Suicide Ideation and Self-Harm Behaviors in First-Year Dormitory Students at a Public Midwestern University: A Pilot Study.

Purpose: Currently, 1 in 5 college students struggle with suicidal ideation while 7% to 44% engage in nonsuicidal self-injury. Illinois has one of the highest teenage and college student suicide rates in the United States. This pilot study assessed suicide ideation and self-harm behaviors at a public Illinois university. This is the first study to use 5 standardized psychological instruments to investigate these 2 crises in freshmen college students who are all required to reside in dormitories. The main hypothesis was to determine if the independent effects of freshmen students' depression, Five-Factor Model, and Reasons for Living affected the dependent variables, self-harm behaviors and suicide ideation. Methods: Forty first-year college dormitory students completed the Beck Depression Inventory-II, Scale of Suicidal Ideation, Five-Factor Model, Inventory of Statements About Self-Injury, and Reasons for Living Scale in person. Results: Participants were 18 to 19 years old, predominantly female (65%), and non-White (62%). Forty percent reported self-harm behaviors and 19% reported suicidal ideation. The top reasons for contemplated suicide attempts included the inability to solve problems (33%) and attention/revenge (28%). Students experienced high levels of anxiety (55%), self-consciousness (43%), and depression (18%). Depression was associated with suicide ideation (ß = 0.05, P = .006), while neuroticism and openness were associated with self-harm behaviors (aOR = 3.36, P = .02, aOR = 0.48, P = .047, respectively). Ninety-five percent reported "responsibility to family" as a Reason for Living. Conclusions: Preliminary evidence necessitates an examination of self-harm and suicide ideation among all freshmen, investigating both risk and protective factors. In the future, a prevention intervention should be implemented campus-wide (and eventually nationwide) for all first-year dormitory students to enhance their mental well-being.

Development of a Risk Score to Predict Sudden Infant Death Syndrome.

Sudden Infant Death Syndrome (SIDS) is the third leading cause of death among infants younger than one year of age. Effective SIDS prediction models have yet to be developed. Hence, we developed a risk score for SIDS, testing contemporary factors including infant exposure to passive smoke, circumcision, and sleep position along with known risk factors based on 291 SIDS and 242 healthy control infants. The data were retrieved from death certificates, parent interviews, and medical records collected between 1989−1992, prior to the Back to Sleep Campaign. Multivariable logistic regression models were performed to develop a risk score model. Our finalized risk score model included: (i) breastfeeding duration (OR = 13.85, p < 0.001); (ii) family history of SIDS (OR = 4.31, p < 0.001); (iii) low birth weight (OR = 2.74, p = 0.003); (iv) exposure to passive smoking (OR = 2.64, p < 0.001); (v) maternal anemia during pregnancy (OR = 2.07, p = 0.03); and (vi) maternal age <25 years (OR = 1.77, p = 0.01). The area under the curve for the overall model was 0.79, and the sensitivity and specificity were 79% and 63%, respectively. Once this risk score is further validated it could ultimately help physicians identify the high risk infants and counsel parents about modifiable risk factors that are most predictive of SIDS.

College Students' Opinions About Coping Strategies for Mental Health Problems, Suicide Ideation, and Self-Harm During COVID-19.

