Behavioral Health and Aging

Increased cannabis use by pregnant women during pandemic: An analysis of more than 100,000 pregnancies in Northern California found the rate of cannabis use early in pregnancy rose from 6.8% to 8.1% after the start of the COVID-19 pandemic. The analysis was reported in JAMA by Kelly Young-Wolff, PhD, MPH, and Lyndsay Avalos, PhD, MPH. “It’s very possible that more pregnant women are using cannabis in an attempt to self-medicate [for stress] during the pandemic,” Young-Wolff said.
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Teen suicidal thoughts and behaviors varied during pandemic: The number of teens being seen at Kaiser Permanente Northern California emergency departments for suicidal thoughts and behaviors did not increase significantly during the first few months of the COVID-19 pandemic, according to research in JAMA Psychiatry led by Kathryn Erickson-Ridout, MD, PhD, and Esti Iturralde, PhD. However, Increases were seen for subsets of patients, such as teen girls.
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Problems for teens who stop taking ADHD medication at adulthood: Teens diagnosed with attention deficit hyperactivity disorder (ADHD) often don’t take their medication regularly, and Kaiser Permanente research indicates the problem gets worse when they approach adulthood. Adolescent psychiatrist Kavitha Rao, MD, worked with research scientist Cynthia Campbell, PhD, MPH, on an analysis published in the Journal of Adolescent Health that found adherence to filling prescriptions among ADHD patients dropped to 19% at age 19.
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Genetic clues for increased risk of age-related cataracts: An analysis led by Hélène Choquet, PhD, and published in Nature Communications identified new locations on the human genome that were associated with the risk of age-related cataracts, including a finding specific to women, who get cataracts more often. A better understanding of the genetic underpinnings of cataracts can lead to the development of tests to identify individuals at greater risk so they can get earlier treatment, Choquet said.
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Biostatistics Core

Air pollution increases risk of death from heart disease and stroke: A meta-analysis of results reported in 69 papers found long-term exposure to fine particulate matter (PM2.5) pollutants increased the risk of death from coronary artery disease by 23% and from stroke by 24%. The study led by Stacey Alexeeff, PhD, is the first to quantify and compare the effects of long-term exposure to these pollutants on risks for these heart problems. The study was published in the Journal of the American Heart Association.
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$5.6 million awarded to Kaiser Permanente researcher to study treatments for type 2 diabetes: A research team co-led by Romain S. Neugebauer, PhD, received a $5.6 million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to study the benefits — and potential harms — on heart health of medications used to treat type 2 diabetes. Said Neugebauer, “We are very excited to . . . generate solid evidence that patients and providers can use to help reduce their risks of cardiovascular and other diabetes-associated complications.”
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Cancer

Spinal fractures tied to bone metastases: A study published in JAMA Network Open highlighted why researchers who follow breast cancer survivors over time should differentiate between fracture types. “As we began to study fracture outcomes in this group it became clear we needed to separate fractures which were pathologic — meaning caused by the cancer — and fractures which were likely related to bone fragility,” said the study’s lead author Joan C. Lo, MD.
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Assessing prognosis for metastatic colorectal cancer: Research published in the Journal of Clinical Oncology found an association between p53 mutations and survival based on the anatomical location of the tumor. “We had expected gain-of-function mutations to be associated with worse survival,” said lead author Minggui Pan, MD, PhD, “but that wasn’t the case with right-sided colorectal cancers.” If the results are confirmed, the findings could aid researchers assessing treatments in clinical trials and help physicians treat patients with colorectal cancer.
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Racial disparities in breast cancer therapy use: Women who identified as American Indian or Alaska Native were less likely than women of other racial and ethnic groups to start hormone therapy for breast cancer after surgery and stay on the treatment for the recommended 5 years. “The disparities we found indicate that further research is needed on modifiable factors that contribute to adherence that might differ by race and ethnicity,” said senior author Laurel Habel, PhD. The study was published in Cancer.
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Studying colorectal cancer screening: Theodore R. Levin, MD, is co-leading a team of researchers from the DOR and Dartmouth that will compare the risks and benefits of an annual fecal immunochemical test (FIT) to colonoscopy for colorectal cancer screening in adults over 70 who have previously been diagnosed with small, low-risk polyps. The study was made possible through a $32.7 million funding award from the Patient-Centered Outcomes Research Institute. “We hope to understand whether older people with small, low-risk polyps can safely opt to use the non-invasive FIT for surveillance,” said Levin.
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Beyond body mass index: Bette Caan, DrPH, and Elizabeth Cespedes Feliciano, ScD, SM,  published a study in the American Journal of Clinical Nutrition on the association between abdominal adipose tissue radiodensity and survival after colorectal cancer. Caan’s research was also featured in a Scientific American documentary. “There was such a belief that it was weight gain that was important in overall cancer survival,” Caan explained. “But now. . . we have learned that overweight or mild obesity is associated with an improved outcome or no worse outcome than people who are in the so-called normal range.”
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Cardiovascular and Metabolic Conditions

