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PurposePatient-reported outcomes are important in the surgical decision-making process for low-risk, differentiated thyroid cancer. Current study aimed to assess patient-reported outcomes in thyroid cancer survivors comparing total thyroidectomy (TT) and lobectomy (LT) using the Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship (PROFILES) registry.MethodsEuropean Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) scales, illness perception questions, Beliefs about Medicines Questionnaire (BMQ) scales and questions about thyroid surgery–related medication use were compared between thyroid cancer patients who underwent TT versus LT using descriptive analyses.ResultsIn total, 58 thyroid cancer patients who underwent TT or LT were included in this study. None of the EORTC QLQ-C30 scales or questions regarding illness perception were significantly different between the surgical groups. Patients in the TT group had significantly higher belief in the necessity of their medication (21.0 vs 15.4; p = 0.003) and greater concerns about taking their medicines (14.7 vs 11.1; p = 0.008) versus patients in the LT group.ConclusionConcerns about post-surgical medication use specifically in the TT group may indicate that clinicians should consider LT in patients with low-risk, differentiated thyroid cancer when LT and TT are viable surgical options. Clinicians should be aware of the impact of post-surgical medication use in particular following TT and use this knowledge to align goals of treatment with the extent of surgery, allowing for a better-informed decision-making process.

Background For people with HIV (PWH), number of chronic medications (meds) used to treat comorbidities may impact quality of life (QoL), illness perception, medication beliefs, and clinical outcomes. Factors associated with adherence to antiretrovirals (ARVs) may differ from adherence to other chronic meds. This study aims to assess these factors to promote better med management and adherence among PWH taking chronic meds and ARVs. Methods 174 participants (pts) were enrolled from an HIV program in a large health system. Inclusion criteria were age > 18 years, English speaking, prescribed ARVs, and having > 1 comorbidity requiring a chronic med (non-ARV). Measures included validated scales of QoL, illness perceptions, med beliefs, and adherence barriers (e.g., forgot, too many pills, avoiding side effects); and past 6-month emergency department (ED) use and hospitalization. Generalized linear models, ANOVA, and Wilcoxon sum rank tests assessed associations between number of chronic meds (< 4 vs > 5) and outcomes. Multivariable logistic regression models using backwards elimination were used to assess factors associated with adherence (overall, HIV-meds, non-HIV meds). Results Complete data from 160 pts were analyzed: 50% male; 84% US-born; 46% taking > 5 chronic meds. Pts taking > 5 meds were older, less likely to be employed, had significantly lower QoL (mean difference=5.23, 95%CI=0.19-10.27. p< .05), significantly higher med side effects (mean ranks=88.51 vs 73.77, p< .05), and 3-fold greater ED visits (mean estimate=2.99, 95%CI=1.52-5.89, p< .05). Regression models indicated that number of adherence barriers (but not other predictors) was consistently associated with lower adherence after controlling for demographics: (overall adherence: OR=0.85, 95%CI=0.79=0.91; HIV med adherence: OR=0.88, 95%CI=0.81-0.94; non-HIV med adherence: OR=0.86, 95%CI=0.80-0.92). Conclusion Adverse events (i.e., ED use, poor QoL, med side effects) are associated with number of chronic meds. Number of adherence barriers is associated with poor adherence across med type, highlighting the importance of interventions to address polypharmacy and the complexities of managing HIV and comorbidities. Assessment of barriers can contribute to the promotion of adherence for both HIV and non-HIV meds. Disclosures Amy Weinberg, DNP, MS, Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds.

In the United States, approximately one in six youth has an intellectual or other developmental disability (DD). Historically, there have been barriers to providing these youths with trauma treatme...

Kristin G Bevilacqua,1 Charell Brinkley,2 Joseph McGowan,2 Frances Wallach,2 Rebecca M Schwartz3,4 1Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; 2Department of Medicine, Division of Infectious Disease, Northwell Health, Manhasset, NY, USA; 3Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Occupational Medicine, Epidemiology and Prevention, Great Neck, NY, USA; 4Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USACorrespondence: Kristin G Bevilacqua, Johns Hopkins University Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 N Wolfe St, Baltimore, MD, 21205, USA, Email kbevila1@jhu.eduIntroduction: Improvements in treatment have led to a growing population of older adults living with HIV. As this population ages, polypharmacy, or the use of more than five medications, may become more common among people living with HIV (PLWH).Methods: Two qualitative focus groups (N=7, N=8) were conducted among a sample of patients who participated in a larger study regarding differential medication adherence. Open-ended questions and probes focused on barriers and facilitators to multiple medication management as well as differential adherence.Results: Overall, patients were able to manage their polypharmacy. Social support facilitated adherence while long-term antiretroviral (ARV) use, medication-specific requirements and emotional fatigue were barriers to management. A small number of participants reported differential adherence that prioritized non-HIV medications over ARVs due to more immediate effects of non-adherence.Discussion: Findings suggest that PLWH have learned to manage their polypharmacy, but still face significant challenges adhering to multiple medications in the long-term. Future research may focus on the emotional toll of long-term ARV use and how patients’ own management strategies may be leveraged to promote adherence.Keywords: HIV/AIDS, polypharmacy, medication management, medication adherence

Objective: Research indicates that greater exposure to Hurricane Sandy is associated with increased mental health difficulties. This study examined whether Project Restoration, a program that linked adults into mental health care (L2C), was effective in reducing post-Sandy mental health difficulties as compared to a cohort of adults matched on mental health difficulties that were not linked into post-Sandy mental health care. Methods: Project Restoration participants (n = 52) with elevated self-reported mental health difficulties had the option to enroll into L2C. Project LIGHT (n = 63) used similar methodologies but did not have a L2C component and served as the matched control group. Results: Multivariable modeling showed significant decreases in all mental health difficulties except for depression in the Project Restoration group, whereas there were no significant decreases in LIGHT. The decrease in anxiety from baseline to follow-up was significantly greater for Project Restoration as compared to LIGHT. Conclusion: Findings confirm the powerful impact community outreach and treatment have on reducing mental health difficulties after a disaster.

