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Fuss CG, Msami K, Kahesa C, Mwaiselage J, Gordon A, Sohler N, Mattick LJ, Soliman AS. The impact of in-house pathology services on downstaging cervical cancer in Tanzania over an 18-year period. Cancer Causes Control 2024; 35:93-101. [PMID: 37574489 DOI: 10.1007/s10552-023-01768-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Reducing time between cancer screening, diagnosis, and initiation of treatment is best achieved when services are available in the same hospital. Yet, comprehensive cancer centers are typically unavailable in low- and middle-income countries (LMICs), where resources are limited and services scattered. This study explored the impact of establishing an in-house pathology laboratory at the largest public cancer hospital in Tanzania on the downstaging of cervical cancer. METHODS We examined clinical datasets of 8,322 cervical cancer patients treated at the Ocean Road Cancer Institute (ORCI). The first period included patients treated from 2002 to 2016, before establishment of the pathology laboratory at ORCI; the second period (post-pathology establishment) included data from 2017 to 2020. Logistic regression analysis evaluated the impact of the pathology laboratory on stage of cervical cancer diagnosis. RESULTS Patients treated during the post-pathology period were more likely to be clinically diagnosed at earlier disease stages compared to patients in the pre-pathology period (pre-pathology population diagnosed at early disease stage: 44.08%; post-pathology population diagnosed at early disease stage: 59.38%, p < 0.001). After adjustment for age, region of residence, and place of biopsy, regression results showed patients diagnosed during the post-pathology period had higher odds of early stage cervical cancer diagnosis than patients in the pre-pathology period (OR 1.35, 95% CI (1.16, 1.57), p < 0.001). CONCLUSIONS Integrated and comprehensive cancer centers can overcome challenges in delivering expedited cervical cancer diagnosis and treatment. In-house pathology laboratories play an important role in facilitating timely diagnosis and rapid treatment of cervical and possibly other cancers in LMICs.
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Affiliation(s)
- Caroline G Fuss
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Khadija Msami
- Department of Cancer Prevention, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Crispin Kahesa
- Department of Cancer Prevention, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Julius Mwaiselage
- Department of Cancer Prevention, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Amanda Gordon
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Nancy Sohler
- Department of Community Health and Social Medicine, City University of New York School of Medicine, 160 Convent Avenue, New York, NY, 10031, USA
| | - Lindsey J Mattick
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Amr S Soliman
- Department of Community Health and Social Medicine, City University of New York School of Medicine, 160 Convent Avenue, New York, NY, 10031, USA.
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Ricklan SJ, Sohler N, Ezie CEC, Avalone L, Dinsell V, Lewis C, Fattal O, Balan S, McQuistion H, Pastore F, Sarcevic N, Swift R, Espejo G, Lorenz C. Impact of Telemedicine on Utilization of Psychiatric Resources in New York City during the COVID-19 Pandemic. Community Ment Health J 2024; 60:115-123. [PMID: 38105337 DOI: 10.1007/s10597-023-01210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/04/2023] [Indexed: 12/19/2023]
Abstract
This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention.
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Affiliation(s)
- Sarah J Ricklan
- NYU Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA.
| | - Nancy Sohler
- CUNY School of Medicine, Harris Hall, 160 Convent Avenue, New York, 10031, NY, USA
| | - C E Chiemeka Ezie
- NYU Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Lynsey Avalone
- NYC Health and Hospitals, 125 Worth Street, New York, NY, 10013, USA
| | - Victoria Dinsell
- NYU Grossman School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Crystal Lewis
- NYU Grossman School of Medicine, One Park Ave, New York, NY, 10016, USA
| | - Omar Fattal
- NYC Health and Hospitals, 125 Worth Street, Office 423, New York, NY, 10013, USA
| | - Sabish Balan
- Harlem Hospital, 506 Lenox Avenue, New York, NY, 10037, USA
| | - Hunter McQuistion
- NYU Grossman School of Medicine, One Park Ave, 8th Floor, New York, NY, 10016, USA
| | - Frank Pastore
- North Central Bronx Hospital, 3424 Kossuth Avenue, New York, NY, 10467, USA
| | - Nermica Sarcevic
- Jacobi Hospital, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Ronnie Swift
- NY Health and Hospitals/Metropolitan, 1901 First Avenue, New York, NY, 10029, USA
| | - Gemma Espejo
- Montefiore Medical Center, 111 East 210th St, New York, NY, 10467, USA
| | - Carina Lorenz
- NYC Health and Hospitals-Bellevue, 462 1st Avenue, New York, NY, 10016, USA
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Lu W, Xu L, Goodwin RD, Muñoz-Laboy M, Sohler N. Widening Gaps and Disparities in the Treatment of Adolescent Alcohol and Drug Use Disorders. Am J Prev Med 2023; 64:704-715. [PMID: 36894480 DOI: 10.1016/j.amepre.2023.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION The overall prevalence of alcohol use disorders and drug use disorders in adolescents has been declining in recent years, yet little is known about treatment use for these disorders among adolescents. This study aimed to examine the patterns and demographics of treatment of alcohol use disorders, drug use disorders, and both conditions among U.S. adolescents. METHODS This study used publicly available data for adolescents aged 12-17 years from the annual cross-sectional surveys of the National Survey on Drug Use and Health, 2011-2019. Data were analyzed between July 2021 and November 2022. RESULTS From 2011 to 2019, fewer than 11%, 15%, and 17% of adolescents with 12-month alcohol use disorders, drug use disorders, and both conditions received treatment, respectively, with significant decreases in treatment use for drug use disorders (OR=0.93; CI=0.89, 0.97; p=0.002). Overall, treatment use in outpatient rehabilitation facilities and self-help groups was most common but decreased over the course of the study period. Extensive disparities in treatment use were further identified on the basis of adolescents' gender, age, race, family structure, and mental health. CONCLUSIONS To improve adolescent treatment use for alcohol and drug use disorders, assessments and engagement interventions that are gender specific, developmentally appropriate, culturally sensitive, and contextually informed are especially needed.
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Affiliation(s)
- Wenhua Lu
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, New York.
| | - Lei Xu
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, School of Public Health, The City University of New York, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Nancy Sohler
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, New York
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Miller A, Bochner R, Sohler N, Calixte R, Chan C, Umpaichitra V, Shalmiyev E, Novikova N, Desai N, Seigel W, Chin V, Periasamy S, Waldman L, Bamji M, Nagpal N, Duh‐Leong C, Reznik M, Messito M, Bargman R. Modified body mass index z-scores in children in New York City during the COVID-19 pandemic. Pediatr Obes 2022; 17:e12958. [PMID: 35770679 PMCID: PMC9350030 DOI: 10.1111/ijpo.12958] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Determine whether the negative impact of the COVID-19 pandemic on weight gain trajectories among children attending well-child visits in New York City persisted after the public health restrictions were reduced. STUDY DESIGN Multicenter retrospective chart review study of 7150 children aged 3-19 years seen for well-child care between 1 January 2018 and 4 December 2021 in the NYC Health and Hospitals system. Primary outcome was the difference in annual change of modified body mass index z-score (mBMIz) between the pre-pandemic and early- and late-pandemic periods. The mBMIz allows for tracking of a greater range of BMI values than the traditional BMI z-score. The secondary outcome was odds of overweight, obesity, or severe obesity. Multivariable analyses were conducted with each outcome as the dependent variable, and year, age category, sex, race/ethnicity, insurance status, NYC borough, and baseline weight category as independent variables. RESULTS The difference in annual mBMIz change for pre-pandemic to early-pandemic = 0.18 (95% confidence interval [CI]: 0.15, 0.20) and for pre-pandemic to late-pandemic = 0.04 (95% CI: 0.01, 0.06). There was a statistically significant interaction between period and baseline weight category. Those with severe obesity at baseline had the greatest mBMIz increase during both pandemic periods and those with underweight at baseline had the lowest mBMIz increase during both pandemic periods. CONCLUSION In NYC, the worsening mBMIz trajectories for children associated with COVID-19 restrictions did not reverse by 2021. Decisions about continuing restrictions, such as school closures, should carefully weigh the negative health impact of these policies.
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Affiliation(s)
- Assia Miller
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Risa Bochner
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Nancy Sohler
- City University of New York School of MedicineManhattanNew YorkUSA
| | - Rose Calixte
- State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Cameron Chan
- City University of New York School of MedicineManhattanNew YorkUSA
| | - Vatcharapan Umpaichitra
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Elman Shalmiyev
- New York City Health and Hospitals Central OfficeManhattanNew YorkUSA
| | - Natalia Novikova
- New York City Health and Hospitals Central OfficeManhattanNew YorkUSA
| | - Ninad Desai
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA
| | - Warren Seigel
- New York City Health and Hospitals Coney Island HospitalBrooklynNew YorkUSA
| | - Vivian Chin
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Sundari Periasamy
- New York City Health and Hospitals Harlem HospitalManhattanNew YorkUSA
| | - Lee Waldman
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA
| | - Mahrukh Bamji
- New York City Health and Hospitals Metropolitan HospitalManhattanNew YorkUSA
| | - Nikita Nagpal
- New York City Health and Hospitals Bellevue HospitalManhattanNew YorkUSA,New York University Grossman School of MedicineManhattanNew YorkUSA
| | - Carol Duh‐Leong
- New York City Health and Hospitals Bellevue HospitalManhattanNew YorkUSA,New York University Grossman School of MedicineManhattanNew YorkUSA
| | - Makhmood Reznik
- New York City Health and Hospitals Coney Island HospitalBrooklynNew YorkUSA
| | - Mary Messito
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,New York University Grossman School of MedicineManhattanNew YorkUSA
| | - Renee Bargman
- New York City Health and Hospitals Kings County HospitalBrooklynNew YorkUSA,State University of New York Downstate Health Sciences UniversityBrooklynNew YorkUSA,New York City Health and Hospitals Coney Island HospitalBrooklynNew YorkUSA
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Slawek DE, Syed M, Cunningham CO, Zhang C, Ross J, Herman M, Sohler N, Minami H, Levin FR, Arnsten JH, Starrels JL. Pain catastrophizing and mental health phenotypes in adults with refractory chronic pain: A latent class analysis. J Psychiatr Res 2021; 145:102-110. [PMID: 34890916 PMCID: PMC9160202 DOI: 10.1016/j.jpsychires.2021.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 01/12/2023]
Abstract
Chronic pain, pain catastrophizing, and mental health disorders such as anxiety or depression frequently occur together and are challenging to treat. To help understand the relationship between these conditions, we sought to identify distinct phenotypes associated with worse pain and function. In a cohort of people with chronic pain on opioids seeking medical cannabis in New York, we conducted latent class analysis to identify clusters of participants based on pain catastrophizing and mental health symptoms of depression, anxiety, post-traumatic stress disorder (PTSD) and attention deficit/hyperactivity disorder (ADHD). We then compared clusters with respect to sociodemographic and clinical characteristics using descriptive statistics. Among 185 participants, we identified four discrete groups: low pain catastrophizing and low mental health symptoms (49% of participants), low pain catastrophizing and ADHD-predominant mental health symptoms (11%), high pain catastrophizing and anxiety-predominant mental health symptoms (11%), and high pain catastrophizing and high mental health symptoms (30%). The group with high pain catastrophizing and high mental health symptoms had the worst pain intensity and interference, disability, insomnia, and quality of life, compared to the two groups with lower pain catastrophizing, though not all differences were statistically significant. Our findings highlight the importance of identifying and addressing pain catastrophizing in patients with comorbid chronic pain and mental health symptoms.
