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Fa-Kaji NM, Silver ER, Hebl MR, King DD, King EB, Corrington A, Bilotta I. Worrying About Finances During COVID-19: Resiliency Enhances the Effect of Worrying on Both Proactive Behavior and Stress. Occup Health Sci 2022; 7:111-142. [PMID: 36531668 PMCID: PMC9734500 DOI: 10.1007/s41542-022-00130-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022]
Abstract
Amidst the COVID-19 pandemic and resulting economic instability, many people are contending with financial insecurity. Guided by Conservation of Resources Theory (Hobfoll, American Psychologist 44:513-524, 1989; Hobfoll et al., Annual Review of Organizational Psychology and Organizational Behavior 5:103-128, 2018), the current research explores the consequences of experiencing financial insecurity during a pandemic, with a focus on individuals who report relatively higher rates of financial insecurity, performance challenges, and stress during such experiences: working parents (American Psychological Association, 2022). This research also examines the role that personal resources, in the form of trait resiliency, play in the relationships between financial insecurity and behavioral and psychological outcomes including worrying, proactive behaviors, and stress. In a study of 636 working parents and their children, we find that financial insecurity heightens worrying, underscoring the threatening nature of the loss or anticipated loss of material resources. Worrying, in turn, promotes proactive behaviors at work-an effect that is more pronounced among high-resiliency individuals. However, worrying is also associated with elevated stress among high-resiliency individuals, providing support for a trait activation perspective (rather than buffering hypotheses) on ongoing, uncontrollable adversities. Taken together, our results help to (1) illuminate the impact of financial insecurity on work and well-being, (2) reveal a mechanism (i.e., worrying) that helps explain the links between financial insecurity and work and personal outcomes, and (3) expand our knowledge of the implications trait resiliency has for both psychological and behavioral reactions to ongoing crises.
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Affiliation(s)
- Naomi M. Fa-Kaji
- Department of Psychological Sciences, Rice University, 6100 Main St., Houston, TX 77005 USA
| | - Elisabeth R. Silver
- Department of Psychological Sciences, Rice University, 6100 Main St., Houston, TX 77005 USA
| | - Mikki R. Hebl
- Department of Psychological Sciences, Rice University, 6100 Main St., Houston, TX 77005 USA
| | - Danielle D. King
- Department of Psychological Sciences, Rice University, 6100 Main St., Houston, TX 77005 USA
| | - Eden B. King
- Department of Psychological Sciences, Rice University, 6100 Main St., Houston, TX 77005 USA
| | - Abby Corrington
- Department of Management, Providence College School of Business, Providence, RI USA
| | - Isabel Bilotta
- Department of Psychological Sciences, Rice University, 6100 Main St., Houston, TX 77005 USA
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Laszkowska M, Kim J, Faye AS, Joelson AM, Ingram M, Truong H, Silver ER, May B, Greendyke WG, Zucker J, Lebwohl B, Hur C, Freedberg DE. Prevalence of Clostridioides difficile and Other Gastrointestinal Pathogens in Patients with COVID-19. Dig Dis Sci 2021; 66:4398-4405. [PMID: 33479861 PMCID: PMC7819769 DOI: 10.1007/s10620-020-06760-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Gastrointestinal symptoms are common in patients with COVID-19, but prevalence of co-infection with enteric pathogens is unknown. AIMS This study assessed the prevalence of enteric infections among hospitalized patients with COVID-19. METHODS We evaluated 4973 hospitalized patients ≥ 18 years of age tested for COVID-19 from March 11 through April 28, 2020, at two academic hospitals. The primary exposure was a positive COVID-19 test. The primary outcome was detection of a gastrointestinal pathogen by PCR stool testing. RESULTS Among 4973 hospitalized individuals, 311 were tested for gastrointestinal infections (204 COVID-19 positive, 107 COVID-19 negative). Patients with COVID-19 were less likely to test positive compared to patients without COVID-19 (10% vs 22%, p < 0.01). This trend was driven by lower rates of non-C.difficile infections (11% vs 22% in COVID-19 positive vs. negative, respectively, p = 0.04), but not C. difficile infection (5.1% vs. 8.2%, p = 0.33). On multivariable analysis, infection with COVID-19 remained significantly associated with lower odds of concurrent GI infection (aOR 0.49, 95% CI 0.24-0.97), again driven by reduced non-C.difficile infection. Testing for both C.difficile and non-C.difficile enteric infection decreased dramatically during the pandemic. CONCLUSIONS Pathogens aside from C.difficile do not appear to be a significant contributor to diarrhea in COVID-19 positive patients.
