Public Health Commons^™

Association Of The Gut Microbiome With Kidney Function And Damage In The Hispanic Community Health Study/Study Of Latinos (Hchs/Sol), Brandilyn A Peters, Qibin Qi, Mykhaylo Usyk, Martha L Daviglus, Jianwen Cai, Nora Franceschini, James P Lash, Marc D Gellman, Bing Yu, Eric Boerwinkle, Rob Knight, Robert D Burk, Robert C Kaplan

Faculty, Staff and Student Publications

BACKGROUND: The gut microbiome is altered in chronic kidney disease (CKD), potentially contributing to CKD progression and co-morbidities, but population-based studies of the gut microbiome across a wide range of kidney function and damage are lacking.

METHODS: In the Hispanic Community Health Study/Study of Latinos, gut microbiome was assessed by shotgun sequencing of stool (

RESULTS: Higher eGFR was associated with overall gut microbiome composition, greater abundance of species from Prevotella, Faecalibacterium, Roseburia, and Eubacterium, and microbial functions related to synthesis of long-chain fatty acids and carbamoyl-phosphate. Higher UAC ratio and CKD were related to lower gut microbiome diversity and …

Application Of Implementation Mapping To Develop Strategies For Integrating The National Diabetes Prevention Program Into Primary Care Clinics, William B Perkison, Serena A Rodriguez, Fernanda Velasco-Huerta, Patenne D Mathews, Catherine Pulicken, Sidra S Beg, Natalia I Heredia, Pierre Fwelo, Grace E White, Belinda M Reininger, John W Mcwhorter, Roshanda Chenier, Maria E Fernandez

Faculty, Staff and Student Publications

BACKGROUND: Diabetes is considered one of the most prevalent and preventable chronic health conditions in the United States. Research has shown that evidence-based prevention measures and lifestyle changes can help lower the risk of developing diabetes. The National Diabetes Prevention Program (National DPP) is an evidence-based program recognized by the Centers for Disease Control and Prevention; it is designed to reduce diabetes risk through intensive group counseling in nutrition, physical activity, and behavioral management. Factors known to influence this program's implementation, especially in primary care settings, have included limited awareness of the program, lack of standard clinical processes to facilitate …

Susceptible Windows Of Exposure To Fine Particulate Matter And Fetal Growth Trajectories In The Spanish Inma (Infancia Y Medio Ambiente) Birth Cohort, Wei-Jen Chen, Alison M Rector, Monica Guxens, Carmen Iniguez, Michael D Swartz, Elaine Symanski, Jesús Ibarluzea, Albert Ambros, Marisa Estarlich, Aitana Lertxundi, Isolina Riano-Galán, Jordi Sunyer, Ana Fernandez-Somoano, Suneet P Chauhan, Jennifer Ish, Kristina W Whitworth

Faculty, Staff and Student Publications

While prior studies report associations between fine particulate matter (PM

Factors Associated With Hiv Testing And Treatment Among Young Black Msm And Trans Women In Three Jail Systems, Nicholas Antos, Rey Flores, Nina Harawa, Natascha Del Vecchio, Rodal Issema, Kayo Fujimoto, Aditya S Khanna, Angela Di Paola, John A Schneider, Anna L Hotton

Faculty, Staff and Student Publications

Black men who have sex with men (BMSM) and transgender women (BTW) are disproportionately affected by incarceration and HIV. We assessed factors associated with HIV testing and viral suppression among 176 incarcerated BMSM and BTW in Chicago, IL; Los Angeles, CA; and Houston, TX. In multivariable logistic regression, having a sexual orientation of bisexual, heterosexual, or other vs. gay or same-gender loving was associated with higher odds of testing in custody (aOR 8.97; 95% CI 1.95 - 41.24). Binge drinking (aOR 0.19; 95% CI 0.04 - 0.92) and being unemployed prior to incarceration (aOR 0.03; 95% CI 0.00 - 0.23) …

Examining Neighborhood-Level Hot And Cold Spots Of Food Insecurity In Relation To Social Vulnerability In Houston, Texas, Ryan Ramphul, Linda Highfield, Shreela Sharma

