Publications

BACKGROUND: Climate-related disruptions to the health system may impact cancer outcomes. This may be particularly true for prostate cancer, which greatly contributes to cancer burden while existing on a risk spectrum, leading some men to delay treatment even in advanced cases.

METHODS: The study included men diagnosed with metastatic prostate cancer from 2010 to 2020 within SEER-supported counties that experienced a climate-related natural disaster from 2012 to 2018. A smaller subgroup of "major" disasters was classified based on individual assistance from FEMA. Year of natural disaster was considered the index date, with 2-year pre- and post-disaster periods compared. Age-standardized incidence-based metastatic prostate cancer mortality (IBM) rates were extracted from SEER and adjusted for demographics. Counties were then compared 147 SEER counties without any climate-related natural disaster.

RESULTS: There were 222 counties across 11 states experiencing a single disaster within the study period, covering an estimated 27,787,120 people. Compared to the index year, prostate cancer IBM was 15% higher (RR: 1.15, 95% CI 1.02-1.30) 1-year post-disaster and 28% higher (RR: 1.28, 95% CI 1.11-1.49) 2 years post-disaster. Associations were stronger among counties (n = 50) experiencing a "major" disaster (RR: 1.21, 95% CI: 1.05-1.40) and 35% (RR: 1.35, 95% CI: 1.17-1.55) at 1 and 2 years. In non-exposed counties, this pattern was absent.

CONCLUSIONS: We report a significant, dose-dependent change in mortality from metastatic prostate cancer following a climate-related natural disaster. The reasons are speculative but may include delayed diagnosis, care fragmentation, and interruptions for treatments for advanced disease including chemotherapy and radio-hormonal therapy.

INTRODUCTION: Online sales of e-cigarettes challenge the enforcement of state tobacco control (TC) policies. Using key informant (KI) interviews, we examined barriers and facilitators to implementing TC policies in the context of e-cigarettes sold online.

METHODS: From April 2023 to December 2024, we invited state representatives from all 50 states and the District of Columbia to participate in KI interviews. Guided by Bullock's (2021) policy implementation framework, we examined licensure, minimum legal sales age (MLSA), flavor bans, and taxation. Data were analyzed using team-based, iterative coding.

RESULTS: We conducted 74 semi-structured interviews with 90 KIs across 41 states, of which online sales emerged as a key theme in 41 interviews with 60 KIs across 34 states. KIs noted how online sales interacted with existing legal frameworks and enforcement methods, often creating challenges, including jurisdictional ambiguity over out-of-state or international sellers, limited capacity to monitor the emergence of new online sellers, statutory language not designed for digital commerce, supply chain ambiguity, and logistical difficulties in conducting online decoy buys. KIs noted several potential enforcement facilitators, including the Prevent All Cigarette Trafficking Act (e.g., monthly delivery sales reports), consumer complaint systems, internet surveillance, directories of products authorized for sale, and interstate coordination of data sharing. Some states pursued legal action against online retailers using consumer protection laws.

CONCLUSIONS: Online e-cigarette sales present a regulatory challenge for TC implementation, requiring policy adaptation, cross-jurisdictional coordination, enhanced monitoring, and research to guide effective regulation of the digital marketplace.

Chronic kidney disease (CKD) is a common non-communicable disease in children, and kidney dysfunction is the leading metabolic risk factor for death. Despite this, awareness of the CKD burden remains limited, and significant inequities exist in access to diagnosis and care worldwide. Kidney disease risk in children begins in utero and is dependent on the mother's health and wellbeing. This is further impacted each day by poverty, nutrition, education, infection, and safety. Greater community awareness is needed, especially in lower resource settings, where children present late and may have no access to care. Early diagnosis, possibly supported by screening at schools, can have important public and individual health consequences. Catastrophic health expenditure is common if families attempt to pay out of pocket for kidney replacement therapy. Health systems require strengthening from the antenatal clinic through tertiary care to ensure children with kidney disease are identified and treated early, appropriately, affordably, and well. Local non-governmental organizations have had some success in mitigating inequities. Governments must step up, measure, and acknowledge the burden of kidney disease in children, ensure appropriate public health measures to reduce risk, strengthen primary care to improve the quality of diagnosis and care, and progressively scale up equitable access to all forms of kidney care. Kidney disease risk is strongly linked with social and structural determinants of health. A holistic approach to supporting child wellbeing-outlined by the Sustainable Development Goals and a One Health Approach-will positively impact child kidney health and promote equity among all children.