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Affiliation(s)
- Monika Laszkowska
- Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, NY, USA.
- Department of Medicine, Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Judith Kim
- Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Adam S Faye
- Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, NY, USA
- Department of Medicine, Henry D. Janowitz Division of Gastroenterology, Mount Sinai Hospital, New York, NY, USA
| | - Andrew M Joelson
- Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Myles Ingram
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Han Truong
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Elisabeth R Silver
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Benjamin May
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - William G Greendyke
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Jason Zucker
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Benjamin Lebwohl
- Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Chin Hur
- Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, NY, USA
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel E Freedberg
- Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, NY, USA
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Wright JD, Silver ER, Tan SX, Hur C, Kastrinos F. Cost-effectiveness Analysis of Genotype-Specific Surveillance and Preventive Strategies for Gynecologic Cancers Among Women With Lynch Syndrome. JAMA Netw Open 2021; 4:e2123616. [PMID: 34499134 PMCID: PMC8430458 DOI: 10.1001/jamanetworkopen.2021.23616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE With the expansion of multigene testing for cancer susceptibility, Lynch syndrome (LS) has become more readily identified among women. The condition is caused by germline pathogenic variants in DNA mismatch repair genes (ie, MLH1, MSH2, MSH6, and PMS2) and is associated with high but variable risks of endometrial and ovarian cancers based on genotype. However, current guidelines on preventive strategies are not specific to genotypes. OBJECTIVE To assess the cost-effectiveness of genotype-specific surveillance and preventive strategies for LS-associated gynecologic cancers, including a novel, risk-reducing surgical approach associated with decreased early surgically induced menopause. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation developed a cohort-level Markov simulation model of the natural history of LS-associated gynecologic cancer for each gene, among women from ages 25 to 75 years or until death from a health care perspective. Age was varied at hysterectomy and bilateral salpingo-oophorectomy (hyst-BSO) and at surveillance initiation, and a 2-stage surgical approach (ie, hysterectomy and salpingectomy at age 40 years and delayed oophorectomy at age 50 years [hyst-BS]) was included. Extensive 1-way and probabilistic sensitivity analyses were performed. INTERVENTIONS Hyst-BSO at ages 35 years, 40 years, or 50 years with or without annual surveillance beginning at age 30 years or 35 years or hyst-BS at age 40 years with oophorectomy delayed until age 50 years. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio (ICER) between management strategies within an efficiency frontier. RESULTS For women with MLH1 and MSH6 variants, the optimal strategy was the 2-stage approach, with respective ICERs of $33 269 and $20 008 compared with hyst-BSO at age 40 years. Despite being cost-effective, the 2-stage approach was associated with increased cancer incidence and mortality compared with hyst-BSO at age 40 years for individuals with MLH1 variants (incidence: 7.76% vs 3.84%; mortality: 5.74% vs 2.55%) and those with MSH6 variants (incidence: 7.24% vs 4.52%; mortality: 5.22% vs 2.97%). Hyst-BSO at age 40 years was optimal for individuals with MSH2 variants, with an ICER of $5180 compared with hyst-BSO at age 35 years, and was associated with 4.42% cancer incidence and 2.97% cancer mortality. For individuals with PMS2 variants, hyst-BSO at age 50 years was optimal and all other strategies were dominated; hyst-BSO at age 50 years was associated with an estimated cancer incidence of 0.68% and cancer mortality of 0.29%. CONCLUSIONS AND RELEVANCE These findings suggest that gene-specific preventive strategies for gynecologic cancers in LS may be warranted and support hyst-BSO at age 40 years for individuals with MSH2 variants. For individuals with MLH1 and MSH6 variants, these findings suggest that a novel 2-stage surgical approach with delayed oophorectomy may be an alternative to hyst-BSO at age 40 years to avoid early menopause, and for individuals with PMS2 variants, the findings suggest that hyst-BSO may be delayed until age 50 years.
