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• Fat mass during weight maintenance is independent of usual weight loss in athletes. • Athletes used to a higher degree of weight loss consumed more protein and less fat. • Athletes with a higher degree of weight loss seem to favor fat-free mass sparing. • Sex influences the negative relationship between fat intake and usual weight loss. • Food reward is not altered in athletes used to higher degrees of weight variations. Weight variations are common in sporting life, with important inter-individual variability in the degree of an athlete's habitual weight loss. As a part of the WAVE study (NCT04107545), the main objective of this preliminary study was to determine whether the habitual degree of weight loss was associated with anthropometric, body composition, nutritional or psychometric profiles during a period of weight maintenance in athletes accustomed to weight variations. We hypothesized that athletes accustomed to a higher habitual degree of weight loss may have a higher body weight and body fat mass, and may present a more controlled diet regimen and cognitive restriction than athletes with a lower habitual degree of weight loss. During a period of weight maintenance, 62 athletes (24.0 ± 5.3 years; 26 women) completed anthropometry and body composition measurements, a 48-hours food diary and self-reported questionnaires to determine their weight variation practice, nutritional profile and mood state. Athletes were stratified within inter- and intra-quartile groups according to their habitual degree of weight loss. Athletes with a higher habitual degree of weight loss were those who consumed more protein (P <.001) and less fat (P =.01) as a proportion of total energy compared with those losing less weight, without any difference in body composition between the groups. The rapid weight loss score was significantly higher in individuals losing more weight (P <.001) and no difference was observed for the mood state profile. The present results suggest a potential control of nutritional regulation during a period of weight maintenance in order to spare fat-free mass and favor fat mass loss in athletes who are routinely losing more weight. Fat-free mass may be the main nutritional driver due to low body fat mass in athletes, which may limit the "catch-up fat" phenomenon commonly observed in nonathletic population. Athletes used to weight variations (N = 62) were enrolled in a stable body weight period for physical and psychological measurements. The habitual degree of weight loss does not seem associated with body weight or composition nor the profile of mood state and food preferences. However, athletes used to a higher degree of weight loss consumed more relative protein and less relative fat than those losing less weight. This may suggest potential conscious control of nutritional regulation in order to spare fat-free mass and favor fat mass loss in those athletes losing more weight. %WL, usual degree of weight loss; BW, body weight; FFM, fat-free mass; FM, fat mass; RWLQ, rapid weight loss questionnaire. [Display omitted] [ABSTRACT FROM AUTHOR]

• Eating low-fat yogurt for 4 weeks had a minor impact on circulating immune markers. • The isocaloric nondairy control food increased regulatory T cells but lowered interleukin-10. • Yogurt consumption maintained the regulatory T and helper T-cell proportions. Yogurt consumption may help reduce chronic inflammation associated with obesity. However, the underlying mechanism(s) by which yogurt consumption modulates the immune system have not been validated in human intervention studies. We hypothesized that 4-week yogurt consumption (12 oz/day) attenuates systemic inflammation by modulating the proportion of circulating T helper (Th) 17 and regulatory T (Treg) cells in adult women with elevated body mass index (BMI). To test the hypothesis, we conducted a randomized crossover dietary intervention study consisted of a 4-week dietary intervention in which participants consumed 12 oz of either low-fat dairy yogurt or a soy pudding control snack per day, with a 4-week washout between treatments. Thirty-nine healthy adult women with a BMI between 25 and 40 kg/m2 were enrolled and 20 completed the study. Changes in the biometrics, circulating T cells, and markers of systemic and colonic inflammation were assessed between the 2 treatment groups, as well as 24-hour diet recalls were conducted at baseline and following each treatment. The primary study outcome, the change in the proportion of circulating Th17 cells, was unaffected by the treatments. Secondary outcome measures, circulating Treg, Th17, and markers of chronic inflammation, were maintained by yogurt treatment, whereas circulating Treg was increased and interleukin-10 was reduced by control snack treatment. However, circulating Treg changes were not associated with changes to other biomarkers of inflammation, implying other immune cells and/or tissues may mediate circulating biomarkers of chronic inflammation. This study was approved by the University of Wisconsin-Madison institutional review board and registered at ClinicalTrials.gov NCT04149418. We hypothesized that 4-week low-fat yogurt consumption (12 oz/day) attenuates systemic inflammation by modulating the proportion of circulating Th17 and Treg cells in adult women with elevated BMI. We conducted a randomized crossover dietary intervention study. Yogurt consumption had a minor impact on the immune cell and cytokine profiles, whereas IL-10 was reduced and Treg was increased by control intervention. Th17, T helper 17; Treg, regulatory T cell; BMI, body mass index; IL, interleukin. [Display omitted] [ABSTRACT FROM AUTHOR]

• Higher intact fruit intake is inversely associated with visceral adipose tissue in US adults aged 18-59 years. • The nonlinear inverse association strengthens with intact fruit intake below 1.7 cups equivalent daily. • Our findings effectively characterize the typical American adult consumer using sample-weighted methodologies. Excess visceral adipose tissue (VAT) plays a crucial role in leading to obesity-related diseases. However, the association between fruit intake (excluding fruit juice) and VAT is not well-known. We aim to further explore this association in a large population. We hypothesized that higher intact fruit intake would be inversely associated with VAT. A total of 9582 adult participants from the National Health and Nutrition Examination Survey and the Food Patterns Equivalents Database 2011-2018 were included. Weighted linear regression models were utilized to evaluate the association between intact fruit intake (from two 24-hour dietary recalls) and VAT area (measured by dual-energy X-ray absorptiometry). Subgroup analysis was conducted to test the robustness of the results. Restricted cubic spline analysis was performed to find the nonlinear association. The median of intact fruit intake was 0.32 cup-equivalent (eq)/d, and the mean of VAT was 104.87 ± 1.23 cm2. Intact fruit intake (increased by 1 cup-eq/d) demonstrated an inverse association with VAT area across three adjusted models, with β (95% confidence interval) values of –7(–8.49, –5.51), –6(–7.50, –4.51), and –3.02(–4.11, –1.94) in model 1, model 2, and model 3, respectively. Subgroup analysis revealed no interactions were found among age, sex, ethnicity, body mass index, and physical activity subgroups. Restricted cubic spline revealed the inverse association was more significant when intact fruit intake was less than 1.7 cups-eq/d. These findings suggest that increasing intact fruit consumption could be an effective public health strategy to mitigate VAT accumulation and associated health risks, advancing our understanding of dietary impacts on adiposity. In this cross-sectional study, a higher intact fruit intake was found to be inversely associated with visceral adipose tissue in United States adults. Abbreviation: NHANES, National Health and Nutrition Examination Surveys. [Display omitted] [ABSTRACT FROM AUTHOR]

A welcoming environment may influence patient care experiences, and it may be particularly relevant for underrepresented groups, such as women veterans at Veterans Health Administration (VA) facilities where they represent only 8–10% of patients. Challenges to ensuring a welcoming environment for women veterans may include unwelcome comments from male veterans and staff or volunteers and feeling unsafe inside or outside VA facilities. We assessed associations between reports of gender-related environment of care problems and patient-reported outcomes. We merged national patient-reported outcomes from women veterans (n = 4,961) using Consumer Assessment of Health Plans & Systems Patient Centered Medical Home (CAHPS-PCMH) survey composite measures with Women Veteran Program Managers' reports of gender-related environment of care problems (n = 127, 2016–2017) at VA facilities. We performed multilevel bivariate logistic regressions to assess associations between Women Veteran Program Managers' reports of large/extreme problems and likelihood of women veterans' optimal ratings of primary care experiences (access, coordination, comprehensiveness, provider communication, and overall rating of primary care provider). We adjusted for patient-, site-, and area-level characteristics, and clustering of patients within VA facilities, and we applied design weights to address nonresponse bias in the patient data. Response rates were 40% for women veterans and 90% for Women Veteran Program Managers. Few (<15%) Women Veteran Program Managers reported large/extreme environment of care problems. Women veterans obtaining care at those sites were less likely to rate provider communication and comprehensiveness (psychosocial health assessed) as optimal. Ensuring a welcoming environment may improve women veterans' primary care experiences. [ABSTRACT FROM AUTHOR]

Women veterans are at elevated risk for suicide and experience a high prevalence of suicidal ideation (SI) and suicide attempt (SA) history. Knowledge regarding SI/SA correlates among women veterans who use reproductive health care services is limited, inhibiting development of evidence-based, gender-sensitive suicide prevention programming tailored to meet women veterans' needs and preferences. This study aimed to 1) describe the prevalence and characteristics of SI and SA among women veterans using Veterans Health Administration (VHA) reproductive health care services and 2) provide an initial exploration of associations between fertility-, pregnancy-, and parenting-related factors with SI and SA to guide future research. Post-9/11 women veterans (n = 352) who used VHA reproductive health care in fiscal year 2018 completed a cross-sectional survey on reproductive health, mental health, and parenting. Approximately 30% and 12% experienced SI and SA(s), respectively, after military service; 10% reported past-month SI. Infertility, pregnancy loss, age at first pregnancy, and parental status were not significantly associated with SI or SA history, although notable effect sizes were observed for infertility and age at first pregnancy; further research is warranted. Among parents, parental functioning was not associated with SI/SA, but lower parental satisfaction was significantly associated with past-month SI (prevalence ratio, 3.36; 95% confidence interval, 1.19–9.46; adjusting for demographics, military characteristics, mental health symptoms). Postmilitary SI and SA(s) are common among women veterans accessing VHA reproductive health care services. Those with low parental satisfaction may be at particularly high risk. Findings can guide future research and inform clinical care to facilitate suicide prevention. [ABSTRACT FROM AUTHOR]

