Faculty Bibliography

INTRODUCTION/UNASSIGNED:Poor dental health is linked to poor physical and mental health. This study was aimed to examine the characteristics of U.S. adults that are associated with having seen a dentist in the past year. METHODS/UNASSIGNED:A cross-section of adults aged 18-64 years (N=19,975) from the 2023 National Health Interview Survey was examined. Bivariate analyses examined the associations of sociodemographic and financial variables with recent dental visits in the last 12 months. Multinomial modeling was used to assess these variables to predict 3 outcomes of time since the last dental visit: in the last 12 months; over a year but <10 years; and over 10 years or never, which was the reference category. RESULTS/UNASSIGNED:In young and middle-aged adults, 4.8% of Americans, representing over 9 million people, had either never seen a dentist or not seen a dentist in 10 years or more. The likelihood of a dental visit in the last 12 months increased with education level (no high-school degree versus a graduate or professional degree [AOR=0.21, 95% CI=0.09, 0.50]) and income (income below the federal poverty line versus income in the highest quartile [AOR=0.20, 95% CI=0.11, 0.35]). Having dental coverage in a private plan or Medicaid, compared with having no coverage, predicted having a dental visit within the last 12 months in both multinomial and bivariate analyses. CONCLUSIONS/UNASSIGNED:Access to dental care in young and middle-aged adults is determined by financial ability. Increasing access to dental care could happen once the financial barriers to dental care are reduced, including increasing the age at which a young adult can be covered by a parent's plan and making dental coverage comparable with physical health coverage. Given the current data about the links between dental, mental, and physical health, parity for all care is warranted.

BACKGROUND/UNASSIGNED:As life expectancy rises, identifying causes and risk factors for incident acute ischemic stroke (AIS) among the oldest-old (≥80 years) is increasingly important. We examined whether the effect of age at stroke on AIS subtype is mediated by embolic risk factors and whether these factors improve AIS prediction. METHODS/UNASSIGNED:-VASc) and compared preinclusion and postinclusion of embolic risk factors. RESULTS/UNASSIGNED:-VASc: C statistics, 0.63 [95% CI, 0.59-0.67]). CONCLUSIONS/UNASSIGNED:These findings suggest that identification and control of embolic risk factors are critical to reduce stroke risk as people age, and better stroke-specific prediction tools are needed.

IntroductionWhile largely preventable, cervical cancer remains a major cause of morbidity and mortality in low- and middle-income countries (LMICs), where gaps in screening uptake persist despite expanding prevention efforts. In many patriarchal settings, men play influential roles in household decision-making and access to healthcare, positioning them as critical but under-engaged stakeholders. There remains limited understanding of how educational strategies to improve health literacy can be designed to effectively engage men in supporting women's screening participation.MethodsWe conducted a qualitative study in northern Ghana to explore men's understanding, priorities, and values related to cervical cancer prevention to inform male-focused educational strategies. Guided by the Consolidated Framework for Implementation Research and the Health Belief Model, 9 in-depth semi-structured interviews were conducted with married adult men recruited from community settings, examining household roles, perceptions of cervical cancer and screening, and preferences for education and engagement approaches. Interviews were conducted in English or Dagbani, audio-recorded, transcribed, and analyzed thematically using a hybrid inductive and deductive approach.ResultsThree cross-cutting themes emerged. Men viewed healthcare professionals as trusted sources of cervical cancer information and described their roles as primary financial decision-makers, with cost and competing household priorities influencing support for screening. Masculine responsibility, particularly related to fertility and family wellbeing, strongly motivated engagement, and messages framed around these themes were more compelling than disease-focused messaging alone. Participants recommended integrating education into routine health services, leveraging healthcare workers, offsetting screening-related costs, and using mass media to initiate awareness and information seeking.ConclusionMen represent pivotal yet underutilized partners in cervical cancer prevention. Educational strategies that align with men's roles, economic realities, and trusted sources of information and address household decision-making barriers may enhance screening uptake while supporting women-centered care. These findings provide implementation-relevant insights to inform male-engaged cervical cancer prevention strategies across diverse LMIC settings.

