Physical aggression, compromised social support, and 10-year marital outcomes: Testing a relational spillover model

The purpose of the present study was to test a relational spillover model of physical aggression whereby physical aggression affects marital outcomes due to its effects on how spouses ask for and provide support to one another. Newlywed couples (n = 172) reported levels of physical aggression over the past year and engaged in interactions designed to elicit social support; marital adjustment, and stability were assessed periodically over the first 10 years of marriage. Multilevel modeling revealed that negative support behavior mediated the relationship between physical aggression and 10-year marital adjustment levels whereas positive support behavior mediated the relationship between physical aggression and divorce status. These findings emphasize the need to look beyond conflict when explaining how aggression affects relationships and when working with couples with a history of physical aggression who are seeking to improve their relationships

Social support in marriage: Translating research into practical applications for clinicians

How spouses support one another may be important in understanding and preventing marital distress, but has received relatively little attention. Instead, the behavioral model of marriage and corresponding treatment protocols have focused on the importance of good conflict management skills in preventing and treating marital distress. This paper outlines recent research indicating that couples social support skills predict marital outcome two years later, above and beyond conflict management skills. These results indicate that successful prevention and treatment programs may need to incorporate support skills training as well as conflict management training. Practical implications of this research are outlined, and specific techniques are recommended for teaching social support skills to couples

Social support, problem solving, and the longitudinal course of newlywed marriage

Married couples (N = 172) were observed as newlyweds and again one year later while engaging in 2 problem-solving and 2 personal support discussions. Microanalytic coding of these conversations was used to examine associations between problem-solving and social support behaviors over one year and their relative contributions to 10-year trajectories of self-reported relationship satisfaction and dissolution. Results demonstrated that initially lower levels of positive support behaviors and higher levels of negative support behaviors predicted 1-year increases in negative emotion displayed during problem-solving conversations. Emotions coded from the initial problem-solving conversations did not predict 1-year changes in social support behaviors. Controlling for emotions displayed during problem-solving interactions eliminated or reduced associations between initial social support behaviors and (a) later levels of satisfaction and (b) relationship dissolution. These findings corroborate models that prioritize empathy, validation, and caring as key elements in the development of intimacy (e.g., Reis & Shaver, 1988), and they suggest that deficits in these domains foreshadow deterioration in problem-solving and conflict management. Implications for integrating support and problem-solving in models of relationship change are outlined, as are implications for incorporating social support in education programs for developing relationships

A Pilot study of the Sharing Risk Information Tool (ShaRIT) for Families with Hereditary Breast and Ovarian Cancer Syndrome

<p>Abstract</p> <p>Background</p> <p>Individuals who carry deleterious BRCA mutations face significantly elevated risks of breast, ovarian, and other cancers. These individuals are also responsible for informing relatives of their increased risk for carrying the family BRCA mutation. Few interventions have been developed to facilitate this family communication process.</p> <p>Methods</p> <p>We developed the Sharing Risk Information Tool (ShaRIT), a personalized educational intervention, to support BRCA carriers as they discuss BRCA positive results and their implications with relatives. We conducted a pilot study of 19 BRCA carriers identified through the University of California San Francisco Cancer Risk Program. Our study had two aims: 1) to assess the feasibility and acceptability of ShaRIT, and 2) describe characteristics associated with increased family communication and BRCA testing. Participants in our study were divided into two groups: those who had not received ShaRIT as part of their genetic counseling protocol (control group, n = 10) and those who received ShaRIT (n = 9).</p> <p>Results</p> <p>All 9 women who received ShaRIT reported that it was a useful resource. Characteristics associated with increased sharing and testing included: female gender, degree of relationship, and frequency of communication. Increased pedigree knowledge showed a trend toward higher rates of sharing.</p> <p>Conclusions</p> <p>Both participants and genetic counselors considered ShaRIT a well-received, comprehensive tool for disseminating individual risk information and clinical care guidelines to Hereditary Breast and Ovarian Cancer Syndrome families. Because of this, ShaRIT has been incorporated as standard of care at our institution. In the future we hope to evaluate the effects of ShaRIT on family communication and family testing in larger populations of BRCA positive families.</p

Serial monitoring of genomic alterations in circulating tumor cells of ER-positive/HER2-negative advanced breast cancer: feasibility of precision oncology biomarker detection.

