Dr. Karishma S Chhabria

Background
Although the association between mental disorder and metabolic syndrome as a bidirectional relationship has been demonstrated, there is little knowledge of the cumulative and individual effect of these conditions on peripartum mental health. This study aims to investigate the association between metabolic syndrome conditions (MetS-C) and maternal mental illness in the perinatal period, while exploring time to incident mental disorder diagnosis in postpartum women.

Methods
This observational study identified perinatal women continuously enrolled 1 year prior to and 1 year post-delivery using Optum’s de-identified Clinformatics® Data Mart Database (CDM) from 2014 to 2019 with MetS-C i.e. obesity, diabetes, high blood pressure, high triglycerides, or low HDL (1-year prior to delivery); perinatal comorbidities (9-months prior to and 4-month postpartum); and mental disorder (1-year prior to and 1-year post-delivery). Additionally, demographics and the number of days until mental disorder diagnosis were evaluated in this cohort. The analysis included descriptive statistics and multivariable logistic regression. MetS-C, perinatal comorbidities, and mental disorder were assessed using the International Classification of Diseases, Ninth, and Tenth Revision diagnosis codes.

Results
372,895 deliveries met inclusion/exclusion criteria. The prevalence of MetS-C was 13.43%. Multivariable logistic regression revealed prenatal prevalence (1.64, CI = 1.59–1.70) and postpartum incident (1.30, CI = 1.25–1.34) diagnosis of mental health disorder were significantly higher in those with at least one MetS-C. Further, the adjusted odds of having postpartum incident mental illness were 1.51 times higher (CI = 1.39–1.66) in those with 2 MetS-C and 2.12 times higher (CI = 1.21–4.01) in those with 3 or more MetS-C. Young women (under the age of 18 years) were more likely to have an incident mental health diagnosis as opposed to other age groups. Lastly, time from hospital discharge to incident mental disorder diagnosis revealed an average of 157 days (SD = 103 days).

Conclusion
The risk of mental disorder (both prenatal and incident) has a significant association with MetS-C. An incremental relationship between incident mental illness diagnosis and the number of MetS-C, a significant association with younger mothers along with a relatively long period of diagnosis mental illness highlights the need for more screening and treatment during pregnancy and postpartum.

Background: Those diagnosed with Metabolic syndrome (MetS) in the general population have a high prevalence of mental illness. The conditions that make up the Metabolic syndrome (MetS-C) are a strong predictor of pregnancy-related complications and postnatal cardiovascular disease.

Objective: To investigate the association between the presence of Metabolic Syndrome conditions and maternal mental illness in the perinatal period using national administrative claims data from 2014-2019

The 2022-23 General Appropriations Act (GAA), House Bill (H.B.) 1, 87th Legislature, Regular Session, 2021 (Article IX, Section 10.06) authorizes the Cross-Agency Coordination on Healthcare Strategies and Measures project. This project, referred to as “The 5 Agencies Project,” requires state agencies that pay for the health care of Texans to coordinate data to identify outliers and improvements for efficiency and quality that can be implemented within each health care system.
This report summarizes actions taken since the initial report to the Legislative Budget Board (LBB) and Office of the Governor, submitted on September 1, 2020. It includes the activities and outcomes during the second year of the initial two-year project period (initial biennium: fiscal year 2020–2021), as well as the first year of the renewed project cycle (renewed biennium: fiscal year 2022–2023).

Background: Head and neck cancer (HNC) patients undergoing chemo/radiation (C/RT) commonly experience severe and persistent distress associated with treatment related fear and physical side effects such as xerostomia, dysphagia, and dryness of mouth. Cortisol, a stress sensitive hormone, can be easily measured in saliva to reflect biobehavioral responses to such stressors. Unfortunately, it has not been used in this population due to concerns associated with C/RT related xerostomia.

Methods: In a proof-of-concept study, we explored the feasibility of collecting salivary cortisol as a marker of fear and distress in HNC patients. Ten HNC subjects undergoing C/RT provided saliva samples for 3 consecutive days across three timepoints (pre-treatment, 3-weeks and 1-month post-treatment) and completed concurrent depression, anxiety and swallowing related fear measures.

Results: Salivary cortisol collection adherence was between 60-80%. It was not impacted by xerostomia. Diurnal cortisol pattern's demonstrated dysregulation at pretreatment in 62%, and flattened aberrant slopes continued at 3-weeks and beyond in 50% of subjects.

Conclusions: Our study supports the feasibility and utility of salivary cortisol measurement in HNC patients across the treatment trajectory. Diurnal cortisol measures may be a valuable tool to detect and monitor treatment distress during C/RT in this population.

