Evaluating the Impact of a Novel Peer-to-Peer Educational Modality on Knowledge and Attitudes About Perinatal Mood and Anxiety Disorders

Maternal and Child Health Journal - This study assessed whether the use of a peer-to-peer educational book, written and illustrated by women who experienced common mental disorders (CMDs) in the...     

The weediness of wild plants: molecular analysis of genes influencing dispersal and persistence of johnsongrass, Sorghum halepense (L.) Pers

Many major weeds rely upon vegetative dispersal by rhizomes and seed dispersal by "shattering" of the mature inflorescence. We report molecular analysis of these traits in a cross between cultivated and wild species of Sorghum that are the probable progenitors of the major weed "johnsongrass." By restriction fragment length polymorphism mapping, variation in the number of rhizomes producing above-ground shoots was associated with three quantitative trait loci (QTLs). Variation in regrowth (ratooning) after overwintering was associated with QTLs accounting for additional rhizomatous growth and with QTLs influencing tillering. Vegetative buds that become rhizomes are similar to those that become tillers--one QTL appears to influence the number of such vegetative buds available, and additional independent genes determine whether individual buds differentiate into tillers or rhizomes. DNA markers described herein facilitate cloning of genes associated with weediness, comparative study of rhizomatousness in other Poaceae, and assessment of gene flow between cultivated and weedy sorghums--a risk that constrains improvement of sorghum through biotechnology. Cloning of "weediness" genes may create opportunities for plant growth regulation, in suppressing propagation of weeds and enhancing productivity of major forage, turf, and "ratoon" crops.     

Impact of urinary FSH price: a cost-effectiveness analysis of recombinant and urinary FSH in assisted reproduction techniques in the USA

This study compares the cost-effectiveness of recombinant human FSH (r(h)FSH, Gonal-F) and urinary FSH (uFSH) in assisted reproduction techniques in the USA, using several hypothetical prices for uFSH. A specifically designed Markov model and Monte-Carlo simulation techniques were used to model the possible outcomes during three treatment cycles. Data included in the model were derived from randomized clinical trials and databases. An expert panel determined probability distributions for each decision point throughout each virtual treatment cycle. The assumed unit cost of r(h)FSH was $58.52 (based on the average retail cost) and three unit prices ($49, $45, $40) were used for uFSH. A total of 5000 simulations was performed on a virtual cohort of 100,000 patients. The mean number of assisted reproduction treatment cycles/success (ongoing pregnancy at 12 weeks) was 4.34 with r(h)FSH and 4.75 with uFSH. The total number of pregnancies achieved was 40,665 and 37,890, respectively. The mean cost per successful pregnancy with r(h)FSH was $40 688. For uFSH at unit costs of $40, $45 and $49, the mean costs per successful pregnancy were $43,500, $44,400 and $45,000, respectively (each P < 0.0001 versus r(h)FSH). Thus, despite its greater cost per unit dose, r(h)FSH is more cost-effective than uFSH over a wide range of uFSH prices, reflecting the greater clinical efficacy of r(h)FSH.     

Promoting Joint Attention in Toddlers with Autism: A Parent-Mediated Developmental Model

Joint attention, a foundational nonverbal social-communicative milestone that fails to develop naturally in autism, was promoted for three toddlers with early-identified autism through a parent-mediated, developmentally grounded, researcher-guided intervention model. A multiple baseline design compared child performance across four phases of intervention: focusing on faces, turn-taking, responding to joint attention, and initiating joint attention. All toddlers improved performance and two showed repeated engagement in joint attention, supporting the effectiveness of developmentally appropriate methods that build on the parent–child relationship. A complementary qualitative analysis explored family challenges, parent resilience, and variables that may have influenced outcomes. Intervention models appropriate for toddlers with autism are needed as improved early identification efforts bring younger children into early intervention services.     

