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Becker E, Atkinson L, Gonzalez A, Khoury J. Social support buffers the impact of pregnancy stress on perceptions of parent-infant closeness during the COVID-19 pandemic. Infant Ment Health J 2024; 45:328-340. [PMID: 38196240 DOI: 10.1002/imhj.22096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
Pregnant individuals and parents have experienced elevated mental health problems and stress during COVID-19. Stress during pregnancy can be harmful to the fetus and detrimental to the parent-child relationship. However, social support is known to act as a protective factor, buffering against the adverse effects of stress. The present study examined whether (1) prenatal stress during COVID-19 was associated with parent-infant closeness at 6 months postpartum, and (2) social support moderated the effect of prenatal stress on the parent-infant relationship. In total, 181 participants completed questionnaires during pregnancy and at 6 months postpartum. A hierarchical linear regression analysis was conducted to assess whether social support moderated the effect of stress during pregnancy on parent-infant closeness at 6 months postpartum. Results indicated a significant interaction between prenatal stress and social support on parents' perceptions of closeness with their infants at 6 months postpartum (β = .805, p = .029); parents who experienced high prenatal stress with high social support reported greater parent-infant closeness, compared to those who reported high levels of stress and low social support. Findings underscore the importance of social support in protecting the parent-infant relationship, particularly in times of high stress, such as during the COVID-19 pandemic.
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Affiliation(s)
- Emma Becker
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Leslie Atkinson
- Department of Psychology, Metropolitan Toronto University, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Khoury
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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Catherine NLA, MacMillan H, Cullen A, Zheng Y, Xie H, Boyle M, Sheehan D, Lever R, Jack SM, Gonzalez A, Gafni A, Tonmyr L, Barr R, Marcellus L, Varcoe C, Waddell C. Effectiveness of nurse-home visiting in improving child and maternal outcomes prenatally to age two years: a randomised controlled trial (British Columbia Healthy Connections Project). J Child Psychol Psychiatry 2024; 65:644-655. [PMID: 37464862 DOI: 10.1111/jcpp.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND We investigated the effectiveness of Nurse-Family Partnership (NFP), a prenatal-to-age-two-years home-visiting programme, in British Columbia (BC), Canada. METHODS For this randomised controlled trial, we recruited participants from 26 public health settings who were: <25 years, nulliparous, <28 weeks gestation and experiencing socioeconomic disadvantage. We randomly allocated participants (one-to-one; computer-generated) to intervention (NFP plus existing services) or comparison (existing services) groups. Prespecified outcomes were prenatal substance exposure (reported previously); child injuries (primary), language, cognition and mental health (problem behaviour) by age two years; and subsequent pregnancies by 24 months postpartum. Research interviewers were masked. We used intention-to-treat analyses. (ClinicalTrials.gov, NCT01672060.) RESULTS: From 2013 to 2016 we enrolled 739 participants (368 NFP, 371 comparison) who had 737 children. Counts for child injury healthcare encounters [rate per 1,000 person-years or RPY] were similar for NFP (223 [RPY 316.17]) and comparison (223 [RPY 305.43]; rate difference 10.74, 95% CI -46.96, 68.44; rate ratio 1.03, 95% CI 0.78, 1.38). Maternal-reported language scores (mean, M [SD]) were statistically significantly higher for NFP (313.46 [195.96]) than comparison (282.77 [188.15]; mean difference [MD] 31.33, 95% CI 0.96, 61.71). Maternal-reported problem-behaviour scores (M [SD]) were statistically significantly lower for NFP (52.18 [9.19]) than comparison (54.42 [9.02]; MD -2.19, 95% CI -3.62, -0.75). Subsequent pregnancy counts were similar (NFP 115 [RPY 230.69] and comparison 117 [RPY 227.29]; rate difference 3.40, 95% CI -55.54, 62.34; hazard ratio 1.01, 95% CI 0.79, 1.29). We observed no unanticipated adverse events. CONCLUSIONS NFP did not reduce child injuries or subsequent maternal pregnancies but did improve maternal-reported child language and mental health (problem behaviour) at age two years. Follow-up of long-term outcomes is warranted given that further benefits may emerge across childhood and adolescence.
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Affiliation(s)
| | | | - Ange Cullen
- Simon Fraser University, Vancouver, BC, Canada
| | - Yufei Zheng
- Simon Fraser University, Vancouver, BC, Canada
| | - Hui Xie
- Simon Fraser University, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | | | | | | | | | | | | | - Lil Tonmyr
- Public Health Agency of Canada, Ottawa, ON, Canada
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Khoury JE, Atkinson L, Gonzalez A. A longitudinal study examining the associations between prenatal and postnatal maternal distress and toddler socioemotional developmental during the COVID-19 pandemic. Infancy 2024; 29:412-436. [PMID: 38329905 DOI: 10.1111/infa.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/15/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
Elevated psychological distress, experienced by pregnant women and parents, has been well-documented during the COVID-19 pandemic. Most research focuses on the first 6-months postpartum, with single or limited repeated measures of perinatal distress. The present longitudinal study examined how perinatal distress, experienced over nearly 2 years of the COVID-19 pandemic, impacted toddler socioemotional development. A sample of 304 participants participated during pregnancy, 6-weeks, 6-months, and 15-months postpartum. Mothers reported their depressive, anxiety, and stress symptoms, at each timepoint. Mother-reported toddler socioemotional functioning (using the Brief Infant-Toddler Social and Emotional Assessment) was measured at 15-months. Results of structural equation mediation models indicated that (1) higher prenatal distress was associated with elevated postpartum distress, from 6-weeks to 15-months postpartum; (2) associations between prenatal distress and toddler socioemotional problems became nonsignificant after accounting for postpartum distress; and (3) higher prenatal distress was indirectly associated with greater socioemotional problems, and specifically elevated externalizing problems, through higher maternal distress at 6 weeks and 15 months postpartum. Findings suggest that the continued experience of distress during the postpartum period plays an important role in child socioemotional development during the COVID-19 pandemic.
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Affiliation(s)
- Jennifer E Khoury
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Leslie Atkinson
- Department of Psychology, Metropolitan Toronto University, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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4
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Gonzalez A, Jack SM, Sim A, Ratcliffe J, Dumbaugh M, Bennett T, MacMillan HL. CHAMPP4KIDS: Mixed methods study protocol to evaluate acceptability and feasibility of Parenting for Lifelong Health materials in a Canadian context. PLoS One 2024; 19:e0298156. [PMID: 38452022 PMCID: PMC10919627 DOI: 10.1371/journal.pone.0298156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/17/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Parents and caregivers play a key role in children's healthy development and well-being. Traditional parenting interventions promote positive parenting practices and are key to preventing child maltreatment. However, numerous barriers can limit access to programs, barriers which were further exacerbated by the COVID-19 pandemic. The Parenting for Lifelong Health group developed mass media and public health communication materials to promote positive caregiving behaviours on a population level. The Champions of Positive Parenting 4 Kids (CHAMPP4KIDS) study will examine the acceptability and feasibility of these materials for service providers and caregivers of children aged 2-6 years in Ontario, Canada. METHODS This study will use a convergent mixed-methods design. Consenting service providers (n = 200) and caregivers (n = 100) will complete a quantitative survey to rate, rank and give feedback on Parenting for Lifelong Health tip sheets and social media ads. Caregivers will also complete self-report scales measuring depression and anxiety. We will hold focus group discussions with a sub-sample of surveyed providers (n = 40) and caregivers (n = 25). An adapted Trials of Improved Practices methodology will explore caregiver perspectives after implementing the tip sheets. Primary quantitative outcomes will be descriptive statistics of rankings, Likert Scale scores and descriptive analysis of caregiver depression and anxiety. Qualitative data will be analyzed using Rapid Qualitative Inquiry and triangulated through a convergent coding matrix. DISCUSSION The Parenting for Lifelong Health COVID-19 parenting materials offer succinct, engaging parenting information in a mass media format that addresses some challenges associated with accessing in-person programming. The CHAMPP4KIDS study will provide mixed methods insights on the materials' acceptability and feasibility from different groups in a Canadian context, with a focus on marginalized families. The use of Trials of Improved Practices methodology could prove a useful tool for participant-led adaptation of existing parenting, early childhood development and other health intervention materials.
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Affiliation(s)
- Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Susan M. Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Sim
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jenna Ratcliffe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Mari Dumbaugh
- School of Public Health, University of Illinois-Chicago, Chicago, Illinois, United States of America
| | - Teresa Bennett
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Harriet L. MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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5
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McLennan JD, Gonzalez A, MacMillan HL, Afifi TO. Routine screening for adverse childhood experiences (ACEs) still doesn't make sense. Child Abuse Negl 2024:106708. [PMID: 38388325 DOI: 10.1016/j.chiabu.2024.106708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/23/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Abstract
When a serious health or social problem is identified as both prevalent and in need of attention, a common response is to propose that various systems implement routine identification, such as universal screening. However, these well-intentioned responses often fail to consider the key requirements necessary to determine whether benefits outweigh harms. Unfortunately, this continues to be the case for calls to implement routine screening for Adverse Childhood Experiences (ACEs). Persistent evidence gaps for this type of screening include the lack of any randomized controlled trials demonstrating that ACEs screening programs lead to any benefits. Rather than being informed by established screening principles, the calls to proceed with ACEs screening appear to rely on the assumption that simply identifying risk factors can lead to beneficial outcomes that outweigh any risk of harms. This may reflect a gap in understanding that patterns identified at the population level (e.g., that more ACEs are associated with more health and social problems) cannot be directly translated to practices at the level of the individual. This commentary does not question the importance of ACEs; rather it identifies that directing limited resources to screening approaches for which there is no evidence that benefits outweigh harms is problematic. Instead, we advocate for the investment in high-quality trials of prevention interventions to determine where best to direct limited resources to reduce the occurrence of ACEs, and for the prioritization of evidence-based treatment services for those with existing health and social conditions, whether or not they are attributed to ACEs.
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Affiliation(s)
- John D McLennan
- Departments of Psychiatry & Community Health Sciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada.
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, Offord Centre for Child Studies, McMaster University, Hamilton, Canada.
| | - Harriet L MacMillan
- Departments of Psychiatry & Behavioural Neurosciences, and of Pediatrics, Faculty of Health Sciences, Offord Centre for Child Studies, McMaster University, Hamilton, Canada.
| | - Tracie O Afifi
- Departments of Community Health Sciences and Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
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6
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McQuillan K, Yoshida-Montezuma Y, Jambon M, Vanderloo LM, Gonzalez A, Anderson LN. Physical activity and unexpected weight change in Ontario children and youth during the COVID-19 pandemic: A cross-sectional analysis of the Ontario Parent Survey 2. PLoS One 2024; 19:e0292934. [PMID: 38300964 PMCID: PMC10833564 DOI: 10.1371/journal.pone.0292934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/01/2023] [Indexed: 02/03/2024] Open
Abstract
The objective of this study was to investigate the association between children's parent-reported physical activity levels and weight changes during the COVID-19 pandemic among children and youth in Ontario Canada. A cross-sectional online survey was conducted in parents of children 5-17 years living in Ontario from May to July 2021. Parents recalled their child's physical activity and weight change during the year prior to their completion of the survey. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multinomial logistic regression for the association between physical activity and weight gain or loss, adjusted for child age and gender, parent ethnicity, current housing type, method of school delivery, and financial stability. Overall, 86.8% of children did not obtain 60 minutes of moderate-to-vigorous physical activity per day and 75.4% of parents were somewhat or very concerned about their child's physical activity levels. For all physical activity exposures (outdoor play, light physical activity, and moderate-to-vigorous physical activity), lower physical activity was consistently associated with increased odds of weight gain or loss. For example, the adjusted OR for the association between 0-1 days of moderate-to-vigorous physical activity versus 6-7 days and child weight gain was 5.81 (95% CI 4.47, 7.56). Parent concern about their child's physical activity was also strongly associated with child weight gain (OR 7.29; 95% CI 5.94, 8.94). No differences were observed between boys and girls. This study concludes that a high proportion of children in Ontario had low physical activity levels during the COVID-19 pandemic and that low physical activity was strongly associated with parent reports of both weight gain and loss among children.
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Affiliation(s)
- Kathryn McQuillan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yulika Yoshida-Montezuma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marc Jambon
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, ON, Canada
| | - Leigh M. Vanderloo
- ParticipACTION, Toronto, Ontario, Canada
- School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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7
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Bennett T, Drmic I, Gross J, Jambon M, Kimber M, Zaidman-Zait A, Andrews K, Frei J, Duku E, Georgiades S, Gonzalez A, Janus M, Lipman E, Pires P, Prime H, Roncadin C, Salt M, Shine R. The Family-Check-Up® Autism Implementation Research (FAIR) Study: protocol for a study evaluating the effectiveness and implementation of a family-centered intervention within a Canadian autism service setting. Front Public Health 2024; 11:1309154. [PMID: 38292388 PMCID: PMC10826514 DOI: 10.3389/fpubh.2023.1309154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/15/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Prevalence rates of emotional and behavior problems (EBP) in autistic children and youth are high (40-70%), and often cause severe and chronic impairment. Furthermore, autistic children are also more likely to experience family "social-ecological" adversity compared to neurotypically developing peers, including social isolation, child maltreatment, caregiver mental illness, and socioeconomic risk. These family stressors increase the risk of co-occurring EBP among autistic children and can often impede access to evidence-based care, thus amplifying long-term health inequities for autistic children and their caregivers. In the current autism services landscape, there are few scalable, evidence-based programs that adequately address these needs. The Family Check-Up (FCU®) is a brief, strength-based, and tailored family-centered intervention that supports positive parenting and explicitly assesses the social determinants of child and family mental health within an ecological framework. Studies have demonstrated long-term positive child and caregiver outcomes in other populations, but the FCU® has not been evaluated in families of autistic children and youth. Therefore, we aimed to evaluate FCU® implementation within an established, publicly funded Autism Program in Ontario, Canada, with delivery by autism therapists, to demonstrate sustainable effectiveness within real-world settings. Methods In this study, we outline the protocol for a hybrid implementation-effectiveness approach with two key components: (1) A parallel-arm randomized controlled trial of N = 80 autistic children/youth (ages 6-17 years) and high levels of EBP and their caregivers. Primary and secondary outcomes include child EBP, and caregiver well-being and parenting. (2) A mixed methods implementation study, to describe facilitators and barriers to implementation of the FCU® within an autism service setting. Discussion Scalable, ecologically focused family-centered interventions offer promise as key components of a public health framework aimed at reducing mental health inequities among autistic children, youth, and their caregivers. Results of this study will inform further program refinement and scale-up.
