New Jersey Department of Health

Traumatic brain injuries (TBI) frequently occur and can lead to lasting negative cognitive, physical, and mental health outcomes. The biological response to even mild TBIs (mTBI) includes well-characterized inflammatory sequelae that start immediately post-injury, remain for weeks, and can develop into long-term systemic inflammation. Studies have shown that TBI influences multiple physiological systems, including the gastrointestinal tract, through bidirectional communication modulated, in part, by the gut microbiome. Brainstem functioning post-TBI, as measured by acoustic startle sensorimotor processing, might play a role in this feedback loop. The current study investigated pre- to post-TBI (lateral fluid percussion injury model) changes in microbial communities and acoustic startle response in male and female rats. That is, the influence of mTBI on gut microbiome and sensorimotor processing was explored to examine: 1) overall and sex-specific differences in the gut microbiome and taxa in response to mTBI; 2) overall and sex-specific differences in sensorimotor processing following mTBI; and 3) associations between the gut microbiome and sensorimotor processing. Results showed mTBI had a limited effect on microbial diversity overall, and the same was observed in males and females independently. Yet, mTBI was associated with differences in 13 genus-level taxa. Further evaluation highlighted that 11 of the 13 genus-level taxa were sex-specific, with several being known to have short-chain fatty acid-producing capabilities. Alterations in sensorimotor processing were identified following mTBI; however, no sex-specific differences were evident. In addition, no associations were observed between sensorimotor processing and the gut microbiome. This study contributes longitudinal and sex-specific findings to the growing body of research examining the diverse effects of mTBI on the brain and gut microbial communities.

IntroductionThe birth of an infant with congenital anomalies is a significant stressor for mothers, often leading to emotional challenges such as anxiety, depression, and grief.ObjectiveThis study aims to investigate the relationship between psychological resilience, coping strategies, and perceived social support in mothers of infants with congenital anomalies hospitalized in the neonatal intensive care unit (NICU).MethodsThis descriptive, cross-sectional study involved 345 mothers of infants with congenital anomalies admitted to NICUs at four hospitals. Data were collected using a demographic questionnaire, the Connor-Davidson Resilience Scale (CD-RISC 10), the Multidimensional Scale of Perceived Social Support (MSPSS), and Lazarus and Folkman’s Ways of Coping questionnaire. Statistical analyses were conducted using Pearson correlation, t-tests, and one-way ANOVA with R software, considering a 5% significance level.ResultsThe mean resilience score was 23.52 ± 6.30, with 49% showing low resilience, 35.1% moderate, and 15.9% high resilience. Resilience significantly correlated with coping strategies (p < 0.0001) and perceived social support (p < 0.0001). Positive reappraisal was the most common coping strategy. A moderate relationship between resilience and social support from friends (r = 0.486) and family (r = 0.473) was observed.ConclusionMothers of infants with congenital anomalies in this study generally reported lower levels of resilience. Higher resilience scores were associated with the use of positive coping strategies and the presence of strong social support. Approaches that emphasize family involvement and provide targeted training in coping skills may be linked to reduced stress and potentially support more effective caregiving experiences in the NICU context.Clinical trial registrationNot Applicable.

ABSTRACT This study investigates the role of multidimensional contextual factors on the perceived effectiveness of community coalitions engaged in the Strategic Prevention Framework (SPF) for addressing substance misuse. We introduced and validated an instrument for assessing a broad range of contextual factors for coalition development and program implementation. This research also scrutinizes how contextual factors impact coalition effectiveness, considering internal capacity indicators as mediators. Data were sourced from 295 and 297 coalition members across 2015 and 2016, respectively, involved in SPF initiatives within a northeastern state in the United States. Our analysis identifies three critical dimensions of contextual factors – collaboration and resources, politics, and demographics and norms – that significantly affect the perceived management and program effectiveness through different mechanisms. The findings underline the importance of prevention coalitions to comprehensively assess community contexts and strategically address contextual challenges to enhance their impact on substance misuse prevention.

