1
|
Zundel CG, Ely S, Brokamp C, Strawn JR, Jovanovic T, Ryan P, Marusak HA. Particulate Matter Exposure and Default Mode Network Equilibrium During Early Adolescence. Brain Connect 2024. [PMID: 38814823 DOI: 10.1089/brain.2023.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
Background: Air pollution exposure has been associated with adverse cognitive and mental health outcomes in children, adolescents, and adults, although youth may be particularly susceptible given ongoing brain development. However, the neurodevelopmental mechanisms underlying the associations among air pollution, cognition, and mental health remain unclear. We examined the impact of particulate matter (PM2.5) on resting-state functional connectivity (rsFC) of the default mode network (DMN) and three key attention networks: dorsal attention, ventral attention, and cingulo-opercular. Methods: Longitudinal changes in rsFC within/between networks were assessed from baseline (9-10 years) to the 2-year follow-up (11-12 years) in 10,072 youth (M ± SD = 9.93 + 0.63 years; 49% female) from the Adolescent Brain Cognitive Development (ABCD®) study. Annual ambient PM2.5 concentrations from the 2016 calendar year were estimated using hybrid ensemble spatiotemporal models. RsFC was estimated using functional neuroimaging. Linear mixed models were used to test associations between PM2.5 and change in rsFC over time while adjusting for relevant covariates (e.g., age, sex, race/ethnicity, parental education, and family income) and other air pollutants (O3, NO2). Results: A PM2.5 × time interaction was significant for within-network rsFC of the DMN such that higher PM2.5 concentrations were associated with a smaller increase in rsFC over time. Further, significant PM2.5 × time interactions were observed for between-network rsFC of the DMN and all three attention networks, with varied directionality. Conclusion: PM2.5 exposure was associated with alterations in the development and equilibrium of the DMN-a network implicated in self-referential processing-and anticorrelated attention networks, which may impact trajectories of cognitive and mental health symptoms across adolescence.
Collapse
Affiliation(s)
- Clara G Zundel
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
| | - Samantha Ely
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
- Translational Neuroscience Program, Wayne State University, Detroit, Michigan, USA
| | - Cole Brokamp
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey R Strawn
- Anxiety Disorders Research Program, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, Michigan, USA
| | - Patrick Ryan
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hilary A Marusak
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, USA
- Translational Neuroscience Program, Wayne State University, Detroit, Michigan, USA
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacology, Wayne State University, Detroit, Michigan, USA
| |
Collapse
|
2
|
Rooney T, Sharpe L, Todd J, Michalski SC, Van Ryckeghem D, Crombez G, Colagiuri B. Beyond the modified dot-probe task: A meta-analysis of the efficacy of alternate attention bias modification tasks across domains. Clin Psychol Rev 2024; 110:102436. [PMID: 38696911 DOI: 10.1016/j.cpr.2024.102436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/25/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
Attention biases towards disease-relevant cues have been implicated in numerous disorders and health conditions, such as anxiety, cancer, drug-use disorders, and chronic pain. Attention bias modification (ABM) has shown that changing attention biases can change related emotional processes. ABM most commonly uses a modified dot-probe task, which has received increasing criticism regarding its reliability and inconsistent findings. The purpose of the present review was thus to systematically review and meta-analyse alternative tasks used in ABM research. We sought to examine whether alternative tasks significantly changed attention biases and emotional outcomes, and critically examined whether relevant sample, task and intervention characteristics moderated each of these effect sizes. Seventy-four (completer n = 15,294) study level comparisons were included in the meta-analysis. Overall, alternative ABM designs had a medium effect on changing biases (g = 0.488), and a small, but significant effect on improving clinical outcomes (g = 0.117). We found this effect to be significantly larger for studies which successfully changed biases compared to those that did not. Across all tasks, it appeared that targeting engagement biases results in the largest change to attention biases. Importantly, we found tasks incorporating gaze-contingency - encouraging engagement with non-biased stimuli - show the most promise for improving emotional outcomes.
Collapse
Affiliation(s)
- Tessa Rooney
- School of Psychology, Faculty of Science, The University of Sydney, Australia.
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Jemma Todd
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| | - Stefan Carlo Michalski
- Department of Developmental Disability Neuropsychiatry, Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Dimitri Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands; Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Ben Colagiuri
- School of Psychology, Faculty of Science, The University of Sydney, Australia
| |
Collapse
|
3
|
Michalopoulou S, Sifaki M, Packer J, Lanigan J, Stansfield C, Viner RM, Russell S. Assessing the impact of obesity interventions in the early years: a systematic review of UK-based studies. BMJ Open 2024; 14:e076479. [PMID: 38740507 PMCID: PMC11097867 DOI: 10.1136/bmjopen-2023-076479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/13/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Childhood obesity rates in the UK are high. The early years of childhood are critical for establishing healthy behaviours and offer interventional opportunities. We aimed to identify studies evaluating the impact of UK-based obesity interventions in early childhood. DESIGN Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Nine databases were searched in March 2023. ELIGIBILITY CRITERIA We included UK-based obesity intervention studies delivered to children aged 6 months to 5 years that had diet and/or physical activity components and reported anthropometric outcomes. The primary outcome of interest was z-score Body Mass Index (zBMI) change (within and between subjects). Studies evaluating the effects of breastfeeding interventions were not included as obesity prevention interventions, given that best-practice formula feeding is also likely to encourage healthy growth. The publication date for studies was limited to the previous 12 years (2011-23), as earlier reviews found few evaluations of interventions in the UK. DATA EXTRACTION AND SYNTHESIS The reviewers worked independently using standardised approach to search, screen and code the included studies. Risk of bias was assessed using Cochrane tools (ROB 2 or ROBINS-I). RESULTS Six trials (five studies) were identified, including two randomised controlled trials (RCT), one cluster randomised trial (CRT), two feasibility CRTs and one impact assessment. The total number of participants was 566. Three trials focused on disadvantaged families and two included high-risk children categorised as having overweight or obesity. Compared with baseline, five interventions reported reductions in zBMI, three of which were statistically significant (p<0.05). Compared with control, five interventions showed zBMI reductions, one of which was significant. Only two trials were followed up beyond 12 months. All studies were found to have a high risk of bias. Meta-analysis was not possible due to the heterogeneity of studies. CONCLUSION UK evidence was limited but some interventions showed promising results in promoting healthy growth. As part of a programme of policies, interventions in the early years may have an important role in reducing the risk of childhood obesity. PROSPERO REGISTRATION NUMBER CRD42021290676.
Collapse
Affiliation(s)
- Semina Michalopoulou
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Maria Sifaki
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Jessica Packer
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Julie Lanigan
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Russell M Viner
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Simon Russell
- Great Ormond Street Institute of Child Health, University College London, London, UK
| |
Collapse
|
4
|
Halladay J, Georgiades K, MacKillop J, Lipman E, Pires P, Duncan L. Identifying patterns of substance use and mental health concerns among adolescents in an outpatient mental health program using latent profile analysis. Eur Child Adolesc Psychiatry 2024; 33:739-747. [PMID: 36947251 PMCID: PMC10031175 DOI: 10.1007/s00787-023-02188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
Though mental health and substance use concerns often co-occur, few studies have characterized patterns of co-occurrence among adolescents in clinical settings. The current investigation identifies and characterizes these patterns among adolescents presenting to an outpatient mental health service in Ontario, Canada. Data come from cross-sectional standardized patient intake assessments from 916 adolescents attending an outpatient mental health program (January 2019-March 2021). Latent profile analysis identified patterns of substance use (alcohol, cannabis, (e-) cigarettes) and emotional and behavioral disorder symptoms. Sociodemographic and clinical correlates of these patterns were examined using multinomial regression. Three profiles were identified including: 1) low substance use and lower frequency and/or severity (relative to other patients in the sample) emotional and behavioral disorder symptoms (26.2%), 2) low substance use with higher emotional and behavioral disorder symptoms (48.2%), and 3) high in both (25.6%). Profiles differed in sociodemographic and clinical indicators related to age, gender, trauma, harm to self, harm to others, and service use. Experiences of trauma, suicide attempts, and thoughts of hurting others increased the odds of adolescents being in the profile high in both substance use and symptoms compared to other profiles. These findings further document the high rates of substance use in adolescents in mental health treatment and the profiles generally map onto three out of four quadrants in the adapted four-quadrant model of concurrent disorders, indicating the importance of assessing and addressing substance use in these settings.
Collapse
Affiliation(s)
- Jillian Halladay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia.
- The Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5Th St, Hamilton, ON, L8N 3K7, Canada.
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- The Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5Th St, Hamilton, ON, L8N 3K7, Canada
| | - Ellen Lipman
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Paulo Pires
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Laura Duncan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| |
Collapse
|
5
|
Halladay J, Sunderland M, Chapman C, Repchuck R, Georgiades K, Boak A, Hamilton HA, Slade T. Examining temporal trends in psychological distress and the co-occurrence of common substance use in a population-based sample of grade 7-12 students from 2013 to 2019. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02619-z. [PMID: 38311705 DOI: 10.1007/s00127-024-02619-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/01/2024] [Indexed: 02/06/2024]
Abstract
PURPOSE Characterizing trends and correlates of adolescent psychological distress is important due to observed global increases over the last 20 years. Substance use is a commonly discussed correlate, though we lack an understanding about how co-occurrence of these concerns has been changing over time. METHODS Data came from repeated, representative, cross-sectional surveys of grade 7-12 students across Ontario, Canada conducted biennially from 2013 to 2019. Poisson regression with robust standard errors was used to examine changes in the joint association between psychological distress (operationalized as Kessler-6 [K6] scores ≥ 13) and substance use over time. Weighted prevalence ratios (PR) and their 99% confidence intervals were estimated, where p < 0.01 denotes statistical significance. RESULTS The prevalence of psychological distress doubled between 2013 and 2019, with adjusted increases of about 1.2 times each survey year. This biennial increase did not differ based on sex, perceived social standing, school level, or any substance use. Students using substances consistently reported a higher prevalence of psychological distress (between 1.2 times and 2.7 times higher). There were similarly no differential temporal trends based on substance use for very high distress (K6 ≥ 19) or K6 items explored individually. CONCLUSION Psychological distress steeply increased among adolescents and substance use remains important to assess and address alongside distress. However, the magnitude of temporal increases appears to be similar for adolescents reporting and not reporting substance use.
