Search results for: psychosocial cybercrime

Authors: Marina Charalambous, Phivos Phylactou, Thekla Elriz, Loukia Psychogios, Jean-Marie Annoni

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Background: Evidence-based practices for the evaluation and treatment of people with aphasia (PWA) in Greek are mainly impairment-based. Functional and multimodal communication is usually under assessed and neglected by clinicians. This study explores the adaptation and psychometric testing of the Greek (GR) version of The Scenario Test. The Scenario Test assesses the everyday functional communication of PWA in an interactive multimodal communication setting with the support of an active communication facilitator. Aims: To define the reliability and validity of The Scenario Test GR and discuss its clinical value. Methods & Procedures: The Scenario Test-GR was administered to 54 people with chronic stroke (6+ months post-stroke): 32 PWA and 22 people with stroke without aphasia. Participants were recruited from Greece and Cyprus. All measures were performed in an interview format. Standard psychometric criteria were applied to evaluate reliability (internal consistency, test-retest, and interrater reliability) and validity (construct and known – groups validity) of the Scenario Test GR. Video analysis was performed for the qualitative examination of the communication modes used. Outcomes & Results: The Scenario Test-GR shows high levels of reliability and validity. High scores of internal consistency (Cronbach’s α = .95), test-retest reliability (ICC = .99), and interrater reliability (ICC = .99) were found. Interrater agreement in scores on individual items fell between good and excellent levels of agreement. Correlations with a tool measuring language function in aphasia (the Aphasia Severity Rating Scale of the Boston Diagnostic Aphasia Examination), a measure of functional communication (the Communicative Effectiveness Index), and two instruments examining the psychosocial impact of aphasia (the Stroke and Aphasia Quality of Life questionnaire and the Aphasia Impact Questionnaire) revealed good convergent validity (all ps< .05). Results showed good known – groups validity (Mann-Whitney U = 96.5, p < .001), with significantly higher scores for participants without aphasia compared to those with aphasia. Conclusions: The psychometric qualities of The Scenario Test-GR support the reliability and validity of the tool for the assessment of functional communication for Greek-speaking PWA. The Scenario Test-GR can be used to assess multimodal functional communication, orient aphasia rehabilitation goal setting towards the activity and participation level, and be used as an outcome measure of everyday communication. Future studies will focus on the measurement of sensitivity to change in PWA with severe non-fluent aphasia.

Keywords: the scenario test GR, functional communication assessment, people with aphasia (PWA), tool validation

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Authors: Obiageli Helen Ezeh, Chuks Clement Ezeh

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Background: It is estimated that more than 330 million persons are living with HIV-infection globally and in Nigeria about 3.4 persons are living with the infection, with an annual death rate of 180,000. Psychological morbidity often accompany chronic illnesses and may be associated with substance abuse, poor health seeking behavior and adherence to treatment program; it may worsen existing health problems and the overall quality of life. Until the burden is effectively identified, intervention cannot be planned. Until there is a cure, the goal is to manage and cope effectively with HIV-infection. Little if any studies have been done in this area in the North West geo-political zone of Nigeria. The study would help to identify high risk groups and prevent the progression and spread of the infection. Aim: To identify HIV-infected persons with psychological morbidity, accessing HIV- clinic at Shika Hospital, Zaria, Kaduna State; and analyze their socio-demographic profile. Methods: A cross sectional descriptive study was carried out to assess and analyze the socio-demographic characteristics of HIV-infected persons attending Shika hospital Zaria Nigeria, who screened positive for psychological morbidity. A total of 109 HIV-infected persons receiving HAART at Shika clinic, Zaria, Kaduna State, Nigeria, were administered questionnaires, the General Health Questionnaire (GHQ-12)measuring psychological morbidity and socio-demographic data. The participants ranged in age between 18 and 75 years. Results: Data were analyzed using SPSS software 15. Both descriptive and inferential Statistics were performed on the data. Results indicate a total prevalent rate of psychological morbidity of 78 percent among participants. Of this, about 16.2 percent were severely distressed, 25.1 percent moderately distressed and 36.7percent were mildly distressed. More females (65 percent of those with psychological morbidity) were found to be distressed than their male (55 percent) counterparts. It was (44 percent) for patients whose HIV-infection was of relatively shorter duration(2-4 years) than those of longer duration(5-9 years; and 10 years/above). The age group (21-30 years) was the most affected (35 percent). The rate was also 55 percent for Christians and 45 percent for Muslims. For married patients with partners it was 20 percent and for singles 30 percent; for the widowed (12 percent) and divorced (38 percent). At the level of tribal/ethnic groups, it was 13 percent for Ibos, 22 percent for Yorubas, 27 percent for Hausas and 33 percent for all the other minority tribes put together. Conclusion/Recommendation: The study has been able to identify the presence of psychological morbidity among HIV-infected persons as high and analyze the socio-demographic factors associated with it as significant. Periodic screening of HIV-infected persons for psychological morbidity and psychosocial intervention was recommended.

Keywords: socio-demographics, psychological morbidities, HIV-Infection, HAART

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Authors: Irene Kretchy, Frances Owusu-Daaku, Samuel Danquah

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Hypertension is the leading risk factor for cardiovascular diseases, and a major cause of death and disability worldwide. This study examined whether psychosocial variables influenced patients’ perception and experience of side effects of their medicines, how they coped with these experiences and the impact on mental health and medication adherence to conventional hypertension therapies. Methods: A hospital-based mixed methods study, using quantitative and qualitative approaches was conducted on hypertensive patients. Participants were asked about side effects, medication adherence, common psychological symptoms, and coping mechanisms with the aid of standard questionnaires. Information from the quantitative phase was analyzed with the Statistical Package for Social Sciences (SPSS) version 20. The interviews from the qualitative study were audio-taped with a digital audio recorder, manually transcribed and analyzed using thematic content analysis. The themes originated from participant interviews a posteriori. Results: The experiences of side effects – such as palpitations, frequent urination, recurrent bouts of hunger, erectile dysfunction, dizziness, cough, physical exhaustion - were categorized as no/low (39.75%), moderate (53.0%) and high (7.25%). Significant relationships between depression (x 2 = 24.21, P < 0.0001), anxiety (x 2 = 42.33, P < 0.0001), stress (x 2 = 39.73, P < 0.0001) and side effects were observed. A logistic regression model using the adjusted results for this association are reported – depression [OR = 1.9 (1.03 – 3.57), p = 0.04], anxiety [OR = 1.5 (1.22 – 1.77), p = < 0.001], and stress [OR = 1.3 (1.02 – 1.71), p = 0.04]. Side effects significantly increased the probability of individuals to be non-adherent [OR = 4.84 (95% CI 1.07 – 1.85), p = 0.04] with social factors, media influences and attitudes of primary caregivers further explaining this relationship. The personal adoption of medication modifying strategies, espousing the use of complementary and alternative treatments, and interventions made by clinicians were the main forms of coping with side effects. Conclusions: Results from this study show that contrary to a biomedical approach, the experience of side effects has biological, social and psychological interrelations. The result offers more support for the need for a multi-disciplinary approach to healthcare where all forms of expertise are incorporated into health provision and patient care. Additionally, medication side effects should be considered as a possible cause of non-adherence among hypertensive patients, thus addressing this problem from a Biopsychosocial perspective in any intervention may improve adherence and invariably control blood pressure.

Keywords: biopsychosocial, hypertension, medication adherence, psychological disorders

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Authors: Dorit Olenik-Shemesh, Tali Heiman

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Aggressive peer behaviors, particularly bullying and cyberbullying (CB) victimization during adolescence, are strongly and consistently linked to decreased levels of subjective well-being, potentially hindering a healthy and consistent developmental process. These negative effects might be expressed in emotional, physical, and behavioral difficulties. Adolescents victims of bullying/CB present more depressive moods, more loneliness, and more suicidal thoughts, while adolescents who had never been victims of bullying and CB acts present higher levels of well-being. These difficulties in their lives may be both a consequence of and a partial explanation for bullying/CB victimization. Interpersonal behavior styles and psychosocial factors may interact to create a vicious cycle in which adolescents place themselves at risk, which might explain the reduced well-being reported among victims. Yet, to the best of our knowledge, almost no study has examined the effect of two key variables in adolescents' lives, resilience and self-concept, in the relationship between bullying/CB victimization and low levels of psychological well-being among adolescents. Resilience is defined as the individual's capacity of maintaining stable functioning and make adjustments in the face of adversity; a capacity that promotes efficiently coping with environmental stressors and protects from psycho-social difficulties when facing various challenges. Self-concept relates to the way we perceive ourselves, influenced by many forces, including our interactions with the surroundings; a collection of beliefs about oneself. Accordingly, the current study has examined the possible mediating effect of these two main positive personal variables, resilience, and self-concept, through a mediation model analysis. 507 middle school students aged 11–16 (53% boys, 47% girls) completed questionnaires regarding bullying and CB behaviors, psychological well-being, resilience, and self-concept. A mediation model analysis was performed, whereas the hypothesized mediation model was accepted in full. More specifically, it was found that both self-concept and resilience mediated the relationship between bullying/CB victimization and a sense of well-being. High levels of both variables might buffer against a potential decrease in well-being associated with youth bullying/CB victimization. No gender differences were found, except a small stronger effect of resilience on well-being for boys. The study results suggest focusing on specific personal positive variables when developing youth intervention programs, creating an infrastructure for new programs that address increasing resilience and self-concept in schools and family-school contexts. Such revamped programs could diminish bullying/CB acts and the harmful negative implications for youth well-being. Future studies that will incorporate longitudinal data may further deepen the understanding of these examined relationships.

