Preventive Interventions Research Articles

The effect of climate crisis on bipolar disorder: A qualitative study about experiences of individuals diagnosed with bipolar disorder.

It can be said that the bipolar disorder is influenced by weather events. It is stated that climate change can have direct and indirect effects on bipolar disorder. Determining the impact of the climate crisis on individuals with bipolar disorder may assist in the development of preventive, protective and active treatment interventions for this group. The aim of this study was to determine the views and experiences of people with bipolar disorder about the impact of the climate crisis on their illness. The study was conducted using the phenomenological method, one of the qualitative study methods. Purposive sampling was used to select the sample for the study. In-depth individual interviews were conducted with the selected sample group. Data saturation was reached with 11 participants and data collection was finalized. The study data was collected using a personal information form and an open-ended structured interview form in which participants were asked about their views and experiences of the climate crisis. Voice recordings were transcribed, and categories, sub-themes and themes were formed. Based on the statements of people with a bipolar diagnosis, the study formed the themes of emotional impact, negative physical impact, impact on daily life, impact on symptoms, negative impact on recovery and ways of coping. People with a bipolar diagnosis are negatively affected by the impact of the climate crisis in many areas. There is a need to develop intervention programmes to arm people with a bipolar diagnosis against the negative effects of the climate crisis.

Digital Phenotyping of Mental and Physical Conditions: Remote Monitoring of Patients Through RADAR-Base Platform.

The use of digital biomarkers through remote patient monitoring offers valuable and timely insights into a patient's condition, including aspects such as disease progression and treatment response. This serves as a complementary resource to traditional health care settings leveraging mobile technology to improve scale and lower latency, cost, and burden. Smartphones with embedded and connected sensors have immense potential for improving health care through various apps and mobile health (mHealth) platforms. This capability could enable the development of reliable digital biomarkers from long-term longitudinal data collected remotely from patients. We built an open-source platform, RADAR-base, to support large-scale data collection in remote monitoring studies. RADAR-base is a modern remote data collection platform built around Confluent's Apache Kafka to support scalability, extensibility, security, privacy, and quality of data. It provides support for study design and setup and active (eg, patient-reported outcome measures) and passive (eg, phone sensors, wearable devices, and Internet of Things) remote data collection capabilities with feature generation (eg, behavioral, environmental, and physiological markers). The back end enables secure data transmission and scalable solutions for data storage, management, and data access. The platform has been used to successfully collect longitudinal data for various cohorts in a number of disease areas including multiple sclerosis, depression, epilepsy, attention-deficit/hyperactivity disorder, Alzheimer disease, autism, and lung diseases. Digital biomarkers developed through collected data are providing useful insights into different diseases. RADAR-base offers a contemporary, open-source solution driven by the community for remotely monitoring, collecting data, and digitally characterizing both physical and mental health conditions. Clinicians have the ability to enhance their insight through the use of digital biomarkers, enabling improved prevention, personalization, and early intervention in the context of disease management.

Punishment and Reward Sensitivity in Risk-Taking as Potential Mechanisms Explaining the Relationships Between Childhood Callous-Unemotional Traits and Adolescent Substance Use in a Longitudinal Cohort Study Sample.

Childhood callous-unemotional (CU) traits are associated with a neurocognitive response style of high reward and low punishment sensitivity, which may make these children particularly vulnerable to substance misuse. However, the mechanisms explaining the link between CU traits and substance use are poorly understood. This study investigated the mediating influences of reward and punishment sensitivity on the association between childhood CU traits and adolescent substance use. Using data from the UK Millennium Cohort Study, mediation analyses were conducted to investigate the potential indirect effects of age 14 reward and punishment sensitivity in risk-taking on the relationships between age 11 CU traits and alcohol, cannabis, and other illicit drug use at age 17. No direct effects of CU traits on substance use were found when accounting for gender, baseline alcohol use, poverty, emotional symptoms, conduct problems, hyperactivity, and verbal ability at age 11. Indirect effects of increased reward sensitivity on the relationship between CU traits and increased use were seen for alcohol, cannabis, and other drugs. There was a significant indirect effect of reduced punishment sensitivity on the relationship between CU traits and increased alcohol use, but not cannabis or other substance use. Findings suggest that reward and punishment sensitivity may have independent effects on decision-making processes contributing to adolescent substance use. Prevention and early intervention for substance use should consider modifying intervention strategies to fit the needs of adolescents with a callous interpersonal style and a neurocognitive profile characterized by a high drive for rewards and low risk aversion.

