Symptoms of anxiety and depression predicting fall-related outcomes among older Americans: a longitudinal study

BackgroundAnxiety and depressive symptoms are associated with fear of falling and fear of falling-related activity restrictions. However, it remains unknown whether anxiety or depressive symptoms alone could predict fear of falling and activity restrictions in older adults. We sought to determine if anxiety and depressive symptoms alone could be an independent predictor of fear of falling and activity restrictions in community-dwelling older adults.MethodsThis longitudinal analysis used waves 5 (time 1, [T1]) and 6 (time 2, [T2], 1 year from T1) data (N = 6376) from the National Health and Aging Trends Study. The Generalized Anxiety Disorder Scale 2 and Patient Health Questionnaire 2 were used to assess anxiety and depressive symptoms, respectively. Interview questions included demographics, health-related data, and fall worry levels (no fear of falling, fear of falling but no activity restrictions, and activity restrictions). Using multinomial logistic regression models, we examined whether anxiety and depressive symptoms (T1) predicted fear of falling and activity restrictions (T2).ResultsIn wave 5 (T1, mean age: 78 years, 58.1% female), 10 and 13% of participants reported anxiety and depressive symptoms. About 19% of participants experienced fear of falling but not activity restrictions, and 10% of participants developed activity restrictions in wave 6 (T2), respectively. Participants with anxiety symptoms at T1 had a 1.33 times higher risk of fear of falling (95% CI = 1.02–1.72) and 1.41 times higher risk of activity restrictions (95% CI = 1.04–1.90) at T2. However, having depressive symptoms did not show any significance after adjusting for anxiety symptoms.ConclusionsAnxiety symptoms seemed to be an independent risk factor for future fear of falling and activity restrictions, while depressive symptoms were not. To prevent future fear of falling and activity restrictions, we should pay special attention to older individuals with anxiety symptoms.</p

Day of the week to tweet: A randomised controlled trial

Objective To assess the effects of using health social media on different days of the working week on web activity.Design Individually randomised controlled parallel group superiority trial.Setting Twitter and Weibo.Participants 194 Cochrane Schizophrenia Group full reviews with an abstract and plain language summary web page. There were no human participants.Interventions Three randomly ordered slightly different messages (maximum of 140 characters), each containing a short URL to the freely accessible summary page, were sent on specific times on a single day. Each of these messages sent on Tuesday, Wednesday, Thursday and Friday was compared with the one sent on Monday.Outcome The primary outcome was visits to the relevant Cochrane summary web page at 1 week. Secondary outcomes were other metrics of web activity at 1 week.Results There was no evidence that disseminating microblogs on different days of the working week resulted in any differences in target website activity as measured by Google Analytics (n=194, all page views, adjusted ratios of geometric means 0.86 (95% CI 0.63 to 1.18), 0.88 (95% CI 0.64 to 1.21), 0.88 (95% CI 0.65 to 1.21), 0.91 (95% CI 0.66 to 1.24) for Tuesday–Friday, respectively, overall p=0.89). There were consistent findings for all outcomes. However, activity on the review site substantially increased compared with weeks preceding the intervention.Conclusion There are no clear differences in the effect when 1 weekday is compared with another, but our study suggests that using microblogging social media such as Twitter and Weibo do increase information-seeking behaviour on health. Tweet any day but do Tweet.</div

An international study of correlates of women's positive body image

Positive body image (PBI) has received attention in the recent research literature. Despite this, its role in daily functioning in different cultural contexts, particularly its potential relationship with academic outcomes, is still lacking. This study aimed to offer an international perspective on the association between PBI and body mass index (BMI), perceived academic achievement, and educational aspirations, as well as the mediating role of self-esteem. A cross-national study was conducted in eight European countries with a total of 2653 female university students. Participants completed an online survey measuring PBI (conceptualized as body appreciation), self-esteem, perceived academic achievement and aspirations, and body mass index (BMI). Results revealed differences in PBI between countries (low magnitude). PBI correlated negatively with BMI in all national groups (low-to-moderate magnitude). Mediation analysis showed that self-esteem mediated the association between PBI and academic variables. Findings from this study suggest that building students' self-esteem and PBI can be a suitable way to boost academic success

