The unseen patient: competing priorities between patients and providers when cannabis is used in pregnancy, a qualitative study.

Objectives: This study aimed to explore competing priorities when cannabis is used during pregnancy from the perspective of providers and Black and Latina people. Maternal cannabis use is increasingly common, but patients and providers alike struggle to navigate it. Methods: This pilot used qualitative, constructivist ground theory methods to conduct semi-structured, remote interviews between 16 November 2021, and 7 February 2022 with 7 Black and Latina people who used cannabis during pregnancy, and 10 providers between 15 March 2022, and 6 April 2022, all of who were in Southern California, U.S. Results: We identified three main findings: (1) Providers reported barriers to caregiving and relationship building with patients due to maternal cannabis use stigma, (2) Providers prioritized the fetus despite patients' current health system challenges that drove cannabis use, and (3) Both patients and providers engaged in personal research beyond the healthcare system to better understand maternal cannabis use. Discussion: Our findings indicate that challenges exist between people who use cannabis during pregnancy and providers. Both groups need accurate, sociocultural sensitive information about maternal cannabis use via a harm reduction lens.

Increased Risk of Gestational Hypertension by Periconceptional Exposure to Ambient Air Pollution and Effect Modification by Prenatal Depression.

BACKGROUND: Air pollution has been associated with gestational hypertension (GH) and preeclampsia, but susceptible windows of exposure and potential vulnerability by comorbidities, such as prenatal depression, remain unclear. METHODS: We ascertained GH and preeclampsia cases in a prospective pregnancy cohort in Los Angeles, CA. Daily levels of ambient particulate matters (with a diameter of ≤10 µm [PM10] or ≤2.5 µm [PM2.5]), nitrogen dioxide, and ozone were averaged for each week from 12 weeks preconception to 20 gestational weeks. We used distributed lag models to identify susceptible exposure windows, adjusting for potential confounders. Analyses were additionally stratified by probable prenatal depression to explore population vulnerability. RESULTS: Among 619 participants, 60 developed preeclampsia and 42 developed GH. We identified a susceptible window for exposure to PM2.5 from 1 week preconception to 11 weeks postconception: higher exposure (5 µg/m3) within this window was associated with an average of 8% (95% CI, 1%-15%) higher risk of GH. Among participants with probable prenatal depression (n=179; 32%), overlapping sensitive windows were observed for all pollutants from 8 weeks before to 10 weeks postconception with increased risk of GH (PM2.5, 16% [95% CI, 3%-31%]; PM10, 39% [95% CI, 13%-72%]; nitrogen dioxide, 65% [95% CI, 17%-134%]; and ozone, 45% [95% CI, 9%-93%]), while the associations were close to null among those without prenatal depression. Air pollutants were not associated with preeclampsia in any analyses. CONCLUSIONS: We identified periconception through early pregnancy as a susceptible window of air pollution exposure with an increased risk of GH. Prenatal depression increases vulnerability to air pollution exposure and GH.

GPS-derived environmental exposures during pregnancy and early postpartum - Evidence from the madres cohort.

