Postoperative Cesarean Section Pain Management Using Transversus Abdominis Plane Block Versus Intrathecal Morphine: A Systematic Review and Meta-analysis.

PURPOSE: Compare and evaluate the effectiveness of transversus abdominis plane (TAP) block versus intrathecal morphine (ITM) on elective postcesarean section pain, opioid consumption, and related side effects. DESIGN: Systematic review and meta-analysis. METHODS: A search for evidence was conducted in PubMed, Google Scholar, CINAHL, Cochrane Collaboration Database, UpToDate, Health Source, and gray literature. Only randomized controlled trials (RCTs) were included in the study. The methodological quality of evidence assessment was conducted using the Risk of Bias and Grades of Recommendation, Assessment, Development, and Evaluation system. The meta-analysis used Review Manager (RevMan 5.4, The Cochrane Collaboration). FINDINGS: A total of 11 RCTs involving 1,129 patients were analyzed. Compared to ITM, TAP has a similar effect on static (mean difference [MD]; 0.37; 95% confidence interval [CI], -0.04 to 0.79; P = .08) and dynamic pain scores (MD, 0.43; 95% CI, -0.06 to 0.92; P = .09) within the first 48 hours after surgery. Additionally, the TAP block had a lower incidence of postoperative nausea and vomiting (risk ratio, 0.45; 95% CI, 0.31 to 0.66; P < .0001) and increased opioid consumption (MD, 6.78; 95% CI, 3.79 to 9.77; P < .00001). Overall, TAP block and ITM did not differ in the time to first to rescue analgesia, incidence of sedation, and pruritus. CONCLUSIONS: Evidence suggests that TAP blocks are equivalent to ITM in pain scores and more effective at lowering the incidence of postoperative nausea and vomiting, yet ITM has been shown to be more effective in reducing postoperative opioid consumption.

Mental Health Symptoms and Parenting Among Father-Only and Dual Substance Use Disorder Couples.

In the present study, we examined associations between fathers' and mothers' mental health symptoms as related to their own and their partner's parenting in couples in which fathers (n = 38 families) or both partners (n = 30 families) had substance use disorder (SUD). Each partner reported on symptoms of depression, anxiety, and hostility; children reported on each parent's parenting behaviors, including acceptance, psychological control, and knowledge of children. Actor-partner interdependence models indicated that when substance-abusing fathers have more symptoms of anxiety and depression, non-substance-abusing mothers report greater knowledge of children, whereas non-substance-abusing mothers' mental health symptoms were related to less paternal knowledge of children. In dual SUD couples, mothers' depressive symptoms were associated with more paternal knowledge of children. These preliminary findings offer select support for family systems theory.

Acceptability of aggression among children who reside with substance-abusing parents: The influence of behavioral dysregulation, exposure to neighborhood violence, and interparental violence.

The present study examined how interparental violence, neighborhood violence, behavioral regulation during parental conflict, and age predicted beliefs about the acceptability of aggression and the acceptance of retaliation against an aggressive peer among youths. Participants were 110 families (mothers, fathers, and children) in which one or both parents met criteria for substance use disorder. Results of a bootstrapped path model revealed higher exposure to neighborhood violence predicted greater acceptability of general aggression, whereas higher father-to-mother violence perpetration predicted lower acceptability of general aggression. Higher exposure to neighborhood violence, behavioral dysregulation during parental conflict, and older child age predicted greater approval of retaliation toward an aggressive peer. Findings are interpreted as related to the cognitive-contextual framework.

Psychotherapy dose, clinical outcome, and academic withdrawal at university counseling centers.

Academic withdrawal from colleges and universities is a common occurrence, particularly among students with mental health concerns. Receiving a successful course of psychotherapy may reduce students' risk of academic withdrawal, but outcomes in university counseling centers (UCCs) could be hindered by strategies used to meet high service demands with limited resources, such as offering a low number or frequency of sessions. The present study examined associations among psychotherapy dose, clinical outcome, and academic withdrawal among students (N = 16,197) in short-term individual psychotherapy at 85 UCCs in the United States. Structural equation modeling results indicated that after controlling for baseline psychological distress, the number of psychotherapy sessions attended positively predicted, and the average number of days between sessions negatively predicted, clients' self-reported reductions in psychological distress. In turn, after controlling for pretreatment characteristics associated with academic withdrawal (prior psychiatric hospitalization, gender, academic distress) reductions in psychological distress negatively predicted therapists' report of clients voluntarily withdrawing from their academic institution during psychotherapy. This indicates that students who receive higher psychotherapy doses within a short-term context (i.e., 10 or fewer sessions) are less distressed by the end of treatment, which then predicts a lower likelihood of academic withdrawal during psychotherapy. UCC leadership and clinicians might enhance clinical and academic outcomes by providing flexibility in the number and frequency of psychotherapy sessions available to students. However, centers may need additional resources from their academic institutions to provide this flexibility. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predicting Chinese Adolescents' Depressive Symptoms from Their Cultural Orientations and Perceived Parental Psychological Control.

