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Howell FM, McCarthy KJ, Boychuk N, Burdick M, Nowlin S, Maru S, Oshewa O, Monterroso M, Rodriguez A, Katzenstein C, Longley R, Cabrera C, Howell EA, Levine L, Janevic T, Gundersen DA. Racism in obstetric care: a psychometric study of the Gendered Racial Microaggressions Scale among Global Majority birthing people in obstetric contexts. BMC Pregnancy Childbirth 2024; 24:448. [PMID: 38943057 PMCID: PMC11214214 DOI: 10.1186/s12884-024-06642-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024] Open
Abstract
In the United States, maternal health inequities disproportionately affect Global Majority (e.g., Asian, Black, and Hispanic) populations. Despite a substantial body of research underscoring the influence of racism on these inequities, little research has examined how experiences of gendered racial microaggressions during pregnancy and birth impact racially and ethnically diverse Global Majority pregnant and birthing people in obstetric hospital settings. We evaluated the psychometric properties of an adapted version of Lewis & Neville's Gendered Racial Microaggressions Scale, using data collected from 417 Global Majority birthing people. Findings from our study indicate that our adapted GRMS is a valid tool for assessing the experiences of gendered racial microaggressions in hospital-based obstetric care settings among Global Majority pregnant and birthing people whose preferred languages are English or Spanish. Item Response Theory (IRT) analysis demonstrated high construct validity of the adapted GRMS scale (Root Mean Square Error of Approximation = 0.1089 (95% CI 0.0921, 0.1263), Comparative Fit Index = 0.977, Standardized Root Mean Square Residual = 0.075, log-likelihood c2 = -85.6, df = 8). IRT analyses demonstrated that the unidimensional model was preferred to the bi-dimensional model as it was more interpretable, had lower AIC and BIC, and all items had large discrimination parameters onto a single factor (all discrimination parameters > 3.0). Given that we found similar response profiles among Black and Hispanic respondents, our Differential Item Functioning analyses support validity among Black, Hispanic, and Spanish-speaking birthing people. Inter-item correlations demonstrated adequate scale reliability, α = 0.97, and empirical reliability = 0.67. Pearsons correlations was used to assess the criterion validity of our adapted scale. Our scale's total score was significantly and positively related to postpartum depression and anxiety. Researchers and practitioners should seek to address instances of gendered racial microaggressions in obstetric settings, as they are manifestations of systemic and interpersonal racism, and impact postpartum health.
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Affiliation(s)
- Frances M Howell
- Department of Population Health Science Policy, Icahn School of Medicine at Mount Sinai, 722 W 168th Street, Room 722, New York, NY, 10032, USA.
- Department of Epidemiology, Columbia University Mailman School of Public Health, 1770 Madison Avenue, 2nd Floor, New York, NY, 10029, USA.
- , Present Address: New York, USA.
| | - Katharine J McCarthy
- Department of Population Health Science Policy, Icahn School of Medicine at Mount Sinai, 722 W 168th Street, Room 722, New York, NY, 10032, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, 1770 Madison Avenue, 2nd Floor, New York, NY, 10029, USA
| | - Natalie Boychuk
- Department of Population Health Science Policy, Icahn School of Medicine at Mount Sinai, 722 W 168th Street, Room 722, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 1770 Madison Avenue, 2nd Floor, New York, NY, 10029, USA
- , Present Address: New York, USA
| | - Micki Burdick
- Department of Women & Gender Studies, University of Delaware, 25N College Ave. 205 McDowell Hall, Newark, DE, 19716, USA
- , Philadelphia, USA
| | - Sarah Nowlin
- Department of Population Health Science Policy, Icahn School of Medicine at Mount Sinai, 722 W 168th Street, Room 722, New York, NY, 10032, USA
- Center for Nursing Research and Innovation, Mount Sinai Health System, 19 East 98th Street, 3rd Floor, Suite E, New York, NY, 10029, USA
| | - Sheela Maru
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 Fifth Ave, 5th Floor, New York, NY, 10029, USA
- New York City Health + Hospitals/Elmhurst, 1216 Fifth Ave, 5th Floor, New York, NY, 10029, USA
| | - Oluwadamilola Oshewa
- Department of Obstetrics and Gynecology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Maria Monterroso
- Department of Obstetrics and Gynecology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Alva Rodriguez
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, 1216 Fifth Ave, 5th Floor, New York, NY, 10029, USA
| | - Cecilia Katzenstein
- Icahn School of Medicine at Mount Sinai, Box 1199, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Regina Longley
- Icahn School of Medicine at Mount Sinai, Box 1199, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Camila Cabrera
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, Box 1199, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, University of Pennsylvania, 3400 Spruce Street, 5 Dulles, Philadelphia, PA, 19194, USA
| | - Lisa Levine
- Department of Obstetrics and Gynecology, University of Pennsylvania, 3400 Spruce Street, 2 Silverstein, Philadelphia, PA, 19104, USA
| | - Teresa Janevic
- Department of Population Health Science Policy, Icahn School of Medicine at Mount Sinai, 722 W 168th Street, Room 722, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 1770 Madison Avenue, 2nd Floor, New York, NY, 10029, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, 1770 Madison Avenue, 2nd Floor, New York, NY, 10029, USA
- , Present Address: New York, USA
| | - Daniel A Gundersen
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, USA
- Rutgers Institute for Nicotine and Tobacco Studies, Rutgers the State University of New Jersey, 303 George Street, Suite 500 New, Brunswick, NJ, 08901, USA
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Bennetter KE, Waage CW, Jenum AK, Vøllestad NK, Robinson HS, Richardsen KR. Cross-Cultural Contact and Norwegian Language Skills Among Ethnic Minority Women in Norway, and Relationship with Physical Activity in Pregnancy and Postpartum: The STORK-Groruddalen Cohort Study. J Immigr Minor Health 2024; 26:63-71. [PMID: 37639042 PMCID: PMC10771598 DOI: 10.1007/s10903-023-01535-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 08/29/2023]
Abstract
There are few studies of the migration context factors and physical activity (PA) level among minority ethnic women in Europe. We investigated the association between migration context factors and moderate to vigorous physical activity (MVPA) among minority ethnic women. Objectively recorded MVPA were obtained from 487 minority ethnic women included in the STORK-Groruddalen Cohort Study at three time points in pregnancy/postpartum. We investigated the associations between (a) contact with ethnic Norwegians and (b) Norwegian language skills and. No associations were observed in pregnancy. Postpartum, women who reported contact with ethnic Norwegians accumulated 17 MVPA min/day (95% CI: -.60, 34.54) more than women with no contact. In complete case analyses, this difference was significant (27 MVPA min/day (95% CI: 8.60, 44.54)). In early postpartum women with contact with ethnic Norwegians seems to be more physically active than women without contact. No associations were observed in pregnancy.