A Study on Assessing the Impact of Smoking and Occupational Exposure on COPD Severity.

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, with occupational exposure to respiratory hazards and smoking being significant risk factors for its development and progression. This study aimed to investigate the relationship between occupational exposure and COPD severity among patients admitted to the new medical ward of a public hospital. The research employed a cross-sectional design and involved a sample of 160 COPD patients. Data collection included patient records, face-to-face interviews, and structured questionnaires that gathered demographic information, smoking history, occupational exposure, and disease severity. Quantitative analysis methods were used, with statistical tools such as chi-square tests and correlation analysis applied to assess the relationships between variables. The chi-square test demonstrated a significant association between occupational exposure and COPD severity (χ² = 45.07, df = 8, p = 0.05). Correlation analysis revealed positive relationships between COPD severity and age (r = 0.40), smoking status (r = 0.53), and duration of occupational exposure (r = 0.69). The findings emphasize the critical role of occupational risks and smoking in exacerbating COPD and suggest the need for preventive workplace interventions and stricter regulations to reduce respiratory hazards.

Psycho-Socio-Demographic Risk Factors of Self-injurious Behaviors in Iranian Females Inmates: A Case-Control Study

Background: Self-injurious behavior or self-harm among inmates is a common phenomenon. However, no study has yet been conducted in Iran regarding self-harm in female inmates. Objectives: The present study aimed to investigate the psycho-socio-demographic risk factors associated with non-suicidal self-harm in Iranian female inmates. Patients and Methods: Participants in this case-control study were 306 female inmates in Tehran, who were randomly selected and divided into two groups: (1) 88 individuals who scored 5 or higher on the Sansone Self-harm Inventory (SHI), and (2) 88 individuals randomly selected from the 218 inmates who did not self-harm as the comparison group. The participants completed a researcher-designed questionnaire, SHI, and the Difficulties in Emotion Regulation Scale. The data were analyzed using logistic regression analysis in SPSS version 16. Results: Logistic regression analysis revealed that marital status (B = 1.438, P = 0.002), arrest history (B = 1.295, P = 0.005), substance abuse (B = 1.198, P = 0.011), psychiatric diagnoses (B = 1.126, P = 0.018), parental divorce (B = 1.280, P = 0.005), and difficulties in emotion regulation (B = 0.027, P = 0.022) were significant predictors of self-harm in inmates. Although there was a difference in the addiction rates of parents between those with self-harm and those without, this variable did not predict self-harm in female inmates (B = 0.488, P = 0.307). Conclusions: The results of this study underscore the importance of family-based preventive interventions to prevent self-harm behaviors among female inmates.

Implementation of an HIV Prevention Intervention at Historically Black Colleges and Universities and Predominantly Black Institutions

Black Americans and the Southern United States are disproportionately represented in the HIV epidemic. Historically Black Colleges and Universities (HBCUs) and Predominantly Black Institutions (PBIs), often located in communities that have been historically underserved, are uniquely positioned to implement HIV prevention interventions focused on Black young adults. The purpose of the current study was to conduct a qualitative study, using the Consolidated Framework for Implementation Research (CFIR) model as a guide, to identify the barriers and facilitators to implementing an HIV intervention pre- and post-implementation. Pre-implementation key informant interviews with administrators, faculty, and staff, alongside focus groups with students, highlighted several themes as potential influencers on intervention rollout. These included perceived need, campus health resources, cost, personnel availability, student priorities, HIV-related stigma, and institutional culture. Post-implementation interviews with campus liaisons further revealed themes including institutional culture, external partnerships, internal communication, student health resource accessibility, and peer educator recruitment and retention. These findings underscore the complexities of implementing public health interventions in academic settings and may guide future efforts at HBCUs and PBIs to effectively address HIV prevention.

