NYU Launches Online MPH Geared Toward Graduate Students in Low- and Middle-Income Countries

May 23, 2017

The College of Global Public Health Degree to Focus on Meeting 2030 UN Sustainable Development Goals in Public Health

First Class to Include Twenty Students from Low-Income Nations Who Wi

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Remote Patient Monitoring and Clinical Outcomes for Postdischarge Patients with Type 2 Diabetes

Michaud, T. L., Siahpush, M., Schwab, R. J., Eiland, L. A., Devany, M., Hansen, G., Slachetka, T. S., Boilesen, E., Tak, H. J., Wilson, F. A., Wang, H., Pagan, J., & Su, D.

Publication year

2018

Journal title

Population Health Management

Volume

21

Issue

5

Page(s)

387-394
Abstract
The objective of this study was to evaluate changes in clinical outcomes for patients with type 2 diabetes (T2D) after a 3-month remote patient monitoring (RPM) program, and examine the relationship between hemoglobin A1c (HbA1c) outcomes and participant characteristics. The study sample included 955 patients with T2D who were admitted to an urban Midwestern medical center for any reason from 2014 to 2017, and used RPM for 3 months after discharge. Clinical outcomes included HbA1c, weight, body mass index (BMI), and patient activation scores. Logistic regression was used to estimate the likelihood of having a postintervention HbA1c <9% by patient characteristics, among those who had baseline HbA1c >9%. Most patients experienced decreases in HbA1c (67%) and BMI (58%), and increases in patient activation scores (67%) (P < 0.001 in all 3 cases) at the end of RPM. Logistic regression analyses revealed that among patients who had HbA1c >9% at baseline, men (odds ratio [OR] = 3.72; 95% confidence interval [CI], 1.43-9.64), those who had increased patient activation scores after intervention (OR = 1.05; 95% CI, 1.01-1.09), those who had higher baseline patient activation scores, and those who had a greater number of biometric data uploads during the intervention (OR = 1.02; 95% CI, 1.00-1.04) were more likely to have reduced their HbA1c to <9% at the end of RPM. RPM for postdischarge patients with T2D might be a promising approach for HbA1c control with increased patient engagement. Future studies with study designs that include a control group should provide more robust evidence.

Qualitative exploration of a smoking cessation trial for people living with HIV in South Africa

Krishnan, N., Gittelsohn, J., Ross, A., Elf, J., Chon, S., Niaura, R., Martinson, N., & Golub, J. E.

Publication year

2018

Journal title

Nicotine and Tobacco Research

Volume

20

Issue

9

Page(s)

1117-1123
Abstract
Introduction: In South Africa, people living with HIV have a high prevalence of smoking, which undermines the beneficial effects of antiretroviral therapy. However, little is known about barriers to smoking cessation and what interventions work for people living with HIV in this setting. Methods: A randomized trial comparing intensive anti-smoking counseling versus counseling and nicotine replacement therapy was recently concluded in Klerksdorp, South Africa. In a post-trial follow-up, 23 in-depth interviews with patients and one focus group discussion with counselors from the trial were conducted. A codebook was developed and codes were applied to the transcripts, which were analyzed using a thematic analysis. Results: Barriers at the economic, social/interpersonal, and individual levels induced stress, which hindered smoking cessation. Economic stressors included unemployment and poverty. Social or interpersonal stressors were lack of social support for quitting smoking and lack of social support due to having HIV. Individual stressors were traumatic life events. Alcohol was used to cope with stress and frequently co-occurred with smoking. Managing cravings was a barrier unrelated to stress. Participants proposed income and employment opportunities, group counseling, and more frequent counseling as solutions to address stressors at different levels. Nicotine replacement therapy was helpful to mitigate cravings. Conclusions: Future smoking cessation interventions need to target barriers at multiple levels. Increasing the supply and duration of nicotine replacement therapy may increase its effectiveness. Other behavioral approaches such as group counseling or peer counseling could hold promise in this setting but need to be tested for efficacy through randomized controlled trials. Implications: To our knowledge, this is the first qualitative study examining barriers to smoking cessation for people living with HIV in South Africa. Smoking is highly prevalent among people with HIV in South Africa and cessation interventions are urgently needed. A better understanding of barriers to smoking cessation that people with HIV face will lead to the development of contextually appropriate interventions. This study also provides feedback on interventions from a recently concluded smoking cessation randomized trial and will help guide the design of future smoking cessation trials.