We aimed to develop and evaluate a novel model, PHI CARE, that provides a standardized framework for shared decision-making in contraceptive counseling. We developed the PHI CARE model with national experts, piloted it at three family planning clinics, and finalized it following additional patient and clinician review. We recruited pregnancy-capable people for an evaluation study via simulated contraceptive counseling and identified salient themes through inductive and deductive coding. Participants (n = 12) felt that counseling with the PHI CARE model was an improvement over previous counseling experiences and led to feelings of empowerment; participants did not feel pressured to decide about method use, felt in control during the conversation, and appreciated the absence of assumptions about their desires around pregnancy. Despite the standardized format, participants felt the counseling was individualized, "values-based," and tailored to their preferences. PHI CARE is a model to support clinicians and counselors in operationalizing the principles of shared decision-making in contraceptive counseling. Through standardization, PHI CARE allows for a more individualized experience for patients and addresses many critiques of traditional counseling. PHI CARE is a memorable, brief tool that can be used for patient-centered contraceptive counseling in any clinical encounter. [ABSTRACT FROM AUTHOR]

In Canada, colonial policies have resulted in health inequities between First Nations and other Canadians. These policies contribute to overrepresentation of First Nations in the criminal legal system, where incarcerated people and their infants face elevated health risks. We investigated the association between prenatal incarceration and adverse birth outcomes among First Nations and other birthing parents in Manitoba, Canada. Using linked whole-population administrative data, we identified all live births (2004–2017) in which the birthing parent (First Nations n = 1,449; other Manitoban n = 278) was prenatally incarcerated and compared them to birthing parents who were postnatally incarcerated (First Nations n = 5,290; other Manitoban n = 790) or not incarcerated (First Nations n = 19,950; other Manitoban n = 3,203). We used generalized linear models adjusted for measured confounders with propensity score weighting to calculate risk differences and 95% confidence intervals for adverse birth outcomes among those prenatally versus postnatally incarcerated in each group. Low birthweight births were more likely among First Nations birthing parents who were prenatally (vs. postnatally) incarcerated (risk difference 1.59, 95% CI [.79, 2.38]) but less likely among other Manitoban birthing parents (risk difference −2.33, 95% CI [−4.50, −.16]) who were prenatally (vs. postnatally) incarcerated. Among First Nations, prenatal incarceration was also associated with large-for-gestational-age births, low Apgar scores, and no breastfeeding (vs. postnatal incarceration), as well as preterm births (vs. no incarceration). Among other Manitobans, prenatal incarceration was also associated with small-for-gestational-age births, low Apgar scores, and no breastfeeding (vs. postnatal incarceration), as well as preterm births (vs. no incarceration). The findings suggest that incarceration may contribute to intergenerational systems of oppression by compromising birth outcomes among First Nations and other birthing parents in Canada and underscore the need to both improve care for pregnant people who are incarcerated and invest in alternatives to incarceration. [ABSTRACT FROM AUTHOR]

Cervical cancer disproportionately affects those who are underscreened. Human papillomavirus self-collection is a promising tool to expand screening. Study objectives were to examine 1) factors (provider characteristics and practice type) associated with and 2) attitudes (perceived benefits and concerns) toward using human papillomavirus self-collection for cervical cancer screening in clinical practice. This study had a mixed method design; prior to regulatory approval of self-collection, we conducted a national survey and interviews of health care providers who perform cervical cancer screening. Quantitative measures included provider and practice characteristics, willingness to recommend, and preferences related to self-collection. Qualitative interviews further elucidated provider perspectives. A total of 1,251 providers completed surveys, and 56 completed interviews. Among survey respondents, 33.4% reported they were likely to offer self-collection, 28.6% were unsure, and 38.0% reported they were unlikely. Most would offer self-collection either in the clinic or at home per patient preference. Male participants, advanced practice providers, internal and family physicians, and those practicing in academic medical center, hospital, or community health settings were more likely than female participants, obstetrician–gynecologist physicians, and those in private practice to indicate they were likely to offer self-collection. Concerns expressed in both surveys and interviews included the adequacy of sample collection and the ability to follow up. Respondents felt that self-collection would be particularly beneficial for those who did not have access to clinician-collected screening, as well as for patients who may have difficulty with pelvic examinations for any reason. Providers considered human papillomavirus self-collection to be a way to expand access for patients with health care barriers and pelvic examination difficulties. They had concerns related to sample adequacy and follow-up after abnormal results. [ABSTRACT FROM AUTHOR]

Self-collected testing for human papillomavirus (HPV) is poised to transform cervical cancer screening. Self-tests demonstrate similar accuracy to clinician-collected tests, but for the half a million women served by the Veterans Health Administration (VA) and their clinicians, self-collected cervical cancer screening would be a new practice. We examined VA patient and staff perspectives to inform future implementation. Semi-structured telephone interviews were conducted between 2021 and 2022 with female veterans receiving VA care (n = 22) and VA women's health nurses, clinicians, and administrators (n = 27). Interviews were audio-recorded and transcribed. Interview questions addressed knowledge and interest, potential advantages or disadvantages, and any questions participants had about self-collected screening. Responses were analyzed using rapid qualitative methods. Five overarching themes were identified. Both patients and staff indicated high interest and enthusiasm for self-collected HPV testing, tempered by questions about test accuracy and logistical considerations. Familiarity with self-testing for other conditions such as colon-cancer screening or COVID made self-collection seem like a simple, convenient option. However, self-testing was not viewed as a good fit for all patients, and concerns about lost opportunities or missed incidental lesions were raised. Patients and staff described challenges with pelvic examinations for patients with past sexual trauma, particularly in the male-dominated VA environment. Pelvic exams can leave patients feeling vulnerable and exposed; self-collected testing was seen as a mechanism for patient empowerment. Veteran patients and VA staff shared common perspectives about potential advantages and disadvantages of self-collected HPV testing. Self-collected HPV testing has the potential to improve trauma-informed preventive health care for veterans. [ABSTRACT FROM AUTHOR]

The U.S. Food and Drug Administration (FDA) approved the etonogestrel contraceptive implant for 3 years of use. Evidence suggests that it may be used for up to 5 years for pregnancy prevention, also known as extended use. We conducted a national cross-sectional survey among a group of reproductive health clinicians. We developed an online survey using the Consolidated Framework for Implementation Research (CFIR) and distributed it through e-mail listservs and social media groups from May to June 2021. We analyzed results using multivariable logistical regression. Among the 300 respondents, 195 (65.0%) reported that they always offer extended use, and 50 (16.7%) reported that they sometimes offer extended use. Fifty-five respondents (18.3%) reported that they never offer extended use. After adjusting for age, gender, and clinical setting, we found that complex family planning sub-specialists (adjusted odds ratio [aOR] = 9.32; 95% confidence interval [CI] [1.81, 48.03]) and family medicine physicians (aOR = 4.37, 95% CI [1.58, 12.10]) were significantly more likely to recommend extended use compared with general obstetrics and gynecology (OBGYN) physicians. Clinicians from private practices or health maintenance organizations were significantly less likely to offer extended use than those from academic centers (aOR = 0.19, 95% CI [0.07, 0.51]; aOR = 0.06, 95% CI [0.01, 0.31]). The most common barriers to offering extended use were concerns about pregnancy risk, bleeding, and lack of FDA approval past 3 years. Meanwhile, clinicians identified strong published evidence supporting extended use as a key facilitator for offering it, and they perceived that prior counseling on extended use from a past clinician was a key facilitator for patients to adopt it. One-third of clinicians in this study did not consistently offer extended use of the contraceptive implant. An opportunity exists to expand access to extended use by focusing on education interventions for clinicians and seeking FDA approval for 5 years of use. [ABSTRACT FROM AUTHOR]

Individuals with severe burn injuries may develop depression, yet knowledge about psychological risk factors for depression following trauma is limited. This study investigated the prospective impact and interplay of prior depression and trauma-related cognitive processes (posttraumatic negative appraisals and trauma-related rumination) to depressive symptoms between 6 and 24 months after burn injury. Taiwanese adult survivors of burn (N = 118) participated in surveys immediately post-burn and at 6-, 12-, and 24-months follow-up. Participants were 7 5% men, with an average age of 41.8 years and an average of TBSA of 18.3%. A total of 8.5%, 5.9%, and 4.2% met criteria for probable major depression at 6, 12, and 24 months post-burn, respectively. The prevalence increased to 23.7%, 11.0%, and 5.9% using the cutoff on the PHQ-9. Prior depression and trauma-related cognitive processes immediately post-burn explained 13.5%, 20.5%, and 18.6% of the variance in depressive symptoms at 6, 12, and 24 months post-burn, respectively. Posttraumatic negative appraisals strongly predicted depressive symptoms post-burn across follow-ups. Moreover, posttraumatic negative appraisals significantly mediated the effect of prior depression on subsequent depressive symptoms across follow-ups. Prior depression significantly moderated the effect of trauma-related rumination on depressive symptoms at 6 months post-burn. Our results are the first to demonstrate the role and interplay of prior depression and trauma-related cognitive processes in post-burn depression. Findings highlight that pre-and post-trauma psychological factors jointly affect depression following trauma, broadening the applicability of cognitive theories of PTSD. • This study examined the contribution effect of early psychological risk factors to post-burn depressive symptoms. • Depression is relatively common at 6 months post-burn and then gradually decreased. • Posttraumatic negative appraisals strongly predicted depressive symptoms between 6 and 24 months post-burn. • Posttraumatic negative appraisals mediated the effect of prior depression on long-term depressive symptoms after burn. [ABSTRACT FROM AUTHOR]