Exploring reciprocal links between early adolescent coping and internalizing symptoms.

The rising prevalence of depression and anxiety among adolescents is a public health concern. Early adolescence is a key developmental period to reduce risks for internalizing symptoms through primary prevention programs, yet additional research is needed on modifiable factors, such as coping skills, to target to mitigate risk factors. Therefore, we investigated the reciprocal link between coping style and internalizing symptoms among a racially/ethnically diverse sample of early adolescents (n = 1273) from 12 middle schools over 1 year. We leveraged a longitudinal data set of a cluster, randomized trial of a preventive intervention from 12 middle schools in a large public-school district in the United States to test our hypotheses using multilevel modeling. The sample was 49% female and racially/ethnically diverse (39% Hispanic/Latinx, 23% Black/African American, 12% Asian or Pacific Islander, 11% other, 9% White, and 5% multiracial). Participants (ages 12-14) completed a baseline questionnaire in 7th grade (Spring 2018) and a 1-year follow-up questionnaire in 8th grade (Spring 2019). Depressive and anxious symptoms affected levels of active and avoidant coping skill use over the 1-year period of the study, indicating that symptoms can be an impetus for maladaptive coping. We also identified bidirectional links between active coping and depression in addition to avoidant coping and anxiety. Our findings have implications for augmenting coping psychoeducation within prevention programs to reduce internalizing symptoms among early adolescents and for future longitudinal and qualitative research exploring how coping skills reduce risks for internalizing symptoms throughout adolescence and into early adulthood.

Single-cell transcriptome profiling identifies the activation of type I interferon signaling in ossified posterior longitudinal ligament.

Ossification of the posterior longitudinal ligament (OPLL) is a condition comprising ectopic bone formation from spinal ligaments. This disease is a leading cause of myelopathy in the Asian population. However, the molecular mechanism underlying OPLL and efficient preventive interventions remain unclear. Here, we performed single-cell RNA sequencing and revealed that type I interferon (IFN) signaling was activated in the ossified ligament of patients with OPLL. We also observed that IFN-β stimulation promoted the osteogenic differentiation of preosteoblasts in vitro and activated the ossification-related gene SPP1, thereby confirming the single-cell RNA sequencing findings. Further, blocking the IFN-α/β subunit 1 receptor (IFNAR1) using an anti-IFNAR1 neutralizing antibody markedly suppressed osteogenic differentiation. Together, these results demonstrated that the type I IFN signaling pathway facilitated ligament ossification, and the blockade of this signaling might provide a foundation for the prevention of OPLL.

A nomogram for predicting postpartum post-traumatic stress disorder: a prospective cohort study

BackgroundPostpartumpost-traumatic stress disorder (PTSD), as a psychological stress disorder, has long-term and widespread harm. Still, compared with other postpartum psychiatric disorders, postpartum PTSD has received relatively littleattention in China. This study aims to investigate the risk factors of postpartum PTSD and to develop a convenient and rapid nomogram screening tool to help clinical staff identify high-risk pregnant womenin time and take preventative and management measures.MethodsRecruited pregnant women hospitalized for delivery in Qingdao Municipal Hospital and Jinzhou Maternal and Child Health Hospital from November 2022 to October 2023 as convenient samples for the questionnaire survey. Telephone follow-up was conducted 42 days after delivery. After univariate analysis, multicollinearity analysis, and logistic regression analysis, the risk factors of postnatal PTSD were obtained, a prediction model was established, and a nomogram was drawn by R software. G*power3.1.9.7 calculated the effectiveness of the test. The model was validated internally using the Bootstrap approach, and external validation was carried out using a verification group. The accuracy of the model's predictions and its clinical application value were evaluated by the area under the curve, calibration plot, and decision curve analysis.ResultsA total of 602 women were recruited in this study, and the incidence of postpartum PTSD was 11.1% (67/602). Multifactorial logistic regression analysis showed that poor self-assessment of sleep status in late pregnancy (OR = 5.336), cesarean section (OR = 2.825), instrumental delivery (OR = 5.994), having fear of labor (OR = 4.857), and a high score of Five Factors Inventory Neuroticism subscale (OR = 1.244) were independent risk factors for developing postpartum PTSD. A high Quality of Relationship Index score (OR = 0.891) was a protective factor for postpartum PTSD. In the training and validation sets, the nomogram model's area under the ROC curve was 0.928 and 0.907, respectively. The calibration curves showed that the nomogram model was well-fitted, and the Decision Curve Analysis indicated that the nomogram model had good value for clinical application.ConclusionsWith its strong predictive capacity, the prediction model built using postpartum PTSD risk factors can help clinical caregivers identify high-risk pregnant women early on and implement timely preventive intervention strategies.

