MicroRNAs as potential biomarkers for diagnosis of post-traumatic stress disorder

Post-traumatic stress disorder is a mental disorder caused by exposure to severe traumatic life events. Currently, there are no validated biomarkers or laboratory tests that can distinguish between trauma survivors with and without post-traumatic stress disorder. In addition, the heterogeneity of clinical presentations of post-traumatic stress disorder and the overlap of symptoms with other conditions can lead to misdiagnosis and inappropriate treatment. Evidence suggests that this condition is a multisystem disorder that affects many biological systems, raising the possibility that peripheral markers of disease may be used to diagnose post-traumatic stress disorder. We performed a PubMed search for microRNAs (miRNAs) in post-traumatic stress disorder (PTSD) that could serve as diagnostic biomarkers and found 18 original research articles on studies performed with human patients and published January 2012 to December 2023. These included four studies with whole blood, seven with peripheral blood mononuclear cells, four with plasma extracellular vesicles/exosomes, and one with serum exosomes. One of these studies had also used whole plasma. Two studies were excluded as they did not involve microRNA biomarkers. Most of the studies had collected samples from adult male Veterans who had returned from deployment and been exposed to combat, and only two were from recently traumatized adult subjects. In measuring miRNA expression levels, many of the studies had used microarray miRNA analysis, miRNA Seq analysis, or NanoString panels. Only six studies had used real time polymerase chain reaction assay to determine/validate miRNA expression in PTSD subjects compared to controls. The miRNAs that were found/validated in these studies may be considered as potential candidate biomarkers for PTSD and include miR-3130-5p in whole blood; miR-193a-5p, -7113-5p, -125a, -181c, and -671-5p in peripheral blood mononuclear cells; miR-10b-5p, -203a-3p, -4488, -502-3p, -874-3p, -5100, and -7641 in plasma extracellular vesicles/exosomes; and miR-18a-3p and -7-1-5p in blood plasma. Several important limitations identified in the studies need to be taken into account in future studies. Further studies are warranted with war veterans and recently traumatized children, adolescents, and adults having PTSD and use of animal models subjected to various stressors and the effects of suppressing or overexpressing specific microRNAs.

Gamification in medical education: identifying and prioritizing key elements through Delphi method

BACKGROUND

Gamification has gained popularity in medical education, but key elements have not been formally identified. This study aimed to generate and prioritize a list of key elements of gamification in medical education.

METHODS

This study utilized a two-stage approach, including the Delphi method and qualitative interview. Nineteen medical educators with expertise in gamification participated in the Delphi method stage. Experts who had more than three years of experience with gamification in medical education constituted the expert panel. The experts were then asked to rate the gamification elements using the Likert five-point scale through at least two consensus-seeking rounds. Consensus for key elements was predefined as ≥ 51% of respondents rating an element as 'important' or"very important." In the qualitative interview stage, 10 experts provided feedback on the application of these key gamification elements.

RESULTS

Eighteen participants (11 males and 7 females) completed the entire Delphi process for this study. After two rounds of surveys, the consensus was reached on all elements. Thirteen elements scored more than 4 points (37%) and reached the criteria of key elements of gamification in medical education. The top five key elements were integration with instruction objectives, game rules, rapid feedback, fairness, and points/scoring. The thirteen key elements for successful gamification in medical education were further organized into two main categories: (1) gamification design principles and (2) game mechanisms.

CONCLUSIONS

Integration with educational objectives, gamification in curriculum design and teaching methods, and balancing between the mechanisms and principles were the three key components for successful gamification. This study explored the gamification key elements, providing practical tips for medical educators in their efforts to gamify medical education. Future studies involving learners could be performed to examine the efficacy of these key elements in gamification.

Prevalence and factors of physical punishment and psychological aggression toward children under five in Mongolia: an analysis of the 2018 Social Indicator Survey

BACKGROUND

The global prevalence of violence against children is alarmingly high, with millions facing violent discipline and physical punishment. In Mongolia, domestic violence-related criminal offenses have sharply increased, with a 46.92% surge in the first quarter of 2020 compared to 2019.

