Faculty Bibliography

Growing evidence suggests that environmental exposures can influence blood pressure over the course of a lifetime. Exposure to toxic metals, such as lead (Pb) and arsenic (As), has been associated with increased blood pressure in adults, but few studies have examined the impacts of in utero and early life toxic metals exposure on blood pressure in childhood. As subclinical vascular changes are thought to begin early in life, it is possible that in utero toxic metals exposure may play a role in blood pressure homeostasis. In the ongoing New Hampshire Birth Cohort Study, we investigated whether in utero exposure to Pb and As was associated with measures of blood pressure in a total of 323 young children (mean age 5.5 years, SD 0.4). Pb and As were measured in maternal toenail samples collected at ~28 weeks gestation (n = 257) and/or 6 weeks postpartum (n = 285), which represent exposures ~6 to 12 months prior to collection and therefore reflect the early prenatal and late prenatal exposures, respectively. Five measurements of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were averaged for each child using a standardized technique. In linear regression analyses, where log₂-transformed prenatal toenail Pb and As were modeled jointly and adjusted for child age, sex, height, weight and maternal smoking during pregnancy, we observed that a doubling of maternal prenatal toenail Pb was associated with statistically significant increases in child SBP (β: 0.58 mm Hg, 95% CI: 0.05, 1.11). We did not observe any association of prenatal or postpartum As, or postpartum Pb, with SBP or DBP. Exploratory sex-stratified analyses suggest that associations of prenatal Pb with BP may be stronger among boys (SBP β: 0.72 mm Hg: 95% CI: -0.01, 1.44; DBP β: 0.37; 95% CI: -0.09, 0.84), compared to girls (SBP β: 0.48 mm Hg: 95% CI: -0.31, 1.26; DBP β: -0.05; 95% CI: -0.52, 0.41), though tests for interaction did not reach statistical significance (p-interaction SBP = 0.059; DBP = 0.057). Our preliminary results suggest that in utero toxic metals exposures may be associated with early life increases in blood pressure in children, which could have consequences for long-term health.

Objective: To validate prior findings of retrospective studies that endometriosis presents with left-sided predominance. Design: Retrospective cohort study. Settings: A single university medical center. Patients: Patients undergoing robot-assisted gynecologic procedures from December 2013 to January 2018. Based on distribution of endometriotic specimens submitted to pathology, patients were divided into three groups: left-predominant, right-predominant, and bilateral/midline. [Figure presented] Interventions: Robot-assisted laparoscopic treatment of endometriosis. Measurements/Results: The three study groups did not differ in median in age, body mass index (BMI), gravidity, parity, and type of prior endometriosis treatment. Distribution of endometriosis was significantly more likely to exhibit left predominance than right-predominant or bilateral distribution (median number of total specimens: 6 vs. 3 vs. 3, p < .05). Endometriotic lesions were significantly located in the left periureteral and uterosacral regions compared to right-predominant and bilateral distribution (median number of total specimens: 1 vs. 0 vs. 0, p < .05 and 1 vs. 0 vs. 0, p = .05, respectively). There was no significant difference in distribution of endometriomas (median number of total endometriomas: 1 vs. 1 vs. 2, left vs. right vs. bilateral, respectively, p = .34). Operative times were not significantly different between groups (60 vs. 84 vs. 90 minutes, left-predominant vs. right-predominant vs. bilateral/midline distribution, respectively, p = .20). Overall complication rates were low with a total of 5 patients requiring intraoperative consults to other surgical teams including general surgery, gynecology oncology, and urology. Four total reoperations were performed in non-urgent fashion due to recurrence of endometriosis. Conclusions: This study reaffirms prior findings that endometriosis often demonstrates a left-predominant distribution. Surgical time, which may function as a surrogate for disease severity, was not significantly different between groups, though may be underpowered. Further investigation will focus on the clinical significance of endometriosis distribution, such as complication rates, intraoperative consults, and disease recurrence.

