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BackgroundIdentifying factors associated with post-disaster youth substance use is a crucial element of developing evidence-based prevention and intervention efforts. Hurricane María struck Puerto Rico in September of 2017 and the wide-spread impact from this disaster, including exposure to trauma, displacement, and disrupted social supports had the potential to negatively impact levels of substance use among youth across the archipelago. However, post-disaster substance use remains under-investigated in this context. The current study sought to identify risk and protective factors associated with substance use among Puerto Rican youth in the aftermath of Hurricane Maria.MethodsCross-sectional, secondary data analyses were conducted using school-based survey data collected at all schools in Puerto Rico between February 1 and June 29, 2018 (5-9 months after Hurricane María). Social supports, substance use, and trauma symptoms were assessed. An ordinal regression analysis was conducted to identify student factors associated with greater likelihood of post-disaster substance use.ResultsA total of 36,485 participants (50.7% female, grades 7-12), were included in an ordinal regression analysis that compared the likelihood of respondents endorsing high, low, or no substance use after Hurricane María based on reported adult social support, counselor/teacher social support, peer social support, ptsd symptomatology, and gender. Findings showed that, when compared to students that endorsed low or no substance use, those who reported having adult social support demonstrated a 58% reduction in odds (OR = 0.42, 95% CI: 0.34-0.53) of reporting high substance use after Hurricane María, while students who reported having teacher/counselor social support demonstrated a 21% reduction in odds (OR = 0.79, 95% CI: 0.69-0.89) of reporting high substance use. Additionally, those that reported having peer social support demonstrated a 31% increase in odds (OR = 1.31, 95% CI: 1.10 to 1.58) of reporting higher substance use, compared to those that reported low or no substance use.ConclusionsWhile social support was generally protective, prevention efforts to build positive family and community connections may be indicated. Evidence-based school screenings of substance use and trauma may help direct intervention to those most at risk for co-occurring issues.

Black men are disproportionately affected by firearm assaults in the United States, and these disparities are rooted in structural and social inequities. The objective of this scoping review of research was to identify risk and protective factors for firearm assault injuries among Black men at all levels of the social-ecological framework. The search was conducted in 2021. The initial search generated 1,122 articles. Studies were eligible if they (a) included an analysis of modifiable risk or protective factors for firearm assaults among Black men; (b) reported an estimate of correlation, association, or effect between risk or protective factors and firearm assault injuries, firearm violence, and/or firearm homicides; and (c) were published peer-reviewed articles. In all, 19 articles were identified for review. Risk factors identified at each ecological level include the following: (1) Individual: firearm possession/weapon use and criminal legal system interaction; (2) Relationships: gang membership and exposure to other people who have experienced a firearm assault; (3) Community: indicators for socioeconomic status and racial residential segregation; and (4) Societal: historical racist policy. Individual-level substance use had mixed results. Few (26%) studies examined protective factors at any ecological level, but community-level factors like neighborhood tree cover were identified. Future research needs to examine risk and protective factors at the societal level and multiple ecological levels simultaneously leading to more effective multi-level interventions that will guide policy formation. A greater diversity of study designs, research methods, and theoretical frameworks is needed to better understand factors associated with firearm assault among Black men.

Introduction: Numerous early-life risk factors are thought to significantly contribute to the development of psychological problems in toddlerhood. However, these factors have seldom been investigated concomitantly and longitudinally, and few studies include both mothers and fathers. This study examines the longitudinal impact of early environmental, parental, and child-specific risk factors on children's internalizing and externalizing symptomatology at age 4. Methods: Families were recruited from a perinatal center at birth and completed self-report questionnaires at birth, 4 weeks postpartum, 6 months postpartum, and annually thereafter. The final population-based sample consisted of n = 560 mothers (and fathers) who gave birth after June 2015, with children who turned 4 years old before March 31, 2021. The primary outcomes, children's internalizing and externalizing symptomatology at age 4, were measured using the Strengthsand Difficulties Questionnaire. Linear mixed effect models were used to estimate growth curves for predictors between 4 weeks and 4 years postpartum, which were subsequently entered into multivariable linear regressions to predict internalizing and externalizing symptomatology at age 4. Results: The study identified several key risk factors: environmental (lack of social support, lower parental education, male sex), parental (poor parental mental health, increased parenting stress, parental sleep difficulties) and child-specific (children's low physical health, children's reduced sleep quality, temperament). Discussion: The findings underscore that most identified risk factors are related to children's temperament, mental and physical health of parents, their experienced stress, and families' social support networks. These insights highlight the importance of targeted interventions focusing on improving parental mental health, reducing stress, and enhancing social support to mitigate early-life psychological problems in children. [ABSTRACT FROM AUTHOR]

Objective: To compare the differences in clinical-related factors between patients with type 2 diabetes (T2DM) and those without diabetic retinopathy (DR) and to explore the risk factors or protective factors affecting DR in T2DM patients. Methods: We performed a retrospective analysis of 380 patients with type 2 diabetes admitted to Handan Central Hospital from June 2023 to May 2024. Clinical data collected included baseline characteristics, hematological tests, metabolic indicators, and information on diabetic complications and comorbidities. Results: Our findings identified intervention, neck vascular disease, bilateral lower limb venous thrombosis, high creatinine, high glomerular filtration rate, high chloride, high fasting C-peptide, and high lactate dehydrogenase as risk factors for DR. In contrast, High 2-hour postprandial C-peptide is a protective factor for diabetic retinopathy. A logistic regression model was constructed using stepwise regression to predict DR occurrence, achieving an accuracy of 0.80 and an AUC of 0.83. [ABSTRACT FROM AUTHOR]

Prostate cancer (PCa) is the second most common malignancy affecting men globally. Recent advances in metabolomics have highlighted significant alterations in specific amino acid (AA) metabolism linked to PCa, indicating their potential utility in diagnosis and therapy. However, no direct causal association between serum AA levels and PCa risk has been established. A total of 35 patients with PCa and 30 individuals with benign prostatic hyperplasia (BPH) were recruited for this study. Targeted metabolomic analysis was performed using ultra-high-performance liquid chromatography-tandem mass spectrometry on serum samples. Two-sample Mendelian randomization (MR) was applied to explore potential causal links between serum AA levels and PCa risk, including mediator effects using dual-phase MR and assessing reverse causality through reverse MR. Results Targeted metabolomic profiling identified six amino acids—glutamate (Glu), Ser, histidine (His), arginine (Arg), aspartic acid (Asp), and glycine (Gly)—that showed significant area under the ROC curve in differentiating between BPH and PCa cases. Notably, Glu demonstrated an inverse association with PCa risk, distinct from the other AAs identified. However, definitive evidence supporting a causal relationship between low Glu levels and increased PCa risk was not observed. Our results suggest a protective role of Glu against PCa development, which may have implications for disease prognosis. Increasing dietary Glu intake may present a potential preventive or therapeutic approach for PCa. [ABSTRACT FROM AUTHOR]

Risk and protective factors for psychiatric illnesses are linked to distinct structural and functional changes in the brain. Further, the prevalence of these factors varies across sexes and genders, yet the distinct and joint effects of sex and gender in this context have not been extensively characterized. This suggests that risk and protective factors may map onto the brain and uniquely influence individuals across sexes and genders. Here, we review how specific risk (childhood maltreatment, the COVID-19 pandemic, experiences of racism), and protective factors (social support and psychological resilience) distinctly influence the brain across sexes and genders. We also discuss the role of sex and gender in the compounding effects of risk factors and in the interdependent influences of risk and protective factors. As such, we call on researchers to consider sex and gender when researching risk and protective factors for psychiatric illnesses, and we provide concrete recommendations on how to account for them in future research. Considering protective factors alongside risk factors in research and acknowledging sex and gender differences will enable us to establish sex- and gender-specific brain-behavior relationships. This will subsequently inform the development of targeted prevention and intervention strategies for psychiatric illnesses, which have been lacking. To achieve sex and gender equality in mental health, acknowledging and researching potential differences will lead to a better understanding of men and women, males and females, and the factors that make them more vulnerable or resilient to psychopathology. Plain English summary: Exposure to different environments and distinct lived experiences for individuals across the sexes and genders have unique effects on mental wellbeing, brain structure, and function. These differences in outcomes arise from interdependent effects of biology and socio-culture and can be challenging to separate. This review describes sex- and gender-specific effects of negative and positive environmental experiences, known as risk and protective factors. Specifically, we review current sex- and gender-specific findings for childhood maltreatment, the COVID-19 pandemic, experiences of racism, social support, and resilience. Risk and protective factors, and sex and gender have bidirectional influences, and our review outlines their dynamic, interconnected and intersectional nature. Including sex and gender as a variable of interest will enable us to capture specific effects that may have previously gone undetected. More broadly, implementing the outlined considerations will lead to more inclusive and representative research that can deliver robust findings and meaningfully propel the field forward. Highlights: Unique effects of sex and gender on brain and behavior necessitate the investigation of these factors as a variable of interest in research. Protective factors should be considered alongside risk factors for a more holistic understanding of mental wellbeing. Investigating sex and gender influences will help detect findings that would have otherwise been overlooked. Risk factors, protective factors, sex, and gender all have bidirectional influences on each other. [ABSTRACT FROM AUTHOR]