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Affiliation(s)
- Deepika E Slawek
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA.
| | - Madiha Syed
- Department of Psychiatry and Behavioral Sciences, Montefiore Health System, Bronx, NY, USA
| | | | - Chenshu Zhang
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
| | - Jonathan Ross
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
| | - Merrill Herman
- Department of Psychiatry and Behavioral Sciences, Montefiore Health System, Bronx, NY, USA
| | - Nancy Sohler
- School of Medicine, City University of New York, New York, NY, USA
| | - Haruka Minami
- Psychology Department, Fordham University, Bronx, NY, USA
| | - Frances R Levin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Julia H Arnsten
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
| | - Joanna L Starrels
- Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA
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Lu W, Muñoz-Laboy M, Sohler N, Goodwin RD. Trends and Disparities in Treatment for Co-occurring Major Depression and Substance Use Disorders Among US Adolescents From 2011 to 2019. JAMA Netw Open 2021; 4:e2130280. [PMID: 34668942 PMCID: PMC8529409 DOI: 10.1001/jamanetworkopen.2021.30280] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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 Major depression and substance use disorders (SUD) commonly co-occur among adolescents, yet little is known about treatment use among adolescents with both conditions. Given the reciprocal influence of these conditions on each other and low prevalence of treatment overall, current information on quantification and trends in treatment of co-occurring depression and SUD is critical toward assessing how the field is performing in reaching youth in need of these services, and among youth with sociodemographic risk factors. OBJECTIVE To examine temporal trends and sociodemographic disparities in the treatment of co-occurring major depression and SUD among US adolescents. DESIGN, SETTING, AND PARTICIPANTS This survey study used publicly available data for adolescents aged 12 to 17 years from the annual cross-sectional surveys of the National Survey on Drug Use and Health from 2011 to 2019 to assess co-occurrence of major depressive episodes (MDE) and SUD through time and prevalence of treatment for either or both of these conditions. Data were analyzed between October 2020 and February 2021. EXPOSURES Survey years, adolescent age, gender, race and ethnicity, type of insurance, annual household income, family structure, and residential stability. MAIN OUTCOMES AND MEASURES Presence and treatment of co-occurring 12-month MDE and SUD. RESULTS In total, 136 262 adolescents participated in the 2011 to 2019 surveys, among whom 69 584 (51.1%) were boys and 66 678 (49.0%) were girls, 46 548 (34.1%) were aged 16 to 17 years, and 18 173 (13.8%) were Black, 28 687 (23.2%) were Hispanic, and 74 512 (53.6%) were White. From 2011 to 2019, the annual prevalence of co-occurring MDE and SUD remained stable, at between 1.4% and 1.7%. Among adolescents with co-occurring MDE and SUD, the prevalence of treatment use for MDE only increased significantly from 28.5% in 2011 to 42.5% in 2019 (odds ratio [OR], 1.07; 95% CI, 1.02-1.11; P = .005), whereas the prevalence of treatment use for SUD only decreased from 4.8% to 1.5% (OR, 0.92; 95% CI, 0.85-0.99; P = .04). Overall, the prevalence of treatment use for both conditions fluctuated between 4.5% and 11.6%, without a significant linear trend over time (OR, 0.95; 95% CI, 0.87-1.03; P = .24). Extensive disparities in treatment use were found among boys for SUD and both conditions, older adolescents for MDE, Hispanic adolescents for co-occurring conditions (adjusted OR, 0.52; 95% CI, 0.27-0.98; P = .04), and Asian, Native Hawaiian, or Pacific Islander adolescents for MDE (adjusted OR, 0.24; 95% CI, 0.10-0.58; P = .002) and co-occurring conditions (adjusted OR, 0.04; 95% CI, 0.01-0.33; P = .003). Moving households 3 or more times in the past 12 months was associated with higher odds that adolescents received treatment for both conditions (adjusted OR, 2.52; 95% CI, 1.26-5.05; P = .009). CONCLUSIONS AND RELEVANCE This survey study found that from 2011 to 2019, less than 12% of adolescents with major depression and SUD received treatment for both conditions from 2011 to 2019. Findings from this study call for expanded service provision for adolescents with co-occurring conditions, improved coordination between service delivery systems, and enhanced policy and funding support for adolescents with unmet treatment needs.
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Affiliation(s)
- Wenhua Lu
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York
| | | | - Nancy Sohler
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York
| | - Renee D. Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Kiriella DA, Islam S, Oridota O, Sohler N, Dessenne C, de Beaufort C, Fagherazzi G, Aguayo GA. Unraveling the concepts of distress, burnout, and depression in type 1 diabetes: A scoping review. EClinicalMedicine 2021; 40:101118. [PMID: 34485879 PMCID: PMC8408521 DOI: 10.1016/j.eclinm.2021.101118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Psychological complications are frequent in type 1 diabetes (T1D) but they might be difficult to distinguish one from the other in clinical practice. Our objective was to study the distinguishing characteristics, overlaps and their use in the literature between three concepts of T1D: depression, diabetes distress (DD) and diabetes burnout (DB). METHODS A scoping review (PRISMA guidelines) performed in three databases (PubMed/MEDLINE, PsycInfo, Web of Science) with the keywords: T1D, depression, diabetes and burnout, from January 1990 to June 2021. We selected original studies with participants with T1D, which reported depression, DD, or DB. We extracted information about the concepts, their sub-concepts and screening tools. FINDINGS Of the 4763 studies identified, 201 studies were included in the study. Seventy-three percent, 57% and 45% of sub-concepts do not overlap in depression, DD, and DB, respectively. We observed overlap between depression (27%)/DD (27%) and between DD (20%)/DB (50%). INTERPRETATION A number of sub-concepts distinguish depression and DD. Overlaps between concepts suggest that a more precise definition is still lacking. DB is still a relatively new concept and more research is needed to better understand how it can present itself differently, in order to personalize care in comparison to those having DD.
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Affiliation(s)
- Dona A. Kiriella
- Community Health and Social Medicine Department, CUNY School of Medicine, New York, NY, United States
| | - Sumaiya Islam
- Community Health and Social Medicine Department, CUNY School of Medicine, New York, NY, United States
| | - Olutobi Oridota
- Community Health and Social Medicine Department, CUNY School of Medicine, New York, NY, United States
| | - Nancy Sohler
- Community Health and Social Medicine Department, CUNY School of Medicine, New York, NY, United States
| | - Coralie Dessenne
- Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Carine de Beaufort
- Department of Paediatric Diabetes and Endocrinology, Paediatric Clinic, Hospital Centre of Luxembourg, Luxembourg, Luxembourg
- Department of Paediatric Endocrinology. Free University Brussels, UZ-VUB, Brussels, Belgium
| | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Gloria A. Aguayo
- Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
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Shalan FH, Ambia S, Martinez B, Jon E, Okorafor U, Yang K, Yim E, Chamberlain RM, Sohler N, Msami K, Kahesa C, Mwaiselage J, Soliman AS. Field Research Experience of Medical Students: Learning and Translation from Global to Underserved US Settings. J Cancer Educ 2021; 36:62-68. [PMID: 34075543 PMCID: PMC8169428 DOI: 10.1007/s13187-021-02036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
While most medical schools in the USA provide opportunities for global health experiences, global health education is not included consistently or emphasized adequately in many medical school curricula. The City University of New York Medical School (CSOM) has a mission to educate and train students who are traditionally underrepresented in medicine to practice primary care in medically underserved communities in New York. This manuscript documents the experience of the CSOM in expanding global health education by introducing a new global health cancer training program, partnering with clinicians at the Ocean Road Cancer Institute (ORCI) in Tanzania. This manuscript illustrates the following points: (1) the CSOM curriculum that focuses on community health and social medicine; (2) the process by which students learn by developing research proposals for global cancer; (3) the field research experience and lessons learned; (4) learning about cancer and medicine in a developing country; and (5) lessons learned for translation from global to domestic underserved populations. We also suggest a checklist for future students interested in pursuing global cancer education and research, and recommendations for maximizing learning and career development of students interested in global cancer research and its application to underserved populations in the USA.
