Now showing items 1-20 of 1158

    • "In Spanish": advancing public health.

      González, Mila C; Santaella, Julian; Puac-Polanco, Victor
    • A Diverse and Inclusive Academic Membership for All.

      Puac-Polanco, Victor; Morabia, Alfredo
      With the growing recognition that diversity and inclusion are essential for the improvement of science and innovation, we provide some perspectives on 3 findings of DeVilbiss et al. (Am J Epidemiol. 2020;189(10):998-1010). We provide points of discussion on factors and strategies to consider when drafting diversity and inclusion programs for the Society for Epidemiologic Research.
    • Previous violent events and mental health outcomes in Guatemala.

      Puac-Polanco, Victor D; Lopez-Soto, Victor A; Kohn, Robert; Xie, Dawei; Richmond, Therese S; Branas, Charles C (2015-02-25)
      We analyzed a probability sample of Guatemalans to determine if a relationship exists between previous violent events and development of mental health outcomes in various sociodemographic groups, as well as during and after the Guatemalan Civil War.
    • Mortality from motorcycle crashes: the baby-boomer cohort effect.

      Puac-Polanco, Victor; Keyes, Katherine M; Li, Guohua (2016-08-09)
      Motorcyclists are known to be at substantially higher risk per mile traveled of dying from crashes than car occupants. In 2014, motorcycling made up less than 1 % of person-miles traveled but 13 % of the total mortality from motor-vehicle crashes in the United States. We assessed the cohort effect of the baby-boomers (i.e., those born between 1946 and 1964) in motorcycle crash mortality from 1975 to 2014 in the United States.
    • Mental health in the Americas: an overview of the treatment gap.

      Kohn, Robert; Ali, Ali Ahsan; Puac-Polanco, Victor; Figueroa, Chantal; López-Soto, Victor; Morgan, Kristen; Saldivia, Sandra; Vicente, Benjamín (2018-10-10)
      To understand the mental health treatment gap in the Region of the Americas by examining the prevalence of mental health disorders, use of mental health services, and the global burden of disease.
    • Prescription Drug Monitoring Programs and Prescription Opioid-Related Outcomes in the United States.

      Puac-Polanco, Victor; Chihuri, Stanford; Fink, David S; Cerdá, Magdalena; Keyes, Katherine M; Li, Guohua
      Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments' response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid-related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the United States is associated with changes in 4 prescription opioid-related outcome domains: opioid prescribing behaviors, opioid diversion and supply, opioid-related morbidity and substance-use disorders, and opioid-related deaths. We searched for eligible publications in Embase, Google Scholar, MEDLINE, and Web of Science. A total of 29 studies, published between 2009 and 2019, met the inclusion criteria. Of the 16 studies examining PDMPs and prescribing behaviors, 11 found that implementing PDMPs reduced prescribing behaviors. All 3 studies on opioid diversion and supply reported reductions in the examined outcomes. In the opioid-related morbidity and substance-use disorders domain, 7 of 8 studies found associations with prescription opioid-related outcomes. Four of 8 studies in the opioid-related deaths domain reported reduced mortality rates. Despite the mixed findings, emerging evidence supports that the implementation of state PDMPs reduces opioid prescriptions, opioid diversion and supply, and opioid-related morbidity and substance-use disorder outcomes. When PDMP characteristics were examined, mandatory access provisions were associated with reductions in prescribing behaviors, diversion outcomes, hospital admissions, substance-use disorders, and mortality rates. Inconsistencies in the evidence base across outcome domains are due to analytical approaches across studies and, to some extent, heterogeneities in PDMP policies implemented across states and over time.
    • Treatment Differences in Primary and Specialty Settings in Veterans with Major Depression.

