Publications by authors named "Lena Saleh"

9 Publications

  • Page 1 of 1

Promoting Judicious Primary Care Referral of Patients with Chest Pain to Cardiology: A Quality Improvement Initiative.

Med Decis Making 2021 Mar 3:272989X21991445. Epub 2021 Mar 3.

Department of Pediatrics, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.

Objective: To decrease referrals to cardiology of patients ages 7 to 21 years with low-probability cardiac pathology who presented to primary care with chest pain by 50% within 24 months.

Study Design: A multidisciplinary team designed and implemented an initiative consisting of 1) a decision support tool (DST), 2) educational sessions, 3) routine feedback to improve use of referral criteria, and 4) patient family education. Four pediatric practices, comprising 34 pediatricians and 7 nurse practitioners, were included in this study. We tracked progress via statistical process control charts.

Results: A total of 421 patients ages 7 to 21 years presented with chest pain to their pediatrician. The utilization of the DST increased from baseline of 16% to 68%. Concurrently, the percentage of low-probability cardiology referrals in pediatric patients ages 7 to 21 years who presented with chest pain decreased from 17% to 5% after our interventions. At a median follow-up time of 0.9 years (interquartile range, 0.3-1.6 years), no patient had a life-threatening cardiac event.

Conclusion: Our health care improvement initiative to reduce low-probability cardiology referrals for children presenting to primary care practices with chest pain was feasible, effective, and safe.
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http://dx.doi.org/10.1177/0272989X21991445DOI Listing
March 2021

#Testathome: Implementing 2 Phases of a HIV Self-Testing Program Through Community-Based Organization Partnerships in New York City.

Sex Transm Dis 2020 May;47(5S Suppl 1):S48-S52

From the New York City Department of Health and Mental Hygiene, Bureau of HIV.

Background: Access to human immnodeficiency virus (HIV) testing in New York City (NYC) has increased, but disparities in testing rates still exist among most communities impacted by HIV. HIV self-tests (HIVSTs) present an opportunity to address testing barriers, but HIV-affected communities experience difficulties accessing HIVSTs, including lack of awareness and cost. To support increased access to HIVSTs, the NYC Health Department launched a partnership with select organizations to pilot distribution of free HIVSTs in 2 phases among priority populations across NYC.

Methods: Organizations that were diverse in their missions, experiences, capacities and populations served were recruited through a formal application process. The program initially launched with 10 organization partners (phase 1); as the pilot continued, partners identified necessary revisions to the program and launched a second phase in year 2. Both phases included outreach to NYC priority populations, HIVST distribution/redemption, and a follow-up survey.

Results: From March 2017 to August 2019, organizations distributed 75 HIVSTs during phase 1 and 252 during phase 2. All intended priority populations were reached, notably, those who had never tested before: 35% in phase 1 and 12% in phase 2. Over half of the follow-up survey respondents reported testing sooner. Respondents reported liking the HIVST because it did not require a visit to a clinic (84%) and preferred an HIVST to testing in a clinic (92%).

Conclusions: Through 2 phases of implementation, this innovative partnership was able to reach and offer HIVSTs to priority populations across NYC. This program supports the feasibility of distributing HIVSTs through close partnerships with diverse organizations.
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http://dx.doi.org/10.1097/OLQ.0000000000001151DOI Listing
May 2020

Spirituality and Multiple Dimensions of Religion Are Associated with Mental Health in Gay and Bisexual Men: Results From the Cohort.

Psycholog Relig Spiritual 2019 Nov 27;11(4):408-416. Epub 2017 Nov 27.

Center for HIV/AIDS Educational Studies and Training (CHEST).

The purpose of this study was to determine the association between religion, spirituality, and mental health among gay and bisexual men (GBM). A U.S. national sample of 1,071 GBM completed an online survey that measured demographic characteristics, religiosity, religious coping, spirituality, and four mental health constructs (i.e., depressive symptoms, rejection sensitivity, resilience, and social support). Hierarchal linear regressions determined the associations between each mental health construct, demographic variables, and the spirituality and religion variables. Controlling for demographic characteristics, spirituality was negatively associated with depression and rejection sensitivity, and positively associated with resilience and social support (all < .001). Religiosity was positively associated with rejection sensitivity ( < .05) and negatively associated with resilience ( < .01). Religious coping was positively associated with depression ( < .001) and rejection sensitivity ( < .05) and negatively associated with resilience ( < .05) and social support (p < .05). The interaction of spirituality with religion was significantly associated with all mental health variables. In general, religious GBM with higher levels of spirituality had better mental health outcomes. Spirituality was significantly positively associated with positive mental health outcomes and negatively associated with negative ones. Religion-solely expressed through behaviors and lacking the functional components of spirituality such as meaning-making and connection to the sacred-was associated with mental health problems among GBM. Public health interventions and clinical practice aimed at decreasing negative mental health outcomes among GBM may find it beneficial to integrate spirituality into their work.
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http://dx.doi.org/10.1037/rel0000146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892427PMC
November 2019

Pain control following tonsillectomy in children: A survey of patients.