New insights on worsening heart failure: A study led by Andrew P. Ambrosy, MD, that used artificial intelligence and natural language processing to scan electronic medical records found the number of patients in the hospital with worsening heart failure was 2 times higher than what was observed relying only on primary discharge diagnoses. This research creates an opportunity to identify these high-risk patients more accurately. The study was published in JAMA Network Open. 
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Removing race from kidney function equations: A study published in the New England Journal of Medicine contributed to efforts to address possible race discrimination in medicine. “Our research showed that if you use a blood cystatin C test, instead of a blood creatinine test, you don’t need to include race to get a similarly accurate estimate of kidney function,” said co-senior author, Alan S. Go, MD, and co-lead author Chi-yuan Hsu, MD, MSc, a DOR adjunct investigator.
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Emergency care for heart attacks and strokes rebounds: The significant declines in heart attack hospitalizations and emergency care for possible strokes seen in Northern California at the beginning of the COVID-19 pandemic were not seen in subsequent surges, researchers reported in JAMA. The research team, which included lead author Matthew D. Solomon, MD, PhD, and co-author Mai N. Nguyen-Huynh, MD, said the findings suggested efforts to reassure patients that it was important to leave their homes and seek emergency care, if needed, were successful.
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Racial disparities in stroke: Research published in Hypertension that used data collected in the Coronary Artery Risk Development in Young Adults (CARDIA) study found that the stroke rate was 4 times higher in Black young and middle-aged adults, compared to whites. “This study confirms that it’s not only whether you have high blood pressure but how long you have had high blood pressure and how long the damage to the blood vessels has been occurring that matters,” said senior author Stephen Sidney, MD, MPH.
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Gestational diabetes is marker for heart disease risk: Research scientist Erica P. Gunderson, PhD, MS, MPH, led a study that found women with a history of gestational diabetes are at increased risk for heart vessel calcification, a marker of increased risk for heart disease, throughout their childbearing years and into mid-life, even if they currently have normal blood sugar levels. The study was published in Circulation.
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Clinical Trials

COVID-19 vaccine trial for children: The Vaccine Study Center, led by Nicola Klein, MD, PhD, headed Kaiser Permanente Northern California’s participation in the Pfizer/BioNTech’s COVID-19 vaccination trials for children aged 5 to 11, enrolling children at 3 medical centers. “Children and adolescents may benefit from having protection from COVID-19 so they can return to school, sports, and other activities safely,” said Klein.
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Early remdesivir to prevent progression to severe COVID-19 in outpatients: In a study in NEJM, co-author Jacek Skarbinski, MD, and colleagues, with support from the KPNC Clinical Trials Program, showed that remdesivir improved outcomes for patients hospitalized with COVID-19. “These data add yet another option to the armamentarium for the treatment of vulnerable patients who are at high risk for progression to severe COVID-19,” wrote the authors.
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GUARD-AF and atrial fibrillation screening efforts: The ReducinG stroke by screening for UndiAgnosed atRial fibrillation in elderly inDividuals (GUARD AF) study aims to determine if earlier detection of atrial fibrillation through one-time screening in previously undiagnosed men and women at least 70 years of age in the U.S. ultimately impacts the rate of stroke, compared to usual standard medical care. The importance of this study, which Alan Go, MD helps lead and recruit for through the Division of Research, was the subject of an NIH workshop report coauthored by Go in the Journal of the American Heart Association.
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No serious health effects linked to mRNA COVID-19 vaccines: The Vaccine Study Center, led by Nicola Klein, MD, PhD, reported in JAMA that no serious health effects could be linked to the COVID-19 vaccines through June 2021. Klein called the initial results of the Vaccine Safety Datalink rapid cycle analysis “reassuring.” “The world is relying on safe and effective vaccines to bring an end to the COVID-19 pandemic,” she added. “The Vaccine Safety Datalink is ideally suited to carry out this important surveillance and we will continue to monitor the safety of all vaccines that protect against COVID-19.”
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Delivery Science

