Faculty Bibliography

According to the family stress model (FSM), economic stressors undermine optimal child development through negative impacts on parent psychological well-being and family relationships, which in turn disrupt positive parenting. However, few studies have examined the role of interparental conflict among these pathways and the resilience factors that buffer the FSM processes. Understanding risk and resilience is especially relevant for families in Flint, MI, for whom poverty resulting from structural racism and chronic disinvestment has coincided with public health crises. Using 199 families from low socioeconomic backgrounds in an ongoing parenting intervention in Flint, this study examined whether parent psychological distress and interparental conflict mediated the association between economic pressure at baseline (around birth) and cognitive stimulation at 9 months, and whether parenting self-efficacy and social support moderated the sequential mediation. Data were collected through parent interviews at both time points. We found that the negative association between economic pressure at baseline and cognitive stimulation at 9 months was sequentially mediated by parent psychological distress and interparental conflict. Furthermore, this negative sequential mediation was reduced and became nonsignificant when parents reported higher levels of parenting self-efficacy and social support. These findings suggest that improving interparental relationships in addition to parent mental health may promote positive parenting in at-risk two-parent families and that strength-based interventions are needed to reinforce parenting self-efficacy and facilitate parents' social networks and connections with the community to foster positive parenting. Programs should address these issues during infancy to build a strong foundation for long-term healthy development. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

OBJECTIVES/OBJECTIVE:In mild traumatic brain injury, imaging biomarkers are needed to support clinical management. In four antecedent publications, we used two new (sodium and fingerprinting) and two established (spectroscopy and diffusion) MR techniques in a longitudinally followed patient cohort. Here we report final results and combine all data to determine which marker(s) from the four modalities offer the greatest utility for detecting injury and predicting outcomes. We also leverage the independent specificities offered by each modality to explore injury mechanisms. MATERIALS AND METHODS/METHODS:The longitudinal spectroscopy data were analysed to complete a full data set of proton (spectroscopy, fingerprinting, diffusion) and sodium MRI, acquired alongside symptomatic, cognitive, and functional assessments in 27 patients at 1, 3, and 12 months following injury. Twenty-three matched controls were scanned once. Testing for associations between nine MR markers and three outcome measures was standardized across the entire data set, and performed using Spearman correlations and logistic regression. RESULTS:from fingerprinting (marker of the cellular microenvironment). CONCLUSIONS:We identified independent, dynamic, metabolic and ionic changes, with choline and creatine from spectroscopy fulfilling the most criteria for a clinical biomarker.

PURPOSE OF REVIEW/UNASSIGNED:As the overdose crisis evolves, it is important to monitor fentanyl consumption patterns. This review provides an overview of recent findings regarding illegally manufactured fentanyl (IMF) availability, use, and associated harms in the US. RECENT FINDINGS/UNASSIGNED:Availability of IMF has increased, especially in pill form, and the increasing adulteration of IMF with veterinary tranquilizers such as xylazine complicates overdose response. Prevalence in the general population based on self-reported IMF use is rare, and likely underestimated. Transitions from injection to smoking have been documented in recent years, particularly in the western US. Fentanyl-stimulant polysubstance use has also been observed increasingly among IMF-related overdose deaths. SUMMARY/UNASSIGNED:Shifts in routes of administration, availability of counterfeit pills containing fentanyl, and common adulterants add complexity to the landscape of IMF use and related harms. Additional data is needed for monitoring changes in consumption patterns to inform prevention and harm reduction efforts.

BACKGROUND:Inappropriate imaging to stage low-risk prostate cancer is considered low-value care. Determining the effectiveness of a theory-based intervention, Prostate Cancer Imaging Stewardship (PCIS), to promote guideline-concordant imaging. METHODS:A stepped-wedge, cluster-randomized trial, PCIS, was conducted between March 2018 and March 2021 at ten Veterans Health Administration medical centers (VAMC) initially selected for prostate cancer volume, geographic diversity, and willingness to participate. Intervention initiation at sites were randomized in 3-month intervals. We enrolled 61 urology providers who treat prostate cancer at participating sites. Outcomes were assessed among 2,302 patients with incident prostate cancer aged 18-85 years. PCIS combines three evidence-based provider-focused behavior change strategies: 1) Clinical Reminder Order Check triggered when a provider attempted to order imaging for a patient with PSA < 20ng/mL; 2) VAMC-level academic detailing at initiation and every three months thereafter; 3) Audit and Feedback for providers to improve their imaging performance. The main outcome was guideline-discordant nuclear medicine bone scan (NMBS) imaging for low-risk prostate cancer patients. RESULTS:NMBS imaging would be consistent with National Comprehensive Cancer Network guidelines in 878 patients (38%) and inconsistent in 1424 patients (62%). Among patients not requiring NMBS, 141/690 (20.4%) received guideline-discordant imaging (ie, NMBS ordered) during Control compared to 109/734 (14.9%) during Intervention (OR = 0.54, p = .04). Among patients requiring a NMBS, 29/425 (6.8%) did not receive one (ie, guideline-discordant imaging) during Control compared to 25/453 (5.5%) during the Intervention (OR = 1.36, p = .36). CONCLUSION/CONCLUSIONS:PCIS significantly reduced low-value, guideline-discordant NMBS imaging among low-risk prostate cancer patients without negatively affecting necessary imaging for high-risk patients. CLINICAL TRIALS REGISTRATION/BACKGROUND:NCT03445559.

