Increased ACE2 Levels and Mortality Risk of Patients With COVID-19 on Proton Pump Inhibitor Therapy.

INTRODUCTION: Proton pump inhibitor (PPI) use was recently reported to be associated with increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and worse clinical outcomes. The underlying mechanism(s) for this association are unclear. METHODS: We performed a prospective study of hospitalized coronavirus disease 2019 (COVID-19) patients and COVID-negative controls to understand how PPI use may affect angiotensin-converting enzyme 2 (ACE2) expression and stool SARS-CoV-2 RNA. Analysis of a retrospective cohort of hospitalized patients with COVID-19 from March 15, 2020 to August 15, 2020 in 6 hospitals was performed to evaluate the association of PPI use and mortality. Covariates with clinical relevance to COVID-19 outcomes were included to determine predictors of in-hospital mortality. RESULTS: Control PPI users had higher salivary ACE2 mRNA levels than nonusers, 2.39 ± 1.15 vs 1.22 ± 0.92 (P = 0.02), respectively. Salivary ACE2 levels and stool SARS-CoV-2 RNA detection rates were comparable between users and nonusers of PPI. In 694 hospitalized patients with COVID-19 (age = 58 years, 46% men, and 65% black), mortality rate in PPI users and nonusers was 30% (68/227) vs 12.1% (53/439), respectively. Predictors of mortality by logistic regression were PPI use (adjusted odds ratio [aOR] = 2.72, P < 0.001), age (aOR = 1.66 per decade, P < 0.001), race (aOR = 3.03, P = 0.002), cancer (aOR = 2.22, P = 0.008), and diabetes (aOR = 1.95, P = 0.003). The PPI-associated mortality risk was higher in black patients (aOR = 4.16, 95% confidence interval: 2.28-7.59) than others (aOR = 1.62, 95% confidence interval: 0.82-3.19, P = 0.04 for interaction). DISCUSSION: COVID-negative PPI users had higher salivary ACE2 expression. PPI use was associated with increased mortality risk in patients with COVID-19, particularly African Americans.

A test of a triadic conceptualization of future self-identification.

People encounter intertemporal decisions every day and often engage in behaviors that are not good for their future. One factor that may explain these decisions is the perception of their distal future self. An emerging body of research suggests that individuals vary in how they perceive their future self and many perceive their future self as a different person. The present research aimed to (1) build on and extend Hershfield's et al. (2011) review of the existing literature and advance the conceptualization of the relationship between the current and future self, (2) extend and develop measures of this relationship, and (3) examine whether and how this relationship predicts intrapsychic and achievement outcomes. The results of the literature review suggested that prior research mostly focused on one or two of the following components: (a) perceived relatedness between the current and future self in terms of similarity and connectedness, (b) vividness in imagining the future self, and (c) degree of positivity felt toward the future self. Additionally, differences in how researchers have labeled the overall construct lead us to propose future self-identification as a new label for the three-component construct. Our research built on existing measures to test the validity of a three-component model of future self-identification. Across three samples of first-year undergraduates, this research established the psychometric properties of the measure, and then examined the relationships between the components and four outcome domains of interest: (1) psychological well-being (self-esteem, hope), (2) imagination of the future (visual imagery of future events, perceived temporal distance), (3) self-control, and (4) academic performance. We demonstrated that the three components of future self-identification were correlated but independent factors. Additionally, the three components differed in their unique relationships with the outcome domains, demonstrating the utility of measuring all three components of future self-identification when seeking to predict important psychological and behavioral outcomes.

Interpersonal pathoplasticity and trajectories of change in routine adolescent and young adult residential substance abuse treatment.

BACKGROUND: Partnerships between mental health care stakeholders provide a context for generalizable clinical research with implications for quality improvement. In the context of a partnership between an adolescent residential substance abuse disorder (SUD) treatment center and clinical researchers, stakeholders identified knowledge gaps (internal and the field broadly) with regard to patient interpersonal factors that influence working alliance and acute SUD residential treatment outcome trajectories. OBJECTIVE: To (a) examine interpersonal pathoplasticity and identify interpersonal subtypes in a naturalistic sample of adolescent and young-adult patients presenting for routine residential SUD treatment and (b) investigate the association between identified interpersonal subtypes and working alliance and acute treatment outcome trajectories. METHOD: N = 100 patients (Mage = 17.39 years, 68% male, 84% White) completed self-reports of symptom and functioning outcomes, interpersonal problems, and the working alliance on multiple occasions between admission and discharge. Multiple methods were used to identify interpersonal subtypes and test pathoplasticity. Interpersonal subtype was entered as a predictor in respective multilevel models of working alliance and symptom outcome. RESULTS: Interpersonal subtypes of vindictive and exploitable patients demonstrated pathoplasticity. Subtype did not predict working alliance trajectories; however, a significant interaction between interpersonal subtype and a quadratic effect for time demonstrated that exploitable patients with longer than average treatment lengths experienced attenuated symptom change over the course of treatment whereas vindictive patients appeared to demonstrate steady progress. CONCLUSIONS: Interpersonal assessments should be integrated into residential SUD treatment to identify patients with an exploitable interpersonal style who might require additional attention or alternative interventions. (PsycINFO Database Record

Feeling Closer to the Future Self and Doing Better: Temporal Psychological Mechanisms Underlying Academic Performance.

