Faculty Bibliography

BACKGROUND:Health and healthcare disparities for surgical patients with blindness and low vision (pBLV) stem from inaccessible healthcare systems that lack universal design principles or, at a minimum, reasonable accommodations (RA). OBJECTIVES/OBJECTIVE:We aimed to identify barriers to developing and implementing RAs in the surgical setting and provide a review of best practices for providing RAs. METHODS:We conducted a search of PubMed for evidence of reasonable accommodations, or lack thereof, in the surgical setting. Articles related to gaps and barriers to providing RAs for pBLV or best practices for supporting RAs were reviewed for the study. RESULTS:Barriers to the implementation of reasonable accommodations, and, accordingly, best practices for achieving equity for pBLV, relate to policies and systems, staff knowledge and attitudes, and materials and technology. CONCLUSIONS:These inequities for pBLV require comprehensive frameworks that offer, maintain, and support education about disability disparities and RAs in the surgical field. Providing RAs for surgical pBLV, and all patients with disabilities is an important and impactful step towards creating a more equitable and anti-ableist health system.

OBJECTIVE:To test the feasibility of implementing The Pittsburgh Study's (TPS) Early Childhood Collaborative, a population-level, community-partnered initiative to promote relational health by offering accessible preventive parenting program options for families with young children. STUDY DESIGN/METHODS:TPS partnered with healthcare and community agencies serving families in Allegheny County, Pennsylvania, to enroll and screen 878 parents of 1,040 children 4-years-old and under. Participants were assigned to one of four tiered groups based on identified needs: (1) universal, (2) targeted/universal, (3) secondary/tertiary, or (4) tertiary programs. Parents were offered choices in empirically supported parenting programs within group ranging from texting programs to intensive home visiting. Program selection was optional. Chi-square tests were conducted to examine the likelihood of selecting a program by group. RESULTS:About 25% of participants were assigned to each tiered group; 78% of parents chose to enroll in a parenting program. In general, parents with higher levels of adversity were more likely to select a parenting program compared with those reporting less adversity, including secondary/tertiary versus targeted/universal groups (81.4% vs. 72.8%), and tertiary versus universal and targeted/universal groups (83% vs. 74.1% and 72.8%, respectively; p < .001). CONCLUSION/CONCLUSIONS:Our high program enrollment rate supports the feasibility of TPS. TPS successfully engaged families in the study by offering choices in, and optimizing accessibility to, parenting programs. TPS is highly aligned with recent recommendations by the American Academy of Pediatrics for tiered approaches as part of a broad public health strategy for supporting early relational health.

OBJECTIVE:To identify primary care structures and processes that have the highest and lowest impact on chronic disease management and screening and prevention outcomes as well as to assess the feasibility of implementing these structures and processes into practice. DESIGN/METHODS:A two-round Delphi study was conducted to establish consensus on the impact and feasibility of 258 primary care structures and processes. PARTICIPANTS/METHODS:29 primary care providers, health system leaders and health services researchers in the USA. OUTCOMES/RESULTS:Primary outcomes were (1) consensus on the impact of each structure and process on chronic disease management and screening and prevention outcomes, separately and (2) consensus on feasibility of implementation by primary care practices. RESULTS:Consensus on high impact and feasibility of implementation was reached on four items for chronic disease management: 'Providers use motivational interviewing to help patients set goals', 'Practice has designated staff to manage patient panel', 'Practice has onsite providers or staff that speak the most dominant, non-English language spoken by patients' and 'Practice includes mental health providers and/or behavioural health specialists in care team' and seven items for screening and prevention: 'Practice utilizes standing protocols and orders', 'Practice generates reports to alert clinicians to missed targets and to identify gaps in care, such as overdue visits, needed vaccinations, screenings or other preventive services', 'Practice has designated staff to manage patient panel', 'Practice sets performance goals and uses benchmarking to track quality of care', 'Practice uses performance feedback to identify practice-specific areas of improvement', 'Practice builds quality improvement activities into practice operations' and 'Pre-visit planning data are reviewed during daily huddles'. Only 'Practice has designated staff to manage patient panel' appeared on both lists. CONCLUSION/CONCLUSIONS:Findings suggest that practices need to focus on implementing mostly distinct, rather than common, structures and processes to optimise chronic disease and preventive care.

INTRODUCTION/BACKGROUND:Bisphenols are endocrine-disrupting chemicals known to contribute to chronic disease across the lifespan. With increased awareness of their health effects, changes in regulation and health behaviors have contributed to reductions in urinary bisphenol A (BPA) levels in the United States, Canada, and Europe. However, global trends in bisphenols outside these regions, especially bisphenol S (BPS) exposure, have been less studied. AIM/OBJECTIVE:We examine trends in urinary BPA and BPS concentration in non-occupationally exposed populations, where representative data at a country level is unavailable. METHODS:index, and funnel plots. RESULTS:, 95% CI: [-0.50, -0.08], respectively). In the sensitivity analyses excluding studies with geometric or arithmetic mean values, each displayed significant shifts from the main findings with some consistent outcomes occurring internationally and/or in specific regions. Heterogeneity was high across studies, suggesting possible bias in our estimations. CONCLUSIONS:Our findings provide evidence for concern about increasing population exposure to BPA and BPS. Further studies estimating attributable disease burden and costs at regional and global levels are warranted to show these chemicals' impact on population health and economies.