      Puac-Polanco, Victor; Leung, Lucinda B; Bossarte, Robert M; Bryant, Corey; Keusch, Janelle N; Liu, Howard; Ziobrowski, Hannah N; Pigeon, Wilfred R; Oslin, David W; Post, Edward P; et al.
      The Veterans Health Administration (VHA) supports the nation's largest primary care-mental health integration (PC-MHI) collaborative care model to increase treatment of mild to moderate common mental disorders in primary care (PC) and refer more severe-complex cases to specialty mental health (SMH) settings. It is unclear how this treatment assignment works in practice.
    • Mental Health of Guatemalan Health Care Workers During the COVID-19 Pandemic: Baseline Findings From the HEROES Cohort Study.

      Paniagua-Avila, Alejandra; Ramírez, Dorian E; Barrera-Pérez, Aida; Calgua, Erwin; Castro, Claudia; Peralta-García, Ana; Mascayano, Franco; Susser, Ezra; Alvarado, Rubén; Puac-Polanco, Victor
      To assess the baseline prevalence of mental health conditions and associated exposures in a cohort of health care workers (HCWs) in Guatemala. We analyzed baseline information from the 2020 Web-based COVID-19 Health Care Workers Study (HEROES)-Guatemala. Outcomes included mental distress and depressive symptoms. Exposures included COVID-19 experiences, sociodemographic characteristics, and job characteristics. We used crude and adjusted Poisson regression models in our analyses. Of the 1801 HCWs who accepted to participate, 1522 (84.5%) completed the questionnaire; 1014 (66.8%) were women. Among the participants, 59.1% (95% confidence interval [CI] = 56.6, 61.5) screened positive for mental distress and 23% (95% CI = 20.9, 25.2) for moderate to severe depressive symptoms. COVID-19 experiences, sociodemographic characteristics, and job characteristics were associated with the study outcomes. Participants who were worried about COVID-19 infection were at higher risk of mental distress (relative risk [RR] = 1.47; 95% CI = 1.30, 1.66) and depressive symptoms (RR = 1.51; 95% CI = 1.17, 1.96). Similarly, the youngest participants were at elevated risk of mental distress (RR = 1.80; 95% CI = 1.24, 2.63) and depressive symptoms (OR = 4.58; 95% CI = 1.51, 13.87). Mental health conditions are highly prevalent among Guatemalan HCWs. (. 2022;112(S6):S602-S614.
    • Foveolar thickness as potential standardized structural outcome measurement in studies of Bietti crystalline dystrophy.

      Jenny, Laura A; Liu, Pei-Kang; Kolesnikova, Masha; Duong, Jimmy; Kim, Angela H; Levi, Sarah R; Greenstein, Vivienne C; Tsang, Stephen H (2022-08-29)
      Bietti crystalline dystrophy (BCD) is an ultra-rare orphan disorder that can lead to blindness. Because of the variable rates of progression of the disease, it is necessary to identify suitable outcome measurements for tracking progression in BCD. A retrospective analysis of patients with a clinical and genetic diagnosis of BCD was conducted. Four measurements of spectral domain-optical coherence tomography were compared to patients' best corrected visual acuity. We observed that patients with higher measurements of foveolar thickness, choroidal thickness in the foveolar region, ellipsoid zone band length and the outer nuclear layer + area, had on average better visual acuity. Future studies are needed to validate the structural-functional correlations we observed in BCD and to propose a sensitive and clinically meaningful outcome measurement for tracking this rare, variable disease.
    • Chorioretinal atrophy following voretigene neparvovec despite the presence of fundus autofluorescence.

      Kolesnikova, Masha; Lima de Carvalho, Jose Ronaldo; Parmann, Rait; Kim, Angela H; Mahajan, Vinit B; Tsang, Stephen H; Sparrow, Janet R (2022-10-12)
      Leber congenital amaurosis (LCA) type 2, due to disease-causing variants in RPE65, is characterized by severe visual loss in early infancy. Current treatments include voretigene neparvovec-rzyl (VN) for RPE65-associated LCA. Herein, we present the long-term follow-up of a patient treated with VN using quantitative autofluorescence (488 nm excitation).
    • Correlation of Intraoperative Ultrasonographic Oral Tongue Shape and Border and Risk of Close Margins.

