Positive Health Outcomes Research Articles

Health Locus of Control and Medical Behavioral Interventions: Systematic Review and Recommendations.

Health locus of control (HLOC) is a theory that describes how individuals perceive different forces that influence their lives. The concept of a locus of control can affect an individual's likelihood to commit to behaviors related to their health. This study explores the literature on the relationships between HLOC and medical behavioral interventions. This study aims to better understand how HLOC constructs can potentially affect patient responses to health behavioral interventions and to propose a series of guidelines for individuals interested in designing medical behavioral interventions related to HLOC. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology and performed an analysis of 50 papers related to the topic of HLOC and medical behavioral interventions. Inclusion criteria were studies that had a behavioral intervention involving patients and contained a metric of at least 1 of the constructs related to HLOC. The initial screening and search were conducted by 2 researchers (AY and SM) separately. The results were then combined and compared. Our findings explore the influence of different levels of HLOC along with the importance of both patient- and health-related context when assessing the relationships between HLOC constructs and the likelihood of health behavior change. The findings show that different constructs related to HLOC can act as reliable predictors for patient responses to medical behavioral interventions. Patients who score higher on internal HLOC measures are more likely to exhibit behaviors that are consistent with positive health outcomes. Patients who score higher on chance HLOC are more likely to exhibit behaviors that may lead to adverse health outcomes. These conclusions are supported by most of the 50 studies surveyed. We propose guidelines for individuals designing medical behavioral interventions so that they can make use of these relationships linked to HLOC. The three guidelines suggested are as follows: (1) in most situations, improving internal HLOC will improve health outcomes for patients; (2) patients with high external HLOC should be further studied to determine the source of the external HLOC; and (3) patients with a high chance HLOC are less likely to follow preventative behaviors or be responsive to interventions. Limitations of the study are that the primary search and analysis were conducted by 2 principal researchers (AY and SM). Interpretation and development of the guidelines are subject to individual interpretation of results and may not be applicable to all contexts.

Mental Health and Suicide Risk Among High School Students and Protective Factors - Youth Risk Behavior Survey, United States, 2023.

Adolescent mental health and suicide risk remain substantial public health concerns. High pre-COVID rates of poor mental health and suicide-related behaviors have continued to rise, highlighting the need to identify factors that might foster positive mental health outcomes and reduce suicide-related behaviors at population levels. Using CDC's 2023 Youth Risk Behavior Survey, CDC analyzed the prevalence of mental health and suicide risk indicators and their associations with individual-, family-, and school- or community-level protective factors. Prevalence estimates were calculated for each of the mental health and suicide risk indicators by demographic characteristic. Prevalence ratios adjusted for sex, sexual identity, grade, and race and ethnicity were calculated to examine the association between protective factors and mental health and suicide risk indicators. Overall, 39.7% of students experienced persistent feelings of sadness and hopelessness, 28.5% experienced poor mental health, 20.4% seriously considered attempting suicide, and 9.5% had attempted suicide. Mental health and suicide risk indicators differed by sex, sexual identity, grade, and race and ethnicity. All protective factors were associated with lower prevalence of one or more risk indicators. Findings from this report can serve as a foundation for the advancement of research on protective factors and for the development and implementation of programs, practices, and policies that protect and promote mental health and emotional well-being among youth.

Implementation of an electronic patient portal in routine mental health care of hospitals in Germany – evaluation of attitudes of healthcare providers

BackgroundThe use of digital tools such as electronic patient portals in different health care disciplines and settings has been increasing, but the rate of implementation in clinical practice still lags behind expectations. While studies have linked the use of electronic patient portals to positive health outcomes for patients, studies addressing the viewpoints of healthcare providers are rare.MethodsWe performed an online survey of attitudes of healthcare providers towards an electronic patient portal for mental health hospitals. The portal was developed by five communal providers of mental health care in different regions in Germany. The survey was carried out during the early phase of implementation of the portal.ResultsTwenty project leaders and 37 clinicians from five different mental health hospitals answered the questionnaire (response rate: 45% and 28%). Overall, acceptance of online applications among respondents was high. The healthcare providers mentioned perceived benefits (e.g. accessibility of new patient groups, use of therapy-free periods) as well as a number of technical, structural, organizational and staffing barriers for successful implementation in hospital settings (e.g. workload of healthcare providers and lack of staff, limited digital competences, unstable WLAN).ConclusionThe perceived barriers and facilitators of the implementation of online applications and electronic patient portals in mental health hospitals identified by healthcare providers may be taken into account. Improving commitment of the healthcare providers to implementation and use of digital interventions may help foster digitalisation in mental health hospitals.

