Faculty Bibliography

BACKGROUND: Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs, but this region has limited access to mental health workers and resources to address these needs. Despite the successes of numerous school-based interventions for promoting child mental health, most evidence-based interventions are not available in SSA. This study will investigate the transportability of an evidence-based program from a developed country (United States) to a SSA country (Uganda). The approach includes task-shifting to early childhood teachers and consists of professional development (five days) to introduce strategies for effective behavior management and positive teacher-student interactions, and group-based consultation (14 sessions) to support adoption of effective practices and tailoring to meet the needs of individual students. METHODS/DESIGN: The design of this study is guided by two implementation frameworks, the Consolidated Framework for Implementation Research and the Teacher Training Implementation Model, that consider multidimensional aspects of intervention fidelity and contextual predictors that may influence implementation and teacher outcomes. Using a cluster randomized design, 10 schools in Uganda will be randomized to either the intervention group (five schools) or the waitlist control group (five schools). A total of 80 to 100 early childhood teachers will be enrolled in the study. Teacher utilization of evidence-based strategies and practices will be assessed at baseline, immediate post-intervention (six months after baseline), and at seven months post-intervention (during a new academic year). Fidelity measures will be assessed throughout the program implementation period (during professional development and consultation sessions). Individual teacher and contextual factors will be assessed at baseline. Data will be collected from multiple sources. Linear mixed-effect modeling, adjusting for school nesting, will be applied to address study questions. DISCUSSION: The study will produce important information regarding the value of an evidence-based early intervention, and a theory-guided implementation process and tools designed for use in implementing early childhood evidence-based programs in SSA countries or resource-constrained community settings. TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov (registration number: NCT097115) on 15 May 2013.

BACKGROUND: Although dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence. METHODS/DESIGN: Guided by a multi-level, conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery, the current protocol will use a cluster, randomized design and multiple data sources (patient exit interviews, provider surveys, site observations, chart audits, and semi-structured provider interviews) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City. The specific aims of this comparative-effectiveness research trial are to: compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines-staff training and current best practices (CBP), CBP + provider performance feedback (PF), and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay-for-performance, or P4P); examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The primary outcome is change in providers' tobacco treatment practices and the secondary outcomes are cost per quit, use of tobacco cessation treatments, quit attempts, and smoking abstinence. DISCUSSION: We hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies (CBP, PF, and P4P) will be superior to CBP alone and CBP + PF in improving delivery of cessation assistance to smokers. The findings will improve knowledge pertinent to the implementation, dissemination, and sustained utilization of evidence-based tobacco use treatment in dental practices. TRIAL REGISTRATION: NCT01615237.

The purpose of this study was to evaluate the feasibility of using global positioning system (GPS) methods to understand the spatial context of obesity and hypertension risk among a sample of low-income housing residents in New York City (n = 120). GPS feasibility among participants was measured with a pre- and post-survey as well as adherence to a protocol which included returning the GPS device as well as objective data analysed from the GPS devices. We also conducted qualitative interviews with 21 of the participants. Most of the sample was overweight (26.7%) or obese (40.0%). Almost one-third (30.8%) was pre-hypertensive and 39.2% was hypertensive. Participants reported high ratings of GPS acceptability, ease of use and low levels of wear-related concerns in addition to few concerns related to safety, loss or appearance, which were maintained after the baseline GPS feasibility data collection. Results show that GPS feasibility increased over time. The overall GPS return rate was 95.6%. Out of the total of 114 participants with GPS, 112 (98.2%) delivered at least one hour of GPS data for one day and 84 (73.7%) delivered at least one hour on 7 or more days. The qualitative interviews indicated that overall, participants enjoyed wearing the GPS devices, that they were easy to use and charge and that they generally forgot about the GPS device when wearing it daily. Findings demonstrate that GPS devices may be used in spatial epidemiology research in low-income and potentially other key vulnerable populations to understand geospatial determinants of obesity, hypertension and other diseases that these populations disproportionately experience.