The built and natural environment factors (e.g., greenspace, walkability) are associated with maternal and infant health during and after pregnancy. Most pregnancy studies assess exposures to environmental factors via static methods (i.e., residential location at a single point in time, usually 3rd trimester). These do not capture dynamic exposures encountered in activity spaces (e.g., locations one visits and paths one travels) and their changes over time. In this study, we aimed to compare daily environmental exposure estimates using residential and global positioning systems (GPS)-measured activity space approaches and evaluated potential for exposure measurement error in the former. To do this, we collected four days of continuous geolocation monitoring during the 1st and 3rd trimesters of pregnancy and at 4-6 months postpartum in sixty-two pregnant Hispanic women enrolled in the MADRES cohort. We applied residential and GPS-based methods to assess daily exposures to greenspace, access to parks and transit, and walkability, respectively. We assessed potential for exposure measurement error in residential vs GPS-based estimates using Pearson correlations for each measure overall and by study period. We found residential and GPS-based estimates of daily exposure to total areas of parks and open spaces were weakly positively correlated (r = 0.31, P < .001) across pregnancy and postpartum periods. Residential estimates of %greenspace (r = 0.52, P < .001) and tree cover (r = 0.55, P < .001) along walkable roads were moderately correlated with GPS-based estimates. Residential and GPS-based estimates of public transit proximity, pedestrian-oriented intersection density, and walkability index score were all highly positively correlated (r > 0.70, P < .001). We also found associations between residential and GPS-based estimates decreased among participants with greater daily mobility. Our findings suggest the popular approach that assessing the built and natural environment exposures using residential methods at one time point may introduce exposure measurement error in pregnancy studies. GPS-based methods, to the extent feasible, are recommended for future studies.

Maternal Dietary Patterns During Pregnancy Are Linked to Hypertensive Disorders of Pregnancy Among a Predominantly Low-Income US Hispanic/Latina Pregnancy Cohort.

BACKGROUND: Diet during pregnancy may be a potential intervention for preventing hypertensive disorders of pregnancy that disproportionally burdens Hispanic/Latina women. METHODS AND RESULTS: The MADRES (Maternal And Developmental Risks from Environmental and Social stressors) study (n=451) is a prospective pregnancy cohort of predominantly low-income Hispanic/Latina women in Los Angeles, California, who completed up to 2 staff-administered 24-hour dietary recalls in the third trimester of pregnancy. Hypertensive disorders of pregnancy were abstracted from medical records and based on a physician's diagnosis or systolic or diastolic blood pressure (≥140 or ≥90 mm Hg, respectively) at ≥2 consecutive prenatal visits. Using multivariable logistic regression, we evaluated associations of 2 previously derived dietary patterns in this population (solid fats, refined grains, and cheese and vegetables, oils, and fruit) and the Healthy Eating Index 2015 with (1) gestational hypertension, (2) preeclampsia, and (3) any hypertensive disorder of pregnancy (either gestational hypertension or preeclampsia). In separate models, we additionally tested interactions with prepregnancy body mass index. Comparing highest-to-lowest quartiles, the solid fats, refined grains, and cheese dietary pattern was associated with an increased odds of any hypertensive disorder of pregnancy (odds ratio [OR], 3.99 [95% CI, 1.44-11.0]; Ptrend=0.014) and preeclampsia (OR, 4.10 [95% CI, 1.25-13.5]; Ptrend=0.036), whereas the vegetables, oils, and fruit pattern was associated with reduced odds of preeclampsia (OR, 0.32 [95% CI, 0.10-0.99]; Ptrend=0.041). Among the overweight prepregnancy body mass index category, inverse associations of vegetables, oils, and fruit and Healthy Eating Index 2015 with preeclampsia were more pronounced (both Pinteractions=0.017). Healthy Eating Index 2015 findings were generally nonsignificant. CONCLUSIONS: While the solid fats, refined grains, and cheese diet was strongly associated with preeclampsia during pregnancy, findings suggest the vegetables, oils, and fruit diet may be more relevant than Healthy Eating Index 2015 for preventing preeclampsia among low-income Hispanic/Latina women.

The temporal stability of maternal parenting style and child feeding practices: A six-wave longitudinal study.