Faculty, Staff and Student Publications

Food insecurity is prevalent and associated with poor health outcomes, but little is known about its geographical nature. The aim of this study is to utilize geospatial modeling of individual-level food insecurity screening data ascertained in health care settings to test for neighborhood hot and cold spots of food insecurity in a large metropolitan area, and then compare these hot spot neighborhoods to cold spot neighborhoods in terms of the CDC's Social Vulnerability Index. In this cross-sectional secondary data analysis, we geocoded the home addresses of 6,749 unique participants screened for food insecurity at health care locations participating in CMS's …

Age-Induced Changes In Anti-Tumor Immunity Alter The Tumor Immune Infiltrate And Impact Response To Immuno-Oncology Treatments, Suzanne I Sitnikova, Jennifer A Walker, Laura B Prickett, Michelle Morrow, Viia E Valge-Archer, Matthew J Robinson, Robert W Wilkinson, Simon J Dovedi

Faculty, Staff and Student Publications

INTRODUCTION: Immuno-oncology (IO) research relies heavily on murine syngeneic tumor models. However, whilst the average age for a cancer diagnosis is 60 years or older, for practical purposes the majority of preclinical studies are conducted in young mice, despite the fact that ageing has been shown to have a significant impact on the immune response.

METHODS: Using aged (60-72 weeks old) mice bearing CT26 tumors, we investigated the impact of ageing on tumor growth as well as the immune composition of the tumor and peripheral lymphoid organs.

RESULTS: We found many differences in the immune cell composition of both the …

Social Determinant Of Health Impact On Diabetes Device Use And Clinical Outcomes In Youth With Type 1 Diabetes, Emily R Crain, Ryan Ramphul, Ashley M Butler, Xiaofan Huang, Charles G Minard, Maria J Redondo, Daniel J Desalvo

Faculty, Staff and Student Publications

Background: Youth with Type 1 diabetes (T1D) who are Black, Hispanic, or lower socioeconomic status (SES) have lower rates of diabetes device use, higher hemoglobin A1c (HbA1c), and higher rates of diabetic ketoacidosis (DKA). However, the associations of individual-level social determinants of health (SDoH) and neighborhood-level factors with device use and clinical outcomes are unknown. Area deprivation index (ADI) is a neighborhood level measure of SES reported in deciles (range 1-10 with 10 representing most deprived neighborhood).

Methods: We evaluated the association of ADI and other SDoH factors with pump/continuous glucose monitor (CGM) use, HbA1c, and DKA in 1,461 youth …

Hpv-Related Oropharyngeal Cancer Early Detection In Gay And Bisexual Men Is An “Orphan” Practice: A Qualitative Analysis Among Healthcare Providers, I Niles Zoschke, Sarah L Bennis, J Michael Wilkerson, Cynthia L Stull, Alan G Nyitray, Samir S Khariwala, C Mark Nichols, B R Simon Rosser, Charlene Flash, Michael W Ross

Faculty, Staff and Student Publications

Introduction: Among US men, oropharyngeal cancer (cancer of the back of the mouth and throat) is the 8th most common cancer. If detected early, human papillomavirus (HPV)-16-associated oropharyngeal cancer has a high 5-year survival rate. Risk factors such as high numbers of oral sex partners, disparities in smoking and drinking, and low rates of HPV vaccination may put gay and bisexual men at even higher risk for oropharyngeal cancer.

Methods: We recruited 21 healthcare providers in Minneapolis-St. Paul, Minnesota and Houston, Texas to participate in semi-structured interviews. Nurses, physician assistants, dental hygienists, and dentists were asked about their clinical experiences …

Editorial: Period Poverty, Lea Sacca, Christine Margaret Markham, Jhumka Gupta, Melissa Peskin

Faculty, Staff and Student Publications

No abstract provided.