Prevalence and correlates of smoking among people living with HIV in South Africa

Elf, J. L., Variava, E., Chon, S., Lebina, L., Motlhaoleng, K., Gupte, N., Niaura, R., Abrams, D., Golub, J. E., & Martinson, N.

Publication year

2018

Journal title

Nicotine and Tobacco Research

Volume

20

Issue

9

Page(s)

1124-1131
Abstract
Introduction: Smoking likely exacerbates comorbidities which people living with HIV (PLWH) are predisposed. We assessed prevalence and correlates of smoking among PLWH in South Africa, which has 7 million PLWH but inadequate reporting of smoking. Methods: A cross-sectional survey was conducted among randomly selected adults with HIV infection in Klerksdorp, South Africa. Current smoking was assessed by questionnaire, exhaled carbon monoxide (eCO), and urine cotinine. Results: Of 1210 enrolled adults, 753 (62%) were women. In total, 409 (34%) self-reported ever smoking: 301 (74%) were current and 108 (26%) were former smokers. Using eCO and urine cotinine tests, 239 (52%) men and 100 (13%) women were defined as current smokers. Nearly all smokers (99%) were receiving ART, and had a median (IQR) CD4 count of 333 cells/μL (181-534), viral load of 31 IU/mL (25-4750), and BMI of 21 kg/m2 (19-24). Adjusted analysis among men showed higher odds of smoking with marijuana use (OR = 7.5, 95% CI = 4.1 to 14.6). Among women, 304 (43%) reported using snuff, compared to only 11 (3%) of men, and snuff use was inversely associated with smoking (OR = 0.1; 95% CI = 0.05 to 0.2). A subset of participants (n = 336) was asked about alcohol use, which was positively associated with smoking for men (OR = 8.1, 95% CI = 2.8 to 25.9) and women (OR = 8.5, 95% CI = 2.9 to 26.8). Conclusion: Smoking prevalence among PLWH in South Africa is alarmingly high. Prevention and cessation strategies that consider marijuana and alcohol use are needed. Implications: As long-term HIV care continues to improve, more people living with HIV (PLWH) will die of diseases, including tuberculosis, for which smoking plays an important causal role. The prevalence of smoking is markedly higher among PLWH in high-resource settings, but data for Africa and other low-resource settings that shoulder the brunt of the HIV epidemic has previously not been well documented. We report an alarmingly high prevalence of smoking among PLWH in South Africa, particularly among men, and a strong association between current smoking and use of other substances.

Efficacy of a Discharge Educational Strategy vs Standard Discharge Care on Reduction of Vascular Risk in Patients with Stroke and Transient Ischemic Attack: The DESERVE Randomized Clinical Trial

-Boden-Albala, B., Goldmann, E., Parikh, N., Carman, H., Roberts, E. T., Lord, A. S., Torrico, V., Appleton, N., Birkemeier, J., Parides, M., & Quarles, L.

Publication year

2018

Journal title

JAMA Neurology
Abstract
Importance: Despite secondary prevention strategies with proven efficacy, recurrent stroke rates remain high, particularly in racial/ethnic minority populations who are disproportionately affected by stroke. Objective: To determine the efficacy of a culturally tailored skills-based educational intervention with telephone follow-up compared with standard discharge care on systolic blood pressure reduction in a multiethnic cohort of patients with mild/moderate stroke/transient ischemic attack. Design, Setting, and Participants: Randomized clinical trial with 1-year follow-up. Participants were white, black, and Hispanic patients with mild/moderate stroke/transient ischemic attack prospectively enrolled from 4 New York City, New York, medical centers during hospitalization or emergency department visit between August 2012 and May 2016. Through screening of stroke admissions and emergency department notifications, 1083 eligible patients were identified, of whom 256 declined to participate and 275 were excluded for other reasons. Analyses were intention to treat. Interventions: The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) intervention is a skills-based, culturally tailored discharge program with follow-up calls delivered by a community health coordinator. This intervention was developed using a community engagement approach. Main Outcomes and Measures: The primary outcome was systolic blood pressure reduction at 12 months postdischarge. Results: A total of 552 participants were randomized to receive intervention or usual care (281 women [51%]; mean [SD] age, 64.61 [2.9] years; 180 Hispanic [33%], 151 non-Hispanic white [27%], and 183 non-Hispanic black [33%]). At 1-year follow-up, no significant difference in systolic blood pressure reduction was observed between intervention and usual care groups (β = 2.5 mm Hg; 95% CI, -1.9 to 6.9). Although not powered for subgroup analysis, we found that among Hispanic individuals, the intervention arm had a clinically and statically significant 9.9 mm Hg-greater mean systolic blood pressure reduction compared with usual care (95% CI, 1.8-18.0). There were no significant differences between arms among non-Hispanic white (β = 3.3; 95% CI, -4.1 to 10.7) and non-Hispanic black participants (β = -1.6; 95% CI, -10.1 to 6.8). Conclusions and Relevance: Few behavioral intervention studies in individuals who have had stroke have reported clinically meaningful reductions in blood pressure at 12 months, and fewer have focused on a skills-based approach. Results of secondary analyses suggest that culturally tailored, skills-based strategies may be an important alternative to knowledge-focused approaches in achieving sustained vascular risk reduction and addressing racial/ethnic stroke disparities; however, these findings should be tested in future studies. Trial Registration: ClinicalTrials.gov identifier: NCT01836354..

