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Few studies have focused on off-reserve Indigenous children and families. This nationally representative, cross-sectional study (data collected from 2006 to 2007) examined Indigenous- and non-Indigenous-specific determinants associated with positive socioemotional and behavioral well-being among First Nations children living off-reserve in Canada. The parents or other caregivers of 2990 two-to-five-year-old children (M = 3.65; 50.6% male) reported on their children's socioemotional and behavioral well-being and a range of child, parent, and housing characteristics. Being taught an Indigenous culture, greater community cohesion, caregiver nurturance, good parental/other caregiver health, and fewer household members were associated with better socioemotional and behavioral well-being. These results highlight the importance of leveraging Indigenous-specific determinants and acknowledging non-Indigenous-specific factors, to promote the well-being of First Nations children living off-reserve., (© 2024 The Author(s). Child Development published by Wiley Periodicals LLC on behalf of Society for Research in Child Development.)

Background As medical education programs transition to competency-based medical education (CBME), experiences transitioning in the context of small subspecialty programs remain unknown, yet they are needed for effective implementation and continual improvements. Objective To examine faculty and resident experiences transitioning to CBME in a small subspeciality program. Methods Using a qualitative descriptive approach and constructivist lens, faculty and residents in McMaster University's geriatric psychiatry subspecialty program were interviewed about their transition experiences between November 2021 and February 2022, after the program's soft launch of CBME in 2020. Interviews were transcribed and data were analyzed using thematic analysis. Reflexive memo writing and investigator and data triangulation strategies were employed to ensure rigor and trustworthiness of the data. Results Ten of the 17 faculty members (59%) and 3 residents (100%) participated. Six themes were developed: (1) Both faculty and residents see themselves as somewhat knowledgeable about CBME, but sources of knowledge vary; (2) More frequent feedback is beneficial; (3) Aspects of CBME that are challenging for residents are beneficial for faculty; (4) Competence committees are perceived positively despite most participants' limited firsthand experience with them; (5) Small program size is both a barrier and facilitator to providing and receiving feedback; and (6) Suggestions for improvement are centered on helping manage faculty and resident workload imposed by CBME. Conclusions Incongruent expectations surrounding entrustable professional activity management were highlighted as an area requiring support. Collegial relationships among faculty and residents made it difficult for faculty to provide constructive feedback but improved residents' perceptions of the feedback.

Objectives: To describe screen time levels and determine their association with socioemotional and behavioural difficulties among preschool-aged First Nations, Métis, and Inuit children., Method: Data were taken from the Aboriginal Children's Survey, a nationally representative survey of 2-5-year-old Indigenous children in Canada. Socioemotional and behavioural difficulties were defined using parent/guardian reports on the Strengths and Difficulties Questionnaire. Multiple linear regression analyses were conducted separately for First Nations, Métis, and Inuit participants, and statistically adjusted for child age, child sex, and parent/guardian education. Statistical significance was set at P  < 0.002 to adjust for multiple comparisons., Results: Of these 2-5-year-old children ( mean [ M ] = 3.57 years) 3,085 were First Nations (53.5%), 2,430 Métis (39.2%), and 990 Inuit (7.3%). Screen time exposure was high among First Nations ( M  = 2 h and 58 min/day, standard deviation [ SD ] = 1.89), Métis ( M  = 2 h and 50 min [ SD  = 1.83]), and Inuit children ( M  = 3 h and 25 min [ SD  = 2.20]), with 79.7% exceeding recommended guidelines (>1 h/day). After adjusting for confounders, screen time was associated with more socioemotional and behavioural difficulties among First Nations (total difficulties β  = 0.15 [95% CI, 0.12 to 0.19]) and Métis ( β  = 0.16 [95% CI, 0.12 to 0.20]) but not Inuit children ( β  = 0.12 [95% CI, 0.01 to 0.23])., Conclusions: Screen time exposure is high among Indigenous children in Canada, and is associated with more socioemotional and behavioural difficulties among First Nations and Métis children. Contributing factors could include enduring colonialism that resulted in family dissolution, lack of positive parental role models, and disproportionate socioeconomic disadvantage. Predictors of poor well-being should continue to be identified to develop targets for intervention to optimize the health and development of Indigenous children., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The objective of