Collapse
Affiliation(s)
- J Halladay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia.
| | - M Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia
| | - C Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia
| | - R Repchuck
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - K Georgiades
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - A Boak
- The Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Canada
| | - H A Hamilton
- The Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, Canada
| | - T Slade
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia
| |
Collapse
|
6
|
Ernstsson O, Heintz E, Nordenskjöld A, Johnson JA, Korkmaz S, Zethraeus N. Association between pulse width and health-related quality of life after electroconvulsive therapy in patients with unipolar or bipolar depression: an observational register-based study. Nord J Psychiatry 2024; 78:137-145. [PMID: 38079191 DOI: 10.1080/08039488.2023.2289915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/12/2023] [Indexed: 02/02/2024]
Abstract
AIMS To examine the association between pulse width and HRQoL measured within one week after electroconvulsive therapy (ECT) and at six-month follow-up in patients with unipolar or bipolar depression. METHODS This was an observational register study using data from the Swedish National Quality Registry for ECT (2011-2019). Inclusion criteria were: age ≥18 years; index treatment for unipolar/bipolar depression; unilateral electrode placement; information on pulse width; EQ-5D measurements before and after ECT. Multiple linear regressions were performed to investigate the association between pulse width (<0.5 ms; 0.5 ms; >0.5 ms) and HRQoL (EQ-5D-3L index; EQ VAS) one week after ECT (primary outcome) and six months after ECT (secondary outcome). RESULTS The sample included 5,046 patients with unipolar (82%) or bipolar (18%) depression. At first ECT session, 741 patients (14.7%) had pulse width <0.5 ms, 3,639 (72.1%) had 0.5 ms, and 666 (13.2%) had >0.5 ms. There were no statistically significant associations between pulse width and HRQoL one week after ECT. In the subsample of patients with an EQ-5D index recorded six months after ECT (n = 730), patients receiving 0.5 ms had significantly lower HRQoL (-0.089) compared to <0.5 ms, after adjusting for demographic and clinical characteristics (p = .011). The corresponding analysis for EQ VAS did not show any statistically significant associations. CONCLUSION No robust associations were observed between pulse width and HRQoL after ECT. On average, significant improvements in HRQoL were observed one week and six months after ECT for patients with unipolar or bipolar disease, independent of the pulse width received.
Collapse
Affiliation(s)
- Olivia Ernstsson
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Emelie Heintz
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | | | - Seher Korkmaz
- Department of Digitalization and IT, Health and Care Administration, Stockholm, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
7
|
Larisch LM, Blom V, Hagströmer M, Ekblom M, Ekblom Ö, Nilsson J, Kallings LV. Improving movement behavior in office workers: effects of two multi-level cluster-RCT interventions on mental health. BMC Public Health 2024; 24:127. [PMID: 38195449 PMCID: PMC10985866 DOI: 10.1186/s12889-024-17647-2] [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: 08/22/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND We have previously reported on the design and efficacy of two cluster-randomized multi-level workplace interventions, attempting to decrease sedentary behavior (SED) or increase moderate to vigorous physical activity (MVPA) among office workers to improve mental health outcomes. The aim of this study was to investigate intervention effects on mental health outcomes, i.e., mental wellbeing, depression or anxiety symptoms, and stress immediately after the 6-month intervention period. METHODS Teams of 263 office workers were cluster-randomized to one of two interventions or a waitlist control group. The PA intervention (iPA) focused on increasing MVPA and the SED intervention (iSED) on reducing SED. Both multi-level interventions targeted individual office workers and their social, physical, and organizational work environment, incorporating counseling based on cognitive behavioral therapy and motivational interviewing. Mental health outcomes were assessed using validated questionnaires before and immediately after the intervention. Intervention effects were analyzed using linear mixed effects models. RESULTS Participants were mostly female and highly educated, with a mean age of 42 years and had favorable levels of mental health at baseline. Mental wellbeing improved for the iSED group (β = 8, 95% CI 1 to 15, p = 0.030) but not for the iPA group (β = 6, 95% CI -1 to 12, p = 0.072) compared to the control group. No effects were found for depression or anxiety symptoms or stress. CONCLUSIONS The multi-level interventions improved mental wellbeing among this population of office workers, reaching statistical significance in the iSED group. The size of the effect can be regarded meaningful, considering favorable mental health and high PA level at baseline. Thus, workplace interventions that provide support on multiple levels appear to have potential for improving mental wellbeing, but not reducing ill-health variables, among healthy office workers. More research is needed to understand the mechanisms through which such improvements can be achieved and to identify the most effective intervention components. TRIAL REGISTRATION ISRCTN92968402 (27 February 2018).
Collapse
Affiliation(s)
- Lisa-Marie Larisch
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Victoria Blom
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden.
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Maria Ekblom
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Örjan Ekblom
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Jonna Nilsson
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Lena V Kallings
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
- Division of Family Medicine and Preventive Medicine, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
8
|
Goldberg TE, Lee S, Devanand DP, Schneider LS. Comparison of relative change with effect size metrics in Alzheimer's disease clinical trials. J Neurol Neurosurg Psychiatry 2023; 95:2-7. [PMID: 37979967 DOI: 10.1136/jnnp-2023-331941] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/20/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Per cent slowing of decline is frequently used as a metric of outcome in Alzheimer's disease (AD) clinical trials, but it may be misleading. Our objective was to determine whether per cent slowing of decline or Cohen's d is the more valid and informative measure of efficacy. METHODS Outcome measures of interest were per cent slowing of decline; Cohen's d effect size and number-needed-to-treat (NNT). Data from a graphic were used to model the inter-relationships among Cohen's d, placebo decline in raw score units and per cent slowing of decline with active treatment. NNTs were computed based on different magnitudes of d. Last, we tabulated recent AD anti-amyloid clinical trials that reported per cent slowing and for which we computed their respective d's and NNTs. RESULTS We demonstrated that d and per cent slowing were potentially independent. While per cent slowing of decline was dependent on placebo decline and did not include variance in its computation, d was dependent on both group mean difference and pooled SD. We next showed that d was a critical determinant of NNT, such that NNT was uniformly smaller when d was larger. In recent AD associated trials including those focused on anti-amyloid biologics, d's were below 0.23 and thus considered small, while per cent slowing was in the 22-29% range and NNTs ranged from 14 to 18. CONCLUSIONS Standardised effect size is a more meaningful outcome than per cent slowing of decline because it determines group overlap, which can directly influence NNT computations, and yield information on the likelihood of minimum clinically important differences. In AD, greater use of effect sizes, NNTs, rather than relative per cent slowing, will improve the ability to interpret clinical trial results and evaluate the clinical meaningfulness of statistically significant results.
Collapse
Affiliation(s)
- Terry E Goldberg
- Geriatric Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Seonjoo Lee
- Biostatistics, Columbia University Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Davangere P Devanand
- Geriatric Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Lon S Schneider
- Psychiatry and the Behavioral Sciences, USC Keck School of Medicine, Los Angeles, California, USA
| |
Collapse
|
9
|
Kastelic K, Šarabon N, Stanford T, Dumuid D, Pedišić Ž. Are reallocations of time between physical activity, sedentary behaviour and sleep associated with low back pain? A compositional data analysis. BMJ Open Sport Exerc Med 2023; 9:e001701. [PMID: 38022760 PMCID: PMC10679988 DOI: 10.1136/bmjsem-2023-001701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives The aim of this cross-sectional study was to explore the associations of reallocating time between moderate- to vigorous-intensity physical activity (MVPA), light-intensity physical activity (LPA), sedentary behaviour (SB) and sleep with occurrence, frequency and intensity of low back pain (LBP) among adults using compositional isotemporal substitution analysis. Methods A total of 2333 participants from the general adult population completed the Daily Activity Behaviours Questionnaire asking about their time-use composition consisting of sleep, SB, LPA and MVPA, and they self-reported their frequency and intensity of LBP in the past year. Results Regression analyses adjusted for age, sex, body mass index, smoking, stress, education and socioeconomic status found that the time-use composition is associated with the frequency (p=0.009) and intensity of LBP (p<0.001). Reallocating time from SB or LPA to sleep was associated with lower frequency and intensity of LBP (p<0.05). Reallocating time from MVPA to sleep, SB or LPA and from SB to LPA was associated with a lower intensity of LBP (p<0.05). For example, reallocating 30 min/day from SB to sleep was associated with 5% lower odds (95% CI: 2% to 8%, p=0.001) of experiencing LBP more frequently, and 2% lower LBP intensity (95% CI: 1% to 3%, p<0.001). Conclusion LBP sufferers may benefit from getting additional sleep and spending more time in LPA, while engaging less in SB and MVPA. These reallocations of time may be meaningful from clinical and public health perspectives.
