Effect of early administration of dexamethasone in patients with COVID-19 pneumonia without acute hypoxemic respiratory failure and risk of development of acute respiratory distress syndrome: EARLY-DEX COVID-19 trial.

Introduction and objectives: Corticosteroids are among the drugs demonstrating a mortality benefit for coronavirus disease 2019 (COVID-19). The RECOVERY trial highlighted that dexamethasone reduced 28-day mortality for hospitalized COVID-19 patients requiring either supplemental oxygen or mechanical ventilation. It is noted that approximately 30% of COVID-19 patients, initially presenting with mild symptoms, will advance to acute respiratory distress syndrome (ARDS), especially those with detectable laboratory markers of inflammation indicative of disease progression. Our research aimed to explore the efficacy of dexamethasone in preventing the progression to ARDS in patients hospitalized with COVID-19 pneumonia who do not yet require additional oxygen but are at high risk of developing ARDS, potentially leading to a reduction in morbimortality. Methods: In this multicenter, randomized, controlled trial, we evaluated the impact of dexamethasone on adult patients diagnosed with COVID-19 pneumonia who did not need supplementary oxygen at admission but were identified as having risk factors for ARDS. The risk of ARDS was determined based on specific criteria: elevated lactate dehydrogenase levels over 245 U/L, C-reactive protein levels exceeding 100 mg/L, and a lymphocyte count below 0.80 × 109/L. Participants were randomly allocated to either receive dexamethasone or the standard care. The primary endpoints included the incidence of moderate or severe ARDS and all-cause mortality within 30 days post-enrollment. Results: One hundred twenty-six patients were randomized. Among them, 41 were female (30.8%), with a mean age of 48.8 ± 14.4 years. Ten patients in the dexamethasone group (17.2%) and ten patients in the control group (14.7%) developed moderate ARDS with no significant differences. Mechanical ventilation was required in six patients (4.7%), with four in the treatment group and two in the control group. There were no deaths during hospitalization or during follow-up. An intermediate analysis for futility showed some differences between the control and treatment groups (Z = 0.0284). However, these findings were within the margins close to the region where the null hypothesis would not be rejected. Conclusion: In patients with COVID-19 pneumonia without oxygen needs but at risk of progressing to severe disease, early dexamethasone administration did not lead to a decrease in ARDS development. Clinical trial registration: ClinicalTrials.gov, identifier NCT04836780.

Mapping knowledge structure and emerging trends of extracorporeal membrane oxygenation for acute respiratory distress syndrome: a bibliometric and visualized study.

Introduction: With the discovery of extracorporeal membrane oxygenation (ECMO), it is considered as a valuable tool for supporting the treatment of severe acute respiratory distress syndrome (ARDS). It has gained increasing attention, particularly during the COVID-19 epidemic. However, to date, no relevant bibliometric research on the association between ECMO and ARDS (ECMO-ARDS) has been reported. Our study aimed to summarize the knowledge structure and research focus of ECMO-ARDS through a bibliometric analysis. Method: Publications related to ECMO-ARDS from 2000 to 2022 were obtained from the Web of Science Core Collection (WoSCC). Research data underwent bibliometric and visual analysis by using CiteSpace, VOSviewer, and one online analysis platform. By analyzing the countries, institutions, journals, authors, the geographic distribution of research contributions as well as the leading institutions and researchers in this field were identified. Additionally, prominent journals and highly cited publications were highlighted, indicating their influence and significance in the field. Moreover, the co-citation references and co-occurring keywords provided valuable information on the major research topics, trends, and potential emerging frontiers. Results: A total of 1,565 publications from 60 countries/regions were retrieved. The annual publication number over time revealed exponential growth trends (R2 = 0.9511). The United States was dominant in ECMO-ARDS research, whereas the Univ Toronto was most productive institution. Prof Combes A published the most publications in this area. ASAIO Journal and Intensive Care Medicine were the most active and co-cited journals, respectively. Reference co-citation analysis showed that current research focus has shifted to COVID-related ARDS, multi-center studies, as well as prone positioning. Apart from the keywords "ECMO" and "ARDS", other keywords appearing at high frequency in the research field were "COVID-19", "mechanical ventilation", "extracorporeal life support", "respiratory failure", "veno-venous ECMO", "SARS-CoV-2", "outcome". Among them, keywords like "mortality", "veno-venous ECMO", "epidemiology", "obesity", "coagulopathy", "lung ultrasound", "inhalation injury", "noninvasive ventilation", "diagnosis", "heparin", "cytokine storm" has received growing interest in current research and also has the potential to continue to become research hotspots in the near future. Conclusion: This bibliometric analysis offers a comprehensive understanding of the current state of ECMO-ARDS research and can serve as a valuable resource for researchers, policymakers, and stakeholders in exploring future research directions and fostering collaborations in this critical field.