this study was to evaluate the online component of a blended curriculum for psychiatry residents on the use of electroconvulsive therapy (ECT) to treat depression in older adults., Methods: Second- and third-year general psychiatry residents completed a blended learning curriculum during their core geriatric psychiatry rotation. The curriculum consisted of didactic seminars, hands-on clinical management, and two online clinical cases focused on the management of late-life depression with ECT. Knowledge acquisition following module completion was measured using a nine-question multiple-choice test. The authors adapted the Medical E-Learning Evaluation Survey (MEES) to measure resident satisfaction, clinical relevance, and instructional design., Results: A total of 37 residents completed both online modules. Of these, 35 residents completed the knowledge test and 23 completed the adapted MEES. Almost all participants (96%) agreed or strongly agreed that the modules were relevant to their clinical work, evidence-based, able to be completed in a reasonable amount of time, and a valuable learning experience. The average score on the knowledge test, after removing one outlier, was 83%., Conclusion: Psychiatry residents are very satisfied with the content and delivery of the online component of a blended curriculum for understanding the use of ECT for late-life depression. Future work should examine satisfaction with the remainder of the curricula as well as the impact on longer-term knowledge acquisition and patient care., (© 2023. The Author(s), under exclusive licence to American Association of Chairs of Departments of Psychiatry, American Association of Directors of Psychiatric Residency Training, Association for Academic Psychiatry and Association of Directors of Medical Student Education in Psychiatry.)

Introduction: The common peroneal nerve (CPN) palsy in military personnel due to chronic exertional compartment syndrome (CECS) is uncommon. There are no previous reports of treatment of this condition with simultaneous CPN and superficial peroneal nerve (SPN) neurolysis and compartment release., Case Report: An 18-year-old military recruit presented with complete CPN palsy after sitting cross-legged for 2 h in training. After 3 months of failed non-operative treatment, a clinical diagnosis of CECS with CPN palsy was made and the patient was treated with simultaneous CPN and SPN neurolysis and release of the anterior and lateral leg compartments. The patient had full recovery at 6 months post-operative period and returned to sports at 1 year follow-up., Conclusion: This case report of a young military recruit with CPN palsy after prolonged cross-legged sitting in the setting of CECS demonstrates successful treatment with simultaneous CPN and SPN neurolysis and anterior and lateral compartment release. Future studies should explore the efficacy of this treatment option and prevention strategies of CPN palsy in military personnel., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Limited data exist on the mental health challenges facing First Nations adolescents and the factors that modify these difficulties. The current study compared levels of common mental health challenges among 112 off-reserve First Nations and 3334 non-First Nations adolescents (12-17 years old) and examined the impact of maternal psychological distress on these mental health challenges. First Nations adolescents self-reported higher symptoms of conduct, oppositional-defiant, attention-deficit hyperactivity, major depressive, social phobia, generalized anxiety, and separation anxiety disorders and all associations remained statistically significant after adjusting for covariates. Moderation analyses found that increasing levels of maternal distress were associated more strongly with symptoms of oppositional defiant, attention-deficit hyperactivity, major depressive, and generalized anxiety disorders in First Nations adolescents. Future work aimed at improving the mental health of First Nations youth that focus on supporting these adolescents, and their mothers in particular, could result in substantial benefits., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Dietary interventions are a widely available mediation for depression and anxiety among pregnant and/or postpartum (i.e., perinatal) persons, but their effectiveness is not well known., Objectives: We performed a systematic review and meta-analysis to assess the effectiveness of dietary interventions for the treatment of perinatal depression and/or anxiety., Methods: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science from their inception to 2 November, 2022. Studies were included if they were available in English and examined the effectiveness of a dietary intervention for perinatal depression and/or anxiety in a randomized controlled trial., Results: Our search identified 4246 articles, of which 36 were included and 28 were eligible for meta-analysis. Random-effects meta-analyses were performed. Polyunsaturated fatty acids (PUFAs) were not found to improve symptoms of perinatal depression