Internalizing disorders as a mediator of the association between adverse childhood experiences and perceived medication intolerance or poly-allergy.

OBJECTIVES: There is a well-established link between adverse childhood events, mental health, and physical health conditions. There is also a large literature showing the relationship between medication intolerance or allergies, and poor health outcomes. However, less is understood about the role of medication intolerance and adverse childhood events. Thus, the present study examines the relationship between adverse childhood events, internalizing disorders (depression, anxiety) and medication intolerance. METHOD: Three hundred forty-nine participants were recruited from 11 primary care practices and health networks located in a large, Midwestern metropolitan area. Unrelated linear and Poisson regression was used to determine whether internalizing disorders, such as depression and anxiety, mediated the relationship between adverse childhood experiences (ACEs) and allergies to medications, accounting for error terms in regression equations that were correlated. RESULTS: Results indicated an association between ACEs and number of allergies to medication, whereby ACEs was associated with depression, anxiety and number of allergies. Sensitivity analysis confirmed these findings. There was a small but significant indirect effect of anxiety on allergies to medication after bootstrapping. CONCLUSION: This study found that inflammatory responses occurring because of trauma and depression may be increasing medication allergies. However, given the size of the sample, more research is needed to confirm these results. Implications for healthcare providers are discussed.

Stroke and stroke risk factors in women of reproductive age with a history of metabolic or bariatric surgery.

OBJECTIVE: To determine the odds of stroke in women of reproductive age who have had metabolic or bariatric surgery (MBS). METHODS: We used the National Inpatient Sample (NIS), a publicly available dataset that samples 20% of hospital discharges. The study population includes women between the ages of 20 and 44 without a maternal admission code. Weighted logistic regression analyses were conducted to assess the odds of stroke in women with history of MBS compared to other women of reproductive age. Adjustment of odds was done for the following covariates: age, race, primary payer, severity of illness, depression, and obesity. RESULTS: Women with a history of MBS had 52% lower adjusted odds of having a stroke than women who did not have MBS (OR = 0.48, 95%CI = 0.42-0.55). Additionally, women who had MBS had lower odds of risk factors for stroke, including diabetes (OR = 0.61, 95%CI = 0.59-0.63), hypertension (OR = 0.82, 95%CI = 0.81-0.84), hypercholesterolemia (OR=0.72, 95%CI =0.68-0.77), and migraine with aura (OR = 0.86, 95%CI = 0.74-0.99). CONCLUSIONS: Among women of reproductive age with a history of MBS, there were lower odds of having a stroke and stroke risk factors when compared to women who did not have MBS. Additionally, this study showed a modest decrease in the odds of stroke among women with obesity when adjusted for other risk factors. Future research should focus on examining this finding further, with a focus on the moderation of the impact of having obesity on stroke risk independent of other stroke risk factors.

Behavioral Health in Primary Care: Expanding Applications in Practice.

Chronic diseases continue to contribute to the leading causes of death in Missouri, and behavioral health plays a key role in their management. Patients receive most of their healthcare in primary care, suggesting primary care providers may serve an important role in the patients' chronic disease management and the behavioral health sequalae. This paper overviews the behavioral health impact of three chronic diseases impacting Missourians and reviews evidence for behavioral health interventions for each disease.

Perceived and Received Support by Academic Medicine Faculty During the COVID-19 Pandemic: A Single Institution Study.

OBJECTIVE: The COVID-19 pandemic negatively impacted healthcare worker well-being, leading to increased burnout and decreased workplace engagement. To combat expected stressors from the pandemic, our mid-sized academic health center implemented numerous institutional support, such as town halls, and virtual support groups. This study aimed to evaluate faculty utilization of institutional support, its association with perceived organizational support, received organizational support, and burnout. METHODS: A retrospective, cross-sectional survey was distributed to 630 faculty employed at our institution in September 2020, assessing participant demographics, institutional support utilized, perceived organizational support, and burnout, through a combination of self-report measures and qualitative responses. RESULTS: A total of 79 (12.5%) faculty provided complete responses and were included in the analysis. Qualitative analysis identified 4 primary themes: (1) flexibility and adjusted expectations, (2) direct communication, (3) sense of community, and (4) no support felt, with additional subthemes within each larger theme. Increased utilization of institutional support was associated with decreased odds of experiencing burnout. CONCLUSION: Flexibility, communication, and sense of community emerged as important strategies for maintaining faculty well-being and engagement during the early stages of the COVID-19 pandemic. This study suggests that utilization of workplace support is protective against burnout. Perceived support was not beneficial.

