutrition Examination Surveys (NHANES), 2003-2008. Body weight and height were measured during the physical examination, while self-perceived body weight and the number of school days missed was assessed using questionnaires. Missing one or more days per school month (nine days per school year) was defined as, and indicative of, experiencing ESA. RESULTS: ESA was reported from 12.31 (SE=0.89) % of adolescents. The highest prevalence occurred among healthy weight adolescents who erroneously self-perceived as overweight [21.6 (4.77) %], two times higher than adolescents with obesity who self-perceived as "just right weight" [10.3 (2.87) %]. The adjusted prevalence ratio (PR) of ESA for healthy weight adolescents who erroneously self-perceived as "overweight" was 1.91 (95%CI=1.10-3.32) compared to healthy weight peers who correctly self-perceived as "just right" (reference group). The PRs were 0.99 (0.48-2.06) and 1.41 (0.86-2.32) respectively for adolescents with obesity who believed that their body weight was "just right" or "overweight". No significant differences were observed between boys and girls, young (12-15 years) and older adolescents (16-19 years). CONCLUSIONS: Perceived overweight rather than actual overweight is significantly associated ESA among adolescents.

Recent studies have examined sleep health among men who have sex with men (MSM), but no studies have examined associations of neighborhood characteristics and sleep health among this population. The purpose of this study was to examine associations between perceived neighborhood safety and sleep health among a sample of MSM in Paris, France. We placed broadcast advertisements on a popular smartphone application for MSM in October 2016 to recruit users in the Paris (France) metropolitan area (n = 580). Users were directed to complete a web-based survey, including previously used items measuring perceptions of neighborhood safety, validated measures of sleep health, and socio-demographics. Modified Poisson models were used to estimate risk ratios (RRs) and 95% confidence intervals (CI) for the associations between perceived neighborhood safety and the following outcomes: (1) poor sleep quality, (2) short sleep duration, and (3) self-reported sleep problems. Poor sleep health was common in our sample; e.g., 30.1% reported poor sleep quality and 44.7% reported problems falling asleep. In multivariate regression models, perceived neighborhood safety was associated with poor sleep quality, short sleep duration, and having sleep problems. For example, reporting living in a neighborhood perceived as unsafe during the daytime (vs. safe) was associated with poor sleep quality (aRR, 1.60; 95% CI, 1.01, 2.52), short sleep duration (aRR, 1.92; 95% CI, 1.26, 2.94), problems falling asleep (aRR, 1.57; 95% CI, 1.17, 2.11), and problems staying awake in the daytime (aRR, 2.16; 95% CI, 1.05, 4.43). Interventions to increase neighborhood safety may improve sleep health among MSM.

AIMS/HYPOTHESIS:Insulin resistance is frequently associated with hypertension and type 2 diabetes. The cytochrome P450 (CYP) arachidonic acid epoxygenases (CYP2C, CYP2J) and their epoxyeicosatrienoic acid (EET) products lower blood pressure and may also improve glucose homeostasis. However, the direct contribution of endogenous EET production on insulin sensitivity has not been previously investigated. In this study, we tested the hypothesis that endogenous CYP2C-derived EETs alter insulin sensitivity by analysing mice lacking CYP2C44, a major EET producing enzyme, and by testing the association of plasma EETs with insulin sensitivity in humans. METHODS:mice using hyperinsulinaemic-euglycaemic clamps and isolated skeletal muscle. Insulin secretory function was assessed using hyperglycaemic clamps and isolated islets. Vascular function was tested in isolated perfused mesenteric vessels. Insulin sensitivity and secretion were assessed in humans using frequently sampled intravenous glucose tolerance tests and plasma EETs were measured by mass spectrometry. RESULTS:vessels (maximal response 39.3 ± 6.5% of control, p < 0.001), suggesting that impaired vascular reactivity produces impaired insulin sensitivity in vivo. Similarly, plasma EETs positively correlated with insulin sensitivity in human participants. CONCLUSIONS/INTERPRETATION:CYP2C-derived EETs contribute to insulin sensitivity in mice and in humans. Interventions to increase circulating EETs in humans could provide a novel approach to improve insulin sensitivity and treat hypertension.