Mindfulness-based intervention for depression and insulin resistance in adolescents: Protocol for BREATHE, a multisite, pilot and feasibility randomized controlled trial.

BACKGROUND: Elevated depression symptoms have been associated with higher insulin resistance in adolescents, and consequently, greater risk for type 2 diabetes (T2D). Mindfulness-based intervention (MBI) may be suited for adolescents at risk for T2D given its potential to decrease depression and improve stress-related behavior/physiology underpinning insulin resistance. To prepare for a future multisite efficacy randomized controlled trial, a rigorous, multisite, pilot and feasibility study is needed to test this approach. The current paper describes the design and protocol for a multisite, pilot and feasibility randomized controlled trial of six-week MBI, cognitive-behavioral therapy (CBT), and health education (HealthEd) group interventions, to assess multisite fidelity, feasibility, and acceptability. METHODS: Participants are N = 120 adolescents ages 12-17, with body mass index (BMI) ≥85th percentile, elevated depression symptoms (20-item Center for Epidemiologic Studies-Depression Scale total score > 20), and family history of diabetes. Enrollment occurs across four United States (US) sites, two in Colorado, one in Washington, D·C., and one in Maryland. Group interventions are delivered virtually by trained psychologists and co-facilitators. Assessments occur at baseline, six-week follow-up, and one-year follow-up. RESULTS: Primary outcomes are intervention implementation fidelity, based upon expert ratings of audio-recorded sessions (≥80% adherence/competence), and recruitment feasibility, based upon percentage enrollment of eligible youth (≥80%). Secondary outcomes are intervention training fidelity/feasibility/acceptability, recruitment timeframe, and retention/assessment feasibility. CONCLUSION: Findings will inform optimization of training, recruitment, intervention delivery, retention, and assessment protocols for a multisite, efficacy randomized controlled trial evaluating MBI for decreasing depression and improving insulin resistance in adolescents at risk for developing T2D.

Anxiety among youth with food allergy.

OBJECTIVE: Anxiety is among the major psychological concerns for children living with food allergy (FA). Yet research exploring the variables driving anxiety symptoms in FA remains sparse, and most studies still utilize homogeneous samples to assess anxiety symptoms. The current study seeks to evaluate the rates of clinically significant anxiety symptoms among a diverse sample of youth with FA and examine whether a heightened risk perception of FA outcomes and FA burden (vs. FA medical history) is associated with anxiety in youth. METHODS: 94 youth ages 10-14 and their parents were recruited from FA clinics at a mid-Atlantic children's hospital. Both youth and parents completed demographic and FA medical history questionnaires, the Screen for Child Anxiety Related Emotional Disorders, and the Food Allergy Independent Measure as part of a longitudinal study about FA adjustment and adherence. RESULTS: Over a third (37%) of youth scored above clinical cut-offs for overall anxiety symptoms. At least 25% of youth reported clinically significant scores on panic disorder, generalized anxiety, social anxiety, separation anxiety, and school avoidance subscales. Perception of risk of adverse FA outcomes and burden-but not FA medical history-were associated with total anxiety, generalized anxiety, panic disorder, and school avoidance symptoms, but not social anxiety and separation anxiety. Having more FAs was associated with higher social anxiety scores but not with other anxiety subscales. CONCLUSIONS: Youth with FA might benefit from psychosocial interventions that address FA risk perception management and promote appropriate FA vigilance to cope with anxiety symptoms.

The dynamic buffering of social support on depressive symptoms and cancer worries in patients seeking cancer genetic counseling.