Background: Mental health problems have emerged as a significant health complication in United States colleges during COVID-19, and as a result, they have been extensively investigated in the United States and internationally. In contrast, research on coping among the college population during the pandemic is scant. Hence, this study investigated coping strategies proposed by undergraduate students attending a Midwestern university. Objectives: The purpose of this preliminary study was to obtain college students' feedback/opinions about coping strategies for mental health problems, suicide ideation, and self-harm during COVID-19. Methods: In December 2021, one-hundred and four undergraduate students (ages 18-22 years) completed an online survey on coping strategies using Qualtrics. Major topics included: (1) Types of coping strategies/styles expressed by students for general mental health problems, (2) Types of coping strategies for suicide ideation and self-harm behaviors, (3) Preferred platforms for receiving coping therapy, and (4) Reasons for accepting or refusing parent involvement with mental health problems. Results: The most beneficial coping strategies for mental health were ranked by college students as follows: (1) a skills training development program (30%), (2) meditation (19%), and (3) mindfulness exercises (15%), and physical education (11%). The respondents' best coping strategies for preventing self-harm and suicide ideation/behaviors during COVID-19 were ranked as: (1) improving support from friends (32%), (2) building self-esteem (29%), and (3) addressing anger, depression, stress, and loneliness (25%). Finally, a total of 50% of participants felt that parents should be involved in college student interventions. Students stated that the most important type of support that they received from their parents were: (1) emotional support (31%), (2) direction and/or assistance with solutions (27%), and problem-solving (16%). Conclusion: This study identified potential avenues which could be implemented into action during future outbreaks. Specifically, employing interventions that: (i) train undergraduate students to employ more effective skills training coping strategies or practicing mindfulness or meditation; (ii) integrate mental health, suicide, and self-harm prevention into the curriculum; (iii) offer more in-person campus services targeted toward the psychological and emotional effects of a pandemic, and (iv) involve support persons (e.g., family) in students' lives to enhance their well-being during and after COVID-19.

Serum ECP as a diagnostic marker for asthma in children less than 5 years: A systematic review and meta-analysis.

BACKGROUND: Currently, there are no clear-cut clinical or laboratory parameters to diagnose asthma in young children. Spirometry or the lung function tests cannot be reliably measured in children less than 5 years. The purpose of this study is to evaluate the efficacy of serum eosinophilic cationic protein (sECP) in diagnosing asthma among children less than 5 years of age. METHODS: A systematic review was performed in PubMed, EMBASE, and Web of Science databases to identify studies investigating the role of sECP in diagnosing childhood asthma. The quality of each study was assessed using quality assessment of diagnostic accuracy studies 2 scale. A meta-analysis was conducted using the RevMan 5.3 application. RESULTS: A total of eight studies meeting the eligibility criteria were included in the systematic review and five studies in the meta-analysis. There was a degree of clinical heterogeneity between studies primarily related to the definition of asthma and the time of assessment of sECP levels. Pooled sensitivity was 0.79 (95% confidence interval [CI]: 0.66-0.88), pooled specificity was 0.79 (95% CI: 0.54-0.92), and the pooled diagnostic odds ratio was 14.73 (95% CI: 3.58-60.58). CONCLUSION: Overall, this review found insufficient evidence to support the role of sECP levels in diagnosing early childhood asthma.

Existence of late-effects instruments for cancer survivors: A systematic review.

INTRODUCTION: The number of cancer survivors is projected to increase to 22.1 million by 2030. Late effects incorporate the full domains of cancer survivorship (e.g., physiologic, psychosocial, economic). They are numerous, complex, and potentially alter the life trajectories of cancer survivors. Currently, research is missing on the impact of late effects (e.g., cardiomyopathy, fertility, lymphedema, anxiety) on cancer survivors. OBJECTIVE: The goal of this study is to present a systematic review of existing instruments for identifying, diagnosing, and managing late effects within cancer survivors. METHODS: Using PRISMA guidelines, a systematic search was conducted using the electronic databases of PubMed and Web of Science to identify relevant papers. Articles considered eligible for this review met the following criteria: 1) written in English, 2) published until September 30, 2019, and 3) containing instruments with questions on late effects. Hypothesis, study design, study sample, questionnaire domains, details of late effects, results, conclusions, and advantages/disadvantages of each article were assessed using a modified version of the NHLBI quality assessment tool. RESULTS: An exhaustive literature review revealed 576 publications in PubMed, 628 in Web of Science, and 260 from additional sources. After removing duplicates, articles without late-effects questionnaires, and publications using identical questionnaires, 11 studies fulfilled the eligibility criteria. Study quality assessment was measured on a scale of 0-6 (0 = poor quality; 6 = highest quality). Only one study was rated with a score of 5 (Rocque). CONCLUSIONS: Taken in totality, none of the studies adequately addressed the prevalence, etiology, characteristics, management, and prevention of late effects. There is currently no comprehensive questionnaire that captures all of the relevant details of late effects across the cancer survivorship continuum nor that tracks the interrelatedness of multiple late effects. Hence, it is difficult to identify, diagnose, manage, and ultimately prevent late effects.