OBJECTIVE

This study aimed to estimate the prevalence of and identify factors associated with physical punishment and/or psychological aggression experienced by children under 5 years old from their caregivers.

METHODS

We used data from the nationally representative 2018 MICS6 dataset. To examine the association between independent and dependent variables, we used multilevel Poisson regression because it provides a better estimate and is more interpretable when the prevalence is relatively high.

RESULTS

The prevalence of psychological aggression was reported at 32.3% and physical punishment at 31.6%, including severe forms. Nonviolent techniques were common, with 77.5% exclusively using nonviolent discipline. Psychological aggression was more likely to occur in older children (3 and 4 years old) and in households with Buddhist heads. Additionally, 3-year-olds are more likely to experience physical punishment compared to 2-year-olds.

CONCLUSION

These findings underscore the need for targeted policy interventions, including age-sensitive parental education programs and religious and cultural sensitivity measures. Comprehensive educational and awareness programs are essential to foster a culture of nonviolence across all educational levels, highlighting the need for context-specific policies to safeguard the well-being of children in Mongolia.

Factors influencing adverse events following COVID-19 vaccination

Various novel platform technologies have been used for the development of COVID-19 vaccines. In this nested cohort study among healthcare workers in Australia and Brazil who received three different COVID-19-specific vaccines, we (a) evaluated the incidence of adverse events following immunization (AEFI); (b) compared AEFI by vaccine type, dose and country; (c) identified factors influencing the incidence of AEFI; and (d) assessed the association between reactogenicity and vaccine anti-spike IgG antibody responses. Of 1302 participants who received homologous 2-dose regimens of ChAdOx1-S (Oxford-AstraZeneca), BNT162b2 (Pfizer-BioNTech) or CoronaVac (Sinovac), 1219 (94%) completed vaccine reaction questionnaires. Following the first vaccine dose, the incidence of any systemic reaction was higher in ChAdOx1-S recipients (374/806, 46%) compared with BNT162b2 (55/151, 36%; p = 0.02) or CoronaVac (26/262, 10%; p < 0.001) recipients. After the second vaccine dose, the incidence of any systemic reaction was higher in BNT162b2 recipients (66/151, 44%) compared with ChAdOx1-S (164/806, 20%; p < 0.001) or CoronaVac (23/262, 9%; p < 0.001) recipients. AEFI risk was higher in younger participants, females, participants in Australia, and varied by vaccine type and dose. Prior COVID-19 did not impact the risk of AEFI. Participants in Australia compared with Brazil reported a higher incidence of any local reaction (170/231, 74% vs 222/726, 31%, p < 0.001) and any systemic reaction (171/231, 74% vs 328/726, 45%, p < 0.001), regardless of vaccine type. Following a primary course of ChAdOx1-S or CoronaVac vaccination, participants who did not report AEFI seroconverted at a similar rate to those who reported local or systemic reactions. In conclusion, we found that the incidence of AEFI was influenced by participant age and COVID-19 vaccine type, and differed between participants in Australia and Brazil.

Use of narratives to enhance childhood vaccine acceptance: Results of an online experiment among Canadian parents

Identifying effective interventions to promote children's vaccination acceptance is crucial for the health and wellbeing of communities. Many interventions can be implemented to increase parental awareness of the benefits of vaccination and positively influence their confidence in vaccines and vaccination services. One potential approach is using narratives as an intervention. This study aims to evaluate the effects of a narrative-based intervention on parents' attitudes and vaccination intentions. In a pre-post experiment, 2,000 parents of young children recruited from an online pan-Canadian panel were randomly exposed to one of the three videos presenting narratives to promote childhood vaccination or a control condition video about the importance and benefits of physical activity in children. Pre-post measures reveal a relatively modest but positive impact of the narratives on parents' attitudes and intention to vaccinate their child(ren). The results also suggest that narratives with more emotional content may be more effective in positively influencing vaccine attitudes than the more factual narrative. Using narratives to promote vaccination can positively influence parents' views and intentions toward childhood vaccines, but research is still required to identify the best components of such interventions.

