Faculty Bibliography

BACKGROUND/UNASSIGNED:Umbrella reviews, or overviews of reviews, synthesize information using systematic reviews (SRs) as their unit of analysis. Although a formal guideline exists for reporting umbrella reviews of healthcare interventions (i.e. Preferred Reporting Items for Overviews of Reviews [PRIOR]), no formal guideline exists for conducting and/or reporting umbrella reviews of observational studies that examine epidemiological associations. OBJECTIVE/UNASSIGNED:To review the existing guidance on conducting and/or reporting umbrella reviews of observational studies on epidemiological associations, as part of the process of developing a formal reporting guideline. METHODS/UNASSIGNED:We reviewed the scoping review conducted in the context of PRIOR development and identified documents through forward citation search in PubMed, Scopus, and manual search in Google Scholar, Google Search up to December 22, 2024. Documents, regardless of format, were included if they provided guidance for conducting and/or reporting umbrella reviews of observational studies (including meta-research studies of their features). Title/abstract screening and data extraction were performed independently and in duplicate and summarized narratively by stages of the umbrella review process. RESULTS/UNASSIGNED:The search retrieved 4491 unique records, with 96 full texts assessed and eight documents included. These documents, published between 2014 and 2023, offered guidance across seven topic areas, but overall guidance on conducting and/or reporting is limited. These areas include the answerable questions, prerequisite considerations, the scope of umbrella reviews, searching for SRs, primary data collection, analysis, presentation, and assessing the certainty/quality of the body of evidence. CONCLUSION/UNASSIGNED:There is a need for dedicated, practical, and evidence-based formal reporting guidelines for umbrella reviews of observational studies on epidemiological associations. This review lays the groundwork for developing the PRIOR-extension for such studies: the Preferred Reporting Items for Umbrella Reviews of Cross-sectional, Case-control, and Cohort Studies.

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.

When thoroughly assessed, the prevalence of attention-deficit hyperactivity disorder (ADHD) in children/adolescents is estimated at 5%. There is no evidence that ADHD is over-diagnosed in the UK. Indeed, available data point to under-diagnosis, even though rigorous updated post-COVID-19 pandemic data are not available. Some cases may be misdiagnosed due to low-quality assessment, poor adherence to national guidance or inappropriate differential diagnosis. Beyond the controversy around over- or under-diagnosis and over-medicalisation of ordinary behaviours or emotions, the main issue is that UK clinical services cannot adequately support individuals with ADHD who need help. There is a risk that the narrative claiming 'ADHD is over-diagnosed' could be used to deny people with properly-diagnosed ADHD the care they deserve.

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.

BACKGROUND:Research demonstrates the effectiveness of evidence-based psychological treatment adjunctive to pharmacotherapy for reducing mood symptoms in bipolar disorder. However, access to these treatments is limited, and innovative strategies are needed to ensure that more patients with bipolar disorder receive the gold-standard treatments that may help them achieve wellness. "Stepped care" models of psychological service delivery represent one potential solution to this problem of treatment access. Under a stepped care model, patients are assigned the minimum necessary psychological treatment for symptom improvement. This typically means that patients who are experiencing more symptoms are assigned to a treatment of greater intensity (e.g., weekly individual therapy) whereas patients who are experiencing fewer symptoms are assigned to a treatment of relatively lesser intensity (e.g., biweekly group therapy). Stepped care models are dynamic, meaning that the level of treatment can be modified depending on the patient's response. Stepped care models have been explored in other clinical populations but require further exploration in bipolar disorder. METHODS:Members of the Psychological Interventions Task Force for the International Society of Bipolar Disorders conducted a narrative review of stepped care models and their application to bipolar disorder. RESULTS:We found evidence that stepped care models are useful approaches to delivering psychosocial treatments for bipolar disorder. We discuss several contextual factors in executing stepped care models in this population (i.e., cultural and pediatric applications), as well as share an example of a stepped care model-Focused Integrated Team-based Treatment for Bipolar Disorder (FITT-BD)-that is currently being evaluated in an academic medical center. CONCLUSION/CONCLUSIONS:Further research is warranted to develop and assess robust stepped care models to determine whether they can improve access to treatment of bipolar disorder while not sacrificing outcomes.

