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A Longitudinal Study of Perinatal Mood and Anxiety Symptoms among Women at Elevated Risk for Psychological Distress
Get PDFPerinatal mood and anxiety disorders (PMADs) constitute a significant public health concern, affecting one in six women and leading to long-term consequences for both parent and child. Understanding the factors that confer risk and resilience during this period is therefore critical. Accordingly, this study aimed to investigate the prevalence, co-occurrence, and predictors of PMAD symptoms among a sample of women at elevated psychosocial risk for perinatal distress. In this pilot longitudinal investigation, 64 pregnant women with elevated risk profiles completed measures of psychological distress as well as psychosocial risk factors at 28 weeks of pregnancy and 2, 6, and 12 weeks postpartum. Results revealed a high prevalence of both subclinical and clinical levels of PMAD symptoms, as well as high rates of co-occurrence among conditions. Symptom trajectories remained fairly stable over the course of the study, particularly for perinatal PTSD and OCD. Difficulties with emotion regulation and lower cognitive flexibility during pregnancy were associated with elevated PMAD symptoms but did not predict worsening symptom trajectories. Temporal effects of predictors and temporal relationships among PMAD symptoms were not observed, potentially due to the small sample size and limited variability in symptoms. Results suggest that emotion regulation and cognitive flexibility may represent shared risk factors for PMADs among women at elevated psychosocial risk for perinatal distress.Doctor of Philosoph
Integrative Multi-Omics of Blood Pressure Traits in Hispanic/Latino Populations
Get PDFHypertension, a highly prevalent yet modifiable risk factor for cardiovascular disease (CVD), is a complex disease influenced by both genetic and environmental factors. Hispanic/Latino (H/L) populations are highly diverse in terms of environmental exposures, socioeconomic factors, and ancestry backgrounds. These intersecting factors collectively shape their susceptibility to hypertension. However, despite the growing population size in the United States and diversity of H/L populations, omics studies of BP have been predominantly conducted in populations of European ancestry, limiting the discovery and applicability of findings in other population groups such as H/L individuals. Furthermore, while genome-wide association studies (GWAS) have identified more than 1,000 BP-susceptibility loci, the biological mechanisms underlying most of these associations remain poorly understood. This dissertation addresses these knowledge gaps through two aims. In Aim 1, we conducted GWAS of systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP) in up to 157,320 H/L participants across 10 cohorts. We identified 56 genome-wide significant loci, including one novel locus on chromosome 2 near DPP10 and 19 genome-wide significant variants common in our H/L populations but rare in others. Fine- mapping improved resolution at 44 loci, revealing eight loci with two independent signals, including one signal near EBF1 that was independent of nearby known BP variants. Colocalization analysis further identified seven genes whose expression in whole blood may mediate GWAS signals and BP traits. In Aim 2, we examined the associations between blood- based transcriptomic and proteomic profiles and the same four BP traits. We identified up to 465 differentially expressed genes and 148 proteins significantly associated with BP traits. Enrichment analysis highlighted transcriptomic and proteomic perturbations related to BP across multiple biological domains, especially cell cycle, immune system, and inflammatory response. Collectively, these findings underscore the value and significance of studying diverse populations like H/L individuals to uncover both population-specific variants and shared genetic architecture across populations. Additionally, the transcriptomic and proteomic results offer insight into potential molecular mechanisms underlying BP regulation and may inform future biomarker and therapeutic target discovery.Doctor of Philosoph
Effects of Childhood Adversity on Neural Function during Emotion
Get PDFEarly environmental contexts contribute to individual differences in emotional development, often with lasting effects into adulthood. Yet, the mechanisms underlying these individual differences remain unclear. This dissertation proposes an interdisciplinary conceptual framework for understanding the emotional consequences of childhood adversity, one that emphasizes “context” as an active ingredient in shaping emotional experiences. Study 1 showed that emotional awareness interacted with childhood threat exposure to predict amygdala-prefrontal connectivity during emotion regulation. Study 2 found that perceived neighborhood disadvantage—a distal form of adversity—modified amygdala representations of emotion in ways similar to more proximal threats (e.g., abuse). Study 3 demonstrated that early threat exposure was associated with blunted inflammation and reduced activation in cognitive control regions during social stress. Together, these studies suggest that childhood threat exposure alters the functional neural architecture underlying emotion regulation, perception, and reactivity.Doctor of Philosoph