Frequency and Longitudinal Course of Behavioral and Neuropsychiatric Symptoms in Participants With Genetic Frontotemporal Dementia.

Behavioral and neuropsychiatric symptoms are frequent in patients with genetic frontotemporal dementia (FTD). We aimed to describe behavioral and neuropsychiatric phenotypes in genetic FTD, quantify their temporal association, and investigate their regional association with brain atrophy. We analyzed data of pathogenic variant carriers in the chromosome 9 open reading frame 72 (c9orf72), progranulin (GRN), or microtubule-associated protein tau (MAPT) gene from the Genetic Frontotemporal dementia Initiative cohort study that enrolls both symptomatic pathogenic variant carriers and first-degree relatives of known carriers. Principal component analysis was performed to identify behavioral and neuropsychiatric clusters that were compared with respect to frequency and severity between groups. Associations between neuropsychiatric clusters and MRI-assessed atrophy were determined using voxel-based morphometry. We applied linear mixed effects and generalized linear mixed effects models to assess the longitudinal course of symptoms. A total of 522 participants were included: 221 c9orf72 (138 presymptomatic), 213 GRN (157 presymptomatic), and 88 MAPT (62 presymptomatic) pathogenic variant carriers. Principal component analysis revealed 5 phenotypic clusters (67.6% of variance), labeled diverse behavioral, affective, psychotic, euphoric/hypersexual, and tactile hallucinations phenotype. In participants presenting behavioral or neuropsychiatric symptoms, affective symptoms were most frequent across groups (83.6%-88.1%), followed by diverse behavioral symptoms (68.4%-77.9%). In c9orf72 and GRN pathogenic variant carriers, psychotic symptoms (32.0% and 19.4%, respectively) were more frequent than euphoric/hypersexual symptoms (28.7% and 14.2%, respectively), which was the other way around in MAPT pathogenic variant carriers (28.6% and 23.8%). Although diverse behavioral symptoms were associated with gray and white matter frontotemporal atrophy, only a small atrophy cluster in the right thalamus was associated with psychotic symptoms. Euphoric/hypersexual symptoms were associated with atrophy in mesial temporal lobes, basal forebrain structures, and the striatum (p < 0.05). Estimated time to symptom onset, genetic group, education, and sex influenced behavioral and neuropsychiatric symptoms (p < 0.05). Particularly, in c9orf72 pathogenic variant carriers, psychotic symptoms may be starting decades before recognition of onset of illness. We identified multiple clusters of behavioral and neuropsychiatric symptoms in participants with genetic FTD that relate to distinct cerebral atrophy patterns. Their severity depends on time, affected gene, sex, and education. These clinical-genetic associations can guide diagnostic evaluations and the design of clinical trials for new disease-modifying and preventive treatments.

