Family Support and Type 2 Diabetes Self-management Behaviors in Underserved Latino/a/x Patients.

BACKGROUND: Latino/a/x families experience persistent Type 2 diabetes mellitus (T2DM) disparities, including higher rates of diagnosis and mortality due to disease complications than their non-Hispanic White counterparts. Though greater social support is associated with improved disease outcomes for Latino/a/x patients with diabetes, research has yet to identify the specific pathways through which social support, and specifically family support, influences self-management. PURPOSE: This study tested a theoretical model highlighting the mechanisms and pathways linking social support and physical health. Specifically, self-efficacy and depression were tested as psychological pathways connecting family support to diabetes self-management behaviors and diabetes morbidity in Latino/a/x patients with T2DM. METHODS: Data from 177 patients were analyzed using structural equation modeling. Measures included diabetes-specific family support needed and received, depressive symptoms, self-efficacy in diabetes management, diabetes self-management behaviors, health appraisal, and hemoglobin A1c. RESULTS: Greater diabetes-specific family support was significantly associated with more frequent engagement in diabetes self-management behaviors, both directly (p < .001) and through diabetes self-efficacy's partial mediation of this relationship (p = .013). Depression was not significantly associated with either family support (support received, p = .281; support needed, p = .428) or self-management behaviors (p = .349). CONCLUSIONS: Family support and diabetes self-efficacy may be important modifiable psychosocial factors to target via integrated care interventions aimed at supporting Latino/a/x patients with T2DM. Future research is needed to test empirically based, culturally adapted interventions to reduce T2DM-related health disparities in this population.

Latino/a/x families experience persistent diabetes disparities, including higher rates of diagnosis and mortality due to disease complications than their non-Hispanic White counterparts. Though greater social support is associated with improved disease outcomes for Latino/a/x patients with diabetes, research has yet to identify the specific pathways through which social support, and specifically family support, influences self-management. This study examined diabetes self-efficacy and depression as potential links in the relationship between family support and diabetes self-management behaviors. Analyses revealed a significant association between greater diabetes-related family support and more frequent engagement in diabetes self-management behaviors, both directly and through diabetes self-efficacy's partial mediation of the relationship. This points to family support and diabetes self-efficacy as important modifiable psychosocial factors that can be targeted in integrated care interventions aimed at supporting Latino/a/x patients with diabetes.

Longitudinal Associations of Family Relationship Quality With Chronic Pain Incidence and Persistence Among Aging African Americans.

OBJECTIVES: This study examines how family relationships convey risk or resilience for pain outcomes for aging African Americans, and to replicate and extend analyses across 2 nationally representative studies of aging health. METHODS: African American participants in Midlife in the United States (MIDUS, N = 755) and the Health and Retirement Study (HRS, N = 2,585) self-reported chronic pain status at 2006 waves and then again 10 years later. Logistic regression was used to estimate the odds of pain incidence and persistence explained by family, intimate partner, and parent-child strain and support, as well as average support and average strain across relationships. RESULTS: On average, MIDUS participants were younger (M = 52.35, SD = 12.06; 62.1% female) than HRS (M = 66.65, SD = 10.92; 63.7% female). Family support and average support were linked to decreased odds of pain incidence in MIDUS, but only when tested without accounting for strain, whereas parent-child strain was a risk factor for pain incidence in HRS, as was average strain. Family support protected against pain persistence in MIDUS, whereas average support was linked to reduced odds of pain persisting in HRS. DISCUSSION: Chronic pain outcomes are worse for African Americans for a number of reasons, but parent-child strain may contribute to the risk of new pain developing over time for older adults. Conversely, family support may offer a protective benefit for pain incidence and persistence among aging African Americans. Findings implicate family relationships as a potential target of pain management interventions.

Overcoming Patient Pain Together: Breast Cancer Patients and Caregivers' Pretreatment Psychosocial Distress Linked to Patients' Pain Interference During the First Year of Treatment.

