Measurement Invariance and Differential Relationship to Substance Use of the Short UPPS-P Impulsive Behavior Scale Across Racial Groups

The Short UPPS-P Impulsive Behavior (SUPPS-P) scale assesses impulsive traits; however, its use among racial/ethnic minorities needs further testing. The aims of this study are to (a) test the measurement invariance of the SUPPS-P scale between White and racial/ethnic minority groups and (b) determine whether impulsive personality traits differentially relate to substance use outcomes across these groups. Participants were 1,301 young adults and recruited through a large public university or Amazon's Mechanical Turk. Multigroup confirmatory factor analysis concluded strong measurement invariance for Black, Asian American, and Hispanic/Latino groups, each compared with a White group. Most relationships between SUPPS-P traits and substance use did not differ across the groups compared, although two differences emerged with alcohol use. The SUPPS-P can validly and reliably measure impulsive traits in Black, Hispanic/Latino, and Asian American young to middle adults. Previous findings on risk patterns with the SUPPS-P likely generalize to these groups.

Efficacy of psychological interventions for dysmenorrhea: a meta-analysis

Dysmenorrhea is pelvic pain associated with menstruation and is one of the most common pain conditions among reproductive-age women. It is commonly treated with medications, complementary and alternative medicine, and self-management techniques. However, there is increased focus on psychological interventions which modify thoughts, beliefs, emotions, and behavioral responses to dysmenorrhea. This review examined the efficacy of psychological interventions on dysmenorrhea pain severity and interference. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, and Embase. A total of 22 studies were included; 21 examined within-group improvement (ie, within-group analysis) and 14 examined between-group improvement (ie, between-group analysis). Random-effects meta-analyses were conducted on pain severity and interference, with average effect sizes calculated using Hedges's g. Within-group analyses showed decreased pain severity and interference at post-treatment (g = 0.986 and 0.949, respectively) and first follow-up (g = 1.239 and 0.842, respectively). Between-group analyses showed decreased pain severity at post-treatment (g = 0.909) and decreased pain severity and interference at first follow-up (g = 0.964 and 0.884, respectively) compared to control groups. This review supports the efficacy of psychological interventions for dysmenorrhea, but conclusions are tempered by suboptimal methodological quality of the included studies and high heterogeneity across studies. Additional, rigorous research is needed to determine the clinical utility of psychological interventions for dysmenorrhea.

Education matters: longitudinal pathways to mid-life heavy drinking in a national cohort of black Americans

AIMS

To estimate longitudinal pathways from childhood socio-economic position (SEP) to educational attainment and mid-life heavy drinking in black Americans in order to identify potential points of early intervention to reduce risk for alcohol-related problems in adulthood.

DESIGN, SETTING AND PARTICIPANTS

Data are from 1299 black Americans in the US National Longitudinal Survey of Youth, followed from 1979 (aged 15-19 years) to 2012. Given gender differences in factors related to education and alcohol outcomes, gender-stratified path models were analyzed.

MEASUREMENTS

Youth socio-economic indicators included parental education (approximating childhood SEP) and adolescent poverty duration. Education-related measures included high-poverty school, perceived school safety, academic problems, suspension from school, educational expectations and educational attainment. Adulthood measures included repeated unemployment, poverty duration and mean frequency of heavy drinking (six or more drinks/day) in young adulthood and mid-life. Covariates included age, dual-parent household, marital status, early drinking onset and family history of alcohol problems.

FINDINGS

For both genders, two main pathways originating from low childhood SEP flowed to educational attainment through (1) educational expectations and (2) suspension and from educational attainment to mid-life heavy drinking [total indirect effect = 0.131, 95% confidence interval (CI) = 0.072-0.197 for women and 0.080, 95% CI = 0.035-0.139 for men]. For both genders, adolescent poverty (standardized βs ≥ 0.139), academic problems (βs ≥ 0.221) and school suspension (βs ≥ 0.166) were significantly (Ps < 0.05) related to lower educational expectations. In adulthood, educational attainment was indirectly protective against mid-life heavy drinking through its significant effects (Ps < 0.05) on young adult heavy drinking for both genders (βs ≤ -0.204) and economic hardships for women (βs ≤ -0.372).

CONCLUSIONS

Low childhood socio-economic position among black Americans appears to be associated with subsequent, adverse socio-economic and school experiences that lead to lower educational attainment and, ultimately, greater heavy drinking at mid-life. Interventions that mitigate these earlier, adverse experiences might have indirect effects on mid-life heavy drinking.