Process evaluation findings from Strong Hearts, Healthy Communities 2.0: a cardiovascular disease prevention intervention for rural women

BackgroundStrong Hearts, Healthy Communities 2.0 (SHHC-2.0) was a 24-week cardiovascular disease prevention program that was effective in improving physical activity and nutrition behaviors and clinical outcomes among women in 11 rural New York, USA towns. This study evaluated the delivery of SHHC-2.0 to prepare the intervention for further dissemination.MethodsThis process evaluation was guided by the Medical Research Council recommendations and engaged program leaders and participants (i.e., women over age 40) using quantitative and qualitative methods. The quantitative evaluation included examination of enrollment and retention data, a participant survey, and a fidelity checklist completed after classes. Descriptive and comparative statistics were used to assess implementation measures: program reach, participant attendance, dose delivered, program length, perceived effectiveness, fidelity, and participant satisfaction. The qualitative evaluation included focus groups (n = 13) and interviews (n = 4) using semi-structured guides; audio was recorded and transcripts were deductively coded and analyzed using directed content analysis and iterative categorization approaches. Comparisons across towns and between intervention and waitlist control groups were explored.ResultsAverage reach within towns was 7.5% of the eligible population (range 0.7-15.7%). Average attendance was 59.8% of sessions (range 42.0-77.4%). Average dose delivered by leaders was 86.4% of curriculum components (range 73.5-95.2%). Average session length was 51.8 ± 4.8 min across 48 sessions. Leaders’ perceived effectiveness rating averaged 4.1 ± 0.3 out of 5. Fidelity to curricular components was 81.8% (range 67.4-93.2%). Participants reported being “more than satisfied” with the overall program (88.8%) and the health benefits they obtained (72.9%). Qualitative analysis revealed that participants: (1) gained new knowledge and enjoyable experiences; (2) perceived improvements in their physical activity, nutrition, and/or health; (3) continued to face some barriers to physical activity and healthy eating, with those relating to social support being reduced; and (4) rated leaders and the group structure highly, with mixed opinions on the research elements.ConclusionsSHHC-2.0 had broad reach, was largely delivered as intended, and participants expressed high levels of satisfaction with the program and its health benefits. Our findings expand on best practices for implementing cardiovascular disease prevention programs in rural communities.Clinical trials Registrationwww.clinicaltrials.gov #NCT03059472.

(Why?) Evidence-Based Treatments for War-Related Posttraumatic Stress Disorder

Any war increases at least twice the prevalence of post-traumatic stress disorder (PTSD) in its victims. Post-traumatic stress disorder (PTSD) affects about 10% of car accident victims, half of the people who have experienced rape or war, and victims of violence. PTSD negatively affects the quality of life. It is associated with direct and indirect health costs. Any effort to treat and prevent PTSD with evidence-based methods is our obligation toward trauma victims and to professionals at an increased risk of job-related traumatization. In the paper, we will focus on three aspects. First – a rationale of decision making – the role of evidence in elaborating the intervention guidelines will be described. Second, an overview of evidence-based guidelines for the psychological help and for the diagnosis and treatment of PTSD will be presented, according to current NICE (National Institute of Care Excellence) and APA (American Psychological Association) and meta-analyses focusing on war-related trauma. The third part of the paper will be devoted to the prevention of PTSD in people who are exposed to professional, duty-related trauma – the data on the efficacy of preventive interventions together with a short description of the programs (on the example of “Effective performance under stress” program designed to prevent PTSD in firefighters and other professions).

Effectiveness of the Application of Lanolin, Aloe Vera, and Peppermint on Nipple Pain and Nipple Trauma in Lactating Mothers: A Systematic Review and Meta-Analysis.

Infants who are not exclusively breastfed are more vulnerable to gastroenteritis, respiratory illness, and type 1 diabetes mellitus. Mothers who do not breastfeed their infants are at a higher risk of cancer. This systematic review and meta-analysis aimed to synthesize evidence regarding the effectiveness of applying lanolin, aloe vera, and peppermint for alleviating nipple pain and nipple trauma among lactating mothers. Electronic databases, including PubMed (MEDLINE), Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Web of Science, Scopus, and Clinical Key, were searched for studies published in English from January 2000 to December 2022. Nipple pain and nipple trauma were the primary outcomes analysed, and a meta-analysis was conducted via RevMan v5.4. The reviewed trials involved 1,495 participants from 11 studies, with an average participant age of 29 ± 5 years. The application of lanolin significantly reduced nipple pain and nipple trauma in lactating mothers. The application of peppermint significantly reduced nipple trauma in lactating mothers. The application of lanolin or peppermint is a beneficial preventive intervention for reducing nipple trauma and pain.