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Affiliation(s)
- Karin Elisabeth Bennetter
- Institute of Health and Society, Department of General Practice, Faculty of Medicine, University of Oslo, Box 1130, 0318, Blindern, Oslo, Norway.
| | - Christin Wiegels Waage
- Institute of Health and Society, Department of General Practice, Faculty of Medicine, University of Oslo, Box 1130, 0318, Blindern, Oslo, Norway
- Institute of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Anne Karen Jenum
- Institute of Health and Society, Department of General Practice, Faculty of Medicine, University of Oslo, Box 1130, 0318, Blindern, Oslo, Norway
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nina Køpke Vøllestad
- Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Hilde Stendal Robinson
- Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Kåre Rønn Richardsen
- Institute of Health and Society, Department of General Practice, Faculty of Medicine, University of Oslo, Box 1130, 0318, Blindern, Oslo, Norway
- Institute of Physiotherapy, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
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Smith D, He B, Shi J, Zhu HJ, Wang X. Novel Independent Trans- and Cis-Genetic Variants Associated with CYP2D6 Expression and Activity in Human Livers. Drug Metab Dispos 2024; 52:143-152. [PMID: 38050015 PMCID: PMC10801631 DOI: 10.1124/dmd.123.001548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/01/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023] Open
Abstract
Cytochrome P450 2D6 (CYP2D6) is a critical hepatic drug-metabolizing enzyme in humans, responsible for metabolizing approximately 20%-25% of commonly used medications such as codeine, desipramine, fluvoxamine, paroxetine, and tamoxifen. The CYP2D6 gene is highly polymorphic, resulting in substantial interindividual variability in its catalytic function and the pharmacokinetics and therapeutic outcomes of its substrate drugs. Although many functional CYP2D6 variants have been discovered and validated, a significant portion of the variability in the expression and activity of CYP2D6 remains unexplained. In this study, we performed a genome-wide association study (GWAS) to identify novel variants associated with CYP2D6 protein expression in individual human livers, followed by a conditional analysis to control for the effect of functional CYP2D6 star alleles. We also examined their impact on hepatic CYP2D6 activity. Genotyping on a genome-wide scale was achieved using the Illumina Multi-Ethnic Genotyping Array (MEGA). A data-independent acquisition (DIA)-based proteomics method was used to quantify CYP2D6 protein concentrations. CYP2D6 activity was determined by measuring the dextromethorphan O-demethylation in individual human liver s9 fractions. The GWAS identified 44 single nuclear polymorphisms (SNPs) that are significantly associated with CYP2D6 protein expressions with a P value threshold of 5.0 × 10-7 After the conditional analysis, five SNPs, including the cis-variants rs1807493 and rs1062753 and the trans-variants rs4073010, rs729559, and rs80274432, emerged as independent variants significantly correlated with hepatic CYP2D6 protein expressions. Notably, four of these SNPs, except for rs80274432, also exhibited a significant association with CYP2D6 activities in human livers, suggesting their potential as novel and independent cis- and trans-variants regulating CYP2D6. SIGNIFICANT STATEMENT: Using individual human livers, we identified four novel cis- and trans-pQTLs/aQTLs (protein quantitative trait loci/activity quantitative trait loci) of Cytochrome P450 2D6 (CYP2D6) that are independent from known functional CYP2D6 star alleles. This study connects the CYP2D6 gene expression and activity, enhancing our understanding of the genetic variants associated with CYP2D6 protein expression and activity, potentially advancing our insight into the interindividual variability in CYP2D6 substrate medication response.
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Affiliation(s)
- Dylan Smith
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, Ohio (D.S., X.W.); Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan (H.-J.Z.); Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan (B.H.); and Bristol Myers Squibb, Lawrence Township, New Jersey (J.S.)
| | - Bing He
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, Ohio (D.S., X.W.); Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan (H.-J.Z.); Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan (B.H.); and Bristol Myers Squibb, Lawrence Township, New Jersey (J.S.)
| | - Jian Shi
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, Ohio (D.S., X.W.); Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan (H.-J.Z.); Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan (B.H.); and Bristol Myers Squibb, Lawrence Township, New Jersey (J.S.)
| | - Hao-Jie Zhu
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, Ohio (D.S., X.W.); Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan (H.-J.Z.); Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan (B.H.); and Bristol Myers Squibb, Lawrence Township, New Jersey (J.S.)
| | - Xinwen Wang
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, Ohio (D.S., X.W.); Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan (H.-J.Z.); Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan (B.H.); and Bristol Myers Squibb, Lawrence Township, New Jersey (J.S.)
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Johansson M, Ledung Higgins K, Dapi Nzefa L, Benderix Y. Postpartum depression and life experiences of mothers with an immigrant background living in the south of Sweden. Int J Qual Stud Health Well-being 2023; 18:2187333. [PMID: 36880807 PMCID: PMC10013500 DOI: 10.1080/17482631.2023.2187333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
PURPOSE Postpartum Depression (PPD) -a common health problem for mothers' postpartum increases the risk of negative interaction between mothers and infants as it reduces the former's ability to respond to the latter's needs appropriately. Migrant mothers exhibit a higher prevalence of risk factors for PPD. Hence, this study aimed to investigate migrant mothers' life experiences pertaining to motherhood and PPD. METHODS Qualitative interviews were conducted with 10 immigrant mothers in the south of Sweden during 2021. RESULTS The qualitative content analysis revealed the following main themes: 1) PPD (two sub themes-psychosomatic symptoms and burden of responsibility due to feelings of loneliness); 2) mistrust of social services (one sub-theme-afraid of losing their children and Swedish social services' lack of understanding); 3) inadequate healthcare (two sub-themes-limited healthcare literacy for migrant mothers and language barrier; 4) women's coping strategy for well-being (two sub-themes-better awareness and understanding of the Swedish system and society, and freedom and independence in the new country). CONCLUSIONS PPD, mistrust of social services, and inadequate healthcare lacking personal continuity were common among immigrant women, thus precipitating discrimination-including lack of access to services because of limited health literacy, cultural differences, language barriers, and insufficient support.