Breast cancer patients experience treatment-related pain from surgery, radiation, chemotherapy, and long-term hormonal treatment, which can lead to poorer outcomes. Patient and family caregivers' psychosocial distress exacerbates patient pain interference, but this has not been directly examined among breast cancer patients in dyadic models longitudinally. Guided by a biopsychosocial framework, the Biobehavioral Family Model, we explore how multiple reports of patient pain interference across the first year of treatment are linked to the patient (N = 55) and caregiver (N = 55) pretreatment psychosocial distress (eg, depression, anxiety, marital satisfaction, family relationship quality). Specifically, we find that breast cancer patients' pain interference increases and then decreases over the first year of treatment. Additionally, caregivers' pretreatment anxiety was associated with increased patient pain interference over time (B = .19, SE = .07, P = .008), while patients' pretreatment psychosocial distress was not associated with a change in their pain interference. Yet, looking at clinically specific times during the first year of treatment, we find that caregiver-reported higher marital satisfaction is associated with lower patient-reported pain interference later in treatment (6 months: B = -.58, SE = .24, P = .017; 12 months: B = -.82, SE = .23, P < .001). We conclude that, per the Biobehavioral Family Model, pretreatment patient and caregiver psychosocial distress is linked to patient pain interference during the first year of breast cancer treatment. Thus, caregivers' psychosocial distress (ie, anxiety and marital satisfaction) may be a particularly important target in future dyadic behavioral intervention strategies to reduce breast cancer patient pain. PERSPECTIVE: This article presents the link between breast cancer patients and family caregiver pretreatment psychosocial distress (anxiety, depression, marital satisfaction, and family quality) on patient pain interference during 1 year of breast cancer treatment. Findings suggest that caregiver anxiety and marital satisfaction may be important targets for future dyadic behavioral pain interventions.

"A cuff is not enough": A community-based participatory research approach to soliciting perspectives of African Americans with hypertension and their family members on self-management intervention features.

We aimed to solicit the perspectives of African Americans with hypertension and their family members on the desired features of a behavioral hypertension self-management intervention. Using a community-based participatory approach to intervention design, we conducted four dyadic focus groups, including African American community members with hypertension (n = 23) and their family members (n = 23), recruited from African American-serving Christian churches in a large, southern metropolitan area. We used open-ended questions to elicit participants' perspectives regarding program features they would recommend, intervention delivery, and barriers necessary to address. Our grounded theory analysis identified themes reflecting participants' recommendations for hypertension self-management interventions to enhance health literacy and provide communication training via an accessible, population-tailored, family-based approach, which they believed has the potential to create family-level impact on health across generations. Participants also recommended intervention researchers engage in advocacy (i.e., via physician education and policy change) as part of a broader impact on structural inequities driving worse hypertension and health outcomes for African Americans. The perceptions and recommendations of African Americans with a lived experience of hypertension, as well as their family members, aid in shaping acceptable and efficacious behavioral interventions aiming to promote hypertension self-management behavior while leveraging the unique power of family relationships to create sustained behavior change.

Multi-campaign ship and aircraft observations of marine cloud condensation nuclei and droplet concentrations.

In-situ marine cloud droplet number concentrations (CDNCs), cloud condensation nuclei (CCN), and CCN proxies, based on particle sizes and optical properties, are accumulated from seven field campaigns: ACTIVATE; NAAMES; CAMP2EX; ORACLES; SOCRATES; MARCUS; and CAPRICORN2. Each campaign involves aircraft measurements, ship-based measurements, or both. Measurements collected over the North and Central Atlantic, Indo-Pacific, and Southern Oceans, represent a range of clean to polluted conditions in various climate regimes. With the extensive range of environmental conditions sampled, this data collection is ideal for testing satellite remote detection methods of CDNC and CCN in marine environments. Remote measurement methods are vital to expanding the available data in these difficult-to-reach regions of the Earth and improving our understanding of aerosol-cloud interactions. The data collection includes particle composition and continental tracers to identify potential contributing CCN sources. Several of these campaigns include High Spectral Resolution Lidar (HSRL) and polarimetric imaging measurements and retrievals that will be the basis for the next generation of space-based remote sensors and, thus, can be utilized as satellite surrogates.

Temperature-Responsive Lactic Acid-Based Nanoparticles by RAFT-Mediated Polymerization-Induced Self-Assembly in Water.

