Background Depressive symptoms are associated with mortality. Data regarding moderation of this effect by age and sex are inconsistent, however. We aimed to identify whether age and sex modify the ...association between depressive symptoms and all-cause and cardiovascular disease (CVD) mortality. Methods and Results The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a prospective cohort of Black and White individuals recruited between 2003 and 2007. Associations between time-varying depressive symptoms (Center for Epidemiologic Studies Depression scale score ≥4 versus <4) and all-cause and CVD mortality were measured using Cox proportional hazard models adjusting for demographic and clinical risk factors. All results were stratified by age or sex and by self-reported health status. Of 29 491 participants, 3253 (11%) had baseline elevated depressive symptoms. Mean age was 65 (9.4) years, with 55.1% of participants female, 41.1% Black, and 46.4% had excellent/very good health. Depressive symptoms were measured at baseline, on average 4.9 (SD, 1.5), then 2.1 (SD, 0.4) years later. Neither age nor sex moderated the association between elevated time-varying depressive symptoms and all-cause or CVD mortality (all-cause: age 45-64 years adjusted hazard ratio aHR, 1.38; 95% CI, 1.18-1.61 versus age ≥65 years aHR,1.36; 95% CI, 1.23-1.50;
=0.05; CVD: age 45-64 years aHR, 1.17; 95% CI, 0.90-1.53 versus age ≥65 years aHR, 1.26; 95% CI, 1.06-1.50;
=0.54; all-cause: males aHR, 1.46; 95% CI, 1.29-1.64 versus female aHR, 1.34; 95% CI, 1.19-1.50;
=0.35; CVD: male aHR, 1.32; 95% CI, 1.08-1.62 versus female aHR, 1.22; 95% CI, 1.00-1.47;
=0.64). Similar results were observed when stratified by self-reported health status. Conclusions Depressive symptoms confer mortality risk regardless of age and sex, including individuals who report excellent/very good health.
OBJECTIVE The Northern Manhattan Diabetes Community Outreach Project evaluated whether a community health worker (CHW) intervention improved clinically relevant markers of diabetes care in adult ...Hispanics. RESEARCH DESIGN AND METHODS Participants were adult Hispanics, ages 35-70 years, with recent hemoglobin A1c (A1C) ≥8% (≥64 mmol/mol), from a university-affiliated network of primary care practices in northern Manhattan (New York City, NY). They were randomized to a 12-month CHW intervention (n = 181), or enhanced usual care (educational materials mailed at 4-month intervals, preceded by phone calls, n = 179). The primary outcome was A1C at 12 months; the secondary outcomes were systolic blood pressure (SBP), diastolic blood pressure, and LDL-cholesterol levels. RESULTS There was a nonsignificant trend toward improvement in A1C levels in the intervention group (from unadjusted mean A1C of 8.77 to 8.40%), as compared with usual care (from 8.58 to 8.53%) (P = 0.131). There was also a nonsignificant trend toward an increase in SBP and LDL cholesterol in the intervention arm. Intervention fidelity, measured as the number of contacts in the intervention arm (visits, phone contacts, group support, and nutritional education), showed a borderline association with greater A1C reduction (P = 0.054). When assessed separately, phone contacts were associated with greater A1C reduction (P = 0.04). CONCLUSIONS The trend toward A1C reduction with the CHW intervention failed to achieve statistical significance. Greater intervention fidelity may achieve better glycemic control, and more accessible treatment models, such as phone-based interventions, may be more efficacious in socioeconomically disadvantaged populations.
NewYork-Presbyterian Hospital partnered with Noom Health to pilot the virtual delivery of the proven National Diabetes Prevention Program (NDPP) to prediabetic patients. Goals were to understand if ...the patients can use a mobile device to receive the NDPP content, perform tasks and communicate with a virtual health coach. This poster describes our preliminary findings and responses from patients and staff.
Communities of poor, low-income immigrants with limited English proficiency and disproportionate health burdens pose unique challenges to health providers and policy makers. NewYork-Presbyterian ...Hospital developed the Regional Health Collaborative, a population-based health care model to improve the health of the residents of Washington Heights-Inwood. This area is a predominantly Hispanic community in New York City with high rates of asthma, diabetes, heart disease, and depression. NewYork-Presbyterian created an integrated network of patient-centered medical homes to form a "medical village" linked to other providers and community-based resources. The initiative set out to document the priority health needs of the community, target high-prevalence conditions, improve cultural competence among providers, and introduce integrated information systems across care sites. The first six months of the program demonstrated a significant 9.2 percent decline in emergency department visits for ambulatory care-sensitive conditions and a 5.8 percent decrease in hospitalizations that was not statistically significant. This initiative offers a model for other urban academic medical centers to better serve populations facing social and cultural barriers to care.