      Au, Vivienne H; Yoon, Byung C; Juliano, Amy; Sadow, Peter M; Faquin, William C; Varvares, Mark A (2023-01-19)
      Intraoperative ultrasound (IOUS) is a potentially useful adjunct to the resection of oral tongue cancers (OTC). IOUS images of the tumor-normal tissue interface show different patterns of invasion. In this retrospective series of 29 patients treated for OTC, we evaluated if there was a correlation between IOUS findings of patterns of invasion and final histology and assessed if there was any associated risk of increased incidence of positive or close margins with different patterns of invasion as seen on ultrasound. Although we found no significant correlation between ultrasound patterns of invasion and histological evaluation, we did find that an infiltrative pattern of invasion on IOUS did result in a significant risk of a close margin. Further exploration of these findings in a larger prospective study could provide definitive information on the efficacy of this modality in OTC resections.
    • Gender and Sex Equity in Stroke Research, Education, and Care.

      Volpe, Salvatore G; Zuniga, Mary C; Caunca, Michelle R; Rosendale, Nicole (2023-01-23)
    • Integrating Electrical Impedance Spectroscopy into Clinical Decisions for Pigmented Skin Lesions Improves Diagnostic Accuracy: A Multitiered Study

      Litchman, Graham H; Marson, Justin W; Svoboda, Ryan M; Rigel, Darrel S (National Society for Cutaneous Medicine, 2020-08-30)
      Introduction: The number-needed-to-biopsy (NNB) metric measures the efficiency of a clinician’s ability to accurately diagnose and recommend pigmented skin lesions (PSLs) for biopsy for suspected melanomas. Electrical impedance spectroscopy (EIS) is a non-invasive technique that measures differences in resistance between healthy and cancerous skin cells, intended as an aid to enhance diagnostic accuracy. Methods: Dermatology clinicians of three distinct groups (residents, physician assistants/nurse practitioners, and practicing dermatologists) were evaluated on their ability to accurately recommend suspect PSLs for biopsy before and after the integration of EIS data. Results: All three groups had a reduction in NNB after the inclusion of EIS. Instances of missed biopsies for malignant melanoma were significantly reduced with simultaneous significant reductions in unnecessary biopsies for benign lesions. There was a material improvement of biopsy selection for PSLs having clinically challenging features. EIS also greatly improved the diagnostic acumen of clinicians whose assessments were less accurate than their peers prior to EIS incorporation. Conclusions: The integration of EIS technology into the PSL biopsy decision was demonstrated to be effective in significantly enhancing clinician NNB and more accurate PSL biopsy selection.
    • Assessment of the 31-Gene Expression Profile Test by Dermatologists: A Cross-Sectional Survey from National Dermatology Conferences

      Marson, Justin; Litchman, Graham; Svoboda, Ryan; Glazer, Alex; Farberg, Aaron; Winkelmann, Richard; Rigel, Darrell (National Society for Cutaneous Medicine, 2021-03-06)
      Background: The 31-gene expression profile (31-GEP) test uses 31 genetic markers obtained from the initial biopsy of a melanoma to assess melanoma-specific survival and sentinel lymph node positivity. Objective: To assess the professional understanding, opinions, and clinical usage of the 31-GEP test by dermatologists. Methods: Data from 589 unique dermatologists were collected during 2 virtual, nation-wide dermatology conferences via an 18-question survey on practice demographics and their clinical use and opinion of the 31-GEP test. Results: Participants reported that integrating the 31-GEP test may benefit patients by increasing knowledge and understanding (72.5%), personalizing treatment options (58.8%), and easing uncertainty about the future (59.7%). Benefits of using the 31-GEP test included identifying true negative patients in high-risk populations (65.6%) as well as true positives in low-risk populations (70.6%).A majority of participants also noted that if a patient received a 31-GEP Class 2B result, they would escalate subsequent management even if the lesions were classified as T1 (61.4%) or AJCC8 Stage I (59.0%). 84.9% of participants were somewhat to very likely to use 31-GEP testing for patient management or recommend this test to a colleague. Limitations: Potential respondent-selection and recall bias. Conclusion: Dermatologists are increasingly integrating the 31-GEP test into their melanoma clinical management decisions. As the 31-GEP test becomes more prevalent in practice, patients may benefit from decreased anxiety and uncertainty from enhanced prognosis, decreased need for unwarranted procedures such as sentinel lymph node biopsy and optimized allocation of healthcare resources.
    • Considerations in the Management of Actinic Keratoses: The Importance of Adherence and Persistence to Therapy