Maternal Malnutrition During Pregnancy Among Women with Metabolic and Bariatric Surgery.

INTRODUCTION: As the utilization of metabolic and bariatric surgery (MBS) continues to rise, it is important to address the nutritional needs of women who had MBS who become pregnant. Not meeting those nutritional needs could lead to complications associated with malnutrition. To better understand the relationship between MBS, pregnancy, and malnutrition, this study sought to determine whether differences exist in the presence of malnutrition during pregnancy in women with a history of MBS compared to women without a history of MBS. METHODS: This cross-sectional study used the National Inpatient Sample (NIS) from 2012 to 2017, which samples 20% of hospital discharges in the USA. Multivariate logistic regression models were fitted, and odds rations and 95% confidence intervals were calculated with obesity and MBS as the independent variables and malnutrition during pregnancy as the dependent variable. Covariates included in the multivariate model were age, primary payer, hypertension, hyperlipidemia, and depression. RESULTS: Compared to women who did not have MBS, women who had MBS had higher odds of malnutrition during pregnancy (aOR = 8.33, 95% CI 7.30-9.50), this result was moderated by racial category (aORBlack = 6.35, 95% CI 4.97-8.13; aORwhite = 8.25, 95% CI 7.00-9.73; aORLatina = 10.93, 95% CI 8.38-14.25). Women with obesity also had higher odds of malnutrition during pregnancy. CONCLUSIONS: The increased odds of malnutrition among women with MBS suggests that it is important to consider tailoring nutrition recommendations to address the different nutritional needs of pregnant women who had MBS and may be at risk for malnutrition.

Pre-pregnancy weight loss associations with prenatal and postpartum mental health conditions: A retrospective cohort study.

Background: Obesity is a risk factor for adverse outcomes during and following pregnancy. Most women are advised to lose weight prior to becoming pregnant, to help alleviate complications including prenatal and postpartum depression and anxiety. Yet, no studies have examined how the process of losing weight prior to pregnancy interacts with the development of prenatal and postpartum mental health disorders.The objective of the study was to determine if women with pre-pregnancy weight loss (≥10%) vs. those who do not, in the two years prior to pregnancy, have a lower risk for new onset prenatal and postpartum mental health conditions. Methods: This retrospective cohort study used data from the Virtual Data Warehouse of a large Midwestern, U.S. based hospital system. The final sample consisted of 6,085 female patients of reproductive age that had given birth between 10/1/2011-6/30/2020 and had two recorded weights in the year prior to conception. Univariate analysis between weight loss and outcome variables (pre-natal and post-partum depression and anxiety) and multivariate analysis using logistic regression was conducted for variable significant on univariate analysis. Results: On univariate analysis, women with pre-pregnancy weight loss had increased odds of post-partum depression (OR=1.47, 95%CI=1.03-2.10), though decreased odds of prenatal anxiety (OR=0.59, 95% CI 0.33-0.90). After controlling for confounders in the multivariate analysis, there was not a significant difference in the odds of post-partum depression; however, women who lost weight had approximately half the odds of having prenatal anxiety than those who did not lose weight (OR=0.54, 95%CI=0.33-0.90). Discussion: The experience of achieving weight loss prior to pregnancy may foster a sense of agency within pregnant women, helping them to reduce their experience of pre-natal anxiety. Providers could engage in patient conversations around weight loss and mental health management in a strengths-based framework to continue to foster this sense of agency. Conclusion: Anxiety and depression were uniquely related to pre-pregnancy weight loss. Pre-pregnancy weight loss was associated with lower odds of prenatal anxiety and higher odds of postpartum depression. These results highlight the need for real world examination of pre-conception treatment recommendations and their association with non-physical health-based outcomes.

Examining differences in long-term weight loss outcomes after bariatric surgery: The role of romantic relationship status.

