"If it has happened once, it can happen again". The impact of previous pregnancy loss on anxious women's ongoing pregnancies: A qualitative study from Pakistan.

BACKGROUND: Pregnancy loss that includes both miscarriage and stillbirth cause significant psychological distress for women including anxiety, depression, and grief that persist long after physical recovery. This study focuses on the experiences of women in Pakistan, where pregnancy loss rates are high. OBJECTIVE: To explore how pregnant women with anxiety symptoms and a history of pregnancy loss perceive their past experiences with the loss and how it affects overall well-being in their current pregnancy. DESIGN: Qualitative methods were used to explore the impact of previous pregnancy loss on the well-being of pregnant women. SETTING: This qualitative research was embedded within a randomized control trial conducted in a tertiary care facility in Rawalpindi, Pakistan. PARTICIPANTS: Data were collected through in-depth interviews with 18 pregnant women who had experienced pregnancy loss. Data was analyzed using Framework Analysis. FINDINGS: The findings revealed several factors influencing participants' well-being during pregnancies that resulted in a loss, such as unsupportive and abusive environments, unintended pregnancies, certain superstitious beliefs, poor health, and lack of access to quality healthcare. The study also highlighted the adverse impact of previous pregnancy loss on the ongoing pregnancy, including deterioration of physical and mental health and aversion of healthcare services. However, some participants reported positive changes in medical and self-care practices and an enhanced faith and reliance on destiny in their subsequent pregnancies. CONCLUSION: Our study highlights the lasting impact of past pregnancy loss on subsequent pregnancies, affecting overall wellbeing and leading to healthcare avoidance. We identified persistent anxiety along with positive outcomes like enhanced medical practices and strengthened faith. Results suggest the need for culturally responsive interventions to support the overall well-being of anxious pregnant women with a history of pregnancy loss in resource-constrained settings.

Okweraliikirira and Okwenyamira: Idioms of Psychological Distress Among People Living with HIV in Rakai, Uganda.

Introduction : Health and illness experiences are positioned within social and cultural contexts. Understanding the mental health and psychological distress of people living with HIV in highly affected communities is critical to addressing their needs and to ensure programming and interventions are targeted and appropriate. Methods : Grounded in the ethnomedical theoretical perspective, we conducted qualitative interviews to understand the experience and expression of psychological distress by people living with HIV in Rakai, Uganda. Participants included adults living with HIV (n=20), health workers (counselors, peer health workers, nurses, n=10), and key informants (n=12). Interviews were audio recorded, transcribed/translated, coded, and analyzed using thematic analysis. Results: Two idioms of distress, okweraliikirira (worry/apprehension) and okwenyamira (deep/many thoughts/lots of thoughts) were described as impacting people living with HIV. Both idioms were said to be alleviated by social support or counseling, but if left unaddressed could lead to more severe mental health problems and poor ART adherence. Conclusion: People living with HIV understand their psychological distress through culturally specific idioms; such distress can have deleterious impacts on well-being. Incorporating idioms of distress into screening and treatment for people living with HIV may improve identification of individuals in need and overall health services to address this need.

Exploring preference for delivery methods for a psychosocial intervention for prenatal anxiety: A qualitative study from a tertiary care hospital in Pakistan.

Objective: This qualitative study explores therapists' and participants' preferences for delivery methods (face-to-face and phone sessions) of a cognitive behavioral therapy-based psychosocial intervention for prenatal anxiety delivered in a tertiary care hospital. Setting: The research was conducted in a randomized controlled trial in Pakistan, where a shift from face-to-face to phone-based therapy occurred during the coronavirus disease-2019 (COVID-19) pandemic. Participants: Twenty in-depth interviews and a focus group discussion were conducted with participants and therapists, respectively. Transcripts were analyzed using thematic analysis. Results: Participants generally preferred face-to-face sessions for rapport building, communication, and comprehension. However, barriers like venue accessibility, childcare, and lack of family support hindered engagement. Telephone sessions were favored for easy scheduling and the comfort of receiving the session at home, but there were challenges associated with phone use, distractions at home, and family members' limited mental health awareness. A mix of face-to-face and telephone sessions was preferred, with rapport from in-person sessions carrying over to telephone interactions. Conclusion: This study underscores the need for adaptable intervention delivery strategies that consider cultural norms, logistical challenges, and individual family dynamics. By combining the benefits of both delivery methods, mental health interventions can be optimized to effectively address prenatal anxiety and promote well-being in resource-constrained settings like Pakistan.

