Do social support and community engagement act as mechanisms in the association between neighbourhood income inequality and the mental health of mothers in Calgary,Canada? A mediation analysis

PurposeAccording to the social determinants of health framework, income inequality is a potential risk factor for adverse mental health. However, few studies have explored the mechanisms suspected to mediate this relationship. The current study addresses this gap through a mediation analysis to determine if social support and community engagement act as mediators linking neighbourhood income inequality to maternal anxiety and depressive symptoms within a cohort of new mothers living in the City of Calgary, Canada.MethodsData collected at three years postpartum from mothers belonging to the All Our Families (AOF) cohort were used in the current study. Maternal data were collected between 2012 and 2015 and linked to neighbourhood socioeconomic data from the 2006 Canadian Census. Income inequality was measured using Gini coefficients derived from 2006 after-tax census data. Generalized structural equation models were used to quantify the associations between income inequality and mental health symptoms, and to assess the potential direct and indirect mediating effects of maternal social support and community engagement.ResultsIncome inequality was not significantly associated with higher depressive symptoms (β = 0.32, 95%CI = −0.067, 0.70), anxiety symptoms (β = 0.11, 95%CI = −0.39, 0.60), or lower social support. Income inequality was not associated with community engagement. For the depression models, higher social support was significantly associated with lower depressive symptoms (β = −0.13, 95%CI = −0.15, −0.097), while community engagement was not significantly associated with depressive symptoms (β = 0.059, 95%CI = −0.15, 0.27). Similarly, for the anxiety models, lower anxiety symptoms were significantly associated with higher levels of social support (β = −0.17, 95%CI = −0.20, −0.13) but not with higher levels of community engagement (β = 0.14, 95%CI = −0.14, 0.41).ConclusionThe current study did not find clear evidence for social support or community engagement mediating the relationship between neighbourhood income inequality and maternal mental health. Future investigations should employ a broader longitudinal approach to capture changes in income inequality, potential mediators, and mental health symptomatology over time.     

General vaccination willingness and current vaccination status in relation to clinical and psychological variables in patients with multiple sclerosis

BackgroundInfections can have a significant impact on morbidity and mortality in multiple sclerosis (MS) patients. Therefore, vaccinations are of immense importance. If vaccination willingness is to be increased, possible influencing factors should be identified. The aim of the present study was to investigate the status of active immunisation in MS patients in association with sociodemographic, clinical-neurological, psychopathological and personality variables using the NEO-Five Factor Inventory, the Temperament and Character Inventory-Revised and the Hospital Anxiety and Depression Scale.MethodFour hundred and four MS patients from two German neurological hospitals were examined for their vaccination attitudes, in detail, the general willingness to vaccinate and the current vaccination status of mumps, measles and rubella (MMR) as well as tetanus and influenza. We also looked at the current level of disability in relation to the current vaccination status, as well as possible associated personality and psychopathological variables.ResultsPatients with a complete MMR vaccination status were significantly younger and those with a complete influenza vaccination status were significantly older than those with related incomplete vaccination status. Tetanus vaccination status completeness did not differ depending on age and did not show substantial association with personality scores. However, influenza vaccination completeness was associated with differences in personality and psychopathological variables; extraversion, openness, novelty seeking, harm avoidance and anxiety. A reported general vaccination willingness was significantly correlated with the current completeness of tetanus and influenza vaccinations. Novelty seeking, persistence, extraversion, agreeableness, conscientiousness and neuroticism were found associated with an increased vaccination willingness. Anxiety and depression were not related to general vaccination willingness.ConclusionsNo specific personality trait could be defined on its own in relation to general vaccination willingness or complete vaccination status. Younger patients should be made more aware of influenza vaccination. Reasons for rather low vaccination rates need to be further investigated.     

Electroacupuncture and acupuncture in the treatment of anxiety - A double blinded randomized parallel clinical trial

BackgroundThe estimated number of people living with anxiety disorders worldwide is around 264 million and is estimated to have worsened with the recent pandemic of COVID-19. Acupuncture has shown to have excellent therapeutic effects in reducing anxiety.DesignDouble-blinded randomized controlled clinical trial with 56 participants (21–82 years) with anxiety diagnosed by 3 different anxiety scales (BAI, GAD-7 and OASIS). A 30-min acupuncture session was applied once a week for 10 weeks.AimsEvaluate the effectiveness of acupuncture and electroacupuncture in the treatment of anxiety to verify if: (1) People with high anxiety report reduced scores after 5 and 10 sessions; (2) Salivary cortisol levels accompanied the reduced scores; (3) Electroacupuncture treatment is more effective than acupuncture; (4) the treatments is independent of anxiolytic medication.MethodsVolunteers were randomized into 3 groups (control, acupuncture, and electroacupuncture). The results were analyzed by anxiety scales and salivary cortisol tests.ResultsThe findings show an improvement in anxiety, assessed by BAI, GAD-7 and OASIS, after the 5th session of acupuncture (p < 0.05) and electroacupuncture (p < 0.05) and the 10th session for both techniques (p < 0.001). The salivary cortisol values measured in the morning followed this pattern (p < 0.05), although the reduction of the night cortisol values was not statistically significant. Electroacupuncture and acupuncture show similar efficacy. The positive effect after the treatments is independent of anxiolytic medication (p < 0.001).ConclusionAcupuncture and electroacupuncture are effective in treating anxiety on their own or as adjuncts to pharmacological therapy.Trial registration numberNºP445-08/2017 (Unidade de Investigação em Ciências da Saúde);     