Keywords: adolescents, well being, bullying/CB victimization, resilience, self-concept

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Authors: G. Melo, J. Felix, S. Maciel, C. Fernandes, W. Rodrigues

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In Brazilian public policy, the Centres of Reference for Social Assistance (CRAS in Portuguese) are part of the Unified Social Assistance System (SUAS in Portuguese). SUAS is responsible for addressing spontaneous or currently active cases that are brought forth from other services in the social assistance network. The following case was reviewed by CRAS’s team in Recife, Brazil, after a complaint of child abuse was filed against the mother of a 7-year-old girl by the girl’s aunt. The girl is the daughter of an incestuous relationship between her mother and her older brother. The complaint was registered by service staff and five interventions were subsequently carried out on behalf of the child. These interventions provided a secure place for dialogue with both the child and her family and allowed for an investigation of the abuse to proceed. They took place in the child’s school as well as her aunt’s residence. At school, the child (with her classmates) watched a video and listened to a song about the prevention of child abuse. This was followed up with a second intervention to determine any signs of Post-Traumatic Stress Disorder (PTSD), by having the child play with the mobile app ‘My Angela’. Books on the themes of family and fear were also read to the child on different occasions at her school – after every intervention she was asked to draw something related to fear and her concept of a family. After the interventions and discussing the case as a team, we reached several conclusions: 1) The child did not appear to show any symptoms of PTSD; 2) She normally fantasized about her future and life story; 3) She did not allow herself to be touched by strangers with whom she lacks a close relationship (such as classmates or her teacher); 4) Through her drawings, she reproduced the conversations she had had with the staff; 5) She habitually covered her drawings when asked questions about the abuse. In this particular clinical case, we want to highlight that the role of the Psychologist’s intervention at CRAS is to attempt to resolve the issue promptly (and not to develop a prolonged clinical study based on traditional methods), by making use of the available tools from the social assistance network, and by making referrals to the relevant authorities, such as the Public Ministry, so that final protective actions can be taken and enforced. In this case, the Guardian Council of the Brazilian Public Ministry was asked to transfer the custody of the child to her uncle. The mother of the child was sent to a CAPS (Centre for Psychosocial Care), having been diagnosed with psychopathology. The child would then participate in NGO programs that allow for a gradual reduction of social exposure to her mother before being transferred to her uncle’s custody in Sao Paulo.

Keywords: child abuse, intervention, social psychology, violence

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Authors: Phillipa Denise Peart

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Black Asian and Minority Ethnic (BAME) people are more at risk of developing mental health disorders because they are more exposed to unfavorable social, economic, and environmental circumstances. These include housing, education, employment, community development, stigma, and discrimination. However, the majority of BAME mental health intervention studies focus on treatment with therapeutically effective drugs and use basic economic methods to evaluate their effectiveness; as a result, little is invested in the economic assessment of psychosocial interventions in BAME mental health. The UK government’s austerity programme and reduced funds for mental health services, has increased the need for the evaluation and assessment of initiatives to focus on value for money. The No Health without Mental Health policy (2011) provides practice guidance to practitioners, but there is little or no mention of the need to provide mental health initiatives targeted at BAME communities that are effective in terms of their impact and the cost-effectiveness. This, therefore, appears to contradict with and is at odds with the wider political discourse, which suggests there should be an increasing focus on health economic evaluation. As a consequence, it could be argued that whilst such policies provide direction to organisations to provide mental health services to the BAME community, by not requesting effective governance, assurance, and evaluation processes, they are merely paying lip service to address these problems and not helping advance knowledge and practice through evidence-based approaches. As a result, BAME communities suffer due to lack of efficient resources that can aid in the recovery process. This research study explores the mental health initiatives targeted at BAME communities, and analyses the techniques used when examining the cost effectiveness of mental health initiatives for BAME mental health communities. Using critical discourse analysis as an approach and method, mental health services will be selected as case studies, and their evaluations will be examined, alongside the political drivers that frame, shape, and direct their work. In doing so, it will analyse what the mental health policies initiatives are, how the initiatives are directed and demonstrate how economic models of evaluation are used in mental health programmes and how the value for money impacts and outcomes are articulated by mental health programme staff. It is anticipated that this study will further our understanding in order to provide adequate mental health resources and will deliver creative, supportive research to ensure evaluation is effective for the government to provide and maintain high quality and efficient mental health initiatives targeted at BAME communities.

Keywords: black, Asian and ethnic minority, economic models, mental health, health policy

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Authors: Aziza Al-Sawafi

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Introduction: The evidence of family interventions in schizophrenia is robust primarily in high-income settings. However, they have been adapted to other settings and cultures to improve effectiveness and acceptability. In Oman, there is limited integration of psychosocial interventions in the treatment of schizophrenia. Therefore, the adaptation of family intervention to the Omani culture may facilitate its uptake. Most service users in Oman live with their families outside the healthcare system, and nothing is known about their experience, needs, or resources. Furthermore, understanding caregivers' and mental health professionals' preferences, perceptions, and experience is a fundamental element in the process of intervention development. Therefore, this study aims to develop a culturally sensitive, feasible, and acceptable family intervention for relatives living with schizophrenia in Oman. Method: The Medical Research Council's framework for the evaluation of complex health care interventions provided the conceptual structure for the study. The development phase was carried out, which involved three stages: 1) systematically reviewing the available literature regarding culturally adapted family interventions in the Arab world 2) In-depth interviews with caregivers to explore their experience and perceived needs and preferences regarding intervention 3) A focus group study involving health professionals to explore the acceptability and feasibility of delivering the family intervention in the Omani context. Data synthesis determined the design of the proposed intervention according to the findings obtained from the previous stages. Results: Stage one: The systematic review found limited evidence of culturally-adapted family interventions in the Arab region. However, the cultural adaptation process was comprehensive, and the implementation was reported to be feasible and acceptable. Stage two: The experience of family caregivers illuminated four main themes: burden, stigma, violence, and family needs. Burdens of care included objective and subjective burdens, positive feelings, and coping mechanisms. Caregivers gave their opinion about the content and preference of the intervention from their personal experiences. Stage three: mental health professionals discussed the delivery system of the intervention from a clinical standpoint concerning issues and barriers to implementation. They recommended modifications to the components of the intervention to ensure its acceptability and feasibility in the local setting. Data synthesis was carried out, and the intervention was designed. Conclusion: This study provides evidence of the potential applicability and acceptability of a culturally sensitive family intervention for families of individuals with schizophrenia in Oman. However, more work needs to be done to test the feasibility of the study and overcome the practical challenges.

Keywords: cultural-adaptation, family intervention, Oman, schizophrenia

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Authors: Einat E. Peles, Shaul Schreiber, Miriam Adelson

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Background: Since established more than 50 years ago, methadone maintenance treatment (MMT) is the most effective treatment for opioid addiction, a chronic relapsing brain disorder that became an epidemic in western societies. Treatment includes daily individual optimal medication methadone dose (a long acting mu opioid receptor full agonist), accompanied with psychosocial therapy. It is well established that the longer retention in treatment the better outcome and survival occur. It reduces the likelihood to infectious diseases and overdose death that associated with drug injecting, enhanced social rehabilitation and eliminate criminal activity, and lead to healthy productive life. Aim: To evaluate predictors for long term retention in treatment we analyzed our prospective follow up of a major MMT clinic affiliated to a big tertiary medical center. Population Methods: Between June 25, 1993, and June 24, 2016, all 889 patients ( ≥ 18y) who ever admitted to the clinic were prospectively followed-up until May 2017. Duration in treatment from the first admission until the patient quit treatment or until the end of follow-up (24 years) was taken for calculating cumulative retention in treatment using survival analyses (Kaplan Meier) with log-rank and Cox regression for multivariate analyses. Results: Of the 889 patients, 25.2% were females who admitted to treatment at younger age (35.0 ± 7.9 vs. 40.6 ± 9.8, p < .0005), but started opioid usage at same age (22.3 ± 6.9). In addition to opioid use, on admission to MMT 58.5% had positive urine for benzodiazepines, 25% to cocaine, 12.4% to cannabis and 6.9% to amphetamines. Hepatitis C antibody tested positive in 55%, and HIV in 7.8% of the patients and 40%. Of all patients, 75.7% stayed at least one year in treatment, and of them, 67.7% stopped opioid usage (based on urine tests), and a net reduction observed in all other substance abuse (proportion of those who stopped minus proportion of those who have started). Long term retention up to 24 years was 8.0 years (95% Confidence Interval (CI) 7.4-8.6). Predictors for longer retention in treatment (Cox regression) were being older on admission ( ≥ 30y) Odds Ratio (OR) =1.4 (CI 1.1-1.8), not abusing opioids after one year OR=1.8 (CI 1.5-2.1), not abusing benzodiazepine after one year OR=1.7 (CI 1.4-2.1) and treating with methadone dose ≥ 100mg/day OR =1.8 (CI 1.5-2.3). Conclusions: Treating and following patients over 24 years indicate success of two main outcomes, high rate of retention after one year (75.7%) and high proportion of opiate abuse cessation (67.7%). As expected, longer cumulative retention was associated with patients treated with high adequate methadone dose that successfully result in opioid cessation. Based on these findings, in order to reduce morbidity and mortality, we find the establishment of more MMT clinics within a general hospital, a most urgent necessity.