Associations between Fecal Contamination of the Household Environment and Enteric Pathogen Detection in Children Living in Maputo, Mozambique
Get PDFEnvironmental exposure to enteric pathogens is generally assessed using fecal indicators but relationships between markers of fecal contamination and actual exposure to enteric pathogens remain poorly characterized. We investigated whether Escherichia coli and two human fecal markers (HF183 and Mnif) in urban Mozambican household soil and drinking water were associated with detection of eight bacteria, three viruses, and three protozoa measured by multiplex reverse-transcription PCR and soil transmitted helminths assessed by microscopy in stool samples from children. We used mixed-effects logistic regression with marginal standardization to obtain a pooled estimate of the overall indicator-pathogen relationship while simultaneously estimating pathogen-specific associations that accounted for assessing multiple pathogens per sample. At least one pathogen was detected in 88% (169/192) of stool samples from children. Increasing drinking water E. coli gene concentration was associated with higher Ascaris prevalence, while human HF183 in drinking water was weakly associated with lower prevalence of the most common pathogens but was infrequently detected. No fecal marker in the soil was clearly associated with any pathogen. We did not find evidence to support human markers as reliable indicators of enteric pathogen carriage in a high-prevalence domestic setting and recommend targeting enteric pathogens directly
Skeletal versus conventional anchorage in dentofacial orthopedics: an international modified Delphi consensus study
Get PDFBackground To establish consensus of skeletal anchorage versus conventional anchorage in treating: 1. Maxillary transverse deficiency in growing and adult patients, 2. Class II skeletal disharmony due to mandibular retrusion in growing patients, 3. Class III skeletal disharmony in growing patients. Methods A four-rounds modified Delphi method was conducted. A steering committee performed a literature selection and compiled a list of 33 statements. An international panel of 25 experts in orthodontics agreed to participate. In each round, panelists were asked to rate their level of agreement with each statement using a 5-point Likert scale and provide comments. Statements that reached consensus were either accepted or rephrased. Statements that did not reach consensus were either rephrased, rejected, or split into two statements or merged with another. Results After the four rounds, 24 statements achieved consensus while 9 were rejected. The distribution of consensus statements was as follows: Maxillary transverse deficiency: 4 statements; Class II skeletal disharmony: 10 statements; Class III skeletal disharmony: 10 statements. Conclusions This modified Delphi consensus study aimed to provide guidance for orthodontists in choosing between skeletal and conventional anchorage for various treatment conditions. The study generated 24 consensus statements across three key domains. While the Delphi method provides valuable expert opinions, future studies, including randomized controlled trials, are needed to confirm these findings and address remaining uncertainties. Such efforts will aid in refining orthodontic treatment protocols and enhancing patient outcomes
Religious Institutions’ Use of Social Media Platforms During COVID-19 in Kenya
Get PDFThis study investigates the communication dynamics within Kenyan religious institutions during the COVID-19 pandemic. It explores the role of diverse social media platforms, such as YouTube and Facebook, in offering emotional and spiritual support in Christian and Islamic institutions. Using a survey and resilience lens, the study analyzes social media usage, utility variations, and the influence of religious institutions on information sharing during lockdowns and pandemic easing. Descriptive statistics and analysis of variance (ANOVA) highlight the significant role of these platforms in crisis communication. This research addresses a gap in the limited literature on the role of social media in crisis communication within religious contexts during the COVID-19 era
Leveraging Academic Health Departments for Place-Based Disaster Response: Lessons from Helene in Western North Carolina
Get PDFThis article examines the role of two Academic Health Departments (AHDs) in Buncombe and Burke Counties, North Carolina in responding to Hurricane Helene in 2024. The partnership between local health departments and the UNC Asheville - UNC Gillings Master of Public Health (MPH) Program fostered a place-based approach to public health. After the hurricane disrupted regional infrastructure, the AHDs integrated students and faculty into recovery efforts. This paper identifies key lessons for strengthening public health preparedness through academic-practice partnerships and highlights the importance of embedding education in local contexts
Polyvagal theory: a journey from physiological observation to neural innervation and clinical insight