COVID-19 in-hospital morbidity and mortality in people living with HIV (PLWH) were compared to HIV-negative COVID-19 patients within a New York City metropolitan health system, the hardest hit region in the United States early in the pandemic. A total of 10,202 inpatients were diagnosed with COVID-19, of which 99 were PLWH. PLWH were younger (58.3 years (SD = 12.42) versus 64.32 years (SD = 16.77), p < 0.001) and had a higher prevalence of men (73.7% versus 57.9%, p = 0.002) and Blacks (43.4% versus 21.7%, p < 0.001) than the HIV-negative population. PLWH had a higher prevalence of malignancies (18% versus 7%, p = < 0.001), chronic liver disease (12% versus 3%, p < 0.001), and end-stage renal disease (11% versus 4%, p = 0.007). Use of a ventilator, admission to the ICU, and in-hospital mortality were not different. Of the 99 PLWH, 12 were virally unsuppressed and 9 had CD4% < 14. Two of the 12 virally unsuppressed patients and 4/9 patients with CD4% < 14 died. Ninety-one of the 99 PLWH were on treatment for HIV, and 5 of the 8 not on treatment died. Among PLWH with prior values, absolute CD4 count decreased an average of 192 cells/mm3 at the time of COVID-19 diagnosis ( p < 0.001). Hospitalized patients with HIV and COVID-19 coinfection did not have worse outcomes than the general population. Among PLWH, those with CD4%

Background Although the value of DACA medical students has been hypothesized, no data are available on their contribution to US healthcare. While the exact number of DACA recipients in medical school is unknown, DACA medical students are projected to represent an increasing proportion of physicians in the future. The current literature on DACA students has not analyzed the experiences of these students. Methods A mixed-methods study on the career intentions and experiences of DACA medical students was performed utilizing survey data and in-depth interviews. The academic performance of a convenience sample of DACA medical students was compared to that of matriculated medical students from corresponding medical schools, national averages, and first-year residents according to specialty. Results Thirty-three DACA medical students completed the survey and five participated in a qualitative interview. The average undergraduate GPA (SD) of the DACA medical student sample was 3.7 (0.3), the same as the national GPA of 2017–2018 matriculated medical students. The most common intended residency programs were Internal Medicine (27.2%), Emergency Medicine (15.2%), and Family Medicine (9.1%). In interviews, DACA students discussed their motivation for pursuing medicine, barriers and facilitators that they faced in attending medical school, their experiences as medical students, and their future plans. Conclusions The intent of this sample to pursue medical specialties in which there is a growing need further exemplifies the unique value of these students. It is vital to protect the status of DACA recipients and realize the contributions that DACA physicians provide to US healthcare.

The COVID-19 pandemic has subjected healthcare workers to enormous stress. Measuring the impact of this public health emergency is essential to developing strategies that can effectively promote resilience and wellness. The Epidemic-Pandemic Impacts Inventory Supplemental Healthcare Module-Brief Version (EPII-SHMb) was developed to measure impacts among occupational cohorts serving on the front lines of healthcare. While this instrument has been utilized in COVID-19 related studies, little is known about its psychometric properties. This study collects evidence for validity of the EPII-SHMb by evaluating its internal structure and how its scores associate with other variables. Physicians and nursing staff across a large New York health system were cross-sectionally surveyed using an online questionnaire between June and November 2020. Exploratory factor analysis resulted in a 3-factor solution, identifying factors Lack of Workplace Safety (7 items), Death/Dying of Patients (3 items), and Lack of Outside Support (2 items). Internal consistency was high overall and within physician/nursing and gender subgroups (Cronbach’s alpha: 0.70 − 0.81). Median scores on Death/Dying of Patients were higher among those who directly cared for COVID-19 patients or worked in COVID-19 hospital units. These results are promising. Additional studies evaluating other dimensions of validity are necessary.

A research initiative was launched during the initial coronavirus disease (COVID-19) outbreak by 3 New York metropolitan area institutions. Collaborators recruited community members and patients from previous research studies to examine COVID-19 experiences and mental health symptoms through self-report surveys. The current report descriptively presents findings from the initial survey characterized by both community and clinical cohorts, and discusses challenges encountered with rapid implementation. The clinical cohort exhibited higher rates of symptoms of mental health difficulties (depression, anxiety, and posttraumatic stress disorder [PTSD]) as compared to the community cohort. COVID-19 positivity rates were similar among both groups and lower than the national average. While both groups reported low rates of job loss, community members reported higher rates of financial difficulty resulting from the pandemic. Findings indicate the need for further collaborative research on the mental health impact of COVID-19.

BACKGROUND: Hurricane Harvey facilitated exposure to various toxic substances and floodwater throughout the greater Houston metropolitan area. Although disparities exist in this exposure and vulnerable populations can bear a disproportionate impact, no research has integrated disparities in exposure to toxic incidents following Hurricane Harvey. OBJECTIVE: The objective of this study was to analyze the relationship between flooding, socioeconomic status (SES), and toxic site incidents. METHODS: Data on toxic site locations, reported releases, and flood water depths during Hurricane Harvey in the greater Houston area were compiled from multiple sources. A multivariable logistic regression was performed to predict the odds of a toxic site release by flooding at the site, SES and racial composition of the census tract. RESULTS: 83 out of 1403 toxic sites (5.9%) had reported releases during Hurricane Harvey. The proportion of toxic sites with reported incidents across increasing SES index quintiles were 8.35, 7.67, 5.14, 4.55, and 0.51, respectively. The odds of an incident was higher in the lowest SES quintiles areas (OR=17.26, 95%CI: 2.39–124.84) compared to the highest quintile. Flooding was similar at toxic sites with and without incidents, and was distributed similarly and highest at toxic sites among lower SES quintiles. SIGNIFICANCE: Despite similar flooding across toxic sites during Hurricane Harvey, areas with lower SES were more likely to have a toxic release during the storm, even accounting for number of toxic sites. Improving quality of maintenance, safety protocols, number of storm-resilient facilities may minimize this disproportionate exposure and its subsequent adverse outcomes among socioeconomically vulnerable populations.