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Affiliation(s)
- Maude Johansson
- Department of Psychology, Linnaeus University, Växjö, Sweden
| | | | | | - Ylva Benderix
- Department of Psychology, Linnaeus University, Växjö, Sweden
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Waage CW, Toftemo I, Brænd AM, Sletner L, Sommer C, Birkeland KI, Richardsen KR, Shakeel N, Vøllestad NK, Jenum AK. Cohort profile update: the Norwegian STORK Groruddalen (STORK G) pregnancy and birth cohort-the role of ethnicity and causal pathways for obesity, type 2 diabetes, cardiovascular disease and other health issues. BMJ Open 2023; 13:e076251. [PMID: 37899145 PMCID: PMC10619061 DOI: 10.1136/bmjopen-2023-076251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Abstract
PURPOSE The STORK Groruddalen cohort was set up in 2008 to explore ethnic differences in: (1) maternal health, primarily gestational diabetes (GDM) and related health issues during pregnancy and post partum, and effects of exposures on risk for type 2 diabetes, cardiovascular disease and other health issues, and (2) offspring's growth and body composition, overweight/obesity and effects of early life exposures. PARTICIPANTS 823 women (74% of invited) were followed from gestational week (GW) 15. Data were collected from 618 fathers. In total, 59% of women and 53% of fathers had origin from non-Western countries. Maternal mean age was 29.9 years (SD 4.9), and body mass index (BMI) 25.3 kg/m2 (4.9). Data were obtained from 772 women (94%) at GW 28, and 662 women (80%) 14 weeks post partum. Eleven years post partum, 385 women (53% of eligible/47% of original cohort) attended, age was 42.0 years (4.8) and BMI 27.1 kg/m2 (5.1). We have data for 783 children at birth, and for 586 at last time point, mean age 8.6 (0.5) years, weight 30.7 (6.8) kg and length 133.9 (6.3) cm. FINDINGS TO DATE We collected questionnaire data from parents, clinical measurements and blood samples from mothers, and data on children's growth (mid-pregnancy to 8 years). Our biobank includes maternal blood and urine samples, biopsy material from placentas and umbilical venous cord blood. We found several clinically important differences in maternal health, with higher risk in ethnic minority groups for GDM, insulin resistance, vitamin D and iron deficiency, depressive symptoms and physical inactivity. Contrasting patterns of fetal growth and risk of overweight/thinness at preschool age were observed across ethnic groups. Maternal GDM, obesity and high gestational weight gain were associated with children's BMI trajectories. FUTURE PLANS We will examine the impact of maternal and fetal health and development during pregnancy on long-term outcomes for mothers and offspring. TRIAL REGISTRATION NUMBER Project title STORK G-2: Women and Risk of Type 2 Diabetes NCT03870724 (ClinicalTrials.gov).
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Affiliation(s)
- Christin W Waage
- Department of General Practice, University of Oslo, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Akershus, Norway
| | - Ingun Toftemo
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Anja Maria Brænd
- Department of General Practice, University of Oslo, Oslo, Norway
- General Practice Research Unit (AFE), University of Oslo, Oslo, Norway
- The Antibiotic Centre for Primary Care, Department of General Practice, University of Oslo, Oslo, Norway
| | - Line Sletner
- Department of Child and Adolescents Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Christine Sommer
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Kåre Inge Birkeland
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Department of Transplantation, University of Oslo, Oslo, Norway
| | - Kåre Rønn Richardsen
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Akershus, Norway
| | - Nilam Shakeel
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Nina Køpke Vøllestad
- Department of Interdisciplinary Health Science, University of Oslo, Oslo, Norway
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), University of Oslo, Oslo, Norway
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Fish-Williamson A, Hahn-Holbrook J. Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries. Front Psychiatry 2023; 14:1193490. [PMID: 37398595 PMCID: PMC10311512 DOI: 10.3389/fpsyt.2023.1193490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background Postpartum depression (PPD) is the most common complication associated with childbirth and can lead to adverse outcomes for both mothers and their children. A previous meta-analysis found that PPD prevalence varies widely across countries. One potential underexplored contributor to this cross-national variation in PPD is diet, which contributes to mental health and varies significantly around the world. Here, we sought to update the global and national estimates of PPD prevalence using systematic review and meta-analysis. Further, we examined whether cross-national variation in PPD prevalence is associated with cross-national variation in diet using meta-regression. Methods To estimate national rates of PPD prevalence, we conducted an updated systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale between 2016-2021 and combined our findings with a previous meta-analysis of articles published between 1985-2015. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To examine dietary predictors, we extracted data on sugar-sweetened beverage, fruit, vegetable, total fiber, yogurt, and seafood consumption from the Global Dietary Database. Random effects meta-regression was used to test whether between-country and within-country variation in dietary factors predicted variation in PPD prevalence, controlling for economic and methodological variables. Results 412 studies of 792,055 women from 46 countries were identified. The global pooled prevalence of PPD was 19.18% (95% confidence interval: 18.02 to 20.34%), ranging from 3% in Singapore to 44% in South Africa. Countries that consumed more sugar-sweetened beverages (SSBs) had higher rates of PPD (Coef. = 0.325, p = 0.044, CI:0.010-0.680); Moreover, in years when higher rates of sugar-sweetened beverages were consumed in a country, there were correspondingly higher rates of PPD in that country (Coef. = 0.129, p = 0.026, CI: 0.016-0.242). Conclusion The global prevalence of PPD is greater than previous calculations, and drastically varies by country. Sugar-sweetened beverage consumption explained some of the national variation in PPD prevalence.
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Li C, Li X, Li Y, Niu X. The Nonlinear Relationship Between Body Mass Index (BMI) and Perceived Depression in the Chinese Population. Psychol Res Behav Manag 2023; 16:2103-2124. [PMID: 37325255 PMCID: PMC10263158 DOI: 10.2147/prbm.s411112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Existing studies on the association between BMI and depression report conflicting results with some demonstrating a positive relationship, while others a negative link or insignificant correlation. Very limited research on the nonlinear relationship between BMI and depression has yet to clarify the reliability and robustness of the potential nonlinearity and whether a more complex association exists. This paper aims to systematically investigate the nonlinear relationship between the two factors applying rigorous statistical methods, as well as explore the heterogeneity of their association. Materials and Methods A large-scale nationally representative dataset, Chinese General Social Survey, is used to empirically analyze the nonlinear relationship between BMI and perceived depression. Various statistical tests are employed to check the robustness of the nonlinearity. Results Results indicate that there is a U-shaped relationship between BMI and perceived depression, with the turning point (25.718) very close to while slightly larger than the upper limit of the range of healthy weight (18.500 ≤ BMI < 25.000) defined by World Health Organization. Both very high and low BMIs are associated with increased risk for depressive disorders. Furthermore, perceived depression is higher at almost all BMI levels among individuals who are older, female, lower educated, unmarried, in rural areas, belonging to ethnic minorities, non-Communist Party of China members, as well as those with lower income and uncovered by social security. In addition, these subgroups have smaller inflection points and their self-rated depression is more sensitive to BMI. Conclusion This paper confirms a significant U-shaped trend in the association between BMI and depression. Therefore, it is important to account for the variations in this relationship across different BMI categories when using BMI to predict depression risk. Besides, this study clarifies the management goals for achieving an appropriate BMI from a mental health perspective and identifies vulnerable subgroups at higher risk of depression.
