Faculty Bibliography

Background: The AGS Choosing Wisely Workgroup recommends incorporating life expectancy in cancer screening decisions. Previous studies indicate that non-geriatricians consider prognosis important to their clinical decisions, but often do not use prognostic tools. Moreover, they rarely discuss prognosis with patients. Little is known about how geriatricians include life expectancy in cancer screening decisions or whether prognosis is discussed. Methods: We surveyed attending geriatricians and fellows who care for community-dwelling older adults in academic clinics in New York City. We inquired whether these physicians incorporate prognosis in cancer screening decisions and discuss prognosis with patients, and how they estimate prognosis; we measured their confidence in estimating and discussing prognosis (5 point Likert scale: 0="not confident at all" to 4="extremely confident"). We also examined barriers to use of 2 common prognostic tools (ePrognosis and Gait speed) and having these discussions. Results: Twelve attendings and six fellows completed surveys (72% response rate). All respondents incorporated prognosis in cancer screening decisions and discussed prognosis with patients. Respondents estimated prognosis based on clinical impression (n=16), life table (n=5), ePrognosis (n=6) and gait speed (n=2). Confidence in estimating and discussing prognosis with patients was neutral (median for both: 2; range 1-3). Attending physicians were more confident in 1) estimating and 2) discussing prognosis with patients than were fellows (median: 2 versus 1, p=0.001; median: 3 versus 1.5, p=0.01, respectively). "Lack of time" was the most frequently reported barrier to prognostic tool use and prognosis discussions with patients followed by "unfamiliarity", "lack of resources" and "uncertainty about prognosis estimates", respectively (see table). Conclusions: Geriatricians identify considerable barriers to discussing prognosis when making cancer-screening decisions. Addressing these barriers may improve confidence in estimating and discussing prognosis. (Table Presented)

INTRODUCTION/BACKGROUND:Self-reported tobacco use in the United Arab Emirates is among the highest in the region. Use of tobacco products other than cigarettes is widespread, but little is known about specific behavior use patterns. There have been no studies that have biochemically verified smoking status. METHODS:The UAE Healthy Future Study (UAEHFS) seeks to understand the causes of non-communicable diseases through a 20,000-person cohort study. During the study pilot, 517 Emirati nationals were recruited to complete a questionnaire, provide clinical measurements and biological samples. Complete smoking data were available for 428 participants. Validation of smoking status via cotinine testing was conducted based on complete questionnaire data and matching urine samples for 399 participants, using a cut-off of 200ng/ml to indicate active smoking status. RESULTS:Self-reported tobacco use was 36% among men and 3% among women in the sample. However, biochemical verification of smoking status revealed that 42% men and 9% of women were positive for cotinine indicating possible recent tobacco use. Dual and poly-use of tobacco products was fairly common with 32% and 6% of the sample reporting respectively. CONCLUSIONS:This is the first study in the region to biochemically verify tobacco use self-report data. Tobacco use in this study population was found to be higher than previously thought, especially among women. Misclassification of smoking status was more common than expected. Poly-tobacco use was also very common. Additional studies are needed to understand tobacco use behaviors and the extent to which people may be exposed to passive tobacco smoke. IMPLICATIONS/CONCLUSIONS:This study is the first in the region to biochemically verify self-reported smoking status.

BACKGROUND:There is a significant link between insecure attachment and the development of psychopathology in adolescence. We investigated the relationship between adolescent attachment styles and the development of emotional and behavioral problems among adolescents in Kenya. We also examined the modifying influence of socio-economic-status (SES). METHOD/METHODS:One hundred and thirty-seven adolescents who were attending two schools participated in the study. One school (low SES school) catered for children from predominantly low-income households, while the second school (middle SES school) catered for children from predominantly middle-income households. The data were collected using three instruments: researcher designed questionnaire to obtain socio-demographic information, the Strength and Difficulties Questionnaire (SDQ) that is designed to assess symptoms of disorder, and the Vulnerable Attachment Scale Questionnaire (VASQ) that is designed to measure attachment style. RESULTS:< 0.01), experiencing significantly higher levels of attachment insecurity than those with lower scores. CONCLUSIONS AND RECOMMENDATIONS/CONCLUSIONS:This study supports the notion that attachment insecurity increases the adolescents' susceptibility to develop psychological problems.

OBJECTIVES/SPECIFIC AIMS: Determine timing of risk of readmissions within 30 days among patients first discharged to a skilled nursing facilities (SNF) after heart failure hospitalization and subsequently discharged home. METHODS/STUDY POPULATION: This was a retrospective cohort study of patients with SNF stays of 30 days or less following discharge from a heart failure hospitalization. Patients were followed for 30 days following discharge from SNF. We categorized patients based on SNF length of stay (LOS): 1-6 days, 7-13 days, 14-30 days. We then fit a piecewise exponential Bayesian model with the outcome as time to readmission after discharge from SNF for each group. Our event of interest was unplanned readmission; death and planned readmissions were considered as competing risks. Our model examined 2 different time intervals following discharge from SNF: 0-3 days post SNF discharge and 4-30 days post SNF discharge. We reported the hazard rate (credible interval) of readmission for each time interval. We examined all Medicare fee-for-service (FFS) patients 65 and older admitted from July 2012 to June 2015 with a principal discharge diagnosis of HF, based on methods adopted by the Centers for Medicare and Medicaid Services (CMS) for hospital quality measurement. RESULTS/ANTICIPATED RESULTS: Our study included 67,585 HF hospitalizations discharged to SNF and subsequently discharged home [median age, 84 years (IQR; 78-89); female, 61.0%]; 13,257 (19.2%) were discharged with home care, 54,328 (80.4%) without. Median length of SNF admission was 17 days (IQR; 11-22). In total, 16,333 (24.2%) SNF discharges to home were readmitted within 30 days of SNF discharge; median time to readmission was 9 days (IQR; 3-18). The hazard rate of readmission for each group was significantly increased on days 0-3 after discharge from SNF compared with days 4-30 after discharge from SNF. In addition, the hazard rate of readmission during the first 0-3 days after discharge from SNF decreased as the LOS in SNF increased. DISCUSSION/SIGNIFICANCE OF IMPACT: The hazard rate of readmission after SNF discharge following heart failure hospitalization is highest during the first 6 days home. Length of stay at SNF also has an effect on risk of readmission immediately after discharge from SNF; patients with a longer length of stay in SNF were less likely to be readmitted in the first 3 days after discharge from SNF.