Mental health in mothers and fathers of children with chronic disorders

Objective

This study applied the Family Systems Illness Model to examine how child disorder severity influences mental health in mothers and fathers of children with chronic (mainly developmental) disorders (CD).

Methods

We measured parental mental health and perceived child disorder severity among 204 mothers and 125 fathers of 220 children with CD and compared the mental health scores with norms. We analyzed how much of the variance in parental mental health was explained by child disorder severity, including discrepancy between maternally and paternally perceived severity.

Results

Compared to norms, we found elevated mental health problems in both mothers (d = 0.45) and fathers (d = 0.20) of children with CD. Mothers had higher scores than fathers on both mental health problems (d = 0.63) and severity (d = 0.43). Perceived disorder severity was similarly associated with mental health problems for mothers (β = 0.23) and fathers (β = 0.34). Discrepancy between maternal and paternal perceived disorder severity did not influence parental mental health.

Conclusion

Findings suggest gender-specific challenges in parenting children with CD. Subjective perception of disorder severity plays a substantial role for parental mental health.

Innovation

This comparative study of mothers and fathers contributes to a predominantly mother-focused field.

Impact of being underweight before pregnancy on preterm birth by race/ethnicity and insurance status in California: an analysis of birth records

BACKGROUND

The US still has a high burden of preterm birth (PTB), with important disparities by race/ethnicity and poverty status. There is a large body of literature looking at the impact of pre-pregnancy obesity on PTB, but fewer studies have explored the association between underweight status on PTB, especially with a lens toward health disparities. Furthermore, little is known about how weight, specifically pre-pregnancy underweight status, and socio-economic-demographic factors such as race/ethnicity and insurance status, interact with each other to contribute to risks of PTB.

OBJECTIVES

The objective of this study was to measure the association between pre-pregnancy underweight and PTB and small for gestational age (SGA) among a large sample of births in the US. Our secondary objective was to see if underweight status and two markers of health disparities - race/ethnicity and insurance status (public vs. other) - on PTB.

STUDY DESIGN

We used data from all births in California from 2011 to 2017, which resulted in 3,070,241 singleton births with linked hospital discharge records. We ran regression models to estimate the relative risk of PTB by underweight status, by race/ethnicity, and by poverty (Medi-cal status). We then looked at the interaction between underweight status and race/ethnicity and underweight and poverty on PTB.

RESULTS

Black and Asian women were more likely to be underweight (aRR = 1.0, 95% CI: 1.01, 1.1 and aRR = 1.4, 95% CI: 1.4, 1.5, respectively), and Latina women were less likely to be underweight (aRR = 0.7, 95% CI: 0.7, 0.7). Being underweight was associated with increased odds of PTB (aRR = 1.3, 95% CI 1.3-1.3) and, after controlling for underweight, all nonwhite race/ethnic groups had increased odds of PTB compared to white women. In interaction models, the combined effect of being both underweight and Black, Indigenous and People of Color (BIPOC) statistically significantly reduced the relative risk of PTB (aRR = 0.9, 95% CI: 0.8, 0.9) and SGA (aRR = 1.0, 95% CI: 0.9, 1.0). The combined effect of being both underweight and on public insurance increased the relative risk of PTB (aRR = 1.1, 95% CI: 1.1, 1.2) but there was no additional effect of being both underweight and on public insurance on SGA (aRR = 1.0, 95% CI: 1.0, 1.0).

