Adelphi University

Background The aging population in the USA is projected to increase significantly, with a corresponding rise in dementia cases, particularly among racial minorities. This study examines the key drivers of racial disparities in dementia risk among older Black adults in the St. Louis area, a region characterized by entrenched structural racism. Utilizing a Community-Based System Dynamics (CBSD) approach, we engaged cognitively normal Black adults (age ≥ 45) to explore the complex interplay of social and structural determinants of health (S/SDOH) affecting dementia risk. Methods Eight CBSD workshops were conducted, during which participants identified and analyzed various factors influencing dementia risk through group model-building techniques. These workshops revealed multiple reinforcing and balancing feedback loops, highlighting the intricate relationships between trauma, health literacy, social isolation, education, healthcare access, and systemic racism. Results There were 59 participants with an average age of 64, a majority of women (88%) and college-educated (15.9 years) residing in areas with moderately severe deprivation. The resulting Causal Loop Diagrams underscored the impact of poverty, discrimination, and limited access to quality education and healthcare on dementia risk across the lifespan. Participants proposed actionable interventions, including health information campaigns, community mobilization, and improvements in public transportation and healthcare accessibility. Conclusion This study emphasizes the necessity of addressing S/SDOH to mitigate dementia risk among Black Americans. The findings call for targeted public health initiatives and policy changes to improve socioeconomic conditions and reduce racial disparities in dementia outcomes.

For two weeks in July 1967, several thousand people attended the International Congress on the Dialectics of Liberation in London, a sprawling event that is now largely remembered as a point of convergence for an unlikely roster of prominent radical intellectuals—Stokely Carmichael, Allen Ginsberg, Paul Goodman, and Herbert Marcuse among them. This article uses a broad array of sources to present the congress as a mass counterinstitution in which a variety of social actors—including not only the invited speakers, but also conference organizers and audience members—struggled to establish nonauthoritarian forms of knowledge production. The record of these efforts, and in particular the audience's demand to participate directly in the production and exchange of ideas, illuminates the ways in which radical intellectuals' challenge to dominant institutions in the global North during the late 1960s threatened to undermine their own discursive authority.

Importance Sex disparities in physical activity (PA) and sports participation among US children and adolescents have been persistent. Quantifying the impact of reducing or eliminating these disparities may help determine how much to prioritize this problem and invest in interventions and policies to reduce them. Objective To quantify what might happen if existing PA and sports participation disparities were reduced or eliminated between male and female children and adolescents. Design, Setting, and Participants This simulation study used an agent-based model representing all children (aged 6 to 17 years) in the US, their PA and sports participation levels, and relevant physical and physiologic characteristics (eg, body mass index) as of 2023. Experiments conducted from April 5, 2024, to September 10, 2024, simulated what would happen during the lifetime of each cohort member if PA and sports participation levels for female participants were increased (to varying degrees) to match male participants in the same age group. Main Outcomes and Measures Health outcomes, such as body mass index, incidence of weight-related conditions (eg, stroke, coronary heart disease, type 2 diabetes, and cancer), and economic outcomes (eg, direct medical costs and productivity losses). Results This simulation study modeled 8 299 353 US children and adolescents (4 240 119 [51.1%] male and 4 059 234 [48.9%] female) aged 6 to 17 years. Eliminating PA sex disparities averted 28 061 (95% CI, 25 358-30 763) overweight and obesity cases per cohort by age 18 years, which in turn averted 4869 (95% CI, 4007-5732) weight-related disease cases during their lifetimes and resulted in recurring savings of $333.45 million (95$290.22 million to $376.68 million) in direct medical costs and$446.42 million (95% CI, $327.39 million to$565.44 million) in productivity losses (in 2024 US dollars) for every new cohort of 6- to 17-year-olds. Reducing PA disparities by 50% averted 9027 (95% CI, 6942-11 112) overweight and obesity cases. Eliminating sex disparities in sports participation averted 41 499 (95% CI, 37 874-45 125) cases of overweight and obesity and 8939 (95% CI, 8088-9790) weight-related disease cases during their lifetimes, generating recurring savings of $713.48 million (95$668.80 million to $758.16 million) in direct medical costs and$839.68 million (95% CI, $721.18 million to$958.18 million) in productivity losses. Conclusions and Relevance In this simulation study of youth PA and sports participation, eliminating sex disparities could save millions of dollars for each new cohort of 6- to 17-year-olds, which could exceed the cost of programs and investments that could enable greater equity.

