Racism-related stress and mental health among black women living in Los Angeles County, California: A comparison of postpartum mood and anxiety disorder screening scales

PURPOSE

To assess Black women's exposure to and appraisal of racism-related stress during the postpartum period and to distinguish its impact on three indicators of postpartum mood and anxiety disorders (PMADs) symptoms.

METHODS

Data from the Black Mothers' Mental Wellness Study (N = 231) and linear regression models estimated the associations between racism-related stress and the PMAD indicators: 3-item Edinburgh Postnatal Depression Scale (EPDS-3), 8-item Patient Health Questionnaire (PHQ-8), and PHQ-15.

RESULTS

The majority of participants (80.5%, N = 186) experienced racism a few times a year or more, of which 37.1% (N = 69) were bothered somewhat and 19.3% (N = 36) a lot. Racism-related stress, income, level of education, and history of mental health diagnosis explained greater variance in PMAD symptoms as measured by the PHQ-8 score (R2 = 0.58, p =  < 0.001) compared to the EPDS-3 (R2 = 0.46, p =  < 0.001) or the PHQ-15 (R2 = 0.14, p = 0.035).

CONCLUSIONS

Racism is a stressor for Black women living in Los Angeles County, California. Racism-related stress and emotional expression of PMAD symptoms were salient to the postpartum mental health of the Black women in this study. Findings from this study suggest that the PHQ-8 should be used to assess how racism impacts Black women's postpartum mental health.

A multimodal magnetoelastic artificial skin for underwater haptic sensing

Future exploitation of marine resources in a sustainable and eco-friendly way requires autonomous underwater robotics with human-like perception. However, the development of such intelligent robots is now impeded by the lack of adequate underwater haptic sensing technology. Inspired by the populational coding strategy of the human tactile system, we harness the giant magnetoelasticity in soft polymer systems as an innovative platform technology to construct a multimodal underwater robotic skin for marine object recognition with intrinsic waterproofness and a simple configuration. The bioinspired magnetoelastic artificial skin enables multiplexed tactile modality in each single taxel and obtains an impressive classification rate of 95% in identifying seven types of marine creatures and marine litter. By introducing another degree of freedom in underwater haptic sensing, this work represents a milestone toward sustainable marine resource exploitation.

Fear of COVID and Physical Health Among People Living with HIV in China: Mediation Effects of HIV Stigma, Social Support, and Substance Use

The COVID-19 pandemic has uniquely impacted people living with HIV (PLWH) worldwide. The negative impacts on PLWH's mental health from fear of COVID-19 are labeled as "a double stress." The association between fear of COVID-19 and HIV (internalized) stigma has been found among PLWH. Studies that explore the relationships between fear of COVID-19 and physical health outcomes are few, especially among PLWH. In this study, we explored the relationship between fear of COVID-19 and physical health among PLWH and the mediated effects of HIV stigma, social support, and substance use. A cross-sectional online survey of PLWH (n = 201) from November 2021 to May 2022 was carried out in Shanghai, China. The data on socio-demographics, fear of COVID-19, physical health, HIV-related perceived stigma, social support, and substance use were gathered and analyzed by structure equation modeling (SEM). In SEM analysis, fear of COVID-19 showed a significant and indirect effect on physical health (β=-0.085) which was primarily mediated by HIV stigma. In SEM analysis, the final model had a good fit. Fear of COVID-19 showed a significant effect on HIV stigma (β = 0.223) with the majority being direct effects (β = 0.262) and a small indirect effect via substance use (β=-0.039). Furthermore, HIV stigma showed a significant effect on physical health (β=-0.382), the majority of which was direct (β=-0.340), and a small indirect effect via social support (β=-0.042). This is one of the first studies to explore how fear of contracting COVID-19 can affect PLWH's coping behaviors (e.g., using substances and obtaining social support) used to combat HIV stigma as well as to achieve better physical health in China.

The impact and outcomes of cancer-macrophage fusion

BACKGROUND

Cancer's hallmark feature is its ability to evolve, leading to metastasis and recurrence. Although genetic mutations and epigenetic changes have been implicated, they don't fully explain the leukocytic traits that many cancers develop. Cell fusion between cancer and somatic cells, particularly macrophages, has been suggested as an alternative pathway for cancer cells to obtain new traits by acquiring exogenous genetic material.