This study investigates the relationship between risk and protective factors and suicidal ideation among teachers, a group often overlooked in suicide prevention efforts. Using the diathesis-stress model as a partial framework, the research explores how depression and anxiety, as risk factors, and emotional intelligence, resilience, and positive thoughts, as protective factors, influence suicidal ideation. A cross-sectional design was employed, involving 1,270 Spanish teachers (median age: 46, 70.2% female). Key measures included the Positive and Negative Suicidal Ideation scale (PANSI), the Brief Emotional Intelligence Scale (BEIS-10), the Brief Resilient Coping Scale (BRCS) for resilience, and the General Health Questionnaire (GHQ-12) for depression and anxiety. A network approach was used to examine the relationships between these variables. Results showed that depression had a stronger relationship with negative ideation than anxiety, while emotional intelligence and positive thoughts acted as protective factors. Positive ideation was negatively associated with depression and anxiety, and positively linked to emotional intelligence and resilience. Emotional intelligence emerged as the most critical protective factor. These findings provide valuable evidence to inform the development of emotional management and resilience-building programs aimed at enhancing teachers' mental health and performance, which could also indirectly benefit students. [ABSTRACT FROM AUTHOR]

Background: Intestinal infectious diseases (IIDs) can impact the growth and development of children and weaken adults. This study aimed to establish a spatial panel model to analyze the relationship between factors such as population, economy and health resources, and the incidence of common IIDs. The objective was to provide a scientific basis for the formulation diseases prevention measures. Methods: Data on monthly reported cases of IIDs in each district and county of Zhejiang Province were collected from 2011 to 2021. The spatial distribution trend was plotted, and nine factors related to population, economy and health resources were selected for analysis. A spatial panel model was developed to identify statistically significant spatial patterns of influencing factors (P < 0.05). Results: The results revealed that each type of IIDs exhibited a certain level of clustering. Each IIDs had a significant radiation effect, HEV (b = 0.28, P < 0.05), bacillary dysentery (b = 0.38, P < 0.05), typhoid (b = 0.36, P < 0.05), other infectious diarrheas (OIDs) (b = 0.28, P < 0.05) and hand, foot and mouth disease (HFMD) (b = 0.39, P < 0.05), indicating that regions with high morbidity rates spread to neighboring areas. Among the population characteristics, density of population acted as a protective factor for bacillary dysentery (b=-1.81, P < 0.05), sex ratio acted as a protective factor for HFMD (b=-0.07, P < 0.05), and aging rate increased the risk of OIDs (b = 2.39, P < 0.05). Urbanization ratio posed a hazard factor for bacillary dysentery (b = 5.17, P < 0.05) and OIDs (b = 0.64, P < 0.05) while serving as a protective factor for typhoid (b=-1.61, P < 0.05) and HFMD (b=-0.39, P < 0.05). Per capita GDP was a risk factor for typhoid (b = 0.54, P < 0.05), but acted as a protective factor for OIDs (b=-0.45, P < 0.05) and HFMD (b=-0.27, P < 0.05). Additionally, the subsistence allowances ratio was a risk factor for HEV (b = 0.24, P < 0.05). Conclusion: The incidence of IIDs in Zhejiang Province exhibited a certain degree of clustering, with major hotspots identified in Hangzhou, Shaoxing, and Jinhua. It would be essential to consider the spillover effects from neighboring regions and implement targeted measures to enhance disease prevention based on regional development. [ABSTRACT FROM AUTHOR]

Community lay leaders are critical in connecting professional services and general populations in communities. However, limited studies have explored the potential protective factors for psychological health among this group of people. In addition, based on the complex nature of spiritual health, the inconsistent findings of previous studies also suggested that different domains of spiritual health may shape psychological health differently in different contexts and among different socio-demographic groups. Therefore, we assessed the psychological health of Hong Kong community lay leaders after COVID-19 and examined the effects of different domains of spiritual health on psychological distress after controlling for age and gender. Cross-sectional data from 234 Hong Kong community lay leaders aged 18 to 84 were analyzed using structural equation modeling. The results showed that most Hong Kong community lay leaders reported moderate anxiety. In addition, personal and communal (one domain) and transcendental domains of spiritual health were negatively associated with depression, anxiety, and stress, and the environmental domain of spiritual health was positively associated with depression, anxiety, and stress. These findings imply the importance of considering both the positive and negative effects of spiritual health on psychological distress. [ABSTRACT FROM AUTHOR]

Purpose: To identify risk and protective factors associated with physician performance in practice; to use this information to create a risk assessment scale; and, to test use of the risk assessment scale with a new population of assessed physicians. Design: Physician assessments that were completed by community-based physicians between March 2016 and February 2022 (n=2708) were gathered to determine what professional characteristics and practice context factors were associated with poor peer practice assessment (PPA). The predictive capacity of the resulting model was then tested against a new sample of physician assessments completed between March 2022 and February 2023 (n=320). Results: N=2401 physicians were eligible for inclusion in a logistic regression analysis, which resulted in an empirical model containing 11 variables that was able to account for 21.6% of the variance in the likelihood of receiving a poor PPA generated by the College of Physicians and Surgeons of British Columbia. The resulting model, when tested against 320 new cases, was able to predict good versus poor PPA performance with a sensitivity of 0.79 and specificity of 0.75. Not having undertaken peer review (OR=1.47) created a risk like that arising from a full decade passing since completion of medical school (OR=1.50). Conclusion: In addition to being the largest known study of its type, this work builds on similar studies by demonstrating the capacity to use regulator-mandated peer review to empirically identify physicians who are at risk of substandard performance using factors that are safe from claims of violating Human Rights Codes; that emphasize modifiable aspects of practice; and that can be readily updated to account for change over time. [ABSTRACT FROM AUTHOR]

Background: Past research suggests that individuals with learning disabilities experience higher levels of emotional difficulties. Objective: The aim of the current study was to investigate the relationships between specific learning disabilities (SLDs) and learning-based stress symptoms (LBSSs). Further, this study examines whether dispositional mindfulness (DM) can be used as a moderating factor for these symptoms resulting from the same stressful learning experience. Methods: The sample consisted of 133 participants (73 male) aged 23–44 years (M = 34.41; SD = 9.69). In this sample, 56 reported that they have been officially diagnosed with a SLD. Participants completed an online survey comprising a demographics questionnaire, self-report SLD questionnaire, school learning-based stress symptoms, and five-facet mindfulness questionnaire (FFMQ-24). Results: Results revealed that participants with an SLD had higher levels of LBSSs compared to the general population. Furthermore, findings revealed that DM significantly predicts LBSS levels. Conclusions: The present study provides further evidence on the impact of learning experiences on stress symptoms among individuals with SLDs, and this phenomenon we have termed as "learning-based stress symptoms". Additionally, our findings introduce novel evidence that DM may influence the relationship between LBSSs and SLDs, suggesting that a high level of DM can serve as a protective factor against these learning-based stress symptoms. [ABSTRACT FROM AUTHOR]

