Faculty Bibliography

Background: Understanding the development of post-traumatic stress disorder (PTSD) is a precondition for efficient risk assessment and prevention planning. Studies to date have been site and sample specific. Towards developing generalizable models of PTSD development and prediction, the International Consortium to Predict PTSD (ICPP) compiled data from 13 longitudinal, acute-care based PTSD studies performed in six different countries. Objective: The objectives of this study were to describe the ICPP's approach to data pooling and harmonization, and present cross-study descriptive results informing the longitudinal course of PTSD after acute trauma. Methods: Item-level data from 13 longitudinal studies of adult civilian trauma survivors were collected. Constructs (e.g. PTSD, depression), measures (questions or scales), and time variables (days from trauma) were identified and harmonized, and those with inconsistent coding (e.g. education, lifetime trauma exposure) were recoded. Administered in 11 studies, the Clinician Administered PTSD Scale (CAPS) emerged as the main measure of PTSD diagnosis and severity. Results: The pooled data set included 6254 subjects (39.9% female). Studies' average retention rate was 87.0% (range 49.1-93.5%). Participants' baseline assessments took place within 2 months of trauma exposure. Follow-up durations ranged from 188 to 1110 days. Reflecting studies' inclusion criteria, the prevalence of baseline PTSD differed significantly between studies (range 3.1-61.6%), and similar differences were observed in subsequent assessments (4.3-38.2% and 3.8-27.0% for second and third assessments, respectively). Conclusion: Pooling data from independently collected studies requires careful curation of individual data sets for extracting and optimizing informative commonalities. However, it is an important step towards developing robust and generalizable prediction models for PTSD and can exceed findings of single studies. The large differences in prevalence of PTSD longitudinally cautions against using any individual study to infer trauma outcome. The multiplicity of instruments used in individual studies emphasizes the need for common data elements in future studies.

BACKGROUND:Psychotherapy and mental health services in Nairobi's public hospitals are increasing. Rather than prematurely imposing psychotherapy protocols developed in Western countries to Kenya, we argue that first studying psychological interventions as they are practiced may generate understanding of which psychological problems are common, what interventions therapists use, and what seems to be effective in reducing psychiatric problems in a lower and middle income country like Kenya. METHOD/METHODS:We present preliminary findings from a process-outcome study involving 345 patients from two public institutions, Kenyatta National and Mathare National Hospitals. We asked our patients to fill out a brief personal information questionnaire, Clinical Outcomes in Routine Evaluation-Outcome Measure (Evans et al. in Br J Psychiatry 180:51-60, 2002, and the Session Alliance Inventory (Falkenström et al. in Psychol Assess 27:169-183, 2015) after each session. We present descriptives for CORE-OM, patient-therapist concordance on the SAI, and using longitudinal mixed-effects model, test change in CORE-OM over time with various therapy and patient factors as predictors in regression analyses. RESULTS: = 0.02). DISCUSSION/CONCLUSIONS:Our objective was to study psychotherapies as they are practiced in naturalistic settings. The overall significant finding is that our participants report improvement in their functioning mental health condition and distress reduced as psychotherapy progressed. There were many more male than female participants in our sample; younger patients improved more than older ones; and while interns had patients with higher distress, their patients improved better than those patients attended by professionals. CONCLUSIONS:These are preliminary observations to consider for a larger sample follow-up study. Before changing practices, evaluating the existing practices by mapping clinical outcomes is a helpful route.

