Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Child and Adolescent Psychiatry
Total Results:
11552
Integrating evidence-based early relational health programs into pediatric primary care: A mixed methods study
OBJECTIVE:Pediatric primary care (PPC) offers an ideal platform for integrating evidence-based programs (EBPs) to enhance early relational health (ERH). However, implementing such integration faces several challenges. This study uses quantitative and qualitative data to identify the barriers, facilitators, and strategies for implementing ERH-focused EBPs in PPC. METHODS:Using the Consolidated Framework for Implementation Research framework, we conducted a survey and focus groups with PPC personnel recruited through nationwide networks. The survey measured clinic readiness (i.e., challenges, resources, and needs) for integration and examined its associations with personnel roles and clinic characteristics using nested ANOVAs and multilevel regressions. Focus groups further probed potential strategies and were coded using thematic analysis. RESULTS:126 PPC personnel from 44 clinics completed the survey, and 18 participated in five focus groups. Clinics had strong leadership support for integrated services and high utilization of program resources and implementation practices, yet notable challenges in structural and human resources existed. Clinic staff perceived higher readiness for integration than other personnel roles. Lower-percent Medicaid eligible patients and urbanicity were associated with higher readiness, while academic affiliation showed both positive and negative associations. Promoting culturally responsive care, fostering team cohesion, utilizing standardized implementation processes, adopting flexible delivery and collaborative models, and partnering with local communities were key strategies for integrating EBPs. CONCLUSIONS:The findings can help PPC clinics more effectively integrate one or multiple EBPs into routine care and can inform ways to sustain such integrated services to optimize population-level reach and positive impacts on child and family well-being.
PMID: 41730331
ISSN: 1876-2867
CID: 6009732
Insurance-based Disparities in Pediatric Psychiatric Hospitalizations from 2018 to 2021: Examining Mental Health Outcomes among Medicaid and Commercially Insured Youth
Insurance type is a key indicator of structural vulnerability in pediatric mental health care and may be associated with differences in psychiatric presentation, treatment course, and diagnosis among hospitalized youth, particularly Black and Hispanic/Latino children insured by Medicaid. Despite these inequities, their impact remains understudied among psychiatrically hospitalized pediatric populations. This retrospective study analyzed 1,101 child and adolescent psychiatric patients admitted to an urban psychiatric hospital between June 2018 and November 2021. Clinical presentation, psychiatric history, treatment course, and discharge diagnoses were compared between patients' insurance by Medicaid (72%) and those with commercial insurance (28%). Compared with commercially insured patients, children and adolescents with Medicaid were more likely to be Black or Hispanic/Latino and had higher rates of trauma exposure, prior psychiatric emergency visits, and higher rates of attention-deficit/hyperactivity disorder (ADHD), impulsive/behavioral disorders, and developmental/intellectual disorders. They were more frequently admitted for aggression-related crises, more likely to receive emergency injectable medications for agitation, and had longer hospital stays. Commercially insured patients had higher rates of anxiety disorders and suicide attempt related admissions. These findings suggest children and adolescents with Medicaid who required psychiatric hospitalization had greater severity of psychosocial histories and higher-acuity inpatient courses, highlighting how structural inequities reflected by insurance type, may shape differing psychiatric treatment pathways, underscoring the need for equity-oriented interventions, particularly during periods of healthcare system strains.
PMID: 41712091
ISSN: 1573-6709
CID: 6005022
Wondering About Wandering
PMCID:12920163
PMID: 41726572
ISSN: 1535-7597
CID: 6009622
The role of negative affectivity in the developmental pathway linking perinatal complications to behavioral and emotional problems in children
Although temperamental negative affectivity has been identified as a developmental mechanism mediating the link between perinatal risk and internalizing problems in early childhood, its role in predicting broader behavioral and emotional problems across childhood remains understudied. We examined the longitudinal relations among perinatal complications (i.e., prenatal maternal depression and cardiometabolic complications, preterm birth, and low birth weight), children's negative affectivity (M
PMID: 41693363
ISSN: 1469-2198
CID: 6004282
Leveraging clinical sleep data across multiple pediatric cohorts for insights into neurodevelopment: the retrospective analysis of sleep in Pediatric (RASP) cohorts study
Sleep disturbances are prominent across neurodevelopmental disorders (NDDs) and may reflect specific abnormalities in brain development and function. Overnight polysomnography (PSG) allows for detailed investigation of sleep architecture, offering a unique window into neurocircuit function. Analysis of existing pediatric PSGs from clinical studies could enhance the availability of sleep studies in pediatric patients with NDDs towards a better understanding of mechanisms underlying abnormal development in NDDs. Here, we introduce and characterize a retrospective collection of 1527 clinical pediatric overnight PSGs across five different sites. We first developed an automated stager trained on independent pediatric sleep data, which yielded better performance compared to a generic stager trained primarily on adults. Using consistent staging across cohorts, we derived a panel of EEG micro-architectural features. This unbiased approach replicated broad trajectories previously described in typically developing sleep architecture. Further, we found sleep architecture disruptions in children with Down's Syndrome (DS) that were consistent across independent cohorts. Finally, we built and evaluated a model to predict age from sleep EEG metrics, which recapitulated our previous findings of younger predicted brain age in children with DS. Altogether, by creating a resource pooled from existing clinical data we expanded the available datasets and computational resources to study sleep in pediatric populations, specifically towards a better understanding of sleep in NDDs. This Retrospective Analysis of Sleep in Pediatric (RASP) cohorts dataset, including staging annotation derived from our automated stager, is deposited at https://sleepdata.org/datasets/rasp.
