Anxiety in a Specialist Perinatal Mental Health Service: patient characteristics, management, and outcomes.

OBJECTIVES: To outline characteristics of patients with anxiety diagnoses attending a Specialist Perinatal Mental Health Service (SPMHS) in Ireland, the mental health care received by those patients, mental health and obstetric outcomes for those patients, and immediate neonatal outcomes for their babies. METHODS: A retrospective chart review was conducted of patients with antenatal anxiety diagnoses who attended the SPMHS in University Maternity Hospital Limerick, from initiation of the service to the end of its first year. RESULTS: Data were collected on 100 patients, 81 with a mental health diagnosis prior to attending the SPMHS, 32 with prior engagement with psychiatry, and 23 with a previous perinatal diagnosis. The mean age of patients was 32.4 (19-47, std 6.158). Beyond initial assessment, the Mental Health Midwife was involved in the care of 61% of patients, more than any other specialty including psychiatry. Twenty-seven patients had psychiatric medication either started or altered by the SPMHS. The most common reason for eventual discharge was that patients were well. Two patients presented in mental-health-related crisis to emergency services and one patient was admitted to an acute psychiatric ward. CONCLUSIONS: Patients attending the SPMHS for anxiety spanned a broad spectrum of demographics and diagnoses and received varied set of interventions. A significant proportion of patients had a primary diagnosis of Pregnancy-related anxiety. The Mental Health Midwife played a key role in management of these patients. Though rates of mental health crises and admissions were low, the absence of a Mother and Baby Unit in Ireland was highlighted.

Formal youth mentoring relationships in the context of risk: What is the role of caregiver-mentor collaboration?

Most research on youth mentoring relationships has focused on the mentor-mentee dyad, yet caregivers play an important role in supporting these relationships. Drawing on a large, multisite sample of youth in formal mentoring programs (N = 2165), this study investigated associations between caregiver-mentor collaboration and mentoring relationship outcomes in the context of environmental and individual youth risk factors. Analysis of novel quantitative measures assessing caregivers' experiences of the mentoring relationships revealed two factors reflecting caregivers' collaboration with mentors (caregiver involvement and mentor backing), and three factors reflecting caregivers' perceptions of mentor effectiveness (meeting youth needs, advocating for youth, and supporting youth behavior). Results indicated that greater caregiver involvement was associated with higher-quality and longer-lasting mentoring relationships. Few associations between risk and mentoring relationships were observed; however, indirect effects indicated that youth environmental risk was positively associated with caregiver involvement, which, in turn, was positively associated with mentoring relationship outcomes.

Climate change anxiety and mental health: Environmental activism as buffer.

A growing body of research has documented the phenomenon of climate change anxiety (CCA), defined broadly as negative cognitive, emotional, and behavioral responses associated with concerns about climate change. A recently validated scale of CCA indicated two subscales: cognitive emotional impairment and functional impairment (Clayton & Karazsia, 2020). However, there are few empirical studies on CCA to date and little evidence regarding whether CCA is associated with psychiatric symptoms, including symptoms of Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD), and whether engaging in individual and collective action to address climate change could buffer such relationships. This mixed methods study draws on data collected from a sample of emerging adult students (ages 18-35) in the United States (N = 284) to address these gaps. Results indicated that both CCA subscales were significantly associated with GAD symptoms, while only the Functional Impairment subscale was associated with higher MDD symptoms. Moreover, engaging in collective action, but not individual action, significantly attenuated the association between CCA cognitive emotional impairment and MDD symptoms. Responses to open-ended questions asking about participants' worries and actions related to climate change indicated the severity of their worries and, for some, a perception of the insignificance of their actions relative to the enormity of climate change. These results further the field's understanding of CCA, both in general and specifically among emerging adults, and suggest the importance of creating opportunities for collective action to build sense of agency in addressing climate change.

Adverse childhood experiences: Examining latent classes and associations with physical, psychological, and risk-related outcomes in adulthood.