This research examined the function of future self-continuity and its potential downstream consequences for academic performance through relations with other temporal psychological factors and self-control. We also addressed the influence of cultural factors by testing whether these relations differed by college generation status. Undergraduate students enrolled at a large public university participated in two studies (Study 1: N = 119, Mage = 20.55, 56.4% women; Study 2: N = 403, Mage = 19.83, 58.3% women) in which they completed measures of temporal psychological factors and psychological resources. In Study 2, we also obtained academic records to link responses to academic performance. Future self-continuity predicted subsequent academic performance and was related positively to future focus, negatively to present focus, and positively to self-control. Additionally, the relation between future focus and self-control was stronger for continuing-generation college students than first-generation college students. Future self-continuity plays a pivotal role in academic contexts. Findings suggest that it may have positive downstream consequences on academic achievement by directing attention away from the present and toward the future, which promotes self-control. Further, the strategy of focusing on the future may be effective in promoting self-control only for certain cultural groups.

Attachment history as a moderator of the alliance outcome relationship in adolescents.

The role of the alliance in predicting treatment outcome is robust and long established. However, much less attention has been paid to mechanisms of change, including moderators, particularly for youth. This study examined the moderating role of pretreatment adolescent-caregiver attachment and its impact on the working alliance-treatment outcome relationship. One hundred adolescents and young adults with primary substance dependence disorders were treated at a residential facility, with a cognitive-behavioral emphasis. The working alliance and clinical symptoms were measured at regular intervals throughout treatment. A moderator hypothesis was tested using a path analytic approach. Findings suggested that attachment to the primary caregiver moderated the impact of the working alliance on treatment outcome, such that for youth with the poorest attachment history, working alliance had a stronger relationship with outcome. Conversely, for those with the strongest attachment histories, alliance was not a significant predictor of symptom reduction. This finding may help elucidate alliance-related mechanisms of change, lending support for theories of corrective emotional experience as one function of the working alliance in youth psychotherapy.

Conducting research and collaborating with researchers: the experience of clinicians in a residential treatment center.

This paper describes the experience of clinicians in conducting research and collaborating with academic researchers. As part of clinical routine of a residential program for adolescent substance abusers, empirical data have been collected to assess client's needs before and after treatment, improve clinical practice, and identify barriers to change. Some of the challenges faced and the benefits learned in conducting these studies are presented. In addition to highlighting the convergence of research interests between clinicians and academicians, the conclusion offers general recommendations to foster these partnerships and solidify the scientific-practitioner model.

Race, gender, and marriage: destination selection during the Great Migration.

Using historical census microdata, we present a unique analysis of racial and gender disparities in destination selection and an exploration of hypotheses regarding tied migration in the historical context of the Great Migration. Black migrants were more likely to move to metropolitan areas and central cities throughout the period, while white migrants were more likely to locate in nonmetropolitan and farm destinations. Gender differences were largely dependent on marital status. Consistent with the "tied-migration" thesis, married women had destination outcomes that were similar to those of men, whereas single women had a greater propensity to reside in metropolitan locations where economic opportunities for women were more plentiful.

Reducing adolescent clients' anger in a residential substance abuse treatment facility.

BACKGROUND: Sundown Ranch, a residential behavioral health care treatment facility for adolescents, tracked the progress and results of treatment by selecting performance measures from a psychosocial screening inventory. The temper scale was one of the two highest scales at admission and the highest scale at discharge. A clinical performance improvement (PI) project was conducted to assess improvements in clients' ability to manage anger after the incorporation of Rational Emotive Behavior Therapy (REBT) into treatment. METHODS: Eighteen months of baseline data (July 1, 1999 - February 1, 2001) were collected, and 20 months of data (May 1, 2001 - December 31, 2002) were collected after the introduction of the PI activity. In all, data were collected for 541 consecutive admissions. RESULTS: A comparison of five successive quarterly reviews indicated average scores of 1.4 standard deviations (SDs) above the mean on the temper scale before the PI activity and .45 SD above the mean after. The performance threshold of reduction of the average temper scale score to < or =1 SD was met for 17 of 20 months. DISCUSSION: The fact that the PI activity reduced the temper scale elevations by almost one full SD is highly suggestive of the efficacy of REBT with the treatment population. After the project was completed, REBT was promoted as an additional therapeutic modality within the treatment program.