Gender, Social Networks, and Stroke Preparedness in the Stroke Warning Information and Faster Treatment Study

Madsen, T. E., Roberts, E. T., Kuczynski, H., Goldmann, E., Parikh, N. S., & -Boden-Albala, B.

Publication year

2017

Journal title

Journal of Stroke and Cerebrovascular Diseases
Abstract
Background and Purpose: The study aimed to investigate the effect of gender on the association between social networks and stroke preparedness as measured by emergency department (ED) arrival within 3 hours of symptom onset. Methods: As part of the Stroke Warning Information and Faster Treatment study, baseline data on demographics, social networks, and time to ED arrival were collected from 1193 prospectively enrolled stroke/transient ischemic attack (TIA) patients at Columbia University Medical Center. Logistic regression was conducted with arrival to the ED ≤3 hours as the outcome, social network characteristics as explanatory variables, and gender as a potential effect modifier. Results: Men who lived alone or were divorced were significantly less likely to arrive ≤3 hours than men who lived with a spouse (adjusted odds ratio [aOR]: .31, 95% confidence interval [CI]: .15-0.64) or were married (aOR: .45, 95% CI: .23-0.86). Among women, those who lived alone or were divorced had similar odds of arriving ≤3 hours compared with those who lived with a spouse (aOR: 1.25, 95% CI: .63-2.49) or were married (aOR: .73, 95% CI: .4-1.35). Conclusions: In patients with stroke/TIA, living with someone or being married improved time to arrival in men only. Behavioral interventions to improve stroke preparedness should incorporate gender differences in how social networks affect arrival times.

Mutational Analysis of the Wolfram Syndrome Gene (WFS1) in Greek and Dominican Patients

Bretschger, S., Deng, L., Caine, E., Leibel, R. L., Chung, W. K., -Boden-Albala, B., Sacco, R., Bretschger, S., Leibel, R. L., & Chung, W. K.

Publication year

2002

Journal title

International Journal on Disability and Human Development

Volume

3

Issue

1

Page(s)

13-20
Abstract
Wolfram syndrome is an autosomal recessive neurodegenerative disorder mapped to 4pl6 associated with juvenile-onset insulin-dependent diabetes mellitus and bilateral progressive optic nerve atrophy. The gene responsible for Wolfram syndrome, WFS1, is a member of a novel gene family whose function is currently undefined. In this study, mutational analysis of WFS1 was performed in three patients from two unrelated families with Wolfram syndrome as well as 35 Greek and 35 Dominican healthy controls. A novel mutation (1683-1697del15nt) was identified in a Greek patient with Wolfram syndrome, and a 1387delCTCT mutation that was previously identified in Italian patients was identified in two affected Dominican siblings. One novel coding variant (D771G) was also identified that is likely not pathogenic. Additionally, several novel polymorphisms of WFS1 were identified in control, unaffected individuals of Greek and Dominican descent. This study represents the first mutational analysis of WFS1 in Greek and Dominican patients with Wolfram syndrome and provides molecular reagents for analysis of this gene in non-syndromic diabetes mellitus, depression, and hearing loss.

Ascertainment of Alaska Native Stroke Incidence, 2005-2009: Lessons for Assessing the Global Burden of Stroke

-Boden-Albala, B., Allen, J., Roberts, E. T., Bulkow, L., & Trimble, B.

