Examining the Relationship Between Sleep-Related Infant Deaths and Social Determinants of Health in Urban Communities.

In 2017, sleep-related infant deaths (SRID) accounted for about 3600 deaths in the USA. The SRID rate for African American infants (186. 41 per 100,000 live births) is more than twice that of Caucasian American infants (85. 43 per 100,000 live births) (Centers for Disease and Prevention, July 2020). PURPOSE: The purpose of this article is to develop a case for considering the relationship between racial disparities in SRID and social determinants of health (SDOH) in impoverished communities. The later has been related to chronic stress impacting biological and psychological functioning. The authors advocate that undesirable SDOH be regarded when developing safe sleep strategies for at risk communities, since chronic stress can impact psychological and biologic functioning, possibly manifesting in inconsistent safe sleep practices by caregivers. METHODS: An adapted environmental scan (AES), using SRID and SDOH data from impoverished communities, was used to illustrate the comparison of SRID and SDOH in contrasting Baltimore neighborhoods. RESULTS: The AES revealed a match between disparities in SRID and SDOH (e.g., educational achievement, unemployment, poverty, poor housing, and violence). The comparison between the SDOH and SRID increases together for named impoverished neighborhoods, as compared to those with low SRID rates in Baltimore. CONCLUSION: Rather than limit safe sleep interventions to crib and infant sleeper give-aways, for example, hazardous SDOH seen in impoverished communities should be addressed. We posit that these results will stimulate discussion for well-placed and financed programs, along with policies that focus on decreasing SRID by improving poor SDOH.

Treatment of older adults with co-morbid personality disorder and depression: a dialectical behavior therapy approach.

BACKGROUND AND SIGNIFICANCE: The treatment of personality disorders in older adults, particularly those co-morbid with other Axis I disorders (e.g., Major Depressive Disorder), is an understudied clinical phenomenon. It has also been demonstrated that personality disorders in older adults complicate treatment of other psychopathology, as well as result in heightened interpersonal disturbance and emotional distress. METHODS: Two studies utilizing standard Dialectical Behavior Therapy (DBT) to treat depression and personality disorders in older adults are reviewed. Study 1 examined 34 chronically depressed individuals aged 60 and older who were randomly assigned to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of DBT skills-training and scheduled telephone coaching sessions (MED + DBT). Study 2 had two phases of treatment: Phase I: 8-week open-trial of antidepressant medication (n = 65); Phase II: 24-week randomized trial of DBT + MED versus MED alone for those who prospectively failed to respond to the Phase I medication trial (n = 37). RESULTS: Study 1 demonstrated that 71% of MED + DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. This became a significant difference at the 6-month follow-up; where 75% of MED + DBT-D patients were in remission compared with only 31% of MED patients. Study 2 showed that after 8 weeks of treatment with antidepressant medication alone (Phase 1) only 14% of the sample had at least a 50% reduction in HAM-D scores. Phase II results showed on average, the DBT + MED group reached depression remission by the post-group assessment and maintained these gains while the MED group did not reach remission, until the follow-up assessment. Results demonstrated superiority of DBT + MED compared to MED alone on Interpersonal Sensitivity and Interpersonal Aggression at post-treatment and 6-month follow-up. CONCLUSION: Results from these two treatment development studies indicate that applying standard DBT for the treatment of co-morbid MDD or MDD + PD in older adults is feasible, acceptable, and has clinical promise. Modifications to standard DBT and an overview of a new treatment manual for this population are summarized.

Fish and omega-3 fatty acid intake and risk of coronary heart disease in women.

CONTEXT: Higher consumption of fish and omega-3 fatty acids has been associated with a lower risk of coronary heart disease (CHD) in men, but limited data are available regarding women. OBJECTIVE: To examine the association between fish and long-chain omega-3 fatty acid consumption and risk of CHD in women. DESIGN, SETTING, AND PARTICIPANTS: Dietary consumption and follow-up data from 84 688 female nurses enrolled in the Nurses' Health Study, aged 34 to 59 years and free from cardiovascular disease and cancer at baseline in 1980, were compared from validated questionnaires completed in 1980, 1984, 1986, 1990, and 1994. MAIN OUTCOME MEASURES: Incident nonfatal myocardial infarction and CHD deaths. RESULTS: During 16 years of follow-up, there were 1513 incident cases of CHD (484 CHD deaths and 1029 nonfatal myocardial infarctions). Compared with women who rarely ate fish (<1 per month), those with a higher intake of fish had a lower risk of CHD. After adjustment for age, smoking, and other cardiovascular risk factors, the multivariable relative risks (RRs) of CHD were 0.79 (95% confidence interval [CI], 0.64-0.97) for fish consumption 1 to 3 times per month, 0.71 (95% CI, 0.58-0.87) for once per week, 0.69 (95% CI, 0.55-0.88) for 2 to 4 times per week, and 0.66 (95% CI, 0.50-0.89) for 5 or more times per week (P for trend =.001). Similarly, women with a higher intake of omega-3 fatty acids had a lower risk of CHD, with multivariable RRs of 1.0, 0.93, 0.78, 0.68, and 0.67 (P<.001 for trend) across quintiles of intake. For fish intake and omega-3 fatty acids, the inverse association appeared to be stronger for CHD deaths (multivariate RR for fish consumption 5 times per week, 0.55 [95% CI, 0.33-0.90] for CHD deaths vs 0.73 [0.51-1.04]) than for nonfatal myocardial infarction. CONCLUSION: Among women, higher consumption of fish and omega-3 fatty acids is associated with a lower risk of CHD, particularly CHD deaths.