The influence of hope and optimism on trajectories of COVID-19 stress, health anxiety, and wellbeing during the COVID-19 pandemic.

The COVID-19 pandemic posed a threat to public health and psychological functioning, with early studies documenting higher rates of psychopathology within the United States and globally. Hope and optimism promote adjustment and are associated with positive physical and mental health outcomes. Thus, individual differences in hope and optimism may also foster resilience during a global health crisis. The current study examined how hope and optimism influenced longitudinal health-focused distress and wellbeing during the pandemic. Data were collected from 788 American adults across three periods during Spring-Summer 2020 using MTurk. Latent growth curve modeling examined whether hope and optimism predicted COVID stress, health anxiety, and wellbeing trajectories. COVID stress and health anxiety decreased after the onset of the pandemic, whereas wellbeing was stable. Individually, hope and optimism predicted lower initial COVID stress and health anxiety, along with greater initial wellbeing. When examining the combined influence of hope and optimism, optimism was more strongly related to health-focused distress, though both were strong predictors of wellbeing. These findings indicate that Americans were resilient and positive expectancies, particularly optimism, predicted better initial adjustment to the early phases of the pandemic. Thus, positive expectancies appear to be protective during a global health crisis.

Men’s involvement in family planning programs: an exploratory study from Karachi, Pakistan

BackgroundIn Pakistan, family planning has traditionally been perceived as primarily a women’s concern, resulting in the exclusion of men from relevant initiatives. This situation is further exacerbated by cultural and social barriers that hinder men’s access to family planning services. This study addresses a significant research gap by assessing the extent of family planning service provision for men in urban areas of Karachi. It delves into the exploration of men’s involvement in family planning service delivery, identifies existing gaps in services catering to men, records men’s perceptions of accessibility and acceptability of these services, and ultimately offers recommendations to enhance men’s involvement and strengthen service provision to better meet their needs.MethodsWe employed a qualitative exploratory research design using semi-structured interviews to investigate perceptions regarding family planning service provision to men. This approach involved 25 interviews, comprising eight key informant interviews with stakeholders, eight with service providers, and nine in-depth interviews with married men.ResultsThis study highlights the limited engagement of men in family planning programs, primarily due to entrenched sociocultural norms that confine female healthcare providers to serving women, hindering men’s involvement. While national and provincial policies endorse men’s participation, they lack defined roles for male providers. Behavioral and information-sharing barriers at the community level discourage male healthcare providers from collaborating with females. Family planning programs, except for NGO-led vasectomy projects, fail to adequately address men’s needs. Despite policy recognition, implementation remains inadequate. Bridging the men’s involvement gap necessitates more male providers and improved contraceptive stigma combat training. Further research is vital to explore effective methods for involving men in community and service delivery in family planning.ConclusionThere is a need to change the perception that contraception is solely the responsibility of women, as men’s participation in family planning in Karachi is limited. Engaging men can yield positive health and non-health outcomes. Culturally sensitive services, developed with community input using a couple-centered approach, are crucial for equitable family planning. Further research is needed to explore men’s inclusion strategies in service provision and utilization.

Investigating the Impact of Caregiver Adverse Childhood Experiences Screening and Pediatrician-Led Discussions on Posttraumatic Stress Disorder Symptoms in a Majority-Hispanic Pediatric Primary Care Clinic Setting

Background: Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied. Objectives: To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening. Research Design: Data was obtained as part of a cluster randomized controlled trial to examine the effects of ACEs screening and provider-led discussions on child health care utilization outcomes. Baseline surveys were completed before scheduled infant well child checks (WCCs). Providers were randomized into the standard of care or intervention (discussion) conditions. Intervention providers were trained in delivering brief trauma-informed discussions about the impact of ACEs on parenting during WCCs. Subjects: Caregivers in a pediatric primary care clinic serving predominantly Hispanic and low socioeconomically resourced families (N=179, 93% female, 87% Hispanic). Measures: The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief Resilience Scale (BRS), and ACEs screening were completed at baseline. PC-PTSD-5 was repeated 1-week after screening. Results: Mixed-effects ordinal logistic regression analysis of PTSD scores from baseline to 1-week postscreening with the full sample showed no significant effect of time [odds ratio (OR)=1.21, P=0.68], group (OR=1.68, P=0.33), or their interaction (OR=0.48, P=0.21). Conclusions: Screening or brief discussion of ACEs with providers trained in trauma-informed care were not associated with worsening PTSD symptoms.