Dietary patterns and micronutrients in respiratory infections including COVID-19: a narrative review.

BACKGROUND: COVID-19 is a pandemic caused by nCoV-2019, a new beta-coronavirus from Wuhan, China, that mainly affects the respiratory system and can be modulated by nutrition. METHODS: This review aims to summarize the current literature on the association between dietary intake and serum levels of micronutrients, malnutrition, and dietary patterns and respiratory infections, including flu, pneumonia, and acute respiratory syndrome, with a focus on COVID-19. We searched for relevant articles in various databases and selected those that met our inclusion criteria. RESULTS: Some studies suggest that dietary patterns, malnutrition, and certain nutrients such as vitamins D, E, A, iron, zinc, selenium, magnesium, omega-3 fatty acids, and fiber may have a significant role in preventing respiratory diseases, alleviating symptoms, and lowering mortality rates. However, the evidence is not consistent and conclusive, and more research is needed to clarify the mechanisms and the optimal doses of these dietary components. The impact of omega-3 and fiber on respiratory diseases has been mainly studied in children and adults, respectively, and few studies have examined the effect of dietary components on COVID-19 prevention, with a greater focus on vitamin D. CONCLUSION: This review highlights the potential of nutrition as a modifiable factor in the prevention and management of respiratory infections and suggests some directions for future research. However, it also acknowledges the limitations of the existing literature, such as the heterogeneity of the study designs, populations, interventions, and outcomes, and the difficulty of isolating the effects of single nutrients from the complex interactions of the whole diet.

Results of a cognitive behavior therapy-based intervention for antenatal anxiety on birth outcomes in Pakistan: a randomized control trial.

Antenatal anxiety is among the risk factors for adverse birth outcomes, which are common in Pakistan. Between 2019 and 2022, we conducted a randomized controlled trial to evaluate the effects of the Happy Mother-Healthy Baby program, designed to reduce anxiety during pregnancy through use of Cognitive Behavior Therapy, on birth outcomes with 796 women in Rwalpindi, Pakistan. We performed intent-to-treat analysis and per protocol analyses. Intention-to-treat analyses showed no difference in the odds of low birthweight (LBW) (Adj. OR = 0.82, 95% CI 0.55-1.28 p = 0.37), preterm birth (PTB) (Adj. OR = 1.20 95% CI 0.83-1.71, p = 0.33) or small-for-gestational age (SGA) birth, (Adj. OR = 0.76, 95% CI 0.56-1.09, p = 0.16). Among completers who received ≥ 5 intervention sessions, the odds of LBW and SGA were 39% and 32% lower (Adj. OR = 0.61, 95% CI 0.43-0.87, p < 0.01; Adj. OR = 0.68, 95% CI 0.53-0.89, p < 0.01). The significant LBW and SGA results among the intervention completers suggest that the program may be effective when a sufficient dose is received. However, confirmation of these findings is needed due to the fact that randomization is not maintained in completer analyses.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03880032, 19/03/2019.

Association between maternal dissatisfaction with oneself at birth and shaking and smothering toward the offspring up to 18 months old.