Although parenting styles and child feeding practices are conceptualized as distal, static predictors of child eating and weight outcomes, few studies have examined the temporal stability (i.e., change over time) of these parenting measures. Also, parental characteristics, such as mental health or socio-demographics, may make it more or less difficult to sustain consistent parenting behavior. This study examined the temporal stability of parenting styles and child feeding practices and the association between temporal stability indices with maternal sociodemographic and mental health characteristics. The analytic sample included 161 ethnically diverse mothers enrolled in a six-wave bi-annual longitudinal study. During each wave, mothers reported on their parenting styles and child feeding practices using validated self-report questionnaires. Temporal stability indices for parenting styles were moderate for authoritative (ICC = 0.57) and authoritarian (ICC = 0.70) styles, yet high for permissive (ICC = 0.78) styles. Temporal stability scores for child feeding practices were low for discipline (ICC = 0.33), limit setting (ICC = 0.33), monitoring (ICC = 0.36), and pressure to eat (ICC = 0.34); however, restriction (ICC = 0.53) and role modeling of healthy eating were moderate (ICC = 0.73). Greater income and education status were positively associated with stability in authoritative, authoritarian, and permissive parenting styles, as well as with limit setting, monitoring, role modeling of healthy eating, and pressure to eat feeding practices. Higher anxiety and depressive symptoms and lower self-esteem were negatively associated with permissive parenting styles and role modeling of healthy eating. Findings show that maternal parenting styles and child feeding practices fluctuate over time, and sociodemographic and mental health characteristics are related to stability of some of these parenting styles and behaviors.

Predicting first use of heroin from prescription opioid use subtypes: Insights from the Monitoring the Future longitudinal panel.

BACKGROUND: Only a small proportion of individuals who initiate nonmedical use of prescription opioids (NUPO) transition to heroin, suggesting that more nuanced aspects of NUPO may be better indicators of risk for escalating opioid use trajectories. This study leveraged panel data to identify NUPO typologies based on NUPO characteristics associated with opioid risk trajectories (route of administration, motives) and compared rates of heroin initiation at follow-up across typologies. METHODS: Latent class analyses were run among respondents with no history of heroin use from the Monitoring the Future Panel Study (base year N=10,408) at modal ages 18, 19/20, 21/22, 23/24, and 25/26. Indicators included oral NUPO, nonoral NUPO, and NUPO motives to experiment, have a good time with friends, get high, escape problems, manage pain, relax, and sleep. Heroin initiation at follow-ups through modal age 29/30 was predicted from class membership. RESULTS: No NUPO, self-medication (oral, manage pain), recreational (oral, nonoral, experiment, get high, have a good time with friends), and mixed-motive (all routes, all motives) classes emerged. Heroin initiation rates did not differ across no NUPO and self-medication classes; recreational and mixed-motives classes initiated heroin at higher rates than the other classes and comparable rates to each other. Non-NUPO drug use prior to heroin initiation was prevalent in recreational and mixed-motive classes. CONCLUSIONS: NUPO does not uniformly or uniquely increase risk for heroin initiation. Leveraging more nuanced indicators of risk for heroin use and targeting polysubstance use in addition to opioid-specific programming may enhance the efficacy of public health efforts.

Long-term effects of the COVID-19 pandemic on children's physical activity and sedentary behavior.

Background: During the early months of the COVID-19 pandemic, decreases in physical activity (PA) and increases in sedentary behavior (SB) were reported among children in the United States (U.S.). This follow-up analysis examines 13-month effects of the COVID-19 pandemic on children's PA and SB one year into the pandemic. Methods: Parents of 5-13-year-old children in the U.S. (N = 71) reported on their child's PA and SB during the early COVID-19 period (April-May 2020) and again 12-14 months later (June-July 2021). Results: Paired t-tests showed significant within-subject reductions in SB minutes per day (M diff = -86.20, t = 3.26, p < 0.01) but no changes in PA minutes per day. Separate mixed-model repeated-measures analysis of covariance procedures found that within-subject changes in PA and SB did not differ by child sex or age. Conclusion: As COVID-19 restrictions lessened, there were more opportunities for children to reduce SB, but there were still barriers to engage in PA.

Prenatal exposures to organophosphate ester metabolites and early motor development in the MADRES cohort.

