Faculty Bibliography

BACKGROUND:Hearing loss is highly prevalent among older adults and has been associated with an increased likelihood of falling. We aimed to examine the effect of a hearing intervention on falls over 3 years among older adults in a secondary analysis of the ACHIEVE study. METHODS:The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study was a 3-year, unmasked, randomised controlled trial of adults aged 70-84 years at enrolment with untreated hearing loss and without substantial cognitive impairment. Participants were recruited at four US community-based field sites from two study populations: (1) an ongoing observational study of cardiovascular health (Atherosclerosis Risk in Communities [ARIC] study), and (2) de novo from the community. Participants were randomly assigned (1:1) to a hearing intervention (audiological counselling and provision of hearing aids) or a health education control (didactic education and enrichment activities covering chronic disease prevention topics). A prespecified exploratory outcome was falls. Self-reported falls in the past 12 months were assessed at baseline and annually for 3 years, and analysed by intention to treat with covariate adjustment. The study was registered with ClinicalTrials.gov, NCT03243422, and is completed. FINDINGS/RESULTS:Between Nov 9, 2017, and Oct 25, 2019, 3004 individuals were screened for eligibility and 977 (238 [24%] from the ARIC study and 739 [76%] de novo) were randomly assigned, with 490 (50%) in the hearing intervention group and 487 (50%) in the health education control group. Overall mean age was 76·8 years (SD 4·0), 523 (54%) participants were female and 454 (46%) were male, and 112 (11%) were Black, 858 (88%) were White, and seven (1%) were other race. In adjusted analyses, the intervention group had a 27% reduction in the mean number of falls over 3 years compared with the control group (intervention group: 1·45 [95% CI 1·28 to 1·61]; control group: 1·98 [1·82 to 2·15]; mean difference: -0·54 [95% CI -0·77 to -0·31]). This 3-year effect of hearing intervention was consistent across both the ARIC and de novo study populations. INTERPRETATION/CONCLUSIONS:Hearing intervention versus a health education control was associated with a reduction in the mean number of falls over 3 years in older adults. Ongoing follow-up of ACHIEVE participants in a separate follow-up study (NCT05532657) will enable examination of the longer term effects of hearing intervention on falls. FUNDING/BACKGROUND:US National Institutes of Health.

Unauthorized immigrants and permanent residents may experience challenges in accessing kidney transplantation due to limited healthcare access, socioeconomic and cultural barriers. Understanding the United States (US) national landscape of kidney transplantation for non-citizens may inform policy changes. To evaluate this, we utilized two cohorts from the US national registry (2013-2023): 287,481 adult candidates for first transplant listing and 190,176 adult first transplant recipients. Citizenship was categorized as US citizen (reference), permanent resident, and presumed unauthorized immigrant. Negative binomial regression was used to quantify the incidence rate ratio over time by citizenship status. Cause-specific hazards models, with clustering at the state of listing/transplant, were used to calculate the adjusted hazard ratio of waitlist mortality, kidney transplant, and post-transplant outcomes (mortality/death-censored graft failure) by citizenship category. The crude proportion of presumed unauthorized immigrants listed increased over time (2013: 0.9%, 2023:1.9%). However, after accounting for case mix and waitlist size, there was no change in listing over time. Presumed unauthorized immigrants were less likely to experience waitlist mortality (adjusted Hazard Ratio 0.54, 95% Confidence Interval: 0.46-0.62), were more likely to obtain deceased donor kidney transplant (1.11: 1.05-1.18), but less likely to receive live donor (0.80: 0.71-0.90) or preemptive kidney transplant (0.52: 0.43- 0.62). When stratified by insurance status, presumed unauthorized immigrants on Medicaid were less likely to receive deceased donor kidney transplants compared to their citizen counterparts; however, presumed unauthorized immigrants with Private insurance or Medicare were more likely to receive deceased donor kidney transplants. Presumed unauthorized immigrants were less likely to experience post-transplant death (0.56: 0.43-0.69) and graft failure (0.69: 0.57-0.84). Residents had similar pre- and post-transplant outcomes. Despite the barriers to kidney transplantation faced by presumed unauthorized immigrants and residents in the US, better post-transplant outcomes for presumed unauthorized immigrants compared to citizens persisted, even after accounting for differences in patient characteristics.

BACKGROUND:concentrations over 1998-2022 across the USA. METHODS:components with diameters below 1 μm were constrained by observations for four major components and from established scientific understanding for the other components. FINDINGS/RESULTS:ratio experienced simultaneous decrease (-0·0013 per year, p<0·0001). INTERPRETATION/CONCLUSIONS:. FUNDING/BACKGROUND:National Institute of Environmental Health Sciences, National Institutes of Health.

