Conceptualizing impulsivity as a construct in relation to posttraumatic stress disorder symptom severity among women.

Despite the established association between posttraumatic stress disorder (PTSD) and impulsivity, the literature is limited regarding impulsivity as a multifaceted construct. That is, the field's understanding of how PTSD symptoms may increase particular impulsive tendencies and behaviors is constrained by examining impulsivity solely as an umbrella term. The aim of the present study was to determine if there are differential associations between PTSD symptom severity and various components of impulsivity across multiple self-report measures. A sample of 215 undergraduate women (M age = 19.77 years, SD = 1.91, Range: 18-39 years) completed the PTSD Checklist for DSM-5 (PCL-5), Barratt Impulsiveness Scale (BIS-11), short version of the UPPS-P Impulsive Behavior Scale (SUPPS-P), and Delaying Gratification Inventory (DGI). Structural equation modeling was used to examine associations between PTSD symptoms and each measure's subscales. The findings included significant predictions from PTSD symptoms to the BIS-11 Attentional Impulsiveness subscale, ß = .23, SE = .07, 95% CI [.09, .37]; DGI Physical Pleasures, ß = -.24, SE = .07, 95% CI [-.38, -.11], and Achievement subscales, ß = -.19, SE = .08, 95% CI [-.34, -.04]; and the SUPPS-P Positive Urgency, ß = .22, SE = .08, 95% CI [.07, .37], and Negative Urgency subscales, ß = .32, SE = .07, 95% CI [.19, .46]. These results have implications for precision medicine approaches that emphasize targeting these specific facets of impulsivity, with likely downstream effects on health risk behaviors for emerging adult women.

Unpacking the 'black box' of suicide: A latent class analysis predicting profiles of suicidal ideation in a longitudinal cohort of adolescent girls from India.

INTRODUCTION: Indian women account for 37% of global suicide-related deaths. As suicide is a growing concern among adolescent girls, identifying the social determinants of suicide with this group targeted prevention. We selected social determinants that include intersectional identities and broader syndemics; we then used longitudinal data from a prospective cohort of adolescent girls from Northern India to classify them into unique profiles across multiple socioecological levels. METHODS: Girls aged 10-19 (N = 11,864) completed self-report questionnaires measuring socio-demographic and trauma exposure variables. At three-year follow-up, they were asked to indicate current suicidal ideation (SI). We conducted latent class analysis (LCA) to classify profiles and then predicted risk of current SI at three-year follow-up. RESULTS: LCA supported a four-class solution: a 'privileged' class (Class 1; n = 1,470), a 'modal' class (Class 2; n = 7,449), an 'intergenerational violence' class (Class 3; n = 2,113), and a 'psychological distress' class (Class 4; n = 732). Classes significantly predicted odds ratios (OR) for SI at follow up; women in Class 4 were associated with the greatest likelihood of SI (OR 1.84, 95% CI 1.38, 2.47), suggesting that psychological distress factors confer greatest risk. CONCLUSION: Results of the distinct classes of risk and protective factors indicate targets for policy-level interventions. Disrupting cycles of psychological distress and substance use, increasing access to behavioral interventions, and intervening to mitigate intergenerational violence may be particularly impactful with this population.

Explaining Suicide Among Indian Women: Applying the Cultural Theory of Suicide to Indian Survivors of Gender-Based Violence Reporting Suicidal Ideation.