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Affiliation(s)
- Teresa Bennett
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Irene Drmic
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Julie Gross
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Marc Jambon
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | | | - K. Andrews
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Julia Frei
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - E. Duku
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Magdalena Janus
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - E. Lipman
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Paulo Pires
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Heather Prime
- Department of Psychology, York University, Toronto, ON, Canada
| | - Caroline Roncadin
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Mackenzie Salt
- Department of Psychiatry and Behavioral Neurosciences, Offord Centre for Child Studies, McMaster University/McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Rebecca Shine
- Ron Joyce Children’s Health Centre Hamilton Health Sciences/McMaster Children’s Hospital, Hamilton, ON, Canada
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Gonzalez A, Soto J, Babiker N, Wroblewski K, Sawicki S, Schoeller D, Luke A, Huisingh-Scheetz M. Higher baseline resting metabolic rate is associated with 1-year frailty decline among older adults residing in an urban area. BMC Geriatr 2023; 23:815. [PMID: 38062368 PMCID: PMC10704798 DOI: 10.1186/s12877-023-04534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Dysregulated energy metabolism is one hypothesized mechanism underlying frailty. Resting energy expenditure, as reflected by resting metabolic rate (RMR), makes up the largest component of total energy expenditure. Prior work relating RMR to frailty has largely been done in cross section with mixed results. We investigated whether and how RMR related to 1-year frailty change while adjusting for body composition. METHODS N = 116 urban, predominantly African-American older adults were recruited between 2011 and 2019. One-year frailty phenotype (0-5) was regressed on baseline RMR, frailty phenotype, demographics and body composition (DEXA) in an ordinal logistic regression model. Multimorbidity (Charlson comorbidity scale, polypharmacy) and cognitive function (Montreal Cognitive Assessment) were separately added to the model to assess for change to the RMR-frailty relationship. The model was then stratified by baseline frailty status (non-frail, pre-frail) to explore differential RMR effects across frailty. RESULTS Higher baseline RMR was associated with worse 1-year frailty (odds ratio = 1.006 for each kcal/day, p = 0.001) independent of baseline frailty, demographics, and body composition. Lower fat-free mass (odds ratio = 0.88 per kg mass, p = 0.008) was independently associated with worse 1-year frailty scores. Neither multimorbidity nor cognitive function altered these relationships. The associations between worse 1-year frailty and higher baseline RMR (odds ratio = 1.009, p < 0.001) and lower baseline fat-free mass (odds ratio = 0.81, p = 0.006) were strongest among those who were pre-frail at baseline. DISCUSSION We are among the first to relate RMR to 1-year change in frailty scores. Those with higher baseline RMR and lower fat-free mass had worse 1-year frailty scores, but these relationships were strongest among adults who were pre-frail at baseline. These relationships were not explained by chronic disease or impaired cognition. These results provide new evidence suggesting higher resting energy expenditure is associated with accelerate frailty decline.
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Affiliation(s)
| | - J Soto
- Illinois Institute of Technology, Chicago, USA
| | | | - K Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, USA
| | - S Sawicki
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, USA
| | - D Schoeller
- University of Wisconsin in Madison, Madison, USA
| | - A Luke
- Department of Public Health Sciences, Loyola University, Chicago, USA
| | - Megan Huisingh-Scheetz
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, USA.
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9
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Neumann AV, Gonzalez A, Walter LC, Rivera J. Improving older adults' telehealth through a novel community-academic partnership: Preliminary data. J Am Geriatr Soc 2023; 71:3886-3895. [PMID: 37607098 DOI: 10.1111/jgs.18556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/28/2023] [Accepted: 07/13/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The COVID-19 pandemic increased the use of telehealth, which posed unique challenges for the provision of care to older adults who face numerous barriers to accessing and using technology. To improve older adults' online health-related abilities, the UCSF Geriatrics Workforce Enhancement Program (UCSF-GWEP) partnered with Little Brothers Friends of the Elderly-San Francisco (LBFE-SF) to develop a model telehealth training intervention. METHODS LBFE-SF recruited older adults from their members with wi-fi and paired each one with a new device and volunteer trainer to cover seven lessons and four key tasks (emailing providers, video visits, accessing health information, and using patient portals). Older adults completed surveys to self-assess their skill level after training, and their confidence before, immediately after, and 3 months post training. A subset of trainees were also interviewed about their program goals and experiences. UCSF-GWEP conducted statistical analyses of survey data, and coded interview transcripts to identify aspects of the model supportive to learning and success. RESULTS Of 43 participants, 31 completed training. Their median age was 75; 48% were non-white; 45% had no more than a high school education; and 63% reported yearly income below U.S. $20,000. Three months after completing the program, more than 50% of trainees reported that they needed little or no help performing all four key tasks, and confidence with video visits, online searches, and patient portals showed significant improvement. Additionally, in interviews participants reported improved health, social benefits, and explained that learning was facilitated by self-pacing, repetition, and longitudinal support from volunteer trainers. CONCLUSIONS Older adults with various barriers to learning technology showed online independence and increased confidence with some telehealth tasks after a novel training intervention. Key characteristics of the model included a tablet device, one-on-one longitudinal support from volunteers, comprehensive learning materials, and community-academic partnership.
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Affiliation(s)
- Alicia V Neumann
- School of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | - Andrea Gonzalez
- School of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | - Louise C Walter
- School of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
- San Francisco VA Medical Center, San Francisco, California, USA
| | - Josette Rivera
- School of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
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Mepham J, Nelles-McGee T, Andrews K, Gonzalez A. Exploring the effect of prenatal maternal stress on the microbiomes of mothers and infants: A systematic review. Dev Psychobiol 2023; 65:e22424. [PMID: 37860905 DOI: 10.1002/dev.22424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/28/2023] [Accepted: 08/16/2023] [Indexed: 10/21/2023]
Abstract
Prenatal maternal stress (PNMS)-characterized by exposure to stress, anxiety, depression, or intimate partner violence-has been linked to biological alterations in infants, including disruptions to their intestinal microbiota, which have long-term implications for children's developmental outcomes. Significant research has been done examining the effects of PNMS on the microbiome in animals, but less is known about these effects in human research. The current systematic review aimed to synthesize current findings on the association between PNMS and mother and infant microbiomes. Medline, Embase, PsycInfo, Web of Science, and Eric databases were searched through to February 2022. A total of eight studies (n = 2219 infants, 2202 mothers) were included in the qualitative synthesis. Findings provided promising evidence of the role that PNMS plays in altering the microbial composition, diversity, and gut immunity in mothers and infants. Notably, majority of included studies found that higher PNMS was linked to increases in genera from the phylum Proteobacteria. The factors influencing these effects are explored including nutrition, birth mode, and parenting behaviors. Potential interventions to mitigate the adverse effects of PNMS are discussed, along with recommendations for future studies with longitudinal designs to better understand the appropriate type and timing of interventions needed to promote "healthy" maternal and infant microbial functioning.
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Affiliation(s)
- Jennifer Mepham
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Taylor Nelles-McGee
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontario, Canada
| | - Krysta Andrews
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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Sim A, Jirapramukpitak T, Eagling-Peche S, Lwin KZ, Melendez-Torres GJ, Gonzalez A, Oo NN, Castello Mitjans I, Soan M, Punpuing S, Lee C, Chuenglertsiri P, Moo T, Puffer E. A film-based intervention to reduce child maltreatment among migrant and displaced families from Myanmar: Protocol of a pragmatic cluster randomized controlled trial. PLoS One 2023; 18:e0293623. [PMID: 37903143 PMCID: PMC10615270 DOI: 10.1371/journal.pone.0293623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/11/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Child maltreatment is a global public health crisis with negative consequences for physical and mental health. Children in low- and middle-income countries (LMIC)-particularly those affected by poverty, armed conflict, and forced migration-may be at increased risk of maltreatment due to heightened parental distress and disruptions to social support networks. Parenting interventions have been shown to reduce the risk of child maltreatment as well as improve a range of caregiver and child outcomes, yet large-scale implementation remains limited in low-resource displacement settings. This study will examine the impact of an entertainment-education narrative film intervention on reducing physical and emotional abuse and increasing positive parenting among migrant and displaced families from Myanmar living in Thailand. METHOD The study is a pragmatic, superiority cluster randomized controlled trial with approximately 40 communities randomized to the intervention or treatment as usual arms in a 1:1 ratio. Participating families in the intervention arm will be invited to attend a community screening of the film intervention and a post-screening discussion, as well as receive a poster depicting key messages from the film. Primary outcomes are changes in physical abuse, emotional abuse, and positive parenting behaviour. Secondary outcomes include caregiver knowledge of positive parenting, caregiver attitudes towards harsh punishment, caregiver psychological distress, and family functioning. Outcomes will be assessed at 3 time points: baseline, 4 weeks post-intervention, and 4-month follow up. A mixed methods process evaluation will be embedded within the trial to assess intervention delivery, acceptability, perceived impacts, and potential mechanisms of change. DISCUSSION To our knowledge, this study will be the first randomized controlled trial evaluation of a film-based intervention to reduce child maltreatment among migrant and displaced families in a LMIC. An integrated knowledge translation approach will inform uptake of study findings and application to potential scale up pending evaluation results. TRIAL REGISTRATION The study was prospectively registered with the Thai Clinical Trials Registry on 22 February 2023 (TCTR20230222005).
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Affiliation(s)
- Amanda Sim
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Khaing Zar Lwin
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
| | | | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Mary Soan
- Sermpanya Foundation, Mae Sot, Tak, Thailand
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
| | - Catherine Lee
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Th’Blay Moo
- Inclusive Education Foundation, Mae Sot, Tak, Thailand
| | - Eve Puffer
- Department of Psychology & Neuroscience, Duke Global Health Institute, Duke University, Durham, NC, United States of America
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12
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Millien V, Leo SST, Turney S, Gonzalez A. It's about time: small mammal communities and Lyme disease emergence. Sci Rep 2023; 13:14513. [PMID: 37667029 PMCID: PMC10477272 DOI: 10.1038/s41598-023-41901-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
Theory predicts that biodiversity changes due to climate warming can mediate the rate of disease emergence. The mechanisms linking biodiversity-disease relationships have been described both theoretically and empirically but remain poorly understood. We investigated the relations between host diversity and abundance and Lyme disease risk in southern Quebec, a region where Lyme disease is rapidly emerging. We found that both the abundance of small mammal hosts and the relative abundance of the tick's natural host, the white-footed mouse (Peromyscus leucopus), influenced measures of disease risk in tick vectors (Borrelia burgdorferi infection abundance and prevalence in tick vectors). Our results suggest that the increase in Lyme disease risk is modulated by regional processes involving the abundance and composition of small mammal assemblages. However, the nature and strength of these relationships was dependent both on time and geographic area. The strong effect of P. leucopus abundance on disease risk we report here is of significant concern, as this competent host is predicted to increase in abundance and occurrence in the region, with the northern shift in the range of North American species under climate warming.
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Affiliation(s)
- V Millien
- Redpath Museum, McGill University, Montréal, QC, H3A 0C4, Canada.
- Department of Biology, McGill University, Montréal, QC, H3A 1B1, Canada.
| | - S S T Leo
- Redpath Museum, McGill University, Montréal, QC, H3A 0C4, Canada
- Department of Biology, McGill University, Montréal, QC, H3A 1B1, Canada
| | - S Turney
- Redpath Museum, McGill University, Montréal, QC, H3A 0C4, Canada
- Department of Biology, McGill University, Montréal, QC, H3A 1B1, Canada
| | - A Gonzalez
- Department of Biology, McGill University, Montréal, QC, H3A 1B1, Canada
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Joshi D, Aschner A, Atkinson L, Halili-Sychangco D, Duku E, Puffer ES, Rieder A, Tonmyr L, Gonzalez A. Predictors of harsh parenting practices and inter-partner conflict during the COVID-19 pandemic in Ontario, Canada: a cross-sectional analysis from the Ontario Parent Survey. BMJ Open 2023; 13:e066840. [PMID: 37640470 PMCID: PMC10462979 DOI: 10.1136/bmjopen-2022-066840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Guided by the bioecological model, the purpose of this study was to examine the associations of (1) individual level factors (sociodemographic, health behaviour and mental health), (2) family (micro) level COVID-19 experiences (difficulty with household management, managing child mood and behaviour, and pandemic-related positive experiences) and (3) community (macro) level factors (residential instability, ethnic concentration, material deprivation and dependency, an indicator of age and labour force) with harsh parenting practices and inter-partner conflict during the early lockdown of the COVID-19 pandemic in Ontario, Canada. DESIGN A cross-sectional analysis of data from the Ontario Parent Survey. SETTING A convenience sample of 7451 caregivers living in Ontario, Canada, at the time of baseline data collection (May-June 2020). PARTICIPANTS Caregivers aged 18 years and older with children 17 years or younger. OUTCOME MEASURES Parenting practices over the past 2 months was assessed using a published modification of the Parenting Scale. The frequency of inter-partner conflict over the past month was assessed using the Marital Conflict scale. RESULTS Individual (sociodemographic factors, alcohol use, and higher depressive and anxiety symptoms) and family (difficulties with managing the household and child mood and behaviour) level factors were positively associated with inter-partner conflict and harsh parenting practices. Having fewer positive experiences (eg, performing activities with children), and economic adversity at the family level were positively associated with inter-partner conflict but inversely associated with harsh parenting. At the community level, residential instability was negatively associated with harsh parenting practices. CONCLUSIONS Individual and family level factors were associated with harsh parenting and inter-partner conflict. The associations of fewer positive experiences and economic hardship with harsh parenting practices may be more complex than initially thought. Efforts that raise awareness and address caregiver mental health concerns are needed as part of the pandemic response to promote positive inter-partner and parent-child interactions.
