Adverse childhood experiences (ACEs) are associated with physical and mental health difficulties in adulthood. This study examines the associations of ACEs with functional impairment and life stress among military personnel, a population disproportionately affected by ACEs. We also evaluate the extent to which the associations of ACEs with functional outcomes are mediated through internalizing and externalizing disorders.

The sample included 4,666 STARRS Longitudinal Study (STARRS-LS) participants who provided information about ACEs upon enlistment in the US Army (2011–2012). Mental disorders were assessed in wave 1 (LS1; 2016–2018), and functional impairment and life stress were evaluated in wave 2 (LS2; 2018–2019) of STARRS-LS. Mediation analyses estimated the indirect associations of ACEs with physical health-related impairment, emotional health-related impairment, financial stress, and overall life stress at LS2 through internalizing and externalizing disorders at LS1.

ACEs had significant indirect effects via mental disorders on all functional impairment and life stress outcomes, with internalizing disorders displaying stronger mediating effects than externalizing disorders (explaining 31–92% vs 5–15% of the total effects of ACEs, respectively). Additionally, ACEs exhibited significant direct effects on emotional health-related impairment, financial stress, and overall life stress, implying ACEs are also associated with these longer-term outcomes via alternative pathways.

This study indicates ACEs are linked to functional impairment and life stress among military personnel in part because of associated risks of mental disorders, particularly internalizing disorders. Consideration of ACEs should be incorporated into interventions to promote psychosocial functioning and resilience among military personnel.

Binge-eating disorder (BED) is characterized by highly distressing episodes of loss-of-control over-eating. We have examined the use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of people with BED and associated obesity. Such non-invasive brain stimulation (NIBS) techniques are used therapeutically in several psychiatric conditions and there is an associated scientific rationale.

Sixty participants were randomly allocated to receive 20 sessions of neuronavigated 10 Hz rTMS administered to the left dorsolateral prefrontal cortex (dlPFC) or sham treatment. Primary outcomes were the frequency of binge eating episodes (BEE) and the ‘urge to eat’ (craving) evaluated at baseline and end-of-treatment (8 weeks post-randomization). Secondary outcomes included body mass index (BMI), hunger, general and specific eating disorder psychopathology. Follow-up analyses were conducted for most outcomes at 16 weeks post-randomization. Multilevel models were used to evaluate group, time, and group-by-time interactions for the association between rTMS exposure and outcomes.

The real rTMS group (compared with sham treatment), showed a significantly greater decrease in the number of BEE at the end of treatment (Estimated Mean [EM]: 2.41 95% CI: 1.84–3.15 versus EM: 1.45 95% CI: 1.05–1.99, p = 0.02), and at follow-up (EM: 3.79 95% CI: 3–4.78 versus EM: 2.45 95% CI: 1.88–3.17, p = 0.02; group × time interaction analysis p = 0.02). No group differences were found for other comparisons.

rTMS was associated with reduced BEE during and after treatment: it suggests rTMS is a promising intervention for BED.

This study examines the prospective associations of alcohol and drug misuse with suicidal behaviors among service members who have left active duty. We also evaluate potential moderating effects of other risk factors and whether substance misuse signals increased risk of transitioning from thinking about to attempting suicide.

US Army veterans and deactivated reservists (N = 6,811) completed surveys in 2016–2018 (T1) and 2018–2019 (T2). Weights-adjusted logistic regression was used to estimate the associations of binge drinking, smoking/vaping, cannabis use, prescription drug abuse, illicit drug use, alcohol use disorder (AUD), and drug use disorder (DUD) at T1 with suicide ideation, plan, and attempt at T2. Interaction models tested for moderation of these associations by sex, depression, and recency of separation/deactivation. Suicide attempt models were also fit in the subgroup with ideation at T1 (n = 1,527).

In models controlling for socio-demographic characteristics and prior suicidality, binge drinking, cannabis use, prescription drug abuse, illicit drug use, and AUD were associated with subsequent suicidal ideation (AORs = 1.42–2.60, ps < .01). Binge drinking, AUD, and DUD were associated with subsequent suicide plan (AORs = 1.23–1.95, ps < .05). None of the substance use variables had a main effect on suicide attempt; however, interaction models suggested certain types of drug use predicted attempts among those without depression. Additionally, the effects of smoking/vaping and AUD differed by sex. Substance misuse did not predict the transition from ideation to attempt.

Alcohol and drug misuse are associated with subsequent suicidal behaviors in this population. Awareness of differences across sex and depression status may inform suicide risk assessment.

Preliminary evidence suggests that a ketogenic diet may be effective for bipolar disorder.

To assess the impact of a ketogenic diet in bipolar disorder on clinical, metabolic and magnetic resonance spectroscopy outcomes.

Euthymic individuals with bipolar disorder (N = 27) were recruited to a 6- to 8-week single-arm open pilot study of a modified ketogenic diet. Clinical, metabolic and MRS measures were assessed before and after the intervention.