Chronically Increased Levels of Circulating Insulin Secondary to Insulin Resistance: A Silent Killer.

Despite all the progress made by science in the prevention and treatment of cardiovascular diseases and cancers, these are still the main reasons for hospitalizations and death in the Western world. Among the possible causes of this situation, disorders related to hyperinsulinemia and insulin resistance (Hyperin/IR) are still little-known topics. An analysis of the literature shows that this condition is a multiple risk factor for type 2 diabetes, cardiovascular diseases, cellular senescence and cancer, and neurodegenerative diseases. Hyperin/IR is progressively increasing worldwide, and its prevalence has now exceeded 50% of the general population and in overweight children. Asymptomatic or poorly symptomatic, it can last for many years before manifesting itself as diabetes, cardiovascular disease, neoplasm, cognitive deficit, or dementia, therefore leading to enormous social and healthcare costs. For these reasons, a screening plan for this pathology should be implemented for the purpose of identifying people with Hyperin/IR and promptly starting them on preventive treatment.

Real-World Experience of Erenumab in Patients with Migraine in Germany: The SPECTRE Study.

To provide real-world insights into migraine patient population in Germany treated with erenumab, focusing on the prescription patterns and reasons for the initial dosage choice. SPECTRE was an observational, non-interventional, multicenter, open-label, single-arm study in patients treated with erenumab according to approved local dose and guidelines. The study enrolled adult patients (n = 571; Germany: 105 sites) with migraine who had received erenumab for not more than 3months before the start of the study. The mean (standard deviation) patient age was 45.0 (12.3) years, and most patients were female (89.0%), Caucasian (97.6%), and non-smokers (85.1%). The starting dose of erenumab was 70mg in 68.5% of patients and 140mg in 31.5%. The proportion of patients with 140mg as the starting dose was the highest (43.5%) in those aged 30-40years. The most common reason for starting a higher dose of erenumab 140mg was severity of migraine (47.4%). During the observational period, the proportion of patients taking erenumab 140mg increased to 64.6% (visit 5; V5) after 12months. Due to attrition of patients towards the end of the study (V9: 90 participants), data at V9 must be interpreted with caution. At least one dose change was performed in 45.3% of patients (i.e., erenumab 70 to 140mg or 140 to 70mg), 21.2% of patients attempted at least once to discontinue treatment (i.e., period with erenumab discontinuation and no other antibody treatment for migraine prevention), and 15.3% discontinued erenumab treatment, mainly because of no or insufficient treatment response (13.5%). The mean time until the first omission attempt was 332.3 (range 37-633) days. Constipation (12.1%) was the most frequently reported adverse event, in line with the summary of product characteristics (SmPC) of erenumab. Most patients with migraine were prescribed erenumab 70mg as the starting dose. No new safety signals were observed for erenumab versus the previous trials.

Maternal NO2 exposure and fetal growth restriction: Hypoxia transmission and lncRNAs-proinflammation-mediated abnormal hematopoiesis

Epidemiological studies show a strong correlation between air pollution and fetal growth restriction (FGR), but existing results are controversial due to inherent limitations, such as causality of specific pollutants, developmental origin, and maternal-fetal transmission. To address this controversy, we first conducted a retrospective analysis of 28,796 newborns and revealed that maternal nitrogen dioxide (NO2) exposure during the second trimester was positively associated with FGR, with an adjusted odds ratio of 1.075 (95% confidence interval: 1.020-1.133) per 10 μg/m3 NO2 increase for small for gestational age. Then, by establishing an animal model of prenatal NO2 exposure, we confirmed its adverse effects on embryonic growth and hematopoiesis in the yolk sac and fetal liver, primarily affecting the differentiation of hematopoietic stem and progenitor cells and erythroid maturation. By applying internal exposure analyses coupled with 15N isotope tracing, we found that maternal NO2 inhalation induced acquired methemoglobinemia through its byproducts and placental hypoxia in pregnant mice. Importantly, by combining transcriptional profiling, bioinformatics analysis, and RNA binding protein immunoprecipitation (RIP)/chromatin immunoprecipitation (CHIP), we clarified that placental-fetal hypoxia transmission activated hypoxia-inducible factors, disturbed hematopoiesis through the hypoxia-inducible factor 1β-long noncoding RNAs-CCAAT/enhancer binding protein alpha-proinflammatory signaling pathway, ultimately contributing to FGR progression. These findings provide insights for risk prevention and clinical intervention to promote child well-being in NO2-polluted areas.