This Assessment of Social Factors impacting Health Care Quality in Texas Medicaid deliverable fulfills one of the eight milestones included in the Delivery System Reform Incentive Payment (DSRIP) Transition Plan, which explains how the Texas Health and Human Services Commission (HHSC) will further develop delivery system reform efforts in Texas Medicaid without DSRIP funding. The objective of this milestone is to assess which social factors may be correlated with health outcomes for beneficiaries enrolled in Texas Medicaid as well as help inform possible new program proposals, policy changes, and strategies for quality improvement related to social determinants of health (SDOH).

Background
Fear is an under‐recognized issue in intervention adherence in head and neck cancer (HNC). We developed and validated a patient reported outcome for swallowing fear in HNC patients.
Methods
Items were adapted from the Tampa Scale for Kinesiophobia to swallowing function. A beta version was completed by 51 HNC patients undergoing chemo +/− radiotherapy at baseline and post‐treatment. Psychometric and factor structure analyses were applied.
Results
Swallowing Kinesiophobia Scale (SWKS) demonstrated strong face and content validity, internal consistency, and test‐retest reliability. Factor analysis revealed three‐factors: somatic factor, swallow avoidance, and fear of harm. Factors correlated positively with depression score, worry scale, and anxiety and pain scales. Score differences between patient subgroups (dysphagic vs nondysphagic) confirmed discriminative validity.
Conclusion
The SWKS is a psychometrically valid tool to identify patients with fear of swallowing and swallowing‐related movement. It can help identify patients early in treatment who may need additional support.

The 2020-21 General Appropriations Act, House Bill 1, 86th Legislature, Regular Session, 2019 (Article II, Health and Human Services Commission [HHSC], Rider 33) requires HHSC to evaluate variation in service delivery to individuals with serious mental illness (SMI) by managed care organization (MCO). Rider 33 also requires HHSC to identify performance measures to better hold MCOs accountable for outcomes and spending for individuals with SMI, evaluate the delivery of services, and develop recommendations to improve quality of care.
STAR+PLUS serves adults with disabilities and individuals who are 65 years or older. For the report, Medicaid STAR+PLUS members were evaluated. Dually enrolled members were not included because data was not available.
Claim-based performance metrics were evaluated to develop the report. The claimbased data, which include managed care encounter data, have several strengths including clinical validity, a representative population, and access. However, like any data set, there are limitations. The claims are based on the record of care received. Furthermore, the data provide no detail on the severity or longevity of the diagnosed condition, which may impact behavioral health (BH) outcomes. Readers should consider these limitations when drawing any conclusions from the findings.

Objective
Oropharyngeal squamous cell carcinoma (OPSCC) incidence is rapidly increasing, as are survival rates, in large part due to the human papillomavirus (HPV). Treatment intensity, however, has remained unchanged, making treatment‐related toxicity (i.e., dysphagia) a critical problem for an increasing number of patients. The primary objective of this study was to determine whether pretreatment objective swallowing measures can predict percutaneous fluoroscopic guided gastrostomy tube (PFG) utilization during OPSCC treatment.
Methods
Forty‐one newly diagnosed OPSCC patients treated with radiation underwent evaluation of swallow function with modified barium swallow study (MBSS) prior to and at completion of radiation treatment using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST); a subset of patients were evaluated using the MD Anderson Dysphagia Inventory (MDADI).
Results
Patients were male (100%), primarily Caucasian (85.4%) and p16 positive (85.4%) with mean age of 65.7 years. PFG were placed in 70.7% patients (n = 29) and used by 63.4% (n = 26). Pre‐ and post‐treatment DIGEST scores were associated with T‐classification (t = −2.9, p = .001, t = −2.7, p = .01) and indicated deteriorating swallow function during treatment (mean change = 0.46 [t = −2.7, p = .01]). DIGEST and MDADI scores were generally not associated with patient PFG utilization. DIGEST and MDADI scores were significantly correlated prior to, but not following completion of treatment.
Conclusion
Pre‐treatment DIGEST and patient reported swallowing outcomes (MDADI) can be useful in identifying patients with unsafe and/or grossly inefficient swallowing function. However, objectively measured swallow function was not associated with PFG utilization. Development of PFG placement algorithms (reactive vs. prophylactic) therefore require additional inputs/metrics.
Level of Evidence
4 Laryngoscope, 130:2153–2159, 2020

The Texas Health and Human Services Commission (HHSC) administers Medicaid health benefits to approximately 4.3 million individuals. Due to increasing interest regarding the impact of social determinants of health (SDOH) on Medicaid health outcomes, this study evaluated the presence of significant associations between a comprehensive set of SDOH variables and key health care quality measures for (1) the Texas Medicaid and Children’s Health Insurance Program (CHIP) population under age 19 in 2018 and (2) the Texas Medicaid pregnant women population in 2018. Additionally, this study estimated the degree (as a percentage) to which individual SDOH variables contributed to the collective SDOH impact by analyzing the statistically significant associations between individual SDOH variables and the performance outcomes of each quality measure per study population.