Patient-reported outcomes in head and neck cancer: Patient-reported outcome surveys that are integrated into an electronic medical record can help oncology care teams quickly address the treatment-related symptoms and side effects head and neck cancer patients experience. “Prompt symptom management can improve a patient’s short- and long-term quality of life,” said the study’s senior author Jed A. Katzel, MD. “It can also reduce hospitalization and emergency room visits during cancer treatment.” The study was published in JCO Clinical Cancer Informatics.
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Artificial intelligence can help improve care for people with heart disease: Teaching computers how to read written notes in medical reports could make it easier for doctors and health systems to track and manage patients with aortic stenosis and other chronic heart conditions. The study, published in Cardiovascular Digital Health Journal, showed that a computer taught to intelligently recognize certain abbreviations, words, and phrases was able to identify nearly 54,000 patients with aortic stenosis. The study was led by Matthew Solomon, MD, PhD, and Alan Go, MD.
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COVID toes were likely not caused by COVID-19, in most cases: In the midst of the pandemic, an unusual number of patients began reporting the red, itchy toes that are the hallmark of chilblains. Many initially assumed it was a symptom of COVID-19. But research led by Patrick McCleskey, MD, suggested the increase in chilblains was more likely related to behavior changes that occurred during the pandemic — not the coronavirus. “The media attention to ‘covid toes,’ along with general anxiety about COVID, likely led more people to contact their doctor,” said the study’s senior author, Lisa Herrinton, PhD. The study was published in JAMA Dermatology.
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Blood clot risk low in non-hospitalized COVID-19 patients: COVID-19 patients who are not hospitalized are at low risk of developing blood clots and should not routinely be prescribed blood thinners, a JAMA Internal Medicine research letter suggested. “It was recognized within the first months of the pandemic that patients with COVID-19 were having more blood clots in the hospital and in the intensive care unit than other patients who were similarly ill,” said Nareg Roubinian, MD, an adjunct investigator and the study’s first author.
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Personalized care for patients with chest pain: Research led by Dustin G. Mark, MD, and Mary E. Reed, DrPh, showed that a KPNC-developed risk-assessment tool provided doctors with a more accurate way to assess how likely it is a patient who comes to the emergency department with chest pain will have or die from a heart attack, stroke, cardiac arrest, or other major heart-related problem within the next 60 days. The study was published in the Journal of the American Heart Association.
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Mental health treatment rate rose early in pandemic: A detailed analysis of mental health treatment trends during the COVID-19 pandemic published in in The Journal of Clinical Psychiatry found a 7% increase in visits during the initial shelter-in-place period in 2020, compared with the same 3-month period in 2019. “The increases we found in patients seeking care for substance use and anxiety are consistent with other data showing the pandemic and shelter-in-place orders were difficult for many people,” said lead author Kathryn Erickson-Ridout, MD, PhD, who co-authored the analysis with Esti Iturralde, PhD, and colleagues.
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Health Care Delivery and Policy

Similar follow-up after telemedicine and office visits: Patients who made appointments to see their primary care doctors by video or phone did not seek substantially more follow-up care than those who had traditional in-person visits, found research led by Mary Reed, DrPH, and published in JAMA Network Open. The results suggested virtual visits can address a person’s concern comparably to in-person care.
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Predictive model, case management reduced readmissions: A predictive model identifying hospital patients at risk of a readmission developed by Gabriel Escobar, MD, was paired with a case management team of registered nurses and social workers in the Transitions program. An analysis published in BMJ found Transitions reduced readmissions without increasing mortality.
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New tool for early identification of COVID-19 surges: Vincent Liu, MD, MS, and DOR’s Systems Research Initiative team developed a predictive model using data from routine clinical care that could identify the onset of upcoming COVID-19 surges as many as 6 weeks before they occur. Using 10 clinical indicators, the COVID-19 HotSpotting Score (CHOTS) significantly increased the lead time to spotting a surge. Their work was published in BMJ Open.
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Continuous glucose monitors for type 2 diabetes: A study led by Andrew J. Karter, PhD, found that in patients with insulin-treated type 2 diabetes prescribed a continuous glucose monitor by their doctor, the monitor’s use was associated with better blood sugar control and fewer visits to the emergency room for hypoglycemia. The study was published in JAMA.
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Pandemic increased mail order pharmacy use: Research published in Diabetes Care found that mail order pharmacy use increased during the COVID-19 pandemic among adults with type 2 diabetes, but use continued to differ by race and ethnicity. Before the pandemic started in March 2020, 8.4% of the study participants had a prescription filled through the mail order pharmacy, reported lead author Tainayah Thomas, PhD, and senior author Julie Schmittdiel, PhD. By September 2020, the number rose to 31.8%.
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Regionalized care for stomach cancer: Research published in the Journal of Clinical Oncology showed that a regionalized, virtual gastric cancer program improved outcomes for stomach cancer patients by making it faster and easier for KPNC oncologists to introduce leading-edge cancer treatments. “The regionalized gastric cancer program combines the benefits of community-based care, which is local and convenient, with the expertise of a specialized cancer center,” said co-author Lisa Herrinton, PhD.
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Infectious Diseases