This work demonstrates for the first-time biobased, temperature-responsive diblock copolymer nanoparticles synthesized by reversible addition-fragmentation chain-transfer (RAFT) aqueous emulsion polymerization-induced self-assembly (PISA). Here, monomers derived from green solvents of the lactic acid portfolio, N,N-dimethyl lactamide acrylate (DMLA) and ethyl lactate acrylate (ELA), were used. First, DMLA was polymerized by RAFT aqueous solution polymerization to produce a hydrophilic PDMLA macromolecular chain transfer agent (macro-CTA), which was chain extended with ELA in water to form amphiphilic PDMLA-b-PELA diblock copolymer nanoparticles by RAFT aqueous emulsion polymerization. PDMLAx homopolymers were synthesized targeting degrees of polymerization, DPx from 25 to 400, with relatively narrow molecular weight dispersities (D < 1.30). The PDMLA64-b-PELAy diblock copolymers (DPy = 10-400) achieved dispersities, D, between 1.18 and 1.54 with two distinct glass transition temperatures (Tg) identified by differential scanning calorimetry (DSC). Tg(1) (7.4 to 15.7 °C) representative of PELA and Tg(2) (69.1 to 79.7 °C) of PDMLA. Dynamic light scattering (DLS) studies gave particle z-average diameters between 11 and 74 nm (PDI = 0.04 to 0.20). Atomic force microscopy (AFM) showed evidence of spherical particles when dispersions were dried at ∼5 °C and film formation when dried at room temperature. Many of these polymers exhibited a reversible lower critical solution temperature (LCST) in water with a concomitant increase in z-average diameter for the PDMLA-b-PELA diblock copolymer nanoparticles.

Family strain, but not family support, is linked to worse pain interference among midlife adults reporting new chronic pain.

INTRODUCTION: Although family relationship quality has been linked to later chronic pain incidence for aging adults, it is unclear whether the quality of these relationships is linked to the impact of pain. We estimated longitudinal associations between family relationship quality (i.e., family support and family strain) and pain interference for adults who develop novel chronic pain across 10 years of midlife. METHOD: We conducted a secondary analysis of data from the Midlife in the United States (MIDUS) study. Using path analysis, we tested whether family support and strain reported by participants (54% female, age M = 54.8 years) who denied having chronic pain at the study's second wave (MIDUS 2, 2004-2006) but reported chronic pain 10 years later (MIDUS 3, 2014-2016; N = 406) was associated with the interference of that pain with daily activities after accounting for key covariates, including sociodemographics, depression symptoms, global physical health, and MIDUS 3 reports of family support and strain. RESULTS: The hypothesized model demonstrated good fit to the data based on multiple model fit indices. Greater family strain at baseline, but not family support, was significantly associated with greater pain interference 10 years later. DISCUSSION: Findings build on prior studies to suggest that not only are stressful family relationships likely associated with the odds of developing chronic pain, but they are also linked to the interference of that chronic pain when it develops. We recommend biopsychosocial screening in primary care that captures family relationship quality and can inform best practices for nonpharmacological, family-based pain management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Association between the timing of childhood adversity and epigenetic patterns across childhood and adolescence: findings from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort.