Although obsessive compulsive disorder (OCD) features maladaptive decision-making, previous research that examined economic decision-making in OCD has yielded inconsistent results. Here, we examined whether unmedicated adults with OCD ( n = 268) differ from healthy control subjects (HCSs; n = 256) on two measures of decision-making about potential rewards: (a) delay discounting, the tendency to prefer rewards sooner rather than later, even if the delayed reward is larger, and (b) risk tolerance, the willingness to gamble for uncertain rewards when the risk is known. Data were collected in Brazil, India, the Netherlands, South Africa, and the United States as part of the Global OCD study. After controlling for age, sex, education, socioeconomic status, IQ, and site, individuals with OCD did not differ from HCSs in either delay discounting or risk tolerance. However, patients with OCD who reported more anxiety and depression showed higher delay discounting, or a relative preference for immediate rewards.

The American social and political climate has become increasingly polarized. To explore the effects of politically based ingroup biases as they relate to intended helping of others, we designed a study in which we hypothesized that people who are extreme on the political spectrum will intend to help in-group members more so than out-group members. Using an experimental manipulation, we asked participants to choose if extremely progressive (N = 212; mean age = 22.9; 69% female), extremely conservative (N = 47; mean age = 32.8; 55% male), or neither represented their political beliefs. Participants were randomized to one of two vignettes, each depicting either a pro-blue lives matter or pro-black lives matter scenario. Results showed that, controlling for both age and gender, progressives were less likely to help out-group members compared with individuals in any other condition. Dispositional variables were also measured with dark and light triad traits. Light triad traits tended to positively predict helping intentions across conditions. Implications for understanding the psychology of helping are discussed.

The worldwide prevalence of disasters exposes students, staff, and faculty at colleges and universities to multiple disasters, potentially impacting their mental health. This study investigates the influence of cumulative disasterrelated stressors on depression among 1,497 higher education participants. Results from modified Poisson regression analyses reveal that individuals exposed to cumulative stressors (COVID-19 and Hurricane Sandy) have a higher prevalence of depression (PR 4.20; 95% CI: 1.45–6.12) compared to those without such exposure. The relationship was confounded when disaster preparedness knowledge factors (specifically, medication and grocery delivery knowledge) were added to the model (PR 3.75; 95% CI: 1.36–5.47). These results underscore the importance of integrating disaster preparedness knowledge into mental health interventions for the higher education community. Adapting interventions based on individual preparedness knowledge levels, especially for students and staff, can be a critical strategy in mitigating the impact of disasters on mental health in higher education settings.

