Better emotion regulation mediates gratitude and increased stress in undergraduate students across a university semester.

It is well established that university students are vulnerable to poor mental health. Although increased gratitude has been shown to reduce stress among students, a clearer understanding of key mechanisms underpinning this relationship are needed to better inform theoretical models and potential interventions targeted at improving well-being in university students. The present study provides the first direct test of whether capacity for emotion regulation mediates the relationship of gratitude with stress at the beginning and middle of the academic semester. This study is also the first to assess this relationship in a cross-lagged panel mediation model. We used a repeated measures design and a total of 343 undergraduate students completed two online surveys with validated measures of gratitude, stress, and emotion regulation-one at the beginning and the second in the middle of the academic semester. Results showed that emotion regulation mediated the relationship between gratitude and stress at the beginning of semester, and again 6 weeks later. A Clogg's z-score test suggested that the strength of the indirect effect significantly increased across the two time points. A post-hoc cross-lagged panel model found that high gratitude at the beginning of the semester predicted low stress in the middle of the semester via emotion regulation. These data provide novel evidence that emotion regulation may serve as a key protective factor against undergraduate stress. The results provide evidence to support leading theories on how gratitude can reduce stress and promote well-being in university students. They also highlight the practical importance of strengthening emotion regulation abilities in university students and can be used to inform future targeted interventions to improve well-being in university students.

Exploring Aromanticism Through an Online Qualitative Investigation With the Aromantic Community: "Freeing, Alienating, and Utterly Fantastic".

Objective: To explore what aromanticism is, common misconceptions about this identity, and the experiences people have connecting with an aromantic identity. Methods: An online, international open-ended survey with a convenience sample of aromantic individuals (N = 1642) analyzed with thematic analysis. Results: To identify as aromantic involves a spectrum of experiences with romance commonly tied to experiencing stigma. Connecting with an aromantic identity allows for a greater understanding of the self and a connection to a community. Conclusions: Future research is needed to explore the experiences and perspectives of this community to gather better understanding of their needs and how to prevent/limit stigmatizing experiences.

Healthcare providers perspectives on digital, self-guided mental health programs for LGBTQIA+ individuals: A cross-sectional online survey.

Digital, self-guided mental health programs are a promising avenue for mental health support for LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual plus additional sexuality, gender, and romantic identities) people - however, healthcare providers (HCPs) perspectives on programs are largely unknown. The aim of this study was to explore these perspectives. A cross-sectional online survey was distributed across Australia, with a final sample of 540 HCPs from a range of disciplines. Most respondents (419, 81.2 %), reported that digital, self-guided mental health programs would be useful, but 74.5 % (n = 380) also reported that they had concerns. Thematic analysis of open-text responses showed that HCPs believe programs may help overcome access barriers and could be useful as part of a wider care journey. Others were concerned about patient safety, and whether programs could be appropriately tailored to LGBTQIA+ experiences. Content analysis of open-text responses showed affirming language and imagery, content on LGBTQIA+ people's unique challenges, wider health information, and connections to community were important to include in programs. HCPs advocated for programs that offered broad and sub-population specific information. These findings show that HCPs are enthusiastic about digital, self-guided mental health programs, but care should be taken to address key concerns to facilitate future implementation.

Sexual and reproductive health integration into pre-travel consultations: a scoping review.

BACKGROUND: Casual sex during travel is a major preventable factor in the global transmission of sexually transmissible infections (STI). Pre-travel consults present an excellent opportunity for practitioners to educate travellers about sexual and reproductive health (SRH) and safety. The scoping review aims to explore and understand the extent to which SRH is included in pre-travel consultations. METHODS: PubMed, Embase, CINAHL, Scopus, Medline and Web of Science were systematically searched for primary research articles exploring whether health care practitioners (HCP) included SRH in pre-travel consultations. Extracted findings were synthesised and presented in narrative form. RESULTS: Findings across 13 articles suggest HCP infrequently broached SRH in pre-travel consultations with HCP discomfort, and lack of time and resources presented as key barriers. Urban practice settings, HCP experience, training in travel medicine, and traveller characteristics such as sexual orientation were positively correlated with discussions about SRH. SRH advice reported was general in nature, primarily focusing on safer sex, condoms, or unspecified STI advice. Risk assessments based solely on age or stereotypes around sexual preferences led to key aspects of SRH care being missed for some (e.g. SRH was less likely to be discussed with older travellers). CONCLUSIONS: HCPs frequently miss opportunities to integrate SRH into pre-travel consultations. Strategies to promote HCP confidence and awareness present a promising means to boost the frequency and quality of SRH advice disseminated. Integrating culturally safe and responsive SRH history-taking and advice into pre-travel consultations may contribute to global reductions in STI transmission and promote traveller SRH well-being.