Posttraumatic stress disorder (PTSD) is associated with accelerated biological aging. In general, psychological resilience is related to more normative aging patterns; however, among individuals with PTSD, resilience may be associated with older biological aging. For example, prior work suggests that individuals with PTSD who have higher psychological resilience show more advanced epigenetic aging than individuals with lower psychological resilience. We investigated whether psychological resilience moderated the relationship between PTSD and brain aging in a community sample of South African women. Individuals (N = 189) were recruited as part of the Drakenstein Child Health Study. Participants underwent a structural MRI and completed questionnaires of PTSD (modified-PTSD Symptom Scale, mPSS) and psychological resilience (Connor-Davidson Resilience Scale; CD-RISC). Using a pre-trained model, a predicted brain age gap was derived. Linear models tested a CD-RISC x Group (no trauma exposure (NTE), trauma-exposed [TE], and PTSD) interaction on brain age gap. Follow-up models probed regional brain age gap (e.g., subcortical, frontal, parietal). There was no main effect of Group on brain age gap. There was a significant CD-RISC x Group interaction, such that higher CD-RISC scores were associated with a positive brain age gap (reflecting an older appearing brain) only in women with suspected PTSD but not in NTE or TE individuals. Follow-up tests showed the CD-RISC x Group interaction was only significant in the subcortical region, suggesting the effect was driven by alterations in subcortical structures frequently implicated in PTSD. Future longitudinal work should examine whether psychological resilience moderates PTSD-related brain aging across time.

PURPOSE: Experts have called for systematic implementation of cognitive behavioral therapy (CBT)-based interventions for cancer pain; however, implementation of CBT for cancer pain has been extremely limited.

DESIGN: We explored nurses' perceptions of implementing a brief, evidence-based pain CBT protocol using a mixed-methods analysis.

METHODS: Registered nurses working within ambulatory oncology/infusion clinics were recruited. Survey items and interviews focused on familiarity and current use of pain self-management strategies and attitudes toward the CBT protocol. We used univariate descriptive statistics to analyze the survey and rapid qualitative analysis for interview data.

RESULTS: Ninety-nine nurses participated in the survey (46% response rate) and 13 nurses participated in the follow-up interviews. Most survey respondents (between 51% and 84%) were moderately/very familiar with nearly all pain self-management strategies mentioned. The three strategies that nurses described as using to a moderate/great extent were advising patients about lifestyle changes (54%), problem-solving (43%), and coping with difficult pain-related emotions (39%).

CONCLUSION: Respondents generally viewed an oncology nurse-led model of pain CBT as acceptable and appropriate. Future studies will need to provide support for a nurse/nurses dedicated to pain CBT and should evaluate the clinical effectiveness of that model while also testing practical strategies for training/supervision.

CLINICAL IMPLICATIONS: Oncology nurses are generally supportive of implementing a brief, evidence-based CBT protocol for cancer pain management. Despite some uncertainty about feasibility, positive attitudes highlight the potential for enhancing cancer pain care through nurse-led behavioral interventions.

BACKGROUND: Patients with Limited English Proficiency (LEP) face poorer surgical outcomes, yet language-access capacity varies by hospital.

OBJECTIVE: Compare 7-day readmission after common surgeries among adult patients with LEP at Language Serving Hospitals (LSH) and non-LSH, stratified by Spanish, Common Non-English, Non-Spanish (NENS) and Rare NENS Languages using the New Jersey State Inpatient Database.

RESULTS: 34,342 adult surgical patients were discharged from LSH with 2.5% readmitted compared to 5.0% of those from non-LSH. Patients from LSH who spoke Spanish, (aOR 0.46, 95% CI 0.40-0.54), Common NENS (aOR 0.49, 95% CI 0.31-0.79), and Rare NENS Languages (aOR 0.50, 95% CI 0.40-0.63) had reduced odds of readmission compared to those from non-LSH.