This study aimed to examine the feasibility and effectiveness of online group psychotherapy focused on self-compassion for individuals experiencing bereavement-related grief. This single-arm feasibility trial involved participants aged 18 years or older who had experienced bereavement at least 6 months prior the five-week intervention. Outcomes were measured at baseline, immediately post-intervention, and 4 and 12 weeks later. The primary endpoint was the percentage of participants who completed four out of five sessions; the pre-defined feasibility criterion was 70%. Secondary endpoints included measures of grief, depression, anxiety, self-compassion, and resilience. The program was conducted in three courses with 18, 26, and 16 participants, respectively. The primary endpoint was met for 83.1% of participants (54/65). Cohen's d effect sizes ([95% CI] 12 weeks vs. baseline) for grief, depression, anxiety, self-compassion, and resilience were − 0.25 [−0.52, 0.03], −0.64 [−0.94, −0.34], −0.48 [−0.77, −0.19], 0.50 [0.21, 0.79], and − 0.07 [−0.34, 0.21], respectively. Online group psychotherapy focused on self-compassion for individuals with bereavement-related grief is feasible and effective for addressing grief and psychological distress. Randomized controlled trials are warranted to confirm the intervention's efficacy. UMIN000048554, registered 2 August 2022. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the independent and joint associations of accelerometer-derived sleep duration and physical activity (PA) in different intensities with the risk of incident heart failure (HF). The study included 89,572 participants (mean age 62.2 ± 7.8 years, 42.8% male) from the UK Biobank. Sleep duration (short: <6 h/day; normal: 6–8 h/day; long: >8 h/day) and PA [total PA, light PA (LPA), moderate-to-vigorous PA (MVPA), vigorous PA (VPA)] were measured using accelerometers over 7 days. MVPA and VPA were categorized according to the World Health Organization's recommended levels, while LPA and total PA were categorized based on the median. HF cases were identified through hospital records or death registries. Over a 7-year follow-up period, 1324 participants (2.1%; incidence rate, 2.1 per 1000 person-years) developed HF. Short, but not long, sleep duration was linked to a 33% increased risk of HF [hazard ratio (HR) 1.33, 95% confidence interval (CI): 1.11–1.59]. This increased risk associated with short sleep could be mitigated by increasing PA, especially to the levels of recommended MVPA or VPA. In joint analyses, compared to participants meeting the recommended MVPA and with normal sleep duration, those not meeting the MVPA recommendation and with short sleep had the highest HF risk (HR 1.78, 95% CI: 1.42–2.25). Accelerometer-derived short, but not long, sleep duration was associated with a higher risk of incident HF. Engaging in sufficient PA, especially recommended MVPA or VPA, can partially mitigate this risk. [Display omitted] • Accelerometer-measured short sleep duration is independently associated with a higher risk of heart failure. • Higher physical activity levels, regardless of intensity, reduce the heart failure risk linked to short sleep duration. • Our study suggests for promoting recommended levels of PA, especially in situations where sleep duration may be compromised. [ABSTRACT FROM AUTHOR]

Psychosocial assessment is a core component of the multidisciplinary evaluation for left ventricular assist device (LVAD) implantation. The degree to which psychosocial conditions are considered a contraindication to LVAD implantation continues to be debated. This systematic review examines modifiable psychosocial factors as predictors of outcomes in patients undergoing LVAD implantation. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The search resulted in 2509 articles. After deduplication, abstract and full-text review, 20 relevant articles were identified. Included studies evaluated socioeconomic status (n = 6), caregiver characteristics (n = 6), non-adherence (n = 6), substance use (n = 13), and psychiatric disorder (n = 8). The most commonly measured outcomes were all-cause death, readmission rate, and adverse events. Studies varied widely in definition of each psychosocial factor and selected outcomes. No psychosocial factor was consistently associated with a specific outcome in all studies. Socioeconomic status was generally not associated with outcomes. Non-adherence, psychiatric disorder, and substance use were associated with higher risks of mortality, adverse events, and/or readmission. Findings on caregiver characteristics were mixed. Of the psychosocial factors studied, non-adherence, psychiatric disorder, and substance use were the most consistently associated with an increased risk of mortality, readmission, and/or adverse events. Heterogeneity in research methodology and study quality across studies precludes firm conclusions regarding the impact of psychosocial factors on long-term patient outcomes. The results of this review reveal a need for adequately powered studies that use uniform definitions of psychosocial factors to clarify relationships between these factors and outcomes after LVAD implantation. [ABSTRACT FROM AUTHOR]

Post-stroke depression (PSD) is a common neurological and psychiatric sequelae following a stroke, often surpassing the primary effects of the stroke due to its strong correlation with high mortality rates. In recent years, non-pharmacological therapy has garnered significant attention as a supplementary treatment for PSD, becoming widely adopted in clinical practice. However, the efficacy of specific intervention strategies remains unclear. This study aimed to conduct a network meta-analysis (NMA) of published studies to compare the efficacy of different non-pharmacological therapies for treating PSD. We systematically searched five databases from inception through March 2024 to identify randomized controlled trials (RCTs) evaluating non-pharmacological therapies for the treatment of PSD. We considered individual intervention and intervention class. Intervention classes included traditional Chinese medicine (TCM), non-invasive electrotherapy stimulation (NIES), psychotherapy (PT), exercise therapy, hyperbaric oxygen, and combined interventions. The NMA was conducted using R and Stata software, following a frequency-based methodology. Assessment of methodological quality and risk of bias was conducted using the Risk of Bias assessment tool 2.0. Therapies were ranked using the P-score, and box-plots visualization, meta-regression, and sensitivity analysis, were performed to assess transitivity, heterogeneity, and consistency, respectively. The NMA included 43 studies with a total of 3138 participants. Random-effects models revealed significant efficacy for acupuncture (ACUP) (P-score = 0.92; pooled standardized mean difference (95% CI): −3.12 (−4.63 to −1.60)) and transcranial direct current stimulation (P-score = 0.85; −2.78 (−5.06 to −0.49)) compared to the treatment as usual (TAU) group. In categorical comparisons, TCM_PT (P-score = 0.82; −1.91 (−3.54 to −0.28)), TCM (P-score = 0.79; −1.65 (−2.33 to −0.97)), and NIES (P-score = 0.74; −1.54 (−2.62 to −0.46)) showed significant differences compared to TAU group. Furthermore, our results indicated no significant difference between PT and the control groups. However, Confidence in Network Meta-Analysis results indicated very low overall evidence grade. Limited evidence suggests that ACUP may be the most effective non-pharmacological therapy for improving PSD, and TCM_PT is the best intervention class. However, the evidence quality is very low, underscoring the need for additional high-quality RCTs to validate these findings, particularly given the limited number of RCTs available for each therapy. • Acupuncture showed the greatest improvement in depression symptoms in patients with post-stroke depression. • Given the overlap between stroke and depression symptoms, passive therapiesmay be more appropriate and efficacious for patients. • Categorical comparisons suggest that traditional Chinese medicine combined with psychotherapy may have the best efficacy in treating post-stroke depression. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the association between depressive symptoms and second primary cancer (SPC) in U.S. cancer survivors. Cancer survivors from the 2005–2018 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study, and depressive symptoms were defined by the Patient Health Questionnaire 9 (PHQ-9). The association between depressive symptoms and SPC was assessed via multiple logistic regression, restricted cubic spline (RCS), sensitivity, and subgroup analyses. This study involved 2315 participants representing >15 million noninstitutionalized U.S. residents. Multivariate logistic regression fully adjusted for confounders revealed that cancer survivors with a PHQ-9 score ≥ 10 had a greater risk of developing SPC than those with a PHQ-9 score of 0–4 ([OR] = 1.88, 95% [CI] = 1.20–2.89, p = 0.005). The RCS showed a linear positive correlation between the PHQ-9 score and SPC (p for overall = 0.017). The robustness of this association was subsequently confirmed via multiple interpolation of missing data and different cluster-level methods (namely weighted linear regression) as sensitivity analyses. Furthermore, subgroup analyses confirmed this correlation was stronger in participants with sleep duration <7 h (p for interaction = 0.036). Moderate to severe depressive symptoms in cancer survivors were associated with an increased risk of developing SPC, especially at <7 h of sleep. • Depressive symptoms may be positively associated with the risk of second primary cancer (SPC). • This study utilized NHANES data to provide a representative analysis of the U.S. population, providing broader implications for public health and policy. • Improving depression is a potential prevention strategy for SPC. [ABSTRACT FROM AUTHOR]

To examine associations between regular statin use and the incidence of depression and anxiety. This cohort was based on UK Biobank participants without depression/anxiety recruited between 2006 and 2010. The self-reported regular statin use was collected at baseline. Depression and anxiety outcomes were assessed by diagnostic interviews (international classification of diseases codes) and nondiagnostic scales (mental well-being questionnaires). Cox proportional hazards models adjusted for a wide range of confounders were used to estimate associations of statins with incident depression/anxiety. Among 363,551 eligible participants, 55,838 reported regular statin use. During a 13-year follow-up, 14,765 cases of depression and 15,494 cases of anxiety were identified. Compared with non-statin users, statin use was associated with reduced risk of depression (hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.81, 0.94) and anxiety (HR: 0.90, 95% CI: 0.84, 0.97). Effects of statins on depression were consistent in sensitivity analyses and may be less influenced by unmeasured confounders. However, results of online survey data showed that statin use might not be associated with incident anxiety (HR: 0.96, 95% CI: 0.85, 1.09). Regular statin use was associated with a lower risk of depression. No clear associations between statin use and anxiety were found. [ABSTRACT FROM AUTHOR]

