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This study aimed to assess differences in emotion and elaboration quality between clinical and community child cohorts in both past reminiscing and future worry conversations. We analyzed 54 Australian parents (46 mothers, 8 fathers) and their 8- to 12-year-old children (M = 9.63, SD = 1.29; 28 boys, 26 girls) in reminiscing interactions. Dyads were recruited from local schools (community cohort, n = 26) or a children's psychology clinic waitlist (clinical cohort, n = 28). Clinical cohort children engaged in less emotion exploration in both past and future conversations, as did parents for future conversations. Elaboration quality did not differ. Parent-son dyads differed in the clinical cohort, exhibiting significantly lower emotion resolution than the community cohort, or parent-daughter dyads when discussing past events. These findings suggest that discussing anticipated negative events may be a relevant point of family-based intervention for anxious children. Additionally, this study highlights the importance of parent-son emotional discussion. [ABSTRACT FROM AUTHOR]

Cannabis Use Disorder (CUD) has no FDA-approved treatment. Serotonin-2c (5HT2c) agonists have preclinical and human laboratory evidence for their potential efficacy for CUD. We assessed the tolerability and effects of lorcaserin (5HT2c agonist) on CUD. In a 10-week, open label, uncontrolled trial, the tolerability of lorcaserin was tested in outpatients with CUD. Adverse events (AE) were assessed weekly. Cannabis use was assessed twice weekly by the Timeline follow-back and quantitative urine metabolites. Seventeen participants enrolled, and 14 received medication. Participants' average age was 35 years; majority were male (N = 12). The medication was well tolerated in males. There were no serious adverse events (SAE). The most common AE's were headache/migraine (N = 4, all females), anorexia (N = 3), and irritability (N = 2). Participants decreased their frequency of cannabis use significantly (p < 0.001), adjusted for baseline use. By the end of the trial, participants decreased by 1.76 (SE = 0.47) cannabis using days/week. Average daily amount of cannabis and urine THC metabolite levels did not change significantly. Lorcaserin was well tolerated in males but not females, suggesting possible sex differences. Future trials of other 5HT2c agonists (lorcaserin was withdrawn at the request of the FDA) should consider longer dose titration phases. [ABSTRACT FROM AUTHOR]

The Self-Concept Clarity Scale (SCCS) is a 12-item self-report measure that assesses self-concept clarity (SCC). Previous research has identified a relationship between lower SCC and higher levels of social anxiety. As a measure of positive psychological well-being, the SCCS can be used as a tool to examine and monitor SCC in populations with social anxiety disorder (SAD) who appear to be susceptible to inconsistent or unstable self-concept. However, the scale has yet to be validated with a SAD sample. A confirmatory factor analysis (CFA) was conducted on the SCCS data of sample of 87 individuals who met criteria for a diagnosis of SAD (M = 20.15, SD = 3.55; 83% female) and the reliability, convergent validity and norm scores of the SCCS with a SAD were also investigated. Results of the CFA supported a unidimensional factor structure. The SCCS was found to have good internal consistency (Cronbach's α =.80) and SCCS scores were found to correlate with measures of psychological distress and social fears, however, no correlation was found with measures of social anxiety behaviours. Also, overall results found that the SAD sample scored lower on SCC than other clinical samples in previous literature. These findings suggest that the SCCS is a psychometrically sound measure with unidimensional factor structure and demonstrated reliability and validity with a SAD sample, although additional research is warranted to replicate and extend the results of the current research. What is already known about this topic: The SCCS is a valid and reliable measure of self-concept clarity (SCC) with unidimensional factor structure, developed by Campbell et al. (1996). The SCCS has been used to identify that individuals with social anxiety symptomology demonstrate lower SCC. To the authors' knowledge, previous literature has not yet used the SCCS to measure SCC in a SAD clinical sample. What the current research adds: The findings of the original development paper and recent validations of the SCCS were supported by the current study – i.e., unidimensional factor structure and sound psychometric properties were demonstrated. Lower SCC was associated with social worry and cognitive distress. No association was found with behavioural symptoms of SAD. The SCCS demonstrated clinical utility as a measure that can be used to assist with treatment planning and formulation, and to address a client's beliefs about the self and their identity. [ABSTRACT FROM AUTHOR]

Expectancy theory supports alcohol expectancies, or the expected effects of drinking, as an important factor in alcohol use behaviors. Recent research supports that alcohol expectancies fluctuate daily, but scant research has examined specific types of expectancies and their associations with alcohol use at the daily level. Consequently, the present study examined (1) the daily association between select expectancies (i.e. sociability, tension reduction, liquid courage) and likelihood of drinking, and (2) whether daily expectancies predict alcohol use outcomes (i.e. alcohol-related problems, heavy drinking) on drinking days. Participants (N = 221; 79.2% women) were primarily White (48.4%) and Black (29.7%) university students. Participants completed daily measures of expectancies, alcohol use, and alcohol-related problems each day for 14 days. Results from multilevel models revealed daily sociability as the only expectancy subscale linked with increased odds of drinking. Daily expectancies did not predict heavy drinking or alcohol-related problems on drinking days. At the between-person level, average levels of sociability and tension reduction expectancies were associated with a greater likelihood of engaging in heavy drinking and experiencing a problem. Findings highlight that fluctuations in sociability expectancies may be proximally linked to likelihood of alcohol use, which may inform just-in-time intervention efforts targeting alcohol expectancies. [ABSTRACT FROM AUTHOR]

Introduction: Prior studies have investigated the diagnostic potential of microRNA (miRNA) expression profiles for endometriosis. However, the vast majority of previous studies have only included adult women. Therefore, we sought to investigate differential expression of miRNAs among adolescents and young adults with endometriosis. Methods: The Women's Health Study: from Adolescence to Adulthood (A2A) is an ongoing WERF EPHect compliant longitudinal cohort. Our analysis included 64 patients with surgically-confirmed endometriosis (96% rASRM stage I/II) and 118 females never diagnosed with endometriosis frequency matched on age (median = 21 years) and hormone use at blood draw. MicroRNA measurement was separated into discovery (10 cases and 10 controls) and internal replication (54 cases and 108 controls) phases. The levels of 754 plasma miRNAs were assayed in the discovery phase using PCR with rigorous internal control measures, with the relative expression of miRNA among cases vs. controls calculated using the 2-ΔΔCt method. miRNAs that were significant in univariate analyses stratified by hormone use were included in the internal replication phase. The internal replication phase was split 2:1 into a training and testing set and utilized FirePlex miRNA assay to assess 63 miRNAs in neural network analyses. The testing set of the validation phase was utilized to calculate the area under the curve (AUC) of the best fit models from the training set including hormone use as a covariate. Results: In the discovery phase, 49 miRNAs were differentially expressed between endometriosis cases and controls. The associations of the 49 miRNAs differed by hormone use at the time of blood draw. Neural network analysis in the testing set of the internal replication phase determined a final model comprising 5 miRNAs (miR-542-3p, let-7b-3p, miR-548i, miR-769-5p, miR-30c-1-3p), yielding AUC = 0.77 (95% CI: 0.67--0.87, p < 0.001). Sensitivity in the testing dataset improved (83.3% vs. 72.2%) while the specificity decreased (58.3% vs. 72.2%) compared to the training set. Conclusion: The results suggest that miR-542-3p, let-7b-3p, miR-548i, miR-769- 5p, miR-30c-1-3p may be dysregulated among adolescent and young adults with endometriosis. Hormone use was a significant modifier of miRNA dysregulation and should be considered rigorously in miRNA diagnostic studies. [ABSTRACT FROM AUTHOR]

Theory of mind (ToM) has been argued to be a multidimensional construct, with ToM inferences depending on distinct processes across affective and cognitive ToM tasks and across first-order cognitive and second-order cognitive ToM tasks. Behavioural evidence for a multidimensional account has primarily depended on dissociations identified via analysis of variance, a statistical approach insufficient for assessing dimensionality. Instead, state-trace analysis (STA) is a more appropriate statistical technique to uncover dimensionality. The current study first applied STA to two summary datasets that had previously identified key dissociations between cognitive and affective ToM; these reanalyses did not support a multidimensional account of ToM. Next, STA was applied to a more detailed dataset to reveal whether ToM is based on multiple processes in a sample of 115 older adults aged 60–85 years (M = 68.5, SD = 5.92, 61.7% female) with higher or lower emotion perception ability. Participants made ToM judgements about different social exchanges (e.g., sarcasm or lying). STA results supported a multidimensional account of ToM across first-order cognitive, second-order cognitive, and affective ToM subdomains. These results lay a more rigorous foundation for subsequent studies to further examine the dimensionality of ToM and to apply formal modelling, progressing the field's understanding and measurement of the cognitive processes driving ToM judgements. [ABSTRACT FROM AUTHOR]