Prevalence of early initiation of breastfeeding and its associated factors among women in Mauritania: evidence from a national survey

BackgroundTimely initiation of breastfeeding is crucial for positive health outcomes for babies and mothers. Understanding the factors influencing timely initiation of breastfeeding is vital for reducing child morbidities and mortalities in Mauritania. This study, therefore, assessed the prevalence of early initiation of breastfeeding and its associated factors among women in Mauritania, providing significant insights for improving maternal and child health in the country.MethodsWe performed a secondary analysis of the 2019–2021 Mauritania Demographic and Health Survey data. A weighted sample of 4,114 mother-child pairs was included in the study. We used percentage to present the prevalence of early initiation of breastfeeding. A four-modelled multilevel binary logistic regression was used to examine the factors associated with early initiation of breastfeeding. The regression results were presented using adjusted odds ratio (aOR) with their respective 95% confidence interval (CI). Stata software version 17.0 was used to perform all the analyses.ResultsThe prevalence of early initiation of breastfeeding was 57.3% (95% CI 54.5, 60.00). Birth order was associated with early initiation of breastfeeding with the highest odds among those in the fourth birth order (aOR 1.61; 95% CI 1.08, 2.39). Mothers who practiced skin-to-skin contact were more likely to initiate breastfeeding early than those who did not (aOR 1.46; 95% CI 1.14, 1.87). There were regional disparities in the early initiation of breastfeeding. The odds of timely initiation of breastfeeding was lower among women who were delivered by caesarean section (aOR 0.22; 95%CI 0.14, 0.36), those who were working (aOR 0.57; 95% CI 0.45, 0.73), those who had four or more antenatal care visits (aOR 0.67; 95%CI 0.47, 0.94)], and those in the richest wealth quintile (aOR 0.61; 95% CI 0.38, 0.98) compared to those who had normal delivery, those who were not working, those who had zero antenatal care visits, and those in the poorest wealth quintile households, respectively.ConclusionOur study found a relatively low prevalence of early initiation of breastfeeding among women in Mauritania. Factor such as birth order, region of residence, mother and newborn skin-to-skin contact after birth, antenatal care visits, caesarean delivery, employment status, and wealth index were associated with early initiation of breastfeeding. Improving optimal breastfeeding practices, such as early initiation of breastfeeding in Mauritania, should be given adequate attention. There is a need for interventions such as baby-friendly facilities, providing an enabling environment for mothers to breastfeed their newborns early. Addressing regional health access disparities is important to improve early initiation of breastfeeding and other maternal, newborn, and child health interventions.

Neonatal Morbidities, Neurodevelopmental Impairments, and Positive Health among Children Surviving Birth Before 32 Weeks of Gestation

To evaluate positive health outcomes among children born at < 32 weeks of gestation, and to determine whether children with three common neonatal morbidities and two neurodevelopmental impairments would have similar positive health outcomes to children and adolescents without these exposures and impairments. In this secondary analysis of prospectively acquired data derived from three multi-center cohorts of children born very preterm (the ELGAN cohort [birth years 2001 to 2004], the NOVI cohort [birth years 2014 to 2016], and the DINE cohort [birth years 2010 to 2020]), we examined associations between the three common neonatal morbidities (bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage, diagnosed before hospital discharge), two neurodevelopmental impairments (developmental delays and cerebral palsy, diagnosed at preschool age follow-up), and perceptions of physical, mental, and social well-being (in either early childhood or adolescence), using the Patient-Reported Outcomes Measurement Information System (PROMIS®) scales for positive health. After adjusting for confounders, bronchopulmonary dysplasia, intraventricular hemorrhage, and cerebral palsy were associated with lower positive health scores, reported by parent-proxy during early childhood. None of the exposures or impairments were associated with lower positive health scores at adolescence, reported by the children themselves. Parents of children born very preterm with bronchopulmonary dysplasia, intraventricular hemorrhage, or cerebral palsy rated their children's positive health lower than did parents of children without these morbidities. However, adolescents' own reports of positive health outcomes were not associated with either neonatal pre-discharge morbidities or preschool neurodevelopmental impairments.