Text communication between newborns' caregivers and healthcare workers allows for real-time decisional guidance; however, its impact on neonatal health outcomes is unknown. Mobile WACh NEO (MWACh NEO) was a parallel, unblinded and individually randomized controlled trial at six health facilities across Kenya. Pregnant women at 28-36 weeks gestation were randomized (1:1) to the MWACh NEO intervention or standard of care. MWACh NEO delivered automated maternal and neonatal health text messages to participants up to 6 weeks postpartum and allowed free text communication with a nurse. This trial sought to determine if text communication decreased neonatal mortality. The analysis was intention to treat. From September 2020 until June 2022, 5,020 participants were enrolled and randomized. One hundred and thirty-six participants were excluded because of incomplete mortality data, leaving 2,442 participants in each group for the analysis. Eighty-three neonatal deaths occurred for a neonatal mortality rate of 18.8 per 1,000 live births in the intervention group and 15.2 per 1,000 live births in the control group, with a risk ratio of 1.25 (0.81, 1.91), P = 0.31. No adverse events related to the intervention were reported. Text communication did not decrease neonatal mortality compared to standard of care. Most neonates died before discharge from the facility. ClinicalTrials.gov registration: NCT04598165 .

BACKGROUND/UNASSIGNED:Systematic screening individuals with non-invasive devices may improve diagnosis of atrial fibrillation (AF) and reduce adverse clinical events. We systematically reviewed the existing literature to determine the yield of new AF diagnosis associated with systematic AF screening, the relative increase in yield of new AF diagnosis with systematic screening compared to usual care, and the effect of systematic AF screening on clinical outcomes compared with usual care. METHODS/UNASSIGNED:The Medline, Embase, Web of Science and Cochrane Library databases were searched from inception through 1st February 2025 for prospective cohort studies or randomised clinical trials (RCTs) of systematic AF screening with the outcome of incidence of previously undiagnosed AF from screening. Incidence rates (IR) and relative risks were calculated and random effects meta-analysis performed to synthesise rates of AF in prospective cohort studies and RCTs, as well as outcomes in RCTs. FINDINGS/UNASSIGNED:From 3806 unique records we included 32 studies representing 735,542 participants from 8 RCTs and 24 prospective cohorts. The diagnosis rate for incident AF in prospective cohorts was 2.75% (95% CI 1.87-3.62), and the pooled relative risk in RCTs was 2.22 (95% CI 1.41-3.50). The use of age and NT-proBNP (IR 4.36%, 95% CI 3.77-5.08) or AF risk score classification (4.79%, 95% CI 3.62-6.29) led to higher new AF diagnosis yields than age alone (0.93%, 95% CI 0.28-2.99). Pooled data from RCTs did not demonstrate an effect of screening on death (RR 1.01, 95% CI 0.97-1.05), cardiovascular hospitalisation (1.00, 95% CI 0.97-1.03), stroke (0.95, 95% CI 0.87-1.04) or bleeding (1.08, 95% CI 0.91-1.29). INTERPRETATION/UNASSIGNED:Systematic screening for AF using non-invasive devices is associated with increased diagnosis of AF, but not reduced adverse clinical events. Screening studies of AF utilising alternative risk stratifications and outcome measures are required. FUNDING/UNASSIGNED:British Heart Foundation (grant reference CC/22/250026) and National Institute for Health and Care Research.

BACKGROUND:This study aimed to explore whether patients' perception of procedural fairness in physicians' communication was associated with willingness to follow doctor's recommendations, self-efficacy beliefs, dietary behaviors, and body mass index. METHODS:(43.6% Black, 40.7% Hispanic/Latino, 55.8% female, mean age = 50 years), who enrolled in a weight management study in two New York City healthcare institutions. We conducted ordinary least squares path analyses with bootstrapping to explore direct and indirect associations among procedural fairness, willingness to follow recommendations, self-efficacy, dietary behaviors, and body mass index, while controlling for age and gender. RESULTS:Serial, multiple mediator models indicated that higher procedural fairness was associated with an increased willingness to follow recommendations which, in turn, was associated with healthier dietary behaviors and a lower BMI (indirect effect =  - .02, SE = .01; 95% CI [- .04 to - .01]). Additionally, higher procedural fairness was associated with elevated dietary self-efficacy, which was, in turn, was associated with healthier dietary behaviors and lower BMI (indirect effect =  - .01, SE = .003; 95% CI [- .02 to - .002]). CONCLUSIONS:These findings highlight the importance of incorporating procedural fairness in physician-patient communication concerning weight management in diverse primary care patients.