compared to control conditions [standardized mean differences (SMD): -0.11; 95% CI: -0.26 to 0.04]. These results neither changed when examined during pregnancy or the postpartum period separately nor varied according to the fatty acid (FA) ratio. Elemental metals (iron, zinc, and magnesium) were also not found to be superior to placebo (SMD: -0.42; 95% CI: -1.05 to 0.21), although vitamin D yielded a small to medium effect size improvement (SMD: -0.52; 95% CI: -0.84 to -0.20) in postpartum depression. Iron may help in those with confirmed iron deficiency. Narrative synthesis was performed for studies ineligible for meta-analyses., Conclusions: Despite their widespread popularity, PUFAs and elemental metals do not appear to effectively reduce perinatal depression. Vitamin D taken in doses of 1800-3500 International Units per day may be, to some extent, promising. Additional high-quality, large-scale randomized controlled trials are needed to determine the true effectiveness of dietary interventions on perinatal depression and/or anxiety. This study was registered at PROSPERO (registration date: 5 July, 2020; CRD42020208830)., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Background: Urolithiasis is a common preventable ailment. Previous studies showed that there are a lot of factors, such as dietary, health and environmental factors, which are likely to develop this condition. Only a few research have been conducted on urolithiasis in the UAE. Therefore, our study aimed to identify the factors associated with urolithiasis in the country, identify the symptoms of urolithiasis among the cases and identify the most common diagnostic methods., Methodology: It was a case-control study design. The study population was adults above 18 years attending a tertiary care centre. Those who have confirmed diagnosis of urolithiasis and gave informed consent were considered cases and those who have not confirmed diagnosis of urolithiasis as controls. Patients with renal, bladder or urinary tract impairment or anomaly were excluded from the study. Ethical approval was obtained for the study., Results: Crude odds ratio (OR) showed that age, gender, past treatment for urinary stones, and lifestyle factors such as diet and smoking are risk factors while exercising is a protective factor. Age-adjusted OR found that past treatment for the urinary disease (OR=10.4), consumption of oily food (OR=11.5), consumption of fast food (OR=11.0) and consumption of energy drinks (OR=5.9) were the significant risk factors for urolithiasis., Conclusion: We found that past urinary disease treatment and diet are vital in developing urinary stones. Higher consumption of salty, oily, sugary and protein foods increases the odds of urinary diseases. Public awareness programs are essential to educating people about urolithiasis risk factors and preventive measures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Owais et al.)

Purpose: To improve awareness of diversity in MD-PhD program applicants, matriculants, and graduates; facilitators and barriers to matriculation and/or completion among minoritized groups; and the effects of research experience programs on admissions processes aimed to increase representation of minoritized groups in MD-PhD programs., Method: The authors conducted a scoping review, searching EMBASE, MEDLINE, PsycINFO, CINAHL, and Web of Science through December 21, 2021, for studies that contained data on the characteristics of MD-PhD learners and initiatives aimed to make the clinician-scientist trainee population more diverse. They excluded studies that had no primary data, were unavailable in English, and were not peer-reviewed., Results: Of 4,369 articles identified, 16 met inclusion criteria. Studies conceptualized diversity inconsistently, including as sex/gender disparities (n = 11), race/ethnicity underrepresentation (n = 9), disability (n = 2), first-generation student (n = 1), visible minority (n = 1), Indigenous population (n = 1), and economic/social disadvantage (n = 1). Potential barriers to entering or continuing in an MD-PhD program among women and underrepresented ethnic minorities included the long program duration and lack of mentorship; potential facilitators included the flexibility of the dual-degree program. Limited data on high school, undergraduate, and postbaccalaureate research experience programs targeting underrepresented minorities suggest that they may help facilitate admission into MD-PhD programs., Conclusions: The findings of this scoping review suggest that the diversity of MD-PhD students has been conceptualized in unitary, inconsistent terms, without addressing how different dimensions of diversity may intersect and impact MD-PhD admissions. Future studies should be explicit and intentional in defining "diversity" as it relates to their research questions, explore the impact of intersectionality, and systematically identify and address causal facilitators and barriers of entry to and completion of MD-PhD programs among minoritized groups., (Copyright © 2022 by the Association of American Medical Colleges.)

