Long-Term Echocardiographic and Clinical Outcomes After Invasive and Non-Invasive Therapies for Sub-Massive and Massive Acute Pulmonary Embolism.

AIM: Acute pulmonary embolism (PE) is a significant cause of mortality in the hospital setting. The objective of this study was to outline the long-term outcomes after surgical and non-surgical management for patients with massive and submassive PE. METHODS: Population cohort observational study evaluating all patients who presented to three tertiary hospitals in the state of Western Australia with access to cardiothoracic services over 5 years (2013-2018). Reviewed notes of all patients as well as radiology, linked mortality data and all available echocardiography studies at the primary hospital. RESULTS: In total, 245 patients were identified, of which 41 received surgical management and 204 non-surgical management; demographic data was similar. Clinically, the surgical group had higher rates of shock requiring vasopressors, severe bradycardia, or cardiopulmonary resuscitation prior to intervention. The 28-day mortality was not statistically significantly different between the surgical embolectomy group (2/41 [4.2%]) and the non-surgical group (17/201 [8.3%]) (p=0.382). There was no difference in 12-month mortality, including when this was adjusted for vasopressors, right ventricular (RV) strain, troponin, and brain natriuretic peptide. In the massive PE sub-group, 28-day mortality was not significantly different: 2/29 (6.9%) surgical group vs 7/34 (20.2%) non-surgical group (p=0.064). Higher rates of severe RV impairment and dilatation were present in the surgical group. All patients with available echocardiography studies at outpatient follow-up returned to normal or mild RV impairment. CONCLUSION: Patients who presented with massive or submassive PE had similar outcomes whether treated with surgical or non-surgical management. Surgical embolectomy is a safe option in a cardiothoracic centre setting.

The contributions of grandparents to preadolescent grandchildren's social skills in rural Malaysia.

This study aimed to generate localized knowledge by investigating the perceptions and experiences of preadolescent grandchildren and grandparents regarding grandparenting and intergenerational interactions and how these processes were related to the social skills of preadolescents from three ethnic groups in Malaysia. Using a concurrent quantitative-qualitative mixed method research design, Chinese, Malay, and Indian preadolescents (N = 465; ages 9-12 years old; M = 10.27 years; SD = 1.03) from rural areas in Malaysia completed a self-administered quantitative survey; furthermore, 25 grandparents participated in one-on-one interviews. Survey findings showed that preadolescent grandchildren who reported higher grandparental warmth and support had greater social skills, mediated by positive grandparent-grandchildren (GP-GC) relationships. The GP-GC relationship and preadolescent social skills association was stronger for skipped generation compared to three-generation households. Interview findings revealed that grandparents expressed unconditional love and autonomy support in their grandparenting roles by guiding and encouraging their preadolescent grandchildren to make decisions. The GP-GC interactions served as a dynamic force in promoting preadolescents' social skills. By employing a decolonized approach and drawing on the lived experiences of grandparents from three ethnic backgrounds in rural Malaysia, the study provided an understanding of grandparenting practices and their general implications across the three ethnic groups. The interview responses highlighted both commonalities and specificities in grandparenting practices and relationship dynamics shaped by religious, class, and sociocultural dimensions in rural Malaysia.

Patient-centred pathology reporting improves patient experience and understanding of disease in prostate cancer care.

Introduction and Objectives: Patient-centred (PC) and holistic care improves patient satisfaction and health outcomes. We sought to investigate the benefit of utilising a PC pathology report in patients undergoing radical prostatectomy (RP) for prostate cancer (PCa). Our study aimed to evaluate and compare patient understanding of their PCa diagnosis after RP, upon receiving either a standard histopathology report or a personalised and PC report (PCR). Moreover, we evaluated knowledge retention at 4 weeks after the initial consultation. Methods: We invited patients undergoing RP at three metropolitan Urology clinics to participate in our randomised controlled study. Patients were randomised to receive either a PCR or standard pathology report. Patient satisfaction questionnaires (Perceived Efficacy in Patient-Physician Interactions [PEPPI], Consultation and Relational Empathy [CARE] and Communication Assessment Tool [CAT]) and a knowledge test were conducted within 72 h of the initial appointment and again at 4 weeks. Accurate recollection of Gleason grade group (GGG) and extracapsular extension (ECE) were classified as 'correct'. Baseline demographic data included age, education, marital and employment status, pre-op prostate specific antigen (PSA) and clinical stage. Baseline data were tested for differences between groups using the Student's t test, chi-squared test or Fisher's exact test depending on whether data were continuous, categorical or sparse. Comparison of correctly answered 'knowledge' questions was analysed using chi-squared test. A significance level of p ≤ 0.05 was used. Results: Data from 62 patients were analysed (30 standard vs. 32 PCR). No significant differences in baseline demographics were found between groups. Both groups reported high levels of satisfaction with their healthcare experiences in all domains of patient-physician rapport, empathy and communication. There were no significant differences between groups in PEPPI (p = 0.68), CAT (p = 0.39) and CARE (p = 0.66) scores, at baseline and 4 weeks. Ninety-three per cent of patients who received the PCR understood the report while 90% felt the report added to their understanding of their PCa. Regarding patient knowledge, the PCR group had significantly more correct answers on GGG and ECE as compared with the standard report group at baseline and 4 weeks (p < 0.001 and 0.001, respectively). Conclusions: Our findings demonstrate that PC pathology reports improve patient knowledge and understanding of their PCa that is retained for at least 4 weeks after initial receipt of results.