BACKGROUND: Childhood adversity is a potent determinant of health across development and is associated with altered DNA methylation signatures, which might be more common in children exposed during sensitive periods in development. However, it remains unclear whether adversity has persistent epigenetic associations across childhood and adolescence. We aimed to examine the relationship between time-varying adversity (defined through sensitive period, accumulation of risk, and recency life course hypotheses) and genome-wide DNA methylation, measured three times from birth to adolescence, using data from a prospective, longitudinal cohort study. METHODS: We first investigated the relationship between the timing of exposure to childhood adversity between birth and 11 years and blood DNA methylation at age 15 years in the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort study. Our analytic sample included ALSPAC participants with DNA methylation data and complete childhood adversity data between birth and 11 years. We analysed seven types of adversity (caregiver physical or emotional abuse, sexual or physical abuse [by anyone], maternal psychopathology, one-adult households, family instability, financial hardship, and neighbourhood disadvantage) reported by mothers five to eight times between birth and 11 years. We used the structured life course modelling approach (SLCMA) to identify time-varying associations between childhood adversity and adolescent DNA methylation. Top loci were identified using an R2 threshold of 0·035 (ie, ≥3·5% of DNA methylation variance explained by adversity). We attempted to replicate these associations using data from the Raine Study and Future of Families and Child Wellbeing Study (FFCWS). We also assessed the persistence of adversity-DNA methylation associations we previously identified from age 7 blood DNA methylation into adolescence and the influence of adversity on DNA methylation trajectories from ages 0-15 years. FINDINGS: Of 13 988 children in the ALSPAC cohort, 609-665 children (311-337 [50-51%] boys and 298-332 [49-50%] girls) had complete data available for at least one of the seven childhood adversities and DNA methylation at 15 years. Exposure to adversity was associated with differences in DNA methylation at 15 years for 41 loci (R2 ≥0·035). Sensitive periods were the most often selected life course hypothesis by the SLCMA. 20 (49%) of 41 loci were associated with adversities occurring between age 3 and 5 years. Exposure to one-adult households was associated with differences in DNA methylation at 20 [49%] of 41 loci, exposure to financial hardship was associated with changes at nine (22%) loci, and physical or sexual abuse was associated with changes at four (10%) loci. We replicated the direction of associations for 18 (90%) of 20 loci associated with exposure to one-adult household using adolescent blood DNA methylation from the Raine Study and 18 (64%) of 28 loci using saliva DNA methylation from the FFCWS. The directions of effects for 11 one-adult household loci were replicated in both cohorts. Differences in DNA methylation at 15 years were not present at 7 years and differences identified at 7 years were no longer apparent by 15 years. We also identified six distinct DNA methylation trajectories from these patterns of stability and persistence. INTERPRETATION: These findings highlight the time-varying effect of childhood adversity on DNA methylation profiles across development, which might link exposure to adversity to potential adverse health outcomes in children and adolescents. If replicated, these epigenetic signatures could ultimately serve as biological indicators or early warning signs of initiated disease processes, helping identify people at greater risk for the adverse health consequences of childhood adversity. FUNDING: Canadian Institutes of Health Research, Cohort and Longitudinal Studies Enhancement Resources, EU's Horizon 2020, US National Institute of Mental Health.

Impairments among DSM-5 eating disorders: A systematic review and multilevel meta-analysis.

Previous research revealed that people who did not meet full DSM-IV criteria for anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED) but met criteria for eating disorder not otherwise specified (EDNOS) display high levels of psychiatric and physical morbidity commensurate with full criteria eating disorders. The DSM-5 introduced significant changes to eating disorder diagnostic criteria, so the present study aimed to determine whether the revised diagnostic criteria better distinguish between full criteria eating disorders, and other specified feeding or eating disorder (OSFED) and unspecified feeding or eating disorder (UFED). We present a series of meta-analyses comparing eating pathology, general psychopathology, and physical health impairments among those with AN, BN, and BED, compared to those with OSFED or UFED (n = 69 eligible studies). Results showed significantly more eating pathology in OSFED compared to AN, no difference in general psychopathology, and greater physical health impairments in AN. BN had greater eating pathology and general psychopathology than OSFED, but OSFED showed more physical health impairments. No differences were found between BN and purging disorder or low-frequency BN, or between BED and OSFED. Findings highlight the clinical severity of OSFED and suggest the DSM-5 criteria may not appropriately account for these presentations.

Childhood sleep health and epigenetic age acceleration in late adolescence: Cross-sectional and longitudinal analyses.

AIM: Investigate if childhood measures of sleep health are associated with epigenetic age acceleration in late adolescence. METHODS: Parent-reported sleep trajectories from age 5 to 17, self-reported sleep problems at age 17, and six measures of epigenetic age acceleration at age 17 were studied in 1192 young Australians from the Raine Study Gen2. RESULTS: There was no evidence for a relationship between the parent-reported sleep trajectories and epigenetic age acceleration (p ≥ 0.17). There was a positive cross-sectional relationship between self-reported sleep problem score and intrinsic epigenetic age acceleration at age 17 (b = 0.14, p = 0.04), which was attenuated after controlling for depressive symptom score at the same age (b = 0.08, p = 0.34). Follow-up analyses suggested this finding may represent greater overtiredness and intrinsic epigenetic age acceleration in adolescents with higher depressive symptoms. CONCLUSION: There was no evidence for a relationship between self- or parent-reported sleep health and epigenetic age acceleration in late adolescence after adjusting for depressive symptoms. Mental health should be considered as a potential confounding variable in future research on sleep and epigenetic age acceleration, particularly if subjective measures of sleep are used.