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Affiliation(s)
- Chao Li
- Business School, Shandong University, Weihai, People’s Republic of China
| | - Xiang Li
- Business School, Shandong University, Weihai, People’s Republic of China
| | - Yuming Li
- Business School, Shandong University, Weihai, People’s Republic of China
| | - Xiaoru Niu
- School of Mechanical, Electrical & Information Engineering, Shandong University, Weihai, People’s Republic of China
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Fonseca A, Branquinho M, Monteiro F, Araújo-Pedrosa A, Bjørndal LD, Lupattelli A. Treatment options and their uptake among women with symptoms of perinatal depression: exploratory study in Norway and Portugal. BJPsych Open 2023; 9:e77. [PMID: 37139793 DOI: 10.1192/bjo.2023.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Perinatal depression is the most undertreated clinical condition during the perinatal period. Knowledge about women's decision-making in seeking and receiving treatment is scarce. AIMS To investigate and compare treatment option uptake in perinatal women with depressive symptoms in Portugal and Norway, and to identify sociodemographic and health-related factors associated with treatment uptake. METHOD Participants were women resident in Portugal or Norway (≥18 years) who were pregnant or had given birth in the past 12 months, who presented with active depressive symptoms (Edinburgh Postnatal Depression Scale score ≥10). In an electronic questionnaire, women reported treatment received and sociodemographic and health-related factors. RESULTS The sample included 416 women from Portugal and 169 from Norway, of which 79.8% and 53.9%, respectively, were not receiving any treatment. Most Portuguese women were receiving psychological treatment, either alone (45.2%) or combined with pharmacological treatment (21.4%). Most Norwegian participants were receiving only pharmacological (36.5%) or combined treatment (35.4%). Compared with the Portuguese sample, a higher proportion of Norwegian women started treatment before pregnancy (P < 0.001). In Portugal, lower depressive symptoms and self-reported psychopathology were significantly associated with higher likelihood of receiving treatment. CONCLUSIONS We found that, in both Norway and Portugal, a substantial number of perinatal women with depressive symptoms do not receive any treatment. Differences exist regarding the chosen treatment option and timing of treatment initiation in the two countries. Only mental health-related factors were associated with treatment uptake for perinatal depression in Portugal. Our results highlight the importance of implementing strategies aimed to improve help-seeking behaviours.
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Affiliation(s)
- Ana Fonseca
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Mariana Branquinho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Portugal
| | - Fabiana Monteiro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Anabela Araújo-Pedrosa
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal; and Clinical Psychology Service, Department of Gynaecology, Obstetrics, Reproduction and Neonatology (Maternity Daniel de Matos), Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Ludvig D Bjørndal
- PROMENTA Research Center, Department of Psychology, University of Oslo, Norway
| | - Angela Lupattelli
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Norway
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Rohr J, Vahidy FS, Bartek N, Bourassa KA, Nanavaty NR, Antosh DD, Harms KP, Stanley JL, Madan A. Reducing psychiatric illness in the perinatal period: A review and commentary. World J Psychiatry 2023; 13:149-160. [PMID: 37123098 PMCID: PMC10130961 DOI: 10.5498/wjp.v13.i4.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] Open
Abstract
This brief overview highlights the global crisis of perinatal psychiatric illness (PPI). PPI is a major contributor to many adverse pregnancy, childbirth, and childhood development outcomes. It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual, their family, and their community. It is also highly preventable. Current recommendations for intervention and management of PPI are limited and vary considerably from country to country. Furthermore, there are several significant challenges asso-ciated with implementation of these recommendations. These challenges are magnified in number and consequence among women of color and/or minority populations, who experience persistent and negative health disparities during pregnancy and the postpartum period. This paper aims to provide a broad overview of the current state of recommendations and implementation challenges for PPI and layout a framework for overcoming these challenges. An equity-informed model of care that provides universal intervention for pregnant women may be one solution to address the preventable consequences of PPI on child and maternal health. Uniquely, this model emphasizes the importance of managing and eliminating known barriers to traditional health care models. Culturally and contextually specific challenges must be overcome to fully realize the impact of improved management of PPI.
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Affiliation(s)
- Jessica Rohr
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Farhaan S Vahidy
- Department of Neurosurgery, Houston Methodist, Houston, TX 77030, United States
| | - Nicole Bartek
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Katelynn A Bourassa
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Namrata R Nanavaty
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Konrad P Harms
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Jennifer L Stanley
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Alok Madan
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
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Application of machine learning in predicting the risk of postpartum depression: A systematic review. J Affect Disord 2022; 318:364-379. [PMID: 36055532 DOI: 10.1016/j.jad.2022.08.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/08/2022] [Accepted: 08/22/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Postpartum depression (PPD) presents a serious health problem among women and their families. Machine learning (ML) is a rapidly advancing field with increasing utility in predicting PPD risk. We aimed to synthesize and evaluate the quality of studies on application of ML techniques in predicting PPD risk. METHODS We conducted a systematic search of eight databases, identifying English and Chinese studies on ML techniques for predicting PPD risk and ML techniques with performance metrics. Quality of the studies involved was evaluated using the Prediction Model Risk of Bias Assessment Tool. RESULTS Seventeen studies involving 62 prediction models were included. Supervised learning was the main ML technique employed and the common ML models were support vector machine, random forest and logistic regression. Five studies (30 %) reported both internal and external validation. Two studies involved model translation, but none were tested clinically. All studies showed a high risk of bias, and more than half showed high application risk. LIMITATIONS Including Chinese articles slightly reduced the reproducibility of the review. Model performance was not quantitatively analyzed owing to inconsistent metrics and the absence of methods for correlation meta-analysis. CONCLUSIONS Researchers have paid more attention to model development than to validation, and few have focused on improvement and innovation. Models for predicting PPD risk continue to emerge. However, few have achieved the acceptable quality standards. Therefore, ML techniques for successfully predicting PPD risk are yet to be deployed in clinical environments.