Keywords: methadone maintenance treatment, epidemic, opioids, retention

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Authors: Wisam Ismail, Chole Wright, Elizabeth Baker, Cathy Tait, Mohamed Salhab, Richard Linforth

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Background: Post-mastectomy breast reconstruction is an important treatment option for women with breast cancer with psychosocial, emotional and quality of life benefits. Despite this, Asian patients are one-fifth as likely as Caucasian patients to undergo reconstruction after mastectomy. Aim: This study aimed to assess the difference in breast reconstruction rates between Asian and Caucasian patients treated at Bradford Teaching Hospitals between May 2011 – December 2015.The long-term goal is to equip healthcare professionals to improve breast cancer treatment outcome by increasing breast reconstruction rates in this sub-population. Methods: All patients undergoing mastectomy were identified using a prospectively collected departmental database. Further data was obtained via retrospective electronic case note review. Bradford city population is about 530.000 by the end of 2015, with 67.44% of the city's population was White ethnic groups and 26.83% Asian Ethnic Groups (UK population consensus). The majority of Asian population speaks Urdu, hence an Urdu speaking breast care nurse was appointed to facilitate communications and deliver a better understanding of the reconstruction options and pathways. Statistical analysis was undertaken using the SAS program. Patients were stratified by age, self-reported ethnicity, axillary surgery and reconstruction. Relative odds were calculated using univariate and multivariate logistic regression analyses with adjustment for known confounders. An Urdu speaking breast care nurse was employed throughout this period to facilitate communication and patient decision making. Results: 506 patients underwent Mastectomy over 5 years. 72 (14%) Asian v. 434 (85%) Caucasian. Overall median age is 64 years (SD1.1). Asian median age is 62 (SD0.9), versus Caucasian 65 (SD1.2). Total axillary clearance rate was 30% (42% Asian v.30% Caucasian). Overall reconstruction rate was 126 patients (28.9%).Only 6 of 72 Asian patients (<1%) underwent breast reconstruction versus 121of 434 Caucasian (28%) (p < 0.04), Odds ratio 0.68, (95% confidence interval 0.57-0.79). Conclusions: There is a significant difference in post-mastectomy reconstruction rates between Asian and Caucasian patients. This difference is likely to be multi-factorial. Higher rates of axillary clearance in Asian patients might suggest later disease presentation and/or higher rates of subsequent adjuvant therapy, both of which, can impact on the suitability of breast reconstruction. Strategies aimed at reducing racial disparities in breast reconstruction should include symptom awareness to enable earlier presentation and facilitated communication to ensure informed decision-making.

Keywords: aesthetic, Asian, breast, reconstruction

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Authors: Fabiola Xavier Leal, Lara Campanharo, Sueli Aparecida Rodrigues Lucas

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The phenomenon of judicialization in health policy brings with it a great deal of problematization, but in general, it means that some issues that were previously solved by traditional political bodies are being decided by the Judiciary bodies. It is, therefore, a controversial topic that has generated many reflections both in the academic and political fields, considering that not only a dispute of public funds is at stake, but also the debate on access to social rights provided for in the Brazilian Federal Constitution of 1988 and in the various public policies, such as healthcare. With regard to the phenomenon in the Mental Health Policy focusing on people who use drugs, the disputes that permeate this scenario are evident: moral, cultural, sanitary, economic, psychological aspects. There are also the individual and collective dimensions of suffering. And in this process, we all question: What is the role of the Brazilian State in this matter? In this context, another question that needs to be answered is the amount spent on this procedure in the state of Espírito Santo (ES), Brazil (in the last 04 years, around R$121,978,591.44 were paid only for compulsory hospitalization of individuals) in the field in question, which is the financing of the services of the Psychosocial Care Network (RAPS). Therefore, this article aims to problematize the phenomenon of judicialization in Mental Health Policy through the compulsory hospitalization of people who use drugs in Espírito Santo (ES). We proposed a study that sought to understand how this has been occurring and making an impact on the provision of RAPS services in the Espírito Santo scenario. Therefore, the general objective of this study is to analyze the expenses with compulsory hospitalizations for drug use carried out by the State Health Department (SESA) between 2014 and 2019, in which we will seek to identify its destination and the impact of these actions on public health policy. For the purposes of this article, we will present the preliminary data of this study, such as the amount spent by the state and the receiving institutions. For data collection, the following data sources were used: documents available publicly on the Transparency Portal (payments made per year, institutions that received, subjects hospitalized, period and the amount of the daily rates paid); as well as the processes generated by SESA through its own system - ONBASE. For qualitative analysis, content analysis was used; and for quantitative analysis, descriptive statistics was used. Thus, we seek to problematize the issue of judicialization for compulsory hospitalizations, considering the current situation in which this resource has been widely requested to legitimize the war on drugs. This scenario highlights the moral-legal discourse, pointing out strategies through the control of bodies and through faith as an alternative.

Keywords: compulsory hospitalization, drugs, judicialization, mental health

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Authors: Sunidhi Sood, Drashti Narendrakumar Shah, Aakarsh Sharma, Nirali Harsh Panchal, Maria Karizhenskaia

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Cancer is a global health concern, causing a significant number of deaths, with chemotherapy being a standard treatment method. However, chemotherapy often induces side effects that profoundly impact the physical and emotional well-being of patients, lowering their overall quality of life (QoL). This research aims to investigate the potential of music and art therapy as holistic adjunctive therapy for cancer patients undergoing chemotherapy, offering non-pharmacological support. This is achieved through a comprehensive review of existing literature with a focus on the following themes, including stress and anxiety alleviation, emotional expression and coping skill development, transformative changes, and pain management with mood upliftment. A systematic search was conducted using Medline, Google Scholar, and St. Lawrence College Library, considering original, peer-reviewed research papers published from 2014 to 2023. The review solely incorporated studies focusing on the impact of music and art therapy on the health and overall well-being of cancer patients undergoing chemotherapy in North America. The findings from 16 studies involving pediatric oncology patients, females affected by breast cancer, and general oncology patients show that music and art therapies significantly reduce anxiety (standardized mean difference: -1.10) and improve perceived stress (median change: -4.0) and overall quality of life in cancer patients undergoing chemotherapy. Furthermore, music therapy has demonstrated the potential to decrease anxiety, depression, and pain during infusion treatments (average changes in resilience scale: 3.4 and 4.83 for instrumental and vocal music therapy, respectively). This data calls for consideration of the integration of music and art therapy into supportive care programs for cancer patients undergoing chemotherapy. Moreover, it provides guidance to healthcare professionals and policymakers, facilitating the development of patient-centered strategies for cancer care in Canada. Further research is needed in collaboration with qualified therapists to examine its applicability and explore and evaluate patients' perceptions and expectations in order to optimize the therapeutic benefits and overall patient experience. In conclusion, integrating music and art therapy in cancer care promises to substantially enhance the well-being and psychosocial state of patients undergoing chemotherapy. However, due to the small population size considered in existing studies, further research is needed to bridge the knowledge gap and ensure a comprehensive, patient-centered approach, ultimately enhancing the quality of life (QoL) for individuals facing the challenges of cancer treatment.

Keywords: anxiety, cancer, chemotherapy, depression, music and art therapy, pain management, quality of life

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Authors: Nalini Kaul, Barrie Drewitt, Elsie Kohoot

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Hyperpigmentation is the third most common pigmentary disorder where dermatologic treatment is sought. It affects all ages resulting in skin darkening because of melanin accumulation. An uneven skin tone because of either exposure to the sun (solar lentigos/age spots/sun spots or skin disruption following acne, or rashes (post-inflammatory hyperpigmentation -PIH) or hormonal changes (melasma) can lead to significant psychosocial impairment. Dyschromia is a result of various alterations in biochemical processes regulating melanogenesis. Treatments include the daily use of sunscreen with lightening, brightening, and exfoliating products. Depigmentation is achieved by various depigmenting agents: common examples are hydroquinone, arbutin, azelaic acid, aloesin, mulberry, licorice extracts, kojic acid, niacinamide, ellagic acid, arbutin, green tea, turmeric, soy, ascorbic acid, and tranexamic acid. These agents affect pigmentation by interfering with mechanisms before, during, and after melanin synthesis. While immediate correction is much sought after, patience and diligence are key. Our objective was to assess the effects of a facial product with pigmentation treatment and UV protection in 35 healthy F (35-65y), meeting the study criteria. Subjects with mild to moderate hyperpigmentation and fine lines with no use of skin-lightening products in the last six months or any dermatological procedures in the last twelve months before the study started were included. Efficacy parameters included expert clinical grading for hyperpigmentation, radiance, skin tone & smoothness, fine lines, and wrinkles bioinstrumentation (Corneometer®, Colorimeter®), digital photography and imaging (Visia-CR®), and self-assessment questionnaires. Safety included grading for erythema, edema, dryness & peeling and self-assessments for itching, stinging, tingling, and burning. Our results showed statistically significant improvement in clinical grading scores, bioinstrumentation, and digital photos for hyperpigmentation-brown spots, fine lines/wrinkles, skin tone, radiance, pores, skin smoothness, and overall appearance compared to baseline. The product was also well-tolerated and liked by subjects. Conclusion: Facial hyperpigmentation is of great concern, and treatment strategies are increasingly sought. Clinical trials with both subjective and objective assessments, imaging analyses, and self-perception are essential to distinguish evidence-based products. The multifunctional cosmetic product tested in this clinical study showed efficacy, tolerability, and subject satisfaction in reducing hyperpigmentation and global photoaging.