PURPOSE: Social support is a crucial protective factor against psychological concerns in patients with cancer. However, there is limited knowledge regarding the differential impacts of social support on cancer worries and depressive symptoms in patients undergoing genetic counseling for hereditary cancer. The current study utilized a high-volume database from a multi-site cancer genetics clinic to assess the impact of perceived social support on depressive symptoms and cancer worries among patients of different age groups (young versus older patients) and diagnosis status (diagnosed survivors versus undiagnosed). METHODS: 6,666 patients completed brief assessments of depressive symptoms, cancer worries, social support, and demographic questionnaires as part of routine clinical care between October 2016 and October 2020. Logistics and moderated regression were used to analyze the relationships between social support, depressive symptoms, and cancer worries. RESULTS: Increased social support was associated with fewer depressive symptoms and fewer cancer worries across all patients. Social support mitigated depressive symptoms most significantly for young adult patients with and without cancer. Social support mitigated cancer worries most significantly for young adults with cancer and older adults without cancer. CONCLUSIONS: While results were mixed, general findings upheld original hypotheses. Social support buffered depressive symptoms and cancer worries differentially for patients of different ages and different disease status. IMPLICATIONS FOR CANCER SURVIVORS: Social support groups are beneficial for all patients and should be emphasized by cancer clinics. However, increasing patient-tailored and age-appropriate support networks will be crucial for managing depression and cancer worries for high-risk survivors: young adults with cancer.

Exploring Depressive Symptoms and Cancer Worries in a High-Volume Cancer Genetics Clinic: What Are the Roles of Age and Cancer Diagnosis?

Limited research has explored depression and cancer worries (CWs) among adolescents and young adults with cancer (AYAs) seeking genetic counseling. This study evaluated depressive symptoms and CWs among five groups: AYAs, adolescents and young adults without cancer (AYAWOCs), older adults with cancer (OAs), older adults without cancer (OAWOCs), and older adults diagnosed with cancer in their adolescent and young adult years (OA/AYAs). A retrospective data analysis was performed on 6524 patients, which found that AYAs reported significantly higher depressive symptoms and CWs compared with all other groups except OA/AYAs. These findings suggest that the intersection between age and cancer diagnosis is related to depressive symptoms and CWs.

Impact of Experience-Based, Longitudinal Psychiatry Training on Family Medicine Residents' Attitudes Toward Depression and Psychiatry in Singapore: a Prospective Study.

OBJECTIVES: The primary aim of this study was to evaluate the impact of an experience-based, longitudinal psychiatry training program in a Family Medicine residency on residents' attitudes toward depression and psychiatry. The secondary aim was to identify background predictor variables of changes in attitudes. METHODS: Pre- and post-training surveys were prospectively conducted on attitudes toward depression and psychiatry on Family Medicine residents undergoing an experience-based, longitudinal psychiatry training program. The primary outcome measures were pre- and post-training Depression Attitude Questionnaire (DAQ) and Modified Attitudes to Psychiatry Scale (mAPS) scores. Regression analysis was carried out to determine background variables predictive of improvement in DAQ and/or mAPS scores post-training. RESULTS: Sixty-three Family Medicine residents (100% response rate) responded to the pre-training surveys. All 63 subjects completed the post-training surveys (100% retention rate). There was significant improvement in DAQ and mAPS scores post-training, indicating better attitudes toward depression and psychiatry. Significant improvement was observed in 8 out of 13 DAQ items and 3 out of 4 mAPS domains. Regression models showed having a previous 3-month elective psychiatry inpatient posting was a predictor of less improvement in mAPS scores. CONCLUSIONS: Our experience-based, longitudinal psychiatry training program significantly improved Family Medicine residents' attitudes toward depression and psychiatry. Experiential and situated learning in communities of practice, as well as educational continuity with longitudinal supervision, coaching, and modeling may have contributed to this improvement.

Ministry of Health Clinical Practice Guidelines: Lipids.

The Ministry of Health (MOH) has updated the Clinical Practice Guidelines on Lipids to provide doctors and patients in Singapore with evidence-based treatment for lipids. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH Clinical Practice Guidelines on Lipids, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.

Use of Ultrasonography for Assessing Treatment Efficacy in a Case With Ankylosis of the Temporomandibular Joint.

The patient was a 32-year-old university lecturer with limited mouth opening for 15 years. The patient was diagnosed with right temporomandibular joint ankylosis 10 years prior. Ultrasonography was employed to assess capsule-condyle distance before and after physical therapy. A treatment plan aiming at mobilizations and exercises was implemented, and the patient reported improvements in eating and speaking.

Nanocatalyst superior to Pt for oxygen reduction reactions: the case of core/shell Ag(Au)/CuPd nanoparticles.