BACKGROUND: A mother who feels dissatisfaction with herself may resort to abusive behavior such as shaking or smothering toward their offspring. Understanding this association can inform effective prevention strategies. OBJECTIVE: This study aimed to investigate the associations between maternal feelings of dissatisfaction with oneself and infant physical abuse. PARTICIPANTS AND SETTING: The study included 434 mothers who had recently given birth in two obstetric wards in a relatively wealthy area in Tokyo, Japan. METHODS: Adopting a longitudinal design, the study used questionnaires post-childbirth to measure mothers' dissatisfaction with themselves. This involved evaluating perceptions of failing to meet personal standards or self-image. Physical abuse (specifically shaking or smothering) in infants was tracked at 3, 6, 12, and 18 months. Data analysis comprised multilevel analysis, group-based trajectory modeling, and multivariable logistic regression to explore the association between maternal dissatisfaction and child physical abuse. RESULTS: Multilevel analysis showed that mothers with middle or high dissatisfaction with themselves were more likely to abuse their infant compared to mothers with low dissatisfaction with themselves (adjusted odds ratios [aOR] 5.71, 95 % confidence interval [CI], 1.06-30.78 and aOR 12.47, 95 % CI: 2.11-73.69, respectively). Trajectory analyses indicated that mothers with middle or high dissatisfaction with themselves were consistently more likely to abuse their infants up to 18 months (aOR 8.08, 95 % CI 1.61-40.53 and aOR 6.42, 95 % CI 1.27-32.43, respectively). CONCLUSIONS: Our findings highlight a robust association between mother's dissatisfaction with themselves and a higher risk of infant physical abuse. These insights call for a comprehensive review of preventive measures for childhood physical abuse.

Self-reported problems and functional difficulties in anxious pregnant women in Pakistan: The use of a patient-generated mental health outcome measure.

Anxiety during pregnancy affects women worldwide and is highly prevalent in Pakistan. The Psychological Outcome Profiles (PSYCHLOPS) questionnaire is an instrument used in therapy to assess patient-generated problems and the consequent functional difficulties. Using the PSYCHLOPS, we aimed to describe the type of problems and the consequent functional difficulties faced by anxious pregnant women in Pakistan. Secondarily, we sought to explore if a cognitive behavioral therapy (CBT)-based intervention brought about changes in the severity score for certain problems or functional difficulties. Anxious pregnant women were recruited from the Obstetrics/Gynecology Department of a tertiary hospital in Rawalpindi, Pakistan. Of 600 pregnant women randomized to receive a psychosocial intervention for prenatal anxiety delivered by non-specialist providers, 450 received ≥1 intervention session and were administered the PSYCHLOPS. Eight types of problems were identified; worries about the unborn baby's health and development (23%), concerns about family members (13%), and financial constraints (12%) were the most frequently reported primary problems. Severity scores between baseline and the last available therapy session indicated the largest decrease for relationship problems (mean = 2.4) and for concerns about family members (mean = 2.2). For functional difficulties, 45% of the participants reported difficulties in performing household chores, but the intervention showed the greatest decrease in severity scores for mental or emotional functional difficulties. Focus on certain types of patient-generated problems, e.g., relationship problems, could anchor therapy delivery in order to have the greatest impact. Tailored CBT-based intervention sessions have the potential to address important but neglected problems and functional difficulties in anxious pregnant women.

Correction: The longitudinal impact of employment, retirement and disability status on depressive symptoms among men living with HIV in the Multicenter AIDS Cohort Study.

[This corrects the article DOI: 10.1371/journal.pone.0239291.].

The immune phenotype of perinatal anxiety in an anxiety-focused behavioral intervention program in Pakistan.