Posttraumatic stress disorder (PTSD) remains one of the most prevalent diagnoses of World Trade Center (WTC) 9/11 responders. Transcutaneous auricular vagus nerve stimulation (taVNS) is a potential treatment for PTSD, as it can downregulate activity in the brain, which is known to be related to stress responses and hyperarousal. To understand barriers and facilitators to engagement in mental health care and the feasibility and acceptability of using the taVNS device as a treatment for PTSD symptoms, a focus group was conducted among patients from the Queens WTC Health Program who had elevated symptoms of PTSD. The focus group discussion was recorded, transcribed, and analyzed. Three themes and subthemes emerged: (1) the continued prevalence of mental health difficulties and systematic challenges to accessing care; (2) positive reception toward the taVNS device as a potential treatment option, including a discussion of how to increase usability; and (3) feedback on increasing the feasibility and acceptance of the research methodology associated with testing the device in a pilot clinical trial. The findings highlight the need for additional treatment options to reduce PTSD symptoms in this population and provide key formative phase input for the pilot clinical trial of taVNS.

Objective: To examine the association between a number of negative COVID-19 occupational experiences and probable anxiety, depression, and PTSD among physicians. Methods: Cross-sectional examination of longitudinal registry data consisting of physician personal and occupational well-being. Multivariable logistic regressions were performed to determine the association between negative COVID-19 experiences and outcomes. Results: Of the 620 eligible physicians, approximately half were female (49%), and 71% white with a mean age of 46.51 (SD = 13.28). A one-point increase in negative experience score was associated with a 23% increase in probable anxiety (OR = 1.23, 95% CI: 1.14–1.34), a 23% increase in probable depression (OR = 1.23, 95% CI: 1.13–1.33), and a 41% increase in probable PTSD (OR = 1.41, 95% CI: 1.30–1.52). Conclusions: Negative pandemic experiences were strongly associated with adverse mental health outcomes while greater resilience was protective.

Background Few studies have examined the differential impact of sublobar resection (SL) and lobectomy (L) on quality of life (QoL) during the first postoperative year. Methods We used a prospective cohort of Stage IA lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS) from the Initiative for Early Lung Cancer Research on Treatment. QoL was measured before surgery, and within 4, 6, and 12 months post-surgery using three validated instruments: SF-12 [physical (PCS) and mental health (MCS)], FACT-LCS (lung-cancer-symptoms), and the PHQ-4 (anxiety and depression subscales). Locally weighted smoothing curve (LOWESS) was fitted to identify the best interval knot for the change in the QoL trend post-surgery. After adjusting for demographic and clinical variables, an adjusted piecewise linear mixed effects model was developed to estimate differences in baseline and 12-month scores, and rates of change for each QoL measure. Results SL resection was performed in 127 (63.2%) and L in 74 (36.8%) patients. LOWESS plots suggested that the shift of QoL (interval knot) was at 2 months post-surgery. Decreases in PCS scores were less severe for SL than L patients 2 months post-surgery (-0.18 vs. -2.30, P=0.02); while subsequent improvements were observed for both groups (SL: +0.29 vs. L: +0.74, P=0.06). SL patients reported significantly better scores a year post-surgery compared to baseline (P=0.003), while L patients did not. Anxiety decreased at similar rates for both SL and L patients within 2 months post-surgery (P=0.18), then stabilized for the remaining months. MCS and depression scores remained stable in both groups throughout. QoL scores were lower for women than for men, but only significantly worse for the lung-cancer-symptoms (P=0.003) and anxiety (P=0.04). Conclusions SL patients fared better in physical health and lung cancer symptoms than L patients. The first two postoperative months showed the most significant change which suggests targeting postoperative intervention during that time.

Disparities exist in post-disaster flooding exposure and vulnerable populations bear a disproportionate impact of this exposure. We describe the unequal burden of flooding in a cohort of New York residents following Hurricane Sandy and assess whether the likelihood of flooding was distributed equally according to socioeconomic demographics, and whether this likelihood differed when analyzing self-reported or FEMA flood exposure measures. Residents of New York City and Long Island completed a self-administered survey 1.5–4.0 years after the storm. Multivariable logistic regressions were performed to determine the relationship between sociodemographic characteristics and flood exposure. Participants (n = 1231) residing in areas of the lowest two quartiles of median household income experienced flooding the most often (FEMA/self-reported

Objectives Disaster workers are at elevated risk for mental health problems as a result of trauma exposures during response efforts. One possible way to prevent mental health problems is to build-up coping resources that promote resilience to the effects of disaster work. The primary aim of this study was to evaluate the efficacy of a resilience building workshop, the Disaster Worker Resiliency Training Program (DWRT), in disaster workers previously exposed to Hurricane Sandy. Methods Disaster workers (N = 167) were randomly assigned to the DWRT workshop (n = 78) or a waitlist (n = 89). Workers completed self-report measures on healthy lifestyle behaviors, perceived stress, depression, and Posttraumatic Stress Disorder (PTSD) symptoms at baseline and 3-month follow-up. They also completed a measure assessing subsequent trauma-exposure between the baseline and 3-month post-intervention. Results Participants in the workshop condition, as compared to those in a waitlist control, reported significantly greater improvements from pre-intervention (T1) to 3-month follow-up (T2) in healthy lifestyle behaviors (η2 = .03; p = .03), stress management (η2 = .03, p = .04), and spiritual growth (η2 = .03, p = .02). Among participants reporting subsequent trauma exposures between T1 and T2 (n = 101), participants in the waitlist condition, were more likely to report significant increases in perceived stress (η2 = .07, p

Objective:Hurricane Harvey made landfall on August 25, 2017 and resulted in widespread flooding in Houston and the surrounding areas. This study aimed to explore the associations between exposure to Hurricane Harvey and various mental health symptoms.Methods:Self-reported demographics, hurricane exposure, and mental health symptomatology were obtained from residents of the greater Houston area through convenience sampling for a pilot study, 5 months after the storm from January 25-29, 2018 (N = 161).Results:Increased hurricane exposure score was significantly associated with increased odds for probable depression, probable anxiety, and probable posttraumatic stress disorder after adjusting for other factors associated with mental health. No significant associations were found between demographic characteristics and risk of mental health difficulties.Conclusions:Mental health difficulties associated with exposure to Hurricane Harvey were still present 5 months after the storm. Future disaster response programs should focus on providing long-term mental health services to hurricane survivors.