Indian women account for 36.6% of suicide-related deaths worldwide and gender-based violence (GBV) is a key social determinant. The cultural theory of suicide (CTS), which synthesizes risk factors and explanations of suicide among racial/ethnic minorities, posits four tenets: idioms of distress, cultural sanctions, and social discord. Our study applied the CTS to Indian women from slums reporting GBV to explore (1) culturally relevant risk pathways towards suicidal ideation using qualitative analyses, and test (2) the association between idioms of distress and suicidal ideation. 112 women from urban slums were recruited and 99 completed surveys. A subset were administered qualitative interviews. Aim 1 explored the CTS framework among participants describing suicidal ideation in qualitative interviews [n = 18]; Aim 2 explored if idioms of distress severity was associated with suicidal ideation through an ANCOVA [N = 99]. Idioms of distress such as 'tension' indicated suicidal ideation. Communities did not sanction suicidal ideation, leading to secrecy regarding disclosure. Women in 'love marriages' (versus arranged marriages) reported minority stress. Social discord heightened suicidal thoughts. Results of the ANCOVA confirmed that women reporting suicidal ideation had higher idioms of distress severity (M = 28.56, SD = 6.37), compared to women who did not (M = 21.77, SD = 6.07), F(1, 96) = 28.58, p < .001 (ηp2 = .23). Our study empirically validates the CTS among Indian GBV survivors. Culturally responsive suicide prevention can include assessing idioms of distress, improving family support, and educating to reduce stigma and enhance help-seeking.

The brain under sexual attack: A brief report on neurobiological disturbances in trauma memory.

OBJECTIVE: The pathway from experiencing sexual assault to successful prosecution of sexual assault cases is plagued by complicated and myriad factors, resulting in suboptimal outcomes for both survivors and judicial systems. In particular, disturbance of posttraumatic memory recall under stressful circumstances can negatively impact the veracity of survivor testimony. METHOD: This brief report integrates empirical findings from studies of trauma memory disturbance, and more specifically the impacts of glucocorticoid activation in sexual assault memory, contextualizing through the lens of implications for sexual assault litigation. RESULTS: Studies have begun to demonstrate the neurobiological underpinnings of such memory disturbance, indicating that trauma memory recall under duress activates the hypothalamic-pituitary-adrenal axis and glucocorticoids, and subsequently inhibits retrieval mechanisms in the hippocampus. However, research in this realm is somewhat nascent, requiring further study to sufficiently build evidence for the adjustment of judicial proceedings to be increasingly trauma-informed. CONCLUSION: A review of current empirical research indicates that survivors of sexual assault are vulnerable to trauma memory disturbance during litigation proceedings. Directions for future research are suggested to fill gaps in the extant literature base and strengthen the case for applications of this work to judicial contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Ongoing traumatic stress during a global pandemic.

OBJECTIVE: The COVID-19 pandemic has been conceptualized as a potentially traumatic event, although heterogeneity in experience (e.g., isolation) and in type and severity of traumatic stress response (e.g., hygiene hypervigilance) query the applicability of the posttraumatic stress disorder (PTSD) diagnostic construct. Parallels may be drawn to chronic illness and continuous traumatic situations (CTS) literature, which suggests unique symptom presentations that may occur during cumulative, ongoing traumas. METHOD: Eighty-four adults completed the PTSD Checklist with appended questions evaluating pandemic index events, temporality of intrusive symptoms, self-appraised abnormality, and context dependence of symptoms. Using exploratory latent profile analysis, we modeled the latent structure of traumatic stress response to COVID-19 in order to evaluate possible nuanced patterns of symptoms differentiating PTSD from a transient ongoing trauma response. RESULTS: Two profiles broadly delineated by severity across all variables emerged, suggesting the framework of PTSD is apt when applied to COVID-19. However, secondary analyses revealed subtle signals supporting chronic illness and CTS frameworks. Specifically, some participants who met criteria for PTSD did not endorse index events meeting Criterion A, most endorsed intrusive symptoms related to a present or future threat (versus a past trauma), and 30% reported their symptoms to be context dependent. CONCLUSION: Results highlight a need for improved assessment and opportunities for treatment modification. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Decreasing delivery room intubations: A quality improvement project.