Background: suPAR is an inflammatory mediator that has been linked to the pathogenesis of FSGS and progression of chronic kidney disease in children and adults. Overexpression of suPAR leads to reduced nephron development in preclinical models. This study was designed to measure suPAR in pregnant women to determine the range of fetal exposure to this molecule and its potential influence on antenatal human kidney growth.
Method(s): Pregnant women enrolled in the Children's Health and Environment Study (CHES) provided serum samples obtaining during 1-3 trimesters. Clinical information was obtained from the electronic health record. suPAR levels were determined by ELISA (Virogates, Copenhagen, Denmark). Data are presented as mean+/-SD. Results were analyzed by Pearson correlation and ANOVA.
Result(s): 515 mothers were studied, age 31+/-6 yr, and racial distribution 44% Caucasian, 7% African American, 9 % Asian, and 41% other/unspecified. 46% of the women were Hispanic. 29% had completed a high school education or less and 28% had an annual income <$50,000. There were 464 livebirths, 50.4% girls. The serum suPAR levels (mean, SD, minimum, maximum) are summarized in the Table. The suPAR levels in the subgroup of women who provided more than one sample during pregnancy were closely correlated (r=0.79-0.94, P<0.0001)). The decline in serum suPAR levels from trimester 1 to 3 was highly significant (P<0.001).
Conclusion(s): Maternal suPAR levels are detectable throughout pregnancy but decline from trimester 1 to 3. The levels are highly correlated and steady during the course of pregnancy in an individual woman. There is more than a 10-fold range in suPAR concentration which may contribute to the biological variation in nephron number at birth. Follow-up assessment in the infants will be performed in the prospective Environmental Influences on Child Health Outcomes (ECHO) cohort study. (Table Presented)

Substantial effort has been devoted to explaining secular trends in childhood obesity and metabolic risks to unhealthy diet and physical activity. While some studies have suggested these factors may play a role in the obesity epidemic, even these studies have only been able to conclude that these factors have a moderate role. Given that a single-generation transformation in the human genome is even more unlikely to have transformed susceptibility to excess weight gain in early life, we are left with the reality that environmental influences represent important risks for obesity and dysmetabolism. In contrast to diet and physical activity, which can require intensive attention, effort and costs to modify through behavioral and other interventions, government action can fundamentally transform the environment and prevent disease and disability. The costs of regulations to limit environmental obesogens can also be much lower than the benefits to society.

Introduction Supporting patients' decision making about clinical trials may enhance trial participation. To date, few theory-based interventions have been tested to address this issue. Objectives In this study, we aimed to evaluate the effect of a multimedia psychoeducation (MP) intervention, relative to print education (PE), on patients' decision support needs and attitudes about clinical trials. Methods Patients with cancer who were eligible for participation in an National Cancer Institute (NCI) therapeutic cancer clinical trial were recruited through the nationwide University of Rochester Cancer Center (URCC) NCI Community Oncology Research Program (NCORP) from 2014- 2016 and randomized to the MP or PE intervention. Assessments at baseline (before intervention), post-intervention, and at a two-month follow- up included patients' decision support needs, attitudes regarding clinical trials, and clinical trial participation. Results We recruited 418 cancer patients (ages 26-89, various cancer types). Relative to the PE condition, the MP condition did not significantly affect decision support needs. However, patients in the MP condition reported significantly more positive attitudes about clinical trials and were more likely to participate in a clinical trial than those in the PE condition (69% vs. 62%, p=0.01). Furthermore, improvement in attitudes about clinical trials significantly mediated the effect of the intervention on participation in clinical trials. Conclusions The MP intervention was able to improve patient attitudes toward clinical trials when compared with PE, and this improvement led to increased rates of participation in trials. The MP intervention could be disseminated to improve attitudes about clinical trials among cancer patients

A 16-year-old adolescent who identifies as transgender wishes to consider fertility preservation prior to the use of gender-affirming hormones. The adolescent's parents are divorced, and one parent supports fertility preservation while the other does not. This case explores the minor's future reproductive autonomy and parental decision making in a field where there is limited evidence of known harms and benefits to the use of fertility preservation in the transgender population and about future potential regret from lack of consideration of fertility preservation during the prime window of opportunity. This case is created from a composite of cases seen at multiple institutions.