Implementation of a Brief Dialectical Behavioral Therapy (DBT) Skills Group in High Schools for At-Risk Youth: Protocol for a Mixed-Methods Study (Preprint)

Background

Adolescence is a developmental period marked by engagement in risk-taking behaviors, especially among impulsive or emotionally dysregulated youth. Thus, interventions that teach skills to reduce the risk of negative outcomes associated with emotional dysregulation are required. Social and emotional learning (SEL) programs have been developed to address both adolescent emotional dysregulation and risk-taking behaviors; however, current programs have mostly been implemented among younger youth and are used as a tier 1 universal intervention rather than a targeted tier 2 intervention for youth identified with emotional regulation difficulties.

Objective

This study aimed to address the need for SEL programming that can be delivered in schools, particularly for older youth who have difficulties with emotional or behavioral dysregulation, to reduce the risk of health-risk behaviors among this population.

Methods

Here, we outline the implementation of an SEL intervention titled Going 4 Goals, a 9-session adaptation of the Dialectical Behavioral Therapy for Adolescents (DBT-A) program delivered to at-risk high school students in a school setting. The primary objectives of the study are to test whether participating in the skills group intervention produces significant increases in the core DBT-A skills of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, while also producing significant decreases in substance use and risky behaviors. These primary outcomes are based on changes in participant scores between baseline and after the intervention and follow-ups at 1, 3, and 6 months compared with a control group of youth participating in the school’s health curriculum at the same time points. Qualitative interviews will also be conducted with intervention participants and school staff to examine acceptability and facilitators of and barriers to the intervention.

Results

A total of 171 participants across 13 groups had been enrolled in the intervention, with data collection ending December 2021. Data analysis will begin in the spring of 2022, with expected results to be published in the spring of 2023.

Conclusions

This paper describes the protocol of the 9-session school-based adaptation of the DBT-A intervention and discusses the strengths and limitations of the study and future directions.

International Registered Report Identifier (IRRID)

DERR1-10.2196/32490

Influence of patient immigrant status on physician trainee diabetes treatment decisions: a virtual patient experimental study

To determine the effect of patient immigrant status on physician trainees' diabetes treatment decisions. Participants were 140 physician trainees ('providers'). Providers viewed videos and vignettes of virtual patients differing in immigrant status (born in Mexico or U.S.; other characteristics held constant). Analyses were completed at the group and individual levels. Providers were less likely to refer foreign-born (vs. U.S.-born) patients to endocrinology. Individual-level results showed an almost even split between treatment ratings for foreign-born vs. U.S.-born patients for three decisions (take no action, add oral hypoglycemic agent, add/switch to insulin), explaining why group-level differences for these ratings did not emerge (i.e., they were cancelled out). Physician trainees are less likely to refer foreign-born patients to endocrinology. Half of individual-level decisions were influenced by patient immigrant status, but group-level analyses mask these differences. Systematic treatment differences based on non-relevant factors could lead to adverse outcomes for immigrants.

1116 Atypical, cardiac location of melanoma

A 66 – year – old woman, never treated because of any cardiac illnesses in the past, suffering from the chest pain evoked by physical activity, came to the outpatient clinic on January, 12 th 2019 for the diagnostics. Clinical examination, apart from an elevated blood pressure – 180/100 mmHg, showed no changes. In the ECG – SR 55 bpm. Performed TTE revealed an abnormal structure, having the dimensions 41x29 mm. Heart chamber dimensions, except for moderately enlarged LA, were in the normal range; ejection fraction was preserved. The patient was referred to the Department of Cardiology aiming at further diagnostics. In the course of hospitalization CT of the heart was done, during which the presence of hipodensic, mobile tissue change, having irregular borders, coming out of left ventricle wall was confirmed. PET examination excluded the existence of other remote changes. TEE corroborated the diagnosis of a tumor, originating from the inferior wall of left ventricle. Performed angiography ruled out significant changes in coronary arteries. Subsequently, the patient underwent the removal of the left ventricle tumor on February, 2 nd 2019 in the Department of Cardiosurgery. Histopathological examination result after the surgery wasn’t unequivocal – differential diagnosis should have included melanoma, myoepithelial cancer and MPNST ‘high – grade’ sarcoma. Immunohistochemical examination was continued. In the meantime, a control TTE was performed, which detected a tumor 14x10 mm.

After the immunohistochemical examination results a woman was qualified to immunotherapy with the usage of pembrolizumab, initiated on March In TTE done on March, 30th 2109 the dimensions of tumor 30x20 mm suggested the disease progression. Therapy was continued. Next echocardiography didn’t visualise the presence of tumor. The patient was after the second cycle of chemotherapy.

Abstract 1116 Figure.