BACKGROUND: Dysregulation of the immune system has been associated with psychiatric disorders and pregnancy-related complications, such as perinatal depression. However, the immune characteristics specific to perinatal anxiety remain poorly understood. In this study, our goal was to examine specific immune characteristics related to prenatal anxiety within the context of a randomized controlled trial designed to alleviate anxiety symptoms-the Happy Mother - Healthy Baby (HMHB) study in Rawalpindi, Pakistan. MATERIALS AND METHODS: Pregnant women (n = 117) were followed prospectively in the 1st, 2nd, and 3rd trimesters (T1, T2, T3) and at 6 weeks postpartum (PP6). Each visit included a blood draw and anxiety evaluation (as measured by the anxiety subscale of the Hospital Anxiety and Depression Scale - HADS -using a cutoff ≥ 8). We enrolled both healthy controls and participants with anxiety alone; those with concurrent depression were excluded. RESULTS: K-means cluster analysis revealed three anxiety clusters: Non-Anxiety, High and Consistent Anxiety, and Decreasing Anxiety. Principal components analysis revealed two distinct clusters of cytokine and chemokine activity. Women within the High and Consistent Anxiety group had significantly elevated chemokine activity across pregnancy (in trimester 1 (ß = 0.364, SE = 0.178, t = 2.040, p = 0.043), in trimester 2 (ß = 0.332, SE = 0.164, t = 2.020, p = 0.045), and trimester 3 (ß = 0.370, SE = 0.179, t = 2.070, p = 0.040) compared to Non-Anxiety group. Elevated chemokine activity was associated with low birthweight (LBW) and small for gestational age (SGA). CONCLUSION: Our findings reveal a unique pattern of immune dysregulation in pregnant women with anxiety in a Pakistani population and offer preliminary evidence that immune dysregulation associated with antenatal anxiety may be associated with birth outcomes. The dysregulation in this population is distinct from that in our other studies, indicating that population-level factors other than anxiety may play a substantial role in the differences found. (Clinicaltrials.gov # NCT04566861).

Family concerns and relationship problems in anxious pregnant women and their associations with postnatal functional disability in Pakistan.

OBJECTIVE: Expanding on existing research suggesting that strategies to reduce prenatal anxiety can decrease functional disability (e.g., difficulties in performing everyday activities and social participation), we examined if this effect varied by type of anxiety-producing problem (i.e., having family concerns and relationship problems versus other problems) reported during pregnancy. Further, we explored if perceived social support mediated this relationship. METHODS: We used longitudinal data on 310 anxious Pakistani women who received any psychosocial intervention sessions as part of a program that was based on Cognitive Behavioral Therapy. The Psychological Outcome Profiles (PSYCHLOPS) was used to assess whether women had 'family concerns and relationship problems' or 'other problems.' The WHO Disability Assessment Schedule 2.0 assessed functional disability at six-weeks after delivery. Lack of support was measured using a 12-item Multi-dimensional Scale of Perceived Social Support. We employed linear regression to examine associations between types of problems reported during pregnancy and postnatal functional disability. Causal mediation analysis was used to assess whether postnatal social support mediated this relationship. RESULTS: Of anxious pregnant women, 34% reported family concerns or relationship problems as primary problems in pregnancy. They were more likely to report higher functional disability at six-weeks after delivery than women who reported other problems (adjusted B = 2.40, 95% CI: 0.83-3.97). Lack of overall social support (Estimateindirect = 0.69, 95% CI: 0.04-1.38) and lack of support from friends (Estimateindirect = 0.62, 95% CI: 0.01-1.29) significantly mediated the relationship. CONCLUSIONS: Findings suggest that complementing pre- and post-natal care with support programs and services that address family concerns and relationship problems, as well as enhancing social support is important to functional disability.

Social Support and Spousal Relationship Quality Improves Responsiveness among Anxious Mothers.

Maternal responsiveness, a mother's ability to consistently identify infant cues and then act on them, is critical for healthy child development. A woman's social support and spousal relationship may affect responsiveness to an infant, especially among mothers with anxiety. We assessed how social support and spousal relationship quality is associated with responsiveness among anxious mothers, and if postpartum depression (PPD) moderated these associations. Cross-sectional data were collected from 2019 to 2022 in a public hospital in Pakistan from 701 women at six-weeks postpartum. Eligible women had at least mild anxiety in early- to mid- pregnancy. Linear regression analyses assessed if spousal relationship quality and social support from family and friends were associated with maternal responsiveness, measured using the Maternal Infant Responsiveness Instrument. Interaction terms were used to examine if PPD moderated these associations. Spousal relationship quality (B = 2.49, 95% CI: 1.48, 3.50) and social support (B = 1.07, 95% CI: 0.31, 1.83) were positively related to maternal responsiveness to the infant. Emotional support from a spouse was positively associated with responsiveness (B = 1.08, 95% CI: 0.12, 2.03 depressed; B = 2.96, 95% CI: 1.34, 4.58 non-depressed), and conflict with the spouse was negatively associated with responsiveness (B=-1.02, 95% CI: -1.94, -0.09 depressed; B=-2.87, 95% CI: -4.36, -1.37 non-depressed). However, social support was related to responsiveness only in non-depressed women (B = 2.61, 95% CI: 1.14, 4.07). While spousal relationships and social support enhance maternal responsiveness, for depressed women, spousal relationships were particularly critical. In considering maternal-infant interventions to improve child development outcomes, our study indicates the importance of supportive relationships that foster effective responsiveness.