The provision of sexual and reproductive health information and services to travellers: an exploratory survey of Australian travel medicine clinicians.

BACKGROUND: International travel can increase the risk of exposure to infectious diseases including sexually transmissible infections (STI). Pre-travel medical consultation provides an opportunity for travel-related health risk assessments and advice. This study explored how travel medicine clinicians integrate sexual and reproductive health (SRH) services into clinical practice. METHODS: A convenience sample of travel medicine clinicians completed a cross-sectional survey online or via hard-copy disseminated at an annual national Australian travel medicine conference. RESULTS: Of the 67 respondents, most (n , 51; 76.1%) had a postgraduate qualification relevant to travel medicine and 55.2% (n , 37) had worked in travel medicine for over 10years. Only 22.4% (n , 15) reported conducting a SRH history/STI risk assessment for all travel patients. STI testing pre-departure was conducted on patient request (48, 71.6%), if symptomatic (32, 47.8%) or based on risk history (28, 41.8%). SRH information pre-departure was most frequently provided if prompted by patient questions (n , 42; 62.7%), or based on the patient's history (n , 37; 55.2%). Over half the sample (n , 40; 59.7%) expressed interest in further training in SRH. CONCLUSION: Providing and engaging with additional training may assist travel medicine clinicians to take a more proactive approach to SRH consultations and STI testing. Additional research is needed to explore models of care that will allow comprehensive SRH and STI services to be integrated into standard pre- and post-travel care.

Highs, Lows, and Hormones: A Qualitative Metasynthesis of Transgender Individuals' Experiences Undergoing Gender-Affirming Hormone Therapy.

Gender Affirming Hormone Therapy (GAHT) is a key therapeutic approach which aims to help trans and gender diverse (or simply "trans") individuals' transition from their sex-presumed-at-birth to their experienced gender identity. Previous reviews have focused on synthesizing quantitative experiences; however, a qualitative lens is important to understand the personal journey of GAHT. This review provides a qualitative meta-synthesis of the experiences of trans people around the world who have undergone GAHT to elicit contextualized understanding of the changes experienced. Systematic searches of eight databases identified an initial 2670 papers, refined to a final 28 papers. Overall, findings suggested that the GAHT journey is unique and elicited a myriad of changes which, whilst challenging at times, were life-changing and brought about positive psychological, physical, and social changes. Other themes explored GAHT not being treated as a fix-all for associated mental health issues, the rules that govern appraisal of physical changes, how privilege and social identity evolve, and the power of affirmation. This work offers important recommendations to improve the care offered to trans people undergoing GAHT. Namely, person-centered support is essential, and peer-navigation may be a useful future direction to explore.

Barriers to optimal management of syphilis in pregnancy and congenital syphilis in south-east Queensland: a qualitative investigation.

BACKGROUND: Australia, like many high-income countries, is experiencing a resurgence of infectious syphilis in pregnancy and congenital syphilis. Evaluations of public health notifications and clinical records suggest that healthcare systems may not be providing optimal care to women and their neonates. This study aims to explore the barriers to optimal management of syphilis in pregnancy and congenital syphilis to identify key areas for improvement. METHODS: Between 2021 and 2022, 34 healthcare workers (HCW) practicing in south-east Queensland (SEQ) Australia were recruited to complete semi-structured interviews regarding their perceptions towards management of syphilis in pregnancy and congenital syphilis. Interviews were analysed thematically. RESULTS: Thematic analysis identified four themes related to the management of syphilis in pregnancy. These included poor communication between disciplines, services, and teams from delivery through to management and post-delivery, lack of formal internal and external referral pathways, unclear and often complex maternal and congenital syphilis management procedures, and limited HCW knowledge of infectious syphilis in pregnancy and congenital syphilis. CONCLUSION: As congenital syphilis numbers continue to rise in SEQ, it is imperative that healthcare systems and HCWs identify and address gaps in the provision of health care.

Digital mental health interventions: A narrative review of what is important from the perspective of LGBTQIA+ people.

