Faculty Bibliography

Maternal mental health during the perinatal period has been linked to the development of infant emotion regulation capacity, largely through its impact on caregiver-infant interactions during the first year of life. The majority of studies have focused on the effects of maternal depression, even though maternal anxiety is more prevalent and its effects on infant outcomes are less well understood. The current study aims to 1) explore differences in infant affect and regulatory behaviors across two commonly implemented infant stress-induction paradigms and 2) evaluate the differential effects of depression and anxiety on infant regulatory behaviors. Six-month-old infants and their mothers (N = 126) completed two tasks remotely in the home: the Arm Restraint task and the Still-Face Paradigm. Maternal depression and anxiety symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) subscales. Within-person results indicated no significant associations among infant regulatory behaviors nor infant reactivity across the two paradigms. Additionally, no significant associations were found between maternal mental health and infant regulatory behaviors during the Still-Face Paradigm. However, higher EPDS composite scores were associated with fewer infant avoidance behaviors during the Arm Restraint task, and this result was driven by items on the anxiety subscale. These findings suggest that infant regulatory behaviors may differ depending on task used and may also be influenced by subclinical levels of maternal anxiety, but not maternal depression.

The social determinants of health (SDOH) framework has proven useful for research and practice in addressing the social causes of many health outcomes. However, its limitations may restrict its value as the world undergoes rapid ecological and social change. We argue that SDOH does not adequately incorporate rapidly changing or "far upstream" social processes (particularly social movements), the dialectics of social conflict and creative social innovation, or bidirectional causation. Ecosocial theory addresses some of these issues, yet dialectical frameworks offer additional insights during periods of rapid social change and disruption. The implications for research methods and practice are discussed. (Am J Public Health. Published online ahead of print September 18, 2025:e1-e9. https://doi.org/10.2105/AJPH.2025.308239).

INTRODUCTION/BACKGROUND:Long-term trajectories of plasma biomarkers in relation to incident traumatic brain injury (TBI) and whether TBI modifies associations of biomarkers with dementia risk are unknown. METHODS:), phosphorylated-tau181 (pTau181), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) measured from plasma collected in 1993 to 1995, 2011 to 2013, and 2016 to 2019. Linear mixed-effects models estimated biomarker trajectories associated with TBI and Cox proportional hazards models determined if TBI modified associations of biomarkers with incident dementia through December 31, 2020. RESULTS:NfL with incident dementia (p = 0.024). DISCUSSION/CONCLUSIONS:TBI alters trajectories of plasma biomarkers of neurodegeneration for approximately a decade after the injury and modifies associations of NfL with dementia risk. HIGHLIGHTS/CONCLUSIONS:Our findings provide evidence that TBI fundamentally alters trajectories of plasma biomarkers of AD-related pathology, neuronal degeneration, and astrogliosis for approximately a decade after the injury. Further, our findings also suggest that an incident TBI event adds to and interacts with ongoing neurodegenerative processes to increase the risk of later life dementia. These results suggest that the pathologic processes underlying post-TBI dementia are heterogeneous, that individuals with preclinical changes in neurodegenerative biomarkers may be more susceptible to TBI (i.e., that associations are bidirectional), or a combination thereof.

BACKGROUND:Early life is a critical period for brain development, laying the foundation for cognitive reserve. However, it remains unclear how various aspects of early life independently contribute to dementia risk, and whether these associations are modified by APOE ε4 genotype. PARTICIPANTS AND SETTING/METHODS:We used data from the U.S. Health and Retirement Study (HRS), a nationally representative cohort of older adults, followed from 2006 to 2020. Our sample included 8678 community-dwelling, dementia-free participants aged ≥ 60 and < 90 at baseline with data on APOE genotype and retrospective early life conditions. METHODS:Dementia incidence was classified using the validated Langa-Weir algorithm. Early life risk domains included financial capital, social capital, human capital, adversity, and health conditions. Cause-specific Cox proportional hazards models assessed the associations between these domains and incident dementia, adjusting for demographics and adulthood risk factors. To examine effect modification by genetic risk, we created 4-category group variables combining APOE ε4 status and early life risk. RESULTS:Deficits in financial, social, and human capital, as well as poor childhood health, were each associated with a 12%-46% increased dementia risk, independently of APOE ε4 status. After further adjusting for adulthood risk factors, low social and human capital remained significant predictors (16% and 21% increased risk, respectively). APOE ε4 was associated with an 83%-86% increased risk across all models. In effect modification analyses, early life disadvantage was associated with dementia only among non-carriers of APOE ε4, whereas ε4 carriers had elevated dementia risk regardless of early life conditions. CONCLUSIONS:Inadequate childhood resources may have enduring impacts on dementia risk among individuals without the APOE ε4 allele. Genetic predisposition via APOE ε4 overwhelms the influence of early life disadvantage. These findings underscore the need for dementia prevention strategies that jointly consider genetic vulnerability and early life conditions.