Controlling the electronic structure and surface strain of a nanoparticle catalyst has become an important strategy to tune and to optimize its catalytic efficiency for a chemical reaction. Using density functional theory (DFT) calculations, we predicted that core/shell M/CuPd (M = Ag, Au) NPs with a 0.8 or 1.2 nm CuPd2 shell have similar but optimal surface strain and composition and may surpass Pt in catalyzing oxygen reduction reactions. We synthesized monodisperse M/CuPd NPs by the coreduction of palladium acetylacetonate and copper acetylacetonate in the presence of Ag (or Au) nanoparticles with controlled shell thicknesses of 0.4, 0.75, and 1.1 nm and CuPd compositions and evaluated their catalysis for the oxygen reduction reaction in 0.1 M KOH solution. As predicted, our Ag/Cu37Pd63 and Au/Cu40Pd60 catalysts with 0.75 and 1.1 nm shells were more efficient catalysts than the commercial Pt catalyst (Fuel Cells Store), with their mass activity reaching 0.20 A/mg of noble metal at -0.1 V vs Ag/AgCl (4 M KCl); this was over 3 times higher than that (0.06 A/mg Pt) from the commercial Pt. These Ag(Au)/CuPd nanoparticles are promising non-Pt catalysts for oxygen reduction reactions.

A facile route to monodisperse MPd (M = Co or Cu) alloy nanoparticles and their catalysis for electrooxidation of formic acid.

MPd (M = Co, or Cu) nanoparticles (NPs) were synthesized by borane-amine reduction of metal acetylacetonates. The size of the MPd NPs was controlled at 3.5 nm and their compositions were tuned by the molar ratios of the metal precursors. These MPd NPs were active catalysts for electrochemical oxidation of formic acid and the Cu30Pd70 NPs showed the highest mass activity at 1192.9 A gPd(-1), much higher than 552.6 A gPd(-1) obtained from the 3.5 nm Pd NPs. Our synthesis provides a facile route to MPd NPs, allowing further investigation of MPd NP catalysts for electrochemical oxidation and many other chemical reactions.

Depression may reduce adherence during CPAP titration trial.

STUDY OBJECTIVES: Depression is a risk factor for medication non-compliance. We aimed to identify if depression is associated with poorer adherence during home-based autotitrating continuous positive airway pressure (autoPAP) titration. DESIGN: Mixed retrospective-observational study. SETTING: Academic center. PARTICIPANTS: Two-hundred forty continuous positive airway pressure-naïve obstructive sleep apnea (OSA) patients. MEASUREMENTS: Patients underwent approximately 1 week of home-based autoPAP titration with adherence data downloaded from the device. Electronic hospital records were reviewed in a consecutive manner for inclusion. Three areas of potential predictors were examined: (i) demographics and clinical factors, (ii) disease severity, and (iii) device-related variables. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Scores on the subscales were categorized as normal or clinical diagnoses of depression (≥ 8) and anxiety (≥ 11). The primary outcome variable was the mean hours of autoPAP used per night. RESULTS: Patients were diagnosed with OSA by either attended polysomnography (n = 73, AHI 25.5[15.1-41.5]) or unattended home oximetry (n = 167, ODI3 34.0[22.4-57.4]) and had home-based autoPAP titration over 6.2 ± 1.2 nights. Mean autoPAP use was 4.5 ± 2.4 hours per night. Multiple linear regression analysis revealed that depression and lower 95(th) percentile pressures significantly predicted lesser hours of autoPAP use (R(2) = 0.19, p < 0.001). Significantly milder OSA in those requiring lower pressures may have confounded the relationship between 95(th) percentile pressure and autoPAP use. CONCLUSION: Depression was independently associated with poorer adherence during home-based autoPAP titration. Depression may be a potential target for clinicians and future research aimed at enhancing adherence to autoPAP therapy.

Comparison of supine-only and REM-only obstructive sleep apnoea.

