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Article ; Online: Characteristics of Population Health Physicians and the Needs of Healthcare Organizations.

Stahlhut, Richard W / Porterfield, Deborah S / Grande, Donna R / Balan, Anita

2021 Volume 60, Issue 2, Page(s) 198–204

Abstract: Introduction: Healthcare organizations are transitioning from fee-for-service, volume-based care toward value-based care and the Triple Aim. Physicians have critical roles as leaders and practitioners in this emerging field of population health ... ...

Abstract	Introduction: Healthcare organizations are transitioning from fee-for-service, volume-based care toward value-based care and the Triple Aim. Physicians have critical roles as leaders and practitioners in this emerging field of population health management; however, the competencies required of these physicians are not well described. The purpose of this study is to explore the approaches of healthcare systems to population health-related functions, the competencies needed, and the characteristics of physicians who lead or staff these functions. Methods: Investigators conducted semistructured interviews with a convenience sample of 14 healthcare executives and 15 Preventive Medicine physicians and a focus group with 9 healthcare executives. Interviews and the focus group were recorded, transcribed, and coded. Themes and notable quotes were identified. Data were collected and analyzed in 2019. Results: Population health was variously defined by the healthcare executives, often naming specific components or activities. The typical population health activities described by healthcare executives (e.g., quality measurement and process improvement) were reported along with the skills of physicians performing these functions (e.g., data analysis, informatics, leadership, business acumen). A total of 2 types of population health physicians were described: the clinician leader and the population health specialist. Conclusions: This exploratory study identified several useful competencies for population health physicians in healthcare systems. Findings point to opportunities to promote a more systematic approach to population health and to prepare Preventive Medicine and other physicians for population health management positions.
MeSH term(s)	Delivery of Health Care ; Humans ; Leadership ; Physicians ; Population Health
Language	English
Publishing date	2021-01-05
Publishing country	Netherlands
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2020.06.016
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Article ; Online: Food allergy, breastfeeding, and introduction of complementary foods in the New York Old Order Mennonite Community.

Phillips, Jonathan T / Stahlhut, Richard W / Looney, Richard J / Järvinen, Kirsi M

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology

2020 Volume 124, Issue 3, Page(s) 292–294.e2

MeSH term(s)	Allergens/immunology ; Breast Feeding/adverse effects ; Female ; Food Hypersensitivity/epidemiology ; Food Hypersensitivity/etiology ; Humans ; Infant ; Infant Food/adverse effects ; Infant, Newborn ; Male ; New York/epidemiology ; Prevalence ; Public Health Surveillance ; Self Report
Chemical Substances	Allergens
Language	English
Publishing date	2020-01-08
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1228189-x
ISSN	1534-4436 ; 0003-4738 ; 1081-1206
ISSN (online)	1534-4436
ISSN	0003-4738 ; 1081-1206
DOI	10.1016/j.anai.2019.12.019
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Article ; Online: Experimental BPA Exposure and Glucose-Stimulated Insulin Response in Adult Men and Women.

Stahlhut, Richard W / Myers, John Peterson / Taylor, Julia A / Nadal, Angel / Dyer, Jonathan A / Vom Saal, Frederick S

Journal of the Endocrine Society

2018 Volume 2, Issue 10, Page(s) 1173–1187

Abstract: Context: Human cross-sectional and animal studies have shown an association of the chemical bisphenol A (BPA) with insulin resistance, type 2 diabetes, and other metabolic diseases, but no human experimental study has investigated whether BPA alters ... ...

Abstract	Context: Human cross-sectional and animal studies have shown an association of the chemical bisphenol A (BPA) with insulin resistance, type 2 diabetes, and other metabolic diseases, but no human experimental study has investigated whether BPA alters insulin/C-peptide secretion. Design: Men and postmenopausal women (without diabetes) were orally administered either the vehicle or a BPA dose of 50 µg/kg body weight, which has been predicted by US regulators (Food and Drug Administration, Environmental Protection Agency) to be the maximum, safe daily oral BPA dose over the lifetime. Insulin response was assessed in two cross-over experiments using an oral glucose tolerance test (OGTT; experiment 1) and a hyperglycemic (HG) clamp (experiment 2). Main outcomes were the percentage change of BPA session measures relative to those of the control session. Results: Serum bioactive BPA after experimental exposure was at levels detected in human biomonitoring studies. In the OGTT, a strong positive correlation was found between hemoglobin A1c(HbA1c) and the percentage change in the insulinogenic index (Spearman = 0.92), an indicator of early-phase insulin response, and the equivalent C-peptide index (Pearson = 0.97). In the HG clamp study, focusing on the later-phase insulin response to a stable level of glucose, several measures of insulin and C-peptide appeared suppressed during the BPA session relative to the control session; the change in insulin maximum concentration (Cmax) was negatively correlated with HbA1c and the Cmax of bioactive serum BPA. Conclusions: This exploratory study suggests that BPA exposure to a dose considered safe by US regulators may alter glucose-stimulated insulin response in humans.
Language	English
Publishing date	2018-09-12
Publishing country	United States
Document type	Journal Article
ISSN	2472-1972
ISSN (online)	2472-1972
DOI	10.1210/js.2018-00151
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Article ; Online: Fetal bisphenol A and ethinylestradiol exposure alters male rat urogenital tract morphology at birth: Confirmation of prior low-dose findings in CLARITY-BPA.