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Affiliation(s)
- Divya Joshi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Amir Aschner
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | - Eric Duku
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Eve S Puffer
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Amber Rieder
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lil Tonmyr
- Family Violence Surveillance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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14
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Shields M, Tonmyr L, Gonzalez A, Atkinson L, Blair DL, Hovdestad W, MacMillan H. Depression, parenting and the COVID-19 pandemic in Canada: results from three nationally representative cross-sectional surveys. BMJ Open 2023; 13:e063991. [PMID: 37580094 PMCID: PMC10432656 DOI: 10.1136/bmjopen-2022-063991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/03/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVES Depression is associated with problems in functioning in many aspects of life, including parenting. COVID-19 has increased risk factors for depression. We investigated the prevalence of depression among parents during the pandemic and the association with dysfunctional parenting. DESIGN Canadian nationwide cross-sectional study. SETTING AND PARTICIPANTS The 2020 and 2021 Surveys on COVID-19 and Mental Health (SCMH) and the Canadian Community Health Survey (CCHS) (2015‒2019). Responding sample sizes for parents were 3121 for the 2020-SCMH; 1574 for the 2021-SCMH and 6076 for the CCHS. PRIMARY OUTCOME MEASURES All three surveys collected information on symptoms of major depressive disorder (MDD). The SCMH measured harsh parenting. RESULTS Based on data from the 2021-SCMH collected during wave 3 of COVID-19, 14.4% of fathers and 21.2% of mothers screened positive for MDD. These prevalence estimates were similar to those from the 2020-SCMH during wave 2, but at least two times higher than pre-COVID-19 estimates from the CCHS. Multivariate analyses revealed a linear association between MDD and harsh parenting. COVID-19-related stressors were associated with harsh parenting. Among mothers, feeling lonely or isolated because of COVID-19 was a risk factor for harsh parenting; among fathers, being a front-line worker was a risk factor. Meditation was a protective factor for mothers. CONCLUSIONS After years of stability, the prevalence of MDD increased substantially among Canadian parents during the pandemic. Ongoing monitoring is vital to determine if elevated levels of depression persist because chronic depression increases the likelihood of negative child outcomes. Programmes aimed at addressing depression and bolstering parenting skills are needed as families continue to face stressors associated with COVID-19.
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Affiliation(s)
| | - Lil Tonmyr
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Dawn-Li Blair
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Harriet MacMillan
- Departments of Psychiatry & Behavioural Neurosciences, and of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Khoury JE, Atkinson L, Jack S, Bennett T, Raha S, Duku E, Gonzalez A. Protocol for the COVID-19 Wellbeing and Stress Study: a longitudinal study of parent distress, biological stress and child biopsychosocial development during the pandemic and beyond. BMJ Open 2023; 13:e071926. [PMID: 37580092 PMCID: PMC10432660 DOI: 10.1136/bmjopen-2023-071926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/22/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had a unique impact on the mental health and well-being of pregnant individuals and parents of young children. However, the impact of COVID-19-related stress during pregnancy on early child biopsychosocial development, remains unclear. The COVID-19 Wellbeing and Stress Study will: (1) investigate the impact of different forms of prenatal stress experienced during the pandemic (including objective hardship, perceived psychological distress and biological stress) on child stress biology, (2) examine the association between child stress biology and child developmental outcomes, (3) determine whether child stress biology acts as a mechanism linking prenatal stress to adverse child developmental outcomes and (4) assess whether gestational age at the onset of the COVID-19 pandemic or child sex, moderate these associations. METHODS AND ANALYSES The COVID-19 Wellbeing and Stress Study is a prospective longitudinal study, consisting of six time points, spanning from pregnancy to 3 years postpartum. The study began in June 2020, consisting of 304 pregnant people from Ontario, Canada. This multimethod study is composed of questionnaires, biological samples, behavioural observations and developmental assessments ETHICS AND DISSEMINATION: This study was approved by the Hamilton Integrated Research Ethics Board (#11034) and the Mount Saint Vincent University Research Ethics Board (#2020-187, #2021-075, #2022-008). Findings will be disseminated through peer-reviewed presentations and publications, community presentations, and electronic forums (social media, newsletters and website postings).
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Affiliation(s)
- Jennifer E Khoury
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Susan Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Teresa Bennett
- Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Sandeep Raha
- Department of Biochemistry & Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Gonzalez
- Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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Cheney AM, Ortiz G, Trinidad A, Rodriguez S, Moran A, Gonzalez A, Chavez J, Pozar M. Latinx and Indigenous Mexican Caregivers' Perspectives of the Salton Sea Environment on Children's Asthma, Respiratory Health, and Co-Presenting Health Conditions. Int J Environ Res Public Health 2023; 20:6023. [PMID: 37297627 PMCID: PMC10252982 DOI: 10.3390/ijerph20116023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
This research investigated Latinx and Indigenous Mexican caregivers' perspectives of the Salton Sea's environment (e.g., dust concentrations and other toxins) on child health conditions. The Salton Sea is a highly saline drying lakebed located in the Inland Southern California desert borderland region and is surrounded by agricultural fields. Children of Latinx and Indigenous Mexican immigrant families are especially vulnerable to the Salton Sea's environmental impact on chronic health conditions due to their proximity to the Salton Sea and structural vulnerability. From September 2020 to February 2021, we conducted semi-structured interviews and focus groups with a total of 36 Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress living along the Salton Sea. A community investigator trained in qualitative research conducted interviews in Spanish or Purépecha, an indigenous language spoken by immigrants from Michoacán, Mexico. Template and matrix analysis was used to identify themes and patterns across interviews and focus groups. Participants characterized the Salton Sea's environment as toxic, marked by exposure to sulfuric smells, dust storms, chemicals, and fires, all of which contribute to children's chronic health conditions (e.g., respiratory illnesses such as asthma, bronchitis, and pneumonia, co-presenting with allergies and nosebleeds). The findings have important environmental public health significance for structurally vulnerable child populations in the United States and globally.
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Affiliation(s)
- Ann Marie Cheney
- Department of Social Medicine Population and Public Health, School of Medicine, University of California Riverside, Riverside, CA 92521, USA
| | - Gabriela Ortiz
- Department of Anthropology, University of California Riverside, Riverside, CA 92521, USA
| | - Ashley Trinidad
- College of Natural & Agricultural Sciences, University of California Riverside, Riverside, CA 92521, USA
| | - Sophia Rodriguez
- Department of Anthropology, University of California Riverside, Riverside, CA 92521, USA
| | - Ashley Moran
- Department of Social Medicine Population and Public Health, School of Medicine, University of California Riverside, Riverside, CA 92521, USA
| | - Andrea Gonzalez
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Jaír Chavez
- College of Natural & Agricultural Sciences, University of California Riverside, Riverside, CA 92521, USA
| | - María Pozar
- Conchita Servicios de la Comunidad, Mecca, CA 92254, USA
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Valle D, Mujica V, Gonzalez A. Herbivore-Dependent Induced Volatiles in Pear Plants Cause Differential Attractive Response by Lacewing Larvae. J Chem Ecol 2023; 49:262-275. [PMID: 36690765 DOI: 10.1007/s10886-023-01403-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
Biological control may benefit from the behavioral manipulation of natural enemies using volatile organic compounds (VOCs). Among these, herbivore-induced plant volatiles (HIPVs) provide potential tools for attracting or retaining predators and parasitoids of insect pests. This work aimed to characterize the VOCs emitted by pear plants in response to attack by Cacopsylla bidens (Hemiptera: Psyllidae), a major pest in pear orchards, to compare these with VOCs induced by a leaf chewing insect, Argyrotaenia sphaleropa (Lepidoptera: Tortricidae), and to evaluate the behavioral response of Chrysoperla externa (Neuroptera: Chrysopidae) to HIPVs from pear plants damaged by either herbivore. The results demonstrated that plants damaged by the pear psylla emitted VOC blends with increased amounts of aliphatic aldehydes. Leafroller damage resulted in increased amounts of benzeneacetonitrile, (E)-4,8-dimethylnona-1,3,7-triene, β-ocimene and caryophyllene. In olfactometer bioassays, larvae of C. externa were attracted to herbivore-damaged plants when contrasted with undamaged plants. When plant odors from psylla-damaged were contrasted with those of leafroller-damaged plants, C.externa preferred the former, also showing shorter response lag-times and higher response rates when psylla-damaged plants were present. Our results suggest that pear plants respond to herbivory by modifying their volatile profile, and that psylla-induced volatiles may be used as prey-specific chemical cues by chrysopid larvae. Our study is the first to report HIPVs in pear plants attacked by C. bidens, as well as the attraction of C. externa to psyllid-induced volatiles.
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Affiliation(s)
- D Valle
- Protección Vegetal, Instituto Nacional de Investigación Agropecuaria, INIA Las Brujas, Canelones, Uruguay.
| | - V Mujica
- Protección Vegetal, Instituto Nacional de Investigación Agropecuaria, INIA Las Brujas, Canelones, Uruguay
| | - A Gonzalez
- Laboratorio de Ecología Química, Facultad de Química, Universidad de la República, Montevideo, Uruguay
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Candib A, Lee N, Sam N, Cho E, Rojas J, Hastings R, DeAlva K, Khon D, Gonzalez A, Molina B, Torabzadeh G, Vu J, Hasenstab K, Sant K, Phillips JA, Finley K. The Influence of Cannabinoids on Drosophila Behaviors, Longevity, and Traumatic Injury Responses of the Adult Nervous System. Cannabis Cannabinoid Res 2023. [PMID: 37158809 DOI: 10.1089/can.2022.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Introduction: The legalization of cannabis products has increased their usage in the United States. Among the ∼500 active compounds, this is especially true for cannabidiol (CBD)-based products, which are being used to treat a range of ailments. Research is ongoing regarding the safety, therapeutic potential, and molecular mechanism of cannabinoids. Drosophila (fruit flies) are widely used to model a range of factors that impact neural aging, stress responses, and longevity. Materials and Methods: Adult wild-type Drosophila melanogaster cohorts (w1118/+) were treated with different Δ9-tetrahydrocannabinol (THC) and CBD dosages and examined for neural protective properties using established neural aging and trauma models. The therapeutic potential of each compound was assessed using circadian and locomotor behavioral assays and longevity profiles. Changes to NF-κB pathway activation were assessed by measuring expression levels of downstream targets using quantitative real-time polymerase chain reaction analysis of neural cDNAs. Results: Flies exposed to different CBD or THC dosages showed minimal effects to sleep and circadian-based behaviors or the age-dependent decline in locomotion. The 2-week CBD (3 μM) treatment did significantly enhance longevity. Flies exposed to different CBD and THC dosages were also examined under stress conditions, using the Drosophila mild traumatic brain injury (mTBI) model (10×). Pretreatment with either compound did not alter baseline expression of key inflammatory markers (NF-κB targets), but did reduce neural mRNA profiles at a key 4-h time point following mTBI exposure. Locomotor responses were also significantly improved 1 and 2 weeks following mTBI. After mTBI (10×) exposure, the 48-h mortality rate improved for CBD (3 μM)-treated flies, as were global average longevity profiles for other CBD doses tested. While not significant, THC (0.1 μM)-treated flies show a net positive impact on acute mortality and longevity profiles following mTBI (10×) exposure. Conclusions: This study shows that the CBD and THC dosages examined had at most a modest impact on basal neural function, while demonstrating that CBD treatments had significant neural protective properties for flies following exposure to traumatic injury.
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Affiliation(s)
- Alec Candib
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Nicholas Lee
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Natasha Sam
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Eddie Cho
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Jesse Rojas
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Reina Hastings
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Kyle DeAlva
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Diana Khon
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Andrea Gonzalez
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Brandon Molina
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Gina Torabzadeh
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Josephine Vu
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Kyle Hasenstab
- Department of Mathematics and Statistics, San Diego State University, San Diego, California, USA
| | - Karylin Sant
- Division of Environmental Health, San Diego State University, San Diego, California, USA
| | - Joy A Phillips
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Kim Finley
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
- Division of Environmental Health, San Diego State University, San Diego, California, USA
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De Rubeis V, Gonzalez A, Tarride JÉ, Griffith LE, Anderson LN. A longitudinal study evaluating adverse childhood experiences and obesity in adulthood using the Canadian Longitudinal Study on Aging (CLSA). Int J Epidemiol 2023:7157038. [PMID: 37155914 PMCID: PMC10396425 DOI: 10.1093/ije/dyad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 04/20/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are a risk factor for obesity; however, the causal mechanisms are not well understood. Objectives were to measure the impact of ACEs on adulthood obesity and to investigate whether the association was mediated by nutrition and stress. METHODS A longitudinal study was conducted using adults aged 46-90 years (n = 26 615) from the Canadian Longitudinal Study on Aging. Participants were asked to recall ACEs from <18 years of age. Body mass index (BMI), waist circumference and per cent body fat were measured (2015-18) and obesity was defined using standard cut points. Nutrition was measured using data from the Short Diet Questionnaire and stress was measured using allostatic load. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% CIs for each obesity measure. Causal mediation methods were used to determine whether nutrition and stress were mediators. RESULTS There were 66% of adults who had experienced one or more ACE. The odds of obesity defined by BMI and waist circumference increased in a dose-response manner with increasing number of ACEs (P trend <0.001). For instance, adults with four to eight ACEs, compared with none, had greater odds of obesity, defined by BMI (adjusted OR: 1.54; 95% CI: 1.28-1.75) and waist circumference (adjusted OR: 1.30; 95% CI: 1.15-1.47). There was no evidence of mediation by stress or nutrition. CONCLUSIONS Adversity experienced in early life is strongly associated with obesity among Canadian adults. Further research is needed to identify other mechanisms for this association to inform obesity prevention strategies.
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Affiliation(s)
- Vanessa De Rubeis
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Jean-Éric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Harris M, MacMillan H, Mepham J, Joshi D, Wekerle C, Atkinson L, Gonzalez A. Maternal Childhood Maltreatment History and Child Behavior Problems: Developmental Patterns and Mediation via Maternal Depressive Symptoms and Parenting Behavior. Child Maltreat 2023; 28:254-264. [PMID: 35081793 PMCID: PMC10021123 DOI: 10.1177/10775595221074364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Maternal exposure to childhood maltreatment (CM) is associated with offspring behavioral problems; however, little work has examined these associations longitudinally across child development. This study examined the effects of maternal history of CM on trajectories of child internalizing and externalizing behavior measured from toddlerhood to preschool, and the role of maternal depressive symptoms and parenting behavior as potential mediators. Participants included 115 mother-child dyads recruited from a hospital maternity ward. Maternal CM was measured at 3-months postpartum. At 18, 36, and 60 months, maternal depressive symptoms and child behavior were assessed via maternal report and parenting behavior was assessed through direct observation. Findings indicated that children of mothers exposed to CM demonstrated poorer trajectories of problem behavior across early childhood. Maternal depressive symptoms mediated the relation between CM and children's internalizing problems. Findings highlight the importance of screening for maternal depressive symptoms and early intervention for maternal and child mental health.