An International Study of Correlates of Women's Positive Body Image

Positive body image (PBI) has received attention in the recent research literature. Despite this, its role in daily functioning in different cultural contexts, particularly its potential relationship with academic outcomes, is still lacking. This study aimed to offer an international perspective on the association between PBI and body mass index (BMI), perceived academic achievement, and educational aspirations, as well as the mediating role of self-esteem. A cross-national study was conducted in eight European countries with a total of 2653 female university students. Participants completed an online survey measuring PBI (conceptualized as body appreciation), self-esteem, perceived academic achievement and aspirations, and body mass index (BMI). Results revealed differences in PBI between countries (low magnitude). PBI correlated negatively with BMI in all national groups (low-to-moderate magnitude). Mediation analysis showed that self-esteem mediated the association between PBI and academic variables. Findings from this study suggest that building students' self-esteem and PBI can be a suitable way to boost academic success

Deficient H2A.Z deposition is associated with genesis of uterine leiomyoma

One in four women suffers from uterine leiomyomas (ULs)-benign tumours of the uterine wall, also known as uterine fibroids-at some point in premenopausal life. ULs can cause excessive bleeding, pain and infertility(1), and are a common cause of hysterectomy(2). They emerge through at least three distinct genetic drivers: mutations in MED12 or FH, or genomic rearrangement of HMGA2(3). Here we created genome-wide datasets, using DNA, RNA, assay for transposase-accessible chromatin (ATAC), chromatin immunoprecipitation (ChIP) and HiC chromatin immunoprecipitation (HiChIP) sequencing of primary tissues to profoundly understand the genesis of UL. We identified somatic mutations in genes encoding six members of the SRCAP histone-loading complex(4), and found that germline mutations in the SRCAP members YEATS4 and ZNHIT1 predispose women to UL. Tumours bearing these mutations showed defective deposition of the histone variant H2A.Z. In ULs, H2A.Z occupancy correlated positively with chromatin accessibility and gene expression, and negatively with DNA methylation, but these correlations were weak in tumours bearing SRCAP complex mutations. In these tumours, open chromatin emerged at transcription start sites where H2A.Z was lost, which was associated with upregulation of genes. Furthermore, YEATS4 defects were associated with abnormal upregulation of bivalent embryonic stem cell genes, as previously shown in mice(5). Our work describes a potential mechanism of tumorigenesis-epigenetic instability caused by deficient H2A.Z deposition-and suggests that ULs arise through an aberrant differentiation program driven by deranged chromatin, emanating from a small number of mutually exclusive driver mutations.Peer reviewe

Cost-effectiveness of the Self-Help Plus Intervention for Adult Syrian Refugees Hosted in Turkey

Importance: The cost-effectiveness of the Self-Help Plus (SH+) program, a group-based, guided, self-help psychological intervention developed by the World Health Organization for people affected by adversity, is unclear.Objective: To investigate the cost-utility of providing the SH+ intervention combined with enhanced usual care vs enhanced usual care alone for Syrian refugees or asylum seekers hosted in Turkey.Design, setting, and participants: This economic evaluation was performed as a prespecified part of an assessor-blinded randomized clinical trial conducted between October 1, 2018, and November 30, 2019, with 6-month follow-up. A total of 627 adults with psychological distress but no diagnosed psychiatric disorder were randomly assigned to the intervention group or the enhanced usual care group.Interventions: The SH+ program was a 5-session (2 hours each), group-based, stress management course in which participants learned self-help skills for managing stress by listening to audio sessions. The SH+ sessions were facilitated by briefly trained, nonspecialist individuals, and an illustrated book was provided to group members. Th intervention group received the SH+ intervention plus enhanced usual care; the control group received only enhanced usual care from the local health care system. Enhanced usual care included access to free health care services provided by primary and secondary institutions plus details on nongovernmental organizations and freely available mental health services, social services, and community networks for people under temporary protection of Turkey and refugees.Main outcomes and measures: The primary outcome measure was incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the Turkish health care system. An intention-to-treat analysis was used including all participants who were randomized and for whom baseline data on costs and QALYs were available. Data were analyzed September 30, 2020, to July 30, 2021.Results: Of 627 participants (mean [SD] age, 31.3 [9.0] years; 393 [62.9%] women), 313 were included in the analysis for the SH+ group and 314 in the analysis for the enhanced usual care group. An incremental cost-utility ratio estimate of T£6068 ($1147) per QALY gained was found when the SH+ intervention was provided to groups of 10 Syrian refugees. At a willingness to pay per QALY gained of T£14 831 ($2802), the SH+ intervention had a 97.5% chance of being cost-effective compared with enhanced usual care alone.Conclusions and relevance: This economic evaluation suggests that implementation of the SH+ intervention compared with enhanced usual care alone for adult Syrian refugees or asylum seekers hosted in Turkey is cost-effective from the perspective of the Turkish health care system when both international and country-specific willingness-to-pay thresholds were applied.</p