Given the relationship between overweight and obesity (OV/OB) and poor oral health in children, paediatric dentists are uniquely positioned to provide educational interventions to children with OV/OB during dental visits. To assess how an educational nutrition intervention delivered by dentists affected dental-nutritional behaviors and body mass index (BMI) percentile in children with OV/OB. Retrospective analysis was performed using data collected on 217 patients with OV/OB aged 6-11 years who received nutritional counseling during dental visits at a Federally Qualified Health Center from September 1, 2021, through September 30, 2022. Data were collected on sociodemographic variables, oral health, and BMI percentile. Participants and their guardians were surveyed to measure the frequency of behaviors related to oral health and weight. Multivariable generalized estimating equations were constructed to determine the effect of the intervention on BMI percentile and reported dental-nutritional behaviors. The intervention had no effect on the BMI percentile (p = .35). There were statistically significant reductions in the reported average number of sugar-sweetened beverages consumed daily (p < .001), reported average daily water intake (p < .001), and the reported frequency of brushing teeth (p < .001), the clinical significance of these reductions remains unclear. Further research is needed to establish the efficacy of behavioral interventions at reducing weight and changing health behaviors.

Serious illness conversations (SICs) that elicit patients' values, goals, and care preferences reduce anxiety and depression and improve quality of life, but occur infrequently for patients with cancer. Behavioral economic implementation strategies (nudges) directed at clinicians and/or patients may increase SIC completion. To test the independent and combined effects of clinician and patient nudges on SIC completion. A 2 × 2 factorial, cluster randomized trial was conducted from September 7, 2021, to March 11, 2022, at oncology clinics across 4 hospitals and 6 community sites within a large academic health system in Pennsylvania and New Jersey among 163 medical and gynecologic oncology clinicians and 4450 patients with cancer at high risk of mortality (≥10% risk of 180-day mortality). Clinician clusters and patients were independently randomized to receive usual care vs nudges, resulting in 4 arms: (1) active control, operating for 2 years prior to trial start, consisting of clinician text message reminders to complete SICs for patients at high mortality risk; (2) clinician nudge only, consisting of active control plus weekly peer comparisons of clinician-level SIC completion rates; (3) patient nudge only, consisting of active control plus a preclinic electronic communication designed to prime patients for SICs; and (4) combined clinician and patient nudges. The primary outcome was a documented SIC in the electronic health record within 6 months of a participant's first clinic visit after randomization. Analysis was performed on an intent-to-treat basis at the patient level. The study accrued 4450 patients (median age, 67 years [IQR, 59-75 years]; 2352 women [52.9%]) seen by 163 clinicians, randomized to active control (n = 1004), clinician nudge (n = 1179), patient nudge (n = 997), or combined nudges (n = 1270). Overall patient-level rates of 6-month SIC completion were 11.2% for the active control arm (112 of 1004), 11.5% for the clinician nudge arm (136 of 1179), 11.5% for the patient nudge arm (115 of 997), and 14.1% for the combined nudge arm (179 of 1270). Compared with active control, the combined nudges were associated with an increase in SIC rates (ratio of hazard ratios [rHR], 1.55 [95% CI, 1.00-2.40]; P = .049), whereas the clinician nudge (HR, 0.95 [95% CI, 0.64-1.41; P = .79) and patient nudge (HR, 0.99 [95% CI, 0.73-1.33]; P = .93) were not. In this cluster randomized trial, nudges combining clinician peer comparisons with patient priming questionnaires were associated with a marginal increase in documented SICs compared with an active control. Combining clinician- and patient-directed nudges may help to promote SICs in routine cancer care. ClinicalTrials.gov Identifier: NCT04867850.

Infections cause substantial morbidity and mortality among patients receiving care in outpatient hemodialysis facilities. We describe comprehensive infection prevention assessments by US public health departments using standardized interview and observation tools. Results demonstrated how facility layouts can undermine infection prevention and that clinical practices often fall short of policies.