Characterizing Employees with Primary and Secondary Caregiving Responsibilities: Informal Care Provision in Malaysia.

There is a need to determine the extent to which Malaysian employees reconcile both paid employment and informal care provision. We examined data from the Malaysia's Healthiest Workplace via AIA Vitality Online Survey 2019 (N = 17,286). A multivariate multinomial regression was conducted to examine characteristics for the following groups: primary caregiver of a child or disabled child, primary caregiver of a disabled adult or elderly individual, primary caregiver for both children and elderly, as well as secondary caregivers. Respondent mean age ± SD was 34.76 ± 9.31, with 49.6% (n = 8573), identifying as either a primary or secondary caregiver to at least one child under 18 years, an elderly individual, or both. Males (n = 6957; 40.2%) had higher odds of being primary caregivers to children (OR 2.06; 95% CI 1.85-2.30), elderly (OR 1.24; 95% CI 1.09-1.41) and both children and elderly (OR 1.87; 95% CI 1.57-2.22). However, males were less likely to be secondary caregivers than females (OR 0.61; 95% CI 0.53-0.71). Our results highlight the differences in characteristics of employees engaged in informal care provision, and to a lesser degree, the extent to which mid-life individual employees are sandwiched into caring for children and/or the elderly.

Parenting measurement, normativeness, and associations with child outcomes: Comparing evidence from four non-Western cultures.

This study compared parenting across four non-Western cultures to test cross-cultural commonality and specificity principles in three aspects: measurement properties, parenting normativeness, and their associations with child outcomes. Both mothers and fathers (N = 1509 dyads) with preschool-aged children (M = 5.00 years; 48% girls) from urban areas of four countries (Malaysia, N = 372; China, N = 441; Turkey, N = 402; and Japan, N = 294) reported on four parenting constructs (authoritative, authoritarian, group harmony socialization, and intrusive control) and their sub-dimensions using modified culturally relevant measures. Teachers reported on children's internalizing, externalizing, and prosocial behaviors. The commonality principle was supported by two sets of findings: (1) full measurement invariance was established for most parenting constructs and sub-dimensions, except that intrusive control only reached partial scalar invariance, and (2) no variations were found in associations between parenting and any child outcomes across cultures or parent gender at the construct level for all four parenting constructs and at the sub-dimensional level for authoritarian and intrusive control sub-dimensions. The specificity principle was supported by the other two sets of findings: (1) cross-cultural differences in parenting normativeness did not follow the pattern of economic development but yielded culture-specific patterns, and (2) at the sub-dimensional level, the authoritative parenting and group harmony socialization sub-dimensions were differently associated with child outcomes across cultures and/or parent gender. The findings suggested that examining specific dimensions rather than broad parenting constructs is necessary to reflect cultural specificities and nuances. Our study provided a culturally-invariant instrument and a three-step guide for future parenting research to examine cross-cultural commonalities/specificities. RESEARCH HIGHLIGHTS: This is the first study to use an instrument with measurement invariance across multiple non-Western cultures to examine the commonality and specificity principles in parenting. Measurement invariance was achieved across cultures for authoritative and authoritarian parenting, group harmony socialization, intrusive control, and their sub-dimensions, supporting the commonality principle. Cross-cultural differences in parenting normativeness did not follow the pattern of economic development but yielded culture-specific patterns, supporting the specificity principle. Both commonalities and specificities were manifested in associations between parenting and child outcomes across cultures.