BACKGROUND: Adverse childhood experiences (ACEs) are a public health crisis, affecting nearly half of children in the United States. Long-term effects of ACEs on psychological well-being, engagement in risk behaviors, and physical health have been observed. Moreover, many individuals exposed to ACEs are also affected by an accumulation of stressors due to broader structural inequities. OBJECTIVE: The current study examined heterogeneity in patterns of ACEs, explored how these patterns varied based on race/ethnicity, biological sex, and socioeconomic status, and assessed how ACE patterns were associated with physical health, mental health, and risk-related outcomes in adulthood. PARTICIPANTS: Drawing on the Add Health dataset, survey data from Waves I, III, IV (n = 12,288) were analyzed. Mean age of participants was 28.3 (SD = 1.9), more than half were female (54.4%), and a little less than half identified as youth of color (46.7%). METHOD: Multigroup latent class analysis explored heterogeneity in ACE exposure and variations based on structural inequities. Latent class regression assessed associations between ACE classes and outcomes. RESULTS: A four-class solution was identified. Class sizes and latent structures differed by biological sex. Among males and females, the low adversity class had more positive physical health, mental health, and risk-related outcomes compared to all classes, while the childhood maltreatment and high adversity/community violence classes engaged in more risk-related behaviors. Very small to medium effects were observed. CONCLUSION: Findings highlight the importance of examining heterogeneity in ACE exposure, and how patterns of ACEs may differentially affect outcomes in adulthood.

Knowledge of Chosen Family History and Depressive Symptoms in Sexual Minority Women.

Recent work on intergenerational memory has revealed a positive association between family of origin knowledge and wellbeing in adolescents. However, little is known about the generalizability of these data, as significantly less attention has focused on autobiographical memory sharing and wellbeing in historically marginalized communities. Given the high incidence of familial rejection and abandonment within the LGBTQIA + community, close relationships with individuals outside of one's family of origin, chosen families, often serve as an important source of social support. This study sought to examine the relationship between knowledge of a close non-family member and wellbeing among emerging adult sexual minority women (SMW) according to their gender presentation. A community sample from New York City comprised of heterosexual women (n = 50), masculine-presenting SMW (n = 50), and feminine presenting SMW (n = 50) completed measures associated with their knowledge of their family of origin, knowledge of a close non-family member, as well as self-reported measures of depression, emotion regulation, and socio-demographic questions. Family of origin knowledge was associated with lower levels of depression only among heterosexual women. However, heterosexual and SMW who knew more about their close non-family member reported lower levels of depression. Additionally, emotion regulation (cognitive reappraisals) mediated the relationship between knowing more about one's chosen family and lower depressive symptom severity among heterosexual women, but this relationship was only significant for SMW who were at least moderately open about their sexuality. These findings extend the literature on the benefits of memory sharing to historically marginalized communities by showing that memory sources outside of one's family of origin may be particularly important. Additionally, these data begin to shed light on potential mediating factors, such as emotion regulation and openness about one's sexual identity, that underlie the links between memory sharing and metrics of wellbeing. Taken together, in contexts in which there may not be opportunities to learn about family history from one's family of origin, it appears that access to stories from someone close outside of one's family is also associated with lower levels of depression.

Natural mentoring relationships among survivors of caregiver childhood abuse: findings from the Add Health Study.

Social support promotes resilience to adverse childhood events, but little is known about the role of natural mentors-caring, nonparental adults-in the lives of childhood abuse survivors. The current study draws from a large, longitudinal, nationally representative sample (Add Health) to examine the prevalence and characteristics of natural mentoring relationships for adolescents with a history of caregiver childhood abuse, and the extent to which these relationships are associated with psychological and health outcomes in adulthood. Among the sample (n = 12,270), 28.82% and 4.86% reported caregiver childhood physical and sexual abuse, respectively. Youth who reported caregiver childhood physical abuse were more likely than those who did not endorse abuse to report having a natural mentor, but their mentoring relationships were characterized by lower interpersonal closeness, shorter duration, and less frequent contact. Exposure to caregiver childhood abuse was associated with adverse outcomes during adulthood, including antisocial behavior, physical health limitations, and suicidality; the presence of a natural mentor did not buffer the negative impact of trauma on adult outcomes. However, longer mentoring relationships during adolescence buffered the strength of the association between both caregiver physical and sexual abuse during childhood and suicidality during early adulthood.

Heterogeneity in temporal self-appraisals following exposure to potentially traumatic life events: A latent profile analysis.