In the current exploratory study we estimate comorbidity rates between FDs [fibromyalgia (FM), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and irritable bowel syndrome (IBS)]—and IDs—[major depressive disorder (MDD) and generalized anxiety disorder (GAD)] by using self-reported diagnostic criteria. We analyzed data from 107,849 participants (mean age = 49.3 (SD = 13.0), 58.6% women) of the Lifelines Cohort Study. Lifelines is a prospective population-based cohort study in the northeast of the Netherlands. Current IDs were assessed using the Mini-International Neuropsychiatric Interview. Current FM, ME/CFS, and IBS were assessed according to the 2010 American College of Rheumatology criteria, the 1994 Centers for Disease Control and Prevention criteria and the ROME IV criteria, respectively. We estimated tetrachoric correlations between diagnoses and tested for sex differences. Additionally, we estimated the ratio of observed-to-expected frequency for combinations of diagnoses. FDs and IDs are highly comorbid (odds ratios: 3.2–12.6) with associations stronger among men. Participants with at least three disorders/diagnoses were more prevalent than expected by chance. Studies that aim to explain sex differences and the comorbidity of specific combinations of IDs and FDs will be an important contribution to understanding the etiology of these conditions. • Internalizing disorders and functional disorders are highly comorbid. • Irritable bowel syndrome is not as closely related to internalizing disorders as the other functional disorders. • The association between functional disorders and internalizing disorders is larger in male participants. • Combinations of functional disorders/internalizing disorders including three or more conditions occur frequently. [ABSTRACT FROM AUTHOR]

Perinatal mental and anxiety disorders (PMADs) contribute to adverse health outcomes, though they are underrecognized and undertreated. Inpatient obstetric settings represent a unique opportunity for behavioral health engagement, including screening, brief treatment, and referrals for outpatient care. The proactive consultation-liaison (CL) model has proven effective in general hospital settings but is not well-studied in obstetric settings. This article describes the implementation and evaluation of a proactive CL model in an inpatient obstetric unit within a tertiary medical center. We implemented a multidisciplinary, proactive CL model in an inpatient obstetric unit with the purpose of identifying patients at risk for or experiencing PMADs and providing intervention and/or referral to treatment. Systematic screening of 7322 admitted patients was performed over a 17-month period to identify eligible patients for behavioral health consultation. Consultation data was retrospectively extracted from the electronic medical record. Key implementation outcomes were assessed using a RE-AIM measures (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. 1589 initial consults were conducted by the multidisciplinary team, yielding a consult rate of 21.7 %. The majority of consults (94 %) were completed by a social worker or psychologist, with most patients identified for consultation at multidisciplinary rounds (60.7 %). The most common indications for consultation with a psychiatrist included medication management, history of bipolar disorder, and history of anxiety. All invited staff and providers participated in the model. Alternative funding sources agreed to cover the salaries of the multidisciplinary team following conclusion of pilot grant funding. A proactive CL model implemented in an inpatient obstetric unit led to a higher consult rate (21.7 %) than is observed with traditional CL services. A multidisciplinary proactive CL model shows promise in identifying people at-risk for PMADs and providing targeted interventions to prevent PMADs and treat those with active symptoms. • The proactive CL model increases the consult rate in inpatient obstetric settings. • Team presence at interdisciplinary rounds leads to identification of most consults. • Many consults can reasonably be seen by a social worker or psychologist. • An interdisciplinary team facilitates targeted use of a psychiatrist for complex cases. [ABSTRACT FROM AUTHOR]

Suicide prevention is a top clinical priority within the Department of Veterans Affairs (VA). While research consistently shows that suicide risk is associated with adverse social determinants of health (SDH, e.g., housing instability, unemployment, justice involvement), less is known about the extent to which suicide prevention staff are aware of and able to address these risk factors. This study aimed to understand the experiences of VA Suicide Prevention Coordinators (SPCs) with referring Veterans at risk of suicide to services that address SDH. In January–February 2022, 171 VA SPCs completed a questionnaire about their experiences connecting Veterans with SDH-focused services. Descriptive statistics summarized closed-response items and a thematic analysis was conducted for open-ended responses. The majority of SPCs agreed that adverse SDH contribute to suicide risk and that services to address SDH could reduce suicide risk for Veterans. While most SPCs were aware of on-site SDH services, many reported barriers to connecting Veterans with those services including insufficient resources, lack of staff time, and eligibility criteria. Changes at the organizational and policy levels are needed to provide comprehensive suicide prevention services that connect at-risk Veteran with services to address adverse SDH. [ABSTRACT FROM AUTHOR]

Addressing the limited access to treatments for alcohol dependence, we developed ALM-002, a therapeutic application to be "prescribed" for non-abstinence-oriented treatment in internal medicine settings. Our objective was to preliminarily assess the efficacy and safety of ALM-002. In a multicenter, open-label randomized controlled trial, participants aged ≥20 with alcohol dependence and daily alcohol consumption exceeding 60 g for men and 40 g for women, without severe complications, were randomly assigned to either the intervention group using ALM-002 or the treatment-as-usual control group. Participant in both groups received individual face-to-face sessions by physicians at weeks 0, 4, 8, and 12. The primary endpoint was the change in heavy drinking days (HDDs) from week 0 to week 12. A mixed model for repeated measures was employed. We enrolled 43 participants: 22 in the intervention group and 21 in the control group. A significant reduction in HDDs every 4 weeks from week 0 to week 12 was observed, with a between-group difference of −6.99 days (95% CI: −12.4 to −1.6 days, standardized mean difference: −0.80). These results indicate the potential of ALM-002 as a viable treatment for alcohol dependence. Further studies are needed to evaluate the clinical potential of ALM-002. [ABSTRACT FROM AUTHOR]

This study aimed to examine blood pressure changes during ketamine infusion for depression and exploring the factors associated with these changes. This study is a retrospective chart-review of patients with depression undergoing ketamine infusion at Yale Psychiatry Hospital during a 7-year period. Blood pressure (BP) was recorded every 10 min during the infusion. Surges in systolic and diastolic blood pressure (SBP, DBP), along with severe hypertension events, were analyzed in relation to patient demographics. A total of 138 patients received a total of 2342 infusions. SBP and DBP peaked at 40 min after the start of the infusion with a mean change of 16.0 (SD: 11.2) and 11.0 mmHg (SD: 8.45) respectively. Severe hypertension was observed in 17 patients (12.5%) and 23 infusion sessions (0.98%), occuring more frequently during the first three infusions (43.4%). Age (OR = 1.04 [1.02,1.05], p -value <0.001) was significantly associated with a surge in SBP and all patients with a past medical history of hypertension experienced a BP surge during their infusions. Ketamine infusions can cause significant blood pressure increases, particularly in older and hypertensive patients, highlighting the need for careful cardiovascular monitoring to mitigate risks during treatment. [ABSTRACT FROM AUTHOR]

Caregiving burden is set to increase with the rising incidence of cancer globally. The meta-analysis seeks to investigate the prevalence of suicide, suicidal ideation and self-harm among the caregivers of patients with cancer (CPCs). This PRISMA-adherent systematic review involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all studies that evaluated the prevalence of suicide, suicidal ideation and self-harm in CPCs. Random effects meta-analyses were used for primary analysis. Eleven studies were included. Meta-analyses indicated that the prevalence of suicidal ideation in CPCs was 11% (95%CI:6–18), suicide prevalence was 6% (95%CI:3–12), and self-harm prevalence was 15% (95%CI:8–26). Subgroup analyses revealed that CPCs above the age of 50 experienced a greater prevalence of suicidal ideation (17%, 95%CI:10–28) as compared to CPCs below 50 (6%, 95%CI:3–12). Family caregivers particularly spouses were also found to have a higher prevalence of suicidal ideation (17%, 95%CI:13–23), as compared to children (5%, 95%CI:2–10) or mothers (3%, 95%CI:1–8). Systematic review found that having a pre-existing mental health condition and lower socioeconomic status increased likelihood of suicidality. We highlight the need for more support of CPCs at risk of suicidality. Additional research is warranted to identify other risk and protective factors. • Statistically high prevalence of suicide ideation, suicide and self-harm in caregivers of cancer patients. • Cancer caregivers above 50 years old compared to those below 50 experienced greater suicide ideation. • Family caregivers particularly spouses compared to children or mothers experienced greater suicide ideation. • Pre-existing mental health condition and lower socioeconomic status increased the likelihood of suicidality. [ABSTRACT FROM AUTHOR]

Limited data exist on racial-ethnic differences in the application of restraints for patients visitng the emergency department (ED). This study examines whether there is an association between race and patient ED visit type with the application of four-point mechanical restraints in a high acuity safety-net urban academic hospital. The study retrospectively reviewed 198,610 visits to the ED at Boston Medical Center made by patients between 18 and 89 years old between May 1, 2014 and May 1, 2019. ED visit type was categorized based on primary billing code for the visit as either medical or behavioral; behavioral visits were further categorized into 5 groups based on corresponding primary psychiatric billing code category. The relationships between race/ethnicity and four-point mechanical restraints were analyzed using binary logistic regression models in SPSS. 1.4% of unique visits involved the use of four-point mechanical restraints. Patients with a behavioral visit were significantly over 16 times more likely to be restrained than those with a medical visit. Black patients were significantly more likely to be restrained than white patients for behavioral visits but less likely for medical visits. Black and Hispanic patients were also significantly more likely to be restrained for a behavioral visit regardless of psychiatric diagnosis. Asian patients were less likely to be restrained regardless of ED visit type. Significant racial differences in restraints for White patients with medical visits and Black and Hispanic patients with behavioral visits prompts further investigation on the role of clinician bias when managing acute patients. [ABSTRACT FROM AUTHOR]