Publication year

2017

Journal title

Journal of Stroke and Cerebrovascular Diseases

Volume

26

Issue

9

Page(s)

2019-2026
Abstract
Background Stroke is a critical public health issue in the United States and globally. System models to optimally capture stroke incidence in rural and culturally diverse communities are needed. The epidemiological transition to a western lifestyle has been associated with an increased burden of vascular risk factors among Alaska Native (AN) people. The burden of stroke in AN communities remains understudied. Methods The Alaska Native Stroke Registry (ANSR) was designed to screen and capture all stroke cases between 2005 and 2009 through its integration into the existing single-payer Alaska Tribal Health System infrastructure. Registry staff received notification each time stroke International Classification of Diseases, Ninth Revision codes (430-436) were initiated anywhere in the system. Trained chart abstractors reviewed medical records to document incident strokes among AN patients, which were adjudicated. Results Between October 2005 and October 2009, over 2100 alerts were screened identifying 514 unique stroke cases, of which 372 were incident strokes. The average annual incidence of stroke (per 100,000) among AN adults was 190.6: 219.2 in men and 164.7 in women. Overall, the ischemic stroke incidence rate was 148.5 per 100,000 with men (184.6) having higher ischemic rates per 100,000 than women (118.3). Men have higher rates of ischemic stroke at all ages, whereas older women experienced higher rates of hemorrhagic strokes over the age of 75 years. Conclusions We report a high rate of overall stroke, 190.6 per 100,000. The ANSR methods and findings have implications for other indigenous populations and for global health populations currently undergoing similar epidemiological transitions.

Age-related differences in antihypertensive medication adherence in hispanics: A cross-sectional community-based survey in New York City, 2011-2012

Bandi, P., Goldmann, E., Parikh, N. S., Farsi, P., & -Boden-Albala, B.

Publication year

2017

Journal title

Preventing chronic disease

Volume

14

Issue

7
Abstract
Introduction US Hispanics, particularly younger adults in this population, have a higher prevalence of uncontrolled hypertension than do people of other racial/ethnic groups. Little is known about the prevalence and predictors of antihypertensive medication adherence, a major determinant of hypertension control and cardiovascular disease, and differences between age groups in this fast-growing population. Methods The cross-sectional study included 1,043 community-dwelling Hispanic adults with hypertension living in 3 northern Manhattan neighborhoods from 2011 through 2012. Age-stratified analyses assessed the prevalence and predictors of high medication adherence (score of 8 on the Morisky Medication Adherence Scale [MMAS-8]) among younger (< 60 y) and older (≥60 y) Hispanic adults. Results Prevalence of high adherence was significantly lower in younger versus older adults (24.5% vs 34.0%, P = .001). In younger adults, heavy alcohol consumption, a longer duration of hypertension, and recent poor physical health were negatively associated with high adherence, but poor self-rated general health was positively associated with high adherence. In older adults, advancing age, higher education level, high knowledge of hypertension control, and private insurance or Medicare versus Medicaid were positively associated with high adherence, whereas recent poor physical health and health-related activity limitations were negatively associated with high adherence. Conclusion Equitable achievement of national hypertension control goals will require attention to suboptimal antihypertensive medication adherence found in this study and other samples of US Hispanics, particularly in younger adults. Age differences in predictors of high adherence highlight the need to tailor efforts to the life stage of people with hypertension.

Barriers and Strategies for Recruitment of Racial and Ethnic Minorities: Perspectives from Neurological Clinical Research Coordinators

Haley, S. J., Southwick, L. E., Parikh, N. S., Rivera, J., Farrar-Edwards, D., & -Boden-Albala, B.

Publication year

2017

Journal title

Journal of racial and ethnic health disparities

Page(s)

1-12
Abstract
Introduction: Randomized controlled trials (RCTs) are the gold standard within evidence-based research. Low participant accrual rates, especially of underrepresented groups (e.g., racial-ethnic minorities), may jeopardize clinical studies’ viability and strength of findings. Research has begun to unweave clinical trial mechanics, including the roles of clinical research coordinators, to improve trial participation rates. Methods: Two semi-structured focus groups were conducted with a purposive sample of 29 clinical research coordinators (CRCs) at consecutive international stroke conferences in 2013 and 2014 to gain in-depth understanding of coordinator-level barriers to racial-ethnic minority recruitment and retention into neurological trials. Coded transcripts were used to create themes to define concepts, identify associations, summarize findings, and posit explanations. Results: Barriers related to translation, literacy, family composition, and severity of medical diagnosis were identified. Potential strategies included a focus on developing personal relationships with patients, community and patient education, centralized clinical trial administrative systems, and competency focused training and education for CRCs. Conclusion: Patient level barriers to clinical trial recruitment are well documented. Less is known about barriers facing CRCs. Further identification of how and when barriers manifest and the effectiveness of strategies to improve CRCs recruitment efforts is warranted.
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