Mental Health Treatment-Seeking Appraisal, Afrocentric Cultural Norms, and Mental Health Functioning: Buffering Factors of Young Black Men's Externalizing Behavior.

Depression rates are disproportionately high among Black American Men. This disparity--compounded by low mental healthcare seeking rates and high incorrect diagnosis rates in men--could be related to masculine norms, including self-reliance, restrictive emotionality, and stoicism. Furthermore, men are more likely to engage in externalized behavior, such as aggression, to cope with mental health challenges; this pattern is influenced by cultural and environmental factors. Contrary to these detrimental factors, social relationships, belief in social networks, and collectivism have been associated with positive mental health in these populations. Similarly, an Afrocentric worldview (including concepts like Ubuntu and African self-consciousness) has been hypothesized to promote positive mental health outcomes among Black American men. However, little research exists on harnessing these factors as a means of increasing health-seeking behaviors in young Black males. To elucidate the effect of region, depression, African humanism, collectivism, and help-seeking values and needs concerning aggression in young Black males. This study included Black or African American participants (n = 428) identifying as male, aged 18-25 years, who responded to a Qualtrics survey with questions on region, aggression, depression, African humanism, collectivism, and help-seeking value and need. Hierarchical linear regression revealed that collectivism, humanness, value, and the need for seeking treatment were inversely associated with aggression (p < 0.001). Highlighting the effect of cultural norms and help-seeking behaviors and the aggravating effect of depression on aggression in young Black males can help to develop aggression-mitigating interventions rooted in Afrocentric Norms.

A concealable intervention for a concealed group: Applying self‐affirmation interventions to people with concealable stigmatized identities

AbstractPeople with concealable stigmatized identities (CSIs)—identities that are devalued by society, but membership can be hidden (e.g., sexual or gender minority, mental illness, sexual assault survivor)—report high rates of negative health outcomes (e.g., depression, anxiety, illness symptoms). The current literature on CSIs suggests that disclosing one's CSI may promote positive health outcomes, but this approach leaves behind individuals who are unable to disclose due to financial, safety, or personal reasons. The current integrative review examines how self‐affirmation –reaffirming a part of one's identity after a psychologically threatening experience—may buffer against negative health outcomes among people with CSIs; a technique that does not require disclosure to reap the benefits. The purpose of this article is to describe why self‐affirmation may be effective at targeting various factors of CSIs (e.g., anticipated stigma, internalization, centrality, salience) and to call for interventions examining self‐affirmations in this population.

Closing the referral loop on health-related social needs.

184 Background: Additional clinical challenges arise by way of health-related social needs (HRSNs) presenting barriers outside of clinic walls. Taking a person-centered approach by assessing and addressing HRSNs to overcome barriers can be practiced through resource referrals to community-based organizations offering specialized social services. Using closed-loop referral (CLR) technology, HRSNs can be addressed resulting in higher treatment completion rates and on-time visits contributing to positive health outcomes, quality of life, and improved business outcomes. HRSNs are categorized in major groups such as transit, food, housing, money, health (i.e. mental health, dental care, nutrition counseling, etc.), and care (i.e. daycare, end-of-life care, physical safety, etc.). In this study, we seek to substantiate CLR technology to address common HRSNs impacting cancer patients through real-time data sharing and resource facilitation showing reportable evidence that the HRSNs have been addressed. Methods: On June 5 th , 2023, The US Oncology Network (The Network) launched Findhelp’s CLR platform onboarding users in over 600 clinical service sites nationwide. Implementation and change management began with a pilot group and deployment to remaining clinical sites in a sequence of three waves. Methods used to measure engagement came through onboarding analytics and click rates tracked through the Findhelp CLR platform. For training and support job aides, new user workflows, promo materials and weekly office hours were held to catalyze engagement. Results: Within an eleven-month measurement period, 75% of practices in The Network showed navigation activities within the referral platform. The top five resource searches by need included health (21.7%), transit (20.8%), food (19.9%), housing (18.9%), and care (6.5%). Over 2,000 referrals were made with 1,306 being CLRs for nearly 500 patients receiving help to meet identified HRSNs through the CLR technology. Conclusions: In this study, over 50% of patients referred to social care services were captured as successfully receiving help meeting identified HRSNs. This study opens doors to further research on what HRSNs were not met, and to identify distressed demographics by location and geographical resource deserts with unmet HRSNs.