Age-related cognitive decline has become an increasingly relevant public health issue. However, risk and protective factors of cognitive decline have yet to be investigated prospectively taking into account genetic, lifestyle, physical and mental health factors. Population-based data from middle-aged (40 to 59 years; N = 2,764) and older individuals (60 to 80 years; N = 1,254) were drawn from a prospective community cohort study using the Tower of London (TOL) planning task. Assessments were repeated at a 5-year interval to investigate age-related changes in planning performance and to determine the impact of risk and protective factors. Planning performance improved in middle-aged, but declined in older participants over 5 years. SNPs affecting the dopamine system (COMT, DRD2) and APOE polymorphisms differentially predicted cognitive performance in older vs. middle-aged individuals. For older individuals, high alcohol consumption, antidepressant medication and living without a partner had additional negative predictive power on cognition. In contrast, undiagnosed hypertension, no obstructive lung disease, and fewer years of education predicted cognitive decline in the middle-aged group. The results inform screening for individuals particularly vulnerable to cognitive decline and interventions (e.g., focusing on lifestyle factors) to help maintain cognitive performance into old age. [ABSTRACT FROM AUTHOR]

Adults with care experience have elevated rates of adverse childhood experiences (ACEs) and a greater likelihood of poor outcomes. Some research has examined how protective factors and resilience impact outcomes among care leavers, but few studies include those from low- and middle-income countries (LMICs). Further, little work has examined the interactive impact of protective factors and resilience in this population. We investigated (a) the prevalence of ACEs among care leavers from LMICs, the mediating roles of (b) resilience and (c) individual and relational protective factors on the relationship between ACEs and life satisfaction, and (d) whether mediation was occurring both in parallel and sequentially. Five hundred forty-two care leavers from twelve LMICs completed an online survey. Participants completed the Brief Resilience Scale, ACEs Questionnaire, and open-ended questions regarding care experiences. Open-ended questions were coded for protective factors. There was a high prevalence of ACEs among care leavers. The relationship between ACEs and life satisfaction was partially mediated by resilience. Individual and relational protective factors partially mediated the relationship between ACEs and life satisfaction. Finally, resilience and protective factors partially mediated the relationship between ACEs and life satisfaction in both parallel and sequential mediation among care leavers from LMICs. Protective factors operate interactively to influence resilience, increasing life satisfaction among care leavers from LMICs. [ABSTRACT FROM AUTHOR]

Major conceptual models of ADHD and learning disabilities underscore the adverse effects they have on academic performance and dropout from university. Therefore, identifying psychological risks and protective factors can aid in managing academic challenges and decreasing dropout rates. In this cross-sectional study, a sample of 395 Hungarian college students (66.6% female, mean age 23.72 years [SD = 3.87]) responded to an online survey including the Adult ADHD Self-Report Scale, Beck Depression Inventory, General Self-Efficacy Questionnaire, Academic Resilience Scale, and the Higher Education Retention Questionnaire. Path analysis indicated that depression and academic resilience mediate the relationship between ADHD symptoms and dropout intention, while self-efficacy moderates this association. The findings highlight the critical role of psychological factors in shaping academic dropout for college students with ADHD symptoms. Enhancing academic resilience and self-efficacy may help mitigate the negative impact of ADHD symptoms on college retention. [ABSTRACT FROM AUTHOR]

Aims: Increasing attention has been given to the concept resilience in the context of healthcare especially during and post the COVID pandemic. Much of the inquiry and evidence reported has focused on promoting or enhancing resilience in healthcare for improving the quality of care and reducing medical negligence. This discursive paper aims to highlight how resilience is conceptualised and identify any potential limitations or gaps in the context of healthcare students, acknowledging considerations for further development and research into this topic. Design and Methods: This discursive discussion draws on relevant theoretical underpinnings from the fields of adjustment and coping psychology, and research and evidence from health sciences, for facilitating an understanding of resilience in supporting healthcare students to adapt into professional practice. Results: Investigation of resilience in healthcare students is mainly identified at an individual level as personal traits or skills for working within complex healthcare systems and clinical environments. Less attention has been given to examining resilience at the organisation or systemic level. This is primarily because of limited frameworks for investigating resilience from a multidimensional perspective recognising a wider systemic level influenced by external factors including socioecological determinants, for example, available support services for healthcare students. Conclusions: The link between resilience and its function to mitigate against associated neuropsychological distress and subsequent pathopsychological disorders in healthcare student cohorts is recognised; however, greater understanding of resilience as a multidimensional construct is warranted. Relevance to Clinical Practice: A multidimensional investigation of resilience is critical for the preparation and readiness of healthcare structures and organisations in facilitating the needs of healthcare students entering challenging and diverse healthcare working environments. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Affiliation to gangs becomes analogous to the need for belongingness; a leader or member of the gang can substitute a primary caregiver, or act as a parent figure or a role model. Children and youth associated with gangs lean toward antisocial activities compared to their nongang counterparts. After-school clubs (ASCs) probably demote gang membership providing support in various aspects of self-growth and thereby compassing the need for affiliation. Objectives: The aim of the study was to assess the relationship between risky behavior and gang membership in children and compare the gender differences for the same. Materials and Methods: This cross-sectional, observational study was conducted using purposive sampling approaching the children enrolled in an ASC run for children who had dropped out of the school. The participants were 97 children (male and female) attending the ASC between the age range of 6–18 years. They were assessed on sociodemographic and academic profiles; Social, Academic, and Emotional Behavior Risk Screener (SAEBRS); and Gang Membership Inventory (GMI). Results: It was observed that the SAEBRS score range of female participants implied "not at risk," while male participants scored "at risk" scores on social and emotional domains. On GMI, only male participants' scores showed gang affiliation. The model explained that 76% of the variance in GMI was contributed by the SAEBRS. Conclusion: ASC contributed valuably in integrating a vulnerable population into the productive national mainstream. Affinity with ASC can enhance the protective factors and minimize the risk of gang membership. Studies in the future can explore parental factors and resilience of this population along with socioeconomic factors to delve into risky as well as protective behaviors. [ABSTRACT FROM AUTHOR]

Backgound: Studies portray that one in every nine Indians develops cancer during their lifetime. Admissions to the Pediatric Oncology departments are increasing like any other department. Cancer affects not only the patients but also their caregivers both physically and psychologically. Aims and Objectives: In this scenario, the study aims to understand the caregivers' level of resilience and the associated risk and protective factors. Materials and Methods: This descriptive study was conducted in Kerala. Sixty caregivers of the children in the age group between 1-17 years, diagnosed with cancer were selected for the study. Mexican Resilience Scale and self-prepared interview schedule were used to collect the quantitative data. Qualitative data were collected using an in-depth interview guide. Results: The study found that the majority of the respondents are moderately resilient, with men exhibiting higher resilience than women. The prime factors contributing to resilience were identified as strength and self-confidence, social competence, family support, social support, and structure. The study further identified individual factors (flexibility, emotional stability, etc.), familial factors (positive family environment), and community factors (support from NGOs and support groups, etc.) as protective factors contributing to resilience. Additionally, the study revealed how individual (lack of emotional stability, introverted nature, etc.), familial (relationship issues), and community (social perceptions about the disease) levels of risk factors impact resilience. Conclusion: The importance of strengthening the support systems around the caregivers and importance of oncology social worker to deal with the psychosocial issues of patients and caregivers are also discussed in this paper. [ABSTRACT FROM AUTHOR]

Backgound: Studies portray that one in every nine Indians develops cancer during their lifetime. Admissions to the Pediatric Oncology departments are increasing like any other department. Cancer affects not only the patients but also their caregivers both physically and psychologically. Aims and Objectives: In this scenario, the study aims to understand the caregivers’ level of resilience and the associated risk and protective factors. Materials and Methods: This descriptive study was conducted in Kerala. Sixty caregivers of the children in the age group between 1-17 years, diagnosed with cancer were selected for the study. Mexican Resilience Scale and self-prepared interview schedule were used to collect the quantitative data. Qualitative data were collected using an in-depth interview guide. Results: The study found that the majority of the respondents are moderately resilient, with men exhibiting higher resilience than women. The prime factors contributing to resilience were identified as strength and self-confidence, social competence, family support, social support, and structure. The study further identified individual factors (flexibility, emotional stability, etc.), familial factors (positive family environment), and community factors (support from NGOs and support groups, etc.) as protective factors contributing to resilience. Additionally, the study revealed how individual (lack of emotional stability, introverted nature, etc.), familial (relationship issues), and community (social perceptions about the disease) levels of risk factors impact resilience. Conclusion: The importance of strengthening the support systems around the caregivers and importance of oncology social worker to deal with the psychosocial issues of patients and caregivers are also discussed in this paper.