METHODS

This study aims to investigate the potential biological outcomes of tumor-myeloid cell fusion by generating tumor-macrophage hybrid cells. Two clones with markedly different tumorigenicity were selected, and RNA-seq was used to compare their RNA expressions with that of the control cells. Based on the results that the hybrid cells showed differential activation in several upstream regulator pathways that impact their biological behaviors, the hybrid cells' abilities to recruit stromal cells and establish angiogenesis as well as their cell cycle distributions were investigated through in vitro and in vivo studies.

RESULTS

Although both hybrid clones demonstrated p53 activation and reduced growth rates, they exhibited distinct cell cycle distributions and ability to grow in vivo. Notably, while one clone was highly tumorigenic, the other showed little tumorigenicity. Despite these differences, both hybrid clones were potent environmental modifiers, exhibiting significant abilities to recruit stromal and immune cells and establish angiogenesis.

CONCLUSIONS

The study revealed that tumor-somatic cell fusion is a potent environmental modifier that can modulate tumor survival and evolution, despite its relatively low occurrence. These findings suggest that tumor-somatic cell fusion could be a promising target for developing new cancer therapies. Furthermore, this study provides an experimental animal platform to investigate cancer-myeloid fusion and highlights the potential role of tumor-somatic cell fusion in modulating the tumor environment.

Are Distressed Black Women Also Depressed? Implications for a Mental Health Paradox

PURPOSE

Recent research suggests the determinants of and links between psychological distress and psychiatric disorder are distinct among Black Americans. Yet, these associations have not been explored among Black women, despite the unique social experiences, risks, and mental health patterns they face. The present study assessed the sociodemographic and psychosocial determinants of distress and disorder and evaluated the distress-disorder association, including whether it was conditional on sociodemographic and psychosocial characteristics among Black women.

METHODS

Data were from 328 Black women in the Nashville Stress and Health Study, a cross-sectional community epidemiologic survey of Blacks and Whites in Nashville, Tennessee, and was used to assess the correlates of distress (CES-D depressive symptoms scale) and major depressive disorder (MDD; based on the CIDI). Multinomial logistic regression models estimated the extent to which greater distress was associated with higher risk of "chronic" or "resolved MDD".

RESULTS

Stress exposure and marital status were associated with greater distress, while stress exposure and childhood SES were associated with elevated disorder risk. Although increased distress was associated with greater disorder risk, significant interactions indicated these associations depend on differences in age and adult socioeconomic status within this population.

CONCLUSIONS

This study identifies distinct correlates of distress and disorder and shows that the distress-disorder association varies among subgroups of Black women. Results have important implications for public health research and practice, as they highlight the factors that matter most for the mental health outcomes of Black women.

Modeling COVID-19 infection dynamics and mitigation strategies for in-person K-6 instruction

Background

U.S. school closures due to the coronavirus disease 2019 (COVID-19) pandemic led to extended periods of remote learning and social and economic impact on families. Uncertainty about virus dynamics made it difficult for school districts to develop mitigation plans that all stakeholders consider to be safe.

Methods

We developed an agent-based model of infection dynamics and preventive mitigation designed as a conceptual tool to give school districts basic insights into their options, and to provide optimal flexibility and computational ease as COVID-19 science rapidly evolved early in the pandemic. Elements included distancing, health behaviors, surveillance and symptomatic testing, daily symptom and exposure screening, quarantine policies, and vaccination. Model elements were designed to be updated as the pandemic and scientific knowledge evolve. An online interface enables school districts and their implementation partners to explore the effects of interventions on outcomes of interest to states and localities, under a variety of plausible epidemiological and policy assumptions.

Results

The model shows infection dynamics that school districts should consider. For example, under default assumptions, secondary infection rates and school attendance are substantially affected by surveillance testing protocols, vaccination rates, class sizes, and effectiveness of safety education.

Conclusions

Our model helps policymakers consider how mitigation options and the dynamics of school infection risks affect outcomes of interest. The model was designed in a period of considerable uncertainty and rapidly evolving science. It had practical use early in the pandemic to surface dynamics for school districts and to enable manipulation of parameters as well as rapid update in response to changes in epidemiological conditions and scientific information about COVID-19 transmission dynamics, testing and vaccination resources, and reliability of mitigation strategies.