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Affiliation(s)
- Madeleine Harris
- Neuroscience Graduate Program,
McMaster
University, Hamilton, ON, Canada
- Offord Centre for Child
Studies, Hamilton, ON, Canada
| | - Harriet MacMillan
- Offord Centre for Child
Studies, Hamilton, ON, Canada
- Department of Psychiatry and
Behavioural Neurosciences, McMaster
University, Hamilton, ON, Canada
- Department of Pediatrics,
McMaster
University, Hamilton, ON, Canada
| | - Jennifer Mepham
- Neuroscience Graduate Program,
McMaster
University, Hamilton, ON, Canada
- Offord Centre for Child
Studies, Hamilton, ON, Canada
| | - Divya Joshi
- Department of Clinical Epidemiology
and Biostatistics, McMaster University, Hamilton, ON,
Canada
| | - Christine Wekerle
- Offord Centre for Child
Studies, Hamilton, ON, Canada
- Department of Pediatrics,
McMaster
University, Hamilton, ON, Canada
| | - Leslie Atkinson
- Department of Psychology,
Ryerson
University, Toronto, ON, Canada
| | - Andrea Gonzalez
- Offord Centre for Child
Studies, Hamilton, ON, Canada
- Department of Psychiatry and
Behavioural Neurosciences, McMaster
University, Hamilton, ON, Canada
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21
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Andrews K, Khoury JE, Tiwari A, Kirupaharan S, Gonzalez A. Maternal History of Child Maltreatment and Household Chaos: Examining the Mediating Role of Maternal and Child Psychopathology. Child Maltreat 2023; 28:221-231. [PMID: 35266834 DOI: 10.1177/10775595221081795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Caregiver history of childhood maltreatment can have pervasive effects on familial and household dynamics. Maternal history of child maltreatment (MCM) is linked to maternal depressive symptoms and offspring behavioural problems. Further, maternal and child mental health are associated with chaotic home environments. In this study, we examined the potential mediating roles of maternal depressive symptoms and child behavioural problems in the association between MCM and household chaos. A sample of 133 mother-child dyads participated in home visits during which mothers completed questionnaires measuring their history of child maltreatment, depressive symptoms, household chaos and child behaviour problems. Mothers also conducted videotaped home tours related to household chaos. Structural equation modelling results indicated that MCM was indirectly associated with higher household chaos via elevated maternal depressive symptoms and child externalizing, but not internalizing behaviour problems. Interventions aimed at mitigating the effects of MCM on maternal and child psychopathology may positively influence household dynamics.
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Affiliation(s)
- Krysta Andrews
- Department of Psychiatry and Behavioural Neurosciences, 62703McMaster University, Hamilton, ON, Canada
| | - Jennifer E Khoury
- Department of Psychiatry and Behavioural Neurosciences, 62703McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, 62703McMaster University, Hamilton, ON, Canada
| | - Ashwini Tiwari
- Institute of Public and Preventive Health, 1421Augusta University, Augusta, GA, USA
| | | | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, 62703McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, 62703McMaster University, Hamilton, ON, Canada
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22
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Orr E, Ballantyne M, Gonzalez A, Jack SM. Providers' perspectives of the neonatal intensive care unit context and care provision for adolescent parents: an interpretive description. BMC Pregnancy Childbirth 2023; 23:259. [PMID: 37069591 PMCID: PMC10107570 DOI: 10.1186/s12884-023-05553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The neonatal intensive care unit (NICU) is a complex care environment, with the NICU patient population among the most vulnerable in a hospital setting. Adolescent parents are a unique group within the broader NICU parent population and admission of their infant to the NICU contributes to an already complex situation as adolescent pregnancy and parenting is often associated with a range of psychosocial challenges. How the NICU care context influences care provision for adolescent parents is a significant gap in the NICU parenting and support discourse. Therefore, this study aimed to explore health and social care providers' perspectives of the NICU care context and how providers perceive the context as influencing the experiences of adolescent parents in the NICU. METHODS This was a qualitative, interpretive description study design. In-depth interviews were conducted with providers, including nurses and social workers, caring for adolescent parents in the NICU. Data was collected between December 2019 and November 2020. Data were analyzed concurrently with data collection. Constant comparison, analytic memos, and iterative diagramming techniques were used to challenge developing analytic patterns. RESULTS Providers (n = 23) described how the unit context influenced care provision as well as experiences for adolescent parents. We learned that having a baby in the NICU was perceived by providers as a traumatic experience for parents - impacting attachment, parenting confidence and competence, and mental health. Environmental factors - such as privacy and time - and perceptions that adolescent parents are treated differently in the NICU were also seen as influencing this overall experience. CONCLUSIONS Providers involved in the care of adolescent parents in the neonatal intensive care unit described the distinctiveness of this group within the broader parent population and how quality of care may be impacted by contextual factors as well as experiences of age-related stigma. Further understanding of NICU experiences from the parents' perspectives are warranted. Findings highlight opportunities for strengthened interprofessional collaboration and trauma- and violence-informed care strategies within the neonatal intensive care environment to mitigate the potential negative influence of this experience and improve care for adolescent parents.
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Affiliation(s)
- Elizabeth Orr
- Department of Nursing, Brock University, Faculty of Applied Health Sciences, 1812 Sir Isaac Brock Way, St. Catharines, Ontario, L2S 3A1, Canada.
| | - Marilyn Ballantyne
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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23
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Khoury JE, Jambon M, Giles L, Atkinson L, Gonzalez A. Trajectories of distress from pregnancy to 15-months post-partum during the COVID-19 pandemic. Front Psychol 2023; 14:1104386. [PMID: 37063573 PMCID: PMC10102331 DOI: 10.3389/fpsyg.2023.1104386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/15/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundThe COVID-19 pandemic has particularly burdened pregnant and postpartum women. It remains unclear how distress levels of pregnant and postpartum people have changed (or persisted) as the pandemic continues on and which factors may contribute to these trajectories of distress.MethodsThis longitudinal study included 304 pregnant people, who were followed during pregnancy, 6-weeks, 6-months and 15-months postpartum. At each time point, a latent “distress” factor was estimated using self-reported depressive symptoms, anxiety symptoms, and stress. Reported negative impact of COVID-19 and social support were assessed during pregnancy as risk and protective factors related to distress. Second-order latent growth curve modeling with a piecewise growth function was used to estimate initial levels and changes in distress over time.ResultsMean distress was relatively stable from the pregnancy to 6-weeks postpartum and then declined from 6-weeks to 15-months postpartum. Higher education, greater social support, and lower negative impact of COVID-19 were associated with a lower distress during pregnancy. Unexpectedly, negative impact of COVID-19 was associated with a faster decrease in distress and more social support was associated with a greater increase in distress from pregnancy to 6-weeks postpartum. However, these effects became non-significant after controlling for distress during pregnancy.ConclusionFindings indicate high but declining levels of distress from pregnancy to the postpartum period. Changes in distress are related to social support and the negative impact of the pandemic in pregnancy. Findings highlight the continued impact of COVID-19 on perinatal mental health and the need for support to limit the burden of this pandemic on pregnant people and families.
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Affiliation(s)
- Jennifer E. Khoury
- Department of Psychology, Mount Saint Vincent University, Halifax, NS, Canada
- *Correspondence: Jennifer E. Khoury,
| | - Marc Jambon
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Lauren Giles
- Department of Psychology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Leslie Atkinson
- Department of Psychology, Metropolitan Toronto University, Toronto ON, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
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24
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Meler E, Mazarico E, Peguero A, Gonzalez A, Martinez J, Boada D, Vellve K, Arca G, Gómez-Roig MD, Gratacos E, Figueras F. Prognosis of periviable early-fetal growth restriction: Gaining accuracy. BJOG 2023; 130:688-689. [PMID: 36896613 DOI: 10.1111/1471-0528.17422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/22/2022] [Indexed: 03/11/2023]
Affiliation(s)
- E Meler
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centre for Biomedical Research on Rare Diseases (CIBER-ER), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - E Mazarico
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut de Recerca Sant Joan de Déu (IR-SJD), Barcelona, Spain.,Maternal and Child Health Development Network, RETICS (Redes Temáticas de Investigación Cooperativa en Salud), Research Institute Carlos III, Spanish Ministry of Economy and Competitiveness, Madrid, Spain
| | - A Peguero
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centre for Biomedical Research on Rare Diseases (CIBER-ER), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - A Gonzalez
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut de Recerca Sant Joan de Déu (IR-SJD), Barcelona, Spain.,Maternal and Child Health Development Network, RETICS (Redes Temáticas de Investigación Cooperativa en Salud), Research Institute Carlos III, Spanish Ministry of Economy and Competitiveness, Madrid, Spain
| | - J Martinez
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centre for Biomedical Research on Rare Diseases (CIBER-ER), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - D Boada
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centre for Biomedical Research on Rare Diseases (CIBER-ER), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - K Vellve
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centre for Biomedical Research on Rare Diseases (CIBER-ER), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - G Arca
- Department of Neonatology, Hospital Clinic, IDIBAPS, Barcelona, Spain.,Neonatal Group, NeNE Foundation, Barcelona, Spain
| | - M D Gómez-Roig
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut de Recerca Sant Joan de Déu (IR-SJD), Barcelona, Spain.,Maternal and Child Health Development Network, RETICS (Redes Temáticas de Investigación Cooperativa en Salud), Research Institute Carlos III, Spanish Ministry of Economy and Competitiveness, Madrid, Spain
| | - E Gratacos
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centre for Biomedical Research on Rare Diseases (CIBER-ER), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - F Figueras
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Centre for Biomedical Research on Rare Diseases (CIBER-ER), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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25
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Atkinson L, Joshi D, Raina P, Griffith LE, MacMillan H, Gonzalez A. Social engagement and allostatic load mediate between adverse childhood experiences and multimorbidity in mid to late adulthood: the Canadian Longitudinal Study on Aging. Psychol Med 2023; 53:1437-1447. [PMID: 37010223 PMCID: PMC10009404 DOI: 10.1017/s0033291721003019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/10/2021] [Accepted: 07/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with multimorbidity in adulthood. This link may be mediated by psychosocial and biological factors, but evidence is lacking. The current study evaluates this mediation model. METHOD We analyzed data from the Canadian Longitudinal Study of Aging (N = 27 170 community participants). Participants were 45-85 years at recruitment, when allostatic load and social engagement data were collected, and 3 years older at follow-up, when ACEs and multimorbidity data were collected. Structural equation modeling was used to test for mediation in the overall sample, and in sex- and age-stratified subsamples, all analyses adjusted for concurrent lifestyle confounds. RESULTS In the overall sample, ACEs were associated with multimorbidity, directly, β = 0.12 (95% confidence interval 0.11-0.13) and indirectly. Regarding indirect associations, ACEs were related to social engagement, β = -0.14 (-0.16 to -0.12) and social engagement was related to multimorbidity, β = -0.10 (-0.12 to -0.08). ACEs were related to allostatic load, β = 0.04 (0.03-0.05) and allostatic load was related to multimorbidity, β = 0.16 (0.15-0.17). The model was significant for males and females and across age cohorts, with qualifications in the oldest stratum (age 75-85). CONCLUSIONS ACEs are related to multimorbidity, directly and via social engagement and allostatic load. This is the first study to show mediated pathways between early adversity and multimorbidity in adulthood. It provides a platform for understanding multimorbidity as a lifespan dynamic informing the co-occurrence of the varied disease processes represented in multimorbidity.
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Affiliation(s)
- Leslie Atkinson
- Department of Psychology, Ryerson University, Toronto, Canada
| | - Divya Joshi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Harriet MacMillan
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada
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26
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De Rubeis V, Gonzalez A, de Groh M, Jiang Y, Erbas Oz U, Tarride JE, Basta NE, Kirkland S, Wolfson C, Griffith LE, Raina P, Anderson LN. Obesity and adverse childhood experiences in relation to stress during the COVID-19 pandemic: an analysis of the Canadian Longitudinal Study on Aging. Int J Obes (Lond) 2023; 47:197-206. [PMID: 36690842 PMCID: PMC9868513 DOI: 10.1038/s41366-023-01258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND People with obesity are at increased risk of chronic stress, and this may have been exacerbated during the COVID-19 pandemic. Adverse childhood experiences (ACE) are also associated with both obesity and stress, and may modify risk of stress among people with obesity. The objectives of this study were to evaluate the associations between obesity, ACEs, and stress during the pandemic, and to determine if the association between obesity and stress was modified by ACEs. METHODS A longitudinal study was conducted among adults aged 50-96 years (n = 23,972) from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Study. Obesity and ACEs were collected pre-pandemic (2015-2018), and stress was measured at COVID-19 Exit Survey (Sept-Dec 2020). We used logistic, Poisson, and negative binomial regression to estimate relative risks (RRs) and 95% confidence intervals (CIs) for the associations between obesity, ACEs, and stress outcomes during the pandemic. Interaction by ACEs was evaluated on the additive and multiplicative scales. RESULTS People with obesity were more likely to experience an increase in overall stressors (class III obesity vs. healthy weight RR = 1.19; 95% CI: 1.12-1.27) as well as increased health related stressors (class III obesity vs. healthy weight RR: 1.25; 95% CI: 1.12-1.39) but did not perceive the consequences of the pandemic as negative. ACEs were also associated an increase in overall stressors (4-8 ACEs vs. none RR = 1.38; 95% CI: 1.33-1.44) and being more likely to perceive the pandemic as negative (4-8 ACEs vs. none RR = 1.32; 95% CI: 1.19-1.47). The association between obesity and stress was not modified by ACEs. CONCLUSIONS Increased stress during the first year of the COVID-19 pandemic was observed among people with obesity or ACEs. The long-term outcomes of stress during the pandemic need to be determined.
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Affiliation(s)
- Vanessa De Rubeis
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Margaret de Groh
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, K0A 0K9, Canada
| | - Ying Jiang
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, K0A 0K9, Canada
| | - Urun Erbas Oz
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
- McMaster University, Chair in Health Technology Management, Hamilton, ON, L8S 4L8, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, L8S 4L8, Canada
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON, L8N 4A6, Canada
| | - Nicole E Basta
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, H3A 1A2, Canada
| | - Susan Kirkland
- Department of Community Health & Epidemiology and Division of Geriatric Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Christina Wolfson
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, H3A 1A2, Canada
- Department of Medicine, Faculty of Health Sciences, McGill University, Montreal, QC, H3A 1A2, Canada
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, H3A 1A2, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada.
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27
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England-Mason G, Andrews K, Atkinson L, Gonzalez A. Emotion socialization parenting interventions targeting emotional competence in young children: A systematic review and meta-analysis of randomized controlled trials. Clin Psychol Rev 2023; 100:102252. [PMID: 36706555 DOI: 10.1016/j.cpr.2023.102252] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although emotion socialization parenting interventions are supported by a growing body of literature, their effects have yet to be systematically examined. The present systematic review and meta-analysis assesses the evidence for emotion socialization parenting interventions for parents of young children. METHODS Six electronic databases were systematically searched from inception to October 5th, 2022. We conducted random effects meta-analyses of randomized controlled trials of emotion socialization interventions delivered to parents of children aged 18 months to 6 years 11 months. RESULTS Twenty-six studies which reported data from 15 individual trials met the inclusion criteria. Interventions had a positive effect on positive and negative emotion socialization parenting practices (g's = 0.50) and child emotional competence (g = 0.44). Interventions also had a positive effect on positive (g = 0.74) and negative parenting behaviors (g = 0.25), parent psychological well-being (g = 0.28), and child behavioral adjustment (g = 0.34). Findings remained significant after considering potential publication bias and conducting sensitivity analyses. Two significant moderating factors emerged. CONCLUSIONS Emotion socialization parenting interventions are effective for improving emotion socialization parenting practices and child emotional competence. Additional methodologically rigorous trials are needed to buttress the current evidence and provide evidence for additional moderating factors.
