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The female pubertal transition is characterized by a rapidly changing hormone milieu, which is heavily influenced by the first menstrual cycle – menarche. The first year following menarche is associated with menstrual cycles that are irregular and anovulatory. Peripuberty also marks the beginning of a female-biased risk for suicidality and depression, suggesting some influence by the menstrual cycle and ovarian hormone fluctuations. However, there are limited methods and guidelines for studying the menstrual cycle and related affective symptoms in this developmental window. Thus, this study's objective was to identify the most accurate methods for detecting ovulation in irregular cycles (Part 1) and develop guidelines based on these methods for determining menstrual cycle phases. These methods were applied to investigate hormones and affective symptoms based on cycle phase and ovulation status in a sample of peripubertal females (Part 2). Thirty-two peripubertal females (ages 11–14) provided daily urine samples of estrogen (E1G) and progesterone (PdG) metabolites and luteinizing hormone (LH), and ratings of affective symptoms for one menstrual cycle. Ten literature-derived methods for determining the presence of an LH-peak or PdG rise were compared, focusing on their feasibility for psychological research. Methods by Sun et al. (2019) and Park et al. (2007) most accurately detected PdG rises and LH peaks in this sample, identifying 40.6% of cycles as ovulatory. As expected, ovulatory participants showed greater LH in the periovulatory phase (p =.001), greater PdG in the mid-luteal phase (p <.0001), and greater E1G in the periovulatory phase (p =.001) com p ared with anovulatory participants. Exemplary methods to compare psychological symptoms between both groups are provided. Recommendations and guidelines for studying the menstrual cycle in irregular cycling adolescents are offered. Novel methods for ovulation detection identified phase-specific hormonal patterns in anovulatory and ovulatory adolescent cycles. • Ovulation determination methods for adults cannot be applied to adolescents. • Relational methods to determine LH peak & PdG rise are essential for ovulation detection. • Daily hormone measurements are recommended, LH testing needs to be modified to sample. • Counting methods need to be used with caution in samples with high rates of anovulation. • Recommendations for menstrual cycle research in peripuberty are discussed. [ABSTRACT FROM AUTHOR]

The pubertal transition is characterized by a rapidly changing hormone milieu, which is heavily influenced by the first menstrual cycle – menarche. The first year following menarche is associated with menstrual cycles that are infrequent, anovulatory, with a greater likelihood of luteal insufficiency and lower hormone levels than adult cycles. Peripuberty also marks the beginning of a female-dominated risk of suicidality and depression, suggesting an important role of the menstrual cycle and hormone fluctuations. However, there are limited methods and no guidelines for studying the menstrual cycle in this age group. Thus, this study investigated methods of characterizing the menstrual cycle in peripubertal females and compared depressive symptoms based on cycle characteristics. 40 peripubertal females (ages 11-14) provided daily ratings of depressive symptoms and urinary metabolites of estrogen and progesterone (estrone-3-glucuronide (E1G), pregnanediol glucuronide (PdG)), and LH for one menstrual cycle. Eleven literature-derived methods for determining LH-peak or PdG rise were compared, focusing on the feasibility of the method for psychological research. Menstrual cycle and phase lengths, hormone concentrations and ovulatory status based on the presence of an LH peak and PdG rise are described. Further, daily mood ratings and their fluctuation related to hormone changes are examined based on menstrual cycle characteristics. Recommendations for studying peripubertal menstrual cycles and associated hormone-related mood changes are offered to assist future investigations. Understanding the involvement of hormone fluctuations and the menstrual cycle in psychopathology during the pubertal transition is critical for developing novel prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

