Faculty Bibliography

RATIONALE/BACKGROUND:) levels. OBJECTIVE:The study objective was to measure the acceptability of a new mind-body intervention we developed called Capnography-Assisted, Learned Monitored (CALM) Breathing, implemented before pulmonary rehabilitation. METHODS:biofeedback, and motivational interviewing. Using qualitative methods and semi-structured interviews immediately post-intervention, we evaluated the acceptability and participation process of CALM Breathing. Themes were identified using constant comparative analysis. RESULTS:Sixteen participants were interviewed after receiving CALM Breathing. Three main themes of CALM Breathing were identified: (1) Process of learning self-regulated breathing, (2) Mechanisms of a mind-body intervention, (3) Clinical and implementation outcomes. CONCLUSIONS:Positive themes supported the acceptability of CALM Breathing and described participants' process of learning more self-regulated breathing to manage their dyspnea and anxiety. Positive signals from qualitative participant feedback provided support for CALM Breathing as an intervention for COPD, but larger scale efficacy trials are needed.

BACKGROUND:, dyspnea, and inefficient recovery from breathing challenges. While pulmonary rehabilitation (PR) improves dyspnea, only 1-2% of patients access it. Individuals with anxiety who use PR have worse outcomes. METHODS:changes to dyspnea and anxiety symptoms and targeting breathing efficiency and self-efficacy in COPD. Participants are randomized to CALM Breathing or a Usual Care control group. RESULTS:Primary outcomes include feasibility and acceptability metrics of recruitment efficiency, participant retention, intervention adherence and fidelity, PR facilitation, patient satisfaction, and favorable themes from interviews. Secondary outcomes include breathing biomarkers, symptoms, health-related quality of life, six-minute walk distance, lung function, mood, physical activity, and PR utilization and engagement. CONCLUSION/CONCLUSIONS:By disrupting the cycle of dyspnea and anxiety, and providing a needed bridge to PR, CALM Breathing may address a substantive gap in healthcare and optimize treatment for patients with COPD.

The COVID-19 pandemic has been difficult for registered nurses. Media reports, most of them anecdotal, have reported upticks in nurse resignations, and plans to resign and/or leave nursing due to COVID-19. This article reports findings from an online anonymous 95-item survey completed by about 1,600 nurses from a New York City metropolitan area health system's (HS) four hospitals and ambulatory care centers about their COVID-19 experience in the spring of 2020, their intent to stay at the HS, and their intent to stay working as a nurse. Conducted early in the pandemic, this survey addresses a major gap in the literature, as there was no timely evaluation of nurses' intent to leave during the "Great Attrition" wave or to stay during the "Great Attraction" trend. Among those nurses completing the survey, 85.7% reported that they planned to work as a nurse one year later and 77.9% reported that they planned to work at the HS one year later. Those nurses who obtained a master's or doctoral degree as their first professional degree in nursing, or had a high level of mastery, were less likely to report an intent to stay at the HS. Those with no children, those who thought the HS was more supportive, and those who thought that registered nurse-medical doctor relations were higher were more likely to intend to stay at the HS. Those nurses who reported worse communication with their nurse manager were less likely to report an intent to stay in nursing. Those who reported lower stress, who were unmarried and had no children were more likely to intend to work as nurses. Our findings on nurses' intent to leave their organization and their intent to leave nursing are much lower than reports in the popular press. Our data were collected early in the pandemic and it may not reflect the accumulated stress nurses experienced from witnessing the death of so many patients.