Retrospective analysis of the use of canine-specific albumin in 125 critically ill dogs.

OBJECTIVE: To describe the clinical use of canine-specific albumin (CSA) in critically ill dogs, report adverse events, and evaluate measurable clinical effects of CSA administration. DESIGN: Retrospective case series from 2019 to 2020. SETTING: Large, urban, private-practice referral and emergency center. ANIMALS: Consecutive sample of 125 client-owned dogs administered CSA transfusions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The conditions most commonly associated with the use of CSA were surgical (32/125) and nonsurgical (20/125) gastrointestinal disease. Both serum albumin and total plasma protein concentrations were significantly increased posttransfusion (P < 0.001), and 16% albumin transfusions produced the greatest magnitude increase in serum albumin (P = 0.0015). Concurrent crystalloid administration did not affect change in albumin. While there was no significant improvement in blood pressure seen in those patients that received albumin, a significant improvement in shock index was identified (P = 0.02). Adverse events were uncommon; however, 8 critically ill dogs died during CSA administration. CONCLUSIONS: CSA appears to be a relatively safe alternative to synthetic colloids and complementary to crystalloids in critically ill patients. More concentrated solutions may be more effective in raising serum albumin concentration. Further investigation into the indications for and efficacy of CSA will continue to improve our knowledge of this blood product.

Validating the TeenHITSS to Assess Child Abuse in Adolescent Populations.

PURPOSE: The purpose of this study is to establish the psychometric properties and diagnostic accuracy of the Teen Hurt-Insult-Threaten-Scream-Sex (TeenHITSS), a 5-item measure used to screen adolescents for family violence in clinical settings. METHODS: Study participants included 251 adolescent participants (n=197 not at-risk subsample; n=56 at-risk subsample), recruited from ambulatory care clinics, a medical center at-risk referral clinic, and area shelters. Participants completed a cross-sectional survey, including the TeenHITSS and Parent-Child Conflict Tactics Scales (CTSPC) questionnaires. We calculated internal reliability, validity, and sensitivity and specificity for the full sample and both subsamples for each screening instrument. RESULTS: Concurrent validity between the TeenHITSS and CTSPC was strong (r=.71, P<.000). We determined an optimal cutpoint based on sensitivity and specificity for correctly identifying abuse victims as a score of one or greater on the TeenHITSS. The TeenHITSS also proved slightly superior to the CTSPC in differentiating between victims and nonvictims of adolescent abuse (AUC=.79 vs .73, respectively). CONCLUSIONS: The TeenHITSS screening tool performed as well as the CTSPC in correctly classifying at-risk and not-at-risk teenagers and offers much greater utility to providers by supplying an actionable cut score. The findings of this study suggest that TeenHITSS is a valid and reliable tool to screen for physical and sexual abuse in children ages 13 years and older in clinical settings and can help health care providers detect adolescent abuse and initiate intervention and prevention of future abuse.

'They should walk with you': the perspectives of African Americans living with hypertension and their family members on disease self-management.

OBJECTIVES: African Americans are at significantly greater risk for hypertension, as well as worse hypertension-related morbidity and mortality than other racial/ethnic groups. Prior research aiming to address these health disparities has focused on improving individual patient self-management, with few studies testing family-centered interventions. We aimed to explore the perspectives of African Americans with hypertension and their family members on hypertension, self-management, and reciprocal family-hypertension impacts to inform future intervention design. DESIGN: We conducted four dyadic focus groups (90-120 minutes) of African American adults with hypertension (i.e. patients) and their family members. We recruited patients (n = 23) and their family members (n = 23) from four African American-serving Christian churches over a period of three months (69.6% female, M age = 60.73 years). Patient-family member dyads were interviewed conjointly (groups ranged from 4 to 6 dyads, each) by facilitators using open-ended questions to elicit perspectives regarding contributors to hypertension, self-management strategies, family influence on self-management, and the impact of hypertension on the family. A grounded theory approach was used for analysis. RESULTS: Participants' responses highlighted themes of societal risk factors and barriers (e.g. racism-related stress worsens blood pressure), influences of African American culture (e.g. culturally-informed diet practices), the patient-physician relationship (e.g. proactive communication is beneficial), family-level influences on health (e.g. family monitoring patients' health behaviors), and patient-level risk factors and self-management strategies (e.g. prayer to cope with stress). Themes reflected a hierarchical, nested, ecological structure such that themes within unique levels of participants' social systems affected, and were affected by, stress, change, or behavior in the other levels. CONCLUSIONS: African American adults with hypertension and their family members described multilevel influences on hypertension and disease self-management, with a strong emphasis on the value of family support. Developing culturally appropriate, family-centered interventions to improve hypertension self-management will be an important next step.

