Faculty Bibliography

AIMS/OBJECTIVE:We aimed to develop a multistage schema to stratify diabetes risk using continuous plasma glucose (PG) values (fasting and 1 h) in combination with clinical variables. METHODS:In 962 Brazilian adults, we initially estimated the probability of developing diabetes with the Finnish Diabetes Risk Score (FINDRISC). We then stratified participants with a FINDRISC score of 9 or higher into three progressive high-risk stages based on their probability of developing diabetes. We evaluated the schemás ability to predict the incidence of diabetes using robust Poisson regression with a time offset, employing bootstrap resampling for internal validation. RESULTS:to scores produced little change. CONCLUSIONS:A staging schema based on scores derived from continuous FPG and 1 h PG values along with clinical variables, applied after a FINDRISC screening, offers a nuanced and practical approach to identifying individuals for diabetes prevention.

Recreational ketamine use and related adverse outcomes have been increasing; however, correct diagnostic classification of quantitative oral fluid test results remains challenging, considering the potential for unintentional exposure to ketamine as an adulterant in other drugs. We surveyed and collected oral fluid from 1819 adults entering nightclubs and compared detection results with past 24-h self-reported ketamine use. Other drug use (based on detection and on self-reported past 24-h use) was considered a risk factor for unintentional ketamine exposure as an adulterant. Oral fluid specimens were analyzed via liquid chromatography quadrupole time-of-flight mass spectrometry. 10.8% of participants reported past 24-h ketamine use, 23.7% tested positive for ketamine (≥ 1 ng/mL), and 10.9% tested positive for norketamine (≥ 1 ng/mL). 46.0% tested positive for drugs other than ketamine, primarily cocaine. Among those testing positive for ketamine (n = 431), 41.5% reported past 24-h use. Among these cases, the optimal ketamine concentration cut-point for predicting self-report was ≥ 18 ng/mL. In analyses using the full sample (n = 1819) and a subsample with data on past 48-h use (n = 795), optimal cut-points were ≥ 2 ng/mL and ≥ 5 ng/mL, respectively. However, norketamine detection was the strongest predictor of self-reported use across the full sample and subsamples examined. Using self-report as the comparison, norketamine detection most accurately classified reported use; however, relying solely on higher concentration thresholds of ketamine or norketamine detection alone may lead to underdetection in some cases. Findings indicate the importance of carefully selected biological markers and thresholds when interpreting oral fluid results in settings where adulterant exposure is common.

OBJECTIVE:Cognitive concerns (CCs) are common for patients with Alzheimer's disease (AD) dementia. We explore anxiety, depression, and clinical impairment as moderators of CCs in early AD. Understanding these associations may help inform efforts to advance early identification of disease progression in AD. METHOD/METHODS:< .05. RESULTS:Higher CCs were associated with early clinical impairment (estimated change in median [β] = 15.5). CCs were higher with higher versus lower anxiety, except in unimpaired persons with elevated amyloid. In this latter group of unimpaired persons with elevated amyloid, CCs were higher with higher versus lower depression. CONCLUSION/CONCLUSIONS:In combination elevated amyloid, anxiety, and depression may offer data to guide clinical interpretation of CCs in early clinical impairment. The findings advance understanding of mood effects in early AD and inform specific measurement considerations. Future longitudinal studies are needed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

INTRODUCTION/BACKGROUND:Chronic traumatic encephalopathy (CTE) is a tauopathy linked to repetitive head impacts. Factors influencing brain regional susceptibility to tau deposition and spreading remain unclear. METHODS:We used three datasets: [18F]flortaucipir positron emission tomography (PET) in 157 former professional American football players and 53 controls (DIAGNOSE CTE); cortical myelin water fractions (MWF) in 50 healthy individuals (Myelin Water Atlas); and white matter (WM) tract MWF and functional connectivity (FC) in 100 healthy individuals (Human Connectome Project). We tested associations between tau-PET uptake and covariance in football players and typical cortical gray matter (GM) MWF, WM tract MWF, and FC. RESULTS:Cortical regions with lower typical GM MWF showed higher tau-PET uptake (β = -0.399, p = 0.001). WM tracts with lower typical MWF were associated with higher tau-PET covariance (β = -0.238, p < 0.001). Higher typical FC was associated with higher tau-PET covariance (β = 0.447, p < 0.001). DISCUSSION/CONCLUSIONS:In former football players at risk for CTE, regional susceptibility to tau deposition may be driven by low myelin and high FC.

