Faculty Bibliography

STUDY OBJECTIVE: Our aim was to assess: (1) medical trainee and practicing physician awareness about domestic sex trafficking of minors; and (2) whether respondents believe that awareness of trafficking is important to their practice. DESIGN AND SETTING: We designed an anonymous electronic survey, and a convenience sample was collected from June through October 2013. PARTICIPANTS: Voluntary participants were 1648 medical students, residents, and practicing physicians throughout the United States. INTERVENTIONS AND MAIN OUTCOME MEASURES: Data were analyzed for correlations between study cohort characteristics and: (1) agreement with the statement: "knowing about sex trafficking in my state is important to my profession"; (2) knowledge of national statistics regarding the sex trafficking of minors; and (3) knowledge of appropriate responses to encountering a trafficked victim. RESULTS: More practicing physicians than residents or medical students: (1) agreed or strongly agreed that knowledge about human trafficking was important to their practice (80.6%, 71.1%, and 69.2%, respectively; P = .0008); (2) correctly estimated the number of US trafficked youth according to the US Department of State data (16.1%, 11.7%, and 7.9%, respectively; P = .0011); and (3) were more likely to report an appropriate response to a trafficked victim (40.4%, 20.4%, and 8.9%, respectively; P = .0001). CONCLUSION: Although most medical trainees and physicians place importance on knowing about human trafficking, they lack knowledge about the scope of the problem, and most would not know where to turn if they encountered a trafficking victim. There exists a need for standardized trafficking education for physicians, residents, and medical students.

Over the last 2 decades human immunodeficiency virus (HIV) infection has become a chronic disease requiring long-term management. Aging, antiretroviral therapy, chronic inflammation, and several other factors contribute to the increased risk of cardiovascular disease in patients infected with HIV. In low-income and middle-income countries where antiretroviral therapy access is limited, cardiac disease is most commonly related to opportunistic infections and end-stage manifestations of HIV/acquired immunodeficiency syndrome, including HIV-associated cardiomyopathy, pericarditis, and pulmonary arterial hypertension. Cardiovascular screening, prevention, and risk factor management are important factors in the management of patients infected with HIV worldwide.

BACKGROUND:Frail individuals are at increased risk for poor outcomes, including adverse drug events. Kidney function is often compromised in frailty and is a key consideration in medication choice and dosing; however, creatinine-based measures of kidney function may be biased in frail individuals. STUDY DESIGN/METHODS:Observational study. SETTING & PARTICIPANTS/METHODS:4,987 community-dwelling older men and women with complete data who participated in visit 5 of the Atherosclerosis Risk in Communities (ARIC) Study (2011-2013). PREDICTORS/METHODS:) and urine albumin-creatinine ratio. OUTCOME/RESULTS:Frailty, defined using established criteria of 3 or more frailty characteristics (weight loss, slowness, exhaustion, weakness, and low physical activity). RESULTS:). Hyperpolypharmacy (taking ≥10 classes of medications) was more common in frail individuals (54% vs 38% of nonfrail), including classes requiring kidney clearance (eg, digoxin) and associated with falls and subsequent complications (eg, hypnotic/sedatives and anticoagulants). LIMITATIONS/CONCLUSIONS:Cross-sectional study design. CONCLUSIONS:. Given the substantial medication burden and uncertainty in chronic kidney disease classification, confirmation of kidney function with alternative biomarkers may be warranted to ensure careful prescribing practices in this vulnerable population.