温针灸对功能性便秘患者临床症状及焦虑抑郁的改善作用

目的:探讨温针灸对功能性便秘(FC)患者临床症状及焦虑抑郁的改善作用。方法:选取2017年1月至2017年12月中国中医科学院广安门医院南区收治的FC患者70例作为研究对象,随机分为观察组和对照组,每组35例。对照组采用常规针刺治疗,观察组采用温针灸治疗,比较治疗前后2组患者便秘临床症状积分、首次排便时间、中医证候评分、焦虑自评量表(SAS)、抑郁自评量表(SDS)评分。结果:观察组有效率96. 00%,对照组有效率68. 00%,差异有统计学意义(P0. 05)。治疗后2组患者的周排便次数、粪便性状积分和排便困难程度均改善,中医证候评分、SAS和SDS评分下降,较治疗前差异有统计学意义(P 0. 05)。治疗后,观察组患者的周排便次数、粪便性状积分高于对照组,中医证候评分、SDS和SAS评分、首次排便时间以及排便困难程度积分小于对照组,差异有统计学意义(P 0. 05)。结论:温针灸治疗能调节胃肠道运动、润湿肠道、显著改善便秘等临床症状,对FC患者有显著临床效果。     

Simeprevir added to peginterferon and ribavirin lessens time with fatigue,depressive symptoms and functional limitations in patients with chronic hepatitis C compared with peginterferon and ribavirin: results from 1161 patients in the QUEST‐1, QUEST‐2 and PROMISE studies

The value of adding simeprevir (SMV) vs placebo (PBO) to peginterferon and ribavirin (PR) for treatment of chronic hepatitis C virus infection was examined using patient‐reported outcomes (PROs); further, concordance of PROs with virology endpoints and adverse events (AEs) was explored. Patients (n = 768 SMV/PR, n = 393 PBO/PR) rated fatigue (FSS), depressive symptoms (CES‐D) and functional impairment (WPAI: Hepatitis C Productivity, Daily Activity and Absenteeism) at baseline and throughout treatment in three randomised, double‐blind trials comparing the addition of SMV or PBO during initial 12 weeks of PR. PR was administered for 48 weeks (PBO group) and 24/48 weeks (SMV group) using a response‐guided therapy (RGT) approach. Mean PRO scores (except Absenteeism) worsened from baseline to Week 4 to the same extent in both groups but reverted after Week 24 for SMV/PR and only after Week 48 for PBO/PR. Accordingly, there was a significantly lower area under the curve (baseline–Week 60, AUC₆₀) and fewer weeks with clinically important worsening of scores in the SMV/PR group at any time point. Incidences of patients with fatigue and anaemia AEs were similar in both groups, but FSS scores showed that clinically important increases in fatigue lasted a mean of 6.9 weeks longer with PBO/PR (P < 0.001). PRO score subgroup analysis indicated better outcomes for patients who met the criteria for RGT or achieved sustained virological response 12 weeks post‐treatment (SVR12); differences in mean PRO scores associated with fibrosis level were only observed with PBO/PR. Greater efficacy of SMV/PR enabled reduced treatment duration and reduced time with PR‐related AEs without adding to AE severity.     

Prostatic Artery Embolization—Anatomic Predictors of Technical Outcomes

PurposeTo determine if cone-beam CT and digital subtraction angiography analysis of pelvic arterial anatomy has predictive value for radiation exposure and technical success of prostatic artery embolization (PAE).Materials and MethodsThis prospective, nonrandomized, single-center study included 104 consecutive patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Cone-beam CT was performed in 160/208 (76.9%) hemipelves to determine prostatic artery (PA) origin. Classification of pelvic arterial tortuosity was possible in 73/104 (70.2%) patients. Learning curves of 2 interventionalists who performed 86.5% of PAEs were analyzed.ResultsTortuosity of pelvic arteries was classified as mild in 25 (34.2%) patients median age 64 years, moderate in 40 (54.8%) patients median age 69 years, and severe in 8 (11.0%) patients median age 70 years (mild vs moderate, P = .002; mild vs severe, P = .019); median fluoroscopy times were 24, 36, and 46 minutes (P = .008, P = .023); median contrast volumes were 105, 122.5, and 142 mL (P = .029, P = .064); and bilateral PAE rates were 84.0%, 77.5%, and 62.5% (P = .437), respectively. PA origin from superior vesical artery was most frequent (27.5%) and showed higher dose area product (median 402.4 vs 218 Gy ∙ cm², P = .033) and fluoroscopy time (median 42.5 vs 27 min, P = .01) compared with PA origin from obturator artery, which was least frequent. Interventionalist experience revealed significant impact on procedure times (median 159 vs 130 min, P = .006).ConclusionsTortuosity of pelvic arteries was more frequent in older patients and predicted worse technical outcomes of PAE. PA origin from obturator artery was associated with lower dose area product and fluoroscopy time, especially compared with PA origin from superior vesical artery. Interventionalist experience showed significant influence on technical outcome.     

Resting respiratory sinus arrhythmia moderates the association between social phobia symptoms and self‐reported physical symptoms

The present study sought to investigate the association between social phobia symptoms and self‐reported physical symptoms and the moderation effect of resting respiratory sinus arrhythmia (RSA) on this link. Data of 5‐min resting RSA, social phobia symptoms assessed by the Social Phobia Scale, and physical symptoms assessed by the Cohen–Hoberman Inventory of Physical Symptoms were collected from 167 undergraduate students. Results indicated that higher levels of social phobia symptoms were associated with higher levels of self‐reported physical symptoms. Resting RSA played the moderating role in the link between social phobia symptoms and self‐reported physical symptoms, such that social phobia symptoms were positively associated with self‐reported physical symptoms among individuals with low resting RSA, whereas this association was nonsignificant among individuals with high resting RSA. These findings suggest that high resting RSA as a physiological marker of better self‐regulation capacity might buffer the effect of social phobia symptoms on physical health.