INTRODUCTION/BACKGROUND:This study examines the association of HealthySteps - a two-generation, team-based pediatric primary care model - on preventive care and healthcare utilization for Medicaid-insured children and mothers, and differences across racial/ethnic groups. METHODS:This retrospective cohort study used linked HealthySteps and Medicaid claims data to compare 12-month outcomes for children receiving comprehensive services with a matched group of similar Medicaid-insured children and mothers. Data used in this study were collected from 2016-2021 and analyzed from 2022-2026. RESULTS:HealthySteps was associated with higher rates of any well-child visit (89.0% vs. 79.6%), attendance of 6+ well-child visits by 15 months of age (64.2% vs. 54.0%), continuity of care with the same provider (65.3% vs. 52.8%), developmental screening (37.9% vs. 26.9%), and Early Intervention (13.8% vs. 8.9%). HealthySteps was also associated with greater likelihood of an emergency department visit (43.9% vs. 38.7%), though not high ED usage (2+ visits). Compared with their counterparts, preventive care increases associated with HealthySteps were larger for Black, Hispanic, and, to a lesser extent, Asian children than for White non-Hispanic children. Among mothers, HealthySteps was associated with greater family planning services (35.8% vs. 31.6%), maternal depression screening (10.9% vs. 8.8%), postpartum care (29.5% vs. 24.6%), and ED visits (36.1% vs. 33.5%), as well as fewer lactation services (6.9% vs. 9.4%). CONCLUSIONS:Improvements in preventive care associated with HealthySteps represent meaningful clinical impact, as timely care in the first three years is crucial for healthy development. The larger gains among Black, Hispanic, and Asian children also highlight HealthySteps potential to mitigate persistent disparities in preventive care receipt.

IMPORTANCE/UNASSIGNED:Group interpersonal psychotherapy (IPT-G) is effective across diverse populations and adaptable to low-resource settings. OBJECTIVE/UNASSIGNED:To assess whether shortened 4-session mini IPT-G vs full IPT-G delivered by lay health care workers reduces depression and improves family functioning among perinatal adolescents. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This pilot randomized clinical trial of group IPT for depression used a 3-arm longitudinal type 1 implementation-effectiveness design between May 13, 2022, and April 1, 2024, at 2 primary care maternal and child health clinics in Nairobi, Kenya. The study applied a collaborative care approach within the World Health Organization (WHO) Mental Health Gap Action Programme framework for training a nonspecialist workforce, where trained nurses screened participants and supervised group sessions delivered by community health promoters collaboratively with psychologists. Participants included perinatal adolescents, aged 13 to 18 years, in their first to second trimester of pregnancy. INTERVENTION/UNASSIGNED:Participants were randomized to treatment as usual (TAU [n = 44]), mini IPT-G (n = 38), or full IPT-G (n = 40). TAU involved information sheets; mini IPT-G was culturally adapted; and full IPT-G followed the WHO protocol. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Primary outcomes included depression measured by the 9-item Patient Health Questionnaire (PHQ-9) and functional impairment within 1 week post intervention and at 6-month follow-up. Secondary outcomes were posttraumatic stress disorder, psychological distress, disability, and self-efficacy. Linear mixed models were used to evaluate the preliminary effectiveness of the interventions. RESULTS/UNASSIGNED:Among the 122 adolescents included in the analysis (median age, 17 [IQR, 17-18] years), 97 (79.5%) were single, and 91 (74.6%) had at least a secondary education level. Retention included 101 participants (82.8%) at 1 week post intervention and 91 (74.6%) at 6-month follow-up. Both IPT arms demonstrated significantly greater reductions in depression than the TAU arm post intervention. Mean (SD) PHQ-9 score decreased from 12.38 (5.90) at baseline to 2.15 (1.94) in the full IPT-G arm (β vs TAU = -5.79; 95% CI, -7.67 to -3.91; P < .001), from 11.58 (4.93) to 3.94 (2.81) in the mini IPT-G arm (β vs TAU = -3.97; 95% CI -5.83 to -2.10; P < .001), and from 11.00 (4.97) to 7.94 (3.71) in the TAU arm. At 6 months, effects were attenuated. Scores in the full IPT-G arm remained significantly lower than in the TAU arm (β = -2.22; 95% CI, -4.25 to -0.18; P = .03) but not in the mini IPT-G arm (β = -1.38; 95% CI, -3.25 to 0.48; P = .15). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this trial, IPT-G delivered by nonspecialists was feasible, acceptable, and effective. Mini IPT-G improved completion rates, while full IPT-G showed more sustained benefits at follow-up. These findings support task-sharing of mental health interventions for perinatal adolescents in low-resource settings. TRIAL REGISTRATION/UNASSIGNED:Pan African Clinical Trial Registry Identification: PACTR202501888041900.

