Faculty Bibliography

The coronavirus disease 2019 (COVID-19) pandemic has caused significant medical, social, and economic impacts globally, both in the short and long term. Although most individuals recover within a few days or weeks from an acute infection, some experience longer lasting effects. Data regarding the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) in children, or long COVID, are only just emerging in the literature. These symptoms and conditions may reflect persistent symptoms from acute infection (eg, cough, headaches, fatigue, and loss of taste and smell), new symptoms like dizziness, or exacerbation of underlying conditions. Children may develop conditions de novo, including postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions and multisystem inflammatory syndrome in children. This state-of-the-art narrative review provides a summary of our current knowledge about PASC in children, including prevalence, epidemiology, risk factors, clinical characteristics, underlying mechanisms, and functional outcomes, as well as a conceptual framework for PASC based on the current National Institutes of Health definition. We highlight the pediatric components of the National Institutes of Health-funded Researching COVID to Enhance Recovery Initiative, which seeks to characterize the natural history, mechanisms, and long-term health effects of PASC in children and young adults to inform future treatment and prevention efforts. These initiatives include electronic health record cohorts, which offer rapid assessments at scale with geographical and demographic diversity, as well as longitudinal prospective observational cohorts, to estimate disease burden, illness trajectory, pathobiology, and clinical manifestations and outcomes.

INTRODUCTION/BACKGROUND:We examined data from a large, high acuity, pediatric psychiatric emergency department (ED) to assess both the immediate and longer-term impact of the pandemic on ED visits for suicidal thoughts and behaviors (STBs) among youth. METHODS:Youth ages 5-17 years presenting at a pediatric psychiatric ED in New York, NY from March 2019-November 2021 were included in this study. Visits were categorized as pre-pandemic, pandemic year 1, or pandemic year 2. We examined changes in demographic and clinical characteristics among patients presenting across the three time periods, as well as multivariable associations between these characteristics and STBs. RESULTS:Over 32 months, 2728 patients presented at 4161 visits. The prevalence of a discharge diagnosis of STBs increased from 21.2% pre-pandemic to 26.3% (p < 0.001) during pandemic year 1, and further increased to 30.1% (p = 0.049) during pandemic year 2. Youth were 21% more likely to receive a discharge diagnosis of STBs in pandemic year 1 (RR 1.21, 95% CI 1.07, 1.36) and 35% more likely in pandemic year 2 (RR 1.35, 95% CI 1.19, 1.52) compared to pre-pandemic baseline. CONCLUSIONS:In a large, high-acuity ED, STBs continued to increase 20 months after the initial COVID-19 lockdown. These findings highlight the persistent detrimental impact of the pandemic on youth mental health.

OBJECTIVE:The dimensional model of adversity and psychopathology hypothesizes deprivation and threat impact distinct neurobiological pathways, such as brain structure. This hypothesis has not been examined longitudinally or in young children. We tested longitudinal associations between threat and deprivation measured in preschool and brain structure in childhood. We hypothesized threat would be associated with amygdala and hippocampal subcortical volume and deprivation would be associated with cortical thickness in association cortex. METHOD/METHODS:The study included T1-weighted scans from 72 children (5-10 years old, 54.2% female participants). Threat was measured by the presence of domestic violence, sexual abuse, physical abuse, or neighborhood violence. Deprivation was measured by the presence of neglect. We examined associations of deprivation or threat with brain structure controlling for other dimension (deprivation or threat) and nuisance covariates using whole-brain vertex-wise analyses. We extracted subcortical volume and examined the same associations using multiple regression. RESULTS:Threat was associated with widespread decreases in cortical surface area across the prefrontal cortex and other regions. Threat was not associated with amygdala or hippocampal volume. Deprivation was associated with increased thickness in occipital cortex, insula and cingulate. CONCLUSION/CONCLUSIONS:Results suggest distinct associations of deprivation and threat on brain structure in early childhood. Threat is associated with widespread differences in surface area and deprivation is associated with differences in cortical thickness. These observations are consistent with work in adolescence and adulthood and reflect how dimensions of adversity differentially impact neural structure.