Evaluating the filial behaviour scale across three cultural groups using exploratory structural equation modelling.

Filial piety is a Confucian concept that guides how children treat and take care of their parents. The Filial Behaviour Scale (FBS) is a 25-item instrument developed in the Chinese context measuring behavioural manifestations of filial piety. Although the components of filial piety have been found to be relevant across cultures, little research has investigated the psychometric properties of the FBS in other cultural contexts. The present study evaluated the factor structure, internal consistency, measurement invariance and construct validity of the FBS across three cultural groups: the United States, Italy and Malaysia. Participants were 1090 emerging adults (67% females; Mage  = 21.29 years, SD = 1.97; White Americans: n = 455, White Italians: n = 428, Malays: n = 328). A two-factor structure emerged across groups: Obedience/Obligation (behaviours showing obedience and obligation towards parents) and Relationship (behaviours expressing affection and promoting positive parent-child relationships). The two factors demonstrated adequate internal consistency, full configural, partial metric and partial scalar invariance, as well as unique associations with depressive symptoms and parent-child relationships across groups. These findings yielded a more nuanced understanding of filial behaviour and supported the utility of a two-factor FBS among emerging adults in various cultural contexts.

Examining a Conceptual Model of Maternal and Paternal Warmth, Emotion Regulation and Social Competence among Preadolescent Children in Malaysia.

Although parental warmth has been shown to be related to children's social competence, the mediating role of preadolescent children's emotion regulation in this context has been less explored, particularly in Asian cultures. Thus, this study examined the role of emotion regulation as a mediator in the relationship between parental warmth (i.e., paternal and maternal warmth) and social competence among preadolescent children in Malaysia. Preadolescent children (N = 720; Mage = 10.95; SD = 0.59; 58.8% female) completed self-administered questionnaires. Results of correlation analysis showed that higher levels of paternal and maternal warmth were associated with greater emotion regulation in preadolescent children and a greater level of social competence. However, analysis of structural equation modeling revealed that emotion regulation significantly mediated only the relationship between maternal warmth and social competence. These findings underscored the importance of maternal warmth in promoting Malaysian preadolescent children's social competence as well as their emotion regulation as a mediating pathway. This study also highlights the direct effect of paternal warmth on preadolescents' social competence. Theoretical and practical implications of this study are discussed.

Critical Inhaler Administration Errors of Patients on Pressurized Meter Dose Inhaler (pMDI): A Hospital-Based Cross-Sectional Study in Malaysia.

Background: Inhaler technique errors can affect the disease outcome through reduced deposition of medication in the lungs with certain errors were more likely to deter the optimum drug from reaching the lung. The objective of this study was to evaluate the pressurized metered-dose inhaler (pMDI) critical technique errors among asthma and COPD patients, and to investigate the predictors of those errors. Methods: A cross-sectional, observational, and multi-centered study conducted in 3 major hospitals in the state of Penang, Malaysia. Asthma and COPD patients aged 18 years or older consented to the study were consecutively recruited if they were at least on 1 pMDI without mouthpiece spacer or facemask space. Direct observation of the patient's technique was recorded using a standard checklist and certain steps in the checklist were pre-determined as critical steps. The number of patients missed or incorrectly performed the steps including the critical steps were documented. Using logistic regression, the factors associated with the critical errors were determined, and the correlation was evaluated between age and pMDI knowledge score with critical inhalation steps score. Results: Of 209 patients observed, only less than half (40.7%) could perform all the critical pMDI steps correctly. Low education level was the only factor associated with critical inhaler errors. The increased knowledge of their inhaled medication was found to positively correlate with the correct critical inhalation steps. The critical errors also increase with the increased age of patients. Conclusion: The majority of the study population make inhalation error particularly in critical steps. Training and education intervention programs may help patients with lower education level, as well as those of advanced age and lack of knowledge of their inhaled medication because those populations are at a greater risk of committing critical errors in their use of pMDI.

Asian "Guan" Parenting and Life Satisfaction Among Adolescents in Malaysia: The Mediating Role of Filial Piety.