Depressed mood and environmental mastery as potential pathways linking family relationship quality and disease self-management for African Americans with hypertension.

African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, Mage  = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.

Relational and individual stress pathways linking discrimination and ageing cardiometabolic health.

Perceived discrimination is a significant risk factor for worse ageing health outcomes. Yet, the specific individual and relational stress pathways linking discrimination to disease are less understood, especially in the context of cardiometabolic health. We tested family stress and psychophysiological distress (negative affect and high-risk lipid/fat metabolism) as mediators linking perceived discrimination to cardiometabolic morbidity and health appraisal over 20 years for midlife adults. Using data from participants who completed the Biomarker Project (2004-2009) of the Midlife in the U.S. project, and examining data over the study's three waves (1995-1996, 2004-2006, and 2013-2014), we used structural equation modelling to test pathways for participants who reported zero cardiometabolic conditions at baseline (n = 799). Greater Time 1 discrimination was associated with greater Time 2 family strain, which was in turn associated with worse negative affect; worse Time 2 negative affect was associated with worse Time 3 health appraisal; metabolic lipids risk did not serve as an indirect pathway to Time 3 cardiometabolic morbidity (χ2  = 147.74, p < 0.001; RMSEA = 0.056; CFI = 0.902; SRMR = 0.047). The inclusion of family in interventions to mitigate the impact of discrimination may be indicated for promoting cardiometabolic wellness.

Relationship quality and psychophysiological distress for underserved breast cancer patients and their caregiver before treatment.

OBJECTIVE: Breast cancer patients and caregivers experience biobehavioral reactivity (e.g., depression, anxiety, pain, fatigue) during breast cancer treatment which predicts cancer recurrence and mortality. High quality patient-caregiver relationships can mitigate this distress during treatment, but this association is unclear pre-treatment. Identifying early interventions that target high risk Appalachian patients could impact biobehavioral reactivity. METHODS: We recruited 55 breast cancer patient-caregiver dyads to complete a self-report survey after diagnosis but before treatment. We used a series of Actor-Partner Interdependence Models to test the hypotheses that both patient and caregiver relationship quality would be linked to their own and their partners' biobehavioral reactivity. RESULTS: Caregiver reported marital quality lower caregiver anxiety, patient anxiety, caregiver depression, patient depression, caregiver pain, and caregiver fatigue. Interestingly, patient-reported marital quality was linked with higher caregiver anxiety, higher patient anxiety, lower patient depression, and lower patient pain. Patients reported family quality was linked to lower patient and caregiver pain. CONCLUSIONS: This study demonstrates that pre-treatment marital and family quality levels are directly related to psychophysiological measures in both the caregiver and the patient, though sometimes in unexpected directions. Additionally, our findings potentially reveal an opportunity to intervene at the time of diagnosis to improve relationship quality, impacting patient and caregiver psychophysiological outcomes.

Patient attitudes towards changes in colorectal cancer surveillance: An application of the Health Belief Model.