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Affiliation(s)
- Gillian England-Mason
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
| | - Krysta Andrews
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada; Offord Centre for Child Studies, McMaster Innovation Park, Hamilton, Canada
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28
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Prime H, Andrews K, Markwell A, Gonzalez A, Janus M, Tricco AC, Bennett T, Atkinson L. Positive Parenting and Early Childhood Cognition: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Child Fam Psychol Rev 2023; 26:362-400. [PMID: 36729307 PMCID: PMC10123053 DOI: 10.1007/s10567-022-00423-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 02/03/2023]
Abstract
This review examines the effectiveness of positive parenting interventions aimed at improving sensitivity, responsiveness, and/or non-harsh discipline on children's early cognitive skills, in four meta-analyses addressing general mental abilities, language, executive functioning, and pre-academics. The objectives are to assess the magnitude of intervention effectiveness and identify moderators of effectiveness. We include randomized controlled trials of interventions targeting positive parenting to improve cognition in children < 6 years. Studies that include children with neurodevelopmental and/or hearing disorders were excluded. MEDLINE, PsycINFO, ERIC, and ProQuest Dissertations & Theses (October 2021) and citation chaining identified relevant records. Five reviewers completed screening/assessments, extraction, and risk of bias. Pooled analysis in Comprehensive Meta-Analysis (Version 3) used random effects modeling, with moderation via Q-statistics and meta-regression. Positive parenting interventions led to significant improvements in mental abilities (g = 0.46, N = 5746; k = 33) and language (g = 0.25, N = 6428; k = 30). Effect sizes were smaller and nonsignificant for executive functioning (g = 0.07, N = 3628; k = 14) and pre-academics (g = 0.16, N = 2365; k = 7). Robust moderators emerged for language and cognition. For cognition, studies with higher risk of bias scores yielded larger intervention effects. For language, studies with younger children had larger effect sizes. Studies mitigated selection and detection bias, though greater transparency of reporting is needed. Interventions that promote parental sensitivity, responsiveness, and non-harsh discipline improve early mental abilities and language. Studies examining executive functioning and pre-academics are needed to examine moderators of intervention effectiveness. Trial registration Systematic review PROSPERO registration. CRD42020222143.
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Affiliation(s)
- Heather Prime
- Department of Psychology, York University, Toronto, Canada. .,LaMarsh Centre for Child & Youth Research, York University, Toronto, Canada.
| | - Krysta Andrews
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Alexandra Markwell
- Department of Psychology, York University, Toronto, Canada.,LaMarsh Centre for Child & Youth Research, York University, Toronto, Canada
| | - Andrea Gonzalez
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Unity Health Toronto, Toronto, Canada.,Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
| | - Teresa Bennett
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
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29
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Hochster HS, Liu H, Berim LD, Spencer KR, Gulhati P, DiRubbo M, Cohen SD, Lee P, Leitner SP, Radovich D, Misdary C, Perez C, Datta S, Gonzalez A, Saunders T, Boland PM. Phase II study of TAS-OX (TAS-102 and oxaliplatin) plus bevacizumab for late-line colorectal cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
144 Background: TAS-102 (trifluridine/tipiracil) is a novel oral antimetabolite for late line metastatic colorectal cancer (CRC) approved in 2018. Many patients are treated early in their course with oxaliplatin (OX), particularly adjuvant, and may benefit from re-treatment. In this trial we combine the typical late line use of TAS with OX (BEV [bevacizumab] added at investigator discretion) with goal of improved response. Methods: Eligibility included measurable CRC previously treated with all approved drugs per TAS package insert (irinotecan, oxaliplatin, 5FU, anti-VEGF, anti-EGF) as appropriate, PS = 0-1, labs within usual range, neuropathy < grade 2, ability to take oral meds, appropriate contraception. If no contraindication to BEV, this could be added at patient. TAS was dosed at 35 mg/m2 days 1-5 with OX 85/m2 d1 every 14 days (and BEV 5 mg/kg, if given). All supportive care was allowed including growth factors. Results: 47 patients (pts, median age 55) were enrolled in a Simon mini-max design, including 45% female, 21% black, 11% Asian, 11% Hispanic and 5% mixed. 26 pts received BEV. For the first 40 pts, 385 cycles were given (mean = 7 cycles, median 8) with 18 pts (45%) requiring dose reductions (1 dose reduction = 9 pts, 2 = 6, 3 = 3), and 9 receiving (peg)/filgrastim. Toxicities leading to SAEs included gr 3 heme (2), heart failure, abd pain/n/v (6), sepsis (2), urinary (4); and related gr 3 included one gr 3 vomiting and one gr 3 neutropenia. Independently reviewed RECIST Response (N = 32) included PR 2(6%), SD 23 (72%), PD 7 (22%). Mean TTP was 4.5 m (median 4, range 1 – 18) with 9 (28%) pts more than 6 months. Conclusions: In patients with late-line CRC and candidates for TAS (trifluridine/tipiracil), treatment with TAS plus OX is both well tolerated and active. RR is higher than single agent and 78% (95% CI, 60-91%) of patients had stable disease or response, with 60% receiving 8 or more cycles. Randomized trials comparing to single agent TAS are warranted in this setting. Clinical trial information: NCT04294264 .
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Affiliation(s)
| | - Hao Liu
- Biostatistics Shared Resource, Rutgers Cancer Institute of New Jersey, and Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, NJ
| | | | | | - Pat Gulhati
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Manda DiRubbo
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | | | | | | | | | - Sutirtha Datta
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Green S, Schmidt A, Gonzalez A, Bhamidipalli SS, Rouse C, Shanks A. Clinical significance of intermittent absent end-diastolic flow of the umbilical artery in fetal growth restriction. Am J Obstet Gynecol MFM 2023; 5:100800. [PMID: 36371037 DOI: 10.1016/j.ajogmf.2022.100800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fetal growth restriction can result from a variety of maternal, fetal, and placental conditions. Umbilical artery Doppler assesses the impedance to blood flow along the fetal component of the placental unit. An abnormal umbilical artery waveform reflects the presence of placental insufficiency and can help differentiate a growth-restricted fetus from the constitutionally small, thus guiding further management. The presence of persistently absent end-diastolic flow and reversed end-diastolic flow is an indication for inpatient antenatal surveillance and preterm delivery. There is no consensus on the optimal management of intermittent absent end-diastolic flow owing to a lack of data to support the ideal delivery timing for growth-restricted fetuses with this finding. OBJECTIVE This study aimed to estimate the risks of adverse perinatal outcomes among growth-restricted pregnancies with persistently elevated, intermittently absent, and persistently absent end-diastolic flow. Fetal growth restriction is a common condition that is associated with an increased risk of fetal morbidity and mortality. Intermittently absent umbilical artery end-diastolic flow may be identified among pregnancies with fetal growth restriction. The fetal risks associated with persistently absent end-diastolic flow have been described. However, the risks associated with intermittent absent end-diastolic flow are not as well-known. STUDY DESIGN We performed a retrospective cohort study including nonanomalous, singleton, growth-restricted pregnancies that received umbilical artery Doppler assessment at our institution from 2009 to 2020. Fetuses were classified into the following 3 categories: elevated umbilical artery Doppler, intermittent absent end-diastolic flow, and persistently absent end-diastolic flow. The Doppler categories were classified by the most severe in the pregnancy. The primary outcome was a composite of neonatal morbidity. RESULTS Total 233 fetuses met the criteria. Of which 78 (33.0%) had elevated umbilical artery Doppler waveforms, 37 (16.0%) had intermittent absent end-diastolic flow, and 119 (51.0%) had absent end-diastolic flow. The composite outcome was statistically different between the groups, occurring in 16.9% with elevated umbilical artery Doppler waveforms (13/77), 35.1% (12/39) with intermittent absent end-diastolic flow, and 56.3% (65/127) with absent end-diastolic flow (P<.001). The odds ratio for the composite outcome was significantly increased in absent end-diastolic flow (odds ratio, 6.15; 95% confidence interval, 3.14-12.80) and was not significantly increased for intermittently absent end-diastolic flow (odds ratio, 2.46; 95% confidence interval, 0.98-6.19) when compared with elevated umbilical artery Doppler waveforms. When adjusted for gestational age at delivery and antenatal steroids, no difference was seen in the primary outcome for intermittent absent end-diastolic flow (adjusted odds ratio, 0.73; 95% confidence interval, 0.20-2.68) and absent end-diastolic flow (adjusted odds ratio, 1.44; 95% confidence interval, 0.51-4.07). CONCLUSION Among growth-restricted pregnancies, intermittent absent end-diastolic flow is associated with a similar rate of composite neonatal morbidity as persistently elevated Doppler waveforms. In addition, there is no difference in composite neonatal morbidity between the 3 groups when corrected for gestational age at delivery and antenatal steroid administration. These similar outcomes should be considered when creating an antenatal surveillance plan and discussing the potential for outpatient management.
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Affiliation(s)
- Sophie Green
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN (Dr Green).
| | - Alison Schmidt
- Indiana University School of Medicine, Indianapolis, IN (Drs Schmidt and Gonzalez)
| | - Andrea Gonzalez
- Indiana University School of Medicine, Indianapolis, IN (Drs Schmidt and Gonzalez)
| | - Surya Sruthi Bhamidipalli
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN (Ms Bhamidipalli)
| | - Caroline Rouse
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN (Drs Rouse and Shanks)
| | - Anthony Shanks
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN (Drs Rouse and Shanks)
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Joshi D, Gonzalez A, Lin D, Raina P. The association between adverse childhood experiences and epigenetic age acceleration in the Canadian longitudinal study on aging (CLSA). Aging Cell 2023; 22:e13779. [PMID: 36650913 PMCID: PMC9924940 DOI: 10.1111/acel.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/07/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
Research examining the association between exposure to a wide range of adverse childhood experiences (ACEs) and accelerated biological aging in older adults is limited. The purpose of this study was to examine the association of ACEs, both as a cumulative score and individual forms of adversity, with epigenetic age acceleration assessed using the DNA methylation (DNAm) GrimAge and DNAm PhenoAge epigenetic clocks in middle and older-aged adults. This cross-sectional study analyzed baseline and first follow-up data on 1445 participants aged 45-85 years from the Canadian Longitudinal Study on Aging (CLSA) who provided blood samples for DNAm analysis. ACEs were assessed using a validated self-reported questionnaire. Epigenetic age acceleration was estimated by regressing each epigenetic clock estimate on chronological age. Cumulative ACEs score was associated with higher DNAm GrimAge acceleration (β: 0.07; 95% CI: 0.02, 0.11) after adjusting for covariates. Childhood exposure to parental separation or divorce (β: 0.06; 95% CI: 0.00, 0.11) and emotional abuse (β: 0.06; 95% CI: 0.00, 0.12) were associated with higher DNAm GrimAge acceleration after adjusting for other adversities and covariates. There was no statistical association between ACEs and DNAm PhenoAge acceleration. Early life adversity may become biologically embedded and lead to premature biological aging, in relation to DNAm GrimAge, which estimates risk of mortality. Strategies that increase awareness of ACEs and promote healthy child development are needed to prevent ACEs.
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Affiliation(s)
- Divya Joshi
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada,Labarge Centre for Mobility in AgingMcMaster UniversityHamiltonOntarioCanada,McMaster Institute for Research on AgingMcMaster UniversityHamiltonOntarioCanada
| | - Andrea Gonzalez
- Labarge Centre for Mobility in AgingMcMaster UniversityHamiltonOntarioCanada,McMaster Institute for Research on AgingMcMaster UniversityHamiltonOntarioCanada,Department of Psychiatry and Behavioral NeurosciencesMcMaster UniversityHamiltonOntarioCanada,Offord Centre for Child StudiesHamiltonOntarioCanada
| | - David Lin
- Centre for Molecular Medicine and TherapeuticsBC Children's Hospital Research InstituteVancouverBritish ColumbiaCanada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada,Labarge Centre for Mobility in AgingMcMaster UniversityHamiltonOntarioCanada,McMaster Institute for Research on AgingMcMaster UniversityHamiltonOntarioCanada,Department of Psychiatry and Behavioral NeurosciencesMcMaster UniversityHamiltonOntarioCanada
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Salmon S, Taillieu TL, Stewart-Tufescu A, MacMillan HL, Tonmyr L, Gonzalez A, Afifi TO. Stressors and symptoms associated with a history of adverse childhood experiences among older adolescents and young adults during the COVID-19 pandemic in Manitoba, Canada. Health Promot Chronic Dis Prev Can 2023; 43:27-39. [PMID: 36223143 PMCID: PMC9894295 DOI: 10.24095/hpcdp.43.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has had major economic, social and psychological consequences for adolescents and young adults. It is unclear whether those with a history of adverse childhood experiences (ACEs) were particularly vulnerable. We examined whether a history of ACEs was associated with financial difficulties, lack of emotional support, feeling stressed/anxious, feeling down/depressed, increased alcohol and/or cannabis use and increased conflict with parents, siblings and/or intimate partners among 16- to 21-year-olds during the pandemic. METHODS Data were collected in November and December 2020 from respondents aged 16 to 21 years (n = 664) participating in the longitudinal and intergenerational Well-being and Experiences Study (Wave 3) conducted in Manitoba, Canada. Age-stratified associations between ACEs and pandemic-related stressors/symptoms were examined with binary and multinomial logistic regression. RESULTS A history of ACEs was associated with pandemic-related financial difficulties (adjusted relative risk ratio [aRRR] range: 2.44-7.55); lack of emotional support (aRRR range: 2.13-26.77); higher levels of feeling stressed/anxious and down/depressed (adjusted odds ratio [aOR] range: 1.78-5.05); increased alcohol and cannabis use (aOR range: 1.99-8.02); and increased relationship conflict (aOR range: 1.98-22.59). Fewer associations emerged for older adolescents and these were not to the same degree as for young adults. CONCLUSION Adolescents and young adults with a history of ACEs reported increased odds of pandemic-related stressors and symptoms, and may need more resources and greater support compared to peers without an ACE history. Differences in results for adolescents and young adults suggest that interventions should be tailored to the needs of each age group.