PMID: 40488421
ISSN: 1550-9109
CID: 5868972
Devaluation of response-produced safety signals reveals circuits for goal-directed versus habitual avoidance in dorsal striatum
Active avoidance responses (ARs) are instrumental behaviors that prevent harm. Adaptive ARs may contribute to active coping, whereas maladaptive avoidance habits are implicated in anxiety and obsessive-compulsive disorders. The AR learning mechanism has remained elusive, as successful avoidance trials produce no obvious reinforcer. We used a novel outcome-devaluation procedure in rats to show that ARs are positively reinforced by response-produced feedback cues that develop into safety signals during training. Males were sensitive to feedback devaluation after moderate training, but not overtraining, consistent with a transition from goal-directed to habitual avoidance. Using chemogenetics and feedback devaluation, we also show that goal-directed vs. habitual ARs depend on dorsomedial vs. dorsolateral striatum, suggesting a significant overlap between the mechanisms of avoidance and rewarded instrumental behavior. Females were insensitive to feedbackdevaluation due to a remarkable context-dependence of counterconditioning. However, degrading the contingency between avoidance and feedback suggests that both sexes rely on safety signals to perform goal-directed ARs.
PMID: 41663373
ISSN: 2041-1723
CID: 6001832
Associations of neighborhood deprivation and household income during pregnancy on child externalizing and internalizing problems
Socioeconomic disadvantage has been established as a key risk factor for adverse child behavioral outcomes. Understanding how individual components of socioeconomic status (SES) interact with each other can elucidate protective factors and inform interventions and policies to promote positive developmental outcomes. This study examined the interactive effects of prenatal household income and neighborhood deprivation on child externalizing and internalizing problems (N = 793; M
PMCID:12888081
PMID: 41645600
ISSN: 1469-2198
CID: 6000512
The International Guideline for the Definition, Classification, Diagnosis and Management of Urticaria
This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA2LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
PMID: 41649409
ISSN: 1398-9995
CID: 6000592
Applying mixtures methodology to analyze how exposure to structural racism and economic disadvantage affect perinatal health outcomes: an ECHO study
Our objective was to examine the role of structural racism and economic disadvantage in perinatal health inequities using the Environmental influences on Child Health Outcomes Cohort. Participants' addresses were linked to area-level measures of life expectancy, education, unemployment, health insurance, jail rate, segregation, and housing cost burden. We created absolute measures to represent economic disadvantage and relative measures comparing values for Black or Latinx people to White people in the same area to represent structural racism. We used quantile G-computation to estimate the effects of a one-quartile increase in all exposures simultaneously on fetal growth and gestational age measures. A one-quartile increase in economic disadvantage was associated with a reduction in birthweight [(-25.65 grams, 95% CI (-45.83, -5.48)], but not gestational age [-0.02 weeks, 95% CI (-0.13, 0.09)]. With a one-quartile increase in Latinx-White structural racism, we observed reductions in birthweight [-80.83, 95% CI (-143.42, -18.23)) among Latinx participants. A one-quartile increase in Black-White structural racism was weakly associated with lower birthweight among Black participants [-15.70, 95% CI (-82.89, 51.48)] but was associated with higher birthweight among White participants [57.47, 95% CI (13.26, 101.67)]. Our findings suggest co-occurring forms of structural inequity likely influence racialized disparities in fetal growth outcomes.
PMID: 41111261
ISSN: 1476-6256
CID: 5956532
Spatial segregation of piriform output neurons toward cognitive and emotional networks
The piriform cortex (PCx), commonly considered to be the primary olfactory sensory cortex, differs from other mammalian sensory cortices by not displaying a stimulus-specific spatial organization but rather displaying widely distributed odor-evoked activity. However, there is evidence of a PCx spatial organization based on output neuron targeting. Here, we performed double-labeled retrograde tracing to reveal neuronal populations of PCx output neurons that project to two regions affiliated with different behavioral significance, the basolateral amygdala (BLA) and lateral orbitofrontal (LO) cortex networks. We found that PCx neurons projecting to BLA and LO are distinct in spatial distribution with minimal overlap, supporting the hypothesis that while odor input is distributed randomly across the PCx, PCx output neurons are organized into target-specific neuronal populations that potentially serve as functional units for odor encoding and odor-guided behavior.
PMCID:12917545
PMID: 41726307
ISSN: 2752-6542
CID: 6009612
