Patient and Clinician Satisfaction with the Early Implementation of Telemental Health Services in an Urban Behavioral Health Clinic During the COVID-19 Pandemic

Objective: The COVID-19 pandemic served as an impetus for the rapid expansion of telehealth. In this study, we examined the experience of rapid transition to telemental health (TMH) within The Family Health Centers at NYU Langone, a large, urban, Federally Qualified Health Center, in the 3 months after the onset of the COVID-19 pandemic. Methods: We administered surveys to clinicians and patients who utilized TMH between March 16, 2020 and July 16, 2020. Patients were sent a web-based survey via email or received a phone survey (for those without email) with four languages choices: English, Spanish, Traditional Chinese, or Simplified Chinese. Results: The majority (79%) of clinicians (n = 83) rated the experience of TMH as "excellent" or "good," and felt that they could establish and maintain the patient relationship through TMH. Four thousand seven hundred seventy-two survey invitations were sent out to patients, and 654 (13.7%) responded. Ninety percent reported that they were satisfied with the service they received and rated TMH as better or the same as in-person care (81.6%) with a high mean satisfaction score (4.5 out of 5). Patients were more likely to rate TMH as better or the same as in-person care relative to the clinicians. Conclusions: These results are consistent with several recent studies that have explored patient satisfaction with TMH during the COVID-19 pandemic and demonstrate that both clinicians and patients experienced a high degree of satisfaction with mental health care delivered virtually compared with face-to-face encounters.

Prevalence of Childhood Trauma in a Community-Based Mental Health Clinic

A large number of individuals in the US have experienced childhood trauma. However, little is known about the prevalence of trauma in a diverse patient population entering treatment in a community mental health center. To assess early trauma in this population, the Adverse Childhood Experience (ACEs) questionnaire was administered to 856 participants over a nine-month period. 40% reported four or more ACEs. Among high scorers, emotional abuse, physical abuse and emotional neglect were the most prevalent ACE experiences. High mean ACE sum scores were observed among patients with PTSD, depression, impulse disorder and substance use disorder. Having a higher ACE sum score was associated with a greater number of co-occurring psychiatric disorders. Characterizing ACEs by patient sociodemographic attributes and psychiatric diagnoses extracted from the electronic medical records (EMR) can benefit therapeutic interventions. These findings indicate a need for creating more trauma-informed settings with knowledgeable, trained staff.

Retrospective analysis of the impact of severe obesity on kidney transplant outcomes

BACKGROUND

The prevalence of obesity among kidney transplant recipients is rising. We sought to determine the association between recipient body mass index (BMI) and post-transplant complications.

METHODS

Single-center, retrospective cohort study of all adult kidney transplant recipients from 2004 to 2020. Recipients were stratified into four BMI categories: normal-weight (BMI 18.5-24.9 kg/m2, n = 1020), overweight (BMI 25-29.9 kg/m2, n = 1002), moderately obese (BMI 30-34.9 kg/m2, n = 510) and severely-to-morbidly obese (BMI ≥35 kg/m2, n = 274). Logistic regression was used to estimate the association between BMI category and surgical site infections (SSIs).

RESULTS

Recipients with BMI ≥35 kg/m2 had significantly higher rates of SSIs (P < .0001) compared with recipients in all other categories. On multivariable analysis, recipients with BMI ≥35 kg/m2 had increased odds of SSIs compared with normal-weight recipients [odds ratio (OR) 3.34, 95% confidence interval (CI) 1.55-7.22, P = .022). On multivariable and Kaplan-Meier analyses, no BMI groups demonstrated increased odds for death-censored graft failure.

CONCLUSION

Severe obesity in kidney transplant recipients is associated with increased SSIs, but not kidney allograft failure.

Anti-Asian Attitudes in the Context of the COVID-19 Pandemic: an Exploratory Study

Objective

The purpose of this paper was to measure if people with greater “structural literacy,” as indicated by greater awareness of racial and socioeconomic disparities in COVID-19 impact, would hold fewer negative attitudes against those perceived to be Asian in the context of the COVID-19 pandemic.

Methods

A survey was administered between April and August 2020 to participants from two longitudinal cohorts in New York State. The survey assessed anti-Asian attitudes relating to COVID-19, awareness of racial and socioeconomic disparities in COVID-19, residential location, socioeconomic status, and other demographic information. The sample included 233 Black, Latinx, and White midlife adults from urban, suburban, and rural New York neighborhoods. Multivariable regression modeling was used to assess associations between COVID-19 disparities awareness, an indicator of structural literacy, and anti-Asian attitudes, adjusting for gender, race/ethnicity, residential location, and socioeconomic disadvantage.

Results

Greater awareness of disparities in COVID-19 was associated with lower levels of anti-Asian attitudes after adjustment (adj-slope =  − 0.358, p < 0.001).

Conclusion

Greater structural literacy, as measured by awareness of socioeconomic and racial disparities in COVID-19 impact, was associated with fewer anti-Asian attitudes among Black, Latinx, and White adults.

Implications

Increasing structural literacy may reduce anti-Asian attitudes that motivate harmful acts against oppressed groups.

Association Between Donor-Recipient Biological Relationship and Allograft Outcomes After Living Donor Kidney Transplant

IMPORTANCE

The proportion of living donor kidney transplants from donors unrelated to their recipients is increasing in the US.

OBJECTIVE

To examine the association between donor-recipient biological relationship and allograft survival after living donor kidney transplant.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study used Organ Procurement and Transplantation Network data on US adult living donor kidney transplants (n = 86 154) performed from January 1, 2000, to December 31, 2014, excluding cases in which recipients previously received a kidney transplant (n = 10 342) or key data were missing (n = 2832). Last follow-up was March 20, 2020.

EXPOSURES

Donor-recipient biological relationship.

MAIN OUTCOMES AND MEASURES

The primary outcome was death-censored allograft failure. Univariate and multivariable time-to-event analyses were performed for death-censored allograft failure for the overall cohort, then separately for recipients with and without primary diagnoses of cystic kidney disease and for transplants from African American and non-African American donors.

RESULTS

Among the 72 980 transplant donor and recipients included in the study (median donor age, 41 years; interquartile range [IQR], 32-50 years; 43 990 [60%] female; 50 014 [69%] White), 43 174 (59%) donors and recipients were biologically related and 29 806 (41%) were unrelated. Donors related to their recipients were younger (median [IQR] age, 39 [31-48] vs 44 [35-52] years) and less likely to be female (24 848 [58%] vs 19 142 [64%]) or White (26 933 [62%] vs 23 081 [77%]). Recipients related to their donors were younger (median [IQR] age, 48 [34-58] vs 50 [40-58] years), more likely to be female (18 035 [42%] vs 10 530 [35%]), and less likely to have cystic kidney disease (2530 [6%] vs 4600 [15%]). Related pairs had fewer HLA mismatches overall (median [IQR], 3 [2-3] vs 5 [4-5]). After adjustment for HLA mismatches, donor and recipient characteristics, and transplant era, donor-recipient biological relationship was associated with higher death-censored allograft failure (hazard ratio, 1.05; 95% CI, 1.01-1.10; P = .03). When stratified by primary disease, this association persisted only for recipients without cystic kidney disease. When stratified by donor race, this association persisted only for transplants from African American donors.

CONCLUSIONS AND RELEVANCE

In this cohort study, living donor kidney transplants from donors biologically related to their recipients had higher rates of allograft failure than transplants from donors unrelated to their recipients after HLA matching was accounted for. Further study is needed to determine which genetic or socioenvironmental factors are associated with this finding.