BACKGROUND:Through diet and exercise interventions, community centers offer an opportunity to address health-related issues for some of the oldest, most vulnerable members of our society. OBJECTIVES/OBJECTIVE:The purpose of this investigation is to draw upon nationwide data to better characterize the population served by the congregate meals program and to gather more detailed information on a local level to identify opportunities for service enhancement to improve the health and well-being of older adults. DESIGN/METHODS:We examined community center data from two sources: 2015 National Survey of Older Americans Act and surveys from two New York City community centers. To assess nationwide service delivery, we analyzed participant demographics, functional status defined by activities of daily living, and perceptions of services received. MEASUREMENTS/METHODS:Participants from the two New York City community centers completed a four-day food record. Functional measures included the short physical performance battery, self-reported physical function, grip strength, and the Montreal Cognitive Assessment. RESULTS:Nationwide (n=901), most participants rated the meal quality as good to excellent (91.7%), and would recommend the congregate meals program to a friend (96.0%). Local level data (n=22) were collected for an in-depth understanding of diet, physical activity patterns, body weight, and objective functional status measures. Diets of this small, local convenience sample were higher in fat, cholesterol, and sodium, and lower in calcium, magnesium, and fiber than recommended by current United States Dietary Guidelines. Average time engaged in moderate physical activity was 254 minutes per week (SD=227), exceeding the recommended 150 minutes per week, but just 41% (n=9) and 50% (n=11) of participants engaged in strength or balance exercises, respectively. CONCLUSION/CONCLUSIONS:Research is warranted to test whether improvements in the nutritional quality of food served and access/supports for engaging in strength training within community centers could help older adults achieve diet and physical activity recommendations.

BACKGROUND:Well-being is a positively-framed, holistic assessment of health and quality of life that is associated with longevity and better health outcomes. We aimed to identify county attributes that are independently associated with a comprehensive, multi-dimensional assessment of individual well-being. METHODS:We performed a cross-sectional study examining associations between 77 pre-specified county attributes and a multi-dimensional assessment of individual US residents' well-being, captured by the Gallup-Sharecare Well-Being Index. Our cohort included 338,846 survey participants, randomly sampled from 3,118 US counties or county equivalents. FINDINGS:We identified twelve county-level factors that were independently associated with individual well-being scores. Together, these twelve factors explained 91% of the variance in individual well-being scores, and they represent four conceptually distinct categories: demographic (% black); social and economic (child poverty, education level [<high school, high school diploma/equivalent, college degree], household income, % divorced); clinical care (% eligible women obtaining mammography, preventable hospital stays per 100,000, number of federally qualified health centers); and physical environment (% commuting by bicycle and by public transit). CONCLUSIONS:Twelve factors across social and economic, clinical care, and physical environmental county-level factors explained the majority of variation in resident well-being.

U.S. global health investment has focused on detection, treatment, and eradication of infectious diseases such as tuberculosis, malaria, and human immunodeficiency virus/acquired immunodeficiency syndrome, with significant results. Although efforts should be maintained and expanded to provide ongoing therapy for chronic infectious disease, there is a pressing need to meet the challenge of noncommunicable diseases, which constitute the highest burden of diseases globally. A Committee of the National Academies of Sciences, Engineering, and Medicine has made 14 recommendations that require ongoing commitments to eradication of infectious disease and increase the emphasis on chronic diseases such as cardiovascular disease. These include improving early detection and treatment, mitigating disease risk factors, shifting global health infrastructure to include management of cardiovascular disease, developing global partners and private-public ventures to meet infrastructure and funding challenges, streamlining medical product development and supply, increasing research and development capacity, and addressing gaps in global political and institutional leadership to meet the shifting challenge.

Recent epidemiological evidence suggests that exposure to particulates may be a factor in the etiology of metabolic syndrome (MetS). In this novel study, we investigated the relationship between particulate levels and prevalence of MetS component abnormalities (hypertension, hyperglycemia, obesity) in a recruited cohort (N = 2025) in Jeddah, Saudi Arabia. We observed significant associations between a 10 μg/m³ increase in PM2.5 and increased risks for MetS (Risk Ratio (RR): 1.12; 95% Confidence Interval (CI): 1.06-1.19), hyperglycemia (RR: 1.08; 95% CI: 1.03-1.14), and hypertension (RR: 1.09; 95% CI: 1.04-1.14). PM2.5 from soil/road dust was found to be associated with hyperglycemia (RR: 1.12; 95% CI: 1.06-1.19) and hypertension (RR: 1.11; 95% CI: 1.05-1.18), while PM2.5 from traffic was associated with hyperglycemia (RR: 1.33; 95% CI: 1.05-1.71). We did not observe any health associations with source-specific mass exposures. Our findings suggest that exposure to specific elemental components of PM2.5, especially Ni, may contribute to the development of cardiometabolic disorders.