Dating Violence Continuity: The Protective Role of Self-Esteem Against Revictimization by Multiple Partners.

Dating violence is a deleterious relational dynamic that affects around one-third of adolescents. It is well documented that dating violence can persist over time, occurring within the same relationship or across multiple relationships. Self-esteem could be a key factor in understanding the mechanisms of violence continuity, potentially acting as a protective factor during adolescence. Exploring its role in the continuity of dating violence and the potential differences based on whether the violence occurs within the same relationship or across different relationships could inform interventions aimed at preventing repetitive violence and revictimization by multiple partners. This study aimed to (1) examine the association between dating violence measured at two distinct time points, (2) investigate the moderating role of self-esteem in this association, and (3) explore potential variations in the protective role of self-esteem based on whether the violence reoccurred within the same relationship or across different relationships. Sex differences were also examined. A subsample of 1,018 adolescents who reported being involved in a dating relationship at two time points completed self-reported questionnaires. A moderation analysis revealed that dating violence at Time 1 predicted dating violence at Time 2 (6 months later) for both boys and girls. Among girls, self-esteem acted as a protective factor when considering the effect of partner change. Hence, girls who experienced dating violence victimization at Time 1 but had higher self-esteem were more inclined to engage in a subsequent relationship devoid of dating violence at Time 2. However, self-esteem did not emerge as a significant protective factor among boys. Self-esteem appears to be a pivotal factor in promoting engagement in subsequent positive relationships following experiences of dating violence among girls. These findings offer valuable insight that can inform preventive measures and interventions, ultimately contributing to healthier relationship dynamics and improving the well-being of dating violence victims during adolescence.

Effects of Angiotensin-I-Converting Enzyme (ACE) Mutations Associated with Alzheimer's Disease on Blood ACE Phenotype.

Our recent analysis of 1200+ existing missense ACE mutations revealed that 400+ mutations are damaging and led us to hypothesize that carriers of heterozygous loss-of-function (LoF) ACE mutations (which result in low ACE levels) could be at risk for the development of late-onset Alzheimer's disease (AD). Here, we quantified blood ACE levels in EDTA plasma from 41 subjects with 10 different heterozygous ACE mutations, as well as 33 controls, and estimated the effect of these mutations on ACE phenotype using a set of mAbs to ACE and two ACE substrates. We found that relatively frequent (~1%) AD-associated ACE mutations in the N domain of ACE, Y215C, and G325R are truly damaging and likely transport-deficient, with the ACE levels in plasma at only ~50% of controls. Another AD-associated ACE mutation, R1250Q, in the cytoplasmic tail, did not cause a decrease in ACE and likely did not affect surface ACE expression. We have also developed a method to identify patients with anti-catalytic mutations in the N domain. These mutations may result in reduced degradation of amyloid beta peptide Aβ42, an important component for amyloid deposition. Consequently, these could pose a risk factor for the development of AD. Therefore, a systematic analysis of blood ACE levels in patients with all ACE mutations has the potential to identify individuals at an increased risk of late-onset AD. These individuals may benefit from future preventive or therapeutic interventions involving a combination of chemical and pharmacological chaperones, as well as proteasome inhibitors, aiming to enhance ACE protein traffic. This approach has been previously demonstrated in our cell model of the transport-deficient ACE mutation Q1069R.

Feasibility and Acceptability of a Self-Guided Digital Family Skills Management Intervention for Children Newly Diagnosed With Type 1 Diabetes: Pilot Randomized Controlled Trial.