Insufficient acute psychiatric care substantially impacts patient well-being and healthcare quality. Early readmissions after discharge from psychiatric care are common, and preventing these is important for the patients as well as appropriate resource allocation. The relationship between post-discharge general practitioner (GP) contact and readmission rates remains to be explored, as does the association between pre-hospital GP contact and post-discharge engagement. This study examines post-discharge GP contact and its association with outpatient revisits and inpatient readmissions among unplanned psychiatric hospital contacts, including the impact of pre-visit GP contact on post-discharge care within 14 days. Utilizing data from the Danish healthcare system (2019–2023), unplanned psychiatric hospital contacts and subsequent 14-day GP encounters were analyzed. Of 298,085 unplanned psychiatric hospital contacts, 12.6% had a 14-day revisit as an outpatient and 13.6% had a 14-day readmission as an inpatient. During regular business hours, GP contact was associated with a decreased risk of unplanned outpatient revisits (HR 0.45, 95% CI 0.44–0.47) and inpatient readmissions (HR 0.43, 95% CI 0.41–0.44). Similarly, utilizing GP on-call services was linked to a reduced risk of unplanned revisits (HR 0.87, 95% CI 0.81–0.94) and readmissions (HR 0.81, 95% CI 0.76–0.87). Having a GP contact within two days before an unplanned psychiatric hospital contact increased the likelihood of having a GP contact within 14 days post-discharge. Post-discharge GP encounters were associated with lower rates of 14-day outpatient revisits and inpatient readmissions following unplanned psychiatric hospital contacts. GP contact before psychiatric hospital contact enhances attendance at post-discharge appointments, suggesting a potential efficacy of promoting GP appointments for mental health care. [ABSTRACT FROM AUTHOR]

Valbenazine is commonly used to treat tardive dyskinesia, and we conducted a pharmacovigilance analysis using the Food and Drug Administration Adverse Event Reporting System (FAERS) to evaluate neurological safety signals associated with valbenazine. Data was collected in FAERS from the second quarter of 2017 to the fourth quarter of 2023 for data cleaning. Neurological adverse event (AE) signals of valbenazine were mined by calculating reporting odds ratios (ROR), information component (IC) and empirical Bayesian geometric mean (EBGM). The serious and non-serious cases and signals were prioritized using a rating scale. The number of neurological AE reports where the primary suspect (PS) drug was 8981 for valbenazine. Significant AE signals were identified by the preferred term (PT) analysis for valbenazine, including somnolence (ROR 19.69), tremor (ROR 15.17), and tardive dyskinesia (ROR 236.91), among which 18 AEs were identified as new signals. Patient age (p < 0.009) and sex (p = 0.197) might be associated with an increased risk of neurological AE severity. Notably, the association between valbenazine and neurological disorders remained when stratified by sex, age, and reporter type. AE timing analysis was performed for the drug and four moderate clinical priority signals [i.e., somnolence, balance disorder, parkinsonism, and akathisia (priorities 7)], showing the same early failure type profiles. The increase in neurological safety signals is identified in the post-marketing research of valbenazine. Clinicians need to pay attention to not only common AEs but also be alert to new neurological AE signals when using valbenazine. • This study provides the latest valbenazine-related neurological safety profiles, and eighteen AEs were identified as new signals. • Neurological AEs most commonly identified for valbenazine were somnolence, tremor, dizziness, drooling, dyskinesia, and balance disorder. • Our findings could potentially prompt improved awareness of valbenazine-related toxicities and help healthcare professionals mitigate the risk of neurological events. [ABSTRACT FROM AUTHOR]

To compare the prevalence of physical morbidities between older aged patients with bipolar disorder (OABD) and non-psychiatric comparisons (NC), and to analyze sex differences in prevalence. OABD was defined as bipolar disorder among adults aged ≥50 years. Outcomes analyzed were the prevalence of diseases affecting the cardiovascular, respiratory, gastrointestinal, genitourinary, renal, musculoskeletal, and endocrine systems. The analysis used cross-sectional data of OABD participants (n = 878; mean age 60.9 ± 8.0 years, n = 496 (56%) women) from the collaborative Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) dataset and NC participants recruited at the same sites (n = 355; mean age 64.4 ± 9.7 years, n = 215 (61%) women). After controlling for sex, age, education, and smoking history, the OABD group had more cardiovascular (odds ratio [95% confidence interval]: 2.12 [1.38–3.30]), renal (5.97 [1.31–43.16]), musculoskeletal (2.09 [1.30–3.43]) and endocrine (1.90 [1.20–3.05]) diseases than NC. Women with OABD had more gastrointestinal (1.56 [0.99–2.49]), genitourinary (1.72 [1.02–2.92]), musculoskeletal (2.64 [1.66–4.37]) and endocrine (1.71 [1.08–2.73]) comorbidities than men with OABD, when age, education, smoking history, and study site were controlled. This replication GAGE-BD study confirms previous findings indicating that OABD present more physical morbidities than matched comparison participants, and that this health burden is significantly greater among women. [ABSTRACT FROM AUTHOR]

Antipsychotic-induced weight gain (AIWG) is a significant but frequently neglected adverse effect of first- and second-generation antipsychotic therapy, which may lead to cardiovascular disturbances. The present network meta-analysis (NMA) was conducted to evaluate and compare the effects of available treatment options in antipsychotic-induced weight gain (AIWG). The data was extracted from 68 relevant clinical trials after a literature search on MEDLINE/PubMed, Embase, Scopus, Cochrane databases and clinical trial registries. Random-effects Bayesian NMA was done to pool the effects across the interventions for the change in body weight from baseline. A network graph was built, a consistency model was run, node split analysis was performed, treatments were ranked as per the SUCRA score and meta-regression was done for the duration of therapy, baseline body weight and treatment strategy as the predictor variables. Finally, the results were sorted based on the certainty of evidence. The drugs showing significant reduction in body weight in order of magnitude of effect size include sibutramine 10 mg (−8.0 kg; −16. to −0.21), metformin 750 mg + lifestyle modification (−7.5 kg; −12 to −2.8), topiramate 200 mg (−7 kg; −10 to −3.4), metformin 750 mg (−5.7 kg; −9.3 to −2.1), topiramate 100 mg (−5.7 kg; −8.8 to −2.5), topiramate 50 mg (−5.2 kg; −10 to −0.57), liraglutide 1.8 mg (−5.2 kg; −10., −0.080), sibutramine 15 mg (−4.5 kg; −8.9 to −0.59), nizatidine 300 mg (−3.0 kg; −5.9 to −0.23) and metformin 1000 mg (−2.3 kg; −4.6 to −0.0046). There was no effect of duration of follow-up, baseline body weight and, preventive versus therapeutic strategy on weight reduction in AIWG. Metformin 750 mg with lifestyle modification was the most effective treatment for AIWG, followed by topiramate 200 mg, metformin 750 mg, and topiramate 100 mg with moderate certainty of evidence. • This network meta-analysis compared pharmacological agents used for antipsychotic-induced weight gain (AIWG) in schizophrenia. • Metformin (750 mg) with lifestyle modification is the best available treatment for AIWG, followed by topiramate (200 mg) and metformin (750 mg). • Other interventions which had a significant weight reduction effect were topiramate (50 mg and 100 mg), nizatidine 300 mg and metformin 1000 mg. • Liraglutide 3 mg had the highest magnitude of weight reduction as compared to placebo when meta-regression with baseline mean weight was done. [ABSTRACT FROM AUTHOR]

This study provides three prevalence-based metrics of potential harm, the fatal toxicity index (FTI), serious morbidity index (SMI) and healthcare utilization index (HUI) for fourteen of the most prescribed antidepressants in the US. For the years 2013–2020, adverse events for single drug exposures were obtained from the National Poison Data System. Prescription estimates were taken from the Agency for Healthcare Research and Quality's Medical Expenditure Survey. 95% confidence intervals were calculated using a Poisson distribution. Chi-square testing was used where significance was not clear. SSRIs and SNRIs had the lowest overall indices (FTI 0.02–0.26). Bupropion's FTI (0.27–0.43) was not statistically significantly different from that of imipramine (FTI 0–1.3, p =.62) or nortriptyline (FTI 0.25–0.78, p =.22), though its SMI and HUI were significantly greater. There was a statistically significant difference in all indices between TCAs (p <.0047). The difference between the FTI of all SSRIs did not remain significant after correction (p =.045). SSRIs and SNRIs are safer than alternative agents on all measures. Bupropion exposure was as likely to cause mortality, and more likely to cause morbidity or require treatment in a healthcare facility, than TCAs nortriptyline and imipramine. [ABSTRACT FROM AUTHOR]

Develop and test a Food-Related Control Scale (FRCS) measuring resident-perceived control in long-term care food service. A bank of 15 initial items based on a multidimensional locus of control construct was developed initially. Expert review, cognitive interviews, a pilot study, and factor analysis were used to validate the instrument and assess reliability. Individual phone-based cognitive interviews and 16 skilled nursing facilities in the US. Cognitive interviews included a convenience sample of independently living adults aged ≥ 65 (n = 13), whereas the pilot study included skilled nursing facility-residing adults (n = 166). Perception of food-related control in a long-term care setting. Cognitive interviews were analyzed to develop items. Quantitative data from skilled nursing facility residents were analyzed using SAS software for structural equation modeling and factor analysis. A 2-dimensional construct (9 items) of the FRCS demonstrated reliability with factor analysis. Concurrent validity within the locus of control construct was demonstrated with the Multidimensional Health Locus of Control Scale (standardized estimate of 0.430; P < 0.1). The FRCS may be used to determine how residents in long-term care perceive control over their food experiences. Further testing is necessary to determine the appropriateness of the FRCS for different population uses. [ABSTRACT FROM AUTHOR]

To understand the perspectives of key informant experts regarding the relationship between food insecurity and gestational diabetes mellitus risk reduction behaviors among young American Indian and Alaska Native females. Participants were adult key informants with expertise in food/nutrition and health within Tribal communities (N = 58) across the US. Data were collected through 1:1 interviews using a semistructured moderator guide and analyzed using thematic content analysis methods. Three themes included (1) diet and nutrition habits are formed through intergenerational food preferences and are driven by lasting implications of colonization; (2) young people are influenced by what their peers eat and the food environment, including outside of the home; and (3) the methods used to understand household food insecurity and nutrition habits in the parent study were likely limited. Findings provide guidance as to where nutrition education and interventions may best support young Native females. [ABSTRACT FROM AUTHOR]

