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

Mindfulness and Affect-Network Density: Does Mindfulness Facilitate Disengagement from Affective Experiences in Daily Life?

This project is part of a larger parent study. These data were already used to examine associations between affect dynamics (inertia, instability, affect valence switch) and mindfulness

Strategy-situation fit as currently operationalized in daily life may not explain variance in affective well-being

Research on emotion regulation (ER) has shifted from focusing on the static to the flexible use of ER strategies in response to environmental demands, emphasizing the importance of strategy-situation fit. Despite the growing theoretical popularity and importance of this concept, empirical evidence remains scarce. To address this gap, we examined the role of negative affect in moderating ER effectiveness because research suggests that as negative affect increases, people tend to prefer distraction over reappraisal. We re-analyzed twelve ambulatory assessment datasets (1,511 participants with 161,513 measurement occasions) collected from predominantly Caucasian undergraduate psychology students. Using meta-analytic techniques, we did not find any evidence for strategy-situation fit, i.e., choosing distraction in high-intensity situations and reappraisal in low-intensity situations, was not significantly associated with positive affect, negative affect, or depressive symptoms. Given these null results, we discuss current problems with how strategy-situation fit is currently operationalized to advance research on this important topic

The effects of computer-based mindfulness training on self-control and mindfulness within ambulatorily assessed network systems across health-related domains in a healthy student population (SMASH) : study protocol for a randomized controlled trial

Background Self-control is an important ability in everyday life, showing associations with health-related outcomes. The aim of the Self-control and Mindfulness within Ambulatorily assessed network Systems across Health-related domains (SMASH) study is twofold: first, the effectiveness of a computer-based mindfulness training will be evaluated in a randomized controlled trial. Second, the SMASH study implements a novel network approach in order to investigate complex temporal interdependencies of self-control networks across several domains. Methods The SMASH study is a two-armed, 6-week, non-blinded randomized controlled trial that combines seven weekly laboratory meetings and 40 days of electronic diary assessments with six prompts per day in a healthy undergraduate student population at the Johannes Gutenberg University Mainz, Germany. Participants will be randomly assigned to (1) receive a computer-based mindfulness intervention or (2) to a wait-list control condition. Primary outcomes are self-reported momentary mindfulness and self-control assessed via electronic diaries. Secondary outcomes are habitual mindfulness and habitual self-control. Further measures include self-reported behaviors in specific self-control domains: emotion regulation, alcohol consumption and eating behaviors. The effects of mindfulness training on primary and secondary outcomes are explored using three-level mixed models. Furthermore, networks will be computed with vector autoregressive mixed models to investigate the dynamics at participant and group level. This study was approved by the local ethics committee (reference code 2015_JGU_psychEK_011) and follows the standards laid down in the Declaration of Helsinki (2013). Discussion This randomized controlled trial combines an intensive Ambulatory Assessment of 40 consecutive days and seven laboratory meetings. By implementing a novel network approach, underlying processes of self-control within different health domains will be identified. These results will deepen the understanding of self-control performance and will guide to just-in-time individual interventions for several health-related behaviors

Self-Control Dynamics in Daily Life: The Importance of Variability Between Self-Regulatory Strategies and Strategy Differentiation

Research on self-control has increasingly acknowledged the importance of self-regulatory strategies, with strategies in earlier stages of the developing tempting impulse thought to be more effective than strategies in later stages. However, recent research on emotion regulation has moved away from assuming that some strategies are per se and across situations more adaptive than others. Instead, strategy use that is variable to fit situational demands is considered more adaptive. In the present research, we transfer this dynamic process perspective to self-regulatory strategies in the context of persistence conflicts. We investigated eight indicators of strategy use (i.e., strategy intensity, instability, inertia, predictability, differentiation, diversity, and within- and between-strategy variability) in an experience sampling study ( N = 264 participants with 1,923 observations). We found that variability between strategies was significantly associated with self-regulatory success above and beyond mean levels of self-regulatory strategy use. Moreover, the association between trait self-control on one hand and everyday self-regulatory success and affective well-being on the other hand was partially mediated by between-strategy variability. Our results do not only show the benefits of variable strategy use for individual’s self-regulatory success but also the benefits of more strongly connecting the fields of emotion regulation and self-control research

Relationship satisfaction can help to maintain the positive effect of childbirth on parental self-esteem

The transition to parenthood is accompanied by declined self-esteem levels, which may be explained by parents’ relationship satisfaction. However, prior research examined self-esteem only shortly before and after childbirth and had no or only unmatched childless respondents as a control group, limiting the possibility to examine long-term adaptive processes and the causal interpretation of the associations. Thus, we used panel data (10 years, 4,075 individuals, and 16,122 observations) to compare self-esteem and relationship satisfaction trajectories of parents with matched childless respondents using propensity score matching. We found a quadratic trajectory for parents’ self-esteem, which declined and increased before birth and declined and returned to baseline levels after birth. In contrast, matched childless respondents’ self-esteem decreased linearly before childbirth and then recovered. The quadratic postpartum process in parents was significantly associated with reduced relationship satisfaction. Thus, a fulfilling relationship may help to maintain the positive effects of childbirth on self-esteem in parents

The Costs and Benefits of Mindfulness and Reappraisal in Daily Life

Reappraisal and mindfulness represent two fundamentally different ways of dealing with one’s emotions: Whereas reappraisal aims at changing one’s thoughts and emotions, mindfulness is aimed at not changing, but appreciating them. Despite this difference, prior research has shown that both are similarly associated with short-term benefits and trait-level correlates. However, research on the spontaneous use of reappraisal and mindfulness in daily life found that mindfulness is more effective in decreasing negative affect than reappraisal. The spontaneous use of reappraisal may be less effective than mindfulness in daily life given that it is more cognitively taxing. Therefore, we assumed in the present research that the increased costs (i.e., feeling exhausted) of spontaneously endorsing reappraisal compared to mindfulness can explain why reappraisal is less effective in regulating negative affect than mindfulness. In two experience sampling studies (N = 125 and N = 179), we found evidence for different costs and benefits of reappraisal compared to mindfulness. Regarding short-term benefits, endorsing reappraisal was significantly associated with increases in positive affect, whereas endorsing the mindfulness component acceptance was significantly associated with decreases in negative affect. Regarding short-term costs, we found that endorsing reappraisal was more exhausting, and that reappraisal was selected less often than mindfulness in daily life. Finally, acceptance was associated more strongly with trait level indicators of well-being than reappraisal, which may be explained by the reduced costs of endorsing acceptance compared to reappraisal. Our results demonstrate the importance of assessing both the benefits and costs of emotion regulation in daily life

The Benefits of Self-Set Goals: Is Ego Depletion Really a Result of Self-Control Failure?

<div><p>Research on ego depletion aims at explaining self-control failures in daily life. Both resource models and motivational accounts have been proposed for explanation. The aim of the present research was to test the different assumptions in two dual-task experiments where we operationalized ego depletion as a performance deviation from a self-set goal. In two experiments, we found evidence for this deviation contradicting motivational accounts of ego depletion: Participants experiencing ego depletion set themselves a stricter instead of a more lenient goal than controls, in that they chose to eat less cookies or wanted to perform better. Moreover, only participants without an initial self-control task could adhere to their self-set goal, whereas participants in the ego depletion condition in both experiments could not follow through with their more ambitious intentions. Taken together, our findings demonstrate the importance of goals in ego depletion research.</p></div