OBJECTIVES/OBJECTIVE:Adolescents transitioning from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) may face challenges in accurately identifying and reporting their mental health symptoms, often leading to discrepancies between clinician and patient evaluations. Using data from the MILESTONE project, this study aims to assess clinician-adolescent concordance over 24 months and identify domains of psychopathology with the highest disparities. METHODS:Participants were assessed at baseline, 9, 15, and 24 months using the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) scale and were categorized in four diagnostic groups. Hierarchical cluster analysis identified symptom-based subgroups of patients based on clinician and patient-rated HoNOSCA scores. Concordance was evaluated through multilevel linear regression models, while Bland-Altman plots examined agreement between scores across time points. RESULTS:Two clusters of patients were identified: one characterized by lower severity and greater prevalence, the other by higher complexity and fewer individuals. Clinician-patient concordance increased over time, rising from 77% to 83% by the second time point and stabilizing. Concordance varied across diagnostic categories, with anxiety showing the highest agreement and ADHD the lowest. CONCLUSIONS:Improved communication, psychoeducation, and tailored interventions may facilitate greater patient-clinician alignment, thereby supporting more favorable outcomes during this critical developmental period. TRIAL REGISTRATION/BACKGROUND:ISRCTN83240263; NCT03013595.

BACKGROUND:The COVID-19 pandemic exacerbated challenges faced by pregnant women, introducing new risks and intensifying existing disparities, particularly among those routinely experiencing race- and ethnicity-based discrimination. It remains unclear how the pandemic affected perceptions of perinatal quality of care (QoC). OBJECTIVES/OBJECTIVE:To explore mothers' experiences of pregnancy, birth, and the early postpartum period during the early COVID-19 pandemic, attending to both health care encounters and to the broader structural and social forces shaping those experiences. DESIGN/METHODS:The COVID-19 Mother Baby Outcomes (COMBO) Initiative is a longitudinal, prospective cohort study investigating maternal-child outcomes among women from a predominantly low socioeconomic status, Latinx community in New York City who delivered during the pandemic. This qualitative substudy analyzed a subset of participants using modified grounded theory. METHODS:Semi-structured interviews explored perinatal and pandemic experiences, perceptions of inequitable or poor treatment, and protective factors among 64 participants purposively sampled from the parent cohort. Analysis focused on 48 transcripts highlighting discrimination-related themes, which were transcribed and systematically coded using both inductive and deductive approaches. RESULTS:phenomenon. CONCLUSION/CONCLUSIONS:Giving birth during the pandemic worsened perceptions of perinatal QoC, with discrimination compounding negative experiences. Findings underscore the link between care quality and trust in medical institutions, highlighting the need for evidence-based crisis protocols that both reduce unnecessary risk while preserving patient agency, particularly for marginalized populations. The pandemic exposed longstanding structural inequities, presenting an opportunity to address these patient-level manifestations and strengthen support for populations facing systemic barriers.

INTRODUCTION/BACKGROUND:The long-standing cholinergic hypothesis posits that cholinergic signaling is uniformly deficient in Alzheimer's disease (AD) and Down syndrome (DS). We tested the hypothesis that this deficiency occurs primarily late in disease, while early stages involve excessive cholinergic signaling, with distinct implications for memory. METHODS:Tg2576 (AD model; n = 38), Ts65Dn (DS model; n = 14), and wild-type (WT; n = 17) mice at young (3 to 4 months) and old (>14 months) ages received treatments to reduce cholinergic signaling (medial septum chemogenetic inhibition, muscarinic antagonist scopolamine) or enhance it (acetylcholinesterase inhibitor donepezil). Memory assessments used novel object recognition. RESULTS:Anticholinergic manipulations restored memory in young Tg2576 and Ts65Dn mice but impaired age-matched WT mice. Conversely, donepezil improved the memory of old Tg2576, Ts65Dn, and WT but not young Tg2576 and Ts65Dn animals. DISCUSSION/CONCLUSIONS:These findings refine and challenge the cholinergic hypothesis, revealing for the first time a functional shift from cholinergic hyperactivity driving early cognitive impairment to late-stage degeneration requiring enhancement.