Repetitive head impacts induce neuronal loss and neuroinflammation in young athletes.

Repetitive head impacts (RHI) sustained from contact sports are the largest risk factor for chronic traumatic encephalopathy (CTE). Currently, CTE can only be diagnosed after death and the multicellular cascade of events that trigger initial hyperphosphorylated tau (p-tau) deposition remain unclear. Further, the symptoms endorsed by young individuals with early disease are not fully explained by the extent of p-tau deposition, severely hampering development of therapeutic interventions. Here, we show that RHI exposure associates with a multicellular response in young individuals (<51 years old) prior to the onset of CTE p-tau pathology that correlates with number of years of RHI exposure. Leveraging single nucleus RNA sequencing of tissue from 8 control, 9 RHI-exposed, and 11 low stage CTE individuals, we identify SPP1+ inflammatory microglia, angiogenic and inflamed endothelial cell profiles, reactive astrocytes, and altered synaptic gene expression in excitatory and inhibitory neurons in all individuals with exposure to RHI. Surprisingly, we also observe a significant loss of cortical sulcus layer 2/3 neurons in contact sport athletes compared to controls independent of p-tau pathology. These results provide robust evidence that multiple years of RHI exposure is sufficient to induce lasting cellular alterations that may underlie p-tau deposition and help explain the early clinical symptoms observed in young former contact sport athletes. Furthermore, these data identify specific cellular responses to repetitive head impacts that may direct future identification of diagnostic and therapeutic strategies for CTE.

Birth Experience Among Black Women in the United States: A Qualitative Meta-Synthesis.

INTRODUCTION: There are striking disparities in perinatal health outcomes for Black women in the United States. Although the causes are multifactorial, research findings have increasingly identified social and structural determinants of health as contributors to perinatal disparities. Maltreatment during perinatal care, which is disproportionately experienced by Black women, may be one such contributor. Qualitative researchers have explored Black women's perinatal care experiences, but childbirth experience data has yet to be analyzed in-depth across studies. The aim of this meta-synthesis was to explore the birthing experience of Black women in the United States. METHODS: PubMed, Embase, PsycINFO, and CINAHL databases were searched. Inclusion criteria were qualitative research studies that included birth experience data shared by self-identified Black or African American women who had given birth in the United States. Exclusion criteria were reports that did not include rich qualitative data or only included experience data that did not specify the race of the participant (eg, data pooled for women of color). The search began February 2022 and ended June 2022. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to appraise the research. Results were synthesized using content analysis. RESULTS: Fifteen studies met inclusion criteria. Main themes included (1) trust: being known and seen; (2) how race influences care; (3) preserving autonomy; and (4) birth as trauma. DISCUSSION: Fragmented care resulted in reports of poor birth experiences in several studies. Open communication and feeling known by perinatal care providers was influential in improving childbirth experiences among Black women; these themes are consistent with existing research. Further prospective research exploring relationships among these themes and perinatal outcomes is needed. Limitations of this report include the use of content analysis and meta-synthesis which may lose the granularity of the original reports; however, the aggregation of voices may provide valuable, transferable, actionable insight that can inform future supportive care interventions.

Barriers and Facilitators of Parent Presence in the Neonatal Intensive Care Unit.

PURPOSE: The purpose of this study was to describe system-level and personal factors influencing parent presence in the neonatal intensive care unit (NICU) and identify differences in factors by sociodemographic characteristics. STUDY DESIGN AND METHODS: In a cross-sectional national survey study using social media recruitment, participants rated the frequency of 13 potential barriers and 12 potential facilitators using a 5-point Likert scale. Experiences of discrimination and parent-staff engagement were also measured. RESULTS: Valid responses were analyzed from 152 participants. Uncomfortable facilities and home responsibilities were the most highly reported system-level and personal barriers, respectively. Encouragement to participate in caregiving and social support were the most highly reported system-level and personal facilitators, respectively. Participants reported low to moderate levels of discrimination and moderate levels of parent-staff engagement. Latent class analysis revealed three sociodemographic clusters. Differences in barriers, facilitators, discrimination, and engagement were found among clusters. CLINICAL IMPLICATIONS: NICU facilities are uncomfortable and may discourage parent presence. Allowing support persons to accompany parents, providing comfortable facilities, and engaging parents in caregiving may promote greater parent presence and improved parent and child outcomes. Studies of potential bias toward parents with lower education and income and effects on parent presence and infant outcomes are needed.