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Affiliation(s)
- Jason D. Wright
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- NewYork-Presbyterian Hospital, New York, New York
| | - Elisabeth R. Silver
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sarah Xinhui Tan
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Chin Hur
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- NewYork-Presbyterian Hospital, New York, New York
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Fay Kastrinos
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- NewYork-Presbyterian Hospital, New York, New York
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Kastrinos F, Ingram MA, Silver ER, Oh A, Laszkowska M, Rustgi AK, Hur C. Gene-Specific Variation in Colorectal Cancer Surveillance Strategies for Lynch Syndrome. Gastroenterology 2021; 161:453-462.e15. [PMID: 33839100 PMCID: PMC9330543 DOI: 10.1053/j.gastro.2021.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Lynch syndrome is associated with pathogenic variants in 4 mismatch repair (MMR) genes that increase lifetime risk of colorectal cancer. Guidelines recommend intensive colorectal cancer surveillance with colonoscopy every 1-2 years starting at age 25 years for all carriers of Lynch syndrome-associated variants, regardless of gene product. We constructed a simulation model to analyze the effects of different ages of colonoscopy initiation and surveillance intervals for each MMR gene (MLH1, MSH2, MSH6, and PMS2) on colorectal cancer incidence and mortality, quality-adjusted life-years, and cost. METHODS Using published literature, we developed a Markov simulation model of Lynch syndrome progression for patients with each MMR variant. The model simulated clinical trials of Lynch syndrome carriers, varying age of colonoscopy initiation (5-year increments from 25-40 years), and surveillance intervals (1-5 years). We assessed the optimal strategy for each gene, defined as the strategy with the highest quality-adjusted life-years and incremental cost-effectiveness ratio below a $100,000 willingness-to-pay threshold. RESULTS Optimal surveillance for patients with pathogenic variants in the MLH1 and MSH2 genes was colonoscopy starting at age 25 years, with 1- to 2-year surveillance intervals. Initiating colonoscopy at age 35 and 40 years, with 3-year intervals, was cost-effective for patients with pathogenic variants in MSH6 or PMS2, respectively. CONCLUSIONS We developed a simulation model to select optimal surveillance starting ages and intervals for patients with Lynch syndrome based on MMR variant. The model supports recommendations for intensive surveillance of patients with Lynch syndrome-associated variants in MLH1 or MSH2. However, for patients with Lynch syndrome-associated variants of MSH6 or PMS2, later initiation of surveillance at 35 and 40 years, respectively, and at 3-year intervals, can be considered.
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Affiliation(s)
- Fay Kastrinos
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York; Division of Digestive and Liver Diseases, Columbia University Irving Medical Cancer and Vagelos College of Physicians and Surgeons, New York, New York.
| | - Myles A. Ingram
- Division of General Medicine, Columbia University Irving Medical Cancer and the Vagelos College of Physicians and Surgeons, New York, New York
| | - Elisabeth R. Silver
- Division of General Medicine, Columbia University Irving Medical Cancer and the Vagelos College of Physicians and Surgeons, New York, New York
| | - Aaron Oh
- Division of General Medicine, Columbia University Irving Medical Cancer and the Vagelos College of Physicians and Surgeons, New York, New York
| | - Monika Laszkowska
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York,Division of Digestive and Liver Diseases, Columbia University Irving Medical Cancer and the Vagelos College of Physicians and Surgeons, New York, New York
| | - Anil K. Rustgi
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York,Division of Digestive and Liver Diseases, Columbia University Irving Medical Cancer and the Vagelos College of Physicians and Surgeons, New York, New York
| | - Chin Hur
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York,Division of Digestive and Liver Diseases, Columbia University Irving Medical Cancer and the Vagelos College of Physicians and Surgeons, New York, New York,Division of General Medicine, Columbia University Irving Medical Cancer and the Vagelos College of Physicians and Surgeons, New York, New York