Uchtmann, Kristen S / Taylor, Julia A / Timms, Barry G / Stahlhut, Richard W / Ricke, Emily A / Ellersieck, Mark R / Vom Saal, Frederick S / Ricke, William A

Reproductive toxicology (Elmsford, N.Y.)

2019 Volume 91, Page(s) 131–141

Abstract: Bisphenol A (BPA) is a contaminant in virtually all Americans. To examine BPA's adverse effects, the FDA-NCTR, NIEHS, and 14 groups of academic scientists formed a consortium: CLARITY-BPA. The purpose of our study was to investigate the effects of a wide ...

Abstract	Bisphenol A (BPA) is a contaminant in virtually all Americans. To examine BPA's adverse effects, the FDA-NCTR, NIEHS, and 14 groups of academic scientists formed a consortium: CLARITY-BPA. The purpose of our study was to investigate the effects of a wide range of doses of BPA on fetal development of the NCTR CD-SD male rat urogenital sinus (UGS). Pregnant rats were administered BPA or positive control ethinylestradiol (EE2) daily, via oral gavage, from gestational day 6 through parturition. Tissues were collected on postnatal day 1 and the UGS was analyzed using computer-assisted 3-D reconstruction. Importantly, only low doses of BPA, as well as EE2, significantly changed birth weight and UGS morphology, including an increased size of the colliculus and decreased size of the urethra, consistent with prior reported BPA and EE2 effects. Our findings provide further evidence that BPA mediates nonmonotonic developmental effects on the fetal urogenital sinus.
MeSH term(s)	Animals ; Benzhydryl Compounds/toxicity ; Endocrine Disruptors/toxicity ; Estrogens/toxicity ; Ethinyl Estradiol/toxicity ; Female ; Fetal Development/drug effects ; Fetus ; Humans ; Male ; Maternal-Fetal Exchange ; Phenols/toxicity ; Pregnancy ; Rats, Sprague-Dawley ; Urogenital Abnormalities/chemically induced
Chemical Substances	Benzhydryl Compounds ; Endocrine Disruptors ; Estrogens ; Phenols ; Ethinyl Estradiol (423D2T571U) ; bisphenol A (MLT3645I99)
Language	English
Publishing date	2019-11-19
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	639342-1
ISSN	1873-1708 ; 0890-6238
ISSN (online)	1873-1708
ISSN	0890-6238
DOI	10.1016/j.reprotox.2019.11.007
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Article ; Online: Reproductive parameters in young men living in Rochester, New York.

Mendiola, Jaime / Jørgensen, Niels / Andersson, Anna-Maria / Stahlhut, Richard W / Liu, Fan / Swan, Shanna H

Fertility and sterility

2014 Volume 101, Issue 4, Page(s) 1064–1071

Abstract: Objective: To describe semen quality and reproductive hormone concentrations of young men living in Rochester, New York, and to compare these with published data from similar European and Japanese populations.: Design: Cross-sectional study.: ... ...