OBJECTIVE:E-cigarette use is associated with subsequent cigarette smoking among youth. The current study examined the mediating role of social-cognitive factors in this association. METHODS:Data from four waves of the Population Assessment of Tobacco and Health study (2013/4 - 2017/8) were analyzed. Among youth who had heard about e-cigarettes at Wave 1 but never used cigarettes before Wave 2, we conducted both causal and traditional mediation analyses to examine the mediated effect of social-cognitive factors (including relative harm perception of e-cigarettes versus cigarettes, harm perception of e-cigarette use, perceptions of addictiveness of e-cigarette use, and e-cigarette use among best friends) in the association between e-cigarette use and subsequent cigarette ever or current smoking, adjusting for covariates. We included sampling weights in all analyses; hence, results are generalizable to the U.S. youth (12 - 14 years) from the 2013-2014 cohort. RESULTS:Results from causal mediation analyses indicated that the total effect of e-cigarette use, compared to no use, increased the risk of cigarette ever smoking (20.9 %) and current smoking (4.6 %). A portion of this effect (4.2 % - 15.1 % for ever smoking; less than 10.6 % for current smoking) can be attributed to changes in social-cognitive factors induced by e-cigarette use. However, these mediated effects were small in magnitude relative to their standard errors and not statistically significant. Results from the traditional mediation analyses largely aligned with these findings, except for a few small sized pathways. CONCLUSIONS:For the U.S. youth population, social-cognitive factors may only minimally or not at all mediate the association between e-cigarette use and subsequent cigarette smoking. Further investigation into the mediation role of social-cognitive factors is warranted. Tobacco control interventions that focus on cigarette smoking initiation among youth should target other mediating factors.

IMPORTANCE/UNASSIGNED:Health-related quality of life is a critical health outcome and a clinically important patient-reported outcome in clinical trials. Hearing loss is associated with poorer health-related quality-of-life in older adults. OBJECTIVE/UNASSIGNED:To investigate the 3-year outcomes of hearing intervention vs health education control on health-related quality of life. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This secondary analysis of a randomized clinical trial included participants treated for hearing loss at multiple US centers between 2018 and 2019 with 3-year follow-up completed in 2022. Eligible participants were aged 70 to 84 years, had untreated hearing loss, and were without substantial cognitive impairment. Participants were randomized (1:1) to hearing intervention or health education control and followed every 6 months. INTERVENTION/UNASSIGNED:Hearing intervention (provision of hearing aids and related technologies, counseling, education) or health education control (individual sessions covering topics relevant to chronic disease, disability prevention). MAIN OUTCOMES AND MEASURES/UNASSIGNED:Three-year change in the RAND-36 physical and mental health component scores over 3 years. The 8 individual domains of health-related quality-of-life were additionally assessed. Outcomes measured at baseline and at 6-month, 1-year, 2-year, and 3-year follow-ups. Intervention effect sizes estimated using a 2-level linear mixed effects model under the intention-to-treat principle. RESULTS/UNASSIGNED:A total of 977 participants were analyzed (mean [SD] age, 76.8 [4.0] years; 523 female [53.5%]; 112 Black [11.5%], 858 White [87.8%]; 521 had a Bachelor's degree or higher [53.4%]), with 490 in the hearing intervention and 487 in the control group. Over 3 years, hearing intervention (vs health education control) had no significant association with physical (intervention, -0.49 [95% CI, -3.05 to 2.08]; control, -0.92 [95% CI, -3.39 to 1.55]; difference, 0.43 [95% CI, -0.64 to 1.51]) or mental (intervention, 0.38 [95% CI, -1.58 to 2.34]; control, -0.09 [95% CI, -1.99 to 1.81]; difference, 0.47 [95% CI, -0.41 to 1.35]) health-related quality of life. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this secondary analysis of a randomized clinical trial, hearing intervention had no association with physical and mental health-related quality-of-life over 3 years among older adults with hearing loss. Additional intervention strategies may be needed to modify health-related quality among older adults with hearing loss. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT03243422.