Evaluation of vitamin D in the diagnosis of infants with respiratory distress, the clinical value: A systematic review and meta-analysis.

INTRODUCTION: Respiratory distress (RD) is the most common cause of admission to the Neonatal Intensive Care Unit (NICU). The role of Vitamin D in the development and fortification of fetal pulmonary architecture and the synthesis of surfactants is well-documented. While different serum levels of 25-hydroxyvitamin D (Vit. D) have been studied for their diagnostic significance in RD, there is limited research on how it specifically affects the development of respiratory problems in infants and their mothers. The purpose of the present study is a systematic review and meta-analysis to evaluate the correlation between serum levels of Vit. D in mothers and newborns with RD, and to determine the impact of treating either population on the clinical outcomes of afflicted infants. METHODS: A comprehensive literature search was conducted across various databases, including PubMed, ScienceDirect, Cochrane Library, ISI, and Google Scholar, using a combination of keywords such as RD, diagnosis, vitamin D, mothers, infants, vitamin D supplementation, Respiratory distress syndrome(RDS), and Transient Tachypnea of Newborn (TTN). The search was carried out until March 2024.The level of vitamin D in both mothers and their infants was systematically extracted and analyzed to determine the diagnostic efficacy of Vit. D levels. The mean difference (MD) was calculated along with a 95% confidence interval to determine the association between the Vit. D levels in newborns and their mothers and the likelihood of RD, RDS and TTN in infants. To assess potential publication bias, a funnel plot was generated and Egger's regression test was applied, utilizing a random-effects model. RESULTS: Initially a total of 298 relevant articles was retrieved. Among them, 17 articles with a total of 1,582 infants (745 cases and 837 healthy controls) met the criteria as eligible studies. Of these six were prospective cohort studies, four retrospective case-control studies, four randomized controlled trials (RCTs), and three descriptive-analytical studies. The meta-results revealed a significant association between Vit. D levels and risk of RD in infants (MD = 6.240, 95 %CI: 4.840-7.840, P < 0.001) and mothers (MD = 8.053, 95 %CI: 4.920-11.186, P < 0.001). Furthermore, a strong association was found for risk of RDS (MD = 5.493, 95 %CI: 3.356-7.631, P < 0.001) in infants and TTN (MD = 6.672, 95 %CI: 4.072-9.272, P < 0.001), (MD = 8.595, 95%CI: 4.604-12.586, P < 0.001) both in infants and mothers. Administering 50,000 units of vitamin D to mothers (MD = 8.595, 95 %CI: 4.604-12.586, P < 0.001) prior to childbirth was observed to reduce the likelihood of RD in newborns by 64 % (RR = 0.36, 95 %CI: 0.23-0.57, P < 0.001). Supplemental vitamin D provided to infants was associated with several clinical benefits. CONCLUSION: Our meta-results indicated a significant correlation between serum levels of Vit. D and the risk of RD, RDS and TTN in infants. Prophylactic maternal administration of vitamin D plays a protective role against neonatal RD. Additionally, providing vitamin D to premature infants has shown a significant impact in reducing the incidence of respiratory complications.

Caregivers of individuals with borderline personality disorder: The relationship between leading caregiver interventions and psychological distress/positive mental well-being.