Over the past decade, the United States military has taken an interest in addressing soldiers' spiritual fitness and readiness to help improve their mental health and resiliency. Similar efforts have not been applied within the Reserve Officers' Training Corps (ROTC) population despite the mental health challenges these college students experience. To examine spiritual readiness, spiritual fitness, and depressive symptoms in ROTC cadets. Cross-sectional study. Web-based survey. We recruited ROTC cadets from 1 large southeastern university (n = 91 of 315, 28.9% response rate). The ROTC cadets (age = 21 ± 3 years; men = 68, 74.7%; women = 22, 24.2%; missing = 1, 1.1%) were mainly classified as juniors (n = 30, 33.0%) and in Army ROTC (ROTC branch: Army = 69, Air Force = 20, Navy = 2). The survey contained 3 validated instruments used to assess spiritual fitness (the Spiritual Fitness Inventory [SFI]), spiritual readiness (Spiritual Wellbeing Scale [SWBS]), and mental health via depressive symptoms (Patient Health Questionnaire [PHQ-9]). Results were analyzed using descriptive statistics and nonparametric Mann-Whitney U tests to compare belief in God or gods with the dependent measures. A Pearson correlation was calculated to assess the relationship between the SWBS score and PHQ-9 data. In total, 85.7% (n = 78/91) of ROTC cadets stated that they believed in God or gods. Overall, the cadets were considered to have average spiritual fitness (mean = 75.04 ± 14.89) and moderate spiritual well-being (mean = 90.46 ± 18.09). The average PHQ-9 score was 4.22 ± 5.25. Individuals who believed in God or gods had higher spiritual readiness (believer = 94.44 ± 16.10, nonbeliever = 67.00 ± 9.35; P ≤.01). No statistically significant differences were noted for symptoms of depression (believer = 3.38 ± 4.90, nonbeliever = 6.60 ± 6.90; P =.143) or spiritual fitness (believer = 76.12 ± 14.78, nonbeliever = 64.40 ± 12.68; P =.054) in ROTC cadets based on belief status. Overall, the ROTC cadets had moderate to average spiritual fitness and readiness, with typical depressive symptoms scores. Spiritual readiness was different for those who believed in God or gods, and existential well-being was significantly correlated with depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was determined whether cognitive impairment is associated with time taken to complete the electronic rapid fitness assessment (eRFA). We hypothesized that taking more time to complete the eRFA will indicate worsened cognitive function. Methods: We retrospectively identified patients who presented to the Memorial Sloan Kettering Cancer Center Geriatrics Service for preoperative evaluation and completed the eRFA as a part of their preoperative assessment from February 2015 to December 2020. Cognitive function was assessed using the Mini‐Cog©, which is a screening test for cognitive function status. Patients in this study underwent elective surgery and had a hospital length of stay ≥1 day. Time to complete the eRFA was automatically recorded by a web‐based tool; assistance with eRFA completion was self‐reported by the patient. In total, 2599 patients were included, of which 2387 had available Mini‐Cog© scores. Results: Overall, 50% of surveys were completed without assistance, 37% were completed with assistance, and 13% were completed by somebody else; Mini‐Cog© scores were lower, corresponding to worsened cognitive function status, in patients requiring assistance (median score respectively, 5 vs. 4 vs. 3; p‐value <0.0001; rates of cognitive impairment 7.5%, 22%, and 38%). Among patients who completed the questionnaire independently, greater cognitive impairment was associated with longer time to complete the eRFA (change in score per 5 min = −0.09; 95% CI −0.14, −0.03; p = 0.002). Conclusions: We found evidence that requirement for assistance in completing web‐based questionnaires, and time taken to complete a questionnaire, predict which patients benefit from more comprehensive cognitive function assessments. Future studies should further validate this finding in a more diverse population and establish optimal clinical pathways. [ABSTRACT FROM AUTHOR]

Gestational diabetes is treated with medical nutrition therapy, delivered by healthcare professionals; however, the optimal diet for affected women is unknown. Randomised controlled trials, such as the DiGest (Dietary Intervention in Gestational Diabetes) trial, will address this knowledge gap, but the acceptability of whole-diet interventions in pregnancy is unclear. Whole-diet approaches reduce bias but require high levels of participant commitment and long intervention periods to generate meaningful clinical outcomes. We aimed to assess healthcare professionals' views on the acceptability of the DiGest dietbox intervention for women with gestational diabetes and to identify any barriers to adherence which could be addressed to support good recruitment and retention to the DiGest trial. Female healthcare professionals (n 16) were randomly allocated to receive a DiGest dietbox containing 1200 or 2000 kcal/d including at least one weeks' food. A semi-structured interview was conducted to explore participants' experience of the intervention. Interviews were audio-recorded, transcribed verbatim and analysed thematically using NVivo software. Based on the findings of qualitative interviews, modifications were made to the dietboxes. Participants found the dietboxes convenient and enjoyed the variety and taste of the meals. Factors which facilitated adherence included participants having a good understanding of study aims and sufficient organisational skills to facilitate weekly meal planning in advance. Barriers to adherence included peer pressure during social occasions and feelings of deprivation or hunger (affecting both standard and reduced calorie groups). Healthcare professionals considered random allocation to a whole-diet replacement intervention to be acceptable and feasible in a clinical environment and offered benefits to participants including convenience. [ABSTRACT FROM AUTHOR]

Introduction: Over four million women in the US alone have been diagnosed with endometriosis. For those living with this disease, surgery and hormonal treatment reduce associated pelvic pain in some, while others continue to experience life impacting pain. Therefore, identification of accessible and cost-effective methods of pain reduction to compliment current treatment is urgently needed. Our objective was to quantify the prevalence of complementary and alternative methods used to manage acyclic pelvic pain and their reported benefit among women of different age groups living with endometriosis. Methods: We used baseline questionnaire data from laparoscopically-confirmed endometriosis cases who completed a WERF EPHect compliant questionnaire in the longitudinal cohort of The Women's Health Study: From Adolescence to Adulthood (A2A). Participants with acyclic pelvic pain were asked to indicate specific methods or activities that either helped or worsened their pelvic/lower abdominal pain. Differences among age groups [adolescent (<18 years), young adult (18-25 years), and adult (>25 years)] were assessed using Fisher's exact test. Results: Of the 357 participants included in analysis, sleep for coping was reported more frequently among adolescents (n = 59, 57.3%) compared to young adults (n = 40, 44.0%) and adults (n=19, 31.1%; p = 0.004). Adolescents also reported more frequent use of music (n = 29, 21.2%) than young adults (n = 10, 7.0%) and adults (n = 7, 9.1%; p = 0.001). Exercise worsened pain most commonly among adolescents (n = 82, 59.9%), followed by younger adults (n = 67, 46.9%), and adults (n=27, 35.1%; p=0.002). Discussion: Our analysis of participants in the A2A cohort showed that the prevalence of complementary and alternative methods used for coping with endometriosis-associated acyclic pelvic pain varied by age group. Future studies should aim to provide information that will further inform decisions in making care plans for managing endometriosis-associated pain that is effective, accessible, and tailored to the preferences of the patient. [ABSTRACT FROM AUTHOR]

Background: It has yet to be fully elucidated how differing populations of obstetric patients adapted to the disruptions in perinatal care and postpartum support from the COVID‐19 pandemic. We surveyed an enriched sample of socioeconomically advantaged patients to understand the influence of COVID‐19 on their perinatal care experience, well‐being, and coping. Methods: We surveyed pregnant and postpartum patients (n = 6140) at a large academic medical center in the Midwest of the United States using the Coronavirus and Perinatal Experiences instrument in Spring 2021. Results: The survey was sent to 6141 pregnant and postpartum patients; 1180 (17.8%) respondents completed the survey, including 256 who were pregnant and 834 postpartum. Most pregnant patients experienced no changes in their prenatal care with 16.5% indicating somewhat worsened care. In the postpartum cohort, 37.5% stated their care had somewhat worsened. In describing influences on stress and mental health, 58.1% of postpartum respondents stated it was moderately, and 17.4% significantly, worse. The pandemic had a somewhat or moderately negative influence for 72.7% of respondents, with 11.0% stating these effects were extremely negative. Both cohorts characterized a range of coping strategies, most commonly, talking with friends and family (76.3%). Conclusion(s): Even among this sample of socioeconomically advantaged patients, respondents indicated that the pandemic disrupted many facets of their medical care and daily life, especially social activities and postpartum support. Our findings suggest that counseling on coping and adaptation strategies for stressors and increased health systems support be part of perinatal care during public health emergencies for all demographic groups. [ABSTRACT FROM AUTHOR]