CONCLUSIONS

We confirm and build upon previous findings that being underweight preconception is associated with increased risk of PTB and SGA - a fact often overlooked in the focus on overweight and adverse birth outcomes. Additionally, our findings suggest that the effect of being underweight on PTB and SGA differs by race/ethnicity and by insurance status, emphasizing that other factors related to inequities in access to health care and poverty are contributing to disparities in PTB.

Development and refinement of a communication guide to help young adults in Texas reconnect and reduce loneliness

Objective

Loneliness among young people is a contemporary public health crisis exacerbated by the COVID-19 pandemic. The present research examined the development of a modest yet meaningful health communication intervention resource that would become an asset in a larger health campaign: a communication guide aimed at helping young people reach out and reconnect with others.

Methods

Study One established the need for a loneliness intervention in Texas with survey data (N = 795). A communication guide was developed based on research and theory. Study Two employed focus group interviews with potential audience members (N = 31) to critically assess and inform revisions to the communication guide.

Results

Study One results indicated that a substantial proportion of young adult Texans felt as though their social connection had decreased and their loneliness had increased since the onset of the pandemic. Themes in focus group responses from Study Two suggested several strengths of the communication guide and some opportunities for revision.

Conclusion

A communication guide with tips for reconnecting could be a valuable tool to empower young people and promote social connection.

Innovation

This study involved the development and refinement of a new communication resource that was informed by a priority audience of a major health communication campaign.

Effects of growth hormone therapy on the onset and progression of pubertal development in girls with idiopathic short stature

OBJECTIVE

The aim of this study was to explore the impact of growth hormone (GH) therapy on the onset and progression of puberty in girls with idiopathic short stature.

METHODS

This study included 541 girls aged between 4.5 and 10.6 years who were receiving GH treatment, monitored over a 22-year follow-up period. Of these, 126 girls have been followed up to the onset of menarche. The participants were divided into two groups: a ISS control group (n = 66) and a group receiving daily GH treatment at a dose of 0.15 iu/kg (n = 60). We assessed the pubertal development and GH usage of these girls every three months.

RESULTS

(1) There was no significant difference in the onset of puberty between the growth hormone (GH) treatment group and the control group; however, the average duration of puberty was longer in the treatment group compared to the control group. (2) During puberty, there were no significant differences in height growth between the treated and untreated groups. (3) The duration of GH treatment showed a significant negative correlation with the age at onset of gonadal development and the age at menarche in females within the treatment group.

CONCLUSION

GH treatment does not seem to accelerate the onset of puberty but may extend its duration, without significantly impacting height growth during puberty. Additionally, longer GH treatment duration is linked to earlier gonadal development and menarche in females.

Young peoples' reflections about using a chatbot to promote their mental wellbeing in northern periphery areas - a qualitative study

An international research collaboration with researchers from northern Sweden, Finland, Ireland, Northern Ireland, Scotland and developed the ChatPal chatbot to explore the possibility of a multilingual chatbot to promote mental wellbeing in people of all ages. In Sweden the end users were young people. The aim of the current study was to explore and discuss Swedish young peoples' experiences of using a chatbot designed to promote their mental wellbeing. Young people aged 15-19 filled out an open-ended survey giving feedback on the ChatPal chatbot and their suggestions on improvements. A total of 122 survey responses were analysed. The qualitative content analysis of the survey responses resulted in three themes each containing two to three sub-themes. Theme 1, feeling as if someone is there when needed, which highlighted positive aspects regarding availability and accessibility. Theme 2, human-robot interaction has its limitations, which included aspects such as unnatural and impersonal conversations and limited content availability. Theme 3, usability can be improved, given technical errors due to lack of internet connection and difficulty navigating the chatbot were brought up as issues. The findings are discussed, and potential implications are offered for those designing and developing digital mental health technologies for young people.