Parkinson's disease (PD) is the second most debilitating neurodegenerative movement disorder. It is characterized by the presence of fibrillar alpha-synuclein amassed in the neurons, known as Lewy bodies. Certain cellular and molecular events are involved, leading to the degeneration of dopaminergic neurons. However, the origin and implication of such events are still uncertain. Nevertheless, the role of microRNAs (miRNAs) as important biomarkers and therapeutic molecules is unquestionable. The most challenging task by far in PD treatment has been its late diagnosis followed by therapeutics. miRNAs are an emerging hope to meet the need of early diagnosis, thereby promising an improved movement symptom and prolonged life of the patients. The continuous efforts in discovering the role of miRNAs could be made possible by the utilisation of various animal models of PD. These models help us understand insights into the mechanism of the disease. Moreover, miRNAs have been surfaced as therapeutically important molecules with distinct delivery systems enhancing their success rate. This review aims at providing an outline of different miRNAs implicated in either PD-associated gene regulation or involved in therapeutics., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: While research has examined the mental health of general population samples of postpartum women during the COVID-19 pandemic, the pandemic's impact on women seeking treatment for postpartum depression (PPD) is not well known. This study compared levels of depression and anxiety, the quality of social relationships, and the temperament of infants of treatment-seeking mothers in Ontario, Canada prior to and during the pandemic., Methods: Mothers with Edinburgh Postnatal Depression Scale scores ≥10 and seeking treatment for PPD prior to COVID-19 ( n  = 100) were compared to those who sought treatment during the pandemic ( n  = 120). Mothers self-reported symptoms of depression, worry/anxiety, partner relationship quality, social support, as well as aspects of the mother-infant relationship and infant temperament., Results: There were no statistically significant differences in symptoms of depression, anxiety, or the quality of social relationships between women seeking treatment for PPD before or during the pandemic. However, mothers reported poorer relationships with their infants, and there was evidence of more negative emotionality in their infants during COVID-19., Conclusions: The pandemic may not have worsened depression, anxiety, relationships with partners, or social support in mothers seeking treatment for PPD, but appears to have contributed to poorer mother-infant interactions and maternal reports of more negative emotionality in their infants. These findings highlight the importance of identifying women with possible PPD, supporting mother-infant interactions, and monitoring their infants during COVID-19 and beyond.

Background and Objectives: The nature and magnitude of the cognitive and mental health risks among the offspring of young mothers is not fully understood. Our objective is to examine the risk of mental disorders in these offspring., Methods: Five databases (Medline, Embase, Web of Science, PsycINFO, and CINAHL) were searched from their inceptions until February 2022. Studies were eligible if they assessed offspring of young mothers (&lt;21 years), contained a control group, and assessed any cognitive and/or mental health outcomes. Random-effects meta-analysis was used to generate standardized mean differences (SMDs) in infants (0-3 years), children (4-9), adolescents (10-19), and adults (20+). Methodological bias was assessed using the Newcastle-Ottawa Scale., Results: 51 outcomes were meta-analyzed. Levels of cognitive and learning problems were higher among the infants (SMD = 0.30 [95% confidence interval 0.0-0.55]) and adolescents (SMD = 0.43 [0.24 to 0.62]) of young mothers. Adolescents had more symptoms of delinquency (SMD = 0.24 [0.12 to 0.36]). As adults, they are more often convicted of violent crimes (SMD = 0.36 [0.22 to 0.50]). Internalizing symptoms were higher in these offspring in childhood (SMD = 0.29 [0.14 to 0.45]) and adulthood (SMD = 0.35 [0.34 to 0.36]). This review uses unadjusted data and is thus unequipped to infer causality. Studies have high attrition and rely heavily on self-report., Conclusions: Young mothers' offspring have more cognitive, externalizing, and internalizing problems across the lifespan than individuals born to mothers ≥21 years of age. They may benefit from early detection and support., (Copyright © 2022 by the American Academy of Pediatrics.)