Background: A common method of pain assessment is the numerical rating scale, where patients are asked to rate their pain on a scale from 0 to 10, where 0 is "no pain" and 10 is "pain as bad as you can imagine". We hypothesize such language is suboptimal as it involves a test of a cognitive skill, imagination, in the assessment of symptom severity. Methods: We used a large-scale online research registry, ResearchMatch, to conduct a randomized controlled trial to compare the distributions of pain scores of two different pain scale anchors. We recruited adults located in the United States who reported a chronic pain problem (> 3 months) and were currently in pain. Participants were randomized in a 1:1 ratio to receive pain assessment based on a modified Brief Pain Inventory (BPI), where the anchor for a score of 10 was either "extremely severe pain", or the original BPI, with the anchor "pain as bad as you can imagine". Participants in both groups also answered additional questions about pain, other symptomatology and creativity. Results: Data were obtained from 405 participants for the modified and 424 for the original BPI. Distribution of responses to pain questions were similar between groups (all p-values ≥ 0.12). We did not see evidence that the relationship between pain score and the anchor text differed based on self-perceived creativity (all interaction p-values ≥ 0.2). However, in the key analysis, correlations between current pain assessments and known correlates (fatigue, anxiety, depression, current pain compared to a typical day, pain compared to other people) were stronger for "extreme" vs. "imaginable" anchor text (p = 0.005). Conclusion: Pain rating scales should utilize the modified anchor text "extremely severe pain" instead of "pain as bad as you can imagine". Further research should explore the effects of anchors for other symptoms. [ABSTRACT FROM AUTHOR]

Evaluate the conceptual framework that age effects on the electrophysiological binaural masking level difference (MLD) are partially mediated by age-related hearing loss and/or global cognitive function via mediation analysis. Participants underwent a series of audiometric tests. The MLD was measured via cortical auditory evoked potentials using a speech stimulus (/ɑ/) in speech-weighted background noise. We used mediation analyses to determine the total effect, natural direct effects, and natural indirect effects, which are displayed as regression coefficients ([95% CI]; p value). Twenty-eight individuals aged 19–87 years (mean [SD]: 53.3 [25.2]), recruited from the community. Older age had a significant total effect on the MLD (-0.69 [95% CI: −0.96, −0.45]; p < 0.01). Neither pure tone average (-0.11 [95% CI: −0.43, 0.24; p = 0.54] nor global cognitive function (-0.02 [95% CI: −0.13, 0.02]; p = 0.55) mediated the relationship of age and the MLD and effect sizes were small. Results were insensitive to use of alternative hearing measures or inclusion of interaction terms. The electrophysiological MLD may be an age-sensitive measure of binaural temporal processing that is minimally affected by age-related hearing loss and global cognitive function. [ABSTRACT FROM AUTHOR]

Simple Summary: ER+ breast cancer is the most diagnosed subtype and patient prognosis has improved in recent years thanks largely to the development of endocrine-targeting therapies including tamoxifen. Unfortunately, many tumors will recur as endocrine-therapy-resistant metastases. Therefore, in order to prolong resistance-free survival, combination therapies that mitigate resistance mechanisms should be pursued. In this study, we tested 516 drug combinations with tamoxifen and identified two that were synergistic. These combinations inhibited breast cancer patient-derived xenograft (PDX) growth in animal models better than either drug or tamoxifen alone. Breast cancer alone accounts for the majority of cancer deaths among women, with the most commonly diagnosed subtype being estrogen receptor positive (ER+). Survival has greatly improved for patients with ER+ breast cancer, due in part to the development of antiestrogen compounds, such as tamoxifen. While treatment of the primary disease is often successful, as many as 30% of patients will experience recurrence and metastasis, mainly due to developed endocrine therapy resistance. In this study, we discovered two tamoxifen combination therapies, with simeprevir and VX-680, that reduce the tumor burden in animal models of ER+ breast cancer more than either compound or tamoxifen alone. Additionally, these tamoxifen combinations reduced the expression of HER2, a hallmark of tamoxifen treatment, which can facilitate acquisition of a treatment-resistant phenotype. These combinations could provide clinical benefit by potentiating tamoxifen treatment in ER+ breast cancer. [ABSTRACT FROM AUTHOR]

BACKGROUND: Respiratory therapists (RTs) work alongside allied health staff, nurses, and physicians during stressful and traumatic events that can be associated with emotional and physiological implications known as second victim (SV) experiences (SVEs). This study aimed to evaluate SVEs of RTs, including both positive and negative implications. METHODS: RTs within a large academic health care organization across Minnesota, Wisconsin, Florida, and Arizona were asked to participate in an anonymous survey that included the validated Second Victim Experience and Support Tool-Revised to assess SVEs as well as desired support services. RESULTS: Of the RTs invited to participate, 30.8% (171/555) completed the survey. Of the 171 survey respondents, 91.2% (156) reported that they had been part of a stressful or traumatic work-related event as an RT, student, or department support staff member. Emotional or physiologic implications experienced by respondents as SVs included anxiety 39.1% (61/156), reliving of the event 36.5% (57/156), sleeplessness 32.1% (50/156), and guilt 28.2% (44/156). Following a stressful clinical event, 14.8% (22/149) experienced psychological distress, 14.2% (21/148) experienced physical distress, 17.7% (26/147) indicated lack of institutional support, and 15.6% (23/147) indicated turnover intentions. Enhanced resilience and growth were reported by 9.5% (14/147). Clinical and non-clinical events were reported as possible triggers for SVEs. Nearly half of respondents 49.4% (77/156) indicated feeling like an SV due to events related to COVID-19. Peer support was the highest ranked form of desired support following an SVE by 57.7% (90/156). CONCLUSIONS: RTs are involved in stressful or traumatic clinical events, resulting in psychological/physical distress and turnover intentions. The COVID-19 pandemic has had a significant impact on RTs' SVEs, highlighting the importance of addressing the SV phenomenon among this population. [ABSTRACT FROM AUTHOR]

Background: Familial hypercholesterolemia (FH) is an inherited disease which causes premature atherosclerotic cardiovascular disease. However, less than 10% of individuals with FH have been identified. Objective: To assess parental perspectives for inclusion of FH on routine newborn screening (NBS) and to highlight potential benefits, harms, and ethical concerns. Methods: Telephone interviews of two groups were conducted: 1) parents of children diagnosed with FH, and 2) parents of children diagnosed with a genetic condition through NBS. Stratified purposive sampling was used to ensure adequate representation. The 11 telephone interviews were conducted in 30-min sessions guided by a semi-structured interview script. At the beginning of the interview, participants were educated on the NBS process and FH. The interviews were transcribed verbatim, and a thematic analysis was performed in multiple steps. Results: All interviewees indicated that they would be interested in having their child be screened for FH on the newborn screen. Reasons supporting screening during the newborn period included knowing their child's diagnosis, the ability to screen family members for FH, incorporation of lifestyle changes, and access to preventive care. Negatives surrounding screening during the newborn period included increased stress or anxiety, knowledge, stigma, and the delay from diagnosis to initiation of pharmacotherapy for FH. Conclusion: While these interviewees were in favor of NBS for FH, further education of parents and clinicians is needed to ensure proper implementation. The results of this study may be useful to formulate family notification and care protocols for newborns diagnosed with FH and other diseases. Significance: What is already known on this subject? Familial hypercholesterolemia is a common inherited disorder that predisposes to early cardiovascular disease, but most affected individuals are not diagnosed. Childhood cholesterol screening is an effective but underutilized diagnostic tool. Previous studies report parents find childhood cholesterol screening acceptable, but it is not known if screening newborns would also be acceptable. What does this study add? Interviewees found screening newborns for familial hypercholesterolemia acceptable and would agree to screen their own newborn. The ability to screen other family members and access to early treatment were important factors in their decision to screen. Education of clinicians about familial hypercholesterolemia was an important concern raised by interviewees. [ABSTRACT FROM AUTHOR]

Background and Objective: Cancer screening rates remain low in rural, racial and ethnic minority, low-income, and uninsured populations. Prior studies showed that cancer screening recommendations vary based on clinicians' factors. We conducted an exploratory study on primary care clinicians' beliefs about new or updated cancer screening guidelines according to clinician demographics. Methods: This cross-sectional study involved administering a web-based survey in July and August of 2021 to primary care clinicians practicing in diverse ambulatory settings in the Pacific Northwest belonging to the same health system. The survey assessed clinician demographics, attitudes about the impact of cancer screening on mortality, and how clinicians stay up-to-date with guidelines. Results: Of the 191 clinicians, 81 responded (42.4%), after removing 13 incomplete surveys, we analyzed 68 (35.6%). The majority agreed/strongly agreed that breast (76.1%), colorectal (95.5%), and cervical (90.9%) cancer screening, and HPV vaccination (85.1%) prevent early cancer mortality: there were no differences according to clinician gender or years in practice. Female compared to male clinicians were more likely to agree/strongly agree that tobacco smoking cessation (female: 100% vs male: 86.4%, P =.01) prevents early cancer mortality, whereas male compared to female clinicians were more likely to agree/strongly agree that lung cancer screening (male: 86.4% vs female: 57.8%, P =.04) prevents early cancer mortality. One-third (33.3%) of clinicians were unaware of the 2021 update on lung cancer screening and females were more likely than males to say they did not know about this change (females: 43.2% vs males: 13.6%, P =.02). Conclusions: This study suggests that clinicians' attitudes are not likely the primary factor affecting low cancer screening rates in some populations and that few differences exist in beliefs based on gender, and none based on years in practice. [ABSTRACT FROM AUTHOR]