Literature on adolescent development has shown that parenting practices have positive relationships with adolescents' life satisfaction. Adolescents' life satisfaction improves when they have parents low in psychological control who uphold reciprocal self-disclosure in their communication. Guan parenting was found to correlate positively with adolescents' development. Therefore, it is methodologically important to replicate the investigation on the relationship between adolescents' life satisfaction and Guan parenting. Literature suggests that filial piety is shaped by parenting practices and adolescents who perceived intense parental concern, care, and involvement tend to uphold filial piety and express gratitude toward parents which may promote the adolescents' life satisfaction. In this study, mediation analysis was done to elucidate the relationship among parents' guan parenting style, filial piety, and life satisfaction on 606 adolescents (Mage=15.07; SDage=1.03; 52.1% females) in Malaysia. The adolescents were sampled through cluster sampling, and data were collected using self-administered questionnaires. The results showed positive relationship between paternal and maternal guan parenting with filial piety and adolescents' life satisfaction. Greater parents' filial piety was linked to higher life satisfaction among adolescents. Findings from the mediation models indicated the association among guan parenting with filial piety, gratitude toward parents, and higher life satisfaction. The findings also offered empirical evidence to the underlying mechanism of how guan parenting could affect adolescent life satisfaction via the mediating role of filial piety. The findings also supported the importance of culture-infused parenting in inculcating adolescents' filial piety besides establishing its link to life satisfaction in Asian families.

Outcomes in robot-assisted partial nephrectomy for imperative vs elective indications.

OBJECTIVES: To assess and compare peri-operative outcomes of patients undergoing robot-assisted partial nephrectomy (RAPN) for imperative vs elective indications. PATIENT AND METHODS: We retrospectively reviewed a multinational database of 3802 adults who underwent RAPN for elective and imperative indications. Laparoscopic or open partial nephrectomy (PN) were excluded. Baseline data for age, gender, body mass index, American Society of Anaesthesiologists score and PADUA score were examined. Patients undergoing RAPN for an imperative indication were matched to those having surgery for an elective indication using propensity scores in a 1:3 ratio. Primary outcomes included organ ischaemic time, operating time, estimated blood loss (EBL), rate of blood transfusions, Clavien-Dindo complications, conversion to radical nephrectomy (RN) and positive surgical margin (PSM) status. RESULTS: After propensity-score matching for baseline variables, a total of 304 patients (76 imperative vs 228 elective indications) were included in the final analysis. No significant differences were found between groups for ischaemia time (19.9 vs 19.8 min; P = 0.94), operating time (186 vs 180 min; P = 0.55), EBL (217 vs 190 mL; P = 0.43), rate of blood transfusions (2.7% vs 3.7%; P = 0.51), or Clavien-Dindo complications (P = 0.31). A 38.6% (SD 47.9) decrease in Day-1 postoperative estimated glomerular filtration rate was observed in the imperative indication group and an 11.3% (SD 45.1) decrease was observed in the elective indication group (P < 0.005). There were no recorded cases of permanent or temporary dialysis. There were no conversions to RN in the imperative group, and seven conversions (5.6%) in the elective group (P = 0.69). PSMs were seen in 1.4% (1/76) of the imperative group and in 3.3% of the elective group (7/228; P = 0.69). CONCLUSION: We conclude that RAPN is feasible and safe for imperative indications and demonstrates similar outcomes to those achieved for elective indications.

Predictors of erectile dysfunction after transperineal template prostate biopsy.

PURPOSE: To investigate the incidence and possible contributing factors of erectile dysfunction (ED) after transperineal template prostate biopsy (TTPB). MATERIALS AND METHODS: Males undergoing TTPB were prospectively administered a Sexual Health Inventory for Men (SHIM) questionnaire before biopsy and one month after. SHIM questionnaires were repeated at 3- and 9-months for males not receiving interventional treatment. Sexually inactive males were excluded. Interval change in SHIM categories based upon baseline characteristics were evaluated. Multivariable logistic regression models were used to evaluate predictors of change in SHIM score category. RESULTS: A total of 576 males were included in our sample. Of these, 450 (78%) males underwent their first biopsy. A decline in SHIM category within the immediate 4-weeks post-biopsy was reported by 167 males (31% of total eligible sample). Age was the strongest predictor of decline in SHIM category, the predicted probability of a decline in SHIM at age 50 was 10% (95% confidence interval [CI], 1%-19%), 32% at age 60 (95% CI, 25%-40%) and 36% at age 70 (95% CI, 29%-44%). For new onset ED, the predicted probability of ED within 4-weeks post-TTPB were 6.7% at age 50 (95% CI, 0%-15%), 26% at age 60 (95% CI, 17%-34%) and 31% at age 70 (95% CI, 21%-40%). CONCLUSIONS: Older age at biopsy is an independent predictor of immediate ED after TTPB in sexually active males. This association was observed in the subgroup with no pre-existing ED. These findings provide useful information when counselling males undergoing TTPB.