BACKGROUND: There are few reports in the literature of the risks associated with second trimester abortion in women with placenta praevia (PP). We hypothesise that PP increases the risk of complications. AIMS: We sought to determine if PP is associated with a higher risk of blood loss and blood transfusion at the time of dilation and evacuation (D&E). MATERIALS AND METHODS: The records of 612 consecutive women undergoing abortion at 15-24 weeks of gestation were reviewed. Participant characteristics, need for blood transfusion, estimated blood loss (EBL) during the abortion and other complications were compared between women with and without ultrasound-documented PP. RESULTS: Eighty-seven of 612 (14.2%, 95% CI 11.5-17.2%) women had ultrasound-documented PP. The rate of blood transfusion was 3.4 and 1.3% in the group with PP and without PP, respectively (adjusted relative risk (RR = 2.8, 95% CI 0.7-11.3). An estimated blood loss of 500 cc or greater during the D&E procedure was observed in 12.6% of women in the PP group compared with 4.2% of women in the group without PP (adjusted RR 3.1, 95% CI 1.4-6.8, P = 0.004). CONCLUSIONS: Second-trimester abortion in women with PP is associated with a higher risk of blood loss of 500 cc or greater. Our study represents a larger sample size of patients with PP undergoing second-trimester abortion than previously reported in the literature. Women with PP may have a higher estimated blood loss and may require access to blood transfusion.

BACKGROUND: Previous studies identified associations between maternal obesity and childhood neurodevelopment, but few examined paternal obesity despite potentially distinct genetic/epigenetic effects related to developmental programming. METHODS: Upstate KIDS (2008-2010) recruited mothers from New York State (excluding New York City) at approximately 4 months postpartum. Parents completed the Ages and Stages Questionnaire (ASQ) when their children were 4, 8, 12, 18, 24, 30, and 36 months of age corrected for gestation. The ASQ is validated to screen for delays in 5 developmental domains (ie, fine motor, gross motor, communication, personal-social functioning, and problem-solving ability). Analyses included 3759 singletons and 1062 nonrelated twins with >/=1 ASQs returned. Adjusted odds ratios (aORs) and 95% confidence intervals were estimated by using generalized linear mixed models accounting for maternal covariates (ie, age, race, education, insurance, marital status, parity, and pregnancy smoking). RESULTS: Compared with normal/underweight mothers (BMI <25), children of obese mothers (26% with BMI >/=30) had increased odds of failing the fine motor domain (aOR 1.67; confidence interval 1.12-2.47). The association remained after additional adjustment for paternal BMI (1.67; 1.11-2.52). Paternal obesity (29%) was associated with increased risk of failing the personal-social domain (1.75; 1.13-2.71), albeit attenuated after adjustment for maternal obesity (aOR 1.71; 1.08-2.70). Children whose parents both had BMI >/=35 were likely to additionally fail the problem-solving domain (2.93; 1.09-7.85). CONCLUSIONS: Findings suggest that maternal and paternal obesity are each associated with specific delays in early childhood development, emphasizing the importance of family information when screening child development.

Since 2000, an increase in hepatitis C virus infection among HIV-infected (HIV+) men who have sex with men has been observed. Evidence points to blood exposure during sex as the medium of hepatitis C virus transmission. Hepatitis C virus prevalence among HIV + MSM overall and in relation to injection drug use is poorly characterized. In this study, a systematic review and meta-analysis examining global hepatitis C virus antibody prevalence and estimating active hepatitis C virus prevalence among HIV + MSM were conducted; 42 reports provided anti-hepatitis C virus prevalence data among HIV + MSM. Pooled prevalence produced an overall anti-hepatitis C virus prevalence among HIV + MSM of 8.1%; active HCV prevalence estimate was 5.3%-7.3%. Anti-hepatitis C virus prevalence among injection drug use and non-injection drug use HIV + MSM was 40.0% and 6.7%, respectively. Among HIV + MSM, hepatitis C virus prevalence increased significantly over time among the overall and non-injection drug use groups, and decreased significantly among injection drug use HIV + MSM. We identified a moderate prevalence of hepatitis C virus among all HIV + MSM and among non-injection drug use HIV + MSM; for both, prevalence was observed to be increasing slightly. Pooled prevalence of hepatitis C virus among HIV + MSM was higher than that observed in the 1945-1965 US birth cohort. The modest but rising hepatitis C virus prevalence among HIV + MSM suggests an opportunity to control HCV among HIV + MSM; this combined with data demonstrating a rising hepatitis C virus incidence highlights the temporal urgency to do so.