Abstract Risk and protective factors for psychiatric illnesses are linked to distinct structural and functional changes in the brain. Further, the prevalence of these factors varies across sexes and genders, yet the distinct and joint effects of sex and gender in this context have not been extensively characterized. This suggests that risk and protective factors may map onto the brain and uniquely influence individuals across sexes and genders. Here, we review how specific risk (childhood maltreatment, the COVID-19 pandemic, experiences of racism), and protective factors (social support and psychological resilience) distinctly influence the brain across sexes and genders. We also discuss the role of sex and gender in the compounding effects of risk factors and in the interdependent influences of risk and protective factors. As such, we call on researchers to consider sex and gender when researching risk and protective factors for psychiatric illnesses, and we provide concrete recommendations on how to account for them in future research. Considering protective factors alongside risk factors in research and acknowledging sex and gender differences will enable us to establish sex- and gender-specific brain-behavior relationships. This will subsequently inform the development of targeted prevention and intervention strategies for psychiatric illnesses, which have been lacking. To achieve sex and gender equality in mental health, acknowledging and researching potential differences will lead to a better understanding of men and women, males and females, and the factors that make them more vulnerable or resilient to psychopathology.

Abstract Prostate cancer (PCa) is the second most common malignancy affecting men globally. Recent advances in metabolomics have highlighted significant alterations in specific amino acid (AA) metabolism linked to PCa, indicating their potential utility in diagnosis and therapy. However, no direct causal association between serum AA levels and PCa risk has been established. A total of 35 patients with PCa and 30 individuals with benign prostatic hyperplasia (BPH) were recruited for this study. Targeted metabolomic analysis was performed using ultra-high-performance liquid chromatography-tandem mass spectrometry on serum samples. Two-sample Mendelian randomization (MR) was applied to explore potential causal links between serum AA levels and PCa risk, including mediator effects using dual-phase MR and assessing reverse causality through reverse MR. Results Targeted metabolomic profiling identified six amino acids—glutamate (Glu), Ser, histidine (His), arginine (Arg), aspartic acid (Asp), and glycine (Gly)—that showed significant area under the ROC curve in differentiating between BPH and PCa cases. Notably, Glu demonstrated an inverse association with PCa risk, distinct from the other AAs identified. However, definitive evidence supporting a causal relationship between low Glu levels and increased PCa risk was not observed. Our results suggest a protective role of Glu against PCa development, which may have implications for disease prognosis. Increasing dietary Glu intake may present a potential preventive or therapeutic approach for PCa.

Abstract Background Intestinal infectious diseases (IIDs) can impact the growth and development of children and weaken adults. This study aimed to establish a spatial panel model to analyze the relationship between factors such as population, economy and health resources, and the incidence of common IIDs. The objective was to provide a scientific basis for the formulation diseases prevention measures. Methods Data on monthly reported cases of IIDs in each district and county of Zhejiang Province were collected from 2011 to 2021. The spatial distribution trend was plotted, and nine factors related to population, economy and health resources were selected for analysis. A spatial panel model was developed to identify statistically significant spatial patterns of influencing factors (P

Abstract Age-related cognitive decline has become an increasingly relevant public health issue. However, risk and protective factors of cognitive decline have yet to be investigated prospectively taking into account genetic, lifestyle, physical and mental health factors. Population-based data from middle-aged (40 to 59 years; N = 2,764) and older individuals (60 to 80 years; N = 1,254) were drawn from a prospective community cohort study using the Tower of London (TOL) planning task. Assessments were repeated at a 5-year interval to investigate age-related changes in planning performance and to determine the impact of risk and protective factors. Planning performance improved in middle-aged, but declined in older participants over 5 years. SNPs affecting the dopamine system (COMT, DRD2) and APOE polymorphisms differentially predicted cognitive performance in older vs. middle-aged individuals. For older individuals, high alcohol consumption, antidepressant medication and living without a partner had additional negative predictive power on cognition. In contrast, undiagnosed hypertension, no obstructive lung disease, and fewer years of education predicted cognitive decline in the middle-aged group. The results inform screening for individuals particularly vulnerable to cognitive decline and interventions (e.g., focusing on lifestyle factors) to help maintain cognitive performance into old age.

BackgroundResearch has demonstrated the importance of understanding risk factors for mental health and wellbeing. Less research has focused on protective factors that protect mental health and promote wellbeing in diverse contexts. Estimating structural paths from risk protective factors to psychopathology and wellbeing can inform prioritization of targeted investment in adolescent health programs that seek to modify factors that are most closely associated with mental wellbeing.Study objectiveThe purpose of this study was to examine risk factors (e.g. emotional neglect, emotional abuse, physical neglect, stigma) and protective factors (e.g. community relationships, self-esteem, and autonomy) among adolescent orphans, protective associations with depression, anxiety and externalizing behaviors and promotive associations with hope, happiness, and health.MethodsThe analytic sample was collected between January and March of 2019 and included 350 adolescent orphans ages 10-15 from three districts in Tanzania. Participants completed survey interviews, 75-90 min in length, that measured risk and protective factors, psychological symptoms, and mental wellbeing measures.ResultsResults of the fitted structural equation model indicated that structural paths from protective factors to psychopathology (β = -0.53, p = 0.015) and mental wellbeing (β = 0.72, p = 0.014) outcomes were significant. Structural paths from risk factors to psychopathology (β = -0.34, p = 0.108) and mental wellbeing (β = -0.24, p = 0.405) were not significant.ConclusionIn a sample of vulnerable youth, protective factors (e.g. community relationships, self-esteem, and autonomy) were significantly associated with reduced depression, anxiety and externalizing behaviors and increased hope, happiness, and health in a structural equation model that included risk factors (emotional neglect, emotional abuse, physical neglect). Results suggest that strong community relationships, self-esteem and autonomy may be important modifiable factors to target in intervention programs aimed at supporting adolescent mental wellbeing.

Adolescents involved in juvenile legal system are at increased risk for self-cutting behavior, however, correlates associated with elevated risk remain underresearched, particularly among youth with first involvement with the court. This study utilized an epidemiological two-year longitudinal study involving 401 adolescents at first contact with the court (Mage = 14.47; SDage = 1.94 years; 43% female; 42% Latinx/Hispanic) and an involved caregiver. Study aims examined key prospective psychosocial correlates of self-cutting behavior. Baseline assessments captured individual and family level risk and protective factors; self-cutting behavior was assessed longitudinally every four months post-baseline for 24 months. Psychosocial correlates of self-cutting behavior included adolescent affect dysregulation, post-traumatic stress disorder symptoms, impulsive decision making, anxiety and depression symptoms. Significant protective factors included positive communication with caregiver and family, higher self-esteem, and having a caring and supportive family. These findings suggest that internalizing symptoms as well as difficulties with emotion regulation and impulsive decision making are correlated with heightened risk for self-cutting behavior among adolescents involved in the juvenile legal system. The findings also suggest that individual and family level protective factors, like positive communication and a supportive family, are associated with decreased risk for self-cutting behavior among adolescents at first contact with the court.

Background: The health-related quality of life (HRQoL) of individuals living with Attention-deficit/hyperactivity disorder (ADHD) is known to be impaired. Identifying factors that influence HRQoL can provide important information for the development of prevention and intervention programmes for affected children and adolescents. The aim of the present study was to investigate health care-related and psychosocial risk and protective factors for HRQoL in children and adolescents with an administrative ADHD diagnosis. Methods: In the consortium project INTEGRATE-ADHD, n = 4,809 parents of children and adolescents aged 7 to 17 years participated in an online survey between October 2021 and August 2022 and answered questions regarding HRQoL (KIDSCREEN-27), health care utilisation, and psychosocial risk and protective factors. Multiple linear regression analyses were conducted to assess the association between these factors and the five HRQoL dimensions of the KIDSCREEN-27. Results: Findings indicate that parental psychopathology and parental burden were risk factors for lower HRQoL in children and adolescents with ADHD. Further, a positive association was found between the five HRQoL dimensions and the psychosocial factors family climate and social support, indicating that these are protective factors. Conclusions: The results highlight the importance of prevention and intervention programmes for individuals with ADHD that consider parental mental health and aim to strengthen resources such as the availability of good family climate and social support.

