Depressive disorder subtypes, depressive symptom clusters, and risk of obesity and diabetes: A systematic review.

BACKGROUND: Overlapping but divided literatures suggest certain depression facets may pose greater obesity and diabetes risk than others. Our objectives were to integrate the major depressive disorder (MDD) subtype and depressive symptom cluster literatures and to clarify which facets are associated with the greatest cardiometabolic disease risk. METHODS: We conducted a systematic review of published studies examining associations of ≥2 MDD subtypes or symptom clusters with obesity or diabetes risk outcomes. We report which facets the literature is "in favor" of (i.e., having the strongest or most consistent results). RESULTS: Forty-five articles were included. Of the MDD subtype-obesity risk studies, 14 were in favor of atypical MDD, and 8 showed similar or null associations across subtypes. Of the symptom cluster-obesity risk studies, 5 were in favor of the somatic cluster, 1 was in favor of other clusters, and 5 were similar or null. Of the MDD subtype-diabetes risk studies, 7 were in favor of atypical MDD, 3 were in favor of other subtypes, and 5 were similar or null. Of the symptom cluster-diabetes risk studies, 7 were in favor of the somatic cluster, and 5 were similar or null. LIMITATIONS: Limitations in study design, sample selection, variable measurement, and analytic approach in these literatures apply to this review. CONCLUSIONS: Atypical MDD and the somatic cluster are most consistently associated with obesity and diabetes risk. Future research is needed to establish directionality and causality. Identifying the depression facets conferring the greatest risk could improve cardiometabolic disease risk stratification and prevention programs.

Longer-Term Mental Health Consequences of COVID-19 Infection: Moderation by Race and Socioeconomic Status.

OBJECTIVE: While evidence suggests that the mental health symptoms of COVID-19 can persist for several months following infection, little is known about the longer-term mental health effects and whether certain sociodemographic groups may be particularly impacted. This cross-sectional study aimed to characterize the longer-term mental health consequences of COVID-19 infection and examine whether such consequences are more pronounced in Black people and people with lower socioeconomic status. METHODS: 277 Black and White adults (age ≥ 30 years) with a history of COVID-19 (tested positive ≥ 6 months prior to participation) or no history of COVID-19 infection completed a 45-minute online questionnaire battery. RESULTS: People with a history of COVID-19 had greater depressive (d = 0.24), anxiety (d = 0.34), post-traumatic stress disorder (PTSD) (d = 0.32), and insomnia (d = 0.31) symptoms than those without a history of COVID-19. These differences remained for anxiety, PTSD, and insomnia symptoms after adjusting for age, sex, race, education, income, employment status, body mass index, and smoking status. No differences were detected for perceived stress and general psychopathology. People with a history of COVID-19 had more than double the odds of clinically significant symptoms of anxiety (OR = 2.22) and PTSD (OR = 2.40). Education, but not race, income, or employment status, moderated relationships of interest such that COVID-19 status was more strongly and positively associated with all the mental health outcomes for those with fewer years of education. CONCLUSION: The mental health consequences of COVID-19 may be significant, widespread, and persistent for at least 6 months post-infection and may increase as years of education decreases.

On the Relationship Between Online Heterosexist Discrimination and Mental Health and Substance Use Among LGBTQ+ Young Adults.

LGBTQ+ individuals experience disproportionately higher rates of mental health and substance use difficulties. Discrimination is a significant factor in explaining these disparities. Meyer's (2003) minority stress theory (MST) indicates that proximal group-specific processes mediate the relationship between discrimination and health outcomes, with the effects moderated by other social factors. However, online discrimination has been understudied among LGBTQ+ people. Focusing on LGBTQ+ young adults experiencing online heterosexist discrimination (OHD), the current study aimed to investigate the effect of OHD on mental health outcomes and explore whether the effect was mediated by proximal factors of internalized heterosexism, online concealment, and acceptance concerns and moderated by social support. Path analysis was used to examine the effects. A total of 383 LGBTQ+ young adults (18-35) from an introductory psychology subject pool, two online crowdsourcing platforms, and the community completed a questionnaire assessing these constructs. OHD was associated with increased psychological distress and cannabis use. Two proximal stressors (acceptance concerns and sexual orientation concealment) mediated the relationship between OHD and psychological distress. Sexual orientation concealment also mediated the relationship between OHD and cannabis use. There was no evidence that online social support from LGBTQ+ peers moderated any of the relationships. MST is a viable guiding framework for exploring OHD. Acceptance concerns and online concealment are important constructs to consider and may be potential treatment targets for individuals experiencing psychological distress or engaging in cannabis use due to OHD.