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Lauren BN, Silver ER, Faye AS, Rogers AM, Woo-Baidal JA, Ozanne EM, Hur C. Predictors of households at risk for food insecurity in the United States during the COVID-19 pandemic. Public Health Nutr 2021; 24:3929-3936. [PMID: 33500018 PMCID: PMC8207551 DOI: 10.1017/s1368980021000355] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 01/04/2021] [Accepted: 01/20/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine associations between sociodemographic and mental health characteristics with household risk for food insecurity during the COVID-19 outbreak. DESIGN Cross-sectional online survey analysed using univariable tests and a multivariable logistic regression model. SETTING The United States during the week of 30 March 2020. PARTICIPANTS A convenience sample of 1965 American adults using Amazon's Mechanical Turk platform. Participants reporting household food insecurity prior to the pandemic were excluded from analyses. RESULTS One thousand two hundred and fifty participants reported household food security before the COVID-19 outbreak. Among this subset, 41 % were identified as at risk for food insecurity after COVID-19, 55 % were women and 73 % were white. On a multivariable analysis, race, income, relationship status, living situation, anxiety and depression were significantly associated with an incident risk for food insecurity. Black, Asian and Hispanic/Latino respondents, respondents with an annual income <$100 000 and those living with children or others were significantly more likely to be newly at risk for food insecurity. Individuals at risk for food insecurity were 2·60 (95 % CI 1·91, 3·55) times more likely to screen positively for anxiety and 1·71 (95 % CI 1·21, 2·42) times more likely to screen positively for depression. CONCLUSIONS An increased risk for food insecurity during the COVID-19 pandemic is common, and certain populations are particularly vulnerable. There are strong associations between being at risk for food insecurity and anxiety/depression. Interventions to increase access to healthful foods, especially among minority and low-income individuals, and ease the socioemotional effects of the outbreak are crucial to relieving the economic stress of this pandemic.
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Affiliation(s)
- Brianna N Lauren
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, 622 W 168th St, PH9E-105, New York, NY10032, USA
| | - Elisabeth R Silver
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, 622 W 168th St, PH9E-105, New York, NY10032, USA
| | - Adam S Faye
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexandra M Rogers
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, 622 W 168th St, PH9E-105, New York, NY10032, USA
| | - Jennifer A Woo-Baidal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Elissa M Ozanne
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake, UT, USA
| | - Chin Hur
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, 622 W 168th St, PH9E-105, New York, NY10032, USA
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
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Laszkowska M, Faye AS, Kim J, Truong H, Silver ER, Ingram M, May B, Ascherman B, Bartram L, Zucker J, Sobieszczyk ME, Abrams JA, Lebwohl B, Freedberg DE, Hur C. Disease Course and Outcomes of COVID-19 Among Hospitalized Patients With Gastrointestinal Manifestations. Clin Gastroenterol Hepatol 2021; 19:1402-1409.e1. [PMID: 33007514 PMCID: PMC7525451 DOI: 10.1016/j.cgh.2020.09.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/12/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Our understanding of outcomes and disease time course of COVID-19 in patients with gastrointestinal (GI) symptoms remains limited. In this study we characterize the disease course and severity of COVID-19 among hospitalized patients with gastrointestinal manifestations in a large, diverse cohort from the Unites States. METHODS This retrospective study evaluated hospitalized individuals with COVID-19 between March 11 and April 28, 2020 at two affiliated hospitals in New York City. We evaluated the association between GI symptoms and death, and also explored disease duration, from symptom onset to death or discharge. RESULTS Of 2804 patients hospitalized with COVID-19, the 1,084 (38.7%) patients with GI symptoms were younger (aOR for age ≥75, 0.59; 95% CI, 0.45-0.77) and had more co-morbidities (aOR for modified Charlson comorbidity score ≥2, 1.22; 95% CI, 1.01-1.48) compared to those without GI symptoms. Individuals with GI symptoms had better outcomes, with a lower likelihood of intubation (aHR, 0.66; 95% CI, 0.55-0.79) and death (aHR, 0.71; 95% CI, 0.59-0.87), after adjusting for clinical factors. These patients had a longer median disease course from symptom onset to discharge (13.8 vs 10.8 days, log-rank p = .048; among 769 survivors with available symptom onset time), which was driven by longer time from symptom onset to hospitalization (7.4 vs 5.4 days, log-rank P < .01). CONCLUSION Hospitalized patients with GI manifestations of COVID-19 have a reduced risk of intubation and death, but may have a longer overall disease course driven by duration of symptoms prior to hospitalization.