OBJECTIVES: Digital mental health interventions are a promising therapeutic modality to provide psychological support to LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual, plus other gender, sexual, and romantic minority identities) people. The aim of this narrative review is to explore how the LGBTQIA+ community has been engaged in the design of digital mental health interventions, how content has been tailored to the LGBTQIA+ community, and features identified as important by LGBTQIA+ participants. METHODS: A total of 33 studies were included in this review from a larger yield of 1933 identified from systematic searches of five databases (PsycINFO, PubMed, Scopus, CINAHAL, and Medline). Data were analyzed narratively and using content analysis. RESULTS: Only half of the studies reported engaging the LGBTQIA+ community in intervention designs. Interventions have been tailored in a variety of ways to support LGBTQIA+ individuals-such as through affirming imagery, recruitment through LGBTQIA+ networks, and designing content to focus specifically on LGBTQIA+ issues. A range of features were identified as important for participants, namely how content was tailored to LGBTQIA+ experiences, providing connection to community, and links to other relevant LGBTQIA+ resources. While not a primary aim, results also showed that a wide range of digital modalities can significantly improve a range of mental health problems. CONCLUSION: Digital interventions are an acceptable and effective form of therapeutic intervention, but future research needs to focus on meaningful engagement of community members to inform design and implementation.

Prevalence of Diastolic Dysfunction in Adult Survivors of Childhood Cancer: A Report From SJLIFE Cohort.

Background: The prevalence of diastolic dysfunction has not been systematically evaluated in a large population of survivors of childhood cancer using established guidelines and standards. Objectives: This study sought to assess the prevalence and progression of diastolic dysfunction in adult survivors of childhood cancer exposed to cardiotoxic therapy. Methods: Comprehensive, longitudinal echocardiographic examinations of adult survivors of childhood cancer ≥18 years of age and ≥10 years from diagnosis in SJLIFE (St. Jude Lifetime Cohort Study) were performed. Diastolic dysfunction was defined based on 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Results: Among 3,342 survivors, the median (25th-75th percentiles [quartile (Q)1-Q3]) age at diagnosis was 8.1 years (Q1-Q3: 3.6-13.7 years), 30.1 years (Q1-Q3: 24.4-37.0 years) at the baseline echocardiography evaluation (Echo 1), and 36.6 years (Q1-Q3: 30.8-43.6 years) at the last follow-up echocardiography evaluation (1,435 survivors) (Echo 2). The proportion of diastolic dysfunction was 15.2% (95% CI: 14.0%-16.4%) at Echo 1 and 15.7% (95% CI: 13.9%-17.7%) at Echo 2, largely attributable to concurrent systolic dysfunction. Less than 5% of survivors with preserved ejection fraction had diastolic dysfunction (2.2% at Echo 1, 3.7% at Echo 2). Using global longitudinal strain assessment in adult survivors with preserved ejection fraction (defined with a cutpoint worse than -15.9%), the proportion of diastolic dysfunction increased to 9.2% at baseline and 9.0% at follow-up. Conclusions: The prevalence of isolated diastolic dysfunction is low among adults who received cardiotoxic therapies for childhood cancer. The inclusion of left ventricular global longitudinal strain significantly increased the identification of diastolic dysfunction.

Syphilis in pregnancy: a qualitative investigation of healthcare provider perspectives on barriers to syphilis screening during pregnancy in south-east Queensland.

BACKGROUND: Increasing rates of syphilis in pregnancy (SiP) in Australia and other high-income countries, has led to the resurgence of congenital syphilis. Suboptimal syphilis screening during pregnancy has been identified as a key contributing factor. METHODS: This study aimed to explore, from the perspective of multidisciplinary healthcare providers (HCPs), the barriers to optimal screening during the antenatal care (ANC) pathway. Semi-structured interviews conducted with 34 HCPs across multiple disciplines practising in south-east Queensland (SEQ) were analysed through a process of reflexive thematic analysis. RESULTS: Barriers were found to occur at the system level of ANC, through difficulties in patient engagement in care, limitations in the current model of health care delivery and limitations in the communication pathways across health care disciplines; and at the individual HCP level, through HCP knowledge and awareness of epidemiological changes in syphilis in SEQ, and adequately assessing patient risk. CONCLUSION: It is imperative that the healthcare systems and HCPs involved in ANC address these barriers to improve screening in order to optimise management of women and prevent congenital syphilis cases in SEQ.

Psychological therapy using virtual reality for treatment of driving phobia: a systematic review.