Extensive media coverage and potential controversy about COVID-19 vaccination during the pandemic may have affected people's general attitudes towards vaccination. We sought to describe key psychological antecedents related to vaccination and assess how these vary temporally in relationship to the pandemic and availability of COVID-19 vaccination. As part of an ongoing online study, we recruited a national (U.S.) sample of young gay, bisexual and other men who have sex with men (N = 1,227) between October 2019 and June 2021, and assessed the "4Cs" (antecedents of vaccination; range = 1–5). Overall, men had high levels of confidence (trust in vaccines; M = 4.13), calculation (deliberation; M = 3.97) and collective responsibility (protecting others; M = 4.05) and low levels of complacency (not perceiving disease risk; M = 1.72). In multivariable analyses, confidence and collective responsibility varied relative to the pandemic phase/vaccine availability, reflecting greater hesitancy during later stages of the pandemic. Antecedents also varied by demographic characteristics. Findings suggest negative effects of the COVID-19 pandemic on key antecedents of general vaccination and identify potential targets for interventions. [ABSTRACT FROM AUTHOR]

The combination of perinatal acidemia with postnatal hyperoxia is associated with a higher incidence of hypoxic-ischemic encephalopathy (HIE) in newborn infants. In neonatal cardiac arrest, current International Liaison Committee on Resuscitation (ILCOR) and Neonatal Resuscitation Program (NRP) guidelines recommend increasing inspired O2 to 100% during chest compressions (CC). Following the return of spontaneous circulation (ROSC), gradual weaning from 100% O2 based on pulse oximetry (SpO2) can be associated with hyperoxia and risk for cerebral tissue injury owing to oxidative stress. We hypothesize that compared to gradual weaning from 100% O2 with titration based on preductal SpO2, abrupt or rapid weaning of inspired O2 to 21% after ROSC or use of 21% O2 during CC followed by upward titration of inspired O2 to achieve target SpO2 after ROSC will limit hyperoxia after ROSC. Nineteen lambs were randomized before delivery and asphyxial arrest was induced by umbilical cord occlusion. There was no difference in oxygenation during chest compressions between the three groups. Gradual weaning of inspired O2 from 100% O2 after ROSC resulted in supraphysiological PaO2 and higher cerebral oxygen delivery compared to 21% O2 during CC or 100% O2 during CC followed by abrupt weaning to 21% O2 after ROSC. The use of 21% O2 during CC was associated with very low PaO2 after ROSC and higher brain tissue lactic acid compared to other groups. Our findings support the current recommendations to use 100% O2 during CC and additionally suggest the benefit of abrupt decrease in inspired oxygen to 21% O2 after ROSC. Clinical studies are warranted to investigate optimal oxygen titration after chest compressions and ROSC during neonatal resuscitation. [ABSTRACT FROM AUTHOR]

Preterm birth predisposes children to internalizing and externalizing behaviors that may persist into adolescence resulting in adult mental health conditions. Social and caregiving contexts, particularly for vulnerable infants born preterm, influence long‐term outcomes, but mechanisms are not clearly understood. Healthcare teams caring for those born preterm face difficulty predicting who will be most affected by risk, who will most benefit, and the optimal timing of intervention. Differential susceptibility theory offers an alternative to the traditional risk‐only assessments and theories by positing that individuals may be more, or less, susceptible to environmental influences. A sample of preterm‐ and term‐born infants were followed from birth to 23 years of age. Mixed model repeated measures analyses of internalizing and externalizing behaviors were utilized for the comparison groups (N = 214; observations = 1070). Environmental contexts were indexed as proximal protection (low, moderate, high) and medical risk (low, moderate, high). Personal characteristic covariates of sex, race, socioeconomic status, and cognition were modeled. Internalizing behavior trajectories varied significantly over time. Early proximal protective environments conferred a sustained positive influence on behaviors. There is partial support for differential susceptibility theory suggesting that prematurity, as a malleability characteristic enables absorption of both the positive and negative influences of the environment, with greater intensity that those without malleability. The current analyses suggest lasting effects of the preschool age proximal environment on internalizing and externalizing behaviors in young adulthood for those born preterm. Understanding these nuances may aid healthcare professionals in the promotion and timing of interventions to support the child and family. The current manuscript reflects ongoing analyses of longitudinal data. No patient or public contribution to the analyses were required for testing the differential susceptibility theory. The authors would solicit patient or public contribution when implementing practice or policy changes based on the results. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate factors related to treatment attendance for patients seeking gender-affirming voice therapy (GAVT). Method: We completed retrospective chart reviews of 50 patients (43 transgender women, three transgender men, four nonbinary patients; aged 18-67 years, M = 34.92 years, SD = 12.32 years) referred for GAVT at a Midwest outpatient center from 2016 to 2021. Data extraction included patient demographics, therapy visit specifics (e.g., number of sessions attended, treatment completion status, and in-person vs. virtual visits) and treatment timing (in relation to the onset of the COVID-19 pandemic), and psychosocial and socioeconomic information. Results: There was no impact of treatment-timing relative to the onset of the pandemic on any attendance measure; however, patients were 1.9 times more likely to complete therapy with each virtual telehealth session attended. Individual factors of outside social support and hormone replacement therapy were positively related to the number of therapy sessions attended, whereas insurance provider and employment status were related to therapy completion. Conclusions: Telehealth attendance during the COVID-19 pandemic was positively associated with GAVT completion. Future research should investigate psychosocial and socioeconomic factors to understand how to identify patients at risk for poor treatment adherence and facilitate access to clinical care. [ABSTRACT FROM AUTHOR]

We aimed to explore participants' experiences of mental health during an acceptance and commitment therapy (ACT)-based guided self-help intervention to support weight management in adults with overweight or obesity during the COVID-19 pandemic (SWiM-C: Supporting Weight Management during COVID-19). We conducted semi-structured telephone interviews with twenty participants and used reflexive thematic analysis to identify patterns of meaning across the dataset relevant to mental health. Four themes were conceptualized: i) Mental health changes associated with SWiM-C, ii) External factors negatively impacted mental health and intervention engagement, iii) Use and impact of coping responses, and iv) Intervention preferences based on psychological needs. Findings suggest that participants were exposed to multiple factors, both related to and external to the intervention, that negatively impact their mental health, yet ACT-based aspects of the SWiM-C intervention appeared to support participants to adaptively manage the decline in their mental health. The findings can be used to inform the development of future weight management interventions, such as through intervention personalization and the inclusion of more strategies that target emotional regulation. Trial registration: ISRCTN 12107048, [ABSTRACT FROM AUTHOR]

The Family Caregiver Activation in Transitions (FCAT) tool in its current, non-scalar form is not pragmatic for clinical use as each item is scored and intended to be interpreted individually. The purpose of the current study was to create a scalar version of the FCAT to facilitate better care communications between hospital staff and family caregivers. We also assessed the scale's validity by comparing the scalar version of the measure against patient health measures. Data were collected from 463 family caregiver–patient dyads from January 2016 to July 2019. An exploratory factor analysis was performed on the 10-item FCAT, resulting in a statistically homogeneous six-item scale focused on current caregiving activation factors. The measure was then compared against patient health measures, with no significant biases found. The six-item scalar FCAT can provide hospital staff insight into the level of caregiver activation occurring in the patient's health care and help tailor care transition needs for family caregiver–patient dyads. [Journal of Gerontological Nursing, 48(12), 35–42.] [ABSTRACT FROM AUTHOR]

Bias-based bullying (e.g., bullying related to race, weight, sexual orientation) is a common experience among youth, yet few school-based prevention programs explicitly address this type of bullying. This study explores whether schools that offer diversity education activities have lower rates of bias-based bullying among students compared to schools that do not offer these activities. Data came from two sources: the 2018 CDC School Profiles Survey (N = 216 schools) and the 2019 Minnesota Student Survey (N = 64,510 students). Multilevel logistic regression tested associations between diversity education activities (diversity clubs, lessons, or special events) and eight types of bias-based bullying among students, with attention to effect modification by relevant demographic characteristics. Students attending schools that offer a wider variety of diversity education opportunities had significantly lower odds of bullying about race, ethnicity, or national origin among boys of color (OR = 0.89, CI: 0.80, 1.00), about sexual orientation for gay, bisexual, and questioning boys (OR = 0.81, CI: 0.67, 0.97), and about disability for boys with a physical health problem (OR = 0.86, CI: 0.76, 0.99). Attending a school with more types of diversity education activities may protect vulnerable students against specific types of bias-based bullying and advance health equity. A diversity education is recommended as a key component of antibullying efforts and policy. [ABSTRACT FROM AUTHOR]

Current use of vaping products has increased in recent years among youth in the United States. We conducted cross-sectional surveys of vaping product users aged 15–17 in New York in 2017 and 2019 to assess vaping freqency, reported nicotine content of vaping products used, risk perceptions of vaping and openness to vaping cannabis (2019 survey only). Between 2017 and 2019, the proportion of youth vapers who were frequent vaping product users increased from 16.8% to 26.2% (P  < 0.05). The proportion of youth vapers who usually used high-nicotine vaping products also increased, from 12.6% to 40.0% (P  < 0.05). In both years, the use of high-nicotine vaping products was positively associated with frequent use (P  < 0.05). The perceived likelihood of harm from vaping increased (P  < 0.05), but respondents' perception of harm from using tobacco-flavored vaping products remained higher than that from using menthol/mint or sweet flavors. In 2019, 60.6% of respondents reported having tried vaping cannabis. Results suggest shifts in youth vaping behavior toward more frequent use and use of higher nicotine vaping products, support previous findings about youth misperceptions about health risks of flavored vaping products and highlight openness to vaping cannabis among youth vaping product users. [ABSTRACT FROM AUTHOR]