Metabolic syndrome has the highest prevalence among Mexican-American women. Little information is available for Caribbean Hispanics, the largest and fastest growing ethnic minority in the United ...States. We sought to evaluate the frequency of metabolic syndrome and its relationship with race/ethnicity, socioeconomic position, and education in women of largely Caribbean Hispanic origin.
There were 204 women enrolled in a cross-sectional study who had demographics, fasting glucose, lipid profile, waist circumference, and blood pressure determined. Metabolic syndrome (defined by the National Cholesterol Education Program/Adult Treatment Panel III NCEP/ATP III) was analyzed using univariate and multivariate logistic regression to test age, race/ethnicity, education, health insurance, and residence on the risk of metabolic syndrome. A P value <0.05 was considered significant.
Mean age was 58 +/- 11 years, Hispanic 44.1% (93% Caribbean), non-Hispanic white (NHW) 38.7%, and non-Hispanic black 9.8%. Education was some high school (<HS) 33.7%, HS graduate 11.2%, some college 12.9%, college graduate 10.1%, and postgraduate 32%. Health insurance was Medicaid 47.8% and commercial 52.2%. Area of residence was urban 77.1% and suburban 22.9%. The frequency of metabolic syndrome was 42.4%, and was increased in Hispanic women (63.3%) versus NHW (29.6%), women with <HS (72.6%) versus postgraduate education (32.1%), women with Medicaid (57.9% vs. 27.4%) and urban residence (47.5% vs. 27.2%). For all comparisons, P < 0.05. Education <HS was linked to increased risk of metabolic syndrome (odds ratio OR = 3.5 1.2-10.0, P = 0.02). Hispanic women had the lowest level of education (P < 0.001) and the highest frequency of individual metabolic syndrome components (P < 0.01).
Metabolic syndrome showed an alarming rate in less educated Caribbean Hispanic women and was independently associated with lower education level.
Background
The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity.
Objective
To determine whether lenient provisional ...discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness.
Design
Retrospective case series
Setting
Tertiary care medical center
Patients
Consecutive adult patients hospitalized with COVID-19 illness between March 26, 2020, and April 8, 2020, with a subset discharged home
Interventions
COVID-19 Discharge Care Program consisting of lenient provisional inpatient discharge criteria and option for daily telephone monitoring for up to 14 days after discharge
Measurements
Fourteen-day emergency department (ED) visits and hospital readmissions
Results
Among 812 patients with COVID-19 illness hospitalized during the study time period, 15.5% died prior to discharge, 24.1% remained hospitalized, 10.0% were discharged to another facility, and 50.4% were discharged home. Characteristics of the 409 patients discharged home were mean (SD) age 57.3 (16.6) years; 245 (59.9%) male; 27 (6.6%) with temperature ≥ 100.4 °F; and 154 (37.7%) with oxygen saturation < 95% on day of discharge. Over 14 days of follow-up, 45 patients (11.0%) returned to the ED, of whom 31 patients (7.6%) were readmitted. Compared to patients not referred, patients referred for remote monitoring had fewer ED visits (8.3% vs 14.1%; OR 0.60, 95% CI 0.31–1.15,
p
= 0.12) and readmissions (6.9% vs 8.3%; OR 1.15, 95% CI 0.52–2.52,
p
= 0.73).
Limitations
Single-center study; assignment to remote monitoring was not randomized.
Conclusions
During the COVID-19 surge in New York City, lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.