Collapse
Affiliation(s)
- Kaja Kastelic
- Department of Health Studies, Andrej Marušič Institute, University of Primorska, Koper, Slovenia
- InnoRenew CoE, Izola, Slovenia
| | - Nejc Šarabon
- InnoRenew CoE, Izola, Slovenia
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Ty Stanford
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Željko Pedišić
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Sapir O, Lopez-Jimenez F, Tsaban G. Habits and heartbeats: learning from historical longitudinal data on primary prevention of atrial fibrillation. Eur J Prev Cardiol 2023; 30:1789-1790. [PMID: 37697416 DOI: 10.1093/eurjpc/zwad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Orly Sapir
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First street SW, Rochester, MN 55905, USA
| | - Francisco Lopez-Jimenez
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First street SW, Rochester, MN 55905, USA
| | - Gal Tsaban
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First street SW, Rochester, MN 55905, USA
| |
Collapse
|
11
|
Glei DA, Weinstein M. Smoking may compromise physical function long before it kills you. Front Public Health 2023; 11:1261102. [PMID: 38026327 PMCID: PMC10666746 DOI: 10.3389/fpubh.2023.1261102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Although prior research has demonstrated an association between smoking and worse physical function, most of those studies are based on older people and do not evaluate whether the age-related increase in physical limitations differs by smoking history. We quantify how the magnitude of the smoking differential varies across age. Methods This cohort study comprised a national sample of Americans aged 20-75 in 1995-1996, who were re-interviewed in 2004-2005 and 2013-2014. Our analysis was restricted to respondents who completed the self-administered questionnaires at Wave 1 (N = 6,325). Follow-up observations for those respondents were included if they completed the self-administered questionnaires at Wave 2 (N = 3,929) and/or Wave 3 (N = 2,849). The final analysis sample comprised 13,103 observations over a follow-up period of up to 19 years (1995-2014). We used a linear mixed model to regress physical limitations on smoking status at baseline adjusted for sex, age, race, socioeconomic status, alcohol abuse, drug abuse, and obesity with an interaction between age and smoking to test whether the age pattern of physical limitations differed by smoking history. Additional models incorporated measures of smoking duration and intensity. Results In the fully-adjusted model, smokers exhibited a steeper age-related increase in physical limitations than never smokers. Thus, the disparities in physical limitations by smoking status widened with age but were evident even at young ages. The estimated differential between heavy smokers and never smokers rose from 0.24 SD at age 30 to 0.49 SD at age 80. At younger ages, heavy smokers who quit recently fared worse than current light smokers and not much better than current heavy smokers. Discussion We know smoking is bad for our health, but these results reveal that differences in physical limitations by smoking history are evident even at ages as young as 30. Physical limitations that emerge early in life are likely to have an especially large impact because they can jeopardize health for decades of remaining life. Smoking probably will not kill you at young age, but it may compromise your physical function long before it kills you. Just do not do it.
Collapse
Affiliation(s)
- Dana A. Glei
- Center for Population and Health, Georgetown University, Washington, DC, United States
| | | |
Collapse
|
12
|
Affiliation(s)
- Zelalem T Haile
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
| |
Collapse
|
13
|
Treeful AE, Searle KM, Carroll DM, Yost KJ, Hedger AL, Friedenberg SG. A case-control survey study of environmental risk factors for primary hypoadrenocorticism in dogs. J Vet Intern Med 2023; 37:2073-2083. [PMID: 37830238 PMCID: PMC10658521 DOI: 10.1111/jvim.16896] [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: 02/27/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Primary hypoadrenocorticism in dogs is thought to be multifactorial with roles for both genetic and environmental factors. The contributions of environmental factors remain unexplored. OBJECTIVE Identify environmental and lifestyle exposures associated with primary hypoadrenocorticism in 2 dog breeds with high risk of developing the disease. ANIMALS Animals were not used in this study. Owners of Standard Poodles (STPDs) and Portuguese water dogs (POWDs) participated in a survey. METHODS Retrospective case-control study. Dog owners were invited to participate in an online survey through convenience sampling. Questions regarded the demographics, health histories, and indoor/outdoor environments in which their dogs live and play. Responses for dogs with primary hypoadrenocorticism were compared to those without the disease using univariate and multivariate logistic regression models. RESULTS Five thousand forty-seven responses (358 cases, 4689 controls) met initial inclusion criteria. Significant associations with modest effect size were found for community type, ingestion of canned food, and use of lawn fertilizer in some analysis models. Reproductive (spay/neuter) status exhibited the strongest association with high effect size across all models with adjusted odds ratio (OR) 2.5 (95% confidence interval [CI], 1.4-4.5; P = .003) for spayed females and 6.0 (95% CI, 2.6-13.9; P < .001) for neutered males. CONCLUSIONS AND CLINICAL IMPORTANCE The large effect size for reproductive status reflects its high potential clinical relevance, whereas modest effect sizes for other environmental variables suggest lower potential clinical relevance. These findings are associations and do not necessarily imply causation. Before any actionable recommendations are warranted, additional evidence regarding biological mechanisms is needed.
Collapse
Affiliation(s)
- Amy E. Treeful
- Department of Veterinary Population Medicine, College of Veterinary MedicineUniversity of MinnesotaSt. Paul, Minnesota 55108USA
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineUniversity of MinnesotaSt. Paul, Minnesota 55108USA
| | - Kelly M. Searle
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolis, Minnesota 55455USA
| | - Dana M. Carroll
- Division of Environmental Health Sciences, School of Public HealthUniversity of MinnesotaMinneapolis, Minnesota 55455USA
| | - Kathleen J. Yost
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Anna L. Hedger
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineUniversity of MinnesotaSt. Paul, Minnesota 55108USA
| | - Steven G. Friedenberg
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineUniversity of MinnesotaSt. Paul, Minnesota 55108USA
| |
Collapse
|
14
|
van Leuven L, Engelbrektsson J, Forster M. Reach and predictors of effects during nation-wide dissemination of the universal parenting program All Children in Focus. BMC Public Health 2023; 23:2027. [PMID: 37853429 PMCID: PMC10583325 DOI: 10.1186/s12889-023-16823-0] [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: 03/29/2023] [Accepted: 09/23/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Parenting programs have the potential to improve population health, if widely disseminated. However, wide-scale dissemination is challenging. Also, more knowledge is needed of whether parenting programs are effective for the variability of families in the general population. METHODS This study aimed to investigate who the universal parenting program All Children in Focus (ABC) reaches when offered in routine care in Sweden. A second aim was to investigate if the outcomes were predicted by factors related to family background, group leader experience, and homework completion. Questionnaires were collected before and after ABC from 1420 parents. Hierarchical regression analyses were performed to examine predictors of disruptive child behavior, parenting practices, and satisfaction. RESULTS ABC was available in about 40% of Swedish municipalities and reached a fairly representative population sample, with the exception that fewer fathers than mothers participated. The examined predictors explained a small proportion of the variance in the outcomes (2.5, 3.5 and 14.7%, respectively). Still, the effect on disruptive child behavior was statistically significantly larger for parents born in Sweden, with higher education, and older children. The effect on parenting practices was also larger for parents born in Sweden, for mothers, and for those practicing homework more frequently. Most examined predictors showed no statistically significant association with child and parenting outcomes. Parents were generally satisfied with ABC and the significant predictors of satisfaction had little practical meaning. CONCLUSIONS A fairly representative group of parents across Sweden were reached by ABC. Background variables, homework completion, and group leaders' experience explained a small proportion of variance in the outcomes. Meanwhile, the slightly lower intervention effects found for preschool children and parents born abroad calls for further investigation, since even small differences in effects can have an impact at a population level. The study also points to the importance of stressing homework completion and to increase the reach of universal parenting interventions to some underrepresented groups.
Collapse
Affiliation(s)
- Livia van Leuven
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden.
| | - Johanna Engelbrektsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden
| | - Martin Forster
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden
| |
Collapse
|
15
|
King SE, Waddell JT, Corbin WR. A preliminary investigation of salivary α-amylase as a novel biomarker of subjective response to alcohol: A brief report. Exp Clin Psychopharmacol 2023; 31:888-894. [PMID: 36757961 PMCID: PMC10409871 DOI: 10.1037/pha0000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Alcohol misuse represents a universal public health concern that spans multiple demographics. As such, understanding shared, biological indicators of alcohol-related risk is vital to implementing targeted prevention and intervention efforts. Self-report measures of subjective response to alcohol (SR) capture both psychological and pharmacological effects of alcohol and robustly predict patterns of alcohol use, negative consequences, and the development of alcohol use disorders. Importantly, several biological markers of alcohol's sedating effects, including cortisol, have been identified and complement subjective response assessments. However, biological markers of alcohol's stimulating effects are less understood. Studies have implicated alcohol-induced changes in heart rate as a viable marker, but heart rate measurements are susceptible to measurement error. Salivary α-amylase, a reliable indicator of sympathetic nervous system activation, represents a promising alternative biomarker of alcohol-induced stimulation. Using data from a large, placebo-controlled alcohol administration study (N = 448), the present study examined the extent to which α-amylase is a viable marker of alcohol-induced stimulation. To test this, a measurement model was estimated in which baseline and ascending limb subjective stimulation latent variables were created using two validated measures of subjective response. Ascending self-reports of stimulation and levels of α-amylase were then regressed onto beverage conditions and allowed to correlate with each other. Findings indicated that α-amylase is sensitive to acute alcohol consumption and is positively, but not statistically reliably, related to the ascending limb stimulant SR. Future studies should consider including salivary α-amylase as a noninvasive physiological indicator of alcohol's stimulating effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Scott E King
- Department of Psychology, Arizona State University
| | | | | |
Collapse
|
16
|
Werner‐Seidler A, Li SH, Spanos S, Johnston L, O'Dea B, Torok M, Ritterband L, Newby JM, Mackinnon AJ, Christensen H. The effects of a sleep-focused smartphone application on insomnia and depressive symptoms: a randomised controlled trial and mediation analysis. J Child Psychol Psychiatry 2023; 64:1324-1335. [PMID: 36991537 PMCID: PMC10952387 DOI: 10.1111/jcpp.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Rates of depression are increasing among adolescents. A novel way to reduce depression is by improving sleep. We evaluated whether an app-based intervention for insomnia improved sleep and depression, and whether changes in insomnia mediated changes in depression. METHODS We conducted a 2-arm single-blind randomised controlled trial at the Black Dog Institute in Australia. Adolescents 12-16 years experiencing insomnia symptoms were randomly allocated to receive Sleep Ninja, an app-delivered cognitive behavioural therapy program for insomnia, or to an active control group involving weekly text message sleep tips. Assessments took place at baseline, 6 weeks (post-intervention) and 14 weeks (post-baseline). Co-primary outcomes were symptoms of insomnia and depression at post-intervention (primary endpoint). Intent-to-treat analyses were conducted. The trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12619001462178. RESULTS Between October 25, 2019, and September 6, 2020, 264 participants were randomised to receive Sleep Ninja (n = 131) or to the control group (n = 133). Relative to the control group, those allocated to the intervention reported a greater reduction in insomnia symptoms at 6 weeks (95% CI: -2.96 to -0.41, d = .41) and 14 weeks (95% CI: -3.34 to -0.19, d = .39), and a greater reduction in depression symptoms at 6 weeks (95% CI: -3.46 to -0.56, d = .28) but not 14 weeks (p < 1). Change in insomnia mediated change in depression. No adverse events were reported. CONCLUSIONS An app-delivered program for insomnia could be a practical, non-stigmatising and scalable way to reduce symptoms of insomnia and depression among adolescents experiencing difficulties getting enough good quality sleep.