Of 27 recruited participants, 26 began and 20 completed the ketogenic diet. For participants completing the intervention, mean body weight fell by 4.2 kg (P < 0.001), mean body mass index fell by 1.5 kg/m2 (P < 0.001) and mean systolic blood pressure fell by 7.4 mmHg (P < 0.041). The euthymic participants had average baseline and follow-up assessments consistent with them being in the euthymic range with no statistically significant changes in Affective Lability Scale-18, Beck Depression Inventory and Young Mania Rating Scale. In participants providing reliable daily ecological momentary assessment data (n = 14), there was a positive correlation between daily ketone levels and self-rated mood (r = 0.21, P < 0.001) and energy (r = 0.19 P < 0.001), and an inverse correlation between ketone levels and both impulsivity (r = −0.30, P < 0.001) and anxiety (r = −0.19, P < 0.001). From the MRS measurements, brain glutamate plus glutamine concentration decreased by 11.6% in the anterior cingulate cortex (P = 0.025) and fell by 13.6% in the posterior cingulate cortex (P = <0.001).

These findings suggest that a ketogenic diet may be clinically useful in bipolar disorder, for both mental health and metabolic outcomes. Replication and randomised controlled trials are now warranted.

Understanding healthcare personnel’s (HCP) contact patterns are important to mitigate healthcare-associated infectious disease transmission. Little is known about how HCP contact patterns change over time or during outbreaks such as the COVID-19 pandemic.

This study in a large United States healthcare system examined the social contact patterns of HCP via standardized social contact diaries. HCP were enrolled from October 2020 to June 2022. Participants completed monthly surveys of social contacts during a representative working day. In June 2022, participants completed a 2-day individual-level contact diary. Regression models estimated the association between contact rates and job type. We generated age-stratified contact matrices.

Three-hundred and sixty HCP enrolled, 157 completed one or more monthly contact diaries and 88 completed the intensive 2-day diary. In the monthly contact diaries, the median daily contacts were 15 (interquartile range (IQR) 8–20), this increased slightly during the study (slope-estimate 0.004, p-value 0.016). For individual-level contact diaries, 88 HCP reported 2,550 contacts over 2 days. HCP were 2.8 times more likely to contact other HCP (n = 1,592 contacts) than patients (n = 570 contacts). Rehabilitation/transport staff, diagnostic imaging technologists, doctors, nurses, mid-level, and laboratory personnel had higher contacts compared with the lowest contact group (Nursing aids). Contact matrices concentrated in working-age populations.

HCP contacts concentrate in their work environment, primarily with other HCP. Their contacts remained stable over time even during large changes to societal contact patterns during the COVID-19 pandemic. This stability is critical for designing outbreak and pandemic responses.

To co-design support strategies to enable sustainable, healthy, affordable food provision, including waste mitigation practices, in Australian Early Childhood Education and Care (ECEC) settings.

Based on the co-design IDEAS framework (Ideate, DEsign, Assess & Share), this co-design process involved iterative interviews and focus groups with ECEC centre staff and workshops with Nutrition Australia. Interview and workshop themes were coded to the Theoretical Domains Framework (TDF) to develop initial prototypes for support strategies that were further developed and refined in focus groups.

ECEC with onsite food provision, in Victoria, Australia.

ECEC staff and a Victorian Government-funded programme delivered through Nutrition Australia that provides nutrition support to ECEC services.

ECEC staff interviews (n 17) suggested a lack of knowledge on the topic of sustainable healthy food provision and a need for resources and support for all staff and children. Workshops with Nutrition Australia built on interviews and suggested a focus on lower intensity strategies and a suggestion to embed knowledge-related activities into the children’s curriculum. Focus groups (n 8) further informed co-design of strategies, producing a visual representation of sustainable healthy food provision with supporting tips and a whole-of-centre approach that includes children through a classroom activity.

The co-designed resources could provide feasible strategies for the adoption of sustainable, healthy and affordable provision practices in the ECEC setting. Involvement of a local government-funded health promotion service provides valuable research-to-practice contribution as well opportunity for scalable dissemination of resources through existing infrastructure.

Identifying persons with HIV (PWH) at increased risk for Alzheimer’s disease (AD) is complicated because memory deficits are common in HIV-associated neurocognitive disorders (HAND) and a defining feature of amnestic mild cognitive impairment (aMCI; a precursor to AD). Recognition memory deficits may be useful in differentiating these etiologies. Therefore, neuroimaging correlates of different memory deficits (i.e., recall, recognition) and their longitudinal trajectories in PWH were examined.

We examined 92 PWH from the CHARTER Program, ages 45–68, without severe comorbid conditions, who received baseline structural MRI and baseline and longitudinal neuropsychological testing. Linear and logistic regression examined neuroanatomical correlates (i.e., cortical thickness and volumes of regions associated with HAND and/or AD) of memory performance at baseline and multilevel modeling examined neuroanatomical correlates of memory decline (average follow-up = 6.5 years).

At baseline, thinner pars opercularis cortex was associated with impaired recognition (p = 0.012; p = 0.060 after correcting for multiple comparisons). Worse delayed recall was associated with thinner pars opercularis (p = 0.001) and thinner rostral middle frontal cortex (p = 0.006) cross sectionally even after correcting for multiple comparisons. Delayed recall and recognition were not associated with medial temporal lobe (MTL), basal ganglia, or other prefrontal structures. Recognition impairment was variable over time, and there was little decline in delayed recall. Baseline MTL and prefrontal structures were not associated with delayed recall.