Breast cancer staging by subtype in the Lower Mississippi Delta region States.

INTRODUCTION: To evaluate disparities in breast cancer stage by subtype (categorizations of breast cancer based upon molecular characteristics) in the Delta Regional Authority (Delta), an impoverished region across eight Lower Mississippi Delta Region (LMDR) states with a high proportion of Black residents and high breast cancer mortality rates. METHODS: We used population-based cancer registry data from seven of the eight LMDR states to explore breast cancer staging (early and late) differences by subtype between the Delta and non-Delta in the LMDR and between White and Black women within the Delta. Age-adjusted incidence rates and rate ratios were calculated to examine regional and racial differences. Multilevel negative binomial regression models were constructed to evaluate how individual-level and area-level factors affect rates of early- and late-stage breast cancers by subtype. RESULTS: For all subtypes combined, there were no Delta/non-Delta differences in early and late stage breast cancers. Delta women had lower rates of hormone-receptor (HR+)/human epidermal growth factor 2 (HER2-) and higher rates of HR-/HER2- (the most aggressive subtype) early and late stage cancers, respectively, but these elevated rates were attenuated in multilevel models. Within the Delta, Black women had higher rates of late-stage breast cancer than White women for most subtypes; elevated late-stage rates of all subtypes combined remained in Black women in multilevel analysis (RR = 1.10; 95% CI = 1.04-1.15). CONCLUSIONS: Black women in the Delta had higher rates of late-stage cancers across subtypes. Culturally competent interventions targeting risk-appropriate screening modalities should be scaled up in the Delta to improve early detection.

Disparities in breast cancer subtypes among women in the lower Mississippi Delta Region states.

PURPOSE: To describe and elucidate rates in breast cancer incidence by subtype in the federally designated Mississippi Delta Region, an impoverished region across eight Southern/Midwest states with a high proportion of Black residents and notable breast cancer mortality disparities. METHODS: Cancer registry data from seven LMDR states (Missouri was not included because of permission issues) were used to explore breast cancer incidence differences by subtype between the LMDR's Delta and non-Delta Regions and between White and Black women within the Delta Region (2012-2014). Overall and subtype-specific age-adjusted incidence rates and rate ratios were calculated. Multilevel negative binomial regression models were used to evaluate how individual-level and area-level factors, like race/ethnicity and poverty level, respectively, affect rates of breast cancers by subtype. RESULTS: Women in the Delta Region had higher rates of triple-negative breast cancer, the most aggressive subtype, than women in the non-Delta (17.0 vs. 14.4 per 100,000), but the elevated rate was attenuated to non-statistical significance in multivariable analysis. Urban Delta women also had higher rates of triple-negative breast cancer than non-Delta urban women, which remained in multivariable analysis. In the Delta Region, Black women had higher overall breast cancer rates than their White counterparts, which remained in multivariable analysis. CONCLUSION: Higher rates of triple-negative breast cancer in the Delta Region may help explain the Region's mortality disparity. Further, an important area of future research is to determine what unaccounted for individual-level or social area-level factors contribute to the elevated breast cancer incidence rate among Black women in the Delta Region.

Pediatric Oncology and Animal-Assisted Interventions: A Systematic Review.