• Slightly higher cortisol concentrations in follicular vs. luteal phase. • Higher cortisol concentrations in menstrual vs. premenstrual phase in precise cycle phase determination. • Majority of studies measuring HPA-axis activity in the menstrual cycle are using single measures of cortisol. • Progesterone derivatives (e.g. ALLO) might decrease cortisol concentrations in luteal/premenstrual phase. Differential HPA axis function has been proposed to underlie sex-differences in mental disorders; however, the impact of fluctuating sex hormones across the menstrual cycle on HPA axis activity is still unclear. This meta - analysis investigated basal cortisol concentrations as a marker for HPA axis activity across the menstrual cycle. Through a systematic literature search of five databases, 121 longitudinal studies were included, summarizing data of 2641 healthy, cycling participants between the ages of 18 and 45. The meta-analysis showed higher cortisol concentrations in the follicular vs. luteal phase (d SMC = 0.12, p =.004, [0.04 – 0.20]). Comparisons between more precise cycle phases were mostly insignificant, aside from higher concentrations in the menstrual vs. premenstrual phase (d SMC = 0.17, [0.02 – 0.33], p =.03). In all included studies, nine samples used established cortisol parameters to indicate HPA axis function, specifically diurnal profiles (k = 4) and the cortisol awakening response (CAR) (k = 5). Therefore, the meta-analysis highlights the need for more rigorous investigation of HPA axis activity and menstrual cycle phase. [ABSTRACT FROM AUTHOR]

Background: Fidelity in complex behavioral interventions is underexplored. This study examines the fidelity of the INFORM trial and explores the relationship between fidelity, study arm, and the trial's primary outcome-care aide involvement in formal team communications about resident care.Methods: A concurrent process evaluation of implementation fidelity was conducted in 33 nursing homes in Western Canada (Alberta and British Columbia). Study participants were from 106 clinical care units clustered in 33 nursing homes randomized to the Basic and Enhanced-Assisted Feedback arms of the INFORM trial.Results: Fidelity of the INFORM intervention was moderate to high, with fidelity delivery and receipt higher than fidelity enactment for both study arms. Higher enactment teams experienced a significantly larger improvement in formal team communications between baseline and follow-up than lower enactment teams (F(1, 70) = 4.27, p = .042).Conclusions: Overall fidelity enactment was associated with improvements in formal team communications, but the study arm was not. This suggests that the intensity with which an intervention is offered and delivered may be less important than the intensity with which intervention participants enact the core components of an intervention. Greater attention to fidelity assessment and publication of fidelity results through studies such as this one is critical to improving the utility of published trials. [ABSTRACT FROM AUTHOR]

Background: Effective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially effective improvement intervention. This study compares the effect of simple and two higher intensity levels of feedback based on goal-setting theory on improving formal staff communication in NHs.Methods: This pragmatic three-arm parallel cluster-randomized controlled trial included NHs participating in TREC (translating research in elder care) across the Canadian provinces of Alberta and British Columbia. Facilities with at least one care unit with 10 or more care aide responses on the TREC baseline survey were eligible. At baseline, 4641 care aides and 1693 nurses cared for 8766 residents in 67 eligible NHs. NHs were randomly allocated to a simple (control) group (22 homes, 60 care units) or one of two higher intensity feedback intervention groups (based on goal-setting theory): basic assisted feedback (22 homes, 69 care units) and enhanced assisted feedback 2 (23 homes, 72 care units). Our primary outcome was the amount of formal communication about resident care that involved care aides, measured by the Alberta Context Tool and presented as adjusted mean differences [95% confidence interval] between study arms at 12-month follow-up.Results: Baseline and follow-up data were available for 20 homes (57 care units, 751 care aides, 2428 residents) in the control group, 19 homes (61 care units, 836 care aides, 2387 residents) in the basic group, and 14 homes (45 care units, 615 care aides, 1584 residents) in the enhanced group. Compared to simple feedback, care aide involvement in formal communications at follow-up was 0.17 points higher in both the basic ([0.03; 0.32], p = 0.021) and enhanced groups ([0.01; 0.33], p = 0.035). We found no difference in this outcome between the two higher intensity groups.Conclusions: Theoretically informed feedback was superior to simple feedback in improving care aides' involvement in formal communications about resident care. This underlines that prior estimates for efficacy of audit and feedback may be constrained by the type of feedback intervention tested.Trial Registration: ClinicalTrials.gov ( NCT02695836 ), registered on March 1, 2016. [ABSTRACT FROM AUTHOR]