Get PDFPolyvagal theory (PVT) offers an integrative model of autonomic regulation that accounts for the evolution, neuroanatomy, and functional organization of the vagus nerve in relation to behavioral and emotional processes. This article revisits PVT by synthesizing its scientific foundations with recent advancements in transcriptomics, neurophysiology, and clinical application. Particular emphasis is placed on the theory's hierarchical model of the autonomic nervous system, the role of the ventral vagal complex in social behavior, and the construct of neuroception—the neural process by which safety and threat are detected without conscious awareness. The discussion incorporates both theoretical refinement and empirical validation while addressing common misconceptions and critiques of the model. In addition to the scientific narrative, the author offers a personal perspective on the intellectual and experiential origins of PVT, illustrating its translational value in clinical and therapeutic settings. By combining rigorous science with experiential insight, this article seeks to advance understanding of the autonomic foundations of social behavior and mental health
Park use patterns and park satisfaction before and after citywide park renovations in low-income New York City neighborhoods
Get PDFUrban parks may promote health through physical activity, stress management, and social connectedness. However, poor-quality parks in disrepair are underutilized, limiting these benefits. This study evaluated the impact of a citywide park renovation program known as the Community Parks Initiative (CPI) on changes in park use patterns and park satisfaction among residents living in low-income New York City neighborhoods. Repeated cross-sectional surveys were administered to residents living near 31 parks undergoing CPI renovations (545 pre-renovation and 201 post-renovation respondents) and near 21 parks in socio-demographically matched control neighborhoods (345 pre-renovation and 129 post-renovation respondents). Surveys measured self-reported past-month park visits, typical park visit duration, and satisfaction with park quality and facilities. Using a difference-in-differences (DID) approach, generalized estimating equations were fit to compare changes over time in park use and satisfaction among residents living near parks receiving renovations compared to those living near control parks. Models were adjusted for age, body mass index, income, public housing, marital status, and children in household. Residents in neighborhoods receiving park renovations reported a larger increase in minutes spent at the park on weekdays [DID = 30.0 min (95% CI 10.3, 49.7)] and total minutes spent at the park in the last 30 days [DID = 466.3 min (95% CI 63.0, 869.6)] compared to controls. Residents of renovated park neighborhoods also reported larger increases in park satisfaction relative to residents of control neighborhoods, with the largest improvements in the percent of residents satisfied with overall park quality [DID = 38.4% (95% CI 25.2, 51.6)] and maintenance of grounds and facilities [DID = 40.9% (95% CI 27.7, 54.1)]. This study provides evidence that park renovations are an important urban planning strategy to support community health through increased park use and improved park perceptions
Nutrient limitation and seasonality associated with phytoplankton communities and cyanotoxin production in a large, hypereutrophic lake
Get PDFThough freshwater harmful algal blooms have been described and studied for decades, several important dynamics remain uncertain, including the relationships among nutrient concentrations, phytoplankton growth, and cyanotoxin production. To identify when and where nutrients limit phytoplankton, cyanobacteria, and cyanotoxins, we conducted in situ bioassay studies. We added nitrogen (N), phosphorus (P), or N + P across various seasons in water collected from three locations across Utah Lake, one of the largest freshwater lakes in the western U.S. This shallow, hypereutrophic lake provides a powerful testbed for quantifying nutrient-growth-toxin interactions. We assessed a range of parameters over time, including photopigment concentrations, phytoplankton abundance (cell counts), cyanotoxins, and nutrient concentrations. Despite high background nutrient concentrations in lake water, phytoplankton abundance and composition were strongly affected by nutrient addition. Phosphorus limitation was more common in the spring, with N limitation and N + P limitation becoming more common in the fall. Nutrient additions were positively associated with cyanobacteria (Microcystis, Aphanocapsa, Dolichospermum, Merismopedia, Aphanizomenon spp.), eukaryotes (Aulacoseira, Desmodesmus spp.), and two taxonomical categories of phytoplankton (i.e., unicellular and colonial green algae). When detected, anatoxin-a was positively associated with Aphanizomenon and negatively associated with Microcystis spp. However, overall cyanotoxin concentrations were not associated with cyanobacterial cell density but varied seasonally. These findings highlight the importance of considering seasonal nutrient availability dynamics and provide insights into specific nutrient targets, species, and cyanotoxins that play a significant role in the health and management of similar eutrophic lake environments around the world