Organophosphate esters (OPEs) are increasingly considered neurotoxicants which may impact gross and fine motor development. We evaluated associations between prenatal OPE exposures and infant motor development. Third trimester urinary concentrations of nine OPE metabolites were measured in 329 mother-infant dyads participating in the Maternal And Developmental Risks from Environmental and Social Stressors (MADRES) cohort. Child gross and fine motor development at 6, 9, 12, and 18-months were assessed with the Ages and Stages Questionnaire-3 (ASQ-3) and operationalized in models using dichotomous instrument-specific cutoffs for typical motor development. Five OPE metabolites with >60% detection were specific-gravity-adjusted, natural log-transformed, and modeled continuously, while four metabolites with <60% detection were modeled dichotomously (detected/not-detected). We fit mixed effects logistic regression between OPE metabolites and fine/gross motor development and assessed sex-specific effects using a statistical interaction term and sex-stratified models. Among children, 31% and 23% had gross and fine motor scores, respectively, below the ASQ-3 at-risk cutoffs at least once across infancy. A doubling in prenatal diphenyl phosphate (DPHP) exposure was associated with 26% increased odds of potential fine motor delays (ORfine = 1.26, 95% CI: 1.02, 1.57, p = 0.04). We also observed significant interactions by infant sex for associations of detected dipropyl phosphate (DPRP) with gross motor development (pinteraction = 0.048) and detected bis(1-chloro-2-propyl) phosphate (BCIPP) with fine motor development (pinteraction = 0.02). Females had greater odds of potential motor delays for both detected DPRP (females vs males ORgross (95% CI) = 1.48 (0.71, 3.09), p = 0.30 vs 0.27 (0.06, 1.29), p = 0.10) and detected BCIPP (females vs males ORfine (95% CI) = 2.72 (1.27, 5.85), p = 0.01 vs 0.76 (0.31, 1.90), p = 0.56). There were no other significant associations between other metabolites and motor development, despite similar patterns. We found evidence of adverse effects of prenatal OPE exposures on infant motor development with greater adverse effects among female infants with some OPE metabolites.

Investigating the day-level associations between affective variability and physical activity using ecological momentary assessment.

BACKGROUND: Understanding affect as a determinant of physical activity has gained increased attention in health behavior research. Fluctuations in affect intensity from moment-to-moment (i.e., affective variability) may interfere with cognitive and regulatory processes, making it difficult to engage in goal-directed behaviors such as physical activity. Preliminary evidence indicates that those with greater trait-level affective variability engage in lower levels of habitual physical activity. However, the extent to which daily fluctuations in affect variability are associated with same-day physical activity levels is unknown. This study used ecological momentary assessment (EMA) to investigate day-level associations between affective variability (i.e., within-subject variance) and physical activity. METHODS: Young adults (N = 231, M = 23.58 ± 3.02 years) provided three months of smartphone-based EMA and smartwatch-based activity data. Every two weeks, participants completed a 4-day EMA measurement burst (M = 5.17 ± 1.28 bursts per participant). Bursts consisted of hourly randomly-prompted EMA surveys assessing momentary positive-activated (happy, energetic), positive-deactivated (relaxed), negative-activated (tense, stressed), and negative-deactivated (sad, fatigued) affect. Participants continuously wore a smartwatch to measure physical activity across the three months. Mixed-effects location scale modeling examined the day-level associations of affective variability (i.e., positive-activated, positive-deactivated, negative-activated, and negative-deactivated) and physical activity, controlling for covariates such as mean levels of affect, between-subject effects of physical activity, time of day, day of week, day in study, and smartwatch wear time. RESULTS: There were 41,546 completed EMA surveys (M = 182.22 ± 69.82 per participant) included in the analyses. Above and beyond mean levels of affect, greater day-level variability in positive-activated affect was associated with greater physical activity on that same day compared to other days (τ = 0.01, p < .001), whereas greater day-level variability in negative-deactivated affect was associated with less physical activity on that same day compared to other days (τ = -0.01, p < .001). Day-level variability in positive-deactivated affect or negative-activated affect were not associated with day-level physical activity (ps > .05) CONCLUSIONS: Individuals were less active on days with greater variability in feeling sad and fatigued but more active on days with greater variability in feeling happy and energetic. Understanding the dynamic relationships of affective variability with day-level physical activity can strengthen physical activity interventions by considering how these processes differ within individuals and unfold within the context of daily life. Future research should examine causal pathways between affective variability and physical activity across the day.