Puff, puff, drink: The association between blunt and alcohol use among African American adolescents and young adults

Although African Americans report lower levels of alcohol use relative to their White counterparts, they experience higher rates of alcohol-related problems (e.g., alcohol dependence). One understudied connection between alcohol use and dependence is the dual use of illicit drugs, especially marijuana use. It is speculated that blunt use in combination with alcohol will have more adverse alcohol-related consequences among African Americans than alcohol use alone or alcohol and nonblunt marijuana use. The current study uses pooled data from the 2011-2014 National Survey on Drug Use and Health to examine the odds of alcohol dependence based on alcohol and marijuana typology in comparison to alcohol only users. Among 11,124 African American adolescents (12-17) and young adults (18-25) who consumed alcohol in the past year, 57.5%, 36.8%, and 5.7% reported alcohol use alone and in combination with blunt use and nonblunt marijuana use, respectively. Relative to alcohol users only, youth who used alcohol and blunts had increased odds of having alcohol dependence. This association was not found among youth who reported alcohol and nonblunt marijuana use. The increased rates of alcohol dependence highlight the public health concern of dual alcohol and a specific type of marijuana use (i.e., blunts) among African American youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Person-Environment Fit, Substance Use Attitudes, and Early Adolescent Substance Use

BACKGROUND

Adolescent substance use is a national health concern. While the literature is clear on the prevalence of substance use during the adolescent developmental period, a dearth of literature is available on the developmental contexts, particularly the influence of school factors, in which substance use occurs.

OBJECTIVES

This study examined the intermediary role of substance use attitudes on the relationship between school racial composition and alcohol and marijuana use in a sample of sixth to eighth graders.

METHODS

The sample consisted of 4228 middle school students (89% White; 53% female) in the Midwest. A moderated mediation analysis was conducted on the relationship between school racial composition, substance use attitudes, and substance use, with race as the moderator.

RESULTS

Results indicated a significant relationship between the percentage of White or Black students in a school and alcohol or marijuana use and that this relationship was mediated by substance use attitudes. These relationships did not differ significantly by student race. Conclusions/Importance: Preliminary findings indicate the importance of considering school racial composition as a systems level risk or promotive factor for attitudes toward substance use as well as substance use outcomes.

[Usefulness of selected echocardiographic parameters at prognosing recurrence of nonrheumatic atrial fibrillation]

INTRODUCTION

Recurrence of atrial fibrillation (FA) is very important problem after sinus rhythm (SR) restoration. The aim of study was to determinate a correlation between FA recurrence and echocardiographic parameters.

MATERIAL AND METHODS

In 98 patients (40 women and 58 men, age 36 do 86, mean 64.72 +/- 10.43 years) with nonrheumatic FA the SR was restored. For left atrium (LA) and its appendage (LAA) assessment the transthoracical (TTE) and transesophageal (TEE) echocardiography were performed during first hour of SR. At the TTE the following parameters were measured: LAmax, LAshort, LAlong, LAarea, LAcirc. During TEE were recorded: LAAshort, LAAlong, LAAcirc, LAAarea, LAAF, LAAB, LAAFintg, LAABintg. Immediately after reversion of FA the Holter recording was started.

RESULTS

In 14 patients FA recurred during 24 hours after cardioversion. In 6 patients FA only short episodes were noted, in the others 8 patients arrhythmia was remained at the end of Holter recordings. Among patients with arrhythmia recurrence during first 24 hours significantly larger LA max, LA short, LAA short and LAA area were measured when compared with patients who maintained sinus rhythm. Most of Doppler echocardiographic parameters measured after SR restoration evidenced better LA performance collarated with improved LA hemodynamic function. LA max and LA short were significantly smaller in patients with sustained SR 6 months follow up than in patients who had recurrence of FA. Most of Doppler echocardiographic parameters characterising LA function were meaningly higher in patient who maintained SR after arrhythmia termination. Similarly LAAF, LAAB, LAAF intg and LAAB intg had significantly greater values than in patients with recurrence of FA during 6-months observation. Spontaneous echocardiographic contrast occurrence both before and after SR restoration coexisted with arrhythmia return either during first 24 hours and 6-months follow-up.

CONCLUSIONS

FA recurrence is connected with LA and LAA enlargement. The LAA function assessed just after SR restoration is not a good predictor of SR stabilization. Long term SR stabilization is related to smaller LA an LAA diameters and theirs better hemodynamic function as well during FA as after arrhythmia termination.

[Function of the left atrial appendage after electrical cardioversion of atrial fibrillation to sinus rhythm]

INTRODUCTION

It is widely believed that atrial fibrillation appears in a secondly manner to atrial enlargement. Morfological alteration might be the source of disturbance of electrical activation and mechanical function to fibres that facilitate arrhythmia preservation as well as life threatening complications.