Objective: The ongoing effects of colonialism disproportionately place Indigenous youth at risk for mental health challenges. This meta-analysis examined lifetime and past-year prevalence estimates of mental health challenges among First Nations, Inuit, and Métis youth in Canada., Method: Five electronic databases were searched from their inceptions until June 17, 2021. Studies were included if they assessed mental health challenges among First Nations, Inuit, and/or Métis youth (≤18 years old). Risk of bias was assessed using the Newcastle-Ottawa Scale., Results: A total of 28 articles were eligible. Sixteen studies contained data on First Nations, 2 on Inuit, one on Métis, and 10 aggregated Indigenous participants. Among First Nations participants, pooled prevalence estimates for past-year suicidality (8.9%), mood and/or anxiety (<2.9%), attention-deficit/hyperactivity (2.9%), oppositional defiant (8.8%), and conduct (12.8%) disorder diagnoses were identified. Limited studies containing Inuit, Métis, and aggregated Indigenous participants also found high levels of disruptive disorder symptoms. Data were very limited for lifetime prevalence estimates. Studies assessed to have a moderate or high methodological risk of bias (k = 19) or using measures that are not yet culturally validated (k = 25) may contribute to inaccuracies in prevalence estimates., Conclusion: Existing data suggest that Indigenous youth have a low prevalence of mental health challenges, with the exception of disruptive behaviors. Future studies should use culturally validated tools and partner with Indigenous communities to ensure optimal identification of mental health challenges., (Copyright © 2022 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objectives: Diverse perspectives improve the quality of scholarly initiatives. The demographic and professional diversity of scientists who contribute to critical care research and publications has not been described for the Canadian Critical Care Trials Group. Our objective was to describe the diversity of authors of publications from the Canadian Critical Care Trials Group., Design: We conducted a quantitative content analysis of peer-reviewed articles published on behalf of the Canadian Critical Care Trials Group., Setting: All peer-reviewed articles that were published on behalf of the Canadian Critical Care Trials Group between 1994 and October 2020., Subjects: For each publication, we recorded the study design, the number of authors, and national or international collaboration. For the lead author, the senior author, and each coauthor, we recorded the following facets of diversity: gender, professional role, medical discipline, geographic location, academic stage, and visible minority status., Interventions: None., Measurements and Main Results: We identified 354 eligible publications; 74% (263/354) reported observational cohort studies, randomized trials, and surveys. Of 4,246 authors, 1,205 were unique individuals. The mean (sd) number of authors per publication was 12 (7.1). Of all 4,246 authors, 37% were women, and 13.7% were members of a visible minority group. Of all lead or senior authors, 40% and 34% respectively were women; 15% of lead and 10% of senior authors were members of a visible minority group. Three-quarters (73%) of publications listed authors from more than one profession, and more than half (54%) listed authors from more than one medical discipline. Nearly half of publications (45%) listed authors who were early career faculty, 33% listed authors who were trainees, and 67% listed authors who were from visible minority groups. Authors from different provinces and from different countries were listed in 67% and 40% of publications, respectively., Conclusions: Authors of Canadian Critical Care Trials Group publications are diverse with regard to demographic and professional characteristics., Competing Interests: Dr. Burns disclosed that she holds a career award from the Physician Services Incorporated Foundation and that she is the current chair of the Women in Critical Care Interest Group of the American Thoracic Society. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Background: Our objectives were to assess: (1) the effectiveness of existing mHealth apps for reducing symptoms of maternal depression and/or anxiety during the prenatal period and/or the first year postpartum, and (2) the app quality of commercially available apps targeting perinatal depression and/or anxiety., Methods: To address Objective 1, we searched five electronic databases (MEDLINE, CINAHL, PsycINFO, Web of Science, and Embase) from their inception until May 3rd, 2021. For the second objective, we searched Google Play and Apple App Stores in the United States, United Kingdom, Canada, and Australia until May 3rd, 2021., Results: Our search identified 3,897 articles, seven of which were meta-analyzed. mHealth apps did not improve perinatal depression (SMD, -0.39; 95% CI, -0.80 to 0.03) or anxiety (SMD, 0.01; 95% CI, -0.13 to 0.16) within the first 3 months post-intervention or at 6 months post-intervention. Our search of app stores identified 74 commercially available apps, 37 of which were evaluated via MARS tool. Current apps for perinatal anxiety and/or depression were rated to be of moderate quality on the MARS (mean, 3.6/5)., Limitations: There is a small number of overall studies in this field and the individual studies have methodological limitations. Furthermore, few apps identified in our app store search have been clinically tested., Conclusion: Despite their widespread availability, mHealth apps do not appear to effectively reduce perinatal depression or anxiety, and few were subjectively rated to be of high