BACKGROUND: People tend to believe that they continuously improve over time. In fact, Temporal Self-Appraisal Theory ("Chump to Champ") has found that people are motivated to derogate their past selves in favor of their present selves. Studies on temporal self-appraisals following trauma is less clear, with some studies showing perceived improvement whereas other studies show appraisals of decline. METHOD: Utilizing Latent Profile Analysis (LPA), we tested for discrete patterns of temporal self-appraisals in undergraduate college students (N = 740) following trauma exposure. We then explored various trauma-related characteristics as predictors of profile membership. RESULTS: LPA revealed three distinct profiles of appraisal styles (Profile 1: optimistic, Profile 2: chump to champ, Profile 3: pessimistic). The optimistic profile was associated with lower levels of PTSD and depression symptoms, whereas the optimistic and chump to champ profiles were associated with greater trauma centrality. LIMITATIONS: Findings are limited in that this study utilized cross-sectional data from a sample of predominantly undergraduate females, thus conclusions regarding temporal relations among study constructs cannot be made and findings may not generalize to other populations. CONCLUSION: Temporal self-appraisals following trauma exposure may reflect prototypical patterns in which individual appraise adaptation to potentially traumatic stress and may confer risk for psychopathology. Such findings have implications for approaches to intervention with clinical and non-clinical populations following trauma exposure.

Connecting Youth: The Role of Mentoring Approach.

While formal youth mentoring can positively influence youth connectedness, little research has studied the specific approaches mentors engage in that support mentee social development. This study examines how mentors' specific approaches are uniquely associated with youth connection outcomes in formal community-based mentoring. Participants were 766 youth, ranging in age from 11 to 14 (M = 12.29), 56.7% female, and racially/ethnically diverse (41.0% Black/African American, 21.4% Hispanic/Latinx, 20.0% White, 10.2% Multiracial/Multiethnic, 5.9% Native American, 1.2% other race, and 0.4% Asian/Pacific Islander). Person-centered analyses revealed three mentoring profiles which were differentially associated with youth outcomes: "Status Quo Mentors," who reported low-to-moderate levels of closeness within the mentor-mentee dyad, low levels of connecting their mentees with programs and people in their community, and low levels of mediating for their mentees; "Close Connectors," who reported moderate-to-high levels of closeness, moderate-to-high levels of connecting, and low levels of mediating; and "Connector-Mediators," who reported moderate levels of closeness, connecting, and mediating. Youth mentored by "Close Connectors" demonstrated the greatest benefit, with significant improvements in parent-child relationship quality, extracurricular activity involvement, and help-seeking. Results suggest that community-based mentoring programs that emphasize connecting youth within their communities may be more effective in enhancing youth support networks.

Pain centrality mediates pain self-efficacy and symptom severity among individuals reporting chronic pain.

Chronic pain is consistently associated with the presence of mental health disorders. Although previous research has shown relations between low levels of self-efficacy with chronic pain severity as well as comorbid mental health symptoms, the link between self-efficacy and mental health symptoms in chronic pain is not well understood. This study examined whether pain centrality, the extent to which pain is viewed as central to self-identity, may underlie these associations. Individuals with a diagnosis of chronic pain (N = 89) recruited through MTurkcompleted self-report measures including demographics, self-efficacy, pain centrality, pain severity, depression, and anxiety. Pain severity was associated with higher levels of pain centrality, depression, anxiety, and lower levels of self-efficacy. Path analysis demonstrated pain centrality significantly mediated the relationship between self-efficacy and pain severity, depression, and anxiety. Future studies would benefit from testing whether modifying pain centrality beliefs shift perceptions of control as well as pain and psychological outcomes.

Posttraumatic stress symptoms and access to services among human rights advocates: The mediating roles of organizational encouragement of support seeking and occupation-related appraisals.

Human rights advocates are routinely exposed to direct and secondary trauma. In addition, a growing body of research has found that trauma exposure in human rights work is associated with depression, burnout, and posttraumatic stress disorder (PTSD) in human rights advocates. Despite the potential mental health risks associated with advocacy, little is known about the ways in which organizational and individual factors contribute to mental health symptoms, such as PTSD, in this population. Human rights advocates (N = 346) completed an online survey assessing access to psychological services, perceived organizational encouragement of support seeking, occupation-related appraisals, and symptoms of PTSD. Structural equation modeling revealed an indirect association between access to psychological services and lower levels of PTSD through perceived organizational encouragement of support seeking and less negative occupation-related appraisals. This study is the first to demonstrate that access to mental health support in human rights organizations may contribute to a reduction in PTSD symptoms when advocates feel a sense of efficacy and support from their organization to seek help. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Sex and age interact to determine clinicopathologic differences in Alzheimer's disease.