INTRODUCTION: This study tested for differences based on relationship status at the time of surgery in baseline body mass index (BMI), weight loss outcomes (change in BMI [ΔBMI], percent total weight loss [%TWL], percent excess weight loss [%EWL]), and rates of successful weight loss (defined as ≥ 50%EWL) up to 4-year postbariatric surgery. METHOD: Data came from a secondary analysis of patients (N = 492) who were up to 4-year postsurgery and completed a presurgical psychological evaluation and postsurgical survey. RESULTS: Sixty-nine percent of participants were patients in committed relationships and 31% were single/divorced/widowed patients. Single patients had higher presurgical BMIs than those who were partnered (t = 2.28, p = .02). There were no differences between those who were partnered and singles regarding ΔBMI and %TWL, although singles had smaller %EWL (t = -2.08, p = .04), which became nonsignificant after controlling for covariates. Most participants had successful weight loss (76.8%); however, this was not related to romantic relationship status. DISCUSSION: The results suggest those who were partnered undergo surgery at better-starting weights than singles and maintain this advantage in the long term. Providers working with patients considering bariatric surgery could inquire about how their romantic and social relationships play a part in their decision-making process. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Helping families heal in substance use treatment: A qualitative study about the role of peer support specialists with client families.

INTRODUCTION: Peer support specialists (PSS) are people with previous psychiatric illness or substance use disorders who use their experience to support those facing similar hardships. PSS offer a range of beneficial outcomes to both the PSS and clients. The most immediate social connections to those seeking treatment are often their families, yet no PSS studies are inclusive of family involvement. Strong theoretical and empirical support exists for family involvement in addiction treatment, but no studies to date on families in substance use treatment include PSS. This study offers a first look at PSS's experiences with client families. We aimed to describe experiences and attitudes of PSS in working with families of those seeking substance use treatment. METHODS: This qualitative study included 25 adult PSS with at least 1 year of work experience in substance use treatment and state credentialing board certification. Participants had one interview either in a focus group format or individually. The recruitment and data collection phase lasted from November 2020 to June 2021. The semi-structured interview protocol included six main questions and interviews lasted 60 to 75 min. Upon completion of each interview, the recordings were transcribed and inductively coded. Thematic analysis of the codes identified overarching themes and their implications were described with associated quotes. RESULTS: Thematic analysis generated three interrelated themes. First, participants described the various ways they often work with the families of their clients, which seemed to be dependent on the age of the client. Second, participants identified the negative aspects of working with families such as family drama, stress, and co-dependency issues. Last, the third theme identified the ways in which PSS assist families in healing from the effects of addiction. The themes identify a complicated and conflicting approach to work with families. Overall, it seemed PSS were operating on their own experiences or suggestions given by supervisors to guide them with no training on how to approach families. CONCLUSIONS: This study highlights a deficit in PSS training on their role with families, family intervention, and the impact of family on substance use treatment for adults and youth. More research needs to establish the PSS role with families and with clients from marginalized backgrounds. Credentialing and national associations that support PSS should develop additional training and education opportunities related to working with families for PSS, supervisors, and organizational leadership who employ PSS for substance use treatment.

Faculty Engagement and Productivity During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: COVID-19 has had an unprecedented effect on faculty of academic family medicine departments. We sought to characterize faculty's self-reported changes in engagement and productivity in clinical, education, and scholarly efforts during the COVID-19 pandemic, and to correlate the changes with age, gender, and level of COVID-19 exposure. We also sought to determine if differences in faculty engagement and productivity were related to departmental efforts to create virtual community, manage conflict, foster engagement with colleagues, and support faculty emotional well-being. METHODS: We surveyed family medicine department faculty nationally on the effects of the COVID-19 pandemic on their engagement and productivity in clinical care, teaching and research, and on the effect of departmental efforts on well-being. RESULTS: Most respondents reported decreased engagement and productivity across clinical, teaching, and research domains. Older age and male gender were associated with higher clinical engagement. Most respondents were satisfied with their departments' virtual community but reported that social distancing had a negative impact on departmental ability to problem-solve and on personal emotional well-being. Higher engagement and productivity in all three domains of effort (clinical, teaching, and research) were associated with respondents' well-being and with positive perceptions of their department's efforts. CONCLUSIONS: Clinical, teaching, and research engagement and productivity for academic family physicians decreased during the COVID-19 pandemic. Faculty well-being and departmental interventions lessened the impact of diminished productivity and research engagement.

COVID-19 Exposure Risk, Burnout, and Shifts in Family Medicine Faculty's Efforts: A National Survey.