      Marson, Justin; Del Rosso, James; Bhatia, Neal; Rigel, Darrell (National Society for Cutaneous Medicine, 2021-03-06)
      Background: Actinic keratosis (AK) is a pre-malignant lesion with a poorly defined risk of progression to invasive squamous cell carcinoma (SCC). AKs are also associated with increased future risk of invasive SCC. However, there are many barriers to therapy adherence that may affect long-term treatment efficacy. Objective: To review the current literature reporting known known factors of AK treatment non-adherence intrinsic to patient behavior and treatment regimens and re-examine how dermatologists can navigate these challenges. Methods: A Medline literature search was performed to identify existing evidence regarding barriers to adherence with AK treatment regimens intrinsic to patient behavior, patient counseling, and treatment regimens pertinent for review. Results & Discussion: Factors intrinsic to prescribed patient-applied therapy that can exacerbate non-adherence include: 1) length of treatment duration, 2) frequency of application, 3) complexity of treatment regimen, 4) duration and 5) severity of local skin reactions (LSR) and adverse reactions. Novel mechanisms of action that induce cellular apoptosis (as opposed to necrosis) via inhibition of tubulin polymerization and cell cycle arrest, may promote treatment regimen adherence and long-term outcomes. Dermatologists should also be conscious of how they counsel patients as insufficient counseling may also lead to poor adherence. Conclusion: Dermatologists must understand the value of shorter course therapies and their positive impact on adherence and be well-versed in the mechanisms, efficacy and adverse events associated with treatment options. By doing so, dermatologists may best counsel and educate patients and devise regimens that address individualized patient concerns.
    • Apremilast as an Off-Label Therapeutic Agent

      Marson, Justin; Lebwohl, Mark (National Society for Cutaneous Medicine, 2021-05-17)
      Objective: To review the literature regarding the efficacy and safety of off-label use of apremilast in combination therapies for psoriasis and psoriatic arthritis and for other currently off-label inflammatory dermatoses. Methods: The Medline database was queried for all relevant articles published between 2014 and 2021 using exploded MeSH terms and keywords pertaining to the following themes: off-label, combination therapy, biologics, biologic therapy, methotrexate, and systemic psoriasis therapy. The Boolean term “AND” was used to find the intersection of these themes with the term “apremilast.” Results: 8 case series and 6 case reports investigated the use of apremilast in combination therapy for psoriasis and psoriatic arthritis. Addition of apremilast improved PASI scores by 31.8-77.4% among case series and 80-100% among case reports with adverse effects primarily consisting of gastrointestinal symptoms. 5 randomized-control trials (RCT), 9 open-label trials, 18 case series, and 30 case reports investigated the use of apremilast for off-label dermatoses. In RCTs, apremilast showed potential efficacy for atopic dermatitis and hidradenitis suppurativa. Open-label trials found apremilast efficacious for atopic dermatitis, allergic contact dermatitis, chronic pruritus, cutaneous sarcoidosis, discoid lupus erythematosus, hidradenitis suppurativa, lichen planus, prurigo nodularis, rosacea, and vitiligo. Limitations: Small sample size and short follow up duration for available randomized-control and open-label trials. Current data from case series/reports potentially limits generalizability of findings. Conclusion: Apremilast's safety profile makes it a potential efficacious, non-biologic systemic agent for monotherapy and combination therapy for a wide range of inflammatory dermatoses.
    • Association between Rosacea, Environmental Factors, and Facial Cutaneous Dysbiosis