Background: Environmental chemical exposures are linked to oxidative stress and kidney injury in children and adults. This applies to short-lived organic compounds such as bisphenol A and phthalates and persistent synthetic chemicals such as perfluoroalkyl acids (PFAAs). Most investigations to date have been conducted in developed countries with few data about environmental chemical exposures in children living in Africa.
Method(s): Clinical and laboratory data about pediatric patients enrolled in the H3 Africa observational cohort study including age, gender, BMI, serum creatinine, eGFR, proteinuria were collected. Serum samples that had been collected at enrollment were retrieved from the Biorepository and analyzed for PFAAs and polybrominated diphenyl ethers (PBDEs) and DDE presticides using established methods. Proteinuria was assessed in a first morning urine sample. Results are presented as mean+/-SD.
Result(s): 86 patients with CKD (41 M:45 F), age 12.6+/-2.6 yr old, were included in this nested case control study. The eGFR was 75+/-4 and the albumin:creatinine ratio was 65+/-186. The chemical exposures are summarized in the Table. There was no association between exposure (log of serum concentration) to PFAAs and proteinuria. However, controlling for age, gender, and BMI, there was an inverse relationship between eGFR and exposure to PFNA, -21.2 [95% CI:-41.6 -0.8] and PFDA -18.3 [95% CI:-35.3 --1.3] ml/min/log unit increase in exposure and a trend towards a similar effect for PFOS. PBDE/DDEs were detected in a small fraction of children and because of small sample size associations with effect markers were not made
Conclusion(s): PFAA exposure is substantially lower in H3 Africa participants than in healthy US children, age 12-19 enrolled in NHANES 2003-2010. However, even at these lower levels of exposure there was an adverse association between select PFAAs and GFR. These studies indicate the feasibility of measuring environmental chemical exposure in developing countries. The impact of these chemical exposures on kidney function will require larger cohorts of children followed for more extended periods of time

Changes in select adipose tissue volumes may differentially impact bone mineral density. This study was performed to assess cross-sectional and longitudinal relationships between computed tomography-determined visceral (VAT), subcutaneous (SAT), inter-muscular (IMAT), and pericardial adipose tissue (PAT) volumes with respective changes in thoracic vertebral and lumbar vertebral volumetric trabecular bone mineral density (vBMD) in African Americans with type 2 diabetes. Generalized linear models were fitted to test relationships between baseline and change in adipose volumes with change in vBMD in 300 African American-Diabetes Heart Study participants; adjustment was performed for age, sex, diabetes duration, study interval, smoking, hypertension, BMI, kidney function, and medications. Participants were 50% female with mean ± SD age 55.1±9.0 years, diabetes duration 10.2±7.2 years, and BMI 34.7±7.7 kg/m2. Over 5.3 ± 1.4 years, mean vBMD decreased in thoracic/lumbar spine, while mean adipose tissue volumes increased in SAT, IMAT, and PAT, but not VAT depots. In fully-adjusted models, changes in lumbar and thoracic vBMD were positively associated with change in SAT (β[SE] 0.045[0.011], p<0.0001; 0.40[0.013], p = 0.002, respectively). Change in thoracic vBMD was positively associated with change in IMAT (p = 0.029) and VAT (p = 0.016); and change in lumbar vBMD positively associated with baseline IMAT (p<0.0001). In contrast, vBMD was not associated with change in PAT. After adjusting for BMI, baseline and change in volumes of select adipose depots were associated with increases in thoracic and lumbar trabecular vBMD in African Americans. Effects of adiposity on trabecular bone appear to be site-specific and related to factors beyond mechanical load.

Latinos are the largest immigrant group in the United States, representing 17.6% of the total U.S. population, and are therefore critical to include in research. However, Latino immigrants-and particularly those who are undocumented residents-may be increasingly wary of participating in research amidst hostile anti-immigrant rhetoric and high profile cases of deportation. In this commentary we discuss challenges of conducting research with undocumented Latino immigrants in the current sociopolitical climate. We provide suggestions for data collection, data protection, and research recruitment techniques that may mitigate some of these challenges.