OBJECTIVE:Many individuals with prediabetes have evidence of subclinical myocardial damage and are at an increased risk of cardiovascular disease (CVD). If subclinical myocardial damage is independently associated with incident diabetes, this may contribute to the understanding of the association between diabetes and CVD. This study was conducted to determine whether high-sensitivity cardiac troponin T (hs-cTnT) is associated with incident diabetes. RESEARCH DESIGN AND METHODS:Using Kaplan-Meier curves and Cox models, we prospectively analyzed 8,153 participants without known diabetes or CVD. We used the Harrell C statistic to investigate whether hs-cTnT added incremental prognostic information for diabetes prediction. RESULTS:During a median of 13 years of follow-up, there were 1,830 incident cases of diagnosed diabetes. After adjustment for demographics and traditional risk factors, participants with a baseline hs-cTnT of 9-13 ng/L or ≥14 ng/L had a significantly increased risk for diabetes compared to those with an hs-cTnT of ≤5 ng/L, with hazard ratios of 1.14 (95% CI 0.99-1.33) and 1.25 (95% CI 1.03-1.53), respectively (P = 0.018 for trend). Linear spline modeling that included adjustment for baseline fasting glucose suggested an increased risk of incident diabetes for participants with hs-cTnT levels >8 ng/L. Furthermore, the addition of hs-cTnT to fully adjusted models that included glucose significantly improved the prediction of incident diabetes from 0.7636 to 0.7644 (P = 0.023). CONCLUSIONS:Participants with elevated hs-cTnT levels at baseline had an increased risk of incident diabetes, suggesting that the measurement of hs-cTnT may incorporate an underlying pathophysiologic overlap between diabetes and CVD not captured by other traditional risk factors. Measurement of hs-cTnT may be useful to identify individuals at an increased risk for incident diabetes and CVD in order to provide early and more intensive risk factor modification.

BACKGROUND AND AIMS:Most prior studies investigating the association of lower extremity peripheral artery disease (PAD) with physical function were small or analyzed selected populations (e.g., patients at vascular clinics or persons with reduced function), leaving particular uncertainty regarding the association in the general community. METHODS:Among 5262 ARIC participants (age 71-90 years during 2011-2013), we assessed the cross-sectional association of ankle-brachial index (ABI) with the Short Physical Performance Battery (SPPB) score (0-12), its individual components (chair stands, standing balance, and gait speed) (0-4 points each), and grip strength after accounting for potential confounders, including a history of coronary disease, stroke, or heart failure. RESULTS:There were 411 participants (7.8%) with low ABI ≤0.90 and 469 (8.9%) participants with borderline low ABI 0.91-1.00. Both ABI ≤0.90 and 0.91-1.00 were independently associated with poor physical function (SPPB score ≤6) compared to ABI 1.11-1.20 (adjusted odds ratio 2.10 [95% CI 1.55-2.84] and 1.86 [1.38-2.51], respectively). The patterns were largely consistent across subgroups by clinical conditions (e.g., leg pain or other cardiovascular diseases), in every SPPB component, and for grip strength. ABI >1.3 (472 participants [9.0%]), indicative of non-compressible pedal arteries, was related to lower physical function as well but did not necessarily reach significance. CONCLUSIONS:In community-dwelling older adults, low and borderline low ABI suggestive of PAD were independently associated with poorer systemic physical function compared to those with normal ABI. Clinical attention to PAD as a potential contributor to poor physical function is warranted in community-dwelling older adults.

Cardiovascular diseases are approaching epidemic levels in Kenya and other low- and middle-income countries without accompanying effective preventive and therapeutic strategies. This is happening in the background of residual and emerging infections and other diseases of poverty, and increasing physical injuries from traffic accidents and noncommunicable diseases. Investments to create a skilled workforce and health care infrastructure are needed. Improving diagnostic capacity, access to high-quality medications, health care, appropriate legislation, and proper coordination are key components to ensuring the reversal of the epidemic and a healthy citizenry. Strong partnerships with the developed countries also crucial.