Assessing Pandemic Preparedness, Response, And Lessons Learned From The Covid-19 Pandemic In Four South American Countries: Agenda For The Future, Andrea Ramírez Varela, Michael Touchton, J Jaime Miranda, Juliana Mejía Grueso, Rachid Laajaj, Gabriel Carrasquilla, Martha Vives Florez, Ana María Vesga Gaviria, Ana María Ortiz Hoyos, Esteban Orlando Vanegas Duarte, Alejandra Velásquez Morales, Nubia Velasco, Silvia Restrepo Restrepo

Faculty, Staff and Student Publications

INTRODUCTION: The COVID-19 pandemic emerged in a context that lacked adequate prevention, preparedness, and response (PPR) activities, and global, regional, and national leadership. South American countries were among world's hardest hit by the pandemic, accounting for 10.1% of total cases and 20.1% of global deaths.

METHODS: This study explores how pandemic PPR were affected by political, socioeconomic, and health system contexts as well as how PPR may have shaped pandemic outcomes in Argentina, Brazil, Colombia, and Peru. We then identify lessons learned and advance an agenda for improving PPR capacity at regional and national levels. We do this through a …

Community-Based Tuberculosis Contact Management: Caregiver Experience And Factors Promoting Adherence To Preventive Therapy, Micaela Sandoval, Godwin Mtetwa, Tara Devezin, Debrah Vambe, Joyce Sibanda, Gloria S Dube, Thandeka Dlamini-Simelane, Bhekumusa Lukhele, Anna M Mandalakas, Alexander Kay

Faculty, Staff and Student Publications

Delivery of tuberculosis preventive therapy (TPT) for children with household exposure to tuberculosis is a globally supported intervention to reduce the impact of tuberculosis disease (TB) in vulnerable children; however, it is sub-optimally implemented in most high-burden settings. As part of a community-based household contact management program, we evaluated predictors of adherence to community based TPT in children and performed qualitative assessments of caregiver experiences. The Vikela Ekhaya (Protect the Home) project was a community-based household contact management program implemented between 2019 and 2020 in the Hhohho Region of Eswatini. At home visits, contact management teams screened children for TB, …

Toward A More Comprehensive Understanding Of Organizational Influences On Implementation: The Organization Theory For Implementation Science Framework, Sarah A Birken, Cheyenne R Wagi, Alexandra G Peluso, Michelle C Kegler, Jure Baloh, Prajakta Adsul, Maria E Fernandez, Manal Masud, Terry T-K Huang, Matthew Lee, Mary Wangen, Per Nilsen, Miriam Bender, Mimi Choy-Brown, Grace Ryan, Aliza Randazzo, Linda K Ko

Faculty, Staff and Student Publications

Introduction: Implementation is influenced by factors beyond individual clinical settings. Nevertheless, implementation research often focuses on factors related to individual providers and practices, potentially due to limitations of available frameworks. Extant frameworks do not adequately capture the myriad organizational influences on implementation. Organization theories capture diverse organizational influences but remain underused in implementation science. To advance their use among implementation scientists, we distilled 70 constructs from nine organization theories identified in our previous work into theoretical domains in the Organization Theory for Implementation Science (OTIS) framework.

Methods: The process of distilling organization theory constructs into domains involved concept mapping and …

Wastewater Pandemic Preparedness: Toward An End-To-End Pathogen Monitoring Program, Justin R Clark, Austen Terwilliger, Vasanthi Avadhanula, Michael Tisza, Juwan Cormier, Sara Javornik-Cregeen, Matthew Clayton Ross, Kristi Louise Hoffman, Catherine Troisi, Blake Hanson, Joseph Petrosino, John Balliew, Pedro A Piedra, Janelle Rios, Jennifer Deegan, Cici Bauer, Fuqing Wu, Kristina D Mena, Eric Boerwinkle, Anthony W Maresso

Faculty, Staff and Student Publications

Molecular analysis of public wastewater has great potential as a harbinger for community health and health threats. Long-used to monitor the presence of enteric viruses, in particular polio, recent successes of wastewater as a reliable lead indicator for trends in SARS-CoV-2 levels and hospital admissions has generated optimism and emerging evidence that similar science can be applied to other pathogens of pandemic potential (PPPs), especially respiratory viruses and their variants of concern (VOC). However, there are substantial challenges associated with implementation of this ideal, namely that multiple and distinct fields of inquiry must be bridged and coordinated. These include engineering, …