Validity of an online, self-administered Timeline Followback for alcohol use with adolescents.

Objective: The Timeline Followback (TLFB) is a widely used and well-validated interview-based tool for assessing patterns of recent health risk behavior. There is some evidence of the validity of the TLFB as a self-administered online tool for assessing alcohol use, but further research is needed to establish its validity in younger populations and populations outside the United States. Further, it is unknown how self-administered online TLFB formats compare to more timesaving and commonly used single-item alcohol questions. The primary aim of the current study was to validate a new online, self-administered TLFB for alcohol use against the TLFB interview in a sample of European (Danish) adolescents aged 16-18 years (N = 30). Methods: Participants completed a TLFB telephone interview, a self-administered online version of the TLFB, and single-item alcohol questions. Assessments were administered using a within-subject, counter-balanced design. Estimates of number of drinking days, binge-drinking days, maximum drinks consumed on one occasion, total drinks, and drinks per drinking day were compared across metrics. Results: All correlations between the drinking outcomes assessed via the TLFB interview and the TLFB online were positive, and statistically significant (rss = 0.86-0.94, p < 0.01). Wilcoxon signed-rank tests showed no significant differences between the TLFB interview and the TLFB online on drinking days, binge drinking days, max drinks, and total drinks. Participants reported drinking significantly more drinks per drinking day on the TLFB online (M = 4.66) compared to on the TLFB interview (M = 4.12; p = 0.009). Conclusion: Overall, the results support the validity of the online, self-administered TLFB in a sample of European (Danish) adolescents.

Motivational and self-regulatory processes associated with weight-related parenting behaviors.

Background: Parents play an influential role on their child's eating and physical activity. How maternal personality and individual differences, such as motivation and self-regulation, are associated with their weight-related parenting has yet to be studied. The current study examined relationships of mothers' motivational and self-regulatory characteristics with weight-related parenting practices. Methods: Mothers (N = 149, MAge = 42.78 years, 49% Hispanic/Latino) of school-aged children (ages 10-14 years, 55.7% female) completed questionnaires assessing behavioral inhibition system/behavioral activation system (BIS/BAS), self-control, and weight-related parenting practices (i.e., role modeling, food restriction, rule enforcement, limiting, discipline, pressure to eat). Structural equation modeling examined associations of BIS, BAS, and self-control with parenting practices. Results: Among mothers, higher avoidance motivation was associated with difficulty with rule enforcement. Higher approach motivation was associated with less limiting of unhealthy food and sedentary behavior. Higher self-control predicted more role modeling and less difficulty with rule enforcement. Conclusion: Findings support associations of maternal motivational and self-regulatory processes with weight-related parenting behaviors. Results may inform tailored strategies based on individual differences for family-based interventions for parenting.

Depressive symptoms and physical activity among young adult survivors of childhood cancer.