The relationship between the World Index for Sustainability and Health (WISH) score and mental health in women: A cross-sectional study.

Diet quality has been associated with mental health, and recently, there has been growing interest in the association between sustainability of diets and human health. The objective of this cross-sectional study was to explore the relationship between a newly developed dietary index for health and sustainability, and psychological disorders among Iranian women. Participants in this cross-sectional study included 479 women living in Tehran with no history of chronic disease. A validated 168-item food frequency questionnaire was used to assess dietary intake. The World Index for Sustainability and Health (WISH) was calculated, consisting of four sub-scores: less healthy, healthy, low environmental impact, and high environmental impact. Participants psychological status was assessed using the Depression Anxiety Stress Scale-21. Logistic regression models were used to examine the association between WISH and psychological disorders. Participant ages ranged from 20-50 years, with a mean age of 31.86 (SD:7.68) years. After adjusting for potential confounders (age, energy, BMI, marital status, education, family history of chronic disease, body satisfaction, socio-economic status, physical activity, smoking), women in the highest tertile of the healthy sub-score had significantly lower odds of experiencing depression (OR: 0.40; 95% CI: 0.24-0.67), anxiety (OR: 0.45; 95% CI: 0.23-0.87) and psychological distress (OR: 0.46; 95% CI: 0.28-0.77) compared to the reference group. Similarly, the less healthy sub-score was significantly associated with depression (OR: 0.51; 95% CI: 0.32-0.89), anxiety (OR: 0.44; 95% CI: 0.25-0.78), and psychological distress (OR: 0.57; 95% CI: 0.36-0.90). An inverse association was observed between the low environmental impact sub-score and depression (OR: 0.32; 95% CI: 0.19-0.54), anxiety (OR: 0.38; 95% CI: 0.18-0.76), and psychological distress (OR: 0.30; 95% CI: 0.17-0.51). However, no further significant associations were found with the high environmental impact sub-score, except with depression (OR: 0.57; 95% CI: 0.33-0.96). The healthy and low environmental impact sub-scores of the WISH were found to be inversely associated with depression, anxiety, and psychological distress. However, due to the cross-sectional study design, causality cannot be inferred. Further prospective studies are required to validate and expand upon these findings and explore potential mechanisms and alternative explanations, such as reverse causation. While this study suggests that choosing a diet that is both healthy for individuals and sustainable for the environment may be associated with lower risk of mental health issues among women, more research is needed.

"We Want to Eat and be Healthy just like Everybody Else:" How Social Infrastructures Affect Nutrition Equity in a Racialized Urban Community in the United States.

Background: Food security and nutrition equity, 2 social determinants of health, are impacted by the coronavirus disease 2019 (COVID-19) pandemic and the racialization of urban communities. Few studies to date have examined how the use of social infrastructures in the United States during COVID-19 affected the ability to achieve food security and nutrition equity. Objectives: To describe how the use of social infrastructures impacts food security and nutrition equity in a majority Black and urban community in the United States. Methods: Semistructured in-depth interviews were conducted with 40 low-income, urban, and predominately Black people living in Buffalo, New York in May-July 2022.A thematic analysis using a phronetic iterative approach informed by the Social Ecological Model, Walsh's Family Resilience Framework, and a framework focused on the advancement of nutrition equity. Results: We identified 9 themes mapped across 3 interrelated domains that impact nutrition equity, including 1) meeting food needs with dignity, 2) supply and demand for fresh and healthy foods, and 3) community empowerment and food sovereignty. We found that people used coping strategies, such as food budgeting and cooking skills, paired with different social infrastructures to meet food needs. People commonly used the Supplemental Nutrition Assistance Program and food pantries to meet food needs over receiving support from family members or friends outside of the household. Poverty, challenges accessing and affording healthy food, and the inability to reciprocate support to others undermined the advancement of nutrition equity despite social infrastructures being available for use. Historical and ongoing acts of disempowerment and disinvestment also hindered the advancement of nutrition equity. Conclusions: Sustained, community-led investment is needed to address structural inequities preventing the advancement of nutrition equity. Social infrastructures should be expanded to inclusively support low-income populations, so wealth generation is possible to address the root cause of food insecurity.