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11
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Qin Y, Guo P, Li J, Liu J, Jiang S, Yang F, Wang R, Wang J, Liu H, Zhang X, Wang K, Wu Q, Shi W. The relationship between social capital and postpartum depression symptoms of lactating women in minority areas—A cross-sectional study from Guangxi, China. Front Psychol 2022; 13:905028. [DOI: 10.3389/fpsyg.2022.905028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
BackgroundPostpartum depression (PPD) is the most common mental illness affecting women during lactation, and good social capital is considered a protective factor. This study aimed to investigate PPD symptoms, and explore the relationships between social capital and PPD symptoms of lactating women in southwest minority areas in China.Materials and methodsThis cross-sectional study was conducted among 413 lactating women in Guangxi, China. Data were collected using the Edinburgh Postnatal Depression Scale and the Chinese version of the Social Capital Assessment Questionnaire. Hierarchical regression analysis was conducted to explore the factors influencing PPD symptoms, and a structural equation model was used to examine how social participation and cognitive social capital mediated PPD symptoms.ResultsThe total prevalence of PPD symptoms (score > 12) was 16.46%, and that of mild depression symptoms (9–12 score) was 22.03%. Nine variables predicted PPD symptoms and explained 71.6% of the variance in the regression model: higher age, lack of medical security, fixed occupation, breastfeeding time, self-caregiver, maternity leave, social participation, social trust, and social reciprocity. Furthermore, cognitive social capital mediated the relationship between social participation and PPD symptoms, with a mediation effect rate was 44.00%.ConclusionThe findings of this study highlight that social capital, support from family members, maternity leave, and medical insurance play protective roles in the PPD symptoms of lactating women. It is necessary to improve social capital as a key strategy for interventions for PPD symptoms, and active social participation activities are critical to reducing PPD symptoms among lactating women in minority areas.
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12
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Martinez-Vázquez S, Hernández-Martínez A, Rodríguez-Almagro J, Delgado-Rodríguez M, Martínez-Galiano JM. Relationship between perceived obstetric violence and the risk of postpartum depression: An observational study. Midwifery 2022; 108:103297. [PMID: 35272086 DOI: 10.1016/j.midw.2022.103297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine the relationship between perceived obstetric violence and the risk of postpartum depression (PPD). DESIGN A cross-sectional observational study SETTING: During 2019 in Spain PARTICIPANTS: 782 women who had given birth in the preceding 12 months in Spain. MEASUREMENTS Online questionnaires were distributed to the women via their midwives and women's associations. The questionnaire included sociodemographic and clinical variables, and questions regarding the mothers' perception of obstetric violence globally and in its different forms: verbal, physical and psycho-affective. The response rate was 93.65%. Crude and adjusted odds ratios (OR and aOR, respectively) were estimated using binary logistic regression. Risk of PPD was estimated by the Edinburgh Postnatal Depression Scale (EPDS). FINDINGS The mean EPDS score was 8.34 points (standard deviation: 3.80), with 25.4% (199) at risk of PPD (≥ 10 points). Risk factors for PPD included, multiparity (aOR: 1.62, 95% CI:1.10-2.39), newborn NICU admission (aOR: 1.93, 95% CI: 1.06-3.51), experiencing verbal obstetric violence (aOR: 2.02, 95% CI: 1.35-3.02), and psycho-affective obstetric violence (aOR: 2.65, 95% CI: 1.79-3.93). The perception of support during pregnancy, birth, and the puerperium was found to be a protective factor: aOR 0.15 (95% CI: 0.04-0.54) for women who perceived enough support and aOR 0.13 (95% CI: 0.0-0.45) for women who received much support KEY CONCLUSIONS: One in four women are at risk of PPD. Multiparous women, those whose newborn required NICU admission, those who lacked partner support, and those who experienced verbal or psycho-affective obstetric violence had a higher prevalence of PPD risk. FUNDING The authors declare that this study was conducted without funding.
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Affiliation(s)
| | - Antonio Hernández-Martínez
- Department of Nursing. Faculty of Nursing of Ciudad Real. The University of Castilla-La Mancha, Ciudad Real, Spain
| | - Julián Rodríguez-Almagro
- Department of Nursing. Faculty of Nursing of Ciudad Real. The University of Castilla-La Mancha, Ciudad Real, Spain.
| | - Miguel Delgado-Rodríguez
- Department of Health Sciences of the University of Jaen, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Juan Miguel Martínez-Galiano
- Department of Nursing of the University of Jaen, Jaén, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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13
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Matthey S. Is Validating the Cutoff Score on Perinatal Mental Health Mood Screening Instruments, for Women and Men from Different Cultures or Languages, Really Necessary? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074011. [PMID: 35409694 PMCID: PMC8998276 DOI: 10.3390/ijerph19074011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
Background: The most commonly used mood screening instrument in perinatal health is the Edinburgh Depression Scale. The screen-positive cut-off score on this scale, as for others, has been determined, via validation techniques, for over 20 languages/cultures, and for both women and men. While such validation appears to be considered essential, there are studies that could be interpreted to suggest that this is not an important consideration. Methods: Selective studies have been chosen to indicate these opposing points of view. Results: Examples of studies that support the notion of validating cut-off scores are described, as are examples of studies that appear not to support this point of view. Conclusions: (i) Clinical services and researchers need to be mindful of these opposing points of view, and openly discuss them when using screening cut-off scores for their respective populations. (ii) Researchers and Journals need to be more rigorous in ensuring this issue is correctly reported in studies, and/or openly discussed when relevant.