Background: Representing approximately 10% of all meniscal tears, bucket-handle meniscal tears (BHMTs) are large longitudinal vertical tears that have an attached fragment flipped into the intercondylar notch. Meniscectomy often results in significant meniscal loss and increased joint loading. Alternatively, meniscal repair attempts to restore the function of the meniscus and aims to preserve joint mechanics. Purpose: To evaluate the long-term risk of subsequent ipsilateral knee surgery in patients who underwent a bucket-handle meniscal repair (BHMR), and to assess risk factors associated with subsequent knee surgical intervention. Study Design: Case series; Level of evidence, 4. Methods: We performed an electronic health record search for all patients aged 12 to 65 years who underwent arthroscopic knee meniscal repairs for BHMT (2011-2018). We excluded patients who had a previous BHMR, did not have magnetic resonance imaging of the knee within 60 days before BHMR, lacked active membership in Kaiser insurance in the year before and after BHMR, or underwent meniscectomy before BHMR. All patients were followed until December 31, 2019, with censoring at death or membership disenrollment. Primary outcomes included ipsilateral knee procedures overall and by type (ie, repeat meniscal repair and meniscectomy); secondary outcomes included other surgical interventions of the same knee, any contralateral knee surgery, deep surgical-site infection, and deep venous thrombosis or pulmonary embolism. Results: The final cohort included 1359 patients with a median age of 24 years (interquartile range [IQR], 17-34) who underwent BHMR for a BHMT. During the follow-up period (median, 50.2 months [IQR, 32.3-60.6]), 495 subsequent ipsilateral procedures were performed in 274 (20.2%) patients, and the median time to the first procedure was 10.6 months (IQR, 4.1-23.5). An overall 59 (4.3%) patients underwent repeat meniscal repair, and 165 (12.1%) had a subsequent meniscectomy of the same knee. Significant risk factors for subsequent ipsilateral procedures included younger age, 12 to 18 years (adjusted odds ratio [aOR], 5.77 [95% CI, 1.84-18.08]) and 19 to 30 years (aOR, 3.65 [95% CI, 1.17-11.36]), as well as normal and overweight body mass index (aOR, 2.84 [95% CI, 1.29-6.23] and 2.34 [95% CI, 1.06-5.17], respectively). Patients undergoing concomitant anterior cruciate ligament reconstruction (ACLR) at the initial BHMR had a lower risk of undergoing subsequent surgery (aOR, 0.66 [95% CI, 0.49-0.87]) than those without concomitant ACLR. Conclusion: This is the largest reported study on outcomes after BHMR in a contained cohort. One-fifth of patients underwent subsequent ipsilateral surgery during follow-up, with 4.3% receiving a repeat meniscal repair and 12.1% experiencing a meniscectomy. Risk factors for subsequent surgery of the same knee included younger age and normal or overweight body mass index. Concomitant ACLR at time of BHMR reduced the risk of subsequent reoperation. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To quantify geographic variation in home health expenditures per Medicare home health beneficiary and investigate factors associated with this variation. STUDY DESIGN: Retrospective study design analyzing US counties in which at least 1 home health agency served 11 or more beneficiaries in 2016. Several sources of 2016 national public data were used. METHODS: The key variable is county-level Medicare home health expenditures per home health beneficiary. Counties were grouped into quintiles based on per-beneficiary expenditures. Analyses included calculation of coefficients of variation, computation of the ratio of 90th percentile to 10th percentile in expenditures, and linear regression predicting expenditure. The control variables included characteristics of patients, agencies, and communities. RESULTS: Significant variation in home health expenditures was identified across county quintiles, with a 90th-to- 10th-percentile expenditure ratio of 2.5. The percentage of for-profit agencies in the lowest quintile was 15.7 compared with 81.7 in the highest quintile of spending. Unadjusted spending differed by $3864 (95% CI, $3793-$3936), compared with $3611 (95% CI, $3514-$3708) in the adjusted model, between counties in spending quintiles 1 and 5. Although state fixed effects explained nearly 20% of the variation in home health expenditures, 42% of the variation remained unexplained. CONCLUSIONS: Home health care exhibits considerable unwarranted variation in per-patient expenditures across counties, signifying inefficiency and waste. Given the expected growth in home health demand, strategies to reduce unwarranted geographic variation are needed. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic inflammation after joint injury, ranging from sprains to articular fracture, contributes to the development of arthritis, and the administration of interleukin 1 (IL-1) receptor antagonist (IL-1Ra) is a potential intervention to mitigate this response. Although IL-1Ra mitigates cartilage degenerative changes induced by IL-1, lidocaine is used for local pain management in acute joint injury. Intra-articular delivery of both drugs in combination would be a novel and possibly disease–modifying treatment. However, it is not known whether the interaction with lidocaine at clinical concentrations (1%) would alter the efficacy of IL-1Ra to protect cartilage from the catabolic effects of IL-1. Hypothesis: Treatment of articular cartilage with IL-1Ra in combination with a clinically relevant concentration of lidocaine (1%) will inhibit the catabolic effects of IL-1α in a manner similar to treatment with IL-1Ra alone. Study Design: Controlled laboratory study. Methods: Fresh porcine cartilage explants were harvested, challenged with IL-1α, and incubated for 72 hours with IL-1Ra or a combination of IL-1Ra and lidocaine. The primary outcome was total sulfated glycosaminoglycan (sGAG) release. Additional experiments assessed the effect of storage temperature and premixing of IL-1Ra and lidocaine on sGAG release. All explants were histologically assessed for cartilage degradation using a modified Mankin grading scale. Results: The combination of IL-1Ra and lidocaine, premixed at various time points and stored at room temperature or 4°C, was as effective as IL-1Ra alone at inhibiting IL-1α–mediated sGAG release. Mankin histopathology scores supported these findings. Conclusion: Our hypothesis was supported, and results indicated that the combination of IL-1Ra and lidocaine was as efficacious as IL-1Ra treatment alone in acutely mitigating biological cartilage injury due to IL-1α in an explant model. Clinical Significance: The combination of IL-1Ra and lidocaine is stable when reagents are stored in advance of administration at varying temperatures, providing clinically relevant information about storage of medications. The ability to premix and store this drug combination for intra–articular delivery may provide a novel treatment after joint injury to provide pain relief and block inflammation–induced catabolism of joint tissues. [ABSTRACT FROM AUTHOR]

Background: Individual variability in tonic (resting) and phasic (reactivity) respiratory sinus arrhythmia (RSA) may underlie risk for dysregulated emotion and behavior, two transdiagnostic indicators that permeate most psychological disorders in youth. The interaction between tonic and phasic RSA may specify unique physiological profiles during the transition to adolescence. The current study utilized clinically referred youth (Mage = 12.03; s.d. = 0.92) to examine baseline RSA, RSA reactivity, and their interaction as predictors of dysregulated emotion and behavior in daily life. Method: Participants were 162 youth (47% female; 60% minority) in psychiatric treatment for any mood or behavior problem. RSA was assessed during three, 2-minute baselines and an 8-minute parent-child conflict discussion task. Dysregulated emotion and behavior were assessed during a 4-day ecological momentary assessment protocol that included 10 time-based prompts over a long weekend. Results: Greater RSA withdrawal to the conflict was associated with dysregulated basic emotion (sadness, anger, nervousness, stress) in daily life. Two distinct interactions also emerged, such that baseline RSA was related to dysregulated complex emotion (shame, guilt, loneliness, emptiness) and dysregulated behavior as a function of RSA reactivity to conflict. Lower baseline RSA and greater RSA withdrawal were associated with dysregulated complex emotion, while higher baseline RSA and greater RSA withdrawal were associated with dysregulated behavior. Conclusions: Findings point to physiological profiles that increase the risk of dysregulated emotion and behavior during the transition to adolescence. Excessive RSA withdrawal uniquely, and in combination with baseline RSA, increased risk for dysregulation in daily life, underscoring the role of autonomic stress responding as a risk factor for psychopathology. [ABSTRACT FROM AUTHOR]