Comparison of perioperative, renal and oncologic outcomes in robotic-assisted versus open partial nephrectomy.

BACKGROUND: To compare perioperative, renal and oncological outcomes after robotic-assisted partial nephrectomy (RAPN) versus open partial nephrectomy (OPN) for the treatment of renal tumours. METHODS: All partial nephrectomies performed at a Metropolitan Urology Centre between 2010 and 2016 were analysed. Baseline data was collected for patient demographics, tumour characteristics (tumour size, laterality and polarity, RENAL scores), and perioperative variables (e.g. warm ischaemic time, operation time, estimated blood loss (EBL), length of stay). Tumour characteristics included malignancy, clinical stage, Fuhrman nuclear grade and surgical margin status. Day-1 post-operative serum creatinine, estimated glomerular filtration rate (eGFR) and 6-month eGFR stage were used for assessing renal function. RESULTS: Two hundred patients underwent partial nephrectomy between 2010 and 2016 (n = 200; 55 OPN versus 145 RAPN). Baseline data was similar between groups, except for lower age (P = 0.0001) and higher RENAL scores (P = 0.001) in the RAPN group. RAPN demonstrated significantly lower complication rates (P = 0.015), lesser EBL (P = <0.0001), shorter hospital stays (P = <0.001) and reduced positive tumour resection margins (P = 0.039). There was no significant difference in mean operation time between RAPN and OPN (137.2 (±48.0) OPN versus 146.07 (±35.91) RAPN; P = 0.16). No statistical difference was shown for post-operative eGFR stage between groups at Day-1 and 6-month post-surgery (P = 0.15 and P = 0.861, respectively). CONCLUSION: We present the largest reported Australian series on partial nephrectomy, confirming that a robotic-assisted approach is equivalent to OPN, with reduced complications, EBL, length of hospital stays and fewer positive margins, even when resecting more complex tumours.

Corrigendum: Hepatic S6K1 Partially Regulates Lifespan of Mice with Mitochondrial Complex I Deficiency.

[This corrects the article on p. 113 in vol. 8, PMID: 28919908.].

Hepatic S6K1 Partially Regulates Lifespan of Mice with Mitochondrial Complex I Deficiency.

The inactivation of ribosomal protein S6 kinase 1 (S6K1) recapitulates aspects of caloric restriction and mTORC1 inhibition to achieve prolonged longevity in invertebrate and mouse models. In addition to delaying normative aging, inhibition of mTORC1 extends the shortened lifespan of yeast, fly, and mouse models with severe mitochondrial disease. Here we tested whether disruption of S6K1 can recapitulate the beneficial effects of mTORC1 inhibition in the Ndufs4 knockout (NKO) mouse model of Leigh Syndrome caused by Complex I deficiency. These NKO mice develop profound neurodegeneration resulting in brain lesions and death around 50-60 days of age. Our results show that liver-specific, as well as whole body, S6K1 deletion modestly prolongs survival and delays onset of neurological symptoms in NKO mice. In contrast, we observed no survival benefit in NKO mice specifically disrupted for S6K1 in neurons or adipocytes. Body weight was reduced in WT mice upon disruption of S6K1 in adipocytes or whole body, but not altered when S6K1 was disrupted only in neurons or liver. Taken together, these data indicate that decreased S6K1 activity in liver is sufficient to delay the neurological and survival defects caused by deficiency of Complex I and suggest that mTOR signaling can modulate mitochondrial disease and metabolism via cell non-autonomous mechanisms.

De novo analysis of the transcriptome of Pratylenchus zeae to identify transcripts for proteins required for structural integrity, sensation, locomotion and parasitism.