INTRODUCTION/BACKGROUND:A 2021 federal rule permits opioid treatment programs (OTPs) to provide methadone through mobile medication units (MMUs), creating an opportunity to provide medication for people in residential care facilities. We used simulations to quantify the potential of MMUs to expand methadone access to people residing in residential substance use treatment facilities (RTF), skilled nursing facilities (SNF), and nursing facilities (NF) in New York State under different scenarios. METHODS:For each facility (RTF, SNF, and NF), a need score was created using three items: facility opioid use disorder (OUD) population, driving distance to nearest OTP, and county overdose mortality rate. We then demonstrated potential patient reach following the launch of 50 hypothetical MMUs making one stop per day to the highest need facilities. In refinements, we examined three additional scenarios involving more daily stops and prioritizing rural areas. RESULTS:Our sample included 3214 people with OUD estimated to be housed in 1052 facilities in New York, with the majority in RTFs (51.5%). The demonstrated percentage of OUD population served ranged from 23.5% to 35.8%, and the percentage of facilities served ranged from 23.8% to 37.4%. Each scenario reached a large percentage of rural facilities (73-76%). Prioritizing rural facilities decreased the proportion of OUD population served (10% reduction) but did not substantially increase driving time. Allowing multiple stops increased the proportion of OUD population served (32-36% vs. 24-26%). CONCLUSIONS:Using methods based on location information and spatial relationships, state officials can develop priorities and assess tradeoffs of MMU deployment and distribution strategies.

BACKGROUND/UNASSIGNED:Precision oncology (PO) improves and extends the lives of patients living with cancer, but multiple studies have documented its underuse in practice. Specifically, studies note a significant lack of PO use within the Veterans Affairs (VA) medical system. A paucity of implementation of PO in oncologic practice poses a significant barrier to providing the most up-to-date guideline-based care. OBJECTIVE/UNASSIGNED:While several studies have explored determinants of PO use, we sought to contribute to the body of knowledge by additionally focusing on the unique perspectives of patients, as well as conducting a comprehensive study within the VA medical system, the United States' largest single-payer health care system. We conducted interviews with both patients and providers at multiple VA sites to identify and characterize barriers and facilitators of PO use in clinical care. METHODS/UNASSIGNED:Using a qualitative descriptive approach, we conducted semistructured interviews with 17 patients with cancer and 16 oncology providers recruited from multiple VA sites. Cancer types included prostate, gastrointestinal, and lung. Data were analyzed via a team-based coding approach using directed content analysis. Data were coded and then aggregated into themes and mapped to the Theoretical Domains Framework (TDF) and Behavior Change Wheel sources of behavior (Capability, Opportunity, and Motivation) based on the consensus of the study team. RESULTS/UNASSIGNED:The patient sample consisted of 17 all-male veterans seen at VA oncology clinics in 2022. Participants predominantly self-identified as White (n=9, 52.9%) or Black (n=6, 35.3%), and the majority (n=11, 64.7%) held a high school degree or a higher level of education. The provider sample consisted of 16 physicians, all of whom held MD degrees and practiced oncology. The provider sample represented 6 states, was 50% (8/16) female, and participants averaged 14 years in their current position. The overarching theme was the "Precision Oncology Feedback Loop," which captured the essence of the complex processes involved in facilitating PO care in the VA system. The TDF and Behavior Change Wheel helped categorize findings to identify where issues in the feedback loop could facilitate or generate barriers to care. CONCLUSIONS/UNASSIGNED:Our findings expand on the current literature by highlighting both patient and provider experiences across key TDF domains (Environmental Context and Resources, Knowledge, Memory, and Attention). The conceptual model produced by the analysis illustrates the complexities associated with the implementation. Our findings support the design of multilevel interventions that target increased knowledge or education, improved workflow, and ease of communication to enhance PO delivery.