TDP43 pathology in chronic traumatic encephalopathy retinas.

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with repetitive head trauma. Brain pathology in CTE is characterized by neuronal loss, gliosis, and a distinctive pattern of neuronal accumulation of hyper-phosphorylated tau (p-tau) and phospho-TDP43 (p-TDP43). Visual anomalies have been reported by patients with CTE, but the ocular pathology underlying these symptoms is unknown. We evaluated retinal pathology in post-mortem eyes collected from 8 contact sport athletes with brain autopsy-confirmed stage IV CTE and compared their findings to retinas from 8 control patients without CTE and with no known history of head injury. Pupil-optic nerve cross sections were prepared and stained with hematoxylin and eosin (H&E), p-tau, p-TDP43, and total TDP43 by immunohistochemistry. No significant retinal degeneration was observed in CTE eyes compared to control eyes by H&E. Strong cytoplasmic p-TDP43 and total TDP43 staining was found in 6/8 CTE eyes in a subset of inner nuclear layer interneurons (INL) of the retina, while only 1/8 control eyes showed similar p-TDP43 pathology. The morphology and location of these inner nuclear layer interneurons were most compatible with retinal horizontal cells, although other retinal cell types present in INL could not be ruled out. No p-tau pathology was observed in CTE or control retinas. These findings identify novel retinal TDP43 pathology in CTE retinas and support further investigation into the role of p-TDP43 in producing visual deficits in patients with CTE.

Narrative Review of Use and Continued Relevance of the Maternal Infant Responsiveness Instrument.

BACKGROUND: The Maternal Infant Responsiveness Instrument (MIRI) was developed in 2002 to measure a critical aspect of maternal-infant health. The objective of this analysis was to examine use, results, and continued relevance of the MIRI 20 years after its creation. METHODS: For the completion of this narrative review, 5 electronic databases were accessed using key search terms. Inclusion criteria were English-language, peer-reviewed research using the MIRI. Hand searches of reference lists were conducted. Five authors performed screening, data extraction, appraisal, and summarized findings. RESULTS: Fifteen studies were included. All studies reported an internal consistency of α > 0.70 for the MIRI. Positive correlations were reported with self-efficacy, infant temperament, and life satisfaction. Inverse relationships were reported with stress, depression, and experiential avoidance. Depressive symptomatology, life satisfaction, self-esteem, self-efficacy, and previous childcare experience were predictors of maternal responsiveness. DISCUSSION: Maternal well-being (postpartum depression and stress) can affect maternal responsiveness. Given the pervasive disparities in maternal health and well-being, it is important to have reliable measures of the effects of those disparities. The MIRI, a valid and reliable measure, may be useful for assessing the effectiveness of interventions designed to improve infant and maternal well-being.

Acculturation, Acculturative Stress, Experience of Discrimination, and Cesarean Birth in Mexican American Women.

Introduction: There is evidence that Mexican Americans are more likely to have cesarean birth than non-Hispanic White Americans. The purpose of this study was to identify factors related to acculturation along with psychological and sociodemographic factors associated with birth mode in a prospective cohort of Mexican American women in Texas. Methods: This secondary analysis included 244 Mexican American pregnant women. Women with a prior cesarean birth were excluded. Variable selection was guided by Berry's Theoretical Framework of Acculturation. Correlations and logistic regression were used to examine relationships and predict risk of cesarean birth. Mediators and moderators were also considered. Results: Eighty women birthed by cesarean. Analytic and parent samples were similar in all demographics. After controlling for parity in logistic regression, greater Spanish language-related acculturative stress (adjusted odds ratio [AOR], 1.06, 95% confidence interval [CI] [1.01, 1.11], p = .028) and experience of discrimination (AOR, 1.18, 95% CI [1.00, 1.38], p = .044) increased the odds of cesarean birth. The relationship between acculturative stress and birth mode was moderated by birth facility. Conclusion: Acculturative stress and discrimination may play a role in birth mode for Mexican American women birthing in Texas. Birth facility and acculturative stress may be interacting in ways that have clinical significance but are yet unexplored.