AIM: The delivery room intubation rate for babies born less than 32 weeks postmenstrual age (PMA) at the Mater Mothers' Hospital in 2017 was 51%. Delivery room intubation of preterm infants may be associated with an increased risk of developing bronchopulmonary dysplasia. This quality improvement project aimed to decrease the rate of delivery room intubation for infants born less than 32 weeks PMA. METHODS: A quality improvement process using the evidence-based practice for improving quality framework and Plan-Do-Study-Act cycles was undertaken from October 2018 to December 2019. Commencing bubble continuous positive airway pressure for initial resuscitation in the delivery room was the principal change idea. RESULTS: The delivery room intubation rate for infants born less than 32 weeks PMA before the commencement of this project was 48% (cohort 1, n = 221). There was a significant decrease in the rate to 37.2% while the project was being conducted (cohort 2, n = 277) and a further significant reduction to 28.2% after introducing bubble continuous positive airway pressure in the delivery room (cohort 3, n = 202). There was a significant improvement in admission temperatures and a significant decrease in mortality rate between cohort 1 and cohort 2 but not between cohort 2 and cohort 3. There was no change in the rate of discharge home on oxygen between cohorts. CONCLUSIONS: This quality improvement project led to a significantly decreased delivery room intubation rate in infants born less than 32 weeks PMA. There was no evidence of any adverse outcomes with this approach.

Mental health and resilience during the coronavirus pandemic: A machine learning approach.

OBJECTIVE: This study explored risk and resilience factors of mental health functioning during the coronavirus disease (COVID-19) pandemic. METHODS: A sample of 467 adults (M age = 33.14, 63.6% female) reported on mental health (depression, anxiety, posttraumatic stress disorder [PTSD], and somatic symptoms), demands and impacts of COVID-19, resources (e.g., social support, health care access), demographics, and psychosocial resilience factors. RESULTS: Depression, anxiety, and PTSD rates were 44%, 36%, and 23%, respectively. Supervised machine learning models identified psychosocial factors as the primary significant predictors across outcomes. Greater trauma coping self-efficacy and forward-focused coping, but not trauma-focused coping, were associated with better mental health. When accounting for psychosocial resilience factors, few external resources and demographic variables emerged as significant predictors. CONCLUSION: With ongoing stressors and traumas, employing coping strategies that emphasize distraction over trauma processing may be warranted. Clinical and community outreach efforts should target trauma coping self-efficacy to bolster resilience during a pandemic.

The effect of lactoferrin supplementation on death or major morbidity in very low birthweight infants (LIFT): a multicentre, double-blind, randomised controlled trial.

BACKGROUND: Very low birthweight or preterm infants are at increased risk of adverse outcomes including sepsis, necrotising enterocolitis, and death. We assessed whether supplementing the enteral diet of very low-birthweight infants with lactoferrin, an antimicrobial protein, reduces all-cause mortality or major morbidity. METHODS: We did a multicentre, double-blind, pragmatic, randomised superiority trial in 14 Australian and two New Zealand neonatal intensive care units. Infants born weighing less than 1500 g and aged less than 8 days, were eligible and randomly assigned (1:1) using minimising web-based randomisation to receive once daily 200 mg/kg pasteurised bovine lactoferrin supplements or no lactoferrin supplement added to breast or formula milk until 34 weeks' post-menstrual age (or for 2 weeks, if longer), or until discharge from the study hospital if that occurred first. Designated nurses preparing the daily feeds were not masked to group assignment, but other nurses, doctors, parents, caregivers, and investigators were unaware. The primary outcome was survival to hospital discharge or major morbidity (defined as brain injury, necrotising enterocolitis, late-onset sepsis at 36 weeks' post-menstrual age, or retinopathy treated before discharge) assessed in the intention-to-treat population. Safety analyses were by treatment received. We also did a prespecified, PRISMA-compliant meta-analysis, which included this study and other relevant randomised controlled trials, to estimate more precisely the effects of lactoferrin supplementation on late-onset sepsis, necrotising enterocolitis, and survival. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12611000247976. FINDINGS: Between June 27, 2014, and Sept 1, 2017, we recruited 1542 infants; 771 were assigned to the intervention group and 771 to the control group. One infant who had consent withdrawn before beginning lactoferrin treatment was excluded from analysis. In-hospital death or major morbidity occurred in 162 (21%) of 770 infants in the intervention group and in 170 (22%) of 771 infants in the control group (relative risk [RR] 0·95, 95% CI 0·79-1·14; p=0·60). Three suspected unexpected serious adverse reactions occurred; two in the lactoferrin group, namely unexplained late jaundice and inspissated milk syndrome, but were not attributed to the intervention and one in the control group had fatal inspissated milk syndrome. Our meta-analysis identified 13 trials completed before Feb 18, 2020, including this Article, in 5609 preterm infants. Lactoferrin supplements significantly reduced late-onset sepsis (RR 0·79, 95% CI 0·71-0·88; p<0·0001; I2=58%), but not necrotising enterocolitis or all-cause mortality. INTERPRETATION: Lactoferrin supplementation did not improve death or major morbidity in this trial, but might reduce late-onset sepsis, as found in our meta-analysis of over 5000 infants. Future collaborative studies should use products with demonstrated biological activity, be large enough to detect moderate and clinically important effects reliably, and assess greater doses of lactoferrin in infants at increased risk, such as those not exclusively receiving breastmilk or infants of extremely low birthweight. FUNDING: Australian National Health and Medical Research Council.