Background/UNASSIGNED:The retinal microcirculation has been studied in various diseases including multiple sclerosis (MS). However, inter-eye correlations and potential differences of the retinal blood flow velocity (BFV) remain largely unstudied but may be important in guiding eye selection as well as the design and interpretation of studies assessing or utilizing retinal BFV. The primary aim of this study was to determine inter-eye correlations in BFVs in healthy controls (HCs). Since prior studies raise the possibility of reduced BFV in MS eyes, a secondary aim was to compare retinal BFVs between MS eyes, grouped based on optic neuritis (ON) history and HC eyes. Methods/UNASSIGNED:Macular arteriole and venule BFVs were determined using a retinal function imager (RFI) in both eyes of 20 HCs. One eye from a total of 38 MS patients comprising 13 eyes with ON (MSON) and 25 eyes without ON (MSNON) history were similarly imaged with RFI. Results/UNASSIGNED: = 0.48, respectively). Conclusions/UNASSIGNED:Inter-eye arteriolar and venular BFVs do not differ significantly in HCs and are strongly correlated. Our findings support prior observations that arteriolar and venular BFVs may be reduced in MS eyes. Moreover, this seems to be the case in both MS eyes with and without a history of ON, raising the possibility of global blood flow alterations in MS. Future larger studies are needed to assess differences in BFVs between MSON and MSNON eyes.

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

BACKGROUND:Local food environments include food stores (eg, supermarkets, grocery stores, bakeries) and restaurants. However, the extent to which other storefront businesses offer food/drink is not well described, nor is the extent to which food/drink availability through a full range of storefront businesses might change over time. OBJECTIVES/OBJECTIVE:This study aimed to assess food/drink availability from a full range of storefront businesses and the change over time and to consider implications for food-environment research. DESIGN/METHODS:Investigators compared direct observations from 2010 and 2015. PARTICIPANTS/SETTING/METHODS:Included were all storefront businesses offering foods/drinks on 153 street segments in the Bronx, NY. MAIN OUTCOME MEASURES/METHODS:The main outcome was change between 2010 and 2015 as determined by matches between businesses. Matches could be strict (businesses with the same name on the same street segment in both years) or lenient (similar businesses on the same street segment in both years). Investigators categorized businesses as general grocers, specialty food stores, restaurants, or other storefront businesses (eg, barber shops/beauty salons, clothing outlets, hardware stores, laundromats, and newsstands). STATISTICAL ANALYSES PERFORMED/METHODS:Investigators quantified change, specifically calculating how often businesses in 2015 were present in 2010 and vice versa. RESULTS:Strict matches for businesses in 2015 present in 2010 ranged from 29% to 52%, depending on business category; lenient matches ranged from 43% to 72%. Strict matches for businesses in 2010 present in 2015 ranged from 34% to 63%; lenient matches ranged from 72% to 83%. In 2015 compared with 2010, on 22% more of the sampled street segments, 30% more businesses were offering food/drink: 66 vs 46 general grocers, 22 vs 19 specialty food stores, 99 vs 99 restaurants, 98 vs 56 other storefront businesses. CONCLUSIONS:Over 5 years, an urban food environment changed substantially, even by lenient standards, particularly among "other storefront businesses" and in the direction of markedly greater food availability (more businesses offering food on more streets). Failure to consider a full range of food/drink sources and change in food/drink sources could result in erroneous food-environment conclusions.