Effect of modernized collaborative care for depression on brain-derived neurotrophic factor (BDNF) and depressive symptom clusters: Data from the eIMPACT trial.

Brain-derived neurotrophic factor (BDNF) levels are lower in people with depression and are normalized following pharmacological treatment. However, it is unknown if psychological treatments for depression improve BDNF and if change in BDNF is a mediator of intervention effects on depressive symptoms. Therefore, using data from the eIMPACT trial, we sought to determine the effect of modernized collaborative care for depression on 12-month changes in BDNF and cognitive/affective and somatic depressive symptom clusters and to examine whether BDNF changes mediate intervention effects on depressive symptoms. 216 primary care patients with depression from a safety net healthcare system were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. Plasma BDNF was measured with commercially available kits, and depressive symptom clusters were assessed by the Patient Health Questionnaire-9. The intervention did not influence BDNF but did improve both the cognitive/affective and somatic clusters over 12 months. Changes in BDNF did not mediate the intervention effect on either cluster. Our findings suggest that modernized collaborative care is an effective treatment for both the cognitive/affective and somatic symptoms of depression and that the mechanism of action is not improvements in BDNF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02458690.

Sleep Quality Moderates the Relationship Between Daily Mean Levels and Variability of Positive Affect.

Despite the well-established bidirectional association between sleep and daytime affect, most studies examining this relationship have focused on mean levels of affect. However, research solely focusing on mean levels of affect inherently neglects variability in affect, which has been shown to predict both psychological and physical well-being beyond mean levels. The present study assessed sleep quality and daytime affect using ecological momentary assessment in a combined sample of individuals (N = 80; 8,881 observations) with and without anxiety and mood disorders. Results from the present study partially replicated extant work on the negative association between negative affect (NA) variability and subsequent sleep quality. Furthermore, less satisfying sleep amplified the positive relationship between daily mean levels and variability of positive affect (PA). The results did not differ by clinical status. The present study offers novel evidence suggesting that previous night's sleep quality influences the stability of varying daily levels of PA. Uncovering the dynamics of sleep and affect beyond mean levels will help further elucidate mechanisms linking sleep and subsequent affective experiences.

Gaps and weaknesses in the global protected area network for safeguarding at-risk species.

Protected areas are essential to biodiversity conservation. Creating new parks can protect larger populations and more species, yet strengthening existing parks, particularly those vulnerable to harmful human activities, is a critical but underappreciated step for safeguarding at-risk species. Here, we model the area of habitat that terrestrial mammals, amphibians, and birds have within park networks and their vulnerability to current downgrading, downsizing, or degazettement events and future land-use change. We find that roughly 70% of species analyzed have scant representation in parks, or occur within parks that are affected by shifts in formal legal protections or are vulnerable to increased human pressures. Our results also show that expanding and strengthening park networks across just 1% of the world's land area could preserve irreplaceable habitats of 1191 species that are particularly vulnerable to extinction.

Global patterns of climate change impacts on desert bird communities.

The world's warm deserts are predicted to experience disproportionately large temperature increases due to climate change, yet the impacts on global desert biodiversity remain poorly understood. Because species in warm deserts live close to their physiological limits, additional warming may induce local extinctions. Here, we combine climate change projections with biophysical models and species distributions to predict physiological impacts of climate change on desert birds globally. Our results show heterogeneous impacts between and within warm deserts. Moreover, spatial patterns of physiological impacts do not simply mirror air temperature changes. Climate change refugia, defined as warm desert areas with high avian diversity and low predicted physiological impacts, are predicted to persist in varying extents in different desert realms. Only a small proportion (<20%) of refugia fall within existing protected areas. Our analysis highlights the need to increase protection of refugial areas within the world's warm deserts to protect species from climate change.

Revision Gastrojejunostomy Versus Suturing With and Without Omental Patch for Perforated Marginal Ulcer Treatment After Roux-en-Y Gastric Bypass.