The purpose was to examine the effects of a round trip trans-American jet travel on performance, hormonal alterations, and recovery. Ten matched pairs of recreationally trained men were randomized to ...either a compression group (COMP) (n = 10; age: 23.1 ± 2.4 yr; height: 174.8 ± 5.3 cm; body mass: 84.9 ± 10.16 kg; body fat: 15.3 ± 6.0%) or control group (CONT) (n = 9; age: 23.2 ± 2.3 yr; height: 177.5 ± 6.3 cm; weight: 84.3 ± 8.99 kg; body fat: 15.1 ± 6.4%). Subjects flew directly from Hartford, CT to Los Angeles, CA 1 day before a simulated sport competition (SSC) designed to create muscle damage and returned the next morning on an overnight flight back home. Both groups demonstrated jet lag symptoms and associated decreases in sleep quality at all time points. Melatonin significantly (P < 0.05) increased over the first 2 days and then remained constant until after the SSC. Epinephrine, testosterone, and cortisol values significantly increased above resting values before and after the SSC with norepinephrine increases only after the SSC. Physical performances significantly decreased from control values on each day for the CONT group with COMP group exhibiting no significant declines. Muscle damage markers were significantly elevated following the SSC with the COMP group having significantly lower values while maintaining neuromuscular performance measures that were not different from baseline testing. Trans-American jet travel has a significant impact on parameters related to jet lag, sleep quality, hormonal responses, muscle tissue damage markers, and physical performance with an attenuation observed with extended wear compression garments.
Use of e-cigarettes and other electronic nicotine delivery systems (ENDS) is on the rise. We administered a health needs survey via email to 804 adult primary care and oncology patients at a large ...urban academic medical center in 2019. We examined differences in e-cigarette use by smoking status, personal history of cancer, alcohol use, and second-hand tobacco smoke exposure. Of the 804 participants, 90 (11.2%) reported ever using e-cigarettes. E-cigarette use was more prevalent in young adults (risk ratio RR for 18–24 years: 4.58, 95% confidence interval 95% CI 2.05, 10.26), current smoking (RR 4.64, 95% CI 1.94, 11.07), very often/often binge drinking (RR 3.04, 96% CI 1.38, 6.73), and ≥ 1 smokers in the home (RR 3.90, 95% CI 2.10, 7.23). Binge alcohol consumption and tobacco smoking are associated with increased risk cancer. Inquiries about e-cigarette use among adults 25–40 years present providers the opportunity to also counsel young adult about reducing cancer risk.
Risk-based genetic tests are often used to determine cancer risk, when to initiate screening, and frequency of screening, but rely on interest in genetic testing. We examined overall interest in ...genetic testing for cancer risk assessment and willingness to change behavior, and whether these are affected by demographic or socioeconomic factors.
We conducted a community needs health survey in 2019 among primary care and cancer patients, family members and community members in New York City. We used univariable analysis and relative risk regression to examine interest in genetic cancer risk testing and willingness to modify lifestyle behaviors in response to an informative genetic test.
Of the 1225 participants, 74.0% (
n
= 906) expressed interest in having a genetic test to assess cancer risk. Interest in genetic testing was high across all demographic and socioeconomic groups; reported interest in genetic testing by group ranged from 65.0 (participants aged 65 years and older) to 83.6% (participants below federal poverty level). Among the 906 participants that reported interest in genetic testing, 79.6% were willing to change eating habits, 66.5% to change exercise habits, and 49.5% to lose weight in response to an informative genetic test result.
Our study reveals that interest in genetic testing for cancer risk is high among patients and community members and is high across demographic and socioeconomic groups, as is the reported willingness to change behavior. Based on these results, we recommend that population-based genetic testing may result in greater reduction cancer risk, particularly among minoritized groups.
The prevalence of obesity is rising rapidly among Hispanics/Latinas. We evaluated the prevalence of being obese or overweight and associated risk factors among 630 low-income, Latina women from ...ambulatory care clinics in Upper Manhattan. Overall, 37 % of the sample was overweight and 41 % of the sample was obese, and yet, almost half of women who are overweight considered their weight “just about right.”After adjusting for socio-demographic, behavioral, and biological risk factors, being obese was strongly associated with having hypertension relative risk ratio (RRR) 3.93, 1.75–8.82, prehypertension (RRR 2.59, 1.43–4.67), diabetes (RRR 2.50, 1.21–5.14) and moderate/moderately severe/severe depression (RRR 2.09, 1.03–4.26). Women who reported that finding time was a barrier to physical activity were also more likely to be obese (RRR 1.78, 1.04–3.02). Chronic financial stress was associated with lower risk of being overweight (RRR 0.47, 0.28–0.79) or obese (RRR 0.51, 0.31–0.86), as well as eating out at restaurants (RRR 0.75, 0.62–0.89). Opportunities for intervention relate to understanding cultural factors around perceptions of weight and helping women find the time for physical activity.
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