Proton spectroscopic imaging (Dixon method) of the liver: clinical utility

The contribution of proton spectroscopic (PS) imaging to magnetic resonance (MR) imaging of the liver was assessed at 0.5 T in 55 patients with known or suspected hepatic malignancy. PS images were compared subjectively with T1- and T2-weighted spin-echo (SE) images for hepatic lesion detection and conspicuity. For hepatic metastases (n = 27), PS images were equal to T1-weighted images in lesion detection in 17 patients but showed fewer lesions in five patients and false-negative results in two. When compared with T2-weighted images, PS images depicted more lesions in six patients, an equal number of lesions in 18, and fewer lesions in two. Hepatomas (n = 8) were detected with each sequence in all patients. Hepatomas were often more conspicuous on PS images than on T2-weighted images; they were of equal conspicuity on PS and T1-weighted images in most cases. Whereas fatty infiltration (n = 16) appeared on PS images as areas of low signal intensity similar to that of paraspinal muscle, it produced no detectable abnormality on either T1- or T2-weighted images. PS imaging is inferior to T1-weighted SE imaging in the detection of hepatic metastases. The major role of PS imaging at intermediate field strength is to differentiate focal fatty infiltration from hepatic metastases.     

Evidence and theory for lower rates of depression in larger US urban areas

It is commonly assumed that cities are detrimental to mental health. However, the evidence remains inconsistent and at most, makes the case for differences between rural and urban environments as a whole. Here, we propose a model of depression driven by an individual’s accumulated experience mediated by social networks. The connection between observed systematic variations in socioeconomic networks and built environments with city size provides a link between urbanization and mental health. Surprisingly, this model predicts lower depression rates in larger cities. We confirm this prediction for US cities using four independent datasets. These results are consistent with other behaviors associated with denser socioeconomic networks and suggest that larger cities provide a buffer against depression. This approach introduces a systematic framework for conceptualizing and modeling mental health in complex physical and social networks, producing testable predictions for environmental and social determinants of mental health also applicable to other psychopathologies.

Living in cities changes the way we behave and think (1–3). Over a century ago, the social changes associated with massive urbanization in Europe and in the United States focused social scientists on the nexus between cities and mental life (2). Along with the urban public health crises of the time, a central question became whether cities are good or bad for mental health.Subsequently, social psychologists (1) started to document and measure the systematic behavioral adaptations among people living in cities. These adaptations included a more intense use of time [e.g., faster walking (4)], a greater tolerance for diversity (5), and strategies to curb unwanted social interactions—such that people in larger cities act in colder and more callous ways (1). These studies attributed the influences of urban environments on mental health to the intensity of social life in larger cities, mediated by densely built spaces and associated dynamic and diverse socioeconomic interaction networks. They did not, however, ultimately clarify whether urban environments promote better or worse mental health. Consequently, concerns persisted that cities are mentally taxing (6–9) and can induce “stimulus overload,” including stress, mental fatigue (10), and low levels of subjective well-being (SWB) (11).More recent studies have focused less on urban environments as a whole and more on contextual and environmental factors associated with depression. For example, a study of the entire population in Sweden (9) uncovered a positive association between neighborhood population density and depression-related hospitalizations. In addition, individual factors of gender, age, socioeconomic status, and race, which vary at neighborhood levels within cities, have been found to be statistically associated with depression (12–14). Other studies using various measures of mental health and broader definitions of urban environments have found evidence for an association between poorer mental health in cities vs. rural areas (7, 8). However, this evidence and that linking SWB and cities (15–18) have remained mixed and often explicitly inconsistent (19, 20) due to differences in 1) reporting (e.g., surveys vs. medical records); 2) types of measurement (e.g., surveys vs. interviews); 3) definitions of what constitutes urban; and 4) the mental disorders studied (e.g., schizophrenia vs. depression).For these reasons, it is desirable to create a systematic framework that organizes this diverse body of research and interrogates how varying levels of urbanization influence mental health across different sets of indicators. Here, we begin to build this framework for depression in US cities. We show that, surprisingly, the per capita prevalence of depression decreases systematically with city size.Like earlier classic approaches, our strategy frames the effects of city size on mental health through the lens of the individual experience of urban physical and socioeconomic environments. Crucial to our purposes, many characteristics of cities have been recently found to vary predictably with city population size. These systematic variations in urban indicators are explained by denser built environments and their associated increases in the intensity of human interactions and resulting adaptive behaviors (21).More specifically, people in larger cities have, on average, more socioeconomic connections mediating a greater variety of functions. This effect is understood theoretically by the statistical likelihood to interact with more people over space per unit time, leading to potential mental “overload” but also, to greater stimulation and choice along more dimensions of life. This expansion of socioeconomic networks is supported structurally by economies of scale (e.g., road length) in urban built environments and by occupational specialization and associated increases in economic productivity and exchange (3).This effect leads to a number of quantitative predictions about the nature of urban spaces and socioeconomic variables, the most central of which is the variation of the average number of socioeconomic interactions, k (network degree), with city size, N, as k(N)=k0Nδeξ. Here, k0 is a prefactor independent of city size, and ξ is a residual measuring the distance from the population average. The exponent 0<δ≃1/6<1 measures the percentage increase in the number of connections with each percentage increase in city population, which is an elasticity in the language of economics. Because the ξ reflects city size–independent statistical fluctuations, these errors average out across cities, and k obeys a scaling relationship on average over cities, such that k(N)∼Nδ. This expectation that k follows a scaling law with city population is directly observed in cell phone networks (22) and indirectly via the faster spread of infectious diseases such as COVID-19 (23), and by higher per capita economic productivity and rates of innovation (4, 21).This result is important to mental health because depression is associated, at the individual level, with fewer social contacts (24, 25). To translate the general scaling of social interactions with city size into a model for the incidence of depression in urban areas, we will now need to pay particular attention not only to the average number of social connections in a city of size N, k(N), but also, to its variance across individuals in that city and how they influence depression.     