Purpose: The COVID-19 pandemic has generated significant psychological distress among health care workers worldwide. New York State, particularly New York City and surrounding counties, were especially affected, and experienced over 430,000 COVID-19 cases and 25,000 deaths by mid-August 2020. We hypothesized that physicians and trainees (residents/fellows) who were redeployed outside of their specialty to treat COVID-19 inpatients would have higher burnout. Methods: We conducted a cross-sectional survey to assess burnout among attending and trainee physicians who provided patient care during the COVID-19 pandemic between March-May 2020 across a diverse health care system in New York. Separate multivariable logistic regressions were performed to determine the association between redeployment and measures of burnout: Emotional Exhaustion (EE) and Depersonalization. Burnout measures were also compared by physician vs trainee status. The differential association between redeployment and outcomes with respect to trainee status was also evaluated. Results: Redeployment was significantly associated with increased odds of EE {OR =1.53, 95% CI: 1.01–2.31} after adjusting for gender and Epidemic-Pandemic Impacts Inventory (EPII) score. Similarly, being a trainee, especially a junior level trainee, was associated with increased odds of EE {OR = 1.59, 95% CI: 1.01–2.51} after adjusting for gender and EPII scores. However, neither redeployment nor trainee status were significantly associated with Depersonalization. Interactions between redeployment and trainee status were not significant for any of the outcomes (p>.05). Conclusion: Physicians who were redeployed to treat COVID–19 patients had higher reported measures of EE. Trainees, irrespective of redeployment status, had higher EE as compared with attendings. Additional research is needed to understand the long-term impact of redeployment on burnout among redeployed physicians. Programs to identify and address potential burnout among physicians, particularly trainees, during pandemics may be beneficial.

BACKGROUND: Data are limited on cumulative impacts of depression on engagement in care and HIV outcomes in women living with HIV (WLWH) during the era of universal antiretroviral therapy (ART). Understanding the relationship of accumulated depression with HIV disease management may help identify benefits of interventions to reduce severity and duration of depressive episodes. SETTING: A cohort of WLWH (N=1,491) from the Women’s Interagency HIV Study (WIHS) at nine sites across the US. METHODS: This longitudinal observational cohort study (2013-2017) followed WLWH for a maximum of nine semi-annual visits. Depression was quantified as a time-updated measure of percent of days depressed (PDD) created from repeated assessments using the Center for Epidemiologic Studies Depression (CES-D) scale. Marginal structural Poisson regression models were used to estimate the effects of PDD on the risks of missing an HIV care appointment

Patients with early-stage non-small-cell lung cancer (NSCLC) have high survival rates, but patients often say they did not anticipate the effect of the surgery on their postsurgical quality of life (QoL). This study adds to the literature regarding patient and surgeon interactions and highlights the areas where the current approach is not providing good communication.Since its start in 2016, the Initiative for Early Lung Cancer Research on Treatment (IELCART), a prospective cohort study, has enrolled 543 patients who underwent surgery for stage I NSCLC within the Mount Sinai Health System. Presurgical patient and surgeon surveys were available for 314 patients, postsurgical surveys for 420, and both pre- and postsurgical surveys for 285.Of patients with presurgical surveys, 31.2% said that their surgeon recommended multiple types of treatment. Of patients with postsurgical surveys, 85.0% felt very well prepared and 11.4% moderately well prepared for their postsurgical recovery. The median Functional Assessment of Cancer Therapy-Lung Cancer score and social support score of the patients who felt very well prepared was significantly higher than those moderately or not well prepared (24.0 v. 22.0,This study provides insight into the areas where surgeons are communicating well with their patients as well as the areas where patients still feel uninformed. Most surgeons feel that they prepare their patients well or very well for surgical recovery, whereas some patients still feel that their surgeons did not prepare them well for postsurgical recovery. Surgeons may want to spend additional time emphasizing postsurgical recovery and QoL with their patients or provide their patients with additional avenues to get their questions and concerns addressed.Pretreatment discussions could help surgeons understand patient priorities and patients understand the anticipated outcomes for their surgeries.There is an association between feeling prepared for surgery and higher quality of life and social support scores after adjustment for confounders.Despite these pretreatment discussions, patients still feel that they are not well prepared about what to expect during their postsurgical recovery.

BackgroundThe repercussions of climate change threaten the population with an increased prevalence of extreme climate events. We explored the impact of climate change induced sea level rise (SLR) and tropical cyclone (TC) exposure on mental illness symptom prevalence.MethodsUsing three datasets, TC exposure scores were calculated for each subject to determine how exposure affects posttraumatic stress disorder (PTSD), anxiety, and major depressive disorder (MDD) symptom prevalence. Inundation mapping of various SLR and storm surge (SS) scenarios were performed for the susceptible region of Miami-Dade and Broward counties to determine the population impact of flooding.ResultsWe found an elevated risk of mental illness symptoms from exposure to more high-intensity TCs and identified demographic variables that may contribute to this risk. Furthermore, inundation mapping demonstrated severe and widespread impact of SLR and SS on the mental health of communities.LimitationsThis study did not include data directly measuring comorbidity, resilience, preparedness, or ability to adapt to climate change. Also, multiple imputation using chained equations may have been imperfect. Finally, when conducting inundation mapping, static mapping may overestimate flooding severity.ConclusionThe impacts of climate change have been frequently studied in terms of physical health, natural disaster prevalence, and economic impacts, but rarely on mental health burden. However, it is vital that national, state, and local governments develop and deploy plans to address mental health needs along with expenditures for protecting infrastructure, the economy, and physical health from the combined effects of SLR and climate change-induced natural disasters.