Keywords: hyperpigmentation; photoaging, clinical testing, expert visual evaluations, bio-instruments

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Authors: Aoxue Yang, Weili Tian, Haikun Liu

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Brain tumor stem cells (BTSCs) are resistant to therapy and give rise to recurrent tumors. These rare and elusive cells are likely to disseminate during cancer progression, and some may enter dormancy, remaining viable but not increasing. The identification of dormant BTSCs is thus necessary to design effective therapies for glioblastoma (GBM) patients. Glucocorticoids (GCs) are used to treat GBM-associated edema. However, glucocorticoids participate in the physiological response to psychosocial stress, linked to poor cancer prognosis. This raises concern that glucocorticoids affect the tumor and BTSCs. Identifying markers specifically expressed by brain tumor stem cells (BTSCs) may enable specific therapies that spare their regular tissue-resident counterparts. By ribosome profiling analysis, we have identified that glycerol-3-phosphate dehydrogenase 1 (GPD1) is expressed by dormant BTSCs but not by NSCs. Through different stress-induced experiments in vitro, we found that only dexamethasone (DEXA) can significantly increase the expression of GPD1 in NSCs. Adversely, mifepristone (MIFE) which is classified as glucocorticoid receptors antagonists, could decrease GPD1 protein level and weaken the proliferation and stemness in BTSCs. Furthermore, DEXA can induce GPD1 expression in tumor-bearing mice brains and shorten animal survival, whereas MIFE has a distinct adverse effect that prolonged mice lifespan. Knocking out GR in NSC can block the upregulation of GPD1 inducing by DEXA, and we find the specific sequences on GPD1 promotor combined with GR, thus improving the efficiency of GPD1 transcription from CHIP-Seq. Moreover, GR and GPD1 are highly co-stained on GBM sections obtained from patients and mice. All these findings confirmed that GR could regulate GPD1 and loss of GPD1 Impairs Multiple Pathways Important for BTSCs Maintenance GPD1 is also a critical enzyme regulating glycolysis and lipid synthesis. We observed that DEXA and MIFE could change the metabolic profiles of BTSCs by regulating GPD1 to shift the transition of cell dormancy. Our transcriptome and lipidomics analysis demonstrated that cell cycle signaling and phosphoglycerides synthesis pathways contributed a lot to the inhibition of GPD1 caused by MIFE. In conclusion, our findings raise concern that treatment of GBM with GCs may compromise the efficacy of chemotherapy and contribute to BTSC dormancy. Inhibition of GR can dramatically reduce GPD1 and extend the survival duration of GBM-bearing mice. The molecular link between GPD1 and GR may give us an attractive therapeutic target for glioblastoma.

Keywords: cancer stem cell, dormancy, glioblastoma, glycerol-3-phosphate dehydrogenase 1, glucocorticoid receptor, dexamethasone, RNA-sequencing, phosphoglycerides

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Authors: Gianluca Castelnuovo, Giada Pietrabissa, Gian Mauro Manzoni, Margherita Novelli, Emanuele Maria Giusti, Roberto Cattivelli, Enrico Molinari

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Diabesity could be defined as a new global epidemic of obesity and being overweight with many complications and chronic conditions. Such conditions include not only type 2 diabetes, but also cardiovascular diseases, hypertension, dyslipidemia, hypercholesterolemia, cancer, and various psychosocial and psychopathological disorders. The financial direct and indirect burden (considering also the clinical resources involved and the loss of productivity) is a real challenge in many Western health-care systems. Recently the Lancet journal defined diabetes as a 21st-century challenge. In order to promote patient compliance in diabesity treatment reducing costs, evidence-based interventions to improve weight-loss, maintain a healthy weight, and reduce related comorbidities combine different treatment approaches: dietetic, nutritional, physical, behavioral, psychological, and, in some situations, pharmacological and surgical. Moreover, new technologies can provide useful solutions in this multidisciplinary approach, above all in maintaining long-term compliance and adherence in order to ensure clinical efficacy. Psychological therapies with diet and exercise plans could better help patients in achieving weight loss outcomes, both inside hospitals and clinical centers and during out-patient follow-up sessions. In the management of chronic diseases clinical psychology play a key role due to the need of working on psychological conditions of patients, their families and their caregivers. mHealth approach could overcome limitations linked with the traditional, restricted and highly expensive in-patient treatment of many chronic pathologies: one of the best up-to-date application is the management of obesity with type 2 diabetes, where mHealth solutions can provide remote opportunities for enhancing weight reduction and reducing complications from clinical, organizational and economic perspectives. A stepped care mHealth-based approach is an interesting perspective in chronic care management of obesity with type 2 diabetes. One promising future direction could be treating obesity, considered as a chronic multifactorial disease, using a stepped-care approach: -mhealth or traditional based lifestyle psychoeducational and nutritional approach. -health professionals-driven multidisciplinary protocols tailored for each patient. -inpatient approach with the inclusion of drug therapies and other multidisciplinary treatments. -bariatric surgery with psychological and medical follow-up In the chronic care management of globesity mhealth solutions cannot substitute traditional approaches, but they can supplement some steps in clinical psychology and medicine both for obesity prevention and for weight loss management.

Keywords: clinical health psychology, mhealth, obesity, type 2 diabetes, stepped care, chronic care management

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Authors: Gabriel Acha Ekobi

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Fathers play a crucial role in meeting family needs such as affection, protection, and socio-economic needs of children in the world in general and South Africa in particular. Fathers’ role in children’s lives is important in providing socialization, leadership skills, and teaching societal norms. Fathers influence is very significant for children’s well-being and development as it provides the child with moral lessons, guidance, and economic support. However, there is a paucity of information regarding the effects of fathers on children. In addition, despite legal frameworks such as the African Charter on the Rights and Welfare of the child (1999) introduced by the African Union to promote child rights nevertheless, it appears maltreatment, abuse, and poor health care continue to face children. Also, the Constitution of 1996 of the Republic of South Africa (Section 28 of the Bill of Rights) and the Children’s Act 38 of 2005 were introduced by the South African government to foster the rights of children. Nevertheless, these legal frameworks remain ineffective as children’s rights are still neglected by resident fathers. This paper explores the impact of resident fathers on children in the Golf View, Alice town of the Eastern Cape Province, South Africa. A qualitative research method and an exploratory research design were utilized, and 30 participants took part in the study. The participants comprised of single mothers or caregivers of children, resident fathers and social workers. Eighteen (18) single mothers or caregivers, 10 resident fathers, and two (2) social workers participated in the study. Data was collected using semi-structured and unstructured interviews and analysed thematically. Two main themes were identified: the role of fathers on children and the effects of resident fathers on children. The study found that the presence of fathers in the lives of children prevented psychosocial issues such as stress, depression, violence, and substance abuse. A father’s presence in a household was crucial in instilling moral values in children. This allowed them to build positive characters such as respect, kindness, humility, and compassion. Children with more involved fathers tend to have fewer impulse control problems, longer attention spans, and a higher level of sociability. The study concludes that the fathers’ role prevented anxiety, depression, and stress and led to the improvement of children’s education performance. Nevertheless, the absence of a father as a role model to act as a leader by instilling moral values hinders positive behaviours in children. This study recommended that occupational training and life skills programmes should be introduced by the government and other stakeholders to empower the fathers as this might provide the platform for them to bring up their children properly.

Keywords: children, fathering, household, resident, single parent

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Authors: Seung Ah Lee, Sunghyun Cho, Kyong Mee Chung

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Rapid population aging became a worldwide demographic phenomenon due to rising life expectancy and declining fertility rates. Considering the current increasing rate of population aging, it is assumed that Korean society enters into a ‘super-aged’ society in 10 years, in which people aged 65 years or older account for more than 20% of entire population. In line with this trend, ICT services aimed to help elderly people to improve the quality of life have been suggested. However, existing ICT services mainly focus on supporting health or nursing care and are somewhat limited to meet a variety of specialized needs and challenges of this population. It is pointed out that the majority of services have been driven by technology-push policies. Given that the usage of ICT services greatly vary on individuals’ socio-economic status (SES), physical and psychosocial needs, this study systematically categorized elderly population into sub-groups and identified their needs and characteristics related to ICT usage in detail. First, three assessment criteria (demographic variables including SES, cognitive functioning level, and emotional functioning level) were identified based on previous literature, experts’ opinions, and focus group interview. Second, survey questions for needs assessment were developed based on the criteria and administered to 600 respondents from a national probability sample. The questionnaire consisted of 67 items concerning demographic information, experience on ICT services and information technology (IT) devices, quality of life and cognitive functioning, etc. As the result of survey, age (60s, 70s, 80s), education level (college graduates or more, middle and high school, less than primary school) and cognitive functioning level (above the cut-off, below the cut-off) were considered the most relevant factors for categorization and 18 sub-groups were identified. Finally, 18 sub-groups were clustered into 3 groups according to following similarities; computer usage rate, difficulties in using ICT, and familiarity with current or previous job. Group 1 (‘active users’) included those who with high cognitive function and educational level in their 60s and 70s. They showed favorable and familiar attitudes toward ICT services and used the services for ‘joyful life’, ‘intelligent living’ and ‘relationship management’. Group 2 (‘potential users’), ranged from age of 60s to 80s with high level of cognitive function and mostly middle to high school graduates, reported some difficulties in using ICT and their expectations were lower than in group 1 despite they were similar to group 1 in areas of needs. Group 3 (‘limited users’) consisted of people with the lowest education level or cognitive function, and 90% of group reported difficulties in using ICT. However, group 3 did not differ from group 2 regarding the level of expectation for ICT services and their main purpose of using ICT was ‘safe living’. This study developed a systematic needs assessment tool and identified three sub-groups of elderly ICT users based on multi-criteria. It is implied that current cognitive function plays an important role in using ICT and determining needs among the elderly population. Implications and limitations were further discussed.