CONCLUSIONS: Surgical patients with LEP discharged from LSH had lower odds of readmission, suggesting LSH may be better equipped than non-LSH. Worse disparities for Common and Rare NENS Languages suggest the need to expand resources beyond Spanish.

INTRODUCTION: Cognition is a common symptom dimension in major mood disorders and is associated with impairments in daily life functioning. Assessments that capture cognitive difficulties reflective of those that people experience in the real world are therefore much needed; however, most cognitive assessments lack ecological validity. A recently developed, fully immersive VR platform for cognitive assessment (CAVIR) has proven to be feasible, well-tolerated, sensitive to cognitive impairment in psychiatric populations, and associated with measures of daily functioning. Here we aimed to assess the validity of a newly developed English language version of CAVIR in people with primary mood disorders (PMD) and controls (HC).

METHOD: We enrolled 40 people with PMD including Bipolar I Disorder, Bipolar II Disorder, and Major Depressive Disorder, and 40 healthy controls. Participants were administered the CAVIR, the MATRICS Consensus Cognitive Battery (MCCB), symptom ratings, and measures of daily functioning (FAST, UPSA-B).

RESULTS: Patients scored worse than controls on the CAVIR composite and all subtests (p = 0.02-p < 0.0001), except the executive functioning task (p = 0.85). Comparing the composite and domain scores of CAVIR to their corresponding domains on the MCCB revealed modest to moderate, significant correlations on the composite and all domains except executive functioning. The CAVIR was associated with both performance-based (UPSA-B) and interview rated (FAST) measures of functioning.

CONCLUSIONS: This newly translated English language version of CAVIR performed very similarly to the original version and was sensitive to cognitive impairments in people with PMD. CAVIR composite and most subtests were correlated with an established paper and pencil cognitive battery and were associated with measures of functioning. The CAVIR is self-administered, quick, and requires minimal training, making it a useful tool for assessing cognition.

Ancient DNA studies revealed that, in Europe from 6500 to 4000 BCE, descendants of western Anatolian farmers mixed with local hunter-gatherers resulting in 70-100% ancestry turnover1, then steppe ancestry spread with the Corded Ware complex 3000-2500 BCE2. Here we document an exception in the wetland, riverine and coastal areas of the Netherlands, Belgium and western Germany, using genome-wide data from 112 people 8500-1700 BCE. A distinctive population with high (approximately 50%) hunter-gatherer ancestry persisted 3,000 years later than in most European regions, reflecting incorporation of female individuals of Early European Farmer ancestry into local communities. In the western Netherlands, the arrival of the Corded Ware complex was also exceptional: lowland individuals from settlements adopting Corded Ware pottery had hardly any steppe ancestry, despite a Y-chromosome characteristic of people associated with the early Corded Ware complex. These distinctive patterns may reflect the specific ecology that they inhabited, which was not amenable to full adoption of the early Neolithic type of farming introduced with Linearbandkeramik3, and resulted in distinct communities where transfer of ideas was accompanied by little gene flow. This changed with the formation of Lower Rhine-Meuse Bell Beaker users by fusion of local people (13-18%) and Corded Ware associated migrants of both sexes. Their subsequent expansion then had a disruptive impact across a much wider part of northwestern Europe, especially in Great Britain where they were the main source of a 90-100% replacement of local Neolithic ancestry.

Methylation quantitative trait loci (mQTL) studies have predominantly focused on European populations (EUR), limiting understanding of the genetic regulation of DNA methylation in other populations. We conduct an East Asian (EAS) mQTL analysis, integrating data from three independent samples comprising 7619 Han Chinese individuals. We identified 331,048 mCpGs, including 28,978 novel mCpGs in EAS. While observing substantial sharing of mQTL between EUR and EAS, we also identify EAS-specific mQTLs, often driven by variants with low minor allele frequencies in EUR. We found that mQTLs enriched for disease and trait heritability, especially for matched-ancestry mQTLs, underscoring their utility for interpreting GWAS results and highlighting the role of DNA methylation in diseases. Our EAS mQTL resource provides valuable insights into the genetic architecture of DNA methylation and its contribution to complex traits.