Int J Pediatr Otorhinolaryngol 2017 Dec 7;103:76-79. Epub 2017 Oct 7.

Pediatric Otolaryngology, Advocate Children's Hospital, Park Ridge, IL, United States. Electronic address:

Objective: This prospective study aimed to survey pediatric patients and their parents after tonsillectomy to assess their pain management utilization and satisfaction.

Introduction: Tonsillectomy is the second most common surgical procedure performed in pediatric patients. Postoperative recovery is often associated with high levels of pain and severe functional limitations. There is currently no consensus on pain control regimens. Additionally, a recent FDA Black Box Warning on narcotic use has caused more uncertainty in appropriate pain control regimens.

Methods: 111 pediatric patients (≤18 years) included in this study underwent tonsillectomy with or without adenoidectomy between October 2013 and August 2015. Postoperatively, each patient/parent was counseled to alternate on an over-the-counter regimen of acetaminophen and ibuprofen and given an additional as-needed acetaminophen with hydrocodone prescription. A survey was administered during the patient's 2-week follow-up that included questions regarding pain levels, worst post-op pain day, pain medications taken during recovery, and patient/parental perceived satisfaction of having the acetaminophen with hydrocodone prescription.

Results: 84 patients/parents (75.7%) felt that OTC medications were not adequate for pain control and used hydrocodone at least once. Between those who took hydrocodone versus those who did not, there was no significant difference in mean age (6.7 ± 2.9 vs. 6.0 ± 2.4 years), percentage of patients with severe pain (36.9% vs. 22.2%) and worst post-op pain day (4.3 ± 1.5 vs. 3.9 ± 1.9 days) (p > 0.05). However, regardless of pain control regimen followed, the majority of patients/parents found it valuable to have the hydrocodone prescription (p = 0.004).

Conclusion: Post-tonsillectomy patients and their parents find being provided with an acetaminophen-hydrocodone prescription is therapeutically valuable, and many find it necessary in their postoperative pain management. However, further studies are needed to determine patient factors that influence narcotic utilization.
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http://dx.doi.org/10.1016/j.ijporl.2017.10.016DOI Listing
December 2017

Race, ethnicity, religious affiliation, and education are associated with gay and bisexual men's religious and spiritual participation and beliefs: Results from the One Thousand Strong cohort.

Cultur Divers Ethnic Minor Psychol 2017 Oct 2;23(4):468-476. Epub 2017 Mar 2.

Center for HIV/AIDS Educational Studies and Training (CHEST).

Objectives: This study examined the rates of spirituality, religiosity, religious coping, and religious service attendance in addition to the sociodemographic correlates of those factors in a U.S. national cohort of 1,071 racially and ethnically diverse HIV-negative gay and bisexual men.

Method: Descriptive statistics were used to assess levels of spirituality, religiosity, religious coping, and religious service attendance. Multivariable regressions were used to determine the associations between sociodemographic characteristics, religious affiliation, and race/ethnicity with four outcome variables: (1) spirituality, (2) religiosity, (3) religious coping, and (4) current religious service attendance.

Results: Overall, participants endorsed low levels of spirituality, religiosity, and religious coping, as well as current religious service attendance. Education, religious affiliation, and race/ethnicity were associated with differences in endorsement of spirituality and religious beliefs and behaviors among gay and bisexual men. Men without a 4-year college education had significantly higher levels of religiosity and religious coping as well as higher odds of attending religious services than those with a 4-year college education. Gay and bisexual men who endorsed being religiously affiliated had higher levels of spirituality, religiosity, and religious coping as well as higher odds of religious service attendance than those who endorsed being atheist/agnostic. White men had significantly lower levels of spirituality, religiosity, and religious coping compared to Black men. Latino men also endorsed using religious coping significantly less than Black men.

Conclusions: The implications of these findings for future research and psychological interventions with gay and bisexual men are discussed. (PsycINFO Database Record
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http://dx.doi.org/10.1037/cdp0000143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581734PMC
October 2017

Social support, psychological vulnerability, and HIV risk among African American men who have sex with men.

Psychol Health 2016 May 4;31(5):549-64. Epub 2016 Jan 4.

d School of Public Health , Brown University , Providence , RI , USA.

Previous research has suggested a need to understand the social-psychological factors contributing to HIV risk among African American men who have sex with men (MSM). We conducted individual in-depth interviews with 34 adult African American MSM to examine their personal experiences about: (i) sources of social support, (ii) psychological responses to the presence or absence of social support and (iii) influences of social support on sexual behaviours. The majority of participants described limited positive encouragement and lack of emotional support from family, as well as few meaningful personal relationships. Feelings of isolation and mistrust about personal relationships led many participants to avoid emotional intimacy and seek physical intimacy through sexual encounters. Findings highlight a need for multilevel interventions that enhance social support networks and address the social-psychological, emotional and interpersonal factors that contribute to HIV risk among African American MSM.
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http://dx.doi.org/10.1080/08870446.2015.1120301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905802PMC
May 2016

DNA methylation and expression of KCNQ3 in bipolar disorder.

