Factors influencing hepatitis B vaccination intention and behavior among college students in Tibet: Insights from the expanded theory of planned behavior

Hepatitis B (Hep B) remains a critical public health issue globally, particularly in Tibet, where vaccination rates and influencing factors among college students are yet understudied. This study applies a cross-sectional design to investigate the Hep B vaccination rate among 1,126 college students in Tibet and utilizes the expanded theory of planned behavior (ETPB) to identify vaccination behavior intention (BI) and vaccination behavior (VB). Stratified cluster sampling across three universities was used to assess behavioral attitudes (BA), subjective norms (SN), perceived behavioral control (PBC), past vaccination history (PVH) and vaccination knowledge (VK), and used structural equation modeling (SEM) for model validation and multi-group comparison. Results indicated that 16.3% of students had received the Hep B vaccine. VK notably improved BA toward vaccination (β = 0.518, p < .001). BA (β = 0.232, p < .001), PBC (β = 0.239, p < .001), SN (β = 0.385, p < .001) positively influenced BI. However, PVH failed to predict BI. BI (β = 0.448, p < .001) and PVH (β = 0.127, p < .001) were significant predictors of VB. Significant ethnic variations were noted. The positive effect of PVH on VB (β = 0.151, p < .001) and the mediating role of PBC in VB (β = 0.076, p < .05) were significant among Tibetan students. The effect of VK on BA was stronger among Tibetans (β = 0.503, p < .05),while the impact of attitude on BI was more pronounced among Han students (β = 0.366, p < .05). The vaccination rate for Hep B among college students in Tibet is relatively low, and the ETPB model effectively explains their vaccination intentions and behaviors. Tailored intervention strategies for Tibetan and Han students are recommended to boost vaccination rates effectively.

The interplay between sleep and cancer-related fatigue in breast cancer: A casual and computer-simulated network analysis

Objective

Sleep problems and cancer-related fatigue are common symptoms in women for breast cancer, during and after treatment. Identifying key intervention targets for this symptom cluster may improve patient reported outcomes. This study aimed to explore the relationship between sleep and cancer-related fatigue to identify optimal intervention targets.

Methods

In the "Be Resilient to Breast Cancer" program, self report data were collected on sleep and cancer-related fatigue the Multidimensional Fatigue Symptom Inventory-Short Form and the Pittsburgh Sleep Quality Index. Gaussian network analysis was employed to identify central symptoms and nodes, while a Bayesian network explored their causal relationships. Computer-simulated interventions were used to identify core symptoms as targets for intervention.

Results

General fatigue (Str ​= ​0.95, Bet ​= ​7, Clo ​= ​0.007) was considered the node with the strongest centrality. The daytime dysfunction item on the Pittsburgh sleep quality index had the strongest bridge strength. Core symptoms were identified as targets for intervention by the computer-simulated analysis.

Conclusions

Sleep quality is the strongest predictor of cancer-related fatigue from a casual networking perspective. Sleep latency and daytime dysfunction should be targeted to break the chained symptom interaction between sleep and cancer-related fatigue.

An antibody developability triaging pipeline exploiting protein language models

Therapeutic monoclonal antibodies (mAbs) are a successful class of biologic drugs that are frequently selected from phage display libraries and transgenic mice that produce fully human antibodies. However, binding affinity to the correct epitope is necessary, but not sufficient, for a mAb to have therapeutic potential. Sequence and structural features affect the developability of an antibody, which influences its ability to be produced at scale and enter trials, or can cause late-stage failures. Using data on paired human antibody sequences, we introduce a pipeline using a machine learning approach that exploits protein language models to identify antibodies which cluster with antibodies that have entered the clinic and are therefore expected to have developability features similar to clinically acceptable antibodies, and triage out those without these features. We propose this pipeline as a useful tool in candidate selection from large libraries, reducing the cost of exploration of the antibody space, and pursuing new therapeutics.

Glucagon-like peptide-1 receptor agonists, inflammation, and kidney diseases: evidence from Mendelian randomization

OBJECTIVE

It has been proved that glucagon-like peptide-1 receptor (GLP1R) agonists have positive effects on renal outcomes in diabetic patients. However, it remains unknown whether GLP1R agonists could provide similar protection against other kidney diseases.

METHODS

We performed two-sample Mendelian randomization (MR) analyses to determine the causal effects of GLP1R agonists on multiple kidney diseases. Exposure to GLP1R agonist was proxied by the available cis-eQTLs for GLP1R. Primary outcomes included the risk assessment for diabetic nephropathy, IgA nephropathy, membranous nephropathy, nephrotic syndrome, chronic kidney disease, acute glomerulonephritis, chronic glomerulonephritis and calculus of kidney/ureter. Type 2 diabetes and body mass index were used as positive control. Two-stage network MR analyses were conducted to assess the mediation effect of inflammatory proteins on the relationships between GLP1R agonists and kidney diseases.

RESULTS

After meta-analyses of both discovery and validation cohorts, genetically proxied GLP1R agonist was found to significantly associated with a decreased risk of diabetic nephropathy (OR = 0.72, 95%CI = 0.54-0.97, p = 0.031) and IgA nephropathy (OR = 0.58, 95%CI = 0.36-0.94, p = 0.027). Two-stage network MR revealed that there was an indirect effect of GLP1R agonist on IgA nephropathy through signaling lymphocytic activation molecule family member 1 (SLAMF1), with a mediated proportion of 34.27% (95% CI, 1.47-67.03%, p = 0.041) of the total effect.

CONCLUSIONS

The findings of current study presented genetic proof for the potential protective effects of GLP1R agonists in the development of diabetic nephropathy and IgA nephropathy, offering a novel sight for future mechanistic and clinical applications.

Network analysis of quality of life among young and middle-aged Korean cancer survivors

Objective

This study aimed to identify and compare the network structure of quality of life factors among cancer survivors to inform tailored interventions.

Methods

A cross-sectional study was conducted using data from 330 cancer survivors aged 18-64 years, drawn from the 2019-2021 Korea National Health and Nutrition Examination Survey (KNHANES). Participants were categorized into two groups: cancer survivors with current cancer and those without. Network analysis using the EBICglasso algorithm was performed to assess eight quality of life (QoL) components measured by the Health-related Quality of Life Instrument with 8 Items (HINT-8) scale: climbing stairs, pain, vitality, work ability, depression, memory, sleep quality, and happiness.

Results

The network analysis revealed distinct patterns between the two groups. Among survivors with current cancer, depression, work ability, and vitality were the most central QoL components, suggesting a need for targeted psychological and occupational support. In contrast, survivors without current cancer exhibited a network where work ability, pain, and climbing stairs (physical function) played a dominant role, emphasizing the importance of pain management and functional rehabilitation. Work ability emerged as a critical determinant in both groups, indicating its sustained impact throughout the survivorship continuum. Additionally, the network structure in survivors without current cancer showed greater interconnectedness, reflecting the complex interplay of long-term survivorship challenges.

Conclusions

The study highlights the need for personalized, stage-specific interventions in cancer survivorship. Work remained central in both groups, emphasizing its ongoing impact on quality of life throughout the survivorship journey. While psychological support is crucial to cancer survivors with current cancer due to the centrality of depression, long-term pain management becomes increasingly important post-treatment. These findings provide valuable insights for nursing practice, suggesting that tailored interventions addressing work-related challenges, psychological distress, and chronic symptom management could improve quality of life and facilitate survivors' reintegration into daily life.

Making trauma ecological momentary assessment studies FAIR: review of design considerations and data procedures

Background: Ecological momentary assessment (EMA) involves collecting data from people in their everyday lives one or more times per day over the course of days, weeks, or months. EMA has been used in the traumatic stress field to better understand how trauma-relevant symptoms, experiences, and behaviours occur under naturalistic conditions and in relation to one another. The FAIR principles specify that data should be Findable, Accessible, Interoperable, and Reusable to maximise the knowledge gained from individual research studies. However, it is unclear how EMA design decisions and data procedures might affect the implementation of these principles.Objective: We articulate key design considerations and data procedures when performing trauma EMA research and outline some challenges and recommendations for implementing the FAIR data principles in trauma EMA research.Method and Results: Using examples from existing trauma EMA studies, we discuss the decisions made when preparing a trauma EMA study; data processing and analytic procedures performed following data collection; and challenges that exist for their implementation, as well as practices that trauma EMA researchers can incorporate into their research to promote FAIR data.Conclusions: Implementing the FAIR data principles in trauma EMA research is critical to advancing scientific knowledge. Researchers should deposit their data in reputable repositories and include documentation detailing design decisions and the steps taken to clean and prepare data. Many challenges remain for the implementation of these practices including balancing privacy concerns and efforts to make trauma EMA data readily shareable.

Validation of the International Trauma Interview (ITI) among treatment-seeking people with adverse childhood experiences in South Korea

Background: The International Trauma Interview (ITI) is a clinician-administered assessment that has been newly developed for the International Classification of Diseases (ICD-11) diagnoses of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD).Objective: The current study evaluated the psychometric properties of the ITI for treatment-seeking people with adverse childhood experiences (ACE) in South Korea, with the aims of verifying the validity and reliability of ITI as well as examining the differentiation of ICD-11 CPTSD and borderline personality disorder (BPD).Methods: In total, data of 103 people were analysed. Clinical psychologists conducted the ITI and the structured interview for BPD. Along with the International Trauma Questionnaire (ITQ), self-report measurements on ACE, adulthood trauma, emotion dysregulation, dissociation, depression, adult attachment, BPD symptoms, self-harm, self-compassion, and quality of life were collected. A confirmatory factor analysis (CFA) was conducted to examine the factorial validity and a structural equation model (SEM) was used to evaluate the convergent and discriminant validity.Results: The CFA supported the second-order two-factor model of ICD-11 CPTSD. However, we determined that the alternatively suggested second-order two-factor model of reexperience avoidance combined PTSD and DSO described the data the best. As was hypothesized, ITI PTSD and DSO showed convergent and discriminant validity, and ITI DSO also showed distinctive features with BPD. Interrater reliability and composite reliability were both found to be acceptable. Agreement and consistency between ITQ and ITI were also fair although tentative.Conclusions: The ITI is determined to be a valid and reliable method for the assessment and diagnosis of ICD-11 PTSD and CPTSD, and it is considered to be promising for the differential diagnosis of BPD in South Korean treatment-seeking people with ACE. Future research should aim to assess the agreement between ITI and ITQ while also seeking alternative criteria for ITI PTSD across variant trauma memory features.