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Affiliation(s)
- Stephen Matthey
- Department of Clinical and Experimental Sciences, Faculty of Medicine and Surgery, Università degli Studi di Brescia, 25123 Brescia, Italy
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Straiton M, Hollander AC, Hynek KA, Liefbroer AC, Hauge LJ. The relationship between motherhood and use of mental health care services among married migrant and non-migrant women: a national register study. BMC Psychiatry 2022; 22:211. [PMID: 35313854 PMCID: PMC8939178 DOI: 10.1186/s12888-022-03848-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/10/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Giving birth to one's first child is a life changing event. Beyond the post-partum period, little is known about the association between becoming a mother and mental disorder among migrant women. This study investigates outpatient mental health (OPMH) service use, a proxy for mental disorder, among married migrant and non-migrant women who become mothers and those who do not. METHODS Using Norwegian register data, we followed 90,195 married women, aged 18-40 years, with no children at baseline between 2008-2013 to see if becoming a mother was associated with OPMH service use. Data were analysed using discrete time analyses. RESULTS We found an interaction between motherhood and migrant category. Married non-migrant mothers, both in the perinatal period and beyond, had lower odds of OPMH use than married non-mothers. There was no association between motherhood and OPMH service use for migrants. However, there was no significant interaction between motherhood and migrant category when we excluded women who had been in Norway less than five years. Among women aged 25-40 years, a stable labour market attachment was associated with lower odds of OPMH use for non-migrants but not migrants, regardless of motherhood status. CONCLUSIONS The perinatal period is not associated with increased odds of OPMH use and appears to be associated with lower odds for married non-migrant women. Selection effects and barriers to care may explain the lack of difference in OPMH service use that we found across motherhood status and labour market attachment for married migrant women. Married migrant women in general have a lower level of OPMH use than married non-migrants. Married migrant women with less than five years in Norway and those with no/weak labour market attachment may experience the greatest barriers to care. Further research to bridge the gap between need for, and use of, mental health care among migrant women is required.
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Affiliation(s)
- Melanie Straiton
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway.
| | - Anna-Clara Hollander
- grid.4714.60000 0004 1937 0626Epidemiology of Psychiatric Conditions, Substance Use and Social Environment, Department of Global Public Health, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Kamila Angelika Hynek
- grid.418193.60000 0001 1541 4204Department of Mental Health and Suicide, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213 Oslo, Norway
| | - Aart C. Liefbroer
- grid.450170.70000 0001 2189 2317Netherlands Interdisciplinary Demographic Institute, PO Box 11650, 2502 AR The Hague, The Netherlands ,grid.4830.f0000 0004 0407 1981Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Sociology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lars Johan Hauge
- grid.418193.60000 0001 1541 4204Department of Mental Health and Suicide, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213 Oslo, Norway
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15
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Marti-Castaner M, Hvidtfeldt C, Villadsen SF, Laursen B, Pedersen TP, Norredam M. Disparities in postpartum depression screening participation between immigrant and Danish-born women. Eur J Public Health 2021; 32:41-48. [PMID: 34864938 PMCID: PMC9090168 DOI: 10.1093/eurpub/ckab197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Qualitative studies suggest that immigrant women experience barriers for postpartum depression (PPD) screening. This study examines the prevalence of participation in PPD screening in the universal home-visiting programme in Denmark, in relation to migrant status and its association with acculturation factors, such as length of residence and age at migration. METHODS The sample consists of 77 694 births from 72 292 mothers (2015-18) that participated in the programme and were registered in the National Child Health Database. Lack of PPD screening using the Edinburgh Postpartum Depression Scale (EPDS) was examined in relation to migrant group and acculturation factors. We used Poisson regression with cluster robust standard errors to estimate crude and adjusted relative risk. RESULTS In total, 27.8% of Danish-born women and 54.7% of immigrant women lacked screening. Compared with Danish-born women, immigrant women in all groups were more likely to lack PPD screening (aRR ranging from 1.81 to 1.90). Women with low acculturation were more likely to lack screening. Women who migrated as adults [aRR = 1.27 (95% CI 1.16, 1.38)] and women who had resided in Demark for <5 years [aRR = 1.37 (95% CI 1.28, 1.46)] were more likely to lack screening. CONCLUSIONS Immigrant women in Denmark, particularly recent immigrants, are at increased risk of not being screened for PPD using the EPDS. This can lead to under-recognition of PPD among immigrant women. More work is needed to understand how health visitors recognize the mental health needs of immigrant women who are not screened, and whether this gap results in reduced use of mental health services.
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Affiliation(s)
- Maria Marti-Castaner
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah Fredsted Villadsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bjarne Laursen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Trine Pagh Pedersen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Marie Norredam
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
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First perinatal psychiatric episode among refugee and family-reunified immigrant women compared to Danish-born women: a register-based study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2239-2250. [PMID: 34008058 DOI: 10.1007/s00127-021-02104-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed at examining psychiatric morbidity in the perinatal period among refugees and family-reunified immigrants compared to Danish-born women, including predictors of psychiatric morbidity according to migration history. METHODS Inclusion criteria were women who had a residence permit in Denmark and gave birth to a live child between 1 April 1998 and 31 December 2014. The study included 7804 refugee women, 21,257 family-reunified women, and 245,865 Danish-born women. We estimated Odds Ratios (ORs) of having a first-time perinatal psychiatric episode (PPE) and specific risk for affective, psychotic, and neurotic disorders. RESULTS Compared with Danish-born women, women family-reunified with immigrants had lower (aOR 0.37, 95% CI 0.22-0.64) and refugees had higher ORs of PPE (OR 1.46, 95% CI 1.22-1.76). In fully adjusted models, refugees no longer presented increased risk of PPE (OR 1.16, 95% CI 0.95-1.42) but showed higher ORs for psychotic (aOR 4.72, 95% CI 2.18-9.84) and neurotic disorders (aOR 1.31, 95% CI 1.01-1.72). Women family-reunified with refugees and to Nordic citizens had higher ORs of psychotic disorders. Among migrants, refugees had higher ORs of PPE. CONCLUSIONS Results suggest that elevation in risk of PPE among refugees compared to Danish-born may be related to higher likelihood of poverty and single-parenting among refugees. Still, refugees appear to have increased risk for neurotic and psychotic disorders. In contrast, family-reunified to immigrants may have lower risk of PPE. Maternal health programs need to focus on promotion of mental health and tackle social risks that disproportionately affect immigrant women, particularly refugees.
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Sharma V, Palagini L, Riemann D. Should we target insomnia to treat and prevent postpartum depression? J Matern Fetal Neonatal Med 2021; 35:8794-8796. [PMID: 34844495 DOI: 10.1080/14767058.2021.2005021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Postpartum depression (PPD) is a major public health problem that affects approximately 12-18% of women and is associated adverse maternal and infant outcome. Given that untreated maternal depression has negative consequences for both the mother and her child, it is important to deploy effective measures to treat or prevent PPD. Antidepressant treatment after delivery has been proposed for prophylaxis, however, this is not firmly established. Since insomnia is an early sign and a common symptom of PPD in this contribution we argue that management of insomnia may play a key role in the treatment and prevention of PPD. To this aim we by discussed the current evidence about the potential prophylactic role of antidepressants compared to that of insomnia treatment in PPD. We concluded that insomnia symptoms may be a better therapeutic target to prevent or treat PPD which is heterogeneous entity and may be more responsive to interventions addressing a common and early symptom such as insomnia.