Self-help plus for refugees and asylum seekers; study protocol for a series of individual participant data meta-analyses

Background Refugees and asylum seekers face various stressors due to displacement and are especially vulnerable to common mental disorders. To effectively manage psychological distress in this population, innovative interventions are required. The World Health Organization (WHO) Self-Help Plus (SH+) intervention has shown promising outcomes in reducing symptoms of common mental disorders among refugees and asylum seekers. However, individual participant differences in response to SH+ remain largely unknown. The Individual Participant Data (IPD) meta-analysis synthesizes raw datasets of trials to provide cutting-edge evidence of outcomes that cannot be examined by conventional meta-analytic approaches.Objectives This protocol outlines the methods of a series of IPD meta-analyses aimed at examining the effects and potential moderators of SH+ in (a) reducing depressive symptoms at post-intervention and (b) preventing the six-month cumulative incidence of mental disorders in refugees and asylum seekers.Method RCTs on SH+ have been identified through WHO and all authors have agreed to share the datasets of the trials. The primary outcomes of the IPD meta-analyses are (a) reduction in depressive symptoms at post-intervention, and (b) prevention of six-month cumulative incidence of mental disorders. Secondary outcomes include post-traumatic stress disorder symptoms, well-being, functioning, quality of life, and twelve-month cumulative incidence of mental disorders. One-stage IPD meta-analyses will be performed using mixed-effects linear/logistic regression. Missing data will be handled by multiple imputation.Conclusions These results will enrich current knowledge about the response to SH+ and will facilitate its targeted dissemination. The results of these IPD meta-analyses will be published in peer-reviewed journals.</p

Self-help plus for refugees and asylum seekers : study protocol for a series of individual participant data meta-analyses

Background: Refugees and asylum seekers face various stressors due to displacement and are especially vulnerable to common mental disorders. To effectively manage psychological distress in this population, innovative interventions are required. The World Health Organization (WHO) Self-Help Plus (SH+) intervention has shown promising outcomes in reducing symptoms of common mental disorders among refugees and asylum seekers. However, individual participant differences in response to SH+ remain largely unknown. The Individual Participant Data (IPD) meta-analysis synthesizes raw datasets of trials to provide cutting-edge evidence of outcomes that cannot be examined by conventional meta-analytic approaches. Objectives: This protocol outlines the methods of a series of IPD meta-analyses aimed at examining the effects and potential moderators of SH+ in (a) reducing depressive symptoms at post-intervention and (b) preventing the six-month cumulative incidence of mental disorders in refugees and asylum seekers. Method: RCTs on SH+ have been identified through WHO and all authors have agreed to share the datasets of the trials. The primary outcomes of the IPD meta-analyses are (a) reduction in depressive symptoms at post-intervention, and (b) prevention of six-month cumulative incidence of mental disorders. Secondary outcomes include post-traumatic stress disorder symptoms, well-being, functioning, quality of life, and twelve-month cumulative incidence of mental disorders. One-stage IPD meta-analyses will be performed using mixed-effects linear/logistic regression. Missing data will be handled by multiple imputation. Conclusions: These results will enrich current knowledge about the response to SH+ and will facilitate its targeted dissemination. The results of these IPD meta-analyses will be published in peer-reviewed journals