quality. There is a need to develop higher quality mHealth apps and assess their potential to improve perinatal maternal mental health., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: The conditions created by the COVID-19 pandemic could negatively affect maternal mental health and the mother-infant relationship. The aim of this study is to determine the impact of the COVID-19 pandemic on depression, anxiety, and mother-infant bonding among women seeking treatment for postpartum depression (PPD)., Methods: Baseline data collected in two separate randomized controlled trials of a psychoeducational intervention for PPD in the same geographic region, one prior to COVID-19 (March 2019-March 2020) and one during the COVID-19 pandemic (April-October 2020), were compared. Eligible participants had an Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10, were ≥ 18 years of age, had an infant < 12 months old, and were fluent in English. Outcomes included PPD (EPDS), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and mother-infant relationship (Postpartum Bonding Questionnaire [PBQ]). All were measured continuously and dichotomized at accepted clinical cutoffs., Results: Of the 603 participants (305 pre-COVID-19; 298 during COVID-19), mothers enrolled during the COVID-19 pandemic reported higher levels of symptoms of PPD (B = 1.35; 95% CI, 0.64 to 2.06; Cohen d  = 0.31) and anxiety (B = 1.52; 95% CI, 0.72 to 2.32; Cohen d  = 0.30). During COVID-19, women had 65% higher odds of clinically significant levels of depression symptoms (OR = 1.65; 95% CI, 1.13 to 2.31) and 46% higher odds of clinically relevant anxiety symptoms (OR = 1.46; 95% CI, 1.05 to 2.05). However, there were no statistically significant differences in mother-infant bonding., Conclusions: The findings of this study suggest that rates and severity of PPD and anxiety symptoms among women seeking treatment for PPD have worsened in Canada during the COVID-19 pandemic. However, treatment-seeking mothers have consistently maintained good relationships with their infants. Considering the difficulties women with PPD face when accessing treatment, it is important that strategies are developed and disseminated to safely identify and manage PPD to mitigate potential long-term adverse consequences for mothers and their families., Trial Registration: ClinicalTrials.gov identifiers: NCT03654261 and NCT04485000., (© Copyright 2021 Physicians Postgraduate Press, Inc.)

Objective: Parental psychopathology is a significant risk factor for mental health challenges in offspring, but the nature and magnitude of this link in Indigenous Peoples is not well understood. This systematic review examined the emotional and behavioral functioning of the offspring of Indigenous parents with mental health challenges., Method: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science from their inceptions until April 2020. Studies were included if they included assessments of emotional, behavioral, or other psychological outcomes in the offspring of Indigenous parents with a mental health challenge., Results: The 14 studies eligible for review were focused on parental substance misuse ( n = 8), maternal internalizing (i.e., depression, anxiety) issues ( n = 5), and poor overall parental mental health ( n = 4). In 11 studies, parental substance misuse, depression, and/or overall mental health challenges were associated with 2 to 4 times the odds of offspring externalizing and internalizing behaviors as compared to offspring of Indigenous parents without mental health challenges., Conclusion: The findings suggest higher risks of mental health challenges among offspring of Indigenous parents with psychiatric difficulties than among Indigenous children of parents without similar difficulties. Knowledge of these phenomena would be improved by the use of larger, more representative samples, culturally appropriate measures, and the engagement of Indigenous communities. Future studies should be focused on both risk and resilience mechanisms so that cycles of transmission can be interrupted and resources aimed at detection, prevention, and treatment optimally allocated.

Background: Several coronavirus vaccine have been fast-tracked to halt the pandemic, the usage of immune adjuvants that can boost immunological memory has come up to the surface. This is particularly of importance in view of the rates of failure of seroconversion and re-infection after COVID-19 infection, which could make the vaccine role and response debatable. Peroxisome proliferator-activated receptors (PPARs) have an established immune-modulatory role, but their effects as adjuvants to vaccination have not been explored to date. It is increasingly recognized that PPAR agonists can upregulate the levels of anti-apoptotic factors such as MCL-1. Such effect can improve the results of vaccination by enhancing the longevity of long-lived plasma cells (LLPCs). The interaction between PPAR agonists and the immune system does not halt here, as T cell memory is also stimulated through enhanced T regulatory cells, antagonizing PD-L1 and switching the metabolism of T cells to fatty acid oxidation, which has a remarkable effect on the persistence of T memory cells. What is even of a more significant value is the effect of PPAR gamma on ensuring a profound secretion of antibodies upon re-exposure to the offending antigen through upregulating lipoxin B4, therefore potentially assisting the vaccine response and deterring re-infection., Short Conclusion: In view of the above, we suggest the use of PPAR as adjuvants to vaccines in general especially the emerging COVID-19 vaccine due to their role in enhancing immunologic memory through DNA-dependent mechanisms.