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Affiliation(s)
- Fatma H Shalan
- The City University of New York School of Medicine, 160 Convent Avenue - Harris Hall 313, New York, NY, 10031, USA
| | - Shanjida Ambia
- The City University of New York School of Medicine, 160 Convent Avenue - Harris Hall 313, New York, NY, 10031, USA
| | - Beatriz Martinez
- The City University of New York School of Medicine, 160 Convent Avenue - Harris Hall 313, New York, NY, 10031, USA
| | - Eric Jon
- The City University of New York School of Medicine, 160 Convent Avenue - Harris Hall 313, New York, NY, 10031, USA
| | - Ugochukwu Okorafor
- The City University of New York School of Medicine, 160 Convent Avenue - Harris Hall 313, New York, NY, 10031, USA
| | - Kristen Yang
- The City University of New York School of Medicine, 160 Convent Avenue - Harris Hall 313, New York, NY, 10031, USA
| | - Elizabeth Yim
- The City University of New York School of Medicine, 160 Convent Avenue - Harris Hall 313, New York, NY, 10031, USA
| | - Robert M Chamberlain
- The City University of New York School of Medicine, 160 Convent Avenue - Harris Hall 313, New York, NY, 10031, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nancy Sohler
- The City University of New York School of Medicine, 160 Convent Avenue - Harris Hall 313, New York, NY, 10031, USA
| | - Khadija Msami
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | | | - Amr S Soliman
- The City University of New York School of Medicine, 160 Convent Avenue - Harris Hall 313, New York, NY, 10031, USA.
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Dunbar W, Labat A, Raccurt C, Sohler N, Pape JW, Maulet N, Coppieters Y. A realist systematic review of stigma reduction interventions for HIV prevention and care continuum outcomes among men who have sex with men. Int J STD AIDS 2021; 31:712-723. [PMID: 32631213 DOI: 10.1177/0956462420924984] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
While stigma associated with human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is well recognized, there remains relatively limited intervention data on effective stigma reduction strategies. This systematic review was conducted to highlight the mechanisms through which sexual and HIV stigma is reduced in relation to HIV prevention and care engagement. Search of PubMed and Scopus resulted in 11 tested interventions to include in our preliminary model constructed from programme frameworks and recommendations. We refined the preliminary programme theory to identify whether, why, or how mitigation strategies produce observed outcomes. Our review showed that the interventions produced stigma reduction through three groups of mechanisms: (1) Self-acceptance, leadership, and motivational activation for behaviour change from intrapersonal strategies, such as education and mobile health strategies, which intervene on internalized and anticipated stigma; (2) socialization, knowledge sharing, and social empowerment from interpersonal strategies, such as peer support and training for care providers; and (3) community introspection, self-reflection, and humanistic activation from structural strategies such as community leaders' sensitization, which intervene on both anticipated and enacted stigma. Interventions mechanisms act complementarily and can be activated in different contexts in which MSM exposed to and infected with HIV are living.
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Affiliation(s)
- Willy Dunbar
- Health Systems and Policies - International Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Aline Labat
- Health Systems and Policies - International Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christian Raccurt
- Faculty of Health Sciences, Quisqueya University, Port-au-Prince, Haiti
| | - Nancy Sohler
- Community Health and Social Medicine, City University of New York, School of Medicine, New York, NY, USA
| | - Jean William Pape
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.,Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nathalie Maulet
- Ecole de Santé Publique, Université Catholique de Louvain, Brussels, Belgium
| | - Yves Coppieters
- Health Systems and Policies - International Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
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10
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Dunbar W, Sohler N, Coppieters Y. Loss to follow up among men who have sex with men and heterosexual men living with HIV in Haiti. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite the benefits of adherence in HIV medication, health systems are struggling to keep all categories of patients in care due to loss to follow up (LTFU). Men who have sex with men (MSM) are at higher risk of HIV infection and also face several barriers to reach treatment, it is hypothesized that they may also have higher incidence of dropping-off. This study aims to determine whether MSM living with HIV have a greater risk of LTFU compared with heterosexual men and to identify the risk factors for the two groups.
Methods
A retrospective matched cohort study of electronic medical record data from 554 patients living with HIV and enrolled in care between 2015 and 2018 at a Port-au-Prince-based HIV clinic was performed. The 125 MSM and 429 heterosexual patients were matched on gender age and enrolment date. The primary outcome was LTFU defined as not refilling an ART prescription for a period of 90 days. MSM and heterosexual men was compared using t-tests and chi-square tests. The Kaplan-Meier technique was used to estimate time to LTFU after initiation of ART and the Cox Proportional Hazards regression model was used to determine predictors of LTFU.
Results
The sample had a mean age of 31.1 years (SD 8.0) for MSM and 32.4 years (SD 7.7) for heterosexual men. LTFU was significantly more common among the MSM group than the heterosexual group (MSM 48.8%, heterosexual men 34.7%; p = 0.012). Factors associated with LTFU were greater amongst younger patients, with lower educational and economic level. The median time to LTFU for MSM was 679 days and 1110 days for heterosexual men. The log rank test showed that this is statistically significant at p = 0.001.
Conclusions
This study showed that the risk of LTFU is significantly higher and the time to LTFU is significantly shorter for MSM relative to heterosexual men. Identifying predictors to LTFU in HIV clinical settings and providing appropriate services and supports are important steps in addressing this issue.
Key messages
Men who have sex with men continue to face barriers to effective HIV treatment in Haiti. Adapted interventions are needed to improve HIV care for Men who have sex with Men in Haiti.
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Affiliation(s)
- W Dunbar
- Health Systems and Policies - International Health, Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium
- Research Unit, GHESKIO Centers, Haiti, Haiti
| | - N Sohler
- Community Health and Social Medicine, City University of New York, School of Medicine, New York, USA
| | - Y Coppieters
- Health Systems and Policies - International Health, Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium
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11
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Dunbar W, Sohler N, Coppieters Y. Outcomes along the HIV continuum of care for Men who have Sex with Men in Haiti. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The HIV epidemic in Haiti continues, with an estimated 160,000 people living with HIV at the end of 2018. Although HIV prevalence in the general population is estimated to be 2.0%, certain groups are at a higher risk of HIV infection. The prevalence of HIV among men who have sex with men (MSM) is estimated to be 12.9%. As previous data have found gaps in HIV care for this population, we explored the steps in the continuum of care to determine outcomes at each step.
Methods
We used an observational retrospective cohort study design to follow up MSM diagnosed with HIV in the largest HIV care clinic in Port-au-Prince, Haiti. Estimates were calculated of proportions of participants reached, tested, linked to care, commencing treatment, adherent to treatment, and who achieved virologic suppression. We identified factors associated with loss to follow-up at each step using multivariable analysis.
Results
Data were collected between January 1, 2015, and December 31, 2018. 5009 MSM were reached for prevention services. Of those reached, 2499 (49.8%, 95% CI 48.5-51.3) were tested for HIV, 222 (8.8%, 95% CI 7.8-10.0) had a positive test result for HIV, and 172 (77,47%, 95% CI 71.4-82.8) were linked to HIV care. Among participants who started care, 54 (44.6 95% CI 24.5-38.9) were retained and 98 (78.4%, 95% CI 49.2-64.5) achieve a suppressed viral load. Fifty-nine (44.8%, 95% CI 27.2-41.9) were lost to follow-up. Participants who had been younger, with lower educational and economic level were significantly less likely to achieve retention and viral suppression (p = 0.001).
Conclusions
HIV cascade data among MSM in Haiti show very poor rates of retention in treatment although those retained had good virologic outcome. Characteristics associated with LTFU suggest an urgent need to develop and implement effective interventions to support patients in achieving retention and viral suppression among MSM living with HIV.
Key messages
Poor HIV outcomes for men who have sex with men in Haiti. Effective interventions to improve HIV outcomes for men who have sex with men in Haiti are urgently needed.
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Affiliation(s)
- W Dunbar
- Health Systems and Policies - International Health, Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium
- Research Unit, GHESKIO Centers, Haiti, Haiti
| | - N Sohler
- Community Health and Social Medicine, City University of New York, School of Medicine, New York, USA
| | - Y Coppieters
- Health Systems and Policies - International Health, Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium
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12
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Slawek DE, Arnsten J, Sohler N, Zhang C, Grossberg R, Stein M, Cunningham CO. Daily and near-daily cannabis use is associated with HIV viral load suppression in people living with HIV who use cocaine. AIDS Care 2020; 33:1350-1357. [PMID: 32748649 DOI: 10.1080/09540121.2020.1799922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Disparities remain in HIV viral load (VL) suppression between people living with HIV (PLWH) who use cocaine and those who do not. It is not known how cannabis use affects VL suppression in PLWH who use cocaine. We evaluated the relationship between cannabis use and VL suppression among PLWH who use cocaine. We conducted a secondary data analysis of 119 baseline interviews from a randomized controlled trial in the Bronx, NY (6/2012 to 1/2017). Participants were adult PLWH prescribed antiretrovirals for ≥16 weeks, who endorsed imperfect antiretroviral adherence and used cocaine in the past 30-days. In bivariate and multivariable regression analyses, we examined how cannabis use, is associated with VL suppression among PLWH who use cocaine. Participants were a mean age of 50 years; most were male (64%) and non-Hispanic black (55%). Participants with VL suppression used cocaine less frequently than those with no VL suppression (p < 0.01); cannabis use was not significantly different. In regression analysis, compared with no use, daily/near-daily cannabis use was associated with VL suppression (aOR = 4.2, 95% CI: 1.1-16.6, p < 0.05). Less-frequent cannabis use was not associated with VL suppression. Further investigation is needed to understand how cannabis use impacts HIV outcomes among PLWH who use cocaine.