Animal-assisted interventions are part of the therapeutic plan in pediatric oncology. This is the first systematic review to summarize the literature and provide insights for new clinical approaches, policy, best practices, and standards. The results underline the potentially beneficial role for pediatric patients, parents, caregivers, and medical staff.

Spatial Accessibility to Mammography Services in the Lower Mississippi Delta Region States.

PURPOSE: To characterize spatial access to mammography services across 8 Lower Mississippi Delta Region (LMDR) states. These states include the Delta Region, a federally designated, largely rural, and impoverished region with a high proportion of black residents and low mammography utilization rates. METHODS: Using the enhanced 2-step floating catchment area method, we calculated spatial accessibility scores for mammography services across LMDR census tracts. We compared accessibility scores between the Delta and non-Delta Regions of the LMDR. We also performed hotspot analysis and constructed spatial lag models to detect clusters of low spatial access and to identify sociodemographic factors associated with access, respectively. We obtained mammography facility locations data from the Food and Drug Administration and sociodemographic variables from the American Community Survey and the US Department of Agriculture. RESULTS: Overall, there were no differences in spatial accessibility scores between the Delta and non-Delta Regions, though there was some state-to-state variation. Clusters of low spatial access were found in parts of the Arkansas, Mississippi, and Tennessee Delta. Spatial lag models found that poverty was associated with greater spatial access to mammography. CONCLUSIONS: The lack of identified differences in spatial access to mammography in the Delta and non-Delta Regions suggests that psychosocial or financial barriers play a larger role in lower mammography utilization rates. Identifying clusters of low spatial access to mammography services can help inform resource allocation. Further, our study underscores the value of using coverage-based methods rather than travel time or container measures to evaluate spatial access to care.

Equivalency of In vitro fertilization Success Rates in Elective Single Blastocyst Transfer and Elective Double Blastocyst Transfer: An Example of Equivalence Methodology in Clinical Reproductive Health.

CONTEXT: When comparing success rates between treatments, it is more appropriate to structure analyses in terms of equivalence rather than traditional analyses that assess differences. Unfortunately, no studies of elective single blastocyst transfer (eSBT) have been conducted in this manner. AIMS: The objective of this study was to assess clinical equivalence of in vitro fertilization success rates among patients undergoing eSBT. SETTINGS AND DESIGN: A historical prospective study was conducted at a private fertility center. METHODS: Medical records were reviewed to identify patients eligible for eSBT. Equivalency of success rates, defined as no more than a 10% difference based on 95% confidence intervals (CIs), was compared between eSBT (n = 125) and eDBT (n = 213) groups. RESULTS: Using traditional analysis techniques, no differences in pregnancy or live-birth rates were seen (eSBT: 84.6% vs. eDBT: 84.5%, P = 0.99; eSBT: 65.3% vs. eDBT: 72.3%, P = 0.23). The 95% CI around the difference in pregnancy rates ranged from -7.9 to 8.1, suggesting clinically equivalent pregnancy rates. Clinical equivalence was not established for live-births (95% CI = -18.5-4.5). CONCLUSIONS: Findings suggest comparable pregnancy rates can be achieved in a clinical setting when utilizing eSBT in good-prognosis patients. Although live-birth rate equivalence was not demonstrated, it is thought the additional complications associated with multiple gestations outweigh the potentially higher live-birth rate. The present study highlights the importance of utilizing equivalence analyses when making statements regarding the similarity of two treatments in reproductive health, rather than relying on superiority analyses alone.

Late effects awareness website for pediatric survivors of acute lymphocytic leukemia.