Burden and psychological distress are higher in informal caregivers (ICs) of people with severe emotional and behavior dysregulation who have been given a diagnosis of borderline personality disorder (BPD) compared with non-caregivers. The current cross-sectional study examines the difference in outcomes of ICs of people with BPD who have received the intervention Family Connections (FC) and who also led interventions for other caregivers (caregiver-leaders) compared with those who have attended FC but not led caregiver interventions (non-leader-FC participants). The sample for this research is from a larger study (Hayes et al., 2023, Borderline Personality Disorder and Emotion Dysregulation, 10, 31). Data for 347 participants who self-reported receiving FC and completed the McLean Screening Instrument for BPD-Carer Version, the Brief COPE, the Multidimensional Scale of Perceived Social Support, the Kessler Psychological Distress scale, the WHO-5 Well-being Index, and the Coronavirus Anxiety Scale were analyzed. The results found that being a caregiver-leader was associated with higher positive mental well-being and lower psychological distress compared with non-leader-FC participants. Being a caregiver-leader was also associated with significantly greater use of the coping strategy of positive reframing and lower use of behavioral disengagement and self-blame than non-leader-FC participants. The study provides preliminary evidence that for those who have received FC, becoming an intervention leader is associated with better outcomes than caregivers who do not become leaders and provides support for caregiver-led rollout of FC across services.

The inner struggle of nurses, exploring moral distress among hospital nurses: A cross-sectional study.

BACKGROUND: As frontline caregivers, nurses often find themselves at the crossroads of complex ethical decisions that can significantly impact patient outcomes and their own well-being. Identifying the areas of experienced moral dilemmas in the workplace and gaining insight into the prevalence of moral distress can lead to a healthier workplace environment. OBJECTIVE: This study aims to examine the frequency, intensity and level of moral distress among nurses who work in a hospital, and to identify the variables associated with the level of moral distress. DESIGN: Cross-sectional study. SETTING: One university hospital and six general hospitals. PARTICIPANTS: 654 of the 1095 nurses working on inpatient units filled out the questionnaire (response rate 60 %). METHODS: The intensity and frequency of moral distress was assessed using the Moral Distress Scale-Revised (MDS-R). We also asked two additional questions about considering leaving their job, and if they could describe a distressing case and how moral distress was discussed. Multivariable regression analysis was conducted to identify the variables associated with the level of moral distress. RESULTS: The overall mean MDS-R score of the 654 included nurses was low at 36.4 (SD 26). Nurses reported to have frequent dilemmas regarding organizational aspects and aspects of end-of-life care. The multivariable analyses showed that higher levels of moral distress were experienced by registered nurses, nurses working on a medical ward, and nurses who had ever left or considered leaving their job, or considering leaving their job at the moment. CONCLUSIONS: Although nurses in our study experiences low levels of moral distress, they do experience moral dilemmas related to organizational topics and end of life care. We all need to pay attention to these dilemmas and how to discuss them in order to achieve a resilient nursing profession at a time of major nursing shortages. TWEETABLE ABSTRACT: Caring for increasingly complex patients in a dynamic healthcare system is likely to continue to produce morally challenging scenarios.

Moral Distress Consultation Services: Insights from Consultants.

Moral distress reflects often recurrent problems within a healthcare environment that impact the quality and safety of patient care. Examples include inadequate staffing, lack of necessary resources, and poor interprofessional teamwork. Recognizing and acting on these issues demonstrates a collaborative and organizational commitment to improve. Moral distress consultation is a health system-wide intervention gaining momentum in the United States. Moral distress consultants assist healthcare providers in identifying and strategizing possible solutions to the patient, team, and systemic barriers behind moral distress. Moral distress consultants offer unique perspectives on the goals, successes, areas for improvement, and sustainability of moral distress consultation. Their ideas can help shape this intervention's continued growth and improvement. This qualitative descriptive study features 10 semi-structured interviews with moral distress consultants at two institutions with longstanding, active moral distress consultation services. Themes from consultant transcripts included consultant training, understanding the purpose of moral distress consultation, interfacing with leadership teams, defining success, and improving visibility and sustainability of the service. These findings describe the beginnings of a framework that organizations can use to either start or strengthen moral distress consultation services, as well as the first steps in developing an evaluation tool to monitor their utility and quality.

The relationship between departmental culture and resuscitation-related moral distress among inpatient medical departments physicians and nurses.