OBJECTIVE: Young adult survivors of childhood cancers are less likely to be physically active compared to non-cancer affected controls, putting them at an increased risk for morbidity and mortality. Preliminary research has examined how mental health may contribute to physical activity (PA) in this population; however, those more recently diagnosed and Hispanic survivors have been understudied. The objectives were to examine associations of dimensions of depressive symptoms, demographic characteristics, and cancer-related predictors with PA among a diverse sample of young adult childhood cancer survivors. METHODS: Participants (N = 895) diagnosed with childhood cancer between 1996 and 2010 (53% Hispanic; Mage  = 26.2 ± 4.9 years; Mage  = 14.8 ± 4.4 years at diagnosis) were recruited from the Los Angeles County cancer registry. Self-report surveys assessed current PA, depressive symptoms (i.e., positive affect, negative affect, somatic symptoms, interpersonal problems), late effects of cancer treatment, and demographic factors. Multivariable ordinal regressions examined the study objectives. RESULTS: About 70% of participants engaged in low or moderate frequency PA (fewer than 3 days a week). Participants who were older, female, Asian, or reported more late effects of cancer treatment were less likely to engage in PA. Greater positive affect was significantly associated with higher frequency PA, whereas negative affect, somatic symptoms, and interpersonal problems were not associated with PA. CONCLUSIONS: The findings suggests that positive-but not negative-mental health characteristics are more likely to facilitate or result from PA among young adult survivors of childhood cancers. Interventions seeking to increase PA may benefit from considering positive aspects of mental health/well-being.

Prenatal exposures to organophosphate ester metabolite mixtures and children's neurobehavioral outcomes in the MADRES pregnancy cohort.

BACKGROUND: Evidence suggests organophosphate esters (OPEs) are neurotoxic; however, the epidemiological literature remains scarce. We investigated whether prenatal exposures to OPEs were associated with child neurobehavior in the MADRES cohort. METHODS: We measured nine OPE metabolites in 204 maternal urine samples (gestational age at collection: 31.4 ± 1.8 weeks). Neurobehavior problems were assessed among 36-month-old children using the Child Behavior Checklist's (CBCL) three composite scales [internalizing, externalizing, and total problems]. We examined associations between tertiles of prenatal OPE metabolites (> 50% detection) and detect/non-detect categories (< 50% detection) and CBCL composite scales using linear regression and generalized additive models. We also examined mixtures for widely detected OPEs (n = 5) using Bayesian kernel machine regression. RESULTS: Maternal participants with detectable versus non-detectable levels of bis(2-methylphenyl) phosphate (BMPP) had children with 42% (95% CI: 4%, 96%) higher externalizing, 45% (-2%, 114%) higher internalizing, and 35% (3%, 78%) higher total problems. Participants in the second versus first tertile of bis(butoxethyl) phosphate (BBOEP) had children with 43% (-1%, 109%) higher externalizing scores. Bis(1-chloro-2-propyl) phosphate (BCIPP) and child sex had a statistically significant interaction in internalizing (p = 0.02) and total problems (p = 0.03) models, with 120% (23%, 295%) and 57% (6%, 134%) higher scores in the third versus first BCIPP tertile among males. Among females, detectable vs non-detectable levels of prenatal BMPP were associated with 69% higher externalizing scores (5%, 170%) while the third versus first tertile of prenatal BBOEP was associated with 45% lower total problems (-68%, -6%). Although the metabolite mixture and each CBCL outcome had null associations, we observed marginal associations between di-n-butyl phosphate and di-isobutyl phosphate (DNBP + DIBP) and higher internalizing scores (0.15; 95% CrI: -0.02, 0.32), holding other metabolites at their median. CONCLUSIONS: Our results generally suggest adverse and sex-specific effects of prenatal exposure to previously understudied OPEs on neurobehavioral outcomes in 36-month children, providing evidence of potential OPE neurotoxicity.

Preconceptional and prenatal exposure to air pollutants and risk of gestational diabetes in the MADRES prospective pregnancy cohort study.