Objective: To investigate the effects of decreasing insufflation pressure during robotic-assisted gynecologic surgery on intraoperative and postoperative parameters. The primary outcomes were patient-reported postoperative pain scores and length of stay in the post-anesthesia care unit (PACU). Secondary outcomes included intraoperative respiratory parameters, duration of surgery, total anesthesia time, and postoperative pain medication use. Design: Retrospective cohort study. Settings: Single academic urban hospital. Patients: Female patients undergoing robot-assisted surgery for benign gynecologic conditions performed by a single surgeon from 2014 to 2018. Interventions: Exposure to surgery performed at four different insufflation pressures: 15 mmHg (n = 99), 12 mmHg (n = 100), 10 mmHg (n = 99), and 8 mmHg (n = 300). Measurements/Results: 598 patients were identified. P values for continuous variables were determined using analysis of variance. Two-sided chi² test was used for categorical variables. When comparing the four groups, each decrease in insufflation pressure correlated with a significant decrease in initial pain scores (5.9 vs 5.4 vs 4.4 vs 3.8, p = < 0.0001), anesthesia time (p = .007), and length of stay in the PACU (449 vs 467 vs 351 vs 317 minutes, p = < 0.0001). There was no difference in duration of surgery (p = .31) or estimated blood loss (p = .09). Throughout the surgery, lower operating pressure was correlated with significantly lower peak inspiratory pressures (p < .0001) and tidal volumes (p < .0001), but a higher end tidal CO2 (p < .0001). Conclusions: Robot-assisted gynecologic surgery is associated with improved intraoperative and postoperative clinical outcomes with each decrease in insufflation pressure. Significant improvements include faster postoperative recovery times, decreased immediate postoperative pain, and improved intraoperative respiratory parameters without increasing duration of surgery or blood loss. [Figure presented] [Figure presented] [Figure presented]

Adults with medical multimorbidity (≥2 chronic conditions) present challenges for health care systems to provide coordinated care. Substance use can complicate the management of chronic medical conditions, but little research has focused on the intersection of medical multimorbidity and substance use. This study uses cross-sectional analysis of 115,335 adult respondents of the 2012-2014 administrations of the National Survey on Drug Use and Health to estimate the prevalence and correlates of past-year drug use among adults with multimorbidity. The prevalence of past-year drug use was compared between individuals reporting 0, 1, and ≥2 chronic medical conditions. We used multivariable logistic regression to determine correlates of past-year drug use among adults with ≥2 chronic medical conditions. 53.1% reported no chronic conditions, 29.5% reported one chronic condition, and 17.4% reported ≥2 chronic conditions. Past-year drug use was reported by 18.3% of those with no chronic conditions, 14.8% with 1 chronic condition, and 11.6% with ≥2 chronic conditions. Cannabis and opioid analgesics (nonmedical use) were the most common drugs used across all three groups. In the adjusted model, among adults with medical multimorbidity, adults with past-year drug use were more likely to be younger, male, have lower income, and report current tobacco use, alcohol dependence, past-year depression, and having received mental health treatment in the past year. In this national cohort, fewer adults with multimorbidity reported substance use compared to adults with no or one chronic condition, however, this population with high multimorbidity may be particularly vulnerable to the negative effects of drug use.

BACKGROUND:Despite decreasing rates of HIV among many populations, HIV-related health disparities among gay, bisexual and other men who have sex with men persist, with disproportional percentages of new HIV diagnoses among racial and ethnic minority men. Despite increasing awareness of HIV pre-exposure prophylaxis (PrEP), PrEP use remains low. In addition to exploring individual-level factors for this slow uptake, structural drivers of PrEP use must also be identified in order to maximize the effectiveness of biomedical HIV prevention strategies. METHOD/METHODS:Using cross-sectional data from an ongoing cohort study of young sexual minority men (N=492), we examine the extent to which structural-level barriers, including access to health care, medication logistics, counseling support, and stigma are related to PrEP use. RESULTS:While almost all participants indicated awareness of PrEP, only 14% had ever used PrEP. PrEP use was associated with lower concerns about health care access, particularly paying for PrEP. Those with greater concerns talking with their provider about their sexual behaviors were less likely to use PrEP. CONCLUSION/CONCLUSIONS:Paying for PrEP and talking to one's provider about sexual behaviors are concerns for young sexual minority men. In particular, stigma from healthcare providers poses a significant barrier to PrEP use in this population. Providers need not only to increase their own awareness of and advocacy for PrEP as an effective risk-management strategy for HIV prevention, but also must work to create open and non-judgmental spaces in which patients can discuss sexual behaviors without the fear of stigma.