Family dynamics play an important role in determining the glycemic outcomes of type 1 diabetes (T1D) in children. The time interval immediately following T1D diagnosis is particularly stressful for families, and interventions to support families in adjusting their family practices to support adjustment to and management of T1D in the months following diagnosis may improve glycemic outcomes. Self-guided digital interventions offer a sustainable model for interventions to support caregivers in learning evidence-based family management skills for adjustment to and management of T1D. We hypothesized that a self-guided, web-based, family skills management program (addressing caregiver social support as well as family problem-solving, communication, and supportive behavior change strategies) initiated at the time of T1D diagnosis would improve glycemic outcomes in children with T1D. In this study, we report on the feasibility and acceptability of this program. We prospectively evaluated a sample of 37 children newly diagnosed with T1D recruited from a pediatric endocrinology clinic. Parent participants were asked to complete web-based modules addressing social support, family problem-solving, communication, and supportive behavior change strategies. Module completion was analyzed for percentage completion, patterns of completion, and differences in completion rates by coparenting status. Qualitative open-ended feedback was collected at the completion of each module. A total of 31 (84%) of the 37 participants initiated the web-based program. Of those 31 participants, 25 (81%) completed some content and 15 (48%) completed all 5 modules. Completion rates were higher when coparenting partners engaged in the intervention together (P=.04). Of the 18 participants given a choice about the spacing of content delivery, 15 (83%) chose to have all sessions delivered at once and 3 (17%) chose to space sessions out at 2-week intervals. Qualitative feedback supported the acceptability of the program for delivery soon after T1D diagnosis. Families reported on positive benefits, including requesting future access to the program and describing helpful changes in personal or family processes for managing T1D. In this study, we found that a self-guided digital family support intervention initiated at the time of a child's T1D diagnosis was largely feasible and acceptable. Overall, rates of participation and module completion were similar to or higher than other self-guided digital prevention interventions for mental and physical health outcomes. Self-guided digital programs addressing family management skills may help prevent challenges common with T1D management and can decrease cost, increase access, and add flexibility compared to traditional interventions. ClinicalTrials.gov NCT03720912; https://clinicaltrials.gov/study/NCT03720912.

Occupation and stress: professional burnout of GPs depending on the profile of the medical institution in situations of high epidemic risk

Introduction. In the context of the COVID-19 pandemic, medical workers turned out to be the most vulnerable category of the population in terms of the risk of developing psycho-emotional disorders. Objective. To establish the characteristics of the psycho-emotional state among general practitioners of COVID hospitals, multidisciplinary hospitals, and polyclinics during the COVID-19 pandemic. Material and methods. The study included: group 1 – general practitioners of COVID hos pitals (n=111); group 2 – internists of multidisciplinary hospitals (n=106); group 3 – GPs working in polyclinics (n=102); group 4 – control group (healthy) (n=190). The assess ment of professional burnout was carried out by means of the Maslach Burnout Inventory, developed by American psychologists C. Maslach and S.E. Jackson, in adaptation by N.E. Vodopyanova and E.S. Starchenkova, as well as using V.V. Boyko’s questionnaire. The study utilized an integrative anxiety test to investigate the formation of psycho-emotional disorders in internists during the pandemic of the novel coronavirus infection. The quality of life was determined by means of the SF-36 questionnaire. The processing of the ob tained data was carried out using the Statistica package from StatSof t (USA). Results. It has been established that the work of general practitioners during the COVID-19 pandemic was associated with the impact of occupational stress related to caring for in fected patients on medical workers, as well as with significant changes in work regarding aspects of organization and safety, which contributed to an increase in the levels of oc cupational stress, professional burnout, and anxiety, and a decrease in the quality of life. Limitations of the study. The study has regional (Samara Region) and professional (in terms of detailing the working conditions in the studied comparison groups) limitations. Conclusions. The work of general practitioners of specialized COVID hospitals, internists of multidisciplinary hospitals, and GPs of polyclinics is associated with an increase in the levels of occupational stress, professional burnout, and anxiety, and a decrease in the quality of life. Notably, psychological changes are most pronounced in employees of specialized COVID hospitals. It is necessary to continue research on the emotional state of medical personnel in order to timely carry out preventive treatment to preserve the health of medical workers.