Dyspareunia Related to GSM: Association of Total Vaginal Thickness via Transabdominal Ultrasound

IntroductionIt has previously been suggested in the literature that ultrasound measurement of total vaginal wall thickness (TVT) differs significantly between pre- and postmenopausal women, indicating that it may be a useful and noninvasive objective assessment to correlate the degree of vaginal atrophy to patient-reported symptoms.AimThe purpose of this cross-sectional pilot study was to determine whether TVT in postmenopausal women, as measured with transabdominal ultrasound, is associated with patient-reported dyspareunia and symptoms related to genitourinary symptomatology.MethodsPostmenopausal women presenting for pelvic ultrasound had TVT and total mucosal thickness (TMT) measured via transabdominal ultrasound. A questionnaire also was administered assessing menopausal status, relevant medical history, and self-report of dyspareunia and other symptoms related to the genitourinary syndrome of menopause (GSM). This questionnaire was derived from the Vulvovaginal Symptom Questionnaire, which has been validated in the literature.Main Outcome MeasureThe main outcome measures included the average TVT and TMT for postmenopausal women reporting any symptom of GSM and average TVT and TMT of women reporting no symptoms of GSM.ResultsData from 44 postmenopausal women showed no significant association between transabdominal ultrasound-measured TVT or TMT and patient report of dyspareunia or other genitourinary symptoms. Data were stratified by individual GSM symptoms, sexual symptoms as an aggregate, and individual sexual symptoms. Neither of these subgroups showed a statistically significant difference in TVT or TMT between symptomatic and asymptomatic women.Clinical ImplicationsAlthough no statistically significant data were derived from this study, we propose that future studies investigating the longitudinal relationship between TVT and GSM symptomatology may show an association between total vaginal thickness measurement change over time as determined by ultrasound with the presence of patient-reported dyspareunia and other GSM symptoms.Strengths & LimitationsThis study is limited by its small sample size as well as the patient population, which was restricted to postmenopausal women with a clinical indication for ultrasound. A major strength of this investigation is that it is the first study to look at the relationship between sexual pain and other GSM symptoms and TVT using transabdominal ultrasound, which is a readily available, non-invasive tool in most clinical settings.ConclusionBased on the results of this small pilot study, transabdominal pelvic ultrasound cannot be used at this time to objectively quantify the presence of sexual pain or other GSM symptoms; however, future studies should continue to investigate the longitudinal relationship between these 2 variables.Balica AC, Cooper AM, McKevitt MK, et al. Dyspareunia Related to GSM: Association of Total Vaginal Thickness via Transabdominal Ultrasound. J Sex Med 2019; 16:2038–2042.