IMPORTANCE/UNASSIGNED:The association between stroke severity and dementia is well established. However, reports on trajectories of cognitive decline comparing stroke survivors with individuals without stroke in large cohorts are insufficient. OBJECTIVES/UNASSIGNED:To examine associations of ischemic stroke incidence and severity with cognitive decline and dementia risk and to explore whether vascular risk factors modify these associations. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cohort study pooled longitudinal data on cognitive function of participants aged 45 years or older and without stroke and dementia at baseline from 3 US prospective cohorts: the Atherosclerosis Risk in Communities study (1987-2019), Framingham Offspring Study (1971-2019), and Reasons for Geographic and Racial Differences in Stroke study (2003-2019). First definite ischemic strokes were reported in each cohort using consistent protocols, with severity defined using the National Institutes of Health Stroke Scale (NIHSS). The data analysis was completed February 27, 2026. EXPOSURE/UNASSIGNED:Incident ischemic stroke categorized as minor (NIHSS 0-5), mild to moderate (NIHSS 6-10), or moderate to severe (NIHSS ≥11). MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcomes were decline in global cognition and incident dementia. Secondary outcomes were changes in memory and executive function. Multivariable linear mixed-effects models were used to test the association of stroke incidence and severity with cognitive decline. RESULTS/UNASSIGNED:A total of 42 342 participants from the pooled cohorts were included (mean [SD] age, 61.3 [9.8] years; 55.0% female). Longitudinal cognitive testing data were available for a median of 11.1 years (range, 0-29.7 years) with 397 344 person-years of observation for dementia incidence. Stroke severity data were available for 1055 of 1505 first-ever ischemic stroke survivors (70.1%). Compared with participants with no stroke, adjusted hazard ratios for incident dementia were 1.93 (95% CI, 1.52-2.45) for NIHSS 0 to 5, 3.26 (95% CI, 1.93-5.53) for NIHSS 6 to 10, and 5.06 (95% CI, 2.71-9.45) for NIHSS 11 or higher. Over the follow-up, higher stroke severity was associated with progressively steeper cognitive declines across all domains, with more prevalent dose-response associations for global cognition (ranging from a mean -0.18 [95% CI, -0.19 to -0.18] points per year for no stroke to -0.58 [95% CI, -0.73 to -0.42] points per year for moderate to severe stroke) and memory (ranging from a mean -0.15 [95% CI, -0.16 to -0.14] points per year for no stroke to -0.36 [95% CI, -0.51 to -0.21] points per year for moderate to severe stroke) than for executive function (ranging from a mean -0.33 [95% CI, -0.34 to -0.32] points per year for no stroke to -0.52 [95% CI, -0.66 to -0.39] points per year for moderate to severe stroke). CONCLUSIONS AND RELEVANCE/UNASSIGNED:This large cohort study of participants from 3 prospective cohorts found that greater stroke severity was associated with substantially elevated dementia risk and accelerated decline in global cognition, memory, and executive function. These findings underscore the critical importance of stroke prevention, particularly severe stroke, and identifying mechanisms that may link stroke to cognitive decline.

More than 6 million persons living with dementia (PLWD) in the United States rely on the emergency department (ED) for unscheduled care, with up to half discharged home after treatment. The ED-to-home transition poses significant challenges for PLWD and their care partners (referred to as "dyads"), contributing to high rates of ED revisits and adverse outcomes. The Community Paramedic-led Transitions Intervention (CPTI) was developed to address these challenges by adapting the validated Care Transitions Intervention for the ED setting. Delivered by trained community paramedics, CPTI is a short-term 30-day program that includes one home visit and up to three follow-up phone calls. Using a coaching model, paramedic coaches work with members of the dyad to strengthen their knowledge, skills, and confidence to manage their health and successfully navigate the health care system. CPTI is being implemented as part of Emergency Departments LEading the Transformation of Alzheimer's and Dementia Care (ED-LEAD), a cluster-randomized pragmatic trial testing 3 interventions designed to improve outcomes for PLWD discharged home from the ED across 14 health systems and 79 EDs nationwide. This paper describes the CPTI model as implemented within ED-LEAD, detailing its theoretical foundation, structure, training curriculum, workflow integration, and implementation monitoring. This framework can provide a model for health systems, provider groups, and emergency medical service agencies interested in adopting this innovative approach and implementing the CPTI. Insights from its implementation within ED-LEAD will guide future efforts to improve post-ED outcomes and continuity of care for PLWD and their care partners.

Reliable structural brain measurements are essential for studying neurodegeneration and for designing adequately powered aging and Alzheimer's disease (AD) research. We evaluated the test-retest reliability of FreeSurfer 7.1 morphometric measures in 100 older adults (mean age 73.5 years) ranging from cognitively unimpaired to dementia. Each participant underwent two T1-weighted 3T MRI scans on the same scanner within a short interval (mean 5.5 weeks), minimizing biological change. Segmentation was performed in both standard cross-sectional and longitudinal FreeSurfer modes, focusing on AD-relevant volumes of entorhinal cortex, hippocampus, lateral ventricles, choroid plexus, and the AD cortical thickness signature. Reliability was quantified using absolute and root-mean-square test-retest differences, standard deviation of differences, and intraclass correlation coefficients. Longitudinal processing improved precision by 15-50% across most measures compared with cross-sectional processing, with the largest gain observed for entorhinal thickness. Larger, anatomically well-defined regions (e.g., hippocampus, AD signature) demonstrated higher reliability than small structures or those with complex geometry (e.g., entorhinal cortex, choroid plexus). Image quality, indexed by the Euler characteristic, was the only factor significantly associated with measurement variability; reliability was unrelated to age, sex, cognitive status, inter-scan interval, or amyloid/tau PET burden. Power analyses indicated that detecting a 1% within-individual change requires sample sizes ranging from 36 (AD signature) to >300 (entorhinal cortex). We observed low reliability of choroid plexus volumetry by FreeSurfer 7. These results provide practical benchmarks for expected FreeSurfer measurement variability in older adults. They highlight the advantages of longitudinal processing and rigorous quality control for research on brain aging and AD.

