Faculty Bibliography

AIMS/OBJECTIVE:Rural communities experience a higher prevalence of type 2 diabetes and diabetes-related mortality than urban populations. This study sought to disaggregate the influences of demographic and socioeconomic factors, food environment, diet quality, and dietary chemical exposures on diabetes risk in rural areas. MATERIALS AND METHODS/METHODS:We enrolled participants from rural Sullivan County in an observational cohort study involving surveys and biospecimen collection measuring bisphenols and phthalates. We measured these endocrine disrupting chemicals found in food packaging, as rural residents generally consume canned foods and other shelf-stable foods more frequently than their urban counterparts. We used LASSO regression to compare the relative influence of these factors had on rural diabetes risk. RESULTS:Based on values for LASSO regression coefficients among 276 participants, the strongest risk factors for diagnosed diabetes included: older age (+0.486), lower household income (+0.172), Hispanic ethnicity (+0.124), red meat intake (+0.093), proportion of fast food restaurants among nearby restaurants (+0.071), and two phthalates (+0.149 and + 0.107). Among study participants without a history of diabetes, high HbA1c levels were associated with older age (+0.106), being non-Hispanic Black (+0.064), more trans-fat and red meat intake (+0.044 and +0.028), higher BMI (+0.014), higher levels of total bisphenols (+0.005), and higher levels of high-molecular weight phthalates (+0.002). CONCLUSIONS:Demographic and socioeconomic factors were the strongest predictors of rural diabetes risk; however, diet quality, food environment, and dietary chemical exposures also each played a key role. Our study identified modifiable risk factors, which could help reduce the burden of rural diabetes.

BACKGROUND:Decisions involving the purchase of procedural equipment at the health system level require balancing efficacy, safety, physician preference, and cost. The application of efficient and low-cost pragmatic study designs has the potential to rapidly generate data to inform health system operations. METHODS:The aim of the pragmatic RAISE-EMR study is to determine physician preference between two commercially available radial artery introducer sheaths, one of which has a higher acquisition cost, to guide inventory selection in the hospital system's catheterization laboratories. Patients undergoing coronary angiography using 6-French radial artery access were prospectively identified and randomized through the health system's electronic medical record (EMR). Among 1696 eligible unique patients, 554 patients (32.7%) were randomized over 37 days across three hospitals. Randomization took place through the EMR after the attending interventional cardiologist signed a mandated pre-procedure note. The study was deemed non-human subject research and approved by the NYU Langone Health Quality Improvement Oversight Committee. The primary endpoint, a physician satisfaction score, will be ascertained by a mandated semi-quantitative survey within the electronic procedure note. All data, including co-variables and clinical outcomes, will be ascertained using structured data within the EMR. CONCLUSIONS:The RAISE-EMR study is designed to determine physician preference of two commercially available radial artery introducer sheaths and potentially reduce supply costs using an entirely EMR-based randomized study design. Pragmatic study designs leveraging structured data within an EMR can be used to rapidly provide data to inform operational decision-making and have implications for the future of evidence generation.

OBJECTIVES/OBJECTIVE:Given the known link between maternal and child mental health, it is likely that children whose mothers experienced more distress because of the COVID-19 pandemic were at greater risk for increased behavior problems. Yet research to date has not tested this hypothesis among families who were hit hardest by the pandemic-those with low incomes and from Black and Hispanic backgrounds. Research is also needed that focuses on young children and uses a longitudinal design. DESIGN/METHODS:We harmonized data from 4 cohorts originally designed to study pediatric parenting interventions with underresourced families in 2 US cities. We examined, first, whether maternal distress because of the pandemic was associated with change over the next 1 to 2 years in preschool-aged children's anxiety/depression and aggression, and second, whether such associations were moderated by maternal depression. RESULTS:Maternal pandemic-related distress predicted a small increase in child aggression but no change in anxiety/depression. There was no moderation by maternal depression. CONCLUSION/CONCLUSIONS:Among families at risk of the most severe health and financial hardships because of the pandemic, maternal pandemic-related distress was associated with increases in child aggression 1 to 2 years later. Maternal mental health must be made a priority in the future disasters not only in its own right but also because of possible spillover effects on young children.

INTRODUCTION/BACKGROUND:Measuring plasma biomarkers effectively assesses early-stage Alzheimer's disease. METHODS:Subjects were categorized as cognitively unimpaired (CU) (n = 66), CU with subjective cognitive decline (SCD) (n = 100), and mild cognitive impairment (MCI) (n = 25). Plasma biomarkers measured were amyloid beta (Aβ) 40, Aβ42, neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), tau phosphorylated at threonine 181 (pTau181), neuroinflammatory biomarkers, and blood-brain barrier biomarkers. Amyloid and tau positron emission tomography (PET) imaging was performed in 186 and 144 subjects, respectively. RESULTS:Comparing those having MCI, both CU and SCD participants had significantly lower amyloid PET standardized uptake value ratio (SUVR) (p < 0.001; p = 0.005). Higher amyloid PET SUVR was significantly associated with higher pTau181 (p = 0.001) and a higher pTau181/Aβ42 ratio (p < 0.001). Higher tau PET SUVR was associated with lower plasma Aβ42 (p = 0.020), older age (p = 0.005), higher GFAP (p = 0.020), and lower interleukin-8 levels (p < 0.001). DISCUSSION/CONCLUSIONS:Our study supports plasma biomarker monitoring of at-risk patients at various stages of pre-dementia.

The American Heart Association's PREVENT equations estimate risk of total cardiovascular disease (CVD), atherosclerotic CVD (ASCVD), and heart failure (HF) to guide lipid and blood pressure-lowering therapy in people ages 30 to 79 years in the United States. The SCORE2 risk algorithm is used to estimate CVD risk for similar purposes in people ages 40 and older in Europe. Neither set of equations has been comprehensively validated in global observational cohorts and randomized trials. Here, in 44 observational cohorts and 18 randomized trials, we assessed discrimination and calibration of the two risk algorithms across geographical regions (North America, Europe, Asia/other, multi-region trials). We also created scaling factors for risk prediction over 1-9 years using the PREVENT equations, enabling shorter-term risk prediction for research purposes or to facilitate clinical trial enrolment. Over 5.1 years of mean follow-up, 293,737 PREVENT total CVD events (fatal and non-fatal ASCVD or HF) and 258,086 SCORE2 CVD events (myocardial infarction, stroke, or cardiovascular death) were observed among 6,422,714 and 5,437,384 individuals, respectively. Despite differences in CVD outcome definitions, target populations and predictor variables, overall discrimination and calibration were similar for both equations, with generally good performance across regions, including in multi-regional randomized trials. These findings lend support for adoption of PREVENT or SCORE2 for cardiovascular risk stratification across diverse settings.