Faculty Bibliography

OBJECTIVE:To assess perceived stress levels and to identify key stressors before and after planned oocyte cryopreservation. DESIGN/METHODS:Cross-sectional mixed methods study. SETTING/METHODS:Academic fertility center. SUBJECTS/METHODS:Patients who underwent their first planned oocyte cryopreservation cycle. MAIN OUTCOME MEASURES/METHODS:Comparison of composite Perceived Stress Scale-10 (PSS-10) scores before and after oocyte cryopreservation, and qualitative thematic analysis of interview transcripts. EXPOSURE/METHODS:Planned oocyte cryopreservation. RESULTS:Of the 471 pre-oocyte cryopreservation orientees contacted, 110 (23.4%) volunteered to participate and 81 (17.2%) were ultimately included in the study analysis after completing both the pre- and post-oocyte cryopreservation surveys; 20 participated in post-treatment interviews. The median composite PSS-10 score was 17 before and after oocyte cryopreservation, indicating moderate perceived stress that did not significantly change after cycle completion. Before oocyte cryopreservation, the most commonly reported stressors were procedural, occupational, and partner-related. Afterwards, procedural stressors largely shifted toward outcome-related concerns. Qualitative analysis identified six major themes influencing stress throughout treatment: financial considerations, medication management, physical and logistical demands, stress surrounding fertility, support systems, and a sense of empowerment coupled with future uncertainty. CONCLUSION/CONCLUSIONS:By integrating quantitative and qualitative findings, this study provides a nuanced understanding of how stress is shaped by financial, procedural, occupational, and emotional factors across the oocyte cryopreservation process. These insights may inform more tailored pre-cycle counseling, strengthen patient-centered support infrastructure, and guide the development of targeted interventions to improve the emotional and psychological well-being of planned oocyte cryopreservation patients.

PURPOSE/OBJECTIVE:Mobile health cardiac rehabilitation may improve access to care among older adults with ischemic heart disease, but engagement remains poorly understood. We analyzed weekly engagement data from the RESILIENT (Rehabilitation Using Mobile Health for Older Adults with Ischemic Heart Disease in the Home Setting) trial, a large, randomized trial of mobile health cardiac rehabilitation in older adults conducted in the United States. METHODS:Data from 298 intervention participants were analyzed. Weekly engagement was scored from 0 to 11 based on exercise entry (7 points), communication with exercise therapist (2 points), video viewing (1 point), and blood pressure measurement (1 point). Latent class analysis identified digital engagement phenotypes. Participant characteristics were compared, and multivariable logistic regression identified factors associated with phenotype membership. RESULTS:Median age was 71.0 years, 28% were women, 23% were non-White, and 62% were enrolled after elective percutaneous coronary intervention. Latent class analysis identified 3 phenotypes: persistently low (n = 81), intermediate declining (n = 93), and persistently high (n = 124). Participants with persistently low engagement were more likely to be non-White (48% vs 12% vs 15%, P < .001), Medicaid enrolled (22% vs 8% vs 7%, P = .001), have less than high school education (16% vs 4% vs 3%, P < .001), have frailty phenotype (28% vs 10% vs 7%, P < .001), and have a greater mean number of comorbidities (3.1 vs 3.0 vs 2.6; P = .012). After adjustment, non-White race and frailty remained independently associated with low engagement. Improvement in 6-minute walk test distance varied: 20.8 m (low), 29.7 m (intermediate), and 54.5 m (high) (P = .003). CONCLUSIONS:Three distinct digital engagement phenotypes emerged. Persistently low engagement was more common among non-White and frail participants, underscoring ongoing disparities despite efforts to overcome the digital divide.

BACKGROUND:There are limited studies on telehealth use patterns among patients with prostate cancer. OBJECTIVE:We assessed the patterns of delivery of care for prostate cancer management in the Veterans Health Administration (VHA). DESIGN/METHODS:A retrospective observational cohort study from January 2016 to February 2023. PARTICIPANTS/METHODS:Data were from the VHA's Corporate Data Warehouse (CDW). Veterans with a new diagnosis of prostate cancer were included in the study. Those who died within 1 year of diagnosis, had missing staging information, or had no prostate-specific antigen (PSA), biopsy, or treatment recorded within 2 years of initial diagnosis were excluded. MAIN MEASURES/METHODS:Veterans were categorized into watchful waiting, active surveillance, and active treatment management groups based on subsequent care received and categorized into National Comprehensive Cancer Network (NCCN) risk categories. We categorized outpatient urology or oncology visits as telephone-based, video-based, or in-person using administrative stop codes. We used logistic regression models to evaluate the characteristics associated with at least one video/virtual visit. KEY RESULTS/RESULTS:In total, 60,381 Veterans were included in the study (20.3% low risk, 49.8% intermediate risk, and 29.8% high risk). Even during the COVID-19 pandemic, less than 6% and 9% of Veterans had at least one urology or oncology video visit, respectively, in the first year after diagnosis across all management groups. In the regression model, Veterans aged 60 and older were less likely to have video visits for both urology and oncology. In contrast, living in urban areas, being diagnosed during the COVID-19 pandemic, and being in the intermediate NCCN risk group were associated with higher odds of having at least one video visit in both specialties. CONCLUSIONS:Despite improvements in telehealth use among Veterans with prostate cancer, telehealth utilization, particularly video visits, remains low, warranting attention from leadership and policymakers.

