Faculty Bibliography

BACKGROUND: Opioid overdose deaths have reached epidemic proportions in the United States. This problem stems from both licit and illicit opioid use. Physicians play a role in prescribing opioids, recognizing risky use, and initiating prevention, including Opioid Overdose Prevention Training (OOPT). The American Heart Association (AHA) modified their basic life support (BLS) algorithms to consider naloxone in high risk populations and when a pulse is appreciated; however, the AHA did not provide OOPT. Our intervention filled this training deficiency by teaching medical students opioid overdose resuscitation with a Train-The-Trainer model as part of mandatory BLS training. METHODS: We introduced OOPT, following a Train-The-Trainer model, into the required Basic Life Support (BLS) training for first-year medical students at a single medical school in a large urban area. We administered pre- and post-evaluations to assess the effects of the training on opioid overdose knowledge, self-reported preparedness to respond to opioid overdoses, and attitudes towards patients with SUDS. RESULTS: In the fall 2014, 120 first-year medical students received OOPT. Seventy-three students completed both pre- and post-training evaluations. Improvements in knowledge about and preparedness to respond to opioid overdoses were statistically significant (p <.01) and large (Cohen's D = 2.70 and Cohen's D = 2.10 respectively). There was no statistically significant change in attitude toward patients with SUDs. CONCLUSIONS: We demonstrated the effectiveness of OOPT as an adjunct to BLS in increasing knowledge about and preparedness to respond to opioid overdoses; improving attitudes toward patients with SUDs likely requires additional intervention. We will characterize knowledge and preparedness durability, program sustainability, and long-term changes in attitudes in future evaluations. These results support dissemination of OOPT as a part of BLS training for all medical students, and potentially all BLS providers.

BACKGROUND: The adoption of Medicaid expansion in some states and not others provided a unique natural experiment to study the effects of Medicaid. Research stemming from this natural experiment suggests that Medicaid expansion increased health insurance coverage, improved access to care, and reduced cost-related barriers to prescription drugs among low income individuals. Findings with respect to health outcomes, however, have been more mixed. Therefore, we analyzed recently released national data from the Behavioral Risk Factor Surveillance System (BRFSS) to assess the relationship between Medicaid expansion and self-reported health measures among low-income individuals. METHODS: We used 2011-2015 BRFSS data, which provided 3 years of data prior to implementation of Medicaid expansion and 2 years of follow-up data in the majority of expansion states. Our study sample consisted of all individuals age 18-64 with household incomes below $15,000, targeting individuals who would have qualified for Medicaid coverage in expansion states. As in prior work, we excluded five states that had previously expanded Medicaid. Our outcomes were self-reported general health, poor physical health days, poor mental health days, and disability following Medicaid expansion. We used a difference-in-differences approach to estimate the effect of Medicaid expansion on our outcomes of interest. Our key independent variable was equal to 1 for individuals living in states where expansion was in effect during the month of their interview. Estimates were obtained with multivariable linear probability models and adjusted for age, race/ethnicity, sex, education, marital status, and children, as well as state-level and quarter year fixed effects. We used BRFSS sampling weights and estimated robust standard errors clustered at the state level to account for serial autocorrelation. RESULTS: In adjusted analyses of the influence of Medicaid expansion, we found that expansion was associated with a significant reduction in fair/poor self-rated health (2.5 percentage points [95% CI, -3.5 to -1.5]). While expansion was not associated with a statistically significant change in the number of poor physical health days (-0.20 days [95% CI, -0.68 to 0.28]), it was associated with a significant reduction in the number of poor mental health days (-0.52 days [95% CI, -0.99 to -0.04]). Change in disability prevalence did not vary between expansion and non-expansion states (P = 0.73). Adjusted linear time trends prior to expansion (2011 to 2013) for all outcomes were similar in expansion and non-expansion states (P > .05 for all comparisons). CONCLUSIONS: To our knowledge this is the first national study to report positives changes in self-reported general health following the ACA's Medicaid expansion provision, driven by changes in mental health. Whether these trends continue to improve will likely depend on whether policymakers choose to improve or repeal the ACA in the coming months

There is widespread agreement among scientists that climate change, primarily due to greenhouse gas (GHG) production from human activities, is causing significant global health impacts.The focus of this Pulmonary Perspective is to highlight emerging evidence for cardio-respiratory health impacts related to climate change, and to suggest possible strategies for individual and collective responses to this threat. Adaptation and mitigation strategies, along with co-benefits of these actions, are also discussed. The association between heat stress and cardiopulmonary mortality is well established. Hot and drier climates are associated with increased land degradation and desertification, impacting food production and particulate matter air pollution worldwide. Warmer temperatures also increase levels of ozone and combustion particles, and extend the growing season of allergenic plants and fungi. Extreme weather (e.g. hurricanes, cyclones and floods) cause acute injuries and associated mortality and morbidity, but also longer term impacts of increased gastro-intestinal illness, degraded housing, and increased levels of indoor microbial growth that can contribute to pulmonary disease. While these impacts are daunting, coping with climate change also offers opportunities for public health. Reductions in GHG emissions reduce other air pollutants. Climate-driven adaptation in our food and water distribution systems could lead to more equitable distribution of these eco-necessities. Improved urban design and transportation could improve physical activity levels and make today's urban environments more hospitable. The positive outcomes of California's multi-pronged climate change mitigation policies provide one example in which such strategies have limited GHG emissions, and shifted energy use to more sustainable sources.

BACKGROUND: A healthy lifestyle is associated with improved quality of life among cancer survivors, yet adherence to health behavior recommendations is low. OBJECTIVE: This pilot trial developed and tested the feasibility of a tailored eHealth program to increase fruit and vegetable consumption and physical activity among older, long-term cancer survivors. METHODS: American Cancer Society (ACS) guidelines for cancer survivors were translated into an interactive, tailored health behavior program on the basis of Social Cognitive Theory. Patients (N=86) with a history of breast (n=83) or prostate cancer (n=3) and less than 5 years from active treatment were randomized 1:1 to receive either provider advice, brief counseling, and the eHealth program (intervention) or advice and counseling alone (control). Primary outcomes were self-reported fruit and vegetable intake and physical activity. RESULTS: About half (52.7%, 86/163) of the eligible patients consented to participate. The most common refusal reasons were lack of perceived time for the study (32/163) and lack of interest in changing health behaviors (29/163). Furthermore, 72% (23/32) of the intervention group reported using the program and most would recommend it to others (56%, 14/25). Qualitative results indicated that the intervention was highly acceptable for survivors. For behavioral outcomes, the intervention group reported increased fruit and vegetable consumption. Self-reported physical activity declined in both groups. CONCLUSIONS: The brief intervention showed promising results for increasing fruit and vegetable intake. Results and participant feedback suggest that providing the intervention in a mobile format with greater frequency of contact and more indepth information would strengthen treatment effects.