Background: Type 2 myocardial infarction (MI) is defined as myocardial necrosis due to an imbalance in supply and demand. Clinical characteristics predisposing to Type 2 MI and medical therapy use remain uncertain. Methods: Charts of patients admitted to NYU Langone Medical Center in 2013 with a diagnosis of secondary myocardial ischemia (ICD9 411.89) or non-primary diagnosis of non-ST-elevation MI (ICD9 410.71) were retrospectively reviewed, following hospital standardization of acute MI ICD9 coding. Cases with suspected/confirmed Type 1 MI or without rise and fall of troponin were excluded. Results: Charts of 104 inpatients with Type 2 MI have been reviewed to date, with evaluation of additional cases ongoing. Conditions associated with and possibly provoking Type 2 MI included sepsis (defined as SIRS with an infectious source, 39%), surgery (37%), anemia (Hgb < 7 mg/dL), bleeding, or transfusion >1 PRBCs (34%), respiratory failure (28%), tachyarrhythmia (21%), hypotension (17%), hypertensive crisis (8%), and bradycardia (2%). Multiple provoking conditions were identified in 74% of cases. See Table for risk factors, procedure use and results and in-hospital outcomes. Inpatient mortality was 3%. Among 92 patients discharged alive and not to hospice, medical regimens included aspirin (65%), statin (66%), ACE inhibition (ACEi) (38%), and beta blocker (65%). Patients with a peak troponin >1.0 ng/mL (35%) were more likely to be discharged on aspirin (p=0.004) and beta-blocker (p=0.027), but not statin or ACEi. Conclusions: Type 2 MI occurs most frequently in the setting of sepsis, surgery, and/or anemia in patients with cardiovascular risk factors, but mechanisms of Type 2 MI remain poorly understood. Rates of outpatient antiplatelet and statin prescription are low at hospital discharge, reflecting physician uncertainty about the role of secondary prevention. Further research into mechanisms is needed to inform management of patients with Type 2 MI

Family and neighborhood influences related to low-income were examined to understand their association with harsh parenting among an ethnically diverse sample of families. Specifically, a path model linking household income to harsh parenting via neighborhood disorder, fear for safety, maternal depressive symptoms, and family conflict was evaluated using cross-sectional data from 2,132 families with children ages 5-16 years from Chicago. The sample was 42% Mexican American, 41% African American, and 17% European American. Results provide support for a family process model where a lower income-to-needs ratio is associated with higher reports of neighborhood disorder, greater fear for safety, and more family conflict, which is in turn, associated with greater frequency of harsh parenting. Our tests for moderation by ethnicity/immigrant status, child gender, and child age (younger child vs. adolescent) indicate that although paths are similar for families of boys and girls, as well as for families of young children and adolescents, there are some differences by ethnic group. Specifically, we find the path from neighborhood disorder to fear for safety is stronger for Mexican American (United States born and immigrant) and European American families in comparison with African American families. We also find that the path from fear for safety to harsh parenting is significant for European American and African American families only. Possible reasons for such moderated effects are considered. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

INTRODUCTION: There is epidemiological evidence that metal contaminants may play a role in the development of atherosclerosis and its complications. Moreover, a recent clinical trial of a metal chelator had a surprisingly positive result in reducing cardiovascular events in a secondary prevention population, strengthening the link between metal exposure and cardiovascular disease (CVD). This is, therefore, an opportune moment to review evidence that exposure to metal pollutants, such as arsenic, lead, cadmium, and mercury, is a significant risk factor for CVD. METHODS: We reviewed the English-speaking medical literature to assess and present the epidemiological evidence that 4 metals having no role in the human body (xenobiotic), mercury, lead, cadmium, and arsenic, have epidemiologic and mechanistic links to atherosclerosis and CVD. Moreover, we briefly review how the results of the Trial to Assess Chelation Therapy (TACT) strengthen the link between atherosclerosis and xenobiotic metal contamination in humans. CONCLUSIONS: There is strong evidence that xenobiotic metal contamination is linked to atherosclerotic disease and is a modifiable risk factor.

Asian American (ASA) children experience high rates of mental health problems. Although there is a pressing need to utilize population approaches, emerging frameworks from the fields of public and population health have not been applied to ASA children. This paper addresses this gap by first discussing applications of the National Prevention Strategy (NPS), a population strategy developed from the Social Determinants of Health perspective, to guide ASA prevention work. Next, we provide a practical example to illustrate how the NPS can be applied to prevention program design (using ParentCorps as an example) and dissemination and implementation processes to broadly address ASA children's mental health needs. Finally, we present preliminary data on the feasibility of applying this population strategy to ASA families and a framework for researchers who are considering disseminating and implementing evidence-based programs to ASA or ethnic minority pediatric populations.

New York City has a large number of individuals seeking asylem who are victims of torture. In addition to dental needs, which include cases of severe trauma to the mouth, these individuasl require special support because of their fear of contact by those they do not know. A cooperative program between the New York University College of Dentistry and Bellevue NYU, known as the Program for Survivors of Torture, is described.

This Commentary briefly reviews the background of prediabetes including its definition and pathophysiology and describes as well the natural course of glycemic deterioration as it follows a continuum. Research efforts in identifying glucose and other biomarkers for the early detection of high-risk individuals are summarized.