'You're Just Thinking About Going Home': Exploring Person-Centred Medication Communication With Older Patients at Hospital Discharge.

The hospital discharge process poses significant safety risks for older patients due to complexities in communication and coordination among stakeholders, leading to potential drug-related problems post-discharge. Adopting a person-centred care (PCC) approach in medication communication by healthcare professionals (HCPs) is crucial to ensure positive health outcomes. This study aimed to explore the practice of PCC in medication communication between older patients and HCPs during the hospital discharge process. We conducted a qualitative study using non-participatory direct observations of patient-HCP consultations during hospital discharge, followed by semi-structured interviews with observed patients and, when applicable, their informal caregivers. Data collection occurred from October 2020 to May 2021 at two Swedish hospitals. We gathered data using an observational form and audio-recorded all consultations and interviews. The data were analysed thematically using the systematic text condensation method. Twenty patients were included (median age: 81 years [range: 65-94]; 9 female) in observations and 13 of them participated in interviews. Two patients were accompanied by an informal caregiver during the interviews. Three main themes were identified: (1) The impact of traditional authoritarian structures, depicts power dynamics between patients and their HCPs, showing how traditional structures influence the practice of PCC in medication communication during hospital discharge; (2) Consultation timing and mode not on patients' terms, describes suboptimal times and settings for consultations, along with the use of complex language that hinders effective communication; and (3) Discrepancy in expectations of self-care ability, illustrates a mismatch between the self-care guidance provided by HCPs during hospital discharge and the actual needs and preferences of patients and informal caregivers. Medication communication between older patients and HCPs during hospital discharge is frequently inconsistent with the practice of PCC. Not only must HCPs improve their communication strategies, but patients and their informal caregivers should also be better prepared for discharge communication and encouraged to participate in their care. This involvement would give them relevant knowledge and tailor communication to their individual needs, preventing problems in managing their medications after discharge. An advisory group of six patients and/or informal caregiver contributors provided input on the study design, edited the consent forms, and helped develop the interview guide.

Greenness visibility in urban living environments as pathway to promote health and well-being: Mapping spatial differentiation in Flanders (Belgium) based on viewshed analysis

A substantial body of evidence links green space to positive health outcomes. Beyond the availability of dedicated green spaces such as parks and the overall presence of vegetation and trees, visual exposure to greenery has also been shown to be important for well-being. Enhancing visual access to greenery may thus represent a pathway to promoting health and well-being. However, at regional or national scales, insights into disparities in visual access to greenery remain scarce. Most research and policy efforts rely on two-dimensional (top-down) data, which often fails to accurately capture the amount of greenery visible from individual perspectives, such as from within homes.This study builds on the work of Labib et al. [20], who developed a high-resolution (5 m grid) Viewshed Greenness Visibility Index (VGVI) for the Greater Manchester area (UK). By introducing technical improvements that significantly increased computational efficiency, we extended this approach to create a comprehensive VGVI map for Flanders, the northern region of Belgium. The resulting map enabled a broad assessment of VGVI disparities across Flanders. Our findings reveal evidence of distributive environmental injustice, as demonstrated by a strong negative correlation (Spearman's Rho = -0.48) between neighbourhood deprivation levels and VGVI scores. In Flanders, residents of more deprived neighbourhoods are exposed to significantly lower levels of visible greenery.We further explored the differences and similarities between traditional top-down greenness mapping and VGVI, which provides an eye-level perspective. Although a strong positive correlation was observed at the regional scale (Pearson's r = 0.80), this relationship weakens at the local level. Our findings suggest that VGVI analysis is particularly valuable at smaller geographic scales, making it especially relevant for research or spatial policies that address disparities in individual living conditions or target specific locations, such as schools, nurseries, hospitals, retirement homes, and community centres.

Unveiling the Effects of Cruciferous Vegetable Intake on Different Cancers: A Systematic Review and Dose-Response Meta-analysis.