Gender differences in early posttraumatic stress disorder symptoms: a network analysis

Background: Despite known gender/sex differences in the prevalence of posttraumatic stress disorder (PTSD), potential differences in the associations among PTSD symptoms between men and women in the early post-trauma period are not well-characterized.Objective: This study utilized network analysis to assess potential differences in the associations among PTSD symptom clusters between men and women during the early post-trauma period.Method: We included n = 475 participants (57.5% self-identified women) who recently (≤2 months) experienced an interpersonal or motor vehicle potential traumatic event in the Netherlands. Past month PTSD symptoms were measured with the PTSD Checklist for DSM-5 (PCL-5) and composited according to the five-node PTSD symptom cluster dysphoric arousal model. We estimated the network as well as indices of centrality (strength and predictability) and assessed the stability of the modelled networks in subsamples of men (n = 202) and women (n = 273). We compared network structures using the Network Comparison Test (NCT).Results: Results largely demonstrated adequate correlation stability for the estimated network structures for women and men. For both men and women, avoidance symptoms were among the strongest nodes with greatest predictability in the networks. In men, anxious arousal additionally showed high strength whereas re-experiencing showed high predictability. In women, re-experiencing symptoms demonstrated both high strength and predictability. The NCT demonstrated nonsignificant differences in global network structure (M = 0.08, p = .054) and strength (S = .073, p = .067). Post hoc comparisons showed an association of re-experiencing symptoms with negative alterations in cognitions and mood in men but not women (E = .038, p = .005).Conclusion: Results demonstrated possible modest gender differences in aspects of network structure although most elements of the network structure were similar across genders. These results help to characterize gender differences in associations among PTSD symptom clusters during the early post-trauma period, which may inform the potential relevance of future gender-sensitive early intervention strategies to ameliorate the risk for long-term PTSD.

Neuroception of psychological safety scale (NPSS): validation with a UK based adult community sample

Background: Psychological safety plays a vital role in rest, recovery, and fostering social connections. However, a history of trauma can predispose individuals to perceive heightened levels of threat and danger. Research suggests that a lack of psychological safety may be a defining biopsychosocial characteristic of posttraumatic stress disorder (PTSD). Persistent feelings of threat and danger are associated with a lack of psychological safety and may be predictive of PTSD. Our pioneering work reported on the development of the neuroception of psychological safety (NPSS), rooted in polyvagal theory, and consists of social engagement, compassion, and body sensations dimensions. Understanding more about the dimensionality of the NPSS and further establishing its psychometric properties was our priority.Objective: Our current research aimed to validate and test the reliability and dimensionality of the NPSS, using a large community sample (n = 2035) of adult residents in the UKMethod: We examined the internal and test-retest reliability, convergent, discriminant, and concurrent validity as well as dimensionality of the NPSS.Results: The 3-factor structure of the NPSS was replicated with regard to the absolute fit indices. Internal consistencies ranged from acceptable to excellent across the NPSS's subscales. Providing support for the validity of the NPSS, scores were predictably related to team psychological safety, wellbeing, post-traumatic stress, burnout, body awareness, and personality, with effect sizes typically in the high to medium range. Scores on the NPSS were found to show good test-retest reliability.Conclusions: This study demonstrates the validity, reliability and dimensionality of the NPSS with an adult sample. Further work is underway to support and enhance understandings of psychological safety with diverse clinical populations impacted by trauma. The NPSS has applicability across a range of health and social care contexts, such as shaping new approaches to evaluating trauma treatments and enhancing trauma informed care.

Using system dynamics modeling approach to strengthen health systems to combat cancer: a systematic literature review

AIM

Dynamic cancer control is a current health system priority, yet methods for achieving it are lacking. This study aims to review the application of system dynamics modeling (SDM) on cancer control and evaluate the research quality.

METHODS

Articles were searched in PubMed, Web of Science, and Scopus from the inception of the study to 15 November 2023. Inclusion criteria were English original studies focusing on cancer control with SDM methodology, including prevention, early detection, diagnosis and treatment, and palliative care. Exclusion criteria were non-original research, and studies lacking SDM focus. Analysis involved categorization of studies and extraction of relevant data to answer the research question, ensuring a comprehensive synthesis of the field. Quality assessment was used to evaluate the SDM for cancer control.

RESULTS

Sixteen studies were included in this systematic review predominantly from the United States (7, 43.75%), with a focus on breast cancer research (5, 31.25%). Studies were categorized by WHO cancer control modules, and some studies may contribute to multiple modules. The results showed that included studies comprised two focused on prevention (1.25%), ten on early detection (62.50%), six on diagnosis and treatment (37.50%), with none addressing palliative care. Seven studies presented a complete SDM process, among which nine developed causal loop diagrams for conceptual models, ten utilized stock-flow charts to develop computational models, and thirteen conducted simulations.

LIMITATIONS

This review's macrofocus on SDM in cancer control missed detailed methodological analysis. The limited number of studies and lack of stage-specific intervention comparisons limit comprehensiveness. Detailed analysis of SDM construction was also not conducted, potentially overlooking nuances in cancer control strategies.

CONCLUSION

SDM in cancer control is underutilized, focusing mainly on early detection and treatment. Inconsistencies suggest a need for standardized SDM approaches. Future research should expand SDM's application and integrate it into cancer control strategies.

Assessing cancer-related fatigue: Validation of the Korean version of the cancer fatigue scale among cancer survivors

Objective

This study aimed to validate the Korean version of the Cancer Fatigue Scale (CFS-K) as a reliable tool for assessing cancer-related fatigue (CRF) for cancer survivors.

Methods

A total of 208 cancer survivors who completed active treatment participated in evaluating the reliability, construct validity, and factor structure of the CFS-K through confirmatory factor analysis (CFA). Correlations with the Functional Assessment of Chronic Illness Therapy-Fatigue (FACT-F) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) scales were analyzed to assess construct validity.

Results

The CFS-K demonstrated strong psychometric properties, with high internal consistency (Cronbach's α ​= ​0.875) and CFA validated a three-factor structure (physical, cognitive, and affective fatigue) with acceptable model fit indices (normed χ2 ​= ​2.62, CFI ​= ​0.899, TLI ​= ​0.878, RMSEA ​= ​0.088, SRMR ​= ​0.069). The standardized factor loadings for all items exceeded 0.5. Construct validity was confirmed through strong correlations with FACT-F (r ​= ​0.43-0.73) and significant correlations with EORTC QLQ-C30 subscales. Cancer survivors reported significantly higher fatigue levels across all subscales than controls.

Conclusions

The CFS-K is a reliable and valid tool for assessing multidimensional CRF in cancer survivors.

Beyond financial incentives: a quantitative study on spatial stigma and Puerto Rican physician migration to the United States

Puerto Rico faces a significant health crisis due to the mass migration of physicians to the United States, exacerbating the challenge of achieving the World Health Organisation's recommended physician-to-population ratio. While economic factors such as higher salaries in the US have been identified as primary drivers, the complexity of this migration wave requires a deeper exploration. This study quantitatively examines the role of push factors, pull factors, and spatial stigmatisation in physician migration from Puerto Rico. Using data from a randomly selected sample of 550 physicians (255 who had migrated to the US and 295 who lived in Puerto Rico), we analyse how perceptions of Puerto Rico's image and reputation, combined with stigmatisation linked to practicing medicine on the Island, influence migration decisions. Findings highlight that while better economic opportunities in the US are significant, the spatial stigma associated with Puerto Rico's healthcare system plays a crucial role in the decision to migrate. Policies aimed at curbing physician migration must address not only economic incentives but also the broader socio-cultural perceptions that contribute to the stigmatisation of practicing medicine in Puerto Rico. This study provides insights to inform comprehensive policy solutions to the healthcare crisis in Puerto Rico.

Critical appraisal of systematic reviews and meta-analyses: a step-by-step guide for nephrologists

BACKGROUND

Systematic reviews and meta-analyses play a pivotal role in evidence-based medicine, including nephrology, by consolidating findings from multiple studies. To maximize their utility, rigorous quality assessment during peer review is essential. Challenges such as heterogeneity, bias, and methodological flaws often undermine these studies, necessitating a structured appraisal process.

METHODS

This guide outlines a framework for nephrologists on appraising systematic reviews and meta-analyses. Key areas include heterogeneity assessment using the I2 statistic, interpretation of forest plots for pooled effect estimates, and the use of funnel plots with Egger's test to identify potential publication bias. Risk of bias is evaluated using RoB 2 for randomized controlled trials and ROBINS-I for non-randomized studies. Subgroup and sensitivity analyses, along with meta-regression, address heterogeneity and examine the robustness of findings.

RESULTS

The I2 statistic quantifies heterogeneity by estimating the proportion of variability in a meta-analysis. Funnel plots and Egger's test help detect publication bias. Major biases, such as selection, performance, detection, and publication bias, are identified using structured tools like AMSTAR 2, Cochrane RoB 2, and ROBINS-I. The GRADE framework further assesses the overall certainty of the evidence. Emphasis is placed on PRISMA compliance, protocol pre-registration, and transparent reporting of statistical analyses, subgroup, and sensitivity assessments. The inclusion of grey literature remains optional.