BACKGROUND:Traumatic encephalopathy syndrome (TES) is a clinical research construct used to identify individuals at risk for chronic traumatic encephalopathy (CTE) following exposure to repetitive head impacts (RHI). Adjudication of TES relies on clinical features such as progressive cognitive impairment and neurobehavioral dysregulation. Blood-based biomarkers and structural neuroimaging abnormalities have been associated with TES but are not part of the criteria. This study evaluated whether TES identification was associated with the combined contribution of cognitive performance, blood biomarkers, and structural neuroimaging measures across two well-characterized cohorts. METHODS:Participants included 158 professional fighters from the Professional Athletes Brain Health Study and 149 former American football players from The DIAGNOSE CTE Research Project. Three indices were constructed representing complementary domains: a cognitive index reflecting cohort-specific cognitive features, a blood biomarker index including plasma neurofilament light chain, glial fibrillary acidic protein, total tau, tau phosphorylated at amino acid 231, and APOE-ε4 carrier status, and an imaging index comprising volumetric MRI measures of subcortical structures, ventricles, and corpus callosum subregions. Grouped weighted quantile sum regression models were estimated within each cohort to evaluate associations between these indices and TES while adjusting for age, race, competition status, and RHI exposure. RESULTS:Multidomain models demonstrated improved model performance compared with single-domain models in both cohorts (PABHS: AUC = 0.91, PPV = 0.80; DIAGNOSE CTE: AUC = 0.84, PPV = 0.85). Biomarker and imaging indices contributed additional information across cohorts, although imaging contributions were more prominent in fighters whereas blood biomarker associations were stronger in football players. CONCLUSION/CONCLUSIONS:TES in RHI-exposed athletes was associated with a convergent clinicobiological profile observed across two independent cohorts with distinct exposure patterns. These findings support multidomain analytic frameworks for evaluating correlated biological signals in RHI-exposed populations and may inform future studies of TES and CTE.

Repetitive head impacts sustained during American football have been associated with neuropathological changes such as white matter shear injuries. However, the impact of specific factors, such as age of first exposure and cumulative head impact burden, on white matter integrity remains unclear. This study investigated in vivo white matter microstructural changes using diffusion tensor imaging and tract-based spatial statistics in 165 male former American football players (mean age 57.3 years, range 45-74) and 52 unexposed asymptomatic male controls (mean age 59.4 years, range 45-74) in the DIAGNOSE CTE Research Project. Compared to controls, former football players exhibited significantly higher fractional anisotropy (FA) in 1.97% of the white matter skeleton (1552 voxels; Cohen's d = 0.587) and higher tissue-corrected FA (FAt) in 1.48% of the white matter skeleton (1004 voxels; Cohen's d = 0.616). No significant differences were observed for mean diffusivity, axial diffusivity, radial diffusivity, or free water between football players and controls. Among football players, there were no significant differences in the white matter microstructure between players diagnosed with traumatic encephalopathy syndrome and those without the diagnosis. Lower FA was significantly associated with older age (P < 0.00001) and an earlier age of first exposure to tackle football (P < 0.01), while lower FAt was associated with greater cumulative head impact burden, specifically higher linear acceleration (P < 0.04) and rotational force (P < 0.02). This study highlights the influential role of exposure factors on white matter microstructure in former American football players, as well as the utility of diffusion tensor imaging to aid in characterizing the long-term effects of repetitive head impacts in contact sport athletes.