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Affiliation(s)
- Verinder Sharma
- Department of Psychiatry, University of Western Ontario, London, Canada
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa; Azienda Ospedaliera Universitaria Pisana (AUOP), Pisa, Italy
| | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg, Freiburg, Germany
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18
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Høivik MS, Eberhard-Gran M, Wang CEA, Dørheim SK. Perinatal mental health around the world: priorities for research and service development in Norway. BJPsych Int 2021; 18:102-105. [PMID: 34747945 PMCID: PMC8554966 DOI: 10.1192/bji.2021.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/17/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022] Open
Abstract
Despite the country's generous social welfare systems, perinatal mental health problems are prevalent in Norway. National guidelines recommend that health services identify women with perinatal mental conditions, but systematic screening and clear treatment pathways are not nationally endorsed, neither are recommendations for evaluating and treating possible parent-infant interaction difficulties of affected mothers. There are no subspecialties in perinatal psychiatry or psychology, hence healthcare personnel often lack expertise about perinatal mental health. To safeguard the mental health of infants and parents, we need to establish systematic communication between primary healthcare professionals, as well as between primary- and secondary-level professionals.
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Affiliation(s)
- Magnhild Singstad Høivik
- Associate Professor, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) of Central Norway, Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Malin Eberhard-Gran
- Professor in Clinical Epidemiology and Health Services Research, Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Catharina Elisabeth Arfwedson Wang
- Professor of Clinical Psychology, Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Signe Karen Dørheim
- Consultant Psychiatrist, Sandnes District Psychiatric Centre, Division of Psychiatry, Stavanger University Hospital, Norway
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Bränn E, Fransson E, Wikman A, Kollia N, Nguyen D, Lilliecreutz C, Skalkidou A. Who do we miss when screening for postpartum depression? A population-based study in a Swedish region. J Affect Disord 2021; 287:165-173. [PMID: 33799034 DOI: 10.1016/j.jad.2021.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Universal screening for postpartum depression is crucial for early detection, interventions and support. The aim of this study was to describe the proportion of, and explore risk factors for, women not being offered screening, as well as for declining an offer or not being screened due to any other unknown reason. METHODS Socioeconomic, obstetrical and neonatal data, extracted from the Swedish Pregnancy Registry, for 9,959 pregnancies recorded for the Östergötland county between 2016 and 2018 were linked to Edinburgh Postnatal Depression Scale (EPDS) screening results at 6-8 weeks postpartum, extracted from medical records. Risk factors were assessed using logistic regression models and with a nomogram for easy visualization. RESULTS In total, there were no recorded offers of EPDS screening in the medical records for 30.0% of women at the postpartum follow-up. Women born outside of Sweden and women reporting poor self-rated health were at increased risk of not being offered screening for postpartum depression. LIMITATIONS There is a possibility that women were offered screening or were screened, but this was incorrectly or never recorded in medical records. CONCLUSIONS The majority of women were offered screening for postpartum depression, but there is room for improvement in order to achieve universal screening. Awareness among healthcare providers of the risk factors for not screening might increase adherence to guidelines for universal screening. Overcoming barriers for screening and raising the topic of mental-health issues for postpartum women should be prioritized.
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Affiliation(s)
- Emma Bränn
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Natasa Kollia
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Diem Nguyen
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynaecology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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20
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Diop S, Turmes L, Juckel G, Mavrogiorgou P. [Postpartum depression and migration]. DER NERVENARZT 2020; 91:822-831. [PMID: 31720700 DOI: 10.1007/s00115-019-00828-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Psychiatric research and care increasingly explore the connection between mental health and migration; however, it is striking that only a small number of analyses exist on the effect of migration on mental ailments specific to women. For example, even though postpartum depression regularly occurs among women with a migration background, in Germany and internationally there is a lack of knowledge on the epidemiology, particularly with respect to factors causing or contributing to postpartum depression among women with a migration background. Prospectively, culturally specific treatment options for women with a migration background are necessary to prevent chronification and subsequent harm to the mother and other family members. With this aim in mind, psychologists, psychiatrists and gynecologists should be aware of the specific factors contributing to the development of postpartum depression among women with a migration background. This overview article focuses on key aspects of postpartum depression, such as epidemiology, symptoms, risk factors and treatment concepts, while contextualizing them with respect to women's experience of migration.
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Affiliation(s)
- Shirin Diop
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum der Ruhr-Universität Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Deutschland
| | - Luc Turmes
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, LWL-Klinik Herten, Im Schloßpark 20, 45699, Herten, Deutschland
| | - Georg Juckel
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum der Ruhr-Universität Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Deutschland.
| | - Paraskevi Mavrogiorgou
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum der Ruhr-Universität Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Deutschland
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Dosani A, Arora H, Mazmudar S. mHealth and Perinatal Depression in Low-and Middle-Income Countries: A Scoping Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207679. [PMID: 33096738 PMCID: PMC7589927 DOI: 10.3390/ijerph17207679] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023]
Abstract
Women in low- and middle-income countries have high rates of perinatal depression. As smartphones become increasingly accessible around the world, there is an opportunity to explore innovative mHealth tools for the prevention, screening, and management of perinatal depression. We completed a scoping review of the literature pertaining to the use of mobile phone technologies for perinatal depression in low-and middle-income countries. PubMed CINHAL, and Google Scholar databases were searched, generating 423 results. 12 articles met our inclusion criteria. Two of the 12 articles reviewed mobile phone applications. The remaining 9 articles were study protocols or descriptive/intervention studies. Our results reveal that minimal literature is currently available on the use of mobile health for perinatal depression in low- and middle-income countries. We found four articles that present the results of an intervention that were delivered through mobile phones for the treatment of perinatal depressive symptoms and an additional qualitative study describing the perceptions of mothers receiving cognitive behavioral therapy via telephones. These studies demonstrated that depressive symptoms improved after the interventions. There is potential to improve the quality of mHealth interventions, specifically mobile phone applications for perinatal depressive symptoms and depression, through meaningful collaborative work between healthcare professionals and application developers.
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Affiliation(s)
- Aliyah Dosani
- School of Nursing and Midwifery, Faculty of Health, Community and Education, Mount Royal University, Calgary, AB T3E 6K6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Correspondence:
| | - Harshmeet Arora
- Department of Computer and Electrical Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (H.A.); (S.M.)
| | - Sahil Mazmudar
- Department of Computer and Electrical Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (H.A.); (S.M.)