Physical activity as a moderator of the association between alcohol consumption and hangovers

Frequently mentioned anecdotally, hangovers are under-investigated within the scientific study of alcohol, as is the role of physical activity (PA) on hangovers. The well-established positive association between PA and AC (AC) suggests that PA may buffer negative physiological consequences of AC, including hangovers. The present study was therefore conducted in order to determine whether PA influences hangovers. Undergraduates (N=1676) from two large universities in the United States who experienced at least one hangover in the past three months and who engaged in at least 30 min of moderate PA per week were recruited to participate. Participants completed online questionnaires about their AC, PA, and frequency and severity of hangover symptoms. Both between- and within-person associations between AC and hangover were examined, factoring in the potential moderating effects of both moderate and vigorous PA. Small effects were observed for correlations between PA and outcomes assessing AC and hangovers (rs ranged from 0.09 to 0.15). Results also revealed that individuals who consumed more alcohol per month experienced hangovers more frequently and had more severe symptoms. These associations were attenuated among individuals who spent more hours engaging in vigorous but not moderate PA. The current study is the first to show PA influences the experience of hangovers, and we posit this may be a mechanism underlying the positive relationship between PA and AC. Our findings advance the growing literature on alcohol use and PA and may contribute to the development of interventions for alcohol-related problems and alcohol use disorders.

Turkish adaptation of the maternal cognition about infant sleep questionnaire

Background

Exploring early childhood sleep problems requires a detailed understanding of parental beliefs and cognitions related to infant sleep. There is a need for validated measures to investigate the cognitions of Turkish mothers about infant sleep however no scale measuring parental perceptions related to infant sleep behaviors in Turkish is available. We aimed to culturally adapt the Maternal Cognitions about Infant Sleep Questionnaire (MCISQ) in Turkish.

Methods

Subjects were recruited from an internet sample through social media. Internal consistency was evaluated by Cronbach's alpha, and test-retest reliability was determined by Pearson's correlation test and paired t-test. For factorial validity, the principal component factor analysis was performed for the components of MCISQ.

Results

A total of 417 mothers, most aged between 25 and 29 years (47.8 %), participated in the study. Infants' age ranged between 6 and 18 months, with a mean of 10.5 ± 3.9 months. Factor analysis revealed four factors after removal of item 11: Anger, doubt, safety, limit setting. Cronbach's alpha was 0.85. A subgroup of 32 mothers completed MCISQ three weeks after the initial administration. Total mean scores showed a significantly strong correlation (p:<0.01, r:0.82). Higher scores were noted in both total and subscale scores in infants with maternally reported sleep problems (p:<0.01).

Conclusion

Findings suggest a four-factor solution for MCISQ in Turkish mothers with infants aged 6-18 months. The adapted Turkish version is composed of 19 items with good reliability. Factor structure and items included in the subscales differed from the original study, highlighting the cultural factors related to maternal perceptions about infant sleep.

Building up bit by bit, parent's experiences of equine-assisted intervention among children and adolescents with mental illness: a grounded theory study

BACKGROUND

Mental ill health among children and adolescents has increased worldwide. Mental health difficulties from a young age are associated with school absence and educational underachievement. A holistic perspective of treatments besides medical treatment is essential Thus, there is a need for research regarding equine-assisted intervention (EAI).

PURPOSE

The present study aimed to understand the outcomes of an equine-assisted intervention for children and adolescents with mental ill health from the perspectives of parents and close relatives.

METHODS

This study used a qualitative research design informed by Charmaz's Grounded Theory, with a purposive sample including six in-depth interviews.

RESULTS

The theory "building up bit by bit" was constructed, explaining the recognition that their children/adolescents were built up bit by bit and created a stronger self-identity. The participants referred to changes in the child's or adolescent's way of being and emotional regulation, which constituted building blocks leading to the child's or adolescent's 1. increased Harmony. 2. enhanced Self-identity, and 3. improved Capability.

CONCLUSION

Parents and close relatives experienced that their child or adolescent was built up bit by bit and gained a stronger foundation to stand on. This led to increased harmony in everyday life with stronger self-worth, better performance, and reduced school absenteeism.