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Affiliation(s)
- Deepika E Slawek
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | - Julia Arnsten
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | - Nancy Sohler
- City University of New York School of Medicine, New York, NY, USA
| | | | - Robert Grossberg
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | - Melissa Stein
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | - Chinazo O Cunningham
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
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13
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Frye V, Camacho-Rivera M, Salas-Ramirez K, Albritton T, Deen D, Sohler N, Barrick S, Nunes J. Professionalism: The Wrong Tool to Solve the Right Problem? Acad Med 2020; 95:860-863. [PMID: 32134778 DOI: 10.1097/acm.0000000000003266] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Medical schools and other higher education institutions across the United States are grappling with how to respond to racism on and off campus. Institutions and their faculty, administrators, and staff have examined their policies and practices, missions, curricula, and the representation of racial and ethnic minority groups among faculty, staff, and students. In addition, student-led groups, such as White Coats for Black Lives, have emerged to critically evaluate medical school curricula and advocate for change. Another approach to addressing racism has been a focus on the role of professionalism, which has been variably defined as values, traits, behaviors, morality, humanism, a role, an identity, and even a social contract.In this article, the authors consider the potential role that professionalism might play in responding to racism in medical education and at medical schools. They identify 3 concerns central to this idea. The first concern is differing definitions of what the problem being addressed really is. Is it isolated racist acts or institutional racism that is a reflection of white supremacy? The second concern is the notion that professionalism may be used as a tool of social control to maintain the interests of the social groups that dominate medicine. The third concern is that an overly simplistic application of professionalism, regardless of how the problem of racism is defined, may result in trainees practicing professionalism that is performative rather than internally motivated. The authors conclude that professionalism may complement a more systematic and holistic approach to addressing racism and white supremacy in medical education, but it is an insufficient stand-alone tool to address this core problem.
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Affiliation(s)
- Victoria Frye
- V. Frye is associate medical professor, Department of Community Health and Social Medicine, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York; ORCID: http://orcid.org/0000-0003-3239-7201. M. Camacho-Rivera is assistant professor, Department of Community Health Sciences, SUNY Downstate School of Public Health, Brooklyn, New York. K. Salas-Ramirez is assistant medical professor, Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York. T. Albritton is assistant medical professor, Department of Community Health and Social Medicine, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York; ORCID: http://orcid.org/0000-0002-7592-4318. D. Deen is distinguished lecturer, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York. N. Sohler is associate medical professor, Department of Community Health and Social Medicine, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York. S. Barrick is lecturer and director, Humanities in Medicine Program, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York. J. Nunes is medical professor, Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York
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14
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Sohler N, Slawek D, Earnshaw V, Jost J, Lee A, Mancini J, Mompremier A, Cunningham CO. Drug use and HIV medication adherence in people living with HIV. Subst Abus 2020; 42:310-316. [PMID: 31951807 DOI: 10.1080/08897077.2019.1706695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Opioid and cocaine use epidemics continue to be substantial in the United States and intersect with the HIV epidemic. Antiretroviral medication (ARV) adherence is critical for optimum HIV outcomes. While previous research explored harm reduction strategies to prevent HIV spread for people who use drugs (PWUD), little is known about strategies used by PWUD living with HIV to maintain ARV adherence. Methods: We explored whether PWUD modify their drug use explicitly to maintain ARV adherence, and identified factors associated with this process. We conducted 23 semi-structured interviews. Data were analyzed using a modified framework analysis approach. Results: Participants had a mean age of 54 years and were predominantly male (70%) and non-Hispanic black (65%). Most described periods of being able to adhere to ARVs while still using drugs, difficulty adhering to ARVs while using drugs, and abstinence/near abstinence from drug use. In exploring factors that influenced changes in drug use and ARV adherence behaviors, we noted consistent acknowledgment of the roles of family, partners, or providers. Conclusions: PWUD living with HIV often modify their drug use to improve ARV adherence. Providers caring for this population might consider family or group education models to encourage harm reduction to improve outcomes.
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Affiliation(s)
- Nancy Sohler
- CUNY School of Medicine, City College of New York, New York, NY, USA
| | - Deepika Slawek
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Valerie Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - John Jost
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Alice Lee
- CUNY School of Medicine, City College of New York, New York, NY, USA
| | - John Mancini
- CUNY School of Medicine, City College of New York, New York, NY, USA
| | | | - Chinazo O Cunningham
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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15
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Albu JB, Sohler N, Li R, Li X, Young E, Gregg EW, Ross-Degnan D. An Interrupted Time Series Analysis to Determine the Effect of an Electronic Health Record-Based Intervention on Appropriate Screening for Type 2 Diabetes in Urban Primary Care Clinics in New York City. Diabetes Care 2017; 40:1058-1064. [PMID: 28620094 PMCID: PMC5521966 DOI: 10.2337/dc16-2133] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/11/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the impact of a health system-wide primary care diabetes management system, which included targeted guidelines for type 2 diabetes (T2DM) and prediabetes (dysglycemia) screening, on detection of previously undiagnosed dysglycemia cases. RESEARCH DESIGN AND METHODS Intervention included electronic health record (EHR)-based decision support and standardized providers and staff training for using the American Diabetes Association guidelines for dysglycemia screening. Using EHR data, we identified 40,456 adults without T2DM or recent screening with a face-to-face visit (March 2011-December 2013) in five urban clinics. Interrupted time series analyses examined the impact of the intervention on trends in three outcomes: 1) monthly proportion of eligible patients receiving dysglycemia testing, 2) two negative comparison conditions (dysglycemia testing among ineligible patients and cholesterol screening), and 3) yield of undiagnosed dysglycemia among those tested. RESULTS Baseline monthly proportion of eligible patients receiving testing was 7.4-10.4%. After the intervention, screening doubled (mean increase + 11.0% [95% CI 9.0, 13.0], proportion range 18.6-25.3%). The proportion of ineligible patients tested also increased (+5.0% [95% CI 3.0, 8.0]) with no concurrent change in cholesterol testing (+0% [95% CI -0.02, 0.05]). About 59% of test results in eligible patients showed dysglycemia both before and after the intervention. CONCLUSIONS Implementation of a policy for systematic dysglycemia screening including formal training and EHR templates in urban academic primary care clinics resulted in a doubling of appropriate testing and the number of patients who could be targeted for treatment to prevent or delay T2DM.
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Affiliation(s)
- Jeanine B Albu
- Division of Endocrinology, Diabetes and Bone Disease and Division of General Medicine, Department of Medicine, Mount Sinai St. Luke's and Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nancy Sohler
- Sophie Davis School of Biomedical Education/CUNY Medical School of the City College of New York, New York, NY
| | - Rui Li
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xuan Li
- Research Foundation of the City University of New York, New York, NY
| | - Edwin Young
- Division of Endocrinology, Diabetes and Bone Disease and Division of General Medicine, Department of Medicine, Mount Sinai St. Luke's and Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dennis Ross-Degnan
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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16
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Sohler N, Adams BG, Barnes DM, Cohen GH, Prins SJ, Schwartz S. Weighing the evidence for harm from long-term treatment with antipsychotic medications: A systematic review. Am J Orthopsychiatry 2015; 86:477-85. [PMID: 26652608 DOI: 10.1037/ort0000106] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Research findings supporting the use of antipsychotic medication for acute treatment of schizophrenia are relatively consistent and undisputed. However, the rationale for recommending long-term antipsychotic medication treatment-the current standard of care treatment strategy-is unclear. A controversial hypothesis proposed recently suggests people with schizophrenia who are exposed to long-term treatment with antipsychotic medications have worse outcomes than people with schizophrenia who are not exposed to these medications. We tested whether a systematic appraisal of published literature would produce data consistent with this hypothesis. We reviewed the published literature to identify studies of patients with psychotic disorders who were followed for at least 2 years that compared outcomes in patients who received antipsychotic medication during the follow-up with patients who did not receive antipsychotic medication during the follow-up. We included all English language articles published through 2013 in this review. Our process for selecting studies and documenting study findings included a consensus decision of 2 members of the research team. We found the published data to be inadequate to test this hypothesis. By extension, these data were also inadequate to conclusively evaluate whether long-term antipsychotic medication treatment results in better outcomes on average. We conclude that careful reappraisal of existing data is useful to ensure standard of care treatment strategies are indeed evidence-based. In the case of long-term use of antipsychotic medications, new data may be needed to establish a sufficient evidence base to understand its benefit/risk balance for patients with schizophrenia. (PsycINFO Database Record
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Affiliation(s)
- Nancy Sohler
- Sophie Davis School of Biomedical Education, The City College of New York
| | - Ben G Adams
- Department of Epidemiology, Columbia University
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17
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Freudenberg N, Franzosa E, Sohler N, Li R, Devlin H, Albu J. The State of Evaluation Research on Food Policies to Reduce Obesity and Diabetes Among Adults in the United States, 2000-2011. Prev Chronic Dis 2015; 12:E182. [PMID: 26513438 PMCID: PMC4651114 DOI: 10.5888/pcd12.150237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Improvements in diet can prevent obesity and type 2 diabetes. Although policy changes provide a foundation for improvement at the population level, evidence for the effectiveness of such changes is slim. This study summarizes the literature on recent efforts in the United States to change food-related policies to prevent obesity and diabetes among adults. METHODS We conducted a systematic review of evidence of the impact of food policies. Websites of government, academic, and nonprofit organizations were scanned to generate a typology of food-related policies, which we classified into 18 categories. A key-word search and a search of policy reports identified empirical evaluation studies of these categories. Analyses were limited to strategies with 10 or more reports. Of 422 articles identified, 94 met these criteria. Using publication date, study design, study quality, and dietary outcomes assessed, we evaluated the strength of evidence for each strategy in 3 assessment categories: time period, quality, and study design. RESULTS Five strategies yielded 10 or more reports. Only 2 of the 5 strategies, menu labeling and taxes on unhealthy foods, had 50% or more studies with positive findings in at least 2 of 3 assessment categories. Most studies used methods that were rated medium quality. Although the number of published studies increased over 11 years, study quality did not show any clear trend nor did it vary by strategy. CONCLUSION Researchers and policy makers can improve the quality and rigor of policy evaluations to synthesize existing evidence and develop better methods for gleaning policy guidance from the ample but imperfect data available.