Intimate Partner Violence (IPV) is a risk factor for depressive disorders and other harms to women and their pregnancy. There is a need for longitudinal evidence to assist with understanding the subgroups of women including those from refugee background affected by IPV. We recruited women at their prenatal visit from three antenatal clinics in Australia (January 2015–March 2016). A total of 1335 women, 650 (48.7%) born in Australia and 685 (51.3%) from refugee backgrounds, completed baseline assessment; then, Time 2 follow-up was at 6 months and Time 3 follow-up was at 24 months post birth. The WHO Intimate Partner Violence (IPV) measure was used. Latent class growth analysis grouped individuals based on trajectories of IPV across three time points. A three-step process identified characteristics associated with respective latent class membership. Similar three-class solutions were observed across both cohorts, composed of Limited IPV (64% and 48% Australian-born and refugee background, respectively); Changing IPV (31%; 46%)—various combinations of IPV categories across time; Combined IPV (4%; 6%)—IPV at all time points, all transitioning to the combined physical and psychological abuse category at Time 3. Older age, fewer children, being in a couple, having a better partner, family and friend relationships, fewer partner trauma events, and fewer living difficulties emerged as protective factors for the changing and combined categories, with a distinct pattern for the refugee cohort. The findings assist with understanding and defining of the highest risk group for targeting interventions to prevent IPV, and the unique protective factors across the two IPV-affected classes for women born in Australia and those who arrived as refugees.

Abstract Introduction Mental health professionals, teachers, families, and public administrators are concerned about suicide rates among young people, particularly in the university context. For every ten college students worldwide, three attempt suicide in their lifetime, and two experience suicidal ideation. Reducing these rates requires interventions that recognize the problem in terms of risk factors and protective factors. Objective The general aim of the study was to map the protective factors for suicide among college students, as perceived by them, mental health professionals, and coordinators of undergraduate courses in a public university in the North of Brazil. Methods The study followed an exploratory, mixed-method design. Data were collected through interviews and the application of a questionnaire with 54 participants, including college students (n = 20), mental health professionals (n = 22), and course coordinators (n = 12). Data were analyzed using Content Analysis and simple descriptive statistics. Results The findings show that the protective factors for suicide most cited among the three groups were social support, strengthening of internal resources, institutional support, and finding meaning about the change to enter the university. Although the three audiences did not converge, the protective factors also frequently reported were psychological treatment, leisure activities, religious engagement, medical treatment, civic engagement, employability, opportunities for social ascension offered by the university, and quality family relationships. Conclusion It is suggested that these protective factors are considered when formulating policies to promote mental health and suicide prevention in the university environment.

Background: Identifying the risk factors and protective measures for Autism Spectrum Disorders (ASD) can significantly contribute to their prevention. This study aimed to ascertain the risk factors and protective measures associated with ASD.Methods: This retrospective case-control study was conducted in Sari, Iran, from 2020 to 2021. A total of 196 children, aged 2-17 years, were recruited by convenience sampling from the Baghban (Touba) Clinic, Zareh Psychiatric Hospital Clinic, and Bu-Ali Child and Adolescent Psychiatric Clinic. The case group consisted of 98 children with ASD, diagnosed based on the DSM-V criteria, while the control group included 98 children without ASD. Subsequently, potential risk factors in both groups were examined. The odds ratio was calculated at a 95% confidence level, with a significance level of P

Cyberbullying is defined as intentional, repetitive, and harmful behaviors carried out using computers, cell phones, or other electronic devices. In recent years, there has been an increase in the rates of cyberbullying parallel to the rise in Internet usage. Particularly among adolescents, the prevalence of cyberbullying and cyber victimization are quite high. Adolescents who cyberbully or cyber victim face serious mental health problems. In this reason, efforts should be made to prevent adolescents from being exposed to these negative effects. It is crucial to identify the risk factors and protective factors related to cyberbullying, as they can guide preventive interventions. The review aims to provide a comprehensive perspective on the risk factors and protective factors influencing cyberbullying. Furthermore, information was provided regarding the definition, historical trend, prevalence, and consequences of cyberbullying. In this review, firstly, the definition of cyberbullying is provided, followed by a detailed discussion of its history, prevalence, risk factors, and protective factors. It is expected that the study, which comprehensively explains the factors related to cyberbullying, will contribute to the literature on cyberbullying and provide guidance to professionals working in this field."

Abstract Background The offspring of parents with bipolar disorder (OBD) are at higher risk of developing psychopathology than the offspring of parents with no affective disorder (control). In addition to genetic predisposition, childhood adversity and a stressful family environment are important risk factors for the OBD. Protective factors in parents, such as social support and coping strategies, may buffer the effects of stress on at-risk children. This study tested whether parents’ social support and coping style attenuated the link between risk status (OBD vs. control) and psychopathology in offspring. Methods During offspring’s middle childhood, parents underwent a diagnostic interview and completed social support and coping style questionnaires. Sixty-nine OBD (39 female) and 69 control (29 female) offspring between ages 13 and 29 completed a diagnostic interview approximately 10 years later. Results Parents’ social support satisfaction moderated the link between offspring risk status and their development of substance use disorder (SUD) symptoms (F(1,131) = 5.90, p = .017). Parents’ social network size moderated the link between offspring risk status and their development of anxiety and depression symptoms in an unexpected direction (F(1,131) = 5.07, p = .026). No effects of parents’ coping style were found. Conclusions Among the OBD, having parents with greater social support satisfaction and, unexpectedly, a smaller social network buffered their development of SUD and depression and anxiety symptoms by early adulthood. Parents’ social support may thus have a protective function for children in these high-risk families.

Malignant lymphoma (ML) is a group of malignant tumors originating from the lymphatic hematopoietic system. Previous studies have found a correlation between circulating immune cells and ML. Nonetheless, the precise influence of circulating immune cells on ML remains uncertain.

Introduction Given the worldwide prevalence of tooth wear and wear related to dental erosion a baseline understanding of the knowledge of populations related to erosive wear is required to maximize public health campaigns developed to address this condition. This research investigated the awareness of dental erosion, its causes, and protective factors among the general adult population of Trinidad and Tobago. Methods An anonymous de-novo questionnaire, developed using Google Forms and aligned with the CHERRIES framework for web-based surveys, was subjected to face validity to ensure the inclusion of content relevant to erosive tooth wear and clarity of items intended for a general population. The questionnaire was deployed on social media platforms (Facebook) and groups (WhatsApp Community Groups) specific to groups in Trinidad and Tobago for four months. Data was entered into SPSS (Version 29) and analyzed using cross-tabulations and Chi-squared tests. Results Of the 210 respondents, 39.2% had previously been diagnosed with tooth wear, 43.1 % believed they could identify erosive wear and 42.1% believed they could differentiate between predominantly erosive wear and dental caries. Sixty-two point nine percent of respondents identified sensitivity as a symptom of erosive tooth wear. Chi-squared tests on cross-tabulated data showed significant relationships between age and GERD causing erosive wear (p=0.03), heartburn causing erosive wear (p=0.049), eating disorders causing erosive wear (p=0.009), disorders with excessive vomiting causing erosive wear (p=0.005), excessive wine consumption (p=0.004). There were no significant statistical significances for cross-tabulated data on sex and the responses on causative factors. Conclusions Respondents were generally knowledgeable about the various types of foods, beverages, and medical conditions that may cause dental erosion but were unfamiliar with other factors that may influence erosion or protect against dental erosion.