Background: Air pollution has been associated with gestational diabetes mellitus (GDM). We aim to investigate susceptible windows of air pollution exposure and factors determining population vulnerability. Methods: We ascertained GDM status in the prospective Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort from Los Angeles, California, USA. We calculated the relative risk of GDM by exposure to ambient particulate matter (PM10; PM2.5), nitrogen dioxide (NO2), and ozone (O3) in each week from 12 weeks before to 24 weeks after conception, adjusting for potential confounders, with distributed lag models to identify susceptible exposure windows. We examined effect modification by prenatal depression, median-split pre-pregnancy BMI (ppBMI) and age. Findings: Sixty (9.7%) participants were diagnosed with GDM among 617 participants (mean age: 28.2 years, SD: 5.9; 78.6% Hispanic, 11.8% non-Hispanic Black). GDM risk increased with exposure to PM2.5, PM10, and NO2 in a periconceptional window ranging from 5 weeks before to 5 weeks after conception: interquartile-range increases in PM2.5, PM10, and NO2 during this window were associated with increased GDM risk by 5.7% (95% CI: 4.6-6.8), 8.9% (8.1-9.6), and 15.0% (13.9-16.2), respectively. These sensitive windows generally widened, with greater effects, among those with prenatal depression, with age ≥28 years, or with ppBMI ≥27.5 kg/m2, than their counterparts. Interpretation: Preconception and early-pregnancy are susceptible windows of air pollutants exposure that increased GDM risk. Prenatal depression, higher age, or higher ppBMI may increase one's vulnerability to air pollution-associated GDM risk. Funding: National Institutes of Health, Environmental Protection Agency.

An ecological momentary assessment study of affectively-charged motivational states and physical activity.

The physical activity (PA) intention-behavior gap has prompted researchers to explore other explanatory factors such as affective mechanisms which might better explain PA engagement. Affectively-charged motivations (e.g., desire, dread) are thought to influence the pursuit or avoidance of future behavior. This study examined whether affectively-charged motivations for PA changed across the day and were differentially associated with PA intensity. Participants (N = 60) wore ActiGraph GT3X accelerometers and answered EMA (M = 134.7 prompts/person) about affectively-charged motivations for upcoming PA using a 0-to-100-point scale (dread-excitement) in the morning, pre-activity, at-random, and evening for 14 days. Affectively-charged motivations for PA were lower in the morning and at-random compared to pre-activity (p = .004) and evening (p < .001). On average, individuals who rated morning affectively-charged motivations for PA 10-points higher engaged in 28 additional min/week of moderate-to-vigorous PA (p = .048). These findings suggest that affectively-charged motivations occurring in the morning may have greater salience for PA.

Oxidative Stress and Its Regulation in Diabetic Retinopathy.

Diabetic retinopathy is the retinal disease associated with hyperglycemia in patients who suffer from type 1 or type 2 diabetes. It includes maculopathy, involving the central retina and characterized by ischemia and/or edema, and peripheral retinopathy that progresses to a proliferative stage with neovascularization. Approximately 10% of the global population is estimated to suffer from diabetes, and around one in 5 of these individuals have diabetic retinopathy. One of the major effects of hyperglycemia is oxidative stress, the pathological state in which elevated production of reactive oxygen species damages tissues, cells, and macromolecules. The retina is relatively prone to oxidative stress due to its high metabolic activity. This review provides a summary of the role of oxidative stress in diabetic retinopathy, including a description of the retinal cell players and the molecular mechanisms. It discusses pathological processes, including the formation and effects of advanced glycation end-products, the impact of metabolic memory, and involvements of non-coding RNA. The opportunities for the therapeutic blockade of oxidative stress in diabetic retinopathy are also considered.

Adolescent: provider connectedness and STI risk reduction following a brief alcohol intervention: findings from a randomized controlled trial.