BACKGROUND/UNASSIGNED:Infections are a major cause of hospitalization in people with chronic kidney disease (CKD), with incidence similar to cardiovascular disease, yet the risk of infection has not been systematically studied across stages of CKD. METHODS/UNASSIGNED:We conducted a meta-analysis of individual participant data including 1,246,912 individuals across 47 cohorts in the CKD Prognosis Consortium, with information on estimated glomerular filtration rate based on serum creatinine (eGFRcr) and urinary albuminuria (ACR) (or proteinuria converted to ACR), to examine the association of eGFR and ACR with the risk of hospitalization with infection. Outcomes were ascertained through diagnostic codes on hospital discharge records relevant to acute infections (i.e., upper and lower respiratory tract, urinary tract, skin and soft tissue, musculoskeletal, gastrointestinal tract, genital, nervous system, and cardiovascular system infections, and sepsis). Follow-up was censored on December 31, 2019 or on the last date of cohort follow-up, whichever was earlier. Multivariable Cox models were used to estimate hazard ratios (HRs). FINDINGS/UNASSIGNED:in eGFR and 1.48 [1.44-1.53] per 8-fold increase in ACR). INTERPRETATION/UNASSIGNED:Lower kidney function and higher albuminuria were independently associated with higher risk of infection. The risk was elevated even in mild to moderate CKD, with the highest risk seen in the most advanced stage of CKD. Infection prevention measures should target individuals across all CKD stages. FUNDING/UNASSIGNED:US National Kidney Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases.

BACKGROUND/UNASSIGNED:A lack of disease-related consensus measures for type 2 diabetes interventions is a barrier to comparing interventions across various contexts, as well as to implementation and scale-up. This study aimed to use an expert consensus approach to select disease-related measures for type 2 diabetes to facilitate cross-contextual research, as well as the implementation and scaling-up of initiatives. METHODS/UNASSIGNED:The study was conducted using a two-phased cross-sectional design consisting of an online survey among research experts in 17 diabetes projects working in a global context, followed by an online modified Delphi panel comprised of reviewers with domain-specific expertise from different income settings who were not survey participants. RESULTS/UNASSIGNED:Out of 153 measures from 11 domains assessed, 49 were classified as core, 58 as optional, and 46 were excluded. The domains and measures spanned several categories, including demographics, medical history, medication adherence, health behaviors, anthropometric measures, biochemical measures, and quality-of-life-related issues. CONCLUSION/UNASSIGNED:The core dataset of selected measures in type 2 diabetes may provide a standardized approach for determining which data should be collected. This can facilitate transnational comparisons between or within implementation projects to advance global diabetes research.

IMPORTANCE/UNASSIGNED:Total particulate matter with a diameter of 2.5 µm or less (PM2.5) has been found to be associated with adverse posttransplant outcomes among kidney transplant (KT) recipients. However, PM2.5 is a complex mixture of multiple constituents, all of which have different toxicity profiles, so it is not clear which constituents are most associated with adverse outcomes among KT recipients. OBJECTIVE/UNASSIGNED:To investigate the associations between PM2.5 constituents and post-KT outcomes among KT recipients. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cohort study was conducted among patients who received a KT between January 2000 and December 2016 and lived in the contiguous United States. Follow-up continued through December 2021, and data were analyzed from August 2023 to May 2025. EXPOSURES/UNASSIGNED:Fifteen PM2.5 constituents (including elemental carbon, ammonium, nitrate, organic carbon [OC], sulfate [SO42-], bromine, calcium, copper, iron, potassium, nickel [Ni], lead [Pb], silicon, vanadium, and zinc) at the zip code of residence prior to KT, estimated from ensembled machine learning models. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Adverse post-KT outcomes included acute rejection, delayed graft function (DGF), death-censored graft failure (DCGF), and mortality. The association of PM2.5 constituents and the outcome were evaluated with weighted quantile sum regressions. RESULTS/UNASSIGNED:In total, 192 587 KT recipients were included in the analysis (mean [SD] age at transplant, 51.56 [13.47] years; 75 021 [39.0%] female; 51 455 [26.7%] Black, 28 586 [14.8%] Hispanic, and 97 927 [50.8%] White). Each decile increase in the PM2.5 constituent mixture was associated with a 6.8% (95% CI, 5.8%-7.8%) and 3.6% (95% CI, 2.1%-5.1%) increase in the odds of DGF and acute rejection, respectively. OC and Ni contributed the largest weights to the observed association between PM2.5 mixture and DGF (OC: relative importance, 35.6%; Ni: relative importance, 34.4%), while Pb had the largest impact on acute rejection (relative importance, 75.0%). Each decile increase in PM2.5 constituent mixture was associated with a 4.7% (95% CI, 3.3%-6.3%) and 3.9% (95% CI, 2.5%-5.2%) increase in the hazard of DCGF and all-cause mortality, respectively. The constituent that contributed the largest weight to the observed association between PM2.5 mixture and long-term post-KT outcomes was SO42- (relative importance, 51.3%). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this cohort study, PM2.5 constituents were associated with an increased risk of adverse posttransplant outcomes among KT recipients. Of the PM2.5 constituents included in this study, SO42- contributed most to long-term outcomes, while Pb, OC, and Ni were more associated with short-term outcomes.