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Affiliation(s)
- Nicholas Freudenberg
- City University of New York School of Public Health, Silberman Bldg, 2180 Third Ave, New York, NY 10035.
| | - Emily Franzosa
- City University of New York School of Public Health, New York, New York
| | - Nancy Sohler
- City University of New York School of Public Health, New York, New York
| | - Rui Li
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heather Devlin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeanine Albu
- St Luke's Roosevelt Hospital Center, Obesity Research Center, New York, New York
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18
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Bullard KM, Ali MK, Imperatore G, Geiss LS, Saydah SH, Albu JB, Cowie CC, Sohler N, Albright A, Gregg EW. Receipt of Glucose Testing and Performance of Two US Diabetes Screening Guidelines, 2007-2012. PLoS One 2015; 10:e0125249. [PMID: 25928306 PMCID: PMC4416019 DOI: 10.1371/journal.pone.0125249] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 03/23/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Screening guidelines are used to help identify prediabetes and diabetes before implementing evidence-based prevention and treatment interventions. We examined screening practices benchmarking against two US guidelines, and the capacity of each guideline to identify dysglycemia. METHODS Using 2007-2012 National Health and Nutrition Examination Surveys, we analyzed nationally-representative, cross-sectional data from 5,813 fasting non-pregnant adults aged ≥20 years without self-reported diabetes. We examined proportions of adults eligible for diagnostic glucose testing and those who self-reported receiving testing in the past three years, as recommended by the American Diabetes Association (ADA) and the US Preventive Services Task Force (USPSTF-2008) guidelines. For each screening guideline, we also assessed sensitivity, specificity, and positive (PPV) and negative predictive values in identifying dysglycemia (defined as fasting plasma glucose ≥100 mg/dl or hemoglobin A1c ≥5.7%). RESULTS In 2007-2012, 73.0% and 23.7% of US adults without diagnosed diabetes met ADA and USPSTF-2008 criteria for screening, respectively; and 91.5% had at least one major risk factor for diabetes. Of those ADA- or USPSTF-eligible adults, about 51% reported being tested within the past three years. Eligible individuals not tested were more likely to be lower educated, poorer, uninsured, or have no usual place of care compared to tested eligible adults. Among adults with ≥1 major risk factor, 45.7% reported being tested, and dysglycemia yields (i.e., PPV) ranged from 45.8% (high-risk ethnicity) to 72.6% (self-reported prediabetes). ADA criteria and having any risk factor were more sensitive than the USPSTF-2008 guideline (88.8-97.7% vs. 31.0%) but less specific (13.5-39.7% vs. 82.1%) in recommending glucose testing, resulting in lower PPVs (47.7-54.4% vs. 58.4%). CONCLUSION Diverging recommendations and variable performance of different guidelines may be impeding national diabetes prevention and treatment efforts. Efforts to align screening recommendations may result in earlier identification of adults at high risk for prediabetes and diabetes.
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Affiliation(s)
- Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Mohammed K. Ali
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Linda S. Geiss
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sharon H. Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeanine B. Albu
- St. Luke's-Roosevelt Hospital Center, Department of Medicine, Columbia University, New York, New York, United States of America
| | - Catherine C. Cowie
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nancy Sohler
- Sophie Davis School of Biomedical Education of The City College of New York, New York, New York, United States of America
| | - Ann Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Edward W. Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Jerant A, Kravitz RL, Sohler N, Fiscella K, Romero RL, Parnes B, Tancredi DJ, Aguilar-Gaxiola S, Slee C, Dvorak S, Turner C, Hudnut A, Prieto F, Franks P. Sociopsychological tailoring to address colorectal cancer screening disparities: a randomized controlled trial. Ann Fam Med 2014; 12:204-14. [PMID: 24821891 PMCID: PMC4018368 DOI: 10.1370/afm.1623] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Interventions tailored to sociopsychological factors associated with health behaviors have promise for reducing colorectal cancer screening disparities, but limited research has assessed their impact in multiethnic populations. We examined whether an interactive multimedia computer program (IMCP) tailored to expanded health belief model sociopsychological factors could promote colorectal cancer screening in a multiethnic sample. METHODS We undertook a randomized controlled trial, comparing an IMCP tailored to colorectal cancer screening self-efficacy, knowledge, barriers, readiness, test preference, and experiences with a nontailored informational program, both delivered before office visits. The primary outcome was record-documented colorectal cancer screening during a 12-month follow-up period. Secondary outcomes included postvisit sociopsychological factor status and discussion, as well as clinician recommendation of screening during office visits. We enrolled 1,164 patients stratified by ethnicity and language (49.3% non-Hispanic, 27.2% Hispanic/English, 23.4% Hispanic/Spanish) from 26 offices around 5 centers (Sacramento, California; Rochester and the Bronx, New York; Denver, Colorado; and San Antonio, Texas). RESULTS Adjusting for ethnicity/language, study center, and the previsit value of the dependent variable, compared with control patients, the IMCP led to significantly greater colorectal cancer screening knowledge, self-efficacy, readiness, test preference specificity, discussion, and recommendation. During the followup period, 132 (23%) IMCP and 123 (22%) control patients received screening (adjusted difference = 0.5 percentage points, 95% CI -4.3 to 5.3). IMCP effects did not differ significantly by ethnicity/language. CONCLUSIONS Sociopsychological factor tailoring was no more effective than nontailored information in encouraging colorectal cancer screening in a multiethnic sample, despite enhancing sociopsychological factors and visit behaviors associated with screening. The utility of sociopsychological tailoring in addressing screening disparities remains uncertain.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California Davis, Sacramento, California (Jerant, Franks); Center for Healthcare Policy and Research, University of California Davis, Sacramento, California (Jerant, Kravitz, Tancredi, Franks); Division of General Internal Medicine, University of California Davis, Sacramento, California (Kravitz); Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education of The City College of New York, New York, New York (Sohler); Department of Family Medicine and Community and Preventive Medicine, University of Rochester, Rochester, New York (Fiscella); Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Romero); Department of Family Medicine, University of Colorado, Denver, Colorado (Parnes); Department of Pediatrics, University of California Davis, Sacramento, California (Tancredi); Department of Internal Medicine, University of California Davis, Sacramento, California (Aguilar-Gaxiola); Center for Reducing Health Disparities, University of California Davis, Sacramento, California (Aguilar-Gaxiola); University of California Davis Medical Center, Sacramento, California (Slee); IET-Academic Technology Services, University of California Davis, Davis, California (Dvorak, Turner); Sutter Medical Foundation, Sacramento, California (Hudnut, Prieto)
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Albu J, Sohler N, Matti-Orozco B, Sill J, Baxter D, Burke G, Young E. Expansion of electronic health record-based screening, prevention, and management of diabetes in New York City. Prev Chronic Dis 2013; 10:E13. [PMID: 23369766 PMCID: PMC3562173 DOI: 10.5888/pcd10.120148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
To address the increasing burden of diabetes in New York City, we designed 2 electronic health records (EHRs)-facilitated diabetes management systems to be implemented in 6 primary care practices on the West Side of Manhattan, a standard system and an enhanced system. The standard system includes screening for diabetes. The enhanced system includes screening and ensures close patient follow-up; it applies principles of the chronic care model, including community–clinic linkages, to the management of patients newly diagnosed with diabetes and prediabetes through screening. We will stagger implementation of the enhanced system across the 6 clinics allowing comparison, through a quasi-experimental design (pre–post difference with a control group), of patients treated in the enhanced system with similar patients treated in the standard system. The findings could inform health system practices at multiple levels and influence the integration of community resources into routine diabetes care.
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Affiliation(s)
- Jeanine Albu
- St. Luke's and Roosevelt Hospital Center, Obesity Research Center, 1111 Amsterdam Ave, New York, NY 10025, USA.
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21
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Jerant A, Kravitz RL, Fiscella K, Sohler N, Romero RL, Parnes B, Aguilar-Gaxiola S, Turner C, Dvorak S, Franks P. Effects of tailored knowledge enhancement on colorectal cancer screening preference across ethnic and language groups. Patient Educ Couns 2013; 90:103-110. [PMID: 22985627 PMCID: PMC3522756 DOI: 10.1016/j.pec.2012.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 08/11/2012] [Accepted: 08/25/2012] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Tailoring to psychological constructs (e.g. self-efficacy, readiness) motivates behavior change, but whether knowledge tailoring alone changes healthcare preferences--a precursor of behavior change in some studies--is unknown. We examined this issue in secondary analyses from a randomized controlled trial of a tailored colorectal cancer (CRC) screening intervention, stratified by ethnicity/language subgroups (Hispanic/Spanish, Hispanic/English, non-Hispanic/English). METHODS Logistic regressions compared effects of a CRC screening knowledge-tailored intervention versus a non-tailored control on preferences for specific test options (fecal occult blood or colonoscopy), in the entire sample (N=1164) and the three ethnicity/language subgroups. RESULTS Pre-intervention, preferences for specific tests did not differ significantly between study groups (experimental, 64.5%; control 62.6%). Post-intervention, more experimental participants (78.6%) than control participants (67.7%) preferred specific tests (P<0.001). Adjusting for pre-intervention preferences, more experimental group participants than control group participants preferred specific tests post-intervention [average marginal effect (AME)=9.5%, 95% CI 5.3-13.6; P<0.001]. AMEs were similar across ethnicity/language subgroups. CONCLUSION Knowledge tailoring increased preferences for specific CRC screening tests across ethnic and language groups. PRACTICE IMPLICATIONS If the observed preference changes are found to translate into behavior changes, then knowledge tailoring alone may enhance healthy behaviors.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA 95817, USA.