Despite progress to define primary care practice transformation models, there remain gaps in translating evidence-based guidelines into routine clinical care. Primary care providers (MD, DO, NP, PA) and researchers need tools to assess modifiable factors that improve practice performance to inform practice transformation efforts. We aimed to develop a pragmatic tool for assessing practice-level primary care structures and processes that are associated with better care quality and clinical outcomes. We generated 314 candidate items for the Tool for Advancing Practice Performance (TAPP) using data from a comprehensive literature review, Delphi study, and qualitative interviews with high-performing practices. We used empirical criteria and expert review to eliminate redundancy and improve clarity via removing and retaining items. The retained items were formatted into a survey tool, and we further revised the tool based on feedback elicited from cognitive interviews and pilot testing with primary care providers and staff. The final candidate pool comprised 126 items after refinement and expert review. For the survey tool, we adapted and developed survey questions for each of the 126 items. Eight cognitive interview participants reviewed the tool and provided feedback on its content and language. Based on this feedback, we eliminated 13 items because they were poorly or incorrectly understood by participants, resulting in a 113-item tool. Fifteen participants pilot tested the tool and no additional items were eliminated. The TAPP is a novel, low-burden tool that researchers and primary care providers can use to identify areas for improvement at the practice-level. Practices and health systems could use the TAPP to assess their own performance and identify gaps in their structures and processes, and practice networks and health systems can use the tool to assess structures and processes at individual clinics, track this information over time, and evaluate its relationship to care quality and clinical outcomes.

OBJECTIVES/UNASSIGNED:Caregivers may experience treatment burden as they care for persons living with dementia and diabetes. This study aims to adapt and validate the Treatment Burden Questionnaire (TBQ) for use among caregivers. METHOD/UNASSIGNED: = 311). The original patient-focused 15-item TBQ scale was adapted to measure caregiver-related burden. We assessed face validity for each item, performed item analysis, and computed the scale's internal consistency (Cronbach alpha). We also performed principal component analysis (PCA) and correlation to assess the construct and convergent validity, respectively. RESULTS/UNASSIGNED:All 15 items in the caregiver TBQ demonstrated face validity, had high acceptability, with a Cronbach alpha of 0.89. The PCA identified three domains-medication monitoring burden, healthcare access burden, and social care burden. Subscale domain reliability was 0.86, 0.77, and 0.77, respectively. The three subscales exhibited significant small to moderate correlations with the stress thermometer, Medical Outcomes Study, and physical and mental health Patient-Reported Outcomes Measurement Information System scores. CONCLUSION/UNASSIGNED:The caregiver TBQ is a reliable and valid tool that captures domains of medication monitoring, healthcare access, and social care burden.

BACKGROUND AND OBJECTIVES/UNASSIGNED:Burnout is a pervasive occupational hazard for neurologists-undermining their well-being, jeopardizing patient safety and satisfaction, limiting access to care, and inflating health care costs. Well-designed appreciation and recognition practices may help mitigate some of its key drivers. This pilot study evaluates faculty perspectives on appreciation strategies in an academic neurology department. We used the Moffitt Provider Appreciation Assessment (MPAA), which assesses the types of appreciation methods respondents value, regardless of whether those practices are currently implemented in their workplace. METHODS/UNASSIGNED:A cross-sectional survey was conducted among full-time clinical faculty in the Department of Neurology at NYU Grossman School of Medicine. The survey included demographics, the MPAA, the single-item Mini-Z burnout inventory to assess self-reported burnout levels, and an intent-to-leave question. MPAA responses were analyzed for frequencies, and the association between burnout and intent to leave was examined. RESULTS/UNASSIGNED:< 0.00001). Because the scores for self-reported burnout and intent to leave reflect current work conditions while MPAA scores capture enduring personal values, MPAA rankings cannot be compared directly with burnout or turnover metrics. DISCUSSION/UNASSIGNED:Neurology clinical faculty prioritized appreciation methods that directly address clinical work, underscoring the value of implementing tailored recognition practices that may reduce burnout. The methodology used in this pilot study can be adapted for broader application in other settings. After identifying faculty preferences, health care organizations can implement meaningful, transparent, and inclusive appreciation strategies that have the potential to strengthen physician relationships, promote well-being, and support a sustainable workforce.