CONCLUSION

By focusing on key areas such as heterogeneity, risk of bias, and robust statistical methods, this guide enables nephrologists to critically appraise systematic reviews and meta-analyses, fostering better clinical decision-making and improved patient care in nephrology.

Trait dissociation in borderline personality disorder: influence on immediate therapy outcomes, follow-up assessments, and self-harm patterns

Background: Dissociative symptoms are suggested to compete with the effectiveness of psychotherapeutic treatment and frequently co-occur with early life trauma and self-harm patterns, including self-injury, suicidal ideation, and suicide attempts, which are characteristic for borderline personality disorder (BPD).Objective: We explore the connections between dissociation and other BPD features like self-harm and childhood traumatization and examine the impact of trait dissociation on both immediate and follow-up psychotherapy outcomes.Method: In this naturalistic prospective evaluation study, we investigated psychopathology including general psychological distress (SCL-90), depression (BDI-II), and borderline-specific pathology (BSL) in 131 patients with BPD pre and post of a certified 8-week inpatient Dialectical Behaviour Therapy (DBT), as well as 3- and 6-month post inpatient treatment. Prior to therapy, we evaluated trait dissociation (Dissociative Experience Scale), early life trauma (Childhood Trauma Questionnaire), and self-harm patterns (clinical interview). We performed a network analysis to explore the interplay between dissociation, self-harm, and childhood traumatization. To analyse the influence of dissociation on treatment outcomes, we employed linear mixed models.Results: Psychopathology (SCL-90, BDI-II and BSL) exhibited significant reductions at post-treatment and follow-up assessments when compared to baseline measurements. Higher levels of trait dissociation were consistently related to higher psychopathology but did not suggest poorer symptom reduction during DBT. However, trait dissociation predicted reduced 6-month follow-up benefits from DBT, regardless of the baseline symptom burden. The network analysis revealed a close association between self-injury and derealization/depersonalization, while the frequency of suicide attempts was more closely connected to childhood emotional abuse, which was identified as a central node of the network.Conclusions: Dissociation was not related to poorer outcomes regarding inpatient DBT. However, trait dissociation predicted reduced follow-up benefits, highlighting the need to address dissociation during psychotherapeutic interventions. Based on the estimated network structure, treating dissociative symptoms could potentially mitigate self-injury while especially childhood emotional abuse was linked with suicide attempts.

The International Trauma Interview (ITI): development of a semi-structured diagnostic interview and evaluation in a UK sample

Background: The International Trauma Interview (ITI) is a structured clinician-administered measure developed to assess posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined in the 11th version of the International Classification of Diseases (ICD-11). This study aimed to investigate a psychometric evaluation of the ITI and to finalise the English language version.Method: The latent structure, internal consistency, interrater agreement, and convergent and discriminant validity were evaluated with data from a convenience sample, drawn from an existing research cohort, of 131 trauma exposed participants from the United Kingdom reporting past diagnosis for PTSD or who had screened positively for traumatic stress symptoms. A range of self-report measures evaluating depression, panic, insomnia, dissociation, emotion dysregulation, negative cognitions about self, interpersonal functioning and general wellbeing were completed.Results: Confirmatory factor analysis supported an adjusted second-order two-factor model of PTSD and disturbances in self-organisation (DSO) symptoms, allowing affect dysregulation to also load onto the PTSD factor, over alternative models. The ITI scores showed acceptable internal consistency, and interrater reliability was strong. Findings for convergent and discriminant validity were mostly as predicted for PTSD and DSO domains. Correlations with the ITQ were good but coefficients for the level of agreement of PTSD diagnosis and CPTSD diagnosis between the ITI and the ITQ were weaker, and item level agreement was variable.Conclusion: Results provide support for the reliability and validity of the ITI as a measure of ICD-11 PTSD and CPTSD. Final revisions of the ITI are described.

Development and validation of the Oxford Benchmark Scale for Rating Vaccine Technologies (OBSRVT), a scale for assessing public attitudes to next-generation vaccine delivery technologies

Next-generation vaccine delivery technologies may provide significant gains from both a technical and behavioral standpoint, but no scale has yet been developed to assess public attitudes to novel vaccine delivery technologies. We therefore performed a cross-sectional validation study that included 1,001 demographically representative participants from the UK and US to develop and validate a novel scale, the Oxford Benchmark Scale for Rating Vaccine Technologies (OBSRVT). A sample of 500 UK participants was used to perform exploratory factor analysis with categorical variables (using a polychoric correlation matrix) followed by promax oblique factor rotation to develop the initial model. This yielded a 15-item 4-domain scale with domains including acceptance (6 items), effectiveness (4 items), comfort (3 items), and convenience (2 items). This model was tested for robustness on a 501-participant demographically representative sample from the US. A confirmatory factor analysis with a Satorra-Bentler scaled test statistic was performed, which demonstrated adequate goodness of fit statistics including the root mean squared error of approximation (0.057), standardized root mean squared residual (0.053), and comparative fit index (0.938). Reliability as internal consistency was excellent (alpha = 0.92). Convergent validity with the Oxford Needle Experience Scale was supported by an adequate correlation (r = 0.31, p < .0001), while discriminant validity was supported by a lack of correlation with an unrelated question (r = -0.03, p < .0001). These findings suggest that the OBSRVT scale represents a feasible, valid, and reliable scale that could be used to gauge the acceptability of existing and future vaccine delivery technologies, and further investigation and testing should be considered.

Identifying the heterogeneity of self-advocacy in Chinese patients with breast cancer using latent profile analysis and symptom networks

Objective

This study aims to identify subgroups of self-advocacy in patients with breast cancer, assess the heterogeneity among different subgroups, and further delineate symptom networks within each subgroup.

Methods

A cross-sectional survey was conducted among 320 patients with breast cancer in Wuxi, China, from September 2023 to March 2024, who completed questionnaires about their demographic and clinical characteristics, the M.D. Anderson Symptom Inventory, and the Female Self Advocacy in Cancer Survivorship scale. Latent profile analysis was conducted to identify subgroups of self-advocacy. Multinomial logistic regression was employed to reveal the heterogeneity of each subgroup in demographics and clinical characteristics. Network analysis was performed to unveil the network structure of clinical symptoms within each subgroup.

Results

Three subgroups were identified: "Profile 1: low self-advocacy", "Profile 2: moderate self-advocacy", and "Profile 3: high self-advocacy". Compared with patients in Profile 3, those in Profile 1 and Profile 2 showed a higher tendency to have more severe symptoms. Network analysis further revealed that "lack of appetite" emerged as the core symptom in Profile 1, while the core symptom in Profile 2 and Profile 3 was "distress".

Conclusions

Patients in different subgroups manifest individualized self-advocacy. The severity of clinical symptoms might serve as an important risk factor for those with low levels of self-advocacy. Conducting symptom networks of diverse subgroups can facilitate tailored symptom management by focusing on core symptoms, thereby enhancing the effectiveness of interventions and improving patients' self-advocacy and overall quality of life.

Exploring the relationship between illness perception, self-transcendence, and demoralization in patients with lung cancer: A latent profile and mediation analysis

Objective

This study examined the heterogeneity of illness perceptions in patients with lung cancer and evaluated the mediating role of self-transcendence in the relation between illness perception and demoralization.

Methods

A convenience sample of 477 patients with lung cancer was selected from three tertiary hospitals in Wuhan, China, between January and June 2024. Participants completed the Brief Illness Perception Questionnaire, Self-Transcendence Scale, and Demoralization Scale. Data were analyzed using Mplus 8.3 and SPSS 25.0.

Results

Three latent illness perception profiles were identified among patients with lung cancer: low (27.25%), moderate (40.04%), and high (32.71%). Mediation analyses revealed a partial mediation effect in the relation between illness perception and demoralization in the low versus moderate (SE ​= ​1.56, 95% CI ​= ​14.71, 20.86) and high versus low illness perception groups (SE ​= ​1.71, 95% CI ​= ​35.44, 42.71).

Conclusions

Patients with lung cancer exhibited heterogeneous illness perceptions, and self-transcendence partially mediated the relation between illness perception and demoralization. Promoting self-transcendence may help mitigate the negative impact of illness perceptions on demoralization. Clinical interventions aimed at reducing negative illness perceptions and enhancing self-transcendence should be prioritized in the care of patients with lung cancer.

Maladaptive appraisals and posttraumatic stress reactions in young terror survivors across 8 years: a random intercepts cross-lagged analysis

Background: Though there is substantial support for the importance of maladaptive appraisals for the development of posttraumatic stress reactions (PTSR), little is known about the long-term temporal relationship between maladaptive appraisals and PTSR beyond the first year after a traumatic event.Objective: We aimed to investigate three research questions: (1) Does the level of maladaptive appraisals change over time? (2) Are maladaptive appraisals and PTSR concurrently related to each other in the long term? (3) What is the direction of the temporal relationship between maladaptive appraisals and PTSR?Method: The participants were young survivors after the terror attack at Utøya island in Norway in 2011. We included data measured at 14-15 months, 30-32 months, and 102-108 months post trauma. The participants (N = 315) were all younger than 25 years at the time of the attack (mean age was 18.4, SD = 2.3), and 48.3% were female. The aims were investigated using correlations, paired t-tests, random intercept cross-lagged panel models (RI-CLPM), and cross-lagged panel models (CLPM).Results: We found a significant decrease in PTSR severity from 14-15 months to 30-32 months, and there was a significant increase in the mean level of maladaptive appraisals from 30-32 months to 102-108 months post trauma. Maladaptive appraisals and PTSR were highly associated across the three time points. Stable individual differences seem to account for most of the longitudinal relationship between maladaptive appraisals and PTSR, and we did not find clear indications of a direction of the temporal relationship between the variables.Conclusions: Our results indicate that the level of maladaptive appraisals can be quite stable once established, that they remain associated with PTSR, and that the long-term relationship between maladaptive appraisals and PTSR in the years following a trauma may best be explained by stable individual differences.