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Jerant A, Sohler N, Fiscella K, Franks B, Franks P. Tailored interactive multimedia computer programs to reduce health disparities: opportunities and challenges. Patient Educ Couns 2011; 85:323-330. [PMID: 21146950 PMCID: PMC3070866 DOI: 10.1016/j.pec.2010.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 09/10/2010] [Accepted: 11/21/2010] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To review the theory and research evidence suggesting that tailored interactive multimedia computer programs (IMCPs) aimed at optimizing patient health behaviors could lessen socio-demographic health disparities. METHODS Selective critical review of research regarding IMCPs tailored to psychological mediators of behavior and their effects on health behavior and outcomes among socio-demographically disadvantaged patients. RESULTS Tailored IMCPs can address patient factors (e.g. language barriers, low self-efficacy) and buffer provider (e.g. cognitive bias) and health system (e.g. office visit time constraints) factors that contribute to poor provider-patient communication and, thereby, suboptimal health behaviors. Research indicates disadvantaged individuals' interactions with providers are disproportionately affected by such factors, and that their behaviors respond favorably to tailored information, thus suggesting tailored IMCPs could mitigate disparities. However, no randomized controlled trials (RCTs) have examined this question. The optimal design and deployment of tailored IMCPs for disadvantaged patients also requires further study. CONCLUSION Preliminary research suggests tailored IMCPs have the potential to reduce health disparities. RCTs designed expressly to examine this issue are warranted. PRACTICE IMPLICATIONS Many socio-demographic health disparities exist, and there is a dearth of proven disparity-reducing interventions. Thus, if tailored IMCPs were shown to lessen disparities, the public health implications would be considerable.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
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Arno PS, Sohler N, Viola D, Schechter C. Bringing health and social policy together: the case of the earned income tax credit. J Public Health Policy 2009; 30:198-207. [PMID: 19597453 DOI: 10.1057/jphp.2009.3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The principal objective of our research is to examine whether the earned income tax credit (EITC), a broad-based income support program that has been shown to increase employment and income among poor working families, also improves their health and access to care. A finding that the EITC has a positive impact on the health of the American public may help guide deliberations about its future at the federal, state, and local levels. The authors contend that a better understanding of the relationship between major socioeconomic policies such as the EITC and the public's health will inform the fields of health and social policy in the pursuit of improving population health.
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Affiliation(s)
- Peter S Arno
- Department of Health Policy and Management, School of Public Health, New York Medical College, Valhalla, New York 10595, USA.
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Sohler N, Lubetkin E, Levy J, Soghomonian C, Rimmerman A. Factors associated with obesity and coronary heart disease in people with intellectual disabilities. Soc Work Health Care 2009; 48:76-89. [PMID: 19197767 DOI: 10.1080/00981380802451160] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Advances in health care for people with intellectual disabilities (ID) that have resulted in increased longevity also force health care providers, researchers, and policymakers to question the adequacy of chronic disease management for the growing number of middle aged and elderly persons in this population. We report on sociodemographic and clinical factors associated with obesity, hypertension, hypercholesterolemia, and diabetes mellitus in an ethnically/racially diverse sample of people with ID in New York City. Administrative and chart review data were collected from a community-based specialty medical practice for people with intellectual disabilities. Adult subjects were included if they had an intellectual disability, lived in the community either independently or with relatives, received all of their planned, outpatient health care services though this practice, and had a primary care visit within the study period. One hundred twenty-six (43.0%) persons were obese, 58 (19.9%) had hypertension, 77 (26.5%) had hypercholesterolemia, and 13 (4.5%) had diabetes mellitus. Age, gender, and BMI (for the latter three conditions) were the most consistent risk factors. Intellectual functioning and behavioral problems were not associated with greater odds of these conditions. This study provides crucial information for improving community-based primary care for people with intellectual disabilities. Specifically, these findings highlight the importance of constructing innovative strategies to mitigate chronic disease risk factors in this population that involve community-based case management service providers who can help adults with ID and their families adopt needed lifestyle and behavior changes.
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Affiliation(s)
- Nancy Sohler
- Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, City College of New York, New York, New York 10031, USA.
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Netherland J, Botsko M, Egan JE, Saxon AJ, Cunningham CO, Finkelstein R, Gourevitch MN, Renner JA, Sohler N, Sullivan LE, Weiss L, Fiellin DA. Factors affecting willingness to provide buprenorphine treatment. J Subst Abuse Treat 2008; 36:244-51. [PMID: 18715741 DOI: 10.1016/j.jsat.2008.06.006] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 05/19/2008] [Accepted: 06/22/2008] [Indexed: 10/21/2022]
Abstract
Buprenorphine is an effective long-term opioid agonist treatment. As the only pharmacological treatment for opioid dependence readily available in office-based settings, buprenorphine may facilitate a historic shift in addiction treatment from treatment facilities to general medical practices. Although many patients have benefited from the availability of buprenorphine in the United States, almost half of current prescribers are addiction specialists suggesting that buprenorphine treatment has not yet fully penetrated general practice settings. We examined factors affecting willingness to offer buprenorphine treatment among physicians with different levels of prescribing experience. Based on their prescribing practices, physicians were classified as experienced, novice, or as a nonprescriber and asked to assess the extent to which a list of factors impacted their prescription of buprenorphine. Several factors affected willingness to prescribe buprenorphine for all physicians: staff training; access to counseling and alternate treatment; visit time; buprenorphine availability; and pain medications concerns. Compared with other physicians, experienced prescribers were less concerned about induction logistics and access to expert consultation, clinical guidelines, and mental health services. They were more concerned with reimbursement. These data provide important insight into physician concerns about buprenorphine and have implications for practice, education, and policy change that may effectively support widespread adoption of buprenorphine.
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Affiliation(s)
- Julie Netherland
- The New York Academy of Medicine, Division of Health Policy, New York, NY 10029, USA.
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Cunningham C, Giovanniello A, Sacajiu G, Whitley S, Mund P, Beil R, Sohler N. Buprenorphine treatment in an urban community health center: what to expect. Fam Med 2008; 40:500-506. [PMID: 18928077 PMCID: PMC2840630] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Despite new opportunities to expand buprenorphine treatment for opioid dependence, use of this treatment modality has been limited. Physicians may question their ability to successfully treat opioid-dependent patients with buprenorphine in a primary care setting. We describe a buprenorphine treatment program and treatment outcomes in an urban community health center. METHODS We conducted retrospective chart reviews on the first 41 opioid-dependent patients treated with buprenorphine/naloxone. The primary outcome was 90-day retention in treatment. RESULTS Patients' mean age was 46 years, 70.7% were male, 58.8% Hispanic, 31.7% black, 57.5% unemployed, and 70.0% used heroin prior to treatment. Twenty-nine (70.7%) patients were retained in treatment at day 90. Compared to those not retained, patients retained in treatment were more likely to have used street methadone (0% versus 37.9%) and less likely to have used opioid analgesics (54.6% versus 20.7%) and alcohol (50.0% versus 13.8%) prior to treatment. Of the 25 patients with urine toxicology tests, 24% tested positive for opioids. CONCLUSIONS Buprenorphine treatment for opioid dependence in an urban community health center resulted in a 90-day retention rate of 70.7%. Type of substance use prior to treatment appeared to be associated with retention. These findings can help guide program development.
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Affiliation(s)
- Chinazo Cunningham
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY 10467, USA
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Nash D, Andreopoulos E, Horowitz D, Sohler N, Vlahov D. Differences among U.S. states in estimating the number of people living with HIV/AIDS: impact on allocation of federal Ryan White funding. Public Health Rep 2007; 122:644-56. [PMID: 17877312 PMCID: PMC1936968 DOI: 10.1177/003335490712200512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We assessed the impact of differing laboratory reporting scenarios on the completeness of estimates of people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) in the U.S., which are used to guide allocation of federal Ryan White funds. METHODS We conducted a four-year simulation study using clinical and laboratory data on 1,337 HIV-positive women, including 477 (36%) who did not have AIDS at baseline. We estimated the completeness of HIV (non-AIDS) case ascertainment for three laboratory reporting scenarios: CD4 < 200 cells/microL and detectable viral load (Scenario A); CD4 < 500 cells/microL and no viral load reporting (Scenario B); and CD4 < 500 cells/microL and detectable viral load (Scenario C). RESULTS Each scenario resulted in an increasing proportion of HIV (non-AIDS) cases being ascertained over time, with Scenario C yielding the highest by Year 4 (Year 1: 69.0%, Year 4: 88.1%), followed by Scenario A (Year 1: 63.3%, Year 4: 84.5%), and Scenario B (Year 1: 43.0%, Year 4: 67.7%). Overall completeness of PLWHA ascertainment after four years was highest for Scenario C (95.8%), followed by Scenario A (94.5%), and Scenario B (88.5%). CONCLUSIONS Differences in laboratory reporting regulations lead to substantial variations in the completeness of PLWHA estimates, and may penalize jurisdictions that are most successful at treating HIV/AIDS patients or those with weak or incomplete HIV/AIDS surveillance systems.
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Affiliation(s)
- Denis Nash
- Center for Urban Epidemiologic Studies, The New York Academy of Medicine, New York, NY, USA.
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Cabral HJ, Tobias C, Rajabiun S, Sohler N, Cunningham C, Wong M, Cunningham W. Outreach program contacts: do they increase the likelihood of engagement and retention in HIV primary care for hard-to-reach patients? AIDS Patient Care STDS 2007; 21 Suppl 1:S59-67. [PMID: 17563291 DOI: 10.1089/apc.2007.9986] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Engagement in HIV primary care and the receipt of antiretroviral therapy when clinically indicated offers patients the opportunity to experience HIV disease as a chronic illness. Yet many people, particularly those with comorbid mental health or substance abuse conditions and those who face multiple barriers to care, cycle in and out of care and thus can not reap the life-prolonging benefits of antiretroviral therapy. Although there is evidence about the impact of different interventions on adherence to HIV medications, there is little information about the impact of interventions on engagement or retention in HIV primary care among the hard-to-reach. In this multisite, national study, we contribute new information by exploring the relationship between outreach program contacts and retention in care over a 12-month period among participants in a demonstration project to promote engagement and retention in HIV primary care. We found that when participants received nine or more contacts during the first 3 months of their programs, they were about half as likely to have a substantial gap (defined as 4 months or more) in primary care during the first 12 months of follow-up. This finding remained after controlling for baseline CD4 count. These findings can be used to improve the effectiveness of programs to increase engagement and retention in HIV primary care among the hard-to-reach.