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Reduction in physical activity significantly increases depression and anxiety in the perinatal period: a longitudinal study based on a self-report digital assessment tool. Arch Gynecol Obstet 2020; 302:53-64. [PMID: 32372342 DOI: 10.1007/s00404-020-05570-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/25/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Physical activity can reduce pregnancy-related complications and contributes substantially to improving maternal mental health. A reduction in activity encompassing exercise and daily household tasks throughout the course of pregnancy increases the risk of depression and anxiety. The following research examines the longitudinal interaction between exercise, general physical activity, and mental health outcomes in pregnant women. METHODS This prospective longitudinal study was conducted at the maternity departments of two major university hospitals in Germany. Self-reported data of 597 women were digitally assessed every 4 weeks from the second trimester until birth as well as 3 and 6 months postnatally. Depressive and anxiety symptoms were assessed using the EPDS, PRAQ, and STAI and physical activity levels were measured using the PPAQ questionnaire. Cross-sectional and longitudinal analyses using Pearson's correlation coefficient and multiple regression models were conducted. RESULTS We found a significant reduction in general physical activity in the period from the 20th to 32nd gestational week. Women who reported a greater decline during pregnancy showed significantly higher depression and anxiety scores. In stratified analyses, only baseline mental health scores proved to be variables with stronger impact on postnatal depression and anxiety outcomes. CONCLUSION General physical activity and maternal mental health significantly influence each other during and after pregnancy. Both physical activity and the prevention of perinatal mental disorders should be systematically encouraged during perinatal care to prevent adverse maternal and fetal birth outcomes.
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Xiong R, Deng A. Incidence and risk factors associated with postpartum depression among women of advanced maternal age from Guangzhou, China. Perspect Psychiatr Care 2020; 56:316-320. [PMID: 31364779 DOI: 10.1111/ppc.12430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/02/2019] [Accepted: 07/20/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To investigate whether advanced maternal age (AMA) increases the risk of postpartum depression (PPD) at 6 weeks after birth and to explore the risk factors. DESIGN AND METHODS A cross-sectional study was conducted at 6 weeks postpartum. The Edinburgh Postnatal Depression Scale and a self-designed questionnaire were administered to participants. Multivariate logistic regression was used to determine risk factors. FINDINGS The prevalence of PPD in women of AMA was 18.0%. Poor relationships with mothers-in-law, female fetus, inconsistency between expected sex and actual sex and primiparae were identified as risk factors. PRACTICE IMPLICATIONS Mothers of AMA require specialized care and support to alleviate their concerns.
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Affiliation(s)
- Ribo Xiong
- Department of Rehabilitation, Nanhai Hospital, Southern Medical University, Foshan, China
| | - Aiwen Deng
- Department of Rehabilitation, Nanhai Hospital, Southern Medical University, Foshan, China
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Wickberg B, Bendix M, Wetterholm MB, Skalkidou A. Perinatal mental health around the world: priorities for research and service development in Sweden. BJPsych Int 2020; 17:6-8. [PMID: 34287422 PMCID: PMC8277534 DOI: 10.1192/bji.2019.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/13/2019] [Accepted: 07/27/2019] [Indexed: 01/28/2023] Open
Abstract
Sweden has a unique opportunity to identify and follow up women presenting with, or at risk for, perinatal mental health problems and disorders because universal screening programmes are provided by its primary healthcare system. Although they are implemented across almost the entire population, screening programmes are not necessarily leading to effective interventions because the multidisciplinary perinatal mental healthcare teams that provide for the assessment and treatment of moderate to severe disorders are very few in number and must be increased. In particular, efforts to reach immigrant parents must be intensified to achieve equal quality of care for all.
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Affiliation(s)
- Birgitta Wickberg
- Associate Professor, Department of Psychology, University of Gothenburg, Göteborg, Sweden.
| | - Marie Bendix
- Liaison Perinatal Consultant Psychiatrist, Centre for Psychiatry Research & Stockholm Health Care Services, Stockholm County Council/Karolinska Institutet Stockholm, Sweden
| | - Margareta Blomdahl Wetterholm
- Liaison Perinatal Consultant Psychiatrist, Centre for Psychiatry Research & Stockholm Health Care Services, Stockholm County Council/Karolinska Institutet Stockholm, Sweden
| | - Alkistis Skalkidou
- Professor, Department of Women's and Children's Health, Uppsala University, Sweden
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Frieder A, Fersh M, Hainline R, Deligiannidis KM. Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development. CNS Drugs 2019; 33:265-282. [PMID: 30790145 PMCID: PMC6424603 DOI: 10.1007/s40263-019-00605-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Postpartum depression is one of the most common complications of childbirth. Untreated postpartum depression can have substantial adverse effects on the well-being of the mother and child, negatively impacting child cognitive, behavioral, and emotional development with lasting consequences. There are a number of therapeutic interventions for postpartum depression including pharmacotherapy, psychotherapy, neuromodulation, and hormonal therapy among others, most of which have been adapted from the treatment of major depressive disorder outside of the peripartum period. Current evidence of antidepressant treatment for postpartum depression is limited by the small number of randomized clinical trials, underpowered samples, and the lack of long-term follow-up. The peripartum period is characterized by rapid and significant physiological change in plasma levels of endocrine hormones, peptides, and neuroactive steroids. Evidence supporting the role of neuroactive steroids and γ-aminobutyric acid (GABA) in the pathophysiology of postpartum depression led to the investigation of synthetic neuroactive steroids and their analogs as potential treatment for postpartum depression. Brexanolone, a soluble proprietary intravenous preparation of synthetic allopregnanolone, has been developed. A recent series of open-label and placebo-controlled randomized clinical trials of brexanolone in postpartum depression demonstrated a rapid reduction in depressive symptoms, and has led to the submission for regulatory approval to the US Food and Drug Administration (decision due in March 2019). SAGE-217, an allopregnanolone analog, with oral bioavailability, was recently tested in a randomized, double-blind, placebo-controlled phase III study in severe postpartum depression, with reportedly positive results. Finally, a 3β-methylated synthetic analog of allopregnanolone, ganaxolone, is being tested in both intravenous and oral forms, in randomized, double-blind, placebo-controlled phase II studies in severe postpartum depression.
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Affiliation(s)
- Ariela Frieder
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Madeleine Fersh
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Rachel Hainline
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kristina M Deligiannidis
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA.
- Departments of Psychiatry and Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Feinstein Institute for Medical Research, Manhasset, NY, USA.
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