The mastery lifestyle intervention to reduce biopsychosocial risks for pregnant Latinas and African Americans and their infants: protocol for a randomized controlled trial.

BACKGROUND: Pregnant Mexican Americans (hereafter called Latinas) and Black/African American women are at increased risk for psychological distress, contributing to preterm birth and low birthweight; acculturative stress combined with perceived stress elevates depressive symptoms in Latinas. Based on our prior research using a psychoneuroimmunology framework, we identified psychological and neuroendocrine risk factors as predictors of preterm birth in Latina women that are also identified as risk factors for Black/African American women. METHODS/DESIGN: In this prospective, randomized controlled trial with parallel group design we will explore psychosocial, neuroendocrine, and birth outcome effects of the Mastery Lifestyle Intervention (MLI). The MLI is a culturally relevant, manualized, psychosocial, group intervention integrating two cognitive behavioral therapies for both pregnant Latinas and Black/African American women (total n = 221). Study inclusion criteria are: women with current pregnancy at 14-20 weeks gestation, ability to read and speak English or Spanish, self-identify as Latina of Mexican heritage or Black/African American, 18-45 years old, born in the US or Mexico, and currently living in the US. Participants must receive Medicaid or other government-supported insurance, and meet screening criteria for anxiety, depressive symptoms, or stress. Participants are randomly assigned to either the intervention (MLI) or usual care group (UCG) in groups of 6-8 participants that occur over 6 consecutive weeks. Data are collected at 3 time points: enrollment (14-20 weeks gestation), following treatment (20-26 weeks), and 6 weeks after treatment (32-36 weeks gestation). Additional outcome, mediating, and moderating data are collected from the electronic health record during pregnancy and at birth. Analyses will primarily use generalized linear mixed modeling (GLMM) to evaluate the relationships between predictors and outcomes. DISCUSSION: This RCT will test the efficacy of two combined third generation cognitive behavioral therapies (the MLI), given in a group format over 6 sessions, as compared to a usual prenatal care group, for both Latina and African American pregnant women. If efficacious, it may be provided as an adjunct to routine prenatal care and improve mental health, as well as babies being born too small and too soon. TRIAL REGISTRATION: The trial was retrospectively registered at ClinicalTrials.gov . Bethesda (MD): National Library of Medicine. Identifier NCT05012072 , Reducing Pregnancy Risks: The Mastery Lifestyle Intervention (MLI); August 19, 2021. The trial is currently recruiting participants.

Integrative Review of Disparities in Mode of Birth and Related Complications among Mexican American Women.

INTRODUCTION: Cesarean rates are particularly high among Hispanic women in some regions of the United States, placing a disproportionate health burden on women and their newborns. This integrative review synthesized the literature on mode of birth (vaginal vs cesarean) and related childbirth complications (hemorrhage, surgical site infection, perineal trauma) among Mexican American women living in the United States. METHODS: Four electronic databases, PubMed, Embase, CINAHL, and SCOPUS, were searched to identify studies meeting the inclusion criteria, research studies that included Mexican American women who were pregnant or postpartum. Results were limited to English language and publications that were peer-reviewed and published before May 2020. Covidence was used in article identification, screening, and assessment. Critical appraisal of the research was performed using the Quality Assessment Tool for Studies with Diverse Designs. RESULTS: Ten articles met inclusion criteria. In some studies, Mexican American women born in the United States were more likely to have cesareans than women born in Mexico; in other studies, these findings were reversed. Mexican American women often had lower unadjusted cesarean rates compared with non-Hispanic white women, but adjusting for birth facility (some facilities perform more cesareans than others), sociodemographic, and risk factors often revealed Mexican American women have a higher adjusted risk for cesarean birth. Women with higher socioeconomic status had higher cesarean rates compared with women with lower socioeconomic status. In studies of birth outcome by level of acculturation, women who were US-oriented had higher rates of cesarean and more frequent perinatal complications. By ethnic subgroup, rates of cesarean and complications varied among Hispanic women. DISCUSSION: Birth facility was associated with perinatal outcomes for Mexican American women; those who gave birth at higher-performing facilities had better outcomes when compared with women who gave birth at lower-performing facilities. After adjusting for pregnancy complications, Mexican American women had a greater risk for cesarean birth compared with non-Hispanic white women, a finding that may have clinical practice implications. Level of acculturation affected birth outcomes, but more research using precise instruments is needed.