Collapse
Affiliation(s)
- Aliza Werner‐Seidler
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | - Sophie H. Li
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | - Samantha Spanos
- Australian Institute of Health InnovationMacquarie UniversitySydneyNSWAustralia
| | - Lara Johnston
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Bridianne O'Dea
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Michelle Torok
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Lee Ritterband
- School of MedicineUniversity of VirginiaCharlottesvilleVAUSA
| | - Jill M. Newby
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | | | | |
Collapse
|
17
|
Kemp BJ, Parrish AM, Chong KH, Cliff D. Sociodemographic moderators of longitudinal changes in active play between childhood and adolescence in Australia. J Sports Sci 2023; 41:1483-1489. [PMID: 37925674 DOI: 10.1080/02640414.2023.2278932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
Physical activity (PA) participation is prone to decline during childhood and adolescence. In Australia, this decline has been shown to particularly occur in active play. This study aimed to identify sociodemographic moderators of change in active play between 10-11y and 12-13y among Australian youth. The data were sourced from Waves 6-7 of the Longitudinal Study of Australian Children (n = 3567). Active play participation was measured using one-day time-use diaries (TUDs) completed by youth. Potential sociodemographic moderators were tested using multilevel mixed modelling, adjusted for pubertal development, body mass index z-score and TUD contextual variables (school attendance and season). Active play declined more among girls (β= -7.6 min/day, 95% CI = -13.3, -1.8), those who spoke English at home (β= -12.3 min/day, 95% CI = -22.0, -2.7) and marginally among those in regional/remote areas (β= -6.3 min/day, 95% CI = -12.8, +0.1). A widening gap in active play by sex was observed, while differences by language spoken at home and geographical remoteness weakened or became marginal over time. Interventions to promote active play could target girls in the transition to adolescence. Future studies could investigate whether active play declines earlier than 10-11y among youth who speak languages other than English at home and those living in urban areas.
Collapse
Affiliation(s)
- Byron J Kemp
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
- School of Education, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Anne-Maree Parrish
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Kar Hau Chong
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Dylan Cliff
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
- School of Education, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| |
Collapse
|
18
|
Xia Y, Tie J, Wang G, Zhuge Y, Wu H, Xue H, Xu J, Zhang F, Zhao L, Huang G, Zhang M, Wei B, Li P, Wu W, Chen C, Tang C, Zhang C. Individualized portal pressure gradient threshold based on liver function categories in preventing rebleeding after TIPS. Hepatol Int 2023; 17:967-978. [PMID: 36807252 PMCID: PMC10386972 DOI: 10.1007/s12072-023-10489-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/16/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND The evidence in Portal pressure gradient (PPG) < 12 mmHg after transjugular intrahepatic portosystemic shunt (TIPS) for preventing rebleeding mostly comes from observations in uncovered stents era. Moreover, association between Child-Pugh classes and post-TIPS hepatic encephalopathy (HE) has indicated that tolerance of PPG reduction depends on liver function. This study aimed to investigate the optimal PPG for covered TIPS and explore the optimal threshold tailored to the Child-Pugh classes to find individualized PPG to balance rebleeding and overt HE. METHODS This multicenter retrospective study analyzed rebleeding, OHE, and mortality of patients associated with post-TIPS PPGs (8, 10, 12, and 14 mmHg) in the entire cohort and among different Child-Pugh classes. Propensity score matching (PSM) and competing risk analyses were performed for sensitivity analyses. RESULTS We included 2100 consecutively screened patients undergoing TIPS. In all patients, PPG < 12 mmHg reduced rebleeding after TIPS (p = 0.022). In Child-Pugh class A, none of the PPG thresholds were discriminative of clinical outcomes. In Child-Pugh class B, 12 mmHg (p = 0.022) and 14 mmHg (p = 0.037) discriminated rebleeding, but 12 mmHg showed a higher net benefit. In Child-Pugh class C, PPG < 14 mmHg had a lower rebleeding incidence (p = 0.017), and exhibited more net benefit than 12 mmHg. CONCLUSION Different PPG standards may be required for patients with different liver function categories. A PPG threshold < 12 mmHg might be suitable for patients in Child-Pugh class B, while < 14 mmHg might be optimal for patients in Child-Pugh class C.
Collapse
Affiliation(s)
- Yifu Xia
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jun Tie
- National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, Shaanxi, China
| | - Guangchuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Yuzheng Zhuge
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Hao Wu
- Department of Gastroenterology and Hepatology, West China Hospital, Chengdu, Sichuan, China
| | - Hui Xue
- Gastroenterology of the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
| | - Jiao Xu
- National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, Shaanxi, China
| | - Feng Zhang
- Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Lianhui Zhao
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Guangjun Huang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Mingyan Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Bo Wei
- Department of Gastroenterology and Hepatology, West China Hospital, Chengdu, Sichuan, China
| | - Peijie Li
- Gastroenterology of the First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
| | - Wei Wu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chao Chen
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chengwei Tang
- Department of Gastroenterology and Hepatology, West China Hospital, Chengdu, Sichuan, China.
| | - Chunqing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| |
Collapse
|
19
|
Schooling CM, Au Yeung SL, Kwok MK, Leung GM. Breastfeeding and ApoB in late adolescence: a Hong Kong birth cohort study. Eur J Pediatr 2023; 182:3733-3741. [PMID: 37289232 DOI: 10.1007/s00431-023-05033-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
Breastfeeding is widely promoted. Experimental evidence concerning long-term benefits is limited. Observational studies are open to bias from confounding by socio-economic position. We assessed the association of breastfeeding with late adolescent lipid sub-fractions, particularly apolipoprotein B (ApoB) and non-high-density lipoprotein cholesterol (non-HDL-c), overall and by sex. We took advantage of a setting where breastfeeding has little association with higher socio-economic position and where several results from randomized controlled trials of breastfeeding promotion have been replicated. We used the population-representative "Children of 1997" birth cohort comprising 88% of births in Hong Kong in April and May 1997. Associations of breastfeeding in the first 3 months of life (never, mixed, exclusive) with lipid sub-fractions were obtained using linear regression adjusted for potential confounders including parental socio-economic position, maternal place of birth, type of delivery, gestational age, and birth weight. Differences by sex were assessed. Multiple imputation and inverse probability weighting were used to recover the original sample. Of the 3462 participants included, mean age was 17.6 years and 48.8% were girls. Mean ApoB was 0.74 g/L (standard deviation 0.15). Exclusive versus never breastfeeding was associated with lower ApoB (-0.027 g/L, 95% confidence interval (CI)-0.046 to-0.007, p = 0.007) and lower non-HDL-c (-0.143 mmol/L, 95% CI-0.237 to-0.048) with similar estimates by sex. CONCLUSION Breastfeeding may provide some population-level lifelong protection against cardiovascular disease. This study supports policies promoting breastfeeding as a modifiable exposure that contributes to a healthy start in life as an investment for lifelong cardiovascular disease prevention. WHAT IS KNOWN • Apolipoprotein B (ApoB) is a recognized risk factor for cardiovascular disease, but whether breastfeeding affects ApoB in later life overall and by sex is unknown. WHAT IS NEW • Exclusive breastfeeding in the first 3 months of life was associated with lower ApoB in late adolescence, with similar estimates for both sexes. • The inverse association of breastfeeding with ApoB suggests that breastfeeding could reduce cardiovascular disease and overall mortality over the lifespan.
Collapse
Affiliation(s)
- C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China
- CUNY School of Public Health, 55 West 125Th St, 10027, New York, NY, USA
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China
| | - Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China
| |
Collapse
|
20
|
Dumuid D, Singh B, Brinsley J, Virgara R, Curtis RG, Brinkman S, Maher CA. Trends in Well-Being Among Youth in Australia, 2017-2022. JAMA Netw Open 2023; 6:e2330098. [PMID: 37606925 PMCID: PMC10445194 DOI: 10.1001/jamanetworkopen.2023.30098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/14/2023] [Indexed: 08/23/2023] Open
Abstract
Importance Little is known about temporal trends in children's well-being and how the COVID-19 pandemic may have influenced the well-being of young Australians. Certain demographic groups may be more vulnerable to experiencing declines in well-being. Objective To examine well-being trends over 6 consecutive years among South Australian students and explore the influence of sociodemographic characteristics. Design, Setting, and Participants Longitudinal analyses of annual (2017 to 2022) cross-sectional data of students in grades 4 through 9 (n = 40 392 to 56 897 per year) attending South Australian government schools from the Well-being and Engagement Collection (WEC) census. Exposures Calendar year (2017-2022) and sociodemographic characteristics (sex, school grade, parental education, language spoken at home, residential region) from school enrollment records. Main Outcomes and Measures Students self-reported life satisfaction, optimism, happiness, cognitive engagement, emotional regulation, perseverance, worry, and sadness. Results Over 6 years (2017 to 2022), a total of 119 033 students (mean [SD] age, 12.1 y; 51.4% male) participated in this study. Most well-being measures declined over time, with consistent worsening of well-being from 2020 onward. For example, compared with 2017, sadness was 0.26 (95% CI, 0.25-0.27) points higher in 2020 (standardized mean difference [SMD], 0.27) and remained elevated by more than 0.26 points (SMD, 0.27) in 2021 and 2022. At almost every time point, greatest well-being was reported by students of male sex (except cognitive engagement and perseverance), in earlier school grades, with highest parental education, speaking a language other than English at home, and residing in outer regional and remote settings (for satisfaction, optimism, and emotional regulation). Sociodemographic differences in well-being were generally consistent over time; however, sex differences widened from 2020 for all indicators except cognitive engagement and perseverance. For example, between 2017 and 2022, sadness increased by 0.27 (95% CI, 0.25-0.29) more points among females than males (SMD, 0.28). Conclusions and Relevance In this longitudinal analysis of annual census data, there were downward trends in students' well-being, especially since 2020. The largest sociodemographic disparities were observed for students of female sex, those in later school grades, and those with lowest parental education. Urgent and equitable support for the well-being of all young people, particularly those facing disparity, is imperative.