The repercussions of climate change threaten the population with an increased prevalence of extreme climate events. We explored the impact of climate change induced sea level rise (SLR) and tropical cyclone (TC) exposure on mental illness symptom prevalence.Using three datasets, TC exposure scores were calculated for each subject to determine how exposure affects posttraumatic stress disorder (PTSD), anxiety, and major depressive disorder (MDD) symptom prevalence. Inundation mapping of various SLR and storm surge (SS) scenarios were performed for the susceptible region of Miami-Dade and Broward counties to determine the population impact of flooding.We found an elevated risk of mental illness symptoms from exposure to more high- intensity TCs and identified demographic variables that may contribute to this risk. Furthermore, inundation mapping demonstrated severe and widespread impact of SLR and SS on the mental health of communities.This study did not include data directly measuring comorbidity, resilience, preparedness, or ability to adapt to climate change. Also, multiple imputation using chained equations may have been imperfect. Furthermore, there is uncertainty in predicting and mapping SLR and TC intensity, which limits complete confidence in our SS predictions.The impacts of climate change have been frequently studied in terms of physical health, natural disaster prevalence, and economic impacts, but rarely on mental health burden. However, it is vital that national, state, and local governments develop and deploy plans to address mental health needs along with expenditures for protecting infrastructure, the economy, and physical health from the combined effects of SLR and climate change-induced natural disasters.

In the midst of widespread community transmission of coronavirus disease 2019 (COVID-19) in New York, residents have sought information about COVID-19. We analyzed trends in New York State (NYS) and New York City (NYC) data to quantify the extent of COVID-19-related queries. Data on the number of 311 calls in NYC, Google Trend data on the search term ‘Coronavirus’ and information about trends in COVID-19 cases in NYS and the USA were compiled from multiple sources. There were 1228 994 total calls to 311 between 22 January 2020 and 22 April 2020, with 50 845 calls specific to COVID-19 in the study period. The proportion of 311 calls related to COVID-19 increased over time, while the ‘interest over time’ of the search term ‘Coronavirus’ has exponentially increased since the end of February 2020. It is vital that public health officials provide clear and up-to-date information about protective measures and crucial communications to respond to information-seeking behavior across NYC.

Background: Although the American Heart Association promotes telehealth models to improve care access, there is limited literature on its use in underserved populations. This study is the first to compare utilization and quality of life (QoL) for underserved black and Hispanic heart failure (HF) patients assigned to telehealth self-monitoring (TSM) or comprehensive outpatient management (COM) over 90 days. Methods: This randomized controlled trial enrolled 104 patients. Outcomes included emergency department (ED) visits, hospitalizations, QoL, depression, and anxiety. Binary outcomes for utilization were analyzed using chi-square or Fisher's exact test. Poisson or negative binomial regression, repeated-measures analysis of variance, or generalized estimating equations were also used as appropriate. Results: Of 104 patients, 31% were Hispanic, 69% black, 41% women, and 72% reported incomes of

Age-related decreases in Quality of Life (QoL) are often compounded by comorbidities, including cancer. This study aimed to examine QoL changes before and after a new cancer diagnosis using data from the National Health and Aging Trend Study (NHATS), linked to Medicare claims (N = 136). There was a significant increase in the relative odds of fair/poor self-reported health and needing help with Activities of Daily Living. There was also a marginal increase in depression, but no change in anxiety or pain scores. Results underscore importance of considering pre-cancer QoL when making treatment decisions for older adult cancer patients.

BACKGROUND: Although surgical resection is considered the standard of care for early-stage non-small cell lung cancer, radiotherapy [stereotactic body radiation therapy (SBRT)] has been proposed as a minimally invasive treatment alternative. Studies have not examined differences in quality of life (QoL) between surgery and radiotherapy, despite important implications for patient and provider decision making. METHODS: The Surveillance, Epidemiology, and End Results Medicare Health Outcomes Survey (1998–2014) was used to assess changes in physical QoL score [Physical Component Summary (PCS)] and mental health QoL score [Mental Component Summary (MCS)] from baseline (prior to cancer diagnosis) to follow-up after treatment with surgery only or radiotherapy only. QoL was measured using the 36-item Short Form Health Survey (SF-36) until 2006, when it was replaced by the Veterans RAND 12-Item Health Survey (VR-12). RESULTS: Data from 184 patients (28 SBRT, 156 surgery) was included. There was a significant decline in PCS score from baseline to follow-up (surgery: −4.81; 95% CI: −6.31, −3.30; P

Background Few studies have focused on quality of life (QoL) after treatment of malignant pleural mesothelioma (MPM). There are still questions as to which surgical procedure, extrapleural pneumonectomy (EPP) or pleurectomy decortication (P/D) is most effective and results in better survival outcomes, involves fewer complications, and results in better QoL. Here we performed a literature review on MPM patients to assess and compare QoL changes after P/D and EPP. Methods Research articles concerning QoL after mesothelioma surgery were identified through May 2018 in Medline. For inclusion, studies were 1) cohort or randomized controlled trials (RCT) design, 2) included standardized QoL instruments, 3) reported QoL measurement after surgery, 4) described the type of surgery performed (EPP or P/D), 5) were written in English. Measures of lung function (FEV1, FVC) and measures from the EORTC-C30 were compared 6 months following surgery with preoperative values. Results QoL data was extracted from 17 articles (14 datasets), encompassing 659 patients (102 EPP, 432 P/D); the available evidence was of low quality. While two studies directly compared QoL between the two surgical procedures, additional data was available from one arm of two RCTs, as the RCTs were not comparing EPP and P/D. The remaining data was reported from observational studies. While QoL was still compromised 6 months following surgery, from the limited and low quality data available it would appear that P/D patients had better QoL than EPP patients across all measures. Physical function, social function and global health were better at follow-up for P/D than for EPP, while other indicators such as pain and cough were similar. Forced Expiratory Volume (FEV1) and Forced Vital Capacity (FVC) were reported in one study only, and were higher at follow-up for P/D compared to EPP. Conclusions Although the existing evidence is limited and of low quality, it suggests that P/D patients have better QoL than EPP patients following surgery. QoL outcomes should be factored into the choice of surgical procedure for MPM patients, and the possible effects on lung function and QoL should be discussed with patients when presenting surgical treatment options.