Background: Perinatal depression (PND) in low‐resource areas is a significant concern that imposes a substantial burden on both families and societies. Although many studies have explored rural PND, there is a lack of systematic synthesis of the existing research. This study aimed to estimate the global prevalence of PND among rural women and to summarize its determinants. Methods: Comprehensively electronic searches were performed across eight English databases. Two reviewers independently assessed the eligibility of the study and extracted the relevant data. Any inconsistencies were resolved through discussion with a third reviewer. Prevalence estimates were calculated using a random‐effects meta‐analysis model. Subgroup analysis, sensitivity analysis, and meta‐regression were employed to examine the source of heterogeneity. In addition, a narrative synthesis of the influence factors reported in the included studies was provided. Results: The search identified 17,810 studies, of which 86 were included in the analyses. The pooled prevalence of PND in rural areas was 22.1% (95% CI 19.0%–25.3%, p < 0.001, I2 = 99.2%). Subgroup analyses indicated higher PND prevalence in low‐income (24.5%) and lower middle‐income countries (22.8%). Additionally, PND prevalence was greater when assessed using self‐reported screening instruments (22.8%) compared to diagnostic interviews (17.6%). Major risk factors included violence, antenatal psychiatric disorder, low family income, male‐child preference, and food insecurity, while positive social support and higher levels of education were protective factors. Conclusions: Our findings suggest that the prevalence of PND is higher in rural areas compared to global data, particularly in low‐income and lower middle‐income countries. To improve rural maternal mental health, it is essential to develop measures targeting modifiable risk factors for PND, including promoting gender equality, implementing antiviolence initiatives, and strengthening economic support systems. Addressing these factors can help reduce the burden of PND and enhance the well‐being of mothers in rural communities. [ABSTRACT FROM AUTHOR]

Background: LGBTIQ+ adolescents face multiple forms of violence due to minority stress, putting their mental health at risk. These adolescents, particularly trans and gender-diverse youth, face significant challenges, including family violence, bullying, and limited access to health services. This article investigates the factors that protect their mental health. Method: A systematic review of articles published between 2019 and 2024 was conducted using the PRISMA method. Results: The study identifies family and school support, peer relationships, and individual resilience as key protective factors to reduce depression, anxiety, and suicidal behavior, as well as increase self-esteem and well-being. Conclusions: This review calls for further research into protective factors related to the microsystem, exosystem, and macrosystem and the impact of intervention programs with adolescents and their families. [ABSTRACT FROM AUTHOR]

Introduction: Mental health professionals, teachers, families, and public administrators are concerned about suicide rates among young people, particularly in the university context. For every ten college students worldwide, three attempt suicide in their lifetime, and two experience suicidal ideation. Reducing these rates requires interventions that recognize the problem in terms of risk factors and protective factors. Objective: The general aim of the study was to map the protective factors for suicide among college students, as perceived by them, mental health professionals, and coordinators of undergraduate courses in a public university in the North of Brazil. Methods: The study followed an exploratory, mixed-method design. Data were collected through interviews and the application of a questionnaire with 54 participants, including college students (n = 20), mental health professionals (n = 22), and course coordinators (n = 12). Data were analyzed using Content Analysis and simple descriptive statistics. Results: The findings show that the protective factors for suicide most cited among the three groups were social support, strengthening of internal resources, institutional support, and finding meaning about the change to enter the university. Although the three audiences did not converge, the protective factors also frequently reported were psychological treatment, leisure activities, religious engagement, medical treatment, civic engagement, employability, opportunities for social ascension offered by the university, and quality family relationships. Conclusion: It is suggested that these protective factors are considered when formulating policies to promote mental health and suicide prevention in the university environment. [ABSTRACT FROM AUTHOR]

Introduction: Psychosis often develops gradually along a continuum of severity. Little is known about the role of protective factors such as positive affect (PA) in the development of psychotic experiences (PEs). This study investigated i) the temporal (between-day) and contemporaneous (within-day) daily associations between PA and PEs in individuals at different early clinical stages for psychosis and ii) whether these associations differed per clinical stage. Methods: Daily diary data for 90 days came from 96 individuals at risk for psychosis, distributed over four subgroups defined according to the clinical staging model (stages 0-1b). We constructed multilevel models with PA as a predictor of PEs and vice versa. We investigated within- and between-person temporal and contemporaneous associations and tested whether these associations differed among early stages with multilevel moderation analyses. Results: We found no within-person temporal effects between PA and PEs in either direction. Contemporaneously, current-day PA predicted current-day PEs (B = -0.14, p < 0.001) and vice versa (B = -0.61, p < 0.001). Between persons, more 90-day PA predicted fewer PEs in the temporal model (B = -0.14, p = 0.03). In addition, more 90-day PEs predicted PA in the temporal (B = -0.26, p < 0.001) and contemporaneous (B = -0.36, p < 0.001) models. The contemporaneous association between PA and PEs was stronger in individuals at ultra-high risk (UHR) for psychosis than in earlier stages. Discussion: Our study supported a significant within-day, bidirectional relationship between PA and PEs. This suggests that a focus on PA and methods to improve PA may be an important addition to early intervention practices, particularly in those at UHR for psychosis. [ABSTRACT FROM AUTHOR]

The present study focused on the roles of self-forgiveness and feeling divine forgiveness in mitigating the adverse effects of stress on substance use cravings in Trinidad and Tobago. We assessed 869 individuals (62 percent of whom were women) through self-report online questionnaires. A moderation analysis using the PROCESS macro and a bootstrapping strategy (N = 5000) revealed that greater levels of self-forgiveness weakened the positive relationship between stress and substance use cravings, though the relationship remained significant. This moderating effect was evident only when individuals reported high levels of feeling divine forgiveness. The findings suggest that both forms of forgiveness lessen the impact of stress on substance use cravings, highlighting their potential as protective factors and underscoring the importance of incorporating religious and spiritual dimensions into psychological education and intervention. However, the study's cross-sectional nature makes it difficult to make causal inferences, indicating a need for longitudinal research. [ABSTRACT FROM AUTHOR]

Identifying protective factors that promote academic resilience is vital. Nevertheless, due to the variations in the operationalizations of academic resilience, timeframes, data sources, and employed research methods, it remains unclear whether the impact of protective factors identified across studies can be attributed to the factors themselves or to these variations. By addressing these uncertainties, this study aims to provide an overview of the protective factors that have been extensively investigated in academic resilience and their degree of influence. A literature search found 119 empirical studies on protective factors in education settings for children and adolescents. The review analyzed five protective factors groups (individual, family, school, peer, community), three operationalizations of academic resilience (simultaneous, progressive, instrumental), two timeframes (longitudinal, non-longitudinal), three data sources (self-collected, national/local assessments, international large-scale assessments), and commonly employed research methods. The studies analyzed in this review yielded mixed results regarding the impact of the examined protective factors, with measurement instruments and statistical power playing a significant role in explaining the variations. Individual and school-level characteristics emerged as the most well-studied protective factors; individual characteristics were often investigated through "instrumental" operationalization and structural equational models, whereas school-level characteristics were typically explored through "simultaneous" or "progressive" operationalizations and multilevel modeling. Approximately 31 and 16% of the studies utilized national assessments and international large-scale assessment data, respectively. Both data sources promoted the exploration of school-level factors, with the former facilitating the exploration of protective factors across time and the latter contributing to the investigation of teaching-related factors. [ABSTRACT FROM AUTHOR]

Intimate Partner Violence (IPV) is a risk factor for depressive disorders and other harms to women and their pregnancy. There is a need for longitudinal evidence to assist with understanding the subgroups of women including those from refugee background affected by IPV. We recruited women at their prenatal visit from three antenatal clinics in Australia (January 2015–March 2016). A total of 1335 women, 650 (48.7%) born in Australia and 685 (51.3%) from refugee backgrounds, completed baseline assessment; then, Time 2 follow-up was at 6 months and Time 3 follow-up was at 24 months post birth. The WHO Intimate Partner Violence (IPV) measure was used. Latent class growth analysis grouped individuals based on trajectories of IPV across three time points. A three-step process identified characteristics associated with respective latent class membership. Similar three-class solutions were observed across both cohorts, composed of Limited IPV (64% and 48% Australian-born and refugee background, respectively); Changing IPV (31%; 46%)—various combinations of IPV categories across time; Combined IPV (4%; 6%)—IPV at all time points, all transitioning to the combined physical and psychological abuse category at Time 3. Older age, fewer children, being in a couple, having a better partner, family and friend relationships, fewer partner trauma events, and fewer living difficulties emerged as protective factors for the changing and combined categories, with a distinct pattern for the refugee cohort. The findings assist with understanding and defining of the highest risk group for targeting interventions to prevent IPV, and the unique protective factors across the two IPV-affected classes for women born in Australia and those who arrived as refugees. [ABSTRACT FROM AUTHOR]