OBJECTIVES: Every day 43 children are newly diagnosed with cancer. Fortunately, almost 90% of these childhood cancer patients will survive. However, 60-90% of these survivors will experience late effects, health problems that occur months or years after treatment has ended. Late effects could occur as a result of the disease, its treatment, and patient-related factors. The two main objectives of this research are to: 1) Examine the existence of all web-based resources for childhood cancer survivors with acute lymphocytic leukemia which focus on medical and psychological aspects of late effects, and 2) Create an innovative website specifically designed to fill this void. MATERIALS AND METHODS: A systematic literature review, followed by input from >20 different organizations, resulted in the creation of LEAP3 AHEAD (Late Effects Awareness for Patients, Physicians and the Public; Advancing Health and Eliminating All Disparities), a multi-dimensional website centering on late effects. RESULTS: An extensive review revealed 14 pediatric cancer websites, none of which focused exclusively on late effects. LEAP3 AHEAD is the first interactive website for acute lympocytic leukemia childhood cancer survivors and families, as well as physicians, and the public to: a) increase awareness about risks, detection, diagnosis, treatment, and prevention of medical and psychological late effects, b) provide suggestions to successfully reintegrate into schools, careers, and socially, and c) present opportunities including camps, scholarships, and pet therapy programs. CONCLUSION: LEAP3 AHEAD is the first national website to provide a comprehensive, accessible, affordable, and multi-dimensional resource for pediatricians, internists, nurse practitioners, psychologists, survivors and their families, as well as the public about late effects.

Eosinophil protein X and childhood asthma: A systematic review and meta-analysis.

BACKGROUND: There are no reference guidelines for health care providers regarding appropriate use and interpretation of urine eosinophil protein X (u-EPX) in clinical practice. Currently, there are no clear-cut clinical or laboratory parameters to diagnose asthma in young children. OBJECTIVE: In this study, we (1) systematically reviewed and qualitatively appraised the epidemiological evidence to determine diagnostic u-EPX cut points for pediatric asthma, and (2) performed a meta-analysis to provide u-EPX estimates for diagnosing pediatric asthma. METHODS: Research articles in literature were identified from PubMed/Medline and Web of Science databases from 1966 to August 2015. Children <18 years of age were included. Both serum and urine EPX were included. Twenty-seven studies met the inclusion criteria for the systematic review and nine studies for the meta-analysis. Details regarding EPX analyses, treatment efficacy, and outcomes were assessed. For meta-analyses, effect estimates were abstracted using standardized means. RESULTS: Over 70% of studies found a significant relationship between u-EPX and childhood asthma. There was 1.94 times higher standardized means of u-EPX among acute asthmatics compared to healthy controls (confidence interval [CI]: 1.67-2.22). Similarly, the difference in standardized means between asymptomatic asthmatics and healthy controls was 1.58 times higher (CI: 1.27-1.88). CONCLUSIONS AND CLINICAL RELEVANCE: Despite differences in sample sizes, EPX processing and measurement, and ages of children, a consistent trend of higher EPX levels with childhood asthma was revealed.

Helping Hospitalized Smokers: A Factorial RCT of Nicotine Patches and Counseling.

INTRODUCTION: Most smokers abstain from smoking during hospitalization but relapse upon discharge. This study tests the effectiveness of two proven treatments (i.e., nicotine patches and telephone counseling) in helping these patients stay quit after discharge from the hospital, and assesses a model of hospital-quitline partnership. STUDY DESIGN: This study had a 2×2 factorial design in which participants were stratified by recruitment site and smoking rate and randomly assigned to usual care, nicotine patches only, counseling only, or patches plus counseling. They were evaluated at 2 and 6 months post-randomization. SETTING/PARTICIPANTS: A total of 1,270 hospitalized adult smokers were recruited from August 2011 to November 2013 from five hospitals within three healthcare systems. INTERVENTION: Participants in the patch condition were provided 8 weeks of nicotine patches at discharge (or were mailed them post-discharge). Quitline staff started proactively calling participants in the counseling condition 3 days post-discharge to provide standard quitline counseling. MAIN OUTCOME MEASURES: The primary outcome measure was self-reported 30-day abstinence at 6 months using an intention-to-treat analysis. Data were analyzed from September 2015 to May 2016. RESULTS: The 30-day abstinence rate at 6 months was 22.8% for the nicotine patch condition and 18.3% for the no-patch condition (p=0.051). Nearly all participants (99%) in the patch condition were provided nicotine patches, although 36% were sent post-discharge. The abstinence rates were 20.0% and 21.1% for counseling and no counseling conditions, respectively (p=0.651). Fewer than half of the participants in the counseling condition (47%) received counseling (mean follow-up sessions, 3.6). CONCLUSIONS: Provision of nicotine patches proved feasible, although their effectiveness in helping discharged patients stay quit was not significant. Telephone counseling was not effective, in large part because of low rates of engagement. Future interventions will need to be more immediate to be effective. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01289275.