Abstract	Objective: To describe semen quality and reproductive hormone concentrations of young men living in Rochester, New York, and to compare these with published data from similar European and Japanese populations. Design: Cross-sectional study. Setting: University and college campuses in the Rochester, New York, area. Patient(s): Unselected young college students (n = 222). Intervention(s): A physical examination, blood and semen samples, and completion of a brief questionnaire. Main outcome measure(s): Semen parameters and serum reproductive hormone levels. Result(s): Subjects were aged 18-22 years (median age, 19.5 years), predominantly Caucasian (81%), and nonsmokers (79%), with a mean (SD) body mass index of 25.5 (4.2) kg/m(2). Overall, median sperm concentration was 52 × 10(6)/mL (5th-95th percentiles: 7-181 × 10(6)/mL), median total sperm count was 158 × 10(6) (14-587 × 10(6)), and 23.1% and 15.8% of men had a sperm concentration below 20 × 10(6)/mL and 15 × 10(6)/mL, respectively. Few men had serum hormones falling outside clinically normal ranges. Median sperm concentrations and reproductive hormone levels were comparable to those seen in young men in Denmark, Finland, and Japan. Conclusion(s): Our study provides the first data in 70 years on semen quality and reproductive hormones in young men in the United States with unknown fertility. These data suggest that, overall, reproductive parameters in our study population of young college students from the northeastern United States are similar to those of young European and Japanese men.
MeSH term(s)	Adolescent ; Denmark/epidemiology ; Finland/epidemiology ; Gonadal Steroid Hormones/blood ; Humans ; Japan/epidemiology ; Male ; Men's Health/standards ; Men's Health/statistics & numerical data ; New York/epidemiology ; Reference Values ; Reproducibility of Results ; Reproduction/physiology ; Semen Analysis/statistics & numerical data ; Sensitivity and Specificity ; Students/statistics & numerical data ; Urban Population/statistics & numerical data ; Young Adult
Chemical Substances	Gonadal Steroid Hormones
Language	English
Publishing date	2014-04
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80133-1
ISSN	1556-5653 ; 0015-0282
ISSN (online)	1556-5653
ISSN	0015-0282
DOI	10.1016/j.fertnstert.2014.01.007
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Article ; Online: Bisphenol A data in NHANES suggest longer than expected half-life, substantial nonfood exposure, or both.

Stahlhut, Richard W / Welshons, Wade V / Swan, Shanna H

Environmental health perspectives

2009 Volume 117, Issue 5, Page(s) 784–789

Abstract: Background: It is commonly stated in the literature on human exposure to bisphenol A (BPA) that food is the predominant BPA exposure source, and that BPA is rapidly and completely cleared from the body. If this is correct, BPA levels in fasting ... ...

Abstract	Background: It is commonly stated in the literature on human exposure to bisphenol A (BPA) that food is the predominant BPA exposure source, and that BPA is rapidly and completely cleared from the body. If this is correct, BPA levels in fasting individuals should decrease with increased fasting time. Objectives: We set out to investigate the relationship between urine BPA concentration and fasting time in a population-based sample. Methods: We modeled log BPA urine concentration as a function of fasting time, adjusted for urine creatinine and other confounders, in 1,469 adult participants in the 2003-2004 National Health and Nutrition Examination Survey. We estimated the BPA "population-based half-life" (pop(1/2)) for a fasting time of 0-24 hr, < 4.5 hr, 4.5-8.5 hr, and > 8.5 hr. Results: The overall pop(1/2) for the 0- to 24-hr interval was 43 hr [95% confidence interval (CI), 26-119 hr]. Among those reporting fasting times of 4.5-8.5 hr (n = 441), BPA declined significantly with fasting time, with a pop(1/2) of 4.1 hr (95% CI, 2.6-10.6 hr). However, within the fasting time intervals of 0-4.5 hr (n = 129) and 8.5-24 hr (n = 899), we saw no appreciable decline. Fasting time did not significantly predict highest (> 12 ng/mL) or lowest (below limit of detection) BPA levels. Conclusions: Overall, BPA levels did not decline rapidly with fasting time in this sample. This suggests substantial nonfood exposure, accumulation in body tissues such as fat, or both. Explaining these findings may require experimental pharmacokinetic studies of chronic BPA exposure, further examination of BPA levels and effects in fat, and a search for important nonfood sources.
MeSH term(s)	Adult ; Aged ; Benzhydryl Compounds ; Environmental Exposure ; Environmental Monitoring ; Fasting ; Female ; Half-Life ; Humans ; Male ; Middle Aged ; Nutrition Surveys ; Phenols/analysis ; Phenols/pharmacokinetics ; Phenols/urine ; Young Adult
Chemical Substances	Benzhydryl Compounds ; Phenols ; bisphenol A (MLT3645I99)
Language	English
Publishing date	2009-01-28
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	195189-0
ISSN	1552-9924 ; 0091-6765 ; 1078-0475
ISSN (online)	1552-9924
ISSN	0091-6765 ; 1078-0475
DOI	10.1289/ehp.0800376
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Article ; Online: Comment on "Optimal Exposure Biomarkers for Nonpersistent Chemicals in Environmental Epidemiology".