BACKGROUND: While moral distress frequency and intensity have been reported among clinicians around the world, resuscitations have not been well documented as its source. OBJECTIVES: to examine the relationship between intensity and frequency of resuscitation- related moral distress and departmental culture among nurses and physicians working in inpatient medical departments. METHODS: This was a cross-sectional, prospective study of medical inpatient department staff from three hospitals. Questionnaires included a demographic and work characteristics questionnaire, the Resuscitation-Related Moral Distress Scale (a revised version of the Moral Distress Scale measuring frequency and intensity of moral distress), and a Departmental Culture Questionnaire. RESULTS: 64 physicians and 201 nurses (response rate 64 %) participated, with a mean of 8.4 (SD = 5.1) resuscitations in the previous 6 months. Highest moral distress frequency scores were reported for items related to family demands or having no medical decision related to life- saving interventions for dying patients. Highest moral distress intensity scores were found when appropriate care for deteriorating patients was not given due poor staffing and when witnessing a resuscitation that could have been prevented had the staff identified the deterioration on time. Most participants strongly agreed (n = 228, 86.0 %) that their department medical director considers it important for staff to determine patients' end-of-life preferences and that quality of life is of the highest value. CONCLUSIONS: Clinicians working in medical inpatient department suffer from moderate frequency and high intensity levels of resuscitation-related moral distress. There was a statistically significant association between intention to leave employment with resuscitation-related moral distress frequency and intensity.

Respiratory Symptoms and Psychological Distress in Farmers Living With Chronic Obstructive Pulmonary Disease.

BACKGROUND: Farmers with chronic obstructive pulmonary disease (COPD) often face both respiratory issues and psychological distress, which can exacerbate their condition. However, no prior research has examined how the frequency of respiratory symptoms is associated to psychological distress in these individuals. Therefore, this study aimed to explore this relationship among U.S. farmers living with COPD. METHODS: A cross-sectional study involved 101 participants, a mix of on-site and online recruits, assessing respiratory symptoms and psychological distress in farmers with COPD. The study employed standard self-reported measures and utilized both simple and multiple linear regression to analyze the association between respiratory symptoms and psychological distress. FINDINGS: Participants reported notably higher levels of respiratory symptoms (61.6 [SD = 13.3]) compared to the reference score of 12, along with elevated psychological distress (25.9 [SD = 10.6]). Factors like COPD duration, income, smoking, and emergency department (ED) visits correlated with respiratory symptoms, while age, COPD duration, income, smoking, pesticide exposure, and farm type were associated to psychological distress. Notably, even after accounting for age, smoking, and pesticide exposure, a significant association remained between respiratory symptoms and psychological distress (ß = 0.46, p < .001). CONCLUSION: Respiratory symptoms were significantly associated to psychological distress, even when considering other factors. While this aligns with existing research, a future longitudinal study is crucial to establish the cause-effect relationship between these variables. Understanding this relationship could inform the development of targeted interventions to alleviate psychological distress in individuals with respiratory symptoms. IMPLICATIONS FOR OCCUPATIONAL HEALTH NURSING PRACTICE: The correlation between COPD symptoms and psychological distress in farmers emphasizes the need for integrated nursing care. Occupational health nurses should prioritize combined respiratory and mental health assessments.

Screen viewing patterns and their association with mental wellbeing and psychological distress: a cross-sectional study amongst university students.

BACKGROUND: Dependency on screen viewing (SV) has reached unprecedented levels, and mental health issues are becoming a major public health concern. However, the associations between SV, including variations in purposes, devices, and timing, and mental health remain unclear. This study aims to provide insights into these associations among university students. METHODS: This analysis used baseline data from a longitudinal cohort study among first-year university students matriculating in the 2021-2022 academic year. Self-reported data on sociodemographics, health behaviors and mental health outcomes alongside anthropometric measurements were collected. Unadjusted and adjusted logistic regression analyses were conducted. RESULTS: The average age of the 997 valid students was 20.2 years, with 59.6% being female and 41.4% male. Students spent 14.3 h daily on SV, with females reporting higher SV than males. Daily SV was predominant for study purposes (7.6 h/day). Computer usage was the highest (7.0 h/day), while TV usage was the lowest (1.7 h/day). Poor mental wellbeing was reported by 33.6% of students, while 13.9% experienced psychological distress. Compared to students with low total SV, those with high levels were more likely to have poor mental wellbeing [OR (95% CI): 1.40 (0.99, 1.98)] and psychological distress [1.56 (1.00, 2.44)]. High levels of recreational and study related SV were significantly associated with poor mental wellbeing [1.81 (1.27, 2.56)] and psychological distress [1.75 (1.11, 2.83)], respectively. Those with high levels of computer time were more likely to have poor mental wellbeing [1.44 (1.01, 2.06)], and high weekend day SV was associated with greater odds of psychological distress [2.16 (1.17, 4.06)]. CONCLUSIONS: SV among university students was high, as was the high prevalence of poor mental wellbeing and psychological distress. Greater SV was associated with poor mental wellbeing and psychological distress. Differences according to purpose of SV were noted. Although recreational SV was associated with poor mental wellbeing, study related SV was associated with psychological distress. Variations across different devices and timing were also noted. This highlights the need for further longitudinal research to understand the impact of SV on mental health and to guide interventions for promoting mental health of university students globally.