Test an obesity intervention for families with low incomes. A total of 208 families were included (a parent with a body mass index [BMI] ≥ 30 and a child aged 6–12 years). A 12-month randomized controlled trial combining family health coaching (motivational interviewing) and connection to community resources. Comparison group: referrals for basic needs, written educational materials. Questionnaires, accelerometry, and anthropometrics. Intention-to-treat analysis of change in outcomes. Two-sided t test with multiple imputation. Parents were 95% female, 31% Black, and 27% Hispanic. Children had a mean BMI-Z score of 1.15. Primary outcomes did not differ between groups at 12 months. Both groups significantly (P < 0.05) improved on the Family Nutrition and Physical Activity Scale for behaviors related to childhood obesity (mean ± SE: comparison, 2.8 ± 1.0; intervention, 2.2 ± 0.9), increased child sedentary activity (comparison, 32.5 ± 12.1; intervention, 39.9 ± 12.4 min/d), and decreased child moderate-vigorous physical activity (comparison, −9.6 ± 3.3; intervention −7.0 ± 3.0 min/d). Parents had no change in BMI. We successfully embedded screening and referral to address social needs within an obesity intervention. The coaching intervention did not provide additional benefits. Future research could explore ways to make these interventions more accessible, valuable, and effective for families. [ABSTRACT FROM AUTHOR]

Economic evaluations of vaccination may not fully account for nonhealth patient impacts on families, communities, and society (ie, broader value elements). Omission of broader value elements may reflect a lack of established measurement methodology, lack of agreement over which value elements to include in economic evaluations, and a lack of consensus on whether the value elements included should vary by vaccination type or condition. We conducted a systematic review of value frameworks to identify broader value elements and measurement guidance that may be useful for capturing the full value of vaccination. We searched Ovid MEDLINE, PubMed, Embase, and the gray literature to identify value frameworks for all health interventions, and we extracted information on each framework's context, value elements, and any available guidance on how these elements should be measured. We used descriptive statistics to analyze and compare the prevalence of broader value elements in vaccination value frameworks and other healthcare-related value frameworks. Our search identified 62 value frameworks that met inclusion criteria, 9 of which were vaccination specific. Although vaccination frameworks included several broader value elements, such as reduced transmissibility and public health benefits, the elements were represented inconsistently across the frameworks. Vaccination frameworks omitted several value elements included in nonvaccination-specific frameworks, including dosing and administration complexity and affordability. In addition, guidance for measuring broader value elements was underdeveloped. Future efforts should further evaluate inclusion of broader value elements in economic evaluations of vaccination and develop standards for their subsequent measurement. • Stakeholders recognize the importance of understanding the full value of vaccination, including benefits and costs to patients, families, and broader society. However, broader value elements are rarely captured in economic evaluations of vaccination. Value frameworks can help decision makers evaluate the full value of vaccination by providing guidance on how to measure and incorporate broader value elements into economic evaluations. • In contrast to previous efforts, we searched for both vaccination-specific value frameworks and frameworks for other health interventions potentially relevant to the full value of vaccination. We found that broader value elements were not consistently included across all value frameworks, and vaccination frameworks excluded important value elements such as affordability and research and development costs. In addition, most value frameworks did not include clear guidance on measuring broader value elements. • Our findings identified key methodology gaps for incorporating broader value elements into vaccination value assessments. Future research should focus on developing clear guidelines on how to measure these elements to support empirical assessments of their impact on policy and decision making. [ABSTRACT FROM AUTHOR]

Limited studies have described the utilization of cannabinoids among patients with cancer. This survey study aimed to characterize utilization patterns and perceptions of cannabinoid use for treatment-related side effects among patients receiving radiation treatment. This was an anonymous survey study of patients who were undergoing or recently completed radiation treatment at a comprehensive cancer center. Data on cannabinoid use during cancer treatment, reasons for the use of cannabinoids, perceived effects of cannabinoids, and formulations of usage were collected and summarized using descriptive statistics. Of the 431 respondents, 111 (25.8%) patients reported cannabinoid use since their cancer diagnosis. Among the cannabinoid users, a majority (73.9%) experienced improvement in symptoms; 38.7% had better relief of cancer-treatment symptoms from cannabinoids in comparison to their prescription medications, and 16.2% lowered the amount of prescription pain medications needed after using cannabinoids. Cannabinoids appeared to be most effective in helping patients manage sleep (76.6%) and anxiety (72.1%). When asked about whether physicians should be discussing cannabinoid use, 45.1% of cannabinoid users wanted to speak with their doctors regarding its utilization. For patients who did not report cannabinoid use, a large majority (83.1%) never had discussions with their doctors regarding its utilization as part of their cancer care, and 34.8% wanted to learn more about cannabinoids from their doctors. About 1 in 4 patients with cancer reported cannabinoid use to assist in symptom control. A majority had subjective alleviation of treatment-related symptoms from cannabinoid use. Regardless of cannabinoid use, a sizable percentage of patients never had any discussions about cannabinoids with their oncologists, with some expressing interest in learning more. Guidelines are needed to assist radiation oncologists on how cannabinoids may play a role in caring for patients. [ABSTRACT FROM AUTHOR]

We aimed to investigate the associations of individual and area-level socioeconomic status (SES) with incident cardiovascular diseases (CVD) alone, cancer alone, and comorbid CVD and cancer, and the mediation role of cardiovascular health score in these associations. This was a population-based prospective cohort study. We used data from the UK Biobank, a population-based prospective cohort study. Latent class analysis was used to create an individual-level SES index based on three indicators (household income, education level, and employment status), and the Townsend Index was defined as the area-level socioeconomic status. We used the American Heart Association's (AHA) Life's Simple 7 (smoking, body weight, physical activity, diet, blood pressure, blood glucose, and total cholesterol) to calculate the cardiovascular health score. We used Cox proportional hazard regression models to estimate the hazard ratio (HR) and 95% confidence interval (CI) adjusted for demographic, environmental, and genetic factors. Compared with high SES, the HRs in participants with low individual and area-level SES were 1.33 (95% confidence interval [CI] 1.29 to 1.38) and 1.24 (95% CI 1.20 to 1.29) for incident CVD, 0.96 (95% CI 0.93 to 0.99) and 0.95 (95%CI 0.92 to 0.98) for incident cancer, 1.32 (95%CI 1.24 to 1.40) and 1.15 (95%CI 1.08 to 1.22) for incident comorbid CVD and cancer, respectively. Additionally, the mediation proportion of CVD score for individual and area-level SES was 47.93% and 48.87% for incident CVD, 44.83% and 59.93% for incident comorbid CVD and cancer. The interactions between individual-level SES and CVD scores were significant on incident CVD, and comorbid CVD and cancer, and the protective associations were stronger in participants with high individual-level SES. Life's Simple 7 significantly mediated the associations between SES and comorbid CVD and cancer, while almost half of the associations remained unclear. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether family poverty over the early childhood, adolescent, and adult periods of the life course independently predicts experiences of intimate partner violence (IPV) in adulthood. This was a birth cohort study in Brisbane, Australia, with pregnant women recruited at their first booking-in visit and their children, followed up to 30 and 40 years of age. Family income was obtained from the mother when the child was 6 months, 5 and 14 years of age. Offspring reported their own family income at 21, 30, and 40 years of age. The offspring completed the Composite Abuse Scale at 30 and 40 years. Adjusted logistic regression models are used to predict experiences of IPV at 30 (n = 2157) and 40 (n = 1438) years. The findings at 30 and 40 years of age are consistent. Only poverty experienced concurrently with the assessment of IPV is strongly associated. At the 40-year follow-up, family poverty predicts higher ratios of all four forms of IPV; severe combined abuse (odds ratio [OR] = 2.24, 95% confidence interval [CI] = 1.24, 4.05), physical abuse (OR = 3.37, 95% CI = 1.95, 5.82), emotional abuse (OR = 2.09, 95% CI = 2.58, 8.57) and harassment (OR = 4.70, 95% CI = 2.58, 8.57). Concurrent family poverty is strongly and consistently associated with patterns of IPV. These associations are for cross-sectionally collected data with the prospectively collected data not replicating these findings. Although it is not possible to identify a specific causal pathway, the findings suggest that the immediate consequences of poverty are strongly associated with IPV. Programmes that address poverty reduction provide the best prospect for reducing societal levels of IPV. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the relationship between the EAT-Lancet diet (ELD) and head and neck cancers (HNCs) in 101,755 Americans enrolled in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Prospective cohort study. ELD score was calculated to assess participant's adherence to ELD. Cox hazard regression models were utilised to evaluate the association of ELD and dietary components with HNC risk. Restricted cubic spline (RCS) plots were employed to explore the linearity of the relationships. Predefined subgroup analyses and sensitivity analyses were performed to identify potential effect modifiers and to assess the stability of the findings, respectively. After a mean follow-up of 8.84 years, 279 cases of HNCs, including 169 cases of oral cavity and pharyngeal cancers and 110 cases of laryngeal cancer were recorded. This study observed a dose–response negative correlation between ELD and HNCs (hazard ratio [HR] Q4 vs Q1 : 0.52; 95% confidence interval [CI]: 0.34, 0.80; P -trend = 0.003; HR per SD increment : 0.80; 95% CI: 0.71, 0.91), and oral cavity and pharyngeal cancers (HR Q4 vs Q1 : 0.52; 95% CI: 0.31, 0.88; P -trend = 0.008; HR per SD increment : 0.78; 95% CI: 0.66, 0.92). Analysis using RCS plots indicated a significant linear association between adherence to the ELD and reduced risk of HNCs and oral cavity and pharyngeal cancers (P -nonlinearity > 0.05). Subgroup analysis did not reveal significant interaction factors (P -interaction > 0.05), and sensitivity analysis confirmed the robustness of this study. Additionally, negative correlations were found between the consumption of fruits and whole grains and HNCs (fruits: HR Q4 vs Q1 : 0.58; 95% CI: 0.40, 0.84; P -trend = 0.010; whole grains: HR Q4 vs Q1 : 0.51; 95% CI: 0.26, 0.97; P -trend = 0.004). Adherence to ELD contributes to the prevention of HNCs. [ABSTRACT FROM AUTHOR]