OBJECTIVE: This is to determine whether health beliefs regarding colorectal cancer (CRC) screening could predict discomfort with a change to CRC surveillance proposing regular faecal immunochemical tests (FIT) instead of colonoscopy. METHODS: Eight hundred individuals enrolled in a South Australian colonoscopy surveillance programme were invited to complete a survey on surveillance preferences. Responses were analysed using binary logistic regression predicting discomfort with a hypothetical FIT-based surveillance change. Predictor variables included constructs based on the Health Belief Model: perceived threat of CRC, perceived confidence to complete FIT and colonoscopy (self-efficacy), perceived benefits from current surveillance and perceived barriers to FIT and colonoscopy. RESULTS: A total of 408 participants (51%) returned the survey (complete data n = 303; mean age 62 years, 52% male). Most participants (72%) were uncomfortable with FIT-based surveillance reducing colonoscopy frequency. This attitude was predicted by a higher perceived threat of CRC (OR = 1.03 [95% CI 1.01-1.04]), higher colonoscopy self-efficacy (OR = 1.34 [95% CI 1.13-1.59]) and lower perceived barriers to colonoscopy (OR = 0.92 [95% CI 0.86-0.99]). CONCLUSIONS: Health beliefs regarding colonoscopy and perceived threat of CRC may be important to consider when changing CRC surveillance protocols. If guideline changes were introduced, these factors should be addressed to provide patients reassurance concerning the efficacy of the alternative protocol.

Couple and family interventions for depressive and bipolar disorders: Evidence base update (2010-2019).

This article systematically reviews the evidence base for couple and family interventions for depressive and bipolar disorders published from 2010 to 2019. Included in the review were intervention studies on depression for couples (n = 6), depression for families (n = 13), and bipolar for families (n = 5); zero studies on couple interventions for bipolar were located. Well-established interventions include cognitive and/or behavioral couple and family interventions for depression and psychoeducational family interventions for bipolar. Attachment-based couple and family interventions for depression are probably efficacious. Finally, family psychoeducation for depression is possibly efficacious, and integrative couple interventions and family play-based interventions for depression are experimental. Couple and family interventions also improved relationship dynamics, which is noteworthy since poor relationships are associated with non-remission, relapse, and recurrence of depressive and bipolar symptoms. Future research is needed on couple interventions for bipolar disorders and interventions for minoritized populations.

Transgender and Gender Diverse Fertility Choices: Supporting the Decision-Making Process for Adolescents and Young Adults.

OBJECTIVE: To qualitatively examine the fertility-related decision making process of transgender and gender diverse (TGD) adolescents and young adults (AYAs) and their parents, in the setting of pursing gender affirming treatments. STUDY DESIGN: Twenty-five TGD AYAs and 6 parents of TGD AYAs participated in a focus group or individual semistructured interviews focused on participants' experience learning about the effects of gender affirming treatments on fertility as well as the process of making a fertility preservation decision. Using open coding, data were analyzed in an iterative process identifying emerging themes and relationships. A decisional satisfaction score was collected and/or coded for each participant. RESULTS: Four broad themes related to the decision-making process were identified: (1) Critical steps include awareness, gathering information, and conversations; (2) External constraints limit choices; (3) Expanding the conversation beyond preservation; and (4) Emotional distress, conflict, and decisional satisfaction. Despite reporting emotional distress or conflict during the decision, TGD AYAs and parents of TGD AYAs generally reported a high level of satisfaction with their fertility preservation decision. CONCLUSIONS: There are specific ways health care professionals and family members can support TGD AYAs in their fertility-related decision making process. Decisional satisfaction was common, regardless of whether TGD AYAs chose to pursue fertility preservation or not.

Characterization of Head Impact Exposure in Women's Collegiate Soccer.

Soccer players are regularly exposed to head impacts by intentionally heading the ball. Evidence suggests repetitive subconcussive head impacts may affect the brain, and females may be more vulnerable to brain injury than males. This study aimed to characterize head impact exposure among National Collegiate Athletic Association women's soccer players using a previously validated mouthpiece-based sensor. Sixteen players were instrumented during 72 practices and 24 games. Head impact rate and rate of risk-weighted cumulative exposure were compared across session type and player position. Head kinematics were compared across session type, impact type, player position, impact location, and ball delivery method. Players experienced a mean (95% confidence interval) head impact rate of 0.468 (0.289 to 0.647) head impacts per hour, and exposure rates varied by session type and player position. Headers accounted for 89% of head impacts and were associated with higher linear accelerations and rotational accelerations than nonheader impacts. Headers in which the ball was delivered by a long kick had greater peak kinematics (all P < .001) than headers in which the ball was delivered by any other method. Results provide increased understanding of head impact frequency and magnitude in women's collegiate soccer and may help inform efforts to prevent brain injury.