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Affiliation(s)
- Monika Laszkowska
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York; Department of Subspecialty Medicine, Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Adam S Faye
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York; Department of Medicine, Henry D. Janowitz Division of Gastroenterology, Mount Sinai Hospital, New York, New York
| | - Judith Kim
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Han Truong
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Elisabeth R Silver
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Myles Ingram
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Benjamin May
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Benjamin Ascherman
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Logan Bartram
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Magdalena E Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Julian A Abrams
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Benjamin Lebwohl
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Daniel E Freedberg
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Chin Hur
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York; Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
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Silver ER, Truong HQ, Ostvar S, Hur C, Tatonetti NP. Association of Neighborhood Deprivation Index With Success in Cancer Care Crowdfunding. JAMA Netw Open 2020; 3:e2026946. [PMID: 33270122 PMCID: PMC7716189 DOI: 10.1001/jamanetworkopen.2020.26946] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/25/2020] [Indexed: 01/16/2023] Open
Abstract
Importance Financial toxicity resulting from cancer care poses a substantial public health concern, leading some patients to turn to online crowdfunding. However, the practice may exacerbate existing socioeconomic cancer disparities by privileging those with access to interpersonal wealth and digital media literacy. Objective To test the hypotheses that higher county-level socioeconomic status and the presence (vs absence) of text indicators of beneficiary worth in campaign descriptions are associated with amount raised from cancer crowdfunding. Design, Setting, and Participants This cross-sectional analysis examined US cancer crowdfunding campaigns conducted between 2010 and 2019 and data from the American Community Survey (2013-2017). Data analysis was performed from December 2019 to March 2020. Exposures Neighborhood deprivation index of campaign location and campaign text features indicating the beneficiary's worth. Main Outcomes and Measures Amount of money raised. Results This study analyzed 144 061 US cancer crowdfunding campaigns. Campaigns in counties with higher neighborhood deprivation raised less (-26.07%; 95% CI, -27.46% to -24.65%; P < .001) than those in counties with less neighborhood deprivation. Campaigns raised more funds when legitimizing details were provided, including clinical details about the cancer type (9.58%; 95% CI, 8.00% to 11.18%; P < .001) and treatment type (6.58%; 95% CI, 5.44% to 7.79%; P < .001) and financial details, such as insurance status (1.39%; 95% CI, 0.20% to 2.63%; P = .02) and out-of-pocket costs (7.36%; 95% CI, 6.18% to 8.55%; P < .001). Campaigns raised more money when beneficiaries were described as warm (13.80%; 95% CI, 12.30% to 15.26%; P < .001), brave (15.40%; 95% CI, 14.11% to 16.65%; P < .001), or self-reliant (5.23%; 95% CI, 3.77% to 6.72%; P < .001). Conclusions and Relevance These findings suggest that cancer crowdfunding success ay disproportionately benefit those in high-socioeconomic status areas and those with the internet literacy necessary to portray beneficiaries as worthy. By rewarding those with existing socioeconomic advantage, cancer crowdfunding may perpetuate socioeconomic disparities in cancer care access. The findings also underscore the widespread nature of financial toxicity resulting from cancer care.
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Affiliation(s)
- Elisabeth R. Silver
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Han Q. Truong
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sassan Ostvar
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Chin Hur
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Nicholas P. Tatonetti
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
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Spurlin EE, Han ES, Silver ER, May BL, Tatonetti NP, Ingram MA, Jin Z, Hur C, Advincula AP, Hur HC. Where Have All the Emergencies Gone? The Impact of the COVID-19 Pandemic on Obstetric and Gynecologic Procedures and Consults at a New York City Hospital. J Minim Invasive Gynecol 2020; 28:1411-1419.e1. [PMID: 33248312 PMCID: PMC7688419 DOI: 10.1016/j.jmig.2020.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022]
Abstract
Study Objective The purpose of this study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on surgical volume and emergency department (ED) consults across obstetrics-gynecology (OB-GYN) services at a New York City hospital. Design Retrospective cohort study. Setting Tertiary care academic medical center in New York City. Patients Women undergoing OB-GYN ED consults or surgeries between February 1, 2020 and April 15, 2020. Interventions March 16 institutional moratorium on elective surgeries. Measurements and Main Results The volume and types of surgeries and ED consults were compared before and after the COVID-19 moratorium. During the pandemic, the average weekly volume of ED consults and gynecology (GYN) surgeries decreased, whereas obstetric (OB) surgeries remained stable. The proportions of OB-GYN ED consults, GYN surgeries, and OB surgeries relative to all ED consults, all surgeries, and all labor and delivery patients were 1.87%, 13.8%, 54.6% in the pre–COVID-19 time frame (February 1–March 15) vs 1.53%, 21.3%, 79.7% in the COVID-19 time frame (March 16–April 15), representing no significant difference in proportions of OB-GYN ED consults (p = .464) and GYN surgeries (p = .310) before and during COVID-19, with a proportionate increase in OB surgeries (p <.002). The distribution of GYN surgical case types changed significantly during the pandemic with higher proportions of emergent surgeries for ectopic pregnancies, miscarriages, and concern for cancer (p <.001). Alternatively, the OB surgery distribution of case types remained relatively constant. Conclusion This study highlights how the pandemic has affected the ways that patients in OB-GYN access and receive care. Institutional policies suspending elective surgeries during the pandemic decreased GYN surgical volume and affected the types of cases performed. This decrease was not appreciated for OB surgical volume, reflecting the nonelective and time-sensitive nature of obstetric care. A decrease in ED consults was noted during the pandemic begging the question “Where have all the emergencies gone?” Although the moratorium on elective procedures was necessary, “elective” GYN surgeries remain medically indicated to address symptoms such as pain and bleeding and to prevent serious medical sequelae such as severe anemia requiring transfusion. As we continue to battle COVID-19, we must not lose sight of those patients whose care has been deferred.
