Faculty Bibliography

We examined disparities in sleep problems by sexual orientation among a population-based sample of adults, using data from the New York City (NYC) Health and Nutrition Examination Survey (NYC HANES), a population-based, cross-sectional survey conducted in 2013-2014 (n = 1220). Two log binomial regression models were created to assess the relative prevalence of sleep problems by sexual orientation. In model 1, heterosexual adults served as the reference category, controlling for gender, age, race/ethnicity, education, marital status, and family income. And in model 2, heterosexual men served as the reference category, controlling for age, race/ethnicity, education, marital status, and family income. We found that almost 42% of NYC adults reported sleep problems in the past 2 weeks. Bisexual adults had 1.4 times the relative risk of sleep problems compared to heterosexual adults (p = 0.037). Compared to heterosexual men, heterosexual and bisexual women had 1.3 and 1.6 times the risk of sleep problems, respectively (p < 0.05). Overall, adults who self-identified as bisexual had a significantly greater risk of sleep problems than adults who self-identified as heterosexual.

Previous research has given considerable attention to venues where men who have sex with men (MSM) meet their sex partners. However, no previous study examined a vast range of sexual risk behaviors. The objective of this study was to examine the association between the types of venues for meeting sexual partners, condomless anal intercourse, engagement in group sex, and HIV and sexually transmitted infection (STI) risk among a sample of MSM. Users of a popular geosocial-networking app in Paris were provided an advertisement with text encouraging them to complete an anonymous web-based survey ( n = 580), which included questions about sex-seeking venues, condomless anal intercourse, HIV status and STI history, and sociodemographic characteristics. A log-binomial model was used to assess association between venues (i.e. public venues [gay clubs, bars, and discos], cruising venues [such as gay saunas, beaches, and parks], and internet-based venues [internet chat sites and geosocial-networking apps]), condomless anal intercourse, engagement in group sex, and HIV infection as well as infection with other STIs, after adjustment for sociodemographics. In multivariable models, attending cruising venues was associated with condomless receptive anal intercourse (adjusted relative risk [aRR] = 1.47; 95% confidence interval [CI] = 1.20-1.81), any kind of condomless anal intercourse (aRR = 1.34; 95% CI = 1.14-1.58), an STI (aRR = 1.50; 95% CI = 1.09-2.05), engagement in group sex (aRR = 1.42; 95% CI = 1.27-1.59), and multiple partners for both condomless insertive (aRR = 2.00; 95% CI = 1.38-2.88), and receptive (aRR = 1.70; 95% CI = 1.23-2.36) anal intercourse, STI infection (aRR = 1.50, 95% CI = 1.09-2.05) and HIV infection (aRR = 1.76; 95% CI = 1.05-2.96). No associations were found with other venue types and sexual risk behaviors, STIs, and HIV infection, except for group sex, which was associated with all venue types. Use of cruising where the primary aim is to have sex was found to be associated with risky sexual behavior. Risky behavior reduction strategies such as preexposure prophylaxis campaigns should be targeted to MSM who frequent cruising venues.

BACKGROUND:Headache diaries are a mainstay of migraine management. While many commercial smartphone applications (apps) have been developed for people with migraine, little is known about how well these apps protect patient information and whether they are secure to use. OBJECTIVE:We sought to assess whether there are privacy issues surrounding apps so that physicians and patients could better understand what medical information patients are providing to the app companies, and the potential privacy implications of how the app companies (and other third parties) might use that information. METHODS:We conducted a systematic search of the most popular "headache" and "migraine" apps and developed a database of the types of data the apps requested for input by the user and whether the apps had clear privacy policies. We also examined the content of the privacy policies. RESULTS:Twenty-nine apps were examined (14 diary apps, 15 relaxation apps). Of the diary applications, 79% (11/14) had visible privacy policies. Of the diary apps with privacy policies, all (11/11) stated whether or not the app collects and stores information remotely. A total of 55% (6/11) stated that some user data were used to serve targeted advertisements. A total of 11/15 (73%) of the relaxation apps had privacy policies. CONCLUSIONS:Headache apps shared information with third parties, posing privacy risks partly because there are few legal protections against the sale or disclosure of data from medical apps to third parties.

OBJECTIVE:To assess changes in the practice patterns of urologists performing male infertility procedures (vasal reconstruction, sperm retrieval, varicocelectomy) from 2004 to 2015 in the United States. DESIGN/METHODS:Examination of self-reported procedural volumes from urologists undergoing certification and recertification using case log data provided by the American Board of Urology. The study period was stratified into early (2004-2007) and recent (2012-2015) time periods. SETTING/METHODS:Not applicable. PATIENT(S)/METHODS:None. INTERVENTION(S)/METHODS:None. MAIN OUTCOMES MEASURE(S)/METHODS:Temporal variations in male infertility practice patterns among different urologic subspecialties between the early and recent time periods. RESULT(S)/RESULTS:The overall proportion of total male infertility procedures performed by andrologists significantly increased between the early and recent groups (23% to 26%). This growth was driven by a significant increase in the proportion of varicocele repairs being performed by andrologists between the early and recent periods (19% to 25%). Most notably, an assessment of total number of male infertility procedures performed by newly certifying urologists showed that there was a significant increase in the overall proportion of all male infertility procedures being performed by recently trained andrologists (24% to 35%). This significant increase was seen individually among all three types of male infertility procedures. CONCLUSION(S)/CONCLUSIONS:With the increased trend in urologists obtaining fellowship training, male infertility surgical volume is beginning to shift from general urologists to subspecialized andrologists.