Background: The risk of stroke in Adult Congenital Heart Disease (ACHD) is well established. However, the prevalence and impact of stroke in young ACHD-related admissions stratified by median household income remain underexplored. Methods: The National Inpatient Sample (2019) was utilized to identify the rate of stroke admissions among young (18-44 years) ACHD patients. We also evaluated comorbidities and outcomes (all-cause mortality [ACM], length of stay [LOS], disposition,&charges) based on the median household income quartiles and compared two cohorts of lowest (0-25th percentile) and highest (75-100thpercentile) median household income (LMHI vs HMHI). Results: Of 41950 young (18-44 years) ACHD patients, 5360 patients had stroke (12.8%). Patients in the LMHI group were relatively older (median age 36 years vs 35 years) and had a greater proportion of males (53.8% vs 46.0%) when compared to patients in the HMHI group. Patients admitted with stroke were of greater proportion in the LMHI group (13.2% vs 12.1%) compared to the HMHI group. Comorbidities like alcohol abuse (4.7% vs. 2.3%), depression (9.8% vs. 7.0%), hypertension (13.0% vs. 5.6%), obesity (21.2% vs. 18%), drug abuse (12.3% vs 4.2%), and tobacco use disorder (30.4% vs 11.2%) were higher for LMHI when compared to HMHI. Regarding in-hospital outcomes, ACM (3.7 vs. 1.9%) and discharge to home (71.6 vs. 66.5) were higher with HMHI, whereas the LMHI cohort demonstrated fewer routine discharges, higher transfers to other facilities, and prolonged LOS (5 vs. 3 days, p<0.001). When adjusted for confounders, there were statistically higher odds of AIS in ACHD patients from the LMHI group vs. the HMHI group [aOR 1.33; 1.02-1.74; p=0.045]. However, no association of income quartile with overall stroke risk was observed. Conclusion: The prevalence of stroke is significantly higher in the LMHI group. When controlled for confounders, there was a higher risk of AIS without any impact on overall stroke. Furthermore, the lowermost income quartile was associated with fewer routine dispositions, and frequent transfers can further adversely increase healthcare inequalities and healthcare costs.

Background: A higher stress hyperglycemic ratio (SHR) has been reported to be associated with adverse cardiac outcomes. However, the role of SHR in predicting clinical outcomes by comparing patients with and without diabetes mellitus is yet to be explored. Objective: To evaluate the prognostic value of the SHR for predicting major adverse cardiovascular (MACE) and all-cause mortality in ACS patients with and without diabetes mellitus. Methods: Per PRISMA guidelines, we comprehensively reviewed PubMed, Google Scholar, and SCOPUS for eligible studies reporting on SHR and its association with MACE (8 studies) and all-cause mortality (7 studies) in ACS patients. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a binary random-effects model, with results displayed as forest plots. Heterogeneity was assessed using I2 statistics, and a leave-one-out sensitivity analysis was performed. P<0.05 was considered significant. Results: A total of 15 studies with 45,774 patients with ACS were included in the analysis. The majority of patients were males (72.6%) with a mean age of 62.8 years. High SHR was associated with higher odds of MACE (1.93 [1.54–2.42]) and all-cause mortality (1.91 [1.58–2.31]) (Fig. 1). Subgroup analysis revealed increased odds of all-cause mortality (1.69 [1.34–2.11] for patients with diabetes vs 2.12 [1.65–2.71] for patients without diabetes) and MACE (1.60 [1.30–1.97] for patients with diabetes vs 1.44 [1.28–1.62] for patients without diabetes), all p<0.01. (Fig. 2). Additionally, the leave-one-out sensitivity analysis demonstrated that excluding any particular study did not significantly affect outcomes (p<0.05). Conclusions: In patients with ACS, SHR is an independent predictor of MACE and all-cause mortality, irrespective of diabetes status. Strict glycemic control strategies may improve outcomes in this high-risk population. These findings underscore the importance of early recognition and management of stress hyperglycemia in ACS patients.

Introduction: Obesity-related heart failure in patients is often associated with high symptom burden. However, no treatments have been proven to specifically target obesity-related heart failure with preserved ejection fraction (HfpEF). Objective: The objective of this study is to evaluate the efficacy of semaglutide in patients with obesity and HfpEF. Methods: The study was by the PRISMA guidelines. Studies reporting endpoints of semaglutide in patients with obesity and HfpEF were included. The outcomes included percentage weight change and adjudicated heart failure events. Both random and common effects models were used for the data analysis. The random intercept logistic regression model was used to compute the proportions, and the Peto method was used to compute the odds ratios. A p-value ≤ 0.05 was considered significant. Results: In total, three studies with 1463 patients with obesity and HfpEF were included in the study. The mean age of the patients was 68.8 ± 3.47 years. 50.7% of the patients were females. Patients who received Semaglutide had statistically higher odds of 10% weight reduction (OR 6.35; 1.54-26.21; p<0.00001) and 15% weight reduction (OR 9.44; 2.91-30.60; p<0.0001) when compared to placebo. Additionally, patients who received Semaglutide had lower odds of adjudicated heart failure event (OR 0.32; 0.15-0.67; p=0.35) when compared to patients on placebo. Conclusion: Our study demonstrates that semaglutide is significantly effective in reducing weight and potentially lowering the risk of heart failure events. This suggests that semaglutide could be a promising therapeutic option for managing obesity-related HfpEF. However, we need large-scale studies to confirm these benefits.