BACKGROUND:Global temperatures and extreme heat events are worsening due to climate change and have been associated with adverse health outcomes. However, studies in low- and middle-income countries (LMICs) are rare, and there has been limited research on the combined effects of heat and relative humidity despite strong physiological evidence. METHODS:We examined 340,758 cardiovascular disease (CVD) emergency department (ED) visits in Dhaka during summer months from 2014 to 2019. Meteorological data on temperature, relative humidity (RH), and precipitation were collected from the Bangladesh Meteorological Department. We fitted time-series regression models on CVD ED data to assess the effects of heat and RH, both individually and in interaction. All models were adjusted for potential time-varying confounders. RESULTS:Exposure to heat was associated with 7.9 % (95 % CI: 4.6 to 11.3 %) excess risk of CVD ED. No association was observed between RH and CVD ED. However, the effect size of heat increased linearly with increasing RH and culminated in a 6-fold increase in excess risk on the most humid days (RH ranges between 82 and 97 %) as compared to days with normal humidity (RH ranges between 34 and 69 %) [excess risk 26.7 % (20.2 to 33.7 %) vs 4.4 % (0.4 to 8.6 %)]. Results held across several sensitivity analyses. No significant risk effect differences were observed for age or sex group in stratified analyses. CONCLUSIONS:This study provides novel and alarming evidence that high RH compounds the effect of heat on cardiovascular health, which underscores the importance of considering these factors together in clinical advice and in the assessment and development of policies addressing climate change at local, regional, and global levels.

BACKGROUND:Hypertension (HTN) is the leading cause of cardiovascular morbidity and mortality among people living with HIV (PLWH) in Africa, yet integration of hypertension treatment in HIV clinics is sub-optimal. Cost-effective strategies to implement evidence-based hypertension care for this population are urgently needed to preserve the life-expectancy gains of antiretroviral therapy. METHODS:Building on insights gained from a comprehensive mixed-methods formative assessment, we used a human-centered design approach to develop a multi-component HIV-HTN integration (HTN-PLUS) strategy. In a stepped-wedge cluster randomized trial, we are assessing the effectiveness, costs, and implementation of HTN-PLUS as well as a less resource intensive strategy of providing HTN medication and blood pressure cuffs (HTN-BASIC) free of charge to clinics. The trial is being conducted in 16 public and private not-for-profit HIV clinics in Kampala and Wakiso districts in Uganda. The co-primary effectiveness outcomes are population BP control (screened and documented BP < 140/90 mmHg) and HTN patient BP control [BP < 140/90 mmHg among PLWH with HTN]. The trial is designed to have > 80% power to detect a 12%-point increase in both outcomes compared to the pre-implementation control period across a range of scenarios of baseline hypertension prevalence and temporal improvements in the control period. At two pre-specified time points, we are conducting a Learn-As-You-Go optimization analysis and will adapt the HTN-PLUS strategy accordingly. To assess implementation outcomes, we have enrolled a prospective longitudinal mixed-methods cohort study of clinic health workers and PLWH with HTN. An extensive economic evaluation will include time and motion studies, facility-based costing, and out-of-pocket cost surveys to determine costs and cost-effectiveness from a societal perspective. DISCUSSION/CONCLUSIONS:Innovative implementation strategies to integrate evidence-based hypertension care for PLWH in Africa must be informed by the health workers and PLWH who are cared for across diverse HIV clinics. These clinics currently provide high quality HIV care as evidenced by high rates of HIV viral suppression but often lack the knowledge, skills and resources to provide HTN care. Funders and policymakers critically need to know both the effectiveness and costs to scale these strategies and potentially expand them to include other non-AIDS comorbidities. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT05609513. Registered on November 11, 2022.