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Affiliation(s)
- Samantha Salmon
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tamara L. Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Harriet L. MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lil Tonmyr
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Tracie O. Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Khoury JE, Giles L, Kaur H, Johnson D, Gonzalez A, Atkinson L. Associations between psychological distress and hair cortisol during pregnancy and the early postpartum: A meta-analysis. Psychoneuroendocrinology 2023; 147:105969. [PMID: 36335755 DOI: 10.1016/j.psyneuen.2022.105969] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/26/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Pregnancy and the early postpartum signify a period of high stress. Perinatal stress can include psychological distress (PD), such as anxiety, depression, and stress, as well as neuroendocrine stress, indexed by activation of the hypothalamic-pituitary-adrenal (HPA) axis and the production of the hormone cortisol. Elevated PD and cortisol levels during the perinatal period can have long-term implications for the mother and child. Methodological advances have enabled the sampling of cortisol from hair, to provide a retrospective marker of HPA axis activity over several months. Despite knowing that maternal PD and HPA activity during the perinatal period independently impact health and development, research to date is unclear as to the association between maternal PD and hair cortisol. The present meta-analysis included 29 studies to assess the strength of the relation between maternal PD and hair cortisol levels during pregnancy and the early postpartum period. Several sample and methodological factors were assessed as moderators of this effect. Analyses were conducted using multilevel meta-analysis. Results of the multilevel meta-analysis indicated that the overall effect size between PD and HCC was small but not significant z = 0.039, 95% CI [- 0.001, 0.079]. Moderator analyses indicated that the strength of the association between PD and hair cortisol was moderated by pregnancy status (i.e., effects were stronger in pregnant compared to postpartum samples), timing of HCC and PD measurements (i.e., effects were larger when PD was measured before HCC) and geographic location (i.e., effects were larger in North American studies). The findings advance our understanding of the link between PD and HPA activity during the perinatal period, a time of critical impact to child development.
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Affiliation(s)
- Jennifer E Khoury
- Department of Psychology, Mount Saint Vincent University, Halifax, NS Canada.
| | - Lauren Giles
- Department of Psychology, Mount Saint Vincent University, Halifax, NS Canada
| | - Hargun Kaur
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Dylan Johnson
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada; Offord Centre for Child Studies, McMaster University, Hamilton, ON Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, ON Canada
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Anderson LN, Yoshida-Montezuma Y, Jambon M, Smith BT, Carsley S, Gonzalez A. Income precarity and child and parent weight change during the COVID-19 pandemic: a cross-sectional analysis of the Ontario Parent Survey. BMJ Open 2022; 12:e063653. [PMID: 36600386 PMCID: PMC9742846 DOI: 10.1136/bmjopen-2022-063653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To describe child and parent weight change during the pandemic, overall and by income precarity. DESIGN A cross-sectional online survey was conducted. SETTING Caregivers of children 0-17 years of age living in Ontario, Canada, during the COVID-19 pandemic from May 2021 to July 2021. PARTICIPANTS A convenience sample of parents (n=9099) with children (n=9667) living in Ontario were identified through crowdsourcing. PRIMARY OUTCOME MEASURE Parents recalled, for themselves and their child, whether they lost weight, gained weight or remained the same over the past year. OR and 95% CI were estimated using multinomial logistic regression for the association between income precarity variables and weight loss or gain, adjusted for age, gender and ethnicity. RESULTS Overall, 5.5% of children lost weight and 20.2% gained weight. Among adolescents, 11.1% lost weight and 27.1% gained weight. For parents, 17.1% reported weight loss and 57.7% reported weight gain. Parent weight change was strongly associated with child weight change. Income precarity measures, including job loss by both parents (OR=7.81, 95% CI 5.16 to 11.83) and disruption to household food supply (OR=6.05, 95% CI 4.77 to 7.68), were strongly associated with child weight loss. Similarly, job loss by both parents (OR=2.03, 95% CI 1.37 to 3.03) and disruption to household food supply (OR=2.99, 95% CI 2.52 to 3.54) were associated with child weight gain. CONCLUSIONS Weight changes during the COVID-19 pandemic were widespread and income precarity was strongly associated with weight loss and weight gain in children and parents. Further research is needed to investigate the health outcomes related to weight change during the pandemic, especially for youth, and the impacts of income precarity.
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Affiliation(s)
- Laura N Anderson
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | | | - Marc Jambon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Brendan T Smith
- Health Promotion, Chronic Disease and Injury Prevention Program, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Carsley
- Health Promotion, Chronic Disease and Injury Prevention Program, Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Dryer A, Zhang X, England-Mason G, Atkinson L, Gonzalez A. Maternal sensitivity moderates the association between maternal history of childhood maltreatment and child executive function. Child Abuse Negl 2022; 134:105933. [PMID: 36283274 DOI: 10.1016/j.chiabu.2022.105933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Experiences of childhood maltreatment are associated with a variety of negative outcomes throughout individuals' lives as well as disadvantaged cognitive and socioemotional development among their offspring. The mechanisms through which some children show resilience against the intergenerational transmission of risk, however, are less well understood. OBJECTIVE The current study focuses on a proximal parental factor that plays a central role in children's early cognitive development - maternal sensitivity - and examines whether it moderates the association between maternal history of childhood maltreatment and child executive function (EF). PARTICIPANTS AND SETTING Data were collected from a community sample of 139 mothers and their infants (51 % female) recruited from urban areas in Ontario, Canada. METHODS Maternal maltreatment history was assessed via self-report at child age 3 months. Maternal sensitivity was assessed observationally at child age 8 months, and child executive function was assessed using performance-based measures at child age 3 years. Hypotheses were tested through multiple regression models. RESULTS In the current sample, maternal maltreatment history was not associated with child EF on average. However, results were consistent with a moderation model, indicating that maternal maltreatment history was associated with lower levels of child EF only when mothers were relatively insensitive. CONCLUSIONS The findings indicate the importance of considering sensitive parenting practices as a protective factor for children's cognitive development in the context of more distal risk factors such as mothers' history of childhood maltreatment.
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Affiliation(s)
- Arielle Dryer
- Department of Psychology, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| | - Xutong Zhang
- Department of Psychiatry and Behavioural Neurosciences and the Offord Centre for Child Studies, McMaster University, 1280 Main Street West, Hamilton, ON L8S 3L8, Canada
| | - Gillian England-Mason
- Department of Pediatrics, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences and the Offord Centre for Child Studies, McMaster University, 1280 Main Street West, Hamilton, ON L8S 3L8, Canada.
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Campeau A, Tanaka M, McTavish JR, MacMillan H, McKee C, Hovdestad WE, Gonzalez A, Afifi TO, Stewart-Tufescu A, Tonmyr L. Asking youth and adults about child maltreatment: a review of government surveys. BMJ Open 2022; 12:e063905. [PMID: 36410827 PMCID: PMC9680163 DOI: 10.1136/bmjopen-2022-063905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES In this review we: (1) identify and describe nationally representative surveys with child maltreatment (CM) questions conducted by governments in low-income, middle-income and high-income countries and (2) describe procedures implemented to address respondents' safety and minimise potential distress. DESIGN We conducted a systematic search across eight databases from 1 January 2000 to 5 July 2021 to identify original studies with information about relevant surveys. Additional information about surveys was obtained through survey methods studies, survey reports, survey websites or by identifying full questionnaires (when available). RESULTS Forty-six studies representing 139 surveys (98 youth and 41 adult) conducted by governments from 105 countries were identified. Surveys implemented a variety of procedures to maximise the safety and/or reduce distress for respondents including providing the option to withdraw from the survey and/or securing confidentiality and privacy for the respondent. In many surveys, further steps were taken such as providing information for support services, providing sensitivity training to survey administrators when interviews were conducted, among others. A minority of surveys took additional steps to empirically assess potential distress experienced by respondents. CONCLUSIONS Assessing risk and protective factors and developing effective interventions and policies are essential to reduce the burden of violence against children. While asking about experiences of CM requires careful consideration, procedures to maximise the safety and minimise potential distress to respondents have been successfully implemented globally, although practices differ across surveys. Further analysis is required to assist governments to implement the best possible safety protocols to protect respondents in future surveys.
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Affiliation(s)
- Aimée Campeau
- Health Promotion and Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Masako Tanaka
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Jill R McTavish
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Harriet MacMillan
- Departments of Psychiatry and Behavioural Neurosciences, and Pediatrics, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Chris McKee
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Wendy E Hovdestad
- Health Promotion and Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Tracie O Afifi
- Departments of Community Health Sciences, and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Lil Tonmyr
- Health Promotion and Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Mehta S, Vieira D, Guillen V, Zerpa D, Quintana A, Sanchez C, Ozair S, Brena-Pastor L, Pinos D, Fleming M, Carrera K, Rossitto F, Martinez F, Gonzalez A, Rodriguez K. Artificial intelligence-guided, single-lead EKG may be a game-changer for symptom-to-balloon time reduction in ST-elevated myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Over decades, efforts to shave off life-saving minutes from ST-Elevated Myocardial Infarction (STEMI) care centred on reducing door-to-needle and door-to-balloon times. We firmly believe that symptom-to-balloon time should prove a better focus to this end. Challenges come with this goal as it heavily relies on a patient's perception and initiative to seek care, which we deem intelligent and wearable Artificial Intelligence (AI)-driven Single Lead EKG technologies as an attractive solution in modern-day cardiology.
Purpose
To provide an accurate, accessible, and cost-effective AI-driven Single Lead STEMI detection algorithm that can be embedded into wearable devices and employed in a self-administered fashion.
Methods
Database: EKG records from Mexico, Colombia, Argentina, and Brazil from April 2014 to December 2019. Dataset: A total of 11,567 12-lead EKG records of 10[s] length with a sampling frequency of 500 Hz, including the following balanced classes: angiographically confirmed and unconfirmed STEMI, branch blocks, non-specific ST-T abnormalities, normal and abnormal (200+ CPT codes, excluding those mentioned above). Cardiologists manually checked the label of each record to ensure precision. Pre-processing: We discard the first and last 250 samples as they may contain a standardisation pulse. The study applied a digital low pass filter of order 5 with a frequency cut-off of 35 Hz. The mean was subtracted from each Lead. Classification: The determined classes were “STEMI” (Including STEMI in different locations of the myocardium – anterior, inferior, and lateral); and “Not-STEMI” (Combination of randomly sample, branch blocks, non-specific ST-T changes, and abnormal records – 25% of each). Training and Testing: A 1-D Convolutional Neural Network was trained and tested with a dataset proportion of 90/10, respectively. A different model was trained and tested for each Lead, using the central 4,500 samples of the records. The last dense layer outputs a probability for each report of being STEMI or Not-STEMI. Lead V2 showed the best overall results. The model was further tested through the same methodology using the best Lead with a subset of the previous data, excluding the unconfirmed STEMI EKG records (Total 7,230 12-lead EKG records for Confirmed Only STEMI dataset). Performance metrics were reported for each experiment and compared.
Results
Combined STEMI data: Accuracy: 91.2%; Sensitivity: 89.6%; Specificity: 92.9%. Confirmed STEMI Only dataset: Accuracy: 92.4%; Sensitivity: 93.4%; Specificity: 91.4% (Figure 1).
Conclusion
By assiduously improving the quality of the model's input, we continue to assess our algorithm's performance and reliability for future clinical validation as a potential remote monitoring and early STEMI detection device.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Mehta
- Lumen Foundation , Miami , United States of America
| | - D Vieira
- Lumen Foundation , Miami , United States of America
| | - V Guillen
- Lumen Foundation , Miami , United States of America
| | - D Zerpa
- Lumen Foundation , Miami , United States of America
| | - A Quintana
- Lumen Foundation , Miami , United States of America
| | - C Sanchez
- Lumen Foundation , Miami , United States of America
| | - S Ozair
- Lumen Foundation , Miami , United States of America
| | | | - D Pinos
- Lumen Foundation , Miami , United States of America
| | - M Fleming
- Lumen Foundation , Miami , United States of America
| | - K Carrera
- Lumen Foundation , Miami , United States of America
| | - F Rossitto
- Lumen Foundation , Miami , United States of America
| | - F Martinez
- Lumen Foundation , Miami , United States of America
| | - A Gonzalez
- Lumen Foundation , Miami , United States of America
| | - K Rodriguez
- Lumen Foundation , Miami , United States of America
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Angeli E, Reese-Petersen A, Gonzalez A, Lopez B, Ravassa S, Genovese F, Karsdal M, Diaz J. Type III collagen formation is significantly associated with risk of outcome in HFpEF patients but loses its significant association with underlying AF. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Heart failure with preserved ejection fraction (HFpEF) is the most common type of heart failure, associated with high morbidity and mortality. Atrial fibrillation (AF) has been associated with structural remodelling and fibrosis and can coexist with HFpEF. Type III collagen is the second most abundant collagen in the heart wall and has been associated with cardiac fibrosis. It has been previously shown that type III collagen formation, measured by PRO-C3, is prognostic for all-cause mortality in HFpEF.
Purpose
In this study, we aimed at investigating if the prognostic power of PRO-C3 in relation to all-cause mortality would be affected by underlying AF in HFpEF patients.
Methods
The analysis included 166 individuals with hypertensive HFpEF. The patients were classified in three groups according to NYHA classification, 43.2% in NYHA Class II, 52.5% NYHA Class III and 2.5% NYHA Class IV. A previous history of AF was present in 53.4% of the patients. Cardiac function was assessed by echocardiography and standard clinical measures. Type III collagen formation was evaluated by means of ELISA with the biomarker PRO-C3, which targets the released N-terminal pro-peptide of type III collagen.
Results
Levels of PRO-C3 were significantly elevated in HFpEF patients with AF (p=0.0063). PRO-C3 was significantly predictive of all-cause mortality in HFpEF patients (AUC=0.643, p=0.0053), but lost its significant association when factoring in AF (AUC=0.581, p=0.235). There was an increased risk of all-cause mortality (p=0.0089) but not statistically significant differences in HFpEF patients with AF (p=0.178) with increasing tertiles of PRO-C3.
Conclusions
Type III collagen formation as measured by PRO-C3, was increased in patients with HFpEF and previously diagnosed AF. However, while PRO-C3 can be predictive of all-cause mortality in HFpEF patients, it lacks predicting ability when AF is considered. The presented data suggest a potential role of increased type III collagen formation in HFpEF patients with adverse outcomes, which is consistent with the presence of increased fibrosis, and can potentially be used as a tool of risk stratification.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Nordic Bioscience A/S
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Affiliation(s)
- E Angeli
- Nordic Bioscience A/S , Herlev , Denmark
| | | | - A Gonzalez
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA , Pamplona , Spain
| | - B Lopez
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA , Pamplona , Spain
| | - S Ravassa
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA , Pamplona , Spain
| | - F Genovese
- Nordic Bioscience A/S , Herlev , Denmark
| | - M Karsdal
- Nordic Bioscience A/S , Herlev , Denmark
| | - J Diaz
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra and IdiSNA , Pamplona , Spain
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Mehta S, Vieira D, Zerpa D, Guillen V, Gonzalez A, Brena-Pastor L, Siyam T, Stoica S, Ozair S, Pinos D, Martinez F, Fleming M, Carrera K, Rossitto F, Whuking C. Performance metrics of AI-enhanced single lead EKG maintained after entry of organised clustered data. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Our experience in creating innovative Artificial Intelligence-guided single lead EKG methodologies for ST-Elevation Myocardial Infarction (STEMI) detection within complex EKG records has been previously validated.