Effects of congruent and incongruent appetitive and aversive well-being comparisons on depression, post-traumatic stress, and self-esteem

Background: People compare their current well-being to different comparison standards (e.g. social or temporal comparisons). These standards are considered as aversive if perceived as threatening to self-motives or appetitive if perceived as consistent with self-motives. However, it remains unknown whether the congruence (vs. incongruence) of aversive and appetitive well-being comparisons (high levels of both vs. preponderance of aversive comparisons over appetitive comparisons) is differentially related to symptoms of depression and post-traumatic stress disorder (PTSD) and self-esteem.Methods: We conducted response surface analysis (RSA) on data from a study with two-timepoints three months apart (N = 921). RSA tests whether the degree of (in-)congruence of two variables is positively or negatively related to an outcome variable. Here, baseline aversive and appetitive well-being comparisons (comparison frequency, discrepancy, and affective impact) served as the two predictor variables, while depression, PTSD, and self-esteem three months later served as outcomes.Results: Findings partially confirmed our hypotheses. Congruently high (vs. low) levels of aversive and appetitive comparison frequency and discrepancy predicted more depressive/PTSD symptoms and lower self-esteem. Some evidence indicated more pronounced depressive symptoms and lower self-esteem (but not PTSD) for the preponderance of aversive over appetitive comparisons.Conclusions: The effects of congruent and incongruent aversive and appetitive comparisons as well as a potentially more crucial role of aversive than appetitive well-being comparisons in depression and self-esteem align with comparison theory.

Upper limb symptoms in breast cancer survivors with lymphedema: A latent class analysis and network analysis

Objective

Breast cancer survivors (BCS) with lymphedema experience multiple symptoms in upper limbs that significantly impact their quality of life. The complexity of symptomology and the connection among these symptoms are unclear. This study aimed to identify upper limb symptom subgroups and symptom networks among BCS.

Methods

This secondary analysis included individuals with lymphedema (defined as an inter-limb circumference difference of ≥ 2 cm) from three cross-sectional studies among post-surgery BCS. Upper limb symptoms were assessed by the Breast Cancer and Lymphedema Symptom Experience Index. Descriptive analysis, latent class analysis, logistic regression analysis, and network analysis were performed.

Results

A total of 341 BCS with upper limb lymphedema were included. Swelling, heaviness and tightness were the most prevalent symptoms. Four distinct latent classes were identified: "Severe symptom" group (Class 1: 9.4%), "Movement-limitation and lymph-stasis" group (Class 2: 24.6%), "Lymph-stasis" group (Class 3: 37.5%), and "Mild symptom" group (Class 4: 28.4%). BCS with axillary lymph node dissection, radiotherapy, longer post-surgery duration, and without medical insurance were less likely to belong to the mild symptom group (P ​< ​0.001). Symptom network density decreased from Class 1 to 4. Core symptoms for each symptom network were tenderness, firmness, arm-swelling, and heaviness, respectively.

Conclusions

This study identified four distinct categories of upper limb symptoms and influencing factors among individuals with breast cancer-related lymphedema (BCRL). Our findings suggest the need to consider individualized approaches to symptom management and support for BCRL, taking into account their specific symptom clusters and associated risk factors.

Network analysis of fatigue symptoms in Chinese patients with advanced cancer

Objective

This study was aimed at investigating the network structures of fatigue symptoms in patients with advanced cancer, with a focus on identifying the central symptom-an aspect crucial for targeted and effective fatigue symptom management.

Methods

In this cross-sectional study, patients with advanced cancer were recruited from the cancer treatment center of a tertiary hospital in China between January and December of 2022. Symptom occurrence and severity were assessed with the Cancer Fatigue Scale. Network analysis was conducted to explore the network structure and identify the core fatigue symptoms.

Results

The study included 416 patients with advanced cancer. Lack of energy (2.25 ​± ​1.24), lack of interest in anything (2.20 ​± ​1.22), and lack of self-encouragement (2.03 ​± ​1.25) were the most severe fatigue symptoms and belonged to the affective fatigue dimension. In the overall network, reluctance (r s  ​= ​5.622), a heavy and tired body (r s  ​= ​5.424), and tiring easily (r s  ​= ​5.319) had the highest strength values. All these core symptoms were classified within the physical fatigue dimension and remained stable before and after adjustment for covariates.

Conclusions

This study identified reluctance, a heavy and tired body, and tiring easily as the core fatigue symptoms in patients with advanced cancer, thus providing valuable insight to help clinical nurses formulate more effective symptom management strategies. Future interventions could assess the efficacy of targeting the central symptom cluster in alleviating other symptoms and patient burden.

Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and complex PTSD: the International Trauma Interview in a clinical sample of military veterans

Background: The International Trauma Interview (ITI) is the first clinician-administered diagnostic tool developed to assess posttraumatic stress disorder (PTSD) and Complex PTSD (CPTSD), both recently recognized in the ICD-11. The current study aims to test the construct and discriminant validity of the ITI in a population of treatment-seeking veterans.Method: 124 Danish veterans seeking psychological treatment were interviewed by a group of trained clinicians for ICD-11 PTSD and CPTSD before beginning treatment at the Military Psychological Department in the Danish Defense. A series of confirmatory factor models were estimated in order to identify the extent to which latent variable operationalizations provide potential explanations for the associations between symptoms.Results: Results indicate that symptoms of CPTSD, as measured by the ITI, are best represented by a single higher-order factor. We also found that a bifactor model provided adequate fit to the data. The commonly identified two-factor higher-order model was rejected due to the lack of discriminant validity between PTSD and DSO. The higher order model was found to explain associations between symptoms of CPTSD and symptoms of depression, stress, anxiety, and well-being.Conclusion: The ITI does not fit a two-factor higher-order model in a sample of treatment-seeking Danish veterans. Rather, a single higher order factor shows excellent fit, and is found to explain associations between ITI symptoms and other internalizing symptoms.

Underreporting in the military: perceived sensitivity of trauma-related and comorbid disorders among soldiers and civilian employees of the Austrian Armed Forces

Background: Underreporting is a potential source of bias. In the context of the military, the underreporting of mental health symptoms may be linked to inconsistent performance of mental health measures and heterogenous prevalence estimates. However, few studies systematically investigated the potential underreporting of mental health symptoms among military personnel.Objective: The present study systematically examined indications of underreporting symptoms of trauma-related and comorbid mental health disorders among three comparative samples of the Austrian Armed Forces.Methods: In a cross-sectional survey, 576 active duty soldiers, 764 conscripts, and 164 civilian employees rated the perceived sensitivity of items of the International Trauma Questionnaire (ITQ), several other commonly used self-report mental health measures, and the Effort-Reward Imbalance Questionnaire/short version as a control measure. Applying multilevel modelling, we tested whether mental health measures/ITQ symptom clusters would be perceived as more sensitive than the control measure across the three samples and investigated associations of demographic variables, trust in data protection and item order with sensitivity ratings.Results: All mental health measures, particularly items on alcohol use disorder and the negative self-concept symptom cluster of complex posttraumatic stress disorder (CPTSD), distrust in data protection and item order predicted perceived sensitivity. Active duty soldiers gave similar ratings as civilian employees while recruits rated the sensitivity of mental health measures lower than civilian employees in relation to the control measure.Conclusions: Although it remains unclear whether this is a specific characteristic of military populations, we conclude that military personnel may underreport mental health disorders, particularly symptoms of alcohol use disorder and CPTSD. In order to avoid biased results, strategies to reduce underreporting may be of particular importance in the field of military mental health. Further research is needed on predictors and effects of sensitivity perceptions as well as corresponding differences between civilian and military populations.Trial registration: German Clinical Trials Register identifier: DRKS00026627.

Network characteristics of comorbid symptoms in alcohol use disorder

BACKGROUND

Individuals with alcohol use disorder (AUD) often experience symptoms such as anxiety, depression, and decreased sleep quality. Although these are not diagnostic criteria, they may increase dependence risk and complicate treatment. This study aims to analyze comorbidities and their complex relationships in AUD patients through epidemiological surveys and network analysis.

MATERIALS AND METHODS

Using multi-stage stratified cluster random sampling, we selected 27,913 individuals and identified those with AUD for the study. All screened subjects were assessed with the General Health Questionnaire, Pittsburgh Sleep Quality Index, and Simple Coping Style Questionnaire, and diagnosed according to DSM-IV criteria. Network analysis and visualization were performed in R 4.4.0. The qgraph and bootnet packages in R were used to obtain partial correlation network analysis and node centrality of mental health, sleep quality, and coping styles in individuals with AUD through the estimateNetwork function. The bootnet package was used to assess the accuracy and stability of the network. The bnlearn package in R was used to construct directed acyclic graph (DAG) for individuals with AUD using the Bayesian hill-climbing algorithm.

RESULTS

In the partial correlation network, among the three major comorbidity categories, 'anxiety/depression' was most strongly associated with 'sleep quality'. 'Anxiety/depression' and 'sleep quality' had the highest node centrality, with 'sleep latency' also showing notable centrality. The DAG results indicated that 'sleep latency' had the highest probability priority, directly affecting 'anxiety/depression' and key sleep quality symptoms such as 'subjective sleep quality', 'sleep disturbances', 'sleep duration', and 'sleep efficiency', while also indirectly influencing other symptoms.

CONCLUSIONS

Among the comorbid symptoms of AUD, sleep latency appears to be a key factor in triggering other comorbid symptoms. This study provides a basis for interventions aimed at reducing the comorbid symptoms of AUD and promoting recovery.