Stahlhut, Richard W / van Breemen, Richard B / Gerona, Roy R / Taylor, Julia A / Welshons, Wade V / vom Saal, Frederick S

Environmental health perspectives

2016 Volume 124, Issue 4, Page(s) A66

MeSH term(s)	Biomarkers/blood ; Biomarkers/urine ; Environmental Exposure/analysis ; Environmental Monitoring/methods ; Environmental Pollutants/blood ; Environmental Pollutants/urine ; Humans
Chemical Substances	Biomarkers ; Environmental Pollutants
Language	English
Publishing date	2016-04
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	195189-0
ISSN	1552-9924 ; 0091-6765 ; 1078-0475
ISSN (online)	1552-9924
ISSN	0091-6765 ; 1078-0475
DOI	10.1289/ehp.1511057
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Article ; Online: Socioeconomic factors and phthalate metabolite concentrations among United States women of reproductive age.

Kobrosly, Roni W / Parlett, Lauren E / Stahlhut, Richard W / Barrett, Emily S / Swan, Shanna H

Environmental research

2012 Volume 115, Page(s) 11–17

Abstract: Introduction: Relatively little is known about the socioeconomic correlates of phthalate metabolite urine concentrations among the general population, exposures of increasing public health concern, particularly for women of reproductive age.: Methods!# ...

Abstract	Introduction: Relatively little is known about the socioeconomic correlates of phthalate metabolite urine concentrations among the general population, exposures of increasing public health concern, particularly for women of reproductive age. Methods: We pooled data from the 2001-2008 cycles of the National Health and Nutrition Examination Survey to examine the associations between phthalate metabolite concentrations (including the molar sum of four di-2-ethylhexyl phthalate (DEHP) metabolites, the molar sum of two dibutyl phthalate (DBP) metabolites, and metabolites of benzylbutyl phthalate (BzBP) and diethyl phthalate (DEP)) with socioeconomic indicators (including ethnicity, education, income, and food security status) among women 20 to 39 years age. We also derived a socioeconomic status summary measure using factor analysis and investigated its associations with metabolite concentrations. Results: In fully adjusted models, the lowest quartile of overall socioeconomic status was associated with 1.83 (95% CI=1.54-2.17) times the concentrations of mono-benzyl phthalate (MBzP), and 0.72 (95% CI=0.54-0.98) times the concentrations of (molar sum) DEHP metabolites compared with the highest quartile of overall socioeconomic status. This latter association was driven primarily by educational attainment. All Non-White ethnicities combined had 1.24 (95% CI=1.09-1.40) times the concentrations of (molar sum) DBP metabolites, 1.32 (95% CI=1.12-1.56) times the mono-ethyl phthalate (MEP) concentrations, and 0.82 (95% CI=0.71-0.96) the concentrations of MBzP of Non-Hispanic Whites. Conclusions: Biomarkers of phthalate exposure vary with socioeconomic factors in women of reproductive age in the United States. Given the public health concern surrounding phthalate exposure, more research is needed to elucidate the reasons for these differences.
MeSH term(s)	Adult ; Cross-Sectional Studies ; Environmental Exposure/statistics & numerical data ; Female ; Humans ; Linear Models ; Models, Statistical ; Nutrition Surveys ; Phthalic Acids/metabolism ; Phthalic Acids/urine ; Socioeconomic Factors ; United States/epidemiology ; Young Adult
Chemical Substances	Phthalic Acids
Language	English
Publishing date	2012-05
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	205699-9
ISSN	1096-0953 ; 0013-9351
ISSN (online)	1096-0953
ISSN	0013-9351
DOI	10.1016/j.envres.2012.03.008
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Article ; Online: Non-monotonic dose effects of in utero exposure to di(2-ethylhexyl) phthalate (DEHP) on testicular and serum testosterone and anogenital distance in male mouse fetuses.

Do, Rylee Phuong / Stahlhut, Richard W / Ponzi, Davide / Vom Saal, Frederick S / Taylor, Julia A

Reproductive toxicology (Elmsford, N.Y.)

2012 Volume 34, Issue 4, Page(s) 614–621

Abstract: Di(2-ethylhexyl) phthalate (DEHP) is a ubiquitous environmental contaminant. Epidemiological studies suggest that DEHP decreases masculinization of male fetuses. Numerous rat studies report DEHP reduces fetal testosterone production at doses greatly ... ...