Collapse
Affiliation(s)
- Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, School of Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Ben Singh
- Alliance for Research in Exercise, Nutrition and Activity, School of Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Jacinta Brinsley
- Alliance for Research in Exercise, Nutrition and Activity, School of Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Rosa Virgara
- Alliance for Research in Exercise, Nutrition and Activity, School of Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Rachel G. Curtis
- Alliance for Research in Exercise, Nutrition and Activity, School of Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Sally Brinkman
- Education Futures, University of South Australia, Adelaide, Australia
| | - Carol A. Maher
- Alliance for Research in Exercise, Nutrition and Activity, School of Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| |
Collapse
|
21
|
Yeung LK, Alschuler DM, Wall M, Luttmann-Gibson H, Copeland T, Hale C, Sloan RP, Sesso HD, Manson JE, Brickman AM. Multivitamin Supplementation Improves Memory in Older Adults: A Randomized Clinical Trial. Am J Clin Nutr 2023; 118:273-282. [PMID: 37244291 PMCID: PMC10375458 DOI: 10.1016/j.ajcnut.2023.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Maintenance of cognitive abilities is of critical importance to older adults, yet few effective strategies to slow cognitive decline currently exist. Multivitamin supplementation is used to promote general health; it is unclear whether it favorably affects cognition in older age. OBJECTIVES To examine the effect of daily multivitamin/multimineral supplementation on memory in older adults. METHODS The COcoa Supplement and Multivitamin Outcomes Study Web (COSMOS-Web) ancillary study (NCT04582617) included 3562 older adults. Participants were randomly assigned to a daily multivitamin supplement (Centrum Silver) or placebo and evaluated annually with an Internet-based battery of neuropsychological tests for 3 y. The prespecified primary outcome measure was change in episodic memory, operationally defined as immediate recall performance on the ModRey test, after 1 y of intervention. Secondary outcome measures included changes in episodic memory over 3 y of follow-up and changes in performance on neuropsychological tasks of novel object recognition and executive function over 3 y. RESULTS Compared with placebo, participants randomly assigned to multivitamin supplementation had significantly better ModRey immediate recall at 1 y, the primary endpoint (t(5889) = 2.25, P = 0.025), as well as across the 3 y of follow-up on average (t(5889) = 2.54, P = 0.011). Multivitamin supplementation had no significant effects on secondary outcomes. Based on cross-sectional analysis of the association between age and performance on the ModRey, we estimated that the effect of the multivitamin intervention improved memory performance above placebo by the equivalent of 3.1 y of age-related memory change. CONCLUSIONS Daily multivitamin supplementation, compared with placebo, improves memory in older adults. Multivitamin supplementation holds promise as a safe and accessible approach to maintaining cognitive health in older age. This trial was registered at clinicaltrials.gov as NCT04582617.
Collapse
Affiliation(s)
- Lok-Kin Yeung
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Daniel M Alschuler
- Area Mental Health Data Science, New York State Psychiatric Institute, New York, NY, United States
| | - Melanie Wall
- Area Mental Health Data Science, New York State Psychiatric Institute, New York, NY, United States; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Heike Luttmann-Gibson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Christiane Hale
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Richard P Sloan
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States; Division of Behavioral Medicine, New York State Psychiatric Institute, New York, NY, United States
| | - Howard D Sesso
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States; Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States.
| |
Collapse
|
22
|
Löchner J, Platt B, Starman-Wöhrle K, Takano K, Engelmann L, Voggt A, Loy F, Bley M, Winogradow D, Hämmerle S, Neumeier E, Wermuth I, Schmitt K, Oort F, Schulte-Körne G. A randomized controlled trial of a preventive intervention for the children of parents with depression: mid-term effects, mediators and moderators. BMC Psychiatry 2023; 23:455. [PMID: 37344778 DOI: 10.1186/s12888-023-04926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND In a parallel randomized controlled trial the effectiveness of the family- and group-based cognitive-behavioural "Gug-Auf" intervention in preventing depression in children of depressed parents was evaluated. We hypothesized that the intervention would be associated with reduced incidence of depression at 15 months as well as with reduced symptom severity at 6, 9, and 15 months. We also explored the role of a number of mediators and moderators. METHODS Families were included if a parent (n = 100, mean age = 46.06, 61% female) had experienced depression and children (n = 135, aged 8-17 years, 53% female) had no mental illness. Families (91.5% German) were randomly allocated (50:50 block-wise; stratified by child age and parental depression) to the 12-session "GuG-Auf" intervention or no intervention. Outcomes were assessed (on an intention-to-treat basis) at 0-(T1), 6-(T2), 9-(T3) and 15-months (T4) after baseline. Primary outcome (onset of depression; T4) was assessed with standardized (blinded) clinical interviews. Secondary (unblinded) outcome was risk of depression (at T2-T4) indicated by self- and parent-reported symptoms of internalizing, externalizing and depressive disorder. Potential mediators were emotion regulation, attributional style, knowledge of depression and parenting style. Potential moderators were parental depression severity and negative life events. RESULTS None of the children who received the intervention developed depression, whereas two of those in the control group did. The intervention significantly reduced depression risk (indicated by severity of self-reported internalizing symptoms) at T3 (p = .027, d = -0.45) and T4 (p = .035, d = -0.44). Both groups showed reduced depressive symptoms (p = .029, d = -0.44). Cognitive problem-solving and negative parenting emerged as mediators. There was no evidence that the intervention was associated with parent-reported internalizing symptoms or externalizing symptoms. No adverse events were observed. CONCLUSIONS Children of parents with depression showed an increase in self-reported (but not parent-reported) internalizing symptoms over time. This increase was not present in children who received the GuG-Auf intervention. The intervention was not associated with changes in externalizing symptoms. Conclusions regarding prevention of the onset of depression were not possible. Despite some limitations in the generalizability, these findings contribute to reducing the burden of youth depression. REGISTRATION The trial was registered on 16/04/2014 at ClinicalTrials.gov ( NCT02115880 ) and study protocol published in BMC Psychiatry ( https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-014-0263-2 ).
Collapse
Affiliation(s)
- Johanna Löchner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Child and Adolescent Psychiatry, University Hospital, Eberhard-Karls-University, Tübingen, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - Kornelija Starman-Wöhrle
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Keisuke Takano
- Human Informatics and Interaction Research Institute (HIIRI), National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Lina Engelmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Alessandra Voggt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Fabian Loy
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Mirjam Bley
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Dana Winogradow
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Stephanie Hämmerle
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Esther Neumeier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Inga Wermuth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Schmitt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Frans Oort
- Faculty of Social and Behavioral Sciences, Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
23
|
Ranucci M, Di Dedda U, Isgrò G, Giamberti A, Cotza M, Cornara N, Baryshnikova E. Plasma-Free Strategy for Cardiac Surgery with Cardiopulmonary Bypass in Infants < 10 kg: A Retrospective, Propensity-Matched Study. J Clin Med 2023; 12:3907. [PMID: 37373602 DOI: 10.3390/jcm12123907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Infants < 10 kg undergoing cardiac surgery with cardiopulmonary bypass (CPB) may receive either fresh frozen plasma (FFP) or other solutions in the CPB priming volume. The existing comparative studies are controversial. No study addressed the possibility of total avoidance of FFP throughout the whole perioperative course in this patient population. This retrospective, non-inferiority, propensity-matched study investigates an FFP-free strategy compared to an FFP-based strategy. METHODS Among patients <10 kg with available viscoelastic measurements, 18 patients who received a total FFP-free strategy were compared to 27 patients (1:1.5 propensity matching) receiving an FFP-based strategy. The primary endpoint was chest drain blood loss in the first 24 postoperative hours. The level of non-inferiority was settled at a difference of 5 mL/kg. RESULTS The 24-h chest drain blood loss difference between groups was -7.7 mL (95% confidence interval -20.8 to 5.3) in favor of the FFP-based group, and the non-inferiority hypothesis was rejected. The main difference in coagulation profile was a lower level of fibrinogen concentration and FIBTEM maximum clot firmness in the FFP-free group immediately after protamine, at the admission in the ICU and for 48 postoperative hours. No differences in transfusion of red blood cells or platelet concentrate were observed; patients in the FFP-free group did not receive FFP but required a larger dose of fibrinogen concentrate and prothrombin complex concentrate. CONCLUSIONS An FFP-free strategy in infants < 10 kg operated with CPB is technically feasible but results in an early post-CPB coagulopathy that was not completely compensated with our bleeding management protocol.
Collapse
Affiliation(s)
- Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Umberto Di Dedda
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Giuseppe Isgrò
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Alessandro Giamberti
- Department of Congenital Heart Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Mauro Cotza
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Noemi Cornara
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| | - Ekaterina Baryshnikova
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
| |
Collapse
|
24
|
Brickman AM, Yeung LK, Alschuler DM, Ottaviani JI, Kuhnle GGC, Sloan RP, Luttmann-Gibson H, Copeland T, Schroeter H, Sesso HD, Manson JE, Wall M, Small SA. Dietary flavanols restore hippocampal-dependent memory in older adults with lower diet quality and lower habitual flavanol consumption. Proc Natl Acad Sci U S A 2023; 120:e2216932120. [PMID: 37252983 PMCID: PMC10265949 DOI: 10.1073/pnas.2216932120] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/29/2023] [Indexed: 06/01/2023] Open
Abstract
Dietary flavanols are food constituents found in certain fruits and vegetables that have been linked to cognitive aging. Previous studies suggested that consumption of dietary flavanols might specifically be associated with the hippocampal-dependent memory component of cognitive aging and that memory benefits of a flavanol intervention might depend on habitual diet quality. Here, we tested these hypotheses in the context of a large-scale study of 3,562 older adults, who were randomly assigned to a 3-y intervention of cocoa extract (500 mg of cocoa flavanols per day) or a placebo [(COcoa Supplement and Multivitamin Outcomes Study) COSMOS-Web, NCT04582617]. Using the alternative Healthy Eating Index in all participants and a urine-based biomarker of flavanol intake in a subset of participants [n = 1,361], we show that habitual flavanol consumption and diet quality at baseline are positively and selectively correlated with hippocampal-dependent memory. While the prespecified primary end point testing for an intervention-related improvement in memory in all participants after 1 y was not statistically significant, the flavanol intervention restored memory among participants in lower tertiles of habitual diet quality or habitual flavanol consumption. Increases in the flavanol biomarker over the course of the trial were associated with improving memory. Collectively, our results allow dietary flavanols to be considered in the context of a depletion-repletion paradigm and suggest that low flavanol consumption can act as a driver of the hippocampal-dependent component of cognitive aging.