Background Given both the increased prevalence of natural disasters in recent years and the crippling opioid epidemic, identifying at-risk groups for substance abuse post-disaster is imperative to survivor mental health. The objective of this study was to examine the association between exposure to Hurricane Sandy and risk of opioid abusive behavior. Methods We conducted a retrospective analysis using data from two cross-sectional studies that examined the impact of Hurricane Sandy on mental health from October 2013- August 2016. Patient demographics, hurricane exposure and mental health history were obtained via self-report questionnaires. Opioid abuse risk was determined and categorized using adaptations from the Opioid Risk Tool (ORT). Multinomial logistic regression was used to examine the relationship between hurricane exposure and opioid abuse risk. Results Data was available on 1,687 Hurricane Sandy survivors, the majority being female (59.3%), white (52.0%) and an average age of 46.1 years (std. 19.2). Approximately 9.0% of survivors were classified as being 'High' risk for opioid abuse. For every increase in total exposure reported, the odds of being classified as high risk was 1.09 greater (95% CI 1.05, 1.14) compared to low risk, after adjusting for covariates. Among personal exposures only (i.e. injury to self or family member), for every increase in reported exposure the adjusted odds of being classified as high risk was 1.25 times greater (95% CI 1.15, 1.37) compared to low risk. Conclusions These findings suggest that exposure to a natural disaster, specifically personal exposures, are associated with increased risk for opioid abusive behavior.

Patient-reported outcomes are important in the surgical decision-making process for low-risk, differentiated thyroid cancer. Current study aimed to assess patient-reported outcomes in thyroid cancer survivors comparing total thyroidectomy (TT) and lobectomy (LT) using the Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship (PROFILES) registry.European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) scales, illness perception questions, Beliefs about Medicines Questionnaire (BMQ) scales and questions about thyroid surgery-related medication use were compared between thyroid cancer patients who underwent TT versus LT using descriptive analyses.In total, 58 thyroid cancer patients who underwent TT or LT were included in this study. None of the EORTC QLQ-C30 scales or questions regarding illness perception were significantly different between the surgical groups. Patients in the TT group had significantly higher belief in the necessity of their medication (21.0 vs 15.4; p = 0.003) and greater concerns about taking their medicines (14.7 vs 11.1; p = 0.008) versus patients in the LT group.Concerns about post-surgical medication use specifically in the TT group may indicate that clinicians should consider LT in patients with low-risk, differentiated thyroid cancer when LT and TT are viable surgical options. Clinicians should be aware of the impact of post-surgical medication use in particular following TT and use this knowledge to align goals of treatment with the extent of surgery, allowing for a better-informed decision-making process.

Background Cancer and dementia have often been studied in isolation. We aimed to examine the spatiotemporal trend of inpatient admissions with both cancer and dementia diagnoses. Methods Using state-wide inpatient claims data, we identified all hospital admissions for patients aged ≥50 years with both cancer and dementia diagnoses in New York State, 2007-2017. We examined the spatiotemporal trend of the admission using a novel Bayesian hierarchical model adjusting for socioeconomic factor, as measured by Yost index. Results Admissions with the presence of both cancer and dementia diagnoses represented 8.5% of all admissions with a cancer diagnosis, and the proportion increased from 7.1% in 2007 to 9.7% in 2017. The median admission rate was 3.5 (interquartile range: 2.2–5.2) hospitalizations per 1000 population aged ≥50 years, which increased from 2.9 in 2007 to 3.7 in 2017. The admission rate peaked first in 2010 followed by a smaller peak in 2014, before stabilizing at a level higher than the pre-2010 period. Taking into account the spatiotemporal heterogeneity, we found that hospitalizations among those with both cancer and dementia diagnoses were associated with a higher socioeconomic status (the posterior median relative risk for Yost index = 1.046 (95% credible interval: 1.033–1.058)). Conclusions Hospitalizations of patients with both cancer and dementia increased over time. Cancer care providers and healthcare systems should be prepared to provide prevention and management strategies and engage in complex medical decision-making for this increasingly common patient population comprised of individuals with cancer and dementia.

Background The autonomic nervous system (ANS) maintains physiological homeostasis in various organ systems via parasympathetic and sympathetic branches. ANS function is altered in common diffuse and focal conditions and heralds the beginning of environmental and disease stresses. Reliable, sensitive, and quantitative biomarkers, first defined in healthy participants, could discriminate among clinically useful changes in ANS function. This framework combines controlled autonomic testing with feature extraction during physiological responses. Methods Twenty-one individuals were assessed in two morning and two afternoon sessions over two weeks. Each session included five standard clinical tests probing autonomic function: squat test, cold pressor test, diving reflex test, deep breathing, and Valsalva maneuver. Noninvasive sensors captured continuous electrocardiography, blood pressure, breathing, electrodermal activity, and pupil diameter. Heart rate, heart rate variability, mean arterial pressure, electrodermal activity, and pupil diameter responses to the perturbations were extracted, and averages across participants were computed. A template matching algorithm calculated scaling and stretching features that optimally fit the average to an individual response. These features were grouped based on test and modality to derive sympathetic and parasympathetic indices for this healthy population. Results A significant positive correlation (p = 0.000377) was found between sympathetic amplitude response and body mass index. Additionally, longer duration and larger amplitude sympathetic and longer duration parasympathetic responses occurred in afternoon testing sessions; larger amplitude parasympathetic responses occurred in morning sessions. Conclusions These results demonstrate the robustness and sensitivity of an algorithmic approach to extract multimodal responses from standard tests. This novel method of quantifying ANS function can be used for early diagnosis, measurement of disease progression, or treatment evaluation. Trial registration This study registered with Clinicaltrials.gov, identifier NCT04100486. Registered September 24, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04100486.