OBJECTIVES/OBJECTIVE:This study aims to enhance the understanding of longitudinal associations between two important facets of well-being in late life: social support and commitment to life and living (CTL). METHODS:Structured home interviews were conducted with 824 Israelis ≥75 years of age, with three annual data collection timepoints. We hypothesized and tested a cross-lagged, longitudinal structural equation model (SEM) in which CTL and social support were assumed to predict each other over time, covarying for previously reported CTL and social support. RESULTS:Social support has a positive, contemporaneous effect, predicting commitment to living at T1 and T3, while CTL predicts social support the following year (i.e., T1-T2 & T2-T3). Satisfaction with relationships significantly contributes to measurement of both latent constructs at each point of data collection. DISCUSSION/CONCLUSIONS:Commitment to life and living and social support are intertwined phenomena. Whereas social support has a concomitant effect on CTL, the effect of CTL on social support emerges over time. This suggests that greater social support fosters greater CTL, leading older adults to nurture social networks and relationships; the effect of which is greater social support in the future. The implications of these results warrant further research over longer periods and across cultures.

We examine the efficacy of MARHABA, a social marketing-informed, lay health worker (LHW) intervention with patient navigation (PN), to increase breast and cervical cancer screening among Muslim women in New York City. Muslim women were eligible if they were overdue for a mammogram and/or a Pap test. All participants attended a 1-h educational seminar with distribution of small media health education materials, after which randomization occurred. Women in the Education + Media + PN arm received planned follow-ups from a LHW. Women in the Education + Media arm received no further contact. A total of 428 women were randomized into the intervention (214 into each arm). Between baseline and 4-month follow-up, mammogram screening increased from 16.0 to 49.0% in the Education + Media + PN arm (p < 0.001), and from 14.7 to 44.6% in the Education + Media arm (p < 0.001). Pap test screening increased from 16.9 to 42.3% in the Education + Media + PN arm (p < 0.001) and from 17.3 to 37.1% in the Education + Media arm (p < 0.001). Cancer screening knowledge increased in both groups. Between group differences were not statistically significant for screening and knowledge outcomes. A longer follow-up period may have resulted in a greater proportion of up-to-date screenings, given that many women had not yet received their scheduled screenings. Findings suggest that the educational session and small media materials were perhaps sufficient to increase breast and cervical cancer screening among Muslim American women. ClinicalTrials.gov NCT03081507.

Purpose: Silver diamine fluoride (SDF) is used as a caries management agent for the arrest of dentinal caries lesions. The purpose of this study was to evaluate the satisfaction with SDF treatment provided at a university pediatric dentistry clinic, and to identify factors that may contribute to parental dissatisfaction. Methods: We obtained retrospective data of children who received SDF treatment at our clinic from February 1st, 2019 to February 28th, 2021. Parents were contacted by phone to participate in a survey that evaluated their satisfaction with the treatment. Satisfaction was evaluated as a function of medical status, ease of treatment, outcome of SDF treatment, esthetics, and understanding of the treatment's goals and side effects using contingency tables and chi-square statistics. Results: From 209 children who received SDF treatment, we were able to contact 91 parents by telephone, and 79 agreed to participate. Special healthcare needs (SHCN) patients were over represented in our sample, comprising 22.3% of all treated and 36.7% of participants. More than 90% were satisfied with the treatment, would do it again and would recommend it to others. Among the 49 children who complained of pain, SDF treatment resolved 82% of these complaints. In the subsample with follow-up in our clinic, approximately half of the treated teeth later received restorative treatment or were extracted, and the other half presented without further treatment. Some children received further treatment elsewhere. Parental dissatisfaction was related to staining of the anterior teeth (p = 0.04), the need for further treatment (p = 0.02) and a lesser understanding of side effects (p = 0.002). Conclusion: Most parents were satisfied with SDF therapy as a dental treatment choice due to its easy application and desensitizing effects. Our findings indicate that parental understanding of the interim nature of the treatment and staining of the lesions are important to achieve parental satisfaction.