BACKGROUND:While a growing body of scientific literature suggests that evidence-based interventions may improve health outcomes in diverse settings, little is known about the best strategies for large-scale implementation. In Africa, music-an important positive social determinant of health-leverages existing cultural values, which may effectively enhance the reach, uptake, and long-term sustainability of evidence-based interventions in the region. To understand how music interventions work, why they are effective, and with whom they resonate, this systematic review aims to evaluate the quality and empirical application of music as an implementation strategy for adopting evidence-based interventions in Africa using the RE-AIM framework as a guide. METHODS:A comprehensive librarian-assisted search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five major electronic databases, EBSCOhost, PubMed, Web of Science, Embase, and MEDLINE, were searched for empirical studies focused on using music as an implementation strategy to improve health outcomes in Africa. Two independent investigators extracted components of retrieved papers using the RE-AIM framework as a guide. RESULTS:From 981 citations, eight studies met the inclusion criteria, each reporting a unique music intervention. The interventions were conducted in West Africa (n = 3), South African regions (n = 4), and East Africa (n = 1) and included seven observational studies and one randomized controlled trial (RCT). Using the RE-AIM scoring criteria, we summarize the RE-AIM dimensions reported from selected studies - Adoption (72.5%) being the highest, followed by Reach (62.5%), Implementation (41.7%), and Efficacy/Effectiveness (20.0%). All eight studies (100%) described the intervention location, the expertise of delivery agents, the target population, and the participant characteristics. Moreover, our analysis highlighted the effectiveness of music interventions in enhancing health outcomes, particularly in improving knowledge and awareness (62.5%), facilitating behavioral change (50%), and promoting mental health (25%). CONCLUSION/CONCLUSIONS:Music interventions adapted to the sociocultural context in Africa have the potential to help prevent diseases, improve well-being, and enhance health outcomes. Our review emphasizes the importance of customizing music-based interventions to fit the cultural context, which can enhance the programs' effectiveness, acceptance, and sustainability. Clinical trials are necessary to confirm the efficacy of music interventions in specific medical conditions and from a public health promotion perspective.

Mechanisms underlying the dynamic relationships of viral infections and neurodegeneration warrant examination. Using a community-based cohort of older adults, the current study characterized the neurocognitive (cognitive functioning, brain volumes, Alzheimer's disease positron emission tomography, and plasma biomarkers) and plasma proteomic (7268 proteins) profiles of four common coronavirus and six herpesvirus antibody titers. Genetic inference techniques demonstrated the associations between viral antibody titers and neurocognitive outcomes may be attributed to altered expression in a subset of mechanistically relevant proteins in plasma. One of these proteins, IGDCC4 (immunoglobulin superfamily deleted in colorectal cancer subclass member 4), was related to 20-year dementia risk, cognitive functioning, and amyloid-β positivity using data from two independent cohorts, while its plasma and intrathecal abundance were causally implicated in dementia risk and clinically relevant brain atrophy. Our findings illuminate the biological basis by which host immune responses to viruses may affect neurocognitive outcomes in older adults and identify IGDCC4 as an important molecular mediator of neurodegeneration.

BACKGROUND:E-cigarettes may serve as a safer alternative to combustible cigarettes and may be more effective than currently available nicotine replacement therapy (NRT). Little is known about the perceptions of using e-cigarettes as part of a smoking treatment program. The objective of this study was to gain insight into patient-level factors to consider when developing smoking treatment programs that incorporate e-cigarettes. METHODS:Qualitative analysis of in-depth interviews with 14 participants enrolled in the e-cigarette treatment arm of a tobacco treatment intervention pilot randomized trial comparing the impact of behavioral counseling paired with e-cigarettes or NRT on smoking outcomes. Participants were prompted to share their experiences with the products and the study overall. Transcripts were coded according to the principles of framework analysis for applied research. Codes were organized into themes using the principles of grounded theory. RESULTS:Themes suggest that while there is an eagerness to try e-cigarettes as a new tool for smoking cessation, there is apprehension regarding what it means to "quit" if switching to e-cigarettes. Reflecting on the transitional purpose of e-cigarettes and potential health concerns associated with their use, many participants differentiated between the short-term goal to quit combustible cigarettes and the long-term goal to quit e-cigarettes. CONCLUSIONS:Including e-cigarettes as an option in smoking treatment regimens may be an opportunity to re-engage people who smoke who have tried and failed to quit with other forms of treatment. Participants found it challenging to establish what it means to quit cigarettes with e-cigarettes due to addiction and other health concerns. Clear guidelines are needed for integrating e-cigarettes into smoking cessation programs. TRIAL REGISTRATIONS/BACKGROUND:ClinicalTrials.gov Identifier: NCT04465318.

BACKGROUND:During the COVID-19 pandemic, data collection activities largely became tele-remote, excluding those who did not have the required technology or digital literacy. METHODS:Between June and September 2020, we collected data in-person from people who use opioids in New York City. Participants were recruited via street intercept and outside four syringe service programs in the city. Surveys were conducted outdoors, with researchers and participants wearing masks and maintaining physical distance. RESULTS:A total of 329 people participated in the survey. Participants reported an average age of 45.8 years, 69.6% identified as male, 32.6% identified as Hispanic/Latino/a and 22.3% identified as Black. Many experienced unstable housing/street homelessness (65.9%) and half did not have regular smartphone access (51.1%). CONCLUSION/CONCLUSIONS:Many participants were struggling to meet their basic needs and did not have the resources to participate in tele-remote research or surveillance. In-person engagement may help researchers build trust, explain data security measures, and decrease technology and comprehension barriers. As data inform policies and programs, researchers must center equity by including under-engaged groups in data collection activities.