Bipolar Disord 2015 Mar 11;17(2):150-9. Epub 2014 Jul 11.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.

Objectives: Accumulating evidence implicates the potassium voltage-gated channel, KQT-like subfamily, member 2 and 3 (KCNQ2 and KCNQ3) genes in the etiology of bipolar disorder (BPD). Reduced KCNQ2 or KCNQ3 gene expression might lead to a loss of inhibitory M-current and an increase in neuronal hyperexcitability in disease. The goal of the present study was to evaluate epigenetic and gene expression associations of the KCNQ2 and KCNQ3 genes with BPD.

Methods: DNA methylation and gene expression levels of alternative transcripts of KCNQ2 and KCNQ3 capable of binding the ankyrin G (ANK3) gene were evaluated using bisulfite pyrosequencing and the quantitative real-time polymerase chain reaction in the postmortem prefrontal cortex of subjects with BPD and matched controls from the McLean Hospital. Replication analyses of DNA methylation findings were performed using prefrontal cortical DNA obtained from the Stanley Medical Research Institute.

Results: Significantly lower expression was observed in KCNQ3, but not KCNQ2. DNA methylation analysis of CpGs within an alternative exonic region of KCNQ3 exon 11 demonstrated significantly lower methylation in BPD, and correlated significantly with KCNQ3 mRNA levels. Lower KCNQ3 exon 11 DNA methylation was observed in the Stanley Medical Research Institute replication cohort, although only after correcting for mood stabilizer status. Mood stabilizer treatment in rats resulted in a slight DNA methylation increase at the syntenic KCNQ3 exon 11 region, which subsequent analyses suggested could be the result of alterations in neuronal proportion.

Conclusion: The results of the present study suggest that epigenetic alterations in the KCNQ3 gene may be important in the etiopathogenesis of BPD and highlight the importance of controlling for medication and cellular composition-induced heterogeneity in psychiatric studies of the brain.
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http://dx.doi.org/10.1111/bdi.12230DOI Listing
March 2015

"We're going to have to cut loose some of our personal beliefs": barriers and opportunities in providing HIV prevention to African American men who have sex with men and women.

AIDS Educ Prev 2011 Dec;23(6):521-32

Department of Social Policy and Intervention, University of Oxford, England, UK.

In the United States, there is an urgent need to provide HIV prevention services to African American men who have sex with men and women (MSMW) but who do not identify as gay or homosexual. Engaging these men in HIV prevention has historically been challenging. This study used qualitative methodology to explore the beliefs and experiences from community-based service providers (n = 21) and from African American MSMW (n = 21) regarding the provision of HIV prevention education and counseling to these men. Data analysis revealed that (a) African American MSMW who do not identify as gay can challenge service providers' assumptions about sexual behavior and sexual identity; (b) service providers' attitudes toward these men can be affected by ambivalent or negative beliefs that pervade the general community; (c) African American MSMW need safe and nonjudgmental spaces that offer HIV risk reduction, but they also might experience anxiety about disclosing same-sex behaviors to counselors. Findings highlighted the complexities related to culture, masculinity, and sexuality as determinants of HIV risk in African American MSMW, and findings also revealed tensions between these factors that may affect the quality of HIV prevention services. Service providers may need additional training to provide appropriate and non-judgmental HIV prevention counseling and education.
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http://dx.doi.org/10.1521/aeap.2011.23.6.521DOI Listing
December 2011

Moving beyond "the down low": a critical analysis of terminology guiding HIV prevention efforts for African American men who have secretive sex with men.

Soc Sci Med 2009 Jan 9;68(2):390-5. Epub 2008 Nov 9.

University of Oxford, Barnett House, Oxford OX1 2ER, UK.

HIV continues to affect African American populations in the United States at disproportionate levels. Recent reports have described potentially high-risk behaviors of African American men who identify as heterosexual but who engage in secretive sex with other men. These men have been referred to as being "on the Down Low," and this terminology has been used to label subgroups of African American men and explain sexual risks for HIV infection in the African American community. In this paper, we argue that an uncritical use of this terminology for guiding public health and HIV prevention strategies can be problematic and counterproductive because it (a) stigmatizes and exoticizes secretive same-sex sexuality as a unique issue among African American men, and (b) ignores the social conditions under which HIV transmission occurs. We explore some historical roots contributing to current perspectives on African American men's sexuality, describe the use of the term "on the Down Low" and its application to same-sex behavior among African American men, and explain how this term can both clarify and potentially ambiguate efforts to address HIV risk among African American men. Recommendations for research and HIV prevention strategies are also provided.
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http://dx.doi.org/10.1016/j.socscimed.2008.09.052DOI Listing
January 2009