Background: Nearly three in four U.S. medical students graduate with debt in six-figure dollar amounts which impairs students emotionally and academically and impacts their career choices and lives long after graduation. Schools have yet to develop systems-level solutions to address the impact of debt on students' well-being. The objectives of this study were to identify students at highest risk for debt-related stress, define the impact on medical students' well-being, and to identify opportunities for intervention. Methods: This was a mixed methods, cross-sectional study that used quantitative survey analysis and human-centered design (HCD). We performed a secondary analysis on a national multi-institutional survey on medical student wellbeing, including univariate and multivariate logistic regression, a comparison of logistic regression models with interaction terms, and analysis of free text responses. We also conducted semi-structured interviews with a sample of medical student respondents and non-student stakeholders to develop insights and design opportunities. Results: Independent risk factors for high debt-related stress included pre-clinical year (OR 1.75), underrepresented minority (OR 1.40), debt $20–100 K (OR 4.85), debt >$100K (OR 13.22), private school (OR 1.45), West Coast region (OR 1.57), and consideration of a leave of absence for wellbeing (OR 1.48). Mental health resource utilization (p = 0.968) and counselors (p = 0.640) were not protective factors against debt-related stress. HCD analysis produced 6 key insights providing additional context to the quantitative findings, and associated opportunities for intervention. Conclusions: We used an innovative combination of quantitative survey analysis and in-depth HCD exploration to develop a multi-dimensional understanding of debt-related stress among medical students. This approach allowed us to identify significant risk factors impacting medical students experiencing debt-related stress, while providing context through stakeholder voices to identify opportunities for system-level solutions. [ABSTRACT FROM AUTHOR]

Background: Suicide is a worldwide public health problem. In response to this problem, Australia was one of the first countries to develop national suicide prevention policy. Guided by the National Suicide Prevention Office (NSPO), which was established in 2021, suicide prevention in Australia is in a period of reform. The NSPO is driving a nationally consistent and integrated approach to suicide prevention including leading the development of a new National Suicide Prevention Strategy. This article summarises findings from an environmental scan of government-led suicide prevention in Australia, conducted as an input for the development of the new Strategy. Methods: The scan was conducted from August 2022 to January 2023. We searched relevant government websites and Google to identify policy documents and programs and services. We undertook a desktop review of documents and programs/services using coding templates developed to address the objectives of the scan. Qualitative information was extracted in a systematic manner using these templates. Results: Australia's suicide prevention efforts are significant as demonstrated by activities ranging from policy documents intended to guide and plan activity, the National Mental Health and Suicide Prevention Agreement committing the Federal Government and jurisdictions to work together, and the availability of national, state, local area based, and digital services and programs. Suicide prevention approaches in Australia are mostly selective or indicated. There is less emphasis on universal approaches, wellbeing promotion, strengthening protective factors and mitigating the impact of known drivers of distress. In addition, there is limited evidence to demonstrate a whole-of-government or whole-of-system approach is operating in Australia. Findings should be interpreted in the context that suicide prevention in Australia is currently in a period of transition. Conclusions: Current government emphasis on and investment in suicide prevention activity, together with strong commitment to lived experience and cross sectorial collaboration, are substantial and appropriate. There are also many opportunities to further progress cross-portfolio and cross-jurisdiction suicide prevention and response efforts. This requires urgently adopting a shared understanding of suicide, which includes the diverse drivers of suicidal distress, and improving protective factors and social wellbeing. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to explore the relationship between changes in neural oscillatory power in the EEG, the severity of depressiveanxiety symptoms, and the risk of suicide in MDD. Methods: 350 MDD patients' demographic and clinical data were collected, and their depressive and anxious symptoms were evaluated using HDRS-17 and HAMA-14, along with a suicide risk assessment using the Nurses' Global Assessment of Suicide Risk (NGASR). EEG data were captured, processed, and analyzed to study brain activity patterns related to MDD. The participants were divided based on suicide risk levels, and statistical analyses, including chi-square, t-tests, Pearson's correlations were used to explore the associations between brain activity, symptom severity, and suicide risk. Closely related variables were identified and ultimately the optimal model was screened using stepwise regression analysis with a forward strategy, and mediation effects were further used to determine the possible interactions between the variables in the regression model. Results: The regression model showed a significant effect of HDRS-17 and alpha power of Medial Occipital Cortex (MOC) on suicide risk, with elevated HDRS-17 increasing suicide risk and elevated alpha power decreasing suicide risk. Mediation effect analyses showed that MOC alpha power partially mediated the effect of depression level on suicide risk, and that an increase in depression severity may lead to a decrease in MOC alpha power, while a decrease in MOC alpha power may lead to an increase in suicide risk. Conclusion: The severity of depression directly increases suicide risk, whereas higher alpha power in the MOC serves as a protective factor, reducing this risk. Notably, MOC alpha power not only directly impacts suicide risk but also mediates the effects of both depression severity and anxiety levels on this risk. Limitations: The relatively small sample size of this study may limit the representativeness of the overall MDD patient population and the detailed analysis of different subgroups. This study did not delve into the relationship between the severity of cognitive symptoms in MDD patients and suicide risk. [ABSTRACT FROM AUTHOR]

Background: Chronic pain often clusters in families, where parents and their offspring both experience chronic pain conditions. Young children of parents with irritable bowel syndrome (IBS) represent an at-risk group for the development of abdominal pain, disability, and excess health care visits in later childhood. Parental solicitous responses to children's expressions of discomfort and maternal modeling of their own illness behavior contribute to a greater focus on somatic sensations, leading to illness behaviors in children. This randomized controlled trial will test the effectiveness of an early preventive web-based psychosocial intervention (REACH)[TM] vs. an educational web-based safety comparison condition delivered to parents with IBS to alter parental responses and lead to improved child health and decreased health care costs. Methods: Parents with IBS who have children ages 4–7 years are recruited via community-based approaches (e.g., social media advertisements, school electronic distribution, research networks) and health care providers. The target sample is 460 parents randomized to REACH, a web-based social learning and cognitive behavior therapy (SLCBT) intervention or an educational web-based safety comparison condition (EC). Participants will be assessed at baseline, 6-week (immediate post-intervention), 6-month, 12-month, and 18-month follow-up periods (months post-completion of intervention). The primary outcome is change in parental solicitous/protective behaviors. Secondary outcomes include parent risk and protective factors, child health and symptom outcomes, and health care utilization and cost savings. Discussion: This study adapts a validated, parent-delivered intervention to treat chronic pain in children to a web-based application designed to prevent the development of chronic pain in very young, high-risk children. If successful, this strategy can both prevent adverse sequelae of this condition from developing as well as be widely accessible. Furthermore, the availability of a prevention model for parent training could result in significant short- and long-term health benefits across a broad spectrum of conditions. Trial registration: ClinicalTrials.gov NCT05730491. Registered on February 15, 2023. [ABSTRACT FROM AUTHOR]

Objective: Using a salutogenic approach, this study aimed to identify similarities in the protective factors of nurses' psychological Quality of Life (QoL) and professional wellbeing (PWB) in four countries and to assess their variability over time during the COVID-19 pandemic. Methods: This multicentric study used a longitudinal design with three measurements points: Autumn 2021, spring 2022, and autumn 2022. The study consisted in a self-administered online questionnaire addressed to nurses working in hospitals. Across all measurement times, 3,310 observations were collected in France, 603 in Switzerland, 458 in Portugal, and 278 in Canada. The outcomes were psychological QoL and PWB, and several potential protective factors were used as determinants. Results: Analyses revealed few changes over time in the outcomes. Across all countries, psychological QoL was associated positively with resilience and perceived social support, whereas PWB was associated positively with the ability to provide quality work and support from colleagues and superiors. Conclusion: The findings of this study highlighted the potential of several factors protective of nurses' psychological QoL and PWB. These should be fostered through policies and measures to support nurses. [ABSTRACT FROM AUTHOR]