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Affiliation(s)
- Emily E Spurlin
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, (Dr. Spurlin)
| | - Esther S Han
- Division of Gynecologic Specialty Surgery, Department of Obstetrics and Gynecology, New York Presbyterian Hospital, Columbia University Irving Medical Center, (Drs. Han, Advincula, and H. Hur)
| | - Elisabeth R Silver
- Department of Medicine, Columbia University Irving Medical Center, (Dr. C. Hur and Ms. Silver and Mr. Ingram)
| | - Benjamin L May
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, (Mr. May)
| | - Nicholas P Tatonetti
- Departments of Biomedical Informatics, Systems Biology, and Medicine, Columbia University Irving Medical Center, (Dr. Tatonetti)
| | - Myles A Ingram
- Department of Medicine, Columbia University Irving Medical Center, (Dr. C. Hur and Ms. Silver and Mr. Ingram)
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, (Dr. Jin), New York, New York
| | - Chin Hur
- Department of Medicine, Columbia University Irving Medical Center, (Dr. C. Hur and Ms. Silver and Mr. Ingram)
| | - Arnold P Advincula
- Division of Gynecologic Specialty Surgery, Department of Obstetrics and Gynecology, New York Presbyterian Hospital, Columbia University Irving Medical Center, (Drs. Han, Advincula, and H. Hur)
| | - Hye-Chun Hur
- Division of Gynecologic Specialty Surgery, Department of Obstetrics and Gynecology, New York Presbyterian Hospital, Columbia University Irving Medical Center, (Drs. Han, Advincula, and H. Hur).
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Laszkowska M, Silver ER, Schrope B, Kastrinos F, Wang TC, Hur C. Optimal Timing of Total Gastrectomy to Prevent Diffuse Gastric Cancer in Individuals With Pathogenic Variants in CDH1. Clin Gastroenterol Hepatol 2020; 18:822-829.e4. [PMID: 31220641 DOI: 10.1016/j.cgh.2019.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/07/2019] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Carriers of pathogenic variants in CDH1 have a high risk of hereditary diffuse gastric cancer (HDGC). Guidelines recommend prophylactic total gastrectomy (PTG) at age 20-30 years, although there is controversy over the optimal age. We developed a simulation model to analyze the effects of PTG at different ages on quality-adjusted life-years (QALYs), cancer mortality, and life expectancy. METHODS We used a Markov model of HDGC progression associated with pathogenic variants in CDH1 to simulate outcomes of hypothetical cohorts with different ages at time of PTG (ages 20-79 years). Model inputs including health state transition probabilities, mortality and complication rates, quality of life utility values, and endoscopic surveillance sensitivity were derived from publications. The primary outcome, used to determine the optimal strategy, was age at which PTG yielded the highest QALYs. Secondary outcomes were cancer mortality and unadjusted life-years. RESULTS Our model found that for men, the optimal age for PTG is 39 years, resulting in 32.01 incremental QALYs, 58.81 life-years (biologic age, 72.81 years), and lifetime cancer mortality of 8.5%. Incorporating endoscopic surveillance prior to PTG decreased cancer mortality to 6.7%, but had lower QALYs (31.59). PTG at age 30 reduced cancer mortality to 3.2%, with 31.45 incremental QALYs. For women, the optimal age for PTG was calculated to be 30 years, with 33.09 incremental QALYs, 66.17 life-years (biologic age, 80.17 years), and lifetime cancer mortality of 1.6%. Addition of endoscopic surveillance did not decrease the risk of HDGC mortality in women. CONCLUSIONS Using a Markov model of HDGC progression associated with pathogenic variants in CDH1 to simulate outcomes, we found the optimal ages for PTG to be 39 years for men and 30 years for women, when QALYs are the primary endpoint. These ages for PTG are older than those of current recommendations.
