Dysmenorrhea catastrophizing and functional impairment in female pelvic pain.

Background: Dysmenorrhea is suggested to increase the risk of chronic pain by enhancing central sensitization. However, little is known about whether emotional and cognitive responses induced by dysmenorrhea contribute to chronic pain interference. This study examined the association between catastrophizing specific to dysmenorrhea and both dysmenorrhea and chronic pelvic pain (CPP)-associated pain interference. Methods: Women (N = 104) receiving care for CPP through a tertiary gynecological pain clinic between 2017 and 2020 were recruited. They completed the Pain Catastrophizing Scale, the Brief Pain Inventory-pain interference, and a separate questionnaire regarding dysmenorrhea symptoms and treatment preceding the development of CPP. Dysmenorrhea catastrophizing and interference measures were developed and tested for internal consistency and construct validity. Multiple linear regression models examined dysmenorrhea catastrophizing in association with dysmenorrhea interference and CPP-associated pain interference. Results: Dysmenorrhea catastrophizing and interference measures demonstrated excellent internal consistency (Cronbach's Alpha = 0.93 and 0.92 respectively) and evidence of construct validity (correlated with dysmenorrhea severity and treatment, Ps < 0.01). Dysmenorrhea catastrophizing was moderately correlated with pain catastrophizing (ρ = 0.30, P = 0.003), and was associated with greater dysmenorrhea interference (P < 0.001) and CPP-associated pain interference (P = 0.032) accounting for general pain catastrophizing and other outcome-specific confounders. Dysmenorrhea intensity was most predictive of dysmenorrhea catastrophizing. Conclusion: Among our clinical sample of women with CPP, dysmenorrhea catastrophizing was associated with greater dysmenorrhea interference and subsequent CPP-associated pain interference. More research is needed to determine whether reduction in dysmenorrhea catastrophizing leads to reduced pain interference associated with female pelvic pain.

"I'm Doing My Part, I Just Need Help From the Community": Intervention Implications of Foster and Adoptive Parents' Experiences Raising Children and Young Adults With FASD.

Individuals with fetal alcohol spectrum disorders (FASD) have high rates of health care service utilization. It is vital that health care professionals understand FASD and associated family experiences to strengthen their ability to respond to family needs and tailor family-focused interventions. This study included 24 foster and adoptive parents of children and adults (aged 3-33 years) with FASD. Data were collected via individual interviews and focus groups and analyzed thematically. Consistent with a developmental psychopathology perspective, parents' experiences interacted with the individual (with FASD), family, and broader systems ecological levels. Parents undertook protective actions in an attempt to prevent secondary conditions, support their child and family, and mitigate systems barriers. They also experienced stressors at each level, and stress was increased by protective actions. The overall parenting experience was fueled by a protective parenting attitude. Findings can strengthen family-focused care practices with individuals with FASD and their families and inform novel family interventions.

Family Physicians' Perspectives on Their Weight Loss Nutrition Counseling in a High Obesity Prevalence Area.

BACKGROUND: Obesity is a serious and highly prevalent health problem. Behavioral modification for weight loss is effective, and physician nutrition counseling is encouraged. Nevertheless, several studies have reported that physicians provide nutrition counseling infrequently. Time constraints and lack of patient compliance are among frequently reported barriers. AIM: In this pilot study, we aimed to examine physician weight loss nutrition counseling among family physicians in Huntington, West Virginia, an area with the highest obesity prevalence in the United States. METHODS: We administered an anonymous 13-question online survey designed for this study to all area family physicians in continuity ambulatory practice, asking about how often they provided nutrition counseling to their comorbidly obese patients, their nutrition education background, the counseling resources used, and the barriers they faced. RESULTS: Thirty-eight of the 47 invited physicians completed surveys. The 35 to 55 age group comprised 55% of the respondents. Men comprised 53% of our sample. Two-thirds of the physicians reported that they counseled at a high frequency. Twenty-six of the 38 physicians reported that their nutrition education in medical school was none to minimal. Of the rest, 47.2% viewed their education as clinically relevant. The most frequently-used specific patient education sources were those embedded in electronic health records, the US Department of Agriculture's MyPlate tool, and a variety of smartphone-based apps. Time constraints and lack of patient interest in nutrition topics were the leading barriers cited. CONCLUSION: Family physicians practicing in the most obese population in the United States tend to be high-frequency obesity nutrition counselors who frequently use specific tools, consider their education lacking and face oft-cited barriers. Studies in other highly endemic areas are needed to confirm these findings.