Clergy wives often face high congregational expectations that impact their psychological well-being. This study investigates the impact of perceived congregational perfectionism on the psychological well-being of 215 Asian clergy wives and explores the moderating effects of self-compassion, social support, and communion with God. The results indicated that the two perceived congregational perfectionism dimensions—perceived congregational standards and judgment—were positively associated with depression, emotional exhaustion, and loneliness. Contrary to the previous literature, high congregational standards alone (without critical judgment) were associated with negative psychological outcomes. Additionally, self-compassion and communion with God emerged as significant buffers against depression associated with congregational perfectionism. However, these protective factors did not significantly prevent ministry burnout or loneliness. This study highlights the maladaptive nature of congregational perfectionism in clergy wives and emphasizes the importance of protective factors like communion with God and self-compassion. It also suggests the need for further research on diverse samples and additional protective factors while providing insights for clinicians and ministry organizations in developing coping strategies that emphasize self-compassion and spiritual practices. [ABSTRACT FROM AUTHOR]

INTRODUCTION: We examined whether the aging suppressor KLOTHO gene's functionally advantageous KL‐VS variant (KL‐VS heterozygosity [KL‐VSHET]) confers resilience against deleterious effects of aging indexed by cerebrospinal fluid (CSF) biomarkers of neuroinflammation (interleukin‐6 [IL‐6], S100 calcium‐binding protein B [S100B], triggering receptor expressed on myeloid cells [sTREM2], chitinase‐3‐like protein 1 [YKL‐40], glial fibrillary acidic protein [GFAP]), neurodegeneration (total α‐synuclein [α‐Syn], neurofilament light chain protein), and synaptic dysfunction (neurogranin [Ng]). METHODS: This Alzheimer disease risk‐enriched cohort consisted of 454 cognitively unimpaired adults (Mage = 61.5 ± 7.75). Covariate‐adjusted multivariate regression examined relationships between age (mean‐split[age ≥ 62]) and CSF biomarkers (Roche/NeuroToolKit), and whether they differed between KL‐VSHET (N = 122) and non‐carriers (KL‐VSNC; N = 332). RESULTS: Older age was associated with a poorer biomarker profile across all analytes (Ps ≤ 0.03). In age‐stratified analyses, KL‐VSNC exhibited this same pattern (Ps ≤ 0.05) which was not significant for IL‐6, S100B, Ng, and α‐Syn (Ps ≥ 0.13) in KL‐VSHET. Although age‐related differences in GFAP, sTREM2, and YKL‐40 were evident for both groups (Ps ≤ 0.01), the effect magnitude was markedly stronger for KL‐VSNC. DISCUSSION: Higher levels of neuroinflammation, neurodegeneration, and synaptic dysfunction in older adults were attenuated in KL‐VSHET. Highlights: Older age was associated with poorer profiles across all cerebrospinal fluid biomarkers of neuroinflammation, neurodegeneration, and synaptic dysfunction.KLOTHO KL‐VS non‐carriers exhibit this same pattern, which is does not significantly differ between younger and older KL‐VS heterozygotes for interleukin‐6, S100 calcium‐binding protein B, neurogranin, and total α‐synuclein.Although age‐related differences in glial fibrillary acidic protein, triggering receptor expressed on myeloid cells, and chitinase‐3‐like protein 1 are evident for both KL‐VS groups, the magnitude of the effect is markedly stronger for KL‐VS non‐carriers.Higher levels of neuroinflammation, neurodegeneration, and synaptic dysfunction in older adults are attenuated in KL‐VS heterozygotes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Evidence indicates that persistent transgressive behaviors often begin early in development and increase around age twelve, and warns that children who exhibit transgressive behaviors in childhood or early adolescence tend to develop criminal behaviors in adulthood which makes childhood a critical unit of analysis for timely intervention. The study examines risk and protective factors in childhood related to illegal behavior, through the perspective of developmental criminology. The observation of risk and protective factors in early stages allows us to design interventions that prevent social adjustment problems in children from becoming more complex by maintaining the transgression of social norms over time. Factors identified by developmental criminology can be organized according to ecological systems theory and discussed in relation to previous criminological studies. Methods: Using a systematic review based on the PRISMA method, the study identifies 24 updated developmental criminology articles that study early protective factors between birth and age twelve. Result: Risk factors at the individual level include biological, socioemotional, behavioral, symptomatic aspects and adverse life experiences. Individual protective factors include cognitive, socioemotional, and personality development aspects. Risk factors at an interpersonal and contextual level are related to family, school, peers, socioeconomic situation and governance. Conclusions: This review highlights the importance of recognizing risk and protective factors in child development, contemplating interventions at multiple levels where an articulation between the various institutions involved in child care is possible. [ABSTRACT FROM AUTHOR]

Background There is controversy regarding the maximum number of elements that can be included in a surgical site infection prevention bundle. In addition, it is unclear whether a bundle of this type can be implemented at a multicentre level. Methods A pragmatic, multicentre cohort study was designed to analyse surgical site infection rates in elective colorectal surgery after the sequential implementation of two preventive bundle protocols. Secondary outcomes were to determine compliance with individual measures and to establish their effectiveness, duration of stay, microbiology and 30-day mortality rate. Results A total of 32 205 patients were included. A 50% reduction in surgical site infection was achieved after the implementation of two sequential sets of bundles: from 18.16% in the Baseline group to 10.03% with Bundle-1 and 8.19% with Bundle-2. Bundle-2 reduced superficial-surgical site infection (OR 0.74 (95% c.i. 0.58 to 0.95); P = 0.018) and deep-surgical site infection (OR 0.66 (95% c.i. 0.46 to 0.93); P = 0.018) but not organ/space-surgical site infection (OR 0.88 (95% c.i. 0.74 to 1.06); P = 0.172). Compliance increased after the addition of four measures to Bundle-2. In the multivariable analysis, for organ/space-surgical site infection, laparoscopy, oral antibiotic prophylaxis and mechanical bowel preparation were protective factors in colonic procedures, while no protective factors were found in rectal surgery. Duration of stay fell significantly over time, from 7 in the Baseline group to 6 and 5 days for Bundle-1 and Bundle-2 respectively (P < 0.001). The mortality rate fell from 1.4% in the Baseline group to 0.59% and 0.6% for Bundle-1 and Bundle-2 respectively (P < 0.001). There was an increase in Gram-positive bacteria and yeast isolation, and reduction in Gram-negative bacteria and anaerobes in organ/space-surgical site infection. Conclusions The addition of measures to create a final 10-measure protocol had a cumulative protective effect on reducing surgical site infection. However, organ/space-surgical site infection did not benefit from the addition. No protective measures were found for organ/space-surgical site infection in rectal surgery. Compliance with preventive measures increased from Bundle-1 to Bundle-2. [ABSTRACT FROM AUTHOR]

There is an increased risk for depression and anxiety across the perinatal period (i.e., spanning pregnancy and the first year postpartum); however, limited research has examined elevations in core negative affectivity underlying internalizing disorders more broadly. The current study sought to characterize trajectories of core internalizing problems among both mothers and fathers across the perinatal period and explored whether modifiable risk and protective factors buffered risk for elevated symptoms during this key developmental transition. A community sample of mixed‐sex couples (N = 159) completed assessments during pregnancy and at four postpartum timepoints. Using growth mixture modeling, we found that 21.2% of mothers demonstrated clinical elevations in core internalizing symptoms that persisted up to 2 years postpartum. In contrast, 7.8% of fathers demonstrated clinical elevations in core internalizing symptoms across this period, with an additional 29.0% of fathers demonstrating subthreshold symptom elevations. Concerns related to pregnancy and childbirth and paternal (partner) internalizing problems during pregnancy conferred risk for elevated symptoms in mothers, whereas psychological flexibility, emotional intimacy, and the quality of received support were identified as protective factors for fathers. Results highlight the importance of repeated screening for internalizing problems and suggest that promoting a strong interparental relationship is critical for emotional health and well‐being across the perinatal period. [ABSTRACT FROM AUTHOR]