OBJECTIVES: The effect of body position and sleep state on sleep apnoea have major clinical implications in the management of patients, yet are infrequently reported in the scientific literature. The aim of this study was to compare and contrast the prevalence and severity of supine-only and rapid eye movement (REM)-only obstructive sleep apnoea (OSA) in a population. METHODS: Prospective cohort analysis of the influence of supine body position and REM sleep on the severity of apnoea in 100 consecutive patients with OSA (apnoea-hypopnoea index [AHI]>5) using attended polysomnography with continuous digital monitoring in an accredited sleep laboratory. Supine-only OSA was defined as a supine:non-supine AHI ratio of >2:1 and non-supine AHI <5 events/h. REM-only OSA was defined as an REM:non-REM ratio of >2:1 and non-REM AHI <5events/h. RESULTS: Supine sleep time represented a greater proportion of total sleep time than REM sleep time (40% vs 13%). The prevalence of supine-only OSA was more than twofold greater than that of REM-only OSA (23% and 10%, respectively). The supine-only group had greater overall AHI (mean 12.6±6.1 vs 7.2±2.2 events/h; P<0.01) than the REM-only group. No significant differences in gender, age, or sleepiness were found between the two groups. CONCLUSIONS: Supine-only OSA is more common and is associated with a greater AHI than REM-only OSA.

Treat-to-target approach in managing modifiable risk factors of patients with coronary heart disease in primary care in Singapore: what are the issues?

BACKGROUND: The key management strategy for established coronary heart disease (CHD) patients is to control the underlying risk factors. Further complications will be reduced when these risk factors are treated-to-target (TTT) as recommended by clinical practice guidelines. These targets include blood pressure (BP) lower than 130/80 mm Hg and LDL-cholesterol of less than 2.6 mmol/L and for those with type 2 diabetes mellitus (DM), HBA1c less than 7%. This article aimed to explore the issues affecting this approach from both the patients' and primary care physicians' (PCP) perspectives. METHODS: The study involved triangulation of research methods to determine the findings. Part A: focus group discussions to collect qualitative data from patients with CHD and from PCPs who were managing them in primary care. Part B: A subsequent questionnaire survey to determine the extent of their awareness of treatment targets for modifiable risk factors. RESULTS: CHD patients had variable awareness of the modifiable risk factors for CHD due to poor concordance between the PCPs' approach in managing the CHD patients and the latter's reception of information. 46% of participants knew their targets of BP control correctly; 11% of them were correct in stating their target for LDL-cholesterol control. Amongst these participants with DM (n = 146), 27% of them were correct in indicating their target of diabetic control. CONCLUSIONS: Communication and practice barriers exist which hinder the treat-to-target approach in mitigating the risk factors for CHD patients. Incorporating this approach in routine clinical practice by PCPs has greater potential to achieve treatment targets for patients.

Changes in abduction and rotation range of motion in response to simulated dorsal and ventral translational mobilization of the glenohumeral joint.

BACKGROUND AND PURPOSE: Translational mobilization techniques are frequently used by physical therapists as an intervention for patients with limited ranges of motion (ROMs). However, concrete experimental support for such practice is lacking. The purpose of the study was to evaluate the effect of simulated dorsal and ventral translational mobilization (DTM and VTM) of the glenohumeral joint on abduction and rotational ROMs. METHODS: Fourteen fresh frozen shoulder specimens from 5 men and 3 women (mean age=77.3 years, SD=10.1, range=62-91) were used for this study. Each specimen underwent 5 repetitions of DTM and VTM in the plane of scapula simulated by a material testing system (MTS) in the resting position (40 of abduction in neutral rotation) and at the end range of abduction with 100 N of force. Abduction and rotation were assessed as the main outcome measures before and after each mobilization procedure performed and monitored by the MTS (abduction, 4 N m) and by a servomotor attached to the piston of the actuator of the MTS (medial and lateral rotation, 2 N m). RESULTS: There were increases in abduction ROM for both DTM (mean=2.10 , SD=1.76 ) and VTM (mean=2.06 , SD=1.96 ) at the end-range position. No changes were found in the resting position following the same procedure. Small increases were also found in lateral rotation ROM after VTM in the resting position (mean=0.90 , SD=0.92 , t=3.65, P=.003) and in medial rotation ROM after DTM (mean=0.97 , SD=1.45 , t=2.51, P=.026) at the end range of abduction. DISCUSSION AND CONCLUSION: The results indicate that both DTM and VTM procedures applied at the end range of abduction improved glenohumeral abduction range of motion. Whether these changes would result in improved function could not be determined because of the use of a cadaver model.