Keywords: elderly population, ICT, needs assessment, population aging

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Authors: Evija Silina, Maris Taube, Maksims Zolovs

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Background: Type 1 diabetes mellitus (T1D) is the most common chronic endocrine pathology in children. The management of type 1 diabetes requires a strong diet, physical activity, lifelong insulin therapy, and proper self-monitoring of blood glucose and is usually complicated and, therefore, may result in a variety of psychosocial problems for children, adolescents, and their families. Metabolic control of the disease is determined by glycated haemoglobin (HbA1c), the main criterion for diabetes compensation. A correlation was observed between anxiety and depression levels and glycaemic control in many previous studies. It is assumed that anxiety and depression symptoms negatively affect glycaemic control. Parental psychological distress was associated with higher child self-report of stress and depressive symptoms, and it had negative effects on diabetes management. Objective: The main objective of this paper is to evaluate the relationship between parental mental health conditions (depression and anxiety) and metabolic control of their adolescents with T1DM. Methods: This cross-sectional study recruited adolescents with T1D (N=251) and their parents (N=251). The respondents completed questionnaires. The 7-item Generalized Anxiety Disorder (GAD-7) scale measured anxiety level; The Patient Health Questionnaire – 9 (PHQ-9) measured depressive symptoms. Glycaemic control of patients was assessed using the last glycated haemoglobin (HbA1c) values. GLM mediation analysis was performed to determine the potential mediating effect of the parent’s mental health conditions (depression and anxiety) on the relationship between the mental health conditions (depression and anxiety) of a child on the level of glycated hemoglobin (HbA1c). To test the significance of the mediated effect (ME) for non-normally distributed data, bootstrapping procedures (10,000 bootstrapped samples) were used. Results: 502 respondents were eligible for screening to detect anxiety and depression symptoms. Mediation analysis was performed to assess the mediating role of parent GAD-7 on the linkage between a dependent variable (HbA1c) and independent variables (child GAD-7 un child PHQ-9). The results revealed that the total effect of child GAD-7 (B = 0.479, z = 4.30, p < 0.001) on HbA1c was significant but the total effect of child PHQ-9 (B = 0.166, z = 1.49, p = 0.135) was not significant. With the inclusion of the mediating variable (parent GAD-7), the impact of child GAD-7 on HbA1c was found insignificant (B = 0.113, z=0.98, p = 0.326), the impact of child PHQ-9 on HbA1c was found also insignificant (B = 0.068, z=0.74, p = 0.458). The indirect effect of child GAD-7 on HbA1c through parent GAD-7 was found significant (B = 0.366, z = 4.31, p < 0.001) and the indirect effect of child PHQ-9 on HbA1c through parent GAD-7 was found also significant (B = 0.098, z = 2.56, p = 0.010). This indicates that the relationship between a dependent variable (HbA1c) and independent variables (child GAD-7 un child PHQ-9) is fully mediated by parent GAD-7. Conclusion: The main result suggests that glycated haemoglobin in adolescents with Type 1 diabetes is related to adolescents’ mental health via parents’ anxiety. It means that parents’ anxiety plays a more significant role in the level of glycated haemoglobin in adolescents than depression and anxiety in the adolescent.

Keywords: type 1 diabetes, adolescents, parental diabetes-specific mental health conditions, glycated haemoglobin, anxiety, depression

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Authors: Modi Alsubaie, Chris Dickens, Barnaby Dunn, Andy Gibson, Obioha Ukoumunned, Alison Evans, Rachael Vicary, Manish Gandhi, Willem Kuyken

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Background: Depression co-occurs in 20% of people with cardiovascular disorders, can persist for years and predicts worse physical health outcomes. While psychosocial treatments have been shown to effectively treat acute depression in those with comorbid cardiovascular disorders, to date there has been no evaluation of approaches aiming to prevent relapse and treat residual depression symptoms in this group. Therefore, the current study aimed to examine the feasibility and acceptability of a randomised controlled trial design evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people with co-morbid depression and cardiovascular disorders. Methods: A 3-arm feasibility randomised controlled trial was conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU), mindfulness-based stress reduction (MBSR) plus TAU, and TAU alone. Participants completed a set of self-report measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion and affect and had their blood pressure taken immediately before, immediately after, and three months following the intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their views about the adapted intervention. Results: 3400 potentially eligible participants were approached when attending an outpatient appointment at a cardiology clinic or via a GP letter following a case note search. 242 (7.1%) were interested in taking part, 59 (1.7%) were screened as being suitable, and 33 (<1%) were eventually randomised to the three groups. The sample was heterogeneous in terms of whether they reported current depression or had a history of depression and the time since the onset of cardiovascular disease (one to 25 years). Of 11 participants randomised to adapted MBCT seven completed the full course, levels of home mindfulness practice were high, and positive qualitative feedback about the intervention was given. Twenty-nine out of 33 participants randomised completed all the assessment measures at all three-time points. With regards to the primary outcome (depression), five out of the seven people who completed the adapted MBCT and three out of five under MBSR showed significant clinical change, while in TAU no one showed any clinical change at the three-month follow-up. Conclusions: The adapted MBCT intervention was feasible and acceptable to participants. However, aspects of the trial design were not feasible. In particular, low recruitment rates were achieved, and there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the sample was high meaning the adapted intervention was unlikely to be well tailored to all participants needs. This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to be revised to more successfully recruit a target sample that optimally matches the adapted intervention.

Keywords: mindfulness-based cognitive therapy (MBCT), depression, cardiovascular disorders, feasibility, acceptability

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Authors: Jovina Concepcion Bachynski, Lenora Duhn, Idevania G. Costa, Pilar Camargo-Plazas

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Kidney failure is a life-limiting condition for which treatment, such as dialysis (hemodialysis and peritoneal dialysis), can exact a tremendously high physical and psychosocial symptom burden. Kidney failure can be severe enough to require a palliative approach to care. The term supportive care can be used in lieu of palliative care to avoid the misunderstanding that palliative care is synonymous with end-of-life or hospice care. Kidney supportive care, encompassing advance care planning, is an approach to care that improves the quality of life for people receiving dialysis through early identification and treatment of symptoms throughout the disease trajectory. Advanced care planning involves ongoing conversations about the values, goals, and preferences for future care between individuals and their healthcare teams. Kidney supportive care is underutilized and often initiated late in this population. There is evidence to indicate nurses are not providing the necessary elements of supportive kidney care. Dialysis nurses’ delay or lack of engagement in supportive care until close to the end of life may result in people dying without receiving optimal palliative care services. Using Charmaz’s constructivist grounded theory, the purpose of this doctoral study is to develop a substantive theory that explains the process of engagement in supportive care by nurses working in dialysis settings in Canada. Through initial purposeful and subsequent theoretical sampling, 23 nurses with current or recent work experience in outpatient hemodialysis, home hemodialysis, and peritoneal dialysis settings drawn from across Canada were recruited to participate in two intensive interviews using the Zoom© teleconferencing platform. Concurrent data collection and data analysis, constant comparative analysis of initial and focused codes until the attainment of theoretical saturation, and memo-writing, as well as researcher reflexivity, have been undertaken to aid the emergence of concepts, categories, and, ultimately, the constructed theory. At the time of abstract submission, data analysis is currently at the second level of coding (i.e., focused coding stage) of the research study. Preliminary categories include: (a) focusing on biomedical care; (b) multi-dimensional challenges to having the conversation; (c) connecting and setting boundaries with patients; (d) difficulty articulating kidney-supportive care; and (e) unwittingly practising kidney-supportive care. For the conference, the resulting theory will be presented. Nurses working in dialysis are well-positioned to ensure the delivery of quality kidney-supportive care. This study will help to determine the process and the factors enabling and impeding nurse engagement in supportive care in dialysis to effect change for normalizing advance care planning conversations in the clinical setting. This improved practice will have substantive beneficial implications for the many individuals living with kidney failure and their supporting loved ones.

Keywords: dialysis, kidney failure, nursing, supportive care

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Authors: Kate Allman, Heather Maranges, Elise Dykhuis

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Moral Growth Mindset (MGM) is the belief that one has the capacity to become a more moral person, as opposed to a fixed conception of one’s moral ability and capacity (Han et al., 2018). Building from Dweck’s work in incremental implicit theories of intelligence (2008), Moral Growth Mindset (Han et al., 2020) extends growth mindsets into the moral dimension. The concept of MGM has the potential to help researchers understand how both mindsets and interventions can impact character development, and it has even been shown to have connections to voluntary service engagement (Han et al., 2018). Understanding the contexts in which MGM might be cultivated could help to promote the further cultivation of character, in addition to prosocial behaviors like service engagement, which may, in turn, promote larger scale engagement in social justice-oriented thoughts, feelings, and behaviors. In particular, college may be a place to intentionally cultivate a growth mindset toward moral capacities, given the unique developmental and maturational components of the college experience, including contextual opportunity (Lapsley & Narvaez, 2006) and independence requiring the constant consideration, revision, and internalization of personal values (Lapsley & Woodbury, 2016). In a semester-long, quasi-experimental study, we examined the impact of a pedagogical approach designed to cultivate college student character development on participants’ MGM. With an intervention (n=69) and a control group (n=97; Pre-course: 27% Men; 66% Women; 68% White; 18% Asian; 2% Black; <1% Hispanic/Latino), we investigated whether college courses that intentionally incorporate character education pedagogy (Lamb, Brant, Brooks, 2021) affect a variety of psychosocial variables associated with moral thoughts, feelings, identity, and behavior (e.g. moral growth mindset, honesty, compassion, etc.). The intervention group consisted of 69 undergraduate students (Pre-course: 40% Men; 52% Women; 68% White; 10.5% Black; 7.4% Asian; 4.2% Hispanic/Latino) that voluntarily enrolled in five undergraduate courses that encouraged students to engage with key concepts and methods of character development through the application of research-based strategies and personal reflection on goals and experiences. Moral Growth Mindset was measured using the four-item Moral Growth Mindset scale (Han et al., 2020), with items such as You can improve your basic morals and character considerably on a six-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). Higher scores of MGM indicate a stronger belief that one can become a more moral person with personal effort. Reliability at Time 1 was Cronbach’s ɑ= .833, and at Time 2 Cronbach’s ɑ= .772. An Analysis of Covariance (ANCOVA) was conducted to explore whether post-course MGM scores were different between the intervention and control when controlling for pre-course MGM scores. The ANCOVA indicated significant differences in MGM between groups post-course, F(1,163) = 8.073, p = .005, R² = .11, where descriptive statistics indicate that intervention scores were higher than the control group at post-course. Results indicate that intentional character development pedagogy can be leveraged to support the development of Moral Growth Mindset and related capacities in undergraduate settings.