Online platforms have transformed gambling into a daily activity for many, raising concerns about its potential harm. Notably, marketing strategies play a crucial role in influencing gambling behaviors and normalizing gambling. This study aims to explore the relationship between monthly marketing expenditure by the gambling industry, the online amount of money bet, and the number of online accounts (active and new) in Spain. A secondary goal is to assess the impact of marketing restrictions under the Spanish Royal Decree 958/2020 on the relationship between marketing and online gambling behavior. Longitudinal study. Data covering January 2013 to December 2023. Dependent variables included: new accounts, active accounts, gambler deposits, and the total money bet. Independent variables included: expenditure on advertising, bonuses, affiliate marketing, and sponsorship. A Seasonal Autoregressive Integrated Moving Average (SARIMA) model was employed to assess marketing's impact on online gambling behavior. Findings show that investment in advertising (P ≤ 0.025), promotions (P < 0.001), and sponsorships (P ≤ 0.004) significantly increase the number of new and active accounts, deposits, and total money bet. For instance, it has been estimated that, for every €1 invested in bonuses and sponsorship, gamblers deposit €1.6 and €4 into their accounts, respectively. Moreover, the Spanish law regulating gambling advertising has seemingly weakened the link between marketing expenditure and gambling behavior, with the notable exception of bonuses, where the impact has intensified. These results underline the importance of ongoing monitoring and regulation of gambling behavior in Spain, emphasizing the need for strict adherence to regulations. [ABSTRACT FROM AUTHOR]

To evaluate the association of ultra-processed food (UPF) consumption with depression among Brazilian adults (≥18 years). Cross-sectional study. Data were obtained from a population-based survey conducted in 2023 (n = 21,690). UPF consumption was investigated using a questionnaire regarding the consumption on the previous day of 13 subgroups of UPF selected from those most consumed in Brazil according to a previous national survey (cutoff score ≥5 subgroups). The medical diagnosis of depression was self-reported. Logistic regression models were used to estimate the adjusted (by sex, age, education, presence of partner/spouse, and overweight) Odds Ratio (aOR) of UPF consumption according to the presence of depression. Analyses were conducted for the total population and stratified by sex. Medical diagnosis of depression was reported by 12.3%. The prevalence of high UPF consumption (≥5 subgroups) was 17.7%, being higher in men (22.0%) and those with depression (19.3%). Depression increased the chance of presenting a high UPF consumption among the total population (aOR 1.35; CI 95% 1.08–1.68) and women (aOR 1.35; CI 95% 1.03–1.77), with no association among men. The presence of depression was associated with greater consumption of UPF among Brazilian adults, especially among the female population. Public health actions to reduce UPF consumption could benefit from targeting this population group. [ABSTRACT FROM AUTHOR]

Several countries in different global regions are implementing lung cancer (LC) screening programmes. This study aimed to estimate the proportion of the Chilean population ≥15 years who are at high risk of developing LC. Cross-sectional study. Data from the Chilean National Health Survey were used in this study. Information on age and history of tobacco consumption were retrieved to estimate national and regional proportions of the Chilean population ≥15 years who are at high risk of developing LC, according to the inclusion criteria in the NELSON trial, NLST trial and USPSTF2021 recommendations. Stratified analyses were performed by sex and quartiles of monthly household income. An estimated 292,158 (2.2%; 95% confidence interval [CI] 1.6–2.8), 174,196 (1.3%; 95% CI 0.9–1.7) and 404,751 (3.1%; 95% CI 2.4–3.8) of Chileans are at high risk of LC according to NELSON and NLST trial inclusion criteria and USPSTF2021 recommendations, respectively. Proportions of males who are at high risk were higher in comparison to females. The highest proportion of people who are at high risk was found in the lowest household income quartile. Regionally, the lowest percentage of Chileans who are at high risk was found in La Araucanía and the highest in Magallanes y Antártica. There is a relevant number of Chileans who are at high risk of developing LC. Policymakers in Chile should enhance tobacco control efforts to reduce the prevalence of tobacco smoking and also explore the implementation of LC screening programmes to reduce the burden of LC. [ABSTRACT FROM AUTHOR]

Prisoners' common mental disorders (CMDs) and their social contacts are a complex and significant concern. We have systematically investigated the relationship between social contacts (i.e. perceived, and objective social support, and loneliness) and prisoners' mental health. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A protocol was developed and registered in PROSPERO (CRD42023372942). A search strategy was applied across four databases (namely MEDLINE [via OVID SP], APA PsycINFO, Scopus, and Web of Science). The quality assessment entailed the critical appraisal skills program (CASP) Checklist for cohort studies. The data were presented through a narrative synthesis. After screening, 32 studies that fulfilled the inclusion criteria were included in this review. Most were cross-sectional (k = 27), while five had a longitudinal design. The total number of study participants was 10,613. The majority of the studies reported negative correlations between perceived and objective social support and symptoms of common mental disorders (CMDs), specifically, depression, anxiety, and post-traumatic stress disorder (PTSD). The included studies appeared to indicate a correlation between loneliness and PTSD symptoms. The lack of social support was linked to the development or exacerbation of CMDs in prisoners. Initiatives, such as reducing visitation barriers and providing access to technology for remote communication, can assist prisoners in strengthening their support systems and enhancing their opportunities for reintegration into society. [ABSTRACT FROM AUTHOR]

The present study aims to develop an effective risk-prediction score (RPS) to improve screening efficiency and contribute to secondary prevention of colorectal cancer (CRC). Screening for colorectal lesions. 14,398 high-risk individuals aged 50–65 years were included. The baseline characteristics of participants with and without colorectal lesions (CL) were compared using a Chi-squared test. The overall population was randomly split into a training set and a test set in the ratio of 80% and 20%. One-factor and multifactor logistic regression analyses were performed in the training set to construct the RPS (scores of 0–9.62). Area under curve (AUC) was calculated as an estimate of predictive performance using the receiver-operating characteristic (ROC) curve in the test set. In the study population, being male, advanced age, current or previous smoking, weekly alcohol consumption, high body mass index (BMI ≥24 kg/m2), and previously detected colonic polyp were associated with higher risk of CL. Compared to the low-risk group (0–2.31 points), the ORs and 95% confidence intervals (CIs) for the moderate-risk group (2.31–3.85 points) and high-risk group (3.85–8.42 points) were 1.58 (1.44, 1.73) and 2.52 (2.30, 2.76), respectively. For every 1-point increase in score, participants had a 27% increased risk of CL (OR:1.27, 95% CI: 1.24, 1.30). For participants with CL predicted by RPS, the area under the working characteristic curve was 0.61 (P < 0.001). Our RPS can quickly and efficiently identify multiple lesions of the colorectum. Combining RPS with existing screening strategies facilitates the identification of very high-risk individuals and may help to prevent CRC. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the risk factors associated with diabetes mellitus (DM) among Brazilian adults. Cross-sectional study. Data of 75,860 Brazilian adults (≥18 years) were collected using the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel) (2020–2023). Variables assessed included self-reported medical diagnosis of DM, sociodemographic factors (sex, age, schooling, marital status) and DM risk factors (regular consumption of sweetened beverages (≥5 times/week), infrequent consumption of fruits and vegetables, and beans (<5 times/week), insufficient physical activity, prolonged screen time on cell phones, computers, tablets (CCT), and television (TV), smoking, heavy episodic drinking, excess weight, and obesity). Logistic regression models estimated crude and adjusted odds ratio (aOR) (adjusted for sociodemographic characteristics) for the association between the risk factors and the presence of DM. The overall prevalence of self-reported DM in the population was 9.2%. There was a lower chance of regular consumption of sweetened beverages (aOR 0.79; 95% CI: 0.65–0.97) and heavy episodic drinking (aOR 0.77; 95% CI: 0.65–0.93) and a greater chance of insufficient physical activity (aOR 1.40; 95% CI: 1.25–1.55), prolonged TV screen time (aOR 1.22; 95% CI: 1.09–1.36), excess weight (aOR 1.62; 95% CI: 1.44–1.82) and obesity (aOR 1.87; 95% CI: 1.67–2.10) among individuals with DM. There was a lower chance of regular consumption of sweetened beverages and heavy episodic drinking among individuals with DM and a greater chance of insufficient physical activity, prolonged TV screen time, excess weight, and obesity, among that. [ABSTRACT FROM AUTHOR]

This study aimed to assess the burden of early-onset gastrointestinal (GI) cancers in China over three decades. A comprehensive analysis was performed using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Data on early-onset GI cancers in 2020 and from 1990 to 2019 were extracted from GLOBOCAN 2020 database and GBD 2019, respectively. The average annual percent change (AAPC) was calculated to analyze the temporal trends using the Joinpoint Regression Program. The Bayesian age-period-cohort (BAPC) model was used to predict future trends up to 2030. In China, there were 185,980 incident cases and 119,116 deaths of early-onset GI cancer in 2020, with the highest incidence and mortality observed in liver cancer (new cases: 71,662; deaths: 62,412). The spectrum of early-onset GI cancers in China has transitioned over the last 30 years. The age-standardized rates of incidence, mortality, and disability-adjusted life years for colorectal and pancreatic cancers exhibited rapid increases (AAPC >0, P ≤ 0.001). The fastest-growing incidence rate was found in colorectal cancer (AAPC: 3.06, P < 0.001). Despite the decreases in liver, gastric, and esophageal cancers, these trends have been reversed or flattened in recent years. High body mass index was found to be the fastest-growing risk factor for early-onset GI cancers (estimated annual percentage change: 2.75–4.19, P < 0.05). Projection analyses showed an increasing trend in age-standardized incidence rates for almost all early-onset GI cancers during 2020–2030. The transitioning pattern of early-onset GI cancers in China emphasizes the urgency of addressing this public health challenge. [ABSTRACT FROM AUTHOR]