The therapeutic benefits and rationale for treating fevers with external cooling methods remain unclear. We aimed to describe the clinical settings in which cooling blankets (CBs) are used.We conducted a retrospective chart review of CB use in adult patients admitted to our tertiary care center over a one-year period. We measured how they are used and correlations between clinical variables and their duration of use.561 patients were included in our study. The mean highest temperature during hospitalization was 39.35 °C (SD, 0.67). Shivering occurred in 176 patients (31.4%) while on a CB although 303 patients (54%) had no data regarding shivering. Discontinuation of CBs was recorded in only 177 (30.5%) cases. Among these, the median duration of use was 33.37 h (IQR: 18.13-80.38) while the median duration of fever was 22.13 h (IQR 6.67-51.98). Duration of CB use was highly correlated with fever duration (Spearman's rho, 0.771, p.001), moderately with length of stay (LOS) (rho, 0.425, p.001), LOS after CB initiation (rho, 0.475, p.001) and antipyretic use (rho, 0.506, p.001). No other statistically significant correlations were observed.Documentation of CB use including temperature set points, time of discontinuation and duration in EMRs was poor. We could not establish benefits of CB use in this study but observed that almost a third of patients developed adverse effects in the form of shivering. Thus, adverse effects of CB use may outweigh potential benefits. Their use should be reevaluated and institutional protocols developed for their use.

Dementia and cancer occur commonly in older adults. Yet, little is known about the effect of dementia on cancer treatment and outcomes in patients diagnosed with cancer, and no guidelines exist. We performed a mixed studies review to assess the current knowledge and gaps on the impact of dementia on cancer treatment decision-making, cancer treatment, and mortality. A search in PubMed, Medline, and PsycINFO identified 55 studies on older adults with a dementia diagnosis before a cancer diagnosis and/or comorbid cancer and dementia published in English from January 2004 to February 2020. We described variability using range in quantitative estimates, ie, odds ratios (ORs), hazard ratios (HRs), and risk ratios (RR) when appropriate and performed narrative review of qualitative data. Patients with dementia were more likely to receive no curative treatment (including hospice or palliative care) (OR, HR, and RR range = 0.40-4.4, n = 8), while less likely to receive chemotherapy (OR and HR range = 0.11-0.68, n = 8), radiation (OR range = 0.24-0.56, n = 2), and surgery (OR range = 0.30-1.3, n = 4). Older adults with cancer and dementia had higher mortality than those with cancer alone (HR and OR range = 0.92-5.8, n = 33). Summarized findings from qualitative studies consistently revealed that clinicians, caregivers, and patients tended to prefer less aggressive care and gave higher priority to quality of life over life expectancy for those with dementia. Current practices in treatment-decision making for patients with both cancer and dementia are inconsistent. There is an urgent need for treatment guidelines for this growing patient population that considers patient and caregiver perspectives.

Experiencing the COVID-19 pandemic simultaneously with the U.S. opioid epidemic is anticipated to have a profound mental health impact on some of our most vulnerable populations. Recent federal and state regulatory changes have been made under the state of emergency in order to ameliorate the some of the challenges faced in maintaining access to substance use and addiction services during such times. There are currently considerable limitations in quantifying the impact of COVID-19 among those with substance use disorders, however, it is imperative that health care systems continue to serve this population in order to prevent associated morbidity and mortality. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Introduction The opioid epidemic has altered normative clinical perceptions on addressing both acute and chronic pain, particularly within the Emergency Department (ED) setting, where providers are now confronted with balancing pain management and potential abuse. This study aims to examine patient sociodemographic and ED clinical characteristics to comprehensively determine predictors of opioid administration during an ED visit (ED-RX) and prescribing upon discharge (DC-RX). Methods ED visit data of patients ≥18 years old from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2014 to 2017 were used. Opioid prescriptions were determined utilizing Lexicon narcotic drug classifications. Visit characteristics studied included sociodemographic variables, and ED clinical variables, such as chief complaint, and discharge diagnosis. Machine learning methods were used to determine predictors of ED-RX and DC-RX and weighted logistic regressions were performed using selected predictors. Results Of the 44,227 ED visits identified, patients tended to be female (57.4%), and White (74.2%) with an average age of 46.4 years (SE = 0.3). Weighted proportions of ED-RX and DC-RX were 23.2% and 18.9%, respectively. The strongest predictors of ED-RX were CT scan ordered (OR = 2.18, 95% CI = 1.84–2.58), abdominal pain (OR = 1.93, 95% CI:1.59–2.34) and back pain (OR = 1.81, 95% CI:1.45–2.27). Tooth pain (OR = 6.94, 95% CI = 4.40–10.94) and fracture injury diagnoses (OR = 3.76, 95% CI = 2.72–5.19) were the strongest predictors of DC-RX. Conclusions These findings demonstrate the utility of machine learning for understanding clinical predictors of opioid administration and prescribing in the ED, and its potential in informing standardized prescribing recommendations and guidelines.

Objective To determine whether procalcitonin (PCT) levels are different in infected versus noninfected febrile patients with intracranial hemorrhage (ICH). Methods This prospective observational study included 104 patients with ICH and fever >38.3°C admitted to the intensive care unit of a tertiary care hospital. PCT was measured on day 1 (PCT 1) of fever and 48–72 hours later (PCT 2). Patients were determined to have an infection (pneumonia, urinary tract infection, or bacteremia) based on cultures, imaging, and clinical impression of treating clinicians. Results Analysis of variance indicated significant mean differences in patients with no, probable, and definite infection (F2,103 = 3.12, P = 0.048) between PCT 1 and PCT 2 (F2,72 = 4.64, P = 0.013). Patients with probable infection had the highest PCT 1 (mean = 0.47, SD = 0.93), and patients with definite infection had higher PCT 2 (mean = 0.62, SD = 0.85). Additional analyses of univariable mean differences showed mean PCT 1 that was significantly higher in the probable infection group compared with the no infection group. Mean PCT was significantly higher at both time points in the definite infection group compared with the no infection group. There were no significant differences between the probable and definite infection groups. Conclusions PCT levels were higher in patients with ICH and infections and may be a useful marker to differentiate between infectious and noninfectious etiologies of fevers in these patients. Further studies, including randomized controlled trials, will help in establishing the utility of this marker in optimal management of febrile patients with ICH.