Keywords: moral personality, character education, incremental theories of personality, growth mindset

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Authors: A. Abubakar, A. Parsa, S. Walker

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Despite advances made in the diagnosis and management of drug-sensitive tuberculosis (TB) over the past decades, treatment of multidrug-resistant tuberculosis (MDR-TB) remains challenging and complex particularly in high burden countries including Nigeria. Treatment of MDR-TB is cost-prohibitive with success rate generally lower compared to drug-sensitive TB and if care is not taken it may become the dominant form of TB in future with many treatment uncertainties and substantial morbidity and mortality. Addressing these challenges requires collaborative efforts thorough sustained researches to evaluate the current treatment guidelines, particularly in high burden countries and prevent progression of resistance. To our best knowledge, there has been no research exploring the acceptability, effectiveness, and cost-effectiveness of community-based-MDR-TB treatment model in Nigeria, which is among the high burden countries. The previous similar qualitative study looks at the home-based management of MDR-TB in rural Uganda. This research aimed to explore patient’s views and acceptability of community-based-MDR-TB treatment model and to evaluate and compare the effectiveness and cost-effectiveness of community-based versus hospital-based MDR-TB treatment model of care from the Nigerian perspective. Knowledge of patient’s views and acceptability of community-based-MDR-TB treatment approach would help in designing future treatment recommendations and in health policymaking. Accordingly, knowledge of effectiveness and cost-effectiveness are part of the evidence needed to inform a decision about whether and how to scale up MDR-TB treatment, particularly in a poor resource setting with limited knowledge of TB. Mixed methods using qualitative and quantitative approach were employed. Qualitative data were obtained using in-depth semi-structured interviews with 21 MDR-TB patients in Nigeria to explore their views and acceptability of community-based MDR-TB treatment model. Qualitative data collection followed an iterative process which allowed adaptation of topic guides until data saturation. In-depth interviews were analyzed using thematic analysis. Quantitative data on treatment outcomes were obtained from medical records of MDR-TB patients to determine the effectiveness and direct and indirect costs were obtained from the patients using validated questionnaire and health system costs from the donor agencies to determine the cost-effectiveness difference between community and hospital-based model from the Nigerian perspective. Findings: Some themes have emerged from the patient’s perspectives indicating preference and high acceptability of community-based-MDR-TB treatment model by the patients and mixed feelings about the risk of MDR-TB transmission within the community due to poor infection control. The result of the modeling from the quantitative data is still on course. Community-based MDR-TB care was seen as the acceptable and most preferred model of care by the majority of the participants because of its convenience which in turn enhanced recovery, enables social interaction and offer more psychosocial benefits as well as averted productivity loss. However, there is a need to strengthen this model of care thorough enhanced strategies that ensure guidelines compliance and infection control in order to prevent the progression of resistance and curtail community transmission.

Keywords: acceptability, cost-effectiveness, multidrug-resistant TB treatment, community and hospital approach

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Authors: Judith Sue Hwa Joo

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Guanyin (Avalokiteśvara in Sanskrit), the Bodhisattva of Mercy and Compassion, is the most widely worshipped Buddhist Divinity in Chinese societies and is also believed by more than half of Asian populations across various countries. The most overwhelming reason for the popularity of Guanyin in Chinese societies is, according to the Lotus Sutra, that Guanyin would apperceive voices of those suffering from immense afflictions and troubles, and liberate them upon crying for his/her holy name with wholeheartedness. Its pervasive social influence has spanned more than two thousand years and is still deeply affecting the lives of most Chinese people. This study aimed to investigate whether Guanyin Worship has evolved and changed in modern Chinese societies across the Taiwan Strait. Taiwan and China, albeit having the same language and culture, have been territorially divided and governed by two different political regimes for over 70 years. It would be scientifically intriguing to unveil any substantial changes in religious behaviors in the context of Guanyin Worship. A comprehensive anonymous questionnaire survey in Chinese communities was conducted from October 2017 to May 2019 across various countries, mostly in China, Taiwan, and Hong Kong areas. Since the religious survey is officially prohibited in China, the study was difficult and could only be exercised by means of snowball sampling. Demographic data (age, sex, education, religious belief) were registered and Guanyin’s salvation functions under various confronting situations were investigated. Psychological dimensions of religious belief in Guanyin were probed in terms of the worship experience, the willingness of veneration, and egoistic or altruistic ideations. A literature review on documented functional attributes was carried out in parallel for comparison analyses with traditional roles. Effective 1123 out of 1139 samples were obtained. Statistical analysis revealed that Guanyin Worship is still commonly practiced and deeply rooted in the hearts of all Chinese people regardless of gender, age, education, and residential area, even though they may not enshrine Guanyin at home nowadays. The conventional roles of Guanyin Bodhisattva are still valid and best satisfy the real interests of lifestyles in modern times. When comparing the traditional Buddhist Sutra and the documented literature, the divine power of modern Guanyin has notably empowered to recover, protect and transform fetal and infant spirits due to the sexual liberation, increased abortion rate, gender awakening and enhanced female autonomy in the reproductive decision. However, the One-Child policy may have critically impacted the trajectory of Guanyin Worship so that people in China prevail over those in Taiwan praying for aborted lives or premature deaths. Furthermore, particularly in Hong Kong and Macao, Guanyin not only serves as the sea guardian for the fishermen but also additional services a new function as the God of Wealth. The divine powers and salvation functions of Guanyin are indeed evolving and expanding to comply with the modern psychosocial, cultural and societal needs. This study sheds light on the modernization process of the two-thousand-year-old Guanyin Worship of contemporary Chinese societies.

Keywords: Buddhism, Guanyin, religious behavior, salvation function

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Authors: Netalie Shloim, Brian Brown, Siobhan Hugh-Jones, Jane Plastow, Diana Setiyawati, Anna Madill

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In June 2021, the World Health Organization launched its guidance and technical packages on community mental health services, stressing a human rights-based approach to care. This initiative stems from an increasing acknowledgment of the role mental health plays in achieving the Sustainable Development Goals. Nevertheless, mental health remains a relatively neglected research area and the estimates for untreated mental disorders in low-and-middle-income countries (LMICs) are as high as 78% for adults. Moreover, the development sector and research programs too often side-line mental health as a privilege in the face of often immediate threats to life and livelihood. As a way of addressing this problem, this study aimed to examine past or ongoing GCRF projects to see if there were opportunities where mental health impact could have been achieved without compromising a study's main aim and without overburdening a project. Projects funded by the UKRI Global Challenges Research Fund (GCRF) were analyzed. This program was initiated in 2015 to support cutting-edge research that addresses the challenges faced by developing countries. By the end of May 2020, a total of 15,279 projects were funded of which only 3% had an explicit mental health focus. A sample of 36 non-mental-health-focused projects was then sampled for diversity across research council, challenge portfolio and world region. Each of these 36 projects was coded by two coders for opportunities to embed mental health impact. To facilitate coding, the literature was inspected for dimensions relevant to LMIC settings. Three main psychological and three main social dimensions were identified: promote a positive sense of self; promote positive emotions, safe expression and regulation of challenging emotions, coping strategies, and help-seeking; facilitate skills development; and facilitate community-building; preserve sociocultural identity; support community mobilization. Coding agreement was strong on missed opportunities for mental health impact on the three social dimensions: support community mobilization (92%), facilitate community building (83%), preserve socio-cultural identity (70%). Coding agreement was reasonably strong on missed opportunities for mental health impact on the three psychological dimensions: promote positive emotions (67%), facilitate skills development (61%), positive sense of self (58%). In order of frequency, the agreed perceived opportunities from the highest to lowest are: support community mobilization, facilitate community building, facilitate skills development, promote a positive sense of self, promote positive emotions, preserve sociocultural identity. All projects were considered to have an opportunity to support community mobilization and to facilitate skills development by at least one coder. Findings provided support that there were opportunities to embed mental health impact in research across the range of development sectors and identifies what kind of missed opportunities are most frequent. Hence, mainstreaming mental health has huge potential to tackle the lack of priority and funding it has attracted traditionally. The next steps are to understand the barriers to mainstreaming mental health and to work together to overcome them.