Comparing five-factor personality traits and psychological distress between dysphonic patients and individuals with vocally healthy voices.

INTRODUCTION: It was reported that voice can carry information about personality and psychological distress. In the current study, the relationship between five-factor personality traits and psychological distress with voice was enlightened from diverse aspects. METHODS: A total of 119 participants (55 with and 64 without dysphonia) sustained vowels /a/ and /i/, read six standard sentences, and answered a question. Three raters auditory-perceptually evaluated the vocal samples using the Persian version of CAPE-V. The participants were distributed into four groups (vocally healthy, mild, moderate, and severe dysphonia). They completed two questionnaires: NEO Five-Factor Inventory (NEO-FFI) and Depression, Anxiety, and Stress Scale-21. RESULTS: Results showed that the conscientiousness (U = 1146.500, z = -3.27, p = .001) in the dysphonia group was significantly less than the vocally healthy group. Depression (U = 1381.000, z = -2.03, p = .042) and anxiety (U = 1181.000, z = -3.10, p = .002) in the dysphonia group were significantly higher than in the vocally healthy group. In comparing different abnormal overall voice qualities, the mild dysphonia group revealed significantly lower conscientiousness (p = .001) and significantly higher anxiety (p = .002) relative to the vocally healthy group. CONCLUSIONS: Findings indicated that the conscientiousness trait could play an influential role in persons with dysphonia and its psychological status. The voice care team should consider conscientiousness and psychological distress during the assessment and treatment of dysphonic patients.

A Case Report of Pulmonary Alveolar Proteinosis Masquerading as Respiratory Distress Syndrome in Preterm Neonates.

A rare and challenging case of a preterm neonate with clinical and radiological signs of respiratory distress syndrome (RDS) since the first hour of life but was refractory to its standard treatment regimes like surfactant therapy and ventilation. Postmortem lung biopsy led us to the diagnosis of congenital pulmonary alveolar proteinosis (PAP). It occurs due to the aggregation of abnormal surfactant proteins and lipids in the alveoli, which hampers gas diffusion across the alveoli. It presents as respiratory distress at birth, and its diagnosis is often missed due to its resemblance with RDS. Although the exact etiology remains elusive, mutations in genes encoding surfactant and granulocyte-macrophage colony-stimulating factor (GM-CSF) pathway components have been implicated in the pathogenesis of PAP. Treatment options are limited and only supportive. Among all these, whole-lung lavage is the most widely used management modality but with limited success in neonates.

Longitudinal effects of parental adverse childhood experiences on offspring problematic media use: The serial mediating role of psychological distress and harsh discipline.

BACKGROUND: Adverse childhood experiences (ACEs) may lead to increased problematic media use (PMU). However, whether parental adverse childhood experiences predict offspring PMU, and the mediating roles of psychological distress and harsh discipline, two common mechanisms underlying the intergenerational transmission of parental ACEs, in this relationship have not been examined in Chinese samples. OBJECTIVE: This study examined the serial mediating effects of psychological distress and harsh discipline on the association between parental ACEs and children's PMU. PARTICIPANTS AND SETTING: Participants were 617 three-year-old children and their parents (mean age of 33.24 years, SD = 4.01) from Wuhu, China. METHODS: Parents completed online questionnaires measuring ACEs, psychological distress, and demographic information in September 2022 (Time 1). Parents completed online questionnaires measuring harsh discipline and offspring PMU in September 2023 (Time 2). Macro Process 6 was used to test two serial mediating effects of psychological distress and corporal punishment, as well as psychological distress and psychological aggression. A total of 5000 bootstrap samples were used to estimate the 95 % confidence intervals. A significant effect was indicated by a 95 % confidence interval that did not include zero. RESULTS: The findings suggest that parental ACEs directly and positively predict offspring PMU. Psychological distress and harsh discipline mediate the association between maternal ACEs and offspring PMU parallelly and sequentially. CONCLUSIONS: Our findings highlight the importance of addressing psychological distress and harsh discipline when designing interventions targeting Chinese parents exposed to ACEs and their children.