      Marson, Justin; Berto, Stefano; Mouser, Paul; Baldwin, Hilary (National Society for Cutaneous Medicine, 2021-09-13)
      Background: To investigate the microbiome composition in individuals with and without rosacea and correlate findings to individual factors that may affect facial cutaneous and enteric microbiome composition. Methods: Participants with and without rosacea (as determined by a board-certified dermatologist) were surveyed regarding factors that may affect the facial cutaneous/enteric microbiome. Microbiome samples were collected, analyzed for 16S sequences, and mapped to an optimized version of existing databases. R was used to perform Mann-Whitney/Kruskal-Wallis test for categorical comparisons. Correlation between two continuous variables was determined with linear regression models. Primary Component Analysis (PCoA) plots employed Monte Carlo permutation test to estimate p-values. All p-values are adjusted for multiple comparisons with the false discovery rate (FDR algorithm) using Benjamini-Hochberg. Results: 84 individuals with rosacea and 44 controls were evaluated. Individuals with rosacea were more likely to currently own pets (p = 0.029) and consume more alcohol (p = 0.006). Absolute bacteria abundance were similar in facial cutaneous (p = 0.36) and enteral microbiome (p = 0.29). Facial cutaneous microbiome showed significantly decreased richness and evenness (OTU: p = 0.019; Shannon: p = 0.049) and a three to four-fold decrease in abundance of 8 distinct cutaneous bacterial genera in rosacea. Enteral microbiome analysis showed significant reduction in abundance of Ruminococcaceae (FDR = 0.002) and Blautia (FDR < 0.001) and increase in Prevotellaceae (FDR = 0.024) in rosacea. Conclusion: Environmental factors may alter relative abundances of specific microbial genera and lead to microbiome diversity. Further studies with increased sample sizes and higher severity cases may further elucidate the role of dysbiosis in rosacea.
    • Differential Impact of COVID-19 on Urban Versus Rural Dermatologic Practice Logistics and Recovery: A Cross-Sectional Investigation of the First Wave

      Marson, Justin; Litchman, Graham; Rigel, Darrell (National Society for Cutaneous Medicine, 2021-03-06)
      Background: COVID-19 materially delayed patient visits and potential skin cancer biopsies/diagnoses among US dermatology practices. However, given a likely heterogenous impact across the US, this study sought to determine COVID-19’s effect on urban versus rural dermatology practices. Methods: Data were analyzed from the first 1000 responses to 3 pre-validated surveys of 9891 practicing US dermatologists comparing outpatient volumes and scheduling issues for the week of February 17th to the week of March 16th (Survey 1), April 13th (Survey 2) and May 18th, 2020 (Survey 3). First 3 US zip-code digits were compared to US Census Bureau data to determine “Urban/Rural” status. Representativeness with AAD membership was confirmed. Statistical significance was calculated using chi-square with Marascuilo procedure and two-tailed independent t-test/ANOVA with post-hoc Tukey-Kramer testing. Results: In April 2020 urban practices reported more closed practices (21.4% vs 5.8%, p<0.0001) and predicted significantly larger patient volume decreases (-45.2% vs -31.4%, p<0.0001) and practice closures (11.9% vs. 2.5% p<0.0001) in the following 2 weeks. In May 2020, urban areas saw significantly fewer patients/week (90.9 vs 142.4 p<0.0001), larger decrease in patient volume relative to May 2019 (-49.4% vs -35.1%, p<0.0001), and conducted more telemedicine visits (27.0% vs 15.1%, p<0.0001). Significantly more rural practices reported already being at baseline volume (Mean Difference 6.2%, 95% CI 2.7%-9.8%) while urban practices predicted return to baseline volume by August (5.7, 95% CI 2.1%-9.3%) or were unsure (5.6, 95% CI 1.6%-9.7%). Conclusion: The initial COVID-19 pandemic differentially affected urban dermatology practices. The effects of the pandemic were mitigated in part by increased use telemedicine. Future studies may further elucidate COVID-19’s effect on clinical practice and highlight areas for improvement in practice logistics and patient care.
    • Expert Consensus on Sunscreen for the Primary Prevention of Skin Cancer: Results of the Skin Cancer Prevention Working Group Conference