RATIONALE & OBJECTIVE/UNASSIGNED:Randomized controlled trials (RCTs) show that integrated palliative care can improve symptoms compared with usual care in many serious illnesses, yet there are no comparable RCTs in chronic kidney disease (CKD). STUDY DESIGN/UNASSIGNED:We conducted a pilot feasibility RCT comparing kidney palliative care (KPC) integrated with CKD care with usual CKD care. SETTING & PARTICIPANTS/UNASSIGNED:English and Spanish speakers aged ≥18 years with CKD stage IV and V, or receiving dialysis, seen at an urban safety-net hospital. EXPOSURES/UNASSIGNED:Participants were randomized to usual CKD care or to usual CKD care plus 6-monthly ambulatory KPC visits. OUTCOMES/UNASSIGNED:Primary outcomes were feasibility of recruitment, retention, intervention delivery, and data collection. Secondary outcomes included change in symptom burden at 6 months, measured by the Integrated Palliative Outcome Scale (IPOS)-Renal (lower scores represent lower burden), quality of life measured by the Kidney Disease Quality of Life 36-item survey, and engagement in advance care planning. ANALYTICAL APPROACH/UNASSIGNED:Feasibility outcomes are reported as proportions and clinical outcomes as descriptive summaries of change in scores. RESULTS/UNASSIGNED:Of the 146 people approached, 84 (56%) consented, 75 (89%) were randomized, and 57 (76%) completed the trial. 56% of participants were Hispanic and 32% were Black, with 49% on Medicaid and 13% uninsured. The mean age of participants was 61 years, and 31% were receiving dialysis. A mean of 4-6 intervention visits was attended. At 6 months, the intervention group had a 4.1-point decrease in IPOS score (standard deviation 13.4), whereas the mean IPOS score of the control group increased by 0.6 points (standard deviation 7.8) from baseline. LIMITATIONS/UNASSIGNED:Small sample size and limited number of providers to assess generalizability. CONCLUSIONS/UNASSIGNED:We demonstrate the feasibility of an RCT comparing integrated KPC with usual CKD care in a safety-net hospital. Although this study was not powered to detect significance in change of clinical outcomes, our findings suggest that there is value in testing KPC in efficacy trials and that these are feasible.

BACKGROUND:The role of maternal and fetal characteristics in determining kidney size in early childhood remains largely unexplored. This study aims to evaluate the association between birth weight and kidney size in children aged one to six years and explore other children and maternal determinants in a United States cohort. METHODS:We analyzed data from 892 mother-child pairs enrolled in the New York University Children's Health and Environment Study (CHES). Renal sonographic measurements were taken from one to six years of age. Kidney size outcomes included average kidney length, width, depth, total kidney volume (TKV), adjusted kidney length (kidney length/body length), and adjusted TKV (TKV/body surface area). Maternal determinants include age, demographic characteristics, pre-pregnancy BMI, lifestyle, pregnancy complications, and diet during pregnancy. Fetal determinants included sex, birth weight for gestational age z-score, and gestational age at delivery. Anthropometric z change and breastfeeding duration were also considered. Associations were examined using crude and covariate-adjusted linear mixed models. RESULTS:Birth weight z-score and anthropometric z change were observed positively associated with all measures except adjusted kidney length. Female children had smaller average kidney length and TKV, and breastfeeding duration was negatively associated with average kidney depth and TKV. Children of non-Hispanic Black mothers and parous mothers had smaller kidney measures. CONCLUSION/CONCLUSIONS:In NYU CHES, we found that early childhood kidney size measures were consistently influenced by birth weight z-scores and changes in postnatal weight gain z-scores. Additionally, we observed racial differences and the influence of breastfeeding duration on kidney size. TRIAL REGISTRATION/BACKGROUND:Not applicable.