Women reportedly make up two-thirds of Alzheimer's disease (AD) dementia sufferers. Many estimates regarding AD, however, are based on clinical series lacking autopsy confirmation. The Florida Autopsied Multi-Ethnic (FLAME) cohort was queried for AD cases with a total of 1625 identified ranging in age from 53 to 102 years at death. Standard neuropathologic procedures were employed and clinical information was retrospectively collected. Clinicopathologic and genetic data (MAPT and APOE) were stratified by sex. Within the neuropathologically diagnosed AD cohort, the overall number of women and men did not differ. Men were younger at onset of cognitive symptoms, had a shorter disease duration, and more often had atypical (non-amnestic) clinical presentations. The frequency of autopsy-confirmed AD among women and men stratified by age at death revealed an inverse U-shaped curve in men and a U-shaped curve in women, with both curves having inflections at approximately 70 years of age. Regional counts of neurofibrillary tangles differed in women and men, especially when examined by age intervals. Women had overall greater severity of neurofibrillary tangle counts compared to men, especially in the hippocampus. Men were more often classified as hippocampal sparing AD, whereas limbic predominant AD was more common in women. Men and women did not differ in frequency of MAPT haplotype or APOE genotype. Atypical clinical presentations, younger age at onset and shorter disease duration were more frequent in men, suggesting that the lower reported frequency of AD in men may be due to more frequent atypical clinical presentations not recognized as AD. Our data suggest that neuropathologically diagnosed AD cases have the same frequency of women and men, but their clinical presentations and ages at onset tend to differ.

Changes in self-reported driving intentions and attitudes while learning to drive in Great Britain.

Novice drivers are overrepresented in traffic collisions, especially in their first year of solo driving. It is widely accepted that some driving behaviours (such as speeding and thrill-seeking) increase risk in this group. Increasingly research is suggesting that attitudes and behavioural intentions held in the pre-driver and learning stage are important in determining later driver behaviour in solo driving. In this study we examine changes in several self-reported attitudes and behavioural intentions across the learning stage in a sample of learner drivers in Great Britain. A sample of 204 learner drivers completed a self-report questionnaire near the beginning of their learning, and then again shortly after they passed their practical driving test. Results showed that self-reported intentions regarding speed choice, perceptions regarding skill level, and intentions regarding thrill-seeking (through driving) became less safe over this time period, while self-reported intentions regarding following distance and overtaking tendency became safer. The results are discussed with reference to models of driver behaviour that focus on task difficulty; it is suggested that the manner in which behind-the-wheel experience relates to the risk measures of interest may be the key determining factor in how these change over the course of learning to drive.

Fitting techniques of cell survival curves in high-dose region for use in stereotactic body radiation therapy.

Stereotactic body radiation therapy (SBRT) uses high doses of radiation to treat tumors. The cell survival behavior at these high doses is subject to debate. We investigated this high-dose region by fitting a variety of formulas to cell survival data. Each of the formulas is motivated by a discussion of the theory of cell survival. Fourteen cell lines are examined. These are fit to a variety of equations. Among the equations include the traditional single-hit multi-target and linear quadratic as well as recent proposals such as the universal survival curve (USC). The chi(2)/df of each fit is compared to determine the best fit. While no formula is clearly superior for all cell lines, the newer formulas often provide better fits than the single-hit multi-target and linear quadratic. We recommend that the more recent formula discussed herein be used over the linear quadratic in dealing with the high-dose regions dealt with in SBRT.

Effectiveness of adalimumab for rheumatoid arthritis in patients with a history of TNF-antagonist therapy in clinical practice.

OBJECTIVE: To evaluate the effectiveness and safety of adalimumab in patients with rheumatoid arthritis (RA) who previously discontinued tumour necrosis factor (TNF) antagonists for any reason in clinical practice. METHODS: ReAct (Research in Active Rheumatoid Arthritis) was a large, open-label trial that enrolled adults with active RA who had previously been treated with traditional disease-modifying anti-rheumatic drugs or biological response modifiers. Patients self-administered adalimumab 40 mg subcutaneously every other week for 12 weeks and were allowed to enter an optional long-term extension phase. Measures of adalimumab effectiveness included American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) response criteria, Disease Activity Score 28 (DAS28) and the Health Assessment Questionnaire Disability Index (HAQ DI). RESULTS: Of 6610 patients, 899 had a history of etanercept and/or infliximab therapy; these patients experienced substantial clinical benefit from adalimumab treatment. At week 12, 60% of patients had an ACR20 and 33% had an ACR50 response; 76% had a moderate and 23% had a good EULAR response. In addition, 12% achieved a DAS28 < 2.6, indicating clinical remission, and 13% achieved a HAQ DI score <0.5. The allergic adverse event rate, regardless of relationship to adalimumab, was 6.5/100-patient-years (PYs) in previously TNF-antagonist-exposed patients and 4.3/100-PYs in TNF-antagonist-naive patients. A multiple regression analysis indicated no statistically significantly increased risk of serious infections in patients who received prior TNF antagonists compared with TNF-antagonist-naive patients. CONCLUSION: In typical clinical practice, adalimumab was effective and well-tolerated in patients with RA previously treated with etanercept and/or infliximab.