Objective: To determine whether initiating saline nasal irrigation after COVID-19 diagnosis reduces hospitalization and death in high-risk outpatients compared with observational controls, and if irrigant composition impacts severity. Methods: Participants 55 and older were enrolled within 24 hours of a + PCR COVID-19 test between September 24 and December 21, 2020. Among 826 screened, 79 participants were enrolled and randomly assigned to add 2.5 mL povidone-iodine 10% or 2.5 mL sodium bicarbonate to 240 mL of isotonic nasal irrigation twice daily for 14 days. The primary outcome was hospitalization or death from COVID-19 within 28 days of enrollment by daily self-report confirmed with phone calls and hospital records, compared to the CDC Surveillance Dataset covering the same time. Secondary outcomes compared symptom resolution by irrigant additive. Results: Seventy-nine high-risk participants were enrolled (mean [SD] age, 64 [8] years; 36 [46%] women; 71% Non-Hispanic White), with mean BMI 30.3. Analyzed by intention-to-treat, by day 28, COVID-19 symptoms resulted in one ED visit and no hospitalizations in 42 irrigating with alkalinization, one hospitalization of 37 in the povidone-iodine group, (1.27%) and no deaths. Of nearly three million CDC cases, 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data. Age, sex, and percentage with pre-existing conditions did not significantly differ by exact binomial test from the CDC dataset, while reported race and hospitalization rate did. The total risk of hospitalization or death (11%) was 8.57 times that of enrolled nasal irrigation participants (SE = 2.74; P =.006). Sixty-two participants completed daily surveys (78%), averaging 1.8 irrigations/day. Eleven reported irrigation-related complaints and four discontinued use. Symptom resolution was more likely for those reporting twice daily irrigation (X 2 = 8.728, P =.0031) regardless of additive. Conclusion: SARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate. [ABSTRACT FROM AUTHOR]

Purpose: From its beginnings in China in December of 2019, the novel coronavirus COVID‐19 spread and quickly became the center of nursing care and conversation across the globe (WHO, 2020). This meta‐ethnographic study was conducted in order to provide the profession of nursing interpretative explanations of a common experience during the care of patients with COVID‐19. Design and method: A literature review focused on the experience of the nurse during the COVID‐19 pandemic revealed a total of 13 qualitative studies conducted in China, Spain, Turkey, Iran, Brazil, and the United States. A meta‐ethnographic review of these qualitative works, using the method of Noblit and Hare, was then conducted which revealed the experience of the nurse across the globe during the COVID‐19 pandemic. Findings: The review revealed strong similarities between the experiences of the nurse across the 13 studies. Given this reciprocal relationship, translations were constructed and synthesized until four new themes emerged outlining the global experience of the nurse during the COVID‐19 pandemic. Conclusions: Despite the differences between the structures of healthcare and government of the six countries represented in this meta‐ethnography, the experience of the nurse emerged into a narrative shared by those represented in this study. As the profession of nursing continues to work through ongoing waves of COVID‐19, these results will help guide the resources and training provided to nurses on the frontline of care. Clinical relevance: Despite great personal risk, nurses across the globe stepped up to the challenge of upholding and improving the health of the world's people during the COVID‐19 pandemic. As health policy, education, and system leaders, we must listen to the common experience revealed in this meta‐synthesis and respond by providing the resources needed to improve nursing practice and care. [ABSTRACT FROM AUTHOR]

Sexual violence perpetration (SVP), including coerced, physically forced, and alcohol- or drug-facilitated unwanted sex, occurs frequently in adolescence and may represent a risk factor for future perpetration. Sexual violence victimization (SVV) has been found to be a risk factor for increased rates of depression and posttraumatic stress disorder (PTSD); however, the associations of SVP with depression or posttraumatic stress symptoms (PTSS) have been less well described. This study examined associations between symptoms of depression and PTSS with SVP in the prior 12 months among high school students. In this cross-sectional analysis, a representative sample of public high school students (ninth–12th grades) completed self-reported surveys on peer SVP and SVV within the past year. Among 16,784 students completing surveys, 7.2% disclosed SVP against another high school student in the past 12 months; 64.4% of students disclosing SVP also experienced SVV. Both SVP and SVV, alone or in combination, were associated with a greater likelihood of symptoms of depression or PTSS. These associations were similar by sex and sexual minority status (e.g., lesbian, gay, bisexual, transgender, and queer [LGBTQ+]). These findings highlight the need for continued primary prevention efforts. Additional screening to recognize adolescent SVP can allow both early treatment of depression and PTSD and address the individual risks of SVP to reduce subsequent repeated sexual assaults. [ABSTRACT FROM AUTHOR]

Overhead-throwing athletes consistently display substantial bilateral differences in humeral retroversion (HRV). However, evidence is limited regarding HRV asymmetries in tennis players despite similarities between the overhead throw and tennis serve. To determine whether (1) junior and collegiate tennis players demonstrated bilateral differences in HRV and (2) the magnitude of the HRV side-to-side difference (HRVΔ) was similar across age groups. Cross-sectional study. Field-based setting. Thirty-nine healthy tennis players were stratified into 3 age groups: younger juniors (n = 11, age = 14.5 ± 0.5 years), older juniors (n = 12, age = 17.1 ± 0.9 years), and collegiate (n = 16, age = 19.6 ± 1.2 years). Three-trial HRV means were calculated for the dominant and nondominant limbs, and HRVΔ was obtained by subtracting the mean of the nondominant side from that of the dominant side. A paired-samples t test was used to determine bilateral differences in HRV, and a 1-way analysis of variance was used to compare HRVΔ among groups. For all 3 groups, HRV angle was greater in the dominant versus nondominant upper limb (younger juniors = 62.9° ± 9.1° versus 56.3° ± 6.8°, P =.039; older juniors = 75.5° ± 11.2° versus 68.6° ± 14.2°, P =.043; collegiate = 71.7° ± 8.5° versus 61.2° ± 6.9°, P =.001). However, no differences were detected in HRVΔ across age groups (P =.511). Consistent with the findings of previous studies of overhead-throwing athletes, we demonstrated greater measures of HRV in the dominant limb of tennis players. Furthermore, HRV asymmetries appeared to have developed before the teenage years, as no changes were observed in HRVΔ among age groups. [ABSTRACT FROM AUTHOR]

Many older adults do not engage in age-based prevention despite evidence to support reduced health risks and enhanced successful aging. The purpose of this study was to determine whether self-perceived aging (SPA) differed among older adults by age (young-old vs. old-old), participation in healthy lifestyle behaviors, screening, vaccinations, and self-rated health. Community-dwelling older adults (n=204) completed questionnaires reporting their SPA, self-rated health, and participation in recommended preventive healthy lifestyle behaviors, screening, and vaccinations. Our findings indicated that adults who were older and engaged in more preventive health behaviors, yet had lower self-rated health, tended to have better SPA. Prevention was greater in older adults who scored higher on aging well and aging successfully. Old-old (75 years or older) participants scored higher on aging successfully than those who were younger. Self-rated health was inversely related to SPA scores. Reporting poor or fair health did not diminish positive SPA in this sample. [ABSTRACT FROM AUTHOR]

Background: Chronic pelvic pain (CPP) is a common condition which significantly impacts the quality of life and wellbeing of many women. Laparoscopy with histopathology is recommended for investigation of pelvic pain and identification of endometriosis with concurrent removal. Never‐the‐less, the association between endometriosis and pelvic pain is challenging, with endometriosis identified in only 30–50% of women with pain. Aims: To explore the predictors for undergoing surgery, for identifying endometriosis and endometriosis severity in a cohort of women with CPP. Materials and Methods: This study forms part of the Persistent Pelvic Pain project, a prospective observational cohort study (ANZCTR:ACTRN12616000150448). Women referred to a public gynaecology clinic with pain were randomised to one of two gynaecology units for routine care and followed for 36 months with 6‐monthly surveys assessing demographics, medical history, quality of life, and pain symptoms measured on a Likert scale. Operative notes were reviewed and endometriosis staged. Results: Of 471 women recruited, 102 women underwent laparoscopy or laparotomy, of whom 52 had endometriosis (n = 37 stage I–II; n = 15 Stage III–IV). Gynaecology unit, pelvic pain intensity and lower parity were all predictors of surgery (odds ratio (OR) 0.342; 95% CI 0.209–0.561; OR 1.303; 95% CI: 1.079–1.573; OR 0.767; 95% CI: 0.620–0.949, respectively). There were no predictors identified for endometriosis diagnosis and the only predictor of severity was increasing age (OR 1.155; 95% CI: 1.047–1.310). Conclusions: Gynaecology unit and pain intensity were key predictors of undergoing laparoscopy; however, pain severity did not predict endometriosis diagnosis or staging. These findings indicate the need to review current frameworks guiding practice toward surgery for pelvic pain. [ABSTRACT FROM AUTHOR]

Objective: To develop evidence-based recommendations on best practices for delivery of clinical preventive services by chiropractors and to offer practical resources to empower provider applications in practice. Design: Clinical practice guideline based on evidence-based recommendations of a panel of practitioners and experts on clinical preventive services. Methods: Synthesizing the results of a literature search for relevant clinical practice guidelines and systematic reviews, a multidisciplinary steering committee with training and experience in health promotion, clinical prevention, and/or evidence-based chiropractic practice drafted a set of recommendations. A Delphi panel of experienced practitioners and faculty, primarily but not exclusively chiropractors, rated the recommendations by using the formal consensus methodology established by the RAND Corporation/University of California. Results: The Delphi consensus process was conducted during January–February 2021. The 65-member Delphi panel reached a high level of consensus on appropriate application of clinical preventive services for screening and health promotion counseling within the chiropractic scope of practice. Interprofessional collaboration for the successful delivery of clinical preventive services was emphasized. Recommendations were made on primary, secondary, tertiary, and quaternary prevention of musculoskeletal pain. Conclusions: Application of this guideline in chiropractic practice may facilitate consistent and appropriate use of screening and preventive services and foster interprofessional collaboration to promote clinical preventive services and contribute to improved public health. [ABSTRACT FROM AUTHOR]