Keywords: GCRF, mental health, psychosocial wellbeing, LMIC

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Authors: M. Petunia Tsweleng

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Statement of the Problem: Research and aid organisations report that children and adolescents orphaned due to HIV and AIDS are particularly vulnerable as they are often exposed to negative effects of both HIV and AIDS and orphanhood. Without much-needed parental love, care, and support, these children and adolescents are at risk of poor developmental outcomes. A cursory look at the available literature on AIDS-orphaned adolescents, and the quality of caregiving relationships with caregivers, shows that this is a relatively under-researched terrain. This article is a review of the literature on caregiving relationships of adolescents orphaned due to AIDS and their current primary caregivers. It aims to inform community programmes and policymakers by providing insight into the qualities of these relationships. Methodology: A comprehensive search of both peer-reviewed and non-peer-reviewed literature was conducted through EBSCOhost, SpringLINK, PsycINFO, SAGE, PubMed, Elsevier ScienceDirect, JSTOR, Wiley Online Library databases, and Google Scholar. The combination of keywords used for the search were: (caregiving relationships); (orphans OR AIDS orphaned children OR AIDS orphaned adolescents); (primary caregivers); and (quality caregiving); (orphans); (HIV and AIDS). The search took place between 24 January and 28 February 2022. Both qualitative and quantitative research studies published between 2010 and 2020 were reviewed. However, only qualitative studies were selected in the end -as they presented more profound findings concerning orphan-caregiver relationships. The following three stages of meta-synthesis analysis were used to analyse data: refutational syntheses, reciprocal syntheses, and line of argument. Results: The search resulted in a total of 2090 titles, of which 750 were duplicates and therefore subtracted. The researcher reviewed all the titles and abstracts of the remaining 1340 articles. 329 articles were identified as relevant, and full texts were reviewed. Following the review of the full texts, 313 studies were excluded for relevance and 4 for methodology. Twelve articles representing 11 studies fulfilled the inclusion criteria and were selected. These studies, representing different countries across the globe, reported similar forms of hardships experienced by caregivers economically, psychosocially, and healthwise. However, the studies also show that the majority of caregivers found contentment in caring for orphans, particularly grandmother carers, and were thus enabled to provide love, care, and support despite hardships. This resulted in positive caregiving relationships -as orphans fared well emotionally and psychosocially. Some relationships, however, were found negative due to unhealed emotional wounds suffered by both caregivers and orphans and others due to the caregiver’s lack of interest in providing care. These findings were based on self-report data from both orphans and caregivers. Conclusion: Findings suggest that intervention efforts need to be intensified to: alleviate poverty in households that are affected by HIV and AIDS pandemic, strengthen the community psychosocial support programmes for orphans and their caregivers; and integrate clinical services with community programmes for the healing of emotional and psychological wounds. Contributions: Findings inform community programmes and policymakers by providing insight into the qualities of the mentioned relationships as well as identifying factors commonly associated with high-quality caregiving and poor-quality caregiving.

Keywords: systematic review, caregiving relationships, orphans and primary caregivers, AIDS

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Authors: Pedro Felgueiras, Ana Miguel, Nélson Almeida, Raquel Silva

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Objective: Through the study of a clinical case of delusional somatic disorder secondary to phantogeusia, we aim to highlight the importance of considering psychosomatic conditions in differential diagnosis, as well as to emphasize the complexity of its comprehension, treatment, and respective impact on patients’ functioning. Methods: Bearing this in mind, we conducted a critical analysis of a case series based on patient observations, clinical data, and complementary diagnostic methods, as well as a non-systematic review of the literature on the subject. Results: A 61-year-old female patient with no history of psychiatric conditions. Family psychiatric history of mood disorder (depression), with psychotic features found in her mother. Medical history of many comorbidities affecting different organ systems (endocrine, gastrointestinal, genitourinary, ophthalmological). Documented neuroticism traits of personality. The patient’s family described a persistent concern about several physical symptoms across her life, with a continuous effort to obtain explanations about any sensation out of her normal perception. Since being subjected to endoscopy in 2018, she started complaints of persistent phantogeusia (acid taste) and developed excessive thoughts, feelings, and behaviors associated with this somatic symptom. The patient was evaluated by several medical specialties, and an extensive panel of medical exams was carried out, excluding any disease. Besides all the investigation and with no evidence of disease signs, acute anxiety, time, and energy dispended to this symptom culminated in severe psychosocial impairment. The patient was admitted to a psychiatric ward for investigation and treatment of this clinical picture, leading to the diagnosis of the delusional somatic disorder. In order to exclude the acute organic etiology of this psychotic disorder, an analytic panel was carried out with no abnormal results. In the context of a psychotic clinical picture, a CT scan was performed, which revealed a right cortical vascular lesion. Neuropsychological evaluation was made, with the description of cognitive functioning being globally normative. During treatment with an antipsychotic (pimozide), a complete remission of the somatic delusion was associated with the disappearance of gustative perception disturbance. In follow-up, a relapse of gustative sensation was documented, and her thoughts and speech were dominated by concerns about multiple somatic symptoms. Conclusion: In terms of abnormal bodily sensations, the oral cavity is one of the frequent sites of delusional disorder. Patients with these gustatory perception distortions complain about unusual sensations without corresponding abnormal findings in the oral area. Its pathophysiology has not been fully elucidated yet. In terms of its comprehensive psychopathology, this case was hypothesized as a paranoid development of a delusional somatic disorder triggered by a post-invasive procedure phantogeusia (which is described as a possible side effect of an endoscopy) in a patient with an anankastic personality. This case presents interesting psychopathology, reinforcing the complexity of psychosomatic disorders in terms of their etiopathogenesis, clinical treatment, and long-term prognosis.

Keywords: psychosomatics, delusional somatic disorder, phantogeusia, paranoid development

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Authors: Harpa Ragnarsdóttir, Magnús Kjartan Gíslason, Kristín Briem, Guðný Lilja Oddsdóttir

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Introduction: Whiplash-Associated Disorder (WAD) is a health problem characterized by motor, neurological and psychosocial symptoms, stressing the need for a multimodal treatment approach. To achieve individualized multimodal approach, prognostic factors need to be identified early using validated patient-reported and objective outcome measures. The aim of this study is to demonstrate the degree of association between patient-reported and clinical outcome measures of WAD patients in the subacute phase. Methods: Individuals (n=41) with subacute (≥1, ≤3 months) WAD (I-II), medium to high-risk symptoms, or neck pain rating ≥ 4/10 on the Visual Analog Scale (VAS) were examined. Outcome measures included measurements for movement control (Butterfly test) and cervical active range of motion (cAROM) using the NeckSmart system, a computer system using an inertial measurement unit (IMU) that connects to a computer. The IMU sensor is placed on the participant’s head, who receives visual feedback about the movement of the head. Patient-reported neck disability, pain intensity, general health, self-perceived handicap, central sensitization, and difficulties due to dizziness were measured using questionnaires. Excel and R statistical software were used for statistical analyses. Results: Forty-one participants, 15 males (37%), 26 females (63%), mean (SD) age 36.8 (±12.7), underwent data collection. Mean amplitude accuracy (AA) (SD) in the Butterfly test for easy, medium, and difficult paths were 2.4mm (0.9), 4.4mm (1.8), and 6.8mm (2.7), respectively. Mean cAROM (SD) for flexion, extension, left-, and right rotation were 46.3° (18.5), 48.8° (17.8), 58.2° (14.3), and 58.9° (15.0), respectively. Mean scores on the Neck Disability Index (NDI), VAS, Dizziness Handicap Inventory (DHI), Central Sensitization Inventory (CSI), and 36-Item Short Form Survey RAND version (RAND) were 43% (17.4), 7 (1.7), 37 (25.4), 51 (17.5), and 39.2 (17.7) respectively. Females showed significantly greater deviation for AA compared to males for easy and medium Butterfly paths (p<0.05). Statistically significant moderate to strong positive correlation was found between the DHI and easy (r=0.6, p=0.05), medium (r=0.5, p=0.05)) and difficult (r=0.5, p<0.05) Butterfly paths, between the total RAND score and all cAROMs (r between 0.4-0.7, p≤0.05) except flexion (r=0.4, p=0.7), and between the NDI score and CSI (r=0.7, p<0.01), VAS (r=0.5, p<0.01), and DHI (r=0.7, p<0.01) scores respectively. Discussion: All patient-reported and objective measures were found to be outside the reference range. Results suggest females have worse movement control in the neck in the subacute WAD phase. However, no statistical difference based on gender was found in patient-reported measures. Suggesting females might have worse movement control than males in general in this phase. The correlation found between DHI and the Butterfly test can be explained because the DHI measures proprioceptive symptoms like dizziness and eye movement disorders that can affect the outcome of movement control tests. A correlation was found between the total RAND score and cAROM, suggesting that a reduced range of motion affects the quality of life. Significance: The NeckSmart system can detect abnormalities in cAROM, fine movement control, and kinesthesia of the neck. Results suggest females have worse movement control than males. Results show a moderate to a high correlation between several patient-reported and objective measurements.

Keywords: whiplash associated disorders, car-collision, neck, trauma, subacute

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Authors: Stephanie J. Sedberry, William J. Gerace, Ian D. Beatty, Michael J. Kane

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Increasing the number of US university students who attain degrees in STEM and enter the STEM workforce is a national priority. Demographic groups vary in their rates of participation in STEM, and the US produces just 10% of the world’s science and engineering degrees (2014 figures). To address these gaps, we have developed and tested a practical, 30-minute, single-session classroom-based intervention to improve students’ self-efficacy and academic performance in University STEM courses. Self-efficacy is a psychosocial construct that strongly correlates with academic success. Self-efficacy is a construct that is internal and relates to the social, emotional, and psychological aspects of student motivation and performance. A compelling body of research demonstrates that university students’ self-efficacy beliefs are strongly related to their selection of STEM as a major, aspirations for STEM-related careers, and persistence in science. The development of an intervention to increase students’ self-efficacy is motivated by research showing that short, social-psychological interventions in education can lead to large gains in student achievement. Our intervention addresses STEM self-efficacy via two strong, but previously separate, lines of research into attitudinal/affect variables that influence student success. The first is ‘attributional retraining,’ in which students learn to attribute their successes and failures to internal rather than external factors. The second is ‘mindset’ about fixed vs. growable intelligence, in which students learn that the brain remains plastic throughout life and that they can, with conscious effort and attention to thinking skills and strategies, become smarter. Extant interventions for both of these constructs have significantly increased academic performance in the classroom. We developed a 34-item questionnaire (Likert scale) to measure STEM Self-efficacy, Perceived Academic Control, and Growth Mindset in a University STEM context, and validated it with exploratory factor analysis, Rasch analysis, and multi-trait multi-method comparison to coded interviews. Four iterations of our 42-week research protocol were conducted across two academic years (2017-2018) at three different Universities in North Carolina, USA (UNC-G, NC A&T SU, and NCSU) with varied student demographics. We utilized a quasi-experimental prospective multiple-group time series research design with both experimental and control groups, and we are employing linear modeling to estimate the impact of the intervention on Self-Efficacy,wth-Mindset, Perceived Academic Control, and final course grades (performance measure). Preliminary results indicate statistically significant effects of treatment vs. control on Self-Efficacy, Growth-Mindset, Perceived Academic Control. Analyses are ongoing and final results pending. This intervention may have the potential to increase student success in the STEM classroom—and ownership of that success—to continue in a STEM career. Additionally, we have learned a great deal about the complex components and dynamics of self-efficacy, their link to performance, and the ways they can be impacted to improve students’ academic performance.