BACKGROUND AND OBJECTIVES: In response to the COVID-19 pandemic, academic family physicians had to change their clinical, teaching, research, and administrative efforts, while simultaneously balancing their home environment demands. It is unclear how the changes in effort affected physicians' personal well-being, particularly burnout. This study sought to identify changes in faculty's clinical, teaching, research, and administrative efforts during the COVID-19 pandemic and how effort shifts were associated with burnout. We also examined associations with important demographics and burnout. METHODS: We took data from the 2020 Council of Academic Family Medicine's Educational Research Alliance survey of family medicine educators and practicing physicians during November 2020 through December 2020. We analyzed self-report measures of demographics, effort (clinical, teaching, research, and administrative) before and during the pandemic, COVID-19 exposure level, and rates of burnout (emotional exhaustion and depersonalization) using logistic regressions. RESULTS: Most participants reported no change in efforts. If changes were reported, clinical (21.6%) and administrative (24.8%) efforts tended to increase from before to during the pandemic, while teaching tended to decrease (27.7%). Increases in teaching and clinical efforts were associated with higher rates of emotional exhaustion. Higher depersonalization was associated with increased clinical efforts. Being older and working in a rural setting was associated with lower burnout, while being female was associated with higher burnout. CONCLUSIONS: Shifts in effort across academic family physicians' multiple roles were associated with emotional exhaustion and, to a lesser degree, depersonalization. The high rates of burnout demand additional attention from directors and administrators, especially among female physicians.

Relational teletherapy experiences of couple and family therapy trainees: "Reading the room," exhaustion, and the comforts of home.

Couple and family therapists are increasingly using telehealth platforms to deliver services. Unfortunately, the literature on relational teletherapy is not well developed. This study sought to understand experiences of teletherapy with couples and families as it contrasts with individual clients and in-person therapy. We utilized a hermeneutic phenomenological approach to qualitative inquiry from data collected through open-ended questions on a web-based survey of graduate student trainees (n = 66) in COAMFTE-accredited couple and family therapy programs. Thematic analysis identified the body-of-the-therapist and client as they exist (and are obstructed) due to technology for creating barriers and opportunities in translating CFT intervention to telehealth platforms. Relational teletherapy cultivated therapist creativity and exhaustion. It also made plain the need for systemic interventions with children and adolescents that engages their parents and home environments. Implications for CFT practice, training, and intervention research are outlined.

Impaired Family Functioning Affects 6-Month and 12-Month Postoperative Weight Loss.

PURPOSE: Prior cross-sectional research details the high rate of impaired family functioning, a measure of the overall family environment, among adult bariatric surgery patients; however, family functioning has not been explored in relation to adult patient's postoperative outcomes. The objective of this study was to determine how family functioning affects postoperative patient outcomes including readmission rates, early complications, and 6- and 12-month percent total weight loss (%TWL). MATERIALS AND METHODS: An observational design at a single-academic medical center was employed. The sample comprised 98 patients, living with ≥1 family member, who enrolled in one of two concurrent studies at the Center. Patients were followed from their surgical intake through 12 months postsurgery; family functioning was assessed within 2 months of their date of surgery. Chi-square and independent t tests determined significant associations between family functioning with readmission and complication rates. Average family functioning was an independent variable in multivariate linear regression models to determine significant correlates of %TWL at 6 and 12 months postsurgery. Patient age, race, and insurance status were included as covariates. RESULTS: Patients with higher impaired family functioning had significantly less %TWL at 6 (p=.004) and 12 months (p=.030). Black patients also had significantly lower %TWL at 6 (p=.003) and 12 months (p=.009). CONCLUSION: Family functioning and patient race were both correlates of weight loss at 6 months and 12 months. Future research should explore additional family factors as correlates of patient outcomes following bariatric surgery.

The Effect of Family Member Attendance at Bariatric Surgery Appointments on Patient and Family Weight-Related Outcomes.

PURPOSE: To assess the effect of family member attendance at routine pre- and postoperative appointments on early postoperative patients' weight loss and physical activity levels and family members' weight control practices. MATERIALS AND METHODS: As part of a RCT, patients were randomized to (1) invite a romantic partner or cohabitating family member to attend routine appointments (FA arm) or (2) proceed with treatment as usual (TAU arm). Patients in FA arm were asked to invite their family member to attend four routine appointments (T1 = pre-surgery class, T2 = 1 month pre-surgery, T3 = 2 weeks post-surgery, T4 = 2 months post-surgery). Assessments of patients' percent excess weight loss (%EWL), change in body mass index (ΔBMI), and levels of physical activity and family members' weight control practices (dietary control, self-monitoring, physical activity, and psychological coping) were conducted at T1-T4 with all dyads, and attendance was documented. Of the 213 dyads approached, 63 dyads consented to participate. RESULTS: There were no significant differences in patient outcomes between FA and TAU arms or based on consistent attendance of family members. There were no significant differences in weight control practices between FA and TAU dyads. At T3 and T4, family members with consistent attendance reported higher self-monitoring, physical activity, and psychological control practices. Family members with consistent attendance reported significant increases in physical activity and psychological control practices from T1 to T4. CONCLUSIONS: Family member attendance at routine appointments had greater positive effects on family members rather than on patient outcomes.