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Affiliation(s)
- Howard J Cabral
- Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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Abstract
Many HIV-infected marginally housed individuals have difficulty engaging in health care. To investigate HIV health-related behaviour, 14 in-depth interviews with marginally housed HIV-infected individuals were conducted and analysed utilizing standard qualitative methodologies. The analysis was based on the Illness Representation Model, which describes five conceptual dimensions of illness: identification; cause; timeline; management; and consequences. A theoretical model of illness representation at two distinct time points emerged and included the two categories: 'didn't suspect and didn't believe it' and 'knew but needed proof'. In this study illness representation categories were found to evolve and change over time, and were associated with engagement in HIV care. This study may help guide programmes that focus on enhancing health-promoting behaviour and improving engagement in health care among marginally housed individuals.
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Affiliation(s)
- G Sacajiu
- Montefiore Medical Center, Internal Medicine, Bronx, USA
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Muennig P, Sohler N, Mahato B. Socioeconomic status as an independent predictor of physiological biomarkers of cardiovascular disease: evidence from NHANES. Prev Med 2007; 45:35-40. [PMID: 17521717 DOI: 10.1016/j.ypmed.2007.04.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 04/03/2007] [Accepted: 04/12/2007] [Indexed: 01/27/2023]
Abstract
BACKGROUND C-reactive protein, homocysteine, cholesterol, and fibrinogen are known to vary by socioeconomic status (SES). Using a nationally representative study, we examined whether these factors vary independently of all other known risk factors, such as diet, exercise, and genetic predisposition. METHODS We analyzed the 1999-2002 National Health Examination and Nutrition Survey using logistic regression models. RESULTS We found that high-density lipoprotein cholesterol blood levels increase with income and educational attainment after controlling all known risk factors for elevated cholesterol (e.g., diet, exercise, and family history). Blood levels of C-reactive protein are inversely associated with income and education. Homocysteine blood levels are inversely associated with income even after controlling for blood folate level. A non-significant inverse relationship between homocysteine levels and educational attainment was also observed. Blood levels of low-density lipoprotein cholesterol and fibrinogen were not significantly associated with income or education. CONCLUSIONS Levels of "good" (high density lipoprotein) cholesterol increase with income and education even after controlling for factors known to place people at risk of high cholesterol. Stress differences by social class may play a role.
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Affiliation(s)
- Peter Muennig
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Abstract
OBJECTIVES Studies continue to document that people with human immunodeficiency virus (HIV) experience discrimination in their interactions with the health-care system, which can have negative implications for maintaining continuity in care and outcomes. We explored the patient characteristics associated with perceived discrimination and whether these experiences are associated with health-care system quality ratings in a survey of severely disadvantaged people with HIV who are at great risk of inconsistent access to appropriate health care. METHODS Five hundred and twenty-three participants were recruited from temporary housing facilities for people with HIV in the New York City area and administered a survey using audio computer-assisted self-interviewing technology. RESULTS Of the 207 participants (39.6%) who reported experiencing discrimination in the health-care system, the most common attributions were HIV infection (n = 122, 59.8%), drug use (n = 100, 49.8%), homelessness (n = 71, 34.6%), and race/ethnicity (n = 69, 35.2%). Length of time HIV infected, use of non-prescription opioids, white race, higher education, female gender, younger age, and poorer self-reported health status were all significantly associated with greater odds of perceived discrimination. After adjusting for participant characteristics, perceived discrimination was significantly associated with poorer participant ratings of quality of health care. CONCLUSIONS Members of this vulnerable population commonly report experiences of discrimination from within the health-care system and these experiences are associated with poor health-care ratings. These findings support the need for closer examination of the adequacy of cultural competency training within the HIV health-care delivery system to improve access to appropriate care for disadvantaged people.
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Affiliation(s)
- Nancy Sohler
- Sophie Davis School of Biomedical Education, City University of New York, 138th St. and Covent Ave., City College Campus, New York, NY 10031, USA.
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Bresnahan M, Begg MD, Brown A, Schaefer C, Sohler N, Insel B, Vella L, Susser E. Race and risk of schizophrenia in a US birth cohort: another example of health disparity? Int J Epidemiol 2007; 36:751-8. [PMID: 17440031 DOI: 10.1093/ije/dym041] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Immigrant groups in Western Europe have markedly increased rates of schizophrenia. The highest rates are found in ethnic groups that are predominantly black. Separating minority race/ethnicity from immigration in Western Europe is difficult; in the US, these issues can be examined separately. Here we compared rates of schizophrenia between whites and African Americans and evaluated whether the association was mediated by socioeconomic status (SES) of family of origin in a US birth cohort. METHODS Study subjects were offspring of women enrolled during pregnancy at Alameda County Kaiser Permanente Medical Care Plan clinics (1959-66) in the Child Health and Development Study. For schizophrenia spectrum disorders, 12 094 of the 19 044 live births were followed over 1981-97. The analysis is restricted to cohort members whose mothers identified as African American or white at intake. Stratified proportional hazards regression was the method of analysis; the robustness of findings to missing data bias was assessed using multiple imputation. RESULTS African Americans were about 3-fold more likely than whites to be diagnosed with schizophrenia [Rate Ratio (RR) = 3.27; 95% confidence interval (CI): 1.71-6.27]. After adjusting for indicators of family SES at birth, the RR was about 2-fold (RR = 1.92; 95% CI: 0.86-4.28). Using multiple imputation in the model including family SES indicators, the RR for race and schizophrenia was strengthened in comparison with the estimate obtained without imputation. CONCLUSION The data indicate substantially elevated rates of schizophrenia among African Americans in comparison with whites in this birth cohort. The association may have been partly but not wholly mediated by an effect of race on family SES.
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Affiliation(s)
- Michaeline Bresnahan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Berkman A, Pilowsky DJ, Zybert PA, Leu CS, Sohler N, Susser E. The impact of substance dependence on HIV sexual risk-reduction among men with severe mental illness. AIDS Care 2007; 17:635-9. [PMID: 16036249 DOI: 10.1080/09540120412331291797] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We explored the impact of substance dependence on the efficacy of an HIV sexual risk reduction intervention previously shown to be effective among men with severe mental illness by comparing rates of high-risk sexual behaviors among men with (n = 26) and without (n = 31) a lifetime history of substance dependence. We sub-divided subjects by alcohol and drug dependence status, comparing each intervention sub-group to the corresponding control sub-group. At each follow-up interval (six, 12 and 18 months), the intervention group as a whole and the non-substance dependent participants showed a significant reduction in risk; the substance-dependent men showed no difference from controls. These data suggest that among men with severe mental illness, substance dependence may be a further impediment to HIV risk reduction.
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Affiliation(s)
- A Berkman
- Mailman School of Public Health at Columbia, Columbia University, New York, NY 10032, USA
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Latka MH, Wilson TE, Cook JA, Bacon MC, Richardson JL, Sohler N, Cohen MH, Greenblatt RM, Andreopoulis E, Vlahov D. Impact of drug treatment on subsequent sexual risk behavior in a multisite cohort of drug-using women: a report from the Women's Interagency HIV Study. J Subst Abuse Treat 2006; 29:329-37. [PMID: 16311186 DOI: 10.1016/j.jsat.2005.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Revised: 07/10/2005] [Accepted: 08/23/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The evidence that drug treatment programs are associated with changes in sexual behavior and, thus, have prevention benefits beyond addiction is inconclusive. We examined whether entry into drug treatment was associated with subsequent alterations in sexual behavior among a group of drug-using women. METHODS Data were collected semiannually via structured interviews over 8 years. Generalized estimating equations evaluated the relationship between self-reported drug treatment at each visit and sexual abstinence and consistent condom use in the subsequent 6-month period. RESULTS In this sample (N = 1,658; mean age, 37.3 years; 57.5% African American; 80.3% HIV positive; 49.6% crack/cocaine users), 40% reported being in a variety of drug treatment programs. Those undergoing drug treatment (vs. those not) were less likely to become sexually active (adjusted odds ratio [AOR], 0.83; 95% confidence interval [CI], 0.76-0.91); this association was unchanged when the frequency of attendance and number of different drug treatment programs were evaluated. Drug treatment was not associated with subsequent consistent condom, regardless of frequency of attendance, but involvement in at least three treatment programs was (AOR, 1.40; 95% CI, 1.00-1.97). CONCLUSIONS Additional efforts are needed to integrate effective sexual risk reduction programs into drug treatment settings; expanding access to different types of drug treatment modalities may be indicated.
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Affiliation(s)
- Mary H Latka
- Center for Urban Epidemiological Studies, New York Academy of Medicine, New York, NY 10029, USA.
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Abstract
OBJECTIVE A six-session version of a longer, 15-session social skills intervention for reducing high-risk sexual behaviors among men with severe mental illness was assessed. METHODS Ninety-two men were randomly assigned to the intervention or to a two-hour standard HIV educational session, and their sexual risk behaviors were assessed every six weeks for six months. RESULTS Among the sexually active men (33 in the intervention group and 23 in the control group), a twofold reduction in sexual risk behaviors was found for the intervention group. This reduction was less than the threefold reduction seen for the original 15-session intervention and was not statically significant. CONCLUSIONS Further study is required to determine the optimal balance between efficacy and feasibility of this intervention.
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Affiliation(s)
- Alan Berkman
- Department of Epidemiology, Mailman School of Public Health, New York, NY 10032, USA.