Introduction: Seasonal variations, particularly cold weather, can increase the risk of acute coronary syndrome, as evidenced by various studies over the years. On the other hand, hot weather can cause dehydration, electrolyte imbalances, and thermoregulatory strain on the heart, leading to adverse cardiac events. In recent years with rising concerns about global warming, we aim to study the impact of climate changes during the summer on outcomes among people hospitalized with ACS. Methods: We used the National Inpatient Sample from 2016 to 2020 to identify young adults hospitalized with ACS using appropriate ICD-10 codes. Patients were categorized into two cohorts: summer (hospitalizations during June, July, and August) and non-summer (hospitalizations during other months). The outcomes studied were ACS hospitalizations and in-hospital mortality. Pearson chi-square tests and the Mann-Whitney U test were used for cohort comparisons. Results: Of 230,555 ACS hospitalizations, 26.2% (n=60,340) occurred during the summer months, with a median age of 40 years. White individuals had higher hospitalization rates compared to others (57.8% vs. 58%), and those from lower socioeconomic statuses had higher ACS hospitalizations in both cohorts (37.5% vs. 38.1%). Comorbidities like hypertension, diabetes, and hyperlipidemia were lower in the summer cohort (all p<0.001). The rates of in-hospital death were higher in the summer cohort compared to the non-summer cohort (4.7% vs. 4.5%, p=0.019). However, logistic analysis showed no significant association between summer climate and ACS hospitalizations (OR 1.02, 95% CI 0.99-1.04, p=0.178) or all-cause mortality (OR 1.04, 95% CI 0.94-1.06, p=0.446), irrespective of region or gender. Conclusion: While in-hospital mortality rates were higher during the summer months, there was no significant association between summer climate and the incidence of ACS or all-cause mortality, regardless of region or gender, when adjusted for confounding factors.

Background Many students would benefit from trauma‐informed physical activity (PA); however, there is a lack of systematic guidance on incorporating trauma‐informed practices across school‐based PA opportunities. The purpose of this study was to generate a feasible framework for trauma‐informed school‐based PA. Methods Framework development was guided by a modified Delphi approach, including an exploration phase and an evaluation phase. First, a multidisciplinary working group reviewed extant literature, mapping trauma‐informed practices onto the domains and components of the Comprehensive School Physical Activity Program (CSPAP). Subsequently, experts (n = 14) provided quantitative feedback on the utility and feasibility of these practices. Results Thirty‐three practices met pre‐determined thresholds for utility and feasibility. Across CSPAP domains, this included attending to: (a) safety; (b) positive communication and relationships; (c) empowerment, choice, and voice; (d) emotion management and skill building; (e) instructor competencies and support; and (f) cultural, historical, and gender issues. Implications for School Health Policy, Practice, and Equity Incorporating trauma‐informed practices into existing frameworks and approaches to school‐based PA may promote uptake of practices that help meet the social and emotional needs of trauma‐exposed youth. Conclusions The present output provides a foundation for generating tools and supports for incorporating trauma‐informed practices into school‐based PA promotion efforts.

This chapter examines the complexities of therapeutic alliance ruptures and their repair processes. It underscores the importance of recognizing and addressing these ruptures to foster deeper therapeutic relationships and improve treatment outcomes. The authors present various strategies for identifying and resolving ruptures, including alliance-building, task-related repair, and exploratory approaches. They also emphasize the significance of supervision and training in helping clinicians navigate these challenging dynamics, highlighting the potential for growth and transformation through effective rupture repair.