Purpose
By expanding the intricate variables of our previously tested algorithm input, we seek to further improve our STEMI detecting tool.
Methods
11,567 12-lead EKG records (10-s length, 500 Hz sample frequency) derived from the Latin America Telemedicine Infarct Network database from April 2014 to December 2019. From these records, we included the following balanced classes: angiographically confirmed and unconfirmed STEMI (divided by wall affected), branch blocks, non-specific ST-T changes, normal, and abnormal (Remaining 200+ CPT codes). Cardiologist annotations ensured precision (Ground truth). Determined classes were “STEMI” and “Not-STEMI”. A 1-D Convolutional Neural Network model was trained and tested for each lead with dataset proportions of 90/10, respectively. The last dense layer outputs a probability for each record being STEMI/Not-STEMI. The analysis also included performance metrics and false-negative reports.
Results
Overall, the most promising Single lead for STEMI detection was V2 (91.2% Accuracy, 89.6% Sensitivity, and 92.9% Specificity). 55% of false negatives were inferior wall STEMI (Table 1).
Conclusion
Appreciable progress of our new methodology compared to our previous experiences in AI-guided Single Lead for STEMI detection, especially for lead V2. By performing a thorough analysis of false-negative reports, we aspire to identify potential areas of STEMI detection weakness which will become the focus of future ventures.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Mehta
- Lumen Foundation , Miami , United States of America
| | - D Vieira
- Lumen Foundation , Miami , United States of America
| | - D Zerpa
- Lumen Foundation , Miami , United States of America
| | - V Guillen
- Lumen Foundation , Miami , United States of America
| | - A Gonzalez
- Lumen Foundation , Miami , United States of America
| | | | - T Siyam
- Lumen Foundation , Miami , United States of America
| | - S Stoica
- Lumen Foundation , Miami , United States of America
| | - S Ozair
- Lumen Foundation , Miami , United States of America
| | - D Pinos
- Lumen Foundation , Miami , United States of America
| | - F Martinez
- Lumen Foundation , Miami , United States of America
| | - M Fleming
- Lumen Foundation , Miami , United States of America
| | - K Carrera
- Lumen Foundation , Miami , United States of America
| | - F Rossitto
- Lumen Foundation , Miami , United States of America
| | - C Whuking
- Lumen Foundation , Miami , United States of America
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Mehta S, Vieira D, Zerpa D, Guillen V, Carrasquel M, Ramadan S, Martinez F, Rossitto F, Carrera K, Fleming M, Pinos D, Brena-Pastor L, Ozair S, Gonzalez A, Barco A. No need for a cardiologist for AMI diagnosis – progress of transforming a behemoth telemedicine program with artificial intelligence. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Latin American Telemedicine Infarct Network (LATIN) Telemedicine is a mammoth hub and spoke model that provides an umbrella of AMI protection for 100 million patients. In the program, 826,043 patients had a telemedicine encounter; 7,400 with AMI were diagnosed; 4,332 of them managed with guidelines-based strategies. We have gradually begun implementing a system for using Artificial Intelligence (AI) algorithms embedded into EKGs for rapid and accurate STEMI detection and validated the results with a cardiologist's interpretations.
Purpose
To test whether an AI-driven EKG algorithm can effectively substitute a cardiologist for STEMI telemedicine protocols.
Methods
The AI algorithm construction was in the following fashion. Sample: a selection of 8,511 EKG and 90,592 classified heartbeats. Pre-processing: segmentation of each EKG into individual heartbeats. Training & testing: 90% and 10% of the total dataset, respectively. Classification: 1-D Convolutional Neural Network; the study constructed classes for each heartbeat. The algorithm was next deployed on a consecutive series of LATIN EKG records to diagnose STEMI. We afterwards compared the algorithm's results with eight expert cardiologists' interpretations of the same sample.
Results
This study achieved a concordance of 91% between the AI algorithm and cardiologist interpretation (Figure 1).
Conclusions
The initial results with AI algorithms for STEMI diagnosis are encouraging and may provide the base work for new tools for cardiologists to improve their efficiency. Moreover, implementing this innovative tool may overcome current limitations associated with the telemedical management of this disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Mehta
- Lumen Foundation , Miami , United States of America
| | - D Vieira
- Lumen Foundation , Miami , United States of America
| | - D Zerpa
- Lumen Foundation , Miami , United States of America
| | - V Guillen
- Lumen Foundation , Miami , United States of America
| | - M Carrasquel
- Lumen Foundation , Miami , United States of America
| | - S Ramadan
- Lumen Foundation , Miami , United States of America
| | - F Martinez
- Lumen Foundation , Miami , United States of America
| | - F Rossitto
- Lumen Foundation , Miami , United States of America
| | - K Carrera
- Lumen Foundation , Miami , United States of America
| | - M Fleming
- Lumen Foundation , Miami , United States of America
| | - D Pinos
- Lumen Foundation , Miami , United States of America
| | | | - S Ozair
- Lumen Foundation , Miami , United States of America
| | - A Gonzalez
- Lumen Foundation , Miami , United States of America
| | - A Barco
- Lumen Foundation , Miami , United States of America
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Rosell A, Baeza S, Lopez-SeguÍ F, Mouriño R, Saigí M, Munné M, Bechini J, Gonzalez A, Cervera E, Compte M, Garcia-Reina S, NUÑEZ A, ARA J. EP01.03-002 Implementation of the International Lung Screen Trial (ILST) in Catalonia: A Cost Analysis study. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gonzalez A, Abrigo J, Achiardi O, Simon F, Cabello-Verrugio C. Intensive care unit-acquired weakness: From molecular mechanisms to its impact in COVID-2019. Eur J Transl Myol 2022; 32. [PMID: 36036350 PMCID: PMC9580540 DOI: 10.4081/ejtm.2022.10511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/08/2022] [Indexed: 01/08/2023] Open
Abstract
Intensive Care Unit-Acquired Weakness (ICU-AW) is a generalized and symmetric neuromuscular dysfunction associated with critical illness and its treatments. Its incidence is approximately 80% in intensive care unit patients, and it manifests as critical illness polyneuropathy, critical illness myopathy, and muscle atrophy. Intensive care unit patients can lose an elevated percentage of their muscle mass in the first days after admission, producing short- and long-term sequelae that affect patients’ quality of life, physical health, and mental health. In 2019, the world was faced with coronavirus disease 2019 (COVID-19), caused by the acute respiratory syndrome coronavirus 2. COVID-19 produces severe respiratory disorders, such as acute respiratory distress syndrome, which increases the risk of developing ICU-AW. COVID-19 patients treated in intensive care units have shown early diffuse and symmetrical muscle weakness, polyneuropathy, and myalgia, coinciding with the clinical presentation of ICU-AW. Besides, these patients require prolonged intensive care unit stays, invasive mechanical ventilation, and intensive care unit pharmacological therapy, which are risk factors for ICU-AW. Thus, the purposes of this review are to discuss the features of ICU-AW and its effects on skeletal muscle. Further, we will describe the mechanisms involved in the probable development of ICU-AW in severe COVID-19 patients.
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Huang G, Strikarsky S, Weinstein J, Ellahi M, Gonzalez A, Idkowiak-Baldys J, Glynn J. 415 Using a cosmetic blend to produce a contraction response in human keratinocytes and deliver tightening of skin around the eye. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mian O, Belsky DW, Cohen AA, Anderson LN, Gonzalez A, Ma J, Sloboda DM, Bowdish DM, Verschoor CP. Associations between exposure to adverse childhood experiences and biological aging: Evidence from the Canadian Longitudinal Study on Aging. Psychoneuroendocrinology 2022; 142:105821. [PMID: 35679774 DOI: 10.1016/j.psyneuen.2022.105821] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
People exposed to adverse childhood experiences (ACEs) suffer from an increased risk of chronic disease and shorter lifespan. These individuals also tend to exhibit accelerated reproductive development and show signs of advanced cellular aging as early as childhood. These observations suggest that ACEs may accelerate biological processes of aging through direct or indirect mechanisms; however, few population-based studies have data to test this hypothesis. We analysed ACEs and biological aging data from the Canadian Longitudinal Study on Aging (CLSA; n = 23,354 adults aged 45-85) and used the BioAge R package to compute three indices of biological aging from blood-chemistry and organ-function data: Klemera-Doubal method (KDM) biological age, phenotypic age (PA), and homeostatic dysregulation (HD). Adults with ACEs tended to be biologically older than those with no ACEs, although the observed effect-sizes were small (Cohen's d<0.15), with the exception of neglect (d=0.35 for KDM and PA). Associations were similar for men and women and tended to be smaller for older as compared to midlife participants. Subtypes of ACEs perceived as being more severe (e.g., being pushed or kicked, experiencing forced sexual activity, witnessing physical violence) and more frequent and diverse exposures were associated with relatively larger effect-sizes. These findings support the hypothesis that ACEs contribute to accelerated biological aging, although replication is needed in studies with access to prospective records of ACEs and cellular-level measurements of biological aging. Furthermore, future work to better understand the degree to which associations between ACEs and biological aging are moderated by specific life-course pathways, and mediated by lifestyle and socioeconomic factors is warranted.
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Affiliation(s)
- Oxana Mian
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Daniel W Belsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, NY, United States; Robert N. Butler Columbia Aging Center, Columbia University, NY, United States
| | - Alan A Cohen
- Groupe De Recherche PRIMUS, Department of Family Medicine, University of Sherbrooke, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, ON, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, ON, Canada
| | - Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, ON, Canada
| | - Deborah M Sloboda
- Department of Biochemistry and Biomedical Sciences, Pediatrics and Obstetrics and Gynecology, Farncombe Family Digestive Health Research Institute, McMaster University, ON, Canada
| | - Dawn Me Bowdish
- Department of Pathology and Molecular Medicine, McMaster University, ON, Canada; Firestone Institute of Respiratory Health, St. Joseph's Healthcare; McMaster University, Hamilton, ON, Canada
| | - Chris P Verschoor
- Health Sciences North Research Institute, Sudbury, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, ON, Canada; Northern Ontario School of Medicine University, Sudbury, ON, Canada.
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Marquez J, Dinguirard N, Gonzalez A, Kane A, Joffe N, Yoshino T, Castillo M. Molecular characterization of thioester-containing proteins in Biomphalaria glabrata and their differential gene expression upon Schistosoma mansoni exposure. Front Immunol 2022; 13:903158. [PMID: 35967434 PMCID: PMC9363628 DOI: 10.3389/fimmu.2022.903158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Schistosomiasis is a disease caused by trematode parasites of the genus Schistosoma that affects approximately 200 million people worldwide. Schistosomiasis has been a persistent problem in endemic areas as there is no vaccine available, currently used anti-helmintic medications do not prevent reinfection, and most concerning, drug resistance has been documented in laboratory and field isolates. Thus, alternative approaches to curtail this human disease are warranted. Understanding the immunobiology of the obligate intermediate host of these parasites, which include the freshwater snail Biomphalaria glabrata, may facilitate the development of novel methods to stop or reduce transmission to humans. Molecules from the thioester-containing protein (TEP) superfamily have been shown to be involved in immunological functions in many animals including corals and humans. In this study we identified, characterized, and compared TEP transcripts and their expression upon S. mansoni exposure in resistant and susceptible strains of B. glabrata snails. Results showed the expression of 11 unique TEPs in B. glabrata snails. These transcripts present high sequence identity at the nucleotide and putative amino acid levels between susceptible and resistant strains. Further analysis revealed differences in several TEPs’ constitutive expression levels between resistant and susceptible snail strains, with C3-1, C3-3, and CD109 having higher constitutive expression levels in the resistant (BS90) strain, whereas C3-2 and TEP-1 showed higher constitutive expression levels in the susceptible (NMRI) strain. Furthermore, TEP-specific response to S. mansoni miracidia exposure reiterated their differential expression, with resistant snails upregulating the expression of both TEP-4 and TEP-3 at 2 h and 48 h post-exposure, respectively. Further understanding the diverse TEP genes and their functions in invertebrate animal vectors will not only expand our knowledge in regard to this ancient family of immune proteins, but also offer the opportunity to identify novel molecular targets that could aid in the efforts to develop control methods to reduce schistosomiasis transmission.
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Affiliation(s)
- J. Marquez
- Department of Biology, New Mexico State University, Las Cruces, NM, United States
| | - N. Dinguirard
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - A. Gonzalez
- Department of Biology, New Mexico State University, Las Cruces, NM, United States
| | - A.E. Kane
- Department of Biology, New Mexico State University, Las Cruces, NM, United States
| | - N.R. Joffe
- Department of Biology, New Mexico State University, Las Cruces, NM, United States
| | - T.P. Yoshino
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - M.G. Castillo
- Department of Biology, New Mexico State University, Las Cruces, NM, United States
- *Correspondence: M.G. Castillo,
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Khoury JE, Atkinson L, Bennett T, Jack SM, Gonzalez A. Prenatal distress, access to services, and birth outcomes during the COVID-19 pandemic: Findings from a longitudinal study. Early Hum Dev 2022; 170:105606. [PMID: 35728399 PMCID: PMC9192354 DOI: 10.1016/j.earlhumdev.2022.105606] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIMS During the COVID-19 pandemic, pregnant people have experienced disruptions to prenatal care, as well elevated rates of mental health problems and distress. The current longitudinal study aims to understand how different forms of prenatal distress (mental health problems, COVID-19 stressful experiences, and access to prenatal services) impact infant birth outcomes during the pandemic. METHODS Participants were 265 pregnant individuals from Ontario, Canada. Maternal depression, pregnancy-related anxiety, COVID-related stressors (i.e., financial difficulties, social isolation), and disruptions to prenatal and health services were assessed during pregnancy. Delivery experiences and birth outcomes were assessed in the early postpartum period. Associations between pregnancy stressors and birth outcomes were assessed using path analyses. RESULTS Participants reported experiencing substantial changes to their prenatal care due to COVID-19; 23.0 % had prenatal appointments cancelled, 47.9 % had difficulty accessing prenatal classes, and 60.8 % reported changes to their birth plans. Results of path analyses showed a unique effect of pregnancy-related anxiety during the pandemic on lower birth weight, younger gestational age at birth, and more infant birth problems. Further, multi-group path analysis revealed these effects were more pronounced in male infants. CONCLUSIONS Findings demonstrate that pregnant individuals in Ontario, Canada have experienced considerable disruptions to services during pregnancy. In addition, pregnancy-related anxiety was uniquely linked to elevated risk for adverse birth outcomes, which more heavily impacted male infants. These findings underscore the need for additional mental health support and access to services for pregnant people and their infants, to reduce long-term adverse maternal and fetal health outcomes.