Episodic memory was associated with prefrontal structures, and MTL and prefrontal structures did not predict memory decline. There was relative stability in memory over time. Findings suggest that episodic memory is more related to frontal structures, rather than encroaching AD pathology, in middle-aged PWH. Additional research should clarify if recognition is useful clinically to differentiate aMCI and HAND.

Binge eating disorder (BED) is a common and disabling condition, typically presenting with multiple psychiatric and obesity-related comorbidities. Evidence-based treatments are either resource-intensive (psychotherapies) or have side-effects (medications): these achieve remission in around 50% of cases. Novel treatments are needed.

This randomised sham-controlled trial aimed to assess feasibility, acceptability and preliminary efficacy of at-home, self-administered transcranial direct current stimulation (tDCS) and attention bias modification training (ABMT) in adults with binge eating disorder.

Eighty-two participants with binge eating disorder were randomly allocated to real tDCS with ABMT, sham tDCS with ABMT, ABMT only or waitlist control. Intervention groups received ten sessions of their allocated treatment over 2–3 weeks. tDCS (2 mA, 20 min) was self-administered using a bilateral (anode right/cathode left) montage targeting the dorsolateral prefrontal cortex. Outcomes were assessed at baseline, post-treatment and 6-week follow-up.

Prespecified feasibility criteria (recruitment ≥80 participants and retention rate ≥75%) were exceeded, and treatment completion rates were high (98.7%). All interventions reduced binge eating episodes, eating disorder symptoms and related psychopathology between baseline and follow-up, relative to waitlist control (medium-to-large between-group effect sizes for change scores). Small-to-medium effect sizes for change scores favoured real tDCS with ABMT versus comparators, suggesting the verum intervention produces superior outcomes.

At-home, self-administered tDCS with ABMT is feasible and acceptable, and preliminary data on efficacy are promising. This approach could be a useful and scalable alternative or adjunct to established treatments for binge eating disorder. Confirmatory trials can, and should, be pursued.

To evaluate the comparative epidemiology of hospital-onset bloodstream infection (HOBSI) and central line-associated bloodstream infection (CLABSI)

Retrospective observational study of HOBSI and CLABSI across a three-hospital healthcare system from 01/01/2017 to 12/31/2021

HOBSIs were identified as any non-commensal positive blood culture event on or after hospital day 3. CLABSIs were identified based on National Healthcare Safety Network (NHSN) criteria. We performed a time-series analysis to assess comparative temporal trends among HOBSI and CLABSI incidence. Using univariable and multivariable regression analyses, we compared demographics, risk factors, and outcomes between non-CLABSI HOBSI and CLABSI, as HOBSI and CLABSI are not exclusive entities.

HOBSI incidence increased over the study period (IRR 1.006 HOBSI/1,000 patient days; 95% CI 1.001–1.012; P = .03), while no change in CLABSI incidence was observed (IRR .997 CLABSIs/1,000 central line days, 95% CI .992–1.002, P = .22). Differing demographic, microbiologic, and risk factor profiles were observed between CLABSIs and non-CLABSI HOBSIs. Multivariable analysis found lower odds of mortality among patients with CLABSIs when adjusted for covariates that approximate severity of illness (OR .27; 95% CI .11–.64; P < .01).

HOBSI incidence increased over the study period without a concurrent increase in CLABSI in our study population. Furthermore, risk factor and outcome profiles varied between CLABSI and non-CLABSI HOBSI, which suggest that these metrics differ in important ways worth considering if HOBSI is adopted as a quality metric.

Identifying thrombus formation in Fontan circulation has been highly variable, with reports between 17 and 33%. Initially, thrombus detection was mainly done through echocardiograms. Delayed-enhancement cardiac MRI is emerging as a more effective imaging technique for thrombus identification. This study aims to determine the prevalence of occult cardiac thrombosis in patients undergoing clinically indicated cardiac MRI.

A retrospective chart review of children and adults in the Duke University Hospital Fontan registry who underwent delayed-enhancement cardiac MRI. Individuals were excluded if they never received a delayed-enhancement cardiac MRI or had insufficient data. Demographic characteristics, native heart anatomy, cardiac MRI measurements, and thromboembolic events were collected for all patients.

In total, 119 unique individuals met inclusion criteria with a total of 171 scans. The median age at Fontan procedure was 3 (interquartile range 1, 4) years. The majority of patients had dominant systemic right ventricle. Cardiac function was relatively unchanged from the first cardiac MRI to the third cardiac MRI. While 36.4% had a thrombotic event by history, only 0.5% (1 patient) had an intracardiac thrombus detected by delayed-enhancement cardiac MRI.

Despite previous echocardiographic reports of high prevalence of occult thrombosis in patients with Fontan circulation, we found very low prevalence using delayed-enhancement cardiac MRI. As more individuals are reaching adulthood after requiring early Fontan procedures in childhood, further work is needed to develop thrombus-screening protocols as a part of anticoagulation management.