Health behavior insights: the transtheoretical/stages of change model: Carlo C. DiClemente, PhD.

Showcased in this article is an interview with Carlo C. DiClemente, PhD, an internationally renowned health behavior researcher and codeveloper of the Transtheoretical or Stages of Change Model. In this verbatim interview transcript, later edited by the authors and interviewee, Dr. DiClemente, he provides practical information and frank commentary on the steps to follow and pitfalls to avoid in developing, implementing, evaluating, and disseminating efficacious programs for affecting the health and well-being of individuals and populations. A concluding section summarizes key lessons learned from the professional experiences of Dr. DiClemente and discusses implications for advancing health behavior intervention practice and research.

Design, synthesis, and evaluation of oxygen-containing macrocyclic peptidomimetics as inhibitors of HCV NS3 protease.

HCV infection is considered a silent epidemic because most people infected do not develop acute symptoms. Instead, the disease progresses to a chronic state leading to cirrhosis and hepatocarcinoma. Novel therapies are needed to combat this major health threat. The HCV NS3 serine protease has been the target of continuous investigation because of its pivotal role in viral replication. Herein, we present the P1-P3 macrocyclization approach followed for identification of HCV NS3 inhibitors as potential backup candidates to our first generation drug candidate, Sch 503034 (1). Different P1-P3 linkers were investigated to identify novel macrocyclic scaffolds. SAR exploration of P3-caps in the macrocyclic cores allowed the identification of l-serine derived macrocycle 32 (Ki* = 3 nM, EC90 = 30 nM) and allo-threonine derived macrocycle 36 (Ki* = 3 nM, EC90 = 30 nM) as potent HCV NS3 protease inhibitors.

Discovery and structure-activity relationship of P1-P3 ketoamide derived macrocyclic inhibitors of hepatitis C virus NS3 protease.

Hepatitis C virus (HCV) infection is the major cause of chronic liver disease, leading to cirrhosis and hepatocellular carcinoma, and affects more than 200 million people worldwide. Although combination therapy of interferon-alpha and ribavirin is reasonably successful in treating majority of genotypes, its efficacy against the predominant genotype (genotype 1) is moderate at best, with only about 40% of the patients showing sustained virological response. Herein, the SAR leading to the discovery of a series of ketoamide derived P(1)-P(3) macrocyclic inhibitors that are more potent than the first generation clinical candidate, boceprevir (1, Sch 503034), is discussed. The optimization of these macrocyclic inhibitors identified a P(3) imide capped analogue 52 that was 20 times more potent than 1 and demonstrated good oral pharmacokinetics in rats. X-ray structure of 52 bound to NS3 protease and biological data are also discussed.

It takes time: Impacts of Early Head Start that lead to reductions in maternal depression two years later.

The Early Head Start Research and Evaluation Project, a random-assignment evaluation, found a broad pattern of positive impacts for children and families. However, there were no program impacts on depression or use of mental health services by the time children reached age 3, at the end of the Early Head Start (EHS) program. This paper presents recent findings from the follow-up study in the spring prior to the children entering kindergarten, when a positive program impact emerged for reducing maternal depression. Results show that earlier program impacts on children and parents (when children were 2 and 3 years of age) mediated, or led to, the delayed impact on maternal depression. The combination of the most promising child factors accounted for over 57% of the later impact on depression, while the most promising parent factors accounted for over 35% of the later impact on depression. Implications for EHS programs are discussed.

Discovery of (1R,5S)-N-[3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl]- 3-[2(S)-[[[(1,1-dimethylethyl)amino]carbonyl]amino]-3,3-dimethyl-1-oxobutyl]- 6,6-dimethyl-3-azabicyclo[3.1.0]hexan-2(S)-carboxamide (SCH 503034), a selective, potent, orally bioavailable hepatitis C virus NS3 protease inhibitor: a potential therapeutic agent for the treatment of hepatitis C infection.