Collapse
Affiliation(s)
- Adam M. Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY10032
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY10032
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY10032
| | - Lok-Kin Yeung
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY10032
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY10032
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY10032
| | - Daniel M. Alschuler
- Mental Health Data Science Area, New York State Psychiatric Institute, New York, NY10032
| | | | - Gunter G. C. Kuhnle
- Department of Food and Nutritional Sciences, Hugh Sinclair Unit of Human Nutrition, University of Reading, Reading RG6 6DZ, United Kingdom
| | - Richard P. Sloan
- Mental Health Data Science Area, New York State Psychiatric Institute, New York, NY10032
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY10032
| | - Heike Luttmann-Gibson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA02115
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA02115
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA02115
| | | | - Howard D. Sesso
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA02115
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA02115
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA02115
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA02115
| | - Melanie Wall
- Mental Health Data Science Area, New York State Psychiatric Institute, New York, NY10032
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY10032
| | - Scott A. Small
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY10032
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY10032
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY10032
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY10032
| |
Collapse
|
25
|
Kolossváry E, Farkas K, Karahan O, Golledge J, Schernthaner GH, Karplus T, Bernardo JJ, Marschang S, Abola MT, Heinzmann M, Edmonds M, Catalano M. The importance of socio-economic determinants of health in the care of patients with peripheral artery disease: A narrative review from VAS. Vasc Med 2023; 28:241-253. [PMID: 37154387 PMCID: PMC10265288 DOI: 10.1177/1358863x231169316] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Socio-economic determinants of health (SDoH) include various nonmedical factors in the socio-economic sphere with a potentially significant impact on health outcomes. Their effects manifest through several mediators/moderators (behavioral characteristics, physical environment, psychosocial circumstances, access to care, and biological factors). Various critical covariates (age, gender/sex, race/ethnicity, culture/acculturation, and disability status) also interact. Analyzing the effects of these factors is challenging due to their enormous complexity. Although the significance of SDoH for cardiovascular diseases is well documented, research regarding their impact on peripheral artery disease (PAD) occurrence and care is less well documented. This narrative review explores to what extent SDoH are multifaceted in PAD and how they are associated with its occurrence and care. Additionally, methodological issues that may hamper this effort are addressed. Finally, the most important question, whether this association may contribute to reasonable interventions aimed at SDoH, is analyzed. This endeavor requires attention to the social context, a whole systems approach, multilevel-thinking, and a broader alliance that reaches out to more stakeholders outside the medical sphere. More research is needed to justify the power in this concept to improve PAD-related outcomes like lower extremity amputations. At the present time, some evidence, reasonable consideration, and intuitive reasoning support the implementation of various interventions in SDoH in this field.
Collapse
Affiliation(s)
- Endre Kolossváry
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- Department of Angiology, St Imre University Teaching Hospital, Budapest, Hungary
| | - Katalin Farkas
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- Department of Angiology, St Imre University Teaching Hospital, Budapest, Hungary
| | - Oguz Karahan
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya/Antalya, Diyarbakir, Turkey
| | - Jonathan Golledge
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- James Cook University & Townsville University Hospital, Townsville, QLD, Australia
| | - Gerit-Holger Schernthaner
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Karplus
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- Department of Vascular Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Jonathan James Bernardo
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- Department of Vascular Medicine, St Luke’s Medical Center, Quezon, NCR, Philippines
| | - Sascha Marschang
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- Department Managing Committee, VAS-European Independent Foundation in Angiology/Vascular Medicine, Bruxelles, Belgium
| | - Maria Teresa Abola
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- University of the Philippines College of Medicine–Philippine, Philippine Heart Center, Quezon, Philippines
| | - Monica Heinzmann
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- Angiology Unit, Allende Sanatorium, Nueva, Cordóba, Argentina
| | - Michael Edmonds
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- King’s College Hospital, Diabetic Foot Clinic, London, UK
| | - Mariella Catalano
- VAS-European Independent Foundation in Angiology/Vascular Medicine
- VAS-International Consortium – International PAD Strategic Network
- Inter-University Research Center on Vascular Disease, Department Biomedical and Clinical Science, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences L Sacco Hospital, Inter-University Research Center on Vascular Disease, University of Milan, Milan, Italy
| |
Collapse
|
26
|
Haro-Ramos AY, Rodriguez HP, Aguilera A. Effectiveness and implementation of a text messaging intervention to reduce depression and anxiety symptoms among Latinx and Non-Latinx white users during the COVID-19 pandemic. Behav Res Ther 2023; 165:104318. [PMID: 37146444 PMCID: PMC10105646 DOI: 10.1016/j.brat.2023.104318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 05/07/2023]
Abstract
Text messaging interventions are increasingly used to help people manage depression and anxiety. However, little is known about the effectiveness and implementation of these interventions among U.S. Latinxs, who often face barriers to using mental health tools. The StayWell at Home (StayWell) intervention, a 60-day text messaging program based on cognitive behavioral therapy (CBT), was developed to help adults cope with depressive and anxiety symptoms during the COVID-19 pandemic. StayWell users (n = 398) received daily mood inquiries and automated skills-based text messages delivering CBT-informed coping strategies from an investigator-generated message bank. We conduct a Hybrid Type 1 mixed-methods study to compare the effectiveness and implementation of StayWell for Latinx and Non-Latinx White (NLW) adults using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Effectiveness was measured using the PHQ-8 depression and GAD-7 anxiety scales, assessed before starting and after completing StayWell. Guided by RE-AIM, we conducted a thematic text analysis of responses to an open-ended question about user experiences to help contextualize quantitative findings. Approximately 65.8% (n = 262) of StayWell users completed pre-and-post surveys. On average, depressive (-1.48, p = 0.001) and anxiety (-1.38, p = 0.001) symptoms decreased from pre-to-post StayWell. Compared to NLW users (n = 192), Latinx users (n = 70) reported an additional -1.45 point (p < 0.05) decline in depressive symptoms, adjusting for demographics. Although Latinxs reported StayWell as relatively less useable (76.8 vs. 83.9, p = 0.001) than NLWs, they were more interested in continuing the program (7.5 vs. 6.2 out of 10, p = 0.001) and recommending it to a family member/friend (7.8 vs. 7.0 out of 10, p = 0.01). Based on the thematic analysis, both Latinx and NLW users enjoyed responding to mood inquiries and sought bi-directional, personalized text messages and texts with links to more information to resources. Only NLW users stated that StayWell provided no new information than they already knew from therapy or other sources. In contrast, Latinx users suggested that engagement with a behavioral provider through text or support groups would be beneficial, highlighting this group's unmet need for behavioral health care. mHealth interventions like StayWell are well-positioned to address population-level disparities by serving those with the greatest unmet needs if they are culturally adapted and actively disseminated to marginalized groups. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04473599.
Collapse
Affiliation(s)
- Alein Y Haro-Ramos
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Hector P Rodriguez
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Adrian Aguilera
- Digital Health Equity and Access Lab, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
27
|
Kwok J, Speyer LG, Soursou G, Murray AL, Fanti KA, Auyeung B. Maternal metabolic syndrome in pregnancy and child development at age 5: exploring mediating mechanisms using cord blood markers. BMC Med 2023; 21:124. [PMID: 37013575 PMCID: PMC10071709 DOI: 10.1186/s12916-023-02835-5] [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] [Received: 07/05/2022] [Accepted: 03/15/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND There is limited evidence on how the classification of maternal metabolic syndrome during pregnancy affects children's developmental outcomes and the possible mediators of this association. This study uses a cohort sample of 12,644 to 13,832 mother-child pairs from the UK Born in Bradford Study to examine the associations between maternal metabolic syndrome classification (MetS) and child development outcomes at age 5, using cord blood markers as candidate mediators. METHODS Maternal cardiometabolic markers included diabetes, obesity, triglycerides, high-density lipoprotein cholesterol, blood pressure, hypertension, and fasting glucose during pregnancy. Cord blood markers of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, leptin, and adiponectin were used as child mediators. Child outcomes included two starting school variables: British Picture Vocabulary Scale (BPVS) and the Letter Identification Assessment (LID), and five developmental milestone domains from a national UK framework: (1) communication and language (COM); (2) personal, social, and emotional (PSE); (3) physical development (PHY); (4) literacy (LIT); and (5) mathematics (MAT). Mediation models were used to examine the associations between the classification of maternal metabolic syndrome and child developmental milestones. Models were adjusted for potential maternal, socioeconomic, and child confounders such as maternal education, deprivation, and gestational age. RESULTS In mediation models, significant total effects were found for MetS associations with children's development in the LIT domain at age 5. MetS predicted individual cord blood mediators of lower HDL and increased leptin levels in both adjusted and unadjusted models. Total indirect effects (effects of all mediators combined) for MetS on a child's COM and PSE domain were significant, through all child cord blood mediators of LDL, HDL, triglycerides, adiponectin, and leptin for adjusted models. CONCLUSIONS The results support the hypothesis that maternal metabolic syndrome classification during pregnancy is associated with some child developmental outcomes at age 5. After adjusting for maternal, child, and environmental covariates, maternal metabolic syndrome classification during pregnancy was associated with children's LIT domain through direct effects of maternal metabolic health and indirect effects of cord blood markers (total effects), and COM and PSE domains via changes only in a child's cord blood markers (total indirect effects).