BACKGROUND: Ulceration at the gastrojejunostomy is a late bariatric surgery complication in 0.6-16% of Roux-en-Y gastric bypass (RYGB) patients. As there is no general consensus on management of acute ulcer perforations, we compare two methods of surgical repair: the most commonly performed procedure, suturing of ulcer with or without omental patch versus revision gastrojejunostomy (RG). METHODS: A retrospective chart review of cases at a single large, Midwestern US high-volume bariatric center from November 2, 2006 through March 11, 2021 identified 144 RYGB patients undergoing surgical repair for a perforated ulcer: 72 treated by SGP and 72 by RG. Outcomes, including length of stay, leaks, readmissions, and reoperations, were compared. Categorical variables were compared by Chi-square tests and continuous variables by ANOVA. RESULTS: Patients were primarily female (77.1%) and Caucasian (97.2%), 49.7 ± 12.5 years old, and 90.6 ± 26.6 kg. Most had laparoscopic RYGBs (98.6%). There were no demographic differences between groups. Of the RG patients, 11.4% experienced ulcer recurrence versus 41.7% of SGP patients (p < .001), and 2.8% of RG versus 11.1% of SGP patients required a reversal (p < .05). No significant differences between groups occurred in time to perforation (3.2 vs. 2.5 years for RG and SGP groups, respectively), length of stay (5.0 vs. 6.8 days), leaks (1.4% vs. 2.8%), readmissions (4.2% vs. 4.2%), or reoperations (2.8% vs 5.6%). CONCLUSIONS: Patients developing perforated marginal ulcers after RYGB can be safely and effectively treated by revision gastrojejunostomy with a lower likelihood of ulcer recurrence. Short-term morbidity was comparable to suturing with or without an omental patch.

Associations between affective factors and high-frequency heart rate variability in primary care patients with depression.

OBJECTIVE: Depression is a risk factor for cardiovascular disease (CVD), and subgroups of people with depression may be at particularly elevated CVD risk. Lower high-frequency heart rate variability (HF HRV), which reflects diminished parasympathetic activation, is a candidate mechanism underlying the depression-CVD relationship and predicts cardiovascular events. Few studies have examined whether certain depression subgroups - such as those with co-occurring affective factors - exhibit lower HF HRV. The present study sought to assess associations between co-occurring affective factors and HF HRV in people with depression. METHODS: Utilizing baseline data from the 216 primary care patients with depression in the eIMPACT trial, we examined cross-sectional associations of depression's co-occurring affective factors (i.e., anxiety symptoms, hostility/anger, and trait positive affect) with HF HRV. HF HRV estimates were derived by spectral analysis from electrocardiographic data obtained during a supine rest period. RESULTS: Individual regression models adjusted for demographics and depressive symptoms revealed that anxiety symptoms (standardized regression coefficient ß = -0.24, p = .002) were negatively associated with HF HRV; however, hostility/anger (ß = 0.02, p = .78) and trait positive affect (ß = -0.05, p = .49) were not. In a model further adjusted for hypercholesterolemia, hypertension, diabetes, body mass index, current smoking, CVD prevention medication use, and antidepressant medication use, anxiety symptoms remained negatively associated with HF HRV (ß = -0.19, p = .02). CONCLUSION: Our findings suggest that, in adults with depression, those with comorbid anxiety symptoms have lower HF HRV than those without. Co-occurring anxiety may indicate a depression subgroup at elevated CVD risk on account of diminished parasympathetic activation.

Rural land abandonment is too ephemeral to provide major benefits for biodiversity and climate.

Hundreds of millions of hectares of cropland have been abandoned globally since 1950 due to demographic, economic, and environmental changes. This abandonment has been seen as an important opportunity for carbon sequestration and habitat restoration; yet those benefits depend on the persistence of abandonment, which is poorly known. Here, we track abandonment and recultivation at 11 sites across four continents using annual land-cover maps for 1987-2017. We find that abandonment is largely fleeting, lasting on average only 14.22 years (SD = 1.44). At most sites, we project that >50% of abandoned croplands will be recultivated within 30 years, precluding the accumulation of substantial amounts of carbon and biodiversity. Recultivation resulted in 30.84% less abandonment and 35.39% less carbon accumulated by 2017 than expected without recultivation. Unless policymakers take steps to reduce recultivation or provide incentives for regeneration, abandonment will remain a missed opportunity to reduce biodiversity loss and climate change.

Consequences of underexplored variation in biodiversity indices used for land-use prioritization.