Epidemiological studies indicated that cruciferous vegetable intake is associated with positive health outcomes. However, the role of cruciferous vegetables may have differential impacts on various cancers. This meta-analysis aims to review recent epidemiological studies on the link between cruciferous vegetables and various cancers. It seeks to identify the optimal intake dose and timing of cruciferous vegetables influencing their association with cancer risk. Studies on cruciferous vegetables and cancer were searched in PubMed, NCBI, Web of Science, and Elsevier databases from 1978 to June 2023. Extracted data from 226 relevant case-control and cohort studies were expressed by standardized mean difference and 95% CI, followed by the subgroup analysis to eliminate heterogeneity. Intake of cruciferous vegetables can prevent cancers, with an odds ratio of 0.77 and risk ratio (RR) of 0.96. The intake levels of cruciferous vegetables associated with the risk of colorectal cancer, lung cancer, upper gastrointestinal cancer, gynecological cancer (ovarian cancer and endometrial cancer), bladder cancer, renal cancer, and prostate cancer were found to be 5.41 servings/week, 5.41 servings/week, 5.5 servings/week, 7.4 servings/week, 5.5 servings/week, 4.85 servings/week, and 3 servings/week, respectively. In a cohort followed for 2 to 15 years, limited consumption of cruciferous vegetables was correlated with a higher cancer RR. In the Asian population, cruciferous vegetables had a significant relationship with lung cancer, head and neck squamous cell carcinoma, and esophageal cancer. Conversely, cruciferous vegetables are predominantly associated with colorectal, renal, gynecological, and prostate cancer in the American population. This study highlights the complex link between cruciferous vegetables and cancer, influenced by factors such as cancer type, region, intake level, and follow-up duration.

Exercise, Neuroprotective Exerkines, and Parkinson's Disease: A Narrative Review.

Parkinson's disease (PD) is a prevalent neurodegenerative disease in which treatment often includes an exercise regimen. Exercise is neuroprotective in animal models of PD, and, more recently, human clinical studies have verified exercise's disease-modifying effect. Aerobic exercise and resistance training improve many of PD's motor and non-motor symptoms, while neuromotor therapy and stretching/flexibility exercises positively contribute to the quality of life in people with PD. Therefore, understanding the role of exercise in managing this complex disorder is crucial. Exerkines are bioactive substances that are synthesized and released during exercise and have been implicated in several positive health outcomes, including neuroprotection. Exerkines protect neuronal cells in vitro and rodent PD models in vivo. Aerobic exercise and resistance training both increase exerkine levels in the blood, suggesting a role for exerkines in the neuroprotective theory. Many exerkines demonstrate the potential for protecting the brain against pathological missteps caused by PD. Every person (people) with Parkinson's (PwP) needs a comprehensive exercise plan tailored to their unique needs and abilities. Here, we provide an exercise template to help PwP understand the importance of exercise for treating PD, describe barriers confronting many PwP in their attempt to exercise, provide suggestions for overcoming these barriers, and explore the role of exerkines in managing PD. In conclusion, exercise and exerkines together create a powerful neuroprotective system that should contribute to slowing the chronic progression of PD.

Assessing the influence of dietary patterns on preeclampsia and obesity among pregnant women in the United States

This review paper examines the influence of dietary patterns on preeclampsia and obesity among pregnant women in the United States, aiming to elucidate the connection between nutrition and maternal health outcomes. The paper explores common dietary patterns, their impact on pregnancy complications, and the potential mechanisms through which nutrition affects maternal and fetal health. By synthesizing existing research, the review highlights the critical role of personalized dietary counseling and lifestyle interventions in improving pregnancy outcomes. It also emphasizes the need for comprehensive policy initiatives and future research directions to enhance maternal health through optimal nutrition and lifestyle modifications. Through a detailed analysis, the review underscores the importance of adopting healthy dietary patterns to mitigate risks and promote positive health outcomes for both mothers and their children.

Impact of Hormone Therapy on Serum Lipids in Transgender People

The term “Transgender” is used to describe individuals whose gender identity is different from their external sexual anatomy at birth. The number of people identifying as transgender has increased in recent years, and consequently, the number of gender affirmation surgeries and the use of hormonal therapies has also increased. A wide range of hormonal therapies has emerged considering the target population, age, and final outcomes, and as such these are becoming increasingly developed and complex in order to be the most appropriate for each individual. However, the side effects of these therapies remain to be fully understood. Therefore, this review aims to assess the impact of hormone therapy, in both transgender men and women of different ages, on the lipid profile. From the studies analyzed, it is possible to conclude that there is a relationship between hormone therapy and the lipid profile, with different outcomes between transgender men and women. There is a reduction in cardiovascular risk for transgender women as opposed to transgender men, in whom cardiovascular risk seems to increase due to lipid changes. It is now necessary to understand the mechanisms involved in order to reduce the consequences of these therapies and promote positive health outcomes.