Hepatitis C virus (HCV) infection is the major cause of chronic liver disease, leading to cirrhosis and hepatocellular carcinoma, which affects more than 170 million people worldwide. Currently the only therapeutic regimens are subcutaneous interferon-alpha or polyethylene glycol (PEG)-interferon-alpha alone or in combination with oral ribavirin. Although combination therapy is reasonably successful with the majority of genotypes, its efficacy against the predominant genotype (genotype 1) is moderate at best, with only about 40% of the patients showing sustained virological response. Herein, the SAR leading to the discovery of 70 (SCH 503034), a novel, potent, selective, orally bioavailable NS3 protease inhibitor that has been advanced to clinical trials in human beings for the treatment of hepatitis C viral infections is described. X-ray structure of inhibitor 70 complexed with the NS3 protease and biological data are also discussed.

"This case is closed": family caregivers and the termination of home health care services for stroke patients.

Policies promoting home- and community-based services and disease management models implicitly rely on family care, still the bedrock of long-term and chronic care in the United States. The United Hospital Fund studied family caregivers of stroke and brain injury patients when home care cases were opened and closed and found that even with short-term formal services, family caregivers provided three-quarters of the care. Patients' mobility impairments and Medicaid eligibility were the main factors in determining the amount and duration of formal services. Between one-third and one-half of family caregivers reported being inadequately prepared for the case closing. At all stages, family caregivers expressed significant isolation, anxiety, and depression. Therefore, home care agency practice and public policies should provide better education, support, and services for family caregivers.

Three-year incidence of first-onset depressive syndrome in a population sample of older adults: the Cache County study.

OBJECTIVE: Estimates of incidence of late-life depression vary greatly with few studies excluding demented cases through in-depth evaluation and most studies failing to control for the effect of mortality and interval treatment. In a large population-based study, the authors examined the effect on incidence of first-onset depressive syndrome to determine whether any gender or age differences in incidence are attenuated with inclusion of these additional measures. METHOD: Incidence rates of depressive syndrome per 1,000 person-years are presented for 2,877 nondemented elderly (ages 65 to 100 years) residents of Cache County, Utah. Cases are identified by direct interview methods, by inference from prescription antidepressant medicine use, and by postmortem informant interview for decedents. RESULTS: In-person interviews yielded incidence rates of first-onset depressive disorder (any type) of 13.09 for men and 19.44 for women. Inclusion of antidepressant users increased these figures to 15.55 for men and 23.30 for women. Addition of postmortem interview data yielded rates of 20.66 for men and 26.29 for women. Individuals with no history of depression had rates for major depression of 7.88 for men and 8.75 for women; minor depression rates were 19.23 for men and 24.46 for women (p = 0.691; effect for minor depression p <0.0001). Age did not predict incidence. CONCLUSIONS: Incidence of first-onset major depression varies with data source and prior lifetime history of depression. Gender effects apparent in interview data are attenuated when postmortem information and pharmacotherapy were considered.

Young adult caregivers: a first look at an unstudied population.

OBJECTIVES: We examined the prevalence, characteristics, and responsibilities of young adults aged 18 to 25 years who are caregivers for ill, elderly, or disabled family members or friends. METHODS: We analyzed 2 previously published national studies (from 1998 and 2004) of adult caregivers. RESULTS: Young adult caregivers make up between 12% and 18% of the total number of adult caregivers. Over half are male, and the average age is 21. Most young adults are caring for a female relative, most often a grandmother. Young adult caregivers identified a variety of unmet needs, including obtaining medical help, information, and help making end-of-life decisions. CONCLUSIONS: Analysis of these 2 surveys broadens our understanding of the spectrum of family caregivers by focusing on caregivers between the ages of 18 and 25 years. The high proportion of young men raises questions about the appropriateness of current support services, which are typically used by older women. Concerted efforts are essential to ensure that young adults who become caregivers are not deterred from pursuing educational and career goals.

Oral piercing and gingival recession: review of the literature and a case report.

A young adult developed severe gingival recessions and radiographic signs of trauma to the periodontium after wearing a tongue barbell and a lip stud. Oral body art (piercing) can be hazardous to the periodontium; nevertheless, patients inclined to such practices do not see them as health hazards and are very reluctant to remove them.