Construction and initial validation of the International Trauma Questionnaire - Caregiver Version (ITQ-CG): assessing ICD-11 PTSD and CPTSD in children from caregiver perspective

ABSTRACTObjective: The 11th version of the International Classification of Diseases (ICD-11) introduces Posttraumatic Stress Disorder (PTSD) and complex PTSD (CPTSD) as two distinct trauma-related disorders. The International Trauma Questionnaire (ITQ) is the most widely used measure of assessment and has been adapted for use in children and adolescents (ITQ-CA), but a corresponding caregiver version is still missing. We aimed to close this gap by adapting the ITQ-CA and provide an initial validation of the ITQ - Caregiver Version (ITQ-CG). A corresponding measure of assessment from caregiver-perspective is integral for the use in child psychology, psychiatry and research.Method: Altogether, 326 children and adolescents who attended the department of child and adolescent psychiatry were rated by their caregivers using a set of standardized measures. Excluding patients due to missing data or no trauma exposure, a final sample of 223 patients was analysed. Factorial structure of the ITQ-CG and multiple forms of validity were examined using confirmatory factor, latent class and correlation analysis.Results: Confirmatory factor analysis supported the two-factor higher-order model of ICD-11 CPTSD as the factorial structure of the ITQ-CG. Convergent-divergent validity of main- and subscales of the ITQ-CG was evidenced by respective correlations with criterion variables. Latent class analysis supported the discriminant validity of the ITQ-CG, identifying a CPTSD-, PTSD-, DSO- and low symptoms-class. The CPTSD-class was associated with highest rates of comorbid psychopathology and functional impairment. Concurrent validity was evidenced by satisfactory concordance between caregiver- and child-reports.Conclusion: This study provides the construction and initial validation of the ITQ-CG to assess ICD-11 PTSD and CPTSD in children and adolescents from caregiver-perspective. We found compelling evidence for the ITQ-CGs validity, identifying it as an easy-to-use screening instrument to assess ICD-11 PTSD and CPTSD from caregiver-perspective. The ITQ-CG is freely available for clinicians and researchers.

The reliability and validity of the Swedish translation of the Vertigo Symptom Scale - short form in a cohort with acute vestibular syndrome

BACKGROUND

The Vertigo Symptom Scale - short form (VSS-SF) is commonly used to measure dizziness and vertigo over the past month. This study aimed to (1) adapt the VSS-SF for the Swedish population and assess its psychometric properties, and (2) develop a modified version for measuring symptoms in the acute phase of acute vestibular syndrome (AVS).

METHODS

The VSS-SF was translated into Swedish and adapted cross-culturally. Its psychometric properties were evaluated in 86 AVS patients, both in the acute stage (1-7 days from symptom onset) with a modified acute version, and after six weeks of vestibular rehabilitation using the standard VSS-SF. Factor structure, convergent and discriminant validity, and internal consistency were analyzed. Test-retest reliability was assessed at six weeks. Participants were also evaluated with the Dizziness Handicap Inventory (DHI) and balance tests. Controls included 54 healthy participants.

RESULTS

Exploratory factor analysis revealed a two-factor structure for both versions, corresponding to vertigo-balance (VSS-V) and autonomic-anxiety (VSS-A) subscales. Both versions demonstrated strong factor structures with adequate loadings. Internal consistency was high for the standard version (Cronbach's alpha 0.76 to 0.87) and for the total and VSS-V subscale of the acute version (0.82 and 0.85, respectively), but poor for the acute VSS-A subscale (0.50). Convergent validity was supported by Spearman's rank correlations. The discriminative ability was excellent for the acute VSS-SF and VSS-V (AUC 0.98 and 0.99), and acceptable for VSS-A (AUC 0.77). After six weeks, discriminative ability decreased but remained above 0.5. Test-retest reliability at six weeks was excellent for all scales (ICC 0.94, 0.93, and 0.93 for VSS-SF, VSS-V, and VSS-A).

CONCLUSIONS

The VSS-SF was successfully adapted for the Swedish population, including an acute version for early dizziness assessment. Both versions confirmed a robust two-factor structure, with the acute version showing excellent early discriminative ability, particularly for the vertigo-balance dimension. However, the autonomic-anxiety subscale showed weaker psychometric properties, suggesting limited suitability for AVS patients. The adapted scales show promise for clinical use in diagnosing and evaluating dizziness and vertigo in the Swedish population.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier NCT05056324, September 24, 2021. https://clinicaltrials.gov/ct2/show/NCT05056324.

Relationships between workplace violence, psychological symptoms, and adverse events: a nationwide cohort study of Chinese nurses

BACKGROUND

Nurses in China are disproportionately exposed to workplace violence. Rates of psychological symptoms and adverse events among Chinese nurses have increased in recent years. To evaluate whether workplace violence is associated with psychological symptoms and adverse events among nurses.

METHODS

This study is a cross-sectional analysis using baseline data from the Nurses' Mental Health Study (NMHS), conducted across 67 tertiary hospitals in 31 regions of China to assess the mental health of nurses. Workplace violence (WPV) from patients and their relatives was assessed using the Workplace Violence Scale (WVS). Outcomes included depressive symptoms (PHQ-9), anxiety (GAD-7), obsessive-compulsive symptoms (SCL-90-R), burnout, insomnia, and adverse events. To reduce selection bias, propensity score matching was applied, followed by multivariable logistic regression to examine associations between WPV, psychological symptoms, and adverse events.

RESULTS

A total of 105,614 nurses participated, with 93.1 % female and 66.0 % married. WPV was reported by 30.3 % (n = 32,027). Before matching, the prevalence of depression, anxiety, obsessive-compulsive symptoms, burnout, and insomnia was 53.0 %, 36.5 %, 74.2 %, 42.4 %, and 22.1 %, respectively. Adverse events were reported by 32.3 % of nurses. Nurses exposed to WPV were significantly more likely to report psychological symptoms and adverse events than those who were not.

CONCLUSIONS

WPV from patients and their relatives was significantly associated with increased psychological symptoms and adverse events among Chinese nurses. Reducing WPV in healthcare settings may improve both nurse well-being and patient safety.

Inducing dissociative states: A (re)view from the laboratory

Laboratory-based inductions of dissociative states promise to facilitate understanding of the etiology, maintenance, and treatment of dissociation and dissociative disorders. In the present scoping review, we identified articles via a systematic search of PsycINFO, PsycARTICLES, PubMed, and Google Scholar, resulting in 59 articles that met a priori inclusion criteria. Of the 19 techniques described, numerous elicited changes in dissociative symptoms. However, studies were highly heterogeneous regarding their definition and measurement of dissociation. We call attention to relevant validity concerns presented by laboratory-based inductions and offer directions and recommendations for future research.

Investigating the role of top-down regulation and bottom-up cues in eating styles transitions: a one-year cohort study with young adults

Young adults often experience deterioration in eating habits during transition periods. However, longitudinal evidence on the changes of eating styles and associated determinants remains limited. This study aimed to explore the eating style transitions among young adults in their graduate transitions and investigate the influences of top-down regulatory factors and bottom-up environmental cues on their eating style transitions. This is a two-wave cohort study involving 594 Hong Kong young adults completing the baseline assessment during their post-secondary graduation year, of whom, 424 completed the one-year follow-up survey. Eating behaviours were measured at both points. Executive function (EF), coping style, exposure to digital food environments, responsiveness to food cues, perceived stress and demographics were also measured. Latent profile analysis was used to explore main eating styles among participants while multinomial logistic regression models were used to assess determinants of eating style transitions. In follow-up assessment, 5.9 % of participants were consistently approaching eaters (APE) across two time points, while 28.8 % have transitioned from moderate eaters (MOE) or APE to mixed eaters (MIE). The multinominal logistic regression model revealed that although EF and coping style were no longer significantly associated with participants' eating style transitions outcomes, greater exposure to digital food environments (OR = 2.60, p = 0.028) and higher responsiveness to food cues (OR = 5.86, p = 0.005) were associated with Persistent APE, while higher responsiveness to food cues (OR = 2.36, p = 0.009) and higher perceived stress (OR = 1.05, p = 0.046) were associated with Converted MIE. Bottom-up cues may dominate eating style transitions compared to top-down regulations. Future interventions should leverage environmental cues, thereby targeting the automatic decision-making process and supporting healthy eating habits during stressful life stages.

Bone mineral density deficits in individuals born preterm persist through young adulthood: A systematic review and meta-analysis of DXA studies

Individuals born preterm are at increased risk for bone deficits given that the majority of skeletal mineral accrual occurs during the final gestational trimester. It is unclear how preterm birth affects bone density with aging or if individuals born preterm have increased rates of osteoporosis. This systematic review and meta-analysis summarizes the current data on bone mineral content and density measured by dual-energy x-ray absorptiometry (DXA) at any time across the lifespan after preterm birth in generally healthy, appropriate size for gestational age individuals. Three databases, including PubMed, Scopus, and CINAHL, were searched using keywords related to preterm birth and skeletal mineralization. Total body, lumbar spine, and femoral neck were the most frequently reported DXA measurement sites. A total of 39 studies (145 comparisons) were included in the meta-analyses, with bone outcomes measured within days of birth through about 30 years of age, depending on the measurement site. Preterm birth was associated with reduced bone mineral content and density. The largest total body bone deficits were observed in preterm individuals who were less than one year of age, with greater variability observed during childhood and adolescence. Individuals born preterm in the oldest cohort (17-30 years) maintained deficits in bone mineral density as they approached the age of peak bone mass. Importantly, there were no DXA studies of preterm individuals beyond 30 years of age, so it remains unclear how preterm birth affects the skeleton with advanced aging.

Assessing the risk of problem gambling among lottery loyalty program members: A machine learning approach

BACKGROUND AND AIMS

Lottery gambling is a relatively benign form of gambling. Nonetheless, individuals with gambling problems may engage in lottery play and/or play the lottery exclusively. Lottery loyalty programs have data that could be used to screen for problem gambling, as they collect information on demographics and ticket purchases from players who sign up to receive incentives. The current study evaluates the feasibility of machine learning to identify individuals who have gambling problems using data collected from a state lottery loyalty program.