This field investigation assessed differences (e.g., drinking behavior, hydration status, perceptual ratings) between female and male endurance cyclists who completed a 164-km event in a hot environment (35 °C mean dry bulb) to inform rehydration recommendations for athletes. Three years of data were pooled to create 2 groups of cyclists: women (n = 15) and men (n = 88). Women were significantly smaller (p < .001) than men in height (166 ± 5 vs. 179 ± 7 cm), body mass (64.6 ± 7.3 vs. 86.4 ± 12.3 kg), and body mass index (BMI; 23.3 ±1.8 vs. 26.9 ± 3.4) and had lower preevent urinary indices of hydration status, but were similar to men in age (43 ± 7 years vs. 44 ± 9 years) and exercise time (7.77 ± 1.24 hr vs. 7.23 ± 1.75 hr). During the 164-km ride, women lost less body mass (-0.7 ± 1.0 vs. -1.7 ± 1.5 kg; -1.1 ± 1.6% vs. -1.9 ± 1.8% of body weight; p < .005) and consumed less fluid than men (4.80 ± 1.28 L vs. 5.59 ± 2.13 L; p < .005). Women consumed a similar volume of fluid as men, relative to body mass (milliliters/kilogram). To control for performance and anthropomorphic characteristics, 15 women were pair-matched with 15 men on the basis of exercise time on the course and BMI; urine-specific gravity, urine color, and body mass change (kilograms and percentage) were different (p < .05) in 4 of 6 comparisons. No gender differences were observed for ratings of thirst, thermal sensation, or perceived exertion. In conclusion, differences in relative fluid volume consumed and hydration indices suggest that professional sports medicine organizations should consider gender and individualized drinking plans when formulating pronouncements regarding rehydration during exercise. [ABSTRACT FROM AUTHOR]

Participants were 5,831 women in their third trimester of pregnancy, part of a large, longitudinal, pre-birth national cohort study. Women reported on their experience of pushing and shoving, throwing or breaking objects within their relationship over the past month. Univariable regression models examined the association of a large number of potential risk and protective factors. Those significant at the univariable level were carried forward into final multivariable analyses, stratified by New Zealand's four main ethnic groups: European, Māori, Pacific, and Asian peoples. Relationship commitment, reduced family cohesion, and perceived stress were associated with increased risk across ethnic groups. [ABSTRACT FROM AUTHOR]

As screens become even more embedded in the everyday lives of young children, understanding the predictors of screen time becomes increasingly important. Our study investigated the predictors of total screen time on a weekday for children at two years of age using data from the Growing Up in New Zealand longitudinal (GUiNZ) study. Our selection of variables was informed by previous research into the predictors of screen time for children aged up to three years, as well as the wider literature on parenting and children's media exposure. We hypothesised that parenting behaviours related to the home media environment would be the most important variables overall. These included coviewing, exposure of children to adult-directed content, TV environment and rules restricting the amount of time that children can spend watching TV, DVD or video. A model including mother, partner and child variables (N = 3081) was tested using GLM Poisson regression in SPSS. Results demonstrated that children's higher use of screen media on a weekday was significantly associated with exposure to a moderate to high or heavy TV environment compared to a low TV environment, exposure to adult-directed TV or DVDs, having no rules about how much time the child can spend viewing TV or videos or DVDs, the child being of Asian ethnicity compared to European ethnicity, and the child not attending childcare regularly. Higher coviewing with the child was significantly negatively, or inversely, associated with screen time. We consider practice implications for children's screen time, study limitations, and recommendations for future research. Highlights: Multiple modifiable screen media parenting practices predicted two-year-olds' weekday screen time. TV environment and viewing adult-directed content were particularly strong predictors of two-year-olds' screen time. Our findings are based on a comprehensive measure of screen time, not only TV viewing. Data provided by fathers as well as mothers were utilised in the current study. [ABSTRACT FROM AUTHOR]

Objective: Obesity is a prominent public health concern significantly impacting various minority groups, especially Latina Americans. However, little study has explored acculturation-related factors associated with obesity among Latinas in the United States. This study examines the link between acculturation-related factors and obesity among Latinas. Design: Using the National Latino and Asian American Study (NLAAS), we detected the incremental associations of acculturation-related factors, especially perceived discrimination with obesity, after controlling for socio-demographics, among all 1427 Latinas. Two-step logistic regression analyses were conducted to investigate the association. Results: Results indicated perceived discrimination and older age were positively associated with Latinas' obesity. Conversely, income and acculturation stress were negatively associated with obesity. Further, results revealed a significant moderating effect of education on the association between perceived discrimination and obesity. Conclusion: The findings suggest the need for clinical attention towards socio-cultural influences and ethnic backgrounds in obesity assessment and intervention. [ABSTRACT FROM AUTHOR]

Aim (s): To investigate second victim experiences and supportive resources for nurses in obstetrics and gynaecology. Background: Nurses are at risk of developing second victim experiences after exposure to work related events. Methods: Nurses at a single institution were invited to participate in an anonymous survey that included the validated Second Victim Experience and Support Tool to assess symptoms related to second victim experiences and current and desired supportive resources. Results: Of 310 nurses, 115 (37.1%) completed the survey; 74.8% had not heard of the term 'second victim'. Overall, 47.8% reported feeling like a second victim during their career and 19.1% over the previous 12 months. As a result of a second victim experience, 18.4% experienced psychological distress, 14.3% turnover intentions, 13.0% decreased professional self‐efficacy, and 12.2% felt that institutional support was poor. Both clinical and non‐clinical events were reported as possible triggers for second victim experiences. Peer support was the most desired form of support as reported by 95.5%. Conclusion(s): Nurses in obstetrics and gynaecology face clinical and non‐clinical situations that lead to potential second victim experiences. Implications for Nursing Management: The second victim experiences of nurses should be acknowledged, and resources should be implemented to navigate it. Educational opportunities and peer supportive interventions specific to second victim experiences should be encouraged. [ABSTRACT FROM AUTHOR]

Purpose: Autistic adults use a variety of communication methods, including both speech and augmentative and alternative communication (AAC); however, there has been limited, if any, academic research in this area. The purpose of this study was to examine the experiences of speaking autistic adults who use AAC. Method: Using a participatory research method, we completed an online survey that included five demographic questions and 29 open-ended questions related to communication choice, communication access, attitudes, and recommendations. Six autistic adults who use AAC participated. The data were analyzed with thematic analysis using an inductive approach at the semantic level. Results: Participants reported identifying AAC as a communication choice as adults, after using speech during childhood. They described how forced communication choices have greatly impacted their lives, both historically and today, and reported on the successes they experience when communication autonomy is promoted within a supportive environment. Participants further described what impacts their in-the-moment decision making related to use of different communication methods. Finally, they discussed the importance of normalizing AAC use and disability in general and provided recommendations for other AAC users, families, and professionals. Conclusions: Historically, AAC intervention was considered a "last resort" for children who did not develop functional speech. Speaking autistic adults encourage families, professionals, and society to promote and accept all communication as equal--ensuring opportunities for all children to develop full and rich communication without delay and without stigma. [ABSTRACT FROM AUTHOR]

Background Medial knee deviation (MKD) during the single leg squat test (SLST) is a common clinical finding that is often attributed to impairments of proximal muscular structures. Investigations into the relationship between MKD and the foot and ankle complex have provided conflicting results, which may impact clinicians' interpretation of the SLST. Purpose The purpose of this study was to compare ankle dorsiflexion range of motion (ROM) and foot posture in subjects that perform the SLST with MKD (fail) versus without MKD (pass). Hypothesis There will be a difference in ankle dorsiflexion ROM and/or foot posture between healthy individuals that pass and fail the SLST for MKD. Study Design Cross-sectional study. Methods Sixty-five healthy, active volunteers (sex = 50 female, 15 male; age = 25.2 +/- 5.6 years; height = 1.7 +/- .1 m; weight = 68.5 +/- 13.5 kg) who demonstrated static balance and hip abductor strength sufficient for performance of the SLST participated in the study. Subjects were divided into pass and fail groups based on visual observation of MKD during the SLST. Foot Posture Index (FPI-6) scores and measures of non-weight bearing and weight bearing active ankle dorsiflexion (ROM) were compared. Results There were 33 individuals in the pass group and 32 in the fail group. The groups were similar on age (p = .899), sex (p = .341), BMI (p = .818), and Tegner Activity Scale score (p = .456). There were no statistically significant differences between the groups on the FPI-6 (pass group mean = 2.5 +/- 3.9; fail group mean = 2.3 +/- 3.5; p = .599), or any of the measures of dorsiflexion range of motion (non-weight bearing dorsiflexion with knee extended: pass group = 6.9° +/- 3.7°, fail group = 7.8° +/- 3.0o; non-weight bearing dorsiflexion with knee flexed: pass group = 13.5° +/- 5.6°, fail group = 13.9° +/- 5.3°; weight bearing dorsiflexion: pass group = 42.7° +/- 6.0°, 42.7° +/- 8.3°, p = .611). Conclusions Failure on the SLST is not related to differences in clinical measures of active dorsiflexion ROM or foot posture in young, healthy individuals. These findings suggest that clinicians may continue using the SLST to assess neuromuscular performance of the trunk, hip, and knee without ankle dorsiflexion ROM or foot posture contributing to results. Level of Evidence Level 3. [ABSTRACT FROM AUTHOR]