      Marson, Justin; Farberg, Aaron; Glazer, Alex; Litchman, Graham; Svoboda, Ryan; Winkelmann, Richard; Rigel, Darrell (National Society for Cutaneous Medicine, 2021-05-21)
      Background:Melanoma and non-melanoma skin cancers (NMSC) are the overall most common type of malignancy. Despite this fact, the use of sunscreen as a primary preventative measure for skin cancer is not ubiquitous.Objective:To review the literature regarding efficacy and safety of sunscreens and to process and condense data into overarching principles to provide guidance to the publicand improve outcomes for melanoma NMSC.Methods:A systematic review of the literature pertaining to sunscreen efficacy in the primary prevention of melanoma and non-melanoma skin cancer, safety in humans and environmental impact was conducted. Following a thorough review of the literature, the Skin Cancer Prevention Working Group (SCPWG), an expert panel consisting of dermatologists with specialized training in melanoma and NMSC diagnosis and management, employed a modified Delphi technique to reach consensus over the development of statements regarding the current level of evidence for sunscreen efficacy and safety. Final statements were only adopted after achieving a supermajority vote >80%.Results:96 articles were identified for further review and discussion. The SCPWG developed 7 consensus statements regarding the efficacy and safety of sunscreens and their role in the prevention of melanoma and NMSC. Conclusion: The proven benefits of primary skin cancer prevention outweigh the potential/hypothetical risks of sunscreen use, especially given insufficient real-world, prospective data for the discussed risks. As experts in skin health and skin cancer pathophysiology, the SCPWG believes dermatologists are uniquely qualified to lead future studies investigating sunscreen efficacy and safety and should counsel patients and the public on skin cancer primary prevention strategies.
    • Temporally defined neocortical translation and polysome assembly are determined by the RNA-binding protein Hu antigen R.

      Kraushar, Matthew L; Thompson, Kevin; Wijeratne, H R Sagara; Viljetic, Barbara; Sakers, Kristina; Marson, Justin W; Kontoyiannis, Dimitris L; Buyske, Steven; Hart, Ronald P; Rasin, Mladen-Roko (2014-08-25)
      Precise spatiotemporal control of mRNA translation machinery is essential to the development of highly complex systems like the neocortex. However, spatiotemporal regulation of translation machinery in the developing neocortex remains poorly understood. Here, we show that an RNA-binding protein, Hu antigen R (HuR), regulates both neocorticogenesis and specificity of neocortical translation machinery in a developmental stage-dependent manner in mice. Neocortical absence of HuR alters the phosphorylation states of initiation and elongation factors in the core translation machinery. In addition, HuR regulates the temporally specific positioning of functionally related mRNAs into the active translation sites, the polysomes. HuR also determines the specificity of neocortical polysomes by defining their combinatorial composition of ribosomal proteins and initiation and elongation factors. For some HuR-dependent proteins, the association with polysomes likewise depends on the eukaryotic initiation factor 2 alpha kinase 4, which associates with HuR in prenatal developing neocortices. Finally, we found that deletion of HuR before embryonic day 10 disrupts both neocortical lamination and formation of the main neocortical commissure, the corpus callosum. Our study identifies a crucial role for HuR in neocortical development as a translational gatekeeper for functionally related mRNA subgroups and polysomal protein specificity.