THE OBJECTIVE

It is crucial to establish whether reversion of atrial fibrillation to sinus rhythm causes size diminishment and function improvement of the left atrial appendage, which creates hope to avoid dangerous complications, particularly systemic embolisation. DATA AND METHODOLOGY: 30 patients were qualified including 18 males and 12 females aged between 52 and 86 (average age was 63.81 +/- 9.22). All the patients suffered from nonrheumatic atrial fibrillation. The echocardiographic examination was conducted before reversion of atrial fibrillation, right after reaching sinus rhythm and after 6 months observation at sustained sinus rhythm. During the transesophageal echocardiographic examination the following parameters were investigated: LAApodł, LAApoprz, LAAobw, LAApole, LAAF, LAAB, LAAF intg, LAAB intg, spontaneous echocardiographic contrast, thrombus.

RESULTS

Left atrial appendage size right after reversion of atrial fibrillation did not considerably differ from the values registered at the time of arrhythmia. It significantly diminished in the case of sustained stabilisation of sinus rhythm. The diminishment of the left atrial appendage size was connected with its function improvement expressed by increased maximum filling and emptying velocities as well as their integrals. SEC appearance frequency considerably increased right after reaching sinus rhythm. SEC appeared very rarely in the examination after 6 months. No single case of THR in LAA was noted. At the same time several cases of THR were disclosed both before and directly after restoration of sinus rhythm.

CONCLUSIONS

Sinus rhythm restoration and its sustaining for a longer period of time results in size diminishing and function improvement of left atrial appendage. The stability of sinus rhythm is closely tied with thromboembolism risk factors.

[Left ventricle function after the reversion of atrial fibrillation]

INTRODUCTION

Atrial fibrillation could be a consequence of heart failure as well as arrhythmia may cause deterioration of left ventricle systolic function. There are also studies suggested that atrial fibrillation promote left ventricle diastolic dysfunction.

AIM OF STUDY

Assessment of left ventricle diastolic function in patients with sustained sinus rhythm during six months observation after reversion of atrial fibrillation.

MATERIAL AND METHODS

The study group comprised 30 patients, which had stabilized sinus rhythm at least six months after successful reversion of atrial fibrillation. Transthoracical and transesophageal echocardiography in all patients was performed during atrial fibrillation, immediately after reversion of arrhythmia and after six months observation without reoccurrence of atrial fibrillation. The transthoracical echocardiographic parameters characterising left ventricle diastolic function was measured: E ampl LV, E acct LV, E dcct LV, E time LV, E intg LV. Consequently TEE was performed with Doppler probe in left superior pulmonary vein and following parameters were recorded: PVD, PVD intg, PVD dcct.

RESULTS

The E ampl LV immediately after sinus rhythm restoration significantly decreased and was similar to values recorded during atrial fibrillation. After six months observation further significant decreasing of this parameter was noted. The E intg LV was markedly smaller after arrhythmia reversion and did not changed during six months period of sustained sinus rhythm. The E acct LV remained almost the same in all points of study. Whereas the E dcct LV and E time LV were only slightly longer just after reversion the values recorded after six months observation were significantly greater compared to both values before and immediately after sinus rhythm restoration. PVD and PVD intg increased just after sinus rhythm restoration but not significantly. During six months observation their values markedly decreased compared to measurements during atrial fibrillation and were slightly smaller than at first hour of sinus rhythm. PVD dcct insignificantly decreased just after sinus rhythm restoration. Stabilization of sinus rhythm for six months has allowed for significant increasing of this parameter.

CONCLUSIONS

Left ventricle diastolic parameters in patients with atrial fibrillation do not significantly change immediately after sinus rhythm restoration. Maximal mitral early diastolic flow velocity and maximal diastolic flow velocity in pulmonary veins markedly decrease at six months observation after reversion of atrial fibrillation, whereas both deceleration time of early diastolic mitral flow and deceleration time of diastolic pulmonary flow became longer and than this indices don't differ from control group without arrhythmia in anamnesis.

[Noninvasive transcutaneous cardiac pacing]

The method of Noninvasive Transcutaneous Cardiac Pacing (NTCP) is presented in this paper. The authors describe the history of this stimulation type and difficulties during the first clinical attempts at pacing. Then they focus on cardiac activation by noninvasive cardiac pacing. Subsequently they analyse the effect of electric field on the myocardium and skeletal muscles. The hemodynamic aspects of NTCP take an important place. A the end the authors review the clinical application of NTCP.