Collapse
Affiliation(s)
- Janell Kwok
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK.
| | - Lydia Gabriela Speyer
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Georgia Soursou
- Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Aja Louise Murray
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
| | - Kostas A Fanti
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Bonnie Auyeung
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, UK
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| |
Collapse
|
28
|
Sinderovsky A, Grosman-Rimon L, Atrash M, Nakhoul A, Saadi H, Rimon J, Birati EY, Carasso S, Kachel E. The Effects of Preoperative Pain Education on Pain Severity in Cardiac Surgery Patients: A Pilot Randomized Control Trial. Pain Manag Nurs 2023:S1524-9042(23)00030-9. [PMID: 36941189 DOI: 10.1016/j.pmn.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 01/08/2023] [Accepted: 02/06/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND There is minimal research on the effect of individualized preoperative education on postoperative pain and postoperative pain medication intake. AIM The study objective was to assess the effect of individually tailored preoperative education on postoperative pain severity, number of pain breakthroughs, and use of pain medication in participants receiving the intervention compared to controls. METHODS A pilot study with 200 participants was conducted. The experimental group received an informational booklet and discussed their ideas surrounding pain and pain medication with the researcher. Controls received no intervention. Postoperative pain severity was measured by a Numerical Rating System (NRS), which was divided into mild (NRS 1-3), moderate (NRS 4-6), and severe (NRS 7-10). RESULTS In the participant cohort, 68.8% of participants were male, and the average age was 60.48±10.7. Average postoperative 48-hour cumulative pain scores were lower in those who received the intervention compared to controls; 50.0 (IQR 35.8-60.0) vs. 65 (IQR 51.0-73.0; p < .01) participants who received the intervention had less frequent pain breakthroughs when compared to controls (3.0 [IQR 2.0-5.0] vs. 6.0 [IQR 4.0-8.0; p < .01]). There was no significant difference in the amount of pain medication taken by either group. CONCLUSIONS Participants who receive individualized preoperative pain education are more likely to have decreased postoperative pain.
Collapse
Affiliation(s)
- Amanda Sinderovsky
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Liza Grosman-Rimon
- Division of Cardiovascular Medicine and Surgery, Tzafon Medical Center, Tiberias, Israel; School of Graduate Studies, The Academic Center Levinsky-Wingate, Wingate Institute, Netanya, Israel
| | - Muhamd Atrash
- Division of Cardiovascular Medicine and Surgery, Tzafon Medical Center, Tiberias, Israel
| | - Aida Nakhoul
- Division of Cardiovascular Medicine and Surgery, Tzafon Medical Center, Tiberias, Israel
| | - Hanadi Saadi
- Division of Cardiovascular Medicine and Surgery, Tzafon Medical Center, Tiberias, Israel
| | - Jordan Rimon
- Faculty of Health, York University, Toronto, Canada
| | - Edo Y Birati
- Division of Cardiovascular Medicine and Surgery, Tzafon Medical Center, Tiberias, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
| | - Shemy Carasso
- The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem
| | - Erez Kachel
- Division of Cardiovascular Medicine and Surgery, Tzafon Medical Center, Tiberias, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; Department of Cardiac Surgery, Sheba Medical Centre, Tel Hashomer, Israel.
| |
Collapse
|
29
|
Chaku N, Barry K, Fowle J, Hoyt LT. Understanding patterns of heterogeneity in executive functioning during adolescence: Evidence from population-level data. Dev Sci 2022; 25:e13256. [PMID: 35238432 PMCID: PMC9901488 DOI: 10.1111/desc.13256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/16/2022] [Indexed: 01/13/2023]
Abstract
Executive functioning (EF) is fundamental to positive development. Yet, little is known about how to best characterize constellations of EF skills that may inform disparate associations between EF and behavior during adolescence. In the current study, cross-validated latent profile analysis (LPA) was used to derive profiles of EF based on measures of inhibitory control, working memory, and cognitive flexibility using data from 11,672 youth (52.2% male, mean age = 9.91 years) in the Adolescent Brain and Cognitive Development study. Four meaningful EF profiles emerged from the data representing Average EF, High EF, Low Inhibitory Control, and Low EF. Boys, youth from low-income households, and early developing youth were more likely to be in profiles distinguished by lower EF. Profile membership also predicted differences in externalizing, internalizing, and other problem behaviors assessed one year later. Findings indicate that youth may have distinct constellations of EF skills, underscoring the need for person-centered approaches that focus on patterns of individual characteristics.
Collapse
|
30
|
A population-based retrospective study of the modifying effect of urban blue space on the impact of socioeconomic deprivation on mental health, 2009-2018. Sci Rep 2022; 12:13040. [PMID: 35906285 PMCID: PMC9338232 DOI: 10.1038/s41598-022-17089-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
The incidence of mental health disorders in urban areas is increasing and there is a growing interest in using urban blue spaces (urban waterways, canals, lakes, ponds, coasts, etc.) as a tool to manage and mitigate mental health inequalities in the population. However, there is a dearth of longitudinal evidence of the mechanisms and impact of blue spaces on clinical markers of mental health to support and inform such interventions. We conducted a 10-year retrospective study, following STROBE guidelines, using routinely collected population primary care health data within the National Health Service (NHS) administrative area of Greater Glasgow and Clyde for the North of Glasgow city area. We explored whether living near blue space modifies the negative effect of socio-economic deprivation on mental health during the regeneration of an urban blue space (canal) from complete dereliction and closure. A total of 132,788 people (65,351 female) fulfilling the inclusion criteria were entered in the analysis. We established a base model estimating the effect of deprivation on the risk of mental health disorders using a Cox proportional hazards model, adjusted for age, sex and pre-existing comorbidities. We then investigated the modifying effect of living near blue space by computing a second model which included distance to blue space as an additional predicting variable and compared the results to the base model. Living near blue space modified the risk of mental health disorders deriving from socio-economic deprivation by 6% (hazard ratio 2.48, 95% confidence interval 2.39–2.57) for those living in the most deprived tertile (T1) and by 4% (hazard ratio 1.66, 95% confidence interval 1.60–1.72) for those in the medium deprivation tertile (T2). Our findings support the notion that living near blue space could play an important role in reducing the burden of mental health inequalities in urban populations.
Collapse
|
31
|
Message Source Credibility and E-Cigarette Harm Perceptions among Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159123. [PMID: 35897488 PMCID: PMC9329714 DOI: 10.3390/ijerph19159123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 02/01/2023]
Abstract
This study examined the effect of message source credibility on e-cigarette harm perceptions among U.S. young adults. An online experimental study was conducted where young adults (n = 302, Mage = 23.7) were randomized to an e-cigarette public health education message from an expert or a peer young adult. Then, participants answered questions about their perceptions about the message source and e-cigarettes. Results suggest that young adults rated experts as a more credible source (vs. peer) (b = −0.39, SE = 0.15, 95% CI [−0.67, −0.10], p < 0.01). Young adults reported greater perceived credibility of the expert message (vs. peer), which was associated with increased e-cigarette harm perceptions. Increased perceived source credibility mediated the association of increased e-cigarette absolute harm perceptions from viewing an expert message (b = −0.11, SE = 0.04, 95% CI: −0.20, −0.02). Source credibility should be considered when designing e-cigarette education messages for young adults.
Collapse
|
32
|
Gaidhane A, Telrandhe S, Holding P, Patil M, Kogade P, Jadhav N, Khatib MN, Zahiruddin QS. Effectiveness of family-centered program for enhancing competencies of responsive parenting among caregivers for early childhood development in rural India. Acta Psychol (Amst) 2022; 229:103669. [PMID: 35878448 DOI: 10.1016/j.actpsy.2022.103669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/20/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Responsive parenting constitutes an essential part of the context in which children live and has shown a positive effect on child development in the early years of life. AIMS This study aimed to assess the effectiveness of family parenting programs for enhancing competencies of responsive parenting among caregivers. STUDY DESIGN Cluster-RCT in 50 Anganwadi center areas. Twenty-five intervention clusters received responsive parenting intervention. Anganwadi workers delivered sessions after support and training. SUBJECTS We enrolled 530 mother-child dyads; 264 (49.9 %) from the intervention arm and 266 (50.1 %) from the control arm. OUTCOME MEASURES We assessed caregivers' knowledge and skills about child development using a parenting quiz. We evaluated the effect of an intervention on the home environment, mother-child interaction, and development outcomes at the endpoint. RESULTS We conducted 200 parenting sessions in 25 intervention clusters. Caregivers attended, on average, five sessions out of the nine scheduled. Caregivers with improved knowledge and skills about nutrition, shelter & care, play & stimulation for responsive parenting were significantly more in the intervention than in the control arm (p < 0.05). Mean difference in scores of home environment (1.24; SE-0.75 & ICC-0.088) and mother to child interaction (2.36; SE-0.87 & ICC-0.023) motor development (1.71; SE-0.61 & ICC-0.002), language development (2.97; SE-0.85 & ICC-0.002) and socioemotional development (1.45; SE-0.56 & ICC-0.066) between intervention and control arm was statistically significant (p < 0.05). CONCLUSIONS A locally adapted, family parenting curriculum was a practical approach for enhancing parents' competencies and confidence to promote early child development.