Rethinking culture: a narrative review on the evolving role of museum and art gallery-based heritage activities and programmes on wellbeing.

The prevalence of chronic mental and physical diseases is increasing globally. In addition, the changing demographics towards an ageing population pose a challenge to healthcare systems, as ageing is associated with a decrease in physical and mental capacity and an increased risk of developing disease. The review aims to explore primary studies that investigated the effect of museum and art gallery-based heritage activities and programmes on the wellbeing of (1) individuals recovering from drug addiction or patients with dementia and (2) younger and older adults. We conducted a search using specific keywords, and inclusion and exclusion criteria, in databases for the period 2013-2023. Following a detailed examination of numerous articles, 15 original studies were included in this review. 15 original studies investigated the effects of museum and art gallery-based heritage activities or programmes on (1) patients with chronic diagnoses associated with mental health and/or physical impairment, such as drug addiction and dementia and (2) the wellbeing of younger and older populations. The interactive environment of museums had positive health outcomes for patients with chronic mental (addiction recovery, dementia) and physical diseases (cancer) as well as hospitalized patients. In addition, it improved the physical and mental wellbeing of younger and older individuals. Museum art-based interventions may be integrated as part of the non-pharmacological management of patients experiencing mental disorders as well as for improving the wellbeing of younger and older populations.

Gut microbiota wellbeing index predicts overall health in a cohort of 1000 infants

The human gut microbiota is central in regulating all facets of host physiology, and in early life it is thought to influence the host’s immune system and metabolism, affecting long-term health. However, longitudinally monitored cohorts with parallel analysis of faecal samples and health data are scarce. In our observational study we describe the gut microbiota development in the first 2 years of life and create a gut microbiota wellbeing index based on the microbiota development and health data in a cohort of nearly 1000 infants using clustering and trajectory modelling. We show that infants’ gut microbiota development is highly predictable, following one of five trajectories, dependent on infant exposures, and predictive of later health outcomes. We characterise the natural healthy gut microbiota trajectory and several different dysbiotic trajectories associated with different health outcomes. Bifidobacterium and Bacteroides appear as early keystone organisms, directing microbiota development and consistently predicting positive health outcomes. A microbiota wellbeing index, based on the healthy development trajectory, is predictive of general health over the first 5 years. The results indicate that gut microbiota succession is part of infant physiological development, predictable, and malleable. This information can be utilised to improve the predictions of individual health risks.

Health enhancing behaviors in early adolescence: an investigation of nutrition, sleep, physical activity, mindfulness and social connectedness and their association with psychological distress and wellbeing.

Nutrition, sleep and physical activity are termed the "big three" health enhancing behaviors (HEB) associated with psychological distress and wellbeing. This study sought to understand differential associations between an expanded group of HEB (nutrition, sleep, physical activity, mindfulness, social connectedness) and psychological distress/wellbeing in early adolescents. Correlational and regression analyses were conducted in N=103 (51% females) adolescents (12.6 ± 0.3 years of age) recruited from the Longitudinal Adolescent Brain Study. Higher scores on sleep, social connectedness and mindfulness scales were significantly associated with lower psychological distress scores. While higher scores on social connectedness and mindfulness scales were significantly associated with higher wellbeing scores. When adjusting for sex, nutrition, sleep, social connectedness and mindfulness accounted for a significant proportion of variance in the psychological distress model whereas physical activity and social connectedness accounted for a significant proportion of the variance in the wellbeing model. Overall findings make a strong case for expansion of the "big three" HEB to include mindfulness and social connectedness, especially given social connectedness emerged as the strongest predictor of both psychological distress and wellbeing. In addition, this research suggests that early adolescent nutrition, sleep quality, and mindfulness should be prioritized in efforts to reduce risk of difficulties, and physical activity prioritized as a protective factor for wellbeing in this population. Findings have implications for interventions, emphasizing the importance of addressing HEB factors comprehensively and tailoring strategies to the unique needs of early adolescents to foster positive mental health outcomes.