Dopamine receptor expression on human T- and B-lymphocytes, monocytes, neutrophils, eosinophils and NK cells: a flow cytometric study.

This study documents expression of dopamine (DA) receptors on leukocyte subpopulations using flow cytometric techniques to identify dopamine receptors with subtype-specific antibodies. Of the D1-like receptor family (D(1) and D(5)), only D(5) was detected, and of the D2-like receptor family (D(2), D(3) and D(4)), all dopamine receptors were detected. T-lymphocytes and monocytes had low expression of dopamine receptors, whereas neutrophils and eosinophils had moderate expression. B cells and NK cells had higher and more consistent expression. Dopamine receptors D(3) and D(5) were found in most individuals whereas D(2) and D(4) had more variable expression. D(1) was never found.

Application of actinomycetes to soil to ameliorate water repellency.

AIMS: The aim of this study was to develop a novel isolation technique using a mixture of Bacillus and Streptomyces phages to selectively isolate wax-utilizing non-streptomycete actinomycetes effective in ameliorating water repellency in a problem soil. METHODS AND RESULTS: Phages added to a soil suspension reduced the dominance of Bacillus and Streptomyces isolates and significantly increased the number of non-streptomycete actinomycetes on isolation plates. Promising isolates, grown on a medium containing beeswax as sole carbon source, were selected for application to water repellent soil. Their addition significantly reduced water repellency. CONCLUSIONS: Phage application significantly increased the isolation of non-streptomycete actinomycetes. Wax-utilizing isolates were found to significantly reduce water repellency in a problem soil. SIGNIFICANCE AND IMPACT OF THE STUDY: The phage technique can be used for the routine isolation of non-streptomycete actinomycetes. Beeswax medium can be used to selectively isolate wax-utilizing micro-organisms with the potential to ameliorate water repellency in soil.

Upper gastrointestinal tolerability of celecoxib compared with diclofenac in the treatment of osteoarthritis and rheumatoid arthritis.

OBJECTIVE: To compare the upper gastrointestinal (UGI) tolerability of celecoxib (a cyclooxygenase-2 specific inhibitor) and diclofenac using data from three randomised, double-blind clinical trials in osteoarthritis (OA) and rheumatoid arthritis (RA). METHODS: Patients in two OA studies received either celecoxib 100 mg BID (n = 545), diclofenac 50 mg BID or TID (n = 540), or placebo (n = 200) for 6 weeks. In the RA study, patients received celecoxib 200 mg BID (n = 326) or diclofenac 75 mg BID (n = 329) for 24 weeks. The cumulative incidence of abdominal pain, dyspepsia, nausea or any of these events (UGI tolerability composite endpoint) after the first 6 weeks was estimated using time-to-event analysis. RESULTS: In the pooled OA trials, the cumulative incidence of the composite endpoint was significantly higher with diclofenac (17.6%; 95% CI: 14.4-20.9%) than celecoxib (11.1%; 95% CI: 8.4-13.8%; p = 0.002) and comparable with placebo (13.3%; 95% CI: 8.1-18.4%; p = 0.157). In the PA trial, the cumulative incidence of the UGI tolerability composite endpoint was also significantly higher with diclofenac (20.7%; 95% CI: 16.3-25.1%) than celecoxib (15.9%; 95% CI: 11.9-20.0%; p = 0.013). Celecoxib was also better tolerated than diclofenac in this trial in terms of the cumulative incidences of abdominal pain (p = 0.031) and dyspepsia (p = 0.062). The results of the UGI tolerability composite endpoint analysis were confirmed using the Cox proportional hazards model to controlfor other predictors of UGI adverse events. CONCLUSION: The UGI tolerability of therapeutic dosages of celecoxib was significantly better than diclofenac in patients with RA or OA.