Abstract	Di(2-ethylhexyl) phthalate (DEHP) is a ubiquitous environmental contaminant. Epidemiological studies suggest that DEHP decreases masculinization of male fetuses. Numerous rat studies report DEHP reduces fetal testosterone production at doses greatly exceeding human exposure. We fed pregnant CD-1 mice 0.5-500,000 μg/kg/day DEHP from gestation day (GD) 9-18 and examined mothers and male fetuses on GD 18. We assessed non-monotonic dose-response by adding a quadratic term to a simple linear regression model. Except at the 500,000 μg/kg/day dose, DEHP stimulated an increase in maternal and fetal serum testosterone and increased anogenital distance (AGD). Non-monotonic dose-response curves were noted for AGD and maternal, and testis testosterone (P values 0.013-0.021). Because data from our highest dose (500,000 μg/kg/day) did not differ significantly from controls, this dose could have been incorrectly assumed to be the NOAEL had we only tested very high doses, as is typical in studies for regulatory agencies.
MeSH term(s)	Anal Canal/anatomy & histology ; Anal Canal/drug effects ; Animals ; Animals, Outbred Strains ; Diethylhexyl Phthalate/pharmacokinetics ; Diethylhexyl Phthalate/toxicity ; Dose-Response Relationship, Drug ; Endocrine Disruptors/pharmacokinetics ; Endocrine Disruptors/toxicity ; Female ; Genitalia, Male/anatomy & histology ; Genitalia, Male/drug effects ; Male ; Maternal-Fetal Exchange ; Mice ; Plasticizers/pharmacokinetics ; Plasticizers/toxicity ; Pregnancy ; Testis/drug effects ; Testis/metabolism ; Testosterone/metabolism
Chemical Substances	Endocrine Disruptors ; Plasticizers ; Testosterone (3XMK78S47O) ; Diethylhexyl Phthalate (C42K0PH13C)
Language	English
Publishing date	2012-10-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	639342-1
ISSN	1873-1708 ; 0890-6238
ISSN (online)	1873-1708
ISSN	0890-6238
DOI	10.1016/j.reprotox.2012.09.006
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Article ; Online: Shorter anogenital distance predicts poorer semen quality in young men in Rochester, New York.

Mendiola, Jaime / Stahlhut, Richard W / Jørgensen, Niels / Liu, Fan / Swan, Shanna H

Environmental health perspectives

2011 Volume 119, Issue 7, Page(s) 958–963

Abstract: Background: In male rodents, anogenital distance (AGD) provides a sensitive and continuous correlate of androgen exposure in the intrauterine environment and predicts later reproductive success. Some endocrine-disrupting chemicals can alter male ... ...

Abstract	Background: In male rodents, anogenital distance (AGD) provides a sensitive and continuous correlate of androgen exposure in the intrauterine environment and predicts later reproductive success. Some endocrine-disrupting chemicals can alter male reproductive tract development, including shortening AGD, in both rodents and humans. Whether AGD is related to semen quality in human is unknown. Objective: We examined associations between AGD and semen parameters in adult males. Methods: We used multiple regression analyses to model the relationships between sperm parameters and two alternative measures of AGD [from the anus to the posterior base of the scrotum (AGD(AS)) and to the cephalad insertion of the penis (AGD(AP))] in 126 volunteers in Rochester, New York. Results: AGD(AS), but not AGD(AP), was associated with sperm concentration, motility, morphology, total sperm count, and total motile count (p-values, 0.002-0.048). Men with AGD(AS) below (vs. above) the median were 7.3 times more likely (95% confidence interval, 2.5-21.6) to have a low sperm concentration (< 20 × 10⁶/mL). For a typical study participant, sperm concentrations were 34.7 × 10⁶/mL and 51.6 × 10⁶/mL at the 25th and 75th percentiles of (adjusted) AGD(AS). Conclusions: In our population, AGD(AS) was a strong correlate of all semen parameters and a predictor of low sperm concentration. In animals, male AGD at birth reflects androgen levels during the masculinization programming window and predicts adult AGD and reproductive function. Our results suggest, therefore, that the androgenic environment during early fetal life exerts a fundamental influence on both AGD and adult sperm counts in humans, as demonstrated in rodents.
MeSH term(s)	Anal Canal/embryology ; Anal Canal/growth & development ; Androgens/metabolism ; Androgens/physiology ; Body Weights and Measures ; Female ; Genitalia, Male/embryology ; Genitalia, Male/growth & development ; Humans ; Male ; New York ; Pregnancy ; Prenatal Exposure Delayed Effects ; Regression Analysis ; Spermatozoa/physiology ; Young Adult
Chemical Substances	Androgens
Language	English
Publishing date	2011-03-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	195189-0
ISSN	1552-9924 ; 0091-6765 ; 1078-0475
ISSN (online)	1552-9924
ISSN	0091-6765 ; 1078-0475
DOI	10.1289/ehp.1103421
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