Racial Discrimination and Stress Across the Life Course: Associations With Prenatal Inflammation, Perceived Stress, and Depressive Symptoms.

BACKGROUND: Among Black Americans, interpersonal racial discrimination is common. Stress, including following discrimination, contributes to pregnancy complications. In this secondary analysis, we provide data on associations among discrimination, stress, and their interaction across the life course and inflammation, perceived stress, and depressive symptoms during pregnancy. METHODS: During the early third trimester, Black American women (n = 93) completed the Experiences of Discrimination Scale, the Stress and Adversity Inventory, the Perceived Stress Scale, and the Center for Epidemiological Studies Depression Inventory. Plasma interleukin-6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α), and IL-ß levels were quantified. Associations were examined by linear regression, controlling for demographic, behavioral, and clinical covariates. RESULTS: Associations among racial discrimination and plasma IL-8, TNF-α, and IL-ß levels depended upon average ratings of life course stress. When stress was low, discrimination in the mid tertile was associated with the highest levels of IL-8, TNF-α, and IL-ß. Subscale analyses suggested that findings related to IL-8 were driven by chronic stress whereas findings related to TNF-α and IL-ß were driven by acute stress. When examined together, greater discrimination but not greater life course stress was associated with higher prenatal perceived stress. In subscale analyses, the association between discrimination and prenatal perceived stress depended upon average ratings of life course acute stress. When acute stress was low, discrimination in the midtertile was associated with the highest levels of prenatal perceived stress. When acute stress was high, discrimination in the high tertile was associated with the highest levels of prenatal perceived stress. There were also direct associations among greater life course chronic stress, prenatal perceived stress, and prenatal depressive symptoms. Associations were attenuated when discrimination was included as a covariate. CONCLUSIONS: The current analyses suggest that, among Black Americans, prenatal inflammation, perceived stress, and depressive symptoms may be shaped by racial discrimination and stress across the life course. In many cases, associations among discrimination and prenatal parameters depended upon how stressful exposures to life course stressors had been rated. The data suggest the potential for adaptive plasticity under some stress and highlight the deleterious nature of compounding stress.

Interventions to Improve Mental Health, Well-Being, Physical Health, and Lifestyle Behaviors in Physicians and Nurses: A Systematic Review.

OBJECTIVE: This systematic review focused on randomized controlled trials (RCTs) with physicians and nurses that tested interventions designed to improve their mental health, well-being, physical health, and lifestyle behaviors. DATA SOURCE: A systematic search of electronic databases from 2008 to May 2018 included PubMed, CINAHL, PsycINFO, SPORTDiscus, and the Cochrane Library. STUDY INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria included an RCT design, samples of physicians and/or nurses, and publication year 2008 or later with outcomes targeting mental health, well-being/resiliency, healthy lifestyle behaviors, and/or physical health. Exclusion criteria included studies with a focus on burnout without measures of mood, resiliency, mindfulness, or stress; primary focus on an area other than health promotion; and non-English papers. DATA EXTRACTION: Quantitative and qualitative data were extracted from each study by 2 independent researchers using a standardized template created in Covidence. DATA SYNTHESIS: Although meta-analytic pooling across all studies was desired, a wide array of outcome measures made quantitative pooling unsuitable. Therefore, effect sizes were calculated and a mini meta-analysis was completed. RESULTS: Twenty-nine studies (N = 2708 participants) met the inclusion criteria. Results indicated that mindfulness and cognitive-behavioral therapy-based interventions are effective in reducing stress, anxiety, and depression. Brief interventions that incorporate deep breathing and gratitude may be beneficial. Visual triggers, pedometers, and health coaching with texting increased physical activity. CONCLUSION: Healthcare systems must promote the health and well-being of physicians and nurses with evidence-based interventions to improve population health and enhance the quality and safety of the care that is delivered.