Aging impairs the unfolded protein response to sleep deprivation and leads to proapoptotic signaling.

Protein misfolding, accumulation, and aggregation characterize many aging-related diseases. Protein aggregates do not accumulate in unstressed cells primarily because of the existence of competent cellular "quality control" machinery. The endoplasmic reticulum (ER) is a major part of this quality control system. Accumulation of misfolded proteins in the ER causes ER stress and activates a signaling pathway called the unfolded protein response (UPR). The UPR limits protein load by upregulating ER chaperones such as Ig binding protein (BiP)/glucose-regulated protein 78 (GRP78) and by attenuating protein translation through eukaryotic initiation factor 2 alpha (eIF2alpha) phosphorylation. Acute sleep deprivation (6 h) in young mice leads to induction of the UPR with upregulation of BiP/GRP78 and attenuation of protein translation. We demonstrate here that aging impairs this adaptive response to sleep deprivation. Aged mice do not display an increase in BiP expression with acute sleep deprivation. In addition, there is decreased basal expression of BiP/GRP78 in aged mice. There is a decline in eIF2alpha phosphorylation in aged mouse cerebral cortex that is associated with higher levels of GADD34 (growth arrest and DNA damage 34) and proapoptotic proteins such as CCAAT/enhancer-binding protein-homologous protein and activated caspase-12, suggesting that young animals possess an efficient ER adaptive response that declines with aging.

Proteomic analysis of the effects and interactions of sleep deprivation and aging in mouse cerebral cortex.

The cellular and molecular processes that underlie the drives and functions of sleep have been the topic of many studies in the last few decades. Discovery-based techniques, such as cDNA microarrays, have increasingly been utilized in conjunction with sleep deprivation paradigms to examine the molecular mechanisms and functions of sleep. These studies have helped to validate and expand existing hypotheses, such as those on the roles of sleep in synaptic plasticity and in energy metabolism. The mechanisms underlying the highly prevalent changes in sleep architecture with age are not known, but likely reflect fundamental changes in the molecular basis of circadian timing and sleep homeostatic processes. We decided to explore the effects and interactions of sleep deprivation and aging utilizing the proteomic technique of difference in gel electrophoresis (DIGE). DIGE, which utilizes cyanine dye labeling of samples, allows for the comparison of multiple experimental groups within and across gels. In this study, we compared cerebral cortex tissue from young (2.5 months) and old (24 months) mice that had been sleep deprived for 6 h to tissue from undisturbed young and old control animals. Following DIGE, automatic image matching and spot identification, and statistical analysis, 43 unique proteins were identified. The proteins were grouped into seven functional classes based on published characteristics: cell signaling, cytoskeletal, energy metabolism, exocytosis, heat shock proteins, mRNA processing/trafficking, and serum proteins. The identity and characteristics of these proteins relevant to sleep and aging are discussed.

Role of Homer proteins in the maintenance of sleep-wake states.

Sleep is an evolutionarily conserved process that is linked to diurnal cycles and normal daytime wakefulness. Healthy sleep and wakefulness are integral to a healthy lifestyle; this occurs when an organism is able to maintain long bouts of both sleep and wake. Homer proteins, which function as adaptors for group 1 metabotropic glutamate receptors, have been implicated in genetic studies of sleep in both Drosophila and mouse. Drosophila express a single Homer gene product that is upregulated during sleep. By contrast, vertebrates express Homer as both constitutive and immediate early gene (H1a) forms, and H1a is up-regulated during wakefulness. Genetic deletion of Homer in Drosophila results in fragmented sleep and in failure to sustain long bouts of sleep, even under increased sleep drive. However, deletion of Homer1a in mouse results in failure to sustain long bouts of wakefulness. Further evidence for the role of Homer1a in the maintenance of wake comes from the CREB alpha delta mutant mouse, which displays a reduced wake phenotype similar to the Homer1a knockout and fails to up-regulate Homer1a upon sleep loss. Homer1a is a gene whose expression is induced by CREB. Sustained behaviors of the sleep/wake cycle are created by molecular pathways that are distinct from those for arousal or short bouts, and implicate an evolutionarily-conserved role for Homer in sustaining these behaviors.