For biodiversity protection to play a persuasive role in land-use planning, conservationists must be able to offer objective systems for ranking which natural areas to protect or convert. Representing biodiversity in spatially explicit indices is challenging because it entails numerous judgments regarding what variables to measure, how to measure them, and how to combine them. Surprisingly few studies have explored this variation. Here, we explore how this variation affects which areas are selected for agricultural conversion by a land-use prioritization model designed to reduce the biodiversity losses associated with agricultural expansion in Zambia. We first explore the similarity between model recommendations generated by three recently published composite indices and a commonly used rarity-weighted species richness metric. We then explore four underlying sources of ecological and methodological variation within these and other approaches, including different terrestrial vertebrate taxonomic groups, different species-richness metrics, different mathematical methods for combining layers, and different spatial resolutions of inputs. The results generated using different biodiversity approaches show very low spatial agreement regarding which areas to convert to agriculture. There is little overlap in areas identified for conversion using previously published indices (mean Jaccard similarity, Jw , between 0.3 and 3.7%), different taxonomic groups (5.0% < mean Jw  < 13.5%), or different measures of species richness (15.6% < mean Jw  < 33.7%). Even with shared conservation goals, different methods for combining layers and different input spatial resolutions still produce meaningful, though smaller, differences among areas selected for conversion (40.9% < mean Jw  < 67.5%). The choice of taxonomic group had the largest effect on conservation priorities, followed by the choice of species richness metric, the choice of combination method, and finally the choice of spatial resolution. These disagreements highlight the challenge of objectively representing biodiversity in land-use planning tools, and present a credibility challenge for conservation scientists seeking to inform policy making. Our results suggest an urgent need for a more consistent and transparent framework for designing the biodiversity indices used in land-use planning, which we propose here.

A qualitative exploration of a mindful resiliency program for community healthcare providers.

Despite the important contribution of nongovernmental organizations (NGOs) to the community healthcare sector, the building and maintenance of occupational resilience in community health workers has received little attention. However, it is recognized that employees in this sector are exposed to significant stressors from the high demand work environment which negatively impacts on their well-being. Therefore, this research examined the acceptability, feasibility, and sustainability of a mindful resiliency program by employing a qualitative analysis of participant subjective experience of the program in this cohort. This was the first study to be conducted with senior managers and frontline healthcare providers in the nongovernmental organizations community sector. A 1-month post-delivery qualitative review of the program identified four major themes: applicability, changes to participant's skills, social support, and coping with COVID-19. A major finding was the ability of the participants to immediately recognize their stress levels and then manage them. Additionally, lessons from the program were shown to be usefully applied with colleagues and clients within the work environment, and with family members.

Improved prescription for winding an electromagnet.

We describe an improvement on the magnetic scalar potential approach to design an electromagnet, which incorporates the need to wind the coil as a helix. Any magnetic field that can be described by a magnetic scalar potential is produced with high fidelity within a Target region; all fields are confined within a larger Return. The helical winding only affects the field in the Return.

Adolescents with congenital heart defects: a patient and parental perspective of genetic information and genetic risk.

Congenital heart defects (CHDs) occur in 8 of 1000 live-born children, making them common birth defects in the adolescent population. CHDs may have single gene, chromosomal, or multifactorial causes. Despite evidence that patients with CHD want information on heritability and genetics, no studies have investigated the interest or knowledge base in the adolescent population. This information is necessary as patients in adolescence take greater ownership of their health care and discuss reproductive risks with their physicians. The objectives of this survey-based study were to determine adolescents' recall of their own heart condition, to assess patient and parent perception of the genetic contribution to the adolescent's CHD, and to obtain information about the preferred method(s) for education. The results show that adolescent patients had good recall of their type of CHD. Less than half of adolescents and parents believed their CHD had a genetic basis or was heritable; however, adolescents with a positive family history of CHD were more likely to believe that their condition was genetic (p = 0.0005). The majority of patients were interested in receiving additional genetics education and preferred education in-person and in consultation with both parents and a physician. The adolescents who felt most competent to have discussions with their doctors regarding potential causes of their heart defect previously had a school science course which covered topics in genetics. These results provide insight into adolescents' perceptions and understanding about their CHD and genetic risk and may inform the creation and provision of additional genetic education.

Parenting and Youth Onset of Depression Across Three Years: Examining the Influence of Observed Parenting on Child and Adolescent Depressive Outcomes.

Concurrent associations between parenting behaviors and youth depression are well established. A smaller body of work has demonstrated longitudinal associations between aspects of parenting and youth risk for depression; however, this limited longitudinal work has predominantly relied upon self- and parent-report questionnaire measures and is thus affected by biases related to retrospective recall and common method variance. The present study used behavioral observation measures of parenting and clinical interview measures of youth depression to examine prospective relationships between observed parental support, responsiveness, criticism, and conflict and youths' onset of a depressive episode in a 3-year longitudinal design. Participants included 585 community youth age 8-16 (M = 11.92, SD = 2.39, 56.6% female) and a participating caregiver. Parental behavior was coded by trained observers in the context of a 5-min conflict resolution discussion at the baseline assessment. Youth onset of depression was subsequently assessed every 6 months for a period of 3 years using the Schedule for Affective Disorders and Schizophrenia for School Aged Children (KSADS) to ascertain whether youth experienced onset of depressive episode over the follow-up. Logistic regression analyses indicated that greater parental conflict at baseline predicted higher odds of youth experiencing a depressive onset across the 3-year follow up period, even after controlling for youth and caregiver history of depression at baseline. Findings suggest that parental conflict is particularly influential in youth vulnerability to depression.