Comorbidity Network Analysis Using Graphical Models For Electronic Health Records, Bo Zhao, Sarah Huepenbecker, Gen Zhu, Suja S Rajan, Kayo Fujimoto, Xi Luo

Faculty, Staff and Student Publications

IMPORTANCE: The comorbidity network represents multiple diseases and their relationships in a graph. Understanding comorbidity networks among critical care unit (CCU) patients can help doctors diagnose patients faster, minimize missed diagnoses, and potentially decrease morbidity and mortality.

OBJECTIVE: The main objective of this study was to identify the comorbidity network among CCU patients using a novel application of a machine learning method (graphical modeling method). The second objective was to compare the machine learning method with a traditional pairwise method in simulation.

METHOD: This cross-sectional study used CCU patients' data from Medical Information Mart for the Intensive Care-3 (MIMIC-3) dataset, …

Ai-Drugnet: A Network-Based Deep Learning Model For Drug Repurposing And Combination Therapy In Neurological Disorders, Xingxin Pan, Jun Yun, Zeynep H Coban Akdemir, Xiaoqian Jiang, Erxi Wu, Jason H Huang, Nidhi Sahni, S Stephen Yi

Faculty, Staff and Student Publications

Discovering effective therapies is difficult for neurological and developmental disorders in that disease progression is often associated with a complex and interactive mechanism. Over the past few decades, few drugs have been identified for treating Alzheimer's disease (AD), especially for impacting the causes of cell death in AD. Although drug repurposing is gaining more success in developing therapeutic efficacy for complex diseases such as common cancer, the complications behind AD require further study. Here, we developed a novel prediction framework based on deep learning to identify potential repurposed drug therapies for AD, and more importantly, our framework is broadly applicable …

Gain-Of-Function Variomics And Multi-Omics Network Biology For Precision Medicine, Mark M Li, Sharad Awasthi, Sumanta Ghosh, Deepa Bisht, Zeynep H Coban Akdemir, Gloria M Sheynkman, Nidhi Sahni, S Stephen Yi

Faculty, Staff and Student Publications

Traditionally, disease causal mutations were thought to disrupt gene function. However, it becomes more clear that many deleterious mutations could exhibit a "gain-of-function" (GOF) behavior. Systematic investigation of such mutations has been lacking and largely overlooked. Advances in next-generation sequencing have identified thousands of genomic variants that perturb the normal functions of proteins, further contributing to diverse phenotypic consequences in disease. Elucidating the functional pathways rewired by GOF mutations will be crucial for prioritizing disease-causing variants and their resultant therapeutic liabilities. In distinct cell types (with varying genotypes), precise signal transduction controls cell decision, including gene regulation and phenotypic output. …

A Novel Bayesian Spatial-Temporal Approach To Quantify Sars-Cov-2 Testing Disparities For Small Area Estimation, Cici Bauer, Xiaona Li, Kehe Zhang, Miryoung Lee, Esmeralda Guajardo, Susan Fisher-Hoch, Joseph Mccormick, Maria E Fernandez, Belinda Reininger

Faculty, Staff and Student Publications

Objectives. To propose a novel Bayesian spatial–temporal approach to identify and quantify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing disparities for small area estimation.

Methods. In step 1, we used a Bayesian inseparable space–time model framework to estimate the testing positivity rate (TPR) at geographically granular areas of the census block groups (CBGs). In step 2, we adopted a rank-based approach to compare the estimated TPR and the testing rate to identify areas with testing deficiency and quantify the number of needed tests. We used weekly SARS-CoV-2 infection and testing surveillance data from Cameron County, Texas, between March 2020 …