Long-Acting Injectable Therapy for People with HIV: Looking Ahead with Lessons from Psychiatry and Addiction Medicine

Long-acting injectable antiretroviral medications are new to HIV treatment. People with HIV may benefit from a treatment option that better aligns with their preferences, but could also face new challenges and barriers. Authors from the fields of HIV, substance use treatment, and mental health collaborated on this commentary on the issues surrounding equitable implementation and uptake of LAI ART by drawing lessons from all three fields. We employ a socio-ecological framework beginning at the policy level and moving through the community, organizational, interpersonal, and patient levels. We look at extant literature on the topic as well as draw from the direct experience of our clinician-authors.

A pragmatic parallel arm randomized-controlled trial of a multi-pronged electronic health record-based clinical decision support tool protocol to reduce low-value antipsychotic prescriptions among older adults with Alzheimer's and related dementias

Among patients with Alzheimer's disease and its related dementias (ADRD) with behavioral disturbances, antipsychotic prescriptions have limited efficacy and increase the risk of death. Yet, physicians continue to routinely prescribe low-value antipsychotic medications for behavioral disturbances among patients with ADRD. We designed a pragmatic randomized-controlled trial to measure the impact of a behavioral economic electronic health record (EHR) clinical decision support (CDS) intervention to reduce physician prescriptions of new antipsychotic medications among patients with ADRD. Utilizing a pragmatic parallel arm randomized-controlled trial design, the study will randomize eligible physicians from a large academic health system to either receive a EHR CDS intervention or not (control) when they prescribe a new antipsychotic medication during visits with patients with ADRD. The intervention will include three components: 1) alerts prescribers that antipsychotic prescriptions increase mortality risk (motivating physicians' intrinsic desire for non-malfeasance); 2) offers non-pharmacological behavioral resources for caregivers; 3) auto-defaults the prescription to contain the lowest dose and number of pill-days (n = 30) without refills if the prescriber does not cancel the order (appealing to default bias). Over 1 year, we will compare the cumulative total of new antipsychotic pill-days prescribed (primary outcome) by physicians in the intervention group versus in the control group. The study protocol meets international SPIRIT guidelines. Behavioral economics, or the study of human behavior as a function of more than rational incentives, considering a whole host of cognitive and social psychological preferences, tendencies, and biases, is increasingly recognized as an important conceptual framework to improve physician behavior. This pragmatic trial is among the first to combine two distinct behavioral economic principles, a desire for non-malfeasance and default bias, to improve physician prescribing patterns for patients with ADRD. We anticipate this trial will substantially advance understanding of how behavioral-economic informed EHR CDS tools can potentially reduce harmful, low-value care among patients with ADRD.

Endocrine Autoantibodies Determine Immune Checkpoint Inhibitor-induced Endocrinopathy: A Prospective Study

CONTEXT

Incidence and awareness of endocrine-related adverse events (ERAE) associated with use of immune checkpoint inhibitors (ICI) has grown with increased ICI use, yet mechanisms for ERAE prediction, surveillance, and development are not well established.

OBJECTIVE

We prospectively evaluated the impact of endocrine autoimmunity on ERAE development and overall survival (OS).

METHODS

Adults ≥ 18 years of age prescribed ICI treatment for advanced or metastatic solid tumors and no known active/past endocrine disorders were eligible for enrollment. Thyroid, adrenal, and pancreatic antibodies as well as hormone levels were assessed prior to ICI treatment and at 8 to 9 weeks and 36 weeks after treatment for ERAE in relation to presence and changes in endocrine-specific antibodies, hormone levels, and OS.

RESULTS

Sixty patients were enrolled and ERAE were detected in 14 (23.3%), with a median onset of 52 days (IQR, 38.5-71.5) after first ICI dose. Hypothyroidism occurred in 12 (20%) patients, and 2 (3.33%) patients developed hypophysitis. Diabetes and primary adrenal insufficiency were not observed. Antibodies were detected in 14 patients (11 at baseline, 3 developed during follow-up) and their presence was significantly associated with ERAE (R2 59.3%, P < 0.001). Thyroid peroxidase antibody (20%) and thyroid-stimulating immunoglobulin (3.3%) were most common, and anti-GAD was present in 1 patient. The presence of ERAE was associated with a more favorable OS (P = 0.001).

CONCLUSION

Endocrine-specific autoantibodies play an important role in ERAE pathogenesis and may serve as predictive markers for early identification and treatment of ICI-induced endocrinopathies.