Predictors of treatment failure in young patients undergoing in vitro fertilization.

PURPOSE: The purpose of the study was to evaluate whether routinely collected clinical factors can predict in vitro fertilization (IVF) failure among young, "good prognosis" patients predominantly with secondary infertility who are less than 35 years of age. METHODS: Using de-identified clinic records, 414 women <35 years undergoing their first autologous IVF cycle were identified. Logistic regression was used to identify patient-driven clinical factors routinely collected during fertility treatment that could be used to model predicted probability of cycle failure. RESULTS: One hundred ninety-seven patients with both primary and secondary infertility had a failed IVF cycle, and 217 with secondary infertility had a successful live birth. None of the women with primary infertility had a successful live birth. The significant predictors for IVF cycle failure among young patients were fewer previous live births, history of biochemical pregnancies or spontaneous abortions, lower baseline antral follicle count, higher total gonadotropin dose, unknown infertility diagnosis, and lack of at least one fair to good quality embryo. The full model showed good predictive value (c = 0.885) for estimating risk of cycle failure; at ≥80 % predicted probability of failure, sensitivity = 55.4 %, specificity = 97.5 %, positive predictive value = 95.4 %, and negative predictive value = 69.8 %. CONCLUSION: If this predictive model is validated in future studies, it could be beneficial for predicting IVF failure in good prognosis women under the age of 35 years.

Timing of breast cancer surgery, menstrual phase, and prognosis: Systematic review and meta-analysis.

BACKGROUND: For over 25 years, there has been a debate revolving around the timing of breast cancer surgery, menstrual cycle, and prognosis. METHODS: This systematic review synthesizes and evaluates the body of evidence in an effort to inform evidence-based practice. A keyword and reference search was performed in PubMed and Web of Science to identify human studies that met the inclusion criteria. A total of 58 studies (48 international and 10 U.S.-based) were identified. We provided a narrative summary on study findings and conducted a meta-analysis on a subset of studies where quantitative information was available. RESULTS: Findings from both qualitative and quantitative analyses were inconclusive regarding performing breast cancer surgery around a specific phase of the menstrual cycle. CONCLUSION: Based on the Institute of Medicine criteria, evidence is insufficient to recommend a change in current primary breast cancer surgery practice based on menstrual phase.

Nicotine patches and quitline counseling to help hospitalized smokers stay quit: study protocol for a randomized controlled trial.