Objective: Given the frequent co-occurrence between alcohol use and sexual behavior among adolescents, alcohol interventions may play a role in helping prevent sexually transmitted infections (STIs) in this age group. Psychotherapy "common factors" are one potential active ingredient in intervention efficacy. Thus, the purpose of this study was to evaluate the influence of a critical common factor, adolescent: provider connectedness, on STI risk reduction at 3 months post-intervention. Methods: Community-based youth (N = 168) were randomized to two 60-min individual sessions of either motivational interviewing (MI) or brief adolescent mindfulness (BAM). Logistic regressions predicted post-intervention positive STI from adolescent: provider connectedness, intervention condition, and their interaction. Path analytic models tested post-intervention hazardous drinking as a mediator of the association between adolescent: provider connectedness and reduction in STI risk at 3-month follow-up. Results: Stronger adolescent: provider connectedness reduced risk of STI at 3 months post-intervention, with no differences by treatment condition. A mediational relationship between adolescent: provider connectedness and STI risk via hazardous drinking was not observed. Conclusion: Psychotherapeutic common factors, including adolescent: provider connectedness, may be important in mitigating adolescent health risk in behavioral interventions, above and beyond intervention condition and beyond the target behavior of the intervention.

Dengue Virus Infection of Human Retinal Müller Glial Cells.

Retinopathy is a recently recognized complication of dengue, affecting up to 10% of hospitalized patients. Research on the pathogenesis has focused largely on effects of dengue virus (DENV) at the blood-retinal barrier. Involvement of retinal Müller glial cells has received little attention, although this cell population contributes to the pathology of other intraocular infections. The goal of our work was to establish the susceptibility of Müller cells to infection with DENV and to identify characteristics of the cellular antiviral, inflammatory, and immunomodulatory responses to DENV infection in vitro. Primary human Müller cell isolates and the MIO-M1 human Müller cell line were infected with the laboratory-adapted Mon601 strain and DENV serotype 1 and 2 field isolates, and cell-DENV interactions were investigated by immunolabelling and quantitative real-time polymerase chain reaction. Müller cells were susceptible to DENV infection, but experiments involving primary cell isolates indicated inter-individual variation. Viral infection induced an inflammatory response (including tumour necrosis factor-α, interleukin [IL]-1ß, and IL-6) and an immunomodulatory response (including programmed death-ligand [PD-L]1 and PD-L2). The type I interferon response was muted in the Müller cell line compared to primary cell isolates. The highest infectivity and cell responses were observed in the laboratory-adapted strain, and overall, infectivity and cell responses were stronger in DENV2 strains. This work demonstrates that Müller cells mount an antiviral and immune response to DENV infection, and that this response varies across cell isolates and DENV strain. The research provides a direction for future efforts to understand the role of human retinal Müller glial cells in dengue retinopathy.

Motivational Profile as a Predictor of Physical Activity Among US Adults During the Early Months of the COVID-19 Pandemic: A Daily Diary Study.

This study used a daily diary approach to examine associations between day-level physical activity (PA) behavior, PA-specific motivational profile, and days since the COVID-19 national emergency declaration during the early months (April-June 2020) of the pandemic. A total of 468 US adults (Mage = 34.8 y, 79% female) participated in a 28-day smartphone-based daily diary study assessing PA. A baseline survey assessed PA and motivation for PA using the Behavioral Regulation in Exercise Questionnaire. Multilevel linear regression models examined the main effects and interactions of motivational profile and time (days since the US March 13, 2020, COVID-19 national emergency declaration) on daily PA minutes. Latent profile analysis identified 4 distinct motivational profiles for PA among this sample: profile 1: high amotivation (n = 100, 21%); profile 2: low controlled motivation (n = 55, 12%); profile 3: high external regulation (n = 47, 10%); and profile 4: moderate autonomous motivation (n = 266, 57%). After controlling for baseline PA, there were significant interactions between profile and time on daily PA (-0.21, P < .01). Profile 2 showed greater decreases in daily PA minutes over time than profile 1 (b = -0.29, P < .01). Profiles 3 and 4 did not indicate significant decreases in PA compared with profile 1 (b = 0.14, P = .31 and b = -0.16, P = .05, respectively). Contrary to previous research, individuals with lower controlled or moderate autonomous motivation demonstrated the largest decreases in PA over time, whereas individuals with higher amotivation or external regulation demonstrated smaller decreases over time. These findings suggest that external motivation may have provided short-term protection against declines in PA observed during early months of the COVID-19 pandemic.