The disproportionate importance of long-unburned forests and woodlands for reptiles.

Our understanding of the impacts of time since fire on reptiles remains limited, partly because there are relatively few locations where long-term, spatially explicit fire histories are available. Such information is important given the large proportion of some landscapes that are managed with frequent prescribed fire to meet fuel management objectives. We conducted a space-for-time study across a landscape in southeastern Australia where the known fire history spanned 6 months to at least 96 years. Four methods were used to survey reptiles in 81 forest and woodland sites to investigate how time since fire (TSF), habitat, and environmental variables affect reptile richness, abundance, and composition. We used generalized linear models, generalized linear mixed-effects models, PERMANOVA, and SIMPER to identify relationships between the reptile assemblage (richness, abundance, and composition, respectively) and TSF, habitat, and environmental variables. All three reptile metrics were associated with TSF. Reptile richness and abundance were significantly higher in sites >96 years postfire than younger fire ages (0.5-12 years). Reptile composition at long-unburned sites was dissimilar to sites burned more recently but was similar between sites burned 0.5-2 and 6-12 years prior to sampling. Synthesis and applications. Long-unburned forests and woodlands were disproportionately more important for reptile richness and abundance than areas burned 6 months to 12 years prior to sampling. This is important given that long-unburned areas represent <8% of our study area. Our results therefore suggest that reptiles would benefit from protecting remaining long-unburned areas from fire and transitioning a greater proportion of the study area to long-unburned. However, some compositional differences between the long-unburned sites and sites 0.5-12 years postfire indicate that maintaining a diversity in fire ages is important for conserving reptile diversity.

Pseudotumor cerebri due to the potentiation of all-trans retinoic acid by voriconazole.

OBJECTIVE: To report an interaction between all-trans retinoic acid (ATRA) and voriconazole resulting in pseudotumor cerebri. SETTING: Hospital in Huntsville, AL, in November 2007.Patient description: 21-year-old black woman admitted to the hospital for fever in the setting of pancytopenia. CASE SUMMARY: The patient had been diagnosed with acute promyelocytic leukemia 5 months before admission and continued on ATRA throughout induction and two consolidation therapies. Voriconazole was started in view of persistent fever and pancytopenia despite adequate broad-spectrum antimicrobial therapy. On day 15 of voriconazole therapy, the patient complained of blurred vision, farsightedness, and dry skin with pruritus and was subsequently diagnosed with pseudotumor cerebri secondary to ATRA toxicity. All symptoms of pseudotumor cerebri resolved after discontinuation of ATRA. MAIN OUTCOME MEASURES: Not applicable. RESULTS: The development of pseudotumor cerebri after initiation of voriconazole may have been secondary to the inhibition of the cytochrome P450 (CYP) enzymes. The interaction may have led to changes in ATRA serum concentrations, thus contributing to the observed adverse drug reaction. CONCLUSION: To our knowledge, this is the first case report of pseudotumor cerebri in an adult patient secondary to metabolic inhibition of ATRA by voriconazole. This case illustrates the importance of monitoring for drug interactions when using medications metabolized via the CYP enzyme pathway.