Keywords: academic performance, affect variables, growth mindset, intervention, perceived academic control, psycho-social variables, self-efficacy, STEM, university classrooms

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Authors: Yagmur Soylu, Emir Ozeren, Erol Esen, Digdem M. Siyez, Ozlem Belkis, Ezgi Burc, Gülce Demirgurz

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The aim of the study is to determine the predictive power of personal growth initiative, socio-demographic variables (such as sex, grade, and working condition) on career adaptability and optimism of bachelor students in Dokuz Eylul University in Turkey. According to career construction theory, career adaptability is viewed as a psychosocial construct, which refers to an individual’s resources for dealing with current and expected tasks, transitions and traumas in their occupational roles. Career optimism is defined as positive results for future career development of individuals in the expectation that it will achieve or to put the emphasis on the positive aspects of the event and feel comfortable about the career planning process. Personal Growth Initiative (PGI) is defined as being proactive about one’s personal development. Additionally, personal growth is defined as the active and intentional engagement in the process of personal. A study conducted on college students revealed that individuals with high self-development orientation make more effort to discover the requirements of the profession and workspaces than individuals with low levels of personal development orientation. University life is a period that social relations and the importance of academic activities are increased, the students make efforts to progress through their career paths and it is also an environment that offers opportunities to students for their self-realization. For these reasons, personal growth initiative is potentially an important variable which has a key role for an individual during the transition phase from university to the working life. Based on the review of the literature, it is expected that individual’s personal growth initiative, sex, grade, and working condition would significantly predict one’s career adaptability. In the relevant literature, it can be seen that there are relatively few studies available on the career adaptability and optimism of university students. Most of the existing studies have been carried out with limited respondents. In this study, the authors aim to conduct a comprehensive research with a large representative sample of bachelor students in Dokuz Eylul University, Izmir, Turkey. By now, personal growth initiative and career development constructs have been predominantly discussed in western contexts where individualistic tendencies are likely to be seen. Thus, the examination of the same relationship within the context of Turkey where collectivistic cultural characteristics can be more observed is expected to offer valuable insights and provide an important contribution to the literature. The participants in this study were comprised of 1500 undergraduate students being included from thirteen faculties in Dokuz Eylul University. Stratified and random sampling methods were adopted for the selection of the participants. The Personal Growth Initiative Scale-II and Career Futures Inventory were used as the major measurement tools. In data analysis stage, several statistical analysis concerning the regression analysis, one-way ANOVA and t-test will be conducted to reveal the relationships of the constructs under investigation. At the end of this project, we will be able to determine the level of career adaptability and optimism of university students at varying degrees so that a fertile ground is likely to be created to carry out several intervention techniques to make a contribution to an emergence of a healthier and more productive youth generation in psycho-social sense.

Keywords: career optimism, career adaptability, personal growth initiative, university students

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Authors: Dirk Bruland, Paulo Pinheiro, Ullrich Bauer

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Introduction: Over 3 million children, about one quarter of all students, experience at least one parent with mental disorder in Germany every year. Children of mentally-ill parents are at considerably higher risk of developing serious mental health problems. The different burden patterns and coping attempts often become manifest in children's school lives. In this context, schools can have an important protective function, but can also create risk potentials. In reference to Jorm, pupil-related teachers’ mental health literacy (Teacher-MHL) includes the ability to recognize change behaviour, the knowledge of risk factors, the implementation of first aid intervention, and seeking professional help (teacher as gatekeeper). Although teachers’ knowledge and increased awareness of this topic is essential, the literature provides little information on the extent of teachers' abilities. As part of a German-wide research consortium on health literacy, this project, launched in March for 3 years, will conduct evidence-based mental health literacy research. The primary objective is to measure Teacher-MHL in the context of pupil-related psychosocial factors at primary and secondary schools (grades 5 & 6), while also focussing on children’s social living conditions. Methods: (1) A systematic literature review in different databases to identify papers with regard to Teacher-MHL (completed). (2) Based on these results, an interview guide was developed. This research step includes a qualitative pre-study to inductively survey the general profiles of teachers (n=24). The evaluation will be presented on the conference. (3) These findings will be translated into a quantitative teacher survey (n=2500) in order to assess the extent of socio-analytical skills of teachers as well as in relation to institutional and individual characteristics. (4) Based on results 1 – 3, developing a training program for teachers. Results: The review highlights a lack of information for Teacher-MHL and their skills, especially related to high-risk-groups like children of mentally ill parents. The literature is limited to a few studies only. According to these, teacher are not good at identifying burdened children and if they identify those children they do not know how to handle the situations in school. They are not sufficiently trained to deal with these children, especially there are great uncertainties in dealing with the teaching situation. Institutional means and resources are missing as well. Such a mismatch can result in insufficient support and use of opportunities for children at risk. First impressions from the interviews confirm these results and allow a greater insight in the everyday school-life according to critical life events in families. Conclusions: For the first time schools will be addressed as a setting where children are especially "accessible" for measures of health promotion. Addressing Teacher-MHL gives reason to expect high effectiveness. Targeting professionals' abilities for dealing with this high-risk-group leads to a discharge for teacher themselves to handle those situations and increases school health promotion. In view of the fact that only 10-30% of such high-risk families accept offers of therapy and assistance, this will be the first primary preventive and health-promoting approach to protect the health of a yet unaffected, but particularly burdened, high-risk group.

Keywords: children of mentally ill parents, health promotion, mental health literacy, school

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Authors: Karen L. Lindsay, Sonja Entringer, Claudia Buss, Pathik D. Wadhwa

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Maternal nutrition and stress are independently recognized as among the most important factors that influence prenatal biology, with implications for fetal development and poor pregnancy outcomes. While there is substantial evidence from non-pregnancy human and animal studies that a complex, bi-directional relationship exists between nutrition and stress, to the author’s best knowledge, their interaction in the context of pregnancy has been significantly understudied. The aim of this study is to assess the interaction between maternal psychological stress and diet quality across pregnancy and its effects on biomarkers of prenatal insulin resistance and inflammation. This is a prospective longitudinal study of N=235 women carrying a healthy, singleton pregnancy, recruited from prenatal clinics of the University of California, Irvine Medical Center. Participants completed a 4-day ambulatory assessment in early, middle and late pregnancy, which included multiple daily electronic diary entries using Ecological Momentary Assessment (EMA) technology on a dedicated study smartphone. The EMA diaries gathered moment-level data on maternal perceived stress, negative mood, positive mood and quality of social interactions. The numerical scores for these variables were averaged across each study time-point and converted to Z-scores. A single composite variable for 'STRESS' was computed as follows: (Negative mood+Perceived stress)–(Positive mood+Social interaction quality). Dietary intakes were assessed by three 24-hour dietary recalls conducted within two weeks of each 4-day assessment. Daily nutrient and food group intakes were averaged across each study time-point. The Alternative Healthy Eating Index adapted for pregnancy (AHEI-P) was computed for early, middle and late pregnancy as a validated summary measure of diet quality. At the end of each 4-day ambulatory assessment, women provided a fasting blood sample, which was assayed for levels of glucose, insulin, Interleukin (IL)-6 and Tumor Necrosis Factor (TNF)-α. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was computed. Pearson’s correlation was used to explore the relationship between maternal STRESS and AHEI-P within and between each study time-point. Linear regression was employed to test the association of the stress-diet interaction (STRESS*AHEI-P) with the biological markers HOMA-IR, IL-6 and TNF-α at each study time-point, adjusting for key covariates (pre-pregnancy body mass index, maternal education level, race/ethnicity). Maternal STRESS and AHEI-P were significantly inversely correlated in early (r=-0.164, p=0.018) and mid-pregnancy (-0.160, p=0.019), and AHEI-P from earlier gestational time-points correlated with later STRESS (early AHEI-P x mid STRESS: r=-0.168, p=0.017; mid AHEI-P x late STRESS: r=-0.142, p=0.041). In regression models, the interaction term was not associated with HOMA-IR or IL-6 at any gestational time-point. The stress-diet interaction term was significantly associated with TNF-α according to the following patterns: early AHEI-P*early STRESS vs early TNF-α (p=0.005); early AHEI-P*early STRESS vs mid TNF-α (p=0.002); early AHEI-P*mid STRESS vs mid TNF-α (p=0.005); mid AHEI-P*mid STRESS vs mid TNF-α (p=0.070); mid AHEI-P*late STRESS vs late TNF-α (p=0.011). Poor diet quality is significantly related to higher psychosocial stress levels in pregnant women across gestation, which may promote inflammation via TNF-α. Future prenatal studies should consider the combined effects of maternal stress and diet when evaluating either one of these factors on pregnancy or infant outcomes.

Keywords: diet quality, inflammation, insulin resistance, nutrition, pregnancy, stress, tumor necrosis factor-alpha

Procedia PDF Downloads 199