Anxiety, Depression, and Comorbid Symptomatology: Different Forms and Severity of Intimate Partner Violence Perpetrated by Men Seeking Help.

Intimate partner violence (IPV) is a serious public health issue associated with numerous deleterious outcomes. Previous studies highlighted the relevance of documenting psychological predictors of IPV to identify prevention strategies. This study examined the links between anxious and depressive symptomatology and perpetrated physical, psychological, and sexual violence among 494 French-Canadian men seeking help for IPV-related difficulties. Differences in the frequency of perpetrated IPV were examined across four groups: (a) no anxious or depressive symptoms reaching a cutoff of high distress, (b) symptoms of anxiety, (c) symptoms of depression, and (d) comorbid symptoms. Results highlighted that men with comorbid symptoms perpetrated significantly more severe violent acts compared to the other groups. This study underscores the importance of targeting the reduction of psychological distress when treating men who perpetrated IPV.

Lung ultrasound to predict the duration of respiratory support in newborn infants with respiratory distress.

AIM: Lung ultrasound (LU) and clinical parameters evaluated during the first postnatal hour potentially predict the length of CPAP therapy in newborns with respiratory distress. METHODS: In a single-centre, prospective observational pilot study, 130 newborns ≥36 weeks gestational age were assessed using standardised LU at 30 and 60 min postnatally. Various clinical parameters were evaluated influencing CPAP duration (<1 vs. ≥1 h) using univariate and multivariate analyses. RESULTS: Lung ultrasound score >5, FiO2 > 0.21 and respiratory acidosis 30 min postnatally were associated with CPAP ≥1 h. Our model showed good diagnostic quality (ROC AUC = 0.87) and was confirmed by classification and regression tree (CART) analysis. Additional LU findings like double lung point and pleural line abnormalities were frequently observed, with good interrater reliability for LU interpretation (ICC = 0.76-0.77). CONCLUSION: Newborns with postnatal respiratory distress at risk for prolonged CPAP therapy can be identified based on specific LU and clinical parameters assessed 30 min postnatally. Despite the need for validation in an independent sample, these findings may lay the groundwork for a prediction tool. LU proved feasible and reliable for assessing respiratory status in this population, highlighting potential utility in clinical practice.

Diabetes Distress and Associated Factors Among Chinese Americans with Type 2 Diabetes in New York City.

Purpose: The purpose of this study is to describe diabetes distress and related factors among Chinese Americans with type 2 diabetes in New York City (NYC). Methods: We conducted a secondary data analysis of the baseline data from three research studies conducted among community-dwelling Chinese American adults with type 2 diabetes. Diabetes Distress Scale (DDS) was used to measure sources of diabetes distress including emotional-, regimen-, interpersonal-, and physician-related distress. A score of 2 or greater indicates moderate diabetes distress or higher. Patient Health Questionnaire-2 (PHQ-2) was used to measure depressive symptoms. Participants' sociodemographic information was also collected. Descriptive statistics were used to describe diabetes distress, and logistic least absolute shrinkage and selection operator (LASSO) regression was used to examine factors associated with diabetes distress level. Results: Data from 178 participants (mean age 63.55±13.56 years) were analyzed. Most participants were married (76.40%), had a high school degree or less (65.73%), had a household annual income < $25,000 (70.25%), and reported limited English proficiency (93.22%). About 25.84% reported moderate or higher overall distress. The most common sources of distress were emotional burden (29.78%), followed by regimen- (28.65%), interpersonal- (18.54%), and physician-related distress (14.04%). Participants who were younger, female, limited English proficient, and had elevated depressive symptoms were more likely to have higher diabetes distress. Conclusion: Diabetes distress is prevalent among Chinese immigrants with type 2 diabetes, especially emotional- and regimen-related distress. Given the known link between diabetes distress and poor glycemic control, it is critical to screen for diabetes distress at primary care clinics and incorporate psychological counseling in diabetes care in this underserved population.

The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives.