BACKGROUND: Hospitalized smokers often quit smoking, voluntarily or involuntarily; most relapse soon after discharge. Extended follow-up counseling can help prevent relapse. However, it is difficult for hospitals to provide follow-up and smokers rarely leave the hospital with quitting aids (for example, nicotine patches). This study aims to test a practical model in which hospitals work with a state cessation quitline. Hospital staff briefly intervene with smokers at bedside and refer them to the quitline. Depending on assigned condition, smokers may receive nicotine patches at discharge or extended quitline telephone counseling post-discharge. This project establishes a practical model that lends itself to broader dissemination, while testing the effectiveness of the interventions in a rigorous randomized trial. METHODS/DESIGN: This randomized clinical trial (N = 1,640) tests the effect of two interventions on long-term quit rates of hospitalized smokers in a 2 x 2 factorial design. The interventions are (1) nicotine patches (eight-week, step down program) dispensed at discharge and (2) proactive telephone counseling provided by the state quitline after discharge. Subjects are randomly assigned into: usual care, nicotine patches, telephone counseling, or both patches and counseling. It is hypothesized that patches and counseling have independent effects and their combined effect is greater than either alone. The primary outcome measure is thirty-day abstinence at six months; a secondary outcome is biochemically validated smoking status. Cost-effectiveness analysis is conducted to compare each intervention condition (patch alone, counseling alone, and combined interventions) against the usual care condition. Further, this study examines whether smokers' medical diagnosis is a moderator of treatment effect. Generalized linear (binomial) mixed models will be used to study the effect of treatment on abstinence rates. Clustering is accounted for with hospital-specific random effects. DISCUSSION: If this model is effective, quitlines across the U.S. could work with interested hospitals to set up similar systems. Hospital accreditation standards related to tobacco cessation performance measures require follow-up after discharge and provide additional incentive for hospitals to work with quitlines. The ubiquity of quitlines, combined with the consistency of quitline counseling delivery as centralized state operations, make this partnership attractive. TRIAL REGISTRATION: Smoking cessation in hospitalized smokers NCT01289275. Date of registration February 1, 2011; date of first patient August 3, 2011.

Prenatal alcohol exposure patterns and alcohol-related birth defects and growth deficiencies: a prospective study.

BACKGROUND: The physical features of fetal alcohol syndrome include smooth philtrum, thin vermillion border, short palpebral fissures, microcephaly, and growth deficiencies on weight and height. However, little is known about the specific quantities of alcohol exposure, pattern of drinking, timing of exposure, and magnitude of risk for each of these features. METHODS: Using data on 992 subjects collected prospectively in California between 1978 and 2005, we examined the patterns and timing of alcohol exposure in relation to these features. Structural features were assessed by a dysmorphologist who performed a blinded physical examination of all infants. Patterns of drinking were evaluated by drinks per day, number of binge episodes, and maximum number of drinks. Timing of exposure was evaluated 0 to 6 weeks postconception, 6 to 12 weeks postconception, first trimester, second trimester, and third trimester. RESULTS: Higher prenatal alcohol exposure in every pattern was significantly associated with the incidence of smooth philtrum but not with short palpebral fissures. The strongest associations were with timing of exposure in the second half of the first trimester (RR 1.25, 95% CI 1.14 to 1.36 for average number of drinks per day; RR 1.17, 95% CI 1.09 to 1.26 for maximum number of drinks in 1 episode). Similarly, thin vermillion border was most strongly associated with exposure in the second half of the first trimester. Findings with respect to timing of exposure were similar for microcephaly and reduced birth weight. However, reduced birth length was increased with exposure in any trimester. These associations were linear, and there was no evidence of a threshold. CONCLUSIONS: Reduced birth length and weight, microcephaly, smooth philtrum, and thin vermillion border are associated with specific gestational timing of prenatal alcohol exposure and are dose-related without evidence of a threshold. Women should continue to be advised to abstain from alcohol consumption from conception throughout pregnancy.

The effect of an expressive writing intervention (EWI) on stress in infertile couples undergoing assisted reproductive technology (ART) treatment: a randomized controlled pilot study.