HIV prevention treatment showed gaps: A large, detailed look at patients taking HIV-prevention drug therapy found strong adherence soon after patients got the prescription but less consistent use thereafter, particularly among groups considered high priority for receiving the medication. The study, led by research fellow Carlo Hojilla, RN, PhD with co-author Michael Silverberg, PhD, MPH, was published in JAMA Network Open.
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Kaiser Permanente data key to nation’s COVID-19 vaccine surveillance strategy: The Vaccine Study Center, led by Nicola Klein, MD, PhD, became a key part of the nation’s surveillance strategy for the COVID-19 vaccines when chosen by the CDC to carry out a rapid cycle analysis tracking serious reactions among patients of the Vaccine Safety Datalink. “The Vaccine Safety Datalink is the premier system in the United States, and arguably in the world, for active, real-time safety surveillance of vaccines,” Klein said.
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Higher risk of dementia for older adults living with HIV: A study using patient data across 3 Kaiser Permanente regions found nearly double the rate of dementia among people with HIV compared with those without HIV, in research led by Jennifer Lam, PhD, with co-authors Catherine Lee, PhD, Paola Gilsanz, ScD, Derek Satre, PhD, and Michael Silverberg, PhD, MPH, and published in the journal AIDS. The patients were all on antiretroviral therapy and their dementia was assumed not to be related to HIV.
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People with HIV at increased risk of heart failure: A large study of people with HIV who were members of 3 Kaiser Permanente regions from 2000 to 2016 found they were more likely to have heart failure than a comparison group of similar people without HIV. The study was published in Mayo Clinic Proceedings and led by Michael Silverberg, PhD, MPH, and Alan Go, MD. “With this study, we now see the cardiovascular impacts for people with HIV extend to end-stage conditions such as heart failure,” Silverberg said.
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Women's and Children's Health

Healthy lifestyle linked to lower risk of preterm birth: A combination of 3 healthy lifestyle factors is associated with 70% lower risk of preterm birth, according to an analysis of data from nearly 2,500 pregnant women by Yeyi Zhu, PhD and Assia Ferrara, MD, PhD, published in The American Journal of Clinical Nutrition.. Women whose weight, diet, and stress were in healthy ranges had lower risk of preterm birth than women who did not have those factors in healthy ranges.
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Kaiser Permanente researchers study pandemic pregnancies: Women’s and children’s health section investigators began publishing studies using data from a unique survey of pregnant members of Kaiser Permanente Northern California about their experiences living through a pandemic while pregnant. The survey was developed by co-principal investigators Lisa Croen, PhD, and Assiamira Ferrara, MD, PhD. Jennifer Ames, PhD, and Croen published in PLOS One, finding higher prevalence of COVID-19 infections among younger pregnant women and those living in neighborhoods with greater economic deprivation.
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No link between autism and common antidepressant when used in pregnancy: A study by Jennifer Ames, PhD, and Lisa Croen, PhD, published in the journal Biological Psychiatry, confirmed previous research that suggested SSRI antidepressants used before and during pregnancy are not associated with increased risk of autism and other neurodevelopmental disorders in children. The analysis offered new insights by including a large and demographically diverse group of mothers and children and looking at specific subgroups of children.
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Pregnant women using cannabis live closer to retailers: Pregnant women who lived near recreational cannabis retailers in California were more likely to use cannabis early in their pregnancies, found research led by Kelly Young-Wolff, PhD, MPH, and published in JAMA Network Open. “What’s important is that we provide universal health education about the potential risks of prenatal cannabis use and empower women to make informed decisions about cannabis use during pregnancy,” Young-Wolff said.
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Longtime women’s health study SWAN tackles the challenges of aging: Monique Hedderson, PhD, became the third DOR investigator to lead the local site of the Study of Women’s Health Across the Nation (SWAN), planning a focus on hormonal changes and symptoms during the menopause transition. SWAN follows a cohort of about 2,500 women of diverse racial and ethnic backgrounds to study their health over time. DOR has managed a study site for 27 years, ever since Emeritus Research Scientist Barbara Sternfeld, PhD, led the local effort with a focus on physical activity. Laurel Habel, PhD, later took over, focusing on breast cancer risk factors.
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