Nearly all estrogen receptor (ER)-positive (POS) metastatic breast cancers become refractory to endocrine (ET) and other therapies, leading to lethal disease presumably due to evolving genomic alterations. Timely monitoring of the molecular events associated with response/progression by serial tissue biopsies is logistically difficult. Use of liquid biopsies, including circulating tumor cells (CTC) and circulating tumor DNA (ctDNA), might provide highly informative, yet easily obtainable, evidence for better precision oncology care. Although ctDNA profiling has been well investigated, the CTC precision oncology genomic landscape and the advantages it may offer over ctDNA in ER-POS breast cancer remain largely unexplored. Whole-blood (WB) specimens were collected at serial time points from patients with advanced ER-POS/HER2-negative (NEG) advanced breast cancer in a phase I trial of AZD9496, an oral selective ER degrader (SERD) ET. Individual CTC were isolated from WB using tandem CellSearch® /DEPArray™ technologies and genomically profiled by targeted single-cell DNA next-generation sequencing (scNGS). High-quality CTC (n = 123) from 12 patients profiled by scNGS showed 100% concordance with ctDNA detection of driver estrogen receptor α (ESR1) mutations. We developed a novel CTC-based framework for precision medicine actionability reporting (MI-CTCseq) that incorporates novel features, such as clonal predominance and zygosity of targetable alterations, both unambiguously identifiable in CTC compared to ctDNA. Thus, we nominated opportunities for targeted therapies in 73% of patients, directed at alterations in phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), fibroblast growth factor receptor 2 (FGFR2), and KIT proto-oncogene, receptor tyrosine kinase (KIT). Intrapatient, inter-CTC genomic heterogeneity was observed, at times between time points, in subclonal alterations. Our analysis suggests that serial monitoring of the CTC genome is feasible and should enable real-time tracking of tumor evolution during progression, permitting more combination precision medicine interventions

<i>Strongyloides</i> questions-a research agenda for the future.

The Strongyloides genus of parasitic nematodes have a fascinating life cycle and biology, but are also important pathogens of people and a World Health Organization-defined neglected tropical disease. Here, a community of Strongyloides researchers have posed thirteen major questions about Strongyloides biology and infection that sets a Strongyloides research agenda for the future. This article is part of the Theo Murphy meeting issue 'Strongyloides: omics to worm-free populations'

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

A psychometric analysis of the Relationship Attribution Measure–Online Behavior

Objective The purpose of the study is to develop and evaluate a measure of attributions about partner online behavior. Background The attributions that intimate partners make for one another\u27s actions foreshadow deterioration in relationship satisfaction. Although online communication is now pervasive, tools for assessing the attributions partners make for online behavior (e.g., why a partner hasn\u27t responded to a text message) are not yet available. Method College students (Sample 1) and individuals recruited via Qualtrics panels (Sample 2) completed an online survey assessing attributions, relationship satisfaction, attachment anxiety, jealousy, and depression. Results The Relationship Attribution Measure–Online Behavior (RAM-OB) is internally consistent, unifactorial, and reasonably stable. Maladaptive attributions (i.e., internal, stable, and global explanations for negative behavior) are negatively correlated with relationship satisfaction and positively correlated with attachment anxiety, jealousy, and depression (Study 1). Further, we demonstrate that maladaptive attributions covary with lower levels of relationship satisfaction even after controlling for anxious attachment, jealousy, and depression, and that the relationship between attributions and satisfaction is stronger for women and for people living with lower incomes (Study 2). Conclusion The RAM-OB is a reliable and valid measure of the attributions partners make about online behavior. Implications The availability of the RAM-OB may create new opportunities for understanding the role of technology and media-related behaviors in intimate relationships