The root lesion nematode Pratylenchus zeae, a migratory endoparasite, is an economically important pest of major crop plants (e.g. cereals, sugarcane). It enters host roots, migrates through root tissues and feeds from cortical cells, and defends itself against biotic and abiotic stresses in the soil and in host tissues. We report de novo sequencing of the P. zeae transcriptome using 454 FLX, and the identification of putative transcripts encoding proteins required for movement, response to stimuli, feeding and parasitism. Sequencing generated 347,443 good quality reads which were assembled into 10,163 contigs and 139,104 singletons: 65% of contigs and 28% of singletons matched sequences of free-living and parasitic nematodes. Three-quarters of the annotated transcripts were common to reference nematodes, mainly representing genes encoding proteins for structural integrity and fundamental biochemical processes. Over 15,000 transcripts were similar to Caenorhabditis elegans genes encoding proteins with roles in mechanical and neural control of movement, responses to chemicals, mechanical and thermal stresses. Notably, 766 transcripts matched parasitism genes employed by both migratory and sedentary endoparasites in host interactions, three of which hybridized to the gland cell region, suggesting that they might be secreted. Conversely, transcripts for effectors reported to be involved in feeding site formation by sedentary endoparasites were conspicuously absent. Transcripts similar to those encoding some secretory-excretory products at the host interface of Brugia malayi, the secretome of Meloidogyne incognita and products of gland cells of Heterodera glycines were also identified. This P. zeae transcriptome provides new information for genome annotation and functional analysis of possible targets for control of pratylenchid nematodes.

Negative automatic thoughts as a mediator of the relationship between depression and suicidal behaviour in an at-risk sample of Malaysian adolescents.

BACKGROUND: This study examined the mediating role of negative automatic thoughts in the relationship between depression and suicidal behaviour in a sample of at-risk Malaysian adolescents. METHOD: A total of 1441 adolescents were initially recruited via multistage cluster sampling. Subsequently, 294 at-risk adolescents were selected for further analyses through a specified cut-off score. RESULTS: The results showed significant positive relationships among the study variables. Specifically, negative automatic thoughts emerged as a significant mediator in the relation between depression and suicidal behaviour (z = 7.15, p < .001). CONCLUSIONS: The findings suggest that depressed adolescents are at high risk for a host of negative thought processes which in turn lead to suicidal behaviour. The study limitations and recommendations for further research are discussed.

Gene silencing in root lesion nematodes (Pratylenchus spp.) significantly reduces reproduction in a plant host.

Root lesion nematodes (RLNs, Pratylenchus species) are a group of economically important migratory endoparasitic plant pathogens that attack host roots of major crops such as wheat and sugarcane, and can reduce crop yields by 7-15%. Pratylenchus thornei and Pratylenchus zeae were treated with double stranded RNA (dsRNA) to study gene silencing, (RNA interference, RNAi), as a potential strategy for their control. Mixed stages of nematodes of both species ingested dsRNA when incubated in a basic soaking solution in the presence of the neurostimulant octopamine. Incubation for up to 16 h in soaking solutions containing 10-50 mM octopamine, 0.1-1.0 mg/mL FITC, and 0.5-6 mM spermidine did not affect vitality. Spermidine phosphate salt hexahydrate rather than spermidine or spermidine trihydrochloride increased uptake of FITC by nematodes, and this resulted in more effective gene silencing. Silencing pat-10 and unc-87 genes of P. thornei and P. zeae resulted in paralysis and uncoordinated movements in both species, although to a higher degree in P. thornei. There was also a greater reduction in transcript of both genes in P. thornei indicating that it may be more susceptible to RNAi. For P. thornei treated with dsRNA of pat-10 and unc-87 there was a significant reduction (77-81%) in nematode reproduction on carrot mini discs over a 5 week period. The results show that RLNs are clearly amenable to gene silencing, and that in planta delivery of dsRNA to target genes in these nematodes should confer host resistance. Moreover, for the two genes, dsRNA derived from either nematode species silenced the corresponding gene in both species. This implies cross-species control of nematodes via RNAi is possible.

Adverse life events, area socio-economic disadvantage, and adolescent psychopathology: The role of closeness to grandparents in moderating the effect of contextual stress.

The study, using data from 801 11-16-year-olds clustered in 68 schools across England and Wales, tested whether closeness to grandparents moderates the association between contextual stress and adolescent psychopathology and prosocial behavior, measured with the strengths and difficulties questionnaire (SDQ). Contextual stress was measured at both school area level (assessed with the index of multiple deprivation) and child level (assessed, as life stress, with the number of proximal and distal adverse life events experienced). At baseline, area stress (multiple deprivation) was unrelated to psychopathology (SDQ), and although both proximal (during the last 12 months) and distal (before the last 12 months) life stress was associated with broad and specific child psychopathology, the association with proximal life stress was stronger. Closeness to the most significant grandparent moderated both the effect of proximal life stress on hyperactivity and broad psychopathology, and the effect of the interaction between distal and proximal life stress on broad and externalizing psychopathology. These findings suggest that the role of grandparents deserves further attention in future investigations of the development of resilience in youth.