BACKGROUND:Emerging evidence suggests endocrine disrupting chemicals, including bisphenols and phthalates, may affect behavioral development in children and adolescents. Risk behavior constitutes a potentially sex hormone sensitive behavioral construct. Here, we examined longitudinal associations of phthalate and bisphenol exposure with performance-based tasks and self-reported risk-taking behaviors. METHODS:Within a population-based birth cohort in the Netherlands, urinary bisphenols and phthalate metabolite concentrations were measured in women during pregnancy (three times, n = 1379) and in children (once at 6 years, n = 775). At 10 years, child risk-taking behavior was assessed with the computerized experimental Columbia Card Task (CCT). At 14 years, adolescents completed a computerized self-assessment of real-life risk-taking behaviors. Linear regression and hurdle models adjusted for confounders were applied in the whole sample and stratified by sex at birth. RESULTS:After multiple testing correction, no associations in all children or in boys were found for prenatal or childhood phthalate exposure with the average CCT-score. In girls, prenatal mono-isobutyl phthalate was associated with a higher average CCT-score, indicting more risk-taking (B per 10-fold increase in creatinine-adjusted average prenatal levels = 2.10, 95% CI: 0.69,3.52). No associations were observed for bisphenol exposure nor for self-reported risk-taking. CONCLUSIONS:Prenatal phthalate exposure was associated with more risk-taking in an experimental task at 10 years-of-age in girls only. The task reflects risky decision-making, which may be a hormonally sensitive construct. Risky decision making potentially precedes real-life risk-taking, which was captured by the self-reported measure and was limited in this young sample.

BACKGROUND:Methadone is the gold standard treatment for opioid use disorder (OUD). In the U.S., methadone is usually only available through licensed opioid treatment programs (OTPs), but a 2021 federal rule provided an opportunity for OTPs to provide methadone on mobile medication units (MMUs). MMUs operate under the license of an OTP and are subject to complex regulatory requirements. New York State provided grant funding to support OTPs to adopt MMUs, aligned with the broader goal to improve methadone access statewide. This study explored barriers and facilitators to MMU implementation across New York State from the perspectives of treatment staff and administrators. METHODS:We conducted semi-structured interviews between June 2024 and June 2025 with 16 staff from four OTPs that adopted MMUs and one residential treatment program served by an MMU. Interviews were audio-recorded, transcribed, and analyzed using a hybrid deductive-inductive thematic analysis approach to identify implementation barriers and facilitators. RESULTS:Staff described a variety of potential models for using MMUs to expand access. In New York City, MMUs were used to serve a residential substance use program. In upstate NY, MMUs were deployed to reduce travel distance in counties with few OTP options. Key facilitators of MMU implementation included leadership persistence in the face of community pushback, creativity and workarounds in the face of logistical hurdles, and support from the state agency. Key barriers included community resistance to MMUs, unclear or inconsistent guidance from the Drug Enforcement Administration, and a variety of operational challenges, such as vehicle maintenance and workforce shortages. Staff generally were positive about the opportunity to use MMUs to address access challenges. CONCLUSIONS:MMUs provide a novel approach to expand methadone access, particularly to populations not currently served by brick-and-mortar OTPs. Early implementers can provide important lessons about how to manage start-up challenges, which can guide later adopters.

Underdiagnosis of cardiometabolic risk factors (CMRFs) may represent an unrecognised biological pathway contributing to dementia risk; yet remains poorly characterised in African and African diaspora populations. We quantified the prevalence and determinants of underdiagnosed hypertension and abnormal glycaemia across four cohorts comprising up to 7000 adults aged ≥40 years from Nigeria, Kenya, and The United States: Indianapolis, and North Texas. Underdiagnosis was defined as absence of self-reported diagnosis despite elevated systolic blood pressure ( ≥130 mmHg) or fasting blood glucose ( ≥100 mg/dL). Cohort-stratified analyses examined demographic, socioeconomic, cognitive, Alzheimer's genetic, and blood-based biomarker correlates. Underdiagnosis was pervasive in African cohorts. Elevated fasting glucose was associated with cognitive impairment in Kenya and North Texas, while severe hypertension and diabetes were linked to Alzheimer's disease-related biomarkers [pTau217/181, NFL and Aβ42/40] in North Texas (all p ≤ 0.05). These findings identify context-specific diagnostic gaps in populations at high dementia risk and highlight cardiometabolic detection as a mechanistic target for prevention.