METHODS

Data from ticket uploads was merged with an online survey sent to loyalty program participants (N = 5903). The Problem Gambling Severity Index (PGSI) was used to screen for problem gambling, with a five or greater denoting problem gambling (n = 809; 14%). Other survey items queried frequency of other gambling (e.g., casino slot machine) as well as amounts spent. Random forests analysis, a predictive modeling technique, was used to predict individuals who have gambling problems.

DISCUSSION AND CONCLUSIONS

Problem gambling was more common among loyalty program players than typical in population samples. The random forest algorithm performed fairly well overall, but sensitivity was poor, indicating that the model did not identify individuals with problem gambling effectively. Lottery loyalty programs may be a promising setting for screening and secondary prevention efforts because of relatively high prevalence of problem gambling, but random forests may not be the best approach for detecting those at risk.

Negative affect and emotional eating: Daily dynamics and their links to difficulties in emotional regulation

Emotional eating is considered a maladaptive coping strategy for negative affect. This study aimed to examine the daily relationship between negative affect and emotional eating, and further explore the role of emotion regulation in this process. Daily diary data was collected among 108 college students (Meanage = 19.8 ± 1.51, 83.3 % women) to assess the dynamic relationships between negative affect and emotional eating over 14 days. Difficulties in emotion regulation was assessed at pre- and post-test. Results of dynamic structural equation modeling revealed that emotional eating predicted next day's negative affect (β = .06, 95 % Credible Interval [.01, .15]), but not vice versa. Moreover, four subscales of difficulties in emotion regulation at baseline-nonacceptance of emotional responses, difficulties in engaging in goal-directed behavior, impulse control difficulties, and limited access to emotion regulation strategies-significantly predicted the association between negative affect and emotional eating. This association, in turn, was associated with five subscales of difficulties in emotion regulation at posttest, including nonacceptance of emotional responses, difficulties in engaging in goal-directed behavior, impulse control difficulties, limited access to emotion regulation strategies, and lack of emotional clarity. Our findings suggest that emotional eating can reinforce negative affect the following day, especially in individuals with difficulties in emotion regulation. Further, when emotional eating and negative affect are strongly linked, this may be associated with the reinforcement of difficulties in emotion regulation. Whether negative affect can trigger emotional eating could not be determined by our study, and should be investigated with more intensive study designs.

A network analysis of depressive symptoms and cognitive performance in older adults with multimorbidity: A nationwide population-based study

BACKGROUND

Depression and cognitive impairment are prevalent mental health issues. Older adults in China exhibits a higher prevalence of multimorbidity, which is linked to an increased risk of depression and cognitive impairment. This study aims to investigate association between depressive symptoms and cognitive impairment in older adults with multimorbidity using network analysis, and to identify important bridge symptoms as potential intervention targets.

METHOD

The study included 5729 individuals aged 60 years and above with multimorbidity, drawn from the China Health and Retirement Longitudinal Survey (CHARLS) dataset. Depressive symptoms and cognitive performance were assessed utilizing the CESD-10 (10-item Center for Epidemiologic Studies Depression) and MMSE (Mini Mental State Examination) scales, respectively. We constructed a network structure of depressive symptoms and cognitive performance, and calculated index of strength and bridge strength for each symptom. Furthermore, a comparative analysis of the network structure across gender and age groups were conducted.

RESULTS

D3 (Felt depressed), C1 (Orientation), and D10 (Could not get going) were identified as the central symptoms of the depressive symptoms - cognitive performance network. C1 (Orientation), C5 (Linguistic skills), and D10 (Could not get going) were bridge symptoms connecting the two illnesses. Moreover, significant differences in edge weights were observed across gender and age groups.

CONCLUSIONS

The central symptoms and bridge symptoms in the network may represent the most effective intervention pathway for addressing cognitive impairment and depression in older adults with multimorbidity. Clinical interventions should properly focus on gender and age differences in symptom presentation.

The longitudinal change of depressive symptoms among people living with HIV in Guangdong Province, China: A network analysis

BACKGROUND

Depression may change over time among people living with HIV (PLHIV). This study aimed to understand longitudinal change of depression among PLHIV in China, and the impact of change in depression on mortality.

METHODS

A cohort study was conducted to collect data on depressive symptoms among PLHIV at baseline and one-year follow-up in Guangdong Province from May 2018 to June 2019 and continued to follow up until June 2023. Generalized estimating equations were used to explore factors associated with depression. Network analysis was used to explore the interrelations between specific depressive symptoms at baseline and one-year follow-up.

RESULTS

30.9 % of 792 participants had a pattern of remission at one-year follow-up, 6.3 % had persistent depression at both baseline and one-year follow-up, and 5.9 % had new-onset depression at one-year follow-up. 46 (5.8 %) participants died. High levels of education, HIV-related symptoms, high levels of HIV-related stigma, and low social cohesion were longitudinally associated with a higher risk of depression. Network analysis revealed that "Depressed mood" and "Sadness" had high centrality in both the baseline and follow-up networks, with "Fearful" being the most increased central node at follow-up compared to baseline. Cox regression after propensity score weighting showed that the groups with new-onset and persistent depression had a higher risk of mortality than the non-depressed group.

CONCLUSION

More attention should be paid to individuals with high levels of education and those with HIV-related symptoms. Interventions targeting symptoms with increased centrality nodes, reducing HIV-related stigma and improving social cohesion may also help to reduce depression among PLHIV.

Bidirectional relationship between gaming disorder, internalizing psychopathology, psychological distress, and well-being: A systematic review with meta-analysis of longitudinal studies

There is a lack of a synthesis of longitudinal studies that clarify the relationship between gaming disorder (GD) symptoms and mental health. To address this gap, we undertook a systematic review with meta-analysis of longitudinal studies. The study protocol was preregistered online on PROSPERO (CRD42023407665). We included studies analyzing the association between GD or problematic/pathological videogame use, and internalizing psychopathology (depression and anxiety), psychological distress (loneliness and stress), and well-being (life satisfaction, quality of life, and well-being). Research articles were searched in PsycInfo, PsycArticles, PubMed, and Web of Science up until December 29, 2022.30 articles were considered for meta-analysis (N = 28,782). Effect sizes (partial correlation) were pooled using random-effects models. Sensitivity analyses excluded studies rated as "poor" - using the National Institutes of Health quality assessment tool for observational cohort studies - and Chinese studies. The associations between GD and subsequent depression, emotional mixed symptoms (i.e., a combination of internalizing symptoms) and life satisfaction were statistically significant. GD was not associated with subsequent anxiety. On the other hand, depression, anxiety, emotional mixed symptoms, life satisfaction and loneliness were significantly associated with subsequent GD. Overall, sensitivity analyses supported the robustness of the main results. In conclusion, this study found reciprocal longitudinal associations between GD and depression, life satisfaction, and emotional mixed symptoms, an effect of anxiety on GD (but not the inverse), and of loneliness on GD. However, the causal nature and practical relevance remain uncertain because effect sizes were small - or medium, depending on effect size guidelines - and based on observational studies.

Prediction and explanation of the increase in suicide risk of emerging adults: A comprehensive approach combining logistic regression, glasso network analysis, and Bayesian networks

BACKGROUND

The high suicide rate among emerging adults is a pressing public health issue. Identifying key suicide risk factors and understanding the mechanisms through which they affect individuals is crucial for intervention.

AIM

To uncover the complex factors influencing suicide risk among emerging adults and to elucidate how these risk factors interact and contribute to the overall risk of suicide.

METHODS

An online survey assessed mental health and suicide risk factors among 29,111 college students. Higher-risk students (n = 4820) were further evaluated using the Adolescent Suicidal Tendency Scale. This two-phase approach identified initial risk factors and subsequent suicide risk, which were analyzed through logistic regression, Glasso, and Bayesian network methods.

RESULTS

Logistic regression results indicated that adverse life events and social support can predict suicide risk, with the model achieving an Area Under the Curve (AUC) of 0.783. Glasso network analysis revealed a highly interconnected symptom network among all factors, where the highest centrality nodes, such as depression (1.465) and neuroticism personality traits (1.139), played central roles in the evolving dynamics of suicide risk. The Bayesian network analysis emphasized the mediating role of social support in the relationship between other risk factors and suicidal ideation.

LIMITATIONS

The lack of repeated measurements and the exclusion of pandemic-related variables may limit a comprehensive understanding of the risk factors.

CONCLUSIONS

Intervening in the mental health issues of individuals with suicidal tendencies and strengthening social support are crucial for reducing suicide risk, and this deserves the attention of mental health professionals.

Skin-to-skin contact at birth for very preterm infants and symptoms of depression and anxiety in parents during the first year - A secondary outcome of a randomized clinical trial

BACKGROUND

Mental health issues are common in parents to preterm infants. In the neonatal intensive care unit (NICU), skin-to-skin contact (SSC) as an avenue for parent-infant closeness may improve parental mental health. Few studies exist regarding its benefits when initiated immediately postbirth. The aim was to determine the effect of SSC for very preterm infants at birth on parents' mental health, by assessing symptoms of depression and anxiety within the first year.

METHODS

The Immediate Parent-Infant Skin-to-Skin Study was a randomized clinical trial conducted 2018-2021 at three NICUs in Sweden and Norway. Very preterm infants (28-33 weeks of gestation) were allocated to standard incubator care or SSC with either parent, initiated at birth and continued throughout the first 6 h. Symptoms of depression and anxiety in parents were assessed with the Edinburgh Postnatal Depression Scale and Spielberger State-Trait Anxiety Inventory.

RESULTS

The study included 91 infants (36 twins [40 %]) and 73 mothers and 73 fathers. Infants had a mean gestational age of 31 + 1 weeks and birthweight of 1534 g. Immediate SSC was found to significantly reduce depression symptoms in mothers and anxiety symptoms in fathers at one week after birth and depression and anxiety symptoms in fathers at term-equivalent age of infant.