Collapse
Affiliation(s)
- Abhay Gaidhane
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India; School of Epidemiology and Public Health, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India.
| | - Shital Telrandhe
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Penny Holding
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Manoj Patil
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Priti Kogade
- School of Epidemiology and Public Health, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Navnita Jadhav
- School of Epidemiology and Public Health, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Mahalaqua Nazli Khatib
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| | - Quazi Syed Zahiruddin
- Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India; School of Epidemiology and Public Health, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India
| |
Collapse
|
33
|
Burgermaster M, Rodriguez VA. Psychosocial-Behavioral Phenotyping: A Novel Precision Health Approach to Modeling Behavioral, Psychological, and Social Determinants of Health Using Machine Learning. Ann Behav Med 2022; 56:1258-1271. [PMID: 35445699 DOI: 10.1093/abm/kaac012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The context in which a behavioral intervention is delivered is an important source of variability and systematic approaches are needed to identify and quantify contextual factors that may influence intervention efficacy. Machine learning-based phenotyping methods can contribute to a new precision health paradigm by informing personalized behavior interventions. Two primary goals of precision health, identifying population subgroups and highlighting behavioral intervention targets, can be addressed with psychosocial-behavioral phenotypes. We propose a method for psychosocial-behavioral phenotyping that models social determinants of health in addition to individual-level psychological and behavioral factors. PURPOSE To demonstrate a novel application of machine learning for psychosocial-behavioral phenotyping, the identification of subgroups with similar combinations of psychosocial characteristics. METHODS In this secondary analysis of psychosocial and behavioral data from a community cohort (n = 5,883), we optimized a multichannel mixed membership model (MC3M) using Bayesian inference to identify psychosocial-behavioral phenotypes and used logistic regression to determine which phenotypes were associated with elevated weight status (BMI ≥ 25kg/m2). RESULTS We identified 20 psychosocial-behavioral phenotypes. Phenotypes were conceptually consistent as well as discriminative; most participants had only one active phenotype. Two phenotypes were significantly positively associated with elevated weight status; four phenotypes were significantly negatively associated. Each phenotype suggested different contextual considerations for intervention design. CONCLUSIONS By depicting the complexity of psychological and social determinants of health while also providing actionable insight about similarities and differences among members of the same community, psychosocial-behavioral phenotypes can identify potential intervention targets in context.
Collapse
Affiliation(s)
- Marissa Burgermaster
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA.,Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Victor A Rodriguez
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.,College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
34
|
Mansfield R, Santos J, Deighton J, Hayes D, Velikonja T, Boehnke JR, Patalay P. The impact of the COVID-19 pandemic on adolescent mental health: a natural experiment. ROYAL SOCIETY OPEN SCIENCE 2022; 9:211114. [PMID: 35601452 PMCID: PMC9043696 DOI: 10.1098/rsos.211114] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 04/06/2022] [Indexed: 05/19/2023]
Abstract
Despite widespread concern about the impact of COVID-19 on adolescent mental health, there remains limited empirical evidence that can causally attribute changes to the pandemic. The current study aimed to overcome existing methodological limitations by exploiting a serendipitously occurring natural experiment within two ongoing, multi-phase cluster randomized controlled trials. Depressive symptoms (primary outcome), externalizing difficulties and life satisfaction (secondary outcomes) were assessed at baseline (phase 1 [pre-COVID-19 group]: September - October 2018, phase 2 [COVID-19 group]: September - October 2019) and 1-year follow-up (pre-COVID-19 group: January - March 2020, COVID-19 group: February - April 2021). Participants in phase 1 (N = 6419) acted as controls. In phase 2, participants (N = 5031) were exposed to the COVID-19 pandemic between the baseline and follow-up assessments providing a natural experimental design. The primary analysis used a random intercept linear multivariable regression model with phase (exposure to the COVID-19 pandemic) included as the key predictor while controlling for baseline scores and individual and school-level covariates. Depressive symptoms were higher and life satisfaction scores lower in the group exposed to the COVID-19 pandemic. Had the COVID-19 pandemic not occurred, we estimate that there would be 6% fewer adolescents with high depressive symptoms. No effect of exposure to the pandemic on externalizing difficulties was found. Exploratory analyses to examine subgroup differences in impacts suggest that the negative impact of the COVID-19 pandemic on adolescent mental health may have been greater for females than males. Given the widespread concern over rising adolescent mental health difficulties prior to the pandemic, this paper quantifies the additional impacts of the pandemic. A properly resourced, multi-level, multi-sector public health approach for improving adolescent mental health is necessary. Following in-principle acceptance, the approved Stage 1 version of this manuscript was preregistered on the OSF at https://doi.org/10.17605/OSF.IO/B25DH. This preregistration was performed prior to data analysis.
Collapse
Affiliation(s)
- Rosie Mansfield
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Joao Santos
- Manchester Institute of Education, University of Manchester, Manchester, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, UCL and Anna Freud National Centre for Children, and Families, London, UK
| | - Daniel Hayes
- Evidence Based Practice Unit, UCL and Anna Freud National Centre for Children, and Families, London, UK
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tjasa Velikonja
- Evidence Based Practice Unit, UCL and Anna Freud National Centre for Children, and Families, London, UK
| | - Jan R. Boehnke
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
- MRC Unit for Lifelong Health and Ageing, Population Science and Experimental Medicine, University College London, London, UK
| |
Collapse
|
35
|
Riehm KE, Badillo Goicoechea E, Wang FM, Kim E, Aldridge LR, Lupton-Smith CP, Presskreischer R, Chang TH, LaRocca S, Kreuter F, Stuart EA. Association of Non-Pharmaceutical Interventions to Reduce the Spread of SARS-CoV-2 With Anxiety and Depressive Symptoms: A Multi-National Study of 43 Countries. Int J Public Health 2022; 67:1604430. [PMID: 35308051 PMCID: PMC8927027 DOI: 10.3389/ijph.2022.1604430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/31/2022] [Indexed: 01/26/2023] Open
Abstract
Objectives: To examine the association of non-pharmaceutical interventions (NPIs) with anxiety and depressive symptoms among adults and determine if these associations varied by gender and age. Methods: We combined survey data from 16,177,184 adults from 43 countries who participated in the daily COVID-19 Trends and Impact Survey via Facebook with time-varying NPI data from the Oxford COVID-19 Government Response Tracker between 24 April 2020 and 20 December 2020. Using logistic regression models, we examined the association of [1] overall NPI stringency and [2] seven individual NPIs (school closures, workplace closures, cancellation of public events, restrictions on the size of gatherings, stay-at-home requirements, restrictions on internal movement, and international travel controls) with anxiety and depressive symptoms. Results: More stringent implementation of NPIs was associated with a higher odds of anxiety and depressive symptoms, albeit with very small effect sizes. Individual NPIs had heterogeneous associations with anxiety and depressive symptoms by gender and age. Conclusion: Governments worldwide should be prepared to address the possible mental health consequences of stringent NPI implementation with both universal and targeted interventions for vulnerable groups.
Collapse
Affiliation(s)
- Kira E. Riehm
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, United States,*Correspondence: Kira E. Riehm,
| | | | - Frances M. Wang
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Luke R. Aldridge
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, United States
| | | | | | - Ting-Hsuan Chang
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Frauke Kreuter
- Joint Program in Survey Methodology, University of Maryland, College Park, MD, United States,School of Social Sciences, University of Mannheim, Mannheim, Germany,Statistical Methods Group, Institute for Employment Research, Nuremberg, Germany
| | - Elizabeth A. Stuart
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
36
|
Schober P, Mascha EJ, Vetter TR. Statistics From A (Agreement) to Z (z Score): A Guide to Interpreting Common Measures of Association, Agreement, Diagnostic Accuracy, Effect Size, Heterogeneity, and Reliability in Medical Research. Anesth Analg 2021; 133:1633-1641. [PMID: 34633993 DOI: 10.1213/ane.0000000000005773] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Researchers reporting results of statistical analyses, as well as readers of manuscripts reporting original research, often seek guidance on how numeric results can be practically and meaningfully interpreted. With this article, we aim to provide benchmarks for cutoff or cut-point values and to suggest plain-language interpretations for a number of commonly used statistical measures of association, agreement, diagnostic accuracy, effect size, heterogeneity, and reliability in medical research. Specifically, we discuss correlation coefficients, Cronbach's alpha, I2, intraclass correlation (ICC), Cohen's and Fleiss' kappa statistics, the area under the receiver operating characteristic curve (AUROC, concordance statistic), standardized mean differences (Cohen's d, Hedge's g, Glass' delta), and z scores. We base these cutoff values on what has been previously proposed by experts in the field in peer-reviewed literature and textbooks, as well as online statistical resources. We integrate, adapt, and/or expand previous suggestions in attempts to (a) achieve a compromise between divergent recommendations, and (b) propose cutoffs that we perceive sensible for the field of anesthesia and related specialties. While our suggestions provide guidance on how the results of statistical tests are typically interpreted, this does not mean that the results can universally be interpreted as suggested here. We discuss the well-known inherent limitations of using cutoff values to categorize continuous measures. We further emphasize that cutoff values may depend on the specific clinical or scientific context. Rule-of-the thumb approaches to the interpretation of statistical measures should therefore be used judiciously.
Collapse
Affiliation(s)
- Patrick Schober
- From the Department of Anesthesiology, Amsterdam University Medical Centers (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Edward J Mascha
- Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| |
Collapse
|
37
|
Cohen R, Maddox R, Sedgwick M, Thurber KA, Brinckley MM, Barrett EM, Lovett R. Tobacco Related Attitudes and Behaviours in Relation to Exposure to the Tackling Indigenous Smoking Program: Evidence from the Mayi Kuwayu Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10962. [PMID: 34682708 PMCID: PMC8535551 DOI: 10.3390/ijerph182010962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/29/2022]
Abstract
Smoking is the leading contributor to the burden of disease and mortality for Aboriginal and Torres Strait Islander peoples, with an estimated 37% of all Aboriginal and Torres Strait Islander deaths attributed to smoking. The Tackling Indigenous Smoking (TIS) program was implemented to support people to quit smoking, prevent initiation, and reduce exposure to second-hand smoke. Analysis of baseline (2018-2020) data from a large-scale cohort study was conducted to quantify smoking-related attitudes and behaviours among Aboriginal and Torres Strait Islander adults, overall and in relation to exposure to the TIS program. Most results were similar for TIS and non-TIS, but there was a significantly lower prevalence of smoking inside households (PR0.85; 95% CI: 0.74, 0.97), smoking ≥21 cigarettes per day (PR0.79; 95% CI: 0.62, <1.00), and smoking a first cigarette within 5 min of waking (PR0.87; 95% CI: 0.76, <1.00) in TIS-funded compared to non-TIS-funded areas. Findings from the analysis highlight encouraging anti-smoking attitudes and behaviours across TIS-funded and non-TIS-funded areas, and serve as a basis for future analysis of change in outcomes over time associated with exposure to a large multi-mode population health program (TIS).
Collapse
|