Pregnancy stressors and postpartum symptoms of depression and anxiety: the moderating role of a cognitive-behavioural therapy (CBT) intervention.

Background: Little is known about the association between stressors (especially positive stressors) during pregnancy and postpartum depression and anxiety. Aims: We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive-behavioural therapy (CBT) had a regulatory effect. Methods: Participants were 621 pregnant Pakistani women with mild anxiety. Using the Pregnancy Experience Scale-Brief Version, six scores were created to assess positive and negative stressors. We performed a multivariate linear regression to examine whether these six scores, measured both at baseline and in the third trimester, were associated with postpartum anxiety and depressive symptoms. The effect of the intervention on this relationship was examined by adding an interaction term to the regression model. Results: Hassles frequency measured in the third trimester was positively associated with depression (B=0.22, 95% confidence interval (CI): 0.09 to 0.36) and anxiety (B=0.19, 95% CI: 0.08to 0.30). At the same timepoint, uplifts intensity was negatively associated with symptoms of depression (B=-0.82, 95% CI: -1.46 to -0.18) and anxiety (B=-0.70, 95% CI: -1.25 to -0.15), whereas hassles intensity was positively related to symptoms of depression (B=1.02, 95% CI: 0.36 to 1.67) and anxiety (B=0.90, 95% CI: 0.34 to 1.47). The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression (B=1.40, 95% CI: 0.59 to 2.20) and anxiety (B=1.26, 95% CI: 0.57 to 1.96). The intervention strengthened the overall positive effects of uplifts and the negative effects of hassles. Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes. Conclusions: Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression. The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes. Programmes that promote positive experiences and reduce negative experiences, especially in late pregnancy, may mitigate postpartum mental health consequences. Trial registration number: NCT03880032.

Anxiety-focused cognitive behavioral therapy delivered by non-specialists to prevent postnatal depression: a randomized, phase 3 trial.

Anxiety experienced by women during pregnancy is highly prevalent, especially in resource-poor settings and strongly predicts postnatal common mental disorders (CMDs), anxiety and depression. We evaluated the effectiveness of an anxiety-focused early prenatal intervention on preventing postnatal CMDs. This study was a phase 3, two-arm, single-blind, randomized controlled trial conducted in Pakistan with women who were ≤22 weeks pregnant and had at least mild anxiety without clinical depression. Participants were randomized to the Happy Mother-Healthy Baby program, based on cognitive behavioral therapy, consisting of six one-on-one intervention sessions in pregnancy delivered by non-specialist providers, or to enhanced care alone. The primary outcome was major depression, generalized anxiety disorder or both at 6 weeks after delivery. Overall, 755 women completed postnatal assessments (380 (50.3%), intervention arm; 375 (49.7%) enhanced-care arm). The primary outcomes were met. Examined jointly, we found 81% reduced odds of having either a major depressive episode (MDE) or moderate-to-severe anxiety for women randomized to the intervention (adjusted odds ratio (aOR) = 0.19, 95% CI 0.14-0.28). Overall, 12% of women in the intervention group developed MDE at 6 weeks postpartum, versus 41% in the control group. We found reductions of 81% and 74% in the odds of postnatal MDE (aOR = 0.19, 95% CI 0.13-0.28) and of moderate-to-severe anxiety (aOR = 0.26, 95% CI 0.17-0.40), respectively. The Happy Mother-Healthy Baby program early prenatal intervention focusing on anxiety symptoms reduced postpartum CMDs. ClinicalTrials.gov identifier NCT03880032 .