LIMITATIONS

Limitations include a small sample size and limited background data on prenatal depression and anxiety.

CONCLUSIONS

Immediate parent-infant SSC following a very preterm birth may provide a protective effect on parents' mental health and should be supported in the clinical setting, alongside necessary nursing, and medical care.

An exploratory psychometric network analysis of depression scales in a sample of adolescents

BACKGROUND

There is heterogeneity in existing depression scales, which may lead to measurement bias. This study aimed to investigate the clustering of depressive symptoms in adolescents, including central symptoms as well as similarities and differences among four commonly used depression scales. Additionally, the study examined gender differences in network structures to explore the suitability of these scales.

METHODS

This study performed an exploratory psychometric network analysis of depression in 620 Chinese adolescents aged 15-17 years using R, which included four depression scales. The mean age of the adolescents was 15.95 ± 0.66 years. Among them, 279 (45.0 %) were boys, 316 (51.0 %) were girls, and 25 (4.0 %) did not report gender.

RESULTS

The network analysis revealed seven distinct symptom clusters among adolescents with depressive symptoms, including "Negative Emotions and Pessimism", "Loss of Positive Emotions", "Interpersonal Issues", "Retardation and Attention Issues", "Fear and Decision-making Difficulties", "Irritability or Stress" and "Low Self-esteem and Self-efficacy". These clusters varied in item distribution across the different scales. Moreover, network comparisons indicated notable gender differences in the structure of depressive symptom networks. Girls exhibited stronger associations between depressive symptoms, particularly concentrating core symptoms in clusters related to "Interpersonal Issues" and "Low Self-esteem and Self-efficacy".

CONCLUSION

Heterogeneity among depression scales may bias detection and identification in adolescents. Selecting appropriate scales based on participant characteristics and symptom clusters is essential. Furthermore, future screening and interventions should account for gender differences.

From error to insight: Removing non-systematic responding data in the delay discounting task may introduce systematic bias

Delay discounting (DD), which reflects a tendency to devalue rewards as the time to their receipt increases, is associated with health behaviors such as sleep disturbances, obesity, and externalizing behavior among adolescents. Response patterns characterized by inconsistent or unexpected reward valuation, called non-systematic responding (NSR), may also predict health outcomes. Many researchers flag and exclude NSR trials prior to analysis, which could lead to systematic bias if NSR (a) varies by demographic characteristics or (b) predicts health outcomes. Thus, in this study we characterized NSR and examined its potential beyond error by comparing it against DD with a secondary data analysis of the Adolescent Brain Cognitive Development (ABCD) Study-a population-based study that tracked youths (N = 11,948) annually from 8 to 11 years of age over 4 years. We assessed DD and NSR using the Adjusting Delay Discounting Task when youths were approximately 9.48 years old (SD = 0.51). We also examined three maladaptive health outcomes annually: sleep disturbances, obesity, and externalizing psychopathology. Our analysis revealed variations in NSR across races, ethnicities, and body mass index categories, with no significant differences observed by sex or gender. Notably, NSR was a stronger predictor of obesity and externalizing psychopathology than DD and inversely predicted the growth trajectory of obesity. These findings suggest that removing NSR patterns could systematically bias analyses given that NSR may capture unexplored response variability. This study demonstrates the significance of NSR and underscores the necessity for further research on how to manage NSR in future DD studies.

Subjective Socioeconomic Status Moderates Self-Esteem Reactivity to Daily Stressor Exposure: Evidence From a Daily Diary Approach

Research on self-esteem reactivity has demonstrated that self-esteem fluctuates in response to daily stressor exposure, and the strength of this relationship varies between individuals. Drawing upon the positive link between objective socioeconomic status (SES) and self-esteem, how subjective SES influences self-esteem reactivity to daily stressor exposure was explored. Using a 7-day daily diary study, the current study (Nparticipants = 243, Ndays = 1651) adopted a multilevel analysis to demonstrate that subjective SES attenuated the within-person association between daily stressor exposure and daily self-esteem, even after controlling for demographics and objective indicators of SES. The interactions were also consistent across social stressors and non-social stressors. The findings provide evidence supporting the protective role of subjective SES in self-esteem reactivity to daily stressor exposure.

Effects of exercise training on cognition in adults with depression: A systematic review and three-level meta-analysis

BACKGROUND

Cognitive impairment is a central feature of depression. Exercise training has enormous potential as a nonpharmacological intervention to improve cognition in depressed individuals.

OBJECTIVE

This review aimed to evaluate and update the effect of exercise training on overall cognition and its subdomains, as well as whether moderators influence the effect of exercise training on cognition in depressed adults.

DESIGN

Systematic review and three-level meta-analysis of randomized controlled trials.

METHODS

We systematically searched Embase, Ovid MEDLINE, Web of Science, PubMed, and Scopus from their inception to February 14, 2024, and updated the search results on December 5, 2024. Randomized controlled trials investigating how exercise training affected cognition in depressed adults were included. The meta-analysis was performed using a random-effects model in R. We used the Physiotherapy Evidence Database scale to evaluate the study's quality.

RESULTS

Twenty-two studies were included. Exercise training showed statistically significant improvements in overall cognition [g = 0.21; 95 % confidence interval (CI) = 0.12, 0.30] and cognitive subdomains of processing speed (g = 0.20; 95 % CI = 0.04, 0.36), attention (g = 0.21; 95 % CI = 0.06, 0.35), memory (g = 0.24; 95 % CI = 0.11, 0.38), and executive function (g = 0.21; 95 % CI = 0.09, 0.33) compared with comparison groups in depressed adults. The greater cognitive benefits were observed when participants exercised twice a week (g = 0.30; 95 % CI = 0.03, 0.56), at a low intensity (g = 0.26; 95 % CI = 0.08, 0.43), spent more than 60 min per session (g = 0.24; 95 % CI = 0.05, 0.44), 150 min or more per week (g = 0.27; 95 % CI = 0.09, 0.45), had a program duration more than 10 weeks (g = 0.25; 95 % CI = 0.12, 0.39), and engaged in mind-body exercise (g = 0.26; 95 % CI = 0.08, 0.43). The clinical setting, sample size, and comparison group for memory moderated the effects of exercise training on cognition.

CONCLUSIONS

Exercise training is an effective nonpharmacological intervention that enhances overall cognition and subdomains of processing speed, attention, memory, and executive function compared with comparison groups in depressed adults. This study only included English-language articles, which may have caused a language bias, and Egger's test revealed a possibility of publication bias.

REGISTRATION NUMBER

CRD42023457900 (PROSPERO).

TWEETABLE ABSTRACT

Exercise training is an effective nonpharmacological intervention for adults with depression to improve overall cognition and cognitive subdomains of processing speed, attention, memory, and executive function compared with comparison groups.

When Confidence in Institutions Backfires: Power-Distance Orientation Moderates the Relationship Between Institutional Trust and Civic Honesty Across Eight Countries

Confidence in institutions is a key predictor of civic honesty, yet evidence shows that this relationship varies across contexts and individuals. This study examined whether power-distance orientation (PDO)-the extent to which individuals accept hierarchical power relations-moderates this association. High-PDO individuals tend to view institutional authorities as entitled to privilege, inclined to engage in patronage relationships and potentially corrupt. We hypothesised that for individuals high in PDO, confidence in institutions could backfire and be linked to the rejection of civic honesty. Using data from 2088 participants across eight countries, we found support for this hypothesis. Specifically, the positive link between institutional confidence and civic honesty was reversed among those who strongly endorse PDO. These findings suggest that individual-level variation in the link between confidence in institutions and civic honesty partly reflects broader beliefs about authorities. We discuss implications of this interaction and outline directions for future research.

Vitamin E ameliorates blood cholesterol level and alters gut microbiota composition: A randomized controlled trial

BACKGROUND AND AIMS

Antioxidants, including vitamin E (VE) and grape seed extract (GSE), as anti-aging supplementation have been widely used to improve human health. The gut microbiota plays a crucial role in health and affects the treatment effect of various interventions. However, the role of gut microbiota in VE remains unclear. This study aimed to assess the longitudinal impact of VE treatment on body health and the gut microbiota.

METHODS AND RESULTS

A randomized controlled trial was conducted with 90 healthy individuals. The participants were randomly assigned to three groups: a treatment group receiving VE, another antioxidant treatment group receiving GSE, and a control group receiving a placebo. We found that VE ameliorated blood cholesterol levels by reducing the levels of low-density lipoprotein cholesterol (LDL-C) in healthy volunteers. After the intervention, there was an increase in the relative abundance of short-chain fatty acid (SCFA)-producing bacteria and bile acid metabolizers. Specifically, the abundances of Lachnospira sp. and Faecalibacterium spp. increased in the VE. Interestingly, the gut microbiota of poor responders harbored a greater proportion of disease-associated bacterial species.

CONCLUSIONS

VE could promote health by lowering LDL-C, partly and indirectly by affecting gut bacteria with the ability to produce SCFAs or metabolize bile acids.

REGISTRATION NUMBER FOR CLINICAL TRIALS

The clinical trial was registered on August 28, 2021. Registration number was ChiCTR2100050567 (https://www.chictr.org.cn).

Diet quality and depression risk: A systematic review and meta-analysis of prospective studies

BACKGROUND

The association between diet and the onset and treatment of depression is unclear. This study aims to estimate the evidence for the prospective association between diet quality and depression.

METHODS

Systematic searches in PubMed, Web of Science and Embase up to 2024/01/04 of propective studies on the potential relationship between diet quality and depression identified 21 randomized clinical trials (RCT) and 92 prospective cohorts (PC) (>700,000 participants), that were pooled in random-effects frequentist and Bayesian meta-analyses.