OBJECTIVE:To examine diet quality and diet-related factors among male adults of reproductive age with and without disabilities. DESIGN/METHODS:Cross-sectional data from the National Health and Nutrition Examination Surveys, 2013-2018. SETTING/METHODS:Disability was reported as serious difficulty hearing, seeing, concentrating, walking, dressing and/or running errands due to physical, mental or emotional conditions. Diet quality was assessed by the Healthy Eating Index (HEI)-2015 and diet-related factors included self-rated diet healthfulness, food security and food assistance programmes. Multivariable linear regression estimated differences in HEI-2015 scores. Multivariable Poisson regression estimated adjusted prevalence ratios (aPR) and 95 % CI for diet-related factors. PARTICIPANTS/METHODS:In total, 3249 males, 18-44 years; of whom, 441 (13·4 %) reported having disabilities. RESULTS:Compared with males without disabilities, those with disabilities had a 2·69-point (95 % CI: -4·18, -1·20) lower mean total HEI-2015 score and approximately one-third to half of a point lower HEI-2015 component scores for greens and beans, total protein foods, seafood and plant proteins, fatty acids and added sugars. Males with any disabilities were more likely to have low food security (aPR = 1·57; 95 % CI: 1·28, 2·92); household participation in food assistance programmes (aPR = 1·61; 95 % CI: 1·34, 1·93) and consume fast food meals during the previous week (1-3 meals: aPR = 1·11; 95 % CI: 1·01-1·21 and 4 or more meals: aPR = 1·18; 95 % CI: 1·01-1·38) compared with males with no disabilities. CONCLUSIONS:Factors affecting diet and other modifiable health behaviours among male adults of reproductive age with disabilities require further investigation. Health promotion strategies that are adaptive to diverse populations within the disability community are needed.

Caring for individuals with autism spectrum disorder (ASD) can be complicated, especially when challenging behaviors are present. Providers may feel unprepared to work with these individuals because specialized training for medical and social service providers is limited. To increase access to specialized training, we modified an effective half-day ASD-Care Pathway training (Kuriakose et al. 2018) and disseminated it within five different settings. This short, focused training on strategies for preventing and reducing challenging behaviors of patients with ASD resulted in significant improvements in staff perceptions of challenging behaviors, increased comfort in working with the ASD population, and increased staff knowledge for evidence-informed practices. Implications, including the impact of sociodemographic characteristics on pre/post changes, and future directions are discussed.

BACKGROUND:Adult females of reproductive age (18-44 years) with disabilities have higher rates of health-risk behaviors and chronic conditions compared to their counterparts without disabilities; however, there is limited examination of diet. OBJECTIVE:To examine associations of self-reported disability status with diet quality and diet-related factors. DESIGN/METHODS:Cross-sectional data were from the National Health and Nutrition Examination Surveys, 2013-2018. PARTICIPANTS/SETTING/METHODS:Adult females aged 18-44 years were included. Disability was defined as serious difficulty hearing, seeing, concentrating, walking, dressing, and/or running errands due to physical, mental, or emotional conditions. MAIN OUTCOME MEASURES/METHODS:The Healthy Eating Index (HEI)-2015 assessed diet quality. Diet-related factors included self-rated diet healthfulness, meal characteristics, food security, and food assistance programs. STATISTICAL ANALYSIS/METHODS:Multivariable linear regression estimated differences in HEI-2015 scores for a given day and multivariable Poisson regression estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) of diet-related factors by disability status. RESULTS:Of 3,579 adult females, 557 (16%) reported any disabilities, 207 (6%) of whom reported having two or more types of disabilities. Differences in mean HEI-2015 scores for a given day were one third to half of a point lower for fruits, total protein foods, and seafood/plant proteins among females with two or more types of disabilities compared to those without disabilities. Females with any disabilities were more likely to rate their diet as poor, have low food security, participate in food assistance programs, and consume frozen foods/pizza compared to those without disabilities (aPR ranged from 1.35 to 1.93); they were less likely to be the main food planner/preparer or shopper for their households. CONCLUSIONS:Some indicators of diet quality and diet-related factors differed between adult females with and without disabilities. Further investigation of dietary intakes and behaviors, as well as access to and availability of healthy foods, among females with disabilities is necessary.

Background and Aims: Diabetes technology (DT) use is associated with lower HbA1c in type 1 diabetes (T1D). Non- Hispanic Black and Hispanic populations are more likely to have lower DT use and higher HbA1c compared to non-Hispanic White populations. We examined the extent to which differential DT use explains outcome disparities at an outpatient pediatric diabetes center in NYC.
Method(s): Patients identifying as non-White, Hispanic, or non-English language preference were grouped (minority race/ language; MRL) and compared to non-Hispanic White, Englishpreferred patients. HbA1c >9% was categorized as high. T-test and chi-square statistics compared patient characteristics by HbA1c category. Binomial regression with generalized estimating equations estimated associations (risk ratios, RR; 95% confidence intervals, CI) between MRL and high HbA1c. First, models were adjusted for insurance type and Child Opportunity Index (COI), then additionally for CGM and pump use.
Result(s): Patients (n = 331) aged 2-25 years with T1D >= 3 months attended 709 visits (mean 2.2, SD 1.2) from 2020-2021; 32% identified as MRL. At the most recent visit, 16% had HbA1c>9% (MRL 29%, non-MRL 10%), 87% used CGMs (MRL 77%, non-MRL 92%), and 78% used pumps (MRL 72%, non-MRL 81%). MRL youth were 2.5 (95% CI 1.6-4.0) times more likely to have HbA1c>9% as compared to non-MRL youth, adjusted for insurance and COI. After adjusting for DT use, MRL youth remained twice as likely to have HbA1c>9% (RR 2.0, 95% CI 1.2-3.3).
Conclusion(s): While the disparity in HbA1c between MRL and non-MRL youth can be partially attributed to DT use, disparity persists even after accounting for DT use