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Mojtabai R, Herman D, Susser ES, Sohler N, Craig TJ, Lavelle J, Bromet EJ. Service use and outcomes of first-admission patients with psychotic disorders in the Suffolk County Mental Health Project. Am J Psychiatry 2005; 162:1291-8. [PMID: 15994711 DOI: 10.1176/appi.ajp.162.7.1291] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of the study was to examine the inpatient and outpatient service use and 4-year outcomes of newly admitted psychotic patients during a period of rapid change in the provision of psychiatric services in a well-defined catchment area in New York State in the 1990s. METHOD Subjects were 573 participants of the Suffolk County Mental Health Project. This group comprised patients with psychotic disorders first admitted between September 1989 and August 1995 to 12 inpatient facilities across Suffolk County, N.Y., and followed for up to 48 months. The subjects' service use, course of illness, symptomatic outcomes, suicide risk, homelessness risk, and satisfaction with care were compared across admission years. RESULTS The length of inpatient stays decreased significantly across the years. However, the number of outpatient visits and therapy sessions did not vary. Although the patients admitted in later years were more symptomatic at admission to their first hospitalization, their course and outcomes over the follow-up period were not worse and they were not less satisfied with their care, compared with the patients admitted in earlier years. CONCLUSIONS The clinical characteristics of patients and the role of inpatient care in the management of patients with psychotic disorders gradually changed during the 1990s. These changes, however, were not associated with changes in the use of outpatient services or outcomes. Nevertheless, shorter hospital stays and the presence of more severely ill patients highlight the need for more attention to linkage to aftercare and enhancement of support networks in the community.
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Affiliation(s)
- Ramin Mojtabai
- Department of Psychiatry, Beth Israel Medical Center, First Ave. at 16th St., New York, NY 10010, USA.
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Kapadia F, Cook JA, Cohen MH, Sohler N, Kovacs A, Greenblatt RM, Choudhary I, Vlahov D. The relationship between non-injection drug use behaviors on progression to AIDS and death in a cohort of HIV seropositive women in the era of highly active antiretroviral therapy use. Addiction 2005; 100:990-1002. [PMID: 15955015 PMCID: PMC3128378 DOI: 10.1111/j.1360-0443.2005.01098.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate the effects of longitudinal patterns and types of non-injection drug use (NIDU) on HIV progression in the highly active antiretroviral therapy (HAART) era. DESIGN Women's Interagency HIV Study (WIHS), a prospective cohort study conducted at six US sites. METHODS Data were collected semi-annually from 1994 to 2002 on 1046 HIV(+) women. Multivariate Cox proportional hazards modeling was used to estimate relative hazards for developing AIDS and for death by pattern and type of NIDU. FINDINGS During follow-up, 285 AIDS events and 287 deaths, of which 177 were AIDS-related, were reported. At baseline, consistent and former NIDU was associated with CD4(+) counts of < 200 cells/microl (43% and 46%, respectively) and viral load > 40,000 copies/ml (53% and 55%, respectively). Consistent NIDU reported less HAART use (53%) compared with other NIDU patterns. Stimulant use was associated with CD4(+) cell counts of < 200 cells/microl (53%) and lower HAART initiation (63%) compared with other NIDU types. In multivariate analyses, progression to AIDS was significantly higher among consistent (RH = 2.52), inconsistent (RH = 1.63) and former (RH = 1.56) users compared with never users; and for stimulant (RH = 2.04) and polydrug (RH = 1.65) users compared with non-users. Progression to all-cause death was higher only among former users (RH = 1.48) compared with never users in multivariate analysis. NIDU behaviors were not associated with progression to AIDS-related death. CONCLUSIONS In this study, pattern and type of NIDU were associated with HIV progression to AIDS and all-cause mortality. These differences were associated with lower HAART utilization among consistent NIDU and use of stimulants, and poor baseline immunological and virological status among former users.
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Affiliation(s)
- Farzana Kapadia
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10029, USA.
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Abstract
BACKGROUND The 1896 and 1996 populations of North West Wales are similar in number, ethnic and social mix and rurality, enabling a study of the comparative incidence and prevalence of service utilization over the course of a century. METHODS We collected records on all psychiatric admissions from North-West Wales in 1894-1896 and 1996. These were assessed and diagnosed by the responsible sector area consultant. RESULTS The data reveal substantially more patients admitted for all diagnoses in 1996. even when comparisons are restricted to detained patients. The incidence of hospitalization by detention for schizophrenia is slightly lower 1996 than in 1896 but the incidence of hospitalization is higher now than in 1996. The incidence of hospitalization by detention for non-affective disorder psychoses is the same in both 1896 and 1996 but there is a doubling of incidence of hospitalization. The incidence of hospitalization for bipolar disorders is similar in the two periods. Modern mental health services admit large numbers of personality disordered patients, where none were admitted 100 years ago. CONCLUSIONS Factors general to changing health care and expectations and others specific to mental health would appear to have led to the increase in rates of admissions observed in the modern period.
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Affiliation(s)
- D Healy
- North Wales Department of Psychological Medicine, University of Wales College of Medicine and School of Sociology and Social Policy, Bangor
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Abstract
The purpose of this investigation was to ascertain the reasons given by mothers diagnosed with AIDS (acquired immunodeficiency syndrome) for disclosing or not disclosing their HIV (human immunodeficiency virus) status to their children, a dilemma faced by most HIV-infected parents and those who counsel them. We interviewed 29 mothers residing in one of two New York City facilities that provide housing and medical treatment for adults with AIDS. The majority of these mothers do not live with their children, but all had recent face-to-face contact with them. The two reasons most frequently considered important for disclosing to children were that disclosure was the "right thing to do" and the need to make arrangements for children's future in case of maternal death or incapacity. The reason most frequently considered important for not disclosing was maternal concern about discussing death and dying with children. These findings have significant implications for counseling of HIV-positive parents.
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Abstract
The reliability of self-reports of sexual behaviors related to HIV transmission was examined in a study of homeless men with severe mental illness. Thirty-nine patients of a New York City shelter psychiatric program were interviewed about their sexual behaviors in the past six months. The same interview was administered twice, with a one- to two-week interval between interviews. Test-retest reliability was assessed using kappa and intraclass correlation coefficients. Reliability estimates ranged from.49 to.93 for overall sexual activity, number of partners, and specific behaviors other than receptive anal sex. Reliability was lower for condom use. The authors conclude that reliable self-reports about sexual behavior can be obtained from homeless men with severe mental illness.
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Affiliation(s)
- N Sohler
- Division of Epidemiology, Columbia University, New York, NY 10032, USA.
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Abstract
As the number of HIV-infected women and children in the USA has increased, clinicians and researchers have debated the benefits and risks of disclosure of parental HIV status to children. Disclosure is usually ascertained through interviews of unknown reliability. Given the need to advance knowledge regarding the benefits and risks of disclosure of parental HIV status to children, a reliable and comprehensive disclosure interview is needed. The Parent Disclosure Interview (PDI) was developed for this purpose. In order to study its reliability, 29 HIV-infected mothers were administered the PDI twice, on average one week apart, by two different female interviewers. Kappa statistics indicate that the PDI is highly reliable in most content areas. Researchers may use the interview for comparing the prevalence of disclosure among different groups of HIV-infected parents. Practitioners who assist parents in making decisions about disclosure of HIV status to children may use the interview to obtain a baseline assessment of the clients' disclosure history and attitudes towards disclosure.
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Affiliation(s)
- D J Pilowsky
- Department of Psychiatry, Johns Hopkins University School of Medicine & Kennedy-Krieger Institute, Baltimore, MD, USA.
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Susser E, Valencia E, Berkman A, Sohler N, Conover S, Torres J, Betne P, Felix A, Miller S. Human immunodeficiency virus sexual risk reduction in homeless men with mental illness. Arch Gen Psychiatry 1998; 55:266-72. [PMID: 9510221 DOI: 10.1001/archpsyc.55.3.266] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The spread of human immunodeficiency virus infection to impaired groups has intensified the challenge for its prevention; control of the epidemic now requires behavioral change among persons with limited ability to sustain attention and learn. In this randomized clinical trial, we tested an intervention to reduce sexual risk behaviors among homeless men with severe mental illness. METHODS Men were recruited from a psychiatric program in a homeless shelter. Of 116 eligible men, 97 (83.6%) participated. Most were African American and had a chronic psychotic disorder and a comorbid substance use disorder. Participants were assigned to a 15-session experimental group intervention or to a 2-session control intervention and observed for 18 months. The 59 participants sexually active before the trial were the main target of the intervention. Sexual risk behavior was the primary outcome. RESULTS Among the 59 sexually active men, follow-up data were obtained on 59 (100%) for the initial 6-month follow-up and on 56 (95%) for the remainder of the 18-month follow-up. The mean score on a sexual risk index for the experimental group was 3 times lower than for the control group (1.0 vs 3.1; P=.01) during the initial 6-month follow-up and 2 times lower during the remainder of the 18-month follow-up. CONCLUSIONS This intervention successfully reduced sexual risk behaviors of homeless men with mental illness. The effect diminished over 18 months but did not disappear. Similar approaches may be effective in other impaired high-risk groups.
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Affiliation(s)
- E Susser
- Department of Psychiatry, Columbia University School of Medicine, New York State Psychiatric Institute, New York 10032, USA
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Susser E, Valencia E, Sohler N, Gheith A, Conover S, Torres J. Interventions for homeless men and women with mental illness: reducing sexual risk behaviours for HIV. Int J STD AIDS 1996; 7 Suppl 2:66-70. [PMID: 8799799 DOI: 10.1258/0956462961917672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- E Susser
- HIV Centre for Clinical and Behavioral Studies, New York State Psychiatric Institute, Presbyterian Hospital, New York, USA
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Abstract
This paper concerns the diagnostic classification of nonaffective acute remitting psychosis (NARP), which we also term acute brief psychosis. We argue that NARP can be delineated from both schizophrenia and the affective psychoses and considered as a single diagnosis. As indicated by the term NARP, four criteria would be central to the diagnosis: 1. nonaffective, 2. acute onset (over less than two weeks), 3. recovery within a brief duration (less than six months), and 4. psychosis broadly defined. We review the rationale and the empirical evidence for this proposed classification.
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Affiliation(s)
- E Susser
- Department of Psychiatry, College of Physicians and Surgeons of Columbia, University, New York, NY 10032, USA
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