Social support functions as an effective buffer against depression, especially among older adults with limited social networks. For the current study, we examined longitudinal bidirectional associations between social support and depression among those 75+ years of age. We recruited and followed a sample of Israeli adults 75+ years of age (N = 824; M = 80.84; range 75-96 years). Structured interviews were conducted in the homes of participants at three annual points of measurement. Participants reported depressive symptoms and emotional and instrumental support received from friends and family. We examined a cross-lagged, longitudinal structural equation model (SEM) in which social support and depressive symptoms predict each other over time, covarying for previously reported social support and depressive symptoms. We found that both depressive symptoms and social support are largely consistent in late life. Depressive symptoms and social support reported at baseline predict levels reported 1 and 2 years thereafter. Cross-over effects emerged over time. Depressive symptoms predicted lower social support in future, and social support at baseline predicted depressive symptoms 2 years later. These findings suggest that associations between depressive symptoms and social support are bidirectional in late life. Further research is needed to replicate findings in other cultures and over longer periods, ideally until end of life.

Despite improvements in colorectal cancer (CRC) screening in New York City (NYC) since the early 2000s, the degree to which disparities persist for specific Asian American subgroups has yet to be fully elucidated. The purpose of this study is to examine disparities in rates of timely colonoscopy screening among five racial/ethnic groups in NYC. We performed a retrospective cross-sectional analysis of combined 2014-2018 NYC Community Health Survey data. Prevalence estimates of timely colonoscopy screening (within the past 10 years) among individuals ≥ 50 years of age were calculated and presented overall (n = 24,288) and by socio-demographic variables. Racial/ethnic categories included White, Black, Hispanic, East Asian, and South Asian. Multivariable models examined socio-demographic and racial/ethnic predictors of timely colonoscopy screening. A trend analysis examined colonoscopy screening by race/ethnicity and year from 2012 to 2018 (n = 33,130). Age-adjusted prevalence of timely colonoscopy screening was lowest among Asian Americans (South Asian 61.1% and East Asian 65.9%) compared to Hispanics (71.3%), Blacks (70.2%), and Whites (68.6%). Adjustment by socio-demographics, including insurance status, further explained disparities for South Asians (adjusted risk ratio [RR] = 0.84, 95% CI = 0.73-0.97) compared to Hispanics; additionally, Whites (adjusted RR=0.88, 95% CI = 0.84-0.92) were less likely to have received a timely colonoscopy compared to Hispanics. Age, health insurance, poverty group, and education were significant predictors in adjusted regression. Results indicate that South Asians have not equally benefited from campaigns to increase colonoscopy screening in NYC. Our findings support the development of targeted, and linguistically and culturally adapted campaigns that facilitate access to health systems and leverage existing community assets and social support systems among South Asian populations.

BACKGROUND:We sought to understand the impacts of religion-related factors, namely perceived discrimination and spiritual health locus of control, on breast and cervical cancer screening for Muslim American women. METHODS:A total of 421 Muslim American women were surveyed at baseline of a breast and cervical cancer screening intervention, measuring discrimination through the Perceived Ethnic Discrimination Questionnaire (PED-Q), a 17-item scale measuring perceived interpersonal racial/ethnic discrimination; and spiritual beliefs through the Spiritual Health Locus of Control Scale, a 13-item scale measuring the link between control over one's health with a connection to religious beliefs. Multivariable logistic regression models were used to determine factors associated with an up-to-date mammogram and Pap test. RESULTS:Most women preferred to receive medical care from a healthcare provider of their same gender (75.2%) and same race, ethnicity or religion (62.1%). The middle age group (50-59) and a lower God's Grace Spiritual Health Locus of Control subscale were associated with up-to-date mammogram. Younger age, lower education, higher Exclusion/Rejection subscale, and lower Spiritual Life/Faith Subscale were associated with an up-to-date Pap test. CONCLUSION/CONCLUSIONS:The spiritual beliefs of Muslim American women impact their likelihood of obtaining breast and cervical cancer screenings. Therefore, these services need to be better tailored to match these needs, for example, by ensuring that Muslim American women have access to healthcare providers of their same gender, race, ethnicity or religion.