Long-Term Effectiveness of Strattice in the Laparoscopic Closure of Paraesophageal Hernias.

Prosthetic reinforcement reduces the recurrence rate of large paraesophageal hernias (PEH), but the use of synthetic or biosynthetic mesh in the repair remains controversial. PEH repair has reported recurrence rates of 12% to 42%, and primary repair of PEH by suture closure under tension is at high risk of disruption. Synthetic mesh use in large PEH repair has shown to reduce recurrence but can lead to problems including mesh erosion, ulceration, stricture, and dysphagia. The objective of this study was to examine the long-term safety and efficacy of Strattice biologic mesh, a porcine acellular dermal matrix, in crural reinforcement of laparoscopic large PEH repair. Thirty-five patients with symptomatic PEH (>5 cm) were consented to receive Strattice for PEH repair. Patients were seen in clinic preoperatively, at surgery, and 2 weeks, 6 months, and 12 months postoperatively. Patients were given a standard subjective reflux test at each visit and a 12-month barium swallow X-ray to test for recurrence. Hernia recurrence was documented in 14.3% of cases by the end of the 1-year follow-up. Symptoms improved in 75% to 100% of patients by 6 months, and 33% to 100% of patients were still reporting symptom improvement at 12 months. Strattice mesh in PEH repair results in similar outcomes to other absorbable meshes, and the recurrence rate is within the 12% to 42% range of recurrences reported in studies outside of our institution. The use of Strattice mesh in large PEH repair had results similar to other biomaterial meshes and successfully decreased patients' symptom scores through surgical intervention.

Sleeve gastrectomy and anti-reflux procedures.

BACKGROUND: Obesity is an epidemic in the USA that continues to grow, becoming a leading cause of premature avoidable death. Bariatric surgery has become an effective solution for obesity and its comorbidities, and one of the most commonly utilized procedures, the sleeve gastrectomy, can lead to an increase in gastroesophageal reflux following the operation. While these data are controversial, sometimes operative intervention can be necessary to provide durable relief for this problem. METHODS: We performed an extensive literature review examining the different methods of anti-reflux procedures that are available both before and after a sleeve gastrectomy. RESULTS: We reviewed several different types of anti-reflux procedures, including those that supplement the lower esophageal sphincter anatomy, such as magnetic sphincter augmentation and radiofrequency ablation procedures. Re-operation was also discussed as a possible treatment of reflux in sleeve gastrectomy, especially if the original sleeve becomes dilated or if a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion is deemed necessary. Sleeve gastrectomy with concomitant anti-reflux procedure was also reviewed, including the anti-reflux gastroplasty, hiatal hernia repair, and limited fundoplication. CONCLUSION: A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.

Surgical Site Infections in Breast Surgery: The Use of Preoperative Antibiotics for Elective, Nonreconstructive Procedures.

Background. Antibiotic prophylaxis for surgical site infections (SSIs) for breast surgery is widespread, but the benefit in clean surgical cases is not well defined. Methods. A retrospective analysis of 855 patients undergoing elective, nonreconstructive breast operations was performed, with 401 patients receiving no antibiotics and 454 patients receiving a single dose of preoperative antibiotic. Results. Administration of a preoperative antibiotic did not decrease the SSI rate. In this community-based study, antibiotic use practices varied considerably by surgeon. In univariate analyses, SSI rates appeared to increase with prophylactic antibiotic use (12% SSI with antibiotics versus 4% without, p < 0.0001), likely because the use of underdosed antibiotics was associated with higher rates of SSI (13.2% SSI with cefazolin 1 gram, p < 0.0001, and 15.4% SSI with clindamycin 300 mg or less, p = 0.0269). Methicillin-resistant Staphylococcus aureus was the most common isolate from SSI cultures, 31.8% (7 of 22). In multivariable analyses, increased risk of SSI was associated with BMI > 25 kg/m2 (OR: 1.08, 95% CI: 1.04-1.11, p < 0.0001). Conclusion. The administration of a single dose of preoperative antibiotic did not decrease the rate of SSI in this large series of patients undergoing clean breast operations. BMI >25 kg/m2 and the use of an inadequate dose of antibiotics for prophylaxis may increase risk of SSI.