Genetic Associations Between Sleep Traits And Cognitive Ageing Outcomes In The Hispanic Community Health Study/Study Of Latinos, Yuan Zhang, Michael Elgart, Einat Granot-Hershkovitz, Heming Wang, Wassim Tarraf, Alberto R Ramos, Ariana M Stickel, Donglin Zeng, Tanya P Garcia, Fernando D Testai, Sylvia Wassertheil-Smoller, Carmen R Isasi, Martha L Daviglus, Robert Kaplan, Myriam Fornage, Charles Decarli, Susan Redline, Hector M González, Tamar Sofer

Faculty, Staff and Student Publications

BACKGROUND: Sleep phenotypes have been reported to be associated with cognitive ageing outcomes. However, there is limited research using genetic variants as proxies for sleep traits to study their associations. We estimated associations between Polygenic Risk Scores (PRSs) for sleep duration, insomnia, daytime sleepiness, and obstructive sleep apnoea (OSA) and measures of cogntive ageing in Hispanic/Latino adults.

METHODS: We used summary statistics from published genome-wide association studies to construct PRSs representing the genetic basis of each sleep trait, then we studied the association of the PRSs of the sleep phenotypes with cognitive outcomes in the Hispanic Community Healthy Study/Study of …

Enabling Structural Resilience Of Street-Involved Children And Youth In Kenya: Reintegration Outcomes And The Flourishing Community Model, Michael L Goodman, Sarah E Seidel, Andrew Springer, Aleisha Elliott, Christine Markham, Hani Serag, Philip Keiser, Ben Raimer, Lauren Raimer-Goodman, Christine Gatwiri, Kelvin Munene, Stanley Gitari

Faculty, Staff and Student Publications

Introduction: Millions of children and youth live on city streets across the globe, vulnerable to substance use, abuse, material and structural neglect. Structural resilience, the re-establishment of access to structural goods within a society such as housing, education, and healthcare following some interruption, provides an orientation for research and interventional efforts with street-involved children and youth (SICY). Further, a structural resilience framework supports organizing interactions between levels and sectors of a socio-ecology.

Methods: Following the expressed interests of Kenyan SICY, and consistent with emerging policy interests at national and global levels, we assess reintegration trajectories of Kenyan SICY (n …

Pregnancy-Related Covid Worry, Depressive Symptom Severity, And Mediation Through Sleep Disturbance In A Low-Income, Primarily Latinx Population In California’S Central Valley, Jennifer N Felder, Patience A Afulani, Kimberly Coleman-Phox, Serwaa S Omowale, Charles E Mcculloch, Lauren Lessard, Miriam Kuppermann

Faculty, Staff and Student Publications

Purpose: This study (1) assessed the psychometric properties of a pregnancy-related COVID worry scale, (2) explored variations in pregnancy-related COVID worry over the course of the pandemic, and (3) examined associations between pregnancy-related COVID worry and depressive symptom severity, and evaluated sleep disturbance as a mediator.

Methods: Data were drawn from an ongoing randomized trial comparing the effectiveness of two enhanced forms of prenatal care. The current analysis includes baseline pre-randomization data collected from participants who enrolled November 2020-November 2021 (n = 201). Participants were pregnant individuals with low income and primarily Latinx.

Results: Our 7-item scale was valid and …

Maternal Perceptions Of Vaccinating Boys Against Human Papillomavirus (Hpv) In Seoul, South Korea: A Descriptive Exploratory Qualitative Study, Jihye Choi, Christine Markham, Irene Tamí-Maury, Sooyoun Kim, Paula Cuccaro

Faculty, Staff and Student Publications

Human Papillomavirus (HPV) vaccination is of paramount importance to reduce HPV-associated cancers in both genders. In South Korea, the prophylactic vaccine is recognized as prevention of cervical cancer with little attention given to male HPV vaccination. The purpose of this study was to explore perceptions of male HPV vaccination and underlying factors for vaccine hesitancy among mothers of unvaccinated boys in Seoul, Korea using a qualitative method. We used a purposive sampling strategy to recruit mothers of unvaccinated middle school-aged boys living in one of the 25 districts in Seoul, supplemented by a snowball sampling approach. We conducted one-on-one telephone …