BACKGROUND:Weight stigma is a fundamental cause of health inequality. Body positivity may be a counterbalance to weight stigma. Social media is replete with weight-stigmatizing content and is a driver of poor mental health outcomes; however, there remains a gap in understanding its potential to mitigate the prevalence and impact of harmful messaging and to promote positive effects on a large scale. OBJECTIVE:We selected musical artist Lizzo, whose brand emphasizes body positivity and empowerment, for an instrumental case study on the discourse on social media and specifically Instagram. We focused on 3 domains, including body positivity, physical health, and emotional well-being. These domains challenge social norms around weight and body size and have the potential to positively affect the physical and psychological health of people with diverse body sizes. METHODS:We evaluated posts by Lizzo, comments from Instagram users, and replies to comments over a 2-month period (October 11 to December 12, 2019). Two coders rated Lizzo's posts and Instagram users' comments for their sentiments on the 3 domains. Replies to Instagram users' comments were assessed for their reactions to comments (ie, did they oppose or argue against the comment or did they support or bolster the comment). Engagement metrics, including the number of "likes," were also collected. RESULTS:The final sample included 50 original posts by Lizzo, 250 comments from Instagram users, and 1099 replies to comments. A proportion of Lizzo's content included body positive sentiments (34%) and emotional well-being (18%); no posts dealt explicitly with physical health. A substantial amount Instagram users' comments and replies contained stigmatizing content including the use of nauseated and vomiting emojis, implications that Lizzo's body was shameful and should be hidden away, accusations that she was promoting obesity, and impeachments of Lizzo's health. In spite of the stigmatizing content, we also discovered content highlighting the beneficial nature of having positive representation of a Black woman living in a larger body who is thriving. Moreover, analysis of the discourse between users illustrated that stigmatizing expressions are being combated online, at least to some degree. CONCLUSIONS:This study demonstrates that Lizzo has exposed millions of social media users to messages about body positivity and provided more visibility for conversations about weight and shape. Future research should examine the extent to which body positive messages can lead to greater acceptance of individuals living in larger bodies. Instagram and other social media platforms should consider ways to reduce body-shaming content while finding ways to promote content that features diverse bodies. Shifting the landscape of social media could decrease stereotypes about weight and shape while increasing dialog about the need for greater acceptance and inclusion of people with diverse bodies.

BACKGROUND:Risk of early-stage lung adenocarcinoma (LUAD) recurrence after surgical resection is significant, and post-recurrence median survival is approximately two years. Currently there are no commercially available biomarkers that predict recurrence. Here, we investigated whether microbial and host genomic signatures in the lung can predict recurrence. METHODS:In 91 early-stage (Stage IA/IB) LUAD-patients with extensive follow-up, we used 16s rRNA gene sequencing and host RNA-sequencing to map the microbial and host transcriptomic landscape in tumor and adjacent unaffected lung samples. RESULTS:23 out of 91 subjects had tumor recurrence over 5-year period. In tumor samples, LUAD recurrence was associated with enrichment with Dialister, Prevotella, while in unaffected lung, recurrence was associated with enrichment with Sphyngomonas and Alloiococcus. The strengths of the associations between microbial and host genomic signatures with LUAD recurrence were greater in adjacent unaffected lung samples than in the primary tumor. Among microbial-host features in the unaffected lung samples associated with recurrence, enrichment with Stenotrophomonas geniculata and Chryseobacterium were positively correlated with upregulation of IL-2, IL-3, IL-17, EGFR, HIF-1 signaling pathways among the host transcriptome. In tumor samples, enrichment with Veillonellaceae Dialister, Ruminococcacea, Haemophilus Influenza, and Neisseria were positively correlated with upregulation of IL-1, IL-6, IL17, IFN, and Tryptophan metabolism pathways. CONCLUSIONS:Overall, modeling suggested that a combined microbial/transcriptome approach using unaffected lung samples had the best biomarker performance (AUC=0.83). IMPACT/CONCLUSIONS:This study suggests that LUAD recurrence is associated with distinct pathophysiological mechanisms of microbial-host interactions in the unaffected lung rather than those present in the resected tumor.

BACKGROUND:Fatigue is a common complaint among older adults with hearing loss. The impact of addressing hearing loss on fatigue symptoms has not been studied in a randomized controlled trial. In a secondary analysis of the ACHIEVE study, we investigated the effect of hearing intervention versus health education control on 3-year change in fatigue in community-dwelling older adults with hearing loss. METHODS:Participants aged 70-84 years old with untreated hearing loss recruited across 4 study sites in the United States (Forsyth County, NC; Jackson, MS; Minneapolis, MN; Washington County, MD) were randomized (1:1) to hearing intervention or health education control and followed for 3 years. Three-year change in fatigue symptoms was measured by 2 instruments (RAND-36 and PROMIS). We estimated the intervention effect as the difference in the 3-year change in fatigue between intervention and control groups using a linear mixed-effects model under the intention-to-treat principle. RESULTS:Participants (n=977) had a mean age (SD) of 76.8 (4.0) years, were 53.5% female and 87.8% White. Over 3 years, a beneficial effect of the hearing intervention versus health education control on fatigue was observed using the RAND-fatigue score (β= -0.12 [95% CI -0.22, -0.02]). Estimates also suggested beneficial effect of hearing intervention on fatigue when measured by the PROMIS fatigue score (β= -0.32 [95% CI -1.15, 0.51]). CONCLUSIONS:Our findings suggest that hearing intervention may reduce fatigue over 3 years among older adults with hearing loss.