Dietary total, plant, and animal protein intake in relation to cardiovascular outcomes and inflammatory factors in elderly men: A cross-sectional study.

The source and amount of protein intake may influence cardiovascular and inflammatory risk, especially in elders who are often more vulnerable. However, findings on elders have been contradictory. Therefore, we examined the association between dietary total, plant, and animal protein intake in relation to cardiovascular outcomes and inflammatory factors in elderly men. The present cross-sectional study included 357 elderly men. A validated and reliable food frequency questionnaire (FFQ) was used to assess dietary intake. All biochemical factors including triglycerides (TG), fasting blood sugar (FBS), high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL6), and tumor necrosis factor-α (TNF-α) were measured. Waist circumference (WC) and blood pressure (BP) were also assessed. A significant inverse association was found between animal protein intake and systolic blood pressure (SBP; OR: 0.62; 95% CI: 0.42, 0.91; ptrend = .014). There were significant inverse associations between plant protein intake and WC (OR: 0.34; 95% CI: 0.17, 0.68; ptrend < .001), FBS (OR: 0.51; 95% CI: 0.29, 0.89; ptrend = .018) and Hs-CRP (OR: 0.39; 95% CI: 0.21, 0.70; ptrend = .002). Moreover, significant inverse associations were also found between total protein intake and SBP (OR: 0.54; 95% CI: 0.33, 0.86; ptrend = .010) and total protein and Hs-CRP (OR: 0.50; 95% CI: 0.28, 0.88; ptrend = .015). In elderly men, a high dietary intake of plant protein was associated with lower odds of having high WC, FBS, and Hs-CRP. In addition, high dietary intake of animal protein was associated with higher odds of having a high SBP level, which was explained by higher intake of dairy products.

Betrayal-Based Moral Injury and Mental Health Problems Among Healthcare and Hospital Workers Serving COVID-19 Patients.

One factor potentially driving healthcare and hospital worker (HHW)'s declining mental health during the COVID-19 pandemic is feeling betrayed by institutional leaders, coworkers, and/or others' pandemic-related responses and behaviors. We investigated whether HHWs' betrayal-based moral injury was associated with greater mental distress and post-traumatic stress disorder (PTSD) symptoms related to COVID-19. We also examined if these associations varied between clinical and non-clinical staff. From July 2020 to January 2021, cross-sectional online survey data were collected from 1,066 HHWs serving COVID-19 patients in a large urban US healthcare system. We measured betrayal-based moral injury in three groups: institutional leaders, coworkers/colleagues, and people outside of healthcare. Multivariate logistic regression analyses were performed to investigate whether betrayal-based moral injury was associated with mental distress and PTSD symptoms. Approximately one-third of HHWs reported feeling betrayed by institutional leaders, and/or people outside healthcare. Clinical staff were more likely to report feelings of betrayal than non-clinical staff. For all respondents, 49.5% reported mental distress and 38.2% reported PTSD symptoms. Having any feelings of betrayal increased the odds of mental distress and PTSD symptoms by 2.9 and 3.3 times, respectively. These associations were not significantly different between clinical and non-clinical staff. As health systems seek to enhance support of HHWs, they need to carefully examine institutional structures, accountability, communication, and decision-making patterns that can result in staff feelings of betrayal. Building trust and repairing ruptures with HHWs could prevent potential mental health problems, increase retention, and reduce burnout, while likely improving patient care.

Associations of dietary methyl donor nutrients with common psychological conditions (depression, anxiety and stress) among reproductive-aged women in Kabul, Afghanistan.