A Narrative Review Of The Lesser Known Medications For Treatment Of Restless Legs Syndrome And Pathogenetic Implications For Their Use, Paul G Yeh, Karen Spruyt, Lourdes M Delrosso, Arthur S Walters

Faculty, Staff and Student Publications

BACKGROUND: There are several well-known treatments for Restless Legs Syndrome (RLS), including dopamine agonists (pramipexole, ropinirole, rotigotine), anticonvulsants (gabapentin and its analogs, pregabalin), oral or intravenous iron, opioids and benzodiazepines. However, in clinical practice, treatment is sometimes limited due to incomplete response or side effects and it is necessary to be aware of other treatment options for RLS, which is the purpose of this review.

METHODS: We performed a narrative review detailing all of the lesser known pharmacological treatment literature on RLS. The review purposefully excludes well-established, well-known treatments for RLS which are widely accepted as treatments for RLS in …

From The National To The Local: Issues Of Trust And A Model For Community-Academic-Engagement, Olufunmilayo Chinekezi, Lauri Andress, Etsemaye P Agonafer, Susan Massick, Sarah Piepenbrink, Karey M Sutton, Philip M Alberti, Desiree De La Torre, Shannon Guillot-Wright, Marshala Lee

Faculty, Staff and Student Publications

Inequities in health and health care in the United States have persisted for decades, and the impacts on equity from the COVID-19 pandemic were no exception. In addition to the disproportionate burden of the disease across various populations, the pandemic posed several challenges, which exacerbated these existing inequities. This has undoubtedly contributed to deeply rooted public mistrust in medical research and healthcare delivery, particularly among historically and structurally oppressed populations. In the summer of 2020, given the series of social injustices posed by the pandemic and highly publicized incidents of police brutality, notably the murder of George Floyd, the Association …

The Predictive Value Of Coronary Microvascular Dysfunction For Left Ventricular Reverse Remodelling In Dilated Cardiomyopathy, Ao Kan, Yinping Leng, Shuhao Li, Fang Lin, Qimin Fang, Xinwei Tao, Mengyao Hu, Lianggeng Gong

Faculty, Staff and Student Publications

AIMS: to evaluate the degree of coronary microvascular dysfunction (CMD) in dilated cardiomyopathy (DCM) patients by cardiac magnetic resonance (CMR) first-pass perfusion parameters and to examine the correlation between myocardial perfusion and left ventricle reverse remodelling (LVRR).

METHODS: In this study, 94 DCM patients and 35 healthy controls matched for age and sex were included. Myocardial perfusion parameters, including upslope, time to maximum signal intensity (Time

RESULTS: With a median follow-up period of 12 months [interquartile range (IQR), 8-13], 41 DCM patients (44%) achieved LVRR. Compared with healthy controls, DCM patients presented CMD with reduced upslope, SI

CONCLUSIONS: CMD could …

A Case Of Successful Treatment Of Recurrent Urinary Tract Infection By Extended-Spectrum Β-Lactamase Producing, Naomi Bier, Blake Hanson, Zhi-Dong Jiang, Herbert L Dupont, Cesar A Arias, William R Miller

Faculty, Staff and Student Publications

Recurrent urinary tract infections (UTIs) are a challenging clinical entity that can be frustrating for patient and physician alike. Repeated rounds of antibiotics can select for multidrug-resistant organisms, further complicating care. We describe the successful use of fecal microbiota transplantation (FMT) for the treatment of recurrent extended-spectrum β-lactamase (ESBL)-producing

Subendocardial And Transmural Myocardial Ischemia: Clinical Characteristics, Prevalence, And Outcomes With And Without Revascularization, K Lance Gould, Tung Nguyen, Richard Kirkeeide, Amanda E Roby, Linh Bui, Danai Kitkungvan, Monica B Patel, Mohammad Madjid, Mary Haynie, Dejian Lai, Ruosha Li, Jagat Narula, Nils P Johnson

Faculty, Staff and Student Publications

BACKGROUND: Subendocardial ischemia is commonly diagnosed but not quantified by imaging.