BACKGROUND:Evidence shows cytokine dysregulation in children with developmental disabilities. The association between immune activity during the perinatal period and child development is less clear. METHODS:We examined the relationship between newborn concentrations of immune markers and child development. Within Upstate KIDS, a population-based birth cohort (2008-2010, upstate New York), we assayed immune markers, which are postulated to have neuro-modulatory effects, in newborn dried blood spots (NDBS, n = 3038). Mothers completed the Ages & Stages Questionnaire© (ASQ) for their children repeatedly through age 36 months. At 30 and 36 months, mothers also reported whether their children received any developmental services. We used generalised linear mixed models adjusted for maternal and child characteristics to test associations. RESULTS:Sixteen immune markers were associated with failing ASQ in unadjusted models. After full adjustment (for gestational age, mode of delivery, parity, pregnancy smoking, etc.), we observed that higher levels of 4 markers, including platelet-derived growth factor-AA (PDGF-AA, OR 0.77, 95% CI 0.67, 0.89), plasminogen activator inhibitor-1 (OR 0.80, 95% CI 0.68, 0.94), stromal cell derived factor-1 (OR 0.85, 95% CI 0.73, 0.98), and macrophage inflammatory protein-1beta (OR 0.87, 95% CI 0.77, 0.98) were associated with lower odds of ASQ failure. The associations did not exist if correction for multiple comparisons was performed, except for PDGF-AA. Analyses with developmental service use revealed similar null findings. CONCLUSIONS:Immune marker concentrations in NDBS may not be associated with developmental delay in the general population. Newborn concentrations of growth factor PDGF-AA may be protective of developmental delay in childhood.

Background/Introduction: The 2016 ESC Guideline on the Diagnosis and Treatment of Acute and Chronic Heart Failure endorsed sacubitril/valsartan (S/V) as class I-B treatment for heart failure with reduced ejection fraction(HFrEF) based on the PARADIGM-HF trial. Data on characteristics of S/V initiators and S/V adherence among renin-angiotensin aldosterone system inhibitor (RAASi)-nai ve patients treated in the community are limited. Purpose: Determine associated baseline patient and healthcare facility characteristics and medication adherence of S/V vs angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) in RAASi-naive HFrEF patients. Methods: Retrospective cohort study of U.S. Veterans Affairs (VA) data including HFrEF ( = 1 record of left ventricular ejection fraction (LVEF) = 40%) patients with = 1 in/outpatient visit for HF within 1-year pre-index (baseline period) treated with S/V, ACEI, or ARB from July 2015-June 2017. The index date was first S/V pharmacy fill and if none, first ACEI or ARB fill. RAASi-naive defined as no S/V, ACEI, or ARB fills during the baseline period. Poisson regression models with robust errors were used to compare baseline characteristics and 4-month medication adherence (i.e. follow-up fills, proportion of days covered [PDC], and discontinuation) for S/V vs ACEI or ARB. Medication adherence comparisons were adjusted for baseline characteristics using matching weights. Results: Among RAASi-naive HFrEF Veterans (N = 10,743),most (97.5%)weremale and 371 (3.5%) had an S/V pharmacy fill and 10,372 (96.5%) had an ACEI or ARB fill on the index date. Mean (standard deviation) baseline age, estimated glomerular filtration rate, and LVEF in S/V vs ACEI or ARB initiators were 73.6 (10.7) vs 70.3 (11.4) years, 61.3 (19.1) vs 66.4 (25.2) mL/min/1.73 m2, and 27.9% (8.3%) vs 34.4% (12.0%), respectively. History of ischemic cardiomyopathy was associated with S/V vs ACEI or ARB initiation. Veterans with lower systolic blood pressure, history of stroke, hypertension, myocardial infarction, or a visit with a Cardiologist on the index date were less likely to initiate S/V. In Veterans with a 30 day-supply index fill (N = 251 S/V and N = 3,101 ACEI or ARB) the adjusted risk ratio for 4-month PDC >80% was 0.78, 95% (confidence interval: 0.66-0.93) for S/V vs ACEI or ARB. Follow-up fills and discontinuation were similar for S/V vs ACEI or ARB. Adherence was similar for S/V vs ACEI or ARB among Veterans with a 90 day-supply. Conclusions: In a large, integrated healthcare system, 3.5% RAASi-naive HFrEF patients initiated S/V during the first 2-years post U.S. FDA approval. Overall, our findings suggest that S/V adherence is similar to ACEI or ARB in community-treated RAASi-naive HFrEF patients. The low numbers of S/V initiation may reflect a lag in formulary availability; S/V was added to the VA Formulary in October 2016. The reasons for lack of guideline-directed S/V initiation needs further elucidation