Objective: Although Indigenous women are exposed to high rates of risk factors for perinatal mental health problems, the magnitude of their risk is not known. This lack of data impedes the development of appropriate screening and treatment protocols, as well as the proper allocation of resources for Indigenous women. The objective of this systematic review and meta-analysis was to compare rates of perinatal mental health problems among Indigenous and non-Indigenous women., Methods: We searched Medline, EMBASE, PsycINFO, CINAHL, and Web of Science from their inceptions until February 2019. Studies were included if they assessed mental health in Indigenous women during pregnancy and/or up to 12 months postpartum., Results: Twenty-six articles met study inclusion criteria and 21 were eligible for meta-analysis. Indigenous identity was associated with higher odds of mental health problems (odds ratio [ OR ] 1.62; 95% confidence interval [CI], 1.25 to 2.11). Odds were higher still when analyses were restricted to problems of greater severity ( OR 1.95; 95% CI, 1.21 to 3.16) and young Indigenous women ( OR 1.86; 95% CI, 1.51 to 2.28)., Conclusion: Indigenous women are at increased risk of mental health problems during the perinatal period, particularly depression, anxiety, and substance misuse. However, resiliency among Indigenous women, cultural teachings, and methodological issues may be affecting estimates. Future research should utilize more representative samples, adapt and validate diagnostic and symptom measures for Indigenous groups, and engage Indigenous actors, leaders, and related allies to help improve the accuracy of estimates, as well as the well-being of Indigenous mothers, their families, and future generations., Trial Registration: PROSPERO-CRD42018108638.

CUL4A; an E3 ubiquitin ligase is involved in the degradation of negative regulators of cell cycle such as p21, p27, p53, etc., through polyubiquitination-mediated protein degradation. The functional role(s) of CUL4A proteins on their targets are well characterized; however, the transcriptional regulation of CUL4A, particularly at its promoter level is not yet studied. Therefore, in this study, using computational tools, we found cAMP responsive elements (CRE) at the locations of - 926 and - 764 with respect to transcription state site + 1 of CUL4A promoter. Hence, we investigated the role of CREB on the regulation of CUL4A transcription. Our chromatin immunoprecipitation (ChIP) data clearly showed increased levels of promoter occupancy of both CREB and pCREB on both CREs of CUL4A promoter. As expected, the expression of CUL4A increases and decreases upon the overexpression of and knocking down of CREB, respectively. Moreover, the inhibition of ERK pathway by U0126 not only reduces the CREB activation but also the CUL4A levels suggesting that CREB is the upstream activator of CUL4A transcription. The reduction of CUL4A levels upon the knocking down of CREB or by U0126 treatment increases the protein levels of CUL4A substrates such as p21 and p27. It is reported that CUL4A activates the ERK1/2 transcription and ERK1/2 pathway activates the CREB by phosphorylation. Based on our data and earlier findings, we report that CREB regulates the CUL4A levels positively which in turn activates the CREB through ERK1/2 pathway in the form of auto-regulatory looped mechanism.This suggests that CUL4A might be involved in proliferation of cancer cells by regulating the ERK1/2 and CREB signaling.