Research on adolescents across cultures has suggested a positive link between parental psychological control and adolescent depression. While a few studies have examined psychological outcomes of adolescents in collectivist groups compared to individualist groups, much less is known about the role of cultural orientations in the parental control-depression link at the individual level. The current study examined: (1) both mother and father psychological control as predictors of depressive symptoms in Chinese adolescents, (2) adolescents' cultural orientations of individualism and collectivism as predictors of their depressive symptoms, and (3) the moderating effects of adolescents' cultural orientations on the association between parental control and depressive symptoms. The sample included 3255 adolescents located in southern China. Adolescents reported on their orientations of individualism and collectivism, perceived mothers' and fathers' psychological control, and their depressive symptoms. Analyses revealed that both mother and father psychological control as well as adolescents' individualism were positive predictors of adolescent depressive symptoms, whereas collectivism was a negative predictor of depressive symptoms. Furthermore, the results indicated that cultural orientations had weak moderating effects on the link between parental control and adolescent depressive symptoms. Theoretical and practical implications are discussed.

Relating Gender to Sex: Gendered Attitudes, Sexual Double Standard, Sexual Intentions and Behaviors in two Chinese Adolescent Samples.

Adolescence is a critical life stage when individuals further consolidate their gender role concepts, develop sexual beliefs, and likely begin to experiment with sexual behaviors. While there have been numerous studies on adolescents' gender role attitudes, sexual beliefs, and sexual behaviors, the bulk of this research has been based on Western samples. The current study aimed to expand our knowledge of adolescents' gender and sexuality by examining gender role attitudes, sexual beliefs, and sexual behaviors in an urban sample (n = 613) and a rural sample (n = 408) from China. Adolescent boys reported stronger identification with the negative male role, less sexual guilt, and stronger sexual intention than their female counterparts. Compared to the urban sample, adolescents in the rural sample were more likely to endorse both negative and positive male roles, hold the sexual double standard, and experience sexual guilt. Regression analyses yielded significant interaction effects between sex and negative male role on sexual guilt and sexual intention, suggesting that the negative male role was differentially associated with sexual guilt and sexual intention in boys versus in girls. Moreover, the negative male role was the only significant predictor of sexual behavior. Cultural implications of these findings were discussed.

Sex differences in mental health symptoms and substance use and their association with moral injury in veterans.

OBJECTIVE: This study examines potential sex differences in 3 types of experiences (i.e., atrocities of war, cognitive and emotional changes from combat, and leadership failure or betrayal) that may result in moral injury (i.e., guilt, shame, inability to forgive one's self, inability to forgive others, and withdrawn behavior associated with these three types of experiences). In addition, we examine whether moral injury results in different associations with mental health and substance use outcomes for female versus male veterans. We expected more symptoms of depression and anxiety for women and more symptoms of hazardous alcohol use and drug abuse for men. Also, we examined sex as a moderator between moral injury and outcomes, expecting stronger relationships between moral injury and symptoms of depression and anxiety among women and stronger associations between moral injury and alcohol use and drug abuse symptoms for men. METHOD: Participants (n = 256; 60.9% [n = 156] males) were a community sample of recent-era military personnel who completed a measure of morally injurious experiences (MIEs) and associated moral injury. RESULTS: After correcting for Type I error rate, sex was not associated with mental health or substance use. Further, no Sex × Moral Injury interactions were present; however, moral injury significantly positively predicted all negative mental health symptoms (depression, anxiety, suicidality, and posttraumatic stress disorder [PTSD]) and hazardous alcohol use, but not drug abuse symptoms. CONCLUSIONS: Results reveal the need for improved screening and treatment of moral injury and integrated treatments that may assess moral injury and associated disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parents' Reports of Children's Internalizing Symptoms: Associations with Parents' Mental Health Symptoms and Substance Use Disorder.