This study assessed the direct and indirect effects (via depressive symptoms) of lifetime use of a broad range of substances on suicide risk among US adolescents. This was a cross-sectional study. Data from the 2021 Youth Risk Behavior Survey were used (N = 12,303, 48.7% female). Associations between five types of substance use (cigarette, e-cigarette, alcohol, marijuana, and prescription pain medicine) and three dimensions of suicide risk (suicidal ideation, suicide plan, and suicide attempt) were measured by multivariate logistic regression models. The role of depressive symptoms was further examined by structural equation modeling. Almost three in five (57.5%) adolescents had used one or more substances in their lifetime (18.1% one type, 12.2% two types, 13.1% three types, 10.2% four types, and 3.8% five types). Adolescents using five substances were up to 16 times more likely to experience suicidal ideation and behaviors. Depressive symptoms significantly linked the pathway from substance use to suicide risk, resulting in much stronger indirect effects than the direct effects. Collectively, the five substance use behaviors and depressive symptoms explained about 60.4% of variance in suicidal ideation, 53.6% of variance in suicide plan, and 55.0% of variance in suicide attempt. Lifetime use of multiple substances is significantly correlated with suicidal ideation and behaviors among adolescents via the pathway of depressive symptoms. Routine screening for a broad range of substance use behaviors is needed to identify adolescents at risk for suicide and accessible mental health services could potentially attenuate the linkage between substance use and suicide risk. [ABSTRACT FROM AUTHOR]

The aims of this study were to examine vaccine hesitancy for COVID-19 vaccinations, comparing immigrant and non-immigrant older adults (aged ≥60 years), after accounting for group-level and individual-level characteristics, and the interaction between immigrant and socio-economic status. This study used a retrospective cohort design. Analyses were conducted using R version 4.3.2. Logistic regression models had the dependent variables of obtained any COVID-19 vaccinations vs not and obtained all four required COVID-19 vaccinations vs not. The linear regression model's dependent variable was the interval in days between the COVID-19 vaccination availability and the date of obtaining the first COVID-19 vaccination. In the cohort of older adults (n = 35,109), immigrants were less likely than non-immigrants to obtain a single COVID-19 vaccination (P < 0.001) or the full series of required COVID-19 vaccinations (P < 0.001); however, immigrants vs non-immigrants delayed only in obtaining the first vaccination (P < 0.001) but not the remaining required COVID-19 vaccinations. In the linear regression model, a longer interval before obtaining the first COVID-19 vaccination was associated with immigrant status (P < 0.001), lower socio-economic status (SES; P < 0.001), and the interaction between immigrant status and low SES (P < 0.001), while a shorter interval was associated with preventive behaviours of obtaining seasonal influenza (P < 0.001) or pneumococcal (P < 0.001) vaccinations previously. Immigrant status in general, and especially when combined with low SES, is a major risk factor for vaccination hesitancy. Reorienting immigrants to embrace preventive healthcare behaviours is key. Culturally appropriate communication campaigns may improve the dissemination of effective vaccination-related information to immigrant communities. [ABSTRACT FROM AUTHOR]

Understanding differences in post-legalization patterns of marijuana between rural and urban environments has the potential to go a long way towards targeting intervention efforts aimed at reducing marijuana use disorders. Data come from the National Survey on Drug Use and Health (NSDUH, 2015–2019, N = 210,392). Survey-weighted multivariable linear and logistic regression analyses were used to assess the relationship between key marijuana-related variables and the status of medical marijuana use in each state with interaction terms for rural versus urban status. Among the entire sample, the prevalence of marijuana abuse and dependence were 0.7% and 1.8%, respectively. Among marijuana users, the average number of days on which marijuana was used was 131.3 (SD = 136.3) days. Those living in states with legalized medical marijuana reported use on a greater number of days (B = 10.69; 95% CI: 5.26, 16.13) with frequency of use increasing as rurality increased, compared to a core based statistical area (CBSA) of ≥1 million: a CBSA of <1 million residents (B = 23.02; 95% CI: 17.38, 28.66) and non-CBSA (B = 37.62; 95% CI: 22.66, 52.58). We also observed lower odds of driving under the influence of marijuana in states where medical marijuana was legal (aOR = 0.86; 95% CI: 0.77, 0.95). We observed an increase in the frequency of marijuana use and a decrease in driving under the influence of marijuana in states with legalized medical marijuana use relative to those states where it remained illegal. We also observed key moderation based on rural-urban status. This body of results suggests that problematic marijuana use may be on the rise following the legalization of marijuana use, but also that corresponding protective attitudes exist. [ABSTRACT FROM AUTHOR]

In non-endemic countries, surveillance of non-travel cases of enteric fever is important to identify carriers and reduce secondary transmission. We characterised these cases in England between 2012 and 2021 and assessed potential sources of infection to inform guidance revision. Retrospective case–case. We identified enteric fever cases from the national surveillance dataset. Non-travel cases were defined as no travel to an endemic country or travel but onset of >60 days after return. Multivariable logistic regression was used to identify factors associated with non-travel cases. We reviewed the case records of cases with unknown source of infection. Compared to travel cases, non-travel cases (7%; 225/3075) were older (odds ratio [OR] = 1.02, 95% confidence interval [CI]: 1.02–1.04), asymptomatic (OR = 9.3: 95% CI: 4.3–20.3), and confirmed with Salmonella typhi infection (OR = 1.74, 95% CI: 1.26–2.4). Non-travel cases had lower odds of being of Indian (OR = 0.27, 95% CI: 0.16–0.45) or Pakistani ethnicity (OR = 0.34, 95% CI: 0.16–0.45) than White British. Surveillance questionnaires identified a possible infection source for 53%: case records review identified a further 23%: 33% secondary transmission, mostly household; 21% had overseas visitors, or travelling family; 12% were carriers (cases with enteric fever in the past), 12% travelled to endemic country outside of the 60-day window, and 22% had other possible sources. Case records differentiated between travel 60–90 days (5%) vs travel years prior to onset (7%), suggesting carrier status. Not all possible carriers were identified through the surveillance questionnaire. Therefore, we recommend additional questions to systematically capture travel history beyond 60 days to assist in classifying carrier status and to updating the source of infection. [ABSTRACT FROM AUTHOR]

This study aimed to investigate (1) definitions of self-isolation used during the COVID-19 pandemic; (2) measures used to quantify adherence and their reliability, validity, and acceptability; (3) rates of self-isolation adherence; and (4) factors associated with adherence. This was a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis Without Meta-analysis (PRISMA) guidelines (PROSPERO record CRD42022377820). MEDLINE, PsycINFO, Embase, Web of Science, PsyArXiv, medRxiv, and grey literature sources were searched (1 January 2020 to 13 December 2022) using terms related to COVID-19, isolation, and adherence. Studies were included if they contained original, quantitative data of self-isolation adherence during the COVID-19 pandemic. We extracted definitions of self-isolation, measures used to quantify adherence, adherence rates, and factors associated with adherence. We included 45 studies. Self-isolation was inconsistently defined. Four studies did not use self-report measures. Of 41 studies using self-report, one reported reliability; another gave indirect evidence for the lack of validity of the measure. Rates of adherence to self-isolation for studies with only some concerns of bias were 51%–86% for COVID-19 cases, 78%–94% for contacts, and 16% for people with COVID-19-like symptoms. There was little evidence that self-isolation adherence was associated with sociodemographic or psychological factors. There was no consensus in defining, operationalising, or measuring self-isolation, resulting in significant risk of bias in included studies. Future definitions of self-isolation should state behaviours to be enacted and duration. People recommended to self-isolate should be given support. Public health campaigns should aim to increase perceived effectiveness of self-isolation and promote accurate information about susceptibility to infection. [ABSTRACT FROM AUTHOR]

This study aimed to explore the intricate relationship between the health literacy and the awareness of risks and prevention awareness of infection disease among prisoners. A cross-sectional descriptive study was conducted among 1350 prisoners at an L Type Closed Penal Execution Institution in Turkey, using comprehensive criteria to ensure the inclusion of a diverse participant pool. Data was collected via face-to-face interviews using the "personal information form," "health literacy scale (HLS)," and "communicable diseases risk awareness and protection Scale (CDRAPS)." Both scales exhibited high reliability. Statistical analyses, including Pearson correlation and linear regression, were conducted to evaluate the relationships between the dimensions of these scales. The study was completed with 1031 prisoners. The participants' mean age was 38.65 with a majority being single (69.2%) and high school graduates (46.3%). A weak positive correlation (r = 0.448, P = 0.000) was observed between the CDRAPS (mean score 135.98 ± 24.00) and the HLS (mean score 89.85 ± 22.30), indicating health literacy explained a 20% variance in communicable diseases risk awareness and prevention. Furthermore, a significant relationship was established considering multiple variables including age, marital and educational status, family health personnel presence, smoking and alcohol use, and comorbidities, showing a combined effect on disease risk awareness and prevention (R2 = 0.203, β = 0.458, P = 0.000). These findings highlight the importance for governments and policy makers to implement preventive and educational programs that are focused on public health, aiming to increase prisoners' health literacy and awareness of infectious diseases. [ABSTRACT FROM AUTHOR]