Background: Demographic and contextual factors are associated with quality of life (QoL) in older adults and prediagnosis QoL among older adults has important implications for supportive care in older cancer patients. Objective: To examine whether lower educational attainment is associated with poorer QoL among community dwelling older adults just before their diagnosis of lung cancer in a nationally representative sample. Design: This study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) dataset, which provides cancer registry data linked with survey data for Medicare Advantage enrollees. Subjects: Adults 65 years and older at time of diagnosis with first or only primary lung cancer and with at least one survey before their cancer diagnosis. Measurements: Level of education attained was categorized as less than high school (

Disparities exist in post-disaster flooding exposure and vulnerable populations bear a disproportionate impact of this exposure. We describe the unequal burden of flooding in a cohort of New York residents following Hurricane Sandy and assess whether the likelihood of flooding was distributed equally according to socioeconomic demographics, and whether this likelihood differed when analyzing self-reported or FEMA flood exposure measures. Residents of New York City and Long Island completed a self-administered survey 1.5-4.0 years after the storm. Multivariable logistic regressions were performed to determine the relationship between sociodemographic characteristics and flood exposure. Participants (n = 1231) residing in areas of the lowest two quartiles of median household income experienced flooding the most often (FEMA/self-reported:$40,298: 65.3%/42.0%, $40,298-$67,188: 43.3%/32.1%), and these areas contained the highest proportions of non-White participants ($40,298: 39.1%, $40,298-$67,188: 36.6%) and those with ≤high school education ($40,298: 35.5%, $40,298-$67,188: 33.6%). Both self-report (p 0.05) and FEMA (p 0.05) flood measures indicated that older participants were more likely to live in a household exposed to flooding, while those living in higher-income areas had decreased likelihood of flooding (p 0.0001). Socioeconomic and age disparities were present in exposure to flooding during Hurricane Sandy. Future disaster preparedness responses must understand flooding from an environmental justice perspective to create effective strategies that minimize disproportionate exposure and its adverse outcomes.

Destruction caused by natural disasters compromises medical providers' and hospitals' abilities to administer care. Hurricane Sandy was particularly devastating, resulting in massive disruptions of medical care in the region. This study aimed to determine whether a lack of access to medical care during Hurricane Sandy was associated with posttraumatic stress disorder (PTSD) symptoms and other mental health/substance abuse outcomes. A secondary aim was to examine whether having a chronic illness moderates those associations. Self-reported medical access and mental health symptomatology were obtained from New York City and Long Island residents (n = 1669) following Hurricane Sandy under the Leaders in Gathering Hope Together project (10/23/2013–2/25/2015) and Project Restoration (6/5/2014–8/9/2016). Multivariable logistic regressions were utilized to determine the relationship between lack of access to medical care and mental health outcomes. Of the 1669 participants, 994 (59.57%) were female, 866 (51.89%) were white, and the mean age was 46.22 (SD = 19.2) years old. Those without access to medical care had significantly higher odds of showing symptoms of PTSD (AOR = 2.71, CI = [1.77–4.16]), as well as depression (AOR = 1.94, CI = [1.29–2.92]) and anxiety (AOR = 1.61, CI = [1.08–2.39]) compared to those with access. Lack of access to care was associated with a 2.12 point increase in perceived stress scale score (SE = 0.63). The interaction between having a chronic illness and lack of access to medical care was not significantly associated with any outcomes. The findings emphasize the importance of making medical care more accessible to patients, both chronically and acutely ill, during natural disasters to benefit their physical as well as their mental health., Highlights • Individuals without access to medical care had asignificantly higher odds of showing symptoms of mental health difficulties. • Chronic illness did not moderate the relationship between a lack of access to care and mental health outcomes. • Access to medical care during natural disasters may benefit the mental health of survivors with and without chronic illness.

Hurricane exposure can have a profound impact on mental health, leading to increased symptoms of stress, anxiety, depression and post-traumatic stress disorder that are still present years after the storm. Those displaced following a hurricane are particularly vulnerable to adverse mental health outcomes, especially if displaced to temporary shelters. The current work highlights the experiences and mental health challenges of displaced populations following Hurricane Sandy and Hurricane Harvey, as well as describing barriers to conducting research in the immediate aftermath of Hurricane Harvey and the need for more comprehensive interventions in these vulnerable populations.

Objective: To assess the effect of displacement due to Hurricane Sandy on mental health outcomes among residents of the greater New York City (NYC) area. Design: Prospective, cross sectional. Setting: NYC area residents, including Queens, Staten Island, and Long Island. Participants: In a 4.25 year period (June 2012 to September 2016), a convenience sample of 1,615 adult residents from the greater NYC area completed validated measures of hurricane exposure (including displacement), perceived stress, depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms as well as indicators of alcohol, illicit substance, and tobacco use. Main Outcome Measures: Perceived stress, depression, anxiety and PTSD symptoms and alcohol, illicit substance, and tobacco use. Results: Multivariable analyses indicated that displaced participants were more likely to have PTSD (adjusted Odds Ratio (AOR): 2.21, 95%CI: 1.73-2.82), depression (AOR: 1.37, 95%CI: 1.05-1.79) and anxiety symptoms (AOR: 1.30, 95%CI: 1.01-1.67) and had a 1.16 unit increase in perceived stress score (SE = 0.38) compared to nondisplaced participants. Staying with friends / family vs. at a shelter was significantly associated with a 48 percent decreased odds of having PTSD symptoms (AOR: 0.52, 95%CI: 0.31-0.88) and of being a current tobacco user (AOR: 0.52, 95%CI: 0.30-0.92). Conclusions: Displacement is associated with negative mental health outcomes, particularly displacement to shelters. Disaster preparedness efforts should involve increasing mental health resources to those who are displaced and providing support services within the shelter setting.

Aim: To investigate medical decision-making from the thoracic surgeons’ and patients’ perspectives in early-stage lung cancer. Patients & methods: We conducted one focus group with thoracic surgeons (n = 15) and one with a group of early-stage lung cancer patients treated with surgery (n = 7). Focus groups were recorded, transcribed and coded for themes. Results: For surgeons, surgical procedure choice was a primary concern, followed by the surgical treatment plan decision-making process. Survivors focused primarily on the physical and mental health-related postsurgical burden for which they felt they were not well prepared and placed less emphasis on surgical decision-making. Conclusion: As early-stage lung cancer mortality rates are improving, surgeons and patients can prioritize surgical approaches and postsurgical care that enhance quality of life.