Effectiveness of clindamycin and intravenous immunoglobulin, and risk of disease in contacts, in invasive group a streptococcal infections.

BACKGROUND: The use of clindamycin and intravenous immunoglobulin (IVIG) in treatment of invasive group A streptococcal (iGAS) infection, and the need for prophylactic antibiotics in close contacts, remains contentious. Controlled trials are unlikely to be conducted, so prospective, observational studies provide the best data to inform practice. METHODS: We conducted population-based, prospective, active surveillance of iGAS infections throughout the state of Victoria, Australia (population 4.9 million), from March 2002 through August 2004. RESULTS: Eighty-four cases of severe iGAS infection (streptococcal toxic shock syndrome, necrotizing fasciitis, septic shock, or GAS cellulitis with shock) were identified. Clindamycin-treated patients had more severe disease than clindamycin-untreated patients but lower mortality (15% vs 39%; odds ratio [OR], 0.28; 95% confidence interval [CI], .10-.80). Among those who received concurrent IVIG, the fatality rate was lower still (7%). The adjusted point estimate of the OR for mortality was lower in clindamycin-treated patients (0.31; 95% CI, .09-1.12) and clindamycin plus IVIG-treated patients (0.12; 95% CI, .01-1.29) compared with clindamycin-untreated patients. Three confirmed cases of iGAS infection occurred in household contacts of index cases. The incidence rate of iGAS disease in contacts was 2011 (95% CI, 413-5929) times higher than the population incidence in Victoria. CONCLUSIONS: Our data suggest that clindamycin treatment of patients with severe iGAS infections substantially reduces mortality and that this effect may be enhanced by concurrent treatment with IVIG. The dramatically increased risk of iGAS disease among household contacts within 1 month of the index case highlights a potential role for antibiotic prophylaxis.

The impact of stressful life events on centralized pain and pain intensity: A combined model examining the mediating roles of anger and perceived injustice among racially minoritized adults with chronic pain.

Stressful life events are highly associated with chronic pain. Yet, research is needed to identify the psychological mechanisms that link life adversity and pain, especially studies that test comprehensive models, recruit racially diverse samples, and measure varied pain-related symptoms. This study examined the relationship between stressful life events and pain in a racially diverse sample and tested the potential mediating roles of both anger and perceived injustice. Both centralized pain symptoms and pain intensity were outcomes. Analyses consisted of two cross-sectional, mediation models among 673 adults with self-reported chronic pain who were racially diverse (Black: n = 258; Latine: n = 254; Asian American: n = 161). Results indicated a positive relationship between stressful life events and centralized pain symptoms (b = 2.53, p <.001) and pain intensity (b = 0.20, p <.001). In parallel mediation analyses, anger (b = 0.91, 95% CI = 0.67, 1.17) and perceived injustice (b = 0.86, 95% CI = 0.64, 1.11) acted as partial mediators on centralized pain symptoms. Also, anger (b = 0.05, 95% CI = 0.03, 0.08) and perceived injustice (b = 0.11, 95% CI = 0.08, 0.14) acted as full mediators on pain intensity. The combined psychosocial variables accounted for 51% of centralized pain symptoms and 26% of pain intensity. Findings suggest that psychosocial factors are significantly associated to pain outcomes. Future research is needed to investigate exposure to adversity in life, anger, and perceived injustice together as psychosocial mechanisms of pain symptoms. PERSPECTIVE: Among racially minoritized adults with chronic pain, this article presents empirical evidence that stressful life events, anger, and perceived injustice are associated with centralized pain symptoms and pain intensity. This could guide psychological intervention to focus on anger and perceived injustice especially when addressing centralized pain.

Familial and religious ethnic-racial socialization in promoting activism among Asian American Christians.

The adversity faced by Asian Americans (AAs) due to discrimination is a testament to the ongoing fight for human rights. At the crux of social activism, familial and religious ethnic-racial socialization (ERS) instills cultural values, ethnic identity, belonging to one's racial group, and a meaningful outlook, navigating generations through these challenges. This study examined the role of family and religion in amplifying social advocacy among AAs by assessing the relationship between race-related stress and social activism, as well as the mediating role of familial and religious ERS via a parallel mediation. Our research, utilizing a cross-sectional, nonexperimental design, involved 254 AA emerging adults identifying as Christian (Mage = 29.06, SDage = 7.55), sourced from Prolific (n = 203) and community sampling (n = 51). Linear regression findings revealed significant positive associations between familial ERS and social action (ß = .226, p < .001), as well as religious ERS and social action (ß = .085, p = .033). Nevertheless, parallel mediation analysis through bootstrapping demonstrated that neither familial nor religious ERS fully mediated the effects of race-related stress on social activism. These results underscore the significance of applying culturally imbued insights from different contexts to address discrimination within the AA Christian community. Scrutinizing these pathways can safeguard AA Christians, while promoting the amalgamation of Christian theology and psychological science. Future research should address the spectrum of beliefs and practices within Christianity that intersect with AA families and culture, unraveling the foundations of the call for social action. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

#NotTheSame: Asian American subgroups moderate the relation between campus racial climate and perceived burdensomeness during the COVID-19 pandemic.