This brief report examined the unique associations between parents' ratings of child internalizing symptoms and their own depression and anxiety in families with parental substance use disorder (SUD). Further, we examined whether parental SUD (father only, mother only, both parents) was related to discrepancy in mothers' and fathers' reports of children's internalizing symptoms. Participants were 97 triads (fathers, mothers) in which one or both parents met criteria for SUD. Polynomial regression analyses were conducted to examine whether father-mother reports of child internalizing symptoms had unique associations with parents' own symptoms of depression and anxiety while controlling for child gender, child age, and SUD diagnoses. Controlling for fathers' symptoms and other covariates, mothers experiencing more depression and anxiety symptoms reported more symptoms of child internalizing symptoms than did fathers. Mothers' and fathers' SUD was associated with higher anxiety symptoms among mothers after controlling for other variables. A second set of polynomial regressions examined whether father-mother reports of child internalizing symptoms had unique associations with parents' SUD diagnoses while controlling for child gender and child age. After controlling for mothers' symptoms and other covariates, parents' reports of children's internalizing symptoms were not significantly associated with either parent's SUD or parental SUD interactions (i.e., both parents have SUD diagnoses). Taken together, mothers' ratings of children's internalizing symptoms may be accounted for, in part, by her reports of depression and anxiety symptoms.

Conditional Disruption of miR17~92 in Osteoclasts Led to Activation of Osteoclasts and Loss of Trabecular Bone In Part Through Suppression of the miR17-Mediated Downregulation of Protein-Tyrosine Phosphatase-oc in Mice.

This study sought to understand the regulation of an osteoclastic protein-tyrosine phosphatase (PTP-oc), a positive regulator of osteoclast activaty. Our past studies suggested that PTP-oc is regulated post-transcriptionally. The 3'-UTR of PTP-oc mRNA contains a target site for miR17. During osteoclastic differentiation, there was an inverse relationship between the cellular levels of miR17 (expressed as one of the six cluster genes of miR17~92) and PTP-oc mRNA. Overexpression of pre-miR17~92 in mouse osteoclast precursors reduced PTP-oc mRNA level and the size of the derived osteoclasts; whereas deletion of miR17~92 or inhibition of miR17 resulted in the formation of larger osteoclasts containing more nuclei that expressed higher PTP-oc mRNA levels and created larger resorption pits. Thus, PTP-oc-mediated osteoclast activation is modulated in part by miR17~92, particularly miR17. The miR17~92 osteoclast conditional knockout (cKO) mutants, generated by breeding miR17~92loxp/loxp mice with Ctsk-Cre mice, had lower Tb.BV/TV, Tb.BMD, Tb.Conn-Dens, Tb.N, and Tb.Th, but larger Tb.Sp, and greater bone resorption without a change in bone formation compared to littermate controls. The cKO marrow-derived osteoclasts were twice as large, contained twice as many nuclei, and produced twice as large resorption pits as osteoclasts of littermate controls. The expression of genes associated with osteoclast activation was increased in cKO osteoclasts, suggesting that deletion of miR17~92 in osteoclasts promotes osteoclast activation. The cKO osteoblasts did not show differences in cellular miR17 level, alkaline phosphatase activity, and bone nodule formation ability. In conclusion, miR17-92 negatively regulates the osteoclast activity, in part via the miR17-mediated suppression of PTP-oc in osteoclasts.

Isolation and Host Range of Bacteriophage with Lytic Activity against Methicillin-Resistant Staphylococcus aureus and Potential Use as a Fomite Decontaminant.

Staphylococcus aureus (SA) is a commensal bacterium and opportunistic pathogen commonly associated with humans and is capable of causing serious disease and death including sepsis, pneumonia, and meningitis. Methicillin-resistant SA (MRSA) isolates are typically resistant to many available antibiotics with the common exception of vancomycin. The presence of vancomycin resistance in some SA isolates combined with the current heavy use of vancomycin to treat MRSA infections indicates that MRSA may achieve broad resistance to vancomycin in the near future. New MRSA treatments are clearly needed. Bacteriophages (phages) are viruses that infect bacteria, commonly resulting in death of the host bacterial cell. Phage therapy entails the use of phage to treat or prevent bacterial infections. In this study, 12 phages were isolated that can replicate in human SA and/or MRSA isolates as a potential way to control these infections. 5 phage were discovered through mitomycin C induction of prophage and 7 others as extracellular viruses. Primary SA strains were also isolated from environmental sources to be used as tools for phage discovery and isolation as well as to examine the target cell host range of the phage isolates by spot testing. Primary isolates were tested for susceptibility to oxacillin in order to determine which were MRSA. Experiments were performed to assess the host range and killing potential of newly discovered phage, and significant reductions in bacterial load were detected. We explored the utility of some phage to decontaminate fomites (glass and cloth) and found a significant reduction in colony forming units of MRSA following phage treatment, including tests of a phage cocktail against a cocktail of MRSA isolates. Our findings suggest that phage treatment can be used as an effective tool to decontaminate human MRSA from both hard surfaces and fabrics.