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Affiliation(s)
- Monika Laszkowska
- Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, New York
| | - Elisabeth R Silver
- Department of Medicine, Division of General Medicine, New York Presbyterian Columbia University Medical Center, New York, New York
| | - Beth Schrope
- Columbia University Irving Cancer Center, New York, New York; Department of Surgery, New York Presbyterian Columbia University Medical Center, New York, New York
| | - Fay Kastrinos
- Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, New York; Columbia University Irving Cancer Center, New York, New York
| | - Timothy C Wang
- Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, New York; Columbia University Irving Cancer Center, New York, New York
| | - Chin Hur
- Department of Medicine, Division of Digestive and Liver Diseases, New York Presbyterian Columbia University Medical Center, New York, New York; Department of Medicine, Division of General Medicine, New York Presbyterian Columbia University Medical Center, New York, New York; Columbia University Irving Cancer Center, New York, New York.
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10
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Silver ER, Hur C. Gender differences in prescription opioid use and misuse: Implications for men's health and the opioid epidemic. Prev Med 2020; 131:105946. [PMID: 31816359 DOI: 10.1016/j.ypmed.2019.105946] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/18/2019] [Accepted: 11/30/2019] [Indexed: 11/16/2022]
Abstract
The majority of research on gender and the opioid epidemic focuses on women as patients, caregivers, or expectant mothers. However, little research approaches men as gendered subjects, despite their dramatically increased risk of opioid overdose. Accordingly, we examined gender differences in prescription opioid use and misuse with specific attention to implications for men using data from the 2017 National Survey on Drug Use and Health. We used design-adjusted, weighted Wald tests and multivariate logistic regression to compare gender differences in rates of prescription opioid use and misuse, prescription opioid sources, primary motivation for misuse, and prescription opioid dependence. We found that although men were significantly less likely than women to report opioid use, they were significantly more likely to report opioid misuse and to misuse prescription opioids primarily to feel good or get high. Among past-year opioid users, men were significantly more likely than women to meet DSM-IV criteria for opioid dependence. Results are consistent with past work on the intersection of masculinity norms and health behaviors. Although gender-specific interventions are typically synonymous with interventions tailored to women, our results suggest that such interventions could alleviate the burden of the opioid epidemic for men as well. Further research studying possible mechanisms that explain men's increased vulnerability to the opioid epidemic is urgently needed to address this growing public health crisis.
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Affiliation(s)
- Elisabeth R Silver
- Department of Medicine, Division of General Medicine, New York Presbyterian Columbia University Medical Center, New York, NY, USA
| | - Chin Hur
- Department of Medicine, Division of General Medicine, New York Presbyterian Columbia University Medical Center, New York, NY, USA.
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Silver ER, Chadwick SB, van Anders SM. Feminist Identity in Men: Masculinity, Gender Roles, and Sexual Approaches in Feminist, Non-Feminist, and Unsure Men. Sex Roles 2018. [DOI: 10.1007/s11199-018-0932-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Abstract
Policy debates have focused on who can participate in or access single-sex activities or services. This article describes how science of the biology of sex is relevant to three major policy areas: parenting (including leaves), sports, and public spaces. We focus on what scientists know about sex and gender (and gender/sex, where gender and sex are intertwined), and the role of various biological factors, including hormones such as testosterone and estradiol as well as genetics, gonads, genitals, and more. The policies under debate often use “biological sex,” but this fails to account for scientific understandings of sex and gender, misrepresents sex as single-faceted and binary, and overlooks scientific consensus about the importance of gender and identity.
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