RESULTS

Treatment-RCT yielded anecdotal-to-moderately strong support for the hypothesis that dietary interventions improve depression (d = -0.80, 95 % CI = -1.46 to -0.14), though their internal validity was low. Interventional effects were observed in nonpatient samples (d = -0.17, -0.29 to -0.08). Prevention-RCT yielded strong evidence indicating no association. Data from PC showed that adherence to some dietary patterns/food groups was associated with depression, e.g., adherence to the Mediterranean-diet was associated to fewer self-reported symptoms (OR = 0.91, 95%CI = 0.88-0.96), with anecdotal-to-moderate strength of evidence but no dose-response relationship. For most dietary patterns and food-groups (e.g., fish), data supported the null-hypothesis of no effect. Effect moderation was present: associations were evident when depression was self-reported but not when diagnosed. Postpartum-depression studies yielded evidence showing dose-response associations between fish (OR = 0.84, 95%CI = 0.78-0.91) and dietary DHA/EPA/Omega3 consumption (OR = 0.84, 95%CI = 0.77-0.92) with self-reported depression-scores.

CONCLUSIONS

The strength of the current evidence on the hypothesis that dietary quality influences depression outcome is very low, due to reverse causation and low internal and construct validity. The clinical significance of fish/dietary DHA/EPA/Omega3 intake to reduce the risk of postpartum-depression should be further investigated.

A structural equation model of psychological capital, self-directed learning, and learned helplessness: Implications for postgraduate nursing education

BACKGROUND

Postgraduate nursing students face complex academic-clinical integration challenges that may precipitate learned helplessness and impede professional development. The mechanisms through which psychological capital and self-directed learning influence learned helplessness in nursing education remain incompletely characterized.

OBJECTIVE

This study aimed to (1) evaluate the prevalence and determinants of learned helplessness among postgraduate nursing students, and (2) analyze the mediating pathways between psychological capital and learned helplessness through self-directed learning components.

DESIGN

Multiple academic medical centers and affiliated teaching hospitals across Chinese provinces.

SETTING

Conducted across multiple universities and hospitals in various provinces of China.

PARTICIPANTS

Full-time and part-time postgraduate nursing students and clinical nurses with completed postgraduate degrees were recruited between September and October 2024.

METHODS

Validated instruments assessed psychological capital (PCQ-24), self-directed learning (SRSSDL), and learned helplessness (LHQ). Analyses included descriptive statistics, stepwise regression, and structural equation modeling with 5000-sample bootstrapping to evaluate cognitive and interpersonal mediation pathways.

RESULTS

Participants demonstrated moderate-to-high learned helplessness (41.86 ± 14.03). Multiple regression analysis identified four significant protective factors: higher levels of hope (β = -0.29), enhanced learning awareness (β = -0.20), stronger professional identity (β = 0.23), and supportive mentor communication styles (β = 0.23) (all P < 0.01). In the mediation analysis, cognitive self-directed learning accounted for 81.8 % of the psychological capital-learned helplessness relationship, while interpersonal relationships mediated 23.4 %.

CONCLUSIONS

Psychological capital significantly reduces learned helplessness through dual pathways, primarily through cognitive self-directed learning and secondarily through interpersonal relationships. Educational interventions should adopt a comprehensive approach: (1) implementing psychological capital training programs incorporating resilience workshops and reflective practices, (2) transitioning to competency-based, self-directed learning models, and (3) establishing adaptive mentorship frameworks that prioritize supportive communication styles. These evidence-based strategies could effectively mitigate learned helplessness and enhance academic success among postgraduate nursing students.

Unpacking the link between hormonal fluctuations and risk-taking: A systematic review and meta-analysis

Previous studies have suggested that hormonal fluctuations, specifically in testosterone, estradiol, and cortisol, may impact reward-related brain functioning and risk-taking behaviors. However, findings in this area have been inconsistent and sometimes contradictory. The current study aimed to conduct a meta-analysis to investigate the effects of both endogenous and exogenous testosterone, estradiol, and cortisol on risk-taking behaviors, as well as identify potential moderators of these effects. This meta-analysis systematically reviewed studies published up to February 20, 2025, encompassing both correlational and experimental designs. After screening 2544 records, 98 studies met inclusion criteria, yielding 162 effect sizes involving 8676 participants for testosterone, 55 effect sizes from 2510 participants for estradiol, and 66 effect sizes from 3933 participants for cortisol. Using the random-effects Bayesian meta-analytic models, our results showed that both testosterone and estradiol had a significant, albeit modest, effect on increasing risk-taking behaviors (testosterone: Hedge's g = 0.22; 95 % CrI [0.14, 0.30]; estradiol: Hedge's g = 0.20; 95 % CrI [0.03, 0.37]). However, cortisol was not associated with changes in risk-taking (Hedge's g = -0.04; 95 % CrI [-0.17, 0.09]). Further analysis indicated that the effects of testosterone were moderated by the study design (experimental vs. correlational), the behavior type (sensation seeking vs. risk-taking vs. impulsivity), the measurement type of risky behavior (self-report vs. behavioral) and the measurement type of hormone (saliva vs. serum), but these moderators had no significant impact on the estradiol effect. Despite the potential for publication bias, no evidence of selective reporting (e.g. p-hacking) was found in the p-curve analysis. In summary, testosterone and estradiol may influence risk-taking behaviors, although further randomized controlled trials (RCTs) with larger sample sizes are necessary to confirm these findings.

Gender differences in the association between childhood socioeconomic status and later-life depression among middle-aged and older adults in China: A chain mediation model of education level and present subjective social status

BACKGROUND

The mechanisms connecting childhood socioeconomic status (SES) to later-life depression remain underexplored. This study aims to examine the mediating roles of education level and subjective social status (SSS) between childhood SES and later-life depression among middle-aged and older adults in China, with a focus on potential gender differences.

METHODS

5485 individuals aged 45 years and older from the 2022 China Family Panel Study were selected for analysis. Depression was assessed via the short form of the Center for Epidemiological Studies Depression Scale. Childhood SES was derived through principal component analysis. The bootstrap program was used to test the chained mediation effects.

RESULTS

The average depression score among the participants was 6.00 ± 4.365. Childhood SES, education level, and subjective social status were negatively associated with depression (P < 0.05). The chain mediation effect was significant for all participants, with education level exhibiting a 2.4 times stronger mediating effect in women than in men. Additionally, a negative correlation was observed between participants' education level and their present SSS (P < 0.05), which contributed to a positive chain-mediated effect that links childhood SES to depression (Effect = 0.011, 95%CI = 0.006 to 0.016).

LIMITATIONS

Retrospective self-reported data and a cross-sectional design.

CONCLUSIONS

Poorer childhood SES was associated with an increased risk of later-life depression in middle-aged and older adults, and this relationship can be partially explained by education level and subjective social status. Attention should be given to those with poor childhood SES to improve their subjective perception of social status along with educational attainment.

Acoustic and phonological processes in Williams Syndrome: A systematic review and meta-analysis

This meta-analysis focuses on acoustic, phonetic and phonological aspects of language processing in Williams syndrome (WS), a rare neurodevelopmental genetic disorder. Based on N = 51 papers, we aimed at identifying the status of these languages processes in WS relative to different types of control groups and we examined possible sources of variability of results through moderator analyses. At the acoustic level, evidence for hearing loss and impaired acoustic discrimination was observed. At the phonetic and sublexical phonological level, results were inconclusive due to limited literature. At the metaphonological level, WS individuals demonstrated better phonological awareness than nonverbal age-matched peers but performed below typically developing (TD) peers matched for verbal mental age. For phonological working memory WS performed worse than mental age matched TD peers but outperformed participants with other disabilities. At the lexical phonological level, WS demonstrated better phonological fluency skills than younger mental age matched peers. A wide range of heterogeneity was observed (I²=0-92.26 %). In some cases, the heterogeneity was partly explained by differences in control groups, but the largest part of heterogeneity could not be accounted for by the moderator variables included in the analysis. Future research needs to address sublexical phonological levels, to consider developmental trajectories and WS group variability, and to examine how impaired acoustic processes impact linguistic processes.

The role of impaired iron transport on exercise performance and prognosis in patients with chronic heart failure

Background

Iron deficiency (ID) is frequent in chronic heart failure (HF). Among HF-ID patients those with impaired iron transport (IIT) (Transferrin saturation (TSAT) < 20 %) have the worst prognosis. In HF survival is strictly related to exercise limitation but the link between IIT, exercise limitation and survival is at present undefined.

Methods

We evaluated in 999 consecutive patients hospitalized for worsening HF whether IIT affects prognosis through cardiopulmonary exercise test (CPET), i.e. peak oxygen uptake (VO2) and ventilation vs. carbon dioxide (VE/VCO2) slope. In all patients at stabilization iron metabolism and maximal CPET were performed. Survival was assessed as all cause death, urgent LVAD and heart transplant were considered death equivalents. The causal relationship between survival and IIT, peakVO2 and VE/VCO2slope was assessed applying path analysis.

Results

PeakVO2, VE/VCO2slope and TSAT were 68 ± 44 %pred, 35 ± 9 and 24.4 ± 12.9, respectively. PeakVO2 and, VE/VCO2slope were 61 ± 18 vs. 72 ± 53 %pred and 38 ± 10 vs. 33 ± 8, in IIT vs. non IIT patients (p < 0.0001 in both). At univariable and multivariable analysis a correlation between survival and VO2, VE/VCO2slope and TSAT was observed; at Kaplan-Myer lower peakVO2, higher VE/VCO2slope and lower TSAT showed worst survival; at path analysis IIT showed both an important effect on survival independent from peakVO2 and VE/VCO2slope (48 %) and an effect on survival independently mediated by VE/VCO2slope and peakVO2 (52 %), contributing to the IIT negative effect on survival.

Conclusions

The adverse impacts of low TSAT on prognosis are in part direct and in part mediated by mechanisms related to reduced peakVO2 and increased @VE/VCO2slope.