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Affiliation(s)
- Jennifer E. Khoury
- Department of Psychology, Mount Saint Vincent University; Halifax, NS, Canada,Corresponding author at: Department of Psychology, Mount Saint Vincent University, 166 Bedford Hwy, Halifax B3M 2J6, NS, Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Teresa Bennett
- Department of Psychiatry and Behavioural Neurosciences, McMaster University; Hamilton ON, Canada,Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Susan M. Jack
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada,School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University; Hamilton ON, Canada,Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
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Zhang X, Jambon M, Afifi TO, Atkinson L, Bennett T, Duku E, Duncan L, Joshi D, Kimber M, MacMillan HL, Gonzalez A. Mental Health Help-Seeking in Parents and Trajectories of Depressive and Anxiety Symptoms: Lessons Learned From the Ontario Parent Survey During the COVID-19 Pandemic. Front Psychol 2022; 13:884591. [PMID: 35783808 PMCID: PMC9243663 DOI: 10.3389/fpsyg.2022.884591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Tracking parents’ mental health symptoms and understanding barriers to seeking professional help are critical for determining policies and services to support families’ well-being. The COVID-19 pandemic has posed enormous challenges to parents’ mental health and the access to professional help, and there are important public health lessons that must be learned from the past 2 years’ experiences to inform future mental health responses to social- and family-level stressful events. This study examines the trajectories of parents’ depressive and anxiety symptoms over a year during the pandemic as related to their mental health help-seeking. Data were collected from a sample of parents residing in Ontario, Canada at baseline (May–June, 2020; Wave 1) and again 1 year later (Wave 2; referred to as W1 and W2 below). Parents (n = 2,439; Mage = 39.47, SD = 6.65; 95.0% females) reported their depressive and anxiety symptoms at both waves. Mental health help-seeking, including self-reported contact with professional help and perceived unmet mental health needs, was measured at W2. Parents were classified into four groups by mental health help-seeking. Inconsistent seekers and non-seeking needers, both reporting perceived unmet needs for professional help, showed greater increases in depressive and anxiety symptoms, whereas parents with no need or needs met showed smaller increases in depressive symptoms and decreases in anxiety symptoms. Belief in self-reliance and time constraints were the leading reasons for not seeking help. These findings suggest that over a year into the pandemic, parents with perceived unmet mental health needs were at greater risk for worsening depressive and anxiety symptoms. Recognizing the demands for mental health services when families experience chronic stressors and targeting the identified barriers may promote family well-being during and beyond this pandemic.
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Affiliation(s)
- Xutong Zhang
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, Hamilton, ON, Canada
| | - Marc Jambon
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, Hamilton, ON, Canada
| | - Tracie O. Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Leslie Atkinson
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Teresa Bennett
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, Hamilton, ON, Canada
| | - Eric Duku
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, Hamilton, ON, Canada
| | - Laura Duncan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, Hamilton, ON, Canada
| | - Divya Joshi
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, Hamilton, ON, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, Hamilton, ON, Canada
| | - Harriet L. MacMillan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, Hamilton, ON, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Centre for Child Studies, Hamilton, ON, Canada
- *Correspondence: Andrea Gonzalez,
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Quintana R, Garcia L, Alba P, Roverano S, Alvarez A, Graf C, Pisoni C, Spindler A, Gomez C, Figueredo HM, Papasidero S, Paniego RH, Delavega M, Civit De Garignani EE, Gonzalez Lucero L, Martire V, Águila Maldonado R, Gordon S, Gobbi C, Nieto R, Rausch G, Góngora V, D’amico MA, Dubinsky D, Orden AO, Zacariaz J, Romero J, Pera MA, Rillo O, Baez R, Arturi V, Gonzalez A, Vivero F, Schmid M, Caputo V, Larroude MS, Gomez G, Rodriguez G, Marin J, Collado MV, Jorfen M, Bedran Z, Sarano J, Zelaya D, Sacnun M, Finucci P, Rojas Tessel R, Sattler ME, Machado Escobar M, Astesana P, Paris UV, Allievi A, Vandale JM, Pons-Estel B, Pons-Estel G, García M. POS0707 POTENTIAL USE OF BELIMUMAB IN LUPUS PATIENTS FROM ARGENTINE COHORT ACCORDING DISEASE ACTIVITY STATE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe goal of targeted treatment in patients with Systemic Lupus Erythematosus (SLE) is to achieve clinical remission or low disease activity, with the best quality of life, low damage rates and better survival 1-4. RELESSAR is a multicenter, cross-sectional study registry of ≥18 years SLE (ACR 97) patients 5.ObjectivesTo describe demographic, clinical characteristics and treatments in SLE patients according to disease activity state. To evaluate the proportion of SLE and refractory SLE patients that are potentially candidates for Belimumab treatment (Active SLE despite standard treatment including increased acDNA autoantibodies and low complement).MethodsWe evaluated demographic and clinical data, treatments, score of damage (SLICC), activity (SLEDAI) and comorbidity (Charlson), hospital admissions and severe infections. The patients were compared according to disease activity: remission (SLEDAI = 0 and without corticosteroids), low disease activity (LDA, SLEDAI> 0 and ≤4 and without corticosteroids) and non-optimal control (SLEDAI> 4 and any dose of corticosteroids). Refractory SLE was defined according to Rituximab (RTX) use, non-response to cyclophosphamide or two or more immunosuppressant or splenectomized patients. Potential use of Belimumab according approved prescription in Argentina was analyzed.ResultsOverall, 1277 patients were analyzed: 299 (23.4%) were in remission, 162 (12.7%) in LDA and 816 (63.9%) with non-optimal control of the disease.Patients in non-optimal control group were younger, less frequently female and they showed less time of disease and lower socioeconomic status (p < 0.001). They were also more prevalent mestizos (p= 0.004), had higher SLEDAI and SLICC indexes (p <0.001) and higher use of immunosuppressant therapy (p <0.001). There was no difference regarding biologic treatment (RTX p= 0.547 and Belimumab p= 0.08). This group had higher proportion of hospital admissions and severe infections (p<0.001, respectively).Two hundred and one SLE patients fulfilled the use of Belimumab prescription criteria but only 45/201 patients (22,3%) received it in the last visit. Malar rash was the only clinical variable associated with the use of Belimumab (72.7% vs 29.8% p= 0.005).Seventy-six patients classified as refractory SLE (15.7%) and 56/76 (75.7%) never received Belimumab. Patients on Belimumab therapy were associated to treatment with lower doses of corticoids (p= 0.018) and lower rate of hospital admission caused by SLE flare (p= 0.027).ConclusionA high percentage of patients had uncontrolled disease upon entry into the registry and were potential candidates for treatment with Belimumab. The patients who received biologic treatment showed the benefit of requiring fewer doses of corticosteroids and having a lower rate of hospitalizations.References[1]Mok CC. Treat-to-target in systemic lupus erythematosus: Are we there yet? Expert Rev Clin Pharmacol. 2016;9(5).[2]Morand EF, Mosca M. Treat to target, remission and low disease activity in SLE. Vol. 31, Best Practice and Research: Clinical Rheumatology. 2017.[3]Golder V, Tsang-A-Sjoe MWP. Treatment targets in SLE: Remission and low disease activity state. Rheumatol (United Kingdom). 2020;59.[4]Ruiz-Irastorza G, Bertsias G. Treating systemic lupus erythematosus in the 21st century: new drugs and new perspectives on old drugs. Vol. 59, Rheumatology (United Kingdom). 2021.[5]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum [Internet]. 1997;40(9):1725. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9324032Disclosure of InterestsRosana Quintana: None declared, Lucila Garcia: None declared, Paula Alba: None declared, Susana Roverano: None declared, Analia Alvarez: None declared, Cesar Graf: None declared, Cecilia Pisoni: None declared, Alberto Spindler: None declared, Catalina Gomez: None declared, Heber Matias Figueredo: None declared, Silvia Papasidero: None declared, Raul Horacio Paniego: None declared, Maria DeLaVega: None declared, Emma Estela Civit De Garignani: None declared, Luciana Gonzalez Lucero: None declared, Victoria Martire: None declared, Rodrigo Águila Maldonado: None declared, Sergio Gordon: None declared, Carla Gobbi: None declared, Romina Nieto: None declared, Gretel Rausch: None declared, Vanina Góngora: None declared, Maria Agustina D´Amico: None declared, Diana Dubinsky: None declared, Alberto Omar Orden: None declared, Johana Zacariaz: None declared, Julia Romero: None declared, Mariana Alejandra Pera: None declared, Oscar Rillo: None declared, Roberto Baez: None declared, Valeria Arturi: None declared, Andrea Gonzalez: None declared, Florencia Vivero: None declared, Marcela Schmid: None declared, Victor Caputo: None declared, Maria Silvia Larroude: None declared, Graciela Gomez: None declared, Graciela Rodriguez: None declared, Josefina Marin: None declared, Maria Victoria Collado: None declared, Marisa Jorfen: None declared, Zaida Bedran: None declared, Judith Sarano: None declared, David Zelaya: None declared, MONICA SACNUN: None declared, Pablo Finucci: None declared, Romina Rojas Tessel: None declared, Maria Emilia Sattler: None declared, MAXIMILIANO MACHADO ESCOBAR: None declared, Pablo Astesana: None declared, Ursula Vanesa Paris: None declared, Alberto Allievi: None declared, Juan Manuel Vandale: None declared, Bernardo Pons-Estel: None declared, Guillermo Pons-Estel: None declared, Mercedes García Grant/research support from: GSK grant
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Lourido L, Quaranta P, Paz González R, Calamia V, Cañete JDD, Fernandez B, González-Álvaro I, Gonzalez A, Pablos JL, Blanco FJ, Ruiz-Romero C. POS0438 IDENTIFICATION OF ANTI-CYTOKINE AUTOANTIBODIES WITH POTENTIAL TO PREDICT FLARE IN RHEUMATOID ARTHRITIS PATIENTS UNDERGOING BIOLOGICAL THERAPIES: A DISCOVERY STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe presence of anti-cytokine autoantibodies (ACAAs) seems to be a physiologic mechanism to control the immune response and regulate cytokine activity. Biological therapies also regulate cytokine activities and have greatly improved the quality of life of RA patients. However, alteration of the cytokine network by the use of these treatments may lead to a disbalance in the regulatory system of ACAAs. We hypothesize the ACAAs network may influence the course of immune response in RA patients and may be useful to predict the therapy efficacy.ObjectivesWe aimed to explore the potential of circulating ACAAs to predict flare in a cohort of RA patients treated with biological therapy.MethodsWe employed sera at baseline from 194 RA patients of the clinical trial OPTIBIO1 (A Coruña), whose primary endpoint is to evaluate the usefulness of standardized protocol strategies of dose reduction in patients with RA in clinical remission treated with biologics. These patients were treated with TNF inhibitors (Etanercept, N=47; Infliximab, N=12; Adalimumab, N=35; Certolizumab (CTZ), N=17; Golimumab, N=5), Tocilizumab (TCZ, N=60) and Abatacept (ABA, N=18). Patients were in clinical remission (DAS 28 <2.6 or SDAI <5 or ACR/EULAR 2011 criteria) at least from 6 months. Patients were followed during a minimum period of one year and maximum period of 3 years. Flare was considered when remission criteria were not fulfilled. The bead-based antigen array MILLIPLEX MAP Human Cytokine Autoantibody Magnetic Bead Panel was used for the simultaneous detection and quantification in sera of anti-BAFF, anti-G-CSF, anti-IFNβ, anti-IFNγ, anti-IL-1α, anti-IL-6, anti-IL-8, anti-IL-10, anti-IL-12 (p40), anti-IL-15, anti-IL-17A, anti-IL-17F, anti-IL-18, anti-IL-22, and anti-TNFα. Non-parametrical tests, ROC curves and logistic regressions were performed for the statistical data analysis using SPSS. P-value < 0.05 was considered statistically significant.ResultsThe levels of anti-17A and anti-IL-1α were increased in the sera from patients who suffered a flare during the follow-up period (N= 76), compared to those who remained in remission (N= 118), showing an area under the curve (AUC) of 0.586 and 0.594, respectively. Segregating by treatment, the levels of anti-17A were specifically increased in those relapsing patients under CTZ (N=6), ABA (N=12) and TCZ (N=20) treatment. The AUC of anti-17A within these three therapies was 0.867, 0.903 and 0.682, respectively. Logistic regression analysis also associated the levels of anti-17A with the risk of suffering a flare in TCZ-treated patients (OR=1.11; p=0.015, for 100 MFI increase). In addition, the TCZ-treated patients who suffered a flare also showed higher levels of anti-IL17F, anti-IL-1α, and anti-IL-18 compared to those that remained in remission, showing AUCs of 0.689, 0.657 and 0.698, respectively. Anti-IL-18 was also associated with the risk of flare in these patients (OR=1.65; p=0.028, for 100 MFI increase). The presence of these three ACAAs was also higher in the TCZ-treated patients who suffered a flare compared to those in remission.ConclusionAlthough further validation of our results is needed, we present a ground-breaking study showing the potential of anti-IL17A, anti-IL-1α, and anti-IL18 to predict flare in RA patients under biological therapies.References[1]Bejerano C, et al. Clinical evaluation usefulness of standardized protocol strategies of dose reduction in patients with RA in clinical remission treated with biologic therapies. The Optibio Study. Arthritis Rheumatol. 2016; 68 (suppl 10): 649.Table 1.Table showing a summary of the results. CI: confidence interval• Treatments• ACAAs• AUC (CI 95%; p)Allanti-IL17A0.586 (0.504-0.668; 0.044)anti-IL-1α0.594 (0.512-0.676; 0.028)CTZanti-IL17A0.867 (0.675,1.000; 0.017)ABAanti-IL17A0.903 (0.761-1.000; 0.007)TCZanti-IL-1α0.657 (0.494-0.820; 0.049)anti-IL-17F0.689 (0.551-0.827; 0.018)anti-IL17A0.682 (0.528-0.835; 0.023)anti-IL180.698 (0.545-0.850; 0.013)Disclosure of InterestsNone declared.
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Banathy A, Gonzalez A, Patrie J, Sheeran D. Abstract No. 87 Splenic artery embolization in grade V blunt splenic injury: 10-year retrospective review. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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