Anxiety and depression are prevalent among autistic adolescents and may be difficult to accurately diagnose and treat given various factors (e.g., diagnostic overshadowing, heterogeneity). Therefore, efforts to examine transdiagnostic factors (i.e., distress tolerance, behavioral activation) may afford more parsimonious means for assessment and treatment. To our knowledge, there has been little research on distress tolerance, behavioral activation, and depressive and anxiety symptoms in autistic adolescents to guide diagnostic practices and treatment planning. In the current study, we examined the interrelationships between these transdiagnostic factors and depressive and anxiety symptoms using ratings from 100 verbally fluent autistic adolescents without intellectual disability (Mage = 13.70, SDage = 2.23, Range: 11:00-17:11 years) and 100 of their caregivers. Many adolescents reported male sex assigned at birth (61%), cisgender (87%), not Hispanic/Latinx (90%), and White (80%) identities. A series of correlational analyses were employed to examine associations between these constructs from youth and caregiver perspectives, and multiple linear regression analyses were conducted to explore the mediating roles of distress tolerance and behavioral activation. Preliminary results show that low distress tolerance and behavioral activation were associated with more severe internalizing symptoms per self- and caregiver-report. Some differences by rater emerged, which highlight the importance of multi-informant ratings in autism. Results from mediation analyses may show that behavioral activation may be more salient to assessments and treatment planning for depression than distress tolerance, while distress tolerance may be important for both anxiety and depression; however, findings are preliminary given the cross-sectional nature of the data. Findings suggest that these transdiagnostic concepts may be important to individualizing treatment approaches, including the timing of certain approaches, for anxiety and/or depression in autistic adolescents.

Neuroticism affects nightmare distress through rumination.

BACKGROUND/AIMS: The role of neuroticism in predicting nightmare distress have been highlighted, and negative coping style may contribute to this relationship, but how these variables interact is limited. The present study aimed to explore how neuroticism and ruminative response contribute to producing nightmare distress, and to explore whether sex influences this relationship. METHODS: We recruited 758 university students, aged an average of 19.07. A moderated mediation model was built to examine the relationships among neuroticism, rumination, and nightmare distress (measured by dream anxiety scale), and explore whether sex could affect this relationship, using the SPSS PROCESS 3.5 macro. RESULTS: The moderated mediation analyses results showed that ruminative response-depression related can significantly partially mediate the relationship between neuroticism and dream anxiety (ß = 0.32), dream anxiety-sleep-related disturbances (ß = 0.11) and dream anxiety-daytime dysfunctions (ß = 0.21). However, the moderating effects of sex were not significant in all path from neuroticism to dream anxiety. CONCLUSION: The study provides a novel architecture on the underlying psychological mechanisms of neuroticism and nightmare distress. This interplay is assumed to be facilitated by ruminations, suggesting that interventions for individuals who suffer from nightmares may focus on their repetitive negative response strategies, especially in people with high neuroticism, irrespective of sex differences.

Factorial Trial to Optimize an Internet-Delivered Intervention for Sexual Health After Breast Cancer: Protocol for the WF-2202 Sexual Health and Intimacy Enhancement (SHINE) Trial.

BACKGROUND: Although most survivors of breast cancer report substantial sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to survivors of breast cancer via the internet could overcome many of the barriers to in-person treatment. Even when delivered remotely, survivor time constraints remain a leading barrier to sexual health intervention uptake. OBJECTIVE: Guided by the multiphase optimization strategy methodological framework, the primary objective of this study is to identify the most efficient internet-delivered sexual health intervention package that is expected to provide survivors of breast cancer the greatest benefit with the fewest (and least-intensive) intervention components. This study aims to determine how intervention components work (mediators) and for whom they work best (moderators). METHODS: Partnered, posttreatment adult female survivors of breast cancer (N=320) experiencing at least 1 bothersome sexual symptom (ie, pain with sex, vaginal dryness, low sexual desire, and difficulty with orgasm) related to their breast cancer treatment will be enrolled. Clinic-based recruitment will be conducted via the Wake Forest National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participants will be randomly assigned to 1 of 16 combinations of four intervention components with two levels each in this factorial trial: (1) psychoeducation about cancer-related sexual morbidity (receive either enhanced vs standard versions); (2) communication skills training for discussing concerns with health care providers (received vs not received); (3) communication skills training for discussing concerns with a partner (received vs not received); and (4) intimacy promotion skills training (received vs not received). Cores will be fully automated and implemented using a robust internet intervention platform with highly engaging elements such as animation, video, and automated email prompts. Survivors will complete web-based assessments at baseline (prerandomization time point) and again at 12 and 24 weeks later. The primary study aim will be achieved through a decision-making process based on systematically evaluating the main and interaction effects of components on sexual distress (Female Sexual Distress Scale-Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Index) using a generalized linear model approach to ANOVA with effect coding. Mediation analyses will be conducted through a structural equation modeling approach, and moderation analyses will be conducted by extending the generalized linear model to include interaction effects. RESULTS: This protocol has been reviewed and approved by the National Cancer Institute Central Institutional Review Board. Data collection is planned to begin in March 2024 and conclude in 2027. CONCLUSIONS: By identifying the combination of the fewest and least-intensive intervention components likely to provide survivors of breast cancer the greatest sexual health benefit, this study will result in the first internet intervention that is optimized for maximum impact on the undertreated, prevalent, and distressing problem of breast cancer-related sexual morbidity. TRIAL REGISTRATION: ClinicalTrials.gov NCT06216574; https://clinicaltrials.gov/study/NCT06216574. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/57781.