Convergence of real-time and retrospective assessments: A systematic investigation of naturally occurring and experimentally induced intrusions

BACKGROUND AND OBJECTIVES

Ecological momentary assessment is a popular method for monitoring symptoms in real-time. Especially for fleeting experiences, such as intrusions, real-time assessments may be more accurate than retrospective estimates. However, there are concerns regarding reactivity effects associated with real-time assessments and, conversely, the reliance on bias-prone retrospective assessments in clinical science and practice. In this study we used a between-groups design to examine whether real-time intrusion assessments influence retrospective reports (aim 1). Then, we investigated whether real-time and retrospective assessments systematically differed within individuals (aim 2).

METHODS

Over two weeks, 150 non-clinical individuals provided weekly retrospective intrusion assessments, while the majority (n = 102) additionally reported their intrusions in real-time, via smartphones. We examined both naturally occurring intrusions, which individuals experience in their everyday lives, and intrusions related to a standardized stressor (i.e., Trier Social Stress Test), taking place halfway.

RESULTS

Using Bayesian statistics, we found that assessing intrusions in real-time did not convincingly affect retrospective reports, and there was no strong evidence that real-time and retrospective intrusion assessments differed. However, the evidence of absence was inconclusive for some measures. Real-time and retrospectively reported intrusion frequencies and distress were strongly associated with one another.

LIMITATIONS

Future research is advised to replicate these findings with larger samples, for other types of stressors, in clinical populations, and over extended assessment periods.

CONCLUSIONS

The general agreement between real-time and retrospective assessments of intrusions is encouraging, tentatively suggesting that researchers and clinicians can flexibly select the assessment method that best suits their objectives.

Using latent variables to improve the management of depression among hemodialysis patients

BACKGROUND

Screening for depression can be challenging among hemodialysis patients due to the overlap of depressive symptoms with dialysis or kidney disease related symptoms. The aim of this study was to understand these overlapping symptoms and develop a depression screening tool for better clinical assessment of depressive symptoms in dialysis patients.

METHODS

We surveyed 1,085 dialysis patients between March 1, 2018 and February 28, 2023 at 15 dialysis facilities in Northeast Ohio with the 9-item patient health questionnaire (PHQ-9) and kidney disease quality of life (KDQOL) instrument. To evaluate overlap across questionnaire items, we used structural equation modeling (SEM). We predicted and transformed factor scores to create a hemodialysis-adjusted PHQ-9 (hdPHQ-9). In exploratory analysis (N = 173), we evaluated the performance of the hdPHQ-9 relative to the PHQ-9 that also received a Mini-International Neuropsychiatric Interview.

RESULTS

Our study sample included a high percentage of Black patients (74.6%) and 157 (14.5%) survey participants screened positive for depression (PHQ-9 ≥ 10). The magnitude of overlap was small for (respectively, PHQ-9 item with KDQOLTM item) fatigue with washed out, guilt with burden on family, appetite with nausea and movement with lightheaded. The hdPHQ-9 showed reasonably high sensitivity (0.81 with 95% confidence interval [CI] 0.58, 0.95) and specificity (0.84 with 95% CI 0.77, 0.89); however, this was not a significant improvement from the PHQ-9.

CONCLUSION

There is little overlap between depressive symptoms and dialysis or kidney disease symptoms. The PHQ-9 was found to be an appropriate depression screening instrument for dialysis patients.

Inflammatory biomarkers and psychological variables to assess quality of life in patients with inflammatory bowel disease: a cross-sectional study

BACKGROUND

Inflammatory bowel disease (IBD) is a chronic gastrointestinal condition. While inflammatory biomarkers are valuable for diagnosing and monitoring the disease, their correlation with patients' quality of life (QoL) is not well-established.

PURPOSE

This study aims to investigate the correlations between inflammatory biomarkers and the quality of life (QoL) variables of individuals diagnosed with IBD in clinical remission.

METHODS

The samp