Evidence suggests that poor postpartum sleep quality is a risk factor for the development of postpartum depression. As such, non-pharmacological interventions have been developed to help improve sleep in the postpartum period. The primary aims of this systematic review and meta-analysis were to determine if non-pharmacological interventions improved maternal sleep and to compare the effectiveness of different intervention types. Secondary aims included examining effects on maternal mood and infant sleep. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science from their inceptions to September 2017 and found 15 eligible studies. Non-pharmacological sleep interventions were found to improve subjective reports of maternal sleep (Cohen's d = -0.54, 95%CI = -0.88 to -0.19). Massage (Cohen's d = -1.07 95%CI = -1.34 to -0.79) and exercise (Cohen's d = -0.82 95%CI = -1.28 to -0.37) interventions had the largest impact on maternal sleep quality. Positive effects on nocturnal infant sleep were found for interventions overall (Cohen's d = -0.27 95%CI = -0.52 to -0.02) but not for maternal depression (Cohen's d = -0.08 95%CI = -0.28 to 0.12). Despite evidence suggesting improvements in subjective maternal sleep, more research must be conducted on the durability of effects of non-pharmacological interventions using objective measures of sleep quality., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Even though more than 20% of women meet diagnostic criteria for an anxiety disorder during the perinatal period, very little is known about the predictors of these problems. As a result, we systematically reviewed the literature on risk factors for new onset anxiety and maternal anxiety exacerbation in the perinatal period., Methods: PubMed, MEDLINE, PsycINFO, CINAHL, Ovid, ProQuest Portal, and Web of Science were searched for studies assessing risk factors for the development of new onset anxiety or anxiety worsening in women during pregnancy and the postpartum period., Results: 11,759 citations were identified, with 11 studies meeting eligibility criteria. New onset anxiety was assessed in 7 studies, anxiety worsening in 3, and 1 assessed both. Lower educational attainment, living with extended family members, multiparity, a family history of psychiatric disorders, hyperemesis gravidarum, comorbid sleep disorders, and prenatal oxytocin exposure were risk factors for new onset perinatal anxiety, while presence of comorbid psychiatric disorders and prenatal oxytocin were risk factors for anxiety worsening., Limitations: Studies not explicitly stating whether participants had pre-existing anxiety disorders were excluded. As a result, meta-analysis was not possible for several risk factors., Conclusions: Risk factors for new onset anxiety and anxiety worsening during the perinatal period include psychological, social, and biological exposures. Given the lack of studies differentiating women with and without pre-existing anxiety disorders, additional research is required in order to determine whether these factors differ from the non-puerperal population, as well as from each other., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: To review women's participation as faculty at five critical care conferences over 7 years., Design: Retrospective analysis of five scientific programs to identify the proportion of females and each speaker's profession based on conference conveners, program documents, or internet research., Setting: Three international (European Society of Intensive Care Medicine, International Symposium on Intensive Care and Emergency Medicine, Society of Critical Care Medicine) and two national (Critical Care Canada Forum, U.K. Intensive Care Society State of the Art Meeting) annual critical care conferences held between 2010 and 2016., Subjects: Female faculty speakers., Interventions: None., Measurements and Main Results: Male speakers outnumbered female speakers at all five conferences, in all 7 years. Overall, women represented 5-31% of speakers, and female physicians represented 5-26% of speakers. Nursing and allied health professional faculty represented 0-25% of speakers; in general, more than 50% of allied health professionals were women. Over the 7 years, Society of Critical Care Medicine had the highest representation of female (27% overall) and nursing/allied health professional (16-25%) speakers; notably, male physicians substantially outnumbered female physicians in all years (62-70% vs 10-19%, respectively). Women's representation on conference program committees ranged from 0% to 40%, with Society of Critical Care Medicine having the highest representation of women (26-40%). The female proportions of speakers, physician speakers, and program committee members increased significantly over time at the Society of Critical Care Medicine and U.K. Intensive Care Society State of the Art Meeting conferences (p < 0.05), but there was no temporal change at the other three conferences., Conclusions: There is a speaker gender gap at critical care conferences, with male faculty outnumbering female faculty. This gap is more marked among physician speakers than those speakers representing nursing and allied health professionals. Several organizational strategies can address this gender gap.

Although theories of emotion have long noted the importance of afferent feedback from the autonomic nervous system in generating feelings, there is a growing appreciation that this feedback may also play a role in shaping cognitive experiences. At present, little is known about its functional role in memory judgments. In the current study, we examined whether afferent cardiovascular feedback shapes recognition-memory decisions and experiences when previously encountered faces are being discriminated from novel ones. To investigate this possibility, we capitalized on the natural variation in baroreceptor mediated cardiovascular feedback that is associated with the cardiac cycle, synchronizing the brief presentation of memory probes during retrieval with individual heartbeats. In Experiments 1 and 2, we found that faces presented during cardiac systole (i.e., when visceral feedback is maximal) were more likely endorsed as "old" than those presented during cardiac diastole (i.e., when afferent feedback is minimal). This pattern was present for targets and lures, and held for faces with fearful or neutral expressions. Combining this manipulation with a remember/know procedure, Experiment 3 showed that the influence of afferent cardiovascular feedback is specific to trials on which participants report a feeling of familiarity without successful recollection of pertinent contextual detail. By revealing an influence of baroreceptor mediated cardiovascular feedback on familiarity, the current findings identify the functional role of a specific autonomic channel, previously implicated in emotion, in feeling states that pertain to memory experience., ((c) 2016 APA, all rights reserved).)