The present study examined the effect of campus racial climate on perceived burdensomeness, a suicide risk factor, among Asian American college students during the COVID-19 pandemic, when anti-Asian racism was present. To disaggregate these data, there was a test of whether Asian American ethnicity subgroup identification as Southeast and South or East Asian changed the association between campus racial climate on perceived burdensomeness. The current sample included 148 college students, 73 Southeast or South Asian Americans, and 75 East Asian American. The study participants were enrolled at a small liberal arts institution located in the Pacific Northwest region of the United States. Researchers collected data across 3 days (9-12 April 2020) via an online questionnaire. Both groups reported similar levels of campus racial climate and perceived burdensomeness. Bivariate correlations indicated that campus racial climate was positively correlated with perceived burdensomeness for Southeast and South Asians only. Moderation analyses revealed that a negative campus racial climate was related to greater perceived burdensomeness among Southeast and South Asian, but not East Asian, American students. This finding supports the need for disaggregation of Asian subgroups in mental health research to understand the diverse experiences within the Asian American community. Furthermore, there is a need for higher education institutions to consider tailoring interventions and tools that fit into the unique cultural and sociohistorical experiences of ethnic and racial subgroups among Asian American students.

A Randomized Trial Evaluating School-Based Mindfulness Intervention for Ethnic Minority Youth: Exploring Mediators and Moderators of Intervention Effects.

The study examined the efficacy of a school-based mindfulness intervention on mental health and emotion regulation outcomes among adolescents in a wait-list controlled trial. The study also explored mediators and moderators of intervention effects. A total of 145 predominantly ethnic minority (Asian and Latino) 9th grade students with elevated mood symptoms were randomized to receive a 12-week mindfulness intervention at the start of the academic year, or in the second semester of the year. Students completed measures of emotion regulation and mental health symptoms at baseline, post-intervention, and 3-month follow-up. Intent-to-treat analyses revealed significant treatment effects of the mindfulness intervention for internalizing symptoms and perceived stress at post-treatment. Pooled pre-to-post treatment analyses of the entire sample revealed a small effect size for attention problems, medium for internalizing and externalizing problems, and large for perceived stress. We also found a small effect size for cognitive reappraisal, medium for expressive suppression, emotional processing, emotional expression, and rumination and large for avoidance fusion. Mediation analyses showed that treatment effects on internalizing symptoms and perceived stress were mediated by reductions in expressive suppression and rumination. Moderation analyses revealed that treatment effects were larger among youth with more severe problems at baseline for internalizing problems, externalizing problems, and perceived stress. However, for attention problems, students with lower severity at baseline appeared to have larger treatment gains. The study provided evidence that mindfulness intervention was beneficial for low-income ethnic minority youth in reducing perceived stress and internalizing problems, and improving emotion regulation outcomes. Furthermore, mindfulness training was associated with reduced mental health symptoms via improvements in emotion regulation.

Perceived Social Change, Parental Control, and Family Relations: A Comparison of Chinese Families in Hong Kong, Mainland China, and the United States.

This study examined the relationship between perceived social change, parental control and family relations in a sample of 419 4th and 5th grade children and their mothers who are of Chinese descent but reside in three different contexts: Los Angeles (LA), Hong Kong (HK), and Beijing (BJ). HK mothers endorsed the highest levels of psychological control and the lowest levels of autonomy support compared to BJ and LA mothers. Perceived social change as measured by mothers' endorsement of new values and ideologies was associated with increased use of both autonomy support and psychological control. Results of the mediation analyses suggested that perceived social change explained differences between LA and HK mothers in autonomy support, but group differences in psychological control were magnified when perceived social change was accounted for. Finally, whereas autonomy support was associated with higher levels of child perceived acceptance in HK and LA, psychological control was associated with greater family conflict in BJ and LA. Findings suggested that as families undergo urbanization or social change, it may shift the implications of traditional strategies that are intended to socialize the child toward interpersonal attunement. Overall, the study highlights the importance of moving beyond ethnic-group or cross-national comparisons to investigate the role of changing social and economic contexts in understanding differences in the use of parental control and their associations with family relations.