BACKGROUND: Higher levels of methyl donor nutrients may be associated with better psychological conditions. Little is known about the association of methyl donor nutrients with psychological conditions among women especially in Asian countries such as Afghanistan. METHOD: This cross-sectional study was conducted in Kabul, Afghanistan to assess the association of methyl donor nutrients with common psychological conditions (depression, anxiety and stress) among reproductive-aged women using multistage random sampling to choose one health center from each municipality out of four cardinal directions. Finally a sample of 421 reproductive-aged women with a mean BMI of 23.3 ± 5.0 kg/m2 and an age range of 15-45 years were collected. All women's dietary intakes were obtained using a 24-recall questionnaire. Depression, Anxiety and Stress Scale - 21 Items (DASS-21) was used to assess psychological conditions. Chi-square tests and one-way ANOVAs were performed to assess general characteristics. Residual model test while adjusting for energy intake was used to assess nutrient intake of methyl donor nutrients and food groups. We fitted logistic regression models to assess risk for Common mental health problems (CMHPs) based on methyl donor tertiles. RESULT: We observed that there is no significant association between methyl donor nutrients and psychological disorders in both crude and adjusted models (depression, OR = 0.95, CI: 0.48; 1.88; anxiety, OR = 0.88, CI: 0.43, 1.79; stress, OR = 0.73, CI: 0.38, 1.40), (p > 0.05). CONCLUSION: Overall, we did not find any significant association between methyl donor nutrients and depression, anxiety and stress.

The Impact of Family Stress and Resilience on Child Development: a scope review.

INTRODUCTION: Children grow up spending most of their time within the family social environment, where they can experience stressful situations such as marital conflict, a non-cohesive environment, parental alcohol use disorder, parental depression, and other parental mental health issues. All these factors are associated with children's developmental delays. OBJECTIVE: We aimed to conduct a scoping review on family stress and family resilience associated with child development delays to examine familial conditions associated with child development. METHODS: We conducted a scoping review of observational studies published between January 2000 to July 2023, indexed in MEDLINE and LILACS databases. We included observational studies that evaluated the history of exposure to violence, and behavioral or emotional symptoms, or mental health problems among children aged 4-12. Data were independently extracted using a structured form. RESULTS: Database searches identified 12,990 different records. A total of 43 articles were included in the review. Three main findings emerged: (1) parental mental health problems, especially depressive symptoms in mothers, were associated with child developmental delays and mental health problems; (2) better parenting practices and cohesive home environment were positively associated with child development, and (3) Vulnerable social environments (e.g., poverty and housing insecurity) may be linked to child mental health problems. CONCLUSIONS: Studies reviewed show that promoting better family dynamics and increasing family cohesion, as well as parenting abilities, are beneficial to a child's socio-emotional development and prevention of child mental health problems. Moreover, increasing family and children's resilience improves the quality of life within family units.

Addressing the smoking-hypertension paradox in pregnancy: insight from a multiethnic US birth cohort.

Background: Smoking during pregnancy has been associated with reduced risk of a spectrum of hypertensive (HTN) disorders, known as the "smoking-hypertension paradox." Objective: We sought to test potential epidemiologic explanations for the smoking-hypertension paradox. Methods: We analyzed 8510 pregnant people in the Boston Birth Cohort, including 4027 non-Hispanic Black and 2428 Hispanic pregnancies. Study participants self-reported tobacco, alcohol, cannabis, opioids, or cocaine use during pregnancy. We used logistic regression to assess effect modification by race/ethnicity, and confounding of concurrent substances on hypertensive disorders or prior pregnancy. We also investigated early gestational age as a collider or competing risk for pre-eclampsia, using cause-specific Cox models and Fine-Gray models, respectively. Results: We replicated the paradox showing smoking to be protective against hypertensive disorders among Black participants who used other substances as well (aOR: 0.61, 95% CI: 0.41, 0.93), but observed null effects for Hispanic participants (aOR: 1.14, 95% CI: 0.55, 2.36). In our cause-specific Cox regression, the effects of tobacco use were reduced to null effects with pre-eclampsia (aOR: 0.81, 95% CI: 0.63, 1.04) after stratifying for preterm birth. For the Fine-Gray competing risk analysis, the paradoxical associations remained. The smoking paradox was either not observed or reversed after accounting for race/ethnicity, other substance use, and collider-stratification due to preterm birth. Conclusions: These findings offer new insights into this paradox and underscore the importance of considering multiple sources of bias in assessing the smoking-hypertension association in pregnancy.