Interdisciplinary provider visits attenuate relationship between patient concerns and distress in older adults with cancer.

PURPOSE: This study examined the relationship between multidimensional patient concerns and anxiety and depression in a national sample of older adults with cancer (OACs ≥ 65 years) and the buffering effect of visiting providers across disciplines (e.g., oncology, allied health, primary care, mental health) on these relationships. METHODS: Participants completed a cross-sectional survey through the Cancer Support Community's Cancer Experience Registry (CER), an online community-based research initiative. Eligible participants were 65 years and older and diagnosed with cancer in the past five years. Participants completed self-report measures of (1) the severity of their concerns across multiple domains, (2) anxiety and depression, and (3) whether they received care for "symptoms and side effects" from various providers. RESULTS: The sample consisted of 277 OACs; 45% endorsed elevated anxiety and 31% endorsed elevated depression. The most severe concerns were in the domains of body image and healthy lifestyle and symptom burden and impact. More severe concerns were associated with higher levels of anxiety and depression. The relationship between concern severity and distress was weaker in OACs who saw a palliative care, mental health, physical or occupational therapy provider, pharmacist, or primary care provider relative to OACs who did not. A visit with an oncology provider did not moderate most relationships between concerns and distress. CONCLUSIONS: The relationship between OACs' concerns and distress was attenuated by treatment with a specialty provider. Interdisciplinary team care may be a vital component of comprehensive patient-centered care for OACs.

Medical tattooing as a complementary cosmetic intervention to reduce body-image distress and mental health symptoms in U.S. breast cancer survivors.

PURPOSE: A review of the literature revealed a high incidence of body-image distress among breast cancer survivors who had surgery. This cross-sectional study examined the relationship between medical tattooing as a complementary cosmetic intervention and body-image distress and mental health outcomes among breast cancer survivors following surgery. METHODS: We examined 330 post-surgical breast cancer survivors collected through a nationwide online survey in the U.S., pursuing two main objectives. First, we investigated body-image distress, depression and anxiety symptoms, and perceived stress in survivors who underwent breast cancer surgery, comparing those with medical tattooing (n = 89) and those without (n = 226). Second, we assessed the influence of the participant's surgery type on body-image distress, depression and anxiety symptoms, and perceived stress. Additionally, we evaluated whether individual factors, such as appearance investment, satisfaction with decision, and cosmetic expectation discrepancy, predicted the participant's body-image distress. RESULTS: Findings suggest that participants with medical tattoos reported significantly lower body-image distress, depression and anxiety symptoms, and perceived stress compared to those without medical tattoos. The participant's surgery type did not significantly predict body-image distress, depression or anxiety symptoms, or perceived stress. However, participants who reported greater appearance investment endorsed higher body-image distress. Participants who reported higher satisfaction with their treatment decisions and lower cosmetic expectation discrepancy endorsed lower body-image distress. CONCLUSION: Medical tattooing may be a valuable tool in improving body-image distress and mental health for those who wish to pursue it, but more research is needed. Empirical studies supporting the mental health benefits of medical tattooing among survivors are crucial to standardize insurance coverage and promote its inclusion as a complementary intervention across insurance providers nationwide. This complementary intervention should be considered using a patient-centered approach that aligns with the patient's values and preferences.