OBJECTIVES: Infertile couples undergoing fertility treatments may experience stress and could benefit from psychological intervention. Expressive Writing Intervention (EWI) has shown promising results on various psychological outcomes, yet only one study has applied the method to infertility-related stress. Our aim was to assess feasibility and effectiveness of EWI for patients in treatment with Assisted Reproductive Technology (ART). DESIGN AND PARTICIPANTS: Patients enrolling in their first ART treatment at the fertility clinic, Aarhus University Hospital, Denmark were offered to participate. A total of 82 participants (45 women, 37 men), mean age: 33.17, were randomized to home-based EWI or neutral writing control group and completed an infertility-related stress questionnaire at treatment enrollment, 3 weeks later (at the time of down regulation), and 6 weeks after the intervention. The intervention took place 2 weeks after treatment start. RESULTS: Mixed between-within ANOVA showed a main effect of time (Wilks Lambda = 0.68, F(2,28) = 6.48) as well as a significant interaction effect between group (control/ EWI) and time (Wilks Lambda = 0.83, F(2,28) = 2.92). Infertility-related stress decreases were observed after the intervention in the EWI group compared to controls. Six weeks after the intervention, stress tended to increase in both groups, with the control group, follow-up stress levels exceeding baseline stress scores, whereas the follow-up scores of EWI-participants' did not exceed baseline levels. CONCLUSIONS: Our preliminary results suggest EWI to be a feasible, cost-effective, and efficient method for alleviating infertility-related stress, although results should be considered preliminary and further testing with a larger sample is warranted.

Patterns of prenatal alcohol exposure and associated non-characteristic minor structural malformations: a prospective study.

The characteristic facial features of the more severe end of Fetal Alcohol Spectrum Disorders (FASD) include smooth philtrum, thin vermillion of the upper lip, and short palpebral fissures. A systematic evaluation of a comprehensive list of minor structural defects in association with varying patterns of prenatal exposure to alcohol has not been performed. We examined the patterns and timing of prenatal alcohol exposure to minor structural malformations occurring in at least 5% of the sample. Patterns of drinking were evaluated by drinks per day, number of binge episodes, and maximum number of drinks. Timing of exposure was evaluated 0-6 weeks post-conception, 6-12 weeks post-conception, first trimester, second trimester, and third trimester. Naevus flammeus neonatorum is significantly associated with various patterns of drinking during the second half of the first trimester (RR 1.14, 95% CI 1.04, 1.24 for average number of drinks per day; RR 1.04, 95% CI 1.02, 1.07 for number of binge episodes; RR 1.08, 95% CI 1.01, 1.15 for maximum number of drinks in one episode) and similar for number of binge episodes in all categories of timing of exposure and in the second trimester for average number of drinks per day. Other minor malformations occurring in at least 5% of the sample were not found to be significantly associated with prenatal alcohol exposure. Expected minor malformations were not found to be significantly associated with prenatal alcohol exposure. Naevus flammeus neonatorum appears to be part of the spectrum of features associated with prenatal alcohol exposure.

Prostate cancer postoperative nomogram scores and obesity.

PURPOSE: Nomograms are tools used in clinical practice to predict cancer outcomes and to help make decisions regarding management of disease. Since its conception, utility of the prostate cancer nomogram has more than tripled. Limited information is available on the relation between the nomograms' predicted probabilities and obesity. The purpose of this study was to examine whether the predictions from a validated postoperative prostate cancer nomogram were associated with obesity. METHODS: We carried out a cross-sectional analysis of 1220 patients who underwent radical prostatectomy (RP) in southern California from 2000 to 2008. Progression-free probabilities (PFPs) were ascertained from the 10-year Kattan postoperative nomogram. Multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: In the present study, aggressive prostate cancer (Gleason ≥7), but not advanced stage, was associated with obesity (p = 0.01). After adjusting for age, black race, family history of prostate cancer and current smoking, an inverse association was observed for 10-year progression-free predictions (OR = 0.50; 95% CI = 0.28-0.90) and positive associations were observed for preoperative PSA levels (OR = 1.23; 95% CI = 1.01-1.50) and Gleason >7 (OR = 1.45; 95% CI = 1.11-1.90). CONCLUSION: Obese RP patients were more likely to have lower PFP values than non-obese patients, suggesting a higher risk of experiencing prostate cancer progression. Identifying men with potentially higher risks due to obesity may improve disease prognosis and treatment decision-making.