Efficacy and safety of i.v. alteplase therapy up to 4.5 hours after acute ischemic stroke onset.

PURPOSE: The efficacy and safety of i.v. alteplase up to 4.5 hours after acute ischemic stroke (AIS) onset were evaluated. SUMMARY: Stroke is the leading cause of disability in the elderly, and i.v. alteplase (recombinant tissue plasminogen activator) is the only Food and Drug Administration (FDA)-approved thrombolytic agent for the treatment of AIS. Alteplase has been shown to decrease the percentage of patients disabled by a stroke. Until recently, the use of alteplase was only recommended within 3 hours of the onset of AIS symptoms. However, two clinical trials published in 2008 demonstrated that therapy with i.v. alteplase remains safe and effective when given 3-4.5 hours after AIS onset. Although FDA has not yet approved expanding the time interval to 4.5 hours for treatment with i.v. alteplase, the American Stroke Association recently published a statement recommending administration of alteplase in eligible patients 3-4.5 hours after symptom onset. There is clinical evidence supporting the safety and efficacy of i.v. alteplase administration to eligible patients who present within 4.5 hours of AIS symptom onset. Treatment with alteplase decreases the likelihood of disability from an AIS and is not associated with an increased rate of mortality. Expanding the time window for treatment with alteplase would likely increase the percentage of AIS patients who are able to receive alteplase and thus ultimately decrease the percentage of those left disabled from an AIS. CONCLUSION: Evidence supports the safety and efficacy of i.v. alteplase administration to eligible patients within 4.5 hours of AIS symptom onset.

Impact of an evidence based prenatal care model on patient outcomes.

Health care providers face many challenges when providing prenatal care. This article reports on a program called Prenatal Care: the Beginning of a Lifetime (PCBL), to implement standardized prenatal care in central North Carolina. The purpose of this pilot study was to determine if there were differences in patient outcomes between a control group and 3 groups (A, B, and C) of increasing levels of intervention in standardized prenatal care. A total of 150 patients were enrolled and followed through delivery. There were no significant differences between the groups in cigarette smoking status, weight gain, genetic screening, sexually transmitted infection screening, diabetes screening, domestic violence assessment, 17P candidacy assessment, gestational age at delivery, or infant birth weight. However, a significant difference was found in depression screening. An association between intervention group membership and likelihood of being screened for depression was found in each trimester. As the level of intervention increased, the number of participants screened for depression increased significantly.

The addition of hydromorphone to epidural fentanyl does not affect analgesia in early labour.

PURPOSE: Epidural fentanyl after a lidocaine and epinephrine test dose, provides adequate analgesia and allows for ambulation during early labour. The current study was designed to determine the influence of hydromorphone added to an epidural fentanyl bolus (e.g., whether there is an increase in duration of analgesia). METHODS: Forty-four labouring primigravid women, at less than 5 cm cervical dilation, who requested epidural analgesia were enrolled in this randomized, double-blind study. After a 3 mL test dose of lidocaine with epinephrine, patients received fentanyl 100 microgram (in 10 mL volume). They randomly received the fentanyl with either saline or hydromorphone (300 microgram). After administration of the initial analgesic, pain scores and side effects were recorded for each patient at ten, 20, and 30 min, and every 30 min thereafter, by an observer blinded to the technique used. RESULTS: The patients were taller in the hydromorphone group (P < 0.04). There were no other demographic differences between the two groups. The mean duration prior to re-dose was not significantly different in the group that received hydromorphone (135 +/- 52 min) compared to the control group (145 +/- 46 min). Side effects were similar between the two groups. No patient in either group experienced any detectable motor block. CONCLUSION: In early labouring patients, the addition of hydromorphone (300 microgram) to epidural fentanyl (100 microgram after a lidocaine and epinephrine test dose) neither prolongs the duration of analgesia nor affects the ability to ambulate, and cannot be recommended according to the current study.