The detrimental effects of prenatal stress on maternal-infant well-being have been well established and highlight increased concern for pregnant African American women. Research supports the notion that positive emotions may have a beneficial impact on the stress process and outcomes. However, the data have been largely restricted to non-African American pregnant women. This study's purpose was to examine potential relationships of both positive (happiness) and negative (stress, anxiety, and depressive symptoms) emotions and pro-inflammatory cytokines (interleukins-1β, -6, -8, -12, -17, tumor necrosis factor, and interferon-γ) in 72 pregnant African American women for a more complete picture of the stress process in this at-risk population. Results of this exploratory secondary data analysis show strong positive correlations between negative emotions and strong negative correlations between happiness and negative emotions. Interleukin-8 was positively correlated with negative emotions and negatively correlated with happiness. Results show mean ratings of negative emotions were higher than previously reported with more heterogeneous samples, while happiness ratings were in the moderate range. Findings suggest that pregnant African American women may experience higher stress and depressive symptoms than women in more heterogeneous samples. However, moderate levels of happiness might contribute to buffering the stress response. [ABSTRACT FROM AUTHOR]

Physical activity is an important part of clinical assessment. However, objective measurement can be expensive and burdensome. The current study validated a single activity question for use in clinical assessment. Ninety-seven older women (mean age = 73.7 years, Physical activity is an important part of clinical assessment. However, objective measurement can be expensive and burdensome. The current study validated a single activity question for use in clinical assessment. Ninety-seven older women (mean age = 73.7 years, SE = 0.7) completed an activity questionnaire and measurement of anthropometrics, body composition, and strength. Activity level was reported as not active, somewhat active, active, and very active. Activity level was significantly related to hours of light, moderate, and vigorous activity; body mass index (BMI); waist circumference; percent fat and lean mass; and strength (p < 0.05). When activity levels were collapsed into two groups (not active + somewhat active, and active + very active), women in the high activity group (n = 48) were significantly (p < 0.05) more active, had healthier BMI and waist circumference values, less fat and more lean mass, and were stronger than women in the low activity group (n = 49). A single activity question is valid for use in clinical assessment. [Journal of Gerontological Nursing, 46(12), 15–22.] [ABSTRACT FROM AUTHOR]

Objective: To develop an evidence-based clinical practice guideline (CPG) through a broad-based consensus process on best practices for chiropractic management of patients with chronic musculoskeletal (MSK) pain. Design: CPG based on evidence-based recommendations of a panel of experts in chronic MSK pain management. Methods: Using systematic reviews identified in an initial literature search, a steering committee of experts in research and management of patients with chronic MSK pain drafted a set of recommendations. Additional supportive literature was identified to supplement gaps in the evidence base. A multidisciplinary panel of experienced practitioners and educators rated the recommendations through a formal Delphi consensus process using the RAND Corporation/University of California, Los Angeles, methodology. Results: The Delphi process was conducted January–February 2020. The 62-member Delphi panel reached consensus on chiropractic management of five common chronic MSK pain conditions: low-back pain (LBP), neck pain, tension headache, osteoarthritis (knee and hip), and fibromyalgia. Recommendations were made for nonpharmacological treatments, including acupuncture, spinal manipulation/mobilization, and other manual therapy; modalities such as low-level laser and interferential current; exercise, including yoga; mind–body interventions, including mindfulness meditation and cognitive behavior therapy; and lifestyle modifications such as diet and tobacco cessation. Recommendations covered many aspects of the clinical encounter, from informed consent through diagnosis, assessment, treatment planning and implementation, and concurrent management and referral. Appropriate referral and comanagement were emphasized. Conclusions: These evidence-based recommendations for a variety of conservative treatment approaches to the management of common chronic MSK pain conditions may advance consistency of care, foster collaboration between provider groups, and thereby improve patient outcomes. [ABSTRACT FROM AUTHOR]

Importance: A predictive tool to support academic and practice outcomes for occupational therapy students is needed for use in advising students. Objective: To determine whether characteristics of academic and professional behavior across cohorts could indicate the likelihood of student success in passing the National Board for Certification in Occupational Therapy® examination. Design: Causal–comparative research. Participants: Master of occupational therapy students (N = 315; eight cohorts). Measures: Demographics, college entrance exams, grade point average, program benchmarks (i.e., specific course grades, fieldwork grades, Occupational Therapy Knowledge Exam scores), licensure exam. Results: Baseline and in-program characteristics were used to determine success; for each unit increase in the success score, the odds of passing the exam were 4.11 (95% confidence interval [2.23, 7.60]). Conclusions and Relevance: Case studies that have used this success score suggest that additional resources and targeted interventions could be allocated to help students at highest risk of not passing the licensure exam. What This Article Adds: Using a predictive tool to support student success can enable more effective academic advising throughout an occupational therapy program and result in positive outcomes on the licensure exam. [ABSTRACT FROM AUTHOR]

Retrospective studies using adult self-report data have demonstrated that adverse childhood experiences (ACEs) increase risk of violence perpetration and victimization. However, research examining the associations between adolescent reports of ACE and school violence involvement is sparse. The present study examines the relationship between adolescent reported ACE and multiple types of on-campus violence (bringing a weapon to campus, being threatened with a weapon, bullying, fighting, vandalism) for boys and girls as well as the risk of membership in victim, perpetrator, and victim–perpetrator groups. The analytic sample was comprised of ninth graders who participated in the 2013 Minnesota Student Survey (n ~ 37,000). Multinomial logistic regression models calculated the risk of membership for victim only, perpetrator only, and victim–perpetrator subgroups, relative to no violence involvement, for students with ACE as compared with those with no ACE. Separate logistic regression models assessed the association between cumulative ACE and school-based violence, adjusting for age, ethnicity, family structure, poverty status, internalizing symptoms, and school district size. Nearly 30% of students were exposed to at least one ACE. Students with ACE represent 19% of no violence, 38% of victim only, 40% of perpetrator only, and 63% of victim–perpetrator groups. There was a strong, graded relationship between ACE and the probability of school-based victimization: physical bullying for boys but not girls, being threatened with a weapon, and theft or property destruction (p s <.001) and perpetration: bullying and bringing a weapon to campus (p s <.001), with boys especially vulnerable to the negative effects of cumulative ACE. We recommend that schools systematically screen for ACE, particularly among younger adolescents involved in victimization and perpetration, and develop the infrastructure to increase access to trauma-informed intervention services. Future research priorities and implications are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Endocrine-disrupting chemicals have been shown to have broad effects on development, but their mutagenic actions that can lead to cancer have been less clearly demonstrated. Physiological levels of estrogen have been shown to stimulate DNA damage in breast epithelial cells through mechanisms mediated by estrogen-receptor alpha (ERa). Benzophenone-3 (BP-3) and propylparaben (PP) are xenoestrogens found in the urine of >96% of U.S. population. OBJECTIVES: We investigated the effect of BP-3 and PP on estrogen receptor–dependent transactivation and DNA damage at concentrations relevant to exposures in humans. METHODS: In human breast epithelial cells, DNA damage following treatment with 17β-estradiol (E[sub 2]), BP-3, and PP was determined by immunostaining with antibodies against γ-H2AX and 53BP1. Estrogenic responses were determined using luciferase reporter assays and gene expression. Formation of R-loops was determined with DNA: RNA hybrid-specific S9.6 antibody. Short-term exposure to the chemicals was also studied in ovariectomized mice. Immunostaining of mouse mammary epithelium was performed to quantify R-loops and DNA damage in vivo. RESULTS: Concentrations of 1µM and 5µM BP-3 or PP increased DNA damage similar to that of E2 treatment in a ERα-dependent manner. However, BP-3 and PP had limited transactivation of target genes at 1µM and 5µM concentrations. BP-3 and PP exposure caused R-loop formation in a normal human breast epithelial cell line when ERa was introduced. R-loops and DNA damage were also detected in mammary epithelial cells of mice treated with BP-3 and PP. CONCLUSIONS: Acute exposure to xenoestrogens (PP and BP-3) in mice induce DNA damage mediated by formation of ERα-dependent R-loops at concentrations 10-fold lower than those required for transactivation. Exposure to these xenoestrogens may cause deleterious estrogenic responses, such as DNA damage, in susceptible individuals. [ABSTRACT FROM AUTHOR]