OBJECTIVES: This study sought to define size and severity of subendocardial and transmural stress perfusion deficits, clinical associations, and outcomes.

METHODS: Regional rest-stress perfusion in mL/min/g, coronary flow reserve, coronary flow capacity (CFC), relative stress flow, subendocardial stress-to-rest ratio and stress subendocardial-to-subepicardial ratio as percentage of left ventricle were measured by positron emission tomography (PET) with rubidium Rb 82 and dipyridamole stress in serial 6,331 diagnostic PETs with prospective 10-year follow-up for major adverse cardiac events with and without revascularization.

RESULTS: Of 6,331 diagnostic PETs, 1,316 (20.7%) had severely …

Corrigendum: Editorial: Period Poverty, Lea Sacca, Christine Margaret Markham, Jhumka Gupta, Melissa Peskin

Faculty, Staff and Student Publications

This corrects the article "Editorial: Period poverty" in volume 5, 1140981.

Quantifying The Implementation And Cost Of A Multisite Antibiotic Stewardship Intervention For Asymptomatic Bacteriuria, Eva Amenta, Larissa Grigoryan, Suja S Rajan, David Ramsey, Jennifer R Kramer, Annette Walder, Andrew Chou, John N Van, Sarah L Krein, Sylvia Hysong, Aanand D Naik, Barbara W Trautner

Faculty, Staff and Student Publications

OBJECTIVE: The intensity of an antibiotic stewardship intervention to achieve clinical impact is not known. We conducted a multisite dissemination project of an intervention to reduce treatment of asymptomatic bacteriuria (ASB) and studied: (1) the association between implementation metrics and clinical outcomes and (2) the cost of implementation.

DESIGN/SETTING/PARTICIPANTS: A central site facilitated a multimodality intervention to decrease unnecessary urine cultures and antibiotic treatment in patients with ASB at 4 Veterans Affairs medical centers.

METHODS: The intervention consisted of a decision support aid algorithm and interactive teaching cases that provided in the moment audit and feedback on how to manage …

Fostering A High-Functioning Team In Cancer Care Using The 4r Oncology Model: Assessment In A Large Health System And A Blueprint For Other Institutions, Raymond Liu, Christine B Weldon, Elizabeth Linehan, Nancy Gordon, Thea Abbe, Marti Hennings, Henie James, Jed Katzel, Chun Ng, Megumi Tomita, Jeffrey B Velotta, Stephanie Ossowski, Lori C Sakoda, Sharon Likely Sprague, Anna Dowling, Kimberly Beringer, Arliene Ravelo, Elaine Yu, Julia R Trosman

Faculty, Staff and Student Publications

PURPOSE: Delivering cancer care by high-functioning multidisciplinary teams promises to address care fragmentation, which threatens care quality, affects patient outcomes, and strains the oncology workforce. We assessed whether the 4R Oncology model for team-based interdependent care delivery and patient self-management affected team functioning in a large community-based health system.

METHODS: 4R was deployed at four locations in breast and lung cancers and assessed along four characteristics of high-functioning teams: recognition as a team internally and externally; commitment to an explicit shared goal; enablement of interdependent work to achieve the goal; and engagement in regular reflection to adapt objectives and processes. …

Cardiovascular Disease Risk Factors Among Middle-Aged And Older Adult Vietnamese American Members Of A Northern California Health Plan, Donna B Haysbert, Joan C Lo, Nirmala D Ramalingam, Nancy P Gordon

Faculty, Staff and Student Publications

OBJECTIVE: There is increasing recognition that cardiovascular disease (CVD) risk factors vary by Asian subgroups. We examined CVD risk factor prevalence among Vietnamese adults in a northern California health plan.

METHODS: We used electronic health record data to examine smoking, overweight/obesity (body mass index ≥23.0 kg/m

RESULTS: Current smoking prevalence was 20.3% for middle-aged men, 7.0% for older men, and

CONCLUSIONS: Study results suggest that more research on health conditions, lifestyle, and social factors among Vietnamese American adults is needed to develop culturally competent interventions to reduce CVD risk in this growing ethnic group.