PURPOSE: Driving phobia is prevalent in injured individuals following motor vehicle crashes (MVCs). The evidence for virtual reality (VR) based psychological treatments for driving phobia is unknown. This systematic review synthesized the available evidence on the effectiveness, feasibility, and user experience of psychological treatments for driving phobia using VR. METHODS: Three databases (PsycINFO, SCOPUS, and PubMed) were searched. Eligibility criteria included adults with clinical or sub-clinical levels of driving phobia manifesting as part of an anxiety disorder or post-traumatic stress disorder (PTSD). Primary outcomes were driving-related anxiety/fear or avoidance, PTSD symptoms and driving frequency/intensity, as well as treatment feasibility including recruitment, treatment completion and retention rates, user experience and immersion/presence in the VR program. Secondary outcomes were other health outcomes (e.g., depression) and VR technological features. RESULTS: The 14 included studies were of low methodological quality. Clinical and methodological heterogeneity prevented quantitative pooling of data. The evidence provided in this review is limited by trials with small sample sizes, and lack of diagnostic clarity, controlled designs, and long-term assessment. The evidence did suggest that VR-based psychological interventions could be feasible and acceptable in this population. CONCLUSIONS: For VR-based psychological interventions to be recommended for driving phobia, more high-quality trials are needed. Implications for rehabilitationVirtual reality (VR) based psychological treatments may be feasible and acceptable to patients with driving phobia.There is potential to increase accessibility to psychological therapies in patients with driving phobia following motor vehicle crashes through the use of digital psychiatry such as VR.

Ventricular global longitudinal strain is altered in children with sickle cell disease.

Cardiac disease is the primary cause of death in sickle cell disease (SCD). Right and left ventricular global longitudinal strain (RVGLS, LVGLS) are early markers of systolic dysfunction but are not well investigated among children with SCD. One hundred and forty-three patients with HbSS or HbSß0 -thalassaemia (median age 11 years, range 5-19 years) and 71 controls matched for age and sex were compared. RVGLS and LVGLS were measured and compared with conventional measures of echocardiography and markers of haemolysis and inflammation. RVGLS was higher in children with SCD than in controls (-25·72% ± 3·45% vs. -24·54% ± 2·41%, P = 0·005); LVGLS was not different. RVGLS decreased with older age in children with SCD (ρ = 0·338, P < 0·001) but not among controls. Decreased RVGLS was associated with increased left atrial end diastolic volume (ρ = 0·181, P = 0·04); RVGLS increased with cardiac output (r = -0·279, P = 0·01). RVGLS and LVGLS were not associated with disease-modifying therapies, degree of anaemia or haemolysis markers. Elevated RVGLS may indicate an early RV compensatory mechanism in response to upstream myocardial insults and elevated cardiac output. Global longitudinal strain may serve as an early marker of altered myocardial function in children with SCD.

Increased tricuspid regurgitant jet velocity by Doppler echocardiography in adult survivors of childhood cancer: a report from the St Jude Lifetime Cohort Study.

PURPOSE: To determine the prevalence of pulmonary hypertension, a late effect of cancer therapy not previously identified in aging survivors of childhood cancer, and associations with chest-directed radiation therapy (RT) and measures of current cardiac function, lung function, and exercise capacity. PATIENTS AND METHODS: Cross-sectional evaluation of 498 survivors at a median age of 38.0 years (range, 20.0 to 59.0 years) and a median of 27.3 years (range, 12.2 to 46.0 years) from primary cancer diagnosis was performed. Abnormal tricuspid regurgitant jet velocity (TRV) was defined as more than 2.8 m/s by Doppler echocardiography. RESULTS: Increased TRV was identified in 25.2% of survivors who received chest-directed RT and 30.8% of those who received more than 30 Gy. In multivariable models, increased TRV was associated with increasing dose of RT (1 to 19.9 Gy: odds ratio [OR], 2.09; 95% CI, 0.63 to 6.96; 20 to 29.9 Gy: OR, 3.46; 95% CI, 1.59 to 7.54; ≥ 30 Gy: OR, 4.54; 95% CI, 1.77 to 11.64 compared with no RT; P for trend < .001), body mass index more than 40 kg/m(2) (OR, 3.89; 95% CI, 1.46 to 10.39), and aortic valve regurgitation (OR, 5.85; 95% CI, 2.05 to 16.74). Survivors with a TRV more than 2.8 m/s had increased odds (OR, 5.20; 95% CI, 2.5 to 11.0) of severe functional limitation on a 6-minute walk compared with survivors with a TRV ≤ 2.8 m/s. CONCLUSION: A substantial number of adult survivors of childhood cancer who received chest-directed RT have an increased TRV and may have pulmonary hypertension as a result of both direct lung injury and cardiac dysfunction. Longitudinal follow-up and confirmation by cardiac catheterization are warranted.