Introduction: We examined data from a large, high acuity, pediatric psychiatric emergency department (ED) to assess both the immediate and longer-term impact of the pandemic on ED visits for suicidal thoughts and behaviors (STBs) among youth. Methods: Youth ages 5"“17 years presenting at a pediatric psychiatric ED in New York, NY from March 2019"“November 2021 were included in this study. Visits were categorized as pre-pandemic, pandemic year 1, or pandemic year 2. We examined changes in demographic and clinical characteristics among patients presenting across the three time periods, as well as multivariable associations between these characteristics and STBs. Results: Over 32 months, 2728 patients presented at 4161 visits. The prevalence of a discharge diagnosis of STBs increased from 21.2% pre-pandemic to 26.3% (p < 0.001) during pandemic year 1, and further increased to 30.1% (p = 0.049) during pandemic year 2. Youth were 21% more likely to receive a discharge diagnosis of STBs in pandemic year 1 (RR 1.21, 95% CI 1.07, 1.36) and 35% more likely in pandemic year 2 (RR 1.35, 95% CI 1.19, 1.52) compared to pre-pandemic baseline. Conclusions: In a large, high-acuity ED, STBs continued to increase 20 months after the initial COVID-19 lockdown. These findings highlight the persistent detrimental impact of the pandemic on youth mental health.

Health status during the reproductive years influences fecundity, fertility, and the future health of males and their offspring. There remains a dearth of literature examining men's preconception health, especially among high-risk populations, such as those with disabilities. The objective of this study was to examine indicators of preconception health, including chronic medical conditions, lifestyle behaviors, and health care utilization, among males of reproductive age with and without disabilities in the United States. Data were from 3,702 males of reproductive age (18-44 years) who participated in the National Health and Nutrition Examination Surveys, 2013-2018. Approximately 14% of males reported having at least one disability related to vision, hearing, cognition, mobility, self-care, or independent living. Among all men, suboptimal preconception health indicators were prevalent including poor or fair self-rated health; low education and household income status; lack of health insurance and no recent utilization of health care and dental care; cigarette smoking; frequent alcohol consumption and binge drinking; marijuana and illegal drug use; obesity; low fruit and vegetable intake and no multi-vitamin use; low physical activity; short sleep durations; depressive symptoms; and hypertension and asthma. Compared to males with no disabilities, males with any disabilities were more likely to have suboptimal preconception health indicators. Strategies to promote and improve sexual health, preconception care, and family planning services among all men are needed. For males with disabilities, specifically, further investigation of their specific health needs related to sex, reproduction, family planning, and fatherhood, as well as interactions with health care providers, is required.

Elevated exposure to multiple trace metals can be neurotoxic even at relatively low levels. These findings are primarily evident from adult occupational studies as well as in children exposed prenatally or in early childhood. Less research has focused on the neurodevelopmental impacts of exposure to metals among school-aged children. We examined associations between exposure to a mixture of four metals (arsenic, cadmium, manganese, lead) measured in hair and markers of cognition, attention, and behavior among 222 6-12 year old children who participated in a 2009-2010 neurodevelopmental follow-up to the C8 Health Project. Using quantile-based g-computation we estimated the adjusted overall metal mixture effect ψ (95 % CI) as the change in outcome per decile increase in all metals in the mixture. Hair metal levels varied by metal, with cadmium being lowest (median 0.007, interquartile range (IQR) 0.013 μg/g) and lead the highest concentration (median 0.152, IQR 0.252 μg/g). Children's cognitive skills and development, attention/impulsivity, and behavior were all close to standardized population means. Each decile increase in all metals was associated with a Full Scale IQ reduction of 1.01 points (95 % confidence interval (CI) -1.88, -0.15) and Verbal IQ reduction of 1.11 points (95 % CI -1.97, -0.25), adjusted for child age, sex, secondhand smoke exposure, HOME score, maternal education, maternal IQ, and examiner. Maternal report of ADHD-like behaviors and executive functioning also showed adverse associations with the metal mixture. Our findings suggest that similar to exposure during prenatal and early childhood periods, recent exposure to metals during middle childhood is associated with adverse neurodevelopmental consequences. Middle childhood may also be a developmental window of susceptibility to the negative consequences of exposure to environmental neurotoxicants.