Faculty Bibliography

Geriatric syndromes are common in hospitalized elders with heart failure (HF), but association with clinical outcomes is not well characterized. The purpose of this study (N = 289) was to assess presence of geriatric syndromes using Joint Commission-mandated measures, the Braden Scale (BS) and Morse Fall Scale (MFS), and to explore prognostic utility in hospitalized HF patients. Data extracted from the electronic medical record included sociodemographics, medications, clinical data, comorbid conditions, and the BS and MFS. The primary outcome of mortality was assessed using Social Security Death Master File. Statistical analysis included Cox proportional hazards models to assess association between BS and MFS scores and all-cause mortality with adjustment for known clinical prognostic factors. Higher risk BS and MFS scores were common in hospitalized HF patients, but were not independent predictors of survival. Further study of the clinical utility of these scores and other measures of geriatric syndromes in HF is warranted.

OBJECTIVE: We examined whether the negative relation between television viewing that exceeds the recommendations of the American Academy of Pediatrics (AAP) and school readiness varied by family income. METHODS: Data were collected from 807 children from diverse backgrounds. Parents reported hours of television viewing, as well as family income. Children were assessed using measures of math, knowledge of letters and words, and executive function (EF). RESULTS: Television viewing was negatively associated with math and EF but not with letter and word knowledge. An interaction between television viewing and family income indicated that the effect of television viewing in excess of the AAP recommended maximum had negative associations with math and EF that increased as a linear function of family income. Furthermore, EF partially mediated the relation between television viewing and math. CONCLUSION: Television viewing is negatively associated with children's school readiness skills, and this association increased as family income decreased. Active efforts to reinforce AAP guidelines to limit the amount of television children watch should be made, especially for children from middle- to lower-income families.

Objective: 1) To demonstrate the feasibility of an interdisciplinary home visit program (HVP) for advanced Parkinson's disease (PD) providing expert, interdisciplinary care directly to homebound patients; 2) to test whether the HVP improves patient quality of life despite disease progression. Background: As PD progresses, symptoms increase, quality of life declines, and individuals may become homebound, often losing access to neurologic care. This leads to a surge in emergency department visits and hospitalizations. Improving access to expert in-home care may improve quality of life. Design/Methods: PD patients meeting Medicare criteria for homebound status are eligible to receive quarterly home visits over 12 months. Each visit entails an evaluation by a movement disorders specialist, social worker, and nurse, including detailed history, physical examination, real-time medication reconciliation, psychosocial evaluation, and referral to in-home services. Quality of life (Neuro-QoL) is measured at Visits 1 and 4. Results: Out of 27 subjects enrolled, 26 have completed the study. At baseline, subjects' mean age is 81 years (SD 7.8); mean PD duration is 10 years; mean UPDRS total score is 65 (SD 20). Of the 26 subjects completing Visit 4, total UPDRS increased by a mean of 12 (SD 10.7), yet quality of life improved in 7/8 Neuro-QoL domains. Conclusions: We identified a unique population typically lost to clinical care and research-the elderly, homebound with advanced PD-and this is the first description of their progression over time. Despite the expected progression of functional and motor disability over one year, subjects reported improved quality of life since entering the HVP. Next steps include the implementation of a hybrid in-person/telehealth home visit model, inclusion of individuals with cognitive impairment in future studies, and comparison of outcomes with other advanced PD populations

BACKGROUND:Motor vehicle traffic (MVT) crashes kill or seriously injure approximately 4250 people in New York City (NYC) each year. Traditionally, NYC surveillance practices use hospitalization and crash data separately to monitor trends in MVT-related injuries, but key information linking crash circumstances to health outcomes is lost when analyzing these data sources in isolation. Our objective was to match crash reports to hospitalization records to create a traffic injury surveillance dataset that can be used to describe crash circumstances and related injury outcomes. The linkage of the two systems presents a unique challenge since the system tracking crashes and the system tracking hospitalizations and emergency department (ED) visits lack key identifying data such as names and dates of birth. METHODS:NYC Department of Transportation provided electronic records based on reports of motor vehicle crashes submitted to the New York State Department of Motor Vehicles for all crashes occurring in NYC from 2009 to 2013. New York Statewide Planning and Research Cooperative System (SPARCS) ED and hospitalization administrative data from NYC hospitals were used to identify unintentional MVT-related injuries using external cause of injury codes. Since the two systems do not share unique individual identifiers, probabilistic record linkage was conducted using LinkSolv9.0. Sensitivity/specificity calculations and chi-square analyses of linkage rates were conducted to assess linkage results. RESULTS:From 2009-2013, there were 1,054,344 individuals involved in MVT crashes in NYC and 280,340 ED visits and hospitalizations from MVT-related injuries. There were 145,003 linked pairs, giving a linkage rate of 52% of the total MVT-related hospital records. This linkage had a sensitivity of 74% and a specificity of 93%. Linkage rates were comparable by age, sex, crash role, collision type, hospital county, injury location, hospital type, and hospital status, indicating no apparent biases in the match by these variables. CONCLUSIONS:Performing a probabilistic linkage between MVT crash reports and hospitalization records is possible with a limited set of identifying variables. These linked data will inform traffic safety policies by providing new information on how crash circumstances translate to health outcomes.

Background Metabolic syndrome (MetS) is associated with increased risk for cardiovascular disease, but there is heterogeneity in this risk. We evaluated whether high-sensitivity troponin T (hs-cTnT), a marker associated with cardiovascular disease, can stratify risk in MetS. Methods We evaluated associations between MetS (and groups with similar number of MetS components) and incident heart failure hospitalization, coronary heart disease, stroke and death using hs-cTnT categories after adjusting for risk factors/markers between 1996 and 2011 in 8204 individuals in the Atherosclerosis Risk In Communities study. Results The mean age of the population was 63 years (56% women, 19% Blacks). hs-cTnT levels were higher with MetS and with increasing MetS components. In individuals with MetS, higher hs-cTnT levels were associated with increased hazard ratios for heart failure, coronary heart disease and death. Within each number of MetS components, higher hs-cTnT was associated with progressively higher heart failure, coronary heart disease and death hazards. The association was particularly strong for heart failure. With increasing hs-cTnT categories, the hazard ratios (95% confidence interval) for heart failure in individuals with MetS increased gradually from 1.68 (1.31-2.16) to 3.76 (2.69-5.26) ( p-trend < 0.001) compared with those with MetS and hs-cTnT < 5 ng/l; and respective hazard ratios with increasing hs-cTnT categories in those with all five MetS components ranged from 2.22 (1.17-4.21) to 4.23 (1.89-9.50) ( p-trend 0.004) compared with those with all five MetS components and hs-cTnT < 5 ng/l. However, mostly there were no significant interactions of hs-cTnT with MetS or its components. Conclusion hs-cTnT is useful for identifying MetS patients with increased hazards for coronary heart disease, death and particularly heart failure.

BACKGROUND:Local ancestry may contribute to the disproportionate burden of subclinical and clinical cardiovascular disease among admixed African Americans compared with other populations, suggesting a rationale for admixture mapping. METHODS AND RESULTS/RESULTS:gene (lipoma high mobility group protein I-C fusion partner-like 2) with hard and all coronary heart disease. CONCLUSIONS:We identified several novel LEA regions, in addition to previously identified genetic variations, associated with cCIMT and cardiovascular disease events among African Americans.

To date, various dimensions of body image and their associations with condom use have not been studied among men who have sex with men (MSM) who use geosocial-networking smartphone applications ("apps") to meet new sexual partners. The purpose of the current study was to evaluate associations between weight perception, body dissatisfaction, and self-objectification with sexual behaviors among a sample of MSM (n = 92) recruited from Grindr, an app popular among MSM, to complete an online survey. Obese participants scored significantly higher on measures of body dissatisfaction and lower on measures of sexual sensation seeking. Decreased propensities to seek sexual sensations were associated with fewer sexual partners. By assessing associations between dimensions of body dissatisfaction and sexual risk behaviors, this study adds support to a theory of syndemics among MSM, which suggests that synergistically related biological, psychological, social, and behavioral factors disproportionately affect health and health-related behaviors in this population.

Medical case management has improved in the past few decades, changing the dynamic interaction between depression and prevalent medical diseases. It is relevant to describe the comorbidity between depression and medical diseases to further improve the effectiveness of case management. We analyzed the data of adults aged 20 years and older, who completed depression screening as a part of the National Health and Nutrition Examination Survey, 2005 to 2012. Depression was ascertained using the Patient Health Questionnaire, a 9-item screening instrument asking about the frequency of depression symptoms over the past 2 weeks. Comorbid diseases were assessed in a self-reported personal interview on doctor-diagnosed health conditions. The associations between depression and medical diseases were limited to the diseases with painful somatic symptoms. Reported from 19.78% of men and 27.84% of women, arthritis was the most prevalent chronic disease, and was the only one consistently associated with depression. The odds ratio of moderate to severe depression was 1.65 (95% confidence interval = 1.12-2.44) for men and 2.11 (1.63-2.99) for women with arthritis compared with their counterparts free of arthritis. Moderate/severe depression was associated with a history of heart disease among men (2.45 [1.19-5.06]) and angina/angina pectoris among women (2.13 [1.07-4.26]). No associations were found between depression and cancer/malignancy, either among men or women. The potential impact of pain management on depression prevention among general population is substantial; more efforts are needed to assess chronic pain to facilitate timely prevention and treatment of depression and comorbid medical conditions.

OBJECTIVE: To use novel geographic methods and large-scale claims data to identify the local distribution of pediatric chronic diseases in New York City. METHODS: Using a 2009 all-payer emergency claims database, we identified the proportion of unique children aged 0 to 17 with diagnosis codes for specific medical and psychiatric conditions. As a proof of concept, we compared these prevalence estimates to traditional health surveys and registry data using the most geographically granular data available. In addition, we used home addresses to map local variation in pediatric disease burden. RESULTS: We identified 549,547 New York City children who visited an emergency department at least once in 2009. Though our sample included more publicly insured and uninsured children, we found moderate to strong correlations of prevalence estimates when compared to health surveys and registry data at prespecified geographic levels. Strongest correlations were found for asthma and mental health conditions by county among younger children (0.88, P = .05 and 0.99, P < .01, respectively). Moderate correlations by neighborhood were identified for obesity and cancer (0.53 and 0.54, P < .01). Among adolescents, correlations by health districts were strong for obesity (0.95, P = .05), and depression estimates had a nonsignificant, but strong negative correlation with suicide attempts (-0.88, P = .12). Using SaTScan, we also identified local hot spots of pediatric chronic disease. CONCLUSIONS: For conditions easily identified in